The rationale for this article was to outline and describe an emerging model of prevention-based violence risk assessment and management and to discuss attendant clinical and research implications. This model draws on structured professional judgment rather than on actuarial prediction or unstructured clinical prediction. Its purpose is to prevent violence through the assessment of relevant violence risk factors and the application of risk management and intervention strategies that flow directly from these factors. The authors discuss the nature of the clinical tasks that stem from the model as well as a four-step validation procedure required to evaluate it.
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References
1.
American Educational Research Association, American Psychological Association, and the National Council on Measurement in Education. (1999). Standards for educational and psychological testing. Washington, DC: American Educational Research Association.
2.
Andrews, D. A., & Bonta, J. (1995). The Level of Service Inventory–Revised (LSI-R). Toronto, Canada: Multi-Health Systems.
3.
Augimeri, L. K., Koegl, C. J., Webster, C. D., & Levene, K. S. (2001). Early Assessment Risk List for Boys (EARL-20B): Version 2. Toronto, Canada: Earlscourt Child and Family Centre.
4.
Beech, A. R. (2000). Case material and interview. In C. R. Hollin (Ed.), Handbook of offender assessment and treatment (pp. 123-136). Chichester, UK: Wiley.
5.
Belfrage, H. (1998). Implementing the HCR-20 scheme for risk assessment in a forensic psychiatric hospital: Integrating research and clinical practice. Journal of Forensic Psychiatry, 9, 328-338.
6.
Belfrage, H., & Douglas, K. S. (2002). Treatment effects on forensic psychiatric patients measured with the HCR-20 violence risk assessment scheme. International Journal of Forensic Mental Health, 1, 25-36.
7.
Boer, D. P., Hart, S. D., Kropp, P. R., & Webster, C. D. (1997). Manual for the Sexual Violence Risk–20: Professional guidelines for assessing risk of sexual violence. Vancouver, Canada: British Columbia Institute Against Family Violence.
8.
Borum, R. (1996). Improving the clinical practice of violence risk assessment: Technology, guidelines, and training. American Psychologist, 51, 945-956.
9.
Borum, R., Bartel, P., & Forth, A. (2001). Manual for the Structured Assessment for Violence Risk in Youth(SAVRY): Consultation version. Tampa: University of South Florida, Florida Mental Health Institute.
10.
Caplan, G., & Caplan, R. B. (2000). The future of primary prevention. Journal of Primary Prevention, 21, 131-136.
11.
Cocozza, J. J., & Steadman, H. J. (1976). The failure of psychiatric predictions of dangerousness: Clear and convincing evidence. Rutgers Law Review, 29, 1084-1101.
12.
Cowen, E. L. (2000). Now that we all know that primary prevention in mental health is great, what is it?Journal of Community Psychology, 28, 5-16.
13.
Dahlberg, L. L. (1998). Youth violence in the United States: Major trends, risk factors, and prevention approaches. American Journal of Preventive Medicine, 14, 259-272.
14.
Dahlberg, L. L., & Potter, L. B. (2001). Youth violence: Developmental pathways and prevention challenges. American Journal of Preventive Medicine, 20(1S), 3-14.
15.
Dempster, R. J. (1998). Prediction of sexually violent recidivism: A comparison of risk assessment instruments. Unpublished master's thesis, Simon Fraser University, Burnaby, British Columbia, Canada.
16.
Dodge, K. A. (2001). The science of youth violence prevention: Progressing from developmental epidemiology to efficacy to effectiveness to public policy. American Journal of Preventive Medicine, 20(1S), 63-70.
17.
Dolan, M., & Doyle, M. (2000). Violence risk prediction: Clinical and actuarial measures and the role of the Psychopathy Checklist. British Journal of Psychiatry, 177, 303-311.
18.
Douglas, K. S. (2001a). HCR-20 violence risk assessment scheme: Overview and annotated bibliography. Retrieved from http://www.sfu.ca/psychology/groups/faculty/hartviolink.htm
19.
Douglas, K. S. (2001b). Making structured clinical decisions about violence risk: The reliability and validity of the HCR-20 violence risk assessment scheme. Unpublished manuscript.
20.
Douglas, K. S., & Belfrage, H. (2001). Use of the HCR-20 in violence risk management: Implementation and clinical practice. In K. S. Douglas, C. D. Webster, S. D. Hart, D. Eaves, & J. R. P. Ogloff (Eds.), HCR-20 violence risk management companion guide (pp. 41-58). Burnaby, Canada/Tampa, FL: Simon Fraser University, Mental Health Law and Policy Institute/University of South Florida, Department of Mental Health Law & Policy.
