1. Violence Risk Assessment
Chapter 5

2. Nature Violence and Violence Risk Assessment
Defining violence
Actual, attempted, or threatened physical harm that is deliberate and non consenting
Violence as a choice
The proximate cause of violence is a decision to act violently
The decision is influenced by a host of biological, psychological, and social factors
Neurological damage, hormonal abnormality
Psychosis, personality disorder
Exposure to violent models, attitudes that condone violence

3. We can not predict violence . . .
Violence is too rare to predict with any accuracy by any means
Clinical decisions are particularly poor
Mental health experts have no particular expertise in the field of violence
Predictions of behavior necessitate a deterministic view of human behavior

4. . . . or, can we? The issue of prediction is moot
Don’t predict, we evaluate risk (e.g., suicide)
Regardless, predictions made by mental health professionals are reliably better than chance
The scientific literature on violence is large and growing
Any choice can be predicted

5. Illegal Realities of Violence Risk Assessment
Barefoot v. Estelle (1983)
APA amicus curiae brief stated that predictions were unreliable and incorrect
Court ruled testimony admissible and expressed faith in the adversarial process
O’Connor v. Donaldson (1975), Addington v. Texas (1979), Schall v. Martin (1984), Kansas v. Hendricks (1997), Kansas v. Crane (2002)
Tarasoff v. Regents of the University of California (1976)

6. The Evolution of Risk Assessment
Early History of Risk Assessment
First Generation – 1970s
Studies were poor in comparison to subsequent generations
clinical decision making
50/50 chance (Monahan, 1981)
Second Generation
More focus on short-term predictions and psychiatric samples
Identification of individual and contextual risk factors
Moved from predicting violence to assessing risk
Third Generation
marked by the use of actuarial or structured approaches to risk assessment

7. Clinical, Actuarial, and Structured Risk Assessments
Clinical Predictions
informal, subjective impressions arrived at with human judgment
Actuarial Predictions
formal, algorithmic, objective procedures used to arrive at a statistical conclusion
VRAG, ICT, COVR
Criticized for lack of generalizability
Nomothetic nature (studying groups) compared to the idiographic (studying individuals) nature of risk assessment 7

8. Structured Professional Judgments
formal but flexible predictions based on the empirical literature
HCR-20, SVR-20
Identifying a list of important risk factors and guidelines for using them
Scoring can be similar to actuarial measures, but clinical judgment is encouraged
May increases the chance of bias
Support for SPJ is promising

9. Risk and Protective Factors
Static Factors
Historical in nature
variables that are unlikely to change and are often fixed
History of Past violence
Young Age
Psychopathy
Hx Employment Instability
Substance Use
Major Mental Disorder

10. Dynamic Factors Clinical in nature
variables that are subject to change
Lack of Insight
Negative Attitudes
Psychiatric Symptoms
Behavioral and Affective Instability
Unresponsiveness to Treatment

11. Risk Management Risk Management Risk Assessment
Reduce likelihood of violence
Dynamic
Post assessment control is high
Multiple administrations
Risk Assessment
Identify potential for future violence
Static and dynamic
Post assessment control is variable
One administration

12. Protective Factors
protective factors as characteristics or conditions that interact with risk factors to reduce violence
offer an explanation for why individuals who face the same degree of risk may be affected differently
protective factors do not guarantee that an individual will not become violent.
reduce the probability that people facing a risk factor or factors will become involved in violence

13. Accuracy of Risk Assessment
Difficulties in Risk Assessment
Difficult to follow-up
Measurement of violence
Definition of violence
Low base rate behavior

14. When are we good at assessing risk?
predictions are for the short-term
environmental settings for which we have past data
high base rates of violence

15. Communicating Risk
Risk management
Categorical risk levels
Probability
Frequencies