Dynamic risk and violence in individuals with an intellectual disability: tool development and initial validation

Without a violence risk assessment designed for people with an intellectual disability (ID), assessors are reliant upon tools developed for mainstream offenders or develop their own tools. This study describes the early stages of development of the Current Risk of Violence (CuRV), an informant-reported measure of dynamic risk for aggression in adults with an ID. The pool of items was generated from a multitude of sources. Predictive accuracy for aggression was tested prospectively among 64 adults with an ID and history of aggression. The 34-item CuRV was found to be a brief, uncomplicated risk assessment. Initial findings revealed good predictive validity over a five-month period: area under the curve (AUC) range from .72, 95% CI [.59, .85] to .77, 95% CI [.66, .89]. These preliminary findings suggest that the CuRV may assist staff to perform assessments of risk in busy clinical settings. Future research effort is needed to fully explore the psychometric properties of the CuRV.     

Incremental validity of ambulatory assessment of acute dynamic risk in predicting time to recidivism among prisoners on parole

ABSTRACT

This study investigates the incremental validity of changes in ten stress-related acute dynamic risk factors, collected through automated telephony over 30 consecutive days following parole, for predicting time to recidivism during the following year. Before release, the participants completed self-report assessment of some stable risk factors – impulsiveness and history of problematic substance use – as well as an assessment of symptoms of anxiety experienced during the weeks prior to release. Analysis of the baseline assessments showed that impulsiveness and a history of problematic substance use, but not pre-release symptoms of anxiety, were associated with recidivism during the parole year. Growth modelling using a linear mixed model was used to assess whether inmates on parole showed changes in acute dynamic risk factors during the first month following release. Individual growth model slopes and intercept were then extracted and used as covariates in a series of Cox regression analyses to test whether changes in acute dynamic risk factors could provide incremental predictive validity beyond baseline stable risk factors. Changes in five dynamic risk factors were associated with an increased risk of recidivism, of which daily drug use and daily summary score showed incremental predictive improvement beyond impulsiveness and history of problematic drug use.     

Construct validity,reliability and predictive validity of the dynamic risk assessment and management system (DRAMS) in offenders with intellectual disability

Background. There have been a number of developments in the assessment of dynamic risk in the criminological literature. The dynamic risk assessment and management system (DRAMS) has been developed to facilitate the measurement of dynamic factors of risk for offenders with intellectual disability. Method. The study was designed to assess the construct validity, reliability and predictive utility of the DRAMS in 23 male forensic patients in a high secure setting. Predictions were made against independently collected incident data. Concurrent validity was assessed against the Ward Anger Rating Scale (WARS). Results. A reformulation of the individual section variables according to convergent and discriminant correlational analysis revealed Cronbach's alpha levels of >.8 for all sections apart from mood (alpha .750) and items retained to facilitate clinical information (alpha ?.017). Two hundred pairs of WARS and DRAMS assessments revealed orderly sectional correlations. The sections of mood, antisocial behaviour, and intolerance/agreeableness predicted incidents with a medium effect size as did total DRAMS score. There were highly significant differences between assessments taken 1 or 2 days prior to an incident and control assessments conducted at least 7 days from an incident. Conclusions. The reformulated DRAMS has good construct and concurrent validity. It appears to be a reliable assessment tool and informs on risk levels relating to stable and acute proximal factors. It appears as an important addition to the utility of risk assessments for this population.     

Assessing dynamic risk and protective factors in the community: examining the validity of the Dynamic Risk Assessment for Offender Re-entry

Recently, there has been a growing interest in advancing the state of offender risk assessment: particularly through the development of risk instruments to assist with parole management and the incorporation of protective factors specific to re-entry. The current study's aim was to validate a measure of stable and acute dynamic risk factors and protective factors used by probation officers managing offenders in the community: the Dynamic Risk Assessment for Offender Re-Entry (DRAOR). Empirical examination of the structure of DRAOR scores soon after release from prison suggested four components, rather than the theoretically proposed three-subscale structure. Both the original three subscales and the four new subscales showed good convergent validity with other dynamic risk instruments, and reliably predicted new convictions; however, only the new stable component added significant incremental predictive power over existing static and dynamic risk instruments. These findings provide initial support for the validity of the DRAOR; suggestions for future research are discussed.     

