The Uncritical Acceptance of Risk Assessment in Forensic Practice

Transcription

1 Law and Human Behavior, Vol. 24, No. 5, 2000 The Uncritical Acceptance of Risk Assessment in Forensic Practice Richard Rogers 1 Forensic psychologists are frequently asked to conduction evaluations of risk assessment. While risk assessment has considerable merit, recent applications to forensic psychology raise concerns about whether these evaluations are thorough and balanced. Forensic adult risk-assessment models stress risk factors, and deemphasize or disregard entirely the other side of the equation: protective factors. Mediating and moderating effects must also be considered. Moreover, base-rate estimates may produce erroneous results if applied imprudently to forensic samples without regard to their unstable prevalence rates or the far-reaching effects of settings, referral questions, and evaluation procedures. Psychologists are offered a preliminary list of relevant issues for evaluating the merits of risk assessment in their forensic practices. Freudenburg (1988) in a seminal Science article chastised social scientists for not taking into account risk probabilities and risk consequences in their determinations. Psychologists, and especially forensic psychologists, have taken this criticism to heart. In the last decade, several hundred articles have detailed and frequently extolled the virtues and values of risk assessment. Risk assessment is not a unitary construct. Hanson (1998) provided three plausible approaches to risk assessment: (a) a guided clinical approach (expert judgment based on validated risk factors), (b) a pure actuarial approach (predetermined numerical weighting of predictors), and (c) an adjusted actuarial approach (an actuarial prediction that can be modified to take into account potentially important factors). According to Borum (1999), risk assessment refers to probabilistic estimates of a continuous variable (e.g., violence) based on both person-based and situational variables. This commentary on risk assessment is not intended as a wholesale indictment. Rather, its purpose is to temper the unbridled enthusiasm by articulating the perils and pitfalls regarding any uncritical acceptance of risk assessment. As a concrete 1 Department of Psychology, University of North Texas, P.O. Box , Denton, Texas /00/ $18.00/ American Psychology-Law Society/Division 41 of the American Psychology Association

2 596 Rogers example of such unbridled enthusiasm, a 1996 issue of American Psychologist devoted most of its pages to the positive aspects of risk assessment. Despite papers by leading forensic experts (e.g., Borum, 1996; Monahan & Steadman, 1996; Schopp, 1996), these otherwise thoughtful papers substantially overlooked any critical analysis of the risks common to risk assessment. This enthusiasm continues unabated. A special issue of Behavioral Sciences and the Law (Ewing, 1999) strongly emphasizes the positive aspects of risk assessment. Much less is known about what occurs with risk assessment in forensic practice. Heilbrun, Philipson, Berman, and Warren (1999) examined how mental health professionals communicated risk assessment to others. Their sample was highly selected, composed of doctoral-level professionals who had completed the Basic Forensic Training Program through the Institute of Law, Psychiatry, and Public Policy at the University of Virginia. Two salient findings emerged: (a) clinicians were markedly divergent in how they utilized and communicated risk assessment, and (b) specific risk factors were addressed by only a minority of respondents. In a factorial design with 222 psychologists, Strohman, O Neill, and Heilbrun (1999) found that psychologists consider both static (i.e., unmodifiable) and dynamic (i.e., modifiable) risk factors in communicating risk assessments. Interpretations of the results are limited by sample characteristics (35.4% forensic; 84.9% Psy.D.) and the narrow focus of the design (e.g., case vignettes predominated by static and fluid factors). Our understanding of forensic practice can also be augmented by reviewing the forensic instruments currently available for risk assessment. In this regard, two recent reviews (Borum, 1999; Rosenfeld, 1999) have addressed the primary riskassessment measures: the HCR-20 (Webster, Douglas, Eaves, & Hart, 1997), Rapid Risk Assessment for Sex Offender Recidivism (RRASOR; Hanson, 1997), Sex Offender Risk Assessment Guide (Quinsey, Harris, Rice, & Cormier, 1998), Sexual Violence Risk-20 (SVR-20; Boer, Hart, Kropp, & Webster, 1997), the Spousal Assault Risk Assessment Guide (SARA; Kropp, Hart, Webster, & Eaves, 1999), and Violence Risk Assessment Guide (VRAG; Harris, Rice, & Quinsey, 1993). In general, use of these measures indicates a heavy emphasis on static risk factors (e.g., background characteristics and offense history). With several measures (e.g., SORAG and VRAG), the combination of risk factors is empirically tested, although important issues of generalizability remain. 2 With others (e.g., HCR-20 and SARA), the assumption of additivity (i.e., more indicators equal more risks) is simply postulated, despite extensive problems with mulitcollinearity. In the following sections, I examine the important constraints on risk assessment as it is currently conceptualized in forensic practice. With most adult samples, the forensic literature appears content simply to enumerate risk factors with little attention to other critical dimensions of their predictions. Any comprehensive examination of risk factors must also consider protective factors as well as moderator and mediator effects. 2 For example, the VRAG was developed on data from an atypical forensic hospital; its past practices included such nonstandardized treatments as psychedelic drugs and nude marathons.

