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Evaluating Actuarial and Clinical Risk Assessment Approaches in the Context of Domestic Violence

Unit Name: PYB215 Forensic Psychology and the Law Word Count: 1722

Abstract It is undoubtable that domestic violence is a terrible reality for many individuals worldwide. The use of risk assessment tools is vital in domestic violence situations, whether it be through the use of an actuarial approach, clinical unstructured decision-making approach or structured clinical judgement approach. This essay aims to critically analyse relevant literature in regard to these risk assessment methods and discuss strengths and limitations of each approach. It was recommended that a structured clinical judgement approach would be the most beneficial in the context of domestic violence, when compared to the other two methods.

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Evaluating Actuarial and Clinical Risk Assessment Approaches in the Context of Domestic Violence Domestic violence occurs where one individual asserts power and dominance over another, often their partner, and creates a perceived control and fear in the other through the use, or intention to use, violence (Kaur and Garg 2008). It is a major issue that impacts the lives of so many individuals across the world, no matter their cultural, socio-economic, racial or class differences. It is understood to include not only physical abuse, but also sexual, emotional, financial, emotional and social abuse (Kaur and Garg, 2008). This essay will critically analyse literature in regard to domestic violence and the associated ‘risk factors’, and compare different types of risk assessment approaches including: clinical risk assessment approaches (both unstructured clinical decision making and structured clinical judgement) and actuarial risk assessment approach. Domestic Violence and Risk Factors Domestic violence, in the various forms that it may occur (physical, sexual, emotional, financial etc.) affects millions of people in Australia alone. It is an unfortunate, but established truth that women are more vulnerable and susceptible to being the victim in a domestically violent relationship, however men may also be affected. The Australian Bureau of Statistics (2016) reported that since the age of 15, approximately 1.6 million (17%) women and 547,600 (6%) men experienced violence, both physical and / or sexual violence, by current or former partners. In addition to this, nearly one in four women (2.2 million or 23%) and one in six men (1.4 million or 16%) reported to have been subjected to emotional abuse by their partner (either current or former), since the age of 15 (Australian Bureau of Statistics, 2016). According to the Victorian Government (2007), there are a number of risk factors that are associated with perpetrators of domestic violence; these include the perpetrator’s

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individual history of abuse to intimate partners, whether sexual, physical or emotional, their past behaviours both inside and outside of the household, their potential history of having witnessed domestic violence as a child and any attitudes that they may have in regard to supporting violence towards women (or others). As well as this, presence of major stress inducing situations (such as unemployment), whether or not the perpetrator has an issue with substance abuse, their access to deadly weapons, any presence of mental health issues, and also evidence of antisocial behaviours and potential affiliation with peers who also experience these behaviours, could be considered risk factors (Victorian Government, 2007). The aforementioned risk factors can be broken down into two categories, static and dynamic, to enhance understanding. Dynamic risk factors refer to those that are able to change over time and “reflect internal states or temporary circumstances of the individual, such as beliefs and cognitions, everyday associates, and feelings of hostility” (Guo and Harstall, 2008). In comparison, static risk factors, such as demographic factors (gender, age at first court appearance etc.) and childhood history, are those that are stable and consistent over time (Guo and Harstall, 2008). It is through the use of these risk factors that ‘professionals’ are able to utilise the risk assessment tools, with emphasis generally being placed on one or the other category (static or dynamic) of risk factors (Guo and Harstall, 2008). Actuarial Risk Assessment Tool One of the commonly utilised risk assessment tools, the actuarial approach, involves the prediction of certain behaviours that may be exhibited by a perpetrator over a specific period of time. This approach aims to calculate the risk and probability of an individual offending by comparing them to a norm-based reference group (Kropp, 2008). This is done by assigning the risk factors a numerical value, and creating an algorithm that may be used to indicate the likelihood of the individual committing future violent acts (Guo and Harstall,

