[Shared decision making in involuntary treatment: four case studies from court ordered psychiatric treatment]. / Gedeelde besluitvorming in het gedwongen kader: vier casestudies uit de tbs.

BACKGROUND: Shared decision making (SDM) can result in better treatment outcomes. Little is known about the practice of SDM in forensic psychiatry; a context in which not only psychiatric problems are present, but also freedom restrictions and involuntary hospitalisation. AIM: To explore the current degree of SDM in a forensic psychiatric setting and to identify factors that influence SDM. METHOD: Semi-structured interviews (n = 4 triads: treatment coordinator, sociotherapeutic mentor and patient) combined with scores on questionnaires (SDM-Q-Doc and SDM-Q-9). RESULTS: The SDM-Q showed a relatively high degree of SDM. Themes like cognitive and executive functions of the patient, subcultural differences, insight into the disease and reciprocal cooperation appeared to influence the SDM. In addition, SDM in forensic psychiatry appeared to be more of a means of improving communication about the decisions of the treatment team than truly ‘shared’ decision making. CONCLUSION: This first exploration shows that SDM is applied in forensic psychiatry, however operationalised differently than the theory behind SDM prescribes.

[Predicting short term intramural violence with the Instrument for Forensic Treatment Evaluation (IBFE), ROM-instrument in tbs for different target groups]. / Voorspellen van intramuraal geweld op korte termijn met het Instrument voor Forensische Behandelevaluatie (IFBE), ROM-instrument in de tbs voor verschillende doelgroepen.

BACKGROUND: The Instrument for Forensic Treatment Evaluation (IFTE) has proven to be useful as an instrument for treatment evaluation and risk management in a heterogeneous group of tbs-patients (tbs = court ordered psychiatric treatment for offenders with a mental disorder). However, it is not known whether this ROM-instrument is a predictor of short term inpatient violence in different tbs-groups.
AIM: To investigate the extent to which the factor Problematic behavior of the IFBE is useful for predicting intramural violence, taking the different target groups in tbs into account. To demonstrate the practical value of the ifte factor Problematic behavior for inpatient violence risk management.
METHOD: Using logistic regression, the predictive validity of the ifte-factor Problematic behavior for inpatient violence was established in a 4 to 8-month follow-up, taking the different target groups into account. Cut-off points based on ROC analysis determined whether this factor could be of practical value for risk management.
RESULTS: The factor Problematic behavior predicted inpatient violence, irrespective of the target group, with an odds ratio of 1.68. A cut-off score of 7, on a scale of 1 to 17, correctly assessed 82% of the patients as a high or low risk for inpatient violent behavior.
CONCLUSION: The factor Problematic behavior of the IFBE can contribute to the prediction of short term inpatient violence for different tbs patient groups.