Actuarial Instruments & Structured Clinical Guides
by Christopher Webster, PhD.
The research of the last two decades has produced a number of assessment tools designed to assess risk of violence. While it still may not be possible to predict risk with unequivocal accuracy, these tools have undoubtedly improved predictive assessment, particularly when used in combination with clinical evaluations. Many of the instruments continue to be refined, develop with continued research, and incorporate new findings. The tools are divided into two principal categories: actuarial instruments and structured clinical guides.
Actuarial instruments attach specific statistical weighting to different variables which assess the risk. They are premised on the idea that, if accuracy of prediction is the most important factor, it is best to find out how members of a comparable group of individuals conducted themselves over time. This is achieved by pains-staking follow-up research on a particular group over set periods of time. With the follow-up data on violence available, it is possible then to link these statistically to various data obtained at an earlier time. It is similar, in principle, to the way in which insurance companies evaluate risk for many types of eventuality in order to set their rates accordingly. A key defiing aspect of actuarial instruments is that scores obtained on individuals can be related to massed statistical reference data.
Structured Clinical Guides, in contrast, invite clinicians to consider a number of variables which will have some application to the assessment of risk in the case under consideration. This type of assessment is based on the idea that a great deal has been learned over the past two decades about the factors which should be taken in account when conducting risk assessments on various types of mental health, forensic, and correctional populations. The various structured guides (see below) define terms, provide items which seem merited on the basic of scientific and professional grounds, and suggest methods of scoring.
Different instruments are used to assess different types of risk. Similarly, different instruments can be used with different age groups, primarily adult and youth. It is important to realize that much of the testing of these instruments has used a predominately male population although several of these tests can be used on females.
General Risk /
General Statistical Information on Recidivism (GSIR)
Early Assessment Risk for Boys (EARL-20B)
Early Assessment Risk for Girls (EARL-21G)
|Spousal Violence Risk||
Spousal Assault Risk Assessment Guide (SARA)
Violent Risk /
Sexual Risk /
Actuarial Risk Assessment Instruments:
VRAG (Violent Risk Appraisal Guide)
Quinsey, Harris, Rice, Cormier (1998)
This instrument contains a 12-item actuarial scale which has been widely used to predict risk of violence within a specific time frame following release in violent, mentally disordered offenders. Developed at Penetanguishene Mental Health Centre, the tool uses the clinical record, particularly the psycho-social history component, as a basis for scoring as opposed to interview or questionnaires. The Hare PCL-R (Psychopathy Checklist -Revised) score is incorporated into the VRAG calculations of risk.
The VRAG is not available as a stand-alone commercially available scheme but the current version is detailed in the text Violent Offenders, Appraising and Managing Risk (p.237) by Quinsey et al.
SORAG (Sex Offender Risk Appraisal Guide)
Quinsey, Harris, Rice, Cormier, 1998
Also developed at Penetanguishene Mental Health Centre, this 14 item instrument is a modification of the VRAG and is used to assess the risk of violent and sexual recidivism of previously convicted sex offenders within a specific period of release. It also uses the clinical record as a basis for scoring and incorporates the PCL-R scores. The VRAG is not available as a stand-alone commercially available test but the current version is detailed in the text Violent Offenders, Appraising and Managing Risk (p.241) by Quinsey et al.
PSYCHOPATHY CHECKLIST - Revised (PCL-R)
Hare, 1991 & 2002
Even though it was not originally designed as a risk assessment device, the Hare PCL-R has gradually come to be used to assess likely future recidivism and violent offending. It is a 20-item rating scale, scored on the basis of both semi-structured interview and collateral information. It has been validated for use in adult male correctional and forensic psychiatric samples. Over recent years, research has shown that it is a relatively good predictor of violence across diverse populations. Hare PCL-R scores are incorporated into a number of subsequently developed risk assessment tools and guides.
PSYCHOPATHY CHECKLIST - SCREENING VERSION (PCL-SV)
(Hart, Cox, Hare, 1995)
This is a 12-item abbreviated tool designed to screen for the possible presence of psychopathy. Based on a subset of the original 12 Hare PCL-R items,it is particularly well suited for community samples.
PSYCHOPATHY CHECKLIST - YOUTH VERSION (PCL-Y)
(Forth, Kossen, Hare, 1996)
This 20-item scale was designed specifically for use with adolescents to assess psychopathic features. It has been validates for use in both male and female populations between the ages of 12 and 17.
