Applying a forensic actuarial assessment (the Violence Risk Appraisal Guide) to nonforensic patients

The actuarial Violence Risk Appraisal Guide (VRAG) was developed for male offenders where it has shown excellent replicability in many new forensic samples using officially recorded outcomes. Clinicians also make decisions, however, about the risk of interpersonal violence posed by nonforensic psychiatric patients of both sexes. Could an actuarial risk assessment developed for male forensic populations be used for a broader clientele? We modified the VRAG to permit evaluation using data from the MacArthur Violence Risk Assessment Study that included nonforensic male and female patients and primarily self-reported violence. The modified VRAG yielded a large effect size in the prediction of dichotomous postdischarge severe violence over 20 and 50 weeks. Accuracy of VRAG predictions was unrelated to sex. The results provide evidence about the robustness of comprehensive actuarial risk assessments and the generality of the personal factors that underlie violent behavior.     

A Classification Tree Approach to the Development of Actuarial Violence Risk Assessment Tools

Since the 1970s, a wide body of research has suggested that the accuracy of clinical risk assessments of violence might be increased if clinicians used actuarial tools. Despite considerable progress in recent years in the development of such tools for violence risk assessment, they remain primarily research instruments, largely ignored in daily clinical practice. We argue that because most existing actuarial tools are based on a main effects regression approach, they do not adequately reflect the contingent nature of the clinical assessment processes. To enhance the use of actuarial violence risk assessment tools, we propose a classification tree rather than a main effects regression approach. In addition, we suggest that by employing two decision thresholds for identifying high- and low-risk cases--instead of the standard single threshold--the use of actuarial tools to make dichotomous risk classification decisions may be further enhanced. These claims are supported with empirical data from the MacArthur Violence Risk Assessment Study.     

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.     

Predicting violence among forensic-correctional populations: the past 2 decades of advancements and future endeavors

Research on violence prediction during the past 2 decades has evolved appreciably in terms of depicting determinants of violence and developing psychometrically sound actuarial measures to predict the probability of future violent behavior. This article provides a brief synopsis of information on predicting violence gained in the past 2 decades, the methodological advances evolved, and finally significant gaps in violence prediction that still exist for future research endeavors.     

The Influence of Actuarial Risk Assessment in Clinical Judgments and Tribunal Decisions about Mentally Disordered Offenders in Maximum Security

Research has shown that actuarial assessments of violence risk are consistently more accurate than unaided judgments by clinicians, and it has been suggested that the availability of actuarial instruments will improve forensic decision making. This study examined clinical judgments and autonomous review tribunal decisions to detain forensic patients in maximum security. Variables included the availability of an actuarial risk report at the time of decision making, patient characteristics and history, and clinical presentation over the previous year. Detained and transferred patients did not differ in their actuarial risk of violent recidivism. The best predictor of tribunal decision was the senior clinician's testimony. There was also no significant association between the actuarial risk score and clinicians' opinions. Whether the actuarial report was available at the time of decision making did not alter the statistical model of either clinical judgments or tribunal decisions. Implications for the use of actuarial risk assessment in forensic decision making are discussed.     

A Time Series Modeling Approach in Risk Appraisal of Violent and Sexual Recidivism

For over half a century, various clinical and actuarial methods have been employed to assess the likelihood of violent recidivism. Yet there is a need for new methods that can improve the accuracy of recidivism predictions. This study proposes a new time series modeling approach that generates high levels of predictive accuracy over short and long periods of time. The proposed approach outperformed two widely used actuarial instruments (i.e., the Violence Risk Appraisal Guide and the Sex Offender Risk Appraisal Guide). Furthermore, analysis of temporal risk variations based on specific time series models can add valuable information into risk assessment and management of violent offenders.     

A prospective study of predictors of violence in adult male mental health admissions

Studies of violence prediction have typically involved long-range follow-up of institutionalized persons and have shown poor predictive accuracy. In the present study a sample of adult males at risk for violent behavior admitted as inpatients at a community mental health center was followed for six months after their release. Data collected at admission (which included demographics, family back-ground, criminal justice and mental health systems contacts, past violent behavior, life stress, family, friendship, and work environment measures, psychiatric diagnosis, and alcohol and drug use) were used to predict subsequent violent arrests or readmissions using stepwise discriminant analysis. Results yielded 85% of the total sample correctly classified. Of those predicted to be nonviolent 94% were actually nonviolent and of those predicted to be violen 59% were actually violent. Seventy-six percent of the violent subjects were identified. Implications of the findings for clinical predictions of violence are discussed.     

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.     

