The Criminogenic and Noncriminogenic Treatment Needs of Intimate Partner Violence Offenders

The criminogenic needs of general offenders have been empirically studied, but the criminogenic treatment needs of intimate partner violence (IPV) offenders, or how they compare with other violent or nonviolent offenders, have not been as thoroughly explored. Therefore, we examined and compared the criminogenic and noncriminogenic needs of 99 IPV offenders, 233 non-IPV violent offenders, and 103 nonviolent offenders, all of whom were men who had undergone institutional forensic assessment. Results indicated that IPV offenders had more treatment needs than the other two offender groups, including the Central Eight criminogenic needs. These findings support a focus on criminogenic treatment needs in batterer intervention programs for men, consistent with the principles of effective intervention for offenders.

Psychiatric Hospital Workers’ Exposure to Disturbing Patient Behavior and Its Relation to Post-Traumatic Stress Disorder Symptoms

Background

About 10% of health-care workers experience post-traumatic stress disorder (PTSD); the rate is higher among workers exposed to aggression.

Objective

We extended this research by examining PTSD and exposure to violence and other disturbing patient behaviors, among nursing and other staff on inpatient psychiatric units (forensic and nonforensic).

Method

Surveys were completed online or in person by 219 respondents (30% response rate). Participants indicated which disturbing behaviors they had been exposed to and ranked the worst three behaviors in each of three categories: most unpleasant to work with, most disruptive to patient care, and most upsetting. Most ( n = 192) also completed the PTSD Checklist (PCL).

Results

All but two participants reported exposure to at least one disturbing behavior and ranked violence, feces smearing, and screaming constantly as the worst experiences overall. On the PCL, 24% scored above the cut off for probable PTSD. Nursing staff had the highest scores, with no difference between nursing staff on forensic versus nonforensic units. PCL score showed a small positive correlation with the number of disturbing behaviors experienced.

Conclusion

PTSD symptoms are common among psychiatric hospital workers, not only nursing staff. Future research using clinical assessment, longitudinal designs, and measurement of nonviolent disturbing behaviors is recommended.

Sixty-Six Years of Research on the Clinical Versus Actuarial Prediction of Violence

In their meta-analysis of clinical versus statistical prediction models, Ægisdóttir et al. (this issue) extended previous findings of statistical-method superiority across such variables as clinicians’ experience and familiarity with data. In this reaction, the authors are particularly interested in violence prediction, which yields the greatest support for actuarial models. In the past decade, actuarial prediction has continued to improve, but clinicians have not readily adopted these models, and new models have emerged that encourage reliance on unaided clinical judgment. Psychologists have made progress developing and disseminating actuarial risk assessments and should use the most accurate available measure suited to the task.

Weight Gain and Its Correlates Among Forensic Inpatients

OBJECTIVE

We investigated changes in weight, body mass index (BMI), and other indices of the metabolic syndrome in forensic inpatients. Weight gain associated with newer antipsychotics (APs) is well established in the general psychiatric population.

METHODS

We examined the medical records of 291 men admitted to a forensic hospital at admission and again at discharge or 365 days later if still in hospital. We also recorded diagnosis and smoker status on admission and quantified psychotropic treatment and adherence, physical activity, and daytime occupation during the hospitalization.

RESULTS

On admission, 33% were obese and 22% of the 106 patients for whom sufficient data were available met criteria for metabolic syndrome. Among patients staying at least 30 days, 60% were weighed again before discharge but repeated blood pressure and waist circumference measures were uncommon, even among those at greatest risk. The 122 forensic inpatients with sufficient information gained an average of 12% of their body weight and 40% increased by at least 1 BMI category, gaining an average of 3.67 kg per month. Weight gain was associated with duration of time and was not attributable to being underweight on admission, diagnosis of schizophrenia, atypical AP treatment, medication adherence, or having been a smoker.

CONCLUSIONS

Patients gained weight during forensic hospitalization independent of medication use. We recommend further research using consistent measurement and wider sampling of both metabolic syndrome indicators and its individual and systemic causes in forensic populations.

