University of Huddersfield, United Kingdom and Honorary Professor, Division of Psychology and Mental Health, University of Manchester, United Kingdom.
West China Brain Research Centre, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
J Psychiatr Res. 2021 Nov;143:416-421. doi: 10.1016/j.jpsychires.2021.10.010. Epub 2021 Oct 11.
Medium secure forensic psychiatric units (MSUs) in the UK aim to be recovery-oriented to enable discharge to community-based services. Risk assessments are key to discharge planning, but clinical practice tends to focus on risk factors for violence rather than protective factors associated with a decrease in risk. The aims of this study were to investigate the reliability and validity of the Structured Assessment of Protective Factors (SAPROF) as a useful measure to support an assets-based approach when planning discharge from MSUs. A prospective cohort follow-up design was chosen for this study using a confidential inquiry design to ensure a total sample of all discharges. All forensic patients discharged from 32 NHS MSUs over a 12-month period were assessed at discharge and followed-up at six and 12 months post discharge. The occurrence and frequency of post-discharge violence were compared with discharge SAPROF scores. The inter-rater reliability between SAPROF raters was very high and the SAPROF significantly predicted community violence and scores were strongly correlated with violence frequency. The higher the SAPROF score the higher the protection against violence and the risk significantly diminished. Assessing protective factors is essential to identify assets and prevent violence with a focus on what makes somebody safe. This study supports the use of the SAPROF to inform discharge planning. Cultivating protective factors is likely to be motivating for patients and the SAPROF can provide an objective, reliable measure of internal, motivational and external assets that reduce risk and support defensible decision making at discharge.
英国的中等安全法医精神病学单位（MSU）旨在以恢复为导向，使患者能够出院到社区为基础的服务。风险评估是出院计划的关键，但临床实践往往侧重于暴力风险因素，而不是与风险降低相关的保护因素。本研究旨在调查结构评估保护因素（SAPROF）作为一种有用的措施的可靠性和有效性，以支持从 MSU 出院时基于资产的方法。本研究选择了前瞻性队列随访设计，并使用机密调查设计来确保所有出院患者的总样本。在 12 个月的时间内，从 32 家 NHS MSU 出院的所有法医患者在出院时进行评估，并在出院后 6 个月和 12 个月进行随访。将出院后的暴力发生和频率与出院 SAPROF 评分进行比较。SAPROF 评分者之间的组内信度非常高，SAPROF 显著预测了社区暴力，且评分与暴力频率呈强相关。SAPROF 评分越高，对暴力的保护就越高，风险显著降低。评估保护因素对于识别资产和预防暴力至关重要，重点关注使某人安全的因素。本研究支持使用 SAPROF 来为出院计划提供信息。培养保护因素可能会激励患者，并且 SAPROF 可以为降低风险和支持出院时合理决策的内在、动机和外在资产提供客观、可靠的衡量标准。
