Routine Risk Assessment and Care Evaluation (RACE) in outpatient forensic psychiatry

Violence risk assessment for forensic psychiatric patients has been dominated by the problem of violence prediction for release decisions. What has been neglected is the problem of ongoing risk monitoring and management for clients who receive (after)care in the community. This setting calls for a different approach; one that focuses on dynamic factors within the individual and situation, that determine the short term risk for violence and identify needs for risk management measures.
We developed a risk assessment procedure for outpatient forensic psychiatry, that is integrated with routine care evaluation by the case manager and client. In a pilot study we tested its feasibility and predictive validity for violent behaviour. In the present RCT we test whether routine Risk Assessment and Care Evaluation (RACE) actually prevents violence.

Routine risk assessment and care evaluation reduces the frequency of violent behaviour (primary outcome) in outpatient forensic psychiatric clients, and increases the quality of life, psychiatric and social functioning, and satisfaction with care of the clients

In the experimental group routine risk assessment and care evaluation is carried out at every formal evaluation of the care plan, but at least once every six months. It consists of (1) an assessment of the violence risk of the client by the case manager using the START (Short-Term Assessment of Risk and Treatability), and (2) a standardized evaluation by the case manager and client of the client's needs for care and satisfaction with care (covering a.o. the view of the client, the view of the case manager or care team, and discussion of adjustments to care). In the control condition no formal method of risk assessment or care evaluation is used, and Care-As-Usual is offered.