Risk assessment is the contemporary term for an estimation ...



A Practical Guide to Risk Assessment

Mary Alice Conroy, Ph.D.

Diplomate in Forensic Psychology

American Board of Professional Psychology

Directions: To receive 1 hour ethics continuing education credit for psychologists, licensed psychological associates, licensed professional counselors and licensed social workers, for this TPA sponsored home study assignment, you must:

1) Read the article in its entirety;

2) Take the test at the end of the article;

Mail or fax the test answers along with $25 (TPA Members) or $50 (Non-TPA Members) to the Texas Psychological Association, PO Box 1930, Cedar Park, TX 78630 or (512) 255-1642. Examinations will not be scored without appropriate fee. You must answer correctly 70% or better to pass the examination.

Risk assessment is the contemporary term for an estimation of the level of risk an individual presents for certain types of violent behavior. In Texas, assessment of risk is required for traditional civil commitment, sexual predator evaluations, sentencing phase evaluations in death penalty cases, evaluations for juvenile transfer to adult court, and various decisions regarding detention of those found not restorable to competence for trial and not guilty only by reason of insanity. Risk assessment may also be important in cases involving probation or parole decisions, the use of diversion programs, domestic violence intervention, termination of parental rights, fitness for duty in potentially hazardous occupations, and certain types of malpractice litigation. This chapter is intended to impart very practical information regarding what courts have said about risk assessment, issues in deciding to perform a risk assessment, essential data collection, methodology, and issues of risk management.

The View from the Bench

Courts have generally relied on mental health professionals to provide information regarding the risks individuals pose to society. In 1983, this practice was challenged in the case of Barefoot v. Estelle. Mr. Barefoot, sentenced to death for murder in a Texas court, contended that psychiatrists have no unique tools or ability to predict dangerousness. An amicus curiae brief filed by the American Psychiatric Association supported this position. Data were presented suggesting that these predictions were wrong as often as two thirds of the time. However, the U. S. Supreme Court ruled that not allowing psychiatrists to testify in this regard would be tantamount to “disinventing the wheel.” The justices went so far as to note that psychiatrists were not always wrong – only wrong most of the time.

Since Barefoot, both psychiatrists and psychologists have continued to provide assessments of violence potential to the judiciary. Thankfully, the scientific data relevant to such predictions has grown and the standards for admitting expert testimony have tightened. In the case of Daubert v. Merrill Dow Pharmaceuticals (1993), the U. S. Supreme Court declared the judge to be the “gatekeeper” to assure that experts who testified were, in fact, experts, and that their evidence was scientific. An expert was to be qualified by knowledge, skill, experience, training, or education – and not simply by degree or profession. The Court suggested criteria a judge might apply in assessing the evidence presented and methodology employed by experts:

1. Does it reflect a theory that has or can be tested?

2. Has it been subject to peer review or publication?

3. Has a potential error rate been established?

4. Has it been accepted by the relevant scientific community?

5.

In 1995, Texas courts embraced the essence of Daubert in the case of E. I. Dupont & Co. v. Robinson. Since that time, so-called “Daubert challenges” have become common in hotly contested cases and “Daubert hearings” are sometimes held before judges prior to allowing the expert to testify before the jury.

In the 1999 case of Kumho v. Carmichael, the U. S. Supreme Court made an additional ruling in this regard. In this case the Court said that not only the presentation of scientific data was at issue, but, if an expert performed some type of evaluation, the methodology employed was subject to scrutiny.

The Decision to Conduct a Risk Assessment

Before agreeing to conduct a risk assessment, several issues should be clarified.

1. Over what period of time is the risk to be assessed? (This could be a lifetime or it could be the time an individual will be on bond.)

2. Is the risk in a structured or unstructured environment? (This is a critical distinction in a death penalty evaluation.)

3. What will be the individual’s likely circumstances?

4. Is there leeway to alter these circumstances (e.g., can conditions be placed upon the release)?

5. Is the decision-maker concerned only about a particular type of violence (e.g.,sexual violence, spousal abuse, child abuse)?

6. Is the issue confined to physical violence or is it intended to mean criminal recidivism in general?

7. Must the particular risk be linked to a mental illness or mental abnormality? Once circumstances have been fully clarified, the evaluator should give careful consideration to potential ethical pitfalls. First and foremost the mental health professional needs to examine whether he or she has the specific competencies needed for the evaluation. Risk assessment is becoming very specialized and an extensive literature has developed. (A brief list of major references is included in Appendix A.) Instruments have been developed to assess risk for specific types of violence in target populations and any evaluator should be familiar with these tools. (A brief catalogue is included in Appendix B for reference.) Cultural competence should be considered in deciding whether the clinician is sufficiently experienced with the population represented. If the mental health professional is uncertain regarding his or her expertise, consultation is strongly recommended.

