used methods for risk assessment
Clinical Judgment (UCJ)
When relying on unaided clinical judgment (UCJ) -- making predictions of future violence based on idiosyncratic impressions obtained from interview and test data -- the performance of psychologists and psychiatrists is abysmal.
Monahan's (1978) review of the accumulated literature reported the rate of error associated with attempts at predicting future violence ranged from 54 to 94%. In this same review, Monahan indicated that the majority of studies reported an error rate of 80% or more when attempting to predict future violence.
A subsequent review by Monahan (1981 b) concluded that mental health professionals are:
1984, Schopp and Quattrochi further reviewed the accuracy of UCJ in predicting
violence. They emphasized:
More recent reviews have also confirmed unacceptable levels of accuracy associated with UCJ related to risk assessment
examining the predictive accuracy of UCJ regarding sexual offender recidivism
risk, Hanson and Bussière (1998) found an average correlation of .10. Quite
obviously, then, relying on UCJ for assessing the recidivism risk of a
previously convicted sexual offender is inconsistent with the ethical
obligations of a psychologist. In particular, the levels of sensitivity and specificity,
and the frequencies of false positive and false negative classifications,
associated with UCJ remain unknown.
Standard 2.04(a), and Testing Standard 6.1, also prohibit psychologists from
resorting to UCJ when undertaking risk assessments. Any reasonably well informed
psychologist must acknowledge that the available validity data related to
assessments premised on UCJ contraindicate such a practice. Moreover, there are
no cutoff scores, or well defined decision-making criteria, available for UCJ
when used to assess recidivism risk. UCJ therefore is also inconsistent with
Testing Standard 1.1, and Ethical Standard 2.02(a). Without a generally
available manual for UCJ, relying on it for predator evaluations also disregards
Standard 5.1 of the testing standards.
Reliance on UCJ in Clinical Practice
This overview of UCJ poses a further question. Do practicing psychologists recognize the many shortcomings of UCJ when assessing recidivism risk in cases of
convicted offenders? Related data, for example, indicate that practicing
psychologists remain unaware of the many problems undermining clinical judgment
in general (Rock, 1994). Absent sufficient familiarity with the many pitfalls
associated with clinical judgment, might practicing psychologists
inappropriately rely on it when undertaking predator evaluations?
for example, how a Florida psychologist responded to questions, regarding
clinical judgment and actuarial instruments, during a pre-trial deposition prior
to a sexual predator hearing.
Above and beyond demonstrating how woefully misinformed he is, this psychologist's persisting affinity for clinical judgment increases the likelihood of his own biases influencing his opinions.
elasticity of clinical judgment allows stretching it to conform with the a
priori expectations of an evaluator. If predisposed to "rule in,"
or "rule out," future sexual dangerousness, evaluators will seek
information consistent with their expectations. When people respond to strong
expectations, they selectively pay attention to the information available to
them. They remember expectancy-consistent information better because it confirms
what they expected to find. They also discount inconsistencies as random
variation, further regarding them as insignificant exceptions to what they
expected (Rothbart, Evans, & Fulero, 1979). Relying on clinical judgment,
therefore, easily allows psychologists to indulge whatever biases they bring to
can also be argued that the biases of practicing psychologists predispose them
to "rule in" future dangerousness. For a practicing psychologist
undertaking a predator evaluation, the costs of false positive and false
negative errors are far from equal. In the instance of a false positive error,
that outcome rarely if ever receives public attention. An offender mistakenly
classified as a predator may protest his fate. His protests, however, typically
fall upon deaf ears as he lingers in the obscurity of indefinite confinement. In
cases of false negative errors, however, the psychologist involved can endure
the harsh spotlight of public criticism.
