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.     

Violence Risk Assessment and Risk Communication: The Effects of Using Actual Cases,Providing Instruction,and Employing Probability Versus Frequency Formats

This article describes studies designed to inform policy makers and practitioners about factors influencing the validity of violence risk assessment and risk communication. Forensic psychologists and psychiatrists were shown case summaries of patients hospitalized with mental disorder and were asked to judge the likelihood that the patient would harm someone within six months after discharge from the hospital. They also judged whether the patient posed a high risk, medium risk, or low risk of harming someone after discharge. Studies 1 and 2 replicated, with real case summaries as stimuli, the response-scale effects found by Slovic and Monahan (1995). Providing clinicians with response scales allowing more discriminability among smaller probabilities led patients to be judged as posing lower probabilities of committing harmful acts. This format effect was not eliminated by having clinicians judge relative frequencies rather than probabilities or by providing them with instruction in how to make these types of judgments. In addition, frequency scales led to lower mean likelihood judgments than did probability scales, but, at any given level of likelihood, a patient was judged as posing higher risk if that likelihood was derived from a frequency scale (e.g., 10 out of 100) than if it was derived from a probability scale (e.g., 10%). Similarly, communicating a patient's dangerousness as a relative frequency (e.g., 2 out of 10) led to much higher perceived risk than did communicating a comparable probability (e.g., 20%). The different reactions to probability and frequency formats appear to be attributable to the more frightening images evoked by frequencies. Implications for risk assessment and risk communication are discussed.     

Study of the correlation between psychiatric and psychological diagnoses in sample offenders

This study deals with the frequency with which expert psychiatrists and psychologists make structural or nosographic diagnoses within the context of expert assessment.Thus, the rates of concordance between psychiatrists and psychologists in both types of diagnoses will be assessed.To do so, the level of inter-observer agreement on diagnoses between 1990 and 2003 was studied retrospectively in France through psychiatric and psychological assessments of 505 male offenders. The assessment of the correlation rates was carried out using the Kappa coefficient.The results show a range of 0.55 to 0.71 in inter-observer (psychiatrists vs psychologists) agreement for structural diagnoses, and 0.51 to 0.89 for nosographic diagnoses.In addition, a marked correlation between psychiatrists and psychologists may be noted regarding abstention in both structural (k = 66) and nosographic (k = 73) diagnoses. In fact, recommendations are made for improvement in the consistency of offender assessment in the psycho-legal French context.     

Workplace Assessment of Targeted Violence Risk: The Development and Reliability of the WAVR‐21

This study describes the development of the WAVR‐21, a structured professional judgment guide for the assessment of workplace targeted violence, and presents initial interrater reliability results. The 21‐item instrument codes both static and dynamic risk factors and change, if any, over time. Five critical items or red flag indicators assess violent motives, ideation, intent, weapons skill, and pre‐attack planning. Additional items assess the contribution of mental disorder, negative personality factors, situational factors, and a protective factor. Eleven raters each rated 12 randomly assigned cases from actual files of workplace threat scenarios. Summary interrater reliability correlation coefficients (ICCs) for overall presence of risk factors, risk of violence, and seriousness of the violent act were in the fair to good range, similar to other structured professional judgment instruments. A subgroup of psychologists who were coders produced an ICC of 0.76 for overall presence of risk factors. Some of the individual items had poor reliability for both clinical and statistical reasons. The WAVR‐21 appears to improve the structuring and organizing of empirically based risk‐relevant data and may enhance communication and decision making.     

Accountability and psychiatric disorders: How do forensic psychiatric professionals think?

Swedish penal law does not exculpate on the grounds of diminished accountability; persons judged to suffer from severe mental disorder are sentenced to forensic psychiatric care instead of prison. Re-introduction of accountability as a condition for legal responsibility has been advocated, not least by forensic psychiatric professionals. To investigate how professionals in forensic psychiatry would assess degree of accountability based on psychiatric diagnoses and case vignettes, 30 psychiatrists, 30 psychologists, 45 nurses, and 45 ward attendants from five forensic psychiatric clinics were interviewed. They were asked (i) to judge to which degree (on a dimensional scale from 1 to 5) each of 12 psychiatric diagnoses might affect accountability, (ii) to assess accountability from five case vignettes, and (iii) to list further factors they regarded as relevant for their assessment of accountability. All informants accepted to provide a dimensional assessment of accountability on this basis and consistently found most types of mental disorders to reduce accountability, especially psychotic disorders and dementia. Other factors thought to be relevant were substance abuse, social network, personality traits, social stress, and level of education.     

