Violence in the Social Services

Introduction

Nearly one-third of the 100 “fatalities in healthcare and social service settings that occurred in 2013 were due to assaults and violent acts” (OSHA, 2016) No matter what area you work in (community mental health, general or mental hospitals, working in client homes or in a centralized office like a crisis line) you may find yourself working with clients who are expressing thoughts or feelings of violence.

Risk Factors for Violence

A number of factors increase the chances that a client will be violent. Some of these include (James, 2008):

  • Substance abuse. Active intoxication increases the chances a client will be violent. (Tomlinson, Brown, & Hoaken, 2016)
  • De-institutionalization. Moving individuals into community care increases the chances they will revert to their previous state and become violent. (Torrey, 2015)
  • Mental illness. Certain mental illnesses might increase the chances a person will become violent (Stuart, 2003) although the evidence is mixed. Most people with mental illness are statistically more likely to be victims than perpretrators of violence (Desmarais, et. al., 2014)
  • Gender. Men are more likely to be violent than women and more likely to be victims of violence. (Kellermann & Mercy, 1992)
  • Gangs. Gang violence, common in some areas, can increase the chances that youth experience violence as a perpetrator and victim (Neville, et. al., 2015)
  • Elderly. As elderly clients are institutionalized, they may find themselves at increased levels of violence as perpetrators and victims. (Sandive, et. al., 2004)

Assessing Violence Risk

The Dynamic Appraisal of Situational Aggression (DASA; Ogloff & Daffern, 2006) can be used to assess the likelihood that a patient or client will become aggressive within a psychiatric inpatient environment. The DASA has 7 items that are scored 0 for absent and 1 for present within the last 24 hours.

Other useful models for assessing violence risk include the Biopsychosocial Model of Violence Risk Assessment and the Violence Risk Appraisal Guide (VRAG).

Assessing Homicide Risk

Assessing long-term homicidal risk is a task best left to clinical and forensic psychologists or social workers who have training specifically in this area. On the other hand, short-term homicide risk (such as the kind required by Tarasoff ethics) can be learned by all social service workers.

Borum & Reddy (2001) provide an article to performing these assessments, and I’ve also written an article on basic homicide risk assessment that you may refer to.

Levels of Violence Intervention

There are 3 levels of intervention related to violence, depending on the situation. These are suggested by dos Reis et al. (2013) in the youth context. Stage 1 is simple behavioural management such as listening, stage 2 involves pharmacotherapy while stage 3 involves the most significant interventions such as restraints, seclusion or antipsychotics.

A different conceptualization more useful for adult clients is as follows:

  • Stage 1: Immediate intervention to prevent further escalation.
  • Stage 2: To reduce symptoms that can lead to aggression
  • Stage 3: Maintain safety of clients and staff

Stages of Violence Intervention (James, 2008)

  • Stage 1: Education
  • Stage 2: Avoidance of Conflict
  • Stage 3: Appeasement
  • Stage 4: Deflection
  • Stage 5: Time-Out
  • Stage 6: Show of Force
  • Stage 7: Seclusion
  • Stage 8: Restraints
  • Stage 9: Sedation

Violence Intervention Training

References

Borum, R. & Reddy, M. (2001) Assessing violence risk in tarasoff situations: A fact-based model of inquiry. Behavioral Sciences and the Law. 19:375-385. doi: 10.1002/bsl.447

Desmarais, S. L., Van Dorn, R. A., Johnson, K. L., Grimm, K. J., Douglas, K. S., & Swartz, M. S. (2014). Community Violence Perpetration and Victimization Among Adults With Mental Illnesses. American Journal Of Public Health, 104(12), 2342-2349. doi:10.2105/AJPH.2013.301680

dosReis, S., Barnett, S., Love, R.C. & Riddle, M.A. (2003) A Guide for Managing Acute Aggressive
Behavior of Youths in Residential
and Inpatient Treatment Facilities. Psychiatric Services. 54(10). Retrieved on March 26, 2017 from http://ps.psychiatryonline.org/doi/pdf/10.1176/appi.ps.54.10.1357

James, R.K. (2008) Crisis Intervention Strategies. Brooks/Cole: Belmont, CA.

Kellermann, A.L. & Mercy, J.A. (1992) Men, women, and murder: gender-specific differences in rates of fatal violence and victimization. Journal of Trauma. 33(1):1-5.

