Risk Assessment Tools and Risk Management through Treatment - Case Study Example

Discuss the assessment and treatment issues that arise when managing violent people."   This essay will discuss the issues will arise when assessing and treating violent offenders, including offenders with personality disorders and sexual offenders. The essay will cover three broad areas in relation to the assessment and treatment of violent people; risk assessment, risk assessment tools and risk management through treatment. Firstly, the different approaches to risk assessment; clinical and actuarial, will be discussed and assessed for their effectiveness with violent and sexual offenders. Next, the current risk assessment tools used for analysis and prediction of future risk will be discussed in a comparative way, to establish their ability to predict precisely the risk of re-offending in violent offenders, looking at offenders with personality disorders and sexual offenders. Thirdly, there will be an evaluation of the most effective way to manage risk through the implementation of treatment programmes for this varied group of offenders. However, the essay will start by defining and discussing factors which promote violent offending and re-offending. Violent behavior has been defined by Nietzal et al. (1998) as individuals’ actions which either use physical force or the threat of it against another individual, which often produces criminal behaviour. Therefore, violent offences are deemed as an ‘assault, aggravated assault, murder, rape and sexual assault against children’ (Nietzal, et al 1998, p. 40). Research has identified factors in three different areas; environmental, biological and psychological, which may increase the risk of an individual developing a tendency of violent offending, and of re-offending in the future. Two types of environments will increase this risk if the individual is living within them; a criminogenic environment, and a family environment which includes factors such as substance abuse, criminality and a raised level of psychopathology. Biological factors which will increase risk are genetic heritage, brain dysfunction, neurochemical and hormonal imbalances; these may lead to overtly aggressive and violent behaviours. Psychological factors which increase risk of an individual developing a violent nature are, having a poor verbal ability, low levels of tolerance for frustration, lack of empathy and impulse control; these factors may produce antisocial behavior and conduct, leading to violent offending (Nietzal, et al 1998). The occurrence of violent offending within the offender population that suffers from mental health problems and illness is considerably higher compared to other offending behaviours. A total of 33% of the offenders that were admitted to a secure setting are charged or found guilty of violent acts (Nottingham Healthcare Trust 2003). However, Taylor and Johnson (2001cited in Nottinghamshire Healthcare NHS Trust) found that 51% of patients held within a secure setting are there because of violent behaviour, not including sexual offences. Individuals with personality disorders rate particularly high in committing violent offences (Nottinghamshire Healthcare NHS Trust 2003). The assessment of violent offenders over the last decades has constantly been a high priority, due to their potential dangerousness for society, in addition to the danger they may present to staff that treat and manage them. However, effective and positive treatment is not able to be produced and maintained if there is no clear understanding to begin with of what motivates the individual to be violent in the first place, therefore assessment is vital, before treatment can begin (McMurran and Hodge 1994). Risk assessment is defined by O’Rourke (1999) as the methodical gathering and compiling of information in order to assist in the determination and prediction of what risk the individual has of either hurting themselves, or others, in the present time or in the future. In light of the above facts risk assessment, treatment and management are therefore an important practice for forensic psychologists (Mullens 2000). To successfully manage risk and assess it, effective techniques are essential. Clinical and actuarial are the two key ways in which to approach management of risk. Diagnostic assessments are in essence used in clinical methods, and are adapted from the mental health field for use within a forensic setting (Kemshall 2001). However, the clinical method has been shown to be less dependable in producing positive results than the actuarial method. Research into the approach has shown that there is a little agreement between professionals as to the predictors to use; some predictors used in these tools have shown to be unrelated the recidivism of violence, and others have produced a low level of accuracy (MHCP 2009). On the other hand, it can make available imperative information on the individual’s violent behaviours and environmental factors that bring about stress, and provide support in establishing suitable treatment and management plans. Nevertheless, current research has shown that structured clinical assessment can play an important role producing behavioural rating scales for actuarial assessment tools (Kemshall 2001). Actuarial methods make use of statistical techniques to produce predictions of risk (Kemshall 2001). Scientific research data has shown that actuarial assessment tools are more precise and consistent in all factors that predict recidivism of violence (MHCP 2009). However, while actuarial assessment methods have shown a superior rate of accuracy in risk prediction, limitations have been noted and there is a possibility of inappropriate use. It is imperative to identify that there are restrictions to a method that uses data that is derived from a widespread and diverse populace and then makes it relevant to an individual undergoing assessment. Kemshall (2001) states that the use of meta-analysis to produce predictions of risk may result in unsuccessfully understanding the complications involved with the processes involved in violent offending and re-offending. Therefore, Kemshall (2001) proposes a holistic approach which combines the use of both clinical and actuarial assessment and their relevant tools; this approach will enhance and hopefully increase the predictive accuracy of both violence and sexual offenders. Many different risk assessment tools have been