Actuarial risk assessment tools are used extensively to predict future violence, but previous studies comparing their predictive accuracies have produced inconsistent findings as a result of various methodological issues. We conducted meta-analyses of the effect sizes of 9 commonly used risk assessment tools and their subscales to compare their predictive efficacies for violence. The effect sizes were extracted from 28 original reports published between 1999 and 2008, which assessed the predictive accuracy of more than one tool. We used a within-subject design to improve statistical power and multilevel regression models to disentangle random effects of variation between studies and tools and to adjust for study features. All 9 tools and their subscales predicted violence at about the same moderate level of predictive efficacy with the exception of Psychopathy Checklist--Revised (PCL-R) Factor 1, which predicted violence only at chance level among men. Approximately 25% of the total variance was due to differences between tools, whereas approximately 85% of heterogeneity between studies was explained by methodological features (age, length of follow-up, different types of violent outcome, sex, and sex-related interactions). Sex-differentiated efficacy was found for a small number of the tools. If the intention is only to predict future violence, then the 9 tools are essentially interchangeable; the selection of which tool to use in practice should depend on what other functions the tool can perform rather than on its efficacy in predicting violence. The moderate level of predictive accuracy of these tools suggests that they should not be used solely for some criminal justice decision making that requires a very high level of accuracy such as preventive detention.

Psychopathy is defined by a constellation of interpersonal, affective and behavioural characteristics that should, in principle, be strongly related to risk for recidivism and violence. We reviewed the literature on The Hare Psychopathy Checklist‐Revised scales (PCL‐R; Hare, 1980, 1991) and recidivism. We found that the PCL‐R consistently was an important predictor across inmate samples and was consistently among the best predictors of recidivism. Average correlations between the PCL‐R and recidivism, weighted by their degrees of freedom, were .27 for general recidivism, .27 for violent recidivism, and .23 for sexual recidivism. Relative risk statistics at one year indicated that psychopaths were approximately three times more likely to recidivate—or four times more likely to violently recidivate—than were non‐psychopaths. The correlation between general recidivism and PCL‐R Factor 2 (a measure of the social deviance facet of psychopathy) was stronger than the correlation between general recidivism and PCL‐R Factor 1 (a measure of the interpersonal/affective facet of psychopathy). Both PCL‐R factors contributed equally to the prediction of violent recidivism. The PCL‐R routinely made a significant contribution towards predicting recidivism beyond that made by key demographic variables, criminal history, and personality disorder diagnoses. Across studies, PCL‐R scores were as strongly associated with general recidivism, and were more strongly associated with violent recidivism, than were actuarial risk scales designed specifically to predict reoffending. Taken together, these findings indicate that the PCL‐R should be considered a primary instrument for guiding clinical assessments of risk for criminal recidivism and dangerousness.

The Violence Risk Scale-Sexual Offender version (VRS-SO) is a rating scale designed to assess risk and predict sexual recidivism, to measure and link treatment changes to sexual recidivism, and to inform the delivery of sexual offender treatment. The VRS-SO comprises 7 static and 17 dynamic items empirically or conceptually linked to sexual recidivism. Dynamic items with higher ratings identify treatment targets linked to sexual offending. A modified stages of change model assesses the offender's treatment readiness and change. File-based VRS-SO ratings were completed on 321 sex offenders followed up an average of 10 years post-release. VRS-SO scores predicted sexual and nonsexual violent recidivism post-release and demonstrated acceptable interrater reliability and concurrent validity. A factor analysis of the dynamic items generated 3 factors labeled Sexual Deviance, Criminality, and Treatment Responsivity, all of which predicted sexual recidivism and were differentially associated with different sex offender types. The dynamic items together made incremental contributions to sexual recidivism prediction after static risk was controlled for. Positive changes in the dynamic items, measured at pre- and posttreatment, were significantly related to reductions in sexual recidivism after risk and follow-up time were controlled for, suggesting that dynamic items are indeed dynamic or changeable in nature.

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A Therapeutic Community (TC) treatment program for adult male offenders is summarized and treatment outcome data are discussed. Psychopaths showed less clinical improvement, displayed lower levels of motivation and were discharged from the program earlier than nonpsychopaths. There were significant positive treatment effects for the non-psychopaths and a mixed group. Psychopathy Checklist scores (Hare, 1985) consistently postdict and predict treatment outcome and attrition from the program.9Criminal psychopaths commit 3.5 times more violent crimes than do non-psychopaths (Hare & McPherson, 1984). Once incarcerated psychopaths also display more violent and aggressive behaviors (Hare & McPherson, 1984; Wong, 1984) and are frequently segregated or referred for treatment (McCord, 1982). They are also more likely to violate conditional releases (Hart, Kropp, & Hare, 1988; Wong, 1984). In many clinical and legal circles, psychopaths are generally seen as untreatable, although the issue is far from settled (Suedfelt & Landon, 1978;Wong, Elek, & Ogloff, 1988). Despite their notorious criminal histories and high recidivism rates, they are just as likely as the non-psychopaths to secure conditional releases (Wong, 1984). Criminal psychopaths, therefore, present significant clinical, legal and administrative concerns that must be addressed by those working within the criminal justice system. This article describes a treatment outcome study of a Therapeutic Community (TC) treatment program designed to treat personality disordered individuals, many of whom are psychopaths. Cleckley (1976) (Hare, 1980b andSchroeder, Schroeder, &Hare, 1983;Raine, 1985; Wong, 1984 and. Hare (1 983) showed a strong agreement between DSM-I11 diagnosis of subjects with Antisocial Personality Disorder (301.7) and psychopaths identified using the PCL ratings (Hare, 1980b). However, as the DSM-111 and the recent revision, the DSM-111-R, both focus almost exclusively on antisocial behaviors, they may not readily identify individuals who may fit the personality characteristics of psychopathy, but who, for one reason or another, manage to avoid early or frequent contact with the judicial system (Hare, 1983). For the present study, the PCL ratings were used for subject selection. THE ASSESSMENT OF PSYCHOPATHY The Therapeutic Community (TC)The T C concept was developed by Jones (1963 and1982) who stressed that one approach to rehabilitate inmates is to provide them with an environment in which they can learn to take responsibility for their behaviors. To this end, positive peer group influences are mobilized, in addition to therapeutic inputs from staff to bring about behavioral changes (see also Vorrath and Brendtro, 1974). The central method of intervention in the T C program is the daily group meeting which includes all patients and staff. This 'large group' functions both as a forum for therapy, as well as a setting for developing unit rules. Personal and other living problems that the inmates have been experiencing are encouraged to be brought up ...