| 1. |
- Levin, Sara, 1974-, et al.
(författare)
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Adherence to planned risk management interventions in Swedish forensic care : What is said and done according to patient records
- 2019
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Ingår i: International Journal of Law and Psychiatry. - : Elsevier. - 0160-2527 .- 1873-6386. ; 64, s. 71-82
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Tidskriftsartikel (refereegranskat)abstract
- Both structured and unstructured clinical risk assessments within forensic care aim to prevent violence by informing risk management, but research about their preventive role is inconclusive. The aim of this study was to investigate risk management interventions that were planned and realized during forensic care by analysing patient records. Records from a forensic clinic in Sweden, covering 14 patients and 526 months, were reviewed. Eight main types of risk management interventions were evaluated by content analysis: monitoring, supervision, assessment, treatment, victim protection, acute coercion, security level and police interventions. Most planned risk management interventions were realized, both in structured and clinical risk assessments. However, most realized interventions were not planned, making them more open to subjective decisions. Analysing risk management interventions actually planned and realized in clinical settings can reveal the preventive role of structured risk assessments and how different interventions mediate violence risk.
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| 2. |
- Levin, Sara, 1974-, et al.
(författare)
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Risk-Increasing and Risk-Reducing Factors for Violence : A Qualitative Study of Forensic Patients’ Perceptions
- 2022
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Ingår i: International Journal of Forensic Mental Health. - : Taylor & Francis. - 1499-9013 .- 1932-9903. ; 21:4, s. 383-398
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Tidskriftsartikel (refereegranskat)abstract
- This study investigated forensic patients’ perceptions of relevant factors for violence risk, to facilitate an understanding of potential reasons for violence and the effect of risk management interventions. Semi-structured interviews with 13 forensic patients were analyzed with qualitative content analysis using an inductive approach. The sample of participants could identify an array of potentially relevant factors for their use of violence related to themselves, the external context, social and relational aspects, as well as situational factors. Most also actively strived to manage such risk. Considering patients’ perceptions could potentially add relevant perspectives and improve clinical and structured risk assessments.
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| 3. |
- Levin, Sara, et al.
(författare)
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Staff perceptions of facilitators and barriers to the use of a short-term risk assessment instrument in forensic psychiatry
- 2018
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Ingår i: Journal of Forensic Psychology Practice. - : Taylor & Francis. - 1522-8932 .- 1522-9092 .- 2473-2850 .- 2473-2842. ; 18:3, s. 199-228
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Tidskriftsartikel (refereegranskat)abstract
- Prospective adverse events within forensic settings should be assessed using structured risk assessment instruments. Our aim was to identify the barriers and facilitators of a structured instrument for assessment of short-term risk within inpatient forensic psychiatric care. The instrument was piloted at a forensic psychiatric clinic. Three focus group interviews were conducted with staff. Content analysis revealed three main categories of barriers and facilitators for clinical use: implementation object, context, and users. Complexity of the instrument, insufficient continuous training and support, difficulties retrieving assessments on wards, and insecurity about translating assessments into actions were perceived barriers to clinical use. Routines for documentation improved communication and the inclusion of protective and short-term dynamic clinical factors were perceived as clinically relevant. Problem-solving ability, attitude, and motivation of staff were facilitating factors. Comprehensive risk assessment instruments require substantial support for staff to find them manageable. Systematic documentation is required to measure actual daily clinical use.
