title: Risk assessment and shared care planning in out-patient forensic psychiatry: cluster randomised controlled trial.
abstract: BACKGROUND
  Forensic psychiatry aims to reduce recidivism and makes use of risk assessment tools to achieve this goal. Various studies have reported on the predictive qualities of these instruments, but it remains unclear whether their use is associated with actual prevention of recidivism in clinical care.
  
  
  OBJECTIVE
  To test whether an intervention combining risk assessment and shared care planning is associated with a reduction in violent and criminal behaviour.
  
  
  METHODS
  A cluster randomised controlled trial (Netherlands Trial Register number NTR1042) was conducted in three out-patient forensic psychiatric clinics. The intervention comprised risk assessment with the Short Term Assessment of Risk and Treatability (START) and a shared care planning protocol formulated according to shared decision-making principles. The control group received usual care. The outcome consisted of the proportion of clients with violent or criminal incidents at follow-up.
  
  
  RESULTS
  In total 58 case managers and 632 of their clients were included. In the intervention group (n = 310), 65% received the intervention at least once. Findings showed a general treatment effect (22% of clients with an incident at baseline v. 15% at follow-up, P<0.01) but no significant difference between the two treatment conditions (odds ratio (OR) = 1.46, 95% CI 0.89-2.44, P = 0.15).
  
  
  CONCLUSIONS
  Although risk assessment is common practice in forensic psychiatry, our results indicate that the primary goal of preventing recidivism was not reached through risk assessment embedded in shared decision-making.
authors.affiliation: Rob Giel Research Center, University Centre for Psychiatry, University Medical Centre Groningen, The Netherlands. N.A.C.Troquete@umcg.nl
authors.forename: N A C
authors.initials: NA
authors.lastname: Troquete
authors.forename: R H S
authors.initials: RH
authors.lastname: van den Brink
authors.forename: H
authors.initials: H
authors.lastname: Beintema
authors.forename: T
authors.initials: T
authors.lastname: Mulder
authors.forename: T W D P
authors.initials: TW
authors.lastname: van Os
authors.forename: R A
authors.initials: RA
authors.lastname: Schoevers
authors.forename: D
authors.initials: D
authors.lastname: Wiersma
mesh_terms: D000328:Adult; D000553:Ambulatory Care / Q000458:organization & administration*; D016000:Cluster Analysis; D003415:Crime / Q000517:prevention & control; D003657:Decision Making; D005260:Female; D005555:Forensic Psychiatry / Q000458:organization & administration*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D010347:Patient Care Planning / Q000458:organization & administration*; D018570:Risk Assessment / Q000379:methods; D016896:Treatment Outcome; D014754:Violence / Q000517:prevention & control*; D055815:Young Adult