Violence Risk Assessment and Risk Management
Risk frameworks
Violence risk assessment uses actuarial, structured professional judgment (SPJ), and anamnestic approaches. The HCR-20 V3 organizes historical, clinical, and risk-management factors; the VRAG and SORAG are actuarial; the PCL-R measures psychopathy but is not a standalone violence predictor; the START assesses strengths and protective factors.
Core rules
- Risk is dynamic and context-dependent; assess past behavior, current clinical state, and future context.
- Use SPJ to combine empirical risk factors with case-specific formulation.
- Communicate risk as probabilistic and conditional, not as a yes or no prediction.
- Management follows assessment: supervision, treatment, substance-use control, weapons restrictions, and safety planning.
- Reassess when circumstances change.
Worked example
A patient has high historical risk but low current clinical risk and strong protective factors. An SPJ report should not simply average scores; it should explain how stressors could raise risk and specify monitoring. Reasoning: risk is not a fixed trait; the formulation links factors to future scenarios.
Traps
Promising certainty; using the PCL-R alone; ignoring base rates; overrelying on actuarial scores; failing to distinguish risk of general violence from sexual violence.