Forensic Risk Research Articles

The impact of interview quality on risk assessment of young people who sexually offend

Forensic risk assessments are used to determine sanctions, identify recidivism risk and inform implementation of risk reduction strategies. The best way to gather reliable data to inform decisions is important and the focus of this mixed-method study. Forty-five experienced professionals performed a risk assessment involving a young person who sexually offended (YPSO). They read a good-quality or a poor-quality interview and collateral information. Under half (42.2%) of participants provided the expected risk ratings. Some participants misidentified elements of good-quality interviewing (e.g. rapport, open questions). Ratings of fairness of the forensic interview were positively associated with increased sense of perceived interview quality. Confidence in risk-assessment decisions tended to be higher in the good-quality than the poor-quality interview group. Practitioners involved in the risk assessment of YPSO should receive effective/robust training in best practice interviewing so they can identify and implement empirically based interviewing techniques for care provision for YPSO.

Forensic risk assessment in people with learning disabilities: principles and process

Forensic risk assessment in people with learning disabilities: principles and process

Supplemental Material for Too Risky to Use, or Too Risky Not to? Lessons Learned From Over 30 Years of Research on Forensic Risk Assessment With Indigenous Persons

Supplemental Material for Too Risky to Use, or Too Risky Not to? Lessons Learned From Over 30 Years of Research on Forensic Risk Assessment With Indigenous Persons

Too risky to use, or too risky not to? Lessons learned from over 30 years of research on forensic risk assessment with Indigenous persons.

Indigenous peoples are overrepresented in correctional systems internationally, reflecting a history of systemic racism and colonial oppression, and the practice of risk assessment with this population has been a focus of legal and sociopolitical controversy. We conducted a systematic review and meta-analysis of the risk assessment literature comparing Indigenous and non-Indigenous (White majority) groups. We retrieved 91 studies featuring 22 risk tools and 15 risk/need/cultural domains (N = 59,693, Indigenous; N = 237,729, non-Indigenous/White) and four documents identifying culturally relevant factors. Most measures demonstrated moderate predictive validity but often had significant ethnoracial differences, particularly for static measures. The Service Planning Instrument/Youth Assessment Screening Inventory, Level of Service Inventory youth variants, Psychopathy Checklist-Revised and Youth Version, and the Violence Risk Scale and its Sexual Offense version had the strongest predictive validity and least ethnoracial discrepancy. The Static Factors Assessment and Dynamic Factors Identification and Analysis-Revised had the weakest predictive validity. For Indigenous persons, the strongest individual predictors of recidivism were low education/employment, substance abuse, antisocial pattern, and poor community functioning, while mitigating factors that predicted decreased recidivism were measures of risk change (i.e., from culturally integrated programs combining mainstream and traditional healing approaches), cultural engagement/connectedness, and protective factors. In practice, static measures need to be supplemented with dynamic ones, and assessors should select measures with at least moderate predictive validity and ideally the least ethnoracial bias. These conclusions are tempered by the quantity and quality of the literature coupled with the circumstance that some study authors have coauthored tools in this review. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Augmenting predictive models in forensic psychiatry with Cultural Consensus Theory

Abstract Forensic psychiatric hospitals regularly monitor the mental health and forensic risk factors of their patients. As part of this monitoring, staff score patients on various items. Common practice is to aggregate these scores across staff members. However, this is suboptimal because it assumes that assessors are interchangeable and that patients are independent. An improvement over averaging scores is the use of Cultural Consensus Theory (CCT), which imposes a hierarchical model across patients, staff members, and items. While accounting for differences between patients and staff members, CCT estimates a ‘true’ score for each patient on each item based on the consensus among staff members. Here, we apply a CCT model to data from a Dutch maximum-security forensic psychiatric centre and use the inferences to predict violent behaviour in patients. The CCT model outpredicts several alternatives, such as random forest and boosted regression trees, albeit by a small margin. We discuss practical limitations and directions for how future monitoring of patients could be adapted to maximize the added value of a CCT-based approach.

