Week 7 & 8: Violence Risk Assessment & Suicide Risk Assessment Flashcards
What are the key elements for duty to warn & protect?
- Specific threat
- Specific victim
- Foreseeable danger
Barefoot v. Estelle (1983)
- Psychiatrists are allowed to testify about future dangerousness during death penalty sentencing.
- Barefoot appealed (MH professionals’ ability to predict future dangerousness is limited)
- SCOTUS: such testimony is not unconstitutional
Thompson v. County of Alameda (1980)
There is a specific threat towards a specific victim.
Ruling: The County is not liable for negligence in releasing the prisoner without warning to the community.
Parens patriae and police power
- A government must protect it’s citizens from each other and themselves.
Rouse v. Cameron (1967)
- Right to treatment
- Can’t just be confinement, must provide treatment
- Argument sometimes used for release
- “…persons committed to a mental hospital after pleading not guilty by reason of insanity have a constitutional right to treatment while institutionalized.”
Rennie v. Klein (1978)
- Factors to consider in overiding refusal:
- Patient’s capacity to make treatment decisions
- Patient’s physical threat to staff/other patients
- Whether any less restrictive treatment exists
- Risk of permanent side effects from treatment
- “An involuntarily committed patient who has not been found incompetent, absent an emergency, has a qualified right to refuse psychotropic medication.”
O’Connor v. Donaldson (1975)
- No dangerousness, no treatment
- “If an individual is not posing a danger to self or others and is capable of living without state supervision, the state has no right to commit the individual to a facility against his or her will.”
Addison v. Texas (1979)
- Level of proof, clear and convincing; burden of proof is on the petitioner
- “A “clear and convincing” standard of proof is required by the Fourteenth Amendment in a civil proceeding brought under state law to commit an individual involuntarily for an indefinite period to a state mental hospital.”
Foucha v. Louisiana (1992)
- Does personality disorder count as mental illness?
- “…a criminal defendant found not guilty by reason of insanity may be committed to a psychiatric hospital.”
Assessments for Tarasoff and civil commitment require focus on risk state rather than risk status:
- Does this present a risk now? (rather than is this a risky person relative to others)
- Need to be able to assess changes over time
Risk state: Challenges
- Need for research on dynamic predictors and causal factors, not just correlates
- Need for research with assessments at multiple time points
- Schedule of assessment: How quickly does risk change and how often should we assess?
- Multifactorial nature of risk, and complex interplay between risk factors
Promising dynamic risk factors:
- Focus on dynamic risk allows for:
- More informed decisions about type of treatment and supervision needed.
- Identification of when intervention is necessary to reduce risk
- Identification of appropriate treatment targets
What are the types of risk assessment procedures?
Clinical, Actuarial, Structured Professional Judgment
Define clinical risk assessment procedures.
- Evidentiary test of admissibility of expert testimony on violence risk assessment:
- Has the theory been tested?
- Reliance on subjective clinical interpretation of the expert?
- Peer review & publication?
- Potential rate of error?
- General acceptance?
- Non-judicial uses of the theory or technique?
- Post Daubert conclusions: “Testimony by a qualified expert re: a properly conducted clinical violence risk assessment will remain admissible as evidence.”
Define actuarial risk assessment procedures.
- Use an algorithm/formula to combine risk factors to calculate an overall risk score.
- Clinical Interview.
- Collateral Information (official records)
- Scoring & weighting of predictive characteristics by formula (weighted towards static risk factors)
Define Structure Professional Judgment risk assessment procedures.
- Structured.
- Based on empirically-supported risk factors.
- SPJ allows clinicians to combine risk factors as they see fit.
Why not to use clinical adjustment of actuarial risk assessments?
- Questionable validity generalization.
- Rare risk or protective factors.
What type of measure is a VRAG?
Actuarial Measure.
What type of measure is a HCR-20?
Structured Professional Judgment.
How does culture affect suicidal risk?
- Highest suicide rate in White males.
- Growing rates in African American adolescent males.
- Among older adults – highest in Asian Americans
- Elevated risk in Latino adolescents & LGBTQ+ adolescents
Four Factors of Model of Suicide:
- Cultural sanctions
- Idioms of Distress
- Minority Stress
- Social Discord
Define Cultural Sanctions.
Cultural values/practices conveying messages about acceptability of suicide (or relevant life events).
Define Idioms of Distress.
Cultural variation in likelihood of, and how, suicidality is expressed; methods/means of likelihood.
Define Minority Stess.
Stresses that cultural minorities experience because of social identity or position (e.g., acculturation)
Define Social Discord.
Alienation, conflict, or lack of integration with one’s family, community or friends.
Best predictors of sexual recidivism (static):
- Sexual deviancy (d=.30)
- Antisocial orientation (d = .23)
- Sexual attitudes (d = .23)
- Intimacy deficits (d = .15)
Best dynamic risk factors:
- Deviant sexual interest
- Sexual preoccupation
- Antisocial personality/psychopathy
- Self-regulation skills
- Employment instability
- Hostility
What are misleading risk factors?
- Force/violence in sex offending
- Neglect or abuse during childhood
- Sexual abuse during childhood
- Loneliness
- Low self-esteem
- Lack of victim empathy
- Denial of sex
- Low motivation for treatment at intake
Specialized assessment techniques for sex offenders:
- Multiphasic Sex Inventory- II (31% of programs)
- Polygraph (79%)
- Sex interest measures (59%)
- 28% use penile plethysmography
- 46% use viewing time measures
Common targets of treatment for sex offenders vs. empirically-supported dynamic factors
- Victim awareness/empathy (92.7%)
- Offense responsibility (91.8%)
- Intimacy/relationship skills (91.2%)
- Social skills training (87.5%)
- Problem solving (79.9%)
- Family support networks (77.2%)
- Arousal control (68.5%)
- Emotional regulation (65.7%)
What is Relapse Prevention for sex offenders?
- Focuses on “offense cycle”
- Seemingly insignificant decisions
- Common in similar model as treatment for substance use treatment
- Research suggests not as effective as originally thought…
