Structured Professional Judgment Research Articles

Probation Officer Assessments of Risk when the Youth Look Different: Contributions of Structured Professional Judgment to Concerns About Racial Bias

Various groups have expressed considerable concern about the potential for actuarial risk assessments to exacerbate racial disparities in justice settings. This study examined that potential when using a different approach to risk assessment, structured professional judgment (SPJ), by comparing risk decisions made by evaluators when the examinee’s race was different versus the same as theirs. A large sample of youth (N = 1,308) evaluated on the Structured Assessment of Violence Risk in Youth (SAVRY) by 137 juvenile probation officers (JPOs) in five states indicated the only moderation effect for the match or mismatch between JPOs’ and youths’ race/ethnicity was in the weight JPOs placed on five (out of 24) risk factors in their overall risk opinions. The match between JPOs' and youths' race had no bearing on JPOs’ final determination of youths’ risk levels. This study lends support for investigating the use of SPJ instruments as a method for minimizing racial bias.

Implementation of risk assessment tools in psychiatric services.

Violence remains a major risk management concern in psychiatric services with implications on the safety and well-being of patients, staff, and the public. Serious physical and psychological consequences of violence involving property damage, bodily injuries, and threat to life have been reported in mental health services. Risk assessment tools are important safeguard measures; however, research on clinical implementation is presently limited. Structured professional judgment (SPJ) risk management tools that incorporate professional discretion with analytical understanding of evidence-based risk factors are widely accepted for risk assessment. However, clinical utility is suboptimal due to several barriers, including those related to the tool, the clinical setting, and resistance from health professionals. To better understand the challenges militating against optimal implementation of risk assessment tools, we reviewed and presented some lessons from the implementation of clinical practice guidelines on a general scale and our experience implementing an SPJ tool called Hamilton Anatomy of Risk Management across a variety of psychiatric services. In summary, the clinical utility of risk assessment tools improves if the tool is psychometrically sound, concise, consensus rated, time efficient, and practical for planning risk management. User feedbacks on the tool utility are also important to sustain implementation.

Factors underlying clinicians’ judgements of patient insight and confidence in using clinical judgement in psycho-legal settings

This study investigates the factors that clinicians use to make clinical judgements of insight and their confidence in using clinical judgement across three clinical and forensic assessment domains. The 12 participating clinicians rated 30 DVD vignettes of psychiatric patients with a psychotic disorder. Qualitative analyses revealed eight themes that align closely with the dimensions of insight reported in the literature. However, it is unclear how clinicians weigh each dimension. The clinicians were more confident in making a judgement on insight for treatment planning than for involuntary treatment or fitness to stand trial evaluations. They wanted more information when making a judgement in the forensic domains, recognising the greater consequences for the patients and the greater level of scrutiny of their judgements in legal settings compared to clinical settings. The data obtained suggest that both clinical and forensic assessment of insight would benefit from empirically derived structured professional judgement (SPJ) tools.

Methodological advances in statistical prediction.

Thirty years ago, Dawes, Faust, and Meehl (1989) argued that mental health professionals should routinely use statistical prediction rules to describe and diagnose clients, predict behaviors, and formulate treatment plans. Subsequent research has supported their claim that statistical prediction performs well when compared to clinical judgment. However, many of the things we thought we knew about statistical prediction have changed. The purpose of this literature review is to describe methodological advances in statistical prediction. Three broad areas are covered. First, while statistical prediction rules are valuable for criterion-referenced assessment (e.g., predicting violence, recidivism, treatment outcomes), they are valuable only for some norm-referenced assessment tasks (e.g., diagnosis but not describing personality and psychopathology). Second, statistical prediction is particularly prominent for the prediction of violence and criminal recidivism. Results from this area will be used to describe the validity of traditional clinical judgment, structured professional judgment, and statistical prediction. The results support the use of both structured professional judgment and statistical prediction. The effect of allowing professionals to override statistical predictions consistently led to lower validity. Third, issues in building statistical prediction rules are described, including the assignment of weights to predictors, the emergence of new statistical analyses (e.g., machine learning), and the role of theory. As research has progressed, statistical prediction has become one of the most exciting areas of psychological assessment. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Predictors of Historical Clinical Risk Management-20 Version 3 (HCR–20:V3) summary risk ratings

How individual risk factors on structured professional judgement (SPJ) assessment tools translate into SPJ final risk formulations is unclear due to a lack of structured criteria. Understanding pathways to risk formulations is vital, as they serve as intervention targets for risk management. This study examined how Historical Clinical Risk Management-20 Version 3 (HCR–20:V3) raters weighed varied information sources to complete summary risk ratings (SRRs). Four independent raters retrospectively coded an archived sample of 32 inpatients at a Canadian forensic psychiatric hospital. HCR–20:V3 SPJ SRRs were regressed on the 20 individual items and sample covariates to identify unique predictors of risk formulations across each rater. Raters consistently used HCR–20:V3 items and composite subscales for SRRs. Despite strong inter-rater agreement on the SRRs, there were variations across raters regarding which items informed each SRR. Rater-unique biases were also shown to influence SRRs. Implications for forensic practice and risk management are discussed.

