Edward P. Mulvey

A classification tree approach to the development of actuarial violence risk assessment tools

Since the 1970s, a wide body of research has suggested that the accuracy of clinical risk assessments of violence might be increased if clinicians used actuarial tools. Despite considerable progress in recent years in the development of such tools for violence risk assessment, they remain primarily research instruments, largely ignored in daily clinical practice. We argue that because most existing actuarial tools are based on a main effects regression approach, they do not adequately reflect the contingent nature of the clinical assessment processes. To enhance the use of actuarial violence risk assessment tools, we propose a classification tree rather than a main effects regression approach. In addition, we suggest that by employing two decision thresholds for identifying high- and low-risk cases--instead of the standard single threshold--the use of actuarial tools to make dichotomous risk classification decisions may be further enhanced. These claims are supported with empirical data from the MacArthur Violence Risk Assessment Study.

Neighborhood structural characteristics and mental disorder: Faris and Dunham revisited.

We examined the relationship between neighborhood structural characteristics and mental disorder using data from the National Institute of Mental Healths Epidemiological Catchment (ECA) surveys (n = 11,686). After controlling for individual-level characteristics, we found that neighborhood disadvantage was associated with higher rates of major depression and substance abuse disorder, and that neighborhood residential mobility was associated with higher rates of schizophrenia, major depression, and substance abuse disorder. Implications for future research on the social ecology of mental disorder are discussed.

Theory and Research on Desistance from Antisocial Activity among Serious Adolescent Offenders

Improving juvenile court decision making requires information about how serious adolescent offenders desist from antisocial activity. A systematic research agenda on this topic requires consideration of several processes, including normative development in late adolescence, what constitutes desistance, and the factors likely to promote the end of involvement in antisocial behavior and successful adjustment in early adulthood. This article presents an overview of the major points to consider in pursuing this research agenda.

Psychopathy and community violence among civil psychiatric patients: results from the MacArthur Violence Risk Assessment Study

Although psychopathy is recognized as a relatively strong risk factor for violence among inmates and mentally disordered offenders, few studies have examined the extent to which its predictive power generalizes to civil psychiatric samples. Using data on 1,136 patients from the MacArthur Violence Risk Assessment project, this study examined whether the 2 scales that underlie the Psychopathy Checklist: Screening Version (PCL:SV) measure a unique personality construct that predicts violence among civil patients. The results indicate that the PCL:SV is a relatively strong predictor of violence. The PCL:SVs predictive power is substantially reduced, but remains significant, after controlling for a host of covariates that reflect antisocial behavior and personality disorders other than psychopathy. However, the predictive power of the PCL:SV is not based on its assessment of the core traits of psychopathy, as traditionally construed. Implications for the 2-factor model that underlies the PCL measures and for risk assessment practice are discussed.

Assessing the Impact of Exposure Time and Incapacitation on Longitudinal Trajectories of Criminal Offending

The authors examine the potential effect of accounting for exposure time by examining the arrests of 272 serious offenders who were paroled at age 18 and followed through age 33. The authors describe the overall change in the arrest rate over the 16-year period, with and without adjustments for exposure time. The authors also estimate latent class models that decompose the heterogeneity of arrest rate trends, with and without variation in exposure time. Two results are noteworthy: (a) conclusions about the level of arrest activity did depend on adjustments for exposure time, but the overall trend in arrest activity did not depend on these adjustments; and (b) latent class analysis without exposure time adjustments suggested that more than 92% of the sample exhibited their highest level of arrest activity in late teens and early 20s; then offending declined during the late 20s and early 30s. When adjusted for exposure time, the analysis revealed that about 72% of the sample exhibited this decline; the remainder remained quite active in offending.

Operational Lessons from the Pathways to Desistance Project

Implementing a large, longitudinal study of any sample is a major undertaking. The challenges are compounded when the study involves multiple sites and a high-risk sample. This article outlines the methodology for the Pathways to Desistance study, a multisite, longitudinal study of serious juvenile offenders, and discusses the key operational decisions with the greatest impact on the study design.

Psychopathy, treatment involvement, and subsequent violence among civil psychiatric patients.

Individuals with psychopathy typically are viewed as incurable cases that should be diverted from treatment settings to environments where their behavior can be monitored and controlled. The prevailing clinical conviction that psychopaths are untreatable has crucial implications, given the scarcity of mental health care resources, the number of legal contexts that call for assessment of treatability, and the explosion of research on psychopathy and violence risk over recent years. Based on a sample of 871 civil psychiatric patients (including 195 “potentially psychopathic” and 72 “psychopathic” patients), this study explores the relations among psychopathy, receipt of outpatient mental health services in real-world settings, and subsequent violence in the community. The results suggest that psychopathic traits do not moderate the effect of treatment involvement on violence, even after controlling statistically for the treatment assignment process. Psychopathic patients appear as likely as nonpsychopathic patients to benefit from adequate doses of treatment, in terms of violence reduction. We interpret these results in light of prior research with offenders and analyze their implications for future research, policy, and practice.

Assessing violence risk among discharged psychiatric patients: toward an ecological approach.

This paper draws upon data from the Pittsburgh site of the MacArthur Foundations Risk Assessment Study, a large-scale study of violence risk among persons discharged from psychiatric hospitals, to examine the effect of the neighborhood context on risk of violence. This paper has two purposes: (1) to assess the extent to which the inclusion of neighborhood characteristics enhances violence prediction models—models that traditionally only include individual-level characteristics; and (2) to assess the consistency of individual level risk factors across different neighborhood contexts. Results indicate that neighborhood poverty has an impact over and above the effects of individual characteristics in identifying cases with violence. These findings support efforts to include neighborhood context in the assessment and management of violence risk among discharged psychiatric patients.

Violent juvenile delinquents. treatment effectiveness and implications for future action

Traditionally, the juvenile justice system has emphasized the goals of treatment and rehabilitation of young offenders, while protecting them from punishment, retribution, and stigmatization. Violent juvenile offenders have posed a challenge to this rehabilitative ideal because of mounting public pressure to ensure societal protection. Juveniles who are perceived as dangerous or persistent in their criminal activity are increasingly transferred to the adult criminal justice system, where they may receive much harsher consequences. Whether violent delinquents can be successfully treated is a key point in the debate regarding the wisdom of this trend in juvenile justice. This article considers the available research to address the policy question of how society should reasonably invest in the treatment of violent juvenile offenders.

The prevention and treatment of juvenile delinquency: A review of the research

Abstract This article reviews available evidence regarding the effectiveness of prevention and treatment programs to reduce juvenile delinquency. A broad range of primary, secondary, and tertiary prevention programs are considered. The conclusions reached from this review are that interventions must be broadly based, extend over long time periods of development, and be assessed with fuller characterization of operational regularities.