The predictive performance of criminal risk assessment tools used at sentencing: Systematic review of validation studies.

Although risk assessment tools have been widely used to inform sentencing decisions, there is uncertainty about the extent and quality of evidence of their predictive performance when validated in new samples. Following PRISMA guidelines, we conducted a systematic review of validation studies of 11 commonly used risk assessment tools for sentencing. We identified 36 studies with 597,665 participants, among which were 27 independent validation studies with 177,711 individuals. Overall, the predictive performance of the included risk assessment tools was mixed, and ranged from poor to moderate. Tool performance was typically overestimated in studies with smaller sample sizes or studies in which tool developers were co-authors. Most studies only reported area under the curve (AUC), which ranged from 0.57 to 0.75 in independent studies with more than 500 participants. The majority did not report key performance measures, such as calibration and rates of false positives and negatives. In addition, most validation studies had a high risk of bias, partly due to inappropriate analytical approach used. We conclude that the research priority is for future investigations to address the key methodological shortcomings identified in this review, and policy makers should enable this research. More sufficiently powered independent validation studies are necessary.

Lost in translation: "Risks," "needs," and "evidence" in implementing the First Step Act.

In this article, we focus on two highly problematic issues in the manner in which the First Step Act of 2018 is being implemented by the Bureau of Prisons: an uncritical separation of "dynamic risks" and "criminogenic needs"; and a spurious reliance on "evidence-based" interventions to reduce recidivism risk. We argue that if the Act is to live up to its promise of being a game-changing development in efforts to reduce crime while simultaneously shrinking mass incarceration, "needs assessment" must be subject to vastly increased empirical attention, variable and causal risk factors must be identified and validly assessed, and interventions to reduce risk must be rigorously evaluated both for their fidelity of implementation and impact on recidivism. Rather than further proliferating programs that ostensibly reduce risk, we believe that serious consideration should be given to the Bureau of Prisons offering one signature, well-established cognitive-behavioral program that can simultaneously address multiple risk factors for moderate and high-risk prisoners.

Risk assessment in sentencing and plea bargaining: The roles of prosecutors and defense attorneys.

Research on risk assessment in sentencing has focused heavily on the role of judges. Ignoring the role of other courtroom actors in the sentencing process, however, leaves unexamined the potentially significant effects on judicial decision making of arguments made by prosecutors and defense attorneys at sentencing hearings. Unduly focusing on judges also overlooks the vast majority of sentences arrived at through negotiated guilty pleas. We explored the extent to which considerations of risk are made among prosecutors and defense attorneys when advocating for given sentences in open court or during plea negotiations. We surveyed all prosecutors and defense attorneys in 14 judicial circuits in Virginia and found that most prosecutors and defense attorneys at least "sometimes" explicitly invoked actuarial risk estimates both at sentencing hearings and during plea negotiations. However, defense attorneys were much more likely than prosecutors to be averse to the use of risk assessment in either form of case disposition.

Impact of risk assessment on judges' fairness in sentencing relatively poor defendants.

OBJECTIVE: Use of risk assessment instruments in the criminal justice system is controversial. Advocates emphasize that risk assessments are more transparent, consistent, and accurate in predicting re-offending than judicial intuition. Skeptics worry that risk assessments will increase socioeconomic disparities in incarceration. Ultimately, judges make decisions-not risk assessments. This study tests whether providing risk assessment information interacts with a defendant's socioeconomic class to influence judges' sentencing decisions. HYPOTHESES: Tentatively, socioeconomic status was expected to have a main effect; without an interaction with risk assessment information. METHOD: Judges (N = 340) with sentencing experience were randomly assigned to review 1 of 4 case vignettes and sentence the defendant to probation, jail, or prison. Information in the vignettes was held constant, except the defendant's socioeconomic status and whether risk assessment information was provided. RESULTS: Risk assessment information reduced the likelihood of incarceration for relatively affluent defendants, but the same information increased the likelihood of incarceration for relatively poor defendants. This finding held after controlling for the sex, race, political orientation, and jurisdiction of the judge. CONCLUSIONS: Cuing judges to focus on risk may re-frame how they process socioeconomic status-a variable with opposite effects on perceptions of blameworthiness for past crime versus perceptions of risk for future crime. Providing risk assessment information may have transformed low socioeconomic status from a circumstance that reduced the likelihood of incarceration (by mitigating perceived blameworthiness) to a factor that increased the likelihood of incarceration (by increasing perceived risk). Under some circumstances, risk assessment information may increase sentencing disparities. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Valid or voodoo? A qualitative study of attorney perceptions of risk assessment in sentencing and plea bargaining.