Adapting measures of social climate for use with individuals with intellectual developmental disability in forensic settings

The social climate of forensic settings is thought to impact on a number of important clinical and organisational outcomes and is, therefore, an important construct in relation to the successful functioning of forensic units. A variety of self-report questionnaires have been developed to objectively measure the social climate of forensic settings (e.g. the Correctional Institutions Environment Scale and the Essen Climate Evaluation Schema), however these questionnaires have not been validated for individuals with intellectual developmental disabilities (IDD). Given the prevalence of IDD in prison and forensic psychiatric settings and the potential impact of such cognitive deficits on the ability to complete a range of self-report questionnaires, it is important to consider the potential reliability and validity of existing social climate measures in IDD populations. This article will, therefore: (1) examine the cognitive, linguistic and response format difficulties that may arise when administering self-report measures of social climate in IDD populations; (2) consider potential adaptations to existing measures of social climate that might make them more suitable for use with IDD populations; and (3) identify important directions for future research in the area.     

The predictive validity of youth violence risk assessment tools: a systematic review

ABSTRACT

This paper reports the findings of a systematic search of published literature which reports the predictive validity of violence risk assessment tools specifically designed for use with youth. A total of 38 studies, involving 9,307 participants, reported data for six different tools; the most common of which were the SAVRY and the YLS/CMI. Each of the tools demonstrated at least moderate levels of predictive validity, with the predictive validity of several newer assessment tools yet to be established. The results provide an up-to-date overview of the state of knowledge in an area in which practitioners make choices about which tools to use on an almost daily basis. It is important that practitioners are aware of the strength of evidence that is available to support the choice of violence risk assessment tools and the interpretation of results.     

Inter-rater reliability of dynamic risk assessment with sexual offenders

Abstract

This paper describes the inter-rater reliability of the Structured Assessment of Risk and Need (SARN, formerly known as Structured Risk Assessment). The SARN is a structured framework for identifying sexual offenders’ dynamic risk factors. The SARN comprises 16 dynamic risk factors, categorized into four domains: Sexual Interests, Distorted Attitudes, Socio-Affective Functioning and Self-Management. Two studies, utilizing three samples, are reported. Study 1 examined the inter-rater reliability of four SARN cases with a sample of seven expert raters. Results indicated high inter-rater reliability amongst these participants. Study 2 examined the reliability of SARN with two samples who had received training before supplying inter-rater data (N=88). Results provided some support for the reliability of SARN. However, strength of reliability was dependent upon the method of analysis applied (percentage agreement, Cohen's Kappa, intra-class correlation coefficients). These results are discussed in terms of their clinical and methodological implications.     

The Static-99R predicts sexual and violent recidivism for individuals with low intellectual functioning*

A current debate is whether actuarial risk assessment tools predict sexual recidivism in sexual offenders with intellectual disabilities (SOIDs). Since intellectual functioning exists on a spectrum, the present study examined the predictive validity of the Static-99R across the range of intellectual functioning. The sample was comprised of 454 adult sexual offenders assessed at an outpatient clinic and followed for an average of 10 years. Offenders in the extremely low/borderline group had higher scores on the Static-99R than other offenders, largely due to their score on the detachment subscale of the Static-99R, but did not have significantly higher recidivism rates. Calibration analyses suggested that the expected and observed recidivism rates did not differ significantly. Intellectual functioning did not add incremental validity to the Static-99R. Further, there was no interaction between intellectual functioning and actuarial risk score. The results suggested that the Static-99R can be used across the range of intellectual functioning, albeit somewhat more cautiously for those at the lowest and highest end of the intellectual functioning distribution.     

Socially desirable responding and psychometric assessment of dynamic risk in sexual offenders against children

Does socially desirable responding (SDR) represent a threat to the validity of dynamic risk assessment in sex offenders’ self-reports? We studied a sample of men (N?=?218) who completed a psychometric assessment battery while enrolled at Kia Marama, a prison-based treatment program for sexual offenders against children. SDR, as measured by the Marlowe-Crowne scale, was elevated compared to non-offender samples, increased from pre- to post-treatment, and was negatively correlated with dynamic risk (rs?=??.30 to ?.40), consistent with previous research. Measures of dynamic risk factors derived from the psychometric battery were correlated with sexual recidivism, but correlations were little changed when variance associated with SDR was removed using a regression procedure [Mills, J. F., &; Kroner, D. G. (2006). Impression management and self-report among violent offenders. Journal of Interpersonal Violence, 21(2), 178–192.]. These results suggest that there is a substantial component of the variance in psychometric self-reports of sexual offenders that is associated with SDR (approximately 10%), but that it does not compromise the predictive or construct validity of dynamic risk measures derived from these reports.     

