Abstract

The DUNDRUM Programme Completion (D3) and Recovery (D4) scales present a promising approach to a recovery-oriented and collaborative method of assessing risk, need, and rehabilitative tasks in forensic settings. We collected clinician- (n = 185) and patient- (n = 118) rated D3 and D4 scores across three security levels (medium, minimum, and outpatient) in a large Canadian forensic service over a 12-month period. Results supported the construct validity of the D3 and D4, showing that clinician (D3 and D4) and patient (D4 only) ratings differed across inpatient and outpatient settings, with lower outpatient scores signaling greater progress in treatment and recovery goals. Only clinician-rated scores differed across patients with moves from higher to lower levels of therapeutic security to those with no movement over the study period. Concordance analyses revealed poor to modest agreement between clinician- and patient-rated item scores, with patient self-ratings observed to be more optimistic than their clinician counterparts. However, concordance strengthened as patients progressed from higher to lower levels of security and restriction. Current findings add to the literature on the feasibility of shared approaches to care planning, and provide validation data for the DUNDRUM scales as part of available tools in collaborative, recovery-oriented forensic care.

摘要

DUNDRUM 计划完成 (D3) 和恢复 (D4) 量表提供了一种有前途的方法，用于评估法医环境中的风险、需求和康复任务的以恢复为导向的协作方法。我们收集了临床医生 - ( n  = 185) 和患者 - ( n = 118）在 12 个月的时间里，在加拿大大型法医服务机构的三个安全级别（中等、最低和门诊）中获得了 D3 和 D4 分数。结果支持 D3 和 D4 的构建有效性，显示临床医生（D3 和 D4）和患者（仅 D4）评分在住院和门诊环境中存在差异，门诊评分较低表明治疗和康复目标取得更大进展。只有临床医生评定的分数在治疗安全性从较高水平移动到较低水平的患者与在研究期间没有移动的患者之间存在差异。一致性分析显示，临床医生和患者评分项目评分之间的一致性较差，患者的自我评分比临床医生同行更为乐观。然而，随着患者从较高的安全和限制级别发展到较低的安全和限制级别，一致性得到加强。目前的研究结果增加了有关护理计划共享方法可行性的文献，并为 DUNDRUM 量表提供了验证数据，作为协作、面向康复的法医护理可用工具的一部分。