Structured Assessment Of Violence Risk Research Articles

A Second Proof of Concept Investigation of Strengths Using the Structured Assessment of Violence Risk in Youth Tool With Justice-Involved Youth: Item Level Risk-Based Effects and Interactions

Despite efforts to incorporate protective factors or ‘strengths’ in applied risk assessments for criminal reoffending, there has been limited progress towards a consensus regarding what is meant by such terms, what effects predictors can exert, or how to describe such effects. This proof of concept study was undertaken to address those issues. A structured professional judgment tool was used to create lower and higher historical/static risk groups with a sample of 273 justice-involved male youth with sexual offenses followed over a fixed 3-year period. Using risk and protective poles to create pairs of dichotomous variables from trichotomously rated risk and protective items, risk-based exacerbation and risk-based protective effects were found. These varied in terms of whether the effect on the outcome of a new violent (including sexual) offense was larger, smaller, or absent for youth at higher or lower historical/static risk. Some of these potentially dynamic dichotomous variables were shown to have a protective (or risk) effect after controlling for both historical/static risk and that same item’s risk (or protective) effect. Some moderated the association between historical/static risk and recidivism, strengthening or reducing it. Terms for these effects and implications of incorporating strengths in research and applied practice were considered.

Predicting the Risk of Re-Offending in Child-to-Parent Violence Using the Structured Assessment of Violence Risk in Youth.

Child-to-parent violence occurs when children engage in violent behaviour towards family members; the principal victim is often the mother. The risk assessment instruments used to identify the risk and protective factors in youth offenders who perpetrate child-to-parent violence are not specific to this type of offense. This study aims to describe the child-to-parent violence group in relation to the risk and protective factors they present in comparison with the group of young people who committed an assault offence. The sample for this study consists of two groups of youth offenders. The first group committed child-to-parent violence, and the second group has committed a violent crime against individuals to whom they are not related. Young people who commit child-to-parent violence have higher scores on the SAVRY risk factors and lower scores on the SAVRY protective factor than young people who have committed an assault offence. The results reveal the importance of identifying the risk and protective factors presented by youth offenders who commit child-to-parent violence in order to create specific intervention programs for the needs and strengths presented by this group of young people.

The Validity of Violence Risk Assessment in Young Adults: A Comparative Study of Juvenile and Adult Risk Assessment Tools

Few studies have addressed the application of violence risk assessment for individuals transitioning from youth to adulthood. For 202 young adults released from Dutch juvenile justice institutions this study investigated the predictive validity and potential disparities in impact of juvenile risk assessment tools (i.e., SAVRY [Structured Assessment of Violence Risk in Youth], and SAPROF-YV [Structured Assessment of Protective Factors for violence risk-Youth Version]), and comparable adult risk assessment tools (i.e., HCR-20V3 [Historical Clinical Risk management-20 Version 3], and SAPROF [Structured Assessment of Protective Factors for violence risk]). Assessments with juvenile and adult risk assessment tools yielded similar predictive validity for violent and non-violent recidivism. Risk and protective factors related to treatability, parents, community participation, resilience, and personality showed individual predictive validity. These findings offer flexibility when applying risk assessment in clinical practice. The choice between youth and adult assessment tools should be made considering the individual’s developmental stage.

Implementation of the dynamic appraisal of situational aggression in inpatient mental health.

To implement structured violence risk assessment (VRA) using the Dynamic Appraisal of Situational Aggression (DASA) on a 25-bed, adult, inpatient psychiatric unit. Inpatient DASA screening for 13 weeks with nursing communication orders (NCOs) to highlight patients at high risk for violence. Pre/posttests measured registered nurse (RN) knowledge and perceptions of the DASA. DASA completion rate equaled 81.8% with an NCO issue rate of only 32.8%. RN perceptions of the DASA were positive, and knowledge of structured violence risk assessment increased. Structured violence risk assessment with the DASA is feasible and well-accepted on psychiatric units.

