scholarly journals Use of risk assessment instruments to predict violence in forensic psychiatric hospitals: a systematic review and meta-analysis

2018 ◽  
Vol 52 ◽  
pp. 47-53 ◽  
Author(s):  
Taanvi Ramesh ◽  
Artemis Igoumenou ◽  
Maria Vazquez Montes ◽  
Seena Fazel
Keyword(s):  
Risk Assessment ◽  
Performance Measures ◽  
Predictive Accuracy ◽  
Psychiatric Inpatient ◽  
Psychiatric Hospitals ◽  
Assessment Tools ◽  
Assessment Instruments ◽  
Predictive Values ◽  
Meta Regression ◽  
Forensic Psychiatric

AbstractBackground and Aims:Violent behaviour by forensic psychiatric inpatients is common. We aimed to systematically review the performance of structured risk assessment tools for violence in these settings.Methods:The nine most commonly used violence risk assessment instruments used in psychiatric hospitals were examined. A systematic search of five databases (CINAHL, Embase, Global Health, PsycINFO and PubMed) was conducted to identify studies examining the predictive accuracy of these tools in forensic psychiatric inpatient settings. Risk assessment instruments were separated into those designed for imminent (within 24 hours) violence prediction and those designed for longer-term prediction. A range of accuracy measures and descriptive variables were extracted. A quality assessment was performed for each eligible study using the QUADAS-2. Summary performance measures (sensitivity, specificity, positive and negative predictive values, diagnostic odds ratio, and area under the curve value) and HSROC curves were produced. In addition, meta-regression analyses investigated study and sample effects on tool performance.Results:Fifty-two eligible publications were identified, of which 43 provided information on tool accuracy in the form of AUC statistics. These provided data on 78 individual samples, with information on 6,840 patients. Of these, 35 samples (3,306 patients from 19 publications) provided data on all performance measures. The median AUC value for the wider group of 78 samples was higher for imminent tools (AUC 0.83; IQR: 0.71–0.85) compared with longer-term tools (AUC 0.68; IQR: 0.62-0.75). Other performance measures indicated variable accuracy for imminent and longer-term tools. Meta-regression indicated that no study or sample-related characteristics were associated with between-study differences in AUCs.Interpretation:The performance of current tools in predicting risk of violence beyond the first few days is variable, and the selection of which tool to use in clinical practice should consider accuracy estimates. For more imminent violence, however, there is evidence in support of brief scalable assessment tools.

scholarly journals The reform of Italian forensic psychiatric hospitals and its impact on risk assessment and management

2018 ◽  
Author(s):  
Vittorio De Luca ◽  
Pieritalo Maria Pompili ◽  
Giovanna Paoletti ◽  
Valeria Bianchini ◽  
Federica Franchi ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Treatment Plan ◽  
Psychiatric Hospitals ◽  
Assessment Tools ◽  
Residential Home ◽  
Security Measures ◽  
Lazio Region ◽  
History Of ◽  
Forensic Psychiatric

Italy has a consolidated history of de-institutionalization, and it was the first country to completely dismantle psychiatric hospitals, in order to create small psychiatric inwards closer to the community (i.e. in general hospitals). Nevertheless, it took the nation nearly 40 years to end the process from the beginning of de-institutionalization, definitely closing all of the forensic hospitals, which was not addressed by the first Italian psychiatric reform. This paper describes the establishment of new facilities substituting old forensic hospitals, called Residences for the Execution of Security Measures (REMS), which are a paradigm shift in terms of community-based residential home, and are mainly focused on treatment and risk assessment, rather than custodial practices. The use of modern assessment tools, such as the Aggressive Incident Scale (AIS) and the Hamilton Anatomy of Risk Management (HARM), is crucial in order to point out the focus and consistent instruments of the treatment plan. A preliminary analysis of data from the first 2 years of activity, considering severely ill patients who have been treated for more than 12 months, is then described for two REMSs in the Lazio region, close to Rome. Encouraging results suggest that further research is needed in order to assess clinical elements responsible for a better outcome, and to detect follow-up measures of violence or criminal relapse after discharge.

scholarly journals Is Knowledge Contagious? Diffusion of Violence-Risk-Reporting Practices Across Clinicians’ Professional Networks

2021 ◽  
pp. 216770262095479
Author(s):  
Yanick Charette ◽  
Ilvy Goossens ◽  
Michael C. Seto ◽  
Tonia L. Nicholls ◽  
Anne G. Crocker
Keyword(s):  
Risk Assessment ◽  
Assessment Tools ◽  
Assessment Instruments ◽  
Assessment Practices ◽  
Violence Risk ◽  
Professional Networks ◽  
Reporting Practices ◽  
Risk Assessment Tools ◽  
Knowledge Practice ◽  
Forensic Psychiatric

