Violence Risk Assessment Research Articles

A Nurse Leader Directed Violence Risk Assessment on Patient-to-nurse Violence: A Quality Improvement Project

A Nurse Leader Directed Violence Risk Assessment on Patient-to-nurse Violence: A Quality Improvement Project

Risk factors for violence among female forensic inpatients with schizophrenia.

Schizophrenia is associated with a heightened risk of violent behavior. However, conclusions on the nature of this relationship remain inconclusive. Equally, the empirical evidence on female patients with schizophrenia spectrum disorders (SSD) is strongly underrepresented. For this purpose, the first aim of the present retrospective follow-up study was to determine the risk factors of violence in a sample of 99 female SSD patients discharged from forensic psychiatric treatment between 2001 and 2017, using three different measures of violence at varying time points (i.e., violent index offense, inpatient violence, and violent recidivism). Potential risk factors were retrieved from the relevant literature on SSD as well as two violence risk assessment instruments (i.e., HCR-20 V3, FAM). Further, we aimed to assess the predictive validity of the HCR-20 V3 in terms of violent recidivism and evaluate the incremental validity of the FAM as a supplementary gender-responsive assessment. The given results indicate strong heterogeneity between the assessed violence groups in terms of risk factors. Particularly, violence during the index offense was related to psychotic symptoms while inpatient violence was associated with affective and behavioral instability as well as violent ideation/intent, psychotic symptoms, and non-responsiveness to treatment. Lastly, violent recidivism was related to non-compliance, cognitive instability, lack of insight, childhood antisocial behavior, and poverty. Further, the application of the HCR-20 V3 resulted in moderate predictive accuracy (AUC = 0.695), while the supplementary assessment of the FAM did not add any incremental validity. This article provides important insights into the risk factors of violence among female SSD patients while highlighting the importance of differentiating between various forms of violence. Equally, it substitutes the existing evidence on violence risk assessment in female offenders with SSD.

A national survey of doctoral psychology education and training in suicide risk and violence risk assessment and management.

When, in the judgment of a mental health professional, patient suicide risk and/or patient violence risk are considered imminent, they have been referred to as behavioral emergencies. Past surveys have suggested that education and training with these emergency situations have been inadequate. The present study was undertaken to obtain more current information on the training that psychologists receive in these areas of practice. All directors of APA-accredited graduate psychology programs and all directors of APA-accredited predoctoral psychology internship programs were asked to complete an online survey inquiring about such training provided in their programs. Results indicated that both sets of directors rated such doctoral training in suicide risk assessment and management as very important. Internship directors, however, were significantly more likely than graduate program directors to state that psychologists should be required to complete continuing education courses on other-directed violence risk. Serious gaps in training were identified; that is, only 59.2% of psychology graduate directors reported that their program offered training in safety planning for suicide risk and only 25.4% reported that their program offered training in safety planning for violence risk. Given that serious injury and even death can occur from patient suicidal behavior and/or a patient violent behavior, the implications of these findings are discussed.

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.

The Effects of Race and Gender When Predicting Intimate Partner Violence Recidivism in Police Reports Using the Ontario Domestic Assault Risk Assessment

Despite a growth in risk assessment for intimate partner violence (IPV), validation research has focused on men’s violence against women leading to a dearth of research among other genders and racialized populations. We examined validity of an IPV risk assessment tool in 448 Black and White men and women identified as IPV perpetrators by a United States urban police service. The Ontario Domestic Assault Risk Assessment (ODARA) predicted new police reports of IPV in a fixed 2-year follow up (baserate = 33%, AUC = 0.59). Predictive effects were mostly small, with few significant differences between groups. Further research should examine the benefits and potential harms of IPV risk assessment to individuals who identify within minority race and gender groups.

Assessing violence risk in first-episode psychosis: external validation, updating and net benefit of a prediction tool (OxMIV)

BackgroundViolence perpetration is a key outcome to prevent for an important subgroup of individuals presenting to mental health services, including early intervention in psychosis (EIP) services. Needs and risks are...

Effects of Online Distance Learning on Violence Risk Knowledge and Competencies.

