Published jointly by the Mental Health, Law, and Policy Institute
of Simon Fraser University, the Pacific Psychological Assessment Corporation,
and the British Columbia Institute Against Family
Violence
128
Pages, $50.00 USD from www.pacific-psych.com/product.htm#RSVP
Review by David Prescott, Forum Editor
Appeared in The ATSA Forum Newsletter, Fall 2004
The
assessment of dangerousness can, itself, be a dangerous undertaking.
Disagreement and acrimony erupt
throughout the
literature. Despite evidence showing the improvement of empirically
derived assessments over unstructured clinical judgments, numerous
questions remain: How closely did the research conditions resemble
current practice conditions? How closely did the tasks of research
subjects match the referral questions of practitioners today? Armed
with the recent research data, can’t clinicians now go about their
assessments more effectively? Or is the fundamental problem that
some clinicians are less motivated to base their assessments on what
the
research tells us?
The predictive validity of many current
actuarial methods for assessing risk of sexual recidivism has already
been described
(Hanson & Morton-Bourgon, 2004). However, their utility beyond
risk classification can be limited, albeit with some exceptions (Roberts,
Doren, & Thornton, 2002; Doren, 2002). Many (e.g. Hart, Laws, & Kropp,
2003) highlight the potential shortcomings of these methods. Still
others (e.g. Beech & Ward, in press; Zamble & Quinsey, 1997)
offer ideas for further refinement and suggest that static factors
are best considered as markers for underlying dynamic processes.
Ultimately, only one thing is clear:
There are many reasons to assess risk, and many frameworks (clinical
and forensic)
in which to assess it. No assessment scheme speaks to every referral
question, practice context, or legal application. In 2000, Serin & Brown
developed their “10 Commandments of Risk Assessment”. These are:
1)
Thou shalt know thy base-rate
2)
Thou shalt use multi-method assessment strategies
3)
Thou shalt not confuse shared method variance with increased validity
(i.e. more information does not necessarily increase accuracy)
4)
Thou shalt be wary of clinical overrides
5)
Thou shalt heed statistical estimates
6)
Thou shalt not covet thy neighbor’s data
7)
Thou shalt know the limits of thy prediction
8)
Thou shalt know thy false positive and false negative rates for specific
cutoffs
9)
Thou shalt provide conditional predictions
10)
Thou shalt follow an aide-memoire
More recently,
Webster, Hucker, & Bloom (2002)
have offered five guidelines for “transcending the actuarial versus
clinical polemic in assessing risk for violence”:
1.
Understand the applicable legal framework
2.
Make risk assessments evidenced-based
3.
Provide an individualized statement of risk
4.
Include steps to reduce that risk
5.
Compare the individual case with scientific data when possible
The RSVP incorporates many, if not
all, of these latter guidelines. It contributes to comprehensive risk
assessment formulations
beyond simple categorization. It is structured to distinguish between
the identification of risk factors and determination of their relevance
to future offending. While the implicit aim of most risk assessment
is the prevention of further sexual abuse, their design tends to be
limited to classification of risk or a probabilistic statement. The
RSVP’s primary and explicit focus is in prevention, as well as protection
of past and future victims.
The RSVP is designed to provide structure
to professional judgement. It is not intended as a revision of the
Sexual Violence
Risk 20 (SVR-20; Boer, Hart, Kropp, & Webster, 1998) or the Sex
Offender Risk Assessment (SORA; Atkinson, Kropp, Laws, & Hart,
1996), but has clearly evolved from both. The authors chose risk factors
based on empirical, clinical, and legal criteria, selecting those associated
with the nature, severity, frequency, imminence, and likelihood of
sexual violence. They further attempted to conceptualize these factors
at a basic level in order to provide clear definitions to help inform
risk management decisions. The authors are clear that the RSVP represents
their own opinions and judgments, and not necessarily those of any
professional organization. There are no restrictions on purchasing
the RSVP, but the authors state it “may be considered a psychological
test” (P. 15).
Administration of the RSVP includes six steps:
1. Gathering and evaluating
case information (including: gathering case information regarding
the individual’s history of sexual violence,
in multiple domains; using multiple methods from multiple sources,
and concerning static and dynamic aspects. Information should be
updated and documented, and its adequacy evaluated.)
2.
Establishing the presence of risk factors (including coding some as
provisional, or omitting them due to lack of information)
3.
Establishing the relevance of risk factors
4. Establishing
risk scenarios (including the questions: “What is it I’m
trying to prevent? What exactly is it I’m worried the person might
do?)
5.
Development of risk management strategies (including monitoring, treatment,
supervision, and victim safety planning)
6.
Summary judgments (including: case prioritization from low/routine
through moderate/elevated to high/urgent, with consideration given
to risk of serious physical harm/need for immediate action and other
risks that may be indicated)
Twenty-two risk factors are presented in five domains:
Sexual Violence, Psychological Adjustment, Mental Disorder, Social
Adjustment, and Manageability. Each factor is given a description with
reference to literature that supports it. No specific protective aspects
that might serve to mitigate risk are offered directly. Although the
absence of some factors might serve a protective function (e.g. problems
with intimate relationships), no discussion is provided on how best
to understand the absence of risk factors. Also excluded is discussion
related to the combination of psychopathy and sexual deviance (Quinsey,
Harris, Rice, & Cormier, 1998; Serin, Mailloux, & Malcolm,
2001). While “treatment problems” are defined effectively, this
factor could benefit from more consideration of how different treatment
strategies apply to certain types of offenders. Examples might include
empathy training for those high in psychopathic traits, or aversive
reconditioning for those whose offending is
related more to antisociality than sexual deviance. Finally, the RSVP
does not discuss the need to anchor assessments in applicable base
rate information.
