One Professional Judgement and Actuarial instruments. I

One of the most
prevailing forms of violence against women is that carried out by a husband or
an intimate male partner (Heise and Garcia-Moreno, 2002). This is also referred
to as intimate partner violence (IPV).  The definition of IPV is
convoluted (Hart 2010), it can defined as “the actual, attempted, or threatened
physical harm of a current or former intimate partner” (Kropp et al, 2005). IPV
includes physical, emotional, sexual and verbal abuse (Guo and Harstall, 2008).
It has a lifetime prevalence of 60% and is a leading cause of morbidity and
mortality for women of all reproductive ages (Gunter, 2007). IPV arises in all
countries, regardless of social, cultural, religious or economic group (Heise
and Garcia-Moreno, 2002). I have been asked by a group of professionals in the
criminal justice system on how they should be assessing and managing risk for
IPV. The central purpose of this report is to provide a recommendation on which
approach to take and the type of violent risk assessment that is suitable for
IPV by using academic research to support my arguments. To begin with I will be
exploring the different types of approaches to violent risk assessments,
focusing on Structured Professional Judgement and Actuarial instruments. I will
then go onto comparing two types of assessments; The Danger Assessment
(Campbell, 2004) and The Brief Spousal Assault Form for the Evaluation of Risk
(Kropp et al, 2005) and conclude which of the two is the best supported
practice for IPV.

 

Assessing the risk of
future violence in IPV cases is important (Kercher et al, 9999). Before
discussing risk assessment tools, it is important to first understand what is
meant by risk and risk assessments. Risk can be defined as a hazard that is not
yet understood and therefore can be forecast only with uncertainty (Storey,
1999). It is context dependent so when making judgements about future risks we
have to consider the nature, the severity, the frequency and the likelihood of
violence. In order to be speculative professionals in the field will use
a violence risk assessment tool to be able to characterise the risk of violence
in the future and to be able to develop interventions to manage or reduce the
violence risk. Risk assessment instruments are used to measure the cessation,
recidivism, or escalation of IPV. They provide a standard against which to
evaluate individuals for potential violence, enabling all professionals in the
criminal justice system to share a common frame of reference and understanding.
Some risk assessments focus on the offender, while others are focused on the
victim and the risk that they will be re-victimized. The majority of risk
assessment tools used in criminal justice settings contain two types of risk
factors: static and dynamic. Specialized risk assessment tools have been
developed for cases of IPV to assess the risk that the offender will reoffend
or that the situation will become calamitous (Roehl and Guertin 2000). There
are a number of goals of using risk assessments in cases of IPV. According to
Hart (2010), the fundamental goal is to avert future harm against an intimate
partner, which is cultivated through risk management strategies.  The
second goal is accountability, increasing the transparency and consistency of
the decisions that are made in the criminal justice system (Hart 2010). The
third goal is the protection of the accused’s rights.

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It is substantial that
the assessor keeps in mind the strengths and limitations of the risk assessment
approaches and the specific risk assessment tools. Keeping these aspects in
mind, the assessors will be able to choose the most appropriate tool to guide
the assessment of the risk that an offender poses to an intimate partner. Thus
the next part of the report will discuss and evaluate the different approaches
to violent risk assessments.  Although violence and aggression are by no
means a new phenomenon, it has only been in the last fifteen to twenty years
that valid violence risk assessment instruments have been developed. The area
today in risk assessments is generally divided into two approaches:
Discretionary and nondiscretionary approaches to decision making. There are
three major forms in the discretionary approach; unstructured judgement, anamnestic
evaluation and structured professional judgement (SPJ). From the three major
forms I will be focusing more on SPJ. SPJ is an approach that seeks to bridge
the gap between actuarial and unstructured professional approaches to risk
assessment (Douglas and Kropp, 2002).  These tools are evidence-based
guidelines where the evaluator must conduct the assessment according to
guidelines that display current knowledge about violence. The guidelines
administer a minimal set of risk factors that should be taken into account in
every case. It also includes recommendations for information gathering and
enforcing violence prevention strategies. The primary goal of the structured
professional approach to risk assessment is to prevent violence (Douglas &
Kropp, 2002). By methodically identifying risk factors relevant to a case,
management strategies can be bespoken to prevent violence.