How to make enemies and influence people: a Social Influence Model of Violent Extremism (SIM-VE)

ABSTRACTThis paper proposes a Social Influence Model of Violent Extremism (SIM-VE). In the context of increasing concern regarding the role of the internet in engaging people in violent extremist groups, particular attention is paid to the nexus between offline and online environments. The article addresses some of the barriers to developing predictive modelling to identify who will undertake an act of violent extremism and discusses how the SIM-VE model provides a conceptual framework to inform the development of online data gathering and information sorting processes that are relevant to enhancing structured professional judgement of risk. Strengths and limitations of the model are also discussed.

An exploration of the symmetry between crime-causing and crime-reducing factors: Implications for delivery of offender services.

Both the Risk-Needs-Responsivity (RNR) and Structured Professional Judgment (SPJ) risk assessment approaches assume that a strong relationship exists between crime-causing and crime reducing factors. Using a probation sample, the present article examines whether crime-causing and crime-reducing factors correspond. Probationers completed questionnaires where they were asked what factors were crime-causing and what factors were crime-reducing. Overall, the relationship between the crime-causing and crime-reducing factors was very weak-even after ruling out potential measurement and methodological artifacts (i.e., internal consistency, item stability, and acquiescent responding). Applied to an individual offender, the results suggest that conducting assessments and recommending interventions need not be bound by assumptions that risk factors for past crime must be targeted to reduce crime. New endeavors to develop causal and idiographic crime-reducing strategies warrant consideration. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

An exploration of MDT views on key factors to consider when determining a service users required level of security

Purpose The purpose of this paper is to identify what key factors multi-disciplinary teams (MDT) deem as most important when making the decision to move service users from one level of security (including low, medium and high secure services) to another. The researchers used the findings from this study to further develop a tool; the assessment for level of security tool (ALS), which aims to structure and streamline this decision-making process. Design/methodology/approach Data from 18 interviews (MDT staff) were analysed using the Delphi technique (Dalkey and Helmer, 1963). This revealed a range of factors discussed when considering service users moves. Participants were asked to rate these factors in accordance with the Delphi which resulted in the removal of certain less important factors based on their scores. The researchers then compared these factors of relevance with a checklist of 16 items previously proposed by a consultant psychiatrist within the trust. This comparison allowed the researchers to highlight any similarities and differences present. Findings Findings from staff interviews revealed a range of 20 clinical factors perceived as essential to this process including procedural, relational and physical security aspects. However, variations were evident between the MDT priorities (20 items) and the originally proposed list. This emphasised the need for a tool which facilitates a holistic and streamlined approach. Practical implications The findings from this research have resulted in the development of the ALS tool comprising of 18 key factors. Originality/value It is envisaged the development of the ALS tool will not only facilitate and structure the decision-making process but also ensure a person-centred approach. This is because the ALS allows for a holistic approach based on an array of factors deemed important to that particular service user. Furthermore, the ALS tool contributes towards the paucity of published structured professional judgement tools needed to make such decisions.

Exploring a new structured professional judgment measure (impulsivity measure related to violence) after an average follow-up of 10years: A study of Finnish offenders.

BackgroundIdentification of the risk factors underlying impulsivity related to violent acts is an essential component of risk assessment and management to reduce violent offending.AimsOur aim was to develop a clinically useful measure for assessing impulsivity related to violence. Our research questions were which items in the newly developed measure are associated with later violent recidivism and what is the measure's predictive validity?MethodsA new scale, the impulsivity measure related to violence (IMP‐V), was studied by completing the scale, blind to outcome, from information in the forensic psychiatric examination reports of 63 of a 1‐year referral cohort of 181 Finnish offenders. Data on reoffending for up to 15 years after release were collected from official criminal records.ResultsThe predictive accuracy of the IMP‐V continuous ratings was 78% and for the categorical summary risk ratings 77%. Univariate analyses of categorical summary risk ratings of the risk factors revealed that, with two exceptions, each additional score on the IMP‐V was associated with a significant increase in violence recidivism.ConclusionsThese preliminary results indicate that the IMP‐V is a promising decision‐enhancing guide for assessing the risk of violence in impulsive people and that the measure is worth developing for use with impulsivity‐prone offenders and forensic psychiatric patients. The IMP‐V organises information on the nature of impulsivity in violence‐prone persons and thus also creates opportunities for more effective risk management.

