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.     

Patient competence and professional incompetence: disagreements in capacity assessments in one Australian jurisdiction, and their educational implications

The determination of capacity to make medical, personal and financial decisions has significant individual and social implications. Medical and other health professionals are traditionally relied on by courts and tribunals to provide clinical and psychometric evidence of the presence or absence of capacity, or competence. Concern has long been expressed over the variability of these assessments. A survey of 285 decisions of the Queensland Guardianship and Assessment Tribunal (GAAT) between 2005 and 2008 was conducted to estimate the incidence of disagreement between health professionals in capacity assessments; to provide examples of conflicting assessments and models of assessment used; and to consider the educational implications of disagreements. While the final capacity determinations by the GAAT appear sound, this case series, and other studies in the capacity literature, strongly suggest the need to improve the education of health professionals, especially doctors, at undergraduate and postgraduate levels, in the practical assessment of capacity as a fundamental clinical skill.     

What do NHS staff learn from training on the Mental Capacity Act (2005)?

Purpose. Many studies have reported that professionals have a limited understanding of mental capacity issues. Implementation (in England and Wales) of the Mental Capacity Act (MCA) (2005) presents a challenge to services. The aim of this study was to evaluate the extent to which National Health Service (NHS) staff benefited from attending MCA training courses. Methods. Participants were assessed before and after MCA training using a structured interview, which included three scenarios describing mental capacity dilemmas, four vignettes addressing the role of the Independent Mental Capacity Advocate (IMCA), and 16 true–false items. Results. Interview performance improved post‐training, but this could be largely ascribed to an increased awareness of mental capacity issues, with minimal improvements in the knowledge that would be needed to undertake the assessments. Nine areas were identified where there remained significant gaps in participants’ knowledge post‐training. Participants with experience of dealing with mental capacity issues performed better than those without. Conclusions. The results suggest that methods other than formal training events may be needed to prepare health staff to implement new legislation.     

Coercion,competence, and consent in offenders with personality disorder

Competence to consent to treatment has not previously been examined in a personality disorder cohort without comorbid mental disorder. We examined competence and coercion in 174 individuals diagnosed with severe personality disorder using two validated tools (the MacArthur Competence Assessment Tool for Treatment and the MacArthur Coercion Assessment Scale – Short Form). Competence was not categorically impaired, but there were variations within the sample on dimensional competence measures. Further, there were significant negative correlations between experienced coercion and competence. Higher coercion scores were associated with two components of competence: lower understanding and reasoning. Patients who consented to treatment had higher scores on competence measures and experienced less coercion. These findings suggest that therapeutic approaches that decrease experienced coercion and increase competence may increase the engagement of individuals diagnosed with severe personality disorders in treatment.     

Mental Capacity in Patients Involuntarily or Voluntarily Receiving Psychiatric Treatment for an Acute Mental Disorder

Despite the growing amount of data, much information is needed on patients' mental capacity to consent to psychiatric treatment for acute mental disorders. The present study was undertaken to compare differences in capacity to consent to psychiatric treatment in patients treated voluntarily and involuntarily and to investigate the role of psychiatric symptoms, competency, and cognitive functioning in determining voluntariness of hospital admission. Involuntary patients were interviewed with the MacArthur Competence Assessment Tool for Treatment (MacCAT‐T), the 24‐item Brief Psychiatric Rating Scale (BPRS), the Mini Mental State Examination (MMSE) and the Raven's Colored Progressive Matrices, and their data were compared with those for age‐ and sex‐matched voluntary patients. Involuntary patients performed worse in all MacCAT‐T subscales. Capacity to consent to treatment varied widely within each group. Overall, involuntary patients have worse consent‐related mental capacity than those treated voluntarily, despite capacity to consent to treatment showing a significant variability in both groups.     

