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Outcome Measures in Forensic Mental Health Research

Consultant Forensic Psychiatrist Dr. Janet Parrott's study focuses on user-focused outcome measures in forensic mental health research. Primary outcomes include Quality of Life, with secondary outcomes such as Recovery and Therapeutic Relationship assessed at different time points. Quality of Life is measured using the MANSA scale, while Recovery is assessed through the Process of Recovery Questionnaire. The study emphasizes the importance of understanding and improving quality of life, recovery, and therapeutic relationships in forensic settings.

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Outcome Measures in Forensic Mental Health Research

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  1. ComQuol: Users Focused Outcomes Dr Janet Parrott, Consultant Forensic Psychiatrist Principal Investigator (ComQuol) Oxleas NHS Foundation Trust 1

  2. Service User Focused Outcome Measures Primary Outcome  Quality of Life (MANSA) Secondary Outcomes  Recovery (Process of Recovery Questionnaire)  Therapeutic Relationship (Helping Alliance Scale) 2

  3. Outcome Assessments Time Point 1 – Baseline – Before intervention Time Point 2 – 6-Months – Following completion of intervention Time Point 3 – 12-Months 3

  4. Definition of Quality of Life (QoL) Broad agreement about characteristics: 1. Subjective experience 2. Multidimensional nature (physical, psychological, social, environmental) 3. Positive and negative aspects (WHOQOL, 1998) 4

  5. Quality of Life and Forensic Mental Health Fitzpatrick et al (2010) - Rated 17thout of 21 variables regarding importance of outcome. QoL has not been extensively employed in forensic mental health research but is a relevant and important issue. 5

  6. Outcome Assessments Primary outcome = Quality of Life  Assessed using Manchester Short Assessment of Quality of Life scale (MANSA) (Priebe et al, 1999)  Short form of the Lancashire Quality of Life Profile (Oliver et al 1996)  Twelve questions rated on 7-point Likert scale (1 = couldn’t be worse to 7 = couldn’t be better)  Generates overall summary mean score (from 1 to 7) 6

  7. Comparison of Mean Quality of Life Scores Domain Mean (range 1-7) (SD) Baseline 6-Months 12-Months Control (N = 52) 4.2 (0.2) 4.3 (0.1) 4.3 (0.3) Intervention (N = 53) 4.4 (0.3) 4.5 (0.4) 4.7 (0.2) 7

  8. Comparison of Treatment Effect Quality of Life Scores Treatment Effect (intervention – control) and Confidence Interval 6-Month 12-Month 0.2 (-0.4 to 0.8) 0.4 (-0.3 to 1.1) ICC (CI) 0.04 (0.00 to 0.17) 0.05 (0.00 to 0.18) ICC = Intracluster Correlation Coefficient 8

  9. Recovery in Forensic Settings Definition of Recovery “A deeply personal, unique process of changing one’s attitudes, values, feelings, goals, skills and/or roles. It is a way of living a satisfying, hopeful, and contributing life even with the limitations caused by illness. Recovery involves the development of new meaning and purpose in one’s life as one grows beyond the catastrophic effects of mental illness.” (Anthony, 1993) 9

  10. Recovery in Forensic Settings Other important aspects of recovery include spirituality, peer support, self-management, creativity, housing, finances, work and hobbies (Roberts & Hollins, 2007) Forensic services definition must acknowledge the challenge of dual recovery from mental illness and offending behaviour, and recognise that risk management is equally necessary and can happen alongside restoration of a meaningful and satisfying life (Aldred & Drennan, 2010) 10

  11. Outcome Assessment Recovery Measure  Assessed using Process of Recovery Questionnaire (QPR) (Neil et al, 2007)  22-item measure rated on 5-point Likert scale (0 = disagree strongly to 4 = agree strongly)  Score generated:  Intrapersonal mean score (from 0 to 51)  Relating to intrapersonal tasks that an individual is responsible for carrying out and that they complete in order to rebuild their life  Interpersonal mean score (from 0 to 15)  Relating to interpersonal ability to reflect on their value in the external world and how recovery is facilitated by external processes in interpersonal relationships with others 11

