Checklist Helps ID Individuals at Risk for Violence New research finds that a simple tool can help inexperienced psychiatrists predict the risk of violence among patients.

Beginning with the Columbine high school massacre and buoyed by the recent movie theater shooting in Aurora, Colo., there has been a new sense of urgency in predicting violence risk in psychiatric patients.

Inexperienced psychiatrists are less likely than their veteran peers to accurately predict violence by their patients, but a simple assessment checklist might help bridge that accuracy gap, according to new research from the University of Michigan.

In the study, psychiatrist Alan Teo, M.D., and colleagues at the University of Michigan, examined how accurate psychiatrists were at predicting assaults by acutely ill patients admitted to psychiatric units.

They found that inexperienced psychiatric resident doctors did no better than a coin flip. Veteran psychiatrists, on the other hand, were 70 percent accurate in predicting risk of violence.

However, when the junior doctors used a brief risk assessment tool, their level of accuracy jumped to 67 percent — nearly as good as the more experienced psychiatrists.

“The tool we used, called the HCR-20-C, is remarkably brief and straightforward. Like a checklist a pilot might use before takeoff, it has just five items that any trained mental health professional can assess,” Teo said.

The study is published in the online version of the journal Psychiatric Services.

“Given public concern about this issue, I think teaching our budding psychiatrists and others how to use a practical tool like this, and encouraging its use in high-risk settings is a no-brainer,” saidTeo.

In the current study, researchers were able to assess doctors’ accuracy by comparing patients who had assaulted hospital staff members with similar patients who had not been violent.

Because all patients received a threat assessment when admitted to the psychiatric unit, the researchers were able to compare a patient’s predicted violence risk with whether they actually had a documented assault while in the hospital.

Incidents of physical aggression typically included punching, slapping, or throwing objects, as well as yelling, directed at staff members of the hospital. The patients studied had severe illnesses, often schizophrenia, and had been involuntarily admitted to the hospital.

Teo says this study is the first to compare the predictive success of violence assessment between experienced and inexperienced psychiatrists. The results, he says, highlight the importance of emphasizing violence risk assessment in clinical training programs.

“If trainees are indeed less able than trained and experienced clinicians to accurately perform risk assessments for violence, it’s important to figure out a way to improve their accuracy,” he said. “Our study shows that evidence-based structured tools might have the potential to augment training and improve risk assessment.”

Source: University of Michigan