Without a doubt the RSVP will assist many evaluators
in structuring assessments, refining their formulations, and communicating
their findings in this most important work. It is applicable to diverse
situations. Further, it will assist in the construction of assessment-driven
treatment plans. Its main advantage, beyond its explicit structure
and focus on prevention, lies in its capacity to remind evaluators
to consider aspects they might have forgotten, and to give thought
to elements that they might otherwise not want to consider. Given its
price and advantages, it will benefit anyone interested in risk assessment.
It builds on the SVR-20 without negating it. It is a welcome contribution
to the literature.
The RSVP would benefit from additional
development in a number of areas. Discussion of current thought into
risk, need,
and responsivity (Andrews & Bonta, 1998) might help evaluators
understand the contribution of risk factors that receive inconsistent
support in the literature, and whose role in an offense may be less
direct than others. Inclusion of current thought into the nature of
acute and stable dynamic risk (as “states and traits”; Beech & Ward,
in press) might also be helpful.
Those entering the unenviable world of risk assessment
are implicitly asked to decide amongst a range of competing perspectives
in high-stakes situations. Many have strong opinions about the meaning
of research findings. There is still a dearth of recommendations for
reconciling the diversity of thought in risk assessment. One might
wish for a more integrated (but still structured and explicit) means
to understand and communicate risk of harm for people across the life
span. No method fully assists practitioners in making sense of what
is known to this point.
Despite its appeal and comprehensive
approach, the RSVP risks continuing much of the debate it might otherwise
have resolved.
Section titles such as “the alleged superiority of actuarial risk assessment
do little to move past an arguably insubstantial debate. One could
argue that the RSVP itself has not yet been demonstrated to be effective,
either. Its predictive validity and inter-rater reliability remain
unknown. In their introduction, the authors present
their own perspective on the actuarial-versus-clinical controversy:
“Despite recent advances in research
(or perhaps more accurately, because of them) there is considerable
debate concerning best practices with respect to sex offender assessment… The
optimistic view highlights the promise of risk assessment. The promise
is that risk procedures can identify the specific or absolute probability
that any given offender will commit another sexual offense… The optimists
believe that such prognoses are stable and accurate, and will assist
in making important decisions about sexual offenders. In contrast,
pessimists highlight the peril. Their primary concern is that mental
health professionals who conduct risk assessments over-rely on methods
of unknown or limited value, pretending a degree of scientific support
and precision that has not been attained… One potential consequence
is that important decisions will be based on professional opinions
of questionable value; another is that decision-makers are encouraged
to think about management in very simplistic terms.” (P. 2)
Ultimately, one might hope that future manuals of
this sort will offer resolution to both promise and peril, and offer
greater insight into how we can best understand those factors whose
empirical support is inconsistent. In the meantime, it is probably
not enough to study risk assessment methods and their development.
One should study how the field produces such diversity of thought.
Despite the areas where the RSVP would be aided by further development,
it will benefit those struggling with risk assessment, treatment planning,
and other aspects of reducing the harm of sexual abuse.
References
Andrews,
D.A. & Bonta, J.L. (1998) The Psychology of Criminal Conduct, Second Edition. Cincinnati: Anderson Publishing.
Atkinson, R.L., Kropp, P.R., Laws, D.R., & Hart,
S.D. (1996). Scoring
Manual for the Sex Offender Risk Assessment Guide (SORA).
Vancouver: The British Columbia Institute Against Family Violence & The
Mental Health, Law, and Policy Institute.
Beech, A.R. & Ward, T. (in press). The integration of
etiology and risk in sexual offenders: A theoretical framework. Aggression and Violent Behavior.
Boer, D.P., Hart, S.D., Kropp, P.R., & Webster, C.D. (1998). Manual
for the Sexual Violence Risk – 20: Professional Guidelines for Assessing
Risk of Sexual Violence. Lutz, Florida: Psychological Assessment Resources, Inc.
Hanson, R.K., & Morton-Bourgon,
K.E. (2004). Predictors of sexual recidivism: An updated meta-analysis. Available
at: www.psepc.gc.ca/publications/corrections/pdf/200402_e.pdf .
Hart, S.D., Laws, D.R., & Kropp,
R. P. (2003). The promise and peril of sex offender risk assessment,
in Ward, T., Laws, D.R., & Hudson, S.M. (eds.). Sexual Deviance: Issues and Controversies. Thousand
Oaks, CA: Sage Publications.
Quinsey, V.L., Harris, G.T., Rice, M.E., & Cormier, C.A. (1998). Violent
offenders: Appraising and managing risk. Washington, D.C.:
American Psychological Association.
Roberts, C.F., Doren, D.M., & Thornton, D. (2002). Dimensions
associated with sex offender recidivism risk, Criminal Justice and Behavior, 29, 569-589.
Serin, R.C. & Brown, S.L. (2000). The
clinical use of the Hare Psychopathy Checklist – Revised in contemporary
risk assessment, in Gacono, C.G. (ed.), The
Clinical and Forensic Assessment of Psychopathy. Mahwah, NJ: Lawrence Erlbaum
Associates.
Serin, R.C., Mailloux,
D.L., & Malcolm, P.B. (2001). Psychopathy,
deviant sexual arousal, and recidivism among sexual offenders. Journal of Interpersonal Violence, 16(3),
234-246.
Webster, C.D., Hucker, S.J. & Bloom, H. (2002). Transcending
the actuarial versus clinical polemic in assessing risk for violence, Criminal
Justice and Behavior, 29 (5) 659-665.
Zamble, E., & Quinsey, V.L. (1997). The Criminal Recidivism Process. New
York: Cambridge University Press.