3 Critique of Risk Assessment 597 PRIZING RISK FACTORS AND NEGLECTING PROTECTIVE FACTORS Most adult-based studies are unabashedly one-sided; they emphasize risk factors to the partial or total exclusion of protective factors (Sheldrick, 1999). In contrast to risk factors, protective factors reduce the likelihood of a maladaptive outcome. This reduction is achieved by either reducing the effect of risk factors (e.g., Clayton, Leukefeld, Donohew, Bardo, & Harrington, 1995) or by exerting an independent influence on the maladaptive outcome (e.g., Hoge, Andrews, & Leschied, 1996). In both mental health and legal contexts, a balanced evaluation of risk assessment must take into account both risk and protective factors (Laub & Lauritsen, 1994). Are protective factors merely the absence of risk factors? For example, an Axis II diagnosis is conceptualized as a risk factor in predicting violence on the HCR-20 (Webster et al., 1997). Would the absence of an Axis II disorder be viewed as a protective factor? The answer is partly dependent on the structure and validation of the risk assessment measure. If data are available on how the absence of this specific variable (e.g., absence of Axis II disorders) reduces the risk, then this variable can be construed as a protective factor. More often, however, risk factors are amalgamated into a composite score. Under these circumstances, we cannot test whether absence of a specific risk factor is actually a protective factor. With continuous variables (e.g., age of first arrest), we cannot assume that the variable has equal predictive value as both a risk and protective factor. While studies of psychopathy (Hemphill, Templeman, Wong, & Hare, 1998; Salekin, Rogers, & Sewell, 1996) indicate that high scores are risk factors of violent crimes, it does not necessarily hold that all other scores serve as protective factors. On this point, Hemphill et al. (1998) found that only low, but not average, scores served as protective factors. Adolescent forensic research underscores the importance of balanced evaluations. Hoge et al. (1996) studied risk and protective factors in a sample of 338 serious juvenile offenders. At follow-up (an interval of months), they established several important findings. First, useful protective factors (e.g., positive peer relations) did not overlap with the absence of risk factors (e.g., family conflict). Second, protective factors appeared to be age-specific. Positive response to authority is predictive for youth in their midteens (ages years), but not in their early teens (ages years; estimated logistic regression coefficients of 0.39 and 0.01, respectively). The first finding addresses the earlier discussion regarding the potential bipolarity of protective-risk factors. The second finding emphasizes the importance of testing protective factors under specific parameters (see subsequent discussion of moderator effects). Other child and adolescent studies have general implications for risk assessment. For example, Grossman et al. (1992) found that protective factors appear to be context-specific with different protective factors being operative depending on gender and outcome criteria. Protective variables are highly diverse. They may be composed of multiple variables (Felix-Ortiz & Newcomb, 1992) and may include biological, psychological, and social variables (Clayton et al., 1995; Grizenko & Pawliuk, 1994; Werner, 1995).

