Development of leave/abscond risk assessment in clinical practice needs evaluation and validation

Individuals more likely to be arrested or taken to ED if living indpependently or with family

The authors of this study, based at the South London and Maudsley Trust, were interested in the way in which leave for patients in secure settings is managed and in particular ways in which the risks associated with managing leave could be assessed. They point out that the number of patients who breach leave conditions by absconding or failing to return to the secure setting following leave is small and represents a small percentage of all leave episodes, but the consequences of such incidents can be negative for all concerned.

The authors therefore describe an approach to devising  a specific risk assessment to support deciision making around patient leave based on the current state of knowledge as described in the published literature.

They carried out a review of literature focusing on approaches currently used in the field of violence risk assessment, and looked specifically at papers relating to absconding.

They found very little in the literature to help with the development of the risk assessment and found that in those studies that did exist, there was a significant variation in the definitions for absconding, making comparisons difficult. The majority of the literature reported on studies in psychiatric acute wards which also created issues when attempting to translate the findings into secure settings.
However, they used what was available to develop the leave/abscond risk assessment (LARA), basing the development on socio-environmental factors.

They point out that the development of the risk assessment at this stage is experimental in that it has not yet been evaluated or validated, but wish to invite comments from the field in relation to its clinical and/or research uses, proposing LARA as a specific leave-decision-making risk assessment tool for teams working in secure environments.

Developing the leave/abscond risk assessment (LARA) from the absconding literature: an aide to risk management in secure services, Hearn D et al., in Advances in Mental Health and Intellectual Disabilities, Vol. 6 Iss: 6, pp.280 – 290

Abscond, Escape, Learning disabilities, Leave, Mental illness, Relational security, Risk analysis, Risk assessment

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John Northfield

After qualifying as a social worker, John worked in community learning disability teams before getting involved in a number of long-stay hospital closure programmes, working to develop individual plans for people moving into their own homes. He worked for BILD, helping to develop the Quality Network and was editorial lead for the NHS electronic library learning disabilities specialist collection. This led him to found the Learning Disabilities Elf site with Andre Tomlin as a way of making the evidence accessible to practitioners in health and social care. Most recently he has worked as part of Mencap's national quality team and also been involved in a number of national website developments, including the General Medical Council's learning disabilities site.

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