The evolution of violence risk assessment

CNS Spectrums ◽  
2014 ◽  
Vol 19 (5) ◽  
pp. 419-424 ◽  
Author(s):  
John Monahan ◽  
Jennifer L. Skeem
Keyword(s):  
Mental Health ◽  
Risk Assessment ◽  
Risk Assessments ◽  
Violence Risk ◽  
Mental Health Clinicians ◽  
Violence Risk Assessment ◽  
Many Instruments ◽  
Better Than

Many instruments have been published in recent years to improve the ability of mental health clinicians to estimate the likelihood that an individual will behave violently toward others. Increasingly, these instruments are being applied in response to laws that require specialized risk assessments. In this review, we present a framework that goes beyond the “clinical” and “actuarial” dichotomy to describe a continuum of structured approaches to risk assessment. Despite differences among them, there is little evidence that one instrument predicts violence better than another. We believe that these group-based instruments are useful for assessing an individual's risk, and that the instrument should be chosen based on the purpose of the assessment.

Predictions of Violence

2018 ◽  
pp. 143-157
Author(s):  
John Monahan
Keyword(s):  
Mental Health ◽  
Risk Assessment ◽  
Criminal Justice ◽  
Central Issue ◽  
Violence Risk ◽  
Historical Account ◽  
Violence Risk Assessment ◽  
Comprehensive Review ◽  
Psychology And Law ◽  
Criminal Justice Systems

This chapter presents an historical account of the emergence of violence risk assessment as a central issue in what were portrayed as reforms of the mental health and criminal justice systems in the 1970s. The author traces his own involvement in the nascent field of psychology and law to his writing the first comprehensive review of research on the validity of violence risk assessment. The chapter then details the major theoretical, empirical, and policy strides that characterized violence risk assessment as it matured over the next several decades. The author concludes by reflecting on several issues whose resolution has proved elusive.

scholarly journals Assessment of violence risk in 440 psychiatric patients in China: examining the feasibility and acceptability of a novel and scalable approach (FoVOx)

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Shaoling Zhong ◽  
◽  
Rongqin Yu ◽  
Robert Cornish ◽  
Xiaoping Wang ◽  
...  
Keyword(s):  
Mental Health ◽  
Risk Factors ◽  
Risk Assessment ◽  
Decision Making ◽  
Clinical Decision Making ◽  
Psychiatric Patients ◽  
Clinical Decision ◽  
Violence Risk ◽  
Violence Risk Assessment ◽  
Risk Categories

Abstract Background Violence risk assessment is a routine part of clinical services in mental health, and in particular secure psychiatric hospitals. The use of prediction models and risk tools can assist clinical decision-making on risk management, including decisions about further assessments, referral, hospitalization and treatment. In recent years, scalable evidence-based tools, such as Forensic Psychiatry and Violent Oxford (FoVOx), have been developed and validated for patients with mental illness. However, their acceptability and utility in clinical settings is not known. Therefore, we conducted a clinical impact study in multiple institutions that provided specialist mental health service. Methods We followed a two-step mixed-methods design. In phase one, we examined baseline risk factors on 330 psychiatric patients from seven forensic psychiatric institutes in China. In phase two, we conducted semi-structured interviews with 11 clinicians regarding violence risk assessment from ten mental health centres. We compared the FoVOx score on each admission (n = 110) to unstructured clinical risk assessment and used a thematic analysis to assess clinician views on the accuracy and utility of this tool. Results The median estimated probability of violent reoffending (FoVOx score) within 1 year was 7% (range 1–40%). There was fair agreement (72/99, 73% agreement) on the risk categories between FoVOx and clinicians’ assessment on risk categories, and moderate agreement (10/12, 83% agreement) when examining low and high risk categories. In a majority of cases (56/101, 55%), clinicians thought the FoVOx score was an accurate representation of the violent risk of an individual patient. Clinicians suggested some additional clinical, social and criminal risk factors should be considered during any comprehensive assessment. In addition, FoVOx was considered to be helpful in assisting clinical decision-making and individual risk assessment. Ten out of 11 clinicians reported that FoVOx was easy to use, eight out of 11 was practical, and all clinicians would consider using it in the future. Conclusions Clinicians found that violence risk assessment could be improved by using a simple, scalable tool, and that FoVOx was feasible and practical to use.

