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Violence Risk Assessment: Can forensic approaches inform campus threat assessment?
Daniel Murrie, PhD Institute of Law, Psychiatry, and Public Policy University of Virginia
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LECTURE GOALS Become familiar with forensic violence risk assessment approaches Recognize strengths and limitations Recognize aspects or techniques that may apply to campus questions of risk or threat. Recognize aspects that are not applicable to campus context
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BACKGROUND: A BRIEF HISTORY OF VIOLENCE RISK ASSESSMENT
Initially: Dangerousness Prediction Violence risk is intrinsic to person Violence risk is stable over time (implicit) Goal is Accuracy Currently: Violence Risk Assessment Violence risk is a function of person and context Violence risk is dynamic, varies Goal is Risk Management
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A BRIEF HISTORY OF VIOLENCE RISK ASSESSMENT: FORENSIC EVALUATIONS
Initially Emphasis on clinical interview Emphasis on intuitive risk factors Clinical opinion formation was unstructured (or structure not explicitly articulated) Risk communication offered in dichotomous terms Currently Clinical interview one of many data sources Emphasis on research-demonstrated risk factors Clinical judgment tends to be more structured, linked explicitly to data Risk communication offered in probabilistic terms
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RECOMMENDED PROCESS IN VIOLENCE RISK ASSESSMENT, GENERALLY:
Clarify referral question (question of risk) Identify relevant base rates of violence Identify relevant empirically-supported risk factors Identify case-specific (idiographic) risk factors Communicate risk estimate Offer Risk Management strategies (as appropriate) Conroy, M.A., & Murrie, D.C. (2007). Forensic evaluation of violence risk: A guide to risk assessment and risk management. Hoboken, New Jersey. John Wiley & Sons.
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CLARIFY REFERRAL QUESTION
Often defined by statute Sometimes defined by institutional policies/procedures Sometimes ill-defined by referring parties Evaluator bears responsibility to clarify as necessary May require educating the referring parties General Principle: In all forensic evals, clarify the question and the evaluator’s role (Heilbrun, 2001)
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STEP 1: CLARIFY REFERRAL QUESTION:
Consider: Risk for what type of violence or behavior? Risk over what time period? (“in the near future” vs ever) Risk in what context? Risk linked to particular cause (e.g., requisite disorder)
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CLARIFY REFERRAL QUESTION: RISK ASSESSMENT VS THREAT ASSESSMENT
General violence Typically prompted by court or institutional policy/procedure Follow guidance from forensic psychology/psychiatry These emphasize empirical-derived group data and risk factors Note: this distinction is debatable, and imperfect Threat Assessment Targeted violence Typically prompted by specific threat (explicit or implicit) or concern Follow guidance from Secret Service model, or school-based models These emphasize “fact-based approach” Borum et al (1999)
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RISK ASSESSMENT VS THREAT ASSESSMENT
University Counseling Contexts: Vast majority probably “threat assessment” “Risk Assessment” scenarios possible
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CLARIFY REFERRAL QUESTION: RISK ASSESSMENT VS RISK MANAGEMENT
Risk Assessment: Evaluating the level of risk presented Leaves system with the choice of accepting risk or incapacitating individual Risk Management: Intervention to reduce the risk Heilbrun (1997) Some questions call for risk assessment, while others call for risk management approaches. All risk management will begin with good risk assessment.
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STEP 2: CONSIDER RELEVANT BASE RATES
Base Rate: Prevalence of particular characteristic or behavior within a particular population In risk assessment, typically consider base rate of violence, reoffense, etc (depending on referral question) Why should assessment begin with group data and not the individual?
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CONSIDER RELEVANT BASE RATES
Knowledge of the appropriate base rate is the most important piece of information in violence risk assessment. Failing to consider relevant base rates is the most significant violence prediction error that clinicians make Monahan (1981)
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CONSIDER RELEVANT BASE RATES: HOW?
The evaluator should use the base rate to set the starting point for subsequent evaluation of probability. That is, higher frequency events will be seen as more likely, and low frequency events will be seen as less likely. With the base rates as a starting point, the examiner can then consider assessment data and (cautiously) modify these rates accordingly to make a judgment about the individual case. (Borum et al., p.46)
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CONSIDER RELEVANT BASE RATES: FROM WHERE?
Government Reports (local, state, federal) Academic Research “Local Base Rates”
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ECA STUDY
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EXAMPLE: INMATES WITH PSYCHIATRIC ILLNESS
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CONSIDER RELEVANT BASE RATES:
From: Conroy, M.A., & Murrie, D.C. (2007). Forensic evaluation of violence risk: A guide to risk assessment and risk management. Hoboken, New Jersey. John Wiley & Sons.
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VIOLENCE BASE RATES ON CAMPUS?
Clery act data from Campus Law Enforcement, (USDOJ, Feb 2008)
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VIOLENCE BASE RATES ON CAMPUS?
