Forensic Psychology: Lecture Notes on Risk Assessment


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Forensic Psychology: Lecture Notes on Risk Assessment

  1. 1. Forensic PsychologyLecture 7: Risk Assessment (risk assessments always have potential errors) 1. What is Risk Assessment?(Used to be viewed as a dichotomy; you are either dangerous or not.) a. Risk is viewed as a range(now risk is viewed as a range; continuum; moderate low or high; idea is people don’t generally fit in all categories) i. Probabilities change across time 1. People change; people who are low risk might become high risk 2. The older the people get, the lower their risk becomes. Good predictor for men. ii. Interaction among offender characteristics and situation 1. Situations can impact; her thesis 2. Men who are more at risk in engaging in sexual coercion 3. Guys predicted to be high enages in more sexual coercion 4. But for the low-risk guys, the situation can make them highly coercive too. 5. Very difficult to do though; hard to be accurate. b. Risk Assessment has 2 components: (typically where it has been lost; normally we use these assessments to come up with labels; low risk vs high risk. But what’s the purpose of risk assessment? To label someone? No. We want to be able to do something about it. So if they are continually coming into your office to with all these problems, you want to treat them) i. Prediction 1. probability that an individual will commit future criminal or violent acts. 2. Based on identifying the risk factors that are associated with future criminal or violent acts. ii. Management (How do we manage the people who are considered at risk?) 1. We spend more time on this aspect than prediction. 2. Interventions to manage or reduce the likelihood of future violence 3. Focus is on identifying what treatment(s) might reduce the individual’s level of risk or what conditions need to be implemented to manage the individual’s risk. 4. Most of the manuals are devoted to thinking about alternative scenario 5. What is the most likely scenario that will happen if this person reoffends. 2. Risk Assessment: Civil Settings(private rights of individuals and the legal proceedings connected with such right) a. Civil commitment i. Not always in forensic. To decide whether to admit people in the hospital or not. What is based on? Threat to society and threat to self. b. Child protection
  2. 2. i. Is this parent harming their child? Taking away rights of being a parent if high risk. c. Immigration laws i. Laws prohibit the admission of individuals into Canada if there are reasonable grounds for believing they will engage in acts of violence or if they pose a risk to the social, cultural or economic functioning of Canadian society d. School and labour regulations i. To evaluate how safe a particular environment is. e. Duty to warn and limits of confidentiality(decisions in when can we breach confidentiality) i. W.v. Egdell (1990) UK 1. Paranoid schizo who shot 7 people. His lawyer called a psychologist to do an assessment. And said he has high risk. The lawyer did not submit in the report because it was not in favor of his client. But psychologist found out, got pissed and submit it into court anyway. However, job of a lawyer is to ensure confidentiality. In this case, the psychologist violated the confidentiality. ii. Tarasoff case (1974) US 1. Landmark case in the state. Has to do with what happens if client discloses to us that they are going to harm someone else. What steps do we need to do to protect the individuals involved. 2. A men who got rejected by a women. He goes in school psychologist and told him that he is planning to harm this girl. So the psychologist reports the school and told the school officers to look after him. However, later when the girl moved in which his brother, he went to the house and killed her. So the girl’s family sue the psychologist for not taking measures to stop him. The psychologist did take measure, but it was the officers who didn’t fully do their job. As a result, psychologist now has a right to breach client’s confidentiality if the client mentions harming anyone. If they know someone is at risk, they have to take reasonable steps to let that person knows.3. Risk Assessments: Criminal Settings(risk assessments are requested at numerous points) a. Risk Assessments conducted at major decision points: i. Pretrial ii. Sentencing 1. Get a referrer. Should they receive treatment should they be locked up? What level of security should this person be in? iii. Release 1. Should this person be let out completely or stay in jail? b. Public safety outweighs solicitor-client privilege(very similar to the above case) i. Smith v. Jones
  3. 3. 1. It’s important for a psychiatrist to inform the law enforcers if they know a client in risk and the defence lawyer hides it.4. Textbook: A History of Risk Assessments a. Debate about the credibility of psychologists risk assessments5. Predictions: Decisions Versus Outcomes Outcome Decision Reoffends Does not reoffend Predicted to Reoffend True Positive (Correct) False Positive (Incorrect) Predicted to NOT reoffend False Negative (incorrect) True Negative (correct)6. Base Rates(Types of errors) a. Represents the % of people within a given population who commit a criminal or violent act(i.e what is the base risk of schizophrenia, depression? Schizois 1%, depression is 10%) so if someone sits in front of you, would you predict them to have schizo or depression? i. ACCURATE prediction difficult when base rates are too high or low 1. If we are in a situation, where base rate is really high, our best bet is to say they are going to revoke their original statements or reoffend. 