LEVEL OF SERVICE INVENTORY - Revised (LSI-R)
Andrews & Bonta, 1995
This is a 54-item rating scale used to assess the likelihood of general recidivism among adult offenders. It is designed to measure attributes of offenders and their situations in relation to level of supervision and treatment decisions. It has been validated for use with adult male and female correctional offenders.
YOUTH LEVEL OF SERVICE INVENTORY/CASE MANAGEMENT STRATEGY (YLSI)
This 43-item instrument was designed to measure risk, need, and responsivity factors in adolescents who have had contact with the justice system. It has been validated for use with both males and females between the ages of 12 and 17 and uses file information, self-report and collateral report information, and as well as results of other formal assessments.
RRASOR (Rapid Risk Assessment for Sex Offence Recidivism)
This is a brief, 4-item screening instrument for risk of sexual offender recidivism among males who have been convicted of at least one sexual offence. It relies on information obtained in files and has been tested extensively on forensic populations. For more detail.
Dr. R.K. Hanson
Senior Research Officer
11th Floor, 340 Laurier Ave. West
Ottawa, ON K1A 0P8
Hanson & Thornton, 1999 and 2002
Developed subsequently to the RRASOR, the original 10-item STATIC-99 was designed to assess the long-term potential for sexual recidivism among adult male sex offenders. It incorporates RRASOR factors. A revised version, STATIC-2002, is currently in development. Again, it has so far been used predominately within the correctional system.
Dr. R.K. Hanson
Senior Research Officer
11th Floor, 340 Laurier Ave. West
Ottawa, ON K1A 0P8
SEX OFFENDER NEEDS ASSESSMENT RATING (SONAR)
Hanson & Harris, 2000
This 9 item scale is designed to measure change in risk level for sexual offenders.
It includes 5 stable factors and 4 acute factors. For more detail.
Contact: Dr. R.K. Hanson
Senior Research Officer
11th Floor, 340 Laurier Avenue West
Ottawa, Ontario, Canada
MINNESOTA SEX OFFENDER SCREENING TOOL - Revised (MnSORT-r)
Epperson, Kaul, & Hasselton, 1998
This is a sexual violence risk assessment tool that is used to predict sexual recidivism in rapists and intra-familial child molesters. It uses 16 static and dynamic variables to distinguish three levels of risk category. For more details
VIOLENCE RISK ASSESSMENT SCALE (VRS) – Experimental Version 1
Wong and Gordon, 1996
This scheme was designed to assess the risk of violent recidivism for incarcerated offenders. It consists of 6 static and 23 dynamic factors, includes a section designed to measure changes in risk level as a result of treatment
Contact: Dr. Steve Wong
Department of Psychology and Research
Regional Psychiatric Centre (Prairies)
Saskatoon, Saskatchewan, Canada S7K 3X5
Structured Clinical Guides:
To order the SARA contact:
HCR-20, Version 2 (Historical, Clinical, Risk-20)
Webster, Douglas, Eaves, & Hart, 1997
Originally made available in 1995, the HCR-20 Structured Guide for the Assessment of Violence Risk was later modified in light of actual clinical experience gained from initial trials. It is intended for use with civil psychiatric, forensic, and criminal justice populations. It consists of 20 items as well as the Hare PCL-R. There are 10 historical variables, 5 clinical variables, and 5 risk management factors. Each item is scored as 0 (not present), 1 (possibly present) or 2 (definitely present) to yield a score out of 40. It includes variables that capture relevant past, present, and future considerations. It can be regarded as an important first step in the risk assessment process. The manual provides information about how and when to conduct violence risk assessments, reviews the research on which the risk factors are based, and suggests key questions which should be addressed when making judgments about risk. The scheme has been tested in all three of the domains for which it was originally intended.
Results of various studies which have emanated from it are summarized by K. Douglas periodically. The HCR-20 has been translated into several different languages and is under active examination internationally. Its work is guided, to an extent, by a consortium of researchers and clinicians who make up the RISC-TEAM, a sub-group of the International Association of Forensic Mental Health Services.