Clery act data from Campus Law Enforcement, (USDOJ, Feb 2008)
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VIOLENCE BASE RATES ON CAMPUS?
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VIOLENCE BASE RATES ON CAMPUS? Consider Limits and Caveats
Consider Law Enforcement vs Victim self report Consider reporting by severity Consider on campus vs off campus Consider the possibility of “local base rates” Make use of existing sources? Collect independently?
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STEP 3: CONSIDER EMPIRICALLY-SUPPORTED RISK FACTORS
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IDENTIFY THE RELEVANT EMPIRICALLY-SUPPORTED RISK FACTORS
Some Static Factors: Age At first offense At time of assessment Gender Male (but context matters!) Prior Violence Strongest risk factor in studies of adult criminals, juvenile offenders, psychiatric patients Prior Supervision Failure
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IDENTIFY THE RELEVANT EMPIRICALLY-SUPPORTED RISK FACTORS
Some (relatively) Dynamic Factors Psychopathy (but consider caveats) Substance Abuse Consider prior (static) and acute (dynamic) Impulsivity Negative Affect Antisocial Attitudes Personality Disorder
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IDENTIFY THE RELEVANT EMPIRICALLY-SUPPORTED RISK FACTORS
Consider both: Risk Status, Risk State Douglas & Skeem (2005); Mulvey et al, 1996; Skeem & Mulvey (2002)
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Risk Status Risk status: one’s risk of violent behavior relative to other people Largely determined by static factors Largely determined in comparison to others
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Risk Status is usually not all we need to know
“Risk status emphasizes static risk factors for violence, leaving little room for change in risk over time. For this reason, risk status is of limited utility when monitoring or treating an identified high-risk individual. While being at high risk as a function of static risk factors might give clinicians some idea of the intensity of intervention required to stem future violence, it does little to direct specific intervention or management efforts toward meaningful targets” (Douglas & Skeem, 2005)
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Risk State Risk State refers to “intra-individual variability in violence potential” (Skeem & Mulvey, 2002) “An individual’s propensity to become involved in violence at a given time, based on particular changes in biological, psychological, and social variables in his or her life (Skeem & Mulvey, 2002). Practicing, non-forensic clinicians often more attuned to risk state (perhaps implicitly). Forensic clinicians have historically been attuned to risk status.
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Risk State and intervention
“Unlike the violence prediction model, the violence reduction model (a) emphasizes dynamic risk factors, particularly those that can be changed by intervention; (b) involves a high degree of contact with and control over the individual after the initial risk assessment (e.g., in ongoing treatment, outpatient commitment, and probation or parole contexts); and (c) has strong implications for planning treatment and (if implemented well) for establishing a collaborative treatment alliance. Largely through emphasis on dynamic risk factors and risk reduction, the model establishes concrete links among assessment, treatment, and decision making” Douglas & Skeem (2005)
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Bottom Line regarding Empirically Supported Risk Factors:
Consider them as they pertain to risk status and risk state
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Step 4: Identify case-specific risk factors
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IDENTIFY CASE-SPECIFIC RISK FACTORS (Idiographic Analysis)
If research-supported risk factors are well-demonstrated and essential, why include case-specific risk factors? The “single, powerful” variable Dynamic role of Dynamic factors Essential for risk management planning
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IDIOGRAPHIC FACTORS TO CONSIDER
Context, context, context Past crime circumstances Broad Narrow Consider “Anamnestic Assessment”
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An “Anamnestic Approach”
“a specific type of clinical assessment whereby the examiner attempts to identify violence risk factors through a detailed examination of the individual’s history of violent and threatening behavior” (Otto, 2000, p. 1241).
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DATA SOURCES FOR ANAMNESTIC ASSESSMENT
Collaterals, Collaterals, Collaterals Clinical interview
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ANAMNESTIC ASSESSMENT: THE CLINICAL INTERVIEW
Standard clinical interview Diagnostic information, relationships, problem-solving, etc Interview questions to search for empirically- identified risk factors
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ANAMNESTIC ASSESSMENT: THE CLINICAL INTERVIEW
Sample Violence History Questions What is the most violent thing you’ve ever done? With regard to past incidents of violence: Where did it happen? (Probe for violence in controlled settings such as jail, inpatient units) Who said what first? How much time elapsed before you decided to act violently? What were you thinking before, during, and after the incident? Did you use a weapon? Were you using drugs or alcohol at the time? Were you alone? Did you or do you have fantasies about violence or revenge? **Tell me about a time you almost became violent, but didn’t..
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Step 5: Risk Communication
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RISK COMMUNICATION General principles
Probabilistic rather than dichotomous Ideally, communicate with a point of reference (e.g., “compared to other offenders released from DOC”) Ideally, communicate with respect to context (e.g., “if released under traditional parole restrictions”) “If….Then….” language Risk can change depending on context and circumstances; risk communication should make this clear. Goal is vprevention not prediction.
