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21 J. Forensic Psychiatry & Psych. 1 (2010)

handle is hein.journals/jnlofncpy21 and id is 1 raw text is: The Journal of Forensic Psychiatry & Psychology | Routledge Vol. 21, No. 1, February 2010, 1-22 Taylor&FrancisGroup RESEARCH ARTICLE Confidence and accuracy in assessments of short-term risks presented by forensic psychiatric patients Sarah L. Desmaraisac*, Tonia L. Nichollsa,b,a J. Don Readb and Johann Brinka,de BC Mental Health & Addiction Services, Forensic Psychiatric Hospital, British Columbia, Canada; bDepartment of Psychology, Simon Fraser University, British Columbia, Canada; School of Population and Public Health, University of British Columbia, Canada; dDepartment of Psychiatry, University of British Columbia, Canada; 'School of Criminology, Simon Fraser University, British Columbia, Canada (Received 30 January 2009; final version received 13 July 2009) Forensic mental health professionals are asked to estimate with appropriate confidence the likelihood of adverse outcomes. But what is an 'appropriate' level of confidence? We examined this question in the context of short-term assessments of risk for violence, suicide, self-harm, and unauthorized leave. Using the Short-Term Assessment of Risk and Treatability (START), treatment team members (n = 23) completed 331 assessments of 137 forensic psychiatric patients appearing before the British Columbia Review Board over a six-month period. Assessors additionally indicated confidence in the accuracy of their risk assess- ments. Clinical-legal outcome data were collected prospectively for one year using a modified version of the Overt Aggression Scale (OAS). Overall, assessors were highly confident in the accuracy of their assessments; however, analyses revealed few differences in accuracy as a function of confidence. When significant differences were observed, higher confidence was associated with lower predictive accuracy. Findings suggest that assessors may benefit from feedback regarding predictive validity of past assessments and speak to the importance of comprehensive and ongoing training in risk assessment. Keywords: structured professional judgment; confidence; predictive validity; violence risk assessment; forensic psychiatric patients; START As a matter of daily practice, clinicians working in forensic settings must make decisions regarding the risks presented by forensic psychiatric patients and how to best manage these risks. During the process of assessing risk, clinicians consider the available information to determine the best course of action (Nicholls, Desmarais, Douglas, & Kropp, 2006). However, as in any *Corresponding author. Email: sarah.desmarais@ubc.ca ISSN 1478-9949 print/ISSN 1478-9957 online © 2010 Taylor & Francis DOI: 10.1080/14789940903183932 http://www.informaworld.com

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