Exposure to Family Violence and Risk Factors for Recidivism in Juvenile Offenders

ABSTRACT A better understanding of the relationship between exposure to family violence and criminal recidivism is essential in order to develop interventions which target the specific needs of juvenile offenders. Using the Structured Assessment of Violence Risk in Youth (SAVRY), we explored the differences in historical, social/contextual, and individual risk and protective factors for delinquency among youth males exposed (n = 253) and not exposed to family violence (n = 497) in Spain. Chi-square test shows that most of the risk factors assessed were present in the group exposed to family violence, especially a history of child maltreatment. Logistic regression analysis show that peer delinquency was a common predictor of recidivism in youth both exposed and not exposed to family violence. Early initiation of violence predicted recidivism in young offenders without exposure to family violence, while the absence of strong social support predicted recidivism in young offenders with this exposure. Professionals in juvenile justice services need to work on peer relationships, but also to keep in mind and to address the specific needs of young offenders both with and without exposure to family violence if the aim is to avoid recidivism.

Risk Assessment in Juvenile and Young Adult Offenders: Predictive Validity of the SAVRY and SAPROF-YV.

Most juvenile risk assessment tools heavily rely on a risk-focused approach. Less attention has been devoted to protective factors. This study examines the predictive validity of protective factors in addition to risk factors, and developmental differences in psychometric properties of juvenile risk assessment. For a national Dutch sample of 354 juvenile and young adult offenders (16-26 years) risk and protective factors were retrospectively assessed at discharge from seven juvenile justice institutions, using the Structured Assessment of Violence Risk in Youth (SAVRY) and Structured Assessment of Protective Factors for violence risk – Youth Version (SAPROF-YV). Results show moderate validity for both tools predicting general, violent, and nonviolent offending at different follow-up times. The SAPROF-YV provided incremental predictive validity over the SAVRY, and predictive validity was stronger for younger offenders. Evidently both the SAVRY and SAPROF-YV seem valid tools for the assessment of recidivism risk in juvenile and young adult offenders. Results highlight the importance of protective factors, especially in juvenile offenders, emphasizing the need for a balanced risk assessment.

Characteristics and recidivism in relation to arrest: differentiating between partner violent perpetrator subtypes

ABSTRACT This study aimed to describe and compare arrested and non-arrested male intimate partner violence (IPV) perpetrators, in terms of individual characteristics and variables related to the IPV incident, in a sample of 628 perpetrators reported to the Swedish police. We also explored recidivism rates in relation to arrest within the total sample, as well as among subtypes of partner violent men (i.e. generally violent [GV] and partner only [PO] violent). The perpetrators in this longitudinal study were reported to the police for male-to-female perpetrated IPV and subjected to a structured violence risk assessment between 2011 and 2014. The results showed that arrested perpetrators were more likely to be reported for severe forms of IPV, being assessed by the police post-arrest with a higher risk for recidivism, and being more likely to be prosecuted for the reported IPV incident. There was also a significant interaction effect between subtypes and arrest for IPV recidivism within 12 months post-arrest. Among those perpetrators who were arrested, GV perpetrators were more than four times as likely as PO violent perpetrators to recidivate in IPV. The results of this study highlight the importance of differentiating between subtypes when examining the impact of sanctions on IPV recidivism.

Intimate Partner Violence Risk Assessment in Community Health Facilities: A Multisite Longitudinal Study

The remarkable development of tools for the structured assessment of violent reoffending of intimate partner aggressors coexists with a relative scarcity of tools adapted for the diversity of community facilities for women who suffer intimate partner violence (IPV). This situation prompted the development of the RVD-Bcn in Catalonia (Spain). The present multisite prospective study is the first to test the predictive validity of this tool for IPV risk assessment in a sample different to the original. Trained assessors interviewed 321 women in five community health facilities in Cordoba (Argentina); 230 of them completed a follow-up that ranged from 47 to 311 days. Incidents of physical IPV, including serious threats and forced sex, were recorded prospectively. Rates of IPV in the low, moderate and high-risk groups were 10, 57, and 33 percent, respectively. The summary risk ratings were significantly associated with the occurrence of violence during follow-up, as were RVD scores (ROC-AUCs = .88 and .89, respectively). Low-risk participants not only suffered fewer IPV events than participants in the moderate and high-risk group, but also suffered them later in time. The most accurate predictive model of IPV included total scores and a dichotomised variable of low vs. moderate-high summary risk rating. Findings contribute to the emerging practice of including structured violence risk assessment in Latin American professional contexts and institutions.