4 598 Rogers Despite fewer studies, clinical research with adults has highlighted the importance of protective factors. For example, Plutchik (1995) compiled 10 protective factors that reduce the likelihood of aggressive and suicidal behavior. In noting that many patients with the highest risk factors manifest no evidence of aggression, he concluded, for most patients the protective factors greatly exceed the risk factors, thus accounting for the relatively low incidence of suicide and violence in our society (Plutchik, 1995, p. 53). What protective factors might psychologists consider? Dynamic protective factors included social relations, self-esteem, religious beliefs, and parents acceptance of the patient (Plutchik, 1995). Even established areas of risk assessment deserve a critical reevaluation. For example, a global measure of psychopathy (i.e., the total score on the Psychopathy Checklist) is established firmly as a risk factor for violence (Hart & Hare, 1996), although its effect sizes range widely by setting (Cohen s d from.42 to 1.92, M.79; Salekin et al., 1996). However, the disaggregation of psychopathy into specific characteristics suggests that simply using global scores may obscure risk assessment. At least with female offenders, individual psychopathic characteristics potentially may contribute to both risk and protective factors (Rogers et al., in press). More specifically, Rogers et al. found one criterion and two subcriteria of psychopathy that are negatively associated with physical aggression: (a) sees self as victim of the system (.70), (b) lacks empathy (.78), and (c) has little emotion in regard to actions (.60). While requiring cross-validation, these results indicate the need for forensic psychologists to exercise caution when applying any global criterion as a risk factor. Risk-only evaluations are inherently inaccurate. As a simple analogy, would most forensic psychologists give credence to a financial planner who dwelled only on their fiscal liabilities to the exclusion of their monetary assets? Predictions based on only one side of the ledger, be it financial or mental health, are markedly constrained in their usefulness. As a concrete example, attempts to rely only on personality characteristics, largely indicative of maladjustment, in the prediction of alcohol abuse have produced meager results (Rogers & Kelly, 1997). Risk-only risk assessments represent implicitly biased evaluations with grave, often negative consequences to forensic populations. For instance, unwarranted classifications of forensic patients as aggressive are likely to result in marked abridgement of personal freedom. Beyond the direct effects on clients, however, the emphasis on risk factors to the virtual exclusion of protective factors may indirectly exert a widespread and corrosive effect on professionals perceptions of their clientele. The continued focus on dangerousness hardly engenders a positive view of forensic populations. For example, to search only for risk factors creates unwarranted perceptions of violence and may evoke detrimental countertransference (Madden, Lion, & Penna, 1977). Moreover, many studies have restricted their scope to static risk predictors (e.g., gender, race, and criminal background), thus promoting an image of chronic and irreversible risks (Sullivan, Wells, Morgenstern, & Leake, 1995). Overfocus on risk factors is likely to contribute to professional negativism and result in client stigmatization. The emphasis on static risk factors also has important implications for assigning risk and evaluating treatment outcome. In an elegant study, Silver, Mulvey, and

5 Critique of Risk Assessment 599 Monahan (1999) examined risk factors for violence among 293 discharged patients. Their study exemplifies the dangers of relying solely on static risk factors: ethnicity alone resulted in dramatic differences (22.4% for African American versus 9.7% for Anglo American) in risks of violence. However, differences in a dynamic risk factor appears to play an important role in determining risk. When concentrated poverty is considered, the difference in odds ratios between African American and Anglo American is no longer significant. Static factors also limit considerations of treatability. As observed by Becker and Murphy (1998), positive therapeutic change cannot be demonstrated in light of the current focus on static risk factors. However, therapeutic changes may have counterintuitive effects, at least with psychopathic sex offenders (Barbaree, 1999). Risk-only assessments in risk-averse mental health systems may produce lopsided assessments and resource allocations. Linhorst and Dirks-Linhorst (1997) provided a stark example of how forensic patients found not guilty by reason of insanity (NGRI) now occupy 50% of Missouri s inpatient beds; the competition for inpatient resources results in nonforensic patients being placed on waiting lists. In addition, the forensic patients are higher functioning than nonforensic patients. Indeed, approximately one fourth (26.1%) have mild to no symptoms. Moreover, these patients are less assaultive than their nonforensic counterparts. One critical issue appears to be a preoccupation with risk factors by courts and clinicians to the point that