Expert Disagreement in Bitemark Casework*

Abstract: Bitemark cases continue to raise controversy due to the degree of expert disagreement which is frequently seen. Using a case mix of 49 bitemark cases from 2000 to 2007 each injury was independently assessed for its forensic significance using a previously described bitemark severity scale. Following the assessment, the mean value for the bites was categorized according to the crime type, the degree of expert agreement, and the judicial outcome. Results suggest that bitemarks found in child abuse cases have statistically significantly lower forensic value than those in other crime types, that bites where there is mutual agreement between experts will have higher forensic value than those where there is disagreement at trial, and that cases in which DNA has provided an exoneration will demonstrate similar quality to those where a conviction was secured. Forensic odontologists should carefully assess bitemark evidence and ensure that it meets certain minimums in relation to the presence of class and unique features before undertaking an analysis.     

Decisional Capacity and Personality Disorders: Substantially Unable or Substantially Unwilling?

Capacity assessments are performed when there is suspicion that a person is unable to adequately care for their physical, medical, or financial well-being. The purpose of these assessments is to inform the legal system as to whether or not guardianship may be necessary. It is well established that certain mental illnesses, such as neurocognitive disorders (dementia) or psychotic disorders (like schizophrenia), may diminish capacity and, in some cases, lead to the need for establishment of a legal guardian. However, personality disorders are another common category of mental illness which may impair decision-making. There is very little information in the literature about how or why these disorders could impair capacity, and thus, it can often be difficult to discern whether clients with personality disorders are substantially unable to care for themselves—versus unwilling to act in a way contrary to their ingrained habits. We present a series of three cases in which clients are determined to lack capacity primarily mediated by a personality disorder diagnosis. They are demonstrated to have mild deficits in cognitive functioning, but they show impaired decision-making out of proportion to these deficits. In all three cases, it is apparent that the personality disorder is substantially impairing their ability to care for themselves. Discussion includes consideration for ways to incorporate evaluations of cognitive function, activities of daily living, and personality considerations into capacity assessments, and how to approach recommendations (such as guardianship vs. less restrictive option) based on both level and scope of impairment.     

Screening for mental disorder using the UK national offender assessment system

Probation officers have large caseloads with high levels of psychiatric morbidity but receive minimal training in recognising/managing mental health problems. In the UK, there is no national screening procedure for mental illness among offenders that is considered effective. This study’s aim was to develop a screening system for mental/personality disorders using the Offender Assessment System. Seven screens for mental disorder were developed using items from assessments on 574 prisoners: alcohol misuse, drug dependence, antisocial personality disorder, psychopathy, learning difficulties, psychosis and severe mood disturbance. Internal validation showed that the screens performed well across accuracy estimates. Prevalence of mental disorders identified with the screens in test and validation samples was similar. However, the psychopathy and severe mood disturbance screens may be more effective in screening for true negatives. The screens are an economical method for prioritising mental health needs of the UK prison and probation population using routinely collected data.     

家事协议的效力与认定

家事协议是由具备家事行为能力的家庭成员就家庭生活重要事项协商一致达成的约束所有家庭成员之协议。具体司法裁判中，家事协议效力应基于其与法律之多重博弈关系，通过考量司法政策取向、司法能力及其系统性影响等因素来认定和择取案件最佳裁判路径与效果。     

Field reliability of the SAVRY with juvenile probation officers: Implications for training

Two complimentary studies were conducted to investigate the inter-rater reliability and performance of juvenile justice personnel when conducting the Structured Assessment of Violence Risk for Youth (SAVRY). Study 1 reports the performance on four standardized vignettes of 408 juvenile probation officers (JPOs) and social workers rating the SAVRY as part of their training. JPOs had high agreement with the expert consensus on the SAVRY rating of overall risk and total scores, but those trained by a peer master trainer outperformed those trained by an expert. Study 2 examined the field reliability of the SAVRY on 80 young offender cases rated by a JPO and a trained research assistant. In the field, intra-class correlation coefficients were 'excellent' for SAVRY total and most domain scores, and were 'good' for overall risk ratings. Results suggest that the SAVRY and structured professional judgment can be used reliably in the field by juvenile justice personnel and is comparable to reliability indices reported in more lab-like research studies; however, replication is essential.     