developed for violent offenders as they can not been seen as a homogenous group, due to the wide range of different violent offences and situational factors that can cause them. This makes comparing theses different tools complicated and hinders the transferring of tools across the population of offenders (Kemshall 2001). Presently, risk assessment requires attention to be given to factors of risk, harm and the possibility of re-offending. They also combine both actuarial and clinical approaches to assessment. The most frequently used tools for are; ‘the Psychopathy Checklist Revised (PCL-R) (Hare 1991), the Violence Risk Appraisal Guide (VRAG) (Quinsey et al. 1998) and the Historical/Clinical/Risk-20 (HCR-20) (Webster et al. 1997)’ (McSherry 2004, p. 1). Through these tools numerous risk predictor factors have been produced; past violence, pre-existing vulnerabilities, social and personal issues, mental health illness and personality constructs (McSherry 2004). The VRAG has been shown to be the most precise and therefore the more extensively used of these assessment tools (Kemshall 2001). It has been tested and evaluated for it’s effectiveness in predicting violent recidivism from more than fifty separate samples of violent offenders (MHCP 2009). These groups of violent offenders were assessed within a diverse mixture of settings in order to establish their accuracy. Four of the groups of offenders were assessed by MHCP (2009); a further fifteen groups of violent offenders, sexual offenders and violent offenders within a forensic setting were independently assessed using this assessment tool through the US and Canada; three groups were studied who are living within institutions; from the UK and from Europe a further nine groups of violent offenders, sexual offenders and violent offenders with personality disorders with also assessed. This large and diverse sample of the population of violent offenders which were assessed using VRAG, and a meta-analysis of the results showed that VRAG has a high rate of accuracy in predicting violent recidivism, that has yet been reported within the scientific research which has been completed on any risk assessment tool (MHCP 2009). Nevertheless, some professionals and researchers have articulated some concern over how VRAG is used, as the population of violent and sexual offenders are not a homogenous group of people, they are individuals with varied mental health problems, and motivations that one tool cannot not possibly accuracy predict risk for the whole of the population, and show a reduction in recidivism (MHCP 2009). However, it is argued that prediction variables are constant over time and across socio-cultural divides. As stated by MHCP (2009); ‘A substantial body of research indicates that the personal characteristics that predict violent recidivism are consistent across such variations as differences in jurisdiction, time period, index offense and offender diagnosis and age’. However, as Prins (1996) states none of these risk assessment tools are ideal in the capacity in which they are used, as because of the individualistic nature of violent offending, which is not only dependent on the personality, history, and environmental factors of the individual, but in addition the situational factors at that time also play a part in whether the individual will re-offend at any given time. Campbell et al (2007) suggest that the best method is to chose the tool which more thoroughly suits that individual person and their personal circumstances and history of offending. In addition to these tools to assess violent offenders, there are also specialized tools for sexual offenders which have been shown to be effective. These are the Structured Anchored Clinical Judgement (SACJ) and the Rapid Risk Assessment for Sex Offence Recidivism (RRASOR), which have been combined to produce the STATIC 99. The combination of the two tools has raised the precision level for recidivism, though they are not advocated to be used on there own as they do not predict the harm or seriousness of offence that the offenders may still be capable of (Kemshall 2001). It is therefore advocated that other risk assessment tolls are used in conjunction with these. Treatment and risk management for violent offenders and sex offenders have historically tended to produce ineffective results (Kemshall 2001; McSherry 2004); though in the last 15 years the results have improved. Nevertheless, not many assessments of the effectiveness of treatment programmes for violent offenders have been completed. Therefore, evaluating the impact and value of them is difficult; further obstacles are the diverse factors that influence violent offences and violent offenders (Kemshall 2001). Hollin (1999) states that in addition to these factors the sheer quantity of different treatment options also makes the assessment of what treatment is the most effective for this diverse offender population. He illustrates the extent of this problem by listing treatments that are used within institutions, in the community, and residential treatment centres which are used to reduce recidivism in the violent offender population. Some of these are diversion therapy, social casework, physical therapy, group counselling and group therapy, vocational training, restitution, life and social skills training, family therapy and individual therapy, educational training, intensive parole aftercare and multimodal treatment programmes (Hollin 1999). Despite all these different types of treatments, cognitive-behavioural treatments have been evaluated to be more successful for the majority of violent and sexual offenders (Kemshall 2001; Boer, Whyte and Maden 2008). This type of treatment focuses on assisting the offenders to understand why they committed the offence, the triggers that lead up to it and their personal motivation. During the treatment for offenders with personality disorders, the focus is on assisting them to further understanding and addressing their antisocial behaviours, such as lack of coping skills, impulsivity, reduced toleration for personal frustration and empathy deficiency (Boer, Whyte and Maden 2008). However, extremely violent sexual offenders have shown to be less responsive to this kind of treatment. The reliability of treatment programmes and the how accurately the offenders is targeted for the right treatment are the key variables for producing positive results. In addition, how motivated the individual