Construct Validity and Concordance of Clinician- and Patient-Rated DUNDRUM Programme Completion and Recovery Scales

Abstract

The DUNDRUM Programme Completion (D3) and Recovery (D4) scales present a promising approach to a recovery-oriented and collaborative method of assessing risk, need, and rehabilitative tasks in forensic settings. We collected clinician- (n = 185) and patient- (n = 118) rated D3 and D4 scores across three security levels (medium, minimum, and outpatient) in a large Canadian forensic service over a 12-month period. Results supported the construct validity of the D3 and D4, showing that clinician (D3 and D4) and patient (D4 only) ratings differed across inpatient and outpatient settings, with lower outpatient scores signaling greater progress in treatment and recovery goals. Only clinician-rated scores differed across patients with moves from higher to lower levels of therapeutic security to those with no movement over the study period. Concordance analyses revealed poor to modest agreement between clinician- and patient-rated item scores, with patient self-ratings observed to be more optimistic than their clinician counterparts. However, concordance strengthened as patients progressed from higher to lower levels of security and restriction. Current findings add to the literature on the feasibility of shared approaches to care planning, and provide validation data for the DUNDRUM scales as part of available tools in collaborative, recovery-oriented forensic care.