 

This approach has been prevalent for some time, portraying some success in
preventing general criminal recidivism (Andrews and Bonta, 2003).  The SPJ
approach allows for a logical, apparent and systematic correlation between risk
factors and intervention. It also has the ability to identify persons who are
either at a lower or higher risk for violence. However it can be criticised as
it allows abundant professional discretion. Regardless of this there is some
evidence of the reliability and validity of SPJ guidelines (Douglas and Kropp,
2002). A number of studies in North America and Europe imply that interrater
reliability is good to excellent for professional judgements regarding the
existence of individual risk factors and overall levels of risk (Kropp and
Hart, 2000). Furthermore, professional judgements of risk have good
criterion-related validity and they correspond considerably with scores on
actuarial measures (Kropp and Hart, 2000). An example of an assessment tool in
this approach is the Brief Spousal Assault Form for the Evaluation of Risk (B
SAFER).The B-SAFER is an abridged adaptation of the Spousal Assault Risk
Assessment (SARA) designed for professionals working in the Criminal Justice
System who deal with IPV.

 

Non-discretionary
approach dictates an adamant structure. Information is assembled weighted, and
connected using fixed and categorical rules. There are two major types;
actuarial use of psychological tests and actuarial risk assessment instrument.
The methods are constructed to predict specific behaviours within a certain
time frame. It uses assessment methods that are formal, algorithmic in
classifying risk. The stated goal of the actuarial method is to assess violence
in both relatively and absolutely. This is achieved by comparing an individual
to a norm-based reference group and by providing a probabilistic estimate of
the likelihood of future violence. Research consistently shows that structured,
actuarial approaches to recidivism prediction are more accurate than
(unstructured) professional judgment. The key strength to this approach is that
it improves upon the poor reliability and validity of unstructured clinical
assessments (Litwack, 2001). The actuarial approach can assist the evaluator to
estimate, in a relative sense, the risk posed by an individual over a fixed
time period, compared to a reference group. In Canada, this approach has been
used by the Ontario Provincial Police in the development of the Ontario Domestic
Assault Risk Assessment (Hilton et al., 2005/2010). However they have been
criticized for their lack of practical utility (Litwack, 2001). From a violence
prevention perspective, actuarial methods can inform us about the overall level
of risk management that might be required (i.e., the greater the risk, the
greater the necessary resources). However, they do little to inform us about
specific violence prevention strategies. Practitioners resist using methods
that eliminate professional discretion, this might be because they see their
role as preventing violence rather than predicting it (Douglas & Kropp,
2002). Heilbrun (1997) contrasted “prediction versus management”
models of risk assessment, noting that the prediction model likely has
“minimal” implications for management due to its lack of sensitivity
to change. Although actuarial approaches give the appearance of objectivity and
precision, they often yield very modest correlations with violence (Douglas,
Cox, & Webster, 1999) and are subject to limitations such as statistical
shrinkage and measurement error. Moreover, practitioners may feel uncomfortable
considering only one “test” of risk, while ignoring legal, ethical,
and professional requirements to consider all available information, from all
perspectives (American Psychological Association, 2002). The example of an
actuarial instrument is that will be used in this report is The Danger
Assessment (DA) which was founded by Campbell (2004) and is used to predict
femicide.

 