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| 4. |
- Levin, Sara, 1974-
(författare)
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The challenges of using structured risk assessment instruments in forensic psychiatric care
- 2019
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: The purpose of psychiatric forensic care is to provide treatment for mentally ill offenders and to prevent future acts of violence and other adverse events. During care, the type of restrictions of freedom, the patient’s continuous need for involuntary treatment and readiness for discharge, are continuously evaluated based on the assessment of risk the patient pose to themselves and others as well as the progress achieved with treatment. The use of structured risk assessment instruments is recommended in clinical guidelines to assess such risks. However, unstructured clinical assessments, considered to be less valid, are often used in clinical practice. There is insufficient research evidence concerning several aspects related to the clinical use of structured risk assessment instruments in terms of guiding the planning and realization of care and risk management interventions. There is also a lack of knowledge about what patients themselves perceive to be mediating factors for their use of violence. Overall aim: The overarching aim of this thesis was to investigate the implementation and use of structured risk assessment instruments to prevent violence and other adverse events in forensic settings and to improve understanding of the factors that influence such events among forensic patients.Methods: Several methods were used for data collection and data were analysed by different types of content analysis. In the first paper, a systematic review of previous research studies on implementation determinants for structured risk assessment instruments in forensic settings was conducted to investigate implementation determinants for such instruments. The second paper evaluates a pilot project of the implementation of a structured risk assessment instrument at a forensic clinic in Östergötland using focus group interviews with staff members who had used the instrument. Their perceptions of the instrument and barriers and facilitators to its implementation and clinical use were investigated. The third paper investigated the actual clinical use of structured risk assessments to guide the planning and realization of care and risk management interventions documented in forensic patients’ records. In the fourth paper, patient perspectives of factors increasing and decreasing the risk for violence were investigated by individual semi-structured interviews with forensic patients.Results: There is a wide variety of determinants for the implementation and clinical use of structured risk assessment instruments, which make such missions complicated. The determinants relate to the characteristics of the implementation object, characteristics of users, the inner setting in which the implementation occurs and the implementation process. Limiting the need to change current routines, and hence the strain on the organization by reducing complexity, and the need for resource allocation seem especially important. Most of the planned risk management interventions in structured risk assessments were realized according to patient records. However, structured risk assessments largely overlap with unstructured risk assessments in terms of planned care and risk management interventions. Noteworthy, most of the interventions realized were not documented as planned. Forensic patients described several risk factors that increased and decreased their use of violence. These factors related to themselves, external influences, social and relational aspects and situational factors. Most patient accounts of mediating factors overlapped with those listed in commonly used risk assessment instruments and previous research. Additional factors identified by patients related to the outer context and interpersonal aspects.Conclusions: There are many barriers and facilitators to the implementation and use of structured risk assessment instruments, implying the need for a multifaceted approach to address determinants at several system levels. Considering the clinical context is important when selecting a structured risk assessment instrument to be implemented, but also the complexity of the instrument, the required change of routines and the provision of continuous resources and interventions to achieve and maintain clinical use. Despite the many barriers, there is evidence of clinical use of both unstructured clinical and structured risk assessments in terms of informing and guiding care and risk management interventions. The large overlap, however, makes it difficult to draw definite conclusion about which type of assessment actually influenced the interventions that were realized. Realized care and risk management interventions are most often not documented as planned. This increases the risk of subjective decisions and provision of interventions, which also make such interventions difficult to evaluate. Forensic patients are actively managing their risk of violence and are capable of identifying and communicating many different mediating factors for their violence risk. They are knowledgeable and important stakeholders and should be involved in their own risk assessments, as well as in research.
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| 5. |
- Bülow, Per, 1953-
(författare)
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Efter mentalsjukhuset : en studie i spåren av avinstitutionaliseringen av den psykiatriska vården
- 2004
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The focus of this thesis is the reorganisation of psychiatric care, the deinstitutionalisation process, which has been carried through in Sweden and other countries in the western world. Psychiatric care has been both specialised and decentralised and new actors, outside the medical service, have been involved in care, support and service to people with severe mental illnesses. The deinstitutionalisation process has been followed by a constant debate about its merits and shortcomings. The critics assert that people with severe mental illnesses have been abandoned by an indifferent society, which has resulted in negative consequences like premature death, homelessness and criminalisation. The proponents of the process, on the other hand, state that people who previously lived their lives in mental hospitals and in the margin of the society now have regained their citizenship and can participate in community life.The overall aim of the thesis was to study and illuminate changes in care, support and service in the wake of the deinstitutionalisation process in Sweden. The study is a retrospective, longitudinal cohort study that extended over a period of 15 years, from 1984 to 1998. It takes its starting-point in one of the about thirty mental hospitals in Sweden at that time. Data were collected from "the Cause of death" Register at Statistics Sweden (SCB), the Swedish Police Register, the Social Insurance Office, from medical records, and via inquiry form from contact persons and staff close to the patients. Through the collected data changes in variables such as criminality, mortality, homelessness, treatment in inpatient and outpatient settings, daily activities, living conditions and other social conditions were followed over the lS-year period covering all 138 patients included in the study.The amount of days in hospitals decreased while attendance at outpatient clinics increased. There was a considerable increase in social service delivery in the form of housing and occupational support. However, many patients lacked social contacts outside their regularly visits at outpatient clinics. There were no increases in premature death or suicide and the criminality showed a decline between 1992-1998. The results of the study suggest that there are some reasons to adopt a positive attitude toward the deinstitutionalisation process in Sweden.
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