Ethical guidelines require that evaluators avoid a conflict of interest or a potentially harmful dual relationship. One of the most common problems in this area stems from mental health professionals serving as forensic evaluators while also functioning as the subject’s therapist. Forensic risk assessments generally should not be performed by the treating professional. A therapist should maintain an alliance with the patient, while a forensic evaluator should be unbiased.

Collecting Research and Collateral Data

Prior to contact with the person to be evaluated, both nomothetic and idiographic data can be assembled. This should include relevant research data on factors predictive of the particular type of risk being assessed in the particular population represented by the individual. Factors with protective value should not be overlooked. The data base on risk assessment is exploding exponentially, and the clinician should actively seek the most current literature or risk serious embarrassment in the courtroom. Websites are now available devoted to various areas of risk assessment. Key sites to explore would include, but are not limited to:

1. macarthur.virginia.edu (the mentally ill offender)

2. (the psychopathic offender)

3. sgc.gc.ca (the sex offender)

Exploring idiographic data involves seeking out collateral information about the individual to be assessed. Collateral information in performing a risk assessment is not simply helpful – it is essential! Much of the risk assessment research has been conducted in Canada – one reason being that the Canadians have developed an extensive record keeping system. Securing records in Texas may be more challenging. To perform a valid assessment there must be sufficient information to verify key facts. Official documents may contain errors and contradictions should be clarified. Attorneys may wish to be helpful, but are frequently unaware of what is needed. Making specific requests for documents and suggesting sources can be productive. Examples of records and possible sources would include:

1. Presentence investigations and reports of prior functioning while under supervision (probation officer)

2. Information, indictment, police reports, witness statements for current and past offenses (district attorney)

3. Reports of institutional behavior (TDCJ, TYC, county jail)

4. Past criminal record (district attorney, probation officer)

5. Report of past mental health treatment or evaluations (defense attorney, hospitals, clinicians)

6. Reports of special programs attended, such as substance abuse or sex offender treatment (defense attorney, TDCJ, TYC, program providers)

7. School records, especially in the case of youthful offenders (defense attorney)

8. Collateral interviews with family members or care-givers may be helpful (generally check with the attorney before proceeding)

Methodology

Clinical and Actuarial Methods

A debate continues to rage in the field between those who favor a strictly actuarial approach and those who defend the role of clinical judgment. Vernon Quinsey and his colleagues, who have done some of the major research in the development of actuarial approaches, have argued that clinical judgment should be completely supplanted by actuarial instruments, because actuarial approaches are too good to risk contaminating them with unreliable clinical judgment (Quinsey, Harris, Rice, & Cormier, 1998). On the other hand, Thomas Litwack has argued vociferously that the day will probably never come when actuarial instruments can be applied to single individuals without the careful application of the clinician’s judgment (Litwack, 2001). Karl Hanson (1998) holds a more conciliatory view, suggesting the application of a guided actuarial approach, adjusting the weight given to both as the research becomes more sophisticated. John Monahan and his colleagues in the MacArthur risk assessment studies have generally supported this view, arguing that it clearly cannot be said that all of the variables potentially related to risk have been uncovered nor that they should be given the same weight for every individual (Monahan et al., 2001). It is even possible that well researched variables involving violence may have paradoxical effects for a specific person.

Beyond Traditional Approaches

Consent or disclosure. In clinical work, the informed consent of the patient or guardian is often the first essential step. However, if an evaluation is court-ordered or required by statute, the individual may have few choices – the evaluation must be completed with or without consent. In such cases an evaluation disclosure may be more honest and appropriate than an informed consent. If, on the other hand, the evaluation is being conducted at the request of an attorney or probation officer, the person’s informed consent will be needed. In either case, the individual under evaluation should be informed of the identity and professional affiliation of the evaluator, the purpose of the evaluation, the limits of confidentiality, who is likely to have access to the evaluation results, the potential consequences of the evaluation, and given a clear statement that the evaluator is not a treating clinician.

The interview. Ordinarily, ethical standards require that an interview of the individual under evaluation be conducted as part of the assessment. It is certainly the most desirable and defensible approach. However, there are circumstances when an interview is not a viable option – either because the individual is incapable of participating, is uncooperative, or is advised by his or her attorney not to speak. Extensive, reliable records may nonetheless make it possible to conduct a thorough risk assessment. However, the reverse is not the case – one cannot complete a risk assessment relying only on the individual’s self-report. If an interview is not conducted this should be clearly explained in subsequent reports or testimony.

Traditional psychological test batteries. The traditional psychological test battery, often composed of personality and cognitive testing, may be of limited value in a risk assessment. Such instruments may be helpful in confirming a particular diagnosis, if one is required. However, broad, general personality inventories (e.g., the MMPI-2, the MCMI-III, the PAI) have not been validated to predict violence, either general or specific. Problems arise when forensic evaluators confirm long-held “myths” about test results or suggest illusory correlations.