Predicting Reoffending Using the Structured Assessment of Violence Risk in Youth (SAVRY): A 5-Year Follow-Up Study of Male Juvenile Offenders in Hunan Province, China.

BackgroundJuvenile violent offending is a serious worldwide public health issue.ObjectiveThe study examined whether the Structured Assessment of Violence Risk in Youth (SAVRY) can be used to predict violent reoffending in Chinese male juvenile offenders, and to determine which risk/protective domains (items) are associated with violent recidivism.MethodsA total of 246 male juvenile offenders were recruited. SAVRY domains were scored by trained raters based on file review and interviews with participants and their legal guardians. Information on further arrests, charges, or convictions for violent offences were collected from police records over a five year follow-up.ResultsOver the course of the five year follow-up periods, 63 (25.6%) juvenile offenders were re-arrested for a further violent reoffence. Receiver Operating Characteristic (ROC) analyses showed Areas Under the Curve (AUCs) ranging from 0.60 to 0.68 for the SAVRY total, risk and protective score domains. Univariate logistic regression analysis showed that 7 of the 30 SAVRY items were significantly associated with reoffending; explaining 36.2% of the variance. Backward stepwise multiple logistic regression analysis showed the independently predictive items were items 2 (‘history of non-violent offending’), 17 (‘negative attitudes’), 18 (‘risk-taking/impulsivity’), and 20 (‘anger management problems’). Together these four items explained 25.0% of the variance in reoffending.ConclusionsThe results suggested that the SAVRY can be meaningfully used to inform the development and evaluation of effective violence risk assessment and management approaches for male juvenile offenders detained in a Youth Detention Center in Hunan province, China.

Interventions following a high violence risk assessment score: a naturalistic study on a Finnish psychiatric admission ward

BackgroundPatient aggression and violence against staff members and other patients are common concerns in psychiatric units. Many structured clinical risk assessment tools have recently been developed. Despite their superiority to unaided clinical judgments, staff has shown ambivalent views towards them. A constant worry of staff is that the results of risk assessments would not be used. The aims of the present study were to investigate what were the interventions applied by the staff of a psychiatric admission ward after a high risk patient had been identified, how frequently these interventions were used and how effective they were.MethodsThe data were collected in a naturalistic setting during a 6-month period in a Finnish psychiatric admission ward with a total of 331 patients with a mean age of 42.9 years (SD 17.39) suffering mostly from mood, schizophrenia-related and substance use disorders. The total number of treatment days was 2399. The staff assessed the patients daily with the Dynamic Appraisal of Situational Aggression (DASA), which is a structured violence risk assessment considering the upcoming 24 h. The interventions in order to reduce the risk of violence following a high DASA total score (≥4) were collected from the patients’ medical files. Inductive content analysis was used.ResultsThere were a total of 64 patients with 217 observations of high DASA total score. In 91.2% of cases, at least one intervention aiming to reduce the violence risk was used. Pro re nata (PRN)-medication, seclusion and focused discussions with a nurse were the most frequently used interventions. Non-coercive and non-pharmacological interventions like daily activities associated significantly with the decrease of perceived risk of violence.ConclusionIn most cases, a high score in violence risk assessment led to interventions aiming to reduce the risk. Unfortunately, the most frequently used methods were psychopharmacological or coercive. It is hoped that the findings will encourage the staff to use their imagination when choosing violence risk reducing intervention techniques.

Factores dinámicos en el comportamiento de delincuentes juveniles con perfil de ajuste social. Un estudio de reincidencia

The aim of this paper is to assess the risk of recidivism by analysing the impact of dynamic factors on adolescents in conflict with the law (ACLs). To this end we evaluate the social adjustment of a sample of 157 ACLs, using the Structured Assessment of Violence Risk in Youth tool (SAVRY) along with other qualitative analysis techniques to triangulate the empirical process. The extensive structure of relationships and occasional links that these ACLs have with formal and informal learning and employment networks point to a good level of adjustment in the future and a low level of recidivism. However, the risk of recidivism is increased by their limited ability to solve problems and their impulsiveness in dealing with difficulties. A special area of interest lies in the relationships and influences that ACLs form with their surroundings in order to avoid or indulge in high-risk practices. These have an effect on their everyday activities and can determine their level of social adjustment.

