Laws seeking to protect the general public from mentally ill individuals who have a history of committing a violent crime can be traced back to the 1800s. Significant changes in the said laws have occurred in the last few years, the main contributor being the assumption that mental illness is a predictor as well as the cause of violent behavior. Judgment by clinicians remains the most frequently utilized approach to violence risk assessment. However, this approach has its fair share of shortcomings including vulnerability to cognitive biases and lack of transparency. To counter the shortcomings of assessments that rely on clinical judgment, a wide range of actuarial risk assessment instruments have been created. The assessments carried out using these tools are based on a score assigned from a list of risk factors. Despite making violence risk assessment more objectives, concerns continue to be raised about their effectiveness.
Folino (2015) examines the predictive effectiveness of some of some of the tools for violence risk assessment used in Latin America. He starts by pointing out that for the better part of the 20th century, violence risk assessment in Latin America had its basis in non-structured clinical approach. Folino (2015) is however quick to point out that things have changed in the recent past, thanks to the conceptual restructuring of violence risk assessment in the academic and forensic fields. He points out that efforts to turn things around, more specifically in Argentina, began in the last decade of 20th century. During this period, researchers focused on the predictive quality of risk assessment as a prevention tool. Folino (2015) states that it was not until 2000 that Argentina eventually established a program to obtain empirical evidence on violence risk assessment.
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The author then goes on to highlight the development of the plan, pointing out that the aim of the pilot initiative for assessment of violence risk among released males was to establish a procedure for systematic assessment of violent recidivism risk among forensic patients as well as prisoners who had applied to any form of anticipated release. In addition to that, it is reported that the program aimed at contributing to the establishment of strategies that would help lower recidivism rates in the province of Buenos Aires. Folino (2015) reports that the prevailing beliefs resulted in notorious shortfalls of knowledge as far as the implementation of the pilot program was concerned. One area he mentions as having been characterized by knowledge shortfalls is the base rate for criminal recidivism. According to Folino (2015), establishing the base rate was one of the main objectives of the program, a fact that led to the formation of a cohort of males that were released from prison in 1991.This was followed by obtaining of the official criminal register for the next 10 years. Analysis of the register revealed that 34% of those released in 1991 had at least a single while 51% registered at least a single charge (Folino, 2015). The author adds that the analysis led to the designing of a protocol for pre-release assessment, part of which were nine instruments that were being used internationally. The instruments include the Violence Risk Appraisal Guide and Hare Psychopathy Checklist.
Folino (2015) then discusses some of the studies done in Argentina and other regions of Latin America to test the effectiveness of various violence risk assessment programs and tools. He then goes ahead to point out the purpose of his study, stating that it sought to establish the violent as well as the general rates of recidivism rates among convicted males released from September 2001 to March 2012 and to examine the predictive efficiency of the instruments for violence risk assessment used in the pre-release assessment. In the methodology section, Folino (2015) points out that 153 consecutive pre-released males who had been convicted took part in the study. The study is said to have been conducted in La Plata, Argentina, with the participants being recruited starting from September 2001 to September 2004. The pre-release assessment measures that were examined were Structured Professional Judgment, Assessing Risk for Violence V2, Violence Risk Appraisal Guide and he Hare Psychopathy Checklist-Revised. In the findings, Folino (2015) reports that 64.7% of those who took part in the study were implicated in at least one general relapse while 59.5% recorded at least one violent relapse. Based on the findings, the researcher concludes that violence risk assessments tools help predict recidivism rates, but they are not that effective. He points out that taking into consideration the probability of accumulated recidivism during the follow-up period results in significant improvement in the predictive efficiency of the assessment tools.
Folino (2015) makes reference to a number of studies conducted earlier own including one by Telles, Folino, and Taborda (2012). In this study, they sought to examine the effectiveness of the Historical, Clinical and Risk Management Scales (HCR-20) when it comes to prediction of violence and related offenses. According to the three researchers, assessing the risk of violence is quite a complex undertaking. They point in most Latin American countries, the assessments utilize approaches that are not structured and objective. Telles, Folino, and Taborda (2012) then go on to state the objective of their study, stating that they aim to find out the predictive validity HCR-20 violent assessment tool using a section of male forensic psychiatric patients in Brazil. They point out that they utilized a concurrent prospective cohort design in which 68 participants were selected. They then state that they used the second version of HCR-20-Assessing Risk for Violence and Hare Psychopathy Checklist, Revised (PCL-R). in their findings, Telles, Folino, and Taborda (2012) report that the mean total score for HCR-20 was 23.32 while that of PCL-R was 13.54 for the entire cohort. They state that the predictive efficacy of both scales was higher for anti-social behaviors compared to violent events
Fazel et al (2012) also carried out a study to examine the predictive validity of instruments that are frequently utilized to evaluate the risk of sexual, violent and criminal behavior. They start by pointing out that violence risk assessment, as a subject, has over the past few years attracted the interest of clinicians as well as researchers. They report that this increased interest has been as a result of increased public acknowledgment of the public health importance of violence. Fazel et al (2012) point out that starting from the 1980’s, violent risk assessments have been done through structured instruments. They point out that the switch to structured instruments from unstructured approaches was informed by a number of studies that found the unstructured approaches to be less effective. They add that over the years the use of the different structured violence risk assessment tools has found widespread application in areas such as management of mental patients as well as the criminal justice system. With regard to the criminal justice system, Fazel et al (2012) state that many countries around the world have embraced the use of this tools in aiding the making of sentencing as well as releasing decisions.
