Risk assessment
What is risk assessment?
Risk assessment is
• Estimating the chances of recidivism in the near or far future
• Estimating risky situations (e.g., alcohol, restraining order)
• Informative of judicial decisions (e.g., parole)
• Indicative of which interventions should be
implemented
It is not...
• Indicative of subjective patient needs
• Indicative of how well treatment is going to
work
• Always in line with your own clinical thinking
• 100% accurate
Types of risk assessment
Unstructured clinical judgement / approach
• Based on your clinical judgment
• Without use of an instrument
• Expertise, knowledge of the clinician, intuition (buikgevoel), preferences
• Clinician determines which factors are relevant
• Tailored to particular case
Criticism:
• Statistical chances of getting it right are about 50% (tossing a coin)
• Untransparent, unstructured
• Influenced by counter-transference, prejudice, history
Actuarial approach
Making a judgment about risk of recidivism based on a mathematical calculation of validated
predictors
• Fixed set of risk factors
• Empirically related to recidivism
• Mathematical calculation of judgment
• Result = a specific risk score and the % of people with this same risk score that recidivated,
based on a comparable sample
1
, Voorbeeld VRAG-R
Pros
• Evidence based
• Less susceptible to interpretation →higher inter-rater reliability
Cons
• Predictions at group level
• Not based on theory (empirically derived)
• Mainly historical factors (not useable in treatment)
• Clinicians sometimes feel that it does not accurately capture their clients
Structured clinical judgement / approach
• Combination of actuarial and unstructured clinical method
• Checklist of empirically validated risk factors →guideline
• Clinicians can “add” other factors
• Result is “clinical judgment”
• No clear scores
• Results mostly in terms of “low-moderate-high”
2
What is risk assessment?
Risk assessment is
• Estimating the chances of recidivism in the near or far future
• Estimating risky situations (e.g., alcohol, restraining order)
• Informative of judicial decisions (e.g., parole)
• Indicative of which interventions should be
implemented
It is not...
• Indicative of subjective patient needs
• Indicative of how well treatment is going to
work
• Always in line with your own clinical thinking
• 100% accurate
Types of risk assessment
Unstructured clinical judgement / approach
• Based on your clinical judgment
• Without use of an instrument
• Expertise, knowledge of the clinician, intuition (buikgevoel), preferences
• Clinician determines which factors are relevant
• Tailored to particular case
Criticism:
• Statistical chances of getting it right are about 50% (tossing a coin)
• Untransparent, unstructured
• Influenced by counter-transference, prejudice, history
Actuarial approach
Making a judgment about risk of recidivism based on a mathematical calculation of validated
predictors
• Fixed set of risk factors
• Empirically related to recidivism
• Mathematical calculation of judgment
• Result = a specific risk score and the % of people with this same risk score that recidivated,
based on a comparable sample
1
, Voorbeeld VRAG-R
Pros
• Evidence based
• Less susceptible to interpretation →higher inter-rater reliability
Cons
• Predictions at group level
• Not based on theory (empirically derived)
• Mainly historical factors (not useable in treatment)
• Clinicians sometimes feel that it does not accurately capture their clients
Structured clinical judgement / approach
• Combination of actuarial and unstructured clinical method
• Checklist of empirically validated risk factors →guideline
• Clinicians can “add” other factors
• Result is “clinical judgment”
• No clear scores
• Results mostly in terms of “low-moderate-high”
2
