An Examination of Predictive Validity and Change in Risk Factors for Stalking over Time.

This study investigates the predictive validity of two risk instruments for stalking, the Guidelines for Stalking Assessment and Management (SAM) and the Stalking Risk Profile (SRP), in a sample of 86 forensic psychiatric patients. We compare these tools against a well-validated violence risk assessment measure (Historical, Clinical, Risk Management-20, Version 3 (HCR-20V3)) for violent and stalking-related outcomes. Dynamic (mutable) components of each tool were rated at three annual intervals and revealed significant change across time. The HCR-20V3, SAM, and SRP measures showed comparable ability to classify those who recidivated with further stalking from those who did not (area under the curves = .72-.73, P < 001). Time-varying scores from the dynamic subscales of the HCR-20V3 and SAM contributed significantly to the prediction of stalking, whereas nonstalking violence was primarily forecast by the static (Historical) scale of the HCR-20V3. This suggests comparable validity of general violence and stalking risk tools for assessing the risk of stalking in forensic patients. Stalking-specific risk factors on the SAM and SRP will likely be of added clinical value in terms of tailoring risk management and treatment plans. Findings also emphasize the importance of attending to changes in risk status over time and incorporating time-sensitive methodologies into predictive models.

Innovations in violence risk assessment: What aviation can teach us about assessing and managing risk for rare and serious outcomes.

This paper describes several ongoing challenges in the field of violence risk assessment (VRA), particularly with respect to establishing acceptable levels of measurement reliability and validity of commonly used risk assessment instruments, and demonstrating their ability to reduce risk and avert harmful outcomes. Drawing on analogous concepts from the risk assessment and management process in the aviation industry, several key lessons and aspirational principles for research and practice in the field of VRA are described. It is argued that significantly more attention is required to evaluate the ability of VRA tools to generate effective risk management plans that measurably lower risk and rates of violent outcomes. Three propositions for advancing common VRA research designs are discussed: (1) improved operationalization of risk management plans and their ability to reduce violence; (2) improved measurement of change in risk status over prospective follow-up periods, and (3) a stronger emphasis on short-term assessments with closer temporal proximity between risk factors and outcomes. Collectively, these advancements may enhance the validity and utility of VRA instruments by permitting better specification of the conditions under which risk factors exert effects, and the development of effective risk management plans that join together explanatory frameworks for the causes of violence with strategies to avoid their recurrence.

The assessment of dynamic risk among forensic psychiatric patients transitioning to the community.

Individuals with serious mental illness (SMI; i.e., psychotic or major mood disorders) are vulnerable to experiencing multiple forms of adverse safety events in community settings, including violence perpetration and victimization. This study investigates the predictive validity and clinical utility of modifiable risk factors for violence in a sample of 87 forensic psychiatric patients found Not Criminally Responsible on Account of Mental Disorder (NCRMD) transitioning to the community. Using a repeated-measures prospective design, we assessed theoretically based dynamic risk factors (e.g., insight, psychiatric symptoms, negative affect, treatment compliance) before hospital discharge, and at 1 and 6 months postdischarge. Adverse outcomes relevant to this population (e.g., violence, victimization, hospital readmission) were measured at each community follow-up, and at 12 months postdischarge. The base rate of violence (23%) was similar to prior studies of discharged psychiatric patients, but results also highlighted elevated rates of victimization (29%) and hospital readmission (28%) characterizing this sample. Many of the dynamic risk indicators exhibited significant change across time and this change was related to clinically relevant outcomes. Specifically, while controlling for baseline level of risk, fluctuations in dynamic risk factors predicted the likelihood of violence and hospital readmission most consistently (hazard ratios [HR] = 1.35-1.84). Results provide direct support for the utility of dynamic factors in the assessment of violence risk and other adverse community outcomes, and emphasize the importance of incorporating time-sensitive methodologies into predictive models examining dynamic risk. (PsycINFO Database Record

Multirater reliability of the historical, clinical, and risk management-20.

The assessment and management of risk for future violence is a core requirement of mental health professionals in many settings. Despite an increasing need for violence risk assessments across diverse contexts, little is known regarding the ecological validity of many widely used risk assessment schemes or the level of reliability with which actual practicing clinicians score these instruments. The current study investigated the interrater reliability of the Historical, Clinical, and Risk Management-20 (HCR-20), a widely used structured professional tool to assess violence risk, among 21 practicing clinicians in a forensic psychiatric program in Ontario, Canada. Results suggest that clinicians with varying professional training backgrounds and experience were able to rate the HCR-20 with good to excellent levels of reliability across three patients who varied in risk level. Consistent with studies investigating rater reliability for research purposes, we found that the risk management scale of the HCR-20 was the most challenging for clinicians to rate reliably. Importantly, results from generalizability theory analyses revealed that less than 3% of the variance in HCR-20 total scores and summary risk ratings is attributable to rater effects, whereas the majority of variance is attributable to differences among patients.

Moderators of informant agreement in the assessment of adolescent psychopathology: extension to a forensic sample.

A well-documented finding in developmental psychopathology research is that different informants often provide discrepant ratings of a youth's internalizing and externalizing problems. The current study examines youth- and parent-based moderators (i.e., youth age, gender, and IQ; type of psychopathology; offense category; psychopathic traits; parental education, income, and stress) of informant discrepancies in a sample of young offenders and compares the utility of youth and caregiver reports against relevant clinical outcomes. Results indicate that gender moderated the discrepancy between informant reports of somatic complaints, while parenting stress moderated the discrepancies across reports of internalizing and externalizing psychopathology. Variables unique to the forensic context (e.g., offense category) were found to moderate cross-informant discrepancies in reports of internalizing and externalizing psychopathology. Further, youth self-reports of internalizing symptoms predicted a clinician-generated diagnosis of a mood disorder, while caregiver reports of aggressive behaviors predicted the presence of an externalizing diagnosis. Results highlight the importance of assessing informant agreement in the context of forensic assessment and raise questions surrounding the optimal use of informant data in this setting.

Gender differences in risk factors for violence: an examination of the predictive validity of the Structured Assessment of Violence Risk in Youth.

The research literature on predicting violence is particularly lacking in specifying risk factors for violence in adolescent girls. The recently developed Structured Assessment of Violence Risk in Youth [SAVRY; Borum et al., 2006] shows promise as it is empirically derived and incorporates dynamic factors in its assessment of risk. To date, there exists little information attesting to the reliability and validity of the SAVRY, and few investigations of the SAVRY's utility across gender. This study investigated the SAVRY in a sample of 144 high-risk adolescents (80 males and 64 females), focusing on gender discrepancies in the predictive utility of the measure. Results indicate that the SAVRY moderately predicts violent and non-violent reoffending in the entire sample, and also suggest that the SAVRY operates comparably across gender. Although not precluding the existence of gender-specific domains of risk, current results suggest that validated risk factors in boys hold relevance for the prediction of violence and delinquency in girls.