Prediction of institutional aggression among personality disordered forensic patients using actuarial and structured clinical risk assessment tools: prospective evaluation of the HCR-20, VRS,Static-99, and Risk Matrix 2000

A minority of men and women with intellectual disabilities at times engage in, and are suspected, or convicted, of illegal activity. Recent policy developments in England and Wales emphasise the need to respond appropriately to putative offending risk through the provision of safe and effective community management, treatment, and support services. In line with these concerns, research has focused increasingly on testing the utility of an evolving variety of risk assessment procedures. Here, the authors set out to challenge the repertoire of a number of prominent and/or recently developed risk assessment procedures and the scope of an associated research literature, on the basis that contextual risk factors are receiving insufficient attention in relation to offending among people with intellectual disabilities. Drawing on the wider criminological literature, a novel study is reported that compares key contemporary proximal social and environmental circumstances in the lives of offenders and non-offenders with intellectual disabilities. A contextual risk score is derived, providing statistical support for increased consideration of the impact of relevant social and environmental circumstances. Increased emphasis on key contextual risk factors is recommended to strengthen community service responses to offenders with intellectual disabilities.     

Assessing change in dynamic risk factors in forensic psychiatric inpatients: relationship with psychopathy and recidivism

This study explored change in dynamic risk for violence using the Clinical and Risk Management subscales of the Historical Clinical and Risk Management-20 version 3 (HCR-20 v3) and sought to determine whether change was associated with violent recidivism. The association between the magnitude of change and psychopathy was also assessed. Participants were 40 male (n = 32) and female (n = 8) forensic psychiatric inpatients discharged from a secure forensic mental health service. Results showed that participants significantly improved on the HCR-20v3 Clinical subscale but significantly worsened on the Risk Management subscale. Psychopathy was unrelated to change in Clinical and Risk Management subscales. The hypothesis that changes in dynamic risk would predict recidivism over and above total pre-treatment risk (HCR-20v3 Total score) and psychopathy was not supported. These results suggest that improvements in mental state risk factors alone are insufficient with regard to lowering violence risk.     

A comparison of seclusion rates between intellectual disability and non-intellectual disability services: the effect of gender and diagnosis

Introduction: The use of seclusion as a means of managing the extreme behaviours forensic patients in secure settings is a controversial yet often common practice, despite there being little evidence that seclusion as a practice has any significant therapeutic value for the patient. The aim of this study was to explore the use of seclusion and whether this differs as a function of gender and diagnosis across secure services. Method: This study collated data from 11 medium and low secure hospitals that admit male and female patients, with some services providing services for patients with intellectual disability (with or without co-morbid disorders), and others for patients with mental illness and/or personality disorder only. Results: Both gender and diagnosis were associated with differential seclusion rates. Seclusions were three times longer for patients in the non-ID compared to the ID service. Male seclusions (for any diagnosis) were around twice as long as those in female services. Female ID patients spent significantly less time in seclusion compared to other groups. Female ID was associated with two to three times the number of seclusion events per patient compared to other groups. No statistically significant association between the type of service and the reason for a patient being secluded. Conclusions: A range of organisational factors that determine the use and duration of seclusion are cited and merit further exploration. High rates of psychiatric co-morbidity and the complexity of patients admitted to services may also mediate risk and use of seclusion. The study supports the use of early intervention techniques and the adoption of positive behaviour support.     

People with special needs and sexual behaviour problems: balancing community and client interests while ensuring effective risk management

Abstract

Deinstitutionalisation movements of the mid-1900s led to changes in policy and practice in the management of people with special needs (defined for this article as people with severe and persistent mental illness, intellectual disabilities and high levels of personality factors that interfere with treatment participation). Although the majority of clients with special needs receive care in community settings and interact more with family, friends and others in the community, some such clients require more rigorous case management. For clients who have offended, especially sexually, community-based services are scarce, and concerns regarding reoffence potential often supersede traditional understandings of diminished capacity. Recent reports suggest that jails and prisons have replaced hospitals as the institutions-of-choice for clients with special needs who engage in inappropriate conduct. This paper examines policies and practices regarding community risk management of people with special needs who have sexually offended. Vignettes are provided to illustrate how some clients and agencies have been affected, and suggestions are made to ensure best practices in risk management and public safety.     