Behavioral health professionals are charged with providing effective outpatient services while addressing patient and public safety, yet training in empirically-informed violence risk assessment strategies remains inaccessible. The authors developed and evaluated an online distance learning (ODL) course on clinical risk assessment targeting frontline providers and trainees in the United States. The ODL consisted of three modules: confidentiality, duty to third parties, and clinical assessment of violence risk. We evaluated the response characteristics and reach among different disciplines, as well as training satisfaction, change in knowledge, self-perceived competence, and self-reported impact on practice at six-week follow-up among 221 learners. Self-perceptions of competence and knowledge in the focal areas increased immediately after completing the training; self-perceived competence increased again by a significant margin at six-week follow-up. Participants reported a moderate-high positive impact of the training on practice.

Child-to-Parent Violence Specialist and Generalist Perpetrators: Risk Profile and Gender Differences.

Like other forms of domestic violence, child-to-parent violence (CPV) is a social and health-related problem. The identification of risk factors has preventive and therapeutic implications. This paper analyzes the risk profiles and gender differences of 206 CPV cases between 12 and 28 years of age (58% males) from clinical and judicial contexts in Spain, assessed using the Child to Parent Violence Risk (CPVR) Assessment tool. Two profiles were compared according to the extent of their violence: those using only CPV (specialist, 64.1%) and those also using other types of violence (generalist, 35.9%), as coded by professionals working with the cases. Generalist perpetrators had a significantly higher prevalence in terms of the bidirectionality of the violence (being victims at home), bullying victimization, empathy problems, anger management issues, attitudes justifying violence, antisocial behavior, failure of previous interventions, violence between parents, cohabitation problems other than CPV, problematic education style, and inversion of the hierarchy. Females were less likely to be generalists, and, in the case of female specialists, violence from parents and issues in the family context may have been among the main explanations for their violence. The results suggest differences between groups, which is consistent with previous research, but also the need for more accurate typological classification methods.

Utilization of the Fordham Risk Screening Tool (FRST) for Violence Risk Assessment in an Emergency Department.

Violence is a critical problem in the emergency department (ED) and patients experiencing mental health crises are at greater violence risk; however, tools appropriate for assessing violence risk in the ED are limited. Our goal was to evaluate the utility of the Fordham Risk Screening Tool (FRST) in reliability assessing violence risk in adult ED patients with acute mental health crises through evaluation of test characteristics as compared to a reference standard. We evaluated performance of the FRST when used with a convenience sample of ED patients undergoing acute psychiatric evaluation. Participants underwent assessment with the FRST and an established reference standard, the Historical Clinical Risk Management-20, version 3 (HCR-20, v3). Diagnostic performance was assessed through evaluation of test characteristics and area under the receiver operating characteristic (AUROC) curve. Psychometric assessments examined the measurement properties of the FRST. 105 participants were enrolled. In comparison to the reference standard, the AUROC for the predictive ability of the FRST was 0.88 (SE 0.39), 95% CI: 0.81-0.96. Sensitivity was 84% (95% CI: 69-94%) while specificity was 93% (95% CI: 83-98%). The positive predictive value was 87% (95% CI: 73-94%) and negative predictive value was 91% (95% CI: 83-86%). Psychometric analyses provided reliability and validity evidence for the FRST when used in the ED setting. Findings support the potential utility of the FRST when used to assess violence risk in adult ED patients experiencing a mental health crisis. Future research with more diverse populations and ED settings is warranted.

Artificial Intelligence in Violence Risk Assessment: Addressing Racial Bias and Inequity.

Although there has been no shortage of technological innovation in recent decades, a solution to sociodemographic disparities in the forensic setting has remained elusive. Artificial intelligence (AI) is a uniquely powerful emerging technology that is likely to either exacerbate or mitigate existing disparities and biases. This column argues that the implementation of AI in forensic settings is inevitable, and that practitioners and researchers should focus on developing AI systems that reduce bias and advance sociodemographic equity rather than attempt to impede the use of this novel technology.

