Violence Risk Assessment Flashcards
Barefoot v. Estelle (1983)
SCOTUS: psychiatric opinions about dangerousness were valid and acceptable in court (even if expert didn’t directly examine the individual, but based their opinion off of responses to questions with hypotheticals). There is precedence that allows for expert opinion about dangerousness, and it’s up to the trier of fact to decide if the testimony is reliable per standards.
Schall v. Martin (1984)
SCOTUS said clinical predictions of risk (with juvies) were constitutional and meaningful. This case involved NY detaining pretrial juvies with probable cause for serious risk in committing another crime before returning to court; SCOTUS was cool with it.
Kansas v. Hendricks (1997)
SCOTUS: It’s ok to civilly commit SVPs (lengthen sentence/confinement) if they have uncontrollable urges or behavior, and VRA says high risk.
Case significant in essentially shutting down constitutional challenges to VRA - now you see it in civil and criminal matters.
Why is Tarasoff relevant to risk assessment?
Duty to protect is a foundation of risk assessment, and thus our professional responsibility.
What is TRIAD
Three Ratings of Involuntary Admissibility. IDed some correlates of violence: hi impulsivity, irritability, thought do, expansiveness, prev violence, ETOH, anger/rage
How accurate are MH clinicians in predicting risk?
Monahan (1981): No more than 1 out of 3 predictions of violent behavior over several years among institutionalized SMIs. (So we think it happens more than it does with this group)
- Lidz (1993): Better than chance.
- We underestimate women’s V.R.
What is the VRAG?
Violence Risk Appraisal Guide. 600 men from max Canadian hospital who were charged with serious criminal offense. Charts used to ID 50 predictors, and a regression model whittled this down to 12 variables for the measure.
What is the HCR-20?
SPJ with 20 items that address historical, clinical, and risk mgmt variables.
What is the MacArthur VRA study?
It took inpatients from acute civil inpx facilities from 3 states, and examined demographic, hx, contextual (social support), and clinical variables + followed peeps after d/c to see if they were violent.
What variables did the MacArthur VRA study ID?
Sex (men more likely), prior violence/criminality, childhood exp/violence (physical abuse, witness DV, not live with parents), diagnosis (bipolar, dep, COD >SCZ), psychopathy factor 2, delusions (misperceptions of others’ bx), CAH to harm, violent thoughts, anger
Should one use clinical judgment in adjusting actuarial results?
Actuarial/VRAG people eventually said no.
However, VRA or Iterative Classification Tree (MacArthur) had little to no people of color in norming. Use actuarial values as guide v. conclusive.
Look for rare risk or protective factors (e.g., the example about dude that’s immobile now)
What are the 4 steps in VRA?
1) ID empirically valid risk factors.
2) Decide on method for scoring risk factors.
3) Est a procedure for combining scores on risk factors.
4) Produce an estimate of v.r.
SPJ = first 2 steps
COVR (MacArthur) = 3 steps
VRAG = all 4 steps
How should one communicate violence risk?
- Clinicians dislike numerical probabilities, and prefer categorical (lo, med, high)
- Estimations of risk are higher if frequency scales are used (1 out of 20) v. probabilities.
- Monahan says use different ways to communicate risk (both estimates and probabilities), probablistic descriptions (%) for common events, categorical for rarer events.
