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PS3216 - Forensic Psychology > Lecture 6 > Flashcards

Lecture 6 Flashcards

1
Q

What is the point of risk assessment?

A
  • Can remove someone’s freedom on basis of outcome OR discharge people who do bad things = very important
  • Must be conducted in a professional, accountable, and evidenced-way
  • Defend decision and show transparency in how you arrived at those decisions
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2
Q

How do you express risk?

A
  • ROC analysis - receiver operator characteristics
  • If predicted to happen, and happens = hit
  • If predicted to happen, and didn’t = false positive
  • Not predicted, happens = miss
  • Not predicted, didn’t = correct rejection
  • Good prediction has lots of hits and few false positives
  • Can be determined by graphing the probability of a hit vs false positives
  • In order to get lots of hits, you could say they could be dangerous, you would also have many false positives
  • As well as ability to tell one group from another, there is a bias for hits/false positive
  • To quantify this, you calculate the area under the curve (AUC)
  • AUC = 0.5 is chance performance, 1.0 is perfect performance, 0.56 is weak, 0.71 regarded as strong
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3
Q

What are the pros/cons of ROC analysis?

A
  • Immune to baseline changes = doesn’t matter if it is rare or common event = keeps continuous nature of assessment scale
  • Lose the quality of event e.g how long to reoffend
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4
Q

What major factors predict violence?

A
  • Mental illness: schiz, mood disorders, PTSD
  • Mental disorders: personality disorders, substance misuse, learning disabilities
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5
Q

What specific factors predict violence?

A
  • Previous violence
  • Negative attitudes
  • Poor temper control
  • Poor relationships
  • Unemployment
  • Victim of abuse
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6
Q

What are the methods of risk assessment?

A
  • Clinical judgement
  • Actuarial measures
  • Structured professional judgement
  • Formulation based approach
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7
Q

What is unstructured clinical judgement?

A
  • Professional makes a decision based on impression, intuition and experience
  • Most widely used method as it allows idiographic analysis of offenders behaviour and specific formulation informing treatment, prevention, and management of individual
  • Allows biases, overlooking of important factors, not based on empirical evidence of risk
  • It does not work
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8
Q

What was the evidence that clinical judgement does not work initially

A
  • Baxtrom was someone held in a NY state prison beyond length sentence due to him being dangerous
  • Appealed and won case = NY state decided that 966 other dangerous patients should also be released
  • Levels of violence in these prisoners was slightly more than the average person in the general population
  • Very few committed any offence and only 20 were later arrested for any violent crime
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9
Q

What was a study looking at why clinical judgements were so bad?

A
  • Gave professional information about a patient and asked to make various risk judgements
  • Events had already happened
  • Asked to say why they made their decisions and cues were unrelated to violence of patient
  • Interrater reliability was very poor
  • AUC was 0.5
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10
Q

Why are they/we so bad at clinical judgement (no study)

A

1) They are blind to their outcomes for the vast majority of cases - small number of those released are violent and they may not hear about it - impression that they were right
2) Tendency to weigh bizarre factors heavily - hallucinations seem important but they might not be = tend to neglect criminogenic factors
3) Too many variables - research in domain of cognitive psychology reveals that we can only keep track of a small number of variables when making decisions
4) We tend to make judgements quickly and then seek support for these

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11
Q

What is actuarial assessment?

A
  • Factors thought to be predictive of risk are put together using a pre-ordained method = normally based on a construction sample or on the scientific literature
  • Avoids individual bias
  • Does not need clinical skills to formulate: computer does it
  • Fast
  • Lacks ideographic information
  • Does not easily suggest risk management = does work
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12
Q

What is the VRAG? And how did it arise? (form of actuarial assessment)

A
  • Violence risk appraisal guide: based on 618 men from Canadian max security psych unit = all committed one serious antisocial act
  • Released to community/min security/ half-way house
  • Target behaviour was violent incident or return to secure unit
  • Violence is broadly defined - common assault, SA, armed robbery or pointing a firearm
  • Not robbery or possession of weapon or arson
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13
Q

How does the VRAG measure?

A
  • Range of potential predictors
  • Dropped any items that did not predict the violence
  • If two items were very correlated, higher correlation was used
  • Regression to see which variables added independently to risk prediction model
  • These 12 items are VRAG items = allows for prediction, as it predicted the Canadian Prisoners
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14
Q

What are the categories and risk probabilities of VRAG?

A
  • Scores range from -26 to +38
  • Scores used to put people into 9 categories = and works (looked at %committed crime 7yo and 10yo after)
  • Reliability is very high = 0.9
  • AUC = 0.76 = predicts violent incidents
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15
Q

What is the evidence for VRAG? (Samples)

A
  • In similar sample = can have slippage = original analysis can take advantage of random correlations
  • Different samples might have different risk factors
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16
Q

What was a study looking at the validity of the VRAG?