Beyond Mental Health Disorders: Risk Assessment by Using the 4th Generation of Forensic Tools

The causal relationship between mental health disorders and (violent) recidivism is weak. Beyond mental health disorders, criminogenic factors contribute to the prediction of recidivism. In order to be effective, interventions need to be offense-oriented, i.e. focused on factors that are directly associated to the offense mechanism. To treat mental health disorders while ignoring criminogenic needs is highly ineffective. A risk/needs orientation of the criminal justice system must be emphasized. Therefore, psychiatric treatment will not be sufficient to prevent future criminal behavior. The main approach should be based on explaining the mechanism of the offense to understand the underlying offense dynamic and develop on that basis a well-fitting intervention strategy. FOTRES (Forensic Operationalized Therapy/Risk Evaluation System) is a structured professional judgment (SPJ) tool of the 4th. generation designed to assess recidivism risk and to monitor treatment progress and intervention quality. FOTRES now is already implemented within the Risk-Oriented Enforcement of Sentence (ROES) project in Switzerland. The cost-benefit analysis with the ROES is positive. The tool is widley used also in Germany and Austria.

Gender and violence risk assessment in prisons.

Our study examines the association between Historical, Clinical, Risk Management-20: Version 2; Psychopathy Checklist-Revised; and Violence Risk Assessment Guide scores and violence perpetrated during incarceration by male and female inmates. Using a sample of 288 men and 183 women selected from prisons in 2 states, we used receiver operating characteristics analyses to assess the potential of these 3 measures to predict threatened, physical, or sexual prison violence measured in 2 ways: inmate self-report and formal institutional infractions. We found all 3 instruments to demonstrate moderate to good levels of predictive accuracy for both the male and female inmates, a finding that suggests that actuarial, structured professional judgment and personality measures perform in a broadly comparable manner in assessing institutional violence for both men and women. Our findings did vary on the basis of the way violence was measured: Women self-reported significantly higher levels of prison violence than was suggested by their institutional infractions, and the associative power of the instruments diminished substantially, particularly among the men, when institutional infractions alone were used in the analyses. These findings suggest that the 3 risk measures are likely to be gender neutral in their association with prison violence, albeit with gender-related differences in the frequency of violent behavior and the relevance of particular subscales. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

How Do Professionals Assess Sexual Recidivism Risk? An Updated Survey of Practices.

Forensic evaluators may be assisted by comparing their use of instruments with that of their peers. This article reports the results of a 2017 survey of instrument use by forensic evaluators carrying out sexual recidivism risk assessments. Results are compared with a similar survey carried out in 2013. Analysis focuses primarily on adoption of more recently developed instruments and norms, and on assessment of criminogenic needs and protective factors, and secondarily, on exploring factors related to differences in evaluator practice. Findings indicate that most evaluators have now adopted modern actuarial instruments, with the Static-99R and Static-2002R being the most commonly used. Assessment of criminogenic needs is now common, with the STABLE-2007 being the most frequently used instrument. Evaluators are also increasingly likely to consider protective factors. While a majority of evaluators uses actuarial instruments, a substantial minority employs Structured Professional Judgment (SPJ) instruments. Few factors discriminated patterns of instrument use.

An evaluation of functional mental capacity in forensic mental health practice: the Dundrum capacity ladders validation study

BackgroundBecause of the potential gravity of finding a person incompetent, assessment of mental capacity is challenging for clinicians. We aimed to test validity of a new structured professional judgement tool designed to assess functional mental capacity in three domains – finances, welfare and healthcare.MethodsFifty-five male forensic psychiatric patients with Schizophrenia were interviewed using the Dundrum Capacity Ladders – a new semi-structured interview, and scores were assigned on a stratified scoring system, measuring ability to understand, reason, appreciate the personal importance of the decision at hand and communicate a decision. Data were also gathered pertaining to level of therapeutic security at the time of interview, diagnosis, neurocognitive function and a validated measure of real world function.ResultsThe results show that internal consistency and inter-rater reliability were high for all items. There were correlations between higher scores of functional mental capacity, neurocognitive function and measures of real world function in this population. Correlations were in the range 0.358 to 0.693, effect sizes that were moderate to high.ConclusionsThe DUNDRUM Capacity Ladders appear to be a valid measure of functional mental capacity in this population. Further prospective studies of functional mental capacity as a measure of recovery are now required.

