RISK ASSESSMENT & MANAGEMENT RESEARCH:
The Literature from 1980 - 2003

A large literature on the topic of risk assessment and risk management has developed over the past quarter century. Some of this is scientific, some is professional, and some accents administrative, policy, and legal issues. Part of the recent work is based in civil psychiatry, part in forensic mental health, and part in corrections.

Attempts have of late been made to summarize the literature in the form of small books (e.g. Blumenthal & Lavender, 2000; Webster & Hucker, 2003). This review, for the viewer’s convenience, draws attention to what seem to be particularly vital books, monographs, and manuals.

Most Influential Texts & Studies on Risk Assessment &/or Management -
"The Top Dozen"

Literature Synopsis: A few words about "The Top Dozen":

• Predicting violent behavior: An assessment of clinical techniques John Monahan, 1981
  Though published two and a half decades ago, this short text by John Monahan remains surprisingly fresh in its outlook (see also an excellent text edited by Hays, Roberts, & Solway published in the same year). The book marks the transition from the older construct of “dangerousness” to the newer idea of “risk”. Monahan lays out a distinction between the so-called actuarial (static) approach and the clinical (dynamic) point of view. The former takes the position that, when it comes to prediction, at least over the long term, there is every reason to place reliance on static factors which for the most part are obtainable from existing records. The latter, which is often more concerned with professional assessment practices than prediction of future violence per se, places weight on the clinician’s opportunity to take account of a number of changing factors, all interacting with one another in the case of the particular individual. The assessment challenge is to estimate the number of factors currently in play and to estimate their roles in the future. In actual practice it is often hard to draw a clear distinction between statistically-driven, static, and individual centered, dynamic considerations. From a practical point of view it makes sense to consider both when conducting violence risk assessments.
  

• Violent offenders: Appraising and managing risk (VRAG) Quinsey, V. L., Harris, G. T., Rice, M. E., & Cormier, C. (1998)
  Within the arena of forensic mental health, the best-known treatment of actuarial factors in prediction is given in a text by Quinsey, Harris, Rice & Cormier (1998). This is required reading for all researchers and clinicians who pretend a knowledge of violence risk assessment.
  
  One of the key predictive variables in the 12-item Violence Risk Appraisal Guide (VRAG) of Quinsey et al. is “psychopathy”. This notion, early elaborated by the American psychiatrist Hervey Cleckley (1941), has been studied extensively over many years by Robert Hare (1985, 1991, 2003). Hare has articulated the construct of psychopathy and shown how it can be measured. His scheme relies on 20 items, all clearly defined in his manual (1991, 2003). Each of these is scored 0, 1, or 2. A score of zero means that the characteristic is not evident in the record, from interviews, or from information supplied by persons other than the assessee. A score of 2 means that the characteristic is definitely present. A score of 1 is given when there is some but not complete evidence in support. In this way, the maximum possible Hare PCL-R score is 40. A score of 30 or over defines psychopathy (though lower cut-offs are sometimes used in research studies).
  
  
• Hare PCL-R Robert Hare (2003)
  It has been compelling to find that the bulk of modern studies which have included Hare PCL-R scores as a violence predictor have shown that these do indeed associate with subsequent violence. This is despite the fact that the Hare PCL-R was never originally developed as a risk assessment device. It is for this reason that we include the 2003 manual in our “top dozen” list. Those wishing a less technical, but nonetheless informative, account of psychopathy are referred to Hare’s popular text Without conscience (1998). The Hare approach to psychopathy is a “structured” one. That is, items are defined and “manualized”. His scheme, as already noted, includes a method of scoring individual items. Over years, he and many others have been able to demonstrate that colleagues in various mental health disciplines can code the items reliably (i.e., one clinician achieves scores similar to those of another given interview access to the same client and that client’s documents).
  
  
• Historical/Clinical/Risk Management – 20 (HCR-20) Webster, Eaves, Douglas, & Wintrup (1995) followed by Webster, Douglas, Eaves, & Hart, (1997)
  In 1995 a group at Simon Fraser University attempted to create an interdisciplinary, structured, violence risk assessment guide for use by mental health practitioners . This is called the Historical/Clinical/Risk Management – 20 (HCR-20). Like the Hare PCL-R scheme outlined above, it contained 20 defined items all scored 0, 1, or 2. What marked the scheme off from others, though, was its partition of variables into past (Historical, 10 items), present (Clinical, 5 items), and future (Risk Management, 5 items).
  