Neville, F. G., Goodall, C. A., Gavine, A. J., Williams, D. J., & Donnelly, P. D. (2015). Public health, youth violence, and perpetrator well-being. Peace And Conflict: Journal Of Peace Psychology, 21(3), 322-333. doi:10.1037/pac0000081

Occupational Safety and Health Administration (OSHA). (2012). Guidelines for Preventing Workplace Violence for Healthcare and Social Service Workers. Retrieved on March 25, 2017 from https://www.osha.gov/Publications/osha3148.pdf

Ogloff, J. P., & Daffern, M. (2006). The dynamic appraisal of situational aggression: an instrument to assess risk for imminent aggression in psychiatric inpatients. Behavioral Sciences & The Law, 24(6), 799-813. doi:10.1002/bsl.741

Sandvide, Å., Åström, S., Norberg, A., Saveman, B., & RNT. (2004). Violence in institutional care for elderly people from the perspective of involved care providers. Scandinavian Journal Of Caring Sciences, 18(4), 351-357. doi:10.1111/j.1471-6712.2004.00296.x

Stuart, H. (2003). Violence and mental illness: an overview. World Psychiatry, 2(2), 121–124.

Tomlinson, M. F., Brown, M., & Hoaken, P. N. (2016). Recreational drug use and human aggressive behavior: A comprehensive review since 2003. Aggression And Violent Behavior, 279-29. doi:10.1016/j.avb.2016.02.004

Torrey, F.E. (2015). Deinstitutionalization and the rise of violence. CNS Spectrums, 20(3), 207-214. doi:10.1017/S1092852914000753

Cite this article as: MacDonald, D.K., (2017), "Violence in the Social Services," retrieved on May 29, 2017 from http://dustinkmacdonald.com/violence-social-services/.

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Childhood and Adolescent Taxon Scale (CATS)

Introduction

The Childhood and Adolescent Taxon Scale (CATS) worksheet was originally created to accompany the Violence Risk Appraisal Guide (VRAG) and the Sex Offender Risk Appraisal Guide (SORAG). Although the Psychopathy Checklist-Revised (PCL-R; Hare, 1991) can be used to assess psychopathy, there are many situations where a Psychologist or other individual trained in the administration of this tool is not available. In this situation, the CATS tool can be used to assess psychopathy instead.

Quinsey et. al. (2006) determined that the CATS tool is an appropriate replacement for the PCL-R assessment when determining psychopathy on the VRAG and SORAG assessments. Lister (2010) examined the CATS and found that there were no differences in rates of psychopathy as determined by the PCL-R and the CATS with Caucasian and African-American individuals.

Conduct Disorder Symptoms

In order to answer question 4 below, it’s necessary to identify how many conduct disorder symptoms are present.

Count those present those that occurred before age 16 except for items 13 and 15 which are before aged 16:

  1. Often bullied, threatened or intimidated others
  2. Often initiated physical fights
  3. Used a weapon that could cause serious physical harm to others (e.g., a bat, brick, broken bottle, knife, gun)
  4. Was physically cruel to people
  5. Was physically cruel to animals
  6. Stolen while confronting a victim (e.g., mugging, purse snatching, extortion, robbery)
  7. Forced someone into sexual activity
  8. Deliberately engaged in fire setting with the intention of causing serious damage
  9. Deliberately destroyed others’ property (other than by fire setting)
  10. Broken into someone else’s house, car, or building
  11. Often lied to obtain goods or favors or to avoid obligations (i.e., “cons” others)
  12. Stolen items of nontrivial value without confronting a victim (like shoplifting, theft, or forgery)
  13. Before [age] 13, stayed out late at night, despite parental prohibitions
  14. Ran away from home overnight (or longer) at least twice while living in parental or parental surrogate home (or once without returning for a lengthy period)
  15. Before [age] 13, was often truant from school

Childhood & Adolescent Taxon Scale (CATS) Items

The CATS scale has 8 items that are reviewed below, along with supplementary scoring guidelines.

Elementary School Maladjustment

This refers to the first 8 years of formal schooling after kindgarten. A couple of incidents of truancy, smoking on school property or other minor incidents like this would be classified as Mild or Moderate. Severe incidents include repeated truancy or violent actions like assault. Also included in Severe is actions that result in criminal convictions like selling drugs at school.