SEXUAL VIOLENCE RISK-20 (SVR-20)
Boer, Hart, Kropp, & Webster, 1997
This is a 20 item guide for assessing violence risk in sex offenders. Eleven items deal with Psychosocial Adjustment, 7 with Sexual Offences and 2 with Future Plans. Scoring is based on a N(definitely not present), ? (perhaps present), or Y (definitely present) scale with allowance for changes over time. Little is currently known about its effectiveness as a predictive device. Its main current usefulness lies in its ability to help structure clinical assessments.
Estimate of Risk of Adolescent Sexual Offence Recidivism (ERASOR)
(Worling & Curwen, 2001)
This scheme is designed for use with adolescents to determine their risk of sexual re-offence. It uses both static and dynamic factors that are empirically linked to sex offending: Historical sexual assaults; Sexual interests, Attitudes and behaviours; Psychosocial functioning; Family/Environmental functioning; and Treatment. The guide is available in either hard copy for a nominal fee or in PDF downloadable format:
For information or copy of the guide, contact:
Consultant Psychologist/Co-ordinator of Research
Thistletown Regional Centre
51 Panorama Court
Toronto, Ontario, Canada M9V 4L8
STRUCTURED ASSESSMENT OF VIOLENCE RISK IN YOUTH (SAVRY)
Bartel, Borum, & Forth, 1999
This is a violence risk assessment scheme designed to assess risk for violence in adolescents. It consists of 10 historical variables, 8 social/contextual variables, 7 individual/clinical variables and 6 protective variables.
To obtain information on the SAVRY:
Mental Health, Law and Policy Institute
University of South Florida
EARL-20B (Consultation Version)
Augimeri, Koegl, Webster & Levene, 1998
This is a 20 item instrument designed to measure risk of violence potential
in boys under the age of 12. The items are grouped under the headings of Family, Child, and Responsivity and items are scored on a 0 (not present), 1(possibly present), or 2 (definitely present) basis. Clinicians offer an overall clinical judgment of risk as Low, Moderate or High.
The guide was developed through references to the published scientific literature and clinical experience based on large numbers of boys and their families followed over several years. It has been translated into Swedish and a large Swedish prospective study is currently under way.
EARL-21G (Version 1 Consultation edition)
Levene, Augimeri, Pepler, Walsh, Webster, Koegl, 2001
Similar in scope and purpose to the EARL-20B, the EARL-21G takes account of the fact that girls often express anti-sociality and aggressiveness in ways that differ from boys. The basic framework is similar to the EARL-20B although some items are labeled and defined differently. Designed for use in girls under 12, the EARL-21G is under test at the Earlscourt Child and Family Centre.
The WORKPLACE RISK ASSESSMENT (WRA-20)
Bloom, Eisen, Pollock & Webster, 2000
This guide focuses exclusively on environmental, situational variables presumed to operate in a wide array of workplaces. It sets out criteria in a 0,1,2 scoring system for the "benchmarking" of violence risks within organizations. Although as yet untested as an instrument in its entirety, the manual contains a good deal of information about the largely as-yet-unstudied field of workplace violence.
The EMPLOYEE RISK ASSESSMENT (ERA-20)
Bloom, Eisen & Webster, 2001
The ERA-20 supplies the "other side" of the WRA-20, with the emphasis on the individual employee. Designed with an eye to mental health professionals, it incorporates 20 variables known or postulated to relate to unacceptable conduct and violence in workplaces, schools, the military and other such organizations. Its accuracy and reliability as a predictive device remain unknown.
References and Further Reading
Rettenberger, M. & Hucker, S.J. (2011) “Structured professional guidelines: International applications”, Chapter 5, pp 85-110. In: International Perspectives on Sex Offender Assessment & Treatment: Theory, Practice and Research. (Eds) Boer, D., Eher, R., Craig, L., Miner M., & Pfaefflin, F. Wiley: London
Rettenberger, M., Hucker, S.J., Boer, D.P., Eher, R. (2009) The Reliability and Validity of the Sexual Violence Risk-20: An International Review. Sexual Offender Treatment, Volume 4, Issue 2, 1-14.
Violence Risk Assessment: Using Structured Clinical Guides Professionally. Christopher D Webster, Rüdiger Müller-Isberner , and Goran Fransson. International Journal of Reonsic Mental Health Services. 2002, Vol 1, No 2 (43-51)
© Christopher D. Webster, PhD, , FRSC, PRCPsych. This material is provided for personal use only. Any other use is strictly forbidden without the express written permission of the author