21.
Douglas, K. S., Cox, D. N., & Webster, C. D. (1999). Violence risk assessment: Science and practice. Legal and Criminological Psychology, 4, 149-184.
22.
Douglas, K. S., Ogloff, J. R. P., Nicholls, T. L., & Grant, I. (1999). Assessing risk for violence among psychiatric patients: The HCR-20 violence risk assessment scheme and the Psychopathy Checklist: Screening version. Journal of Consulting and Clinical Psychology, 67, 917-930.
23.
Douglas, K. S., & Webster, C. D. (1999). Predicting violence in mentally and personality disordered individuals. In R. Roesch, S. D. Hart, & J. R. P. Ogloff (Eds.), Psychology and law: The state of the discipline (pp. 175-239). New York: Plenum.
24.
Douglas, K. S., Webster, C. D., Hart, S. D., Eaves, D., & Ogloff, J. R. P. (Eds.). (2001). HCR-20 violence risk management companion guide. Burnaby, Canada/Tampa, FL: Simon Fraser University, Mental Health Law and Policy Institute/University of South Florida, Department of Mental Health Law & Policy.
25.
Dvoskin, J. A., & Heilbrun, K. (2001). Risk assessment and release decision-making: Toward resolving the great debate. Journal of the American Academy of Psychiatry and the Law, 29, 6-10.
26.
Edens, J. F., & Otto, R. K. (2001). Release decision making and planning. In J. B. Ashford, B. D. Sales, & W. H. Reid (Eds.), Treating adult and juvenile offenders withspecial needs (pp. 335-371). Washington, DC: American Psychological Association.
27.
Ennis, B. J., & Emory, R. D. (1978). The rights of mental patients. New York: Free Press.
28.
Ennis, B. J., & Litwack, T. R. (1974). Psychiatry and the presumption of expertise: Flipping coins in the courtroom. California Law Review, 62, 693-752.
29.
Grove, W. M., & Meehl, P. E. (1996). Comparative efficiency of informal (subjective, impressionistic) and formal (mechanical, algorithmic) prediction procedures: The clinical-statistical controversy. Psychology, Public Policy, and Law, 2, 293-323.
30.
Hall, G. C. N., & Barongan, C. (1997). Prevention of sexual aggression: Sociocultural risk and protective factors. American Psychologist, 52, 5-14.
31.
Hanson, R. K. (1998). What do we know about sex offender risk assessment?Psychology, Public Policy, and Law, 4, 50-72.
32.
Hanson, R. K., & Harris, A. J. R. (2000). Where should we intervene? Dynamic predictors of sexual offense recidivism. Criminal Justice and Behavior, 27, 6-35.
33.
Hanson, R. K., & Thornton, D. (2000). Improving risk assessments for sex offenders: A comparison of three actuarial scales. Law and Human Behavior, 24, 119-136.
34.
Harlan, W. R. (1998). Prevention research at the national institutes of health. American Journal of Preventive Medicine, 14, 302-307.
35.
Hart, S. D. (1998). The role of psychopathy in assessing risk for violence: Conceptual and methodological issues. Legal and Criminological Psychology, 3, 121-137.
36.
Hart, S. D. (2001a). Assessing and managing violence risk. In K. S. Douglas, C. D. Webster, S. D. Hart, D. Eaves, & J. R. P. Ogloff (Eds.), HCR-20 violence risk management companion guide (pp. 13-25). Burnaby, Canada/Tampa, FL: Simon Fraser University, Mental Health Law and Policy Institute/University of South Florida, Department of Mental Health Law & Policy.
37.
Hart, S. D. (2001b). Complexity, uncertainty, and the reconceptualization of risk assessment. Retrieved from http://www.sfu.ca/psychology/groups/faculty/hart
38.
Hart, S. D., Webster, C. D., & Douglas, K. S. (2001). Risk management using the HCR-20: A general overview focusing on historical factors. In K. S. Douglas, C. D. Webster, S. D. Hart, D. Eaves, & J. R. P. Ogloff (Eds.), HCR-20 violence risk management companion guide(pp. 27-40). Burnaby, Canada/Tampa, FL: Simon Fraser University, Mental Health Law and Policy Institute/University of South Florida, Department of Mental Health Law & Policy.
39.
Heilbrun, K. (1997). Prediction versus management models relevant to risk assessment: The importance of legal decision-making context. Law and Human Behavior, 21, 347-359.
40.
Heilbrun, K. (2001, November). Risk assessment and risk management: Toward an integration. Plenary session delivered at the International Conference, Violence Risk Assessment and Management: Bringing Science and Practice Closer Together, Sundsvall, Sweden.
