The EU-VIORMED project works across seven distinct but inter-related Work Packages (WPs) (Figure 1 -see below-), each with clearly identified roles and responsibilities.
The inter-relationship between WPs and timeline has been arranged to fulfil the project objectives:
1) To identify factors associated with the risk of violence to self and others in patients with severe mental disorders;
2) To assess tools capable of predicting violence risk to assist policy makers in the decision-making process;
3) To evaluate effective treatments able to assist in the planning of services (clinicians, managers, lawmakers and governments) in the development of preventive and supportive measures;
4) To compare national variations in pathways into and out of care, including specialized secure services in different countries.
Figure 1. EU-VIORMED Work Packages (WPs)
EU-VIORMED project Work Packages:
WP 1 “Management”, consists of coordination of different administrative and research actions to ensure that the project is implemented as planned and results and deliverables are attained at milestones. This task, including also the consolidation of scientific progress reports to be submitted to the European Commission, is managed by the EU-VIORMED Coordinator, supported by his team at P1-IRCCS. P1-IRCCS is also responsible for logistics activities and communication between EU-VIORMED partners.
WP2 “Evaluation”, coordinated by P5-IPIN, concerns the assessment of the on-going project in order to determine the relevance and fulfilment of its objectives:
This WP evaluates the impact and sustainability of the project activities, providing an opportunity for adjustment to its strategy if needed.
WP 3 “Dissemination”, coordinated by P8-UNIMIB, implements activities to make results and deliverables available to the target groups, using conventional channels as well as non-conventional ones. A full set of communication tools (project logo, presentation templates…) have been made available to all project participants in order to establish a consistent public perception. Communication strategy includes the project dissemination through the EU-VIORMED website, enriched by timely news on the project progress and related topics.
WP 4 “Identifying risk factors for violence in patients with SMDs and effective risk assessment tools in forensic psychiatric services”, coordinated by P2-KCL, assesses socio-demographical, clinical and forensic characteristics of study participants. We collect data on individual and situational risk factors for severe violence in adult suffering from Schizophrenia Spectrum Disorders (SSDs) and staying in forensic units compared to age- and sex-matched controls in treatment at mental health services of five European countries. WP4 also analyses the predictive validity of different clinical tools for risk assessment in accordance with guidelines (e.g., the Health Clinical Risk-20 -HCR-20v3- and OxMIV). Indeed, we will prospectively rate all subsequent incidents of violent behaviour against others and self, using the Modified Overt Aggression Scale (MOAS; Kay et al., 1988) on a monthly basis over the next 12 months.
WP 5 “Evaluation of effective treatments in forensic psychiatric services”, coordinated by P4-MUW, aims at evaluating effective treatments in order to assist clinicians, managers, lawmakers, and governments in planning of services for preventive and support measures.
This approach includes a cross-sectional evaluation to (i) analyse the patients’ needs and (ii) investigate patients’ competence to make decisions about treatment in forensic and general psychiatry services, and a literature review, using relevant international electronic databases, on treatments currently available in psychiatric forensic units and/or for forensic patients with SSDs. Relevant protocols for both pharmacological and non-pharmacological treatments are already available in the International prospective register of systematic reviews -PROSPERO.
WP 6 “Mapping of forensic services across EU”, coordinated by P3-MANN, compares national variations in pathways into and out of care, including specialized secure services in different countries. We propose a mapping survey of national approaches and variations of legal frameworks and prerequisites for forensic psychiatric care; structure, procedures, capacities and quality of forensic psychiatric service provision; pathways to forensic care, including forensic psychiatric aftercare interfaces, overlaps and collaboration with the criminal justice system, the prison sector and general psychiatry. Within this task we are going to develop a questionnaire to collect data on legal frameworks in forensic psychiatry, procedures and practices in forensic psychiatry, characteristic and activity data of forensic psychiatric service, and epidemiology, prevalence and outcomes.
WP 7 “Data analysis”, coordinated by P1-IRCCS, consists of the development of the project online dataset, through an online system via web-based interface (with a dedicated server), based on a secure and confidential data capture system. Access to stored information will be restricted to authorised personnel. This task also involves data entry monitoring and quality control. We will then perform data analysis, including generalized linear and mixed models and multivariable logistic models with all significant risk factors, to improve the prediction capability of risk of violence in SSDs patients.
The overall strategy of the project is to understand the organisational structure of forensic psychiatric care at the interface with legal institutions across the Europe (WP6), develop a set of tools to assess the clinical, sociodemographic and treatment-related characteristics of patients with SSDs in forensic and general psychiatric services (WP4), identify the best treatment strategy with a meta-analytic approach as well as to define the needs of users in general and forensic psychiatric services (WP5) and disseminate findings to all relevant stakeholders (WP3).