Research Department, Ottho Gerhard Heldring Institution, Zetten, Netherlands.
Department of Clinical Psychological Science, Maastricht University, Maastricht, Netherlands.
Behav Sci Law. 2021 Feb;39(1):123-144. doi: 10.1002/bsl.2503. Epub 2021 Feb 10.
There is emerging evidence that the performance of risk assessment instruments is weaker when used for clinical decision-making than for research purposes. For instance, research has found lower agreement between evaluators when the risk assessments are conducted during routine practice. We examined the field interrater reliability of the Short-Term Assessment of Risk and Treatability: Adolescent Version (START:AV). Clinicians in a Dutch secure youth care facility completed START:AV assessments as part of the treatment routine. Consistent with previous literature, interrater reliability of the items and total scores was lower than previously reported in non-field studies. Nevertheless, moderate to good interrater reliability was found for final risk judgments on most adverse outcomes. Field studies provide insights into the actual performance of structured risk assessment in real-world settings, exposing factors that affect reliability. This information is relevant for those who wish to implement structured risk assessment with a level of reliability that is defensible considering the high stakes.
越来越多的证据表明，风险评估工具在用于临床决策时的表现不如用于研究目的时那么强。例如，研究发现，当风险评估在常规实践中进行时，评估者之间的一致性较低。我们研究了青少年版短期风险评估和可治疗性评估（START:AV）的现场评分者间信度。荷兰一家安全的青年照护机构的临床医生将 START:AV 评估作为治疗常规的一部分完成。与之前的文献一致，项目和总分的评分者间信度低于之前非现场研究报告的信度。然而，对于大多数不良结局的最终风险判断，发现了中等至良好的评分者间信度。现场研究深入了解了在现实环境中结构化风险评估的实际表现，揭示了影响可靠性的因素。对于那些希望在考虑到高风险的情况下，以具有可辩护的可靠性实施结构化风险评估的人来说，这些信息是相关的。