better-functioning NGRI patients are largely precluded from community placement because of their much earlier criminal histories. Extrapolating from the current influx of NGRI patients, all inpatient beds in Missouri will be dedicated to these better-functioning NGRI patients during the next decade. As a parallel, allocation of resources based on risk assessment has led Mississippi to limit inpatient services to only civilly committed patients (Sullivan et al., 1995). TERRA INCOGNITA: MODERATOR AND MEDIATING EFFECTS Moderator and mediating effects remain a largely unexplored territory with respect to risk assessment. In their classic paper, Baron and Kenny (1986) carefully differentiated between moderator and mediating effects. As they noted (p. 1174), moderator effects refer to those variables that affect the strength and direction of the relationship between the predictor and the criterion variables. Moderator variables can be either categorical (e.g., race and gender), or continuous (e.g., number of treatment sessions). In the previously cited Silver et al. (1999) study of discharged patients, ethnicity is an important moderator variable. Mediating effects are intervening variables between independent and dependent variables that influence risk assessment. As observed by Shadish and Sweeney (1991), mediators can result from either the intervention or research processes. In forensic cases, inpatient risk assessments of dangerousness are likely to be influenced by mediating effects (e.g., clinical interventions, such as medication or isolation) that independently affect the aprioristic predictions. In forensic assessments, many sex offenders are likely to experience reactivity to intrusive measures, especially

6 600 Rogers penile plethysmography, that independently may affect their results (Sewell & Salekin, 1997). Shadish and Sweeney (1991) performed a major meta-analysis of psychotherapy effectiveness and demonstrated the importance of both moderator and mediating variables in predicting effect sizes. They found that the type of measurement appeared to play a significant role; greater effect sizes were reported with (a) more reactivity to the measure, (b) more vulnerability of the measure to manipulation (e.g., clients self-reports and therapist s ratings), and (c) more targeted treatment goals. In risk assessment, the Shadish and Sweeney results raise alarming possibilities regarding the reactivity and manipulability of the measures. Extrapolating from this research, forensic psychologists would be prudent to consider (a) how clients will react to specific measures and (b) the transparency of specific measures. Salekin et al. (1996) in a meta-analysis of psychopathy and violent behavior concluded that moderator variables, such as ethnicity and gender, must be taken into account in risk assessments. Despite expressed optimism regarding the use of the Psychopathy Checklist-Revised (PCL-R; Hare, 1991) with African American populations, practitioners cannot assume that similar PCL scores across ethnic identities represent corresponding risk estimates. In an adolescent offender sample, Hicks, Rogers, and Cashel (in press) examined PCL-SV scores for a juvenile maximum security facility. They found that ethnicity was a critical moderator variable; elevated PCL-SV scores were associated with violence in African Americans (r 0.57), but not in European Americans (r 0.06). Gender poses similar problems. Unlike male participants, Salekin, Rogers, and Sewell (1997) found very modest increases in risk estimates for females with high PCL-R scores; these differences remained in a 12-month follow-up (Salekin & Rogers, 1998). What are the practical implications of these studies for forensic psychologists? As noted by Rogers (1995), psychologists are on the safest ground if they limit their risk predictions on the PCL-R to White males with criminal histories. Several studies have examined directly the role of mediating factors in the assessment of violence. For example, Choice, Lamke, and Pittman (1995) in a national study of 1,836 men found that simple reliance on childhood witnessing of interparental violence to explain subsequent wife battering was relatively unsuccessful (R 2.002). However, such early experiences contributed to ineffective conflict resolution which resulted in marital distress. Both ineffective conflict resolution and marital distress contributed significantly to the explanation of spousal violence (combined R 2.20). The implication of this study to forensic practice is readily apparent: parental violence by itself is not likely to be a risk factor for spousal abuse. Gidycz, Hanson, and Layman (1995) explored possible mediating effects for female survivors of sexual assault. For instance, childhood victimization predicted adolescent victimization, which subsequently prognosticated adult victimization. Most disturbingly, recent adult victimization was a strong predictor (zero-order r.59) of further victimization. Interestingly, childhood victimization without adolescent revictimization was not correlated with adult victimization. In this study, any facile assumption of intergenerational violence as a risk factor is likely to result in erroneous conclusions if the mediating effects are not addressed.

