Conceptual Issues in Risk Assessment

1. Conceptual Issues in Risk Assessment Randy K. Otto, PhD Department of Mental Health Law & Policy Florida Mental Health Institute University of South Florida otto@fmhi.usf.edu

2. Agenda • Legal Contexts • Rationale for Involving Mental Health Professionals • Complexity of Risk Assessment • Approaches to Risk Assessment and Limitations • Features of a Competent Risk Assessment

3. Legal Contexts in Which Risk is an Issue • Criminal (and Delinquency) • Sentencing • Capital Sentencing • Parole • Civil • Civil Commitment • Sex Offender Registration • Sexually Violent Predator Proceedings

4. Why Involve Mental Health Professionals? • “In my view, psychiatry represents the ‘penultimate grey area’…particularly with regard to issues of foreseeability and predictability of future dangerousness.” • Judge Jorgensen dissenting in Lindabury v. Lindabury, 552 So2d 1117, 1118 (Fla 3d DCA, 1989)

5. Why Involve Mental Health Professionals? • “Neither petitioner nor the [American Psychiatric] Association suggests that psychiatrists are always wrong with respect to future dangerousness, only most of the time.” • Justice White in his opinion for the majority in Barefoot v. Estelle, 463 US 880 (1983).

6. Why Involve Mental Health Professionals? • Specialized knowledge of (individual and environmental) factors related to behaviors of interest • Non-violent criminal behavior • Violent (criminal) behavior • Sexual offending • Knowledge of interventions which may diminish risk for behaviors of interest • Presumption of better informed decisions

7. Sexual Violence is a Complicated Construct • Behavior is a function of BOTH the person and the environment • Assessment of only one of the above limits understanding of risk for violence • Some factors may correlate with sexual violence but not cause it

8. Sexual Violence is a Complicated Construct • Some factors may appear to be associated or correlate with sexual violence, but may not actually be related to or correlate with violence • Correlates or predictors of some kinds of violence (e.g., non-sexual violent behavior) do not not correlatewith or predict sexual violence

9. Correlates of Sexual and Violent Reoffending [r]

10. From “Violence Prediction” to “Risk Assessment” • Assessment Approach • Language/Communication • Relative Levels of Risk • Identification of Risk and Protective Factors • Decision Making Responsibility • Treatment/Management/Intervention

11. Various Approaches to Risk Assessment • Clinical Assessment • Unstructured • Structured Professional Judgment • Anamnestic • Actuarial Assessment • “Pure” • “Adjusted”

12. Clinical Assessment • Factors of relevance are identified by each examiner based on training and experience • Varies from clinician to clinician • Poor reliability • Poor validity • Person focused, less attention paid to important environmental variables

13. Structured Professional Judgment • Clinical judgment that is structured, but still a clinical judgment • Items are identified a priori and typically based on empirical literature • Increased reliability of judgments • Potential for improving validity of clinical judgment • Can be used in various settings and with various populations

14. Structured Professional Judgment Tools • Competence Assessment Instrument • HCR-20 • Sexual Violence Risk-20 • RSVP • Spousal Assault Risk Assessment Guide (SARA) • Structured Assessment for Violence Risk in Youth (SAVRY)

15. Actuarial Assessment • Items and weights are calculated based on known outcomes or relationships • Empirically based • Mechanistic • Generally reliable • Demonstrated levels of validity • Relative levels of risk • Rarely used in practice, if at all

16. Actuarial Assessment • Concerns regarding validity when used with groups differing (in important ways) from the group on which the instrument was derived • Reliability and validity of the clinical assessment approach most typically used with actuarial instruments-the “adjusted” actuarial approach-is unknown

17. Actuarial Assessment Tools • Violence Risk Appraisal Guide • Iterative Classification Tree (COVR) • Sex Offender Risk Appraisal Guide • RRASOR • MnSOST/MnSOST-R • Static-99 • CARAT

18. Methods For Assessing Technique Accuracy • ROC/AUC • Survival Analysis • Sensitivity/Specificity • Positive Predictive Power & Negative Predictive Power

19. Features of a Competent Risk Assessment • Conducted by professional who can talk competently about accuracy indices • Employs an acceptable assessment approach • Does not rely heavily on psychological testing • Examines both individual and environmental/contextual factors

20. Features of a Competent Risk Assessment • Identifies empirically established risk and protective factors • Offers relative estimates of risk • Acknowledges limitations of ability • Identifies interventions and conditions which may increase or decrease risk