The impact of childhood maltreatment on aggression, criminal risk factors, and treatment trajectories in forensic psychiatric patients

IntroductionChildren’s development into healthy well-functioning adults can be negatively affected by adversity. Adverse childhood experiences (ACEs) have been shown to lead to a variety of poor life outcomes, ranging from mental health problems (e.g., anxiety or suicidality) through problematic health behaviors to serious physical diseases and even early death. ACEs can also make people more prone to aggressive behavior, criminality, and recidivism. In this study, we investigated the association between ACEs, specifically childhood maltreatment (CM), and forensically relevant factors; aggression, criminal risk factors, and treatment trajectories, as little is known about these associations in forensic psychiatric patients.MethodsThe study includes data derived from two studies in The Netherlands, of which the first study enrolled 128 patients residing in a Forensic Psychiatric Center (FPC) and the second study included 468 patients who were released unconditionally from FPCs between 2009 and 2013. We expected that more CM would be correlated with higher levels of aggression, higher clinical risk factor scores, and less decrease in clinical risk factor scores over time. To investigate this, we applied correlational analyses and linear growth curve modeling on risk assessment scores and self-report as well as staff report questionnaires on CM and aggression.ResultsConsistent with our first hypothesis, patients with higher CM scores also had higher aggression and risk assessment scores. The effect sizes were small to medium (0.12 to 0.34). Unexpectedly, CM did not influence the course of these treatment trajectories, however, we found that patients with histories of CM had a significantly longer length of stay in a forensic facility than patients without CM (respectively, 10.8 years and 9.3 years on average).DiscussionThis study underlines the importance of carefully examining the history of ACEs and CM in forensic psychiatric patients and considering this in forensic risk assessment and risk guided treatment. More research is needed to draw conclusions about whether and how histories of ACEs should be considered and targeted during treatment trajectories.

Static and dynamic predictors of forensic mental health decision-making.

In Canada, individuals found not criminally responsible on account of mental disorder (NCR) fall under the supervision of a jurisdictional review board (RB) per the Criminal Code. Limited research has examined whether RB decisions balance the needs of public safety with social reintegration as intended by federal legislation. To fill this gap, the present study determined whether forensic decisional outcomes in one provincial RB system accounted for information relevant to violence risk. Study instruments included the Level of Service/Case Management Inventory (LS/CMI), Historical Clinical Risk Management-20 Version 3, and the Revised Violence Risk Appraisal Guide. A retrospective longitudinal design was employed to examine an NCR cohort (N = 109) that entered the RB system between 2005 and 2010 and their respective RB hearings (N = 327) until 2015. Results indicated that risk-relevant information was supplied to the RB by forensic professionals; however, key criminogenic risk and need factors as defined by the LS/CMI were absent in clinical reports. RB decisions were still strongly predicted by empirically supported risk factors linked to violent recidivism. Higher release likelihoods corresponded to a proportionally greater reliance on dynamic risk factors to enact dispositions. Forensic risk instruments are central aspects of correctional rehabilitation, and the results demonstrated their relevance to forensic tribunals. It is recommended that information from a forensic risk instrument be routinely delivered to RBs to support evidence-based decision-making. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Comprehensiveness and Context of Psychiatric Reports Submitted to Review Boards in Cases of People Found Not Criminally Responsible on Account of Mental Disorder

Recent research suggests that empirically validated risk factors for persons found not criminally responsible on account of mental disorder (NCRMD) are rarely mentioned by clinicians in reports for Review Boards in Canada. This study aims to better understand this observation by examining the styles of clinical reports (i.e., types of report according to their comprehensiveness and their content) and the contextual factors associated with them. To identify styles of reports, mentions of risk factors within reports were subjected to a series of latent class analyses. Regression analyses were then carried out to identify which contextual factors (characteristics related to the person found NCRMD, the timing of the report, and the clinical team/care setting) were significantly associated with the styles of reports. Findings revealed four styles of reports which were also correlated to contextual factors, some unrelated to the risk of violence and/or reoffending for the person found NCRMD. These results reinforce the need to implement evidence-based practices in forensic risk assessment and management.

“Stigmatization and perceived dangerousness for intrafamilial child sexual abuse of fathers with a history of sexual offenses and paraphilic interests: Results from a survey of legal psychological experts”

