The Forensic Outcome Measure

FORUM

The Forensic Outcome Measure (FORUM), is designed to help safeguard patients and the public, monitor progress, inform treatment plans and assist in service evaluation and planning.

Background

Forensic mental health services provide care to people in secure psychiatric hospitals and via specialised community teams. Such services are typically low volume and high cost, often highly restrictive and average duration of inpatient care prior to discharge is long.

The FORUM is free of charge for healthcare providers, publicly funded organisations and use within academic studies and is Licenced on behalf of Oxford University.

Design & Development

FORUM contains two separate, but linked questionnaires: a Patient Reported Outcome Measure (PROM), and a Clinician Reported Outcome Measure (ClinRO).

The FORUM was developed in accordance with best practice development guidelines. It is simple to complete within 1-2 minutes from both a patient & clinician perspective, which allows for a high response rate.

All decisions during development were empirically informed and involved considerable input from the full range of stakeholders, including patients both as participants and in guiding the research through a Patient and Public Advisory Group (PPAG).

The Forensic Outcome Measure research project was funded by the NIHR (NIHRDH-DRF-2017-10-019). The views expressed on this website are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.

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Scoring System

The outcome framework consists of six overarching domains

  • ‘About me’, concerns questions of self-concept and encompassed ideas of meaning and belonging, as well as feelings of control and wellbeing;
  • ‘My quality of life’ considers the interaction of a person with the outside world and the degree of satisfaction this affords that individual. Outcome areas in this domain span from simple items, such as whether a person’s basic needs are met, to more complex concepts, such as whether they feel respected and accepted by others;
  • ‘My health’ then considers the individual’s physical and mental health, such as whether they are able to maintain a healthy weight or their mental and emotional health is good;
  • ‘My safety and risk’ concerns both behavioural and internalised aspects of risk, such as avoiding behaviours and situations that reduce safety and recognising and coping with difficult feelings;
  • ‘My life skills’ incorporates both current and future capabilities, from being able to look after every day needs, to being able to make realistic plans;
  • ‘My progress’ attempts to quantify the person’s position within the care pathway, both considering where that individual is at that point in time, to thinking about where they need to move towards.

The responses for all items on both FORUM-P and FORUM-C are similar and based on a five point frequency scale (never, rarely, sometimes, often, always).

For individual patients it is recommended to focus on the personal meaning of these answers.  The response options are inherently subjective and an answer such as ‘sometimes’ will mean different things to different people.   Clinical teams and patients may wish to compare their answers with previous times that they have completed the FORUM for that individual. This can be done using the responses as they are: for example, a patient may score an item as ‘always’ this month, which was rated ‘often’ the previous month, indicating an improvement.

To convert the frequency based responses to numerical scores, we would recommend using the following system:

Never=0

Rarely=1

Sometimes=2

Often=3

Always=4

All items are of equivalent importance and therefore should be evenly weighted.

 

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