  • 0 – No Problems
  • 0 – Slight (Minor discipline or attendance) or Moderate Problems
  • 1 – Severe Problems (Frequent disruptive behavior and/or attendance or behavior resulting in expulsion or serious suspensions)

Teenage Alcohol Problem

The National Institute on Alcohol Abuse and Alcoholism produces a guide to screening and intervening with youth (NIAAA, 2015) who consume alcohol. Their screening and assessment rubric can be used to determine if there is a teenage alcohol problem.

Based on the empirically determined risk guidelines, someone who is 12-15 and drinks more than 6 days in the past year would indicate a 1 below, someone who is 16 and drinks more than 12 days in the last year, someone who is 17 would need to drink more than 24 days while an individual who is 18 or higher would need to drink more than 52 days a year.

  • 0 – No
  • 1 – Yes

Childhood Aggression Rating

  • 0 – No Evidence of Aggression
  • 0 – Occasional Moderate Aggression
  • 1 – Occasional or Frequent Extreme Aggression

More Than 3 DSM Conduct Disorder Symptoms

These are the conduct disorder symptoms filled out below.

  • 0 – No
  • 1 – Yes

Ever suspended or expelled from school

  • 0 – No
  • 1 – Yes

Arrested under the age of 16

  • 0 – No
  • 1 – Yes

Lived with both biological parents to age 16 (except for death of parents)

Separation for more than one month is required for coding a “no” on this item. This could be because of institutionalization, divorce, or other separations but does not include death of one or both parents.

  • 0 – Yes
  • 1 – No

Scoring the CATS

Each of these items will result in a 0 or 1 score. All items are summed and the value can then be used to complete Item 12.b on the VRAG or item 14b on the SORAG.

References

American Psychological Association. (2006) Quinsey, V.L., Harris, G.T., Rice, M.E. & Cormier, C.A. (2006) 2nd Ed. Violent Offenders: Appraising and Managing Risk. Washington D.C: American Psychological Association.

Hare, R.D. (1991) The Hare Psychopathy Checklist-Revised (Hare PCL-R). Toronto: Multi-Health Systems.

Lister, M.B. (2010) A Comparison of the Violence Risk Appraisal Guide, Psychopathy Checklist, and child and Adolescent Taxon Scale: Predictive Utility And Cross Cultural Generalizable. Dissertation.

National Institute on Alcohol Abuse and Alcoholism (NIAAA). (2015). Alcohol Screening and Brief Intervention for Youth: A Practitioner’s Guide. Retrieved on January 28, 2017 from https://pubs.niaaa.nih.gov/publications/Practitioner/YouthGuide/YouthGuide.pdf

Cite this article as: MacDonald, D.K., (2017), "Childhood and Adolescent Taxon Scale (CATS)," retrieved on May 29, 2017 from http://dustinkmacdonald.com/childhood-adolescent-taxon-scale-cats/.
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Using the Sex Offender Risk Appraisal Guide (SORAG)

Introduction

Following up on my article about how to use the Violence Risk Appraisal Guide (VRAG), this article reviews how to use a tool that is bundled with that tool, the Sex Offender Risk Appraisal Guide (SORAG). Like the VRAG, this is an actuarial tool that can be used to predict the risk of re-offending among sex offenders.

Before reading about the SORAG, it is helpful to review the VRAG post as many of the elements that are covered in that post are required before proceeding to the SORAG items. It is recommended that any completion of the SORAG be preceded by a completion of the VRAG as this will save you a significant amount of time.

Completing the SORAG

Like the VRAG, the first step is to complete the Childhood & Adolescent Taxon Scale (CATS) worksheet and the list of Conduct Disorder Symptoms.

Cormier-Lang Criminal History Scores

In order to answer item 5 on the SORAG, Criminal History Score for Non-Violent Offenses Prior to the Index Offense, it’s necessary to complete the Cormier-Lang Criminal History worksheet also provided on the SORAG. This worksheet is completed by filling out the number of non-violent offenses and applying the weight to them noted on the sheet.

Sex Offender Risk Appraisal Guide (SORAG) Items

The SORAG itself has 14 items that are similar to those found on the VRAG.

