The DUNDRUM-1 structured professional judgment for triage to appropriate levels of therapeutic security: retrospective-cohort validation study.

2.50
Hdl Handle:
http://hdl.handle.net/10147/135990
Title:
The DUNDRUM-1 structured professional judgment for triage to appropriate levels of therapeutic security: retrospective-cohort validation study.
Authors:
Flynn, Grainne; O'Neill, Conor; McInerney, Clare; Kennedy, Harry G
Affiliation:
National Forensic Mental Health Service, Central Mental Hospital, Dundrum, Dublin 14, Ireland.
Citation:
The DUNDRUM-1 structured professional judgment for triage to appropriate levels of therapeutic security: retrospective-cohort validation study. 2011, 11:43 BMC Psychiatry
Journal:
BMC psychiatry
Issue Date:
2011
URI:
http://hdl.handle.net/10147/135990
DOI:
10.1186/1471-244X-11-43
PubMed ID:
21410967
Additional Links:
http://www.ncbi.nlm.nih.gov/pubmed/21410967
Abstract:
The assessment of those presenting to prison in-reach and court diversion services and those referred for admission to mental health services is a triage decision, allocating the patient to the appropriate level of therapeutic security. This is a critical clinical decision. We set out to improve on unstructured clinical judgement. We collated qualitative information and devised an 11 item structured professional judgment instrument for this purpose then tested for validity.; All those assessed following screening over a three month period at a busy remand committals prison (n = 246) were rated in a retrospective cohort design blind to outcome. Similarly, all those admitted to a mental health service from the same prison in-reach service over an overlapping two year period were rated blind to outcome (n = 100).; The 11 item scale had good internal consistency (Cronbach's alpha = 0.95) and inter-rater reliability. The scale score did not correlate with the HCR-20 'historical' score. For the three month sample, the receiver operating characteristic area under the curve (AUC) for those admitted to hospital was 0.893 (95% confidence interval 0.843 to 0.943). For the two year sample, AUC distinguished at each level between those admitted to open wards, low secure units or a medium/high secure service. Open wards v low secure units AUC = 0.805 (95% CI 0.680 to 0.930); low secure v medium/high secure AUC = 0.866, (95% CI 0.784 to 0.949). Item to outcome correlations were significant for all 11 items.; The DUNDRUM-1 triage security scale and its items performed to criterion levels when tested against the real world outcome. This instrument can be used to ensure consistency in decision making when deciding who to admit to secure forensic hospitals. It can also be used to benchmark admission thresholds between services and jurisdictions. In this study we found some divergence between assessed need and actual placement. This provides fertile ground for future research as well as practical assistance in assessing unmet need, auditing case mix and planning care pathways.
Item Type:
Article
Language:
en
MeSH:
Criminals; Decision Making; Humans; Judgment; Mental Disorders; Mental Health Services; Needs Assessment; Prisoners; Referral and Consultation; Reproducibility of Results; Retrospective Studies; Triage
ISSN:
1471-244X

Full metadata record

DC FieldValue Language
dc.contributor.authorFlynn, Grainneen
dc.contributor.authorO'Neill, Conoren
dc.contributor.authorMcInerney, Clareen
dc.contributor.authorKennedy, Harry Gen
dc.date.accessioned2011-07-13T15:10:59Z-
dc.date.available2011-07-13T15:10:59Z-
dc.date.issued2011-
dc.identifier.citationThe DUNDRUM-1 structured professional judgment for triage to appropriate levels of therapeutic security: retrospective-cohort validation study. 2011, 11:43 BMC Psychiatryen
dc.identifier.issn1471-244X-
dc.identifier.pmid21410967-
dc.identifier.doi10.1186/1471-244X-11-43-
dc.identifier.urihttp://hdl.handle.net/10147/135990-
dc.description.abstractThe assessment of those presenting to prison in-reach and court diversion services and those referred for admission to mental health services is a triage decision, allocating the patient to the appropriate level of therapeutic security. This is a critical clinical decision. We set out to improve on unstructured clinical judgement. We collated qualitative information and devised an 11 item structured professional judgment instrument for this purpose then tested for validity.-
dc.description.abstractAll those assessed following screening over a three month period at a busy remand committals prison (n = 246) were rated in a retrospective cohort design blind to outcome. Similarly, all those admitted to a mental health service from the same prison in-reach service over an overlapping two year period were rated blind to outcome (n = 100).-
dc.description.abstractThe 11 item scale had good internal consistency (Cronbach's alpha = 0.95) and inter-rater reliability. The scale score did not correlate with the HCR-20 'historical' score. For the three month sample, the receiver operating characteristic area under the curve (AUC) for those admitted to hospital was 0.893 (95% confidence interval 0.843 to 0.943). For the two year sample, AUC distinguished at each level between those admitted to open wards, low secure units or a medium/high secure service. Open wards v low secure units AUC = 0.805 (95% CI 0.680 to 0.930); low secure v medium/high secure AUC = 0.866, (95% CI 0.784 to 0.949). Item to outcome correlations were significant for all 11 items.-
dc.description.abstractThe DUNDRUM-1 triage security scale and its items performed to criterion levels when tested against the real world outcome. This instrument can be used to ensure consistency in decision making when deciding who to admit to secure forensic hospitals. It can also be used to benchmark admission thresholds between services and jurisdictions. In this study we found some divergence between assessed need and actual placement. This provides fertile ground for future research as well as practical assistance in assessing unmet need, auditing case mix and planning care pathways.-
dc.language.isoenen
dc.relation.urlhttp://www.ncbi.nlm.nih.gov/pubmed/21410967en
dc.subject.meshCriminals-
dc.subject.meshDecision Making-
dc.subject.meshHumans-
dc.subject.meshJudgment-
dc.subject.meshMental Disorders-
dc.subject.meshMental Health Services-
dc.subject.meshNeeds Assessment-
dc.subject.meshPrisoners-
dc.subject.meshReferral and Consultation-
dc.subject.meshReproducibility of Results-
dc.subject.meshRetrospective Studies-
dc.subject.meshTriage-
dc.titleThe DUNDRUM-1 structured professional judgment for triage to appropriate levels of therapeutic security: retrospective-cohort validation study.en
dc.typeArticleen
dc.contributor.departmentNational Forensic Mental Health Service, Central Mental Hospital, Dundrum, Dublin 14, Ireland.en
dc.identifier.journalBMC psychiatryen
dc.description.provinceLeinster-

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