Structured professional judgment in the new italian forensic treatment model: the validation of the italian version of the DUNDRUM TOOLKIT

Abstract

Objective: The purpose was to demonstrate the effectiveness of the DUNDRUM Toolkit in Italy. The research focused on evaluating the disposition of forensic patients in REMS and CRAPs, hypothesizing that the correspondence between standardized assessments and juridical decisions was not that satisfying.
Methods: The DUNDRUM Toolkit was translated, after adapting it to national standards and tested in different regions. A total of 192 forensic patients from 9 REMS and several CRAPs in Italy were evaluated, comparing current levels of therapeutic safety with those ones considered as most appropriate. The evaluation used DUNDRUM1 to determine pretreatment safety needs. The progress in the treatment and recovery was examined through DUNDRUM3
and DUNDRUM4. Interrater reliability was assessed by two independent evaluators on a sample of 50 patients. All health professionals involved in the
research had been previously trained in the use of the DUNDRUM Toolkit.
Results: Results revealed that 3.7% of patients in REMS needed more security, while 38.2% could be placed in less restrictive environments. In CRAPs, 56% of patients required a higher level of security.
Conclusions: The study demonstrated the validity and reliability of the Italian version of the DUNDRUM Toolkit and highlighted significant discrepancies between current forensic patient placements and needed levels of safety, suggesting the importance of using professional tools in the forensic practice that allow more accurate assessment of safety needs for each patient.