Doctors are always on the lookout for good mental health risk assessment tools that are based on solid evidence and hospital expertise. St. Joseph’s Healthcare in Hamilton recently developed such a tool for its forensic psychiatry program, and is planning to launch a similar tool for general psychiatric programs later this year. “We believe that the eHARM-FV is absolutely ground-breaking for forensic psychiatry, as there is no other tool with analytics like it,” says researcher Katelyn Mullally (pictured on left).
The eHARM is based on the HARM (Hamilton Anatomy of Risk Management) risk assessment tool the hospital has been using and perfecting for over a decade in its forensic psychiatry department, which manages care of individuals found Not Criminally Responsible or Unfit to Stand Trial, who are now under jurisdiction of the Ontario Review Board.
About three years ago, the research team led by Dr. Gary Chaimowitz (pictured on right) and Dr. Mini Mamak started developing and testing an electronic version to tackle some of the paper tool’s shortcomings.
As a Word document that was administered on a monthly basis to patients, the HARM was more difficult to work with, says Mullally. “It was hard to see what was going on with a patient because you had to open multiple reports. Nothing was automated so you couldn’t see how a patient was progressing over time.”
The new eHARM is Excel-based, and the uniqueness of the tool lies in its advanced analytics, she says. “The eHARM stores multiple reports in one file and graphs them all for you. Once two risk assessments have been completed, the tool will automatically generate graphs that allow clinicians to track different facets of a patient’s risk over time.”
A second level of analytics allows users to upload numerous patient risk reports into an aggregator to view trends in diagnoses, treatment, risk levels, and more across a group of patients over time. This is all done with the click of a button.
“In the past, staff had to put the Word HARM documents up on the smart board at team meetings and fill out the variables manually. Now with the electronic tool, it’s all drop-down menus. It’s all there for you.”
In addition, the Aggressive Incidents Scale (AIS) – a sensitive, first-class measure of aggression – is embedded within the eHARM form and is a component of the risk assessment process.
“AIS basically provides a language for the clinical team to discuss aggressive behaviour. It is scored by severity on a 9-point scale, and also by the type of intervention used to diffuse the situation. These two factors together, as a ‘two-part code,’ allow staff to better understand incidents. It also helps improve communication, foster discussion of risk, allow for monitoring of escalation, and inform interventions.”
The eHARM is being used at several institutions outside St. Joseph’s, and the development team hopes it gains wider uptake, says Mullally. “We’ve trained three institutions to use it right now. We recently presented the tool at conference in Hamilton and New York. And an article released in Medscape received worldwide interest.”
Many doctors have expressed great interest in using the version intended for general psychiatric assessments, which the team plans to test and release in the coming months.
“The general version covers a broader range so it could be used by all doctors for general psychiatric risk, whereas forensic is for a more specialized population. Our next step is to transform the general version from the Word document into the same electronic format. We’re also collaborating with people in general psychiatry who are more familiar with the content and the relevant risk factors to perfect the form before we put it into electronic format.”
For more information, visit www.ais-HARM.com