BackgroundIntrafamilial child sexual abuse (ICSA) is a puzzling phenomenon that is not well understood by researches. Nevertheless, psychologists are demanded to assess the risk for child maltreatment by family courts regarding male caregivers with a history of sex offenses and/or paraphilic interests. ObjectiveThe aim of this study was to assess legal psychological experts' perspective on risk assessment in family court proceedings regarding ICSA, their opinions regarding the necessity of contact limitations between fathers/stepfathers who might impose a risk for ICSA, and experts' stigmatization of minor-attracted persons. Participants and setting153 psychological experts working in family court proceedings were assessed via an online survey. MethodJahnke's Stigma Inventory was used as well as a questionnaire tapping into different contact limitations, the perception of child maltreatment risk, and parental capacity. Network analysis was conducted to multivariately investigate item intercorrelations. ResultsFathers/stepfathers with a diagnosed pedophilic disorder are being regarded as most dangerous, 71 % of the experts agreed with the necessity of a complete contact ban. Reduced parental capacity and increased risk for child maltreatment was observed with regard to sexual offending history and paraphilias. ConclusionsPsychological experts in family court proceedings hardly discriminate between sexual offending and paraphilic interests which might be associated with stigmatizing attitudes and lack of experience. An increasing cooperation between family psychologists and experts of forensic risk assessment might reduce the risk of stigmatization and may contribute to more adequate risk assessments for ICSA thus aiding to prevent children from sexual victimization or misinformed risk management interventions.

Predictive validity on clinical item-level of the HKT-R divided into clinical patient classes

BackgroundBecause of the heterogeneity of forensic groups, latent class analysis (LCA) can allow for the formation of stronger homogeneous patient classes, which can improve the predictive validity of forensic risk assessment tools, such as the Historical Clinical Future – Revised (HKT-R), which was used in this study. In particular, dynamic clinical risk and protective items are important in treatment and are obligatory assessed annually for every forensic patient with a TBS measure in the Netherlands. Therefore, this study investigated the predictive validity of the HKT-R at clinical item-level per patient class.MethodA cohort of 332 forensic patients, who were discharged from highly secured Forensic Psychiatric Centers/Clinics (FPCs) in the Netherlands between 2004 and 2008, was followed. LCA was performed to cluster this group of patients based on psychopathology and criminal offenses. The predictive validity of the HKT-R clinical items by class was assessed with official reconviction data two and five years after discharge as outcome measure.ResultsFour classes were identified. The predictive validity of the HKT-R clinical items showed differences between and within classes on admission or discharge, and for predicting violent reoffending after two or five years after discharge.DiscussionDifferent risk/protective factors of the HKT-R may play a role for different subgroups of patients. Therefore, this heterogeneity should be considered for any measure or intervention.

Risk formulation in forensic practice: a review of the evidence

PurposeThe purpose of this paper is to review the evidence base for the use of risk formulation in forensic practice settings.Design/methodology/approachSystematic literature review principles were adopted to identify literature exploring risk formulation in forensic practice settings in relation to offending behaviour.FindingsData were analysed using a narrative synthesis approach, and commonalities were observed across some of the studies in terms of definitions, outcomes, and implementation, of risk formulation; however, the findings of the review did not provide a definitive account of risk formulation practice in forensic settings. This is due to the narrow scope of the included studies, the small yet diverse samples, the heterogeneity in research aims and the methodological weaknesses apparent within the included studies.Research limitations/implicationsFurther research is needed to understand the application and outcomes of risk formulation in forensic practice settings.Practical implicationsPractitioners should be clear about how they are defining, implementing and assessing the outcomes of risk formulation, alongside being mindful of the evidence base when utilising forensic risk formulation in practice.Originality/valueTo the best of the authors’ knowledge, this is the first paper to focus solely on the evidence base for forensic risk formulation in practice.

Aboriginal and Torres Strait Islander perspectives on forensic risk assessment

Risk assessment instruments are used to estimate risk of recidivism and aid in decision-making and treatment planning. However, many of these instruments, including the Level of Service/Risk, Need, Responsivity (LS/RNR), are validated on predominantly Western populations, and research has questioned whether the factors included in the LS/RNR adequately capture the experiences and needs of non-Western communities, including Aboriginal and Torres Strait Islanders. The current study aimed to canvas the opinions of Aboriginal and Torres Strait Islander community justice workers as to the suitability of the LS/RNR for use with this population. A general qualitative methodology was adopted to gain in-depth information through the facilitation of a focus group, and data were analysed thematically. Whilst participants agreed that the LS/RNR risk factors are relevant to Aboriginal and Torres Strait Islander offenders, they reported that the instrument did not adequately capture relevant culturally specific considerations and made suggestions to improve the LS/RNR.

