University of Essex, Colchester, UK.
Clin Psychol Psychother. 2012 Sep;19(5):399-410. doi: 10.1002/cpp.754. Epub 2011 May 19.
This study investigated individual differences in the use of risk factors when making risk assessments for self-harm. Clinical judgement analysis using 35 hypothetical case scenarios was used to determine how case characteristics influence risk assessment for self-harm by mental health professionals. Seven practitioners made four risk/priority assessment judgements for each case, and individual models of judgement for risk and priority were constructed by regressing 10 case variables onto these sets of judgements. All but two of the variables (potential risk factors) examined were related to risk and/or priority judgements. Risk assessors applied cues to make assessments consistently-broadly consistent with practice guidelines-although precise cue application varied between professionals. The findings demonstrate the potential for ambiguity in risk assessment (terms such as 'low' or 'high' risk had variable interpretation) and that it can be important to specify whether risk is to be assessed for the initiation, continuation, re-occurrence, or escalation of an event or condition. The study shows the importance of clear practice guidelines (not all risk factors were used as might be anticipated from practice guidelines) and illustrates how clinical judgement analysis can be used to understand and enhance the reliability of professional judgement.
The process by which risk assessment is undertaken can be reliably statistically modelled to allow an in-depth examination of an individual practitioner or comparisons between practitioners, which can be used to support efforts to improve assessment reliability. Senior practitioners may be more consistent in applying information to clinical judgements of self-harm. Apparent agreement over a categorical judgement of risk may mask an underlying disagreement over numerical probabilities. The term 'low risk' may be particularly subject to variability in its interpretation. The term 'risk' can be ambiguous, reflecting the probability of occurrence for some practitioners and the severity of its occurrence for others, a problem that may be compounded if it is unclear exactly which event is being assessed (e.g., risk of initiating the behaviour versus risk of re-occurrence).
本研究调查了在进行自残风险评估时使用风险因素的个体差异。使用 35 个假设案例进行临床判断分析，以确定案例特征如何影响心理健康专业人员对自残风险的评估。七名从业者对每个案例进行了四次风险/优先级评估判断，并通过将 10 个案例变量回归到这些判断集来构建个体判断模型。除了两个变量（潜在风险因素）之外，所有被检查的变量都与风险和/或优先级判断有关。风险评估员应用线索进行评估-大致符合实践指南-尽管专业人员之间的精确线索应用有所不同。研究结果表明风险评估存在歧义的可能性（例如“低”或“高”风险等术语的解释各不相同），并且重要的是要指定风险是要评估事件或情况的开始、持续、再次发生还是升级。该研究表明明确的实践指南的重要性（并非所有风险因素都如实践指南所预期的那样使用），并说明了临床判断分析如何用于理解和增强专业判断的可靠性。
可以可靠地对风险评估的过程进行统计建模，以允许对单个从业者进行深入检查或对从业者之间进行比较，这可以用于支持改善评估可靠性的努力。资深从业者在对自残的临床判断中应用信息可能更为一致。对风险的分类判断的明显一致可能掩盖了对数值概率的潜在分歧。“低风险”一词可能特别容易受到其解释的可变性的影响。“风险”一词可能存在歧义，反映了某些从业者发生的概率和其他从业者发生的严重程度，如果不清楚正在评估的具体事件（例如，开始行为的风险与再次发生的风险），则问题可能会更加复杂。
