PMID- 30282248
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20191120
IS  - 2051-6967 (Electronic)
IS  - 0790-9667 (Linking)
VI  - 25
IP  - 4
DP  - 2008 Dec
TI  - Risk stratification and the care pathway.
PG  - 123-127
LID - 10.1017/S0790966700011228 [doi]
AB  - OBJECTIVES: It was hypothesised that patients admitted to forensic mental health 
      facilities are stratified along the pathway through care according to levels of 
      need. Level of risk and psychopathology should vary with different levels of 
      security. METHOD: Seventy-five men in a forensic hospital were interviewed by 
      three trained clinicians using the HCR-20 (Historical Clinical Risk Assessment) - 
      clinical and risk items, The Health of the Nation Scales - Secure (HoNOS-SECURE), 
      PANSS (Positive and Negative Syndrome Scale), GAF (Global Assessment of 
      Functioning) and the CANFOR (Camberwell Assessment of need Forensic Version). 
      RESULTS: The mean scores on a variety of clinical measures were higher in 
      admission/high security areas and progressively lower in rehabilitation and 
      pre-discharge areas. As patients moved through the pathways of care, they 
      improved in a number of areas including psychiatric morbidity, risk, function, 
      unmet needs. The following results stratified significantly; the HCR-20 summated 
      clinical and risk (F = 9.2, df = 5, p < 0.001), the HoNOS secure (F = 18.2, df = 
      5, p < 0.001), PANSS (positive, general and total), GAF, staff and user unmet 
      needs on the CANFOR. CONCLUSIONS: The data indicate that the theoretical 
      organisation of the units of the hospital into high, medium and low security 
      units to form a coherent pathway through care is reflected in practice. This is a 
      transparent route out of secure care in which restrictions are proportionate to 
      risk and supports proportionate to need. It is unclear whether alternative 
      models, consisting of a series of generic unstratified units for admission and 
      discharge, all at the same level of therapeutic security, allow for the provision 
      of treatment programmes and relational interventions appropriate to the patient's 
      stage of recovery and rehabilitation.
FAU - Pillay, Selena M
AU  - Pillay SM
AD  - University of Dublin,Trinity College,Central Mental Hospital,Dundrum,Dublin 
      14,Ireland.
FAU - Oliver, Brid
AU  - Oliver B
AD  - Central Mental Hospital,Dundrum,Dublin 14,Ireland.
FAU - Butler, Louise
AU  - Butler L
AD  - Central Mental Hospital,Dundrum,Dublin 14,Ireland.
FAU - Kennedy, Harry G
AU  - Kennedy HG
AD  - University of Dublin,Trinity College.
LA  - eng
PT  - Journal Article
PL  - England
TA  - Ir J Psychol Med
JT  - Irish journal of psychological medicine
JID - 8900208
EDAT- 2008/12/01 00:00
MHDA- 2008/12/01 00:01
CRDT- 2018/10/05 06:00
PHST- 2018/10/05 06:00 [entrez]
PHST- 2008/12/01 00:00 [pubmed]
PHST- 2008/12/01 00:01 [medline]
AID - S0790966700011228 [pii]
AID - 10.1017/S0790966700011228 [doi]
PST - ppublish
SO  - Ir J Psychol Med. 2008 Dec;25(4):123-127. doi: 10.1017/S0790966700011228.