Dodging justice: characteristics of men with multiple victims who evade detection for long periods

ABSTRACT Little is known about men who sexually abuse multiple children and evade detection for long periods. This group is responsible for inflicting significant harm due to the severity, and longevity of their offending. The aim of the study was to identify men who perpetrate persistent sexual offences against children and differentiate them by those with long detection lags (LDLs) (n = 35) and short detection lags (SDLs) (n = 35) using police databases and case files. The men were compared on demographic characteristics, lifestyle factors, victimisation, psychopathic traits, antisocial orientation, atypical sexual interest, and descriptive sexual offence variables. The LDL participants had more psychopathic traits, more pre-pubescent child victims, more often be in professional employment and have less antisocial and criminogenic indicators than the comparative SDL group. These findings have significant practical implications for reduced victimisation through early identification, forensic risk assessment, treatment and earlier prevention strategies for CSA. Practice impact statement The current findings have important and practical implications within forensic risk assessment, especially Structured Professional Judgement (SPJ) when assessing specific groups of offenders. In addition, research informed SPJ can better prioritise policing investigative resources, both retrospectively (e.g. identifying victims) and prospectively (e.g. reducing detection lags and victimisation) while defensively informing the criminal justice system of the most appropriate supervision intensity and intervention modalities for men with clinical and forensic indicators of potential high victimisation and longer detection lags.

A systematic review of in-patient psychiatric care for people with intellectual disabilities and/or autism: effectiveness, patient safety and experience.

An increasing number of children, adolescents and adults with intellectual disabilities and/or autism are being admitted to general psychiatric wards and cared for by general psychiatrists. The aim of this systematic review was to consider the likely effectiveness of in-patient treatment for this population, and compare and contrast differing models of in-patient care. A systematic search was completed to identify papers where authors had reported data about the effectiveness of in-patient admissions with reference to one of three domains: treatment effect (e.g. length of stay, clinical outcome, readmission), patient safety (e.g. restrictive practices) and patient experience (e.g. patient or family satisfaction). Where possible, outcomes associated with admission were considered further within the context of differing models of in-patient care (e.g. specialist in-patient services versus general mental health in-patient services). A total of 106 studies were included and there was evidence that improvements in mental health, social functioning, behaviour and forensic risk were associated with in-patient admission. There were two main models of in-patient psychiatric care described within the literature: admission to a specialist intellectual disability or general mental health in-patient service. Patients admitted to specialist intellectual disability in-patient services had greater complexity, but there were additional benefits, including fewer out-of-area discharges and lower seclusion rates. There was evidence that admission to in-patient services was associated with improvements in mental health for this population. There was some evidence indicating better outcomes for those admitted to specialist services.

Von der Risikoeinschätzung zur Risikokommunikation

The field of risk assessment was long dominated by the view that the scientific focus should be on the analysis of accuracy. The methods under investigation were considered valid if they succeeded in distinguishing recidivists from non-recidivists with a sufficient degree of accuracy. The forensic risk assessment process is part of a more complex event that has implications for different parties. The result of the risk assessment must be communicated to different audiences. Forensic risk assessment is thus the basis of forensic risk communication, which in turn is the basis of forensic intervention or risk management. We recommend that forensic risk communication be guided by Fischhoff's (1995) model. This is a seven-stage model to which we add reference literature from forensic research. Key questions are provided to facilitate the application of the model to practical work.

Kognitive Verzerrungen im forensischen Kontext – Zuverlässigere Risikobeurteilungen durch Debiasing?

Although the validity of forensic risk assessment has been in the focus of academic research in forensic mental health for the last 40 to 50 years, the quality of such assessments is still only moderately satisfactory on average. On one hand, there have been numerous attempts to improve the quality of assessments by developing new instruments or revising the content criteria of existing instruments. On the other hand, significant findings from decision psychology regarding the effect of cognitive biases on processes of judging have hardly found their way into the scientific debate so far. Consequently, there is also a lack of in-depth consideration of measures that counteract cognitive biases by applying debiasing strategies. However, erroneous judgements in the field of forensic mental health can cause severe consequences for individuals as well as for society. Therefore, sound empirical examination of debiasing strategies and their relevance to improve the validity of risk assessment is strongly recommended.

Hemodynamic activity in the limbic system predicts reoffending in women

Previous research (Aharoni et al., 2013, 2014) found that hemodynamic activity in the dorsal anterior cingulate cortex (dACC) during error monitoring predicted non-violent felony rearrest in men released from prison. This article reports an extension of the Aharoni et al. (2013, 2014) model in a sample of women released from state prison (n = 248). Replicating aspects of prior work, error monitoring activity in the dACC, as well as psychopathy scores and age at release, predicted non-violent felony rearrest in women. Sex differences in the directionality of dACC activity were observed—high error monitoring activity predicted rearrest in women, whereas prior work found low error monitoring activity predicted rearrest in men. As in prior analyses, the ability of the dACC to predict rearrest outcomes declines with more generalized outcomes (i.e., general felony). Implications for future research and clinical and forensic risk assessment are discussed.

