Risk assessment and shared care planning in out-patient forensicpsychiatry: cluster randomised controlled trial

BackgroundForensic psychiatry aims to reduce recidivism and makes use of riskassessment tools to achieve this goal. Various studies have reported onthe predictive qualities of these instruments, but it remains unclearwhether their use is associated with actual prevention of recidivism inclinical care.AimsTo test whether an intervention combining risk assessment and shared careplanning is associated with a reduction in violent and criminalbehaviour.MethodA cluster randomised controlled trial (Netherlands Trial Register numberNTR1042) was conducted in three outpatient forensic psychiatric clinics.The intervention comprised risk assessment with the Short Term Assessmentof Risk and Treatability (START) and a shared care planning protocolformulated according to shared decision-making principles. The controlgroup received usual care. The outcome consisted of the proportion ofclients with violent or criminal incidents at follow-up.ResultsIn total 58 case managers and 632 of their clients were included, in theintervention group (n=310), 65% received theintervention at least once. Findings showed a general treatment effect(22% of clients with an incident at baseline v. 15% atfollow-up, P