7 Critique of Risk Assessment 601 PROBLEMS IN APPLYING BASE RATES Psychologists are frequently counseled to take into account base rates in conducting their risk assessments (Melton, Petrila, Poythress, & Slobogin, 1997). This advice assumes that it is a simple matter to determine which base rates ought to be applied. Hiday (1990) conducted an insightful review of violent behavior among civilly committed inpatients. Even within this circumscribed clinical population, the base rates varied dramatically from 7.5% to 66.7%. Any averaging method is likely to obscure key moderator variables. Borum s (1999) definition of risk assessment as referring to probabilistic estimates of a continuous variable further complicates the establishment and application of base rates. Ideally, base rates should be established within specific clinical and forensic settings for different levels of violence. This point must be underscored. The definition of violent behavior ranges markedly from belligerent statements to physical assaults (Hiday, 1990; Mulvey & Lidz, 1993). Collapsing verbal threats with physical assaults into a single violent category would confound base rates and violate the basic assumptions of risk assessment. The issue of base rates is also a significant problem in applying clinical research to risk assessment. Rosenfeld (1999) noted that a common solution to relatively low base rates is addressed by artificially increasing the base rates. Increases can be achieved by employing extremely long follow-up periods or decreasing the stringency of the outcome criteria. With the first alternative, use of these base rates from a 5-year follow-up would be inapplicable to risk assessment for civil commitment (i.e., imminently dangerous). As an example of the second, violence might be broadened to include any sexual offense (e.g., pornography and voyeurism). Forensic psychologists are cautioned that base rates may not be applicable, even if they were known. In forensic settings, a selective process is typically implemented to decide which forensic patients are subjected to a formal risk assessment. Determinants of this selection process and generally nonstandardized, but may include (a) clinically relevant behaviors (e.g., a recent incident of aggression), (b) requests from an external source (e.g., a referral question), (c) subjective impressions (e.g., a staff person feels scared ), and (d) resource allocation (e.g., an informal triaging of caseload demands and other risk assessment cases). The base rate within the population of mentally disordered offenders or even the specific forensic setting is likely inapplicable to selected risk assessments. This is not a trivial point; the institutional base rate could easily be a small fraction of the base rate for risk assessment cases. RISKY CONSEQUENCES OF RISK ASSESSMENT Risk assessment carries two additional risks for forensic psychologists. First, risk probabilities are often misunderstood. Second, some risk measures have a floor effect, assigning low to moderate risk to all mentally disordered persons. The implications of these additional risks for forensic practice are briefly reviewed.

8 602 Rogers A potentially contentious issue is whether forensic psychologists bear any ethical responsibility for the misuse or misinterpretation by courts and legal professionals. One view is that psychologists take reasonable steps to prevent others from misusing information these techniques provide (Ethical Standard 2.02, subsection b; American Psychological Association, 1992). From this perspective, psychologists might well be constrained in offering even well-established probability estimates. Research on prospective jurors (e.g., Faigman & Baglioni, 1988; Smith, Penrod, Otto, & Park, 1996) has demonstrated convincingly that triers of fact do not accurately utilize probabilistic estimates, even when these estimates are explained clearly. An alternative perspective was cogently expressed by an anonymous reviewer, Psychologists can t prevent the rest of the world from being venal or stupid. If jurors or judges misuse accurately-stated probabilistic information, that s not the psychologist s fault. Clearly, the ethical implications of risk assessment remain unsettled. While ultimately addressed via experimental research and scholarly debate, individual psychologists must decide for themselves the relevance of Ethical Standard 2.02 to forensic conclusions on risk assessment. Psychologists must wrestle with the misuse of probability estimates even when these estimates are relatively high. Melton et al. (1997, p. 15) illustrate