Specialized risk assessment instruments. Recently, some instruments have been developed specifically designed to predict violence risk. These are generally constructed in one of three formats: 1) the structured interview, 2) an actuarial device consisting of variables chosen based upon regression analysis, and 3) the decision-tree approach. (See Appendix B.)

Instruments of this type have some distinct advantages in the courtroom. They can provide an anchor onto which an evaluator may graft more idiographic data. Such instruments have almost invariably been published and peer reviewed, which can be helpful if faced with a Daubert challenge. It is often possible to grossly compare offenders by level of risk using these methods. For example, the Violence Risk Appraisal Guide (VRAG) divides the population into nine risk levels ranging from the highest (in which virtually the entire sample re-offended) to the lowest (in which almost none of the norm group re-offended.)

However, the limitations of these devices must also be considered. For valid results, they universally require accurate, extensive records. Courts are sometimes confused by statistical information or may put unwarranted faith in numbers. Selection and proper use of a risk assessment instrument requires a thorough understanding of certain statistical concepts (e.g., ROC curves, sensitivity, specificity, positive predictive power.) Each instrument has been normed on a select population that may not match the individual being evaluated. Finally, most rely almost exclusively on static variables (things that are historical and will not change with time.) Thus the instruments themselves tend to be static and are insensitive to change over time or to varying levels of immediate risk.

Diagnosis. A precise diagnosis may be helpful (or even required) in the process of a risk assessment; however, diagnoses have very limited value in actually assessing risk. The limitation of diagnoses include two specific caveats noted in the DSM-IV-TR. 1) Clinical diagnoses often do not equate to what the legal community views as mental disorder or mental abnormality, and 2) No diagnosis carries with it specific implications regarding degree of behavioral or volitional control.

Current research does provide support for some basic premises regarding mental disorder and risk for violence. Some relationship between mental disorder and violence has been found to exist (Monahan & Steadman, 1994). Substance abuse is a critical factor to be considered and generally more predictive of violence than major mental illness (Steadman, Mulvey, Monahan, Robbins, Appelbaum, Grisso, Roth, & Silver, 1998). A personality disorder diagnosis is more predictive of violence than any of the major mental illnesses (Hodgins, 2000). Base rates of violence within any diagnostic category tend to be low (Swanson, Borum, Swartz, & Monahan, 1996). Special attention has been given to delusions, particularly those with paranoid content – also referred to as “threat control override” variables (Appelbaum, Robbins, & Monahan, 2000; Appelbaum, Robbins, & Roth, 1999; Monahan & Steadman, 1994). Hallucinations, particularly command hallucinations, have been studied with mixed results (Hersh & Borum, 1998; McNeil, Eisner, & Binder, 2000; Monahan & Steadman, 1994; Rudnick, 1999).

For a diagnosis to be relevant to a risk assessment the connection between the psychopathology and violence displayed by the individual must be explored. Critical questions would include: 1) Was the individual’s behavior consistent with a delusional belief? 2) Is there evidence the person was experiencing command hallucinations concurrent with past violence? 3) Were there obvious motives for the violence unrelated to the mental abnormality? 4) Did all of the individual’s past violence seem to stem from the mental disorder? 5) To what extent did substance abuse contribute to the events?

Psychopathy. Although not a diagnostic category included in the DSM-IV-TR,

the construct of psychopathy has been found to have strong positive predictive power relative to future violent behavior. Psychopathy must be clearly distinguished from Antisocial Personality Disorder. It is a much more restrictive category and goes back to Hervey Cleckley’s conceptualization of the “as if” personality. Robert Hare (1991, 1996, 1999) has devoted much of his long career to refining and clarifying the construct.

In study after study, psychopathy has been found to be among the best predictors of future violent behavior (Hemphill, Hare, & Wong, 1998; Salekin, Rogers, & Sewell, 1996; Serin & Amos, 1995). Correlates of psychopathy include both general and violent recidivism, institutional maladjustment, and poor treatment response. Meta-analyses of recidivism studies have shown psychopathic offenders to be three times as likely to be reconvicted and four times as likely to commit a violent reoffense (Hemphill et al., 1998). The MacRisk Study found psychopathy more predictive of violence than any of the other 133 variables included in the study (Skeem & Mulvey, 2001). Psychopathy has been found to be predictive of violence even when diagnosed in conjunction with substance abuse or a major mental illness (Hill, Rogers, & Bickford, 1996; Rice & Harris, 1992).

The Psychopathy Checklist—Revised (PCL-R), developed by Robert Hare, is currently the “gold standard” in assessing for psychopathy, but care should be exercised in its use. Specialized training is strongly recommended for evaluators using the PCL-R. It is essential that the person being assessed is representative of the populations on which the instrument has been researched. Although predictive of general institutional maladjustment, the PCL-R has not been demonstrated to predict risk for violence within a structured environment. Finally, a low PCL-R score does not indicate low risk – only that it is one risk factor not present.

