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1 – 10 of over 3000Tobias Wasser, Saksham Chandra and Katherine Michaelsen
The purpose of this paper is to review the impact of a new, brief forensic rotation for general psychiatry residents on the variety of residents’ forensic exposures.
Abstract
Purpose
The purpose of this paper is to review the impact of a new, brief forensic rotation for general psychiatry residents on the variety of residents’ forensic exposures.
Design/methodology/approach
The authors surveyed residents who trained before and after the implementation of the new rotation to assess the impact of the rotation on the residents’ forensic experiences during training across a variety of domains.
Findings
Even in a highly clinical forensic setting, residents participating in the required rotation reported significantly greater variety of forensic experiences than those who had not completed the required rotation, including types of settings and assessments, Rotation completers reported greater exposure to various types of settings and assessments, and courtroom-related experiences, as well as the overall number of forensic exposures. The two groups did not differ in their forensic exposures in general psychiatry settings, civil-forensic evaluations or diverse forensic populations. Secondary analyses showed that increased exposure to court-based experiences and multiple forensic settings was associated with forensic fellowship interest.
Originality/value
This study demonstrates that a brief, mandatory forensic clinical rotation may increase residents’ exposure to forensic settings, assessments and courtroom-related experiences and that increased exposure to courtroom-based experiences in particular may increase interest in forensic fellowship. While not surprising, the results demonstrate that residents were not otherwise having these forensic experiences and that even time-limited forensic rotations can enhance the breadth of residents’ forensic exposures. Further, the rotation achieved these outcomes without using typical forensic sites but instead highly clinical sites, which may be particularly encouraging to residency programs without ready access to classic forensic rotation sites. This study contributes to the small but expanding body of the literature describing the value of increasing psychiatry residents’ training in clinical forensic psychiatry.
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The forensic nursing role is complex, creates tensions within itself and is underpinned by core values, knowledge, skills and personal attributes; often referred to as ‘good…
Abstract
The forensic nursing role is complex, creates tensions within itself and is underpinned by core values, knowledge, skills and personal attributes; often referred to as ‘good nurse’ characteristics (Smith & Godfrey, 2002). Forensic nurses perform unique, multifaceted roles; they are viewed by patients as ‘a source of treatment, comfort and advice’, but also as ‘part of the system that deprives them of their liberty’ (United Kingdom Central Council for Nursing, Midwifery and Health Visiting & University of Central Lancashire (UKCC & UCLAN), 1999: 42). This is problematic both for nurses and patients. Although appearing as opposites, security and therapeutic characteristics of nurses can and do co‐exist in forensic nursing (Peternelji‐Taylor & Johnson, 1996). Through critical analysis of dialogue from interviews and focus groups, this paper depicts forensic practice with people with a learning disability through a study that explores apparent ‘truths’ about such people detained in forensic settings (here referred to as ‘the men’) and the staff who work with them. Beliefs about nursing characteristics were exposed through discourses present in dialogue between the men and the staff. General research questions included: (1) What are the discourses related to learning disability and forensic practice? (2) What ideologies underpin and justify forensic practice? (3) What in particular are the positive discourses? Related discussion is primarily concerned with the way that staff and men share relationships and with characteristics of the nursing staff. Findings generally suggest that the staff may be viewed as prison wardens, leading to relationships of mistrust. Paradoxically, there are also positive discourses identifying warm and therapeutic relationships and good nurse characteristics of the staff. This may have practice implications, such as enabling staff to hear positive views expressed by the men and begin to develop metrics of ‘good’ forensic nurse characteristics that may positively affect treatment.
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Vivienne de Vogel, Petra Schaftenaar and Maartje Clercx
Continuity of forensic mental health care is important in building protective structures around a patient and has been shown to decrease risks of relapse. Realising continuity can…
Abstract
Purpose
Continuity of forensic mental health care is important in building protective structures around a patient and has been shown to decrease risks of relapse. Realising continuity can be complicated due to restrictions from finances or legislation and difficulties in collaboration between settings. In the Netherlands, several programs have been developed to improve continuity of forensic care. It is unknown whether professionals and clients are sufficiently aware of these programs. The paper aims to discuss this issue.
Design/methodology/approach
The experienced difficulties and needs of professionals and patients regarding continuity of forensic care were explored by means of an online survey and focus groups. The survey was completed by 318 professionals. Two focus groups with professionals (15 participants), one focus group and one interview with patients (six participants) were conducted.
Findings
The overall majority (85.6 percent) reported to experience problems in continuity on a frequent basis. The three main problems are: first, limited capacity for discharge from inpatient to outpatient or sheltered living; second, collaboration between forensic and regular mental health care; and, third, limited capacity for long-term inpatient care. Only a quarter of the participants knew the existing programs. Actual implementation of these programs was even lower (3.9 percent). The top three of professionals’ needs are: better collaboration; higher capacity; more knowledge about rules and regulation. Participants of the focus groups emphasized the importance of transparent communication, timely discharge planning and education.