So far this report has
introduced risks and risk assessments as a whole. It has also discussed the two
different approaches to decision making for risk assessments; discretionary and
nondiscretionary and the strengths and weaknesses of SPJ and actuarial
approach.  Now it will move on to focusing on two types of assessments
from each approach; The Danger Assessment (DA) and BSAFER. The DA was developed
by Jacquelyn Campbell in the United States, initially designed to predict
femicide. It was constructed using femicide cases and attempted femicide cases.
 It is used throughout the United States and Canada (Millar 2009). The
DA is an instrument devised to assess the likelihood of fatality or near
fatality happening in a case of IPV. In other words it is used to predict
domestic violence recidivism, and is used in a number of settings; including
for the purposes of victim education and awareness and safety planning (Guo and
Harstall 2008). The DA is comprised of two parts; the first is a calendar on
which the victim states the severity and frequency of instances of domestic violence
that they have experienced within the last 12 months. The second part is a
20-item checklist of risk factors that are related to intimate partner homicide
(Millar 2009). Guo and Harstall (2008) state that the most appropriate users of
the DA are victim advocates, social workers or clinicians in various settings,
such as women’s shelters. The DA also includes victim-focused risk factors
such as the victim’s concern about future violence by the accused and barriers
for the victim in accessing support (Campbell et al. 2009). The assessment then
places the perpetrator in four categories: variable danger, increased danger,
severe danger and extreme danger.

 

The DA can be useful as part of a comprehensive assessment of risk of
intimate partner violence as it helps to determine the level of danger an
abused woman has of being killed by her intimate partner. It systematically
gathers information from victims, who can provide a unique perspective on the
history of violence in the relationship and on the perpetrator’s background and
psychosocial adjustment. Another strength of is that it considers victim
vulnerability factors that are relevant to safety planning. There is direct
evidence that comes from prospective studies that have found a moderate
association between DA total scores and repeated intimate partner violence.
Although there have been few direct comparisons, the predictive validity of the
DA appears to be about the same as that of other procedures for assessing risk
of intimate partner violence. Thus the strengths of the DA are that it has
strong test-retest reliability, good inter-rater reliability and construct
validity, and correlates strongly with other measures of domestic violence
recidivism (Kropp 2008). In addition, it is a good tool to use with victims as
it allows victims to better understand the risk that the relationship may pose
to them and what risk management options are available (Guo and Harstall 2008).
It may also serve as a useful instrument when information is difficult to
obtain or when the offender cannot be interviewed. An 11-city study of intimate
partner femicide used multivariate analysis to test the predictive validity of
the risk factors on the DA from intimate partner femicide cases (N = 310)
compared with 324 abused women in the same cities . The results were used to
revise the DA and the calculated weights used to develop a scoring algorithm
with levels of risk. These levels of risk were then tested with an independent
sample of attempted femicides (N = 194) with a final outcome of .90 of the
cases included in the area under the receiver operating characteristic (ROC)
curve. The accuracy of the DA, however, is not as strong as other tools and it
does not provide the evaluator with a means of assessing the risk level posed
by the accused (Hilton and Harris 2005). Northcott (9999). Furthermore the
danger assessment has been criticised for being insensitive to short-term
changes or fluctuations in violence risk.

The B-SAFER is a set of inclusive SPJ guidelines for assessing and managing
risk for IPV created by Kropp and Hart (2004). It was designed for police
officers by shortening the Spousal Assault Risk Assessment guide to be able
reduce the amount of time it took to complete an assessment reflecting on the
time constraints faced by police. The B-SAFER was created for use with adult
male perpetrators and includes 10 risk factors in two realms: Intimate Partner
Violence and Psychosocial Adjustment. Recently, a third domain containing five
risk factors related to the victim was added, called Victim Vulnerability
Factors. The presence of each risk factor is codified for the most recent four
weeks and for any time prior to that on a three point scale. This is then
converted into numerical scores and then the sum of the scores creates an index
reflecting overall risk. Based on the existence of the risk factors, a
summary judgement is made on a 3-point scale (low risk, moderate risk or high
risk). In the B-SAFER, summary judgments are made for three risk categories:
acute violence risk, long-term violence risk, and lethal violence risk.

 

BSAFER tool grants logical, transparent, and methodical link between risk
factors and intervention. There has also been significant predictive validity
of using BSAFER with respect to risk management recommendations made by police.
A study by Storey et al (1999) looked at the B-SAFER as used by Swedish police
officers when assessing and managing IPV. The results showed a positive
correlation between risk and management and the overall risk ratings predicted
recidivism. The results also validate the use of the B-SAFER by police and
reveal comparable findings between the B-SAFER and the Spousal Assault Risk
Assessment Guide (Belfrage et al 1997). However it suggests that the B-SAFER is
more suitable for the police. The use of this tool reinforces but does not
replace psychiatric opinion. Another weakness is that this tool is more focused
on marriage relationships than on couple relationships (Echeburua, et al,
2009). Thijssen and Rutler (2011) also found poor to moderate interrater
reliability when using the items. They suggest that this derives from the lack
of information contained within the client’s file.     

