Standardized risk assessment

Abstract

Violence risk assessment and management are key components of clinical practice, especially in forensic services. Although unstructured and semi-structured professional judgement approaches are widely used to assess risk, non-standardized approaches have been criticized for being ambiguous, subjective, impressionistic and inaccurate. In an attempt to improve the accuracy of predictions, many have argued that clinicians need to adopt a more systematic actuarial approach. Actuarial approaches have definite advantages, but tend to focus on relatively static factors derived from aggregate data that might not translate to individual cases. Greater emphasis needs to be placed on standardizing and structuring the task of violence risk assessment and management The Structured Professional Judgement approach would seem to offer the most practical link between the science and the clinical practice of violence risk assessment and management. This approach moves the emphasis from one of prediction to risk management where the conditions under which the risk will increase and decrease are highlighted. Systematic frameworks have been developed to guide risk assessment that clearly outline the sequence and stages of clinical risk management. In clinical practice, these should be applied and supported by evidence-based tools and guidelines such as the HCR-20. In addition, it is important that training requirements, validity, reliability and practical utility of any standardized tool or guideline are considered before implementation in practice.