The knowledge–practice gap remains a challenge in many fields. Health research has shown that professional networks influence various aspects of patient care, including diffusion of innovative practices. In the current study, we examined the potential utility of professional networks to spread the use of violence-risk-assessment tools in forensic psychiatric settings. A total of 6,664 reports, written by 708 clinicians, were used to examine the effect of clinicians’ use of risk-assessment tools on subsequent reports by other clinicians with whom they share patients. Results show that professional networks serve as an important channel for the spread of assessment practices. Simulation of a continuing education program showed that targeting more influential clinicians in the network could be 3 times more efficient at disseminating best practices than randomly training clinicians. Decision-makers may consider using professional networks to identify and train influential clinicians to maximize diffusion of the use of risk-assessment instruments.

scholarly journals Rates of violence in patients classified as high risk by structured risk assessment instruments

2014 ◽  
Vol 204 (3) ◽  
pp. 180-187 ◽  
Author(s):  
Jay P. Singh ◽  
Seena Fazel ◽  
Ralitza Gueorguieva ◽  
Alec Buchanan
Keyword(s):  
Risk Assessment ◽  
High Risk ◽  
Risk Groups ◽  
Evidence Base ◽  
Assessment Tools ◽  
Current Evidence ◽  
Assessment Instruments ◽  
Individual Liberty ◽  
Current Evidence Base ◽  
Study Heterogeneity

BackgroundRates of violence in persons identified as high risk by structured risk assessment instruments (SRAIs) are uncertain and frequently unreported by validation studies.AimsTo analyse the variation in rates of violence in individuals identified as high risk by SRAIs.MethodA systematic search of databases (1995–2011) was conducted for studies on nine widely used assessment tools. Where violence rates in high-risk groups were not published, these were requested from study authors. Rate information was extracted, and binomial logistic regression was used to study heterogeneity.ResultsInformation was collected on 13 045 participants in 57 samples from 47 independent studies. Annualised rates of violence in individuals classified as high risk varied both across and within instruments. Rates were elevated when population rates of violence were higher, when a structured professional judgement instrument was used and when there was a lower proportion of men in a study.ConclusionsAfter controlling for time at risk, the rate of violence in individuals classified as high risk by SRAIs shows substantial variation. In the absence of information on local base rates, assigning predetermined probabilities to future violence risk on the basis of a structured risk assessment is not supported by the current evidence base. This underscores the need for caution when such risk estimates are used to influence decisions related to individual liberty and public safety.

Factors Predicting Desistance From Reoffending: A Validation Study of the SAPROF in Sexual Offenders

2016 ◽  
Vol 62 (3) ◽  
pp. 697-716 ◽  
Author(s):  
Dahlnym Yoon ◽  
Daniel Turner ◽  
Verena Klein ◽  
Martin Rettenberger ◽  
Reinhard Eher ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Sexual Offenders ◽  
Interrater Reliability ◽  
Predictive Accuracy ◽  
Negative Relationship ◽  
Incremental Validity ◽  
Assessment Tools ◽  
Violence Risk ◽  
Limited Extent ◽  
Risk Assessment Tools

The present study aims at validating the German version of the Structured Assessment of PROtective Factors (SAPROF) for violence risk in a representative sample of incarcerated adult male sexual offenders. Sexual offenders ( n = 450) were rated retrospectively with the SAPROF using the database of the Federal Evaluation Centre for Violent and Sexual Offenders (FECVSO) in the Austrian Prison System. Interrater reliability and predictive validity of the SAPROF scores concerning desistance from recidivism were calculated. Concurrent and incremental validity were tested using the combination of the SAPROF and the Sexual Violence Risk–20 (SVR-20). Interrater reliability was moderate to excellent, and predictive accuracy for various types of recidivism was rather small to moderate. There was a clear negative relationship between the SAPROF and the SVR-20 risk factors. Whereas the SAPROF revealed itself as a significant predictor for various recidivism categories, it did not add any predictive value beyond the SVR-20. Although the SAPROF itself can predict desistance from recidivism, it seems to contribute to the risk assessment in convicted sexual offenders only to a limited extent, once customary risk assessment tools have been applied. Implications for clinical use and further studies are discussed.