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2008). The risk factors, or predictor items, are well researched and proven to be related to the outcome of reoffending (Hilton, Harris and Rice, 2010). An example of an actuarial risk assessment tool includes the VRAG (Violent Risk Appraisal Guide) developed by Quinsey, Harris, Rice and Cormier (1998). This consists of 12 items, and incorporates the Hare PCL-R (Psychopathy Checklist – Revised) when determining risk; it is mostly used to determine re-offence of mentally disordered perpetrators (Quinsey et al., 1998). According to Kropp (2008) there are a few advantages to using the actuarial approach; these include that the actuarial based risk assessment tools result generally in more accurate predictions than other, interview based, methods, and that the findings of actuarial approaches are easily duplicated, due to the use of the same risk factors and scales. On the other hand, there are also some weaknesses, also discussed by Kropp (2008). One such limitation to the actuarial approach is that, due to the total scores being based on assignment to set risk factors, it limits the person observing the list - the assessor. In doing this, it therefore disregards other factors that may have an impact on the individual perpetrator. Furthermore, another limitation could be that the actuarial approach only looks at the probability of re-offence, but not other important factors such as the frequency, severity or imminence of violence (Dvoskin and Heilbrun, 2001). Clinical Risk Assessment Tools Unstructured Clinical Decision Making This is a subjective approach, and involves a professional assessor compiling relevant information and facts to form the risk assessment (Helmus and Bourgon, 2011). An unstructured clinical decision making approach to determining risk assessment is the most commonly used (Kropp, 2008).

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According to Gou and Harstall (2008), this approach is a flexible approach. This is evident in that the use of an unstructured clinical decision-making approach is individualised and specific to the perpetrator in question; their behaviours and personal situations are what is being analysed (Kropp, 2008). There are also some weaknesses to this approach that must be discussed. One such disadvantage to the use of this method is that the results are not easily reproduced, due to its subjective nature (Hilton et al., 2010). As well as this, it has also been suggested that the unstructured approach has poor validity in regard to prediction of future offences (Hanson and Morton-Bourgon, 2009). Adding onto this, this approach has been criticized, as it is easier for crucial factors to be missed, due to the reliance on professional discretion (Guo and Harstall, 2008). Structured Clinical (Professional) Judgement This approach “attempts to bridge the gap between actuarial and unstructured clinical approaches to risk assessment” with the main purpose being the prevention of future violence; the approach acknowledges systematic and logical links between risk factors and intervention (Kropp and Hart, 2005). A structured clinical (or professional) judgement risk assessment approach requires the professional assessor to utilise guidelines that are based off empirical and theoretical evidence in regard to violence (Guo and Harstall, 2008). The term ‘professional’ could apply to clinical and non-clinical professionals, such as probation officers and police officers, as they are often also required to engage in and conduct risk assessment processes (Kropp and Hart, 2005). The most commonly referred to example of a structured clinical judgement risk assessment tool is the Spousal Assault Risk Assessment Guide (SARA) which includes 20 risk factor based items, specifically regarding domestic violence (Kropp, Hart, Webster and

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Eaves, 1995). These 20 items are broken down into four categories: criminal history, psychosocial adjustment, spousal assault history and alleged / current offense (Helmus and Bourgon, 2011). Strengths to this approach include that it is more generalizable than other approaches that rely on just one population, due to scoring criteria being drawn from literature that specifies male abuser characteristics, clinical experience and potential tell tale signs of future violent crime. As well as this, correlation to re-offence of domestic violence is more effortlessly established as the scoring criteria and item list are easily generated (Guo and Harstall, 2008). Although many do believe that the actuarial approach is the most accurate in regard to risk assessment, it has also been suggested that the structured clinical approach is just as valid (Guy, 2008). There are also some limitations that must be discussed, including that, in comparison to an actuarial approach, it is also more subjective (Helmus and Bourgon, 2011). Furthermore, it requires training for the clinical professionals and is time consuming when actually condicting the risk assessment (Guo and Harstall, 2008). Critical Analysis of Literature For the many research articles and studies discussed above, it is important to critically analyse and discuss strengths and limitations to establish their relevance. A major strength that may be associated to the articles utilised is that they are all peer reviewed and highly referenced in other articles. This could suggest that the articles are reliable and influential. As well as this, when reading all the articles, there were few discrepancies in regard to views of the approaches, as the articles all appeared to be of the same opinion. The main limitation to some of the articles is that they are over ten years old. While, the basics of the risk assessment tools may be generally the same, new developments and additions would not be accounted for in the older articles.

