Introduction and Overview Stephen D. Hart, PhD Introduction and Overview Violence: New Developments in Risk Assessment, Formulation, and management

Risk Assessment: Task Analysis

VPD Threat Assessment Course February 18, 2005 Multiple Goals Prevent violence Guide intervention Improve consistency Protect patient rights Minimize professional liability Sexual Violence

Multiple Stakeholders VPD Threat Assessment Course February 18, 2005 Multiple Stakeholders Patients and offenders Service providers Administrators Courts and tribunals Public Sexual Violence

Multiple Steps Clarify psycholegal issues Gather relevant information Identify relevant risk factors Weight and combine risk factors Determine preferred actions Optimize risk Communication

Risk Assessment as Prediction

Actuarial Approach Problem is task complexity Clinicians don’t have the necessary brainpower Solution is simplification + automation Reconceptualize risk assessment as violence prediction Develop algorithms (ARAIs) for discriminating known groups of violent recidivists versus non-recidivists Apply algorithms to new cases

Multiple Steps Clarify psycholegal issues Gather relevant information Identify relevant risk factors Weight and combine risk factors Determine preferred actions Optimize risk Communication

Problems with ARAI Predictions Ignore complexity Ignore causality Not individualized Not contextualized Discourage action

Assessing Psychopathy: An Overview of the Hare Scales 31 October 2005 Niels Bohr “Predicting is very difficult, especially about the future.” (c) 2005 by Stephen D. Hart

Prevention Through Planning

Planning Directly guides action Focuses on what should be done Based on prudence Goes beyond abstract knowledge and technical skills Relies on qualitative, narrative reasoning Uses formulation, rather than formulas

Advantages Does not require prediction Considers what might happen, not what will happen Does not require certainty Evaluates action in light of current knowledge Encourages causal, systemic thinking Identifies controlling factors

Approaches to Planning Clinical case formulation Root cause analysis Scenario planning Failure modes and effects analysis

Assessing Psychopathy: An Overview of the Hare Scales 31 October 2005 Dwight D. Eisenhower “Plans are nothing; planning is everything.” (c) 2005 by Stephen D. Hart

Conclusions

Evidence-Based Decisions “[T]he conscientious, explicit and judicious use of current best evidence in making decisions” – David Sackett

Evaluating Plans HCR-20 for CONREP 18-19 March 2008 Plausibility Information anchors should be relevant, comprehensive, and credible Utility Plans should be detailed, individualized, and feasible Reliability Different evaluators should develop similar plans Acceptability Plans should be agreeable to stakeholders Validity Properly implemented plans should reduce violence © 2008 by Stephen D. Hart, PhD

Assessing Psychopathy: An Overview of the Hare Scales 31 October 2005 Alan Kay “The best way to predict the future is to invent it.” (c) 2005 by Stephen D. Hart

Correspondence Stephen D. Hart, PhD Department of Psychology Simon Fraser University 8888 University Drive Burnaby, BC Canada V5A 1S6 Tel: +1 (778) 782 3996 E-mail: hart@sfu.ca