Practical implications
Gathering best practices about regional collaboration networks and developing a blueprint based on the best practices could be helpful in improving collaboration between setting in the forensic field. In addition, more use of systematic discharge planning is needed to improve continuity in forensic mental health care. It is important to communicate in an honest, transparent way to clients about their forensic mental health trajectories, even if there are setbacks or delays. More emphasis needs to be placed on communicating and implementing policy programs in daily practice and more education about legislation is needed Structured evaluations of programs aiming to improve continuity of forensic mental health care are highly needed.
Originality/value
Policy programs hardly reach professionals. Professionals see improvements in collaboration as top priority. Patients emphasize the human approach and transparent communication.
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Maartje Clercx, Robert Didden, Leam A. Craig and Marije Keulen-de Vos
Forensic vigilance is a central competency that forensic professionals need to meet the complex demands of working in forensic settings. Until recently, no instrument for forensic…
Abstract
Purpose
Forensic vigilance is a central competency that forensic professionals need to meet the complex demands of working in forensic settings. Until recently, no instrument for forensic vigilance was available. This study aims to develop a self-assessment tool of forensic vigilance for individuals and teams working in forensic settings, and investigated its psychometric properties.
Design/methodology/approach
The Forensic Vigilance Estimate (FVE) was presented to 367 forensic psychiatric professionals and 94 non-forensic psychiatric professionals by means of an online survey. Professionals rated themselves on 15 aspects of forensic vigilance.
Findings
The results indicated that the FVE had good psychometric properties, reflected by a good to excellent internal consistency (Cronbach’s α of 0.903), a good split-half reliability (0.884) and good test–retest reliability (0.809). The factor structure of the FVE was captured by a one-factor model (RMSEA 0.09, SRMR 0.05, TLI 0.91 and CFI 0.92). Proportion of explained variance was 52%. Forensic professionals scored significantly higher than non-forensic professionals on the FVE (t(459) = 3.848, p = 0.002).
Practical implications
These results suggest that the FVE may reliably be used for research purposes, e.g. to study the effects of targeted training or intervention or increasing work experience on forensic vigilance or to study which factors influence forensic vigilance.
Originality/value
This study represents the first attempt to capture forensic vigilance with a measuring instrument.
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Jessica Holley, James Tapp and Simon Draycott
Coercive practices – which are used as means to manage violent/aggressive behaviour in secure forensic settings – have come under scrutiny in recent years due to their paradoxical…
Abstract
Purpose
Coercive practices – which are used as means to manage violent/aggressive behaviour in secure forensic settings – have come under scrutiny in recent years due to their paradoxical effects on provoking further service user aggression and violence. Previous research has found relationships between increased service user aggression with both service users’ interpersonal styles and perceptions of staff coercion (i.e. staff limit setting). This paper aims to investigate whether forensic service users’ levels of interpersonal sensitivity to dominance increase levels of self-reported anger and rates of aggression towards staff through perceptions of staff coercion.
Design/methodology/approach
In a cross-sectional quantitative study design, 70 service users were recruited from one high and two medium secure forensic hospitals. Standardised measures were completed by service users and recorded incident data was collected within the past year. Correlation and mediation analyses were run to investigate the relationship between study variables.
Findings
A significant relationship was found between service users’ interpersonal sensitivity to dominance and self-reported rates of anger, where forensic service users’ who had higher levels of interpersonal sensitivity to others’ dominance were likely to report higher rates of anger. No significant relationships were found between all other study variables.
Practical implications
The findings from this study contradict previous research where coercive practices may not necessarily increase rates of aggression towards staff but, in the context of service users’ interpersonal sensitivities to dominance, it may be more useful to consider the way in which coercive practices are implemented.
Originality/value
There is a gap in the literature, which looks at the way in which forensic service users perceive coercive practices in relation to their interpersonal sensitivities and whether this too has an impact upon service user aggression.
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Maartje Clercx, Marije Keulen-de Vos, Leam A. Craig and Robert Didden
Forensic mental health care is a unique field that poses complex demands on professionals. Forensic vigilance is a hypothesized specialty of forensic mental health professionals…
Abstract
Purpose
Forensic mental health care is a unique field that poses complex demands on professionals. Forensic vigilance is a hypothesized specialty of forensic mental health professionals, allowing them to meet the complex demands of working in forensic settings. Forensic vigilance consists of theoretical and experiential knowledge of mental disorders, theory of offending behavior, the criminal history of patients and environmental observations and clinical judgment. Although this concept has only been recently described and defined, it is still unknown which professional and individual factors are related to forensic vigilance, and if forensic vigilance is related to job stress and burnout symptoms. The purpose of this study was to investigate the relation between forensic vigilance and several professional and individual factors.
Design/methodology/approach
The current study investigated whether forensic vigilance is predicted by years of work experience and the Big Five personality traits by means of an online survey among forensic mental health professionals and whether forensic vigilance is associated with work-related stress, burnout and workplace satisfaction.
Findings
The 283 forensic mental health professionals who responded to the survey indicated that forensic work experience, but not general experience, positively predicted forensic vigilance. Forensic vigilance was negatively associated with Neuroticism and positively associated with Openness to experience and Conscientiousness. Forensic vigilance did not predict work-related stress, burnout symptoms and workplace satisfaction. Personal accomplishment was positively related to forensic vigilance.