Green Criminology and the Reconceptualization of School Violence: Comparing Green School Violence and Traditional Forms of School Violence for School Children

School crime and violence continue to be important topics of criminological inquiry. Forms of violence that have received much attention from criminologists include school gun violence, assaults, and bullying. What appears missing from criminological studies are analyses of different forms of violent victimization imposed on school children related to environmental injustice, pollution, and exposure to toxins. In this article, we argue for the interpretation of these harms as violent victimizations. To facilitate this, we draw upon definitions of violent victimization developed in green criminology, conceptualizing exposure to environmental toxins as violent assault, and introduce the term green school violence (GSV). Next, we draw upon the medical, environmental, and public health literature to offer a series of examples of GSV in the United States, discuss numerous environmental hazards present in American schools, and describe their scope and severity. A conservative estimate of the frequency of GSV suggests that far more school children are victimized by GSV than forms of interpersonal acts of violence.     

Strategies for an empirical analysis of the prediction of violence in emergency civil commitment

Dix (1976) recently has proposed that a “true experiment” be conducted to assess the validity of predictions of imminent violence. A random sample of persons predicted to be iminently violent would be denied emergency civil commitment in order to test whether they do, in fact, commit a violent act. This article analyzes Dix's proposal and finds that it presents an unacceptable level of risk to the community. Four alternative methodologies by which preliminary data can be gathered on the validity of predictions of violence in emergency civil commitment are described.     

Violent Sex Offenses: How are They Best Measured from Official Records?

In the United States, sexually violent predator (SVP) commitment statutes generally require assessment of an offender's risk of subsequent sexual violence. Current actuarial methods for predicting sexual reoffending were actually designed to predict something else—charges or convictions for offenses deemed sexual based on information obtained from police “rapsheets” alone. This study examined the referral and past offenses of 177 sex offenders. Results showed that police rapsheets (and data based on them) underestimated the number and severity of sexually motivated violent offenses for which sex offenders were actually apprehended. Rapsheet violent offenses seemed a more accurate index of the conduct addressed by SVP legislation than were rapsheet sex offenses. We suggest that, when evaluating sex offenders for SVP status, actuarial instruments designed to predict violent recidivism (as measured by rapsheet violent reoffenses) might be preferable to those designed to predict sexual recidivism (as measured by rapsheet sexual reoffenses).

DOES UNDOCUMENTED IMMIGRATION INCREASE VIOLENT CRIME?*

Despite substantial public, political, and scholarly attention to the issue of immigration and crime, we know little about the criminological consequences of undocumented immigration. As a result, fundamental questions about whether undocumented immigration increases violent crime remain unanswered. In an attempt to address this gap, we combine newly developed estimates of the unauthorized population with multiple data sources to capture the criminal, socioeconomic, and demographic context of all 50 states and Washington, DC, from 1990 to 2014 to provide the first longitudinal analysis of the macro‐level relationship between undocumented immigration and violence. The results from fixed‐effects regression models reveal that undocumented immigration does not increase violence. Rather, the relationship between undocumented immigration and violent crime is generally negative, although not significant in all specifications. Using supplemental models of victimization data and instrumental variable methods, we find little evidence that these results are due to decreased reporting or selective migration to avoid crime. We consider the theoretical and policy implications of these findings against the backdrop of the dramatic increase in immigration enforcement in recent decades.     

Dating violence among college men and women: evaluation of a theoretical model

This study empirically evaluates the Riggs and O'Leary (1989) model of dating violence. A sample of 200 college students completes assessments concerning the occurrence of violence in their dating relationships. The incidence of self-reported partner violence is 25% for women and 10% for men. Multivariate logistic regression analyses are performed to determine the most salient predictors of dating violence for each gender. Findings reveal that the model is more accurate in predicting female, as compared with male perpetration of dating violence. The model accurately classifies 83% of violent women and only 30% of violent men. This study has several implications for the field of dating violence. Results indicate that although there is some degree of overlap, variant constructs predict violence for each gender. Identifying these constructs will guide prevention efforts in more effectively decreasing the occurrence of dating violence.     

Behind closed doors: the effect of pretrial publicity on jury deliberations

Abstract

Effective treatment of aggressive behaviour and accurate release decision making are necessary components of adequate clinical practice in forensic psychiatric units. Unfortunately, methods to identify treatment targets and ameliorate aggressive behaviour have developed at a slower pace than risk assessment technologies. Recent progress on the identification of offence paralleling or functionally equivalent behaviour offers a framework for individually tailored treatment and idiographic release decision making, although empirical scrutiny of this approach is inadequate. This paper describes an examination of the relationship between aggressive behaviour prior to admission with aggression during inpatient psychiatric treatment, and reconviction for violent offending following discharge. Results showed a relationship between pre- and post-admission aggression but no relationship between aggression during inpatient psychiatric treatment with either pre-admission aggressive behaviour or violent recidivism. These findings indicate the importance of state psychological variables, specifically those states affected by symptoms of psychiatric illness, as well as environmental activators and inhibitors of violence that operate within the hospital. These require inclusion in an adequate functional analysis of aggressive behaviour for forensic psychiatric patients.     

