title: The DUNDRUM Quartet: validation of structured professional judgement instruments DUNDRUM-3 assessment of programme completion and DUNDRUM-4 assessment of recovery in forensic mental health services.
abstract: BACKGROUND
  Moving a forensic mental health patient from one level of therapeutic security to a lower level or to the community is influenced by more than risk assessment and risk management. We set out to construct and validate structured professional judgement instruments for consistency and transparency in decision making
  
  
  METHODS
  Two instruments were developed, the seven-item DUNDRUM-3 programme completion instrument and the six item DUNDRUM-4 recovery instrument. These were assessed for all 95 forensic patients at Ireland's only forensic mental health hospital.
  
  
  RESULTS
  The two instruments had good internal consistency (Cronbach's alpha 0.911 and 0.887). Scores distinguished those allowed no leave or accompanied leave from those with unaccompanied leave (ANOVA F = 38.1 and 50.3 respectively, p < 0.001). Scores also distinguished those in acute/high security units from those in medium or in low secure/pre-discharge units. Each individual item distinguished these levels of need significantly. The DUNDRUM-3 and DUNDRUM-4 correlated moderately with measures of dynamic risk and with the CANFOR staff rated unmet need (Spearman r = 0.5, p < 0.001).
  
  
  CONCLUSIONS
  The DUNDRUM-3 programme completion items distinguished significantly between levels of therapeutic security while the DUNDRUM-4 recovery items consistently distinguished those given unaccompanied leave outside the hospital and those in the lowest levels of therapeutic security. This data forms the basis for a prospective study of outcomes now underway.
authors: National Forensic Mental Health Service, Central Mental Hospital, Dundrum, Dublin 14, Ireland. kennedh@tcd.ie.
authors: Sarah
authors: S
authors: O'Dwyer
authors: Mary
authors: M
authors: Davoren
authors: Zareena
authors: Z
authors: Abidin
authors: Elaine
authors: E
authors: Doyle
authors: Kim
authors: K
authors: McDonnell
authors: Harry G
authors: HG
authors: Kennedy