Clinical assessment of risk decision support (CARDS): The development and evaluation of a feasible violence risk assessment for routine psychiatric practice

Background: Adult psychiatric services are increasingly required to assess and manage the risk of violence, but the evidence base to guide clinical practice is limited. Aims: To develop an evidence-based method of assessing risk of violence and to demonstrate its feasibility in routine practice. Methods: Consensus workshops were held to design a form based decision support system, which was refined using a Delphi consultation. The system was introduced into practice in 7 mental health services in England. Its feasibility was measured through assessment of case notes, questionnaires and focus groups of clinical staff. Results: CARDS is a two-stage assessment, with a screen and full assessment stage (at http://www.iop.kcl.ac.uk/iopweb/virtual/?path = /hsr/prism/cards/). A high degree of consensus was achieved for the structure and content. CARDS met each of the six feasibility criteria: brevity, simplicity, relevance, acceptability, availability and value, though acceptability was only achieved when the assessment of violence risk was supplemented with an assessment of suicide risk. Conclusion: CARDS provides a feasible, evidence-based decision support procedure for assessing risk of violence in patients using adult mental health services. It can help clinicians meet policy requirements to assess risk, though its effect on actual violence is unknown.