Recovery and concordance in a secure forensic psychiatry hospital – the self rated DUNDRUM-3 programme completion and DUNDRUM-4 recovery scales

Hdl Handle:
http://hdl.handle.net/10147/572572
Title:
Recovery and concordance in a secure forensic psychiatry hospital – the self rated DUNDRUM-3 programme completion and DUNDRUM-4 recovery scales
Authors:
Davoren, Mary; Hennessy, Sarah; Conway, Catherine; Marrinan, Seamus; Gill, Pauline; Kennedy, Harry G
Citation:
BMC Psychiatry. 2015 Mar 28;15(1):61
Issue Date:
28-Mar-2015
URI:
http://dx.doi.org/10.1186/s12888-015-0433-x; http://hdl.handle.net/10147/572572
Abstract:
Abstract Background Detention in a secure forensic psychiatric hospital may inhibit engagement and recovery. Having validated the clinician rated DUNDRUM-3 (programme completion) and DUNDRUM-4 (recovery) in a forensic hospital, we set out to draft and validate scales measuring the same programme completion and recovery items that patients could use to self-rate. Based on previous work, we hypothesised that self-rating scores might be predictors of objective progress including conditional discharge. We hypothesised also that the difference between patients’ and clinicians’ ratings of progress in treatment and other factors relevant to readiness for discharge (concordance) would diminish as patients neared discharge. We hypothesised also that this difference in matched scores would predict objective progress including conditional discharge. Method In a prospective naturalistic observational cohort study in a forensic hospital, we examined whether scores on the self-rated DUNDRUM-3 programme completion and DUNDRUM-4 recovery scales or differences between clinician and patient ratings on the same scales (concordance) would predict moves between levels of therapeutic security and conditional discharge over the next twelve months. Results Both scales stratified along the recovery pathway of the hospital, but clinician ratings matched the level of therapeutic security more accurately than self ratings. The clinician rated scales predicted moves to less secure units and to more secure units and predicted conditional discharge but the self-rated scores did not. The difference between clinician and self-rated scores (concordance) predicted positive and negative moves and conditional discharge, but this was not always an independent predictor as shown by regression analysis. In regression analysis the DUNDRUM-3 predicted moves to less secure places though the HCR-20 C & R score dominated the model. Moves back to more secure places were predicted by lack of concordance on the DUNDRUM-4. Conditional discharge was predicted predominantly by the DUNDRUM-3. Conclusions Patients accurately self-rate relative to other patients however their absolute ratings were consistently lower (better) than clinicians’ ratings and were less accurate predictors of outcomes including conditional discharge. Quantifying concordance is a useful part of the recovery process and predicts outcomes but self-ratings are not accurate predictors.
Language:
en
Keywords:
FORENSIC MENTAL HEALTH; RECOVERY; VALIDATION SCALES

Full metadata record

DC FieldValue Language
dc.contributor.authorDavoren, Maryen
dc.contributor.authorHennessy, Sarahen
dc.contributor.authorConway, Catherineen
dc.contributor.authorMarrinan, Seamusen
dc.contributor.authorGill, Paulineen
dc.contributor.authorKennedy, Harry Gen
dc.date.accessioned2015-08-17T11:35:34Zen
dc.date.available2015-08-17T11:35:34Zen
dc.date.issued2015-03-28en
dc.identifier.citationBMC Psychiatry. 2015 Mar 28;15(1):61en
dc.identifier.urihttp://dx.doi.org/10.1186/s12888-015-0433-xen
dc.identifier.urihttp://hdl.handle.net/10147/572572en
dc.description.abstractAbstract Background Detention in a secure forensic psychiatric hospital may inhibit engagement and recovery. Having validated the clinician rated DUNDRUM-3 (programme completion) and DUNDRUM-4 (recovery) in a forensic hospital, we set out to draft and validate scales measuring the same programme completion and recovery items that patients could use to self-rate. Based on previous work, we hypothesised that self-rating scores might be predictors of objective progress including conditional discharge. We hypothesised also that the difference between patients’ and clinicians’ ratings of progress in treatment and other factors relevant to readiness for discharge (concordance) would diminish as patients neared discharge. We hypothesised also that this difference in matched scores would predict objective progress including conditional discharge. Method In a prospective naturalistic observational cohort study in a forensic hospital, we examined whether scores on the self-rated DUNDRUM-3 programme completion and DUNDRUM-4 recovery scales or differences between clinician and patient ratings on the same scales (concordance) would predict moves between levels of therapeutic security and conditional discharge over the next twelve months. Results Both scales stratified along the recovery pathway of the hospital, but clinician ratings matched the level of therapeutic security more accurately than self ratings. The clinician rated scales predicted moves to less secure units and to more secure units and predicted conditional discharge but the self-rated scores did not. The difference between clinician and self-rated scores (concordance) predicted positive and negative moves and conditional discharge, but this was not always an independent predictor as shown by regression analysis. In regression analysis the DUNDRUM-3 predicted moves to less secure places though the HCR-20 C & R score dominated the model. Moves back to more secure places were predicted by lack of concordance on the DUNDRUM-4. Conditional discharge was predicted predominantly by the DUNDRUM-3. Conclusions Patients accurately self-rate relative to other patients however their absolute ratings were consistently lower (better) than clinicians’ ratings and were less accurate predictors of outcomes including conditional discharge. Quantifying concordance is a useful part of the recovery process and predicts outcomes but self-ratings are not accurate predictors.en
dc.language.isoenen
dc.subjectFORENSIC MENTAL HEALTHen
dc.subjectRECOVERYen
dc.subjectVALIDATION SCALESen
dc.titleRecovery and concordance in a secure forensic psychiatry hospital – the self rated DUNDRUM-3 programme completion and DUNDRUM-4 recovery scalesen
dc.language.rfc3066enen
dc.rights.holderDavoren et al.; licensee BioMed Central.en
dc.date.updated2015-08-14T13:24:24Zen
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