  1. Lived with both biological parents to age 16 (except for death of parent)
  2. Elementary School Maladjustment
  3. History of alcohol problems
  4. Marital status (at the time of or prior to index offense)
  5. Criminal history score for nonviolent offenses (from Cormier-Lang system)
  6. Criminal history score for violent offenses (from Cormier-Lang system)
  7. Number of previous convictions for sexual offenses (pertains to convictions known from all available documentation to be sexual offenses prior to the index offense)
  8. History of sex offenses only against girls under 14 (including index offenses; if offender was less than 5 years older than victim, always score +4)
  9. Failure on prior conditional release (includes parole or probation violation or revocation, failure to comply, bail violation, and any new arrest while on conditional release)
  10. Age at index
  11. 11. Meets DSM criteria for any personality disorder (must be made by appropriately licensed or certified professional)
  12. Meets DSM criteria for schizophrenia (must be made by appropriately licensed or certified professional)
  13. Phallometric test results
  14. 14. a. Psychopathy Checklist score (if available, otherwise use item 12.b. CATS score)
    14. b. CATS score (from the CATS worksheet)
    14. WEIGHT (Use the highest circled weight from 12 a. or 12 b.)

You’ll note that many of these items are available from the VRAG. The tool indicates where there are overlaps in order to save you time filling out the worksheets and tools.

Determining Risk Level of Sex Offenders

After completing the tool, you must take the total score of the SORAG and compare it to the below levels.

  • A score of -17 to +2 indicates an individual is at Low risk for re-offending
  • A score of +3 to +19 indicates an individual is at Medium risk for re-offending
  • A score of +20 to +34 indicates an individual is at High risk for re-offending

An individual who is on the border between these two levels should have that indicated. For instance, someone who scores at +1 or +2 should be noted as “Low-Medium Risk” to highlight that they are at the edge of the established risk level.

Recidivism Rates using the SORAG

Rather than grouping an individual into low, medium or high risk categories, it is often more illuminating to examine the recidivism rates. These come from Violent Offenders as well.

Probability of Recidivism
SORAG score 7 years 10 years
< − 9 0.07 0.09
−9 to -4 0.15 0.12
-3 to +2 0.23 0.39
+3 to +8 0.39 0.59
+9 to +14 0.45 0.59
+15 to +19 0.58 0.76
+20 to +24 0.58 0.80
+25 to +30 0.75 0.89
> +31 1.00 1.00

References

American Psychological Association. (2006) Quinsey, V.L., Harris, G.T., Rice, M.E. & Cormier, C.A. (2006) 2nd Ed. Violent Offenders: Appraising and Managing Risk. Washington D.C: American Psychological Association.

Cite this article as: MacDonald, D.K., (2017), "Using the Sex Offender Risk Appraisal Guide (SORAG)," retrieved on May 29, 2017 from http://dustinkmacdonald.com/using-sex-offender-risk-appraisal-guide-sorag/.
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Dynamic Appraisal of Situational Aggression (DASA)

Introduction

The Dynamic Appraisal of Situational Aggression (DASA) is a tool developed by Ogloff & Daffern (2006) to assess the likelihood that a patient or client will become aggressive within a psychiatric inpatient environment. The DASA is based on the Norwegian Brøset-Violence-Checklist (BVC).

DASA Items

  1. Irritability
  2. Impulsivity
  3. Unwillingness to follow instructions
  4. Sensitive to perceived provocation
  5. Easily angered when requests are denied
  6. Negative attitudes
  7. Verbal threats.

Scoring the DASA

Each of the items are scored 0 if absent or 1 if is present now or has been present in the last 24 hours. This means that if someone is not currently displaying easy anger upon denied requests, but was earlier, that item should be scored 1.

There is no typical cut-off score for the DASA, although Barry-Walsh et. al. (2009) note in their research that “for each increase in DASA total score, there was a 1.77 times increased likelihood that the patient would behave aggressively in the following 24 hours.”

In Ogloff & Daffern’s original 2006 study

  • 18% of aggressive patients scored 1 to 3
  • 15% of aggressive patients scored 4 or 5
  • 55% of aggressive patients scored 6 or 7

Kaunomäki (2013) used a cut-off score of 4 to identify high-risk individuals.

DASA Research

A study of the DASA by Griffith, Daffern & Godber (2013) the DASA allowed nurses to predict aggressive behaviour significantly better than unaided judgements. Lantta et. al. (2016) confirmed the same on mental health inpatient units.

