The Structured Assessment of Protective Factors for Violence Risk (SAPROF): A Meta-Analysis of its Reliability and Predictive Validity

Although the inclusion of protective factors in risk assessment is believed to improve prediction, most risk assessment tools emphasize risk factors. One tool that attempts to balance risk factors with protective factors is the Structured Assessment of Protective Factors for Violence Risk (SAPROF). The SAPROF focuses exclusively on protective factors and is used in conjunction with a structured risk assessment tool. It has received increasing attention from both researchers and forensic mental health practitioners in recent years. To assess its psychometric performance, we conducted a meta-analysis of validation studies using random effects models. Our final sample included 22 studies with 3,216 subjects from 12 countries. Overall, the SAPROF showed good interrater reliability and moderate to good predictive performance for desistance from violence in terms of institutional misconduct and community recidivism. The instrument also exhibited incremental validity when used in conjunction with the Historical Clinical Risk Management-20 (HCR-20). Despite these promising results, this meta-analysis also uncovered several shortcomings in current research on the SAPROF. Studies did not report data on calibration, thus failing to capture the full picture of the SAPROF’s predictive performance. Moreover, risk of bias across studies was high and findings are mostly restricted to male samples. Directions for future research and recommendations for the use of the SAPROF are offered.

Smaller Amygdala Subnuclei Volume in Schizophrenia Patients with Violent Behaviors

Objective To investigate the association between the volume of amygdala subnuclei and violent behaviors in patients with schizophrenia (SCZ). Methods In the present study, we recruited 40 SCZ patients with violent behaviors (VS), 26 SCZ patients without violent behaviors (NVS), and 28 matched healthy controls (HC) who completed T1-weighted magnetic resonance imaging. Both the total amygdala and amygdala subnuclei volumes were estimated with FreeSurfer. Results When comparing the whole SCZ patients with HC, SCZ patients had smaller volume of the left amygdala and the left basal nucleus. Further, the VS patients had smaller volume of the amygdala central nucleus as compared to the NVS group. Conclusions Our findings suggested that a smaller volume of the amygdala central nucleus might be relevant to violence risk in SCZ patients.

Drawing upon the evidence to develop a multiagency risk assessment and risk management framework for domestic violence

Domestic violence poses a threat to the health, safety and wellbeing of women internationally and is associated with a range of physical injuries, chronic mental and physical health issues and death. In recognition of the serious consequences and to guide the allocation of resources, multiple countries have invested in efforts to measure domestic violence risk. This study aimed to determine whether there was an existing validated risk assessment tool with an actuarial element, or a common set of evidence-based risk factors that could be implemented in Victoria, Australia. A tool was sought which would effectively predict risk of severity, lethality and re-assault and support risk management strategies. The tool needed to be suitable for administration by a variety of professionals. Through an audit and analysis of existing tools, the study found an absence of universal standards or guidance for weighting actuarial tools and clear insight into how risk assessments currently inform risk management practice and multidisciplinary responses. However, the literature provides clarity around the key evidence-based risk factors that most commonly form a validated tool for adult victim survivors. The evidence was less definitive in terms of assessing risk of lethality and re-assault for children and young people.<br /><br />Key messages<br /><ul><li>There has been considerable investment in approaches to measure domestic violence risk.</li><br /><li>Some consistency exists in terms of evidence-based risk factors across existing risk assessment tools.</li><br /><li>There is an absence of universal standards for weighting actuarial tools as well as guidance to inform a response by a broad range of professionals.</li></ul>

Use of the Violence Risk Scale – Sexual Offense version (VRS-SO) within sexually violent persons evaluations

In many parts of the United States, individuals can be civilly committed as Sexually Violent Persons (SVP) to a secure treatment center based on their history of sexual offenses, current mental disorder, and current risk for sexual recidivism. While the specific criteria vary between jurisdictions, SVP civil commitment is indefinite, and periodic examinations occur to determine if ongoing commitment is necessary. Release recommendations may be made in part based on patients’ treatment progress. Therefore, incorporating treatment change into periodic risk assessments is an important role of the SVP evaluator. The current paper sought to explore the benefits of using an actuarial tool within SVP populations to measure decreased sexual recidivism risk as a result of treatment change. Specific discussion of the use of the Violence Risk Scale – Sexual Offense version (Olver et al., 2007, https://doi.org/10.1037/1040-3590.19.3.318) is provided.

Dynamic sexual offense risk assessment using the VRS-SO with indeterminate sentenced men

Indeterminate detention (ID) is a high stakes sanction reserved for exceptionally high risk-high need (HRHN) persons who are deemed to pose an undue risk to public safety. It is one of the most extreme measures that is routinely taken by justice systems to manage sexual violence risk and prevent sexual and violent recidivism. Naturally, risk assessment is most frequently employed as a mechanism to keep dangerous people in custody; but seldom is risk assessment viewed as a possible ticket out for men with an ID designation who have made substantive risk changes and whose risk can be safely managed in the community. This article features applications of a dynamic sexual violence risk assessment and treatment planning tool, the Violence Risk Scale-Sexual Offense version (VRS-SO), with ID individuals and other HRHN men, to assess risk in a dynamic manner to inform risk management efforts and release decisions. VRS-SO data on an ID sample are presented along with clinical illustrations of dynamic risk assessment. Several propositions are made with supporting data from VRS-SO normative research with treated sexual offending samples regarding the use of dynamic tools with ID men and the perils and pitfalls of relying solely on static measures. Ultimately, dynamic risk instruments can be used to track progress and monitor risk change over multiple assessments to inform release and reintegration decisions with ID persons. In this regard, dynamic assessment has the potential to help, rather than hinder, reintegration of ID sentenced persons and can inform safe, fair, and humane decisions.

Forensic application of static and dynamic risk factors: Is it the right time?

It is common, accepted clinical practice to conduct risk assessments of individuals who commit sexual offenses using the combination of sexual violence risk actuarial measures and dynamic risk factors. This assessment approach has utility when identifying treatment targets, assessing progress in sexual offender treatment, and forming risk management plans. Little research has examined this method in forensic contexts such as deciding whether individuals who suffer from mental disorders are likely to engage in sexually dangerous behavior as defined by sexually violent predator or persons (“SVP”) involuntary civil confinement laws in the USA. In particular, it is uncertain whether the combination of sexual violence risk actuarial measures and dynamic risk factors (DRF) produces sufficiently reliable, relevant, and probative evidence for the trier of fact to properly evaluate the SVP legally defined likelihood of sexual dangerousness. This article explores the efficacy of combining actuarial measures of sexual violence risk and dynamic risk factors as applied in SVP risk assessments based on some commonly observed forensic practices among evaluators. Based on the analysis, recommendations for forensic practice and future research are offered.