Prior research largely has explored judicial perceptions of risk assessment in sentencing. Little is known about how other court actors, specifically, prosecutors and defense attorneys, perceive risk assessments in the sentencing process. Here, we report a qualitative study on the use of risk assessment by prosecutors and defense attorneys in Virginia. A prior survey (n = 70) pointed to a statistically significant difference in how prosecutors and defense attorneys view the role of recidivism risk in sentencing. On the basis of the results of this quantitative study, we collected follow-up qualitative data via interview (n = 30) to explain this unexpected difference. Analysis confirmed the survey findings that prosecutors and defense attorneys differ in their perceptions of risk assessment in sentencing. Results suggest that court actor perceptions vary as a function of professional role in the service of the identified client (the community or the defendant) and their interests. Although perceptions diverged on utility risk assessment in sentencing, both prosecutors and defense attorneys were outspoken in their skepticism of the Nonviolent Risk Assessment instrument that is used to predict recidivism risk in Virginia. This latter finding identifies obstacles that may emerge as jurisdictions adopt a risk-based approach to sentencing. We conclude with recommendations for addressing these barriers that may provide useful guidance on the implementation process.

Risk and resources: A qualitative perspective on low-level sentencing in Virginia.

Virginia's sentencing guidelines include alternative sanctions based on the use of a quantitative instrument called the Nonviolent Risk Assessment (NVRA) that identifies individuals convicted of drug and property crimes that are considered to be at lower risk of recidivism. Although nondispositive, the NVRA affords judges the discretion to grant alternative sentences to eligible low-risk defendants. In this study, we explore how judges make use of the NVRA instrument when sentencing individuals convicted of low-level drug and property crimes. Through semistructured interviews (N = 24) and inductive thematic analysis, the research team identified contextual factors that influence the use of the NVRA results, including: the availability of alternative programs in a community, the role of court actors, particularly prosecutors, in shaping the sentencing outcomes, as well as an individual judge's willingness to defer to or reject negotiated plea agreements offered by the prosecutor. Our research shows that while some judges are aware of and embrace the benefits of the instrument, others lack knowledge altogether of its function and empirical basis. We identified seven themes that account for variation in how actuarial risk is utilized in the sentencing process. Our findings provide insight into the practical challenges of using risk-based assessment as a tool for the sentencing of low-level convictions. As more states adopt risk-based approaches to sentencing, studying Virginia, which has gone farther than other states in legislating this strategy, becomes increasingly important.

Predeployment predictors of psychiatric disorder-symptoms and interpersonal violence during combat deployment.

BACKGROUND: Preventing suicides, mental disorders, and noncombat-related interpersonal violence during deployment are priorities of the US Army. We used predeployment survey and administrative data to develop actuarial models to identify soldiers at high risk of these outcomes during combat deployment. METHODS: The models were developed in the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS) Pre-Post Deployment Study, a panel study of soldiers deployed to Afghanistan in 2012-2013. Soldiers completed self-administered questionnaires before deployment and one (T1), three (T2), and nine months (T3) after deployment, and consented to administrative data linkage. Seven during-deployment outcomes were operationalized using the postdeployment surveys. Two overlapping samples were used because some outcomes were assessed at T1 (n = 7,048) and others at T2-T3 (n = 7,081). Ensemble machine learning was used to develop a model for each outcome from 273 predeployment predictors, which were compared to simple logistic regression models. RESULTS: The relative improvement in area under the receiver operating characteristic curve (AUC) obtained by machine learning compared to the logistic models ranged from 1.11 (major depression) to 1.83 (suicidality).The best-performing machine learning models were for major depression (AUC = 0.88), suicidality (0.86), and generalized anxiety disorder (0.85). Roughly 40% of these outcomes occurred among the 5% of soldiers with highest predicted risk. CONCLUSIONS: Actuarial models could be used to identify high risk soldiers either for exclusion from deployment or preventive interventions. However, the ultimate value of this approach depends on the associated costs, competing risks (e.g. stigma), and the effectiveness to-be-determined interventions.

The Cancer Cell Line Encyclopedia enables predictive modelling of anticancer drug sensitivity.

