Screening for Violence Risk in Military Veterans: Predictive Validity of a Brief Clinical Tool

Violence toward others is a serious problem among a subset of military veterans. This study reports on predictive validity of a brief screening tool for violence in veterans

Sreenivasan S: A practical guide for the evaluation of sexual recidivism risk among mentally retarded sex offenders

Although sex offender risk assessment has progressed greatly over the past decade and a half since most states implemented the sexually violent predator/sexually dangerous person (SVP/SDP) laws, there continues to be limited applicability of such models to intellectually disabled sex offenders because there has been no empirical validation. However, SVP/SDP civil commitment programs have reported increased admission of developmentally disabled sex offenders. Differentiating sexual deviance, the primary factor predisposing most individuals to criminal sexual violence, from impulsive, immature, and inappropriate behavior stemming from cognitive deficits presents yet another challenge to the clinician tasked with performing such evaluations. This article reviews actuarial risk models and their limited applicability to mentally retarded sex offenders and offers a conceptual method of assessing the risk of recidivism in intellectually disabled sex offenders under SVP/SDP evaluation

A practical method for the evaluation of symptom exaggeration in minor head trauma among civil litigants

Forensic psychiatrists and psychologists are often called on to provide opinions and render testimony in which minor head trauma accompanied by persistent somatic, cognitive, and/or emotional symptoms is alleged. The frequency of persistent symptoms following such minor head injury is generally low. The forensic clinician therefore must differentiate between subtle brain dysfunction, symptom amplification, psychogenic-based causes for the presence of cognitive and other deficits, or frank malingering. The purpose of this article is twofold: first, to review critical issues related to the assessment of malingering and symptom exaggeration in mild head injury cases; and second, to offer a practical model for the assessment of amplified neuropsychological and psychiatric deficits in civil litigants in cases of minor head trauma

Screening for Violence Risk in Military Veterans: Predictive Validity of a Brief Clinical Tool

OBJECTIVE: Violence toward others is a serious problem among a subset of military veterans. This study reports on predictive validity of a brief screening tool for violence in veterans. METHODS: Data on risk factors at an initial wave and on violent behavior at 1-year follow-up were collected in two independent sampling frames: (a) a national random sample survey of 1090 Iraq and Afghanistan veterans, and (b) in-depth assessments of 197 dyads of Iraq and Afghanistan veterans and collateral informants. RESULTS: We chose candidate risk factors—financial instability, combat experience, alcohol misuse, history of violence and arrests, and anger associated with posttraumatic stress disorder (PTSD)—based on empirical support in published research. Tools measuring these risk factors were examined, and items with the most robust statistical association to outcomes were selected. The resultant 5-item clinical tool, the Violence Screening and Assessment of Needs (VIO-SCAN), yielded area under the curve (AUC) statistics ranging from .74 – .78 for the national survey and from .74 – .80 for the in-depth assessments, depending on level of violence analyzed using multiple logistic regression. CONCLUSIONS: To our knowledge, the VIO-SCAN is the first empirically-derived assessment tool for violence developed specifically for military veteran populations. As in civilians, past violence and arrest history had a robust association with future violence in veterans. Analyses show that individual factors examined in isolation (e.g., PTSD, combat experience) do not adequately convey a veteran’s level of violence risk; rather, as shown by the VIO-SCAN, multiple risk factors need to be taken into account in tandem when assessing risk in veterans. Use of evidence-based methods for assessing and managing violence in veterans is discussed, addressing benefits and limits of integrating risk assessment tools into clinical practice

D: Critical concerns in Iraq/Afghanistan war veteran-forensic interface: combat-related postdeployment criminal violence

Identifying whether there is a nexus between Iraq and Afghanistan combat injuries and civilian violence on return from deployment is complicated by differences in reactions of individuals to combat exposure, the overlapping effects of traumatic brain injury (TBI) and posttraumatic stress disorder (PTSD), and the low base rate of civilian violence after combat exposure. Moreover, the overall prevalence of violence among returning Iraq and Afghanistan combat war veterans has not been well documented. Malingered symptoms and either exaggeration or outright fabrication of war zone exposure are challenges to rendering forensic opinions, with the risk reduced by accessing military documents that corroborate war zone duties and exposure. This article serves as a first step toward understanding what may potentiate violence among returning Iraq and Afghanistan veterans. We offer a systematic approach toward the purpose of forensic case formulation that addresses whether combat duty/war zone exposure and associated clinical conditions are linked to criminal violence on return to civilian life