  After initial publication, the scheme was revised in 1997. It has now been translated into several languages. Viewers especially interested in an up-to-date summary of research evidence and commentary in support of the HCR-20 are referred to an Annotated Bibliography of the HCR-20 prepared by Dr. Kevin Douglas of the University of South Florida.
  
  As well, readers interested in a more fully developed account of this and related “structured “decision-enhancing” schemes are referred to anImpulsivity (1997) edited text by Webster and Jackson. We include this in the “top dozen”. Some readers will be interested in an attempt by Douglas, Webster, Hart, Eaves, & Ogloff (2001) to show how the individual C and R items can prompt clinicians to think about how best to help clients create changes in their lives and how such changes can be measured.
  
  
• Violence among the mentally ill: Effective treatment and management strategies (2000), Hodgins (ed) (See also a further edited extension by Hodgins and Müller-Isberner, 2000). This is impressive collection of papers on risk assessment and risk management, well deserving of inclusion in our “top dozen” list.
  
  
• Rethinking risk assessment: The MacArthur study of mental disorder and violence Monahan, J., Steadman, H. J., Silver, E., Appelbaum, P. S., Robbins, P. C., Mulvey, E. P., Roth, L., Grisso, T., & Banks, S. (2001)
  Without question, this long-anticipated monograph warrants close attention. This text summarizes the authors’ painstaking research over several years on the “MacArthur project”. Their large scale, multi-site, study relied on thorough assessment of about 1,000 civil patients release into the community. In line with other emerging results from contemporary research, the study showed that various aspects of previous violence and Hare PCL-R psychopathy link to subsequent violence. The findings also buttress the fact that violence at follow-up can be “predicted” to some extent by a combination of major mental illness and substance abuse. By itself major mental illness was not found to be a particularly strong variable, but increased markedly in power when use of substances was added.
  
  While, generally, the variable-by-variable results from the MacArthur study accord with those found in other modern investigations, Monahan and colleagues suggest that the way forward lies not so much in isolating and refining further the definition of actuarial and dynamic variables but of finding out how those variables combine and interact in the individual clinical case. They argue that while clinical acumen will have to continue to be depended upon for the foreseeable future, it may be possible, eventually, to develop computer software which will aid clinicians make judgments on behalf of their clients. The 2001 text contains a wealth of new information and commentary. Certainly, it is easy to confer upon it the honor of “top twelve” placement. An earlier edited volume by Monahan and Steadman (1994) laid out the groundwork for the study proper. Although supplanted to some extent by the 2001 text, it remains a valuable resource.
  
  
• Criminality and violence among the mentally disordered: The Stockholm metropolitan project  Hodgins and Janson (2001).
  This recent text gains admission for many of the same reasons as apply to the MacArthur project. The“Stockholm project” takes advantage of a very large data set, maintained over many years. Whereas the Monahan undertaking was largely psychiatric and psychological in emphasis, the Hodgins and Janson study is weighted more toward sociological and epidemiological interests (though by no means ignoring psychological and clinical variables). Perhaps the main impression left by this undertaking is that variables isolated in early childhood continue to play an exceedingly important role throughout the life span. The authors also provide evidence in support of the idea that clinicians who work in the civil psychiatric area should be attentive to carrying out thorough assessments for possible violence against others.
  
  
• Child delinquents: Development, interventions, and service needs. Loeber, R., & Farrington, D. P. (Eds.) (2001)
  The notion that early childhood factors are crucial in the area of risk assessment and risk management in adolescence and adulthood is ably demonstrated in this 2001 edited text by Loeber and Farrington. This text too demands inclusion in our “top dozen” list (but see also three practical guides called the Early Assessment Risk List for Boys, EARL-20B, Augimeri, Koegl, Webster, & Levene, 2001, The Early Assessment Risk List for Girls, EARL-21G, Levene, Augimeri, Pepler, Walsh, Webster, & Koegl, and the Manual for the Structured Assessment of Violence Risk in Youth, SAVRY, Borum, Bartel, & Forth, 2002.) The former two guides are provided for use with children under 12. The third-mentioned is intended for assessing adolescents (i.e., it uses the same basic format as the two EARL manuals and the HCR-20)
  