The systematic translation of cancer genomic data into knowledge of tumour biology and therapeutic possibilities remains challenging. Such efforts should be greatly aided by robust preclinical model systems that reflect the genomic diversity of human cancers and for which detailed genetic and pharmacological annotation is available. Here we describe the Cancer Cell Line Encyclopedia (CCLE): a compilation of gene expression, chromosomal copy number and massively parallel sequencing data from 947 human cancer cell lines. When coupled with pharmacological profiles for 24 anticancer drugs across 479 of the cell lines, this collection allowed identification of genetic, lineage, and gene-expression-based predictors of drug sensitivity. In addition to known predictors, we found that plasma cell lineage correlated with sensitivity to IGF1 receptor inhibitors; AHR expression was associated with MEK inhibitor efficacy in NRAS-mutant lines; and SLFN11 expression predicted sensitivity to topoisomerase inhibitors. Together, our results indicate that large, annotated cell-line collections may help to enable preclinical stratification schemata for anticancer agents. The generation of genetic predictions of drug response in the preclinical setting and their incorporation into cancer clinical trial design could speed the emergence of 'personalized' therapeutic regimens.

Judicial appraisals of risk assessment in sentencing.

The assessment of an offender's risk of recidivism is emerging as a key consideration in sentencing policy in many US jurisdictions. However, little information is available on how actual sentencing judges view this development. This study surveys the views of a population sample of judges in Virginia, the state that has gone further than any other in legislatively mandating risk assessment for certain drug and property offenders. Results indicate that a strong majority of judges endorse the principle that sentencing eligible offenders should include a consideration of recidivism risk. However, a strong majority also report the availability of alternatives to imprisonment in their jurisdictions to be inadequate at best. Finally, most judges oppose the adoption of a policy requiring them to provide a written reason for declining to impose alternative interventions on "low-risk" offenders.

Sexual Assault Victimization and Mental Health Treatment, Suicide Attempts, and Career Outcomes Among Women in the US Army.

OBJECTIVES: To examine associations of administratively recorded sexual assault victimization during military service with subsequent mental health and negative career outcomes among US Army women controlling for nonrandom victimization exposure. METHODS: We used data from the Army Study to Assess Risk and Resilience in Servicemembers to apply propensity score methods to match all 4238 female Regular Army soldiers with administratively recorded sexual assault victimization during 2004 to 2009 to 5 controls per case with similar composite victimization risk. We examined associations of this victimization measure with administratively recorded mental health treatment, suicide attempt, and Army career outcomes over the subsequent 12 months by using survival analysis for dichotomous outcomes and conditional generalized linear models for continuous outcomes. RESULTS: Women with administratively recorded sexual assault had significantly elevated odds ratios (ORs) of subsequent mental health treatment (any, OR = 2.5; 95% confidence interval [CI] = 2.4, 2.6; specialty, OR = 3.1; 95% CI = 2.9, 3.3; inpatient, OR = 2.8; 95% CI = 2.5, 3.1), posttraumatic stress disorder treatment (any, OR = 6.3; 95% CI = 5.7, 6.9; specialty, OR = 7.7; 95% CI = 6.8, 8.6; inpatient, OR = 6.8; 95% CI = 5.4, 8.6), suicide attempt (OR = 3.0; 95% CI = 2.5, 3.6), demotion (OR = 2.1; 95% CI = 1.9, 2.3), and attrition (OR = 1.2; 95% CI = 1.1, 1.2). CONCLUSIONS: Sexual assault victimization is associated with considerable suffering and likely decreased force readiness.

Age, risk assessment, and sanctioning: Overestimating the old, underestimating the young.

While many extoll the potential contribution of risk assessment to reducing the human and fiscal costs of mass incarceration without increasing crime, others adamantly oppose the incorporation of risk assessment in sanctioning. The principal concern is that any benefits in terms of reduced rates of incarceration achieved through the use of risk assessment will be offset by costs to social justice-which are claimed to be inherent in any risk assessment process that relies on variables for which offenders bear no responsibility, such as race, gender, and age. Previous research has addressed the variables of race and gender. Here, based on a sample of 7,350 federal offenders, we empirically test the predictive fairness of an instrument-the Post Conviction Risk Assessment (PCRA)-that includes the variable of age. We found that the strength of association between PCRA scores and future arrests was similar across younger (i.e., 25 years and younger), middle (i.e., 26-40 years), and older (i.e., 41 years and older) age groups (AUC values .70 or higher). Nevertheless, rates of arrest within each PCRA risk category were consistently lower for older than for younger offenders. Despite its inclusion of age as a risk factor, PCRA scores overestimated rates of recidivism for older offenders and underestimated rates of recidivism for younger offenders. (PsycINFO Database Record

Risk Assessment in Criminal Sentencing.