for example, that Dr. Jones evaluates Mr. Smith pursuant to a sexual predator
statute. Dr. Jones concludes that Mr. Smith does not warrant civil commitment as
a sexual predator. Subsequent to his release into the community, Mr. Smith
commits a particularly brutal sexual assault. Scenarios such as these attract considerable media attention with the potential of enormous costs
related to Dr. Jones' professional reputation. These considerations indicate
that when relying on clinical judgment in sexual predator evaluations,
psychologists may be more inclined to tolerate false positive than false
Clinical Risk Assessments (GCRAs)
In contrast to UCJ, guided clinical risk assessments (GCRAs) address various empirically validated risk factors, arriving at recidivism estimates based on an offender's status on these factors. Previous work has identified the following factors as increasing the risk of recidivism for sexual offenders:
Hanson and Bussière (1998), however, reported data inconsistent with the factors cited above. In their meta-analysis of 61 follow-up studies examining sexual offender recidivism (n = 23 393), they found no significant correlations between recidivism and any
Hanson and Bussière (1998) additionally found no significant correlations between recidivism and the following factors:
Quite clearly, then, attempts at identifying risk factors for sexual offender recidivism have led to some inconsistent and equivocal results. In this writer's experience, reviewing sexual predator evaluations made in California, Florida, Ohio, and Wisconsin, he has encountered numerous instances of psychologists invoking factors for which Hanson and Bussière found no empirical support.
It should also be pointed out that Hanson and Bussière (1998) did identify other risk factors that correlated significantly with sexual offender recidivism:
Violence Risk-20 (SVR-20)
SVR-20 (Boer, Hart, Kropp, & Webster, 1997) is a commercially available
instrument (Psychological Assessment Resources, Inc.) for GCRAs. It directs
users to assess recidivism risk for previously convicted sexual offenders by
addressing 20 risk factors. Each factor is coded according to whether it is
definitely present, possibly present, or not present. The SVR-20 manual,
however, does not report data regarding inter-rater reliabilities for these
factors. The extent to which two or more evaluators reach the same or similar
conclusions when independently evaluating the same offender therefore
The manual advises evaluators to summarize their ratings into an overall risk rating of low, moderate, or high. Nevertheless, the manual does not specify what values of the SVR-20 (ranging from 0 to 20) correspond to different risk levels. In particular, the manual contends:
Additionally, available data (Hanson & Bussière, 1998) do not support at least five of the SVR-20 factors:
SVR-20 manual acknowledges "... there is little evidence supporting a
specific link between [being a victim of] child sexual abuse and later sexual
violence" (p. 44). The manual nonetheless invokes considerations of
"professional reviews" to support its position.
The manual then proceeds to defend relying on this factor indicating:
Elevating "professional reviews" to a level of equal or greater importance than relevant data is obviously ill advised. Doing so ultimately embraces theory in preference to empirically supported fact; and, in turn, encourages those who use the SVR-20 to rely on what is -- at best -- a modest improvement over UCJ.
SVR-20 can claim a generally available manual; but, beyond that consideration,
there is little else to recommend it for assessing the recidivism risk of
previously convicted sexual offenders. Unfortunately, the commercial
availability of the SVR-20 suggests that practitioners may be more inclined to
rely on it.
Hanson (1998) has acknowledged, GCRAs inevitably contend with the problem of how
to best weight and combine the different factors. Despite Testing Standard 5.1,
there is no manual available for GCRAs to address this issue. Without an
explicitly defined method for converting various risk factors into recidivism
probabilities, different evaluators can reach very different conclusions when
assessing the same offender. When they occur, these inconsistent conclusions
correspond to variations in clinical judgment between two or more evaluators
assessing the same offender. Psychologist A attributes considerable significance
to the offender's age, but psychologist B views the offender's failure to
complete treatment as more compelling. Ultimately, then, the value of GCRAs is
undermined by their unavoidable reliance on clinical judgment.
Moreover, there are no data available for GCRAs to answer the four critical questions for evaluating an assessment method for sexual predators:
a result, GCRAs fail to comply with Ethical Standard 2.02(a). Without a
generally available manual for GCRAs (except for the SVR-20), relying on them
for predator evaluations also disregards Testing Standard 5.1. Relatedly, then,
opinions premised on GCRAs regarding recidivism risk also neglect Testing
Standard 6.1 and Ethical Standard 2.04(a).
considerations discussed above lead to a sobering conclusion -- for purposes of
assessing the recidivism risk for previously convicted sexual offenders, GCRAs
are -- at best -- experimental procedures. As experimental procedures, they do
not possess sufficient evidentiary reliability to support expert testimony in a
legal proceeding. In particular, GCRAs present an alarming potential for
misleading and misinforming a trier of fact.