A Prevention-Based Paradigm for Violence Risk Assessment

Abstract

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.

Routine violence risk assessment in community forensic mental healthcare

“…This finding corroborates the Structured Professional Judgment approach (Douglas & Kropp, 2002;Webster et al, 1997), which deliberately gives the assessor the opportunity to weigh the particular constellation of risk factors as well as any idiosyncratic risk factors for the client in his or her final professional risk judgment. Previous studies also showed such an incremental predictive validity for the final risk judgment (De Vogel & De Ruiter, 2006;Douglas, Ogloff, & Hart, 2003).…”

“…In addition, retrospective assessment of dynamic factors by researchers (as conducted by Gray et al, 2008, and many others), which is based on-probably limited-file information about the patient's functioning at that particular time, may be qualitatively different from the real time assessment by the treating clinician, advocated here. It may be different with respect to the information available to the assessor, the likelihood of bias due to the direct interaction between assessor and assessee (Philipse, Koeter, Van der Staak, & Van den Brink, 2006), and the opportunity to influence the predicted outcome by taking risk management measures (Douglas & Kropp, 2002).…”

“…The method of routine violence risk assessment we developed is an operationalization of the 'prevention based paradigm for violence risk assessment', suggested by Douglas and Kropp (2002). They remind us that the ultimate goal of risk assessment is violence prevention, not prediction.…”

“…To reach this goal, they emphasize the need to thoroughly integrate risk assessment in patient care, in such a way that observations of crucial risks for the individual are directly translated into risk management and treatment interventions, addressing these risks. Douglas and Kropp (2002) speak of an 'ongoing risk reassessment and management revision process' to accomplish this. We incorporated these suggestions in the routine violence risk assessment method, studied here.…”

“…Mean scores were calculated for the 11 factors of the historical, the 13 of the clinical, and the 6 of the situational subscales of the HKT-30. Finally, in accordance with the structural professional judgment approach (Douglas & Kropp, 2002;Webster et al, 1997), the case manager directly estimated the risk of violent behavior by the client in the next three months, taking account of the assessed risk factors. This final risk judgment had to be expressed on a five-point Likert scale, ranging from 'very low' to 'very high'.…”