The situation. Level of risk may vary markedly with the situation. It is important to determine the period of time over which one is expected to assess risk and whether future circumstances are likely to be similar to those in which past violence occurred. The degree of available structure and support should be considered. Access to potential victims may make a difference. Finally, the availability of effective treatment and the likelihood the individual will comply with treatment should be assessed.

Risk Management

Beyond risk assessment, the forensic evaluator may be called upon to establish specific plans for the management of risk. In such cases, the goal of treatment in this context is not reduction of the person’s distress, but rather the reduction of risk. Well applied, this concept stresses the protection of society along side the least restrictive environment for the offender.

The task is challenging, and several principles of sound risk management have been developed to assist the forensic evaluator:

1) Risk factors should be identified and linked specifically to the risk management strategies proposed.

2) Consideration should not be limited to medical or psychological interventions.

3) Effective plans generally identify a central entity charged with on-going monitoring and enforcement.

4) Communication between treatment providers and the monitor needs to be clearly outlined and limits to confidentiality specified.

5) Mechanisms should be in place to allow for immediate intervention when necessary to assure public safety.

6) There must be a balance between individual rights, the need for treatment, and public safety.

7) The subject of the plan should be involved in the planning process.

8) Services and conditions proposed must be reasonably available.

9) Factors that contribute to risk, but are not amenable to change, should also be identified to the decision-making authority.

10) A mechanism for regular re-assessment should be in place.

11)

Risk Assessment Reports

A risk assessment report should follow the general principles that apply to any good forensic report. It should include an explanation of the referral and documentation of the confidentiality disclaimer. All procedures and sources of information (including documents and any collateral interviews) should be included. Focus should be on the specific issue at hand and extraneous information should be excluded. Complete and clear explanations should be given for any conclusions drawn. Additional literature is available addressing issues specific to communication about violence risk (Heilbrun, O’Neill, Strohman, Bowman, & Philipson, 2000; Monahan, 2003; Monahan & MacGregor, 2000).

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APPENDIX A

Appelbaum, P., Robbins, P., & Monahan, J. (2000). Violence and delusions: Data from the MacArthur Violence Risk Study. American Journal of Psychiatry, 157, 566-572.

Appelbaum, P., Robbins, P., & Roth, L. (1999). A dimensional approach to the study of delusions. American Journal of Psychiatry, 156, 1938-1943.

Ashford, J. B., Sales, B. D., & Reid, W. H. (Eds.). (2001). Treating adult and juvenile offenders with special needs. Washington, DC: American Psychological Association.

Barbaree, H. E., Seto, M. C., Langston, C., & Peacock, E. (2001). Evaluating the predictive accuracy of six risk assessment instruments for adult sex offenders. Criminal Justice and Behavior, 28, 490-521.

Bonta, J., Law, M., & Hanson, R. K. (1998). The prediction of criminal and violent recidivism among mentally disordered offenders: A meta-analysis. Psychological Bulletin, 123, 123-142.

Cooke, D. J., Forth, A. E., & Hare, R. D. (Eds.). (1998). Psychopathy: Theory, research, and implications for society. Boston: Kluwer Academic Publishers.

Cunningham, M. D., & Reidy, T. J. (1998). Antisocial Personality Disorder psychopathy: Diagnostic dilemmas in classifying persons of antisocial behavior in sentencing evaluations. Behavioral Sciences and the Law, 16, 333-351.

Doren, D. M. (2002). Evaluating sex offenders: A manual for civil commitment and beyond. Thousand Oaks, CA: Sage Publications.

Douglas, K. S., & Webster, C. D. (1999). Predicting violence in mentally and personality disordered individuals. In R. Roesch, S. D. Hart, & J. R. P. Ogloff (Eds.), Psychology and Law (pp. 175-239). NY: Kluwer Academic Publishers.

Grann, M., Belfrage, H., & Tendstrom, A. (2000). Actuarial assessment of risk for Violence: Predictive validity of the VRAG and the historical part of the HCR-20. Criminal Justice and Behavior, 27, 97-114.

Grove, W. M., & Meehl, P. E. (1996). Comparative efficiency of informal (subjective, impressionistic) and formal (mechanical, algorithmic) prediction procedures: The clinical-statistical controversy. Psychology, Public Policy, and Law, 2, 293-323.

Hanson, R.K. (1998). What do we know about sex offender risk assessment? Psychology, Public Policy, and Law, 4, 50-72.

Hanson, R. K., & Bussiere, M. T. (1998). Predicting relapse: A meta-analysis of sexual offender recidivism studies. Journal of Consulting and Clinical Psychology, 66, 348-362.

Hare, R. D. (1996). Psychopathy and antisocial personality disorder: A case of diagnostic confusion. Psychiatric Times, February, 39-41.