Taylor & Large (2013) question the predictive validity of the DASA, noting that of 200+ patients identified as potentially becoming aggressive, only one actually will. (This “low base rate” problem is the same issue affecting violence risk assessment and suicide risk assessment.)

Daffern & Howells (2007) compared the DASA with the HCR-20 and noted moderate predictive validity.

Current Use

The DASA is currently used by a variety of mental hospitals around the world. Some DASA write-ups include:

Reference

Barry-Walsh, J., Daffern, M., Duncan, S., & Ogloff, J. (2009). The prediction of imminent aggression in patients with mental illness and/or intellectual disability using the Dynamic Appraisal of Situational Aggression instrument. Australasian Psychiatry, 17(6), 493-496. doi:10.1080/10398560903289975

Chan, O. (2014) The Assessment of Imminent Aggression in Forensic Setting A Validation Study of the Dynamic Appraisal of Situational Aggression (DASA) in Hong Kong. Non-Peer Reviewed. Retrieved on November 13, 2016 from http://www.hkcpsych.org.hk/index.php?option=com_docman&task=doc_view&gid=1338&Itemid=354&lang=en

Daffern, M., & Howells, K. (2007). The Prediction of Imminent Aggression and Self-Harm in Personality Disordered Patients of a High Security Hospital Using the HCR-20 Clinical Scale and the Dynamic Appraisal of Situational Aggression. International Journal Of Forensic Mental Health, 6(2), 137.

Griffith, J. J., Daffern, M., & Godber, T. (2013). Examination of the predictive validity of the Dynamic Appraisal of Situational Aggression in two mental health units. International Journal Of Mental Health Nursing, 22(6), 485-492. doi:10.1111/inm.12011

Kaunomäki, J. (2015) Patient interventions after the assessment of violence risk: Observational study in a Finnish psychiatric admission ward. Institute of Behavioral Sciences. Thesis. Retrieved on November 13, 2016 from https://helda.helsinki.fi/bitstream/handle/10138/156453/Pro%20Gradu%20Kaunomäki%202015.pdf?sequence=3

Lantta, T., Kontio, R., Daffern, M., Adams, C. E., & Välimäki, M. (2016). Using the Dynamic Appraisal of Situational Aggression with mental health inpatients: a feasibility study. Patient Preference & Adherence, 10691-701. doi:10.2147/PPA.S103840

Ogloff, J. P., & Daffern, M. (2006). The dynamic appraisal of situational aggression: an instrument to assess risk for imminent aggression in psychiatric inpatients. Behavioral Sciences & The Law, 24(6), 799-813. doi:10.1002/bsl.741

Taylor, L., & Large, M. (2013). Dynamic Appraisal of Situational Aggression lacks utility. International Journal Of Mental Health Nursing, 22(6), 579. doi:10.1111/inm.12019

Cite this article as: MacDonald, D.K., (2016), "Dynamic Appraisal of Situational Aggression (DASA)," retrieved on May 29, 2017 from http://dustinkmacdonald.com/dynamic-appraisal-situational-aggression-dasa/.

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Biopsychosocial Model of Violence Risk Assessment

Introduction

Violence risk assessment is an important element of counselling and crisis intervention. Although in high-risk situations it can (and should be) performed by clinicians with specific training in violence risk, there may be situations where clinicians or others (corrections officers, private practice therapists, crisis line supervisors, etc.) need to have a understanding of the principles of violence risk assessment in order to respond appropriately.

Types of Violence Risk Assessment

There are three types of violence risk assessment, based on the way risk is estimated or “calculated.” The first is unstructured professional judgement. This is where the clinician merely listens to the client and makes their best judgement, based on their existing professional training. (Murray & Thomson, 2010) While some professionals made good predictions relative to others, some were very poor. It emerged that the reason for this disparity was that some clinicians considered factors relevant to violence while others did not. Unstructured professional judgement no longer stands up in court.

The second form of risk assessment is known as actuarial risk assessment. This is an entirely mathematical technique that examines what factors were present in offenders who later went on to commit violent crimes. (Brown & Singh, 2014) This is similar to the approach used in insurance to calculate the likelihood a person will die, and has the same flaw as that approach: you can determine over a large pool what percentage of individuals will be violent, but you risk ignoring salient risk or protective factors in an individual that may heighten or reduce their violence risk.

