Saskia Roggeman’s scientific contributions

The effect of de-escalation training on aggression incidents and the use of restraints in females in forensic psychiatry De-escalation is recommended as the first response to potential aggression within forensic psychiatry. To imbed de-escalating techniques in daily clinical practice, education and training of the staff is essential. Various de-escalation training programmes have been developed, but research on the effectiveness of these training programmes in the forensic psychiatry is scarce. Previous research rarely focused on the impact of the training on the prevalence of aggressive behaviour and the use of coercive measures within forensic psychiatric clinics. Therefore, the aim of the current study is to measure the effect of a de-escalation training programme on aggressive incidents and the use of seclusion. A pre-post measurement design with paired data was set up within a Flemish high-security forensic psychiatric unit, that provides treatment for female forensic psychiatric patients. No significant differences were found in the number of aggressive incidents between the pre- and post-measurement period, not even when the type of aggression was taken into account. However, there was a decrease in the severity of verbal aggression. Although, no significant differences were found in the number of seclusions with and without restraint between the pre- and post-measurement period, the mean number of seclusion hours did decrease significantly. The findings of the current study were not consistent with those of previous research. Possible explanations for these differences are variation in the implementation process of the de-escalation training, in the contextual factors and in the methodology used. Decreasing the prevalence of aggressive incidents and the use of seclusion by using de-escalating techniques is a long-term goal and asks a lot of reflection and further practice. Future research should focus on the factors that facilitate or complicate the impact of a de-escalation training. In this way, the possible added value of de-escalation in clinical practice can be further scientifically supported.

Protective factors are now commonly included in comprehensive risk assessment. This study concerns an initial validation of the new SAPROF-Extended Version (SAPROF-EV) pilot, containing modifications and additions to the original SAPROF. For 139 forensic psychiatric inpatients, assessment results with the SAPROF-EV pilot and HCR-20 V3 were compared with aggressive incidents. Results show good predictive validity for the SAPROF-EV pilot for all outcomes and incremental predictive validity for both the (modified) original SAPROF and the full SAPROF-EV pilot over the HCR-20 V3. For the outcome aggression toward others, the additional SAPROF-EV factors provide incremental predictive validity over the (modified) original SAPROF. In addition, the user feedback from clinicians highlights experienced additional value of the new factors for treatment guidance. Based on the findings from this study, the SAPROF-EV pilot will be adjusted further into an improved and enhanced version of the SAPROF.