Rates of violence in patients classified as high risk by structured risk assessment instruments
01 Mar 2014-British Journal of Psychiatry (Royal College of Psychiatrists)-Vol. 204, Iss: 3, pp 180-187
TL;DR: After controlling for time at risk, the rate of violence in individuals classified as high risk by SRAIs shows substantial variation and assigning predetermined probabilities to future violence risk on the basis of a structured risk assessment is not supported by the current evidence base.
Abstract: Background
Rates of violence in persons identified as high risk by structured risk assessment instruments (SRAIs) are uncertain and frequently unreported by validation studies.
Aims
To analyse the variation in rates of violence in individuals identified as high risk by SRAIs.
Method
A systematic search of databases (1995-2011) was conducted for studies on nine widely used assessment tools. Where violence rates in high-risk groups were not published, these were requested from study authors. Rate information was extracted, and binomial logistic regression was used to study heterogeneity.
Results
Information was collected on 13 045 participants in 57 samples from 47 independent studies. Annualised rates of violence in individuals classified as high risk varied both across and within instruments. Rates were elevated when population rates of violence were higher, when a structured professional judgement instrument was used and when there was a lower proportion of men in a study.
Conclusions
After controlling for time at risk, the rate of violence in individuals classified as high risk by SRAIs shows substantial variation. In the absence of information on local base rates, assigning predetermined probabilities to future violence risk on the basis of a structured risk assessment is not supported by the current evidence base. This underscores the need for caution when such risk estimates are used to influence decisions related to individual liberty and public safety.
Citations
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Molde University College1, North Carolina State University2, University of South Florida3, University of Barcelona4, University of New South Wales5, Centre for Mental Health6, National University of La Plata7, Universidad Autónoma de Yucatán8, Karolinska Institutet9, Castle Peak Hospital10, University of Southern Denmark11, University of Mons12, Simon Fraser University13, University of Mainz14, Maastricht University15, University of Konstanz16
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TL;DR: In this paper, the authors applied meta-analytic techniques to examine the predictive validity of the SPJ model using 113 disseminations and concluded that both types of technologies perfonn at comparably good levels of predictive accuracy, but that additional factors are relevant when selecting an approach for clinical practice.
Abstract: Tremendous advancements have been realized during the past several decades in the science and practice of the field now known as violence risk assessment. Whereas in the 1970s and 1980s estimates (dichotomous predictions) of individuals' potential to act violently tended to be based on unstructured clinical judgment, new technologies, or risk assessment tools, were developed during subsequent decades to assist professionals conducting such assessments. Initial technologies available were actuarial in nature; these efforts were followed by clinically based tools developed according to the stmctured professional judgment (SP1) model with the intent of overcoming the perceived limitations of the actuarial approach. Throughout the field's metamorphosis, a steadfast theme has been impassioned commentary regarding the relative merit of actuarial and clinical approaches. Although much research has examined specific SPJ tools, to date, a comprehensive evaluation of the SPJ decision making model has not been conducted. This dissertation applied meta-analytic techniques to examine the predictive validity of the SPJ model using 113 disseminations. Results supported the utility of the SPJ model (especially when summary risk ratings were used) and indicated no distinct superiority for either the actuarial or SPJ model among the 44 samples in which direct comparisons of both approaches were made. It is concluded that both types of technologies perfonn at comparably good levels of predictive accuracy, but that additional factors are relevant when selecting an approach for clinical practice. Implications for practice and research are discussed.
97 citations
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TL;DR: The evidence shows that prediction can be significantly better than chance, but how well do the best instruments perform in the real?
Abstract: Dolan & Doyle ([2000][1]) provide a helpful review of clinical and actuarial measures in violence risk prediction. The evidence shows that prediction can be significantly better than chance. However, they present only one half of the story. How well do the best instruments perform in the real
88 citations
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TL;DR: The father-daughter molesters exhibited an average absolute phallometric preference for prepubertal children and had a violent recidivism rate of 22% in a follow-up of less than 5 years.
Abstract: Child molesters who target their own children have been described as low risk and not pedophilic. Men who had molested a daughter or stepdaughter (n = 82) were compared to 102 molesters whose only female victims were extrafamilial. Men who offended against their own daughters had less deviant sexual age preferences and were less likely to commit new violent and sexual offenses. However, the father-daughter molesters exhibited an average absolute phallometric preference for prepubertal children and had a violent recidivism rate of 22% in a follow-up of less than 5 years. Actuarial risk assessment instruments (the Violence Risk Appraisal Guide and the Sex Offender Risk Appraisal Guide; V. L. Quinsey, G. T. Harris, M. E. Rice, and C. A. Cormier, 1998) worked as well for intrafamilial child molesters as for other sex offenders.
87 citations
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TL;DR: It is suggested that nonnumerical descriptive terms do not aid effective communication of violence risk and that contextual information might artificially affect estimated risk.
Abstract: Actuarial risk assessments yield valid numerical information about violence risk, but research suggests that forensic clinicians prefer to communicate risk using nonnumerical information (i.e., verbal terms such as high risk). In an experimental questionnaire study, 60 forensic clinicians disagreed on the interpretation of nonnumerical terms, and their nonnumerical risk estimates for one group of violent offenders were influenced by comparison with another group. Adding nonnumerical terms to numerical probability statements had no effect on hypothetical forensic decisions. These findings suggest that nonnumerical descriptive terms do not aid effective communication of violence risk and that contextual information might artificially affect estimated risk.
87 citations
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TL;DR: In this article, the authors examined the prediction of recidivism using diagnostic, personality, and risk/need approaches over a 10-year follow-up in a heterogeneous sample of 61 offenders (i.e., probationers and provincial and federal offenders).
Abstract: The present study examined the prediction of recidivism using diagnostic, personality, and risk/need approaches over a 10-year follow-up in a heterogeneous sample of 61 offenders (i.e., probationers and provincial and federal offenders). The Level of Service/Case Management Inventory (LS/CMI), Psychopathy Checklist–Revised (PCL-R), and DSM–III antisocial personality disorder (APD) were examined. The measures were highly correlated and demonstrated theoretically meaningful patterns of convergent validity. Although psychopathy was highly correlated with both LS/CMI and APD, the majority of the shared variance with LS/CMI and with APD was accounted for by Factor 2 and the criminality facet of the PCL-R. All three assessment measures predicted future violence, any future reincarceration upon release, and recidivism severity (as measured by aggregate sentence length). However, none of these measures made a significant incremental contribution to the prediction of recidivism beyond either of the other two measures. Differences between the predictive validities of the three measures were minimal. The results are discussed in terms of recent debates concerning the use of these instruments in the assessment of offender risk.
84 citations