Violence Risk Assessment in the Emergency Department

IntroductionWorkplace violence is a prevalent problem in health care, with mental health and emergency departments being the most at-risk settings. The aim of this evidence-based practice project was to pilot use of a violence risk assessment tool, the Broset Violence Checklist, to assess for risk of type II violence and record the interventions that nurses chose to implement to mitigate the situation. Additionally, reports made to the hospital reporting system were tracked and compared to previous reporting frequency. MethodsFollowing staff education, nurses were instructed to complete checklists for all patients who have a score of 1 or higher, which indicates the presence of at least 1 high-risk behavior, and continue hourly scoring until the score returned to 0 or the patient was dispositioned. The number of incidents recorded, time of day, scores, interventions applied to mitigate violence, and change in scores after interventions were evaluated. The number of Broset Violence Checklist scoring sheets submitted and reports made via the hospital reporting system were compared. ResultsIncidents were most frequent from 11 am until 3 am. The highest scores occurred in the late evening and early morning hours. There were significantly more incidents captured with the use of the Broset Violence Checklist as compared to the hospital reporting system. Incidents significantly associated with higher scores included providing comfort measures, addressing concerns, and applying restraints. DiscussionThe Broset Violence Checklist was used successfully in the emergency department setting to identify behaviors associated with violence. Under-reporting to the hospital report system was identified in this project, consistent with reports in the literature. Specific interventions were not associated with a decrease in Broset Violence Checklist scores.

Violence and Suicidal/Nonsuicidal Self-Injury Among Adolescents Undergoing Residential Treatment: An Examination of the Predictive Validity of the SAVRY, START:AV, and VRS-YV.

Using a retrospective study design, predictive validity of the Structured Assessment of Violence Risk in Youth, Short-Term Assessment of Risk and Treatability: Adolescent Version (START: AV), and the Violence Risk Scale-Youth Version (VRS-YV) was examined among 87 adolescents referred to a residential treatment program. With few exceptions, moderate to high accuracy was achieved for the three measures in predicting violence and suicidal/nonsuicidal self-injury occurring during the adolescents' time in treatment. Accuracy of the measures peaked within 90 days for violence and gradually increased over the 180-day follow-up for suicidal/nonsuicidal self-injury. Dynamic factors were more predictive of repeated events involving violence relative to static/historical factors, whereas only factors from the START: AV were predictive of repeated events involving suicidal/nonsuicidal self-injury. These results emphasize the need for further examining the risk of adverse outcomes beyond violence among adolescents.

Study on clinical characteristics of event-related potential P300 in elderly schizophrenics and associated risk factors.

To investigate the clinical characteristics of event-related potential P300 in elderly schizophrenics with different levels of violence and the risk factors of severe violence. A total of 138 elderly schizophrenic patients from January 2020 to December 2021 in the First Hospital of Hebei Medical University were enrolled in this retrospective analysis. Based on the violence risk assessment, 61, 102, and 145 patients were divided into high-risk, medium-risk, and low-risk groups, respectively. Clinical characteristics, P300 latency, and P300 amplitude were compared among the three groups followed by a logistic regression analysis of elderly schizophrenics with severe violence. The latency of P300 in the high-risk group was higher than that in the low-risk group (p<.05). The P300 amplitude of patients in the high-risk group was significantly lower than that in the low-risk group (p<.05). Univariate logistic regression analysis showed that previous history of violence, delusion of persecution, P300 latency, and amplitude were independent influencing factors of severe violence in elderly schizophrenics (odds ratio [OR]: 0.022, 95% confidence interval [CI]: 0.007-0.067, p<.001; OR: 0.118, 95% CI: 0.043-1.763, p=.037; OR: 1.289, 95% CI: 1.142-1.673, p<.001; and OR: 0.049, 95% CI: 0.021-0.067, p<0.001, respectively). After adjusting gender, age, and other confounding factors, multivariate logistic regression analysis showed that delusion of persecution, P300 latency, and P300 amplitude were associated with severe violence in elderly schizophrenics (OR: 2.211, 95% CI: 0.061-4.067, p<.001; OR: 2.006, 95% CI: 1.421-2.721, p=.017; and OR: 0.067, 95% CI: 0.037-0.276; p<.001; respectively). The latency and amplitude of P300 can be used as effective neuroelectrophysiological indicators to evaluate the violence level of elderly schizophrenics. Delusion of persecution, P300 latency, and P300 amplitude were independent influencing factors of severe violence in elderly schizophrenics.

