Assessing Risk

for Violence

Dr Lorraine Johnstone
Consultant Clinical Forensic Psychologist
Honorary Research Fellow
Accredited Risk Assessor

Lorraine.Johnstone@ggc.scot.nhs.uk
Perspectives

RESEARC
H

PRACTITIO ORGANISATI
NER ONAL
 What is Risk Assessment?

Process of evaluating the

characteristics of
offenders and their
environment to estimate
the likelihood and the
nature of a negative
outcome (in this case,
“Prediction of dangerousness is particularly
difficult because: dangerousness is the
resultant of a number of processes which
occasionally may be synergistic
amounting to more than the sum of the
parts, some within the individual and some
in society; it is not static; key factors are
the individual’s adaptiveness, resistance
to change, and his intentions…” Scott
(1977, p. 128)
False errors
RMA Standards: Assessment

Offender Background
Offence Analysis
Risk Factors
Protective Factors
Risk Scenarios
Risk Management
 •Drive
•Disinhibit
•Destabilise Scenarios

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 Risk Assessment: Approaches

Unstructur Actuarial Structu

ed (Prediction) red
Clinical Clinical
Judgement Judgem
ent
Which method is best?
Research Perspective

PREDICTIVE
VALIDITY
 Unstructured Clinical Judgement

Unstructur
ed
Clinical
Judgement
Unstructured Clinical Judgement

“…relies on an
informal, ‘in the head,’
impressionistic,
subjective conclusion,
reached (somehow)
by a human clinical
judge”
Grove and Meehl
ACTUARIA SCJ
L

PREDICTIVE
VALIDITY
Methodologies
Assessing Risk for
Violence
A Framework for
Practice

David Farrington
Darrick Jolliffe
Lorraine Johnstone

RMA Scotland
 Aims and objectives
CHARACTERISE AND QUANTIFY THE
EVIDENCE

PREDICTIVE
VALIDITY
 Method

ROC Analysis and studies reported

AUC (or these could be derived)

Overall ES
Inclusion Criteria

Prospective

Violence AUC for ROC

Males N= 50 or
more
 Search Terms and Strategy

Terms: Violen*, Aggressiv*, Serious*, Crim*,

Assessment, HCR-20, VRAG, Etc.

Strategy: Contact leading researchers,

electronic database, internet and
citation searches
Studies Retrieved & Included

145

31
 Results: Overall ES
Device N AUC Lower CI Upper
CI
GSIR 4 0.73 0.68 0.79
OGRS 4 0.71 0.66 0.75
HCR-20 13 0.70 0.66 0.74
PCL 18 0.69 0.66 0.73
VRAG 18 0.69 0.67 0.72
LSI-R 7 0.64 0.63 0.66
From the Group to the
Individual....
 Illustration
Violence Risk Assessment
Guide
VRAG Variables - 1

Psychopathy Checklist Score +VE

Elementary school maladjustment +VE
DSM-III diagnosis of Personality +VE
Disorder
–VE
Age at index offence
Separated from parents under age 16 +VE
Failure on prior conditional release +VE
VRAG Variables - 11

Non-violent offence history +VE

Never married +VE
DSM-III diagnosis of –VE
Schizophrenia –VE
Victim injury +VE
Alcohol abuse –VE
Female victim index offence
Probability of Violent Recidivism
1
Seven Year Follow-up
0.9
0.8
0.7
0.6
0.5
0.4
0.3
0.2
0.1
0
1 2 3 4 5 6 7 8 9

VRAG CATEGORY
 Probability of Violent Reconviction after Two Years

1.0
95% CI Individual

0.8
Probability

0.6

95% CI Group

0.4

0.2
95% CI Group

95% CI Individual
0.0
-20 -10 0 10 20

VRAG
“The ARAIs cannot be used to estimate
an individual’s risk for future violence
with any reasonable degree of certainty
and should be used with great caution
or not at all.”
 •Drive
•Disinhibit
•Destabilise Scenarios

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METHOD: DESIGN
 Standards and Principles
1. User Manual
2. Specified User Qualifications, Competencies
and Skills
3. Accessible Training
4. Ease of Use
5. Uses a Comprehensive Information Source
6. Appropriate Administration Time
7. Social History
8. Offence Analysis
9. Appropriate Number of Risk Factors
10. Appropriate Emphasis on Static Factors
 Standards and Principles
11. Appropriate Emphasis on Dynamic Risk
Factors
12. Well Defined Risk Factors
13. Ease of Scoring/Rating Procedures
14. Describes and Identifies Protective Factors

15. Assists in Risk Formulation

16. Assists in Identifying Plausible Risk
Scenarios
17. Assists in the Development of a Risk
Management Plan
18. Assists in the Identification of Treatment
Needs
19. Assists in the Identification of Monitoring
METHOD: Sample
Respondents
 Perceived Utility

HCR-20 RAG-F LSI/ PCL

/RA1-4 LS-CMI

Standard 21 18 20 18
s
(Max =
22)
Which tool is best?
 But.....Organisational Issues

Expertise
Time intensive

High Cost

On-going
Training
Labour &
Intensive Development
 2004
MWC Inquiry Senior Management
Directive to develop
RA policy
Legislative and Policy
Drivers

2006
2 Dedicated Posts

MDT Risk Policy Group 2006/07

Framework for Practice, Training

and Documentation
Draft Policy:
Presentation and
Consultation March
2007
 DFMH Risk Policy (NHSGG&C)

Model and Format

–SCJ Model as per RMA standards

–Psychiatrist or psychologist co-

ordinates but strong emphasis on
MDT involvement
 DFMH Risk Policy (NHSGG&C)

Aims
1) to have at least a preliminary
formulation of the person’s risk
available to inform management;

2) to have a full risk assessment with all

specialist assessments completed
 Pathway and Process

1) Risk Screen for Risk

Identification

2) Risk assessment
 Limited Information used to inform HCR-20

Preliminary formulation

Additional information used to update HCR-20

Re-formulation

Specialist Assessment (e.g. Personality disorder)

Re-formulation
 Implementation

( 1) Lead Posts (x2)

(2) On-going training Strategy for
MDT staff on:
Awareness training
Risk Policy
HCR-20
PCL-R and other specialist assessments
(START)
* internal and external trainers
 Does it work?

More of the same...

Back to before...

Something entirely new

raining Strategy for MDT staff
Risk Policy
HCR-20
PCL-R
(START)
 Summary and Conclusions

• Assessing Risk for Violence is a complex

and controversial task

• Priorities differ depending on

perspective

• Common question: Which model is best?

 Summary and Conclusions

• Meta-analysis indicated that the empirical research

supports HCR-20 (and OGRS) in terms of predictive
validity

• Practitioners prefer the HCR-20 in terms of risk

assessment standards

• Challenge for organisations to promote and support

the widespread use of the SCJ approach in a way that
is time and cost effective: Models need to be tried
and tested