Understanding dynamic risk factors for violence

ABSTRACTRecent years have seen a consensus emerge regarding the dynamic risk factors that are associated with future violence. These risk factors are now routinely assessed in structured violence risk assessment instruments. They provide a focus for treatment in structured group programmes. However, relatively little attention has been paid to risk-related theoretical issues, whether these dynamic risk factors are causally related or simply correlates of violent offending, or the extent to which they change as a consequence of treatment. More challenging is the lack of evidence to suggest that changes in these dynamic risk factors actually result in reductions in violent offending. In this paper we consider the meaning of the term dynamic risk, arguing that only those factors that, when changed, reduce the likelihood of violent recidivism, can be considered to be truly dynamic. We conclude that few of the violence risk factors commonly regarded as dynamic fulfil this requirement. There is a need to think more critically about assessment findings and treatment recommendations relating to dynamic risk, and conduct research that establishes, rather than assumes, that certain dynamic risk factors are directly related to violence. Some suggestions for advancing knowledge and practice are provided.

The HCR-20 as a measure of reliable and clinically significant change in violence risk among secure psychiatric inpatients

ObjectivePeriodic structured violence risk assessment is the principle method underlying treatment planning for mentally disordered offenders but little is known about how risk changes over time. We aimed to determine whether hospitalised patients underwent reliable clinical change in assessed risk. MethodWe used a pseudo-prospective longitudinal study design. Demographic, clinical and risk assessment data of adult inpatients (N=480) who had been routinely assessed with the HCR-20 on two to four occasions over a mean period of 17 months (SD=2) were collated. Linear mixed models regression was conducted to determine change over time on total, subscale, and individual item scores, and relative change between clinical and demographic groups. The Reliable Change Index was calculated to examine whether change was greater than that expected by measurement error; clinically significant change was defined as the extent to which HCR-20 scores reduced below previously reported scores for patients not requiring hospitalisation. ResultsHCR-20 total score (Estimate −0.42, 95% CI=−0.84, −0.01, p<.05; d=.20) and clinical score (Estimate=−0.42, 95% CI=−0.64, −0.20, p<.001; d=.36) reduced over assessments. Significant differences in change were evident between clinically and demographically defined groups. A maximum of 3% of individuals showed clinically significant reliable reductions in HCR-20 total scores. The scores of patients whose overall level of risk was judged to have decreased did not reduce between assessments. ConclusionViolence risk changes very little over the course of treatment although there is some variation between groups. Most change cannot be demonstrated to be reliable or clinically significant. Important clinical management decisions should not depend solely on evidence from changes in HCR-20 risk assessment.

Implementing the dynamic appraisal of situational aggression in mental health units.

The aims of this study are to explain the intervention of implementing a structured violence risk assessment procedure in mental health inpatient units using the Ottawa Model of Research Use (OMRU) as a guiding framework and to consider nurses' perspectives of its clinical utility and implementation process. Patient aggression toward staff is a global concern in mental health units. The limited extant literature exploring the use of structured violence risk assessments in mental health units, although small and inconsistent, reveals some positive impacts on the incidence of aggression and staff's use of restrictive interventions. Although numerous violence risk assessment instruments have been developed and tested, their systematic implementation and use are still limited. A project titled "Safer Working Management" (111298) was conducted in a Finnish hospital district, across 3 mental health units. The 6 steps of OMRU were followed during implementation of the Dynamic Appraisal of Situational Aggression (DASA). Nurses' views toward structured violence risk assessment procedures varied. Although implementation of the DASA was seen as a useful method to increase discussions with patients and nursing staff, some staff preferred their own clinical judgment for assessment of violence risk. It is possible to use a specific model to promote the implementation of risk assessment instruments in mental health units. However, the complex mental health inpatient environment and the difficulties in understanding and managing aggressive patients present challenges for the implementation of structured violence risk assessment methods. The OMRU provides a tool for clinical nurse specialists to guide implementation process in mental health units. Clinical nurse specialists must promote training for staff regarding use of new innovations, such as the DASA. Implementation processes should be reviewed so that clinical nurse specialists can lead and support mental health staff to properly use structured violence risk assessment measures.

