Original Title: Identification des facteurs influençant le risque qu’un usager atteint d’une déficience intellectuelle, d’un trouble du spectre de l’autisme ou d’un trouble de santé mentale soit manquant

Authors' objectives: To identify the most relevant risk factors associated with situations where users may abscond from a new residential facility as well as the practices used to assess these risk factors.

Authors' results and conclusions: Based on a high level of evidence, the predictors of absconding are young age (under 40 years old), a diagnosis of schizophrenia, substance use problems, a history of running away, legal status (involuntary admission) and a short stay on psychiatric units (less than 21 days). The presence of comorbidities, male gender and belonging to an ethnic minority are predictors of absconding associated with a moderate level of evidence. No specific standardized tools/practices used to assess the risk of absconding were identified. The field data collected were insufficient to provide a picture of the tools/practices currently used in Quebec’s health care system network.

Authors' recommendations: a) ID-ASD clientele › No evidence was identified in the literature regarding the risk factors associated with absconding for this clientele. › A single grey literature document, with moderate credibility, identified one individual risk factor (clinical presentation) and two environmental risk factors (hot months and transition periods) that could be considered when assessing the risk of absconding in clients with an ID-ASD. › No specific tools or practices used to detect users at risk of absconding were identified in the literature. › Field data, which concern only clients with an ID-ASD, were insufficient to be generalized to all institutions in the health network, but indicate factors that could be considered when assessing the risk of absconding in this clientele. They include a history of running away, clinical presentation and legal status. › With respect to risk assessment tools, the use of “in-house” tools was mentioned in the survey, but no standardized tools were mentioned. b) Mental health clientele Since the objective was to identify the most relevant risk factors that can be used in the clinical assessment of the risk of absconding, only the predictors are presented. › Considering the evidence and based on a high level of scientific evidence, the most likely factors to predict the risk of absconding in users are: • Young age (≤ 40 years old) • A diagnosis of schizophrenia • Problems with substance use • A history of absconding (running away) • Legal status (involuntary admission) • A short stay (less than 21 days) › Based on the evidence, the following risk predictors of absconding are associated with a moderate level of evidence: • Male gender • Belonging to an ethnic minority • Other mental health disorders › Although clinical presentation is not considered to be a predictor, it was found, based on a moderate level of evidence, to be significantly associated with a risk of absconding. › Some elements addressed in clinical presentation stand out among the items in the tools identified in the scientific and grey literature. 6 Identification of factors influencing the risk of absconding in a user with an intellectual disability, autism spectrum disorder or a mental health disorder. › No specific standardized practices or tools for assessing the risk of absconding were identified. › The evidence indicates that the START vulnerability subscale can be used to predict absconding in high-risk users. › The Historical Clinical and Risk Management (HCR-20) tool, which is used to assess the risk of violent and/or criminal behaviour in users, demonstrated a better predictive value for absconding than the Psychopathy Checklist-Revised (PCL-R) and Violence Risk Appraisal (VRAG) tools.

Authors' methods: A literature review using a systematic approach was done in the MEDLINE, CINHAL and PsycINFO databases. A field data collection was also conducted in the form of a survey addressed to CISSSs and CIUSSSs in the province in order to identify the tools/practices used in these institutions to detect absconders.

Project Status: Completed

URL for project: https://www.ciusss-capitalenationale.gouv.qc.ca/sites/d8/files/docs/MissionUniversitaire/ETMISSS/Sommaire-executif-usagers-manquants_ang.pdf

URL for protocol: https://www.ciusss-capitalenationale.gouv.qc.ca/sites/d8/files/docs/Aproposdenous/Publications/ETMI_usagers_manquants.pdf

Year Published: 2021

URL for published report: https://www.ciusss-capitalenationale.gouv.qc.ca/sites/d8/files/docs/MissionUniversitaire/ETMISSS/Etmi-abregee-usager-manquant.pdf

English language abstract: An English language summary is available

Publication Type: Full HTA

Country: Canada

Province: Quebec

Organisation Name: Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale

Contact Address: 525, boulevard Wilfrid-Hamel, bureau A-122

Contact Name: Sylvie St-Jacques

Contact Email: uetmisss.deau.ciussscn@ssss.gouv.qc.ca

Copyright: © Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, 2021