Popping the cultural bubble of violence risk assessment tools

Violence risk instruments are administered in medico-legal contexts to estimate an individual’s likelihood of future violence. However, their ostensible limitations; in particular their mono-cultural and risk-centric composition, has drawn academic attention. These concerns may facilitate erroneous risk evaluations for certain non-white populations. Yet it remains unaddressed how cultural differences will be appraised in a risk assessment framework and which specific cultural factors should be considered. Provisions under the Canadian Criminal Code allow for Gladue Reports, to be sought by judicial officers prior to sentencing Indigenous people. Gladue Reports provide insights into an Indigenous person’s unique circumstances that may have led to their offending as well as community-based options for rehabilitation. We proffer that there may be value in augmenting the risk evaluation with culturally relevant Gladue style considerations identified by relevant Indigenous people to provide a more holistic account of an Indigenous individual’s circumstances.     

Challenges for the theory and application of dynamic risk factors

ABSTRACT

The inclusion of dynamic factors in risk assessment measures used with forensic populations has largely been considered an improvement in both the accuracy and utility of these assessments in informing treatment and sentencing. However, there are important challenges associated with the current approach to the conceptualisation, identification, and use of dynamic factors in risk assessment. Whereas some of these challenges relate to applied settings (such as the use of measures with different offender populations), there are also deeper questions regarding the construct validity of dynamic risk measures and the methodological strategies used to identify them. More emphasis on theoretically driven research is needed, to identify causal and explanatory relationships between dynamic risk factors and recidivism. We hope that highlighting these challenges can help to build a consensus on a future research agenda for dynamic risk factors.     

Resettle: a significant new step in an emerging pathway that manages risk and addresses need in high-risk personality disordered offenders on their release into the community

Abstract

This paper will describe an innovative UK service development, Resettle, which is designed to address the needs and risks of personality disordered offenders who are released into the community from prison and whose high risks of harm and re-offending are linked to their personality disorder (PD). All the cases worked with are subject to Multi-Agency Public Protection Arrangements (MAPPA). This non-residential, intensive community-based service is nationally funded jointly by the Department of Health and Ministry of Justice, originally as part of the Dangerous and Severe Personality Disorder (DSPD) programme for high-risk offenders. Resettle became operational in 2008. It is currently being independently evaluated via a randomised control trial that is due to complete in March 2013. Formal outcome data are, therefore, not yet available, however, the developing model of intervention based on experience and learning to date is described alongside the policy and service context for this area of work.     

Violence risk profile of medium- and high-security NGRI offenders in Belgium

Under Belgian law, offenders not guilty by reason of insanity (NGRI) are committed by the courts to forensic mental health treatment. The use of violence risk assessment tools has become routine in these settings. However, there are no national statistics regarding violence risk assessment in the Belgian forensic population. A study was undertaken to collect risk assessment data (PCL-R, VRAG, HCR-20) on a large cohort of forensic patients committed to Medium Security units in the Flanders region and in High-Security units in the Walloon region. Flemish patients were expected to present a lower risk compared with their Walloon counterparts. Instead, data yielded by a structured risk assessment method demonstrate the opposite. Moreover, the majority of patients in Flemish facilities had committed violent offenses and were institutionalized for shorter periods whereas the majority of Walloon patients had committed sexual offenses and were institutionalized for markedly longer periods.     

WAIS-RC简式与成人智残评定量表在精神伤残评定中的应用

目的 考察中国修订版韦氏成人智力量表(WAIS-RC)简式与成人智残评定量表在精神伤残评定中的适用性.方法 对台州学院司法鉴定所2009年7月-2011年3月进行精神伤残鉴定的案例,用WAIS-RC简式和成人智残评定量表分别评定并与专家鉴定意见进行比较,用SPSS11.5进行统计分析.结果 WAIS-RC简式、成人智残...     

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.