Violence risk assessment practices in Israel: a preliminary survey investigation

2019 ◽  
Vol 11 (2) ◽  
pp. 116-126
Author(s):  
Jay P. Singh ◽  
Rabeea Assy ◽  
Katrina I. Serpa
Keyword(s):  
Risk Assessment ◽  
Social Workers ◽  
Assessment Process ◽  
Risk Assessments ◽  
Survey Method ◽  
Assessment Practices ◽  
Violence Risk ◽  
Violence Risk Assessment ◽  
Web Based ◽  
Content Type

Purpose The purpose of this paper is to explore the violence risk assessment practices in Israel by social workers, clinical criminologists, and marriage and family therapists using a Web-based survey. Design/methodology/approach A Web-based survey and participation letter were translated into Hebrew and distributed to members of the Israel Association of Social Workers, the Israel Society of Clinical Criminology and the Israel Association for Marital and Family Therapy following the Dillman Total Design Survey Method. Findings The sample was composed of 34 professionals, who reported using structured instruments to predict and manage the likelihood of violence in over half of their risk assessments over both their lifetime and the past 12 months. Younger female respondents who entered their profession more recently were more likely to use instruments during the risk assessment process. There appeared to be a trend toward decreased use of actuarial instruments and increased use in structured professional judgment instruments. Originality/value The first national survey of violence risk assessment practices by behavioral healthcare professionals in Israel was conducted. This study revealed the risk assessment utility trends in Israel, finding that compared to professionals in North America, South America, Europe, East Asia and Australia, professionals in Israel conducted fewer risk assessments and used structured instruments less often, highlighting concern about the lack of reliance on evidence-based techniques in the country.

scholarly journals Use of the HCR-20 for violence risk assessment: views of clinicians working in a secure inpatient mental health setting

2017 ◽  
Vol 19 (2) ◽  
pp. 130-138 ◽  
Author(s):  
Geoffrey L. Dickens ◽  
Laura E. O’Shea
Keyword(s):  
Mental Health ◽  
Risk Assessment ◽  
Online Survey ◽  
Predictive Accuracy ◽  
Violence Risk ◽  
Violence Risk Assessment ◽  
Cross Sectional Survey ◽  
Vast Number ◽  
Content Type ◽  
Historical Factors

Purpose The purpose of this paper is to explore how raters combine constituent components of Historical Clinical Risk-20 (HCR-20) risk assessment, and how relevant they rate the tool to different diagnostic and demographic groups. Design/methodology/approach A cross-sectional survey design of n=45 mental health clinicians (psychiatrists, psychologists, and others) working in a secure hospital responded to an online survey about their risk assessment practice. Findings HCR-20 Historical and Clinical subscales were rated the most relevant to violence prediction but four of the five items rated most relevant were Historical items. A recent history of violence was rated more important for risk formulation than Historical and Risk management items, but not more important than Clinical items. While almost all respondents believed predictive accuracy would differ by gender, the tool was rated similarly in terms of its relevance for their client group by people working with men and women, respectively. Research limitations/implications This was an exploratory survey and results should be verified using larger samples. Practical implications Clinicians judge recent violence and Clinical items most important in inpatient violence risk assessment but may overvalue historical factors. They believe that recent violent behaviour is important in risk formulation; however, while recent violence is an important predictor of future violence, the role it should play in SPJ schemes is poorly codified. Social implications It is important that risk assessment is accurate in order to both protect the public and to protect patients from overly lengthy and restrictive detention. Originality/value Despite the vast number of studies examining the predictive validity of tools like HCR-20 very little research has examined the actual processes and decision-making behind formulation in clinical practice.

scholarly journals Violence Risk Assessment Practices in Denmark: A Multidisciplinary National Survey

2015 ◽  
Vol 21 (2) ◽  
pp. 103-110 ◽  
Author(s):  
Louise Hjort Nielsen ◽  
Sarah van Mastrigt ◽  
Randy K. Otto ◽  
Katharina Seewald ◽  
Corine de Ruiter ◽  
...  
Keyword(s):  
Mental Health ◽  
Risk Assessment ◽  
Risk Management ◽  
Mental Health Professionals ◽  
Health Professionals ◽  
Assessment Practices ◽  
Violence Risk ◽  
Violence Risk Assessment ◽  
Risk Monitoring ◽  
Professional Disciplines

Abstract With a quadrupling of forensic psychiatric patients in Denmark over the past 20 years, focus on violence risk assessment practices across the country has increased. However, information is lacking regarding Danish risk assessment practice across professional disciplines and clinical settings; little is known about how violence risk assessments are conducted, which instruments are used for what purposes, and how mental health professionals rate their utility and costs. As part of a global survey exploring the application of violence risk assessment across 44 countries, the current study investigated Danish practice across several professional disciplines and settings in which forensic and high-risk mental health patients are assessed and treated. In total, 125 mental health professionals across the country completed the survey. The five instruments that respondents reported most commonly using for risk assessment, risk management planning and risk monitoring were Broset, HCR-20, the START, the PCL-R, and the PCL:SV. Whereas the HCR-20 was rated highest in usefulness for risk assessment, the START was rated most useful for risk management and risk monitoring. No significant differences in utility were observed across professional groups. Unstructured clinical judgments were reported to be faster but more expensive to conduct than using a risk assessment instrument. Implications for clinical practice are discussed.

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