High Risk or Low Risk: Screening for Violent Extremists in DDR Programmes

ABSTRACTProgrammes of disarmament, demobilization, and reintegration (DDR) are increasingly implemented in contexts of violent extremist conflict. In such settings, DDR practitioners may need to distinguish between ex-combatants who can be safely reintegrated into civilian life, and ex-combatants who are likely to present a danger to the community in terms of violent and/or extremist re-offending. To help practitioners make this assessment, this paper explores how risk assessment tools used by psychologists in criminal justice settings may be adapted to screen for violent extremist offenders in DDR programmes. The findings suggest that the method of structured professional judgment (SPJ) can be used to assess the risk that individual ex-combatants will re-offend upon return to civilian life. By extension, SPJ can also: (1) help practitioners to understand what type of deradicalization and disengagement programming former members of extremist groups may require and (2) contribute to decisions concerning the release of ex-combatants from prisons and transitional DDR centres.

Flexible Assertive Community Treatment

Background: Carraig Mor Psychiatric Intensive care unit has developed a Flexible Assertive Community Treatment (FACT) approach for mental health service users with complex needs. The aim of FACT is to reduce readmissions and increase voluntary engagement with mental health services through increased levels of outpatient care. FACT combines two approaches within one multidisciplinary team: Individual case management: A more intensive flexible approach for patients at times of need. FACT is a versatile and comprehensive model with continuity of care as its cornerstone; as service user’s needs fluctuate they remain under the care of the same team who adapt their approach to meet changing needs (Drukker, Visser, Sytema, & van Os, 2013) Rationale: One of the essential components of the FACT approach is the ability to confidently make decisions around risk. This is often under difficult circumstances and sometimes will involve using incomplete, conflicting and unconfirmed information. Historically, this has led to mental health practitioners becoming risk averse resulting in extended involuntary admissions due to perceived risk. This is especially true in case management where physical or sexual violence has to be considered. These factors can cause decision making to become paralysed. Such fears can become a significant barrier to recovery, denying service users opportunities to reach their full potential. Structured Professional Judgment: The Carraig Mor FACT team utilise a structured professional judgment (SPJ) approach to aid decision making. SPJ provides a transparent structure that gives explicit instructions and recommendations for the process of identifying risk factors and protective factors unique to the individual service users. It further allows the combining and understanding of this information to aid decision making by means of risk formulation and scenario planning. Decision Making: Formulation is the process of making sense of the complex interactions between different sources of information, including from clinical interview, scales and collateral reports, while identifying potential causation. Examples of this approach include the HCR-20 & RSVP. Risk formulation describes how and why people make decisions to engage in violence, and seeks to understand the various factors that influence their decision making. In practice, risk formulation examines protective factors and destabilising factors unique to the individual service user to inform decision making and individual care planning. Scenario planning is a process of developing several possible futures and individual care or safety plans to meet the potential needs of these hypothetical situations. Conclusion: Labelling and stigma are not confined to diagnosis of mental illness; service users with complex presentations which include histories of violence or sexual offending are often perceived to be dangerous outside the context of the violent event. Risk formulation allows mental health practitioners to make decisions based around service user needs without becoming fixated upon previous offending. Furthermore, it allows for the identification and implementation of protective factors which support the service user to continue through the care pathway unimpeded by stigma and to reach their full potential of personal recovery.

Use of structured professional judgment by probation officers to assess risk for recidivism in adolescent offenders.

The current study tested a method of risk assessment for adolescent offenders that relies on structured professional judgment: the Structured Assessment of Violence Risk for Youth (SAVRY; Borum, Bartel, & Forth, 2006). Trained probation officers in 3 jurisdictions administered the SAVRY to 505 adjudicated adolescents (M age = 15.43 years, SD = 1.62). The results supported the validity of the SAVRY administered in this juvenile justice context. Specifically, scores from the SAVRY differentiated violent from nonviolent offenders and predicted both violent and nonviolent recidivism over a 12-month follow-up period. Violent offenders showed more historical and individual risk factors than nonviolent offenders, and violent sex offenders were rated as more deficient in empathy and remorse. The anger control item was a particularly important indicator of risk for reoffending in the violent offender group. The implications of these findings for weighting risk factors in individual cases when using structured professional judgment are discussed. (PsycINFO Database Record

Violent reinjury risk assessment instrument (VRRAI) for hospital-based violence intervention programs