Screening for risk of inpatient violence

A screening checklist for assessing the risk of violence at the time of psychiatric hospitalization was developed. Checklist items and a cutoff point for low versus high risk of violence were selected based on a previous study of statistical prediction of violence. Application of the checklist to a new sample of 338 patients admitted to a university-based inpatient unit revealed promising results in identifying patients who later displayed aggressive behavior in the hospital, as indicated by its positive predictive value (59.0%), negative predictive value (70.6%), sensitivity (57.2%), specificity (70.0%), total predictive value (65.4%), and likelihood ratio (1.97). The results suggest the potential value of incorporating actuarial methods in the evaluation of violence risk.Funded in part by Biomedical Research Support Grant Program grant No. SO7-RR05775 from the Division of Research Resources, National Institutes of Health. Portions of this paper were presented at the Biennial Conference of the American Psychology-Law Society/Division 41 of the American Psychological Association, San Diego, CA, March 12–14, 1992. Correspondence concerning this article should be addressed to Dale E. McNiel.     

Patterns of violence and self-harm in women prisoners: characteristics,co-incidence and clinical significance

Self-harm and violence in women’s prisons in England are common and occurring with increasing frequency. We aimed to describe the characteristics and patterns of violent and/or self-harming behaviours in women in prison by conducting a retrospective analysis of routine data about self-harm incidents and adjudications. Incidence rates of self-harm and violence were calculated and associated factors explored using logistic regression. We found that only 6.7% of 5486 women prisoners self-harmed and 7.9% had been violent. Eighty per cent of all self-harm incidents related to 70 women. Almost 4 in 10 women prisoners who self-harmed were also violent. Multiple incarcerations and court movements are associated with incidents of self-harm and violence. Women with high-frequency self-harm (≥6) began self-harming early in their custodial period. We conclude that women prisoners who are very behaviourally disturbed can and should be identified early. They warrant clinical formulation and multi-agency responses to risk. Those with high-frequency self-harm should be cared for by external health services.     

Limitations of Diagnostic Precision and Predictive Utility in the Individual Case: A Challenge for Forensic Practice

Knowledge of group tendencies may not assist accurate predictions in the individual case. This has importance for forensic decision making and for the assessment tools routinely applied in forensic evaluations. In this article, we applied Monte Carlo methods to examine diagnostic agreement with different levels of inter-rater agreement given the distributional characteristics of PCL-R scores. Diagnostic agreement and score agreement were substantially less than expected. In addition, we examined the confidence intervals associated with individual predictions of violent recidivism. On the basis of empirical findings, statistical theory, and logic, we conclude that predictions of future offending cannot be achieved in the individual case with any degree of confidence. We discuss the problems identified in relation to the PCL-R in terms of the broader relevance to all instruments used in forensic decision making.     

Against Prevention? A Response to Harcourt's Against Prediction on Actuarial and Clinical Predictions and the Faults of Incapacitation

This article reviews Bernard Harcourt's Against Prediction: Profiling, Policing, and Punishing in an Actuarial Age (2007), in which he criticizes the use of actuarial prediction methods in the contexts of policing and sentencing. I focus on the latter context. I argue that Harcourt has identified an important, and not exclusively American, trend and develops a valid critique of it that should be pushed further. From a theory of punishment perspective, I argue that Harcourt's critique is no less applicable to clinical prediction methods than to the use of actuarial ones. Harcourt's arguments, however, beg a more general explanation of the flaws of incapacitation as a justification for punishment. If we base our objection to the use of prediction methods on such larger grounds, questions arise as to the legitimacy of other practices that are not considered punitive but rather "regulatory" or "preventive."     

Issues in violent risk assessment: lessons learned and future directions

Realizing that the assessment of dangerousness with a yes/no format as a poor form of violent risk assessment has been the most important lesson learned about violence in the last 20 years. Further examining (a) what outcome and (b) how the indicators of the outcome should be measured has resulted in better violent risk assessment. The most promising methodological innovation in violent risk assessment has been the introduction of the receiver operating characteristic to assess the efficiency of risk prediction. In the future, the tension between prediction and explanation of violence will need to be maintained while focusing on a mechanism-driven strategy of risk management.