Static and Dynamic Patient Characteristics as Predictors of Criminal Recidivism: A Prospective Study in a Dutch Forensic Psychiatric Sample

If clinicians in forensic psychiatry want to reduce risk of reoffending in their patients, they require insight into dynamic risk factors, and evidence that these add predictive power to static risk indicators. Predictors need to be evaluated under clinically realistic circumstances. This study aimed to validate dynamic and static variables as predictors of reconviction in a naturalistic outcome study. Data on static and dynamic risk factors were collected for 151 patients discharged from Dutch forensic psychiatric hospitals. Community follow-up was prospective, with a 5.5 year minimum. A prediction model was developed using Cox regression analysis. The magnitude of the predictive power of this model was estimated using receiver operating characteristic (ROC) analysis. The final prediction model contained four static and no dynamic predictors. The model's ROC area under the curve was .79 (95% CI .69–.89). Clinical risk ratings were non-predictive. Post hoc analyses exploring the influence of subgroups of patients did not yield better models. It is concluded that a small set of static predictors yielded a good estimate of future reconvictions; inclusion of dynamic predictors did not add predictive power.     

The Dynamic Prediction of Criminal Recidivism: A Three-wave Prospective Study

A three-wave, prospective panel design was used to assess the extent to which static and dynamic risk factors could predict criminal recidivism in a sample of 136 adult male offenders released from Canadian federal prisons. Static measures were assessed only once, prior to release while dynamic measures were assessed on three separate occasions: pre-release, 1 month, and 3 months post-release. Recidivism was coded during an average of 10.2-month follow-up period (SD = 19.2). A series of Cox regression survival analyses with time-dependent covariates and Receiver Operator Characteristic (ROC) analyses were conducted to assess predictive validity. Although the combined static and time-dependent dynamic model (AUC = .89, CI = .81–.93) significantly (p < .01) outperformed the pure static model (AUC = .81, CI = .73–.87) the confidence intervals did overlap to some extent. Implications for dynamic risk assessment and management are discussed.

A Comparative Test of Clinical Judgment Versus Actuarial Prediction of Future Violence

This study tested how graduate level psychology graduate students (n = 20) using the Adapted Violence Risk Appraisal Guide (Adapted VRAG) would do relative to practicing psychologists/psychiatrists (n = 16) using clinical judgment when predicting violence in 10 narratives from the MacArthur Violence Risk Assessment study (Monahan et al., The MacArthur violence risk assessment study. . Retrieved 10 Oct 2005). Results indicated that the practicing psychologists/psychiatrists made significantly more correct predictions than the master’s level students. The professional group demonstrated sensitivity levels of 77.7% and specificity of 96.3%. For the use of the adapted VRAG method by the graduate student group, specificity levels were modest at 54.0%. Sensitivity levels, however, were lower than earlier demonstrated levels at 58.0%. These findings are at variance with earlier reports comparing clinical and actuarial methods. The results may reflect the short amount of time the master’s level students were trained using the Adapted VRAG as well as the small number of participants in this study. Additional research comparing other professions is recommended, as well as examining if experience in the forensics field would affect one’s ability to predict violence.     

Predictive Validity of the SVR-20 and Static-99 in a Dutch Sample of Treated Sex Offenders

In this retrospective study, the interrater reliability and predictive validity of 2 risk assessment instruments for sexual violence are presented. The SVR-20, an instrument for structured professional judgment, and the Static-99, an actuarial risk assessment instrument, were coded from file information of 122 sex offenders who were admitted to a Dutch forensic psychiatric hospital between 1974 and 1996 (average follow-up period 140 months). Recidivism data (reconvictions) from the Ministry of Justice were related to the risk assessments. The base rate for sexual recidivism was 39%, for nonsexual violent offenses 46%, and for general offenses 74%. Predictive validity of the SVR-20 was good (total score: r = .50, AUC = .80; final risk judgment: r = .60, AUC = .83), of the Static-99 moderate (total score: r = .38, AUC =.71; risk category: r = .30, AUC = .66). The SVR-20 final risk judgment was a significantly better predictor of sexual recidivism than the Static-99 risk category.     