BackgroundViolent injury is the second most common cause of death among 15- to 24-year olds in the US. Up to 58% of violently injured youth return to the hospital with a second violent injury. Hospital-based violence intervention programs (HVIPs) have been shown to reduce injury recidivism through intensive case management. However, no validated guidelines for risk assessment strategies in the HVIP setting have been reported. We aimed to use qualitative methods to investigate the key components of risk assessments employed by HVIP case managers and to propose a risk assessment model based on this qualitative analysis. Materials and methodsAn established academic hospital-affiliated HVIP served as the nexus for this research. Thematic saturation was reached with 11 semi-structured interviews and two focus groups conducted with HVIP case managers and key informants identified through snowball sampling. Interactions were analyzed by a four-member team using Nvivo 10, employing the constant comparison method. Risk factors identified were used to create a set of models presented in two follow-up HVIP case managers and leadership focus groups. ResultsEighteen key themes within seven domains (environment, identity, mental health, behavior, conflict, indicators of lower risk, and case management) and 141 potential risk factors for use in the risk assessment framework were identified. The most salient factors were incorporated into eight models that were presented to the HVIP case managers. A 29-item algorithmic structured professional judgment model was chosen. ConclusionsWe identified four tiers of risk factors for violent reinjury that were incorporated into a proposed risk assessment instrument, VRRAI.

The 3 R’s of risk assessment for violent extremism

PurposeThe purpose of this paper is to explore two distinct yet complimentary “structured professional judgement (SPJ)” approaches to terrorist/extremist risk assessment on the vexing issue of how best to deal with the subjectivity inherently involved in professional judgement.Design/methodology/approachAn SPJ methodology is considered the best practice approach for assessing terrorism risk. Currently there are four specific terrorism risk instruments that have been published in the literature. Two of these SPJ tools are examined in detail, namely the Violent Extremist Risk Assessment tool (Pressman, 2009; Pressman et al., 2012) and the Structured Assessment of Violent Extremism (SAVE) tool (Dean, 2014). The paper critically unpacks the conceptual and methodological stumbling blocks of an SPJ methodology for controlling human subjectivity.FindingsThe paper presents the case for adopting a “controlling in” approach rather than a “controlling out” approach of an analyst’s subjective tacit (in-the-head) knowledge inherent in their professional judgement. To have a quantifiable SPJ tool that triangulates the multi-dimensionality of terrorism risk which can validate an analyst’s professional judgement is the next logical step in terrorist/extremist risk assessment work. The paper includes a case example of this “controlling in” approach and the validation methodology used by the SAVE software system.Practical implicationsThe implications for practice range from incorporating the SAVE system in operational policing/national security work with its quantitative nature, triangulated risk scores, visualisation output of a prioritised case report with in-built alerts, to the required training for system calibration to enhance user proficiency.Originality/valueThis is a highly original and innovative paper as this type of quantified SPJ tool (SAVE) has up until now never been applied before in terrorist/extremist risk assessment work.

Validity and Predictive Accuracy of the Structured Assessment of Protective Factors for Violence Risk in Criminal Forensic Evaluations

Some actuarial and structured professional judgment (SPJ) risk-assessment instruments have already demonstrated their validity and predictive accuracy in expert criminal forensic evaluations. In contrast, little is known about the effectiveness of instruments identifying protective factors in risk of recidivism prediction. The present study was designed to evaluate the validity and predictive accuracy of the Structured Assessment of Protective Factors for Violence Risk (SAPROF) in 94 violent and sexual violent offenders assessed in a Swiss pretrial criminal forensic context. The SAPROF showed good interrater reliability, and was significantly correlated to predominately dynamic instruments but not to predominately actuarial instruments. However, in terms of predictive accuracy, the SAPROF did not perform as well as expected when compared with other instruments and with previous SAPROF accuracy validation studies. These results have implications for the use of the SAPROF in criminal forensic contexts risk assessment.

Exploring Gender Differences in the Utility of Strength-Based Risk Assessment Measures

ABSTRACTThe generalizability of risk assessment measures to female populations remains up for debate; in particular, few studies have made direct comparisons between male and female civil psychiatric patients on protective factors and risk factors relevant to violence risk assessments. To address this gap in the literature, we conducted a prospective study with 102 civil psychiatric patients (60.8% male) to investigate strength-based risk assessments. Outcome data (i.e., verbal, physical, and sexual aggression) was collected after 6 and 12 months. We found a number of potentially interesting gender differences in the predictive validity of the START, HCR-20V2, and SAPROF. Findings are generally supportive of the use of established Structured Professional Judgement (SPJ) risk assessment measures with male civil psychiatric populations, and with the exception of the START, caution is warranted when using these measures with female civil psychiatric patients. Findings suggest that SPJ assessments that utilize both strengths and vulnerabilities generally performed better than SPJ assessments relying on either strengths alone or vulnerabilities alone.