Assessing Risk for Violence

1. Assessing Risk for Violence Dr Lorraine Johnstone Consultant Clinical Forensic Psychologist Honorary Research Fellow Accredited Risk Assessor Lorraine.Johnstone@ggc.scot.nhs.uk

2. Perspectives RESEARCH ORGANISATIONAL PRACTITIONER

3. What is Risk Assessment? Process of evaluating the characteristics of offenders and their environment to estimate the likelihood and the nature of a negative outcome (in this case, violence)

4. “Prediction of dangerousness is particularly difficult because: dangerousness is the resultant of a number of processes which occasionally may be synergistic amounting to more than the sum of the parts, some within the individual and some in society; it is not static; key factors are the individual’s adaptiveness, resistance to change, and his intentions…” Scott (1977, p. 128)

5. False errors

6. RMA Standards: Assessment Offender Background Offence Analysis Risk Factors ProtectiveFactors Risk Scenarios Risk Management

7. Drive • Disinhibit • Destabilise Scenarios Formulate Management Risk Management Background Communicate Assess

8. Risk Assessment: Approaches Structured Clinical Judgement Unstructured Clinical Judgement Actuarial (Prediction)

9. Which method is best?

10. Research Perspective PREDICTIVE VALIDITY

11. Unstructured Clinical Judgement Unstructured Clinical Judgement

12. Unstructured Clinical Judgement “…relies on an informal, ‘in the head,’ impressionistic, subjective conclusion, reached (somehow) by a human clinical judge” Grove and Meehl (1996)

13. SCJ ACTUARIAL PREDICTIVE VALIDITY

14. Methodologies

15. Assessing Risk for Violence A Framework for Practice David Farrington DarrickJolliffe Lorraine Johnstone RMA Scotland May 2008

16. Aims and objectives CHARACTERISE AND QUANTIFY THE EVIDENCE PREDICTIVE VALIDITY

17. Method ROC Analysis and studies reported AUC (or these could be derived) Overall ES

18. Inclusion Criteria Prospective AUC for ROC Violence Males N= 50 or more

19. Search Terms and Strategy Terms: Violen*, Aggressiv*, Serious*, Crim*, Assessment, HCR-20, VRAG, Etc. Strategy: Contact leading researchers, electronic database, internet and citation searches

20. Studies Retrieved & Included 145 31

21. Results: Overall ES

22. From the Group to the Individual....

24. Illustration Violence Risk Assessment Guide

25. Psychopathy Checklist Score Elementary school maladjustment DSM-III diagnosis of Personality Disorder Age at index offence Separated from parents under age 16 Failure on prior conditional release +VE +VE +VE –VE +VE +VE VRAG Variables - 1

26. Non-violent offence history Never married DSM-III diagnosis of Schizophrenia Victim injury Alcohol abuse Female victim index offence +VE +VE –VE –VE +VE –VE VRAG Variables - 11

28. Probability of Violent Recidivism Seven Year Follow-up VRAG CATEGORY

29. Probability of Violent Reconviction after Two Years 1.0 95% CI Individual 0.8 0.6 Probability 95% CI Group 0.4 0.2 95% CI Group 95% CI Individual 0.0 -20 -10 0 10 20 VRAG

30. “The ARAIs cannot be used to estimate an individual’s risk for future violence with any reasonable degree of certainty and should be used with great caution or not at all.”

31. Drive • Disinhibit • Destabilise Scenarios Formulate Management Risk Management Background Communicate Assess

32. METHOD: DESIGN

35. METHOD: Sample

36. Respondents

38. Perceived Utility

39. Which tool is best?

40. But.....Organisational Issues Expertise Labour Intensive Violence Time intensive High Cost On-going Training & Development Suicide

41. Senior Management Directive to develop RA policy 2004 MWC Inquiry Legislative and Policy Drivers 2006 2 Dedicated Posts 2006/07 MDT Risk Policy Group Framework for Practice, Training and Documentation Draft Policy: Presentation and Consultation March 2007

42. DFMH Risk Policy (NHSGG&C) Model and Format • SCJ Model as per RMA standards • Psychiatrist or psychologist co-ordinates but strong emphasis on MDT involvement

43. DFMH Risk Policy (NHSGG&C) Aims 1) to have at least a preliminary formulation of the person’s risk available to inform management; 2) to have a full risk assessment with all specialist assessments completed

44. Pathway and Process 1) Risk Screen for Risk Identification 2) Risk assessment

45. Limited Information used to inform HCR-20 Preliminary formulation Additional information used to update HCR-20 Re-formulation Specialist Assessment (e.g. Personality disorder) Re-formulation

46. Implementation ( 1) Lead Posts (x2) (2) On-going training Strategy for MDT staff on: Awareness training Risk Policy HCR-20 PCL-R and other specialist assessments (START) * internal and external trainers

47. Does it work? raining Strategy for MDT staff Risk Policy HCR-20 PCL-R (START) More of the same... Back to before... Something entirely new

48. Summary and Conclusions • Assessing Risk for Violence is a complex and controversial task • Priorities differ depending on perspective • Common question: Which model is best?

49. Summary and Conclusions • Meta-analysis indicated that the empirical research supports HCR-20 (and OGRS) in terms of predictive validity • Practitioners prefer the HCR-20 in terms of risk assessment standards • Challenge for organisations to promote and support the widespread use of the SCJ approach in a way that is time and cost effective: Models need to be tried and tested