Decision-Making About Volitional Impairment in Sexually Violent Predators

The Kansas v. Hendricks (1997) decision, in which the Supreme Court authorized post-sentence civil commitment for certain sex offenders, appeared to be constitutionally legitimized by limiting the class of offenders eligible for this special form of civil commitment to those who are "unable to control" their dangerousness. Nowhere in the available record, however, did the Court elucidate what they meant by this notion of volitional impairment. This study sought to examine factors that legal professionals (n=43), psychologists (n=40), and mock jurors (n=76) deem most relevant to a determination of sex offender volitional impairment. Participants, who were randomly assigned to a sexual predator commitment or an insanity hearing context, read a series of 16 vignettes that described a pedophilic offender and included combinations of variables hypothesized to be related to judgments of volitional impairment. Results suggested that participants, who as a group made remarkably high estimates of likelihood of future sexual violence, considered verbalization of control, history of sexual violence, and the context of the hearing as highly relevant to determinations of volitional impairment. Implications for policy and practice are explored.     

Police attitudes in assigning responsibility for wife abuse

Prevailing myths concerning wife abuse generally tend to blame the victim. The present study examines the degree of responsibility assigned by police officers to the wife, the husband, as well as the couple's socioeconomic situation in cases of wife abuse. The officer's position (neutral vs supportive) adopted toward the woman is also investigated. The influence of eight characteristics related either to the spouses or to the situation of violence on both the officer's position and the attribution of responsibility is analyzed. The characteristics are: couple's socioeconomic status, type of household, drinking by husband, alleged antagonism on the part of the wife, ambivalence of wife to press charges, type of abuse, history of assault, and violence toward children. The results are based on answers to case vignettes provided by 235 municipal police officers. The data were analyzed by performing a multivariate analysis of variance. Results indicate the type of abuse to be the characteristic with the greatest impact on police attitudes. While the husband is systematically considered more responsible than the wife, police officers always consider the wife somewhat responsible, particularly when there is alleged antagonism by the woman and when threats of violence are present.     

The Effect of Framing Actuarial Risk Probabilities on Involuntary Civil Commitment Decisions

Despite a proliferation of actuarial risk assessment instruments, empirical research on the communication of violence risk is scant and there is virtually no research on the consumption of actuarial risk assessment. Using a 2 × 3 Latin Square factorial design, this experiment tested whether decision-makers are sensitive to varying levels of risk expressed probabilistically and whether the framing of actuarial risk probabilities is consequential for commitment decisions. Consistent with research on attribute framing, in which describing an attribute in terms of its complement leads to different conclusions, this experiment found that the way actuarial risk estimates are framed leads to disparate commitment decisions. For example, risk framed as 26% probability of violence generally led decision-makers to authorize commitment, whereas the same risk framed in the complement, a 74% probability of no violence, generally led decision-makers to release. This result was most pronounced for moderate risk levels. Implications for the risk communication format debate, forensic practice and research are discussed.     

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.     

Attributions about perpetrators and victims of interpersonal abuse: results from an analogue study

This analogue study (written vignettes and videotapes) examines the influence of victim-perpetrator relationship (spouse or acquaintance), sex of perceiver, and type of abuse (psychological vs. physical) on attributions about victims and perpetrators of domestic abuse. College student participants (73 men, 108 women) were randomly assigned to condition. As expected, type of relationship influenced observer perceptions. Specifically, participants rated the victim of marital violence as more psychologically damaged and disturbed by the abuse than the victim of acquaintance violence. Furthermore, interaction effects showed that men, more than women, rated the actions of the married perpetrator as more of a victim's rights violation than the actions of the acquaintance perpetrator. Second, type of abuse was shown to influence perceptions of the perpetrator but not the victim. Sex-of-perceiver effects were also obtained. Women held the perpetrator more responsible and assigned less blame to the victim than did men. Legal and clinical implications are then discussed.     