Hare, R. D. (1998). The Hare PCL-R: Some issues concerning its use and misuse. Legal and Criminological Psychology, 3, 99-119.

Hare, R. D. (1999). Without conscience: The disturbing world of the psychopaths among us. NY: Guilford Press.

Harris, G. T., Rice, M. E., & Cormier, C. A. (2002). Prospective replication of the Violence Risk Appraisal Guide in predicting violent recidivism among forensic Patients. Law and Human Behavior, 26, 377-394.

Heilbrun, K. (1997). Prediction versus management models relevant to risk assessment: The importance of legal decision-making context. Law and Human Behavior, 21, 347-359.

Heilbrun, K., Dvoskin, J., Hart, S. D., & McNeil, D. (1999). Violence risk communication: Implications for research, policy, and practice. Health, Risk, and Society, 1, 91-106.

Heilbrun, K., O’Neill, M., Strohman, L., Bowman, Q., & Philipson, J. (2000). Expert approaches to communicating violence risk. Law and Human Behavior, 24, 137-148.

Hemphill, J. F., Hare, R. D., & Wong, S. (1998). Psychopathy and recidivism: A review. Legal and Criminological Psychology. 3, 139-170.

Hersh, K., & Borum, R. (1998). Command hallucinations, compliance, and risk assessment. Journal of the American Academy of Psychiatry and the Law, 26, 353-359.

Hill, C. D., Rogers, R., & Bickford, M. E. (1996). Predicting aggressive and socially disruptive behavior in a maximum security forensic hospital. Journal of Forensic Sciences, 41, 56-59.

Hogkins, S. (Ed.). (2000). Effective prevention of crime and violence among the mentally ill. Dordrecht, the Netherlands: Kluwer Academic Publishers.

Janus, E.S., & Meehl, P. E. (1997). Assessing the legal standard for predictions of dangerousness in sex offender commitment procedures. Psychology, Public Policy, and Law, 3, 33-64.

Litwack, T. R. (2001). Actuarial versus clinical assessments of dangerousness. Psychology, Public Policy, and Law, 7, 409-443.

McNeil, D. E., Eisner, J. P., & Binder, R. L. (2000). The relationship between command hallucinations and violence. Psychiatric Services, 51, 1288-1292.

Monahan, J. (2003). Violence risk assessment. In A. M. Goldstein (Ed.). Handbook of Psychology, Volume 11: Forensic Psychology (pp. 527-540). NY: John Wiley & Sons.

Monahan, J., & Steadman, H. (Eds.). (1994). Violence and mental disorder: Developments in risk assessment. Chicago: University of Chicago Press.

Monahan, J., Steadman, H., Silver, E., Appelbaum, P., Robbins, P., Mulvey, E., Roth, L., Grisso, T., & Banks, S. (2001). Rethinking risk assessment: The MacArthur Study of mental disorder and violence. NY: Oxford University Press.

Quinsey, V. L., Harris, G. T., Rice, M. E., & Cormier, C. (1998). Violent offenders: Appraising and managing risk. Washington, DC: APA.

Rice, M. E., & Harris, G. T. (1992). A comparison of criminal recidivism among schizophrenic and nonschizophrenic offenders. International Journal of Law and Psychiatry, 15, 397-408.

Rogers, R. (2000). The uncritical acceptance of risk assessment in forensic practice. Law and Human Behavior, 24, 595-605.

Rudnick, A. (1999). Relationship between command hallucinations and dangerous behavior. Journal of the American Academy of Psychiatry and the Law, 27, 253-257.

Salekin, R. T., Rogers, R., & Sewell, K. W. (1996). A review and meta-analysis of the Psychopathy Checklist and Psychopathy Checklist—Revised: Predictive validity of dangerousness. Clinical Psychology: Science and Practice, 3, 203-215.

Serin, R. C., & Amos, N. L. (1995). The role of psychopathy in the assessment of dangerousness. International Journal of Law and Psychiatry, 18, 231-238.

Seto, M. C., & Barbaree, H. E. (1999). Psychopathy, treatment behavior, and sex offender recidivism. Journal of Interpersonal Violence, 14, 1235-1248.

Skeem, J., & Mulvey, E. (2001). Psychopathy and community violence among civil psychiatric patients: Results from the MacArthur Violence Risk Assessment Study. Journal of Consulting and Clinical Psychology, 69, 358-374.

Slovic, P., Monahan, J., & MacGregor, D. G. (2000). Violence risk assessment and risk communication: The effects of using actual cases, providing instruction, and employing probability versus frequency formats. Law and Human Behavior, 24, 271-296.

Steadman, H., Mulvey, E., Monahan, J., Robbins, P., Appelbaum, P., Grisso, T., Roth, L., & Silver, E. (1998). Violence by people discharged from acute psychiatric inpatient facilities and by others in the same neighborhoods. Archives of General Psychiatry, 55, 393-401.