  12. Comparison of Mean Recovery Scores Domain Mean (range 0-51)(SD) Baseline 6-Months 12-Months Control (N = 52) Intrapersonal 45.6 (4.1) 47.1 (2.0) 46.9 (1.1) Interpersonal 13.9 (0.8) 14.0 (0.7) 14.7 (0.9) Domain Mean (range 0-15) (SD) Intervention (N = 53) Intrapersonal 48.4 (1.7) 49.4 (2.0) 48.6 (1.0) Interpersonal 14.1 (0.3) 13.9 (0.4) 13.9 (0.7) 12

  13. Comparison of Treatment Effect Recovery Scores Treatment Effect (intervention – control) and Confidence Interval 6-Months 12-Months Intrapersonal 2.2 (-2.3 to 6.7) 1.7 (-0.7 to 4.1) Interpersonal -0.1 (-1.3 to 1.2) -0.9 (-2.7 to 1.0) 13

  14. Therapeutic Relationship in Forensic Settings Best Practice Guidelines in Medium Secure Units  Therapeutic alliance between staff and patients is at the centre of high-quality care and treatment Research in Mental Health Setting:  Influential in predicting positive outcomes such as reducing hospitalisation, symptomatology and social disability, increasing engagement with services, medication, adherence and global functioning. (Priebe & Gruyters, 1993; Tatten & Tarrier, 2000) 14

  15. Outcome Assessment Therapeutic Relationship  Assessed using the Helping Alliance Scale  3-item questionnaire rated on a 11-point Likert scale (0 = not at all to 10 = entirely)  Three domain scores generated (from 0 to 10) and total score  Feeling clinician understands you and is engaged in your treatment  Belief about getting right treatment  Feeling respected 15

  16. Comparison of Mean Therapeutic Relationship Scores Domain Mean (range 0-10) (SD) Baseline 6-Months 12-Month Control N = 52 N = 41 N = 41 6.9 (0.2)† Understanding/Engaged 6.4 (0.3) 7.1 (0.3) Belief 5.6 (0.8) 6.2 (0.3) 6.2 (0.6) Respected 6.0 (0.9) 6.0 (0.2) 6.7 (0.6) 6.2 (0.2)† Total Score 6.3 (0.5) 6.7 (0.2) Intervention N = 52 N = 46 N = 47 Understanding/Engaged 6.4 (0.4) 6.9 (0.5) 7.0 (0.4) Belief 6.1 (0.8) 6.2 (1.0) 6.9 (1.3) Respected 6.1 (0.5) 6.4 (0.6) 7.1 (0.7) Total Score 6.2 (0.6) 6.6 (0.6) 7.0 (0.8) †N = 51 16

  17. Comparison of Treatment Effect Therapeutic Relationship Scores Treatment Effect (intervention – control) and Confidence Interval 6-Month 12-Months Understanding/Engaged 0.4 (-0.5 to 1.4) -0.1 (-0.9 to 0.7) Belief 0.1 (-1.6 to 1.7) 0.8 (-1.6 to 3.1) Respected 0.5 (-0.6 to 1.5) 0.3 (-1.1 to 1.8) Total Score 0.3 (-0.9 to 1.6) 0.3 (-1.0 to 1.7) 17

  18. Concluding Remarks  Outcome assessments understood by participants and gave relevant information outcomes  QoL treatment effect is viewed as clinically important  A difference of 0.2 equates to a increase in 1 point on the MANSA for 2-3 items  A difference of 0.4 equates to a 1 point difference in 5 items  Recovery indicates estimated treatments effect increase intrapersonal scores a 6- and 12-months, and decrease in interpersonal scores at 12- months  In line with non-forensic scores  Therapeutic Relationship  Overall score shows good improvements  Equates to approx 1-point increase in one of the domains  ‘Understanding’ has improvement at 6-monts but not at 12-months (Reduction in feeling of being cared for after completing of intervention)  ‘Belief’ most improved  Consistent improvement in ‘Respect and Regard’ 18

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