Validity of Risk Assessment Instruments Among Juveniles Who Sexually Offended: Victim Age Matters

Sexual Abuse ◽  
2020 ◽  
pp. 107906322091071
Author(s):  
Chiara Krause ◽  
Alexander Roth ◽  
Markus A. Landolt ◽  
Cornelia Bessler ◽  
Marcel Aebi
Keyword(s):  
Risk Assessment ◽  
Sexual Offender ◽  
Assessment Tools ◽  
Professional Judgment ◽  
Assessment Instruments ◽  
Child Victim ◽  
Assessment Protocol ◽  
Significant Difference ◽  
Risk Assessment Tools ◽  
Sexually Offended

Research has identified meaningful subtypes among the heterogeneous population of juveniles who sexually offended (JSO). However, studies that test the validity of risk assessment tools with JSO subtypes are limited. This study compared JSO who offended against a child victim (JSO-C) and JSO who offended against an adolescent/adult victim (JSO-A) with regard to rates of recidivism and the predictive validity of two risk assessment tools (Estimate of Risk of Adolescent Sexual Offense Recidivism [ERASOR] and Juvenile Sexual Offender Assessment Protocol-II [J-SOAP-II]). Data were analyzed from case files of 185 JSO-C and 297 JSO-A aged 12 to 18 years ( M = 14.11, SD = 1.44) from a consecutive sample of JSO with contact sexual offenses. A total of 34 (7.1%) juveniles reoffended sexually, with no significant difference between the subtypes. The present results suggest that the ERASOR, particularly the structured professional judgment, and to a lesser degree the J-SOAP-II are better suited to predicting sexual recidivism in JSO-A than in JSO-C.

Further validation of an opioid risk assessment tool: The Brief Risk Interview

2014 ◽  
Vol 10 (5) ◽  
pp. 353 ◽  
Author(s):  
Ted Jones, PhD ◽  
Samantha Lookatch, MA ◽  
Patricia Grant, MS, ANP-C ◽  
Janice McIntyre, MS, ANP-C ◽  
Todd Moore, PhD
Keyword(s):  
Risk Assessment ◽  
Chronic Pain ◽  
Assessment Tool ◽  
Predictive Accuracy ◽  
Training Session ◽  
Predictive Ability ◽  
Standard Of Care ◽  
Assessment Tools ◽  
Risk Assessment Tool ◽  
Aberrant Behavior

Opioids remain a common method of treating chronic pain conditions despite some controversy. In an effort to address some of the risks of opioid medications, opioid risk assessment has become a standard of care when opioids are used to treat a chronic pain condition. Research to date has found that clinical interviews may be superior to currently available patient-completed written questionnaires in identifying patients likely to engage in medication aberrant behavior. The Brief Risk Interview (BRI) has been developed as a risk assessment tool that has the sensitivity of a clinical interview while eliminating the need for the lengthy process of an interview. The current study compared the predictive ability of the BRI with two commonly used patient-completed risk assessment tools: the Opioid Risk Tool (ORT) and the Screener and Opioid Assessment for Patients with Pain-Revised (SOAPP-R). After clinical staff at a pain practice underwent a 1-hour training program, 124 consecutive new patients were evaluated using the BRI, ORT, and SOAPP-R. Follow-up data found that the BRI was a good predictor of medication aberrant behavior and offered better sensitivity and better overall predictive accuracy than the ORT or the SOAPP-R. Overall, it appears that the BRI is a valid risk assessment tool that, after a brief training session, can be used effectively by pain clinicians. Further study is needed in other practice settings and with larger sample sizes.

Client Management Classification and Prediction of Probation Outcome

1994 ◽  
Vol 40 (2) ◽  
pp. 154-174 ◽  
Author(s):  
Patricia M. Harris
Keyword(s):  
Risk Assessment ◽  
Predictive Accuracy ◽  
False Positives ◽  
Assessment Instrument ◽  
Assessment Instruments ◽  
Risk Assessment Instrument ◽  
System A ◽  
Probation Supervision ◽  
Supervision Practices ◽  
Client Management

This article compares the predictive accuracy of a traditional, objective probation risk assessment instrument with the considerably more subjective, interview-based Client Management Classification (CMC) System, a tool with no previously noted applications to the prediction of risk. Subjects of the study were probationers under supervision in Austin, Texas. Results indicated that the CMC performed far more satisfactorily than did the traditional instrument. The CMC was found to be particularly successful in minimizing false positives (i.e., probationers incorrectly predicted to be high risks). The results suggest that offender risk assessment instruments of a national scope are possible. Implications for assessment and probation supervision practices are considered.

scholarly journals Risk, Actuarialism, and Punishment

2017 ◽  
Author(s):  
Hazel Kemshall
Keyword(s):  
Risk Assessment ◽  
Criminal Justice ◽  
Minority Groups ◽  
Predictive Accuracy ◽  
Insurance Industry ◽  
Assessment Tools ◽  
Ethical Challenges ◽  
Risk Assessment Tools ◽  
Risk Practices ◽  
High Crime