Swanson, J., Borum, R., Swartz, M., Monahan, J. (1996). Psychotic symptoms and disorders and the risk of violent behavior in the community. Criminal Behavior and Mental Health, 6, 317-338.

Webster, C. D., & Jackson, M. A. (Eds.). (1997). Impulsivity: Theory, assessment, and treatment. NY: Guilford Press.

Weiner, I. B. (1999). Writing forensic reports. In A. K. Hess & I. B. Weiner (Eds.). The Handbook of Forensic Psychology (pp. 501-520). NY: John Wiley & Sons.

APPENDIX B – RISK ASSESSMENT INSTRUMENTS

A. Hare Psychopathy Checklist-Revised (PCL-R)

This instrument was developed by Robert Hare and his colleagues to assess the psychopathic personality as characterized by Hervey Cleckley and not necessarily the antisocial personality envisioned in the DSM-IV. It is a combination of interview and review of collateral information. It generally takes several hours to complete. To assure reliability the author recommends rather extensive training before using the instrument. This included attending a three-day workshop, completing some video-taped test cases, and taking a written test. This is one of the few instruments on the market with very promising predictive validity regarding violence.

Reference: Hare, R. D. (1996). Psychopathy: A clinical construct whose time has come. Criminal Justice and Behavior, 23, 25-54.

Source: Multi-Health Systems, Inc.

908 Niagara Falls Blvd.

North Tonawanda, NY 14120-2060

Web Address:

B. HCR-20

The Historical/Clinical/Risk Management Scheme was developed on the basis of an earlier instrument (the Dangerousness Behavior Rating Scale). It is a checklist rather than a test and includes 20 items: 10 historical, 5 clinical, and 5 future risk management. It was designed for clinicians working with persons suffering from mental and personality disorders, whether or not they also have criminal histories. It correlates moderately with the PCL-R and the VRAG, but does measure slightly different constructs.

Source: Webster, C. D., Douglas, K. S., Eaves, D., & Hart, S. D. (1997). HCR-20: Assessing risk for violence (version 2). Vancouver: Mental Health, Law, and Policy Institute, Simon Fraser University.

Reference: Webster, C. D., Douglas, K. S., Eaves, D., & Hart, S. D. (1997). Assessing risk of violence to others. In C. D. Webster & M. A. Jackson (Eds.). Impulsivity: Theory, assessment, and treatment (pp. 251-277). NY: Guilford Press.

C. JJPI-Maine Juvenile Sex Offender Assessment Protocol (JSOAP)

The JSOAP is an actuarial instrument consisting of four rationally derived factors, two historical and two dynamic. It was initially designed to assess change, administered before and after treatment. It includes variables from the Adolescent Psychopathy Taxon Scale developed by Grant Harris and his colleagues. It is still in the research stage, but some initial findings regarding reliability and validity have been positive.

Reference: Prentky, R. A., Harris, B., Frizzell, K., & Righthand, S. (2000).An actuarial procedure for assessing risk with juvenile sex offenders. Sexual Abuse: A Journal of Research and Treatment, 12, 71-93.

D. Level of Service Inventory-Revised (LSI-R)

This instrument was researched and developed for use in risk and needs assessment for general offenders. It is for use with persons sixteen and older for treatment planning and placement. It consists of a structured interview and expert rating form and generally takes from 30 to 45 minutes to complete. A screening version (LSI-R-SV) has been constructed, as well as a computer application.

Reference: Andrews, d. A., & Bonta, J. (1995). LSI-R: The Level of Service Inventory-Revised. Toronto, Ontario, Canada: Multi-Health Systems, Inc.

Source: Multi-Health Systems, Inc.

908 Niagara Falls Blvd.

North Tonawanda, NY 14120-2060

E. Minnesota Sex Offender Screening Tool – Revised (MnSOST-R)

The MnSOST-R is a 16-item inventory developed for use by the Minnesota Department of Corrections. As developed in 1996, it is based upon actuarial data and very different from the original MnSOST protocol developed in 1991, which was primarily based on clinical observations. The instrument includes 12 static and four dynamic variables and was designed to be completed by persons such as case managers. Suggested cutoff scores are provided and matched with expected rates of recidivism. Given this is a relatively new instrument, research has been limited and done primarily by those who developed it.

Source: Minnesota Department of Corrections

CD/SO Services Unit

1450 Energy Park Drive, Suite 200

St. Paul, MN 55108-5219

Reference: Epperson, D. L., Kaul, J. D., & Hesselton, D. (1998, October). Final report of the development of the Minnesota Sex Offender Screening Tool – Revised (MnSOST-R). Presentation at the 17th Annual Research and Treatment Conference of the Association for the Treatment of Sexual Abusers, Vancouver, B. C., Canada.