The past several years have seen a surge of interest in using risk assessment in criminal sentencing, both to reduce recidivism by incapacitating or treating high-risk offenders and to reduce prison populations by diverting low-risk offenders from prison. We begin by sketching jurisprudential theories of sentencing, distinguishing those that rely on risk assessment from those that preclude it. We then characterize and illustrate the varying roles that risk assessment may play in the sentencing process. We clarify questions regarding the various meanings of "risk" in sentencing and the appropriate time to assess the risk of convicted offenders. We conclude by addressing four principal problems confronting risk assessment in sentencing: conflating risk and blame, barring individual inferences based on group data, failing adequately to distinguish risk assessment from risk reduction, and ignoring whether, and if so, how, the use of risk assessment in sentencing affects racial and economic disparities in imprisonment.

Evidence-based sentencing: Public openness and opposition to using gender, age, and race as risk factors for recidivism.

The incarceration of criminal offenders in the United States has reached epidemic proportions. One way to scale back the prison population is by using empirical risk assessment methods to apportion prison sentences based on the likelihood of the offender recidivating, so-called "evidence-based sentencing." This practice has been denounced by some legal scholars, who claim that the use of certain empirically relevant risk factors--including gender, age, and race--is plainly immoral. This study tested whether lay individuals share their sentiment. More than 600 participants weighted to be representative of the United States population were asked about the extent to which they would support imposing shorter sentences for old versus young offenders, female versus male offenders, and white versus black offenders, all else being equal. The results indicate that very few participants (<3%) had no settled opinion about using evidence-based sentencing, and approximately half were unequivocally opposed to the practice. Whereas more than 3-quarters of participants were against using race to determine prison sentences, almost half were open to the possibility of using gender and more than 3-quarters of the participants were open to the possibility of using age to determine prison sentences. Individual differences as a function of participants' own demographic characteristics, or of their belief in "just deserts" as the primary purpose of sentencing, or of their political outlook, were either inconsistently or meagerly related to these findings. The profoundly disparate views held by the general public regarding the use of specific risk factors do not bode well for the use of demographic risk factors in sentencing as a way to roll back mass incarceration.

Gender, risk assessment, and sanctioning: The cost of treating women like men.

Increasingly, jurisdictions across the United States are using risk assessment instruments to scaffold efforts to unwind mass incarceration without compromising public safety. Despite promising results, critics oppose the use of these instruments to inform sentencing and correctional decisions. One argument is that the use of instruments that include gender as a risk factor will discriminate against men in sanctioning. On the basis of a sample of 14,310 federal offenders, we empirically test the predictive fairness of an instrument that omits gender, the Post Conviction Risk Assessment (PCRA). We found that the PCRA strongly predicts arrests for both genders, but overestimates women's likelihood of recidivism. For a given PCRA score, the predicted probability of arrest, which is based on combining both genders, is too high for women. Although gender neutrality is an obviously appealing concept, it may translate into instrument bias and overly harsh sanctions for women. With respect to the moral question of disparate impact, we found that women obtain slightly lower mean scores on the PCRA than men (d = .32, 99% CI = .29-.35, or 87% overlap in scores); this difference is wholly attributable to men's greater criminal history, a factor already embedded in sentencing guidelines. (PsycINFO Database Record

The evolution of violence risk assessment.

Many instruments have been published in recent years to improve the ability of mental health clinicians to estimate the likelihood that an individual will behave violently toward others. Increasingly, these instruments are being applied in response to laws that require specialized risk assessments. In this review, we present a framework that goes beyond the "clinical" and "actuarial" dichotomy to describe a continuum of structured approaches to risk assessment. Despite differences among them, there is little evidence that one instrument predicts violence better than another. We believe that these group-based instruments are useful for assessing an individual's risk, and that the instrument should be chosen based on the purpose of the assessment.

Determination of a perfusion threshold in experimental perforator flap surgery using indocyanine green angiography.

Indocyanine green (ICG) angiography has been used in the evaluation of flap perfusion but the viability threshold has not been elucidated. In this study, we determined the threshold by comparing perfusion, using ICG imaging (SPY imaging system, LifeCell Corporation), to clinical evidence of nonviability in rat abdominal perforator flaps. Abdominal flaps, based on a single perforator, were elevated and re-inset in Sprague-Dawley rats. ICG imaging and clinical assessments were conducted preoperatively, as well as 0, 24, and 48 hours postoperatively. SPY-Q software allowed standardization of the perforator's perfusion for comparison purposes. A total of 278 random percentage measurements were made from postoperative day 0 giving a mean (SE) percentage perfusion of 26.8% (1.6%) and 59.1% (1.3%), respectively, for necrosis and survival (P<0.05). We demonstrate that ICG angiography can be readily analyzed in a perforator flap environment allowing a determination of the perfusion threshold.