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Forensic Psych > Risk assessment > Flashcards

Risk assessment Flashcards

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1
Q

Why are risk assessments important?

A

Can change the outcome of someone’s life.

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2
Q

What does ROC stand for?

A

Receiver operating characteristic.

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3
Q

What is ROC?

A

Used to look at the usefulness of a risk assessment tool through a graph and figure.

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4
Q

What does the curve of an ROC graph depend on?

A

Different biases/cut-off scores of an instrument.

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5
Q

What is an ROC result expressed as?

A

Area Under the Curve (AUC).

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6
Q

What is regarded as a weak, moderate and strong AUC?

A

Weak - 0.56
Moderate - 0.65
Strong - 0.71

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7
Q

What are the pros of ROC?

A

Immune to baseline changes.

Keeps continuous nature of assessment scale.

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8
Q

What are the cons of ROC?

A

Lose ‘quality’ of event, e.g., how long to re-offend, how violent, etc.

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9
Q

What are the types of risk assessment?

A

Clinical judgement, actuarial measures, structured professional judgement.

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10
Q

What is unstructured clinical judgement?

A

Professional makes a decision based on impression, intuition and experience.

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11
Q

What is the biggest limitation of clinical judgements?

A

Allows biases - not based on empirical evidence of risk.

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12
Q

What did the Baxstrom study (Steadman et al., 1970) find?

A

When 966 ‘dangerous’ patients were released, only very few committed any ohter offences (20 were later arrested for any violent crime).

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13
Q

What did Odeh et al. (2006) find when looking at the reliability of clinical judgements?

A

Different people made widely different predictions form the same vignette - across all professions. People also had different reasons for why they came to their conclusions. Interrater relaibility was very poor.

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14
Q

What are 4 reasons why clinical judgements are so bad?

A
  1. Blind to the outcomes of the cases.
  2. Tendency to weigh bizarre or unusual facts rather heavily.
  3. Too many variables (we can only keep track of a small number of variables when making a decision).
  4. Tend to make judgements quickly and then seek support for these.
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15
Q

What are actuarial assessments?

A

Make a decision off a preordained plan.

Factors thought to be perdictive of risk are put together using a preordained method.

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16
Q

What are actuarial assessments based on?

A

‘Construction sample’ or the scientific literature.

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17
Q

What are the pros of actuarial assessment?

A

Avoids individual bias, doesn’t need clinical risk to formulate, fast.

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18
Q

What are the cons of actuarial assessment?

A

Often lacks ideographic information.
Does not easily suggest risk management.
Person has to fit with the sample.
Uses static measures.
Based on most common violence.
Getting a number is not enough.

19
Q

What are some examples of an actuarial assessment?

A

Violence Risk Assessment Guide (VRAG), OGRS, RM2000, COVR.

20
Q

What is the VRAG based on?

A

Based on men in a Canadian maximum secure psychiatric unit who were released to the community, minimum security or a half way house.

21
Q

What was the target behaviour looked for when creating the VRAG?

A

‘Violent incident’ - charge or conviction or violence or return to secure unit for reasons that would otherwise have led to a charge.

22
Q

How was the VRAG created?

A

Measured a range of potential predictors and dropped any that didn’t predict the violence. If two items were correlated, the one with the highest correlation was used. Then used a ‘least-squares regression’ to see which of the remaining variables added independently to risk prediction model.

23
Q

How many items are on the VRAG?

A

12

24
Q

Explain the scores on the VRAG.

A

Range from -26 to +38 which are split into 9 categories.

0 is the average score for people in maximum security so average population would score lower than 0.

25
Q

What is the reliability, standard error of measurement (SEM) and AUC of the VRAG?

A

Reliability is 0.9, small SEM, and AUC of 0.76.

26
Q

What has been suggested when looking at the AUC of the VRAG in other populations?

A

Different samples might have different risk factors, even similar samples might show some slippage.

27
Q

What methodology did Snowden et al. (2007) use when exploring the VRAG?

A

Followed up 421 male patients being dischraged 2 years later from MSUs in the UK - pseudo prespective study. Scored on case note review at time of discharge and blind to outcome.

28
Q

What did the Snowden et al. (2007) find when exploring the VRAG?

A

After 6 months, VRAG scored .86, decreased over time but only went down to .76.

29
Q

What was different about the VRAG sample and the Snowden et al. (2007) sample and why?

A

Snowden sample had lower base rates of violence.

Less violent than Canadians, use of formal reconnections may miss all violent incidences, may be more supervision/management, didn’t correct for any further time spent incarcerated, less competent detection/prosecution of incidences.

30
Q

Why don’t people use actuarial assessments?

A

Feel it ‘de-individualises’ the patient, clinicans feel their status is being eroded, clinicans feel risk assessment is not their job.

31
Q

Why have people argued that it isn’t fair to compare clinical judgements and actuarial assessments?

A

Clinicians tend to concentrate of ‘short-term’ outcome, they also have different information available, they concentrate on the really dangerous (not a single act of violence in years ahead), some clinians are bad.

32
Q

What did Harris et al. (2002) find when comparing VRAG scores and clinical judgements?

A

AUC for clinicans - 0.59, AUC for VRAG - 0.80.

Same scores whe compared to short-term follow ups, usec composite scores - not one clinican letting everyone down, only VRAG significantly predicted homicides.

33
Q

What are structured clinical assessments?

A

Combined clinical judgements and actuarial assessments.

34
Q

What are some examples of structured clinical assessments?

A

HCR20, SARA, SAVRY, SVR20

35
Q

What are the limitations of the HCR20?

A

Need more evidence of its utility in specific populations and specific forms of violence.

Need to see if treatment produces changes in HCR20 and if this is indicative of less dangerousness.

Homicide is rare and therefore few studies of its prediction.

36
Q

What are some problems when looking at the effectiveness of the HCR20?

A

Most violence is missed when committed in the community, most studies are retrospective, and often trying to predict behaviour in different setting to assessment.

37
Q

What did Gray et al. (2003) find when looking at HCR20 scores and future violence in a forensic MH setting?

A

HCR20 significantly predicted physical aggression as a whole but the individual rating scales also did.

38
Q

What did Gray et al. (2008) find when looking at effectiveness of the HCR20 in predicting recidivism following discharge in UK male MI offenders being discharged from MSUs?

A

HCR20 was a good predictor of future violence according to the AUC scores. But the clinical scale was poor.

39
Q

Why might the clinical scale of the HCR20 be poor when looking at future violence?

A

It is about current presentation so it wouldn’t stay static.

40
Q

What has been found using the HCR20 with females?

A

It has some predictive value with women but the AUC was smaller.

AUC was better when clinical judgement using the HCR20 was much better.

41
Q

What was found using the HCR20 with people with learning disabilities?

A

It was a very good predictor of violence (in UK sample) - better than other offenders. Clinical scale was also a good predictor, suggested because their clinical presentation is pretty much static.

42
Q

What has been found in ethnic minorities using the HCR20?

A

HCR20 has very similar properties in UK black population as in the white sample.

43
Q

What has been found when using the HCR20 with different diagnoses?

A

HCR20 was a good predictor in those with schizophrenia but worse in those with PDs.

PDs were the hardest to predict although they are the most violent.

44
Q

What other measure in the Gray et al. (2003) study predicted violence as well as the HCR20?

A

BPRS predicted physical and verbal aggression.

Forensic Psych (6 decks)

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