Transcript Violence Risk Assessment: From formula to formulation

Stephen D. Hart, PhD
Introduction and Overview
VIOLENCE: NEW DEVELOPMENTS IN
RISK ASSESSMENT, FORMULATION,
AND MANAGEMENT
Risk Assessment: Task Analysis
Multiple Goals
Prevent
violence
Guide
intervention
Protect
patient
rights
Improve
consistency
Minimize
professional
liability
Multiple Stakeholders
Patients and
offenders
Service
providers
Courts and
tribunals
Administrators
Public
Multiple Steps
Clarify
psycholegal
issues
Gather
relevant
information
Identify
relevant risk
factors
Weight and
combine risk
factors
Determine
preferred
actions
Optimize
risk
Communication
Risk Assessment as Prediction
Actuarial Approach
Problem is task complexity
• Clinicians don’t have the necessary brainpower
Solution is simplification + automation
• Reconceptualize risk assessment as violence prediction
• Develop algorithms (ARAIs) for discriminating known
groups of violent recidivists versus non-recidivists
• Apply algorithms to new cases
Multiple Steps
Clarify
psycholegal
issues
Gather
relevant
information
Identify
relevant risk
factors
Weight and
combine risk
factors
Determine
preferred
actions
Optimize
risk
Communication
Problems with ARAI Predictions
Ignore
complexity
Ignore
causality
Not
contextualized
Not
individualized
Discourage
action
Niels Bohr
 “Predicting is very difficult, especially about the
future.”
Prevention Through Planning
Planning
Directly guides action
• Focuses on what should be done
Based on prudence
• Goes beyond abstract knowledge and technical skills
Relies on qualitative, narrative reasoning
• Uses formulation, rather than formulas
Advantages
Does not require prediction
• Considers what might happen, not what will happen
Does not require certainty
• Evaluates action in light of current knowledge
Encourages causal, systemic thinking
• Identifies controlling factors
Approaches to Planning
Clinical case
formulation
Root cause
analysis
Scenario
planning
Failure modes
and effects
analysis
Dwight D. Eisenhower
 “Plans are nothing; planning is everything.”
Conclusions
Evidence-Based Decisions
“[T]he conscientious, explicit and judicious use of
current best evidence in making decisions”
– David Sackett
Evaluating Plans
Plausibility
• Information anchors should be relevant, comprehensive, and credible
Utility
• Plans should be detailed, individualized, and feasible
Reliability
• Different evaluators should develop similar plans
Acceptability
• Plans should be agreeable to stakeholders
Validity
• Properly implemented plans should reduce violence
Alan Kay
 “The best way to predict the future is to invent
it.”
Correspondence
 Stephen D. Hart, PhD
Department of Psychology
Simon Fraser University
8888 University Drive
Burnaby, BC
Canada V5A 1S6
Tel: +1 (778) 782 3996
E-mail: [email protected]