The final form of risk assessment is Structured Professional Judgement (SPJ; Falzer, 2013). SPJ attempts to merge the predictive ability of the actuarial approach with the flexibility of the unstructured approach by providing a list of evidence-based risk factors (elements that have been demonstrated to increase risk of violence) along with a coding or scoring method to generate a “Low”, “Moderate”, or “High” risk, and usually the freedom to modify the scoring for items or list additional contributing factors that entered into a clinician’s assessment.

Static vs Dynamic Risk Factors

Static risk factors are elements that are known to increase risk that are not changeable. An example of static risk factors for violence include sex and age. As a male, you will always have elevated risk of violence versus a female (Sorrentino, Friedman, & Hall, 2016), and as someone who is aged 18-24 you will always have a heightened risk of violence relative to someone older or younger. (Harris & Rice, 2007) There is nothing a clinician can do to change your age or sex.

On the other hand, other risk factors are called dynamic risk factors. These are factors that can be modified by the clinician or by the client (Public Safety Canada, 2010), such as one’s peer group, use of alcohol or stimulants, or access to a pool of victims.

Affective vs. Predatory Violence

Affective violence is also called impulsive or reactive violence. (Berg, 2014) This is violence that results from a threat, causes an individual to experience physiological arousal (heart racing, blood pressure increase, etc.) and then to strike back in a “fight or flight” response.

In contrast, predatory violence is more common among psychopaths and serial killers. This is violence that is not associated with an increase in physiological arousal or an identified threat. Instead, the predatory killer “stalks his prey” and then strikes without warning.

Biopsychosocial Model Items

This model comes from “Violence Risk and Threat Assessment” by Meloy (2000), but closely matches other models of violence risk.

Individual/Psychological Domain

  • Male
  • Age
  • Past History of Violence
  • Paranoia
  • Intelligence Below Average
  • Anger/Fear Problems
  • Psychopathy / Other Attachment Difficulties

Social/Environmental Domain

  • Family of Origin Violence
  • Adolescent Peer Group Violence
  • Economic Instability
  • Weapons History/Skill/Interest and Approach Behaviour
  • Victim Pool
  • Alcohol/Psychostimulant Use
  • Popular Culture

Biological Domain

  • History of CNS Trauma
  • Signs and Symptoms
  • Objective CNS Measures
  • Major Mental Disorder

Assessing Psychological Factors of Violence Risk

The elements in the psychological or individual domain cover static and dynamic items that relate to the person’s mental health and personal demographics. They include:

Men are up to 10x more likely to be involved in violence than women (Meloy, 2000; p.19); sex is a static variable. Significantly more crimes are committed before the age of 25 (Bureau of Justice Statistics, 2011), therefore age is an important static variable. Past history of behaviour is one of the most important future predictors of future violence. If the situations that led to violence in the past aren’t modified, we will find ourselves in them in the future, therefore Past History of Violence becomes an important static behaviour.

Other elements associated with increased violence risk include acute paranoia or a delusional state (Yang, 2008); this can cause them to genuinely believe they are in danger, and therefore Not Guilty by Reason of Insanity (NGRI) or Not Criminally Responsible (NCR). Someone in a paranoid state, with thought insertion or homicidal thoughts needs immediate psychiatric attention.

Below average intelligence and anger/fear problems are linked to the concept of affective violence above. Lower levels of intelligence are perhaps linked to violence in that people cannot think of responses quick enough to avoid violence (Freeman, 2012), and may find themselves unable to label or understand their emotions. Anger and fear problems cause an increase in violence by causing an individual to perceive threats where maybe none exists. It is the presence of these threats that causes affective violence (Helfgott, 2008)

Psychopathy and other attachment difficulties are associated with an increased risk of predatory violence. Psychopaths have difficulty perceiving empathy for others, and individuals who lack attachments may be able to cause those individuals pain without considering the impact their actions have on those people. (Brook & Cosson, 2013) A standardized assessment like the PCL-R (Hare Psychopathy Checklist–Revised; Hare, 2003) can be used to assess for the presence of psychopathy, with a score of 30 (out of 40) indicating psychopathy.

Assessing Social Factors of Violence Risk

Social factors of violence risk include those individuals that are around us who can model violent behaviour, and are caused by factors beyond mental health.