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RISK COMMUNICATION (CONT’D)
Survey Research Suggests Impact of frequency versus probability terms Some preference for categorical versus probabilistic Some preference for “risk management” (identify relevant factors and strategies to manage) versus risk prediction messages Remember that Referral question (or guiding statute) drives risk communication
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But What About Testing!?
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But What About Testing!? Administering testing is not conducting a risk assessment Administering a risk assessment instrument is not conducting a risk assessment No test or instrument can answer questions about violence risk But, instruments very helpful for certain steps of the risk assessment
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Testing can inform steps of the risk assessment
Consider the relevant base rates among particular population Some instruments are essentially “base rate estimators” Examples: VRAG, COVR Static-99, MnSOST-R Consider empirically-supported risk factors Some instruments quantify a single risk factor (e.g., PCL-R) Some instruments help evaluator “walk through” potentially relevant risk factors (e.g., HCR:20)
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Examples of Instruments that provide base rate estimates
Violence Risk Appraisal Guide Includes 12 risk factors, combined with statistical weighting Strong research base Developed on 600 men from max- security forensic hospital in Canada. Followed 7 years. Forbids clinicians to adjust final estimate Some Risk factors: PCL score Separate from parents <16 Victim injury in index offense Schizophrenia (less) Never married School maladjustment Female victim in index offense (less)
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Another approach: Classification of Violence Risk
COVR (Monahan et al) computer software based on MacArthur Violence Risk Assessment Study of >1000 civil psychiatric patients. Considered >100 risk factors, patients followed for 20 weeks Combines 40 strongest risk factors in “classification tree” sequence (interactive vs main effects model) Places patient into one of 5 risk categories (1% in lowest, 76% in highest) Encourages clinicians to review/modify final estimate
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How applicable are actuarial or “base rate” related instruments to campus setting?
Instrument development process Instrument development sample Instrument replication samples Outcomes studied as related to instrument How do details above “fit” with context and goals of your assessment?
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Example of an instrument to quantify one risk factor
Psychopathy Checklist- Revised—2nd Ed (Hare, 2003) Psychopathy strongly related to violence and recidivism across many, many studies PCL-R score is strongest predictor in general risk assessment measures (i.e., VRAG, HCR:20) Widely accepted in court (DeMatteo & Edens, 2006) Some have argued its unethical to assess violence risk without assessing psychopathy
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PSYCHOPATHY (PCL-R) Glib/Superficial charm Grandiose self-worth
Pathological lying Conning/ Manipulative Lack of guilt/ remorse Shallow affect Callous/ Lack empathy Fail to accept responsibility Criminal Versatility, Many short-term marriages Promiscuous Need stim/ Prone to boredom Parasitic lifestyle Poor behavioral controls Early behavior problems Lack realistic goals Impulsivity Irresponsibility Juvenile Delinquency Revoked Conditional Release
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Limits of PCL-R assessment (particularly in campus threat context)
PCL-R developed and tested with criminal justice and forensic psychiatric populations Similarity of population? Availability of similar records for scoring? Practical concerns Staff trained to administer? Adversarial allegiance in scoring? (Murrie et al, 2008; 2009) Conceptual concerns: One of many “pathways” to violence Can be overvalued
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A summary of risk factors derived from empirical research
HCR:20 An example of a risk measure that helps evaluators consider relevant risk factors A summary of risk factors derived from empirical research Not an actuarial measure, but an “aide de memoire”
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HCR:20 RISK FACTORS Historical Factors (0, 1 or 2) Previous violence
Young age at first violence Relationship instability Employment problems Substance abuse Major psychotic illness Major non-psychotic illness Psychopathy Early maladjustment Personality disorder Supervision failure
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HCR:20 RISK FACTORS (CONTINUED)
Clinical factors Negative attitudes Active psychotic symptoms Lack of insight Active non-psychotic symptoms Impulsivity Non-response to treatment /partial compliance Risk factors Plans lack feasibility Exposure to destabilizers Lack of personal support Non-compliance with remediation Stress
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HCR:20 Guides review of risk factors, but not combination of factors or overall estimate
For clinical purposes, it makes little sense to sum the number of risk factors present in a given case, and then used fixed, arbitrary cutoffs to classify the individual as low, moderate, or high risk. It is both possible and reasonable for an assessor to conclude that an assessee is high risk for violence based on the presence of a single factor (Webster et al., 1997, p. 22). In other words, there are no “cut-offs”. Clinicians use good judgment to draw inferences from review of risk factors.
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Another way to conceptualize instruments:
Monahan suggests considering instruments on a spectrum from least structured to most structured.
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Review: Forensic risk assessment vs Campus threat assessment
Consider differences in terms of: Risk questions posed and info available Scope and span of time Therapeutic responsibility and goals
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Review and questions
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http://www.ilppp.virginia.edu /
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