Multidisciplinary Routine Outcome Monitoring in Forensic Psychiatry: Concordance Between Clinician and Patient Assessment

Abstract

Patient involvement in routine outcome monitoring (ROM) is vital for collaborative treatment and understanding differences between patient and clinician perspectives. This study assessed the agreement between patient and clinician ratings using the Instrument for Forensic Treatment Evaluation (IFTE) and its self-report version (IFTE-S) in high-security forensic psychiatric centers in Flanders, Belgium. Results showed concordance in domains like protective behavior and resocialization skills, but patients rated their problematic behavior as less severe than clinicians did. Item-level analyses revealed a more differentiated pattern, identifying more concordance on observable items and discordance in subjective or stigmatized behaviors. Discrepancies remained stable over the first 15 months of treatment and were not influenced by primary psychiatric diagnosis. The study underscores the importance of addressing such differences in treatment to enhance shared understanding, promote feedback-informed care, and support patient engagement. Further longitudinal research is needed to confirm these findings and improve ROM practices in forensic settings.

Plain language summary

Comparison of patient and clinician perspectives on treatment progress in high-security forensic psychiatry

In forensic psychiatric treatment, it is important that patients are actively involved in evaluating their own treatment progress. One way to do this is through routine outcome monitoring (ROM), where patients and clinicians regularly rate how treatment is going. Comparing these perspectives can help improve communication, trust, and collaboration. However, little research has explored how much patients and clinicians agree on these evaluations in high-security forensic settings. This study examined how closely patients and clinicians agreed when using the Instrument for Forensic Treatment Evaluation (IFTE) and its self-report version (IFTE-S). The study included patients living in both high-security forensic psychiatric centers in Flanders, Belgium, and followed them during the first 15 months of treatment. Overall, patients and clinicians showed good agreement when rating protective skills (such as coping skills and responsibility for the offense) and resocialization skills (such as work, finances, and daily activities). However, patients consistently rated themselves as having fewer problematic behaviors (such as substance use or manipulative behavior) than clinicians did. When looking more closely at individual questions, agreement was higher for behaviors that are easy to observe, while disagreement was more common for behaviors that are private, sensitive, or linked to stigma or legal consequences. The level of agreement did not change over time during the first 15 months of treatment and did not differ between diagnostic groups. This suggests that early in high-security treatment, differences in perspective may remain stable and are not strongly influenced by diagnosis. These findings highlight the importance of openly discussing differences between patient and clinician views during treatment. Addressing these differences may improve understanding, strengthen collaboration, and support more meaningful and feedback-informed care in forensic psychiatry.