Family of origin violence (a static risk factor) and adolescent peer group violence (a dynamic risk factor) are both risk factors because of the ability of them to model answers to threats or problems that involve violence (Franklin, Menaker & Kercher, 2011), rather than non-violent alternatives. Additionally, family of origin violence can lead to a sense of detachment which can involve the attachment difficulties noted in the Psychological Factors above; finally, a family that suppresses emotional expression may prevent men from ventilating their stress until it is expressed in a maladaptive way (e.g. through violence.)

Economic instability or poverty is a static or dynamic risk factor for violence (McAra, & McVie, 2016) because of the known causal relationship between poverty and violence; additionally, for those who are at risk of or have recently lost their jobs, intense anger can cause violent acts and so should be kept in mind. (Catalano, Novaco, & McConnell, 1997)

Weapons history/skill/interest is a static variable and approach behaviour is a dynamic behaviour. The first set refers to a potentially violent individual’s history with weapons, especially firearms. Do they own any guns, have they received professional training (e.g. police, military, private instruction)? Owning guns does not make a person more violent on their own, but they do provide a violent individual with easier tools with which to carry out their violence.

“Approach behaviour” (Meloy, 2000; p.57) is the term used to describe what someone does when they cannot possess guns (for instance, because of a felony conviction or financial reasons). This could include reading about guns, owning gun accessories and being around people who own guns. Approach behaviour is  a person’s ability to “approach” the off-limits items psychologically. The more approach behaviour is noted, the higher the violence risk is.

Victim pool is important in assessing violence risk because violence does not occur in a vacuum. This is especially important in predatory violence (such as sex offenders or serial killers) but may also be important for gang members or others who only become violent in specific, limited situations. Meloy (1996) discusses this in particular in violent stalkers but it applies equally to all violent crimes.

Drugs and alcohol (especially psychostimulants like cocaine) increase violence risk by reducing one’s inhibition and increasing impulsiveness. (Haggård-Grann, Hallqvist, Långström, & Möller, 2006) Additionally, stimulants like cocaine, methamphetamine and others can cause “stimulant psychosis” (Curran, Byrappa & Mcbride, 2004), a condition that can cause paranoia and homicidal thoughts.

The last element in assessing social factors of violence risk is popular culture. (De Venanzi, 2012) This is a controversial element but like suicide contagion, mass media glorifying elements of homicide can increase the risk of violence in vulnerable individuals. It’s important to pay close attention to court cases, movies or other elements that the person being assessed may identify with.

Assessing Biological Factors of Violence Risk

Biological factors are elements not related to a person’s mental health or social environment, but rather their neurological. They include a history of central nervous system (CNS) trauma (Rao et. al., 2009), signs and symptoms of CNS problems (such as headaches, dizziness, memory difficulties, and many others), objective CNS measures and the presence of a mental health diagnosis. (Rueve & Welton, 2008)

With the exception of some CNS measures which may be administered by clinicians, these items are most easily determined by a neuropsychologist or neurologist who can perform the required brain scans and administer and interpret the tests for CNS function. Major mental disorders may be diagnosed by social workers in some jurisdictions, or may be required to be diagnosed by a psychologist or psychiatrist in others.

Violence Risk Assessment Tools

Below are some tools that I’ve got articles for on my blog.

Other Resources

References

Bureau of Justice Statistics. (2011) “Homicide Trends in the United States, 1980-2008” Retrieved on October 28, 2016 from https://www.bjs.gov/content/pub/pdf/htus8008.pdf

Berg, L. (2014) “Comparing Predatory Versus Affective Violence and Examining Early Life Stress as a Risk Factor” Writing Excellence Award Winners. Paper 37. Retrieved on October 28, 2016 from http://soundideas.pugetsound.edu/writing_awards/37

Brown, J. & Singh, J.P. (2014) Forensic Risk Assessment: A Beginner’s Guide. Archives of Forensic Psychology. 1(1). 49-59. Retrieved on October 28, 2016 from http://www.archivesofforensicpsychology.com/web/wp-content/uploads/2015/01/Brown-and-Singh1.pdf

Brook, M., & Kosson, D. S. (2013). Impaired cognitive empathy in criminal psychopathy: Evidence from a laboratory measure of empathic accuracy. Journal Of Abnormal Psychology, 122(1), 156-166. doi:10.1037/a0030261

Catalano, R., Novaco, R., & McConnell, W. (1997). A model of the net effect of job loss on violence. Journal Of Personality And Social Psychology, 72(6), 1440-1447. doi:10.1037/0022-3514.72.6.1440

Curran, C., Byrappa, N. & Mcbride, A. (2004) Stimulant psychosis: systematic review. British Journal of Psychiatry. 