2. If base rate is too high or too low, we can not further use it.. we base our answer on base rate) 3. Q: so how is it difficult with a high base rate? What sort of problems can it cause? What is a good base rate then? ii. False positives tend to occur with low base rates 1. When we have low base rate, we have higher false positives (which is predicting that people will commit a crime when they won’t) b. Easier to predict frequent vs infrequent events i. Violence is not as frequent as the media portrays7. Methodological Issues(what are the risk factors for reoffence) a. Assumptions of risk assessment and measurement(score an idnvidiual on each of the factors; they are low moderate or high. If we do an ideal assessment what would this look like? We would take all of them, and put them back in society and see what happens. What’s the problem? Ethical concerns. We can’t really release the high risk people, because they are already put on a full term jail sentence. i. Ideal evaluation vs reality b. The weaknesses of research (Monahan & Steadman, 1994): i. Limited number of risk factors (we need more predictor variables) 1. Sometimes, 30 different factors. Problem? We look at their records, but the person has to be caught. ii. How criterion variable (variable you are trying to measure) is measured 1. Official criminal records 2. However, many crimes may not be reported to police
  4. 4. a. i.eviolent sexual crimes might just be reported as simply violent in nature 3. records underestimates a. using official agency records, the base rate for violence was 4.5% (cause it goes unreported) b. but when patient and collateral reports were added, the base rate increased to 27.5%, a rate of violence six times higher than the original base rate iii. How criterion variable is defined 1. Coding should include severity of violence (severe to less severe)8. Other Methodological Challenges (not mentioned in textbook?) a. Measuring Recidivism i. Problems with outcome measures 1. Some people will rely on arrest, or conviction. Each study is different. ii. Length of outcome period 1. Each study also differs in the amount of time they follow an offender. What would the results from 1 year suggest? Low. iii. Categories of offenders9. Judgment Error and Biases a. Heuristics* i. Illusory correlation 1. Definition: two things appear to be related but they are not 2. i.e hot weather and crime goes up 3. i.e violence and psychosis or violence and drug use 4. but violence and psychosis is not related. ii. Ignore base rates 1. Whether than figuring out the base rate of homicide rate, people might just look at how brutal it is… iii. Reliance on salient or unique cues 1. i.e relying on whether people have delusion or not rather than asking whether the delusion makes people at risk at harming people b. Overconfidence in judgements(used to be thought of as a source of error; people who are more confident are actually more accurate. Different from the 50’s though. This is a current finding) (link between confidence and accuracy was minimal) : overconfidence bias. i. Role of gender 1. Woman psychologist tends to judge men as being more dangerous 2. Both men and women underestimates the dangerousness of women of risk assessments.10. Unstructured clinical judgement a. Decisions characterized by professional discretion and lack of guidelines
  5. 5. b. Subjective i. Criteria are very subjective. Each professional have their own judgement c. No specific risk factors d. No rules about how risk decisions should be made i. Really, we are just going in there. Getting a gut report and deciding.11. Dr. James Grigson a. Nicknamed “Dr. Death” or “the hanging shrink”(a higher gun. If a lawyer wanted a death sentence of someone, they higher him) b. Forensic psychiatrist in Dallas i. Used unstructured clinical judgment ii. Expelled from professional association for claims of 100% accuracy in predicting violence 1. Because of unstructured clinical judgement, we actually took a long break in our assessments. Our chances were like flipping coins.12. Measuring Accuracy of Dangerousness predictions a. Ultimate Outcome Clinician’s predictions Homicide No Homicide Homicide 8 True Positives 1998 False Positives No Homicide 2 False Negatives 7992 True Negatives -let say a professional is really good at predicting homicide. Want to see whether someone is likely to commit homicide . Say base rate is 10 for every 1000 people. 0.1 %. . We had people being locked up … 1998. Our false positive rate is very high… In order to try to off set this, we use actuarial prediction .Takes out the human aspect out of it. Take a whole bunch of cases. Determine the statistical probability. That prints out, high risk, low risk.13. Actuarial Prediction a. Decisions based on risk factors that are selected and combined based on empirical or statistical evidence i. Takes a couple of known factors and determine the factors that determine risk assessments b. Evidence favours actuarial assessments over unstructured clinical judgments i. So now we are not using gut judgements c. Weakness (textbook) i. Do not permit measuring changes in risk over time (very static), or provide information relevant for intervention ( individual information) ii. Did not allow for individualized risk appraisal or for consideration of the impact of situational factors to modify risk level14. Static-99-R- An Actuarial Measure(you score them on each of these factors) a. Young(if you are older, it actually takes points away so that’s lowering risk factors) b. Have not lived with a lover for 2+ years(more points you have, higher risk) at the end you have a chart that measures their total percentage. Why is this a high risk factor? People who stay longer than 2 years are (pertaining to lovers) more likely to not be
