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Table 1 STRESS-testing: screening, identification and description of service caseload, transfer of care, risk-appropriateness of diversions, efficiency and productivity, self-harming behaviours and service mapping

From: STRESS-testing clinical activity and outcomes for a combined prison in-reach and court liaison service: a 3-year observational study of 6177 consecutive male remands

  Domain Aim
1. Screening, Identification and caseload description How many remands were screened?
How many were assessed and taken onto the team caseload?
Is the caseload over time described in terms of diagnosis, co-morbid conditions and offence type?
Is the caseload described in terms of other factors including homelessness, whether or not known to have a past history of self harm and whether or not known to have previous contact with psychiatric services outside prison
Is the service identifying persons with the most severe acute symptoms, such as active psychotic symptoms at rates in keeping with expected rates based on the existing epidemiological literature?
2. Transfer of care How many were diverted from the criminal justice system to mental health treatment settings?
3. Risk-appropriateness of diversions Were diversions to forensic inpatient settings, to general psychiatric inpatient settings and to outpatient settings justifiable in terms of assessed security requirements and clinical urgency?
4. Efficiency and productivity What was the delay from committal screening to first comprehensive assessment?
Were persons identified as actively psychotic seen more rapidly than persons without acute psychotic symptoms?
What was the delay from committal and first assessment to diversion?
How many cases were managed and diversions achieved per whole time equivalent employed?
5. Self-harm How many persons deliberately harmed themselves in custody over the study period?
6. Service mapping Can the service ‘map’ the flow of all patients through the system, with outcomes at the point of discharge and times to those outcomes?
Can the service map subsequent outcomes for persons admitted to the ‘parent’ forensic psychiatric unit?
7. Testing How did the above activity and outcome data compare with previously published findings for the same service in the six years preceding this three-year study?
How did outcomes compare year on year within the same service?