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Risk Assessment (Lecture Notes)

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Risk Assessment (500198B6)

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Tilburg University (UVT)

Lecture notes for the course Risk Assessment. Contains elaborations on the slides and some pointers regarding what is needed for the exam (e.g., what info about each tool is important from the slides). With these notes and the slides, I got a 10 on the final exam.

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RISK ASSESSMENT
LECTURE 1
1. Case study – the corn-killing
 court psychiatrist assessment:
- introverted (not part of the central 8/ non-criminogenic need)
- tendency to bottle up aggression (not part of the central 8/ non-criminogenic need)
- difficulty empathizing with the feelings of others (part of the central 8)
- no personality disorder (it was not mentioned how the psychiatrist came to that
conclusion/ not part of the central 8)
- anger issues regarding his mother (not part of the central 8)
- very high chances for recidivism unless treatment is provided
! the risk of recidivism should be decided first, and then the need for an intervention
should be established
- no guilt/ no remorse (not part of the central 8)
2. History of risk assessment
 older and newer definitions
- they portray different reasons for risk assessment
- the first one points to the severity of the crime – it is not that important
- the second definition – risk assessment is not only determining risk but also identifies the
need of interventions
 several definitions are available
 risk management – the chance of re-offending is never 0, but what can be done to reduce
the risk factors a person has?
 why do we do risk assessment?
- increase safety
- public interest
- ethical importance
- therapeutic importance
- communication
 Lombroso (not completely wrong)
- criminal behavior is inborn and it is shown in one’s physical characteristics
- characteristics related to higher chances of becoming violent
 father of risk assessment – Burgess
- created the first risk assessment tool
- the tool was actuarial in nature
- re-offending rates dropped
- data from offenders who were on parole
- the instrument has been validated
 Baxstrom v Herold (1966) – American case
- Baxstrom was released and many high-risk patients were let back into society or sent to
regular mental institutions (not forensic psychiatric hospitals)
 expertise of the expert study
- teachers who had no background in forensic psychiatry/ law
- low IRR between the teachers and the specialists
- many similarities but the teachers did better than the psychiatrists

, - the more information that is available, the more conservative one is in their judgment
- psychiatrists guess correctly 1/3
 the 90s
- the Dutch TBS system was praised across the world
- denial/ lack of empathy – risk factors
- the experts were wrong when pointing out important risk factors
 Monahan – investigated true risk factors and the RNR model was developed later
2.1 RNR model
 4 main principles (22 in total):
1) evidence-based practice
2) risk principle – who to treat?
- the risk of recidivism is central, not the disorder
- focus on the risk factors
- RNR would not treat a mental illness if present (and if it is unrelated to re-offending)
3) need principle – what to treat?
- focus on criminogenic needs which are related to future re-offending behavior that has
been predicted (for the specific individual)
- dynamic risk factors (which can be changed) are targeted
- central 8 risk factors according to Andrews & Bonta (first they were the big 4 and then
the moderate 4 were added)
4) responsivity principle – how to treat?
- people with intellectual disabilities should not be treated with CBT
- droping out of treatment is a risk factor
- external responsivity – related to characteristics of the psychologist/ availability of the
treatment possibilities
ex. a young mother psychologist should treat pedophiles
- internal responsivity – individual characteristics of the offender/ personal learning
styles/ motivation of the patient
- responsive treatment is associated with a reduction in recidivism
2.2 the central 8 (criminogenic needs)
 history of antisocial behavior (static factor)
- history cannot be changed
- the dynamic need would be used to change antisocial behavioral tendencies
 antisocial personality pattern
- characteristics associated with higher risk of offending
 antisocial cognitions
- CBT is widely used
 antisocial peers
- not having contact with non-criminal others is a risk factor
 family/marital relationships
- education
- level of care you have received/ receive
- supervision while growing up
- parenting style
 school and/or job
- not having a steady job, dropping out of school and low levels of satisfaction are risk
factors

, pro-social recreational activities
- sports, extracurricular activities
- criminals do not participate in pro-social groups
 substance abuse
 remorse/ guilt are not established as factors that reduce recidivism
2.3 non-criminogenic needs
 focus on the risk principle only leads to loss of a lot of information
 dynamic risk factors that are indirectly related to the increase in general offending
- psychiatric disorder
- emotional problems
- self-esteem
- health
 Crime Behavior Checklist – looks at the characteristics of the crime scene (not exam
material)
 questions:
- Lombroso said that crime is biologically motivated
- the risk principle states that you should take into account who we need to treat

LECTURE 2
1. Predictive validity
 is the tool able to predict behaviors/ re-offending?
 Singh: it is important to know if the instrument is influenced by the base rate/ do we need
to have a cut-off score?
- low base rate, bad prediction
1.1 area under the curve (AUC)
 comes from the receiver operating curve
 classifies offenders vs non-offenders
 0 to 1 (1 is perfect prediction)
- 0.50 – as good as chance
- 0.71 and above – the instrument is a good predictor
 a fairly simple way of assessing risk
- used in cancer measurements
 the most commonly used
 AUC is a retrospective measure – we look at recidivists’ history of offending
 prospective measure – we follow a person in order to see if they’ll re-offend
 sensitivity and specificity
- both are retrospective
- sensitivity is about recidivists
- specificity is about non-recidivists (in the slide should be “non-recidivists classified as
low risk”)
 advantage of the AUC: no cut-off score is needed
 disadvantage of the AUC: it does not give any information about the patient, it just
provides a measure of the validity
 AUC is not sensitive to the base rate/ it does not depend on the base rate
1.2 NPV/ PPV
 prospective measures
1.3 NSD/NND

,  clinically relevant
 identification of high-risk patients is always difficult (low-risk patients are always easier
to identify)
2. Generations of risk assessment instruments
 first generation – unstructured professional judgment
 second generation – actuarial judgment
- no clinical judgment
- static risk factors
 third generation – structured clinical judgment
- the clinician uses lists/ risk factors that have been validated by research
- dynamic risk factors
 fourth generation – combined with case management
- both static and dynamic risk factors
2.1 unstructured professional judgment
 no risk assessment tool is required
2.2 actuarial instruments
 a list of factors that have been shown to be related to re-offending
 evidence-based instruments
 static items are used
ex. age of first offense
 advantages:
- quick and easy is not the case for all instruments
 disadvantages:
- atheoretical – we do not know why there is a relationship between the factors and
offending
- no clinical override – items that are not related to offending of a person are also added to
the final score of the patient
- difficult to make conclusions about the individual level
 the PCL-R is good at predicting violent re-offending
- not a risk assessment tool but used as such
 StatRec – actuarial instrument
- only 6 items
- good predictive validity (.80)
 Static99-R – actuarial instrument
- 10 static risk factors
- no clinical judgment included
 training is required in order to work with actuarial instruments
2.3 structured clinical judgment
 combination of actuarial and clinical method
- risk factors could be added/ excluded depending on the clinician’s perspective
 mostly dynamic risk factors
 used to measure change over time
 good predictive validity
 professionals decide what is important and what is not
- they can focus on context-dependent factors/ add risk factors to the list that they find
important
 includes factors (multi-dimensional)

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