balancing right to liberty vs public safety: intro to risk assessment

Question 1

what is change in security?

Answer 1

if offender is deemed good candidate to move to min. security prison

Question 2

what are base rates?

Answer 2

represents the percent of people within a given population who commit a specific act

ie. criminal or violent act ie. suicide
- prediction difficult when base rates are too low

Question 3

when do false positives occur?

Answer 3

with low base rates –> they mean offenders who would integrate nicely don’t get released and remain burden on system

Question 4

what was early risk assessment like prior to 1981?

Answer 4

clinician collects info about offender and situation
semi structured at best-accuracy relied on experience of interviewer
-no more than 1/3

Question 5

what are judgement errors and biases prior to 1981?

Answer 5

1. heuristics
2. illusory correlation: when 2 things that are loosely correlated are used to draw associations between
3. ignoring base rates
4. reliance on salient or unique cues
5. overconfidence in judgements

Question 6

1980’s

Answer 6

growing appreciation that maybe strict operationalization and quantification are needed
- mask of sanity written

Question 7

if an offender is predicted to reoffend and he does what is that?

Answer 7

true positive

Question 8

if an offender is predicted to reoffend and they don’t what is that?

Answer 8

false positive

Question 9

if an offender is predicted to not reoffend but they do what is that?

Answer 9

false negative

Question 10

if an offender is predicted to not reoffend and they don’t what is that?

Answer 10

true negative

Question 11

Violence Risk Appraisal Guide

Answer 11

• rise, harris, quinsy and cormier

- -618 adult male patients assessed or treated at max security psychiatric hospital

Question 12

what is one major concern with VRAG?

Answer 12

where test was developed and with who

-validated with people who had been shown to either be unfit to stand trial or not criminally responsible

Question 13

what are pros and cons of actuarial prediction?

Answer 13

PROS:
increases reliability and validity 
CONS:
-exclude low base rate
- threaten comprehensiveness 
-minimize treatment, management and prevention 
- overestimated in terms of superiority 
*better than clinical predictions

Question 14

What is the HCR-20?

Answer 14

• historical (past) clinical (present) risk (future)
• allows us to make use of benefits of actuarial prediction but also with full deck of info
• assist not replace clinical evaluations of violence risk across broad range of population and settings
• administered by clinical team
• monitor clinical and situational factors that may be relevant to violence (ie. attendance of religious service)

Question 15

what is the HCR-20 intended to do?

Answer 15

1. bridge clinical and empirical domains and knowledge bases

2. content determined rationally

Question 16

where are situations where the HCR-20 could be administered?

Answer 16

-civil and forensic psychiatric, correctional institution, community

Question 17

what are the 3 elements of risk assessment

Answer 17

1. historical: fixed or static over time
2. clinical: current and based on some up to date assessment of relevant clinical material obtained from health and mental health professionals
3. Risk variables: determine factors that may aid decision makers in determine how well person may manage risk in different contexts

Question 18

what are the 10 items that are risk markers for violence (historical)?

Answer 18

1. previous violence (coded from 0-2) based on frequency and severity
2. young age at first violence(under 20)
3. relationship instability
4. employment problems
5. substance use problems
6. major mental illness
7. psychopathy
8. early maladjustment: serious conduct problems before 17
9. personality disorder
10. prior supervision failure

Question 19

what are the 5 items that are on the clinical scale of the HCR 20?

Answer 19

1. lack of insight
2. negative attitudes
3. active symptoms of MMI
4. impulsivity
5. unresponsiveness to treatment

Question 20

what are the 5 items that are on the risk management scale of the HCR 20?

Answer 20

1. plans lack feasibility
2. exposure to destabilizers ie. weapons, drugs, gambling
3. lack of personal support
4. noncompliance with remediation attempts
5. stress

Question 21

final risk judgement for case study is low:

Answer 21

• assessor believes individual is at no risk, very low risk
• isn’t in need of any special intervention or supervision
• no need to monitor closely for changes in risk

Question 22

final risk judgment for case study is moderate:

Answer 22

• believes individual is at somewhat elevated risk for violence
• risk management plan should be developed
• mechanism for reevaluation is needed

Question 23

final risk judgement for case study is high:

Answer 23

• believes individual is at high risk for violence
• urgent need for management plan
• regular reassessments are needed