Rural Differences in Victim Vulnerability and Revictimization of Intimate Partner Violence.

The aim of this study was to examine the association between the victim vulnerability factors included in the intimate partner violence (IPV) risk assessment tool used by the Swedish police (Brief Spousal Assault Form for the Evaluation of Risk [B-SAFER]) and rates of IPV revictimization among female victims living in rural towns, countryside, or remote areas. This study also aimed to examine the interaction between rurality and IPV revictimization in relation to victim vulnerability. The sample consisted of 695 cases of male-to-female perpetrated IPV, which had been reported to the Swedish police and subjected to a B-SAFER assessment. Rates of revictimization were examined in police registers. The results demonstrated that several vulnerability factors could discriminate between IPV revictimization across rurality. There was also an interaction effect between rurality and IPV revictimization in relation to the number of victim vulnerability factors present, where revictimization was more common for victims with many vulnerability factors living in more sparsely populated areas.

Using the Dynamic Appraisal of Situational Aggression (DASA) to assess the impact of unit atmosphere on violence risk assessment.

Research suggests that the Dynamic Appraisal of Situational Aggression (DASA) is a useful risk assessment instrument to identify individuals who might be at risk of aggression in mental health inpatient units. Although, risk assessment research has typically focused on an individual's risk of aggression, recent research has begun exploring whether the DASA could be used to assess the likelihood that a group of patients would be aggressive. While the DASA was useful for assessing whether an individual was likely to be aggressive, the group average score was not a useful indicator for the likelihood of aggression once the individual DASA score was taken into consideration. Unexpectedly, patients who were assessed as high risk on the DASA were more likely to be aggressive on settled units compared to unsettled units, which included other individuals whose risk was elevated. There is not enough evidence to suggest that the group DASA average improves the identification of aggression above the individual DASA score. INTRODUCTION: The Dynamic Appraisal of Situational Aggression (DASA) is an inpatient aggression risk assessment instrument. Recently, research explored whether the unit atmosphere, as indicated by a unit's average DASA score, was related to inpatient aggression risk, but failed to control for individual risk. Investigate whether the DASA unit average score or an interaction between the unit average and an individual patient's DASA score was related to the likelihood that an individual would act aggressively. Cox regression with repeated assessments and recurrent events was used to analyse 11,243 DASA risk assessments of 113 inpatients collected via retrospective file review. The unit DASA average score was not related to aggression towards staff. There was a negative interaction between the individual and the unit DASA average scores when identifying patient-to-patient aggression; high-risk patients engaged in less aggression when the unit average was heightened relative to units with lower DASA average scores. It is possible that there were more nursing interventions and/or patients engaged in greater self-regulation on unsettled units, thus reducing aggression. Currently, there is insufficient evidence to suggest that the unit average score should be used to supplement individual DASA scores to identify aggression risk.

Anger Rumination Vs. Revenge Planning: Divergent Associations with Aggression and Life Satisfaction

ABSTRACT Rumination about anger experiences prolongs anger arousal and increases the likelihood of aggression. School violence perpetrators have ruminated angrily. Research measures and personal accounts of anger rumination often contain revenge-planning as a subtheme, the relevance of which has received insufficient attention in accounting for aggressive behavior. This study differentially examines anger rumination with and without revenge-thinking, testing for their differential effects in association with aggression and life satisfaction. In a sample of 340 undergraduates, anger rumination (without revenge-thinking) was not significantly associated with self-reported physical or verbal aggression, while revenge-thinking was, controlling for gender and anger disposition. However, anger rumination, but not revenge-thinking, was associated with poorer life satisfaction. Relevant extensions for violence risk assessment, anger treatment, and future research concerning anger rumination are discussed.

Evaluating the HCR-20V3 violence risk assessment measure with mentally disordered offenders and civil psychiatric patients in China.