Fazel et al (2012) highlight how most of the violence risk assessment tools work, pointing out that they either avail a probabilistic likelihood of violence risk within a specified period or facilitate the making of professional judgments with regard to risk level. The making of professional judgment is said often done after taking into consideration the absence or presence of certain pre-determined risk factors. Fazel et al (2012) report that as at the moment, there are over 150 structured violence risk assessment tools and that most countries around the world, including low and middle-income countries, are now using them. However, they are quick to point out that the risk assessment tools have their flaws, including the fact that they are resource intensive, requiring analysis by professions from multiple disciplines. Fazel et al (2012) point out additional shortcomings of the structured violence risk assessment tools, stating that they are also time-consuming and are often expensive to utilize. They also add that the predictive accuracy of the tools has also emerged as an important issue, with many researchers raising doubts about their overall effectiveness.
In the methodology section, Fazel et al (2012) point out that their study was a combination of a meta-analysis and systematic review of replication studies on the violence risk assessment tools. The researchers go on to mention the databases from which they sourced the studies. The databases included Embase, Medline, PsycINFO and United States Criminal Justice Reference Service Abstracts. They state that the searched for studies published between 1 January 1995 to 1 January 2011. The studies that the researchers included in their analysis had to avail the contingency information for the offending results that the assessment tools were meant to predict. For the systematic review, Fazel et al (2012) report that they were able to identify 251 valid studies. Studies that were included in the meta-analysis, on the other hand, had to provide rates of false positives, true positives, false negatives and false positives at a specified cut-off score for the outcome an instrument was meant to predict.
Fazel et al (2012) point out that the analysis of the studies they identified was in accordance with the current guidelines set by the Cochrane Collaboration for Systematic Reviews of Diagnostic Test Accuracy. In their findings, they report that risk assessment using the different violence risk assessment tools was carried in 73 samples, making a total of 24,847 participants. They report that when utilized in the prediction of violent offending risk, the tools resulted in low to moderate positive predictive values. They add that in general, instruments meant to predict violent offending outperformed those designed for predicting general crime as well as sexual offending. In their conclusion, Fazel et al (2012) acknowledge that despite their widespread utilization in the criminal justice system, the effectiveness of violence risk assessment tools vary depending on the manner in which they are used.
Fazel et al (2012) utilize a number of articles to support their arguments. One of the articles used in the study conducted by Khiroya, Weaver, and Maden (2009) in which the three sought to find out the usage as well as the perceived utility of standardized risk measures in medium secure forensic units in the UK. The researchers start by stating that violence risk assessment takes center stage when it comes to the provision of forensic mental health services. They point out that over the years, standardized methods of violence risk assessment have become quite popular, but there is a significant variation between services as far as the utilization of the said instruments is concerned. According to Khiroya, Weaver, and Maden (2009), actuarial approaches and structured clinical methods are the only available alternative to the clinical assessments. They point out that actuarial methods propose the collection and interpretation of information that is relevant to risk while structured clinical approaches call for the collection of the same information but incorporate clinical discretion in utilizing some information.
Khiroya, Weaver, and Maden (2009) then highlight the objectives of their studies, stating that the aim was to measure the number of medium secure services that utilize structured violence risk and sexual offender risk assessment tools, to establish the specific tools used and to work out the perceived utility of the said tools. They point out that a total of 29 forensic medium secure units were surveyed and that the findings revealed that Psychopathy Checklist – Revised (PCL–R) and Historical Clinical Risk–20 (HCR–20) were the most widely utilized instruments. They also report that for sex offender assessment, the common assessment instruments were Static-99 and Sex Offender Risk Appraisal Guide (SORAG). In their conclusion, they state that a good number of medium secure units utilize structured risk assessments tools and that most staff member positively perceives their utility.
In conclusion, the use of tools for violence risk assessment has increased over the past few years. However, concerns continue to be raised about their predictive efficacy. This paper discussed two studies that sought to investigate. The efficiency of violence risk assessment tools and two supportive articles for each of the studies. Both the studies and the support articles reveal that despite making violence risk assessment more objectives, concerns continue to be raised about their effectiveness. Some of the violence risk assessment instruments that are used in the criminal justice system include the Hare Psychopathy Checklist–Revised, the Violence Risk Appraisal Guide, he Rapid Risk Assessment for Sexual Offense Recidivism.
References
De Borba Telles, L. E., Folino, J. O., & Taborda, J. G. V. (2012). The accuracy of the Historical, Clinical and Risk Management Scales (HCR-20) in predicting violence and other offenses in forensic psychiatric patients in Brazil. International journal of law and psychiatry , 35 (5), 427-431.
Fazel, S., Singh, J. P., Doll, H., & Grann, M. (2012). Use of risk assessment instruments to predict violence and antisocial behavior in 73 samples involving 24 827 people: systematic review and meta-analysis. BMJ , 345 , e4692.
Folino, J. O. (2015). Predictive efficacy of violence risk assessment instruments in Latin-America. The European Journal of Psychology Applied to Legal Context , 7 (2), 51-58.
Khiroya, R., Weaver, T., & Maden, T. (2009). Use and perceived utility of structured violence risk assessments in English medium secure forensic units. The Psychiatrist , 33 (4), 129-132.