De Venanzi, A. (2012). School shootings in the USA: Popular culture as risk, teen marginality, and violence against peers. Crime, Media, Culture, 8(3), 261-278. doi:10.1177/1741659012443233

Falzer, P. R. (2013). Valuing Structured Professional Judgment: Predictive Validity, Decision-making, and the Clinical-Actuarial Conflict. Behavioral Sciences & The Law, 31(1), 40-54. doi:10.1002/bsl.2043

Franklin, C. A., Menaker, T.A. & Kercher, G.A. (2011) The Effects of Family-of-Origin Violence on Intimate Partner Violence. Crime Victims’ Institute. Retrieved on October 28, 2016 from http://dev.cjcenter.org/_files/cvi/7935%20Family%20of%20Origin%20Violence.pdf

Freeman, G. (2012) The relationship between lower intelligence, crime and custodial outcomes: a brief literary review of a vulnerable group. Journal of Society, Health & Vulnerability. Volume 3. Retrieved on October 28, 2016 from http://www.societyhealthvulnerability.net/index.php/shv/article/view/14834/22691

Hare, R. D. (2003). Manual for the Revised Psychopathy Checklist (2nd ed.). Toronto, ON, Canada: Multi-Health Systems

Haggård-Grann, U., Hallqvist, J., Långström, N., & Möller, J. (2006). The role of alcohol and drugs in triggering criminal violence: a case-crossover study. Addiction, 101(1), 100-108.

Harris, G. T., & Rice, M. E. (2007). Adjusting Actuarial Violence Risk Assessments Based on Aging or the Passage of Time. Criminal Justice & Behavior, 34(3), 297. doi:10.1177/0093854806293486

Helfgott, J.B. (2008) Criminal Behavior: Theories, Typologies and Criminal Justice. Thousand Oaks, CA: SAGE Publications.

McAra, L., & McVie, S. (2016). Understanding youth violence: The mediating effects of gender, poverty and vulnerability. Journal Of Criminal Justice, 45. 71-77. doi:10.1016/j.jcrimjus.2016.02.011

Meloy, J.R. (1996) Stalking (Obsessional Following): A Review of Some Preliminary Studies. Aggression and Violent Behavior. 1(2). 147-162. http://drreidmeloy.com/wp-content/uploads/2015/12/1996_StalkingObsessi.pdf

Meloy, J. R. (2000). Violence risk and threat assessment. San Diego, CA: Specialized Training Services.

Murray, J., & Thomson, M. E. (2010). Clinical judgement in violence risk assessment. Europe’s Journal Of Psychology, 127-149.

Public Safety Canada. (2010) “Giving Meaning to Risk Factors.” Research Summary. 15(6) Retrieved on October 28, 2016 from https://www.publicsafety.gc.ca/cnt/rsrcs/pblctns/mnng-fctrs/mnng-fctrs-eng.pdf

Rueve, M.E & Welton, R.S. (2008) Violence and Mental Illness. Psychiatry.

Sorrentino, R., Friedman, S. H., & Hall, R. (2016). Gender Considerations in Violence. Psychiatric Clinics Of North America, doi:10.1016/j.psc.2016.07.002

Yang, S. (2008) Dangerously Paranoid? Overview and Strategies for a Psychiatric Evaluation of a Highly Prevalent Syndrome. Psychiatric Times.
Rao, V., Rosenberg, P., Bertrand, M., Salehinia, S., Spiro, J., Vaishnavi, S., Rastogi, P., Noll, K., Schretlen, D.J., Brandt, J., Cornwell, E., Makley, M. & Miles, Q.S. (2009) Aggression After Traumatic Brain Injury: Prevalence and Correlates. The Journal of Neuropsychiatry and Clinical Neurosciences. 21(4):420-429
Cite this article as: MacDonald, D.K., (2016), "Biopsychosocial Model of Violence Risk Assessment," retrieved on May 29, 2017 from http://dustinkmacdonald.com/biopsychosocial-model-violence-risk-assessment/.
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