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- Dernevik, Mats
(författare)
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Structured clinical assessment and management of risk of violent recidivism in mentally disordered offenders
- 2004
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: The assessment of risk of violence among mentally disordered offenders has been a controversial but well-researched area in forensic psychology and psychiatry during the last decades. The main focus of this research has been on the predictive validity of various risk factors and methods of combining risk factors to gain the highest possible predictive accuracy. In the present thesis, risk assessment is defined more broadly than predictive accuracy, and also includes process factors, risk-management, and the communication and decision-making associated with risk of violence. The overall aim of this thesis was to explore the process of structured risk assessment in its naturalistic clinical setting. Method: Four different samples were across 5 studies. A guideline for structured clinical risk assessment, Historical-Clinical-Risk assessment (HCR-20), was used in the first 4 studies. The first study used a 6 raters x 6 patients design to establish inter-rater reliability and validity of the HCR-20. 54 forensic patients were followed over time and monitored for inpatient violence and violence after discharge during three risk-management conditions in study 2. A sample of 40 nurses, assessing the same 8 patients, was included in studies 3 and 4. Finally study 5 included a sample of 88 decisionmakers, divided into 3 groups; Clinicians, Criminal law professionals and Controls. Results: The HCR-20 was found to have reasonable reliability and validity in study 1. The main finding in study 2 was that the predictive accuracy of the HCR-20 was influenced by the intensity of risk management (AUC .64 compared to .82). In study 3 it was found that structured clinical risk assessment was not "immune" to emotional bias in the assessment process. 43% of the variance in risk-scores could be attributed to the assessors' emotions towards the patient. The information utilised to make the assessment, and how the assessor values it, also influenced the assessments in study 4. Placing value on personal interaction was more associated with inpatient violence than with recidivism. In study 5 we found that the inclination of making release decisions was greatly influenced (eta2=.58 ) by the prospect of making false negative error of judgement. Conclusions: Structured clinical risk assessments can be undertaken in a reliable and valid way in forensic clinical settings. Attention needs to be paid to factors that might influence the outcome of the assessments and the risk-management decisions that are the consequence of risk assessment. These factors can be emotional biases, evaluation of different kinds of information that form the basis for the process. There needs to be an awareness of other factors than probabilities that influence decisions about risk. It is suggested that future descriptive, as opposed to prescriptive, research is needed on the processes and influences on risk assessments, as they are actually conducted by clinicians in actual forensic, psychiatric and correctional settings, and not by researchers or trained research assistants.
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| 2. |
- Dernevik, Mats, et al.
(författare)
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Violent behaviour in forensic psychiatric patients: Risk assessment and different risk-management levels using the HCR-20
- 2002
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Ingår i: Psychology, Crime and Law. - : Informa UK Limited. - 1068-316X .- 1477-2744. ; 8:1, s. 93-111
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Tidskriftsartikel (refereegranskat)abstract
- There has been a growing optimism regarding the accuracy of structured instruments for violence risk assessment in mentally disordered offenders, However, several issues pertaining to forensic assessments of risk remains unsolved, one of which is the relationship between risk assessment and risk management. In this paper we argued that research that evaluate efforts to assess risk must take into account the level of risk management in the sample. We attempted to illustrate this using prospective follow-up data on the frequency and type of inpatient violent behaviours and their relationship to risk management within the context of care. Risk assessments were made upon admission to hospital with the Historical-Clinical-Risk assessment (HCR-20, Webster et al., 1997) in 54 forensic patients followed through three different risk management conditions: High security risk management, medium risk management, and only risk monitoring (low). The results showed large differences in baserate and type of violence in the three management conditions. Results also suggested that the HCR-20 accurately assessed risk in medium and low security conditions, but not in the high security condition. We conclude that the findings reinforce rather than contraindicate the usefulness of the HCR-20 in for clinical practice.
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| 3. |
- Grann, Martin, et al.
(författare)
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Methodological development : structured outcome assessment and community risk monitoring (SORM)
- 2005
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Ingår i: International Journal of Law and Psychiatry. - : Elsevier BV. - 0160-2527 .- 1873-6386. ; 28:4, s. 442-456
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Tidskriftsartikel (refereegranskat)abstract
- This paper describes an effort to develop a clinical tool for the continuous monitoring of risk for violence in forensic mental health clients who have left their institutions and who are dwelling in the community on a conditional release basis. The model is called Structured Outcome Assessment and Community Risk Monitoring (SORM). The SORM consists of 30 dynamic factors and each factor in SORM is assessed in two ways: The current absence, presence or partial och intermittent presence of the factors, which is an actuarial (systematized and 'objective') assessment. Secondly, the risk effect, i.e. whether the presence/absence of factors currently increases, decreases or is perceived as unrelated to violence risk, is a clinical (or impressionistic) assessment. Thus, the factors considered via the SORM can be coded as risk factors or protective factors (or as factors unimportant to risk of violence) depending on circumstances that apply in the individual case. Further, the SORM has a built-in module for gathering idiographical information about risk-affecting contextual factors. The use of the SORM and its potential as a risk monitoring instrument is illustrated via preliminary data and case vignettes from an ongoing multicenter project. In this research project, patients leaving any of the 9 participating forensic hospitals in Sweden is assessed at release on a variety of static background factors, and the SORM is then administered every 30 days for 2 years.
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| 4. |
- Wallinius, Märta, et al.
(författare)
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SELF-SERVING COGNITIVE DISTORTIONS AND ANTISOCIAL BEHAVIOR AMONG ADULTS AND ADOLESCENTS
- 2011
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Ingår i: CRIMINAL JUSTICE AND BEHAVIOR. - : Sage Publications Ltd. - 0093-8548 .- 1552-3594. ; 38:3, s. 286-301
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Tidskriftsartikel (refereegranskat)abstract
- The reliability and validity of the self-report questionnaire How I Think (HIT), designed to assess self-serving cognitive distortions related to antisocial behavior, was tested among Swedish offender and nonoffender adults and adolescents (N = 364). The results showed self-serving distortions to be more common among offenders and to predict self-reported antisocial behavior when tested among adults. Confirmatory factor analysis revealed, in contrast to earlier findings, that the underlying structure of the HIT was best explained by a three-factor solution with one major cognitive factor, referred to as "criminal mind." It was concluded that the HIT, after further examination of its structural and divergent validity, could be used as a measure of criminal thinking in adults as well as in adolescents.
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