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On April 5-7 2018 EU-VIORMED partners and relevant researchers will gather in Wien hosted by Johannes Wancata from the local Medical University in order to receive appropriate training for standardized instruments which will be used for data collection throughout the research project.

The educational focus will be on several instruments that will have a key role for EU-VIORMED data collection.

Risk assessment tools: HCR-20v3

The Health, Clinical, Risk-20 (HCR-20) is a structured guide for use by trained evaluators to aid violence risk assessment for institutional and community violence in people with mental disorders as part of clinical practice. It is recommended for forensic psychiatric settings due to its ability to assess risk of violence. Internationally the HCR-20 is the most widely used violence risk assessment guide across mental health and criminal justice settings. The HCR-20 comprises 20 risk factors across three scales, Historical (past), Clinical (current) and Risk Management (future). Evaluators determine the presence and relevance of each of the 20 risk factors based on clinical interview with the subject and collateral information.

Previous meta-analyses examining the predictive ability of the HCR-20 have done so alongside other violence risk assessment tools, producing favourable results for the HCR-20. The vast majority of HCR-20 validity studies were conducted in predominantly Caucasian and English speaking samples in North America and the UK. There is a paucity of data from across Europe and from other countries so far.

Risk assessment tools: OxMIV

OxMIV is a very new tool developed as an evidence-based violence risk assessment guide tailored for forensic psychiatric patients. It is web-based and was designed to be simple to complete, with little training and to be user friendly. It assesses dynamic risk factors, and so may be better suited for short-term violence risk monitoring.

The development if the OxMIV adopts a different approach compared to HCR-20 for several reasons. Firstly, no current widely used empirically tested violence-risk assessment tool is available in an online platform. Secondly, the tool emphases dynamic factors, rather than static factors that tend to be very high in these populations. Thirdly, the latest evidence suggests that relevant risk factors are not included in currently used instruments such as the HCR-20. Finally the OxMIV is quick to administer and needs little training.

The Camberwell Assessment of Need – Forensic version (CANFOR)

This has been found to be a useful tool to help identify individually tailored care pathways in different functional security levels and settings, as well as assisting with evidence-based interventions. Derived from the CAN, CANFOR has maintained the same format as CAN, with three new areas of evaluation (treatment, arson and sexual offending) added to the original 22 areas. The interviewer first evaluates whether a need is present or not and if present, whether that need is met or unmet. A need is defined as being present when the interviewer indicates that there have been difficulties in a particular area over the last month. A met need is defined as an area of difficulty for which an appropriate intervention is currently being received from either formal or informal sources. An unmet need is defined as an area of difficulty for which no interventions are currently being provided by local services, or that interventions provided are not perceived as effective. If a need is not considered to be present, it can be scored as no need or, in certain instances, not applicable. The total need score is defined as the sum of the number of met needs and unmet needs.

CANFOR will be administered to violent patients (N = 200) recruited from the case-control study.

The MacArthur Competence Assessment Tool for Treatment (MacCAT-T)

The project will also intend to evaluate the decision-making capacities of patients with schizophrenia who are hospitalized in forensic units. In this way, we will test in detail (a) how often forensic SSDs patients are challenged/compromised by coercive treatment without their consent, and (b) how often they willingly neglect therapy and whether they understand the therapeutic needs and targets of the care in forensic units. This knowledge will help to predict the outcome and prognosis of forensic hospitalization better. For this purpose we will use the MacArthur Competence Assessment Tool for Treatment (MacCAT-T) and will have this semi-structured interview with 200 forensic patients and approximately a similar number of controls. The results of this assessment will be analysed from an ethical perspective and connected to the previously mentioned questions of consent in forensic psychiatry since it was not possible to determine whether forensic patients were a particularly impaired group or a group with similar levels of capacity to comparable non-forensic samples.

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