Risk is a pervasive feature of contemporary life, and has become a key feature of penal policy, systems of punishment, and criminal justice services across a number of the Anglophone jurisdictions. Risk as an approach to calculating the probability of “danger” or “hazard” has its roots in the mercantile trade of the 16th century, growing in significance over the intervening centuries until it pervades both the social and economic spheres of everyday life. Actuarialism, that is the method of statistically calculating and aggregating risk data, has similar roots, steeped in the probability calculations of the insurance industry with 20th-century extension into the arenas of social welfare and penality. Within criminal justice one of the first risk assessment tools was the parole predictor designed by Burgess in 1928. Since then we have seen a burgeoning of risk assessment tools and actuarial risk practices across the penal realm, although the extent to which penality is totally risk based is disputed. Claims for a New Penology centered on risk have been much debated, and empirical evidence would tend toward more cautious claims for such a significant paradigm shift. Prevention and responsibilization are often seen as core themes within risk-focused penality. Risk assessment is used not only to assess and predict future offending of current criminals, but also to enable early identification of future criminals, “high crime” areas, and those in need of early interventions. The ethics, accuracy, and moral justification for such preventive strategies have been extensively debated, with concerns expressed about negative and discriminatory profiling; net-widening; over targeting of minority groups especially for selective incarceration; and more recently criticisms of risk-based pre-emption or “pre-crime” targeting, particularly of ethnic minorities. Responsibilization refers to the techniques of actuarial practices used to make persons responsible for their own risk management, and for their own risk decisions throughout the life course. In respect of offenders this is best expressed through corrective programs focused on “right thinking” and re-moralizing offenders toward more desirable social ends. Those offenders who are “ripe for re-moralization” and who present a level of risk that can be managed within the community can avoid custody or extended sentencing. Those who are not, and who present the highest levels of risk, are justifiably selected for risk-based custodial sentences. Such decision-making not only requires high levels of predictive accuracy, but is also fraught with severe ethical challenges and moral choices, not least about the desired balance between risks, rights, and freedoms.

Use of risk assessment tools for people with intellectual disability: The latest evidence

2016 ◽  
Vol 33 (S1) ◽  
pp. S38-S38 ◽  
Author(s):  
C. Morrissey
Keyword(s):  
Risk Assessment ◽  
Intellectual Disability ◽  
Intellectual Disabilities ◽  
Outcome Measurement ◽  
Psychiatric Patients ◽  
Psychiatric Hospitals ◽  
Assessment Tools ◽  
High Rate ◽  
Lower Intelligence ◽  
The Uk

A relatively high proportion of people detained in forensic psychiatric hospitals have intellectual disabilities (up to 3000 people in the UK; Royal College of Psychiatrists, 2013), and people with intellectual disability are significantly over-represented among those psychiatric patients with long lengths of hospital stay (CQC, 2013; Vollm, 2015). People with mild to borderline intellectual disabilities are also prevalent in the UK prison system.Although the relationship between intelligence and offending is complex, lower intelligence is a known actuarial risk factor for offending behaviour. Studies, which have investigated the prediction of re-offending risk in populations with intellectual disability, have nevertheless found lower rates of recorded re-offending compared to those in mainstream forensic populations (e.g. Gray et al., 2010). The relatively high rate of ‘offending-like’ behaviour, which is not processed through the criminal justice system in people with intellectual disability makes risk prediction a more complex exercise with this group of people. It also makes outcomes measurement more difficult.This paper will give an overview of the current research evidence and clinical practice in the field of risk assessment, risk management and outcome measurement with offenders with intellectual disability. It will summarise the findings of a recent NIHR funded systematic review by the author, which pertains to this area, and will point to future developments in the field.Disclosure of interestThe author has not supplied his declaration of competing interest.

scholarly journals Predicting future violence among individuals with psychopathy

2013 ◽  
Vol 203 (5) ◽  
pp. 387-388 ◽  
Author(s):  
Jeremy W. Coid ◽  
Simone Ullrich ◽  
Constantinos Kallis
Keyword(s):  
Risk Assessment ◽  
Personality Disorder ◽  
Mental Disorder ◽  
Predictive Accuracy ◽  
Diagnostic Assessment ◽  
Assessment Instruments ◽  
Criminal Behaviour ◽  
Clinical Syndromes ◽  
Public Risk ◽  
Better Than

SummaryStructured risk assessment aims to help clinicians classify offenders according to likelihood of future violent and criminal behaviour. We investigated how confident clinicians can be using three commonly used instruments (HCR-20, VRAG, OGRS-II) in individuals with different diagnoses. Moderate to good predictive accuracy for future violence was achieved for released prisoners with no mental disorder, low to moderate for clinical syndromes and personality disorder, but accuracy was no better than chance for individuals with psychopathy. Comprehensive diagnostic assessment should precede an assessment of risk. Risk assessment instruments cannot be relied upon when managing public risk from individuals with psychopathy.

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