Cost-effectiveness of electronic training in domestic violence risk assessment: ODARA 101

The need for domestic violence training has increased with the development of evidence-based risk assessment tools, which must be scored correctly for valid application. Emerging research indicates that training in domestic violence risk assessment can increase scoring accuracy, but despite the increasing popularity of electronic training, it is not yet known whether it can be an effective method of risk assessment training. In the present study, 87 assessors from various professions had training in the Ontario Domestic Assault Risk Assessment either face-to-face or using an electronic training program. The two conditions were equally effective, as measured by performance on a post-training skill acquisition test. Completion rates were 100% for face-to-face and 86% for electronic training, an improvement over a previously evaluated manual-only condition. The estimated per-trainee cost of electronic training was one third that of face-to-face training and expected to decrease. More rigorous evaluations of electronic training for risk assessment are recommended.

Evidence for risk estimate precision: implications for individual risk communication

Actuarial risk assessment instruments using well-established predictor variables measured at the individual level (e.g., age, criminal history, psychopathy) discriminate well between recidivists and non-recidivists across diverse samples. Data indicating the relative risk of recidivism can inform policy decisions about allocating resources according to risk within a correctional system, consistent with the first of the risk-need-responsivity (RNR) principles. Evidence for the precision of absolute risk as applied to an individual based on scores from many samples, however, has proven challenging. In this paper, we present a study examining the association of actuarial risk estimate precision with sample size using the Post Conviction Risk Assessment (PCRA; Lowenkamp et al., 2013), in samples of up to 26,642 offenders. Results indicate that the precision of individual estimates can be demonstrated with sufficient sample size. We believe that the implications of absolute risk for the communication of an individual offender's risks have been poorly understood. We argue that the purpose of individual-level risk communication is to ensure the effective application of policy, which requires matching a new case to aggregate data. We illustrate how an offender's risk might thus be communicated, and conclude that this function is distinct from management of an individual's criminogenic needs and identification of effective and suitable treatments.

Communicating the risk of violent and offending behavior: review and introduction to this special issue

How to communicate risk of recidivism in correctional and forensic contexts has been a subject of scholarly discussion for two decades. This emerging literature, however, is sparse compared with studies on the assessment of risk for violent and offending behavior. In this special issue of Behavioral Sciences and the Law, we have gathered together empirical and review papers exemplifying promising directions and methodologies. We begin with a review of the state of the field, and lessons that can be drawn from research into medical risk assessment and risk communication, finding that many of the same principles apply to the forensic context. How risks are framed, and how numerate assessors are, affects how risk information is understood and applied. We discuss the existing research bearing on these issues, as well as the conceptual, practical, empirical, and legal implications of communicating risk using numerical or categorical risk terms. Along with the seven articles in this volume, we suggest directions for future research on measuring and communicating change, understanding and managing the statistical literacy of those who use and communicate risk assessments, and developing a theoretical framework for forensic risk communication research. We hope this volume will help integrate and invigorate research into forensic risk communication.

Availability of services for parents living with mental disorders: a province-wide survey

OBJECTIVE

There is evidence that parents living with mental disorders have limited access to parenting support. We conducted a survey of mental health agencies in Ontario, Canada, to establish a benchmark from which progress in service availability can be evaluated, and to identify any barriers to availability in terms of program location and parent gender.

METHOD

We surveyed 119 directors of community and inpatient mental health service agencies (54% response rate) and directors of 80 different agencies to which they referred clients for parenting support services (56% response rate). Respondents indicated the types of parenting support services they provided and the clientele they served.

RESULTS

The most common parenting support service in mental health agencies was referral to another agency. Individuals with mental disorders were eligible for services at the referral agencies on a case-by-case basis, and few agencies had programs for children. Parenting services were associated with the number of staff in the agency and with offering programs in urban or both urban and rural locations, which perhaps also indicates larger size of the organization. Agencies served fathers and mothers approximately equally, but child care was uncommon.

CONCLUSIONS

Integrated clinical services for parents living with mental disorders are lacking. Such services should be designed to treat mental health as well as provide parenting skills intervention and practical support for parents, consistent with a recovery model.