Functional mental capacity is not independent of the severity of psychosis

BACKGROUND: Function-specific mental capacities are the legal criteria for competence. These are regarded as superior to clinical assessments of mental state and general function. AIMS: To determine whether tests of fitness to plead and capacity to consent are independent of each other and independent of mental state and global function in psychosis. METHOD: The MacCAT-T and MacCAT-FP, PANSS and GAF were administered to 102 compulsorily detained forensic patients with psychosis. Criteria for incompetence were inability to express a preference concerning treatment, and independent rating as unfit to plead. RESULTS: MacCAT-T, MacCAT-FP totals and sub-scales correlated with each other and with PANSS and GAF. Those independently rated unfit to plead or who were incapable of making a treatment choice scored significantly worse on all rating scales. No test had satisfactory sensitivity or specificity. CONCLUSIONS: Legal definitions of mind and of functional capacity offer a basis for structured clinical judgement regarding decision-making capacity. However, function-specific measures of understanding, reasoning and appreciation generate much the same results as measures of mental state and global functioning.     

Physical and Emotional Well‐Being: Court Performance Measures for Children and Youth in Foster Care

Given that courts have the responsibility to ensure the state is providing proper care to children in its custody, courts need to consider whether those children over whom they have jurisdiction are receiving a quality education and are physically and emotionally healthy. Court well‐being measures were not developed when the safety, permanency, timeliness, and due process measures were established. However, there have been recent efforts to address this void. This article describes the newly developed set of well‐being measures for courts to track success in improving well‐being outcomes in the areas of physical health, mental health, maintaining permanent relationships, transition to adulthood, and enhanced family capacity to provide for their children's needs.     

Validation of Spouse Violence Risk Assessment Inventory for Police Purposes

The Spouse Violence Risk Assessment Inventory (SVRA-I) is a new scale developed by the Israeli police to measure the likelihood of male perpetrators repeating violent behavior toward their partners. This article describes the objectives of the inventory, its distinction in comparison to existing inventories, and the process of its development. Our preliminary study demonstrated a reasonable level of inter-rater reliability. Two subsequent studies examined the relationships between clinical assessments and SVRA-I scores, and additional two studies tested the validity of the inventory against criteria of repeated partner abuse. The inventory was found to be a valid and efficient tool for predicting recidivism of intimate partner violence (IPV). In the discussion, we review the limitations of devices aimed at predicting repeated IPV.     

Assessing the Relative Importance of the Child Sexual Abuse Interview Protocol Items to Assist Child Victims in Abuse Disclosure

This study identifies (1) the importance of using the Child Sexual Abuse Interview Protocol for multiple disciplines to obtain detailed information of what the alleged child victims say and claim, and (2) the concurrence of multiple professionals about the relevance of items in the protocol in their practice. A survey with 100 items based on the Child Sexual Abuse Interview Protocol was self administered by 36 professionals working at a child advocacy center including administrators, attorneys, child advocates, support persons, physicians, police, psychologists, and social workers. These respondents unanimously felt it was very important for interviewers to complete two specific items during the course of an investigative interview: “showing the interviewer is listening to the child” and “showing patience with the child.” As indicated by the average rating scores, 89 items were perceived between very important and important, and nine items as somewhat important. No item on this scale was rated as doesn’t matter or unimportant. Social workers and police officers did not differ significantly in their ratings of the importance of these items. Both quantitative and qualitative results support four major considerations when using an interview guide: 1) flexibility in opening and closing the interview, 2) professional and appropriate use of the anatomical dolls, 3) assessment of the age and mental state of the child, and 4) determination of the order of questions based on severity of incidents. This study provides data to identify the importance of using a comprehensive interview protocol for multidisciplinary professionals who work with alleged victims of child sexual abuse. The use of these 100 items will enhance the effectiveness of conducting a one-time interview to avoid repeated interviews. This study that was originally aimed at comparing differences among professionals has, in fact, demonstrated the similarities across disciplines, as agreement among various professional groups was substantial. This finding dissolves the myth that multiple disciplines brought forth diverse opinions and instead encourages the “working together” concept of a team.     

