Confidence in the face of risk: the Risk Assessment and Management Self-Efficacy Study (RAMSES)

Factors influencing acceptance and trust of chatbots in juvenile offenders' risk assessment training

Introduction

Research has identified simulation-based training with chatbots and virtual avatars as an effective educational strategy in some domains, such as medicine and mental health disciplines. Several studies on interactive systems have also suggested that user experience is decisive for adoption. As interest increases, it becomes important to examine the factors influencing user acceptance and trust in simulation-based training systems, and to validate applicability to specific learning tasks. The aim of this research is twofold: (1) to examine the perceived acceptance and trust in a risk assessment training chatbot developed to help students assess risk and needs of juvenile offenders, and (2) to examine the factors influencing students' perceptions of acceptance and trust.

Methods

Participants were 112 criminology students in an undergraduate course in a Canadian university. Participants were directed to use a custom-designed chatbot with a virtual 3D avatar for juvenile offenders' risk assessment training, to complete online questionnaires and a risk assessment exercise.

Results

Results show satisfactory levels of acceptance and trust in the chatbot. Concerning acceptance, more than half appeared to be satisfied or very satisfied with the chatbot, while most participants appeared to be neutral or satisfied with the benevolence and credibility of the chatbot.

Discussion

Results suggest that acceptance and trust do not only depend on the design of the chatbot software, but also on the characteristics of the user, and most prominently on self-efficacy, state anxiety, learning styles and neuroticism personality traits. As trust and acceptance play a vital role in determining technology success, these results are encouraging.

The Adaptation of a Measure of Confidence in Assessing, Formulating, and Managing Suicide Risk

Background: To date little has been done to evaluate the effectiveness of suicide risk formulation training. Aims: We aimed to investigate the psychometric properties of a new scale measuring clinicians' confidence in assessing, formulating, and managing suicide risk. Method: A total of 128 mental health practitioners from an UK National Health Service Trust completed the scale. Of them, 85 from an Improving Access to Psychological Therapies service did so before and after training in Risk Assessment, Formulation, and Management (RAFM); 28 practitioners from the Older Adults service also completed the measure. For test-retest analysis, a further 15 completed the scale again 1 week after baseline without attending any training. Of the training group, 52 (61%) completed the measure at the 6-month follow-up. Results: Analysis indicated a single-factor structure, good test-retest reliability, and statistically significant increases in confidence between pre- and posttraining and between pretraining and 6 month follow-up. Cohen's effect size values suggest a moderate-to-large effect. Limitations: The relatively small sample sizes indicate that this study should be considered a preliminary investigation of a new measure, which warrants further replication. Conclusion: This measure could be useful in gauging practitioners' confidence in the RAFM approach and in evaluating and developing training.

Examination of risk assessment tools developed to evaluate risks in mental health areas: A systematic review

The purpose of this research was to identify and examine risk assessment tools evaluating at least two risk dimensions to evaluate the risk assessments of patients in mental health areas in a more comprehensive and standard manner. This systematic review was prepared according to the PRISMA guidelines. The databases to be scanned and the keywords to be entered were identified before scanning the literature. The keywords risk assessment, risk management, mental health, psychiatry, risk assessment scales, and risk assessment tools were scanned. The CINAHL, EMBASE, PsycInfo, Medline, APA PsycNET, Science Direct, Pubmed, ProQuest, and Google Scholar databases were searched. All full-text articles published between December 30th, 1970, and January 1st, 2020, were examined. A total of 7385 papers were investigated using the keywords listed above, and 18 studies meeting the inclusion criteria were identified. The tools involved were SPC, FACE, Clinical Risk Management, Threshold Assessment Grid, Risk Assessment for People with Mental Health Problems, Psychogeriatric and Risk Behavior Assessment Scale, Sainsbury Risk Assessment Tool, Risk Assessment Management and Audit Systems, Generic Integrated Risk Assessment for Forensic Environments, FRAME, Brief Risk Assessment, Clinical Assessment of Risks to Self & Others, RIO, The Risk Assessment and Management, Risk Assessment and Management Self-Efficacy Study, Galatean Risk and Safety Tool, Short-Term Assessment of Risk and Treatability, and Psychiatric Risk Assessment Scale.

Suicide safer care in behavioral health settings: A comparative analysis of perceptions, training completion, and practice between mental health and substance use disorder treatment providers

BACKGROUND

Despite prevention and treatment efforts, opioid overdose deaths continue to rise in the United States and totaled 46,802 in 2018. This public health crisis is closely linked with suicide, with those who misuse opioids at six times the risk of death by suicide. Suicide prevention in substance use disorder (SUD) treatment may be a critical step in saving lives and promoting recovery among those at risk for opioid overdose.

METHODS

We distributed an electronic survey to clinicians in mental health and SUD treatment in nine health systems across New York State from November 2018 to January 2019. The goal of the survey was to assess attitudes, perceptions, practice, and training needs among SUD treatment providers and how they differ from those of mental health providers.

RESULTS

A total of 633 clinicians responded to the survey (62.4% response rate). Seventy-one percent of SUD providers reported working with a client who attempted suicide. Even so, less than half of SUD providers reported routinely screening new (48.9%) or existing patients (25.6%) for suicidal thoughts/behaviors; overall, 28.4% of SUD providers reported low levels of action to address suicide risk, compared to 9.0% of mental health providers (p < 0.001). Perceived self-efficacy and effectiveness at reducing a patient's risk of suicide and training completion were strongly associated with routine delivery of suicide safer care in adjusted logistic regression models.