Preliminary Validation of the ODARA for Female Intimate Partner Violence Offenders

Female perpetrators of assault against dating, cohabiting, or marital partners (intimate partner violence [IPV]) recidivate less than their male counterparts. Risk assessment instruments, though, have been developed almost exclusively on men. In a prospective, masked 9-year follow up of 30 female IPV offenders incarcerated in a correctional treatment institution within one decade, the base rate of IPV recidivism was 23%. The Ontario Domestic Assault Risk Assessment (ODARA) predicted IPV recidivism, receiver operating characteristic (ROC) area = .724, 95% confidence interval (CI) = [0.503, 0.944], but recidivism rates differed significantly from rates based on male samples. Gender-modified items did not improve prediction. We recommend further research with larger samples to seek improved recidivism estimates among female IPV offenders, but in the interim, we suggest the ODARA can be used to apportion intervention resources for female IPV perpetrators.

Weapon use increases the severity of domestic violence but neither weapon use nor firearm access increases the risk or severity of recidivism

Use of weapons is a risk factor for domestic violence severity, especially lethality. It is not clear, however, whether access to firearms itself increases assault severity, or whether it is characteristic of a subgroup of offenders who are more likely to commit severe and repeated domestic assault. This reanalysis of 1,421 police reports of domestic violence by men found that 6% used a weapon during the assault and 8% had access to firearms. We expected that firearm use would be rare compared to other weapons and that actual weapon use rather than firearm access would increase the severity of domestic assaults. Firearm access was associated with assault severity, but this was mostly attributable to use of nonfirearm weapons. Weapon use was associated with older age, lower education, and relationship history as well as to assault severity. Victims were most concerned about future assaults following threats and actual injuries. Although firearm access and weapon use were related to actuarial risk of domestic violence recidivism, neither predicted the occurrence or severity of recidivism. We conclude that, consistent with previous research in the United States and Canada, firearm use in domestic violence is uncommon even among offenders with known firearm access. Weapon use is characteristic of a subgroup of offenders who commit more severe domestic violence, and seizure of weapons may be an effective intervention.

Predictors of recidivism by stalkers: a nine-year follow-up of police contacts

In a subsample of a multisite stalking study (Mohandie, Meloy, McGowan, & Williams, 2006) comprising 78 offenders from one site, 77% committed new offenses within an average follow-up of 106 months (8.8 years). Over half (56%) were charged for new stalking related offenses and 33% for violent recidivism. Violent reoffending, including sexual offenses, was predicted by risk factors consistent with existing literature: younger age at first conviction, prior release failures, and criminal history. Stalking recidivism was predicted by pre-index offending scores, using the Cormier-Lang, and prior diagnosis of a mental illness. In addition, stalkers with previously diagnosed mental illness had significantly more police contacts as complainants than those without; their recidivism was also more likely to be non-violent.

How nonrecidivism affects predictive accuracy: evidence from a cross-validation of the Ontario Domestic Assault Risk Assessment (ODARA)

Prediction effect sizes such as ROC area are important for demonstrating a risk assessment's generalizability and utility. How a study defines recidivism might affect predictive accuracy. Nonrecidivism is problematic when predicting specialized violence (e.g., domestic violence). The present study cross-validates the ability of the Ontario Domestic Assault Risk Assessment (ODARA) to distinguish subsequent recidivists and nonrecidivists among 391 new cases with less extensive criminal records than previous cross-validation samples, base rate=27%, ROC area=.67. Excluding ambiguous nonrecidivists increases the base rate to 33%, ROC area=.74. Random samples of 50 recidivists and 50 unambiguous nonrecidivists yield ROC areas from .71 to .80. Published norms significantly underestimate official recidivism. Ambiguous nonrecidivism is prevalent and leads to underestimating base rates and predictive accuracy.

Actuarial assessment of violence risk in hospital-based partner assault clinics

Hospital-based partner assault clinics are a relatively recent addition to the community response to partner violence. In this study, 66% of 111 women attending hospital clinics for partner assault were physically injured and 43% reported death threats. Few concurrently used other services (shelters or police) and most relied on female friends and relatives for help. Many participants who currently lived with the perpetrator were contemplating leaving but only a third had made plans to do so. Participants faced an unusually high risk of future assault, according to both victim interview using the ODARA actuarial risk assessment and their own perceptions. Findings imply an important role for partner assault clinics and the feasibility of the victim service sector's using the same actuarial risk assessments as the criminal justice system.

