The CONCEPT VRA eBook: Evidence-Based Evaluations: Which Violence Risk Assessment Tools Should Forensic Psychologists Use?

In the first article of our eBook, An Introduction to Violence Risk Assessment (linked here in its blog format), author Amanda Beltrani explains the concept and context of Violence Risk Assessment for the forensic psychologist:

“Violence risk assessment is a process of estimating and attempting to limit the likelihood that an undesirable event will occur. The demand for these evaluations is increasing in the legal system, workplace settings, health care, and higher education. Yet, despite the increasing frequency, there is still uncertainty surrounding what a violence risk assessment is, how it can be used, and the benefits and limitations of such assessments.”

“Assessment of risk is ubiquitous. Across virtually all realms of life, some level of risk evaluation is expected. The result is an entire field of actuarial science, assessing the risk that determines how much we pay for automobile insurance, homeowners' insurance, or health insurance. Moreover, physicians and nurses evaluate the risk of diseases or death, economists consider the risk of market impacts, and information technology security officers assess the risk of data breaches. Similarly, in criminal justice and mental health settings, professionals are frequently asked to evaluate an individual's potential risk of violence. Across all of these fields, predicting future adverse events is accomplished with varying degrees of accuracy."

“Assessing the risk for violence or criminality is exceptionally difficult to do well. The challenges inherent in making such judgments are considerable, and the consequences of erroneous decisions are often grave. For example, failure to correctly identify individuals who pose a high risk could jeopardize public safety. Conversely, erroneously deeming individuals high risk could lead to unjustified restrictions of their liberty, public stigma, and needless expense…”

In the second article of the eBook, Beltrani continued with an explanation of the SPJ approach: General Violence Risk: A Structured Professional Judgement Approach (linked here in its blog format):

“Violence is not rare; it is a pervasive social problem that takes many distinct forms. Diverse professions are commonly tasked with identifying situations for increased violence risk and individuals who may pose this risk. Then, these professionals are tasked with providing necessary and appropriate recommendations to protect public safety.”

“Individuals without comprehensive training and experience are less able to accurately perform risk assessments for violence compared to professionals with a well-developed skill set. Therefore, individuals must consider improving their skills.”

“The HCR-20 is the world’s leading violence risk assessment instrument. It is a set of professional guidelines which aids in conducting risk assessments and developing and monitoring risk management plans. It is intended to help professionals determine the risk for psychological and physical interpersonal violence by examining 20 items related to an individual’s history (H), clinical presentation (C), and risk management problems (R). “

“The HCR-20 does not use algorithms, cutoffs, or formulas; instead, it utilizes a Structure Professional Judgment (SPJ) approach. It aims to improve and clarify areas of risk assessments, offer guidance on summary risk ratings, and assist in the planning and implementation of risk management. This method provides structure, consistency, discretion, and flexibility. The HCR-20 guides professionals through the conceptualization of violence with an emphasis on intervention and how to manage risk.”

“Over the years, the authors of the HCR have modified it to reflect changes and growth within the field, making “V3” the third version. This version has been subjected to extensive clinical testing and empirical evaluation, making it more valuable than previous versions. The HCR-20 V3 integrates new insight and novel concepts, prevents evaluators from considering too broad or redundant items, and provides specifications in the assessment process…”

Today, these two articles continue to provide the forensic psychologist with a foundational context for understanding the importance of risk and threat assessment when considering how to specialize and distinguish themselves professionally.

In the fourth article of our eBook: General Violence Risk: A Strength-Based Approach, Beltrani introduces the Short-Term Assessment of Risk & Treatability (START) instrument as “a guide that was developed to evaluate an individual’s risk for aggression and their likelihood of responding well to treatment.”

“Violence is when… A person engaged in an act (or omission) with some degree of willfulness that caused or had the potential to cause physical or psychological harm to another person or persons.”

“Violence is not rare; it is a pervasive social problem that takes many distinct forms. Diverse professions are commonly tasked with identifying situations with increased violence and the individuals who may pose this risk. Then, professionals are tasked with identifying the necessary and appropriate steps to protect public safety.”

“The field of risk assessment has evolved from focusing mainly on risk prediction to more significant consideration of risk formulation and understanding of risk and risk management and reduction. The Short-Term Assessment of Risk & Treatability (START) is a guide that was developed to evaluate an individual’s risk for aggression and their likelihood of responding well to treatment. The START moves the assessment from assessing an individual’s vulnerability to violence and aggression to intervening and informing clinical interventions and the development of treatment plans. This tool guides the assessor in performing repeated evaluations and documenting treatment and management modifications as needed. Completing the START helps identify who is at risk from which person(s), under what circumstances, with what likely adverse effect(s), and over what period. The START unites research with clinical practice by relying on clinical expertise with a structured application…”

Beltrani addresses the complexity of risk assessment in the juvenile justice system in the sixth article in the eBook, Juvenile General Violence Risk Assessments (linked here in its blog format): 

“Adolescent violence risk assessment research emerged in the late 1990s and early 2000s. Since then, many measures for assessing violence and re-offense risk in adolescents have been developed. While the use of risk assessment instruments is established as a best practice in juvenile justice systems, the selection of the specific tool most appropriate is not straightforward due to the variety of options.”