The current prospective risk assessment study evaluated the application of the Chinese translation of the Historical-Clinical-Risk Management-20 Version 3 (HCR-20V3 ) in a sample of 152 offenders with mental disorders and civil psychiatric patients. The ratings of the presence and relevance of risk factors were compared, as well as summary risk ratings (SRRs), both across offenders and civil psychiatric patients, and across male and female sub-samples. Interrater reliability was consistently "excellent" for the presence and relevance of risk factors and for SRRs. Concurrent validity analyses indicated that HCR-20V3 was strongly correlated with Violence Risk Scale (from r=0.53 to 0.71). The results of predictive validity analyses provided strong support for the bivariate associations between the main indices of HCR-20V3 and violence within 6weeks, 7-24weeks, and 6months; SRRs added incrementally to both relevance and presence ratings across three follow-up lengths.

The 'officer effect' in risk assessment for domestic abuse: Findings from a mixed methods study in England and Wales.

Research on risk assessment for domestic abuse has focused primarily on the predictive validity of specific tools; less attention has been paid to implementation of risk tools by practitioners. This paper presents findings from a mixed methods study in England and Wales. Multi-level modelling reveals an 'officer effect' whereby victims' responses to the Domestic Abuse, Stalking and Harassment and Honour-Based Violence (DASH) risk assessment are influenced by the specific officer that completes the assessment. Specifically, this officer effect is strongest in relation to questions intended to capture elements of controlling and coercive behaviour, and least apparent in relation to identifying physical injuries. We further present findings from field observations and interviews with first response officers that corroborate and help explain the officer effect. We discuss implications for the design of primary risk assessments, victim safeguarding, and the use of police data for predictive modelling.

Introducing a Digital Occupational Violence Risk Assessment Tool Into an Emergency Department: A Pilot Implementation Study

IntroductionOccupational violence in emergency departments is prevalent and detrimental to staff and health services. There is an urgent call for solutions; accordingly, this study describes the implementation and early impacts of the digital Queensland Occupational Violence Patient Risk Assessment Tool (kwov-pro). MethodsSince December 7, 2021, emergency nurses have been using the Queensland Occupational Violence Patient Risk Assessment Tool to assess 3 occupational violence risk factors in patients: aggression history, behaviors, and clinical presentation. Violence risk then is categorized as low (0 risk factors), moderate (1 risk factor), or high (2-3 risk factors). An important feature of this digital innovation is the alert and flagging system for high-risk patients. Underpinned by the Implementation Strategies for Evidence-Based Practice Guide, from November 2021 to March 2022 we progressively mobilized a range of strategies, including e-learning, implementation drivers, and regular communications. Early impacts measured were the percentage of nurses who completed their e-learning, the proportion of patients assessed using the Queensland Occupational Violence Patient Risk Assessment Tool, and the number of reported violent incidents in the emergency department. ResultsOverall, 149 of 195 (76%) of emergency nurses completed their e-learning. Further, adherence to Queensland Occupational Violence Patient Risk Assessment Tool was good, with 65% of patients assessed for risk of violence at least once. Since implementing the Queensland Occupational Violence Patient Risk Assessment Tool, there has been a progressive decrease in violent incidents reported in the emergency department. DiscussionUsing a combination of strategies, the Queensland Occupational Violence Patient Risk Assessment Tool was successfully implemented in the emergency department with the indication that it could reduce the number of incidents of occupational violence. The work herein provides a foundation for future translation and robust evaluation of the Queensland Occupational Violence Patient Risk Assessment Tool in emergency departments.

Factors Associated with Successful Completion of Juvenile Mental Health Court.

Justice-involved youth experience a high number of mental health symptoms. There has been an increased effort to address the mental health needs of these youth through specialized juvenile mental health courts (JMHC). To date, there have been few studies that examined characteristics related to successful completion of a JMHC program. This study is a retrospective case file review of 99 individuals ages 10 to 18 years who were involved in a JMHC program. Information collected included educational history, parental factors, psychiatric and abuse history, legal history, risk of removal from home, and risk and protective factors from the Structured Assessment of Violence Risk in Youth (SAVRY) measure. The primary outcome was successful completion of the program. Forty-eight participants (48.5%) successfully completed the program. Neglect, removal from the home, new charges, probation violation, and number of previous charges were negatively associated with successful completion. Positive attitude toward intervention was positively associated with successful completion. Measures that juvenile justice systems may use, such as the SAVRY risk factors and abuse and neglect screens, were not associated with completion. More studies are needed to identify factors associated with successful completion of a JMHC program and to develop interventions to improve outcomes.