Conceptual Issues in Risk
Assessment
Randy K. Otto, PhD
Department of Mental Health Law & Policy
Florida Mental Health Institute
University of South Florida
otto@fmhi.usf.edu
Agenda
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Legal Contexts
Rationale for Involving Mental Health
Professionals
Complexity of Risk Assessment
Approaches to Risk Assessment and
Limitations
Features of a Competent Risk
Assessment
Legal Contexts in Which
Risk is an Issue

Criminal (and Delinquency)
– Sentencing
– Capital Sentencing
– Parole

Civil
– Civil Commitment
– Sex Offender Registration
– Sexually Violent Predator Proceedings
Why Involve Mental
Health Professionals?

“In my view, psychiatry represents the
‘penultimate grey area’…particularly with
regard to issues of foreseeability and
predictability of future dangerousness.”
– Judge Jorgensen dissenting in Lindabury
v. Lindabury, 552 So2d 1117, 1118 (Fla
3d DCA, 1989)
Why Involve Mental
Health Professionals?

“Neither petitioner nor the [American
Psychiatric] Association suggests that
psychiatrists are always wrong with respect to
future dangerousness, only most of the time.”
 Justice
White in his opinion for the
majority in Barefoot v. Estelle, 463 US
880 (1983).
Why Involve Mental
Health Professionals?

Specialized knowledge of (individual
and environmental) factors related to
behaviors of interest
– Non-violent criminal behavior
– Violent (criminal) behavior
– Sexual offending
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Knowledge of interventions which may
diminish risk for behaviors of interest
Presumption of better informed
decisions
Sexual Violence is a
Complicated Construct
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Behavior is a function of BOTH the
person and the environment
Assessment of only one of the above
limits understanding of risk for violence
Some factors may correlate with sexual
violence but not cause it
Sexual Violence is a
Complicated Construct

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Some factors may appear to be
associated or correlate with sexual
violence, but may not actually be
related to or correlate with violence
Correlates or predictors of some kinds
of violence (e.g., non-sexual violent
behavior) do not not correlate with or
predict sexual violence
Correlates of Sexual and
Violent Reoffending [r]
Factor
Age
Sex Reoffending
Hanson et al
-.13
Violent Reoffending
Bonta et al.
.16
Race
.00
.12
APD
.00
.18
Violence
History
Work
Problems
.05
.16
.00
.22
From “Violence Prediction”
to “Risk Assessment”


Assessment Approach
Language/Communication
– Relative Levels of Risk
– Identification of Risk and Protective Factors

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Decision Making Responsibility
Treatment/Management/Intervention
Various Approaches to
Risk Assessment
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Clinical Assessment
– Unstructured
– Structured Professional Judgment
– Anamnestic
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Actuarial Assessment
– “Pure”
– “Adjusted”
Clinical Assessment
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Factors of relevance are identified by
each examiner based on training and
experience
Varies from clinician to clinician
Poor reliability
Poor validity
Person focused, less attention paid to
important environmental variables
Structured Professional
Judgment
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Clinical judgment that is structured,
but still a clinical judgment
Items are identified a priori and
typically based on empirical literature
Increased reliability of judgments
Potential for improving validity of
clinical judgment
Can be used in various settings and
with various populations
Structured Professional
Judgment Tools
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Competence Assessment Instrument
HCR-20
Sexual Violence Risk-20
RSVP
Spousal Assault Risk Assessment
Guide (SARA)
Structured Assessment for Violence
Risk in Youth (SAVRY)
Actuarial Assessment
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Items and weights are calculated based
on known outcomes or relationships
Empirically based
Mechanistic
Generally reliable
Demonstrated levels of validity
Relative levels of risk
Rarely used in practice, if at all
Actuarial Assessment
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Concerns regarding validity when used
with groups differing (in important
ways) from the group on which the
instrument was derived
Reliability and validity of the clinical
assessment approach most typically
used with actuarial instruments-the
“adjusted” actuarial approach-is
unknown
Actuarial Assessment Tools
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Violence Risk Appraisal Guide
Iterative Classification Tree (COVR)
Sex Offender Risk Appraisal Guide
RRASOR
MnSOST/MnSOST-R
Static-99
CARAT
Methods For Assessing
Technique Accuracy
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ROC/AUC
Survival Analysis
Sensitivity/Specificity
Positive Predictive Power & Negative
Predictive Power
Features of a Competent
Risk Assessment
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Conducted by professional who can
talk competently about accuracy
indices
Employs an acceptable assessment
approach
Does not rely heavily on psychological
testing
Examines both individual and
environmental/contextual factors
Features of a Competent
Risk Assessment
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Identifies empirically established risk
and protective factors
Offers relative estimates of risk
Acknowledges limitations of ability
Identifies interventions and conditions
which may increase or decrease risk