this point with hypothetical data on child sexual abuse profile: depending on the base rates, even a measure with 90% accuracy may result in 68% false-positives. Moreover, this conservative 68% misclassification does not take into account protective factors, moderator effects, or mediating effects. Clinical and forensic measures often have a floor effect, assigning low to moderate risks to all patient groups. For example, the lowest category of psychopathy may still signal a substantial risk of recidivism. Hart, Kropp, and Hare (1988) examined categories of psychopathy (low, medium, and high) for inmates released on parole or mandatory supervision. The floor effect (.20) was substantial in predicting the likelihood of reincarceration during the first 12 months of release. If an expert opinion took into account these base rates, the lowest possible probability estimate would be 20%. While it is possible that 20% is accurate on an aggregate level, can we justify assigning this floor-effect probability to the most exemplary inmate in whom we have every confidence will not recidivate? As an extreme example, would an inmate with compromised physical functioning (e.g., quadeplegia) warrant this risk estimate? A systematic consideration of protective factors (e.g., treatment gains or physical incapacitation) would likely inform the floor-effect base rates. Risk assessment in forensic practice is most often construed in terms of the selection of individuals composing a particular category. Risk assessment can also be conceptualized as deselection (Nietzel & Dillehay, 1986) or exclusion of persons based on defined characteristics. For instance, many half-way houses commonly exclude any patient with a documented risk for violence. Even forensic patients with low risks may be deemed unacceptable. As a further example, Rice and Harris (1997) demonstrated the risk of sexual misconduct among child molesters treated in a maximum security hospital was relatively low during the first 2 years (.20), but nearly doubled during the next 7 years. Because many communities are intolerant of

9 Critique of Risk Assessment 603 Table 1. Risk Assessment for Forensic Purposes: Questions to Consider 1. Comprehensiveness: Do predictions a. Use both static and dynamic risk factors? b. Take into account protective factors? c. Assess the effects of intervention? d. Specify the conditions under which they are valid? 2. Measurement: Do estimates of the index behavior a. Use a consensual definition? b. Address the imprecision as documented by SEm? c. Examine the distribution of scores and express this variability as a range of percentages? d. Apply to a particular setting/referral question? e. Apply to an evaluatee s gender, ethnicity, and psychiatric background? 3. Base-rate estimates: Are such estimates a. Aligned with a well-defined referral question? b. Established for a specific forensic setting? c. Demonstrably stable for that forensic setting? d. Specific to sociodemographic and other background variables? even small risks, low probabilities may have far-ranging effects on the release of forensic patients. FINAL CONSIDERATIONS Risk assessments are not inherently inaccurate. However, two broad questions appear fundamental when contemplating the use of risk assessment in forensic psychology. First, is the risk assessment fair and balanced? Among many other issues, psychologists may wish to consider the role of protective factors, mediating effects, and moderating effects. Second, is the risk assessment based on relevant and well-established base rates? Base-rate information is likely to be helpful when it takes into account referral questions, setting, and clinical characteristics. Table 1 summarizes a preliminary list of issues raised by risk assessments. For forensic practice, psychologists will likely select which issues are most salient to their risk assessments. For research, Table 1 provides an initial template of potential issues that deserve painstaking investigations. Despite important advances during the last two decades, systematic research is urgently needed on risk assessment to explore the complex relationships between risk and protective factors and the influences of mediating and moderating effects. REFERENCES American Psychological Association (1992). Ethical principles of psychologists and code of conduct. American Psychologist, 47, Barbaree, H. E. (1999). Effect of treatment on risk for recidivism in sex offenders. In American Psychological Association (Ed.), Psychological expertise and criminal justice (pp ). Washington, DC: American Psychological Association. Baron, R. M., & Kenny, D. A. (1986). The moderator mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology, 51,

