This is a summary of the entire course Capita Selecta: Forensic risk assessment and risk management interventions, with the exception of the example cases.
Forensic risk assessment and risk management
interventions
Chapter 1: General introduction to risk assessment, forensic treatment models and treatment
planning
Chapter 2: Adult Violent Offenders
a) Risk assessment: Historical Clinical Risk Assessment- 20 (HCR-20)
b) Selected interventions for Adult Violent Offenders with a focus on Anger management
programs
Chapter 3: Violent Youths (12-18 years of age).
a) Risk assessment: Structured Assessment for Violence Risk in Youth (SAVRY)
b) Selected interventions with a focus on Multisystemic therapy
Chapter 4: Intimate partner violence
a) Risk assessment: Spousal Assault Risk Assessment (SARA)
b) Selected interventions with a focus on Intimate violence programs
Chapter 5: Sexual Offenders
a) Risk assessment: STATIC-99R
b) Selected interventions with a focus on Cognitive Behavioural Interventions and Strength-
Based/Good-Lives-Model-based Approaches in the Treatment of Adult Sexual Offenders
Chapter 1
The introduction underscores the critical role of risk assessment and management
within psychology, particularly in forensic settings. It draws parallels between the daily
practice of assessing risks in personal decisions and the structured evaluation of future
violence risks in individuals with a history of violent behavior, highlighting the common
cognitive processes involved.
Furthermore, it delineates three primary methods of risk assessment: unstructured
clinical judgment, actuarial tools, and structured clinical judgment. Actuarial tools rely
on statistical analysis of historical data to predict recidivism, offering an objective but
somewhat limited perspective. In contrast, structured clinical judgment combines
clinical expertise with evidence-based risk factors, allowing for a more holistic
understanding of risk within individual contexts. Overall, structured approaches are
considered superior due to their ability to inform risk management plans and track
progress over time.
However, even though risk assessments are not always 100% accurate, evidence
suggests that some incidents may be preventable if risk assessments are conducted,
and specific risk management plans are made. Thus, the prevalence of prediction errors
,does not entirely undermine the rationale for conducting risk assessments and they
should still be used by professionals to try to eliminate risk.
● Step 1 "Identification": Initially, the identification of risk and protective factors is
imperative, facilitated through the use of a risk assessment instrument. The final
assessment is formulated in a Risk Formulation.
● Step 2: "Construction of Theory": Subsequently, the clinician engages in forming a
hypothesis or theory concerning the interplay between these factors and their
correlation with offensive behavior, often termed (Cognitive) Case Formulation or
Case Conceptualization
● Step 3: "Risk Management": Finally, a risk management plan is created, which
forms the basis for implementing specific therapeutic interventions.
A risk management plan is a part of the treatment plan and describes the systematic
and organized actions in terms of 4 main components:
● Treatment
● Monitoring
● Supervision
● Victim safety planning
Disorder-specific interventions are mostly combined with specific treatment
interventions aimed at dynamic, psychological risk factors like for example anger
management, distorted cognitions, self-esteem and violent attitudes as well as
strength-based interventions to enhance protective factors. Most research indicates
that CBT-informed treatment has the most effective outcome. In youth, systemic family-
based interventions are most effective.
The Risk Need Responsivity Model (RNR) is the most commonly theoretical model of
forensic care, and includes three components; risk, need and responsivity:
Firstly, according to the risk principle, the level of risk management should align with
the individual's risk of reoffending, thereby necessitating more intensive management
for high risk offenders. Thus, relatively intensive services should target higher risk
offenders, while leaving lower risk offenders with less therapeutic attention.
Secondly, the need principle dictates that interventions should target dynamic
(modifiable) risk factors and/or protective elements associated with criminal conduct
(criminogenic needs), e.g., criminal attitudes, substance abuse, impulsivity.
Lastly, the responsivity principle emphasizes that treatment ought to be customized to
the patient's characteristics and readiness for change (specific responsivity), adopting
the most effective approaches (general responsivity).
,The RNR model operates on a risk-centric basis, wherein risk factors pertaining to
offense behavior, as evaluated through risk assessment instruments, become the focal
point of offender rehabilitation. In general, the more programs adhere to these
principles, the larger the reductions overall in reconviction risk.