Prospective Replication of the Violence Risk Appraisal Guide in Predicting Violent Recidivism Among Forensic Patients

An exhaustive survey of a cohort of forensic patients provided an opportunity for a prospective replication of the predictive accuracy of the Violence Risk Appraisal Guide (VRAG). Data collected during the original survey also permitted a test of the predictive accuracy of clinical assessments of risk on the same cohort. The VRAG yielded a large effect size in predicting violent recidivism (ROC area = .80) over a constant 5-year follow-up and performed significantly better than averaged clinical opinions. The superiority of the VRAG was also observed at very short follow-up times and for very serious violence. Moreover, for 16 subsamples, observed rates of violent recidivism did not differ significantly from the expected rates. VRAG score was unrelated, and clinical judgments inversely related to violent recidivism in the small low-risk sample of female forensic patients. The authors conclude that, regardless of length of opportunity or severity of outcome, actuarial methods are more accurate than is clinical judgment.     

The Impact of Confidence on the Accuracy of Structured Professional and Actuarial Violence Risk Judgments in a Sample of Forensic Psychiatric Patients

Some previous research indicates that confidence affects the accuracy of probabilistic clinical ratings of risk for violence among civil psychiatric inpatients. The current study investigated the impact of confidence on actuarial and structured professional risk assessments, in a forensic psychiatric population, using community violence as the outcome criteria. Raters completed the HCR-20 violence risk assessment scheme for a sample of 100 forensic psychiatric patients. Results showed that accuracy of both actuarial judgments (HCR-20 total scores) and structured professional judgments (of low, moderate, and high risk) were substantially more accurate when raters were more confident about their judgments. Findings suggest that confidence of ratings should be studied as a potentially important mediator of structured professional and actuarial risk judgments.     

“MIGHT NOT BE A TOMORROW”: A MULTIMETHODS APPROACH TO ANTICIPATED EARLY DEATH AND YOUTH CRIME*

Several researchers point to the anticipation of early death, or a sense of “futurelessness,” as a contributing factor to youth crime. It is argued that young people who perceive a high probability of early death may have little reason to delay gratification for the promise of future benefits, as the future itself is discounted. Consequently, these young people tend to pursue high‐risk behaviors associated with immediate rewards, which include crime and violence. Although existing studies lend support to these arguments and show a statistical relationship between anticipated early death and youth crime, this support remains tentative. Moreover, several questions remain regarding the interpretation of this relationship, the meanings that offenders attach to the prospect of early death, and the cognitive processes that link anticipated early death to youth crime. In this article, we address the limitations of previous studies using a multimethods approach, which involves the analyses of national survey data and in‐depth interviews with active street offenders.     

DOMESTIC VIOLENCE,DOVE, AND DIVORCE MEDIATION

The primary objective of this article is to describe DOVE, a 19‐item instrument designed to assess and manage the risk of domestic violence between partners during and following their participation in divorce mediation. Assessing risk, more specifically how DOVE can be used to assess risk, is described first. The resulting risk scores (TOTDOVE) are used to assign individuals to risk categories. Problems associated with using categorical, frequency, and probability risk assessment formats in interpreting and communicating risk are discussed in the second segment of the article. A dual, categorical/probability format is advocated. Managing risk using Safety Plan interventions that are linked with risk category and predictor subscores on control, substance abuse, anger, relationship problems, mental health problems, and conflict is covered in the final segment.     

A Pre-Trial Domestic Violence Intensive Supervision Unit: Exploring Case Seriousness and Successful Disposition

This study measures the seriousness of domestic violence cases from the population of cases (N = 96) sentenced to a pre-trial domestic violence intensive supervision unit in one county probation office in Florida from April 1, 2006, to April 30, 2007. No significant differences were found in seriousness across sex, self-reported drug use, or attorney type. Furthermore, no relationship was found between the number of special conditions imposed by the court and the seriousness index value for a case. However, non-Whites had a significantly higher mean case seriousness index than Whites. Findings suggest that using the seriousness index presented in this study, some of the cases examined were not serious enough to warrant being sentenced to the pre-trial domestic violence intensive supervision unit. Implications for future research, including the use of lethality assessments, are addressed.