F. Rapid Risk Assessment for Sexual Offense Recidivism (RRASOR)

This is a brief actuarial scale created from four variables found through meta-analysis to independently predict recidivism among sex offenders. These include prior sexual arrests (most heavily weighted), age, targeting of male victims, and whether any victims were unrelated to the offender. Taken together these variables still correlate only moderately with sex offender recidivism.

Source: Hanson, R. K. (1997). The development of a brief actuarial scale for sexual offense recidivism (User Report No. 1997-04). Ottawa, Ontario, Canada: Department of the Solicitor General of Canada.

Reference: Hanson, R. K. (1998). What do we know about sex offender risk assessment? Psychology, Public Policy, and Law, 4, 50-72.

G. Sex Offender Risk Appraisal Guide (SORAG)

This is a 14-factor risk assessment instrument developed by the Canadian research group responsible for the VRAG. In its current form, it includes administration of the Hare Psychopathy Checklist-Revised and the penile plethysmograph. It necessitates collection of accurate historical data, but can be completed without substantial cooperation by the offender. It is designed to assess the probability that a sex offender is apt to recidivate.

Reference: Quinsey, V. L., Harris, G. T., Rice., M. E., & Cormier, C. (1998). Violent offenders: Appraising and managing risk. Washington, DC: American Psychological Association.

H. Spousal Assault Risk Assessment Guide (SARA)

This instrument was developed by the risk assessment research group at Simon Fraser University in British Columbia. It recognizes that persons who principally assault their spouses are a heterogeneous population, but also may be quite different from those who engage in other types of assault. It is brief, having 20 items and two summary ratings. It has four sections and a five level scoring system. It is not a test, per se, but rather a checklist to assure that all pertinent information is considered.

Source: Kropp, P. R., Hart, S. D., Webster, C. D., & Eaves, D. (1995). Manual for the Spousal Assault Risk Assessment Guide (2nd. ed.). Vancouver: British Columbia Institute on Family Violence.

Reference: Kropp, P. R., & Hart, S. D. (2000). The Spousal Assault Risk Assessment (SARA) Guide: Reliability and validity in adult male offenders. Law and Human Behavior, 24, 101-118.

I. Static-99

This is one of the more recent sex offender risk assessment instruments, which combines items from the RRASOR and the SACJ-Min. Studies thus far indicate that its predictive accuracy exceeds that of either of the previous instruments alone. It is based completely on static variables including prior sexual offenses, unrelated victims, stranger victims, male victims, age, never married, non-contact sexual offenses, prior sentences, current non-sexual violence, and prior non-sexual violence. It is designed to measure long-term risk potential.

Source: R. Karl Hanson, Ph.D.

Corrections Research

Department of the Solicitor General of Canada

340 Laurier Ave. West

Ottawa, Ontario, Canada

Reference: Hanson, R. K., & Thornton, D. (1999). Static-99: Improving actuarial risk assessments for sex offenders. (User Report 99-02). Ottawa: Department of the Solicitor General of Canada. Web Address: sgc.gc.ca

J. Structured Anchored Clinical Judgment (SACJ-Min)

Also known as “the Thornton,” this instrument was designed to assess the risk of sex offender recidivism on the basis of a stage approach. Stage One considers official convictions, Stage Two potentially aggravating factors, and Stage Three treatment variables (usually only available on those who have been in a sex offender treatment program.) Available research is limited and conducted primarily by the developer.

Source: David Thornton

Offender Behaviour Programmes Unit

Room 701, HM Prison Service, Abell House

John Islip Street

London SW1P4LH

Reference: Grubin, D. (1998). Sex offending against children: Understanding the risk. Police Research Series Paper 99. London: Home Office.

K. SVR-20

The Sexual/Violence/Risk instrument was developed by the risk assessment researchers at Simon Fraser University in British Columbia. It is a checklist designed to assess the risk of future sexual violence by examining psychosocial adjustment, past sexual offenses, and future risk management options.

Source: Boer, D., Hart, S., Kropp, R., & Webster, C. (1997). Manual for the Sexual Violence Risk B 20. Simon Fraser University: Mental Health, Law, and Policy Institute, Burnaby, British Columbia.

L. Violence Risk Appraisal Guide (VRAG)

This approach was developed by Christopher Webster, Grant Harris, Marnie Rice, Catherine Cormier, and Vernon Quinsey in Canada. It was originally published as the Violence Prediction Scheme. It includes administration of the Hare Psychopathy Checklist-Revised. It has been validated primarily on populations of violent offenders.

Source: Webster, C. D., Harris, G. T., Rice, M. E., Cormier, C., & Quinsey, V. L. (1994). The violence prediction scheme: Assessing dangerousness in high risk men. University of Toronto: Centre of Criminology.