10 604 Rogers Becker, J. V., & Murphy, W. D. (1998). What we know and do not know about assessing and treating sex offenders. Psychology, Public Policy, and Law, 4, Boer, D. P., Hart, S. D., Kropp, P. R., & Webster, C. D. (1997). Manual for the Sexual Violence Risk- 20: Professional guidelines for assessing risk of sexual violence. Burnaby, BC, Canada: Mental Health, Law, and Policy Institute. Borum, R. (1996). Improving the clinical practice of violence risk assessment. American Psychologist, 51, Borum, R. (1999). Advances in the assessment of dangerousness and risk. In American Psychological Association (Ed.), Psychological expertise and criminal justice (pp ). Washington, DC: American Psychological Association. Choice, P., Lamke, L. K., & Pittman, J. F. (1995). Conflicting resolution strategies and marital distress as mediating factors in the link between witnessing interparental violence and wife battering. Violence and Victims, 10, Clayton, R. R., Leukefeld, C. G., Donohew, L., Bardo, M., & Harrington, N. G. (1995). Risk and protective factors: A brief review. Drugs and Society, 8, Ewing, C. P. (Ed.) (1999). Threat assessment [Special issue]. Behavioral Sciences and the Law, 17(3). Faigman, D. L., & Baglioni, A. J. (1988). Bayes theorem in the trial process: Instructing jurors on the value of statistical evidence. Law and Human Behavior, 12, Faust, D. (1989). Data integration in legal evaluations: Can clinicians deliver on their premises? Behavioral Sciences and the Law, 7, Felix-Ortiz, M., & Newcomb, M. D. (1992). Risk and protective factors for drug use among Latino and White adolescents. Hispanic Journal of Behavioral Sciences, 14, Freudenburg, W. R. (1988). Perceived risk, real risk: Social science and the art of probabilistic risk assessment. Science, 241, Gidycz, C. A., Hanson, K., & Layman, M. J. (1995). A prospective analysis of relationships among sexual assault experiences: An extension of previous findings. Psychology of Women Quarterly, 19, Grizenko, N., & Pawliuk, N. (1994). Risk and protective factors for disruptive behavior disorders in children. American Journal of Orthopsychiatry, 64, Grossman, F. K., Beinashowitz, J., Anderson, L., Sakurai, M., Finnin, L., & Flaherty, M. (1992). Risk and resilience in young adolescents. Journal of Youth and Adolescence, 21, Hanson, R. K. (1997). The development of a brief actuarial risk scale for sexual offender recidivism. Ottawa, ON, Canada: Department of the Solicitor General of Canada. Hanson, R. K. (1998). What do we know about sex offender risk assessment? Psychology, Public Policy, and Law, 4, Hare, R. D. (1991). Manual for the Hare Psychopathy Checklist-Revised. Toronto: Multi-Health Systems. Harris, G. T., Rice, M. E., & Quinsey, V. L. (1993) Violent recidivism of mental disordered offenders: The development of a statistical prediction instrument. Criminal Justice and Behavior, 20, Hart, S. D., & Hare, R. D. (1996). Psychopathy and risk assessment. Current Opinion in Psychiatry, 9, Hart, S. D., Kropp, P. R., & Hare, R. D. (1988). Performance of male psychopaths following conditional release from prison. Journal of Consulting and Clinical Psychology, 56, Heilbrun, K., Philipson, J., Berman, L., & Warren, J. (1999). Risk communication: Clinicians reported approaches and perceived values. Journal of the American Academy of Psychiatry and the Law, 27, Hemphill, J. F., Templeman, R., Wong, S., & Hare, R. D. (1998). Psychopathy and crime: Recidivism and criminal careers. In D. Cooke, A. Forth, & R. Hare (Eds.), Psychopathy: Theory, research, and implications for society (pp ). Dordrecht, Netherlands: Kluwer Academic. Hicks, M. M., Rogers, R., & Cashel, M. L. (In press). Predictions of violent and total infractions among institutionalized male juvenile offenders. Journal of the American Academy of Psychiatry and Law. Hiday, V. A. (1990). Dangerousness of civil commitment candidates: A six-month follow-up. Law and Human Behavior, 14, Hoge, R. D., Andrews, D. A., & Leschied, A. W. (1996). An investigation of risk and protective factors in a sample of youthful offenders. Journal of Child Psychology and Psychiatry, 37, Koehler, J. J., & Macchi, L. (1997, August). Improving jurors comprehension of statistical DNA evidence by inducing an outside perspective. Paper presented at the American Psychological Association Convention, Chicago. Kropp, P. R., Hart, S. D., Webster, C. D., & Eaves, D. (1999). Manual for the Spousal Assault Risk Assessment Guide. Toronto: Multi-Health Systems. Laub, J. H., & Lauritsen, J. L. (1994). The precursors of criminal offending across the life course. Federal Probation, 58,