Trajectories and Outcomes of Those Not Criminally Responsible on Account of Mental Disorder through a Canadian Forensic System

Canadians adjudicated Not Criminally Responsible on Account of Mental Disorder (NCR) are detained in forensic psychiatric hospitals under a jurisdictional review board (RB) governed by the Canadian Criminal Code. The custody and management of NCR populations are administered independently across jurisdictions despite being federally legislated, and research is limited on how RBs may vary in their efforts to balance public safety and social reintegration across cases, settings, and provinces. To this end, the trajectories and outcomes were investigated in one understudied Canadian RB system on a sample of NCR individuals (n = 109) and compared to other provincial practices. A retrospective longitudinal design was employed to track an NCR cohort between 2005 and 2010 until 2015. Results demonstrated that the provincial RB aligned their operational and management practices with federal legislation, but unique deviations contributed to novel NCR trajectories and outcomes under RB supervision that were conservative relative to provincial partners. Dispositions varied as a function of risk level and were informed by clinician recommendations. Detention length differences were observed between ancestral lines, as the White ancestral group spent an average of three years less in custody than the Nonwhite ancestral group despite limited differences in demographic, clinical, and criminogenic profiles. Further research is required on NCR trajectories and outcomes across other understudied provinces and the role of forensic risk instruments in assisting with the consistent application of federal law.

The Forensic Supplement to the interRAI Mental Health Assessment Instrument: Evaluation and Validation of the Problem Behavior Scale.

Background: Numerous validation studies support the use of the interRAI Mental Health (MH) assessment system for inpatient mental health assessment, triage, treatment planning, and outcome measurement. However, there have been suggestions that the interRAI MH does not include sufficient content relevant to forensic mental health. We address this potential deficiency through the development of a Forensic Supplement (FS) to the interRAI MH system. Using three forensic risk assessment instruments (PCL-R; HCR-20; VRAG) that had a record of independent cross validation in the forensic literature, we identified forensic content domains that were missing in the interRAI MH. We then independently developed items to provide forensic coverage. The resulting FS is a single-page, 19-item supplementary document that can be scored along with the interRAI MH, adding approximately 10–15 min to administration time.We constructed the Problem Behavior Scale (PBS) using 11 items from the interRAI MH and FS. The Developmental Sample, 168 forensic mental health inpatients from two large mental health specialty hospitals, was assessed with both an earlier version of the interRAI MH and FS. This sample also provided us access to scores on the PCL-R, the HCR-20 and the VRAG. To validate our initial findings, we sought additional samples where scoring of the interRAI MH and the FS had been done. The first, the Forensic Sample (N = 587), consisted of forensic inpatients in other mental health units/hospitals. The second, the Correctional Sample (N = 618) was a random, representative sample of inmates in prisons, and the third, the Youth Sample (N = 90) comprised a group of youth in police custody.Results: The PBS ranged from 0 to 11, was positively skewed with most scores below 3, and had good internal consistency (Cronbach's Alpha = 0.80). In a test of concurrent validity, correlations between PBS scores and forensic risk scores were moderate to high (i.e., r with PCL-R Factor two of 0.317; with HCR-20 Clinical of 0.46; and with HCR-20 Risk of 0.39). In a test of convergent validity, we used Binary Logistic Regression to demonstrate that the PBS was related to three negative patient experiences (recent verbal abuse, use of a seclusion room, and failure to attain an unaccompanied leave). For each of these three samples, we conducted the same convergent validity statistical analyses as we had for the Developmental Sample and the earlier findings were replicated. Finally, we examined the relationship between PBS scores and care planning triggers, part of the interRAI systems Clinical Assessment Protocols (CAPs). In all three validity samples, the PBS was significantly related to the following CAPs being triggered: Harm to Others, Interpersonal Conflict, Traumatic Life Events, and Control Interventions. These additional validations generalize our findings across age groups (adult, youth) and across health care and correctional settings.Conclusions: The FS improves the interRAI MH's ability to identify risk for negative patient experiences and assess clinical needs in hospitalized/incarcerated forensic patients. These results generalize across age groups and across health care and correctional settings.

Excess forensic lifetime cancer risk assessment of soils around petroleum product marketing company using gamma ray spectrometry

Excess forensic lifetime cancer risk assessment of soils around petroleum product marketing company using gamma ray spectrometry