Methodological development: structured outcome assessment and community risk monitoring (SORM)

This paper describes an effort to develop a clinical tool for the continuous monitoring of risk for violence in forensic mental health clients who have left their institutions and who are dwelling in the community on a conditional release basis. The model is called Structured Outcome Assessment and Community Risk Monitoring (SORM). The SORM consists of 30 dynamic factors and each factor in SORM is assessed in two ways: The current absence, presence or partial och intermittent presence of the factors, which is an actuarial (systematized and 'objective') assessment. Secondly, the risk effect, i.e. whether the presence/absence of factors currently increases, decreases or is perceived as unrelated to violence risk, is a clinical (or impressionistic) assessment. Thus, the factors considered via the SORM can be coded as risk factors or protective factors (or as factors unimportant to risk of violence) depending on circumstances that apply in the individual case. Further, the SORM has a built-in module for gathering idiographical information about risk-affecting contextual factors. The use of the SORM and its potential as a risk monitoring instrument is illustrated via preliminary data and case vignettes from an ongoing multicenter project. In this research project, patients leaving any of the 9 participating forensic hospitals in Sweden is assessed at release on a variety of static background factors, and the SORM is then administered every 30 days for 2 years.     

MDS use with crime scene data replicates poorly: response to Goodwill,Alison, and Humann (this issue) and Davis (this issue)

Abstract

Examinations of treatment attrition form an important – although sometimes neglected – component of evaluating a correctional programme's effectiveness in reducing recidivism. Previous research has identified offender characteristics that predict non-completion. This study investigated non-completion in 138 high-risk, violent male prisoners attending an intensive cognitive–behavioural programme. Almost one-third of men who commenced it did not complete the 7-month programme. Most asked to leave of their own accord, or were removed for ongoing offending. In contrast to previous research, no support was found for the hypothesis that those who terminated treatment prematurely were more in need of intervention than those who completed the programme; non-completers did not differ from completers on static estimates of criminal risk, PCL-R scores, demographic variables or self-report scales measuring dynamic risk factors. It was concluded that successful prediction using variables related to criminal risk and criminogenic need depends both on the characteristics of programme participants, and on contextual factors such as programme policies: when high-risk high needs offenders are a programme's target clientele, variables related to risk and need will have limited predictive utility. From a practice perspective, the programme was successful in retaining through to completion a relatively untreatable group: high-risk offenders with moderate to high PCL-R scores.     

Using multidimensional scaling for the analysis of sexual offence behaviour: A replication and some cautionary notes

Abstract

Crime scene profiling has received considerable attention, particularly in popular media. First, since low inter-rater reliability would affect the validity of profiling, we tested inter-rater agreement for 33 variables often used in manuals for the coding of crime-related behaviour. Thirty cases were chosen randomly from 146 cases of assault rape with unknown male offenders in Sweden during 1990–1994. Second, we used multidimensional scaling (MDS) with all 146 cases to replicate earlier work by Canter and Heritage (Journal of Forensic Psychiatry, 1, 185–212, 1990) regarding motivational dimensions in unknown assault rapists. On average, inter-rater reliability was good; physical behaviours were more reliably coded than were verbal behaviours. However, a two-dimensional MDS solution with the motivational dimensions suggested by Canter and Heritage was not replicated. We argue for better empirical support for the inclusion of specific variables in coding formats for crime scene information. This is particularly important for analyses like the MDS, since the number, representativity, and intercorrelations of such variables could affect results considerably.     

Psychopathy (PCL-R) as a Predictor of Violent Recidivism Among Criminal Offenders with Schizophrenia

Hare's Psychopathy Checklist-Revised (PCL-R) was used to test the hypothesis that psychopathy predicts violent recidivism in a cohort subjected to forensic psychiatric investigation and consisting of male violent offenders with schizophrenia (N = 202). Psychopathy was assessed with retrospective file-based ratings. Mean follow-up time after detainment was 51 months. Twenty-two percent of the offenders had a PCL-R score 26 (cutoff), and the base rate for violent recidivism (reconvictions) during follow-up was 21%. Survival analysis revealed that psychopathy was strongly associated to violent recidivism (log-rank = 17.71, df = 1, p < 0.0001). The area under the curve (AUC) of the receiver operating characteristics (ROC) of PCL-R total score to predict violent recidivism varied between different time frames from .64 to .75. Cox regression analyses revealed that other potential risk factors could not equally well or better explain violent recidivism in the cohort than psychopathy as measured by PCL-R.     

