Goldfinger S M, Schutt R K, Turner W, Tolomiczenko G, Abelman M
Massachusetts Department of Mental Health, Boston, USA.
Community Ment Health J. 1996 Jun;32(3):275-88. doi: 10.1007/BF02249428.
Although placement in community housing is a frequent intervention with populations of seriously mentally ill homeless individuals, there has been little formal investigation of the criteria used by clinicians in screening individuals for such placement. In this paper, we describe screening a population of 303 homeless people with severe mental illness for placement in independent apartments. We assess subjects' level of risk along multiple dimensions and determine the contribution of each risk dimension to the final safety decision. In addition, we evaluate the validity of the risk measures with other measures of clinical condition. Two-thirds of the sample were judged as safe for independent living. Assaultiveness was the most frequent risk identified, followed by self-destructiveness, substance abuse, and medication non-compliance. The final safety decision was associated most strongly with assaultiveness, self-destructiveness, and medication non-compliance. We conclude that it is possible to assess risk with measures that are available from shelter and medical records, and call for more research on the role of medication non-compliance in safety decisions and for longitudinal research to validate risk assessments.
尽管为患有严重精神疾病的无家可归者提供社区住房是一种常见的干预措施，但临床医生在筛选此类安置对象时所使用的标准几乎没有经过正式调查。在本文中，我们描述了对303名患有严重精神疾病的无家可归者进行筛选以安置到独立公寓的过程。我们从多个维度评估受试者的风险水平，并确定每个风险维度对最终安全决策的贡献。此外，我们用其他临床状况指标评估风险测量的有效性。三分之二的样本被判定适合独立生活。攻击性是最常被识别出的风险，其次是自我毁灭行为、药物滥用和不遵医嘱。最终的安全决策与攻击性、自我毁灭行为和不遵医嘱的关联最为紧密。我们得出结论，利用收容所记录和医疗记录中可得的测量方法来评估风险是可行的，并呼吁对不遵医嘱在安全决策中的作用进行更多研究，以及开展纵向研究以验证风险评估。
