Katharina Seewald

International Perspectives on the Practical Application of Violence Risk Assessment: A Global Survey of 44 Countries

Mental health professionals are routinely called upon to assess the risk of violence presented by their patients. Prior surveys of risk assessment methods have been largely circumscribed to individual countries and have not compared the practices of different professional disciplines. Therefore, a Web-based survey was developed to examine methods of violence risk assessment across six continents, and to compare the perceived utility of these methods by psychologists, psychiatrists, and nurses. The survey was translated into nine languages and distributed to members of 59 national and international organizations. Surveys were completed by 2135 respondents from 44 countries. Respondents in all six continents reported using instruments to assess, manage, and monitor violence risk, with over half of risk assessments in the past 12 months conducted using such an instrument. Respondents in Asia and South America reported conducting fewer structured assessments, and psychologists reported using instruments more than psychiatrists or nurses. Feedback regarding outcomes was not common: respondents who conducted structured risk assessments reported receiving feedback on accuracy in under 40% of cases, and those who used instruments to develop management plans reported feedback on whether plans were implemented in under 50% of cases. When information on the latter was obtained, risk management plans were not implemented in over a third of cases. Results suggest that violence risk assessment is a global phenomenon, as is the use of instruments to assist in this task. Improved feedback following risk assessments and the development of risk management plans could improve the efficacy of health services.

Violence Risk Assessment Practices in Denmark: A Multidisciplinary National Survey

Abstract With a quadrupling of forensic psychiatric patients in Denmark over the past 20 years, focus on violence risk assessment practices across the country has increased. However, information is lacking regarding Danish risk assessment practice across professional disciplines and clinical settings; little is known about how violence risk assessments are conducted, which instruments are used for what purposes, and how mental health professionals rate their utility and costs. As part of a global survey exploring the application of violence risk assessment across 44 countries, the current study investigated Danish practice across several professional disciplines and settings in which forensic and high-risk mental health patients are assessed and treated. In total, 125 mental health professionals across the country completed the survey. The five instruments that respondents reported most commonly using for risk assessment, risk management planning and risk monitoring were Broset, HCR-20, the START, the PCL-R, and the PCL:SV. Whereas the HCR-20 was rated highest in usefulness for risk assessment, the START was rated most useful for risk management and risk monitoring. No significant differences in utility were observed across professional groups. Unstructured clinical judgments were reported to be faster but more expensive to conduct than using a risk assessment instrument. Implications for clinical practice are discussed.

Effectiveness of a risk–need–responsivity-based treatment program for violent and sexual offenders : Results of a retrospective, quasi-experimental study

Effectiveness of a risk–need–responsivity-based treatment program for violent and sexual offenders: Results of a retrospective, quasi-experimental study Katharina Seewald, Astrid Rossegger, Juliane Gerth, Frank Urbaniok, Gary Phillips and J erôme Endrass* Department of Psychology, University of Konstanz, Germany Department of Mental Health Services, Office of Corrections, Canton of Zurich, Switzerland Gary S. Phillips, MAS Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University College of Medicine, Columbus, Ohio, USA

Assessing the Risk of Intimate Partner Violence: Expert Evaluations Versus the Ontario Domestic Assault Risk Assessment

ABSTRACT In the forensic field, a reliable and valid assessment of domestic perpetrators who pose a high risk of reassaulting an intimate partner is needed to implement effective risk management strategies. The purpose of the present study was to examine the accuracy of two violence risk assessment methods in identifying high-risk perpetrators of IPV, comparing forensic experts with psychology students. For a cohort (n = 30) of domestic violent cases that required an expert evaluation in the Canton of Zurich in Switzerland, violence risk was assessed by certified forensic psychiatrists using unstructured clinical judgment (UCJ) and by undergraduate and graduate research assistants scoring the actuarial Ontario Domestic Assault Risk Assessment (ODARA) instrument. After a mean follow-up period of 8.0 years, the base rate of violent recidivism was 20.0%. Students were significantly more accurate than clinical experts in assessing long-term violent recidivism (AUC = 0.78 vs. 0.44). Raters without extensive clinical training could differentiate those spouses who carried on assaulting their intimate partner from those who desisted from violent behavior. Potential explanations are clinical assessment biases and the mediating effect of interventions. Further research should address the lack of use of mechanical instruments in clinical forensic practice.