“Assessing risk in the presence of developmental change introduces great uncertainty with juveniles. Unlike adults, who typically present with long-standing behavior patterns, adolescents have minimal life experience and may offer little reliable evidence of a stable pattern helpful in gauging risk. As adolescents’ behaviors, emotional expressions, peer groups, and decision-making are inherently evolving, assessing risk within this population is akin to hitting a moving target…”

In Intimate Partner Violence (SARA-V3 & B-SAFER-2) (linked here in its blog format, it appeared as the seventh article in the eBook), Beltrani defines the term intimate partner violence and discusses assessments relevant to this tailored approach to evaluation:

“Intimate Partner Violence (IPV), sometimes referred to as spousal assault, partner assault, spousal violence, and domestic violence—is the actual, attempted, or threatened physical harm of a current or former intimate partner.”

“It is a broad definition so that any type of violence in a sexual or romantic relationship is included regardless of the relationship's legal status or the gender of the individuals involved. However, severe IPV is most often perpetrated by males against females.

IPV is different from violent crimes committed against strangers. As a result of the close relationship between the perpetrator and victim, the violence is more frequent and severe. The access and proximity of the victim and the perpetrator of IPV increase the frequency of violence. Close emotional attachment increases the severity, and intense emotions can result in extreme physical or psychological harm. IPV results in victims experiencing a profound loss of safety and security.”

“In general, violence risk assessments have multiple goals:

• Prevent Violence
• Guide Interventions
• Protect Patient Rights

Risk assessments specific to IPV are concerned with gathering information to make decisions regarding an individual's risk of perpetrating intimate partner violence. Evaluators are to speculate about how and why an individual would choose to commit violence and consider how past choices may impact future decisions…”

Beltrani also addressed sexual violence and how a forensic psychologist can apply assessment tools to manage risk in Sexual Violence (RSVP-V2 & SVR-20-V2 (linked here in its blog format and included as article 8 in the ebook):

“Sexual violence is truly a public matter of legitimate concern, and it must be addressed comprehensively.”

“In recent years, several guidelines have been proposed for evaluating the risk of violence. The various risk assessment instruments’ goal has shifted from predicting violence to understanding its causes and preventing its (re)occurrence. Some risk assessment tools fail to predict the risk of reoffending for specific populations with adequate accuracy, perhaps due to the nuances of those variations applied to different populations in different locations at other times. As there is a collection of instruments that are well validated for various groups, selecting an assessment tool should ultimately be driven by the purpose of the evaluation.”

“...Sexual violence risk assessment tools have been created to aid practitioners in addressing and managing the risk posed by perpetrators of sexual violence. Generally, these assessment measures fall into the actuarial approach and the structured professional judgment (SPJ) approach….”

Stalking Assessment and Management (SAM), (the 9th article in the eBook and linked here in blog format), explores guidelines to evaluate risk in “stalking”. Beltrani explains:

“Despite its nebulous nature and varied legal and clinical definitions, researchers and clinicians are referring to the same phenomenon when they use the term “stalking…”

“...Risk assessment on stalking is relatively new. The recency of increased attention makes assessing and managing this behavior a challenging task to do effectively. However, a few instruments have been developed to assist professionals in managing this problematic behavior. In particular, the Stalking Assessment and Management (SAM) is a risk assessment instrument aimed at preventing future stalking behavior by assessing and managing offender and victim vulnerability factors…”

“In Overview of the Violence Risk Assessment Certificate (linked here in its blog format and included as article 10 in the eBook), Beltrani explains how the CONCEPT Certificate training program in Violence Risk Assessment “aims to enhance professional decision-making associated with violence risk and learn skills to effectively formulate and communicate risk, develop management plans, and implement preventive measures…”

Beltrani further develops the potential professional path of the specialized forensic psychologist in Violence Risk Assessment - From Certificate to Career (linked here in its blog format and appearing as article 11 in the eBook): “The public, credentialing organizations, the legal system, school systems, and various other stakeholders expect and need mental health and legal professionals to have competency in violence risk assessment…”

Our VRA eBook has been widely read and well-received by our community of forensic psychologists and mental and behavioral health professionals for many years. As the field progresses, it remains a relevant and valuable introduction to structured professional judgement tools and a contextual handbook for risk and threat assessment. Forensic psychologists expanding and specializing in their profession can begin with this eBook today to improve their understanding of the field and better serve their clients by pursuing these skills and insights. 

• Violence Risk Assessment Certificate
• HCR-20-V3 Overview
• Foundations of Violence Risk Assessment and Management
• Short-Term Assessment of Risk & Treatability (START)
• Structured Assessment of Violence Risk in Youth (SAVRY) Overview
• Assessing Psychopathy using the Hare Scales (PCL-R and PCL-SV)
• Advanced Issues in the Assessment of Risk for Violence: Formulation

Blog Posts

• An Introduction to Violence Risk Assessment
• General Violence Risk: A Structured Professional Judgement Approach
• Violence Risk Assessment Case Study: Dangerousness Evaluation Using the HCR-20-V3
• General Violence Risk : A Strength-Based Approach
• Juvenile General Violence Risk Assessments
• Intimate Partner Violence (SARA-V3 & B-SAFER-2)
• Sexual Violence (RSVP-V2 & SVR-20-V
• Stalking Assessment and Management (SAM)
• Overview of the Violence Risk Assessment Certificate
• Violence Risk Assessment - From Certificate to Career

eBook

• Violence Risk Assessment eBook