A
  • Followed 421 male patients being discharged from medium security units
  • Found records of people who were discharged on dates in the future, and scored VRAG by case-note reviews at time of discharge and blind to outcome, can see in present the outcome
  • After first year AUC = 0.86, and as time goes on, performance went down to 0.76
  • VRAG has good validity for predicting crime, especially violent crime
  • Absolute rates of violence in this group are lower than Canadian Sample
17
Q

Why were the rates in the UK lower than in Canada?

A
  • Use of formal reconviction may miss many violent incidents
  • More supervision?
  • Not able to correct for any further ti,e spent incarcerated
  • We are less violent than Canadians
  • Less competent detection/prosecution of incidents
18
Q

Why do Clinicians argue that the comparisons are not fair?

A
  • Clinicians focus on STM outcomes
  • Clinicians have different information available
  • Clinicians used to be bad, but now they know so can do better
  • Clinicians concentrate on really dangerous - not single act that might occur years ahead
  • Some Clinicians are bad
19
Q

What was a study looking at if this was fair?

A
  • Clinicians who knew patient well were convened = had access to all information
  • Gave patients rating of patients security needs and compared this rating to VRAG
  • AUC for Clinicians = 0.59, VRAG = 0.8
  • Same when compared for short follow-ups
  • Used composite scores - not letting one Clinicians letting the side down
  • Only VRAG significantly predicted homicides - clinicians were at chance levels
20
Q

What are other Actuarial?

A
  • ORGS - predicts general offending
  • RM2000 - predicts sexual offences
  • COVR - uses classification tree and easy to get variables
21
Q

Why do people not use actuarial?

A
  • Many clinicians feel that such a method ‘de-individuates’ the patient
  • Many clinician feel that there status is being eroded – if a formula / computer can make the decision then what is the clinician for?
  • Many clinicians feel that risk assessment is NOT their job – they are there to treat the person’s illness.
  • Person has to fit with sample – broken leg problem
  • Tend to use static measures – not good at showing any change in dangerousness – but does not have to be so!
  • Tend to be based on most common violence – though this does not have to be so – however, empirically they seem to do very well with rare violence (murder) as well
  • Getting a number is not enough – we really also need to know why risk, when a risk, what can we do about it
22
Q

What is a structured clinical assessment?

A
  • Combines clinical and actuarial measures
  • Clinicians scores set of preset items on whether present or not, but makes decision or risk in a clinical manner
  • Avoids individual bias only to some extent
  • Contains ideographic info and good and making evidence-based formulation
  • Time consuming and needs clinical skills to interpret
23
Q

What is the HCR20?

A

Using historical, clinical and risk management = looking at 20 items

24
Q

What was a study looking at prediction with the HCR20?

A
  • Most violence missed when in community
  • Most studies are retrospective - biased by event they are trying to predict
  • Often trying to predict behaviour in a different setting to assessment
  • Prospective study of violence in local Forensic Mental Health Setting
  • Assessed at admission, followed for 3 months and all incidences of violence noted - classified according to type
  • In physical aggression = HCR20 had AUC of 0.81
25
Q

What was the recidivism following discharge with HCR20?

A
  • UK male mentally disordered offenders discharged from MSUs for at least 2 years
  • Traced via home office
  • Assessments made at time of release so study is prospective
  • HCR20 is a good predictor of future violence: 6mo after = AUC of 0.76, after 2y = 0.71
  • Also predicted any offences
  • But clinical scale was not very good when people when leaving the unit, but very good when they arrives in the other study
26
Q

What was the HCR20 like for female patients?

A
  • HCR20 has some predictive validity in women
  • Men AUCs ranged from 0.75-0.88, but women: 0.52-0.63 but the clinical judgement for women was much better
27
Q

What was the HCR20 like for other populations?

A
  • Learning Disability: PiC (Partnerships in Care) sample.
  • HCR-20 very good (AUC > 0.80) – better than other offenders. (UK sample). C-scale good predictor as their condition does not change
  • Ethnic Minorities: Male PiC sample.
  • HCR-20 has very similar properties in UK ‘Black’ population as in the ‘White’ sample
28
Q

What was a study looking at the diagnosis using HCR20 and the effect on mental illnesses?

A
  • Diagnosis is an indicator of future violence - those with PD are most dangerous
  • HCR20 us a good predictor in those with Schiz but worse in those with PDs
  • Maybe because they are more impulsive or because the files have been lost due to suicide/fights or different prison
29
Q

What are the limitations of the HCR20?

A
  • Need more evidence of its utility in specific populations and violence e.g violence to children or DV
  • Need to see if treatment produces changes in HCR20 and if this is indicative of less dangerousness
  • Homicide is rare and therefore few studies of its prediction
30
Q

What is the HCR20v3?

A
  • Update in 2014
  • Small changes to items
  • Seven steps:
  • Gather info
  • Presence of item
  • Relevance of item
  • Formulation of Risk
  • Scenario planning
  • Case management plan
  • Develop final options
31
Q

What is the other side of the HCR20?

A
  • Not all clinicians are happy about the use of any instruments
  • Appears to argue that all attempts at risk assessment are useless
  • Argues to stop risk-assessment but to focus on treatment like they do in self-harm and suicide

PS3216 - Forensic Psychology (7 decks)

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