Sex Differences in the Measurement Invariance and Factors That Influence Structured Judgments of Risk Using the Structured Assessment of Violence Risk in Youth (SAVRY)

The goals of this study were to test the measurement invariance of the Structured Assessment of Violence Risk in Youth (SAVRY) across sex and to assess whether the same items on the SAVRY influenced practitioners’ judgments about the risk for boys and girls separately. Using administrative data from 292 adjudicated juvenile offenders placed in state custody, we found that the internal structure of risk was invariant across sex. We also found both similarities and differences in the factors used to make judgments about risk across boys and girls. Our results provide support for the use of the SAVRY for boys and girls and supplement previous research examining the predictive validity of the SAVRY, the structured professional judgment framework for juvenile justice risk assessment, and the utility of the SAVRY across gender groups.

Predictive validity of the structured assessment of violence risk in youth: A 4‐year follow‐up

Structured violence risk assessment is an essential part of treatment planning for violent young people. The Structured Assessment of Violence Risk in Youth (SAVRY) has been shown to have good reliability and validity in a range of settings but has hardly been studied in adolescent mental health services. This study aimed to evaluate the long-term predictive validity of the SAVRY in adolescent psychiatry settings. In a prospective study, 200 SAVRY assessments of adolescents were acquired from psychiatric, forensic and correctional settings. Re-offending records from the Finnish National Crime Register were collected. Receiver operating curve statistics were applied. High SAVRY total and individual subscale scores and low values on the protective factor subscale were significantly associated with subsequent adverse outcomes, but the predictive value of the total score was weak. At the risk item level, those indicating antisocial lifestyle, absence of social support and pro-social involvement were strong indicators of subsequent criminal convictions, with or without violence. The SAVRY summary risk rating was the best indicator of likelihood of being convicted of a violent crime. After allowing for sex, age, psychiatric diagnosis and treatment setting, for example, conviction for a violent crime was over nine times more likely among those young people given high SAVRY summary risk ratings. The SAVRY is a valid and useful method for assessing both short-term and long-term risks of violent and non-violent crime by young people in psychiatric as well as criminal justice settings, adding to a traditional risk-centred assessment approach by also indicating where future preventive treatment efforts should be targeted. The next steps should be to evaluate its role in everyday clinical practice when using the knowledge generated to inform and monitor management and treatment strategies.

The Use of the SAVRY and YLS/CMI in Adolescent Court Proceedings: A Case Law Review

Despite the continued growth of adolescent risk assessment tools, we do not know how these tools are being used in adolescent court cases or how this information influences legal decision making. To address this gap, we reviewed 50 Canadian, American, and international adolescent offender cases using the Structured Assessment of Violence Risk in Youth or Youth Level of Service/Case Management Inventory. The results confirm that adolescent risk assessment tools are primarily introduced during sentencing or adult transfer proceedings. Judges identified the specific risk and protective factors of youth in 36.2% and 19.0% of cases, respectively. In terms of legal decision making, the risk assessment was either directly or indirectly referred to in 76.0% of cases; however, judges most often placed some weight on the risk assessment as a part of an enumerated list of other important factors. Although risk assessments were generally considered admissible in these cases, some legal concerns were raised, particularly with the use of risk assessments to guide sentencing decisions.

EPA-0442 – All things being equal? predictive validity of the hcr-20 among heterogenous groups of secure psychiatric inpatients

Introduction The HCR-20 is the most widely used structured violence risk assessment tool in medium secure units in England and has good predictive validity for inpatient violence. However little is known about whether its predictive validity varies between different clinical and demographic groups. Objectives 1) collect HCR-20 risk assessment and three month follow-up data for all eligible inpatients 2) examine the ability of the HCR-20 to predict various indices of inpatient aggression using receiver operating characteristics (ROC), and 3) compare AUC values derived from different groups (i.e. men vs. women) Aim determine if the HCR-20 performs equally across different clinical and demographic groups. Methods This study was conducted amongst inpatients at St Andrew's (N=505). Demographic (age, ethnicity, gender), clinical (diagnosis) and routinely collected risk assessment data (HCR-20) were collated. Incidents of aggression were coded using the OAS for the three months following assessment. Results ROC analysis revealed that the HCR-20 total, Clinical scale and Risk Management scale were predictive of all types of aggression; the Historical scale was a significant predictor of verbal aggression and physical aggression towards objects but not physical aggression towards people. The predictive efficacy of the HCR-20 differed according to gender and diagnosis, with superior performance obtained with women and those with a diagnosis of personality disorder. Conclusions This study reveals differences in the HCR-20's efficacy between groups. Further development and optimisation of the HCR-20 may be required. Alternatively, interventions to prevent aggression may be more effective among some groups. Future research should address these issues.