An indepth actuarial assessment for wife assault recidivism: the Domestic Violence Risk Appraisal Guide

An actuarial tool, the Ontario Domestic Assault Risk Assessment (ODARA), predicts recidivism using only variables readily obtained by frontline police officers. Correctional settings permit more comprehensive assessments. In a subset of ODARA construction and cross-validation cases, 303 men with a police record for wife assault and a correctional system file, the VRAG, SARA, Danger Assessment, and DVSI also predicted recidivism, but the Hare Psychopathy Checklist (PCL-R) best improved prediction of recidivism, occurrence, frequency, severity, injury, and charges. In 346 new cases, ODARA and PCL-R independently predicted recidivism. An algorithm was derived for a combined instrument, the Domestic Violence Risk Appraisal Guide (DVRAG), and an experience table is presented (N=649). Results indicated the importance of antisociality in wife assault.

Does using nonnumerical terms to describe risk aid violence risk communication? Clinician agreement and decision making

Actuarial risk assessments yield valid numerical information about violence risk, but research suggests that forensic clinicians prefer to communicate risk using nonnumerical information (i.e., verbal terms such as high risk). In an experimental questionnaire study, 60 forensic clinicians disagreed on the interpretation of nonnumerical terms, and their nonnumerical risk estimates for one group of violent offenders were influenced by comparison with another group. Adding nonnumerical terms to numerical probability statements had no effect on hypothetical forensic decisions. These findings suggest that nonnumerical descriptive terms do not aid effective communication of violence risk and that contextual information might artificially affect estimated risk.

Coercive and precocious sexuality as a fundamental aspect of psychopathy

Sexual behavior is closely associated with delinquency and crime. Although psychopaths, by definition, have many short-term sexual relationships, it has not been shown that sexuality is a core aspect of psychopathy. A Darwinian view of psychopathy led to the hypothesis that psychopaths have a unique sexuality involving early, frequent, and coercive sex. Our subjects were 512 sex offenders assessed on the Hare Psychopathy Checklist (PCL-R). Five variables reflecting early, frequent, and coercive sex loaded on the same principal component in exploratory factor analysis on a subset of the sample, whereas PCL-R items pertaining to adult sexual behavior did not. Confirmatory factor analysis of the remaining subjects yielded a measurement model containing three inter-correlated factors - the traditional two PCL-R factors, and coercive and precocious sexuality. Taxometric analyses gave evidence of a natural discontinuity underlying coercive and precocious sexuality. Coercive and precocious sexuality yielded statistically significant associations with other study variables predicted by the Darwinian hypothesis. The present findings are consistent with prior empirical findings and support the hypothesis that psychopathy has been a nonpathological, reproductively viable, alternate life history strategy.

A brief actuarial assessment for the prediction of wife assault recidivism: the Ontario domestic assault risk assessment

An actuarial assessment to predict male-to-female marital violence was constructed from a pool of potential predictors in a sample of 589 offenders identified in police records and followed up for an average of almost 5 years. Archival information in several domains (offender characteristics, domestic violence history, nondomestic criminal history, relationship characteristics, victim characteristics, index offense) and recidivism were subjected to setwise and stepwise logistic regression. The resulting 13-item scale, the Ontario Domestic Assault Risk Assessment (ODARA), showed a large effect size in predicting new assaults against legal or common-law wives or ex-wives (Cohen's d = 1.1, relative operating characteristic area =.77) and was associated with number and severity of new assaults and time until recidivism. Cross-validation and comparisons with other instruments are also reported.