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Conclusion In conclusion, when critically analysing literature in regard to the various risk assessment methods, it is evident that all the types of approaches have advantages and disadvantages when evaluating risk. An actuarial approach is generally very accurate in predicting re-offence, however other important factors, outside of the set risk factors, may be dismissed even though they could be important. A clinical unstructured decision making approach allows for the risk assessment to be more individualised and specific due to the subjective nature; on the other hand it has less validity and also, due to the reliance on professional discretion. Structured clinical (or professional) judgement relies on empirical evidence and is considered to be more generalizable than other approaches. The main disadvantage to this approach could be it is also subjective, and time consuming. Recommendations Based on the literature reviewed above, it may be suggested that the structured clinical judgement risk assessment tool would be the most effective in the majority of situations, where the objective is to predict the likelihood of risk for domestic violence situations. As this approach is more generalizable, and generally believed to be just as accurate as an actuarial approach, it is recommended that this approach be used more often in assessing domestic violence situations.

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References Australian Bureau of Statistics. (2016). Personal Safety, Australia, 2016. Retrieved from http://www.abs.gov.au/ausstats/[email protected]/mf/4906.0 Dvoskin, Joel & Heilbrun, Kirk. (2001). Risk assessment and release decision-making: Toward resolving the Great Debate. The journal of the American Academy of Psychiatry and the Law, 29. 6-10. Guo, B. & Harstall, C. (2008). Spousal violence against women: Preventing recurrence. Institute of Health Economics. Alberta, Canada. Retrieved from http://www.ihe.ca/documents/SpousalViolence_1.pdf Guy, L. (2008). Performance indicators of the structured professional judgment approach for assessing risk for violence to others: A meta-analytic survey. Unpublished doctoral dissertation, Simon Fraser University, Burnaby, BC. Helmus, L & Bourgon, G. (2011). Taking stock of 15 years of research on the Spousal Assault Risk Assessment Guide (SARA): A critical review. International Journal of Forensic Mental Health, 10(1), 64-75. Hilton, N.Z., G.T. Harris and M. Rice. 2010. Risk assessment for domestically violent men: Tools for criminal justice, offender intervention, and victim services. Washington, DC: American Psychological Association. Kaur, R & Garg, S. (2008). Addressing Domestic Violence Against Women: An Unfinished Agenda. Indian Journal Community Med, 33(2), 73-76. Kropp, P.R. (2008). Intimate partner violence risk assessment and management. Violence and Victims 23(2), 202-220. Kropp, P & Hart, S. D, (2005). The development of the Brief Spousal Assault Form for the Evaluation of Risk (B-SAFER): A tool for criminal justice professionals. Ottawa, ON: Department of Justice Canada. Retrieved from http://www.justice.gc.ca/eng/pi/rs/rep-

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rap/2005/rr05_fv1-rr05_vf1/rr05_fv1.pdf Kropp, P. R., Hart, S. D., Webster, C. W., & Eaves, D. (1995). Manual for the Spousal Assault Risk Assessment Guide, 2nd ed. Vancouver, BC: British Columbia Institute on Family Violence. Quinsey V. L, Harris G. T, Rice M. E, Cormier C. A. (1998). Violent offenders: Appraising and managing risk. Washington, DC: American Psychological Association, 237. Victorian Government. (2007). Family Violence Risk Assessment and Risk Management. Retrieved from https://providers.dhhs.vic.gov.au/sites/dhhsproviders/files/201706/family-violence-risk-assessment-risk-management-framework.pdf

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