Prediction of institutional aggression among personality disordered forensic patients using actuarial and structured clinical risk assessment tools: prospective evaluation of the HCR-20, VRS, Static-99, and Risk Matrix 2000

Entry to the Dangerous and Severe Personality Disorder (DSPD) service in England and Wales is heavily determined by risk status, and therefore requires valid procedures for monitoring changes in risk over time in order to make risk management decisions and determine patients' suitability for transfer to lower security settings. Yet little is known about the validity of current risk assessment tools with the new DSPD population. This study reports a prospective evaluation of the predictive accuracy of the HCR-20, VRS, Static-99, and Risk Matrix 2000 with 44 consecutive admissions to the DSPD unit at a high secure forensic psychiatric hospital. Thirty eight per cent of the sample exhibited interpersonal physical aggression (IPA) on one or more instances over an average 1.5 year period following admission, and a similar percentage caused damage to property (DTP) on one or more occasions over the same period. All tools predicted DTP. HCR-20 Total and scale scores predicted IPA with structured final risk judgements also predicting repetitive (2 + incidents of) IPA. HCR-20 Risk Management scores were significantly associated with imminence of IPA. Results were discussed in terms of the practical utility of these tools with high risk forensic psychiatric inpatients

Predicting Recidivism in Sex Offenders Using the SVR-20: The Contribution of Age-at-release

Sex offenders (N = 468) were released from custody and recidivism outcome was recorded. The Sexual Violence Risk-20 (SVR-20) was scored for each offender and the relationship between age-at-release and SVR-20 item and total scores was examined. SVR-20 total scores were not correlated with age-at-release (r = .-057). SVR-20 scores were combined with a score representing the age of the offender at their release from custody. On the basis of ROC analysis, predictive accuracy was significantly enhanced when age-atrelease was included in the risk score. We suggest that the SVR-20, and perhaps other similar risk instruments, could be improved by including age-at-release information. We discuss the possibility that the advantage obtained by empirical actuarial instruments may be due in part to their close relation with age-at-release

Women’s desistance from crime: The role of individual, relational and socio-structural factors over time

Crime and, in particular, violent crime, committed early in life, can have long-term effects not only on the life of offenders but also on the life of its victims. This chapter reviews the literature regarding factors that predict desistance from crime for both young adult and adult female offenders. The factors fall within the domains of psychological and psychosocial desistance theories on the one hand and social processes or sociological desistance theories on the other. The individual factors, psychosocial maturity and prosocial identity development (indices of internal control) appear to be important for desistance during the transition from adolescence to young adulthood while cognitive transformations and stable mental health were found to be related to desistance in older adult females. The relational and social-structural factors such as prosocial romantic relationships, children, and work (indices of external control) were found to be important in the desistance process of both young adult and adult female offenders

Women's desistance from crime: The role of individual, relational, and socio-structural factors over time

Crime and, in particular, violent crime, committed early in life, can have long-term effects not only on the life of offenders but also on the life of its victims. This chapter reviews the literature regarding factors that predict desistance from crime for both young adult and adult female offenders. The factors fall within the domains of psychological and psychosocial desistance theories on the one hand and social processes or sociological desistance theories on the other. The individual factors, psychosocial maturity and prosocial identity development (indices of internal control) appear to be important for desistance during the transition from adolescence to young adulthood while cognitive transformations and stable mental health were found to be related to desistance in older adult females. The relational and social-structural factors such as prosocial romantic relationships, children, and work (indices of external control) were found to be important in the desistance process of both young adult and adult female offenders

Denial and minimization among sexual offenders: Posttreatment presentation and association with sexu

The relationship between sexual recidivism and posttreatment denial and minimization was examined among 436 sex offenders followed up for an average period of more than 5 years. Treatment completion status and psychopathic traits, both established predictors of sexual recidivism also associated with denial and minimization, were included in survival analyses to remove their confounding influence on the focal relationships. The potential role of actuarial risk as a moderating variable was also investigated. A dichotomous variable reflecting denial and minimization failed to predict sexual recidivism. However, among a subset of 102 sex offenders who received no additional treatment after completing an initial program, the interaction between actuarial risk and scores on a continuous measure of minimization predicted sexual recidivism. Implications for assessment, particularly the need to move beyond dichotomous operationalizations of denial and minimization, and treatment were discussed

Personality traits as predictors of inpatient aggression in a high-security forensic psychiatric setting: prospective evaluation of the PCL-R and IPDE dimension ratings

The Dangerous and Severe Personality Disorder (DSPD) initiative in England and Wales provides specialized care to high-risk offenders with mental disorders. This study investigated the predictive utility of personality traits, assessed using the Psychopathy Checklist–Revised (PCL-R) and the International Personality Disorder Examination, with 44 consecutive admissions to the DSPD unit at a high-security forensic psychiatric hospital. Incidents of interpersonal physical aggression (IPA) were observed for 39% of the sample over an average 1.5-year period following admission. Histrionic personality disorder (PD) predicted IPA, and Histrionic, Borderline, and Antisocial PDs all predicted repetitive (2+ incidents of) IPA. PCL-R Factor 1 and Facets 1 and 2 were also significant predictors of IPA. PCL-R Factor 1 and Histrionic PD scores were significantly associated with imminence of IPA. Results were discussed in terms of the utility of personality traits in risk assessment and treatment of specially selected high-risk forensic psychiatric patients in secure settings