A psychological perspective on vulnerability in the fear of crime

Abstract

This paper examines vulnerability and risk perception in the fear of crime. Past studies have often treated gender and age as proxies for vulnerability, and on the few occasions that vulnerability has been operationalized, there has been little agreement on the mechanisms that underpin perceived susceptibility. To develop a more theoretically-driven approach, the current study examines whether markers of vulnerability are associated with higher levels of fear through mediating assessments of likelihood, control and consequence. Females are found to worry more frequently than males partly because (a) they feel less able to physically defend themselves, (b) they have lower perceived self-efficacy, (c) they have higher perceived negative impact, and (d) they see the likelihood of victimization as higher for themselves and for their social group. Younger people are also found to worry more frequently than older people, but differential vulnerability does not explain this association. Finally, structural equation modelling shows that the effects on worry of physical defence capabilities, self-efficacy and perceived consequence are mostly mediated through judgements of absolute and relative risk. Conclusions focus on the implications of this finding for debates about the rationality of the fear of crime.     

Thermal Imaging as a Lie Detection Tool at Airports

We tested the accuracy of thermal imaging as a lie detection tool in airport screening. Fifty-one passengers in an international airport departure hall told the truth or lied about their forthcoming trip in an interview. Their skin temperature was recorded via a thermal imaging camera. Liars’ skin temperature rose significantly during the interview, whereas truth tellers’ skin temperature remained constant. On the basis of these different patterns, 64% of truth tellers and 69% of liars were classified correctly. The interviewers made veracity judgements independently from the thermal recordings. The interviewers outperformed the thermal recordings and classified 72% of truth tellers and 77% of liars correctly. Accuracy rates based on the combination of thermal imaging scores and interviewers’ judgements were the same as accuracy rates based on interviewers’ judgements alone. Implications of the findings for the suitability of thermal imaging as a lie detection tool in airports are discussed.     

Health economists' views of health policy

This article reports the views of a national survey of U.S. health economists on a series of questions ranging from mergers among health care providers to the profits of pharmaceutical manufacturers to fundamental health care reform. We find a high degree of agreement on issues of fact but considerable disagreement on issues that depend on values. Additional research may help to resolve some remaining disagreement about issues of fact but may do little to resolve disagreement over values. Results from this fall 2005 survey are compared with those from surveys conducted in 1989 and 1995.     

Sentencing

While there is nearly unanimous agreement among social scientists that the defendant's prior record is important in explaining the sentence imposed on the defendant, there is little agreement on the "best" or most appropriate measure of prior record to use in examining sentence disparity. This study provides an assessment of the utility of 11 commonly used measures of prior record. We find that the various measures are not interrelated highly and thus necessarily are not interchangeable. We also find that the measures of prior record affect sentence severity differently and that the relationships between these measures and sentence severity varies for black and white defendants.     

We all want it, but we don't know what it is: toward a standard of affordability for health insurance premiums

The 2010 Patient Protection and Affordable Care Act (P.L. 111-148), or ACA, requires that U.S. citizens either purchase health insurance or pay a fine. To offset the financial burden for lower-income households, it also provides subsidies to ensure that health insurance premiums are affordable. However, relatively little work has been done on how such affordability standards should be set. The existing literature on affordability is not grounded in social norms and has methodological and theoretical flaws. To address these issues, we developed a series of hypothetical vignettes in which individual and household sociodemographic characteristics were varied. We then convened a panel of eighteen experts with extensive experience in affordability standards to evaluate the extent to which each vignette character could afford to pay for one of two health insurance plans. The panel varied with respect to political ideology and discipline. We find that there was considerable disagreement about how affordability is defined. There was also disagreement about what might be included in an affordability standard, with substantive debate surrounding whether savings, debt, education, or single parenthood is relevant. There was also substantial variation in experts' assessed affordability scores. Nevertheless, median expert affordability assessments were not far from those of ACA.