offender is to change and treatment timing are also essential for a positive outcome (Kemshall 2001). Connelly and Williamson (2000) state that offenders with specific problems such as personality disorders, sexual problems, or disorders such as autism and Asperger’s need to receive the appropriate type of treatment for their problems to enhance a positive outcome. Kemshall (2001) states that cognitive behavioural programmes are recommended as being valuable as evidence has undoubtedly shown their effectiveness. These programmes identify that the internal controls of an offender need to be encouraged and balanced with the execution of controls that are external. The main characteristics of the structure are methods for early response to indications of a relapse, for instance not attending appointments, and therefore methodical monitoring of improvement is required. In addition, treatment intervention need to be incorporated into a wider range of risk management tactics, to guarantee supervision, monitoring and suitable conduct to implement conditions and controls on individuals as the professionals feels is suitable (Kemshall 2001). Certain components have been identified by Hollin (1999) as being essential for treatment programmes to be effective. Firstly, that individual’s need to be targeted to specific treatment types, as arbitrary targeting is counterproductive in reducing re-offending. Secondly, treatment should be structured, focused and multimodal, as research has shown that these treatments produce better results than other kinds of treatments. Thirdly, that treatment programmes should be based in cognitive-behavioural principles, focusing on beliefs and attitudes. Fourthly, offenders should be highly engaged in the treatment for the best results to occur. Lastly, though not always possible treatment is enhanced when it is community based, rather than residential (Hollin 1999). Gendreau and Andrews (1990) also state that the most successful treatment contains components from both behavioural and cognitive theory, as this combination will more effectively attend to ‘attitudes, values, and beliefs that support anti-social behavior’ (p. 182). Furthermore, treatment needs to tackle antisocial thought-patterns, along with assisting the offender in gaining the ability to stay away from offending and to adhere to pro-social activities (Hollin 1999). However, the most important point to stress in eliminating negative outcomes for treatment is for the offenders to be seen as an individual and have their treatment tailored accordingly, though this brings it own problems as there are issues of cost and of treatment and staff availability. In an environment of ever rising community scrutiny and worry for accountability, the dependable assessment and successful management of violent and sexual offenders is a serious issue. This essay discusses and assesses issues raised within the literature of problems associated with producing accurate risk assessment, and relevant assessment tools, and the subsequent problems in finding an effective treatment for all the individuals within the violent offender population in order to manage of risk of further re-offending. Therefore, to conclude it has been seen that there are various problems in assessing and treating violent and sexual offenders. They are not a homogenous group, and cannot be assessed or treated as one if the results are going to be positive. Violent offenders consist on a diverse group of individuals who commit different offences for different motivations, and in different settings. They also suffer from a varied set of mental health problems, often with a diagnosis of a personality disorder. It has been shown that while there are many clinical and actuarial assessment tools, research has not shown conclusively which is the most effective. However, the VRAG has been shown to be the most precise assessment tool for the study of violent and sexual recidivism. A prediction of relapse in sexual, violent or criminal behaviour is assessed better by actuarial assessments rather than unstructured clinical judgement, in addition it is superior to empirically-guided approaches or structured professional discretion. Some professionals advocate evaluating which of the tools will best suit that individual and their history of offending, to enhance effectiveness. Many professionals however have concluded that cognitive- behavioural treatments are the most effective treatment programmes for a majority of violent offenders. Nevertheless, many also suggest that the individual must be personally matched to the treatment programme for the best results to be obtained.           REFERENCES Boer, Judithe, Whyte, Sean and Tony Maden. “Compulsory treatment of dangerous offenders with severe personality disorders.” The Journal of Forensic Psychiatry and Psychology 19.2. (2008): 148–163. Campbell, Mary Ann, French, Sheila and Paul Gendreau. Assessing the Utility of Risk Assessment Tools and Personality Measures in the Prediction of Violent Recidivism for Adult Offenders. 2007. Connelly, C. and Williamson, S. (2000) Review of the Research Literature on Serious Violent and Sexual Offenders. Crime and Criminal Justice Research Findings No. 46. Edinburgh: Scottish Executive Central Research Unit. Gendreau, P., & Andrews, D. A. “What the meta-analyses of the offender treatment literature tells us about “what works.”” Canadian Journal of Criminology 32 (1990): 173–184. Hollin, Colin. R. “Treatment programmes for offenders: meta-analysis, “what works”and beyond.” International Journal of Law and Psychiatry 22.3-4. (1999): 361–372. Kemshall, Hazel. “Risk assessment and management of known sexual and violent offenders: a review of current issues.” Police Research Series Paper 140. 2001. McMurran, Mary & Hodge, John E. The assessment of criminal behaviours in a secure setting. New London: Jessica Kingsley Publishers, 1994. McSherry, Bernadette. “Trends and issues in crime and criminal justice: Risk assessment by mental health professionals and the prevention of future violent behavior.” Australian Institute of Criminology 281 (2004). < http://www.aic.gov.au/publications/tandi2/tandi281.pdf> MHCP. “The Violence Risk Appraisal Guide: A Brief Summary.” Research Department. 2009. Mullen, P. “Dangerousness, risk and the prediction of probability.” New Oxford textbook of psychiatry. Eds M.G. Gelder, J.J. Lopez-Ibor and N. 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