11 Critique of Risk Assessment 605 Linhorst, D. M., & Dirks-Linhorst, P. A. (1997). The impact of insanity acquittees on Missouri s public mental health system. Law and Human Behavior, 21, Madden, D. J., Lion, J. R., & Penna, M. W. (1977). Assaults on psychiatrists by patients. American Journal of Psychiatry, 133, Melton, G. B., Petrila, J., Poythress, N. G., & Slobogin, C. (1997). Psychological evaluations for the courts: A handbook for mental health professionals and lawyers (2nd ed.). New York: Guilford Press. Monahan, J., & Steadman, H. J. (1996). Violent storms and violent people: How meteorology can inform risk communication in mental health law. American Psychologist, 51, Mulvey, E. P., & Lidz, C. W. (1993). Measuring patient violence in dangerousness research. Law and Human Behavior, 17, Nietzel, M. T., & Dillehay, R. C. (1986). Psychological consultation in the courtroom. New York: Pergamon Press. Plutchik, R. (1995). Outward and inward directed aggressiveness: The interaction between violence and suicidality. Pharmacopsychiatry, 28(Supplement), Quinsey, V. L., Harris, G. T., Rice, M. E., & Cormier, C. A. (1998). Violent offenders: Appraising and managing risk. Washington, DC: American Psychological Association. Rice, M. S., & Harris, G. T. (1997). Cross-validation and extension of the Violence Risk Appraisal Guide for child molesters and rapists. Law and Human Behavior, 21, Rogers, R. (1995). Diagnostic and structured interviewing: A handbook for psychologists. Odessa, FL: Psychological Assessment Resources. Rogers, R., & Kelly, K. S. (1997). Denial and misreporting of substance abuse. In R. Rogers (Ed.), Clinical assessment of malingering and deception (2nd ed., pp ). New York: Guilford Press. Rogers, R., Salekin, R. T., Hill, C., Murdock, M., Sewell, K. W., & Neumann, C. S. (In press). The Psychopathy Checklist-Screening Version: An examination of criteria and subcriteria in three forensic samples. Criminal Justice and Behavior. Rosenfeld, B. (1999). Risk assessment in the wake of Hendricks. In American Psychological Association (Ed.), Psychological expertise and criminal justice (pp ). Washington, DC: American Psychological Association. Salekin, R. T., & Rogers, R. (1998). Psychopathy and recidivism among female inmates. Law and Human Behavior, 22, Salekin, R. T., Rogers, R., & Sewell, K. W. (1996). A review and meta-analysis of the Psychopathy Checklist and the Psychopathy Checklist-Revised: Predictive validity of dangerousness. Clinical Psychology: Science and Practice, 3, Salekin, R. T., Rogers, R., & Sewell, K. W. (1997). Construct validity of psychopathy in a female offender sample: Multitrait-multimethod evaluation. Journal of Abnormal Psychology, 106, Schopp, R. F. (1996). Communicating risk assessments: Accuracy, efficacy, and responsibility. American Psychologist, 51, Sewell, K. W., & Salekin, R. T. (1997). Understanding and detecting dissimulation in sex offenders. In R. Rogers (Ed.), Clinical assessment of malingering and deception (2nd ed., pp ). New York: Guilford Press. Shadish, W. R., Jr., & Sweeney, R. B. (1991). Mediators and moderators in meta-analysis: There s a reason we don t let dodo birds tell us which psychotherapies should have prizes. Journal of Consulting and Clinical Psychology, 59, Sheldrick, C. (1999). Practitioner review: The assessment and management of risk in adolescents. Journal of Child Psychology and Psychiatry, 40, Silver, E., Mulvey, E. P., & Monahan, J. (1999). Assessing violence risk among discharged psychiatric patients: Toward an ecological approach. Law and Human Behavior, 23, Smith, B. C., Penrod, S. D., Otto, A. L., & Park, R. C. (1996). Jurors use of probabilistic evidence. Law and Human Behavior, 20, Strohman, L., O Neill, M., & Heilbrun, K. (1999, August). Violence risk communication: A review of the literature. Paper presented at the Annual Convention of the American Psychological Association, Boston. Sullivan, G., Wells, K. B., Morgenstern, H., & Leake, B. (1995). Identifying modifiable risk factors for rehospitalization: A case control study of seriously mentally ill persons in Mississippi. American Journal of Psychiatry, 152, Webster, C. D., Douglas, K., Eaves, D., & Hart, S. D. (1997). HCR-20: Assessing risk for violence, version 2. Burnaby, BC, Canada: Simon Fraser University and Forensic Psychiatric Services Commission of British Columbia. Werner, E. E. (1995). Resilience in development. Current Directions in Psychological Science, 4,