Practical implications
Findings of the present study increase the understanding of the construct of forensic vigilance. The findings presented here highlight the importance of differences between professionals in terms of experience and personality. Training programs should capitalize on experience, while taking personality differences in consideration. Personality differences are relevant in hiring policies and team composition. Finally, to reduce workplace-related stress and burnout symptoms, institutions should consider known factors that influence work-related symptoms (e.g. experienced autonomy) rather than forensic vigilance.
Originality/value
To the best of the authors’ knowledge, this study represents the first effort to study forensic vigilance in relation to personality, work experience and experienced workplace-related stress and satisfaction.
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Recent years have seen some significant changes to the psychology profession in Australia that have prompted debate about the role of specialist areas of practice. This study aims…
Abstract
Purpose
Recent years have seen some significant changes to the psychology profession in Australia that have prompted debate about the role of specialist areas of practice. This study aims to investigate those attitudes and values that might be associated with one particular specialism, that of forensic psychology.
Design/methodology/approach
The influence of specialist forensic training on the professional identity of 30 correctional psychologists was examined in relation to their self‐reported level of stress, organisational membership, and organisational commitment.
Findings
The results suggest that exposure to specialist training in forensic psychology may not be directly associated with organisational commitment, membership or stress, although some differences between forensic psychologists and those who held other professional practice qualifications were observed.
Research limitations/implications
The main limitations of the study include the small sample size and the use of a scale that has not been well‐validated. Replication and extension of the study is required.
Practical implications
The study has implications for the recruitment and retention of psychologists in correctional settings and for the development of professional identity in post‐graduate training programmes.
Originality/value
This study is the first to explore the differences in professional identity, organisational commitment, organisational membership and stress in a sample of psychologists who practice in the correctional setting.
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Forensic nursing is a term applied to nurses working in many different areas of clinical practice, such as high security hospitals, medium secure units, low secure units, acute…
Abstract
Forensic nursing is a term applied to nurses working in many different areas of clinical practice, such as high security hospitals, medium secure units, low secure units, acute mental health wards, specialised private hospitals, psychiatric intensive care units, court liaison schemes, and outpatient, community and rehabilitation services. Rarely is the term defined in the general literature and as a concept it is multifaceted. Concept analysis is a method for exploring and evaluating the meaning of words. It gives precise definitions, both theoretical and operational, for use in theory, clinical practice and research. A concept analysis provides a logical basis for defining terms and helps us to refine and define a concept that derives from practice, research and theory. This paper uses the strategy of concept analysis to explore the term ‘forensic nursing’ and finds a working definition of forensic mental health nursing. The historical background and literature are reviewed using concept analysis to bring the term into focus and to define it more clearly. Forensic nursing is found to derive from forensic practice. A proposed definition of forensic nursing is given.
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Nikki Wood, Kiran Patel, Josephine Skinner and Kirsty Thomson
In 2008 a dual diagnosis service was set up within the forensic services of East London NHS Foundation Trust. This paper provides an outline of the service as it currently stands…
Abstract
In 2008 a dual diagnosis service was set up within the forensic services of East London NHS Foundation Trust. This paper provides an outline of the service as it currently stands, and a description of the multidisciplinary staff roles within the service. Each staff member reflects on the success and challenges over the year that the service has been operational. Pointers to our future plans and strategy development are made.
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Petra Habets, Inge Jeandarme and Harry G. Kennedy
Criteria to determine in which level of security forensic patients should receive treatment are currently non-existent in Belgium. Research regarding the assessment of security…
Abstract
Purpose
Criteria to determine in which level of security forensic patients should receive treatment are currently non-existent in Belgium. Research regarding the assessment of security level is minimal and few instruments are available. The DUNDRUM toolkit is a structured clinical judgement instrument that can be used to provide support when determining security level. The purpose of this paper is to investigate the applicability and validity of the DUNDRUM-1 in Flanders.
Design/methodology/approach
The DUNDRUM-1 was scored for 50 male patients admitted at the forensic units in the public psychiatric hospital Rekem. Some files were rated by three researchers who were blind to participants’ security status, resulting in 33 double measurements.
Findings
Almost all files (96 per cent) contained enough information to score the DUNDRUM-1. Average DUNDRUM-1 final judgement scores were concordant with a medium security profile. No difference was found between the current security levels and the DUNDRUM-1 final judgement scores. Inter-rater reliability was excellent for the DUNDRUM-1 final judgement scores. On item level, all items had excellent to good inter-rater reliability with the exception of one item institutional behaviour which had an average inter-rater reliability.
Practical implications
The DUNDRUM-1 can be a useful tool in Flemish forensic settings. It has good psychometric properties. More research is needed to investigate the relationship between DUNDRUM-1 scores and security level decisions by the courts.
Originality/value
This is the first study that investigated the applicability of the DUNDRUM-1 in a Belgian setting, also a relative large number of repeated measurements were available to investigate the inter-rater reliability of the DUNDRUM-1.
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