  
• Treating adult and juvenile offenders with special needs. Ashford, J. B., Sales, B. D., & Reid, W. H. (Eds.) (2001)
  With emerging knowledge about risk assessment and management, Ashford, Sales, and Reid edited via the American Psychological Association, a useful and authoritative compendium on “best practices” in risk assessment and management. This is largely “population-based”, meaning that the editors have tried to capture what is known about how basic risk assessment and risk management principles can be applied to mentally handicapped offenders, sex offenders, spousal assaulters, and others. In our view, this is a must-read volume
  
  
• Clinical assessment of dangerousness, Pagani and Pinard (2001). This should also be considered essential reading. It provides much essential information on the topic (as did an earlier edited volume Predicting Dangerousness by Webster, Ben-Aron and Hucker, also published by Cambridge University Press.
  
  
• Violence and mental disorder: A critical aid to the assessment and management of risk,Blumenthal and Lavender (2000)
• Release decision making , Webster and Hucker (2003) concentrates on how best to make decisions concerning the release of patients, accused persons, and prison inmates.
  
  These two short texts, both designed to be easily readable, bring our list to completion. They provide an historical overview on the topic, discuss the seemingly pointless debate about the relative merits of actuarial versus clinical variables, and comment lightly on such topics as psychopathy, variables arising in early childhood and risk management issues.
  

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• Augimeri, L., Koegl, C., Webster, C. D., & Levene, K. (2001). The Early Assessment of Risk List for Boys (EARL-20B), Version 2. Toronto: Earlscourt Child and Family Centre.
  
  
• Borum, R., Bartel, P., Forth, A. (2002). Manual for the Structured Assessment of Violence Risk in Youth (SAVRY). Tampa, FL: University of South Florida.
  
  
• Cleckley, H. (1941). The mask of sanity. St. Louis, MO: Mosby.
  
  
• Douglas, K. S., Webster, C. D., Eaves, D., Hart, S. D. & Ogloff, J. R. P. (Eds.) (2001). HCR-20 Violence risk management companion guide. Burnaby: Mental Health Law and Policy Institute, Simon Fraser University and Louis de la Parte Florida Mental Health Institute, University of South Florida.
  
  
• Hare, R. (1985). A checklist for the assessment in criminal populations. In M.H. Ben-Aron, S.J. Hucker, & C.D. Webster (Eds.), Clinical criminology: The assessment and treatment of criminal behaviour. M and M Graphics: Toronto.
  
  
• Hare, R. (1991). Manual for the Hare Psychopathy Checklist-Revised. Toronto, Ontario: Multi-Health Systems.
  
  
• Hare (1998). Without conscience: The disturbing world of the psychopaths among us. New York: Guilford.
  
  
• Hays, J.R., Robers, T.K., & Solway, K. (Eds.) (1981). Violence and the violent individual. New York: SP Medical and Scientific Books.
  
  
• Hodgins, S., & Müller-Isberner (Eds.) (2000). Violence, crime and mentally disordered offenders: Concepts and methods for effective treatment and prevention. Chichester: Wioley.
  
  
• Levene, K. S., Augimeri, L. K., Pepler, D. J., Walsh, M. M., Webster, C. D., & Koegl, C. J. (2001). Early Assessment Risk List for Girls (EARL-21G), Version 1, Consultation Edition. Toronto: Earlscourt Child and Family Centre.
  
  
• Monahan, J., & Steadman, H. J. (Eds.) (1994). Violence and mental disorder: Developments in risk assessment. Chicago, IL: University of Chicago Press.
  
  
• Shah, S. A. (1978) Dangerousness: A paradigm for exploring some issues in law and psychology. American psychologist, 33, 224-238.
  
  
• Webster, C. D., Ben-Aron, M. H., & Hucker, S. J. (1985). Dangerousness: Probability and prediction, psychiatry and public policy. New York, NY: Cambridge University Press.
  
  
• Webster, C. D., Eaves, D., Douglas, K. S., & Wintrup, A. (1995). The HCR-20 Scheme: The Assessment of Dangerousness and Risk – Version 1. Burnaby: Mental Health, Law and Policy Institute, Simon Fraser University.
  
  
• Webster, C. D., Douglas, K. S., Eaves, D., & Hart, S. D. (1997). The HCR-20 Scheme: Assessing Risk for Violence, Version 2, Burnaby: Mental Health, Law, and Policy Institute, Simon Fraser University.