  6. 6. offenders because they are more likely to be able to solve problems that occurs in the rleationships and hence generalizes. c. Index-non-sexual violence i. Why is this a risk factor? What do you have to do, variations of sexual crimes, if it is aggravated sexual assaults. d. Previous nonsexual violence e. Number of previous sentencing dates f. Previous sexual offences g. Physical harm to victim during sex offences, or use of weapon or threats. h. Any non-contact sex offences (i.e exhibitionisms, viewing child porn) i. Why? Indicative of an internal urge. Paraphilia. One of the main things that guys tell her is that they didn’t harm anyone, didn’t touch anyone, what’s wrong with that? i. Any unrelated victim i. Stronger desire on outside family j. Any stranger victim k. Any male victims i. If you have a victim who is male, that automatically gets you a point. ii. Take whole bunch of factors and see the ones that consistently predicts. But does not look at idea why. l. Do you see any problems with this? i. It’s not looking at the invidual… but numbers. You are an individual, but here’s their number. Takes away clinician abilities to use intuition.15. Actuarial vs Clinical Judgment Source # of Studies Variables Clinical Statistical Tie Predicted Better Better Grove et al. 136 Success in 8 63 65 (2000) school/military; recidivism; recovery from psychosis; personality; tx outcome; dx; job success and satisfaction; medical dx; marital satisfaction Egisdottir et 51 Brain 5 25 18 al impairment; personality; length of stay; dx; adjustment or prognosis;
  7. 7. violence; IQ; academic performance; suicide risk; sexual orientation; MMPI – real or fake16. Acturial>unstructural. From study above. We just breezed through the study without looking at it.17. Structured Professional Judgment(now we use all the risk factors; structured and acturials) a. Decisions guided by predetermined list of risk factors derived from research literature b. Judgement of risk level is based on professional judgement i. So the untimate decision c. Diverse group of professionals i. The term professional means even law enforcers, probation officers, and social workers can do this.18. Types of Predictors (traditionally risk factors were divided into two main types: static and dynamic) a. Static Risk Factors(unchangeable or fixed) i.e. things on the actuarial factors i. Historical (i.e never living with a partner for 2 years) ii. Factors that cannot be changed 1. i.e age at first arrest. b. Dynamic Risk Factors (also been called criminogenic needs) i. Fluctuate over time(i.e substance abuse) 1. i.eantisocial attitude ii. Factors that can be changed iii. Acute vs Stable Dynamic Risk Factors 1. Things that happen right the moment that can increase risk. Like drinking alcohol. 2. Negative mood19. Important Risk Factors(can be classified into 4 categories) a. Dispositional i. Are those that reflect the person’s traits, tendencies, or style and include demographic (where the person lives), attitudinal, and personality variables, such as gender, age, criminal attitudes, and psychopathy (antisocial ?) ii. Age, gender (research shows that men tends to commit more violent crime than women ) iii. Demographics 1. Young age and age of first offence 2. Mares > Females (more serious offence)
  8. 8. a. But some studies suggest that females > M in less serious offence iv. Personality Characteristics 1. Psychopaths and impulsiveness are linked to higher risk factorsb. Historical (Sometimes called static risk factors) i. Events experienced in the past and include general social history of violence ii. Looking at the static things (were they abused as kids) iii. Past Behavior 1. Offenders who have a history of break and enter offences are at a n increased risk of future violence iv. Age of Onset 1. Individuals who start their antisocial behaviors at an earlier age are more chronic and serious offenders v. Childhood History Of Maltreatment 1. Victims of sexual abuse were no more likely to commit criminal acts than non-abused 2. But physical abused is.c. Clinical i. Symptoms of mental disorders that contribute to violence, such as substance abuse or major psychosis ii. Do they have substance abuse issues. Do they have mental illness. There are some psychotic disorders where rate of violence is higher. iii. Substance use 1. Both direction; less clear a. People offend to get drug and people who use drug maybe offend 2. Alcohol has been linked to general violence iv. Mental Disorder 1. Although most people with mental disorders are not violent, a diagnosis of affective disorders and schizophrenia has been linked to high rates of violence 2. Patients who were suicidal and have self-harm behaviors were more likely to engage in verbal and physical aggression than were other patients 3. Threat/control override (TCO) a. Feeling if your mind is being dominated by forces beyond your control or thinking that someone is planning to hurt you b. Is a significant predictor of violenced. Contextual (situational risk factors) i. Aspects of individual current environment that can elevate the risk, such as access to victims or weapons, lack of social supports, and perceived stress.
