scholarly journals Developing a clinically useful actuarial tool for assessing violence risk

2000 ◽  
Vol 176 (4) ◽  
pp. 312-319 ◽  
Author(s):  
John Monahan ◽  
Henry J. Steadman ◽  
Pamela C. Robbins ◽  
Eric Silver ◽  
Paul S. Appelbaum ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Assessment ◽  
Clinical Utility ◽  
Psychiatric Patients ◽  
Classification Tree ◽  
Base Rate ◽  
Violence Risk ◽  
Violence Risk Assessment ◽  
High Degree ◽  
Actuarial Method

BackgroundA new actuarial method for violence risk assessment – the Iterative Classification Tree (ICT) – has become available. It has a high degree of accuracy but can be time and resource intensive to administer.AimsTo increase the clinical utility of the ICT method by restricting the risk factors used to generate the actuarial tool to those commonly available in hospital records or capable of being routinely assessed in clinical practice.MethodA total of 939 male and female civil psychiatric patients between 18 and 40 years old were assessed on 106 risk factors in the hospital and monitored for violence to others during the first 20 weeks after discharge.ResultsThe ICT classified 72.6% of the sample as either low risk (less than half of the sample's base rate of violence) or high risk (more than twice the sample's base rate of violence).ConclusionsA clinically useful actuarial method exists to assist in violence risk assessment.

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.

Risk Assessment

Criminology ◽  
2014 ◽  
Author(s):  
Ashley A. Pritchard ◽  
Adam J. E. Blanchard ◽  
Kevin S. Douglas
Keyword(s):  
Risk Factors ◽  
Risk Assessment ◽  
Psychiatric Patients ◽  
Poor Performance ◽  
Professional Judgment ◽  
Violence Risk ◽  
Violence Risk Assessment ◽  
Dynamic Risk Factors ◽  
Forensic Patients ◽  
Empirically Supported

Violence risk assessment is the process of identifying the level of risk for future violence posed by offenders, forensic patients, and civil psychiatric patients. In each such context, whether persons are detained or released into the community is a decision governed by law. The field of violence risk assessment has witnessed tremendous growth over the past several decades. With few exceptions, its use in numerous legal settings has been upheld by courts, and in some cases professionals have positive duties to conduct risk assessments and protect potential victims. After early research findings suggesting very poor performance of clinicians in predicting violence, a great deal of research has focused on improving risk assessment. Several hundred studies have now been conducted on structured approaches to risk assessment (e.g., actuarial prediction, structured professional judgment). Similarly, a great amount of scientific attention has been paid to identifying empirically supported violence risk factors. More recently, scholars have been focusing on identifying so-called dynamic risk factors, or those that are changeable and of most relevance to intervention. Current themes in risk assessment include focusing on how risk assessment can inform risk management and risk reduction and how best to integrate risk assessment technology into actual practice.

scholarly journals Gender-Sensitive Violence Risk Assessment: Predictive Validity of Six Tools in Female Forensic Psychiatric Patients

2019 ◽  
Vol 46 (4) ◽  
pp. 528-549 ◽  
Author(s):  
Vivienne de Vogel ◽  
Mieke Bruggeman ◽  
Marike Lancel
Keyword(s):  
Risk Assessment ◽  
Risk Management ◽  
Predictive Validity ◽  
Predictive Accuracy ◽  
Psychiatric Patients ◽  
Violence Risk ◽  
Clinical Risk Management ◽  
Violence Risk Assessment ◽  
Forensic Psychiatric Patients ◽  
Forensic Psychiatric

Most violence risk assessment tools have been validated predominantly in males. In this multicenter study, the Historical, Clinical, Risk Management–20 (HCR-20), Historical, Clinical, Risk Management–20 Version 3 (HCR-20V3), Female Additional Manual (FAM), Short-Term Assessment of Risk and Treatability (START), Structured Assessment of Protective Factors for violence risk (SAPROF), and Psychopathy Checklist–Revised (PCL-R) were coded on file information of 78 female forensic psychiatric patients discharged between 1993 and 2012 with a mean follow-up period of 11.8 years from one of four Dutch forensic psychiatric hospitals. Notable was the high rate of mortality (17.9%) and readmission to psychiatric settings (11.5%) after discharge. Official reconviction data could be retrieved from the Ministry of Justice and Security for 71 women. Twenty-four women (33.8%) were reconvicted after discharge, including 13 for violent offenses (18.3%). Overall, predictive validity was moderate for all types of recidivism, but low for violence. The START Vulnerability scores, HCR-20V3, and FAM showed the highest predictive accuracy for all recidivism. With respect to violent recidivism, only the START Vulnerability scores and the Clinical scale of the HCR-20V3 demonstrated significant predictive accuracy.

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