Conroy & Murrie (2007) point out that over time scholars have suggested that it may be difficult to distinguish whether clinical or actuarial methods may be better, but rather one may interpret the two as a continuum. The researchers note that Hanson (1998) suggests that between actuarial and pure clinical assessments there is room for “guided clinical judgment or adjusted actuarial assessments” (Conroy & Murrie, p. 9). Further, guided clinical judgment may include risk indicators that are validated by testing, but include estimates of recidivism based on rankings and expected rates of recidivism for offenders in similar categories of violence (Conroy & Murrie, p. 9). Whereas, in an adjusted actuarial assessment, one might begin with “actuarial predictions, adjusting these based on compelling evidence” (Conroy & Murrie, p. 10). Thus, one may not have to limit a violence assessment to one method that may not be foolproof alone.
I would have to agree, based on this synopsis, that the best method is a combination of clinical and as Conroy & Murrie (2007) suggest, based on their research of other clinicians, an adjusted actuarial prediction. If I must choose just one methodology, I would select a clinical approach. Violence risk assessment provides an ideal opportunity to empirically test data, which can be accomplished in the clinical setting (Borum, 1996). While these methods are not always foolproof they do provide insights into offenders. Mills, Kroner & Morgan (2011) suggest that 25 percent of offenders will seek health services, including community support at some point, at which point assessment and clinical investigation may be accomplished. Through consistent practice clinicians can determine how successful risk assessment is. This can only be accomplished through consistency and appropriate training (Borum, 1996; Mills, Kroner & Morgan, 2011).
Many people have difficulty using clinical assessment when making decisions regarding sentencing or releasing, primarily because there is lack of training regarding appropriate assessment tools (Borum, 1996) but also because there are independent variables that can impact violent behaviors that cannot always be accounted for when creating assessments. Some tables developed for risk assessment allow the examiner to calculate true positives, and true negatives; as well as false positives and false negatives; however, some methods used to assess certain types of violent behavior may obscure the true predictive performance of the actual assessment (Conroy & Murrie, 2007). This can be mitigated by using multiple instruments, or multiple methods as suggested above. Sometimes however, this may be cost prohibitive. However, some violently prone deviants are also intelligent, and understand how to work the system. One never knows; the role of the clinician is constantly to adapt a test to rule out factors that may prohibit a test from truly performing optimally.
Ultimately, risk assessments serve to reduce the risk of violence, including the probability that violence will occur and/or re-occur. In the future it is important to continually improve on the value of testing, particularly clinical instruments, so that they can become as predictive as possible. This may indeed involve combining testing methods, so that multiple risk factors can be identified. It doesn’t seem reasonable to assume that one method is ideal for identifying violence or predicting violence among any population. One method may emphasize factors that are more dynamic, while another may emphasize more static factors; another may emphasize traits that occur more readily in the present, while clinical measures for example, may tend to reveal more traits that occurred in the past and thus may tend to emphasize more predictive factors (Conroy & Murrie, 2007). A clinician must also realize that tests are a unique as individual offenders.
- Borum, R. (1996). Improving the Clinical Practice of Violence Risk Assessment: Technology,
Guidelines, and Training. American Psychologist. 51(9): 945-956.
- Conroy, M.A. & Murrie, D.C. (2007). Forensic Assessment of Violence Risk. John Wiley &
- Mills, J.F., Kroner, D.G., and Morgan, R.D. (2011). Clinician’s Guide to Violence Risk
Assessment. Guildford Press.