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Violence risk assessment in psychiatric hospitals: Studies of the integration of science and practice
Clinicians assess violence risk of psychiatric patients regularly in a number of settings. To improve risk assessment, researchers have sought to establish empirically-validated risk factors and to develop actuarial instruments and structured guidelines. Although research in the past decade has focused on what clinicians should consider when assessing violence, less attention has been devoted to what clinicians do when assessing violence risk in practice. Commentators have urged that this imbalance be corrected and that efforts be made to study how violence risk assessment occurs in actual practice. In particular, a wide separation between the science and practice of violence risk assessment calls for examination of how risk assessment research is integrated in clinical practice. The aims of this dissertation are to ascertain to what extent risk assessment research is incorporated into clinical practice and to identify aspects of practice that thwart implementation of risk assessment technology. ^ The research employed multiple methods in multiple psychiatric settings. First, 135 clinicians from four facilities (acute, chronic, crisis, forensic) reported on the risk factors they considered when assessing patients' violence risk, engaged in a simulated judgment task on a computer program, and rated the relevance and availability of risk factors. Second, 283 patient charts were randomly selected from the same four facilities and coded for documentation of critical risk information. The results showed that although clinicians consider, perceive as relevant, and document some empirically-validated risk factors, there was a substantial gap between science and practice. Obstacles for integrating risk assessment research into practice were identified, including limited availability of risk information in some settings, difficulty combining static and dynamic risk cues, lack of awareness of the research base, and unsystematic communication of testing results. Findings also indicated that clinician characteristics affected use of cues from research risk measures and that clinicians with formal mental health training considered a wider range of research risk factor domains. In conclusion, although the findings indicated some degree of research integration, much work needs to be done to bridge the gap between violence risk assessment research and practice. ^
Elbogen, Eric Bradley, "Violence risk assessment in psychiatric hospitals: Studies of the integration of science and practice" (2001). ETD collection for University of Nebraska - Lincoln. AAI3004610.