Exam 10: B: Risk Assessment

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1)Clinicians may rely on illusory correlations.Clinicians include traits they intuitively believe to be important or assume to be associated with the risk but that actually are not ( Odeh,Zeiss,& Huss,2006 ).Chapman and Chapman (1967 )defined an illusory correlation as the belief that a correlation exists between two events that in reality are either not correlated or are correlated to a much lesser degree.For example,a clinician might assume a strong correlation between a diagnosis of mental disorder and high risk for violent behaviour.
Although some forms of mental disorder are related to an increased risk,a relationship has not been consistently found ( Monahan & Steadman,1994 ).2)Clinicians also tend to ignore base rates of violence ( Monahan,1981 ).Clinicians working in prisons or forensic psychiatric facilities may not be aware of how often individuals with specific characteristics act violently.For example,the base rate for recidivism in homicide offenders is extremely low.Other investigators ( Borum,Otto,& Golding,1993 )have noted the tendency to rely on highly salient or unique cues,such as bizarre delusions.3)Clinicians tend to have an overconfidence bias.Clinicians who are very confident in their risk assessments will be more likely to recommend and implement intervention strategies.However,people can be very confident in their risk assessments but be completely wrong.Desmarais,Nicholls,Read,and Brink (2010 )investigated the association between clinicians' confidence and accuracy of predicting short-term in-patient violence.Clinicians completed a structured professional judgment measure designed to assess the likelihood of violent behaviour (i.e.,verbal and physical aggression,self-harm)and indicated on a five-point scale their level of confidence.Most clinicians were highly confident; however,the association between confidence and accuracy was minimal.

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-HCR-20 (Webster et al.,1997)
-Relies on structured clinical judgment
-Designed to predict violent behaviour in correctional and forensic psychiatric samples
-HCR-20 contains 20 items organized into three main scales that represent Historical (past,static),Clinical (current,dynamic risk factors),and Risk Management (future community or institutional adjustment)

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-Static risk factor: measurable feature of an individual that is predictive of violence; does not fluctuate over time and cannot be changed through treatment-e.g.,age at first arrest,history of childhood abuse,history of substance abuse,criminal record
-Dynamic risk factor: measurable feature of an individual that is predictive of violence; fluctuates over time and is amenable to change-e.g.,antisocial attitudes,coping style,impulsivity
-Protective factor: factor that mitigates or reduces the likelihood of violence-e.g.,prosocial environment,strong social supports,positive social orientation,intelligence