The dynamic prediction of antisocial behavior among forensic psychiatric patients: a prospective field study

Staff ratings of 595 supervised forensic psychiatric patients on the Proximal Risk Factor Scale and the Problem Identification Checklist were completed monthly for an average of 33 months. During the follow-up, there were 265 incidents, 86 of which were violent. The average ratings, excluding those from the index month, differentiated patients who had incidents from those who did not. As well, the average ratings distinguished between individuals with and without incidents of a violent or sexual nature. There were significant increases in staff ratings in the months preceding the index incident month. Within-patient analyses showed that changes in dynamic risk scales comprising the best items for predicting incidents of any kind and violent or sexual incidents were strongly related to their respective outcomes and were significantly related to outcome in an independent sample. Changes in monthly staff ratings predict the imminent occurrence of antisocial and violent behaviors.     

Assessment and training of social competence in dangerous psychiatric patients

Traditional approaches to the assessment and treatment of individuals who have demonstrated dangerous behavior have been based upon a trait model of personality. The social competence model differs from the trait model by assuming that much behavior is situationally determined, that new socially competent behavior patterns can be acquired through observation of models and practice, and that the frequency of undesirable behaviors can be reduced by increasing the frequency of incompatible, desirable behaviors. This paper reports the applications of the social competence model to the assessment and treatment of men in a security hospital, including individuals confined because of specific offenses, such as sex crimes, arson, and institutional assault, as well as those with high overcontrolled-hostility scores, low overall social skill ratings, and low popularity ratings from their peers. The social skills training approach that we have employed has been most successful with sex offenders and arsonists. The results suggest that the most withdrawn and shy individuals derive the greatest benefit from our social skills training approach while overassertive individuals benefit least. It is hypothesized that staff may reward unassertive patient behavior and punish assertive behavior and that future research must focus on changing this pattern in order to foster socially competent behavior by institutional residents. While many problems remain to be answered, our preliminary results suggest the usefulness of the social competence approach in the assessment and treatment of dangerous psychiatric patients and offer the possibility that the approach may lead to better control of violent behavior in the future.