41.
Heilbrun, K., Dvoskin, J., Hart, S., & McNiel, D. (1999). Violence risk communication: Implications for research, policy, and practice. Health, Risk, and Society, 1, 91-106.
42.
Heilbrun, K., O'Neill, M. L., Strohman, L. K., Bowman, Q., & Philipson, J. (2000). Expert approaches to communicating violence risks. Law and Human Behavior, 24, 137-148.
43.
Ikeda, R. M., Simon, T. R., & Swahn, M. (2001). The prevention of youth violence: The rationale for and characteristics of four evaluation projects. American Journal of Preventive Medicine, 20(1S), 15-21.
44.
Janus, E. S., & Meehl, P. E. (1997). Assessing the legal standard for predictions of dangerousness in sex offender commitment proceedings. Psychology, Public Policy, and Law, 3, 33-64.
45.
Kapp, M. B., & Mossman, D. (1996). Measuring decisional competency: Cautions on the construction of a “capacimeter”. Psychology, Public Policy, and Law, 2, 73-95.
46.
Kazdin, A. E. (1992). Researchdesign in clinical psychology (2nd ed.). Boston: Allyn & Bacon.
47.
Koziol-McLain, J., Coates, C. J., & Lowenstein, S. R. (2001). Predictive validity of a screen for partner violence against women. American Journal of Preventive Medicine, 21, 93-100.
48.
Kraemer, H. C., Kazdin, A. E., Offord, D. R., Kessler, R. C., Jensen, P. S., & Kupfer, D. J. (1997). Coming to terms with the terms of risk. Archives of General Psychiatry, 54, 337-343.
49.
Kropp, P. R., & Hart, S. D. (2000). The Spousal Assault Risk Assessment (SARA) Guide: Reliability and validity in adult male offenders. Law and Human Behavior, 24, 101-118.
50.
Kropp, P. R., Hart, S. D., Lyon, D. R., & Le Pard, D. (in press). Managing stalkers: Coordinating treatment and supervision. In L. Sheridan & J. Boon (Eds.), Stalking and psychosexual obsession: Psychological perspectives for prevention, policing and treatment. New York: Wiley.
51.
Kropp, P. R., Hart, S. D., Webster, C. D., & Eaves, D. (1999). Manual for the Spousal Assault Risk Assessment Guide (3rd ed.). Toronto, Canada: Multi-Health Systems.
52.
Laws, R. (Ed.). (1989). Relapse prevention withsex offenders. New York: Guilford Press.
53.
Laws, R. (2000, November). Risk for Sexual Violence Protocol (RSVP): A new guide for assessment and management. Symposium presented at the founding conference of the International Association of Forensic Mental Health Services, Vancouver, Canada.
54.
Lidz, C. W., Mulvey, E. P., & Gardner, W. (1993). The accuracy of predictions of violence to others. Journal of the American Medical Association, 269, 1007-1111.
55.
Litwack, T. R. (2001). Actuarial versus clinical assessments of dangerousness. Psychology, Public Policy, and Law, 7, 409-443.
56.
Litwack, T. R., & Schlesinger, L. B. (1987). Assessing and predicting violence: Research, law, and applications. In I. B. Weiner & A. K. Hess (Eds.), Handbook of forensic psychology (pp. 205-257). New York: Wiley.
57.
Litwack, T. R., & Schlesinger, L. B. (1999). Dangerousness risk assessments: Research, legal and clinical considerations. In A. K. Hess & I. B. Weiner (Eds.), Handbook of forensic psychology (2nd ed., pp. 171-217). New York: Wiley.
58.
Luke, D. A., & Homan, S. M. (1998). Time and change: Using survival analysis in clinical assessment and treatment evaluation. Psychological Assessment, 10, 360-378.
59.
Lyon, D. R., Hart, S. D., & Webster, C. D. (2001). Violence risk assessment. In R. Schuller & J. R. P. Ogloff (Eds.), Law and psychology: Canadian perspectives (pp. 314-350). Toronto, Canada: University of Toronto Press.
60.
Maclure, M., & Mittleman, M. A. (2000). Should we use a case-crossover design?Annual Review of Public Health, 21, 193-221.
61.
Mathiesen, T. (1998). Selective incapacitation revisited. Law and Human Behavior, 22, 455-469.
62.
McCaw, B., Berman, W. H., Syme, S. L., & Hunkeler, E. F. (2001). Beyond screening for domestic violence: A systems model approach in a managed care setting. American Journal of Preventive Medicine, 21, 170-176.