 

The research tells us that SPJ is useful not only for supporting
evidence-based practice, but also for increasing the transparency of
decision-making. However it can be seen as time consuming and it assists but
does not replace psychiatric opinion. Actuarial risk assessment has many
empirical evidence to support its validity however it is not generalizable and
it ignores case specific factors. In addition translating results into numbers
can fail to provide meaning for type of intervention. Another limitation of the
actuarial approach is that risk probabilities does not advise clinicians about
the circumstances or the severity or of the act. The risk statement about the
patient may be mathematically correct, but it is of limited use in informing
management. The SPJ approach is more flexible that the actuarial method as the
actuarial approach lacks the ability to take into account fluctuations in the
level of risk as circumstances change. Furthermore the same guidelines that
advances predictive accuracy in one setting when using actuarial risk instruments
will decrease that tests accuracy in others (Baldry and Winkel, 2008). Moreover
calculating the absolute likelihood or probability of recidivism requires time
and effort to construct and validate.

 

The DA has strong test-retest reliability and good inter-rater reliability.
It also correlates with other measures of domestic violence recidivism (Kropp
2008). However there is no formal guide to properly administer, score, and interpret
the test.  BSAFER tool on the other hand allows for a logical and systematic
link between risk factors and intervention. There has also been compelling
predictive validity of using BSAFER where as there is a lack of research on the
predictive validity of the DA in relation to IPV. A study that looked at the
validation of B-SAFER in Hong Kong by Au et al (2008) found that the B-SAFER
could correctly classify 95% of the cases. Results regarding the present
situation was found to be important in predicting IPV (Au et al, 2008). Kropp,
et al (2004) found that the inter-relater reliability of this test as
excellent. However, there is no statistical score as the study used qualitative
analysis. A study that pilot tested the BSAFER found that officers who used it
stated that it was simple and easy to use. Some of the officers claimed that it
encouraged them to think about risks in ways that might otherwise have been
overlooked.  Studies show that the risk factors included in the DA are
only at least moderately correlated, suggesting that they are likely to be unnecessary
as predictors of IPV. The B-SAFER provides a consistent tool to use in each
case. Police officers in the pilot testing suggested that it improved services
to the victim. Each item in the BSAFER is rated twice, once for the past and
once for the last 4 weeks. Thus it takes into account not only the present but
also the past. Alternatively, the DA is insensitive to short-term changes in
violence risk.

 

To conclude, this review
illustrated many options available to assessors assigned with the
responsibility of reckoning the risk that an offender will reoffend against
their partner. The research tells us that SPJ is the best route to take in
relation to IPV. SPJ has been proven to be valid and reliable and it helps
provide consistency and usefulness of decisions. SPJ will provide the clinician
structure to your clinical and forensic risk assessment that links wilfully
into risk management for treatment and supervision. Furthermore guidelines of
SPJ reflect present theoretical and professional knowledge about violence
benefitting those working in the criminal justice system. The actuarial
approach on the other hand may be a more suitable approach for violence and
sexual offending (Heilbrun et al, 2010). Actuarial tools also have the
limitation of the test findings not being able to be used in planning
interventions. Thus based on the research literature the best supported
practice for Intimate Partner Violence is the BSAFER. Police officers stated
that the BSAFER was easier to use and it helped them make better management
decisions (Baldry et al, 2008). BSAFER uses fewer items and there is
less technical specialised language related to mental disorder, thus there is
less expertise and training required to use the tool. BSAFER is sensitive to
fluctuations in violence risk which is an important factor to take into account
in terms of IPV. In addition studies proven significant predictive validity of
using BSAFER (Storey, 1999). Furthermore the content of BSAFER is firmly
grounded in the professional and scientific literatures of IPV.