A Comparison of Empirically Based and Structured Professional Judgment Estimation of Risk Using the Structured Assessment of Violence Risk in Youth

This study builds on a long-standing debate focusing on whether structured professional judgment (SPJ) or empirically based methods of risk estimation are more valid and reliable measures of future behavior by comparing three different measures of risk. Data were collected from the Structured Assessment of Violence Risk in Youth administered to a sample of 177 adjudicated juvenile offenders prior to being placed on probation. Three measures of risk were examined: an empirically derived measure of risk using latent class analysis, a violence risk based on SPJ, and a nonviolent delinquency risk based on SPJ. The ability of each measure to predict probation-related outcomes and recidivism was also addressed. Results provide moderate support for the continued use of the SPJ framework and highlight the need for future research regarding risk assessment procedures in juvenile justice settings.

A systematic review of risk assessment strategies for populations at high risk of engaging in violent behaviour: update 2002–8

This review systematically examines the research literature published in the period 2002-8 on structured violence risk assessment instruments designed for use in mental health services or the criminal justice system. It adopted much broader inclusion criteria than previous reviews in the same area in order to capture and summarise data on the widest possible range of available instruments. To address two questions: (1) what study characteristics are associated with a risk assessment instrument score being significantly associated with a violent outcome? and (2) which risk assessment instruments have the highest level of predictive validity for a violent outcome? Nineteen bibliographic databases were searched from January 2002 to April 2008, including PsycINFO, MEDLINE, Cumulative Index to Nursing and Allied Health Literature, Allied and Complementary Medicine Database, British Nursing Index, International Bibliography of the Social Sciences, Education Resources Information Centre, The Cochrane Library and Web of Knowledge. Inclusion criteria for studies were (1) evaluation of a structured risk tool; (2) outcome measure of interpersonal violence; (3) participants aged 17 years or over; and (4) participants with a mental disorder and/or at least one offence and/or at least one indictable offence. A series of bivariate analyses using either a chi-squared test or Spearman's rank-order correlation were conducted to explore associations between study characteristics and outcomes. Data from a subset of studies reporting area under the curve (AUC) analysis were combined to provide estimates of mean validity. For the overall set of included studies (n = 959), over three-quarters (77%) were conducted in the USA, Canada or the UK. Two-thirds of all studies were conducted with offenders who had either no formal mental health diagnosis (43%) or forensic samples with a formal diagnosis (25%). The Psychopathy Checklist-Revised was tested in the largest number of studies (n = 192). Most studies (78%) reported a statistically significant (p < 0.05) relationship between the instrument score and a violent outcome. Prospective data collection (chi-squared = 4.4, p = 0.035), number of people recruited (U = 27.8, p = 0.012) and number of participants at end point (U = 26.9, p = 0.04) were significantly associated with predictive validity. For those instruments tested in five or more studies reporting AUC values, the General Statistical Information on Recidivism instrument had the highest mean AUC (0.73). Agreement between pairs of reviewers in the initial pilot exercises was good but less than perfect, so discrepancies may be present given the complexity and subjectivity of some aspects of violence research. Only five of the seven calendar years (2003-7) are completely covered, with partial coverage of 2002 and 2008. There is no weighting for sample or effect sizes when results from studies are aggregated. A very large number of studies examining the relationship between a structured instrument and a violent outcome were published in this relatively short 7-year period. The general quality of the literature is weak in places (e.g. over-reliance on cross-sectional designs) and a vast range of distinct instruments have been tested to varying degrees. However, there is evidence of some convergence around a small number of high-performing instruments and identification of the components of a high-quality evaluation approach, including AUC analysis. The upper limits (AUC ≥ 0.85) of instrument-based prediction have probably been achieved and are unlikely to be exceeded using instruments alone. The National Institute for Health Research Health Technology Assessment and Research for Patient Benefit programmes.