Screening practices for adolescent dating violence

This study sought to determine the screening practices of child and adolescent psychiatrists regarding adolescent dating violence (DV). A questionnaire regarding screening practices for DV and other risk behaviors was administered to 817 child and adolescent psychiatrists via the Internet and mail. Twenty-one percent of clinicians screened for DV "more than 90% of the time," and 65% had identified it in the past year. Multiple logistic regression analyses found that screening for DV was associated with consistent screening for either substance use or interparental violence (OR=3.0 and 6.3, respectively). Despite the prevalence of DV, only a minority of psychiatrists screen their adolescent patients for this type of risk. These data suggest that screening for DV is associated with consistent screening practices for other risk behaviors. Screening rates may be improved with training and adherence to specific protocols.     

A Preliminary Report of Psychiatric Diagnoses in a Scottish County Sample of Persons of National Security Concern

Increasing anecdotal, empirical, and research evidence indicates mental disorder history is one of the several factors associated with increased risk of involvement in lone-actor terrorist activities. Currently, few studies have been conducted on the mental disorder histories of individuals assessed as at risk of involvement in terrorist activities (Meloy, J Threat Assess Manag 2019;6:93). This pilot study describes demographic, psychiatric, and criminal characteristics of a sample of Scottish individuals identified by the Prevent element of the U.K. national counterterrorism strategy, and outcome data after follow-up at 2 years. Twenty-three individuals were referred to Prevent as posing a national security risk from a county in Scotland. Their records were studied for psychiatric and criminal histories. Nine (39%) had previous psychiatric contact, all were “lone actors”, and none were embedded with organized terrorist groups. The most common diagnoses were substance use disorder, personality disorder, depression, and psychotic disorder. The sample displayed factors associated with increased risk of violence including previous offending, early behavioral difficulties, school problems, substance misuse, cluster B personality disordered traits. After 2 years, 44% of the mentally disordered group had re-offended. The offense types were generally similar to those prior to the individual being involved with the Prevent counter terrorism program. Only one of the mentally disordered group committed a further national security offense. In this sample, mental disorder history is overrepresented in individuals who come to the attention of the U.K. Prevent counter terrorism strategy. Further empirical studies with additional power are required to develop the empirical evidence base in this under-researched area.     

Examining the Role of Static and Dynamic Risk Factors in the Prediction of Inpatient Violence: Variable- and Person-Focused Analyses

Although the construct of psychopathy is related to community violence and recidivism in various populations, empirical evidence suggests that its association with institutional aggression is weak at best. The current study examined, via both variable-level and group-level analyses, the relationship between standard violence risk instruments, which included a measure of psychopathy, and institutional violence. Additionally, the incremental validity of dynamic risk factors also was examined. The results suggest that PCL-R was only weakly related to institutional aggression and only then when the behavioral (Factor 2) aspects of the construct were examined. The clinical and risk management scales on the HCR-20, impulsivity, anger, and psychiatric symptoms all were useful in identifying patients at risk for exhibiting institutional aggression. These data suggest that factors other than psychopathy, including dynamic risk factors, may be most useful in identifying forensic patients at higher risk for exhibiting aggression.     

Perpetration of Gay and Lesbian Partner Violence: A Disempowerment Perspective

Gay men and lesbians may experience domestic violence at rates as high as, or higher than heterosexuals, yet there is a noticeable absence of empirical research investigating this phenomenon. This study investigated same-sex partner violence from a disempowerment perspective to determine the influence of (a) individual characteristics, (b) family of origin factors, and (c) intimate relationship factors. A sample of 77 individuals in distressed relationships (40 gay men and 37 lesbians) were administered a series of quantitative measures in our project office. Data primarily were analyzed using two-way ANOVAs (gender×perpetrator of violence). The greatest number of differences between perpetrators and nonperpetrators was found in individual characteristics. Implications for practitioners working with gay men and lesbians experiencing partner violence are discussed.     