Risk factors for violent offending in autism spectrum disorder: a national study of hospitalized individuals

Little is known about risk factors for violence among individuals with autism spectrum disorder (ASD). This study uses data from Swedish longitudinal registers for all 422 individuals hospitalized with autistic disorder or Asperger syndrome during 1988-2000 and compares those committing violent or sexual offenses with those who did not. Thirty-one individuals with ASD (7%) were convicted of violent nonsexual crimes and two of sexual offenses. Violent individuals with ASD are more often male and diagnosed with Asperger syndrome rather than autistic disorder. Furthermore, comorbid psychotic and substance use disorders are associated with violent offending. We conclude that violent offending in ASD is related to similar co-occurring psychopathology as previously found among violent individuals without ASD. Although this study does not answer whether ASDs are associated with increased risk of violent offending compared with the general population, careful risk assessment and management may be indicated for some individuals with Asperger syndrome.     

Risk factors for recidivism among spousal assault and spousal homicide offenders

Abstract

The Spousal Assault Risk Assessment Guide (SARA; Kropp et al., 1995) is a 20-item checklist for the structured professional assessment of risk for partner violence. This study reported on a retrospective follow-up of file-based SARA assessments of offenders convicted 1988–1990 in Sweden. A total of 88 male batterers referred for court-ordered forensic psychiatric evaluations were included. During the 7-year follow-up, twenty-five (28%) were re-convicted of spousal assault. A few SARA items were statistically significantly associated with increased risk of recidivism, namely: Items #3, Past violation of conditional release or community supervision, #10 Personality disorder with anger, impulsivity, or behavioural instability (psychopathy), and #16 Extreme minimisation or denial of spousal assault history. The severity of the index crime (#18 Severe and/or sexual assault) was negatively related to risk for recidivism during follow-up. Offenders scoring above the median on the SARA were at more than 2.5 higher the risk for recidivism than those scoring below the median. In terms of predictive validity, the SARA actuarial score exhibited a marginal but statistically significant improvement over chance in this sample.     

The quality of written expert testimony in alleged child sexual abuse: An empirical study

Abstract

The purpose of this study was to empirically evaluate written expert testimonies in cases of suspected child sexual abuse in Sweden. A total of 121 expert testimonies were rated with an instrument developed for the study, the SQX-12 (Gumpert et al., 2001) which is a 12-item checklist aimed to reflect consensus-established concepts of quality. Reports from different professional groups were compared, as were reports produced before and after the 1991 publication of national guidelines. The results suggested that the reports produced by professionals using statement analysis generally were of higher quality than reports written by professionals from child- and adolescent psychiatry. There was a slight increase in report quality, as measured by the SQX total score, over the studied years. However, it is concluded that the overall quality of written expert testimony on child credibility still does not reach the recommended level in Sweden.     

An empirical investigation of written risk communication in forensic psychiatric evaluations

Abstract

There has been an increased interest in approaches for improving violence risk assessment, but less so how to communicate risk assessment results. We studied the written risk communication of 142 cases of forensic psychiatric evaluations in Sweden. The results suggested that risk for criminal recidivism was communicated in the vast majority of the cases (122 out of 142), but that risk was primarily communicated when the risk was perceived to be high. A six-item protocol to assess the content of the risk communication suggested that the communication was well elaborated in 21/122 of the cases, moderately elaborated in 53/122, poorly or very poorly elaborated in 43/122, and non-elaborated in 5/122 of the cases. Level of elaboration was only vaguely related to sociodemographic characteristics pertaining to the assessed (sex, age, citizenship) and the type of crime committed, but highly correlated to clinical diagnoses (DSM-IV) as well as contextual factors of the evaluation (which professional group and which clinic the assessment was performed).     

Psychopathy (PCL-R) Predicts Violent Recidivism Among Criminal Offenders with Personality Disorders in Sweden

Psychopathy as conceptualized with Hare's Psychopathy Checklist Revised, PCL-R, has attracted much research during the 1990s. In the Scandinavian countries, few studies that empirically support the validity of North American risk assessment techniques in our regional context have been published. The purpose of this paper is to explore the predictive power of the PCL-R in a population of personality-disordered violent offenders subjected to forensic psychiatric evaluation in Sweden. Following release from prison (n = 172), discharge from forensic psychiatric treatment (n = 129), or probation (n = 51), a total of 352 individuals were followed for up to 8 years (mean = 3.7 years) with reconviction for violent crime as endpoint variable (base rate 34%). As the estimate of predictive power, the area under the curve of a receiver operating characteristic (AUC of ROC) analysis was calculated. For PCL-R scores to predict 2-year violent recidivism, AUC of ROC was .72 (95% CI: .66–.78). In addition, the personality dimension of psychopathy (Factor 1) and the behavioral component (Factor 2) both predicted 2-year recidivism significantly better than random: AUC of ROC .64 (95% CI: .57–.70) and .71 (95% CI: .65–.77), respectively. We conclude that psychopathy is probably as valid a predictor of violent recidivism in Swedish forensic settings as seen in previous North American studies.