title: Risk assessment by client and case manager for shared decision making in outpatient forensic psychiatry.
abstract: BACKGROUND
  In outpatient forensic psychiatry, assessment of re-offending risk and treatment needs by case managers may be hampered by an incomplete view of client functioning. The client's appreciation of his own problem behaviour is not systematically used for these purposes. The current study tests whether using a new client self-appraisal risk assessment instrument, based on the Short Term Assessment of Risk and Treatability (START), improves the assessment of re-offending risk and can support shared decision making in care planning.
  
  
  METHODS
  In a sample of 201 outpatient forensic psychiatric clients, feasibility of client risk assessment, concordance with clinician assessment, and predictive validity of both assessments for violent or criminal behaviour were studied.
  
  
  RESULTS
  Almost all clients (98 %) were able to fill in the instrument. Agreement between client and case manager on the key risk and protective factors of the client was poor (mean kappa for selection as key factor was 0.15 and 0.09, respectively, and mean correlation on scoring -0.18 and 0.20). The optimal prediction model for violent or criminal behaviour consisted of the case manager's structured professional risk estimate for violence in combination with the client's self-appraisal on key risk and protective factors (AUC = 0.70; 95%CI: 0.60-0.80).
  
  
  CONCLUSIONS
  In outpatient forensic psychiatry, self-assessment of risk by the client is feasible and improves the prediction of re-offending. Clients and their case managers differ in their appraisal of key risk and protective factors. These differences should be addressed in shared care planning. The new Client Self-Appraisal based on START (CSA) risk assessment instrument can be a useful tool to facilitate such shared care planning in forensic psychiatry.
authors.affiliation: Department of Psychiatry, University of Groningen, University Medical Center Groningen, CC73, PO Box 30.001, 9700 RB, Groningen, The Netherlands. r.h.s.van.den.brink@umcg.nl.
authors.forename: Rob H S
authors.initials: RH
authors.lastname: van den Brink
authors.affiliation: Department of Psychiatry, University of Groningen, University Medical Center Groningen, CC73, PO Box 30.001, 9700 RB, Groningen, The Netherlands. nadinetroquete@gmail.com.
authors.forename: Nadine A C
authors.initials: NA
authors.lastname: Troquete
authors.affiliation: Mental Health Organisation Lentis and Forensic Psychiatric Clinic Dr. S. van Mesdag, Groningen, The Netherlands. h.beintema@fpcvanmesdag.nl.
authors.forename: Harry
authors.initials: H
authors.lastname: Beintema
authors.affiliation: Mental Health Organisation Drenthe, Assen, The Netherlands. tamaramulder@home.nl.
authors.forename: Tamara
authors.initials: T
authors.lastname: Mulder
authors.affiliation: Mental Health Organisation Friesland, Leeuwarden, The Netherlands. titus.van.os@ggzfriesland.nl.
authors.forename: Titus W D P
authors.initials: TW
authors.lastname: van Os
authors.affiliation: Department of Psychiatry, University of Groningen, University Medical Center Groningen, CC73, PO Box 30.001, 9700 RB, Groningen, The Netherlands. r.a.schoevers@umcg.nl.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Schoevers
authors.affiliation: Department of Psychiatry, University of Groningen, University Medical Center Groningen, CC73, PO Box 30.001, 9700 RB, Groningen, The Netherlands. d.wiersma@umcg.nl.
authors.forename: Durk
authors.initials: D
authors.lastname: Wiersma
mesh_terms: D019090:Case Management; D003415:Crime / Q000517:prevention & control; D057237:Criminals / Q000523:psychology*; D003657:Decision Making; D005260:Female; D005555:Forensic Psychiatry; D006801:Humans; D001523:Mental Disorders / Q000523:psychology; D010045:Outpatients / Q000523:psychology; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data; D011594:Psychometrics; D018570:Risk Assessment / Q000379:methods*; D012647:Self-Assessment; D014754:Violence / Q000517:prevention & control