63.
McNiel, D. E., & Binder, R. L. (1994a). The relationship between acute psychiatric symptoms, diagnosis, and short-term risk of violence. Hospital and Community Psychiatry, 45, 133-137.
64.
McNiel, D. E., & Binder, R. L. (1994b). Screening for risk of inpatient violence: Validation of an actuarial tool. Law and Human Behavior, 18, 579-586.
65.
McNiel, D. E., & Binder, R. L. (1995). Correlates of accuracy in the assessment of psychiatric inpatients'risk of violence. American Journal of Psychiatry, 152, 901-906.
66.
Melton, G. B., Petrila, J., Poythress, N. G., & Slobogin, C. (1997). Psychological evaluations for the courts: A handbook for mental health professionals and lawyers (2nd ed.). New York: Guilford.
67.
Menzies, R. J., Webster, C. D., & Sepejak, D. S. (1985). Hitting the forensic sound barrier: Predictions of dangerousness in a pre-trial psychiatric clinic. In C. D. Webster, M. H. Ben-Aron, & S. J. Hucker (Eds.), Dangerousness: Probability and prediction, psychiatry and public policy (pp. 115-143). New York: Cambridge University Press.
68.
Miller, M., & Morris, N. (1988). Prediction of dangerousness: An argument for limited use. Violence & Victims, 3, 263-269.
69.
Moffitt, T. E. (1993). Adolescent-limited and life-course-persistent antisocial behavior: A developmental taxonomy. Psychological Review, 100, 674-701.
70.
Monahan, J. (1981). Predicting violent behavior: An assessment of clinical techniques. Beverly Hills, CA: Sage.
71.
Monahan, J. (1988). Risk assessment of violence among the mentally disordered: Generating useful knowledge. International Journal of Law and Psychiatry, 11, 249-257.
72.
Monahan, J. (1996). Violence prediction: The last 20 and the next 20 years. Criminal Justice and Behavior, 23, 107-120.
73.
Monahan, J., & Steadman, H. J. (1994a). Toward a rejuvenation of risk assessment research. In J. Monahan & H. J. Steadman (Eds.), Violence and mental disorder: Developments in risk assessment (pp. 1-17). Chicago: University of Chicago Press.
74.
Monahan, J., & Steadman, H. J. (Eds.). (1994b). Violence and mental disorder: Developments in risk assessment. Chicago: University of Chicago Press.
75.
Monahan, J., & Steadman, H. J. (1996). Violent storms and violent people: How meteorology can inform risk communication in mental health law. American Psychologist, 51, 931-938.
76.
Monahan, J., Steadman, H. J., Appelbaum, P. S., Robbins, P. C., Mulvey, E. P., Silver, E., et al. (2000). Developing a clinically useful actuarial tool for assessing violence risk. British Journal of Psychiatry, 176, 312-319.
77.
Monahan, J., Steadman, H. J., Silver, E., Appelbaum, P. S., Robbins, P. C., Mulvey, E. P., et al. (2001). Rethinking risk assessment: The MacArthur study of mental disorder and violence. New York: Oxford University Press.
78.
Mossman, D. (2000). Evaluating violence risk by the book: A review of HCR-20: Assessing risk for violence, Version 2 and the manual for the Sexual Violence Risk-20. Behavioral Sciences and the Law, 18, 781-789.
79.
Mulvey, E. P., & Lidz, C. W. (1995). Conditional prediction: A model for research on dangerousness to others in a new era. International Journal of Law and Psychiatry, 18, 129-143.
80.
Mulvey, E. P., Shaw, E., & Lidz, C. W. (1994). Why use multiple sources in research on patient violence in the community?Criminal Behavior and Mental Health, 4, 253-258.
81.
Muñoz, R. F., Mrazek, P. J., & Haggerty, R. J. (1996). Institute of medicine report on prevention of mental disorders. American Psychologist, 51, 1116-1122.
82.
Otto, R. K. (1992). Prediction of dangerous behavior: A review and analysis of “second-generation”research. Forensic Reports, 5, 103-133.
83.
Otto, R. K. (2000). Assessing and managing violence risk in outpatient settings. Journal of Clinical Psychology, 56, 1239-1262.
84.
Pearlman, D. N., & Waalen, J. (2000). Violence against women: Charting the impact on health policy, health care delivery, and the law. American Journal of Preventive Medicine, 19, 212-213.
85.
Quinsey, V. L., Harris, G. T., Rice, M. E., & Cormier, C. A. (1998). Violent offenders: Appraising and managing risk. Washington, DC: American Psychological Association.
86.