Predicting wife assault: a critical review and implications for policy and practice

In this review, the authors examine the research evidence for the prediction of wife assault recidivism, lethal wife assault, and wife assault onset. They also review and present original data on the effect of treatment attendance on wife assault risk. Violence does not always become a stable habit, and variables associated with wife assault onset do not necessarily predict recidivism. General antisociality, psychopathy, substance abuse, and a history of assault and psychological abuse in the relationship are the most promising predictors of recidivism. Formal risk assessments, and victims' predictions, have demonstrated value in predicting recidivism. The authors review existing assessments for wife assault onset and recidivism and explain the relative merits of actuarial tools and structured clinical assessments. Because of statistical and practical limitations to predicting lethal assault, they recommend using an actuarial assessment of wife assault risk, plus attention to the strongest correlates of lethal assault when lethality is a concern.

Adolescents' perceptions of the seriousness of sexual aggression: influence of gender, traditional attitudes, and self-reported experience

Little is known about adolescents' perceptions of interpersonal aggression and the role of traditional social attitudes in these perceptions. Sixteen-year-old students (N = 212) of both sexes rated the seriousness of 9 aurally presented scenarios depicting either sexual or nonsexual, physical aggression. Sex of perpetrator and sex of victim were manipulated partly factorially. Students also reported on their own experiences (as perpetrators and victims) of the aggression portrayed, and completed a measure of traditional sex role ideology. Sexual aggression was rated as more serious than nonsexual physical aggression, especially when involving physical force. Girls gave higher seriousness ratings than did boys. Male-to-female aggression was rated as most serious, and male-to-male aggression, least serious. Self-reported perpetrators tended to give lower ratings of seriousness than did victims. Traditional sex-role attitudes were associated with lower rated seriousness but not with reported perpetration or victimization. Multivariate analyses suggested that the effects of traditional sex-role attitudes could largely be subsumed by the effects of other study variables, especially participant sex. The role of attitudes as a direct cause of interpersonal aggression is discussed along with implications for intervention.

The influence of actuarial risk assessment in clinical judgments and tribunal decisions about mentally disordered offenders in maximum security

Research has shown that actuarial assessments of violence risk are consistently more accurate than unaided judgments by clinicians, and it has been suggested that the availability of actuarial instruments will improve forensic decision making. This study examined clinical judgments and autonomous review tribunal decisions to detain forensic patients in maximum security. Variables included the availability of an actuarial risk report at the time of decision making, patient characteristics and history, and clinical presentation over the previous year. Detained and transferred patients did not differ in their actuarial risk of violent recidivism. The best predictor of tribunal decision was the senior clinician's testimony. There was also no significant association between the actuarial risk score and clinicians' opinions. Whether the actuarial report was available at the time of decision making did not alter the statistical model of either clinical judgments or tribunal decisions. Implications for the use of actuarial risk assessment in forensic decision making are discussed.

The functions of aggression by male teenagers

A selectionist theory states that violence by males toward male peers originally served specific functions and violence to female peers served others. Differences in self-reported victimization and perpetration in studies of 1.452 high school students were hypothesized. In Study 1, male-to-male aggression was reported to be more prevalent than male-to-female aggression. For male-to-male aggression, perpetrator reports agreed with or exceeded victim reports, and victims were more often strangers than close friends, In contrast, for male-to-female aggression, there were consistently fewer reports from perpetrators than from victims, and victims were less often strangers than girlfriends. Study 2 obtained similar findings for reported frequency, number of victims and perpetrators, and sexual aggression. Study 3 showed that girls' aggression contrasted with that by boys with respect to intra- versus intersex aggression and perpetrator victim agreement.

The functions of aggression by male teenagers

A selectionist theory states that violence by males toward male peers originally served specific functions and violence to female peers served others. Differences in self-reported victimization and perpetration in studies of 1.452 high school students were hypothesized. In Study 1, male-to-male aggression was reported to be more prevalent than male-to-female aggression. For male-to-male aggression, perpetrator reports agreed with or exceeded victim reports, and victims were more often strangers than close friends, In contrast, for male-to-female aggression, there were consistently fewer reports from perpetrators than from victims, and victims were less often strangers than girlfriends. Study 2 obtained similar findings for reported frequency, number of victims and perpetrators, and sexual aggression. Study 3 showed that girls' aggression contrasted with that by boys with respect to intra- versus intersex aggression and perpetrator victim agreement.