A prospective study of pathways to hospital readmission in Canadian forensic psychiatric patients

Individuals admitted to secure care often experience lengthy hospitalizations and are likely to be admitted on more than one occasion. In the context of growing demand and costs associated with secure care, the current study investigates the frequency and reasons for readmission among 87 forensic patients recently discharged into the community. We identify risk factors that are associated with the likelihood of readmission and describe areas of overlap and discordance with the existing literature in civil and forensic samples. Using a prospective design that included patient follow-up interviews and records review, we found that 28% of patients were readmitted on one or more occasions over a 12-month period. Psychiatric decompensation, substance use, and treatment non-adherence were the central reasons prompting readmission. Patients with one or more readmissions were found to have spent significantly more time in the forensic mental health system as compared to patients not readmitted. They were more likely to have a substance use disorder and were estimated to be at higher risk for violence. Results replicate the finding of low rates of serious violence and reoffending among discharged forensic patients, and substantiate the centrality of substance use as a growing and clinically important treatment issue.     

The impact of an intensive inpatient violent offender treatment programme on intermediary treatment targets,violence risk and aggressive behaviour in a sample of mentally disordered offenders*

This study examined the impact of an intensive inpatient violent offender treatment programme, Life Minus Violence-Enhanced (LMV-E), on intermediary treatment targets, risk for violence, and aggressive behaviour during treatment in a sample of male mentally disordered offenders. Using quasi-experimental design, offenders who completed LMV-E and a comparison group showed reduced problems with impulsivity and anger regulation and improvements in social problem solving. Aggregate risk for future violence lessened in both treatment and comparison groups, although by a significantly greater degree for the comparison group. The aggressive behaviour of both groups reduced. Completion of the LMV-E conferred additional improvements in some facets of social problem solving and anger regulation. Neither group showed improvements in empathic responses, coping skills or problematic interpersonal style. Overall, these results suggest anger regulation, impulsivity and social problem solving are most amenable to change, that reductions in certain facets of these dynamic risk factors transpires with nonspecific psychiatric inpatient treatment, but that the LMV-E, a cognitive behavioural violence specific psychological treatment, confers greater change in some facets of social problem solving and anger regulation.     

Returning to the child welfare system: Understanding the wellbeing,health, education,and placement of children who return

Using longitudinal archival Child Welfare System (CWS) data, this study describes child health and wellbeing at their initial entrance into the CWS and subsequent returns. Associations between child wellbeing, health, placement stability, and frequency of returning to the system were also investigated. Results indicated most children were healthy and developmentally on target. In addition, emotional distress, behavioral concerns, and number of placements in the CWS were significantly correlated with placement stability. Future work should utilize the use of developmental assessments to systematically and reliably document the concerns for children in the system, and investigate factors contributing to stable placements.     

Backloading to extinction: Coping with values conflict in the administration of Australia's federal biodiversity offset policy

Policy-makers are frequently required to consider and manage conflicting public values. An example of this in the environmental domain is biodiversity offset policy, which governments worldwide have adopted as a mechanism to balance environmental protection with socio-economic development. However, little work has examined administrative practices underpinning biodiversity offset policy implementation, and how the adoption of coping strategies to manage value conflicts may influence resulting policy outcomes. This study fills this research gap using a case study of Australia's federal biodiversity offset policy under the Environment Protection and Biodiversity Conservation (EPBC) Act 1999. Using data from 13 interviews of federal policy administrators, I show that the introduction of a new policy in 2012 enabled a shift from the use of precedent to a technical approach for setting offset requirements under the EPBC Act. Yet, multiple sources of policy ambiguity remain, and administrators have adopted post-approval condition-setting, or ‘backloading’—a form of cycling, facilitated by structural separation—to defer detailed assessments of offset requirements until after biodiversity losses are approved. Backloading thus undermines the effectiveness of environmental policy and will persist as coping strategy unless policy ambiguity is reduced via legislative amendments and adequate resourcing of biodiversity conservation.

Points for practitioners

• Biodiversity offset policy requires administrators to manage conflicting environmental and socioeconomic values.
• Technical decision tools reduce reliance on case-by-case decision-making, but multiple ambiguities persist.
• Backloading (post-approval condition-setting) defers values conflict, but reduces transparency, accountability, and policy effectiveness.
• Policy ambiguity must be reduced at the political level to facilitate effective biodiversity conservation.