  9. 9. ii. Things that happen at the moment. Like the environment. e. Some of these factors can be treated whereas others are in past or fixed. f. Meta-analysis: (Q: page 271) i. First, factors that predict general recidivism also predict violent or sexual recidivism ii. Second, predictors if recidivism in offenders who do not have a mental overlap considerably with predicotrs found among offenders who do not have a mental disorder iii. The strongest predictors were age of first police contact, nonsevere pathology (i.e stress or anxiety), family problems, conduct problems (i.e presence of conduct disordered symptoms), ineffective use of leisure time, and delinquent peers. g. Lack Of Social Factors i. Instrumental “to provide the necessities of life’ ii. Emotional ‘to give strength to’ iii. Appraisal ‘to give aid or courage to’ iv. Information ‘ by providing new facts’ h. Access to weapons or victims20. Risk Assessments Instruments: HCR-20(Most frequently used structured judgment) a. Ie. A teenager who was involved with gang. Drugs. Became a hitman for gang. Went to jail. While in jail, became psychotic. Refused treatment. First degree murder over 6year+. Gets released back into home with wife and kids. Started to think that he was part of an experiment that a probe was talking to him. That if he does everything the probe tells him, the probe would be released. So he comes home to his wife and kids. The voices start to tell him that the children aren’t really his. So before they thought he was not a harm to community, so they let him out. But now they put him back in hospital. Refused treatment. So he walks back home. So then he gets send to us. Before he did that, he used risk assessments. Decided that he was high risk. Where would you put his risk? High..why? He ended up spending 3 months at the locked yard. He was psychotic that it was impossible for him to have a plan. b. Historical Items i. Previous Violence 1. 2 ii. Young age at first violent incident 1. 2 iii. Relationship problems 1. 1 iv. Employment problems (2) was part of gang v. Substance use problems 1 (used cocaine) vi. Major mental illness 2 vii. Psychopathy (1) he was more antisocial and psychopathic
  10. 10. viii. Early maladjustment ix. Personality disorder x. Prior Supervision Failure xi. Based on these factors would you give him low, moderate or high? High. c. Clinical Items i. Lack of insight (all he thought was that it was a probe and that there was probe in his brain and that one day it would be remove) ii. Negative attitudes (he had previously endorsed violence; does he still endorse these) iii. Active symptoms of major mental illness (2) iv. Impulsivity (0) gave him a pass and takes out his wife. Very predictable. v. Unresponsive to treatment (especially responsive to treatment; didn’t want to take it) d. Risk Management Items(what do we do with them?) i. Plans lack feasibility (he was going to live in the basement sweep that his parents has prepared for him? ii. Exposure to destabliizers (wasn’t using drugs anymore iii. Lack of personal support (his family was really taking care of him iv. Noncompliance with remediation attempts (he’s still out in community without any problems v. Stress ( e. This is different from the actuarial measures. Allows us to look more at the individual; like how they would be if we let them out. f. Q: how is the HCR – 20 an example of a structured risk assessment? Which part of it contains the actuarial?21. Video: a. Police officer was killed. b. Adams random is false positive c. David harris is false negative. He got executed.22. Paper is due on the 17th. Setting up office hours on the 10th.23. Current Issues a. Protective factors i. Factors that reduce or mitigate the likelihood of violence b. Use of scientific research i. Practitioners not using instruments c. Where is the theory? i. More attention on WHY is needed