The Social Ecology of Violent Victimization: Individual and Contextual Effects in the NCVS

Multi-level research has shown that individual and community factors are important predictors of the risk for violent victimization. However, previous analyses have drawn different conclusions about the role of any given factor. These differences likely are related to variations in how violence is measured and to the fact that the data are drawn from different locales. The research presented here uses the 1995 National Crime Victimization Survey and tract-level census data to examine (1) how the risk of violence is distributed across persons and places in the United States and (2) whether empirical findings are sensitive to the operationalization of violence. Results show that some individual-level predictors (e.g., gender and race) are sensitive to the operationalization of violence, whereas others (e.g., age and marital status) are not. In addition, the impact of community characteristics on violence depends on central-city residence. In central cities, persons most at risk are in disadvantaged tracts, with lower proportions of immigrants. Outside central cities, the proportion of immigrants in an area increases risk, while community disadvantage has no independent influence. The importance of an empirical foundation for the development of theories of risk is discussed.     

The Influence of Case and Professional Variables on the Identification and Reporting of Child Maltreatment: A Study of Licensed Psychologists and Certified Masters Social Workers

All 50 states have laws requiring mental health and other professionals to report suspected maltreatment. Unfortunately, many professionals who are mandated to report suspicions of child maltreatment often fail to recognize potential maltreatment or fail to report their suspicions. The present study examines several factors that may influence identification and reporting of child maltreatment. Subjects were licensed psychologists in the Midwest and certified Masters social workers in Nebraska. Child maltreatment included neglect, physical abuse, psychological maltreatment, and sexual abuse. Characteristics associated with the family or “case” (race, socioeconomic status of family, age of victim, type of maltreatment) were manipulated and presented in hypothetical case vignettes. Characteristics of the professional (e.g., training and experience with identification and reporting, personal history of maltreatment and violence) were also investigated. Ratings of the severity of the potential maltreatment situation, suspiciousness that maltreatment is occurring, and likelihood of reporting maltreatment were completed after reading each case vignette. The results indicate that a variety of case and professional factors may influence identification and reporting of maltreatment. Implications for training professionals and further research are discussed.     

Intimate Partner Violence Perpetration from Adolescence to Young Adulthood: Trajectories and the Role of Familial Factors

Prior empirical research on intimate partner violence (IPV) in adolescence and young adulthood often focuses on exposure to violence in the family-of-origin using retrospective and cross-sectional data. Yet individuals’ families matter beyond simply the presence or absence of abuse, and these effects may vary across time. To address these issues, the present study employed five waves of longitudinal data from the Toledo Adolescent Relationships Study (TARS) to investigate the trajectory of IPV from adolescence to young adulthood (N = 950 respondents, 4,750 person-periods) with a specific focus on how familial factors continue to matter across the life course. Results indicated that family-of-origin violence and parent-child relationship quality were independent predictors of IPV. The effect of parent-child relationship quality on IPV also became greater as individuals aged. These results have implications for policies targeted at reducing IPV.     

Management of violent behaviour in the correctional system using qualified risk assessments

Purpose. This study focused on whether institutional violence in a maximum‐security correctional institution could be prevented using comprehensive risk assessments followed by adequate risk management. And, could this be shown by a decrease in risk factors for violence according to the HCR‐20 Risk Assessment Scheme in the study group? Methods. Offenders with a history of violent criminality were subject to real‐life assessments using the HCR‐20 Risk Assessment Scheme. The assessments were followed by discussions with members of staff, in which risk management strategies were designed. Thus, the members of staff were fully aware of every inmate's personality characteristics (e.g. psychiatric diagnoses), what risk factors for violence they displayed, and how best to manage those risk factors. With the aim of evaluating the possible effects of our interventions, approximately one third of the study group was reassessed after a mean of 12 months. Results. The follow‐up showed no significant decrease in important risk factors for violence in the study group. However, the number of violent incidents showed a remarkable decrease during the study period. Conclusions. Not being able to reduce important risk factors for violence does not necessarily mean that one cannot decrease the risk for, or the incidence of, violence. This study indicates that proper and adequate risk management, using the best protective factors available, can reduce violence even though important risk factors cannot be decreased. The study also supports the theoretical assumption that changes in risk factors are more possible in some populations (e.g. general psychiatric) than in others (e.g. correctional) depending on the nature of the study group and the risk factors that are at hand (e.g. dynamic vs. static). This seems to be important to bear in mind when performing evaluation research using risk assessment instruments.