VIOLENCE RISK ASSESSMENT

EDPS 676

Violence Risk Assessment

Process of conceptualizing hazards in order to make

judgements about their likelihood and the need for

various preventative measures

Assessing individuals threat to society and/or threat to

self

History of Risk Assessment

Prior to 1966 little attention paid to clinical risk assessment
1966

Baxstrom v. Herold

1976

Tarasoff v. The Regents of the University of California

1983

Barefoot v. Estelle

1999

Smith v. Jones

1993

Wenden v. Trika

 Was viewed as dichotomy either dangerous or not

Risk now viewed as range/continuum low to

moderate, significant or extreme/high

Probabilities change across time
People change low risk might become high risk
Older the person gets lower their risk becomes (good predictor for

men)

Risk assessment is an ongoing process and requires

regular review
Here and Now, good for 24 - 48 hours or less

Like weather forecasting

 People at high risk do not always commit violent acts

People who commit violent acts may not be considered high

risk
Most violence is committed by people without psychiatric

diagnosis
Violence = Specific Individual + Specific Situation

Two components of risk assessment

Prediction
Probability that individual will commit future criminal or violent acts
Based on identifying the risk factors that are associated with future
criminal or violent acts
Management
Interventions to manage or reduce the likelihood of future violence
Focus on identifying what treatment might reduce level of risk or
what conditions need to be implemented to manage risk
Thinking about alternative scenarios if client reoffends

What Is Best Predictor of Violence?

a. Criminal Record
b. Presence of Intoxication

c. Past History of Violence

d. Perception of Self as a Victim
e. All of the Above
f.

None of the Above

Judgement Errors and Biases

Illusory correlation
Two things appear to be related but they are not
Hot weather and crime goes up
Violence and psychosis or violence and drug use

Ignore base rates

Rather than figuring out base homicide rate people look at
how brutal it is

Reliance on salient or unique cues

Does having delusions make person at risk of harming others

Overconfidence in judgements

Guiding Questions
Is there risk?
What sort of risk and degree?

How likely is it?

Immediacy?
How long will it last?
What factors increase or buffer risk?

How can factors be modified or managed?

Warning Behaviors
Pathway

Energy Burst

Fixation

Leakage

Novel aggression

Last Resort

Identification

Directly Communicated

threat

Biopsychosocial model
Individual/Psychological risk factors
Biological risk factors
Social/Environmental risk factors

Static
Dynamic

historical or dispositional
situational or clinical

Individual/Psychological Factors
Male gender
Age 15 24
Past history of violence: frequency, recency, severity
Paranoia
Intelligence below average
Anger/fear problems: frequency, intensity, control
Psychopathy and other attachment problems

Biological Factors
History of CNS trauma
CNS signs and symptoms

Objective CNS measures

Major mental disorder

Social/Environmental Factors
Family of origin violence
Adolescent peer group violence
Economic instability or poverty
Weapons history, skill, interest, and approach behavior
Victim pool
Alcohol and/or psychostimulant use
Popular culture

Applying the Model

Each client should be assessed on all 18 factors to maintain standard

of practice
Each factor may be more or less important for client depending on

who that client is and what he has done with his life
Whether factor is static or dynamic determines what, if anything, can

be done to reduce risk of violence

If a person does not fit a particular factor, that factor may act as a

buffer against violence risk

Likely to overestimate violence risk due to fear of generating false

negative and low base rate for most forms of violence

Measurements
Hares Psychopathy Checklist (PCL-R)
20 items scored on 3 point scale
2 factors personality and case history
Traits not correlated with either factor

Psychopathy Checklist
Personality Aggressive Narcissism

Early behaviour problems

Glibness/superficial charm
Lack of realistic long-term goals
Grandiose sense of self-worth
Juvenile delinquency

Pathological lying
Revocation of conditional release
Cunning/manipulative
Impulsivity
Lack of remorse or guilt

Irresponsibility
Shallow affect
Callousness/lack of empathy
Traits Not Correlated With Either Factor
Failure to accept responsibility for own actions
Promiscuous sexual behaviour

Case History Socially Deviant Lifestyle

Many short-term relationships

Criminal versatility

Parasitic lifestyle
Poor behavioural controls
Need for stimulation/proneness to boredom

Acquired behavioral sociopathy/sociological

conditioning

SAVRY
Structured Assessment of Violence Risk in Youth
(SAVRY)

24 items in 3 risk domains

6 protective factor items

Identifies affective and predatory aggression

Risk Domains
Historical risk factors
History of violence
Early initiation of violence
Parental/caregiver criminality

Social/Contextual Risk Factors

Peer delinquency
Peer rejection
Stress and poor coping

Individual/Clinical Risk Factors

Negative attitudes
Risk taking/impulsivity
Low empathy/remorse

Protective Factors
Prosocial involvement
Strong social support
Strong attachments and bonds
Positive attitude toward interventions

and authority
Strong commitment to school
Resilient personality traits

ACUTE
Adolescent & Child Urgent Threat Evaluation (ACUTE)
Assesses risk for violence to self or others for clients age 8 to 18

Assigns violence risk levels within minutes of an intake capturing

high-risk situations before they occur

Once violence has already occurred can be used to determine

treatment efficacy

 Does the person express violent or suicidal behaviors that have

certain death as the objective?

Does the person have an unstable home environment?

Does the person express dire predictions, such as being dead and/or

stopping the pain?

Does the persons violent or suicidal behavior involve alcohol or drug

abuse?
Has the person acquired the behavior and skills of a delinquent peer

group?

Interventions
Pharmacotherapy
Substance abuse treatment
Psychosocial intervention

Removal of available weapons

Individual counselling
Increased supervision