Saltzman, L. E., Green, Y. T., Marks, J. S., & Thacker, S. B. (2000). Violence against women as a public health issue: Comments from the CDC. American Journal of Preventive Medicine, 20, 325-329.
87.
Shah, S. A. (1978). Dangerousness and mental illness: Some conceptual, prediction, and policy dilemmas. In C. Frederick (Ed.), Dangerous behavior: A problem in law and mental health (pp. 153-191). Washington, DC: Government Printing Office.
88.
Silver, E., Mulvey, E. P., & Monahan, J. (1999). Assessing violence risk among discharged psychiatric patients: Toward an ecological approach. Law and Human Behavior, 23, 237-255.
89.
Skeem, J. L., Mulvey, E. P., & Lidz, C. W. (2000). Building mental health professionals'decisional models into tests of predictive validity: The accuracy of contextualized predictions of violence. Law and Human Behavior, 24, 607-628.
90.
Slovic, P., Monahan, J., & MacGregor, D. G. (2000). Violence risk assessment and communication: The effects of using actual cases, providing instruction, and employing probability versus frequency formats. Law and Human Behavior, 24, 271-296.
91.
Steadman, H. J. (2000). From dangerousness to risk assessment of community violence: Taking stock at the turn of the century. Journal of the American Academy of Psychiatry and the Law, 28, 265-271.
92.
Steadman, H. J., Monahan, J., Appelbaum, P. S., Grisso, T., Mulvey, E. P., Roth, L. H., et al. (1994). Designing a new generation of risk assessment research. In J. Monahan & H. J. Steadman (Eds.), Violence and mental disorder: Developments in risk assessment (pp. 297-318). Chicago: University of Chicago Press.
93.
Steadman, H. J., Monahan, J., Robbins, P. C., Appelbaum, P., Grisso, T., Klassen, D., et al. (1993). From dangerousness to risk assessment: Implications for appropriate research strategies. In S. Hodgins (Ed.), Mental disorder and crime (pp. 39-62). London: Sage.
94.
Steadman, H. J., Mulvey, E., Monahan, J., Robbins, P. C., Appelbaum, P. S., Grisso, T., et al. (1998). Violence by people discharged from acute psychiatric inpatient facilities and by others in the same neighborhoods. Archives of General Psychiatry, 55, 393-401.
95.
Steadman, H. J., Silver, E., Monahan, J., Appelbaum, P. S., Robbins, P. C., Mulvey, E. P., et al. (2000). A classification tree approach to the development of actuarial violence risk assessment tools. Law and Human Behavior, 24, 83-100.
96.
Stone, A. (1975). Mental health and the law: A system in transition. Washington, DC: Government Printing Office.
97.
Swartz, M. S., Burns, B. J., George, L. K., Swanson, J., Hiday, V. A., Borum, R., et al. (1997). The ethical challenges of a randomized controlled trial of involuntary outpatient commitment. Journal of Mental Health Administration, 24, 35-43.
98.
Webster, C. D., & Bailes, G. (2000). Assessing violence risk in mentally and personality disordered individuals. In C. R. Hollin (Ed.), Handbook of offender assessment and treatment (pp. 71-84). Chichester, UK: Wiley.
99.
Webster, C. D., Douglas, K. S., Belfrage, H., & Link, B. (2000). Capturing change: An approach to managing violence and improving mental health. In S. Hodgins & R. Müller-Isberner (Eds.), Violence among the mentally ill: Effective treatment and management strategies (pp. 119-144). Dordrecht, the Netherlands: Kluwer/Academic.
100.
Webster, C. D., Douglas, K. S., Eaves, D., & Hart, S. D. (1997). HCR-20: Assessing risk for violence (Version 2). Burnaby, Canada: Simon Fraser University, Mental Health, Law, and Policy Institute.
101.
Webster-Stratton, C., & Taylor, T. (2001). Nipping early risk factors in the bud: Preventing substance abuse, delinquency, and violence in adolescence through interventions targeted at young children (0-8 years). Prevention Science, 2, 165-192.
102.
Witt, P. H. (2000). A practitioner's view of risk assessment: The HCR-20 and SVR-20. Behavioral Sciences and the Law, 18, 791-798.
103.
Woolf, S. H., & Atkins, D. (2001). The evolving role of prevention in health care: Contributions of the U.S. Preventive Services Task Force. American Journal of Preventive Services, 20(3S), 13-20.
104.
Yoshikawa, H. (1994). Prevention as cumulative protection: Effects of early family support and education on chronic delinquency and its risks. Psychological Bulletin, 115, 28-54.