The fundamental premise of the Good Live Model posits that all individuals share
comparable aspirations and fundamental needs, engaging in the process of setting
goals, devising plans, and taking autonomous actions to realize them. Criminal behavior
is viewed either as a dysfunctional method of fulfilling life values or as a shortfall in
pursuing constructive life objectives through socially acceptable means. Thus,
intervention strategies should empower offenders to attain personally significant goals
based on values and equip them with the required competencies, knowledge, and
opportunities to live a fulfilled life based on values without resorting to delinquent
actions.
Article: Violence Risk Assessment And Management in Outpatient Clinical Practice Aaron
J. Kivisto
Violence risk assessment and management has become a routine aspect of outpatient
clinical practice. There now exists a substantial body of research on risk factors, a
range of well-established instruments to evaluate dangerousness, and an emerging
body of evidence on strengths-based protective factors that together can enhance the
accuracy of risk assessments and directly inform treatment planning. A five-part
strategy for evaluating and managing violence risk is recommended, which emphasizes
the integration of empirically derived dynamic risk and protective factors with a detailed
anamnestic analysis. This approach underscores the integration of nomothetic
information with highly personalized idiographic data, with the primary aim of informing
empirically based and individually tailored risk management practice. As the gap
between risk assessment and risk management continues to narrow, clinicians working
in forensic and therapeutic settings will increasingly benefit from the contributions of
the other.
Article: Risk Formulation: What are We Doing and Why?
In research examining risk prediction, the key questions are about establishing the
ability of an instrument to accurately distinguish those who are likely to be violent from
those who are not. In clinical practice, however, where clinicians are responsible for
both the assessment and care of patients, the focus is more on gaining an
understanding of why a person presents a risk, in order to then prescribe treatment and
management interventions to reduce the likelihood of that risk being enacted. A critical
perspective should acknowledge, however, the limits of our understanding about the
value or efficacy of formulation. On one hand, the approach does seem to have good
, ‘face validity,’ i.e., the experience of practitioners on the ground seems to support the
notion that formulations are a useful and workable concept. On the other hand,
however, we cannot ignore the fact that there remains a paucity of research examining
formulation in relation to the assessment and management of risk.
Article: Use of risk assessment instruments to predict violence and antisocial behavior in
73 samples involving 24 827 people: systematic review and meta-analysis
Although risk assessment tools are widely used in clinical and criminal justice settings,
their predictive accuracy varies depending on how they are used. They seem to identify
low risk individuals with high levels of accuracy, but their use as sole determinants of
detention, sentencing, and release is not supported by the current evidence. Further
research is needed to examine their contribution to treatment and management.
Article: A review and comparative analysis of the risk-needs-responsivity, good
lives, and recovery models in forensic psychiatric treatment
Forensic mental health care primarily focuses on aspects of safety. Treatment
is involuntary, and personal rights are highly restricted. Both direct and
indirect coercion and significant power imbalances can impede not only the
psychological state of inpatients but also their treatment motivation and the
therapeutic process in general. However, successful treatment is essential
to enable patients to regain their freedom. Therefore, the question arises
whether and how health professionals, without disregarding the potential
risks, can enable forensic psychiatric patients to experience meaningfulness
and self-efficacy in their lives. In offender rehabilitation, the Risk-Need-
Responsivity (RNR) model and Good Lives Model (GLM) are widely established
theories. The RNR model focuses not only on the risk of recidivism but also
on those needs of a person that provoke or prevent criminal behavior and
the individual’s ability to respond to various kinds of interventions. In contrast,
the GLM aims to reduce the risk of re-offending by enabling an individual to
live a “good life,” i.e., a meaningful and fulfilling life. Originally developed in
correctional services, i.e., for offenders without severe mental disorders, both
the RNR model and the GLM have also been tested in forensic psychiatric
treatment contexts. The Recovery Model is based on the concept of personal
recovery in mental health care and is understood as the development of a
sense of purpose and mastery in one’s own life during the process of coping
with the sequelae of a mental disorder. It is a central element of rehabilitation
in general, but is also being increasingly applied in forensic psychiatric
treatment settings. This review aims to compare the central concepts of the
three models, in particular regarding personal development, and the current
evidence for their efficacy in mentally disordered offenders.
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