M. Youth Level of Service/Case Management Inventory

This is a guide developed at Carleton University to assist those tasked with the management of potentially violent juveniles. It is divided into nine sections and includes prior offenses, family circumstances, education, employment, peer relationships, substance abuse, personality variables, interests, and attitudes. It is designed as an aid and not a psychometric instrument.

Reference: Hoge, R., & Andrews, D. (1996). Assessing the youthful offender. NY: Plenum Press.

N. Iterative Classification Tree

This is an approach being studied by the MacArthur group. Unlike most currently

available risk assessment instruments that are based upon main effects linear regression models, this approach utilizes a decision tree. The developers argue that the typical linear regression model is a “one size fits all” approach, assuming

that the same risk factors are applicable to everyone and applicable to the same degree. Using a decision tree allows the evaluator to include a wide range of variables (the project used a total of 134). Software is under development that is expected to make the approach user friendly. The research is specifically targeting the population with serious mental illness.

References: Monahan, J., Steadman, H. J., Silver, E., Appelbaum, P. S., Robbins, P. C., Mulvey, E. P., Roth, L. H., Grisso, T., & Banks, S. (2001). Rethinking risk assessment: The MacArthur Study of mental disorder. Oxford: Oxford University Press.

Steadman, H. J., Silver, E., Monahan, J., Appelbaum, P. S., Robbins, P. C., Mulvey, E. P., Grisso, T., Roth, L. H., & Banks, S. (2000). A classification tree approach to the development of actuarial violence risk assessment tools. Law and Human Behavior, 24, 83-100.

O. Structured Assessment of Violence Risk in Youth (SAVRY)

The design of the SAVRY is modeled after existing assessment protocols for adult violence risk (e.g., the HCR-20), but the item content is focused specifically on risk in adolescents. It is composed of 24 items (Historical, Individual, and Contextual) drawn from existing research and professional literature in adolescent development and on violence and aggression in youth. An additional five protective factors are also provided. The Individual and Social/Contextual sections emphasize dynamic risk/needs factors.

Source:Randy Borum, Psy.D., ABPP

Department of Mental Health Law & Policy

Florida Mental Health Institute

University of South Florida

13301 Bruce B. Downs Blvd.

Tampa, FL 33612

borum@fmhi.usf.edu

A PRACTICAL GUIDE TO RISK ASSESSMENT

First Name: Last Name: Degree

Mailing Address:

City/State/Zip:

Email: Phone:

Visa/MC:

Security Code (3-digit code on the signature panel):______ Exp. Date:

Check #:

Signature: Date:

Fees: Texas Psychological Association Members $25, Non-Members $50

Mail or fax the test answers along with fee to the TPA Central Office, PO Box 1930, Cedar Park, TX 78630 (512) 255-1642..

Risk Assessment Review Test

1. The U.S. Supreme Court suggested specific criteria for evaluating evidence presented by experts in the case of:

a. Barefoot v. Estelle

b. Estelle v. Smith

c. Daubert v. Merrill Dow Pharmaceuticals

d. Kumho v. Carmichael

2. In Texas, consideration of future risk for violence is required by law in:

a. the sentencing phase of death penalty cases

b. the determination of competence to be executed

c. all evaluations done for the juvenile justice system

d. child custody evaluations

3. Research indicates that the psychopathology most predictive of future violent behavior is:

a. antisocial personality disorder

b. psychopathy

c. command hallucinations

d. mania

4. Forensic risk assessments should not be performed by:

a. the therapist of the person being evaluated

b. an evaluator who is not board certified

c. an evaluator of a different cultural background than the person being evaluated

d. an evaluator who is not trained in projective techniques

5. According to the DSM-IV-TR, one reason diagnoses may be of limited value in forensic cases is:

a. diagnoses cannot be established beyond a reasonable doubt

b. diagnostic impressions are generally unreliable

c. jurors often do not understand diagnostic labels

d. diagnoses do not establish whether an individual has control of his or her

behavior

6. One researcher who has expressed the opinion that clinical judgment should be completely replaced by actuarial assessment is:

a. Vernon Quinsey

b. Robert Hare

c. Karl Hanson

d. Thomas Litwack

7. Use of an actuarial risk assessment instrument almost always requires:

a. the availability of computer technology

b. extensive, accurate records

c. a comprehensive interview

d. collateral interviews with family members

8. The most appropriate instrument to use in assessing psychopathy is:

a. the MMPI-2

b. the MCMI-III

c. the PAI

d. the PCL-R

9. Research has demonstrated that:

a. there is no relationship between violence and mental illness

b. persons with schizophrenia are at higher risk for violence than persons who are diagnosed only with personality disorders

c. substance abuse is a stronger predictor of violence than schizophrenia

d. base rates for violence among persons with major mental illnesses exceed 50%

10 Risk management is the effort to:

a. establish base rates for specific types of violent behavior

b. develop strategies to reduce identified risk factors

c. contain individuals identified as being at risk for violence

d. develop actuarial instruments that predict treatment outcome

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