CONCLUSIONS

The results of this study identify key areas for targeted training and technical assistance to increase the provision of quality suicide safer care in SUD treatment.

A Mixed-Methods Realist Evaluation of the Implementation and Impact of Community Forensic CAMHS to Manage Risk for Young People With Forensic and Mental Health Needs: Study Protocol

Introduction: Young people in contact with forensic child and adolescent mental health services present with more complex needs than young people in the general population. Recent policy has led to the implementation of new workstreams and programmes to improve service provision for this cohort. This paper aims to present the protocol for a national study examining the impact and implementation of Community Forensic Child and Adolescent Mental Health Services (F:CAMHS). Methods and analysis: The study will use a mixed-methods Realist Evaluation design. Quantitative service activity and feedback data will be collected from all 13 sites, as well as questionnaires from staff. Non-participant observations and qualitative interviews will be conducted with staff, young people and parents/guardians from four focus study sites. An economic evaluation will examine whether Community F:CAMHS provides good value for money. The results will be triangulated to gain an in-depth understanding of young people's, parents/guardians' and staff experiences of the service. Ethics and dissemination: Ethical approval was granted by the Health Research Association and UCL Ethics. The results will be disseminated via project reports, feedback to sites, peer-reviewed journal publications and conference presentations.

Suicide prevention by emergency nurses: perceived self-efficacy in assessment, management and referral at Kenyatta National Hospital in Kenya

BACKGROUND

Emergency Departments are underutilized settings for suicide prevention and management as patients with occult (camouflaged) suicides and suicidal ideation are rarely screened by nurses and other health workers in these sites. The under-detection rates could be a result of lack of suicide assessment and management confidence among the hospital staff. The aim of the study was to find out the perceived self-efficacy in suicide risk assessment, management and referral among nurses working in an emergency department within a lower income country.

METHOD

The Risk Assessment and Management Self-Efficacy Scale (RAMSES) was administered among nurses in an emergency department (ED) within an urban region in a descriptive study. The risk assessment, management and referral domains among 64 respondents were evaluated using mean and standard deviation calculations in SPSS v 21.

RESULTS

The total RAMSES composite score in risk assessment, management and referral was 6.19 (SD 2.107) with risk assessment having the lowest mean score of 6.09 (SD 2.08), while risk referral process mean score was the highest at 6.55 (SD 2.36). The nurses had the least confidence in developing a written risk management plan 5.68 (SD 2.51) as well as using screening instruments to assess risk 5.90 (SD 2.15).

FINDINGS

Nurses in emergency department have below average self-efficacy in suicide assessment and management necessitating training as well as integration of protocols that could enhance effective utilization of emergency departments as suicide prevention and management settings.

FACTORS INFLUENCING LAY AND PROFESSIONAL HEALTH WORKERS' SELF-EFFICACY IN IDENTIFICATION AND INTERVENTION FOR ALCOHOL, TOBACCO, AND OTHER SUBSTANCE USE DISORDERS IN KENYA

The global burden of substance use disorders (SUDs), including alcohol and tobacco, disproportionately affect low- and middle-income countries (LMICs), considering their rising disease burden and low service capacity. Nested within a Kenyan training program, this study explores factors associated with healthcare providers' self-efficacy to treat SUD. Surveys of 206 healthcare workers were used to perform regression and sensitivity analysis assessing various factors association with self-efficacy. Self-efficacy for SUD was lower in those practicing in public facilities and perceiving a need for alcohol use disorder (AUD) training; while higher self-efficacy correlated with a higher proportion of patients with AUD in one's setting, access to mental health worker support, cannabis use at a moderate risk level, and belief that AUD is manageable in outpatient settings. Increasing awareness about SUD prevalence, identification, and treatment skills could improve the self-efficacy of LMICs' health care providers and therefore the willingness to implement more services for patients with SUDs.

Effective communication in eliciting and responding to suicidal thoughts: a systematic review protocol

BACKGROUND

In the UK, over 6500 people die by suicide each year. In England alone, this is one person every 2 h. Professionals assess risk of suicide in face-to-face contacts with people potentially at risk. The National Confidential Inquiry into Suicide found that most people who took their life were classified as 'low risk' in their final contact with mental health services. Training for front-line staff in reducing suicide is a NHS priority. While there is considerable evidence on what to assess when exploring suicidal ideation, there is little evidence on how to ask sensitive questions to effectively identify suicide risk and how to respond in the treatment encounter to reduce patient distress and suicidal ideation. This is critical for identifying risk and putting appropriate care in place.

METHODS

An electronic search will be conducted using MEDLINE, CINAHL, Cochrane Library, EMBASE and PsycINFO databases. Controlled studies of effectiveness will be identified using a predefined search strategy. The focus will be on suicidal thoughts/feelings rather than self-harm without intent to die. Two authors will independently screen articles using predefined inclusion and exclusion criteria and relevant data will be extracted using the Cochrane Collaboration data extraction form for randomised controlled trials (RCTs). Discrepancies between the two authors will be resolved by consensus or by consulting a third author at all levels of screening. We will assess the quality of evidence as well as risk of bias. A meta-analysis will be conducted if participants, interventions and comparisons are sufficiently similar, and we will perform the meta-analysis using Stata data analysis and statistical software.

DISCUSSION

The results of this systematic review will be used to guide training and practice for health care professionals.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42015025867.