Transcript Document

Assessment of Risk
and Need
Douglas B. Marlowe, J.D., Ph.D.
National Association of Drug Court Professionals
Exigent Risk
• History of violence or dangerousness
– Records check
– Interview collaterals
– GAIN-Q Behavioral Health Scale; TCU Hostility Scale
• Substance abuse and psychosis, combat-related
PTSD, mania or frontal brain injury
– Mental status assessment or psychiatric history
– Any substance abuse screen (CAGE, DAST, AUDIT, etc.)
• Psychopathy
– PCL-R
Risk of Dangerousness Tools
• COMPAS Violence Scale
• Violence Risk Appraisal Guide (VRAG)
• Sex Offender Risk Appraisal Guide (SORAG)
• Historical-Clinical-Risk 20 (HCR-20)
• Classification of Violence Risk (COVR)
• Static-99
Prognostic Risk
~ Any validated recidivism risk tool
Prognostic Risk
~ Any validated recidivism risk tool
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Prior criminal history
Current age < 25 years
Delinquent onset < 16 years
Substance abuse onset < 14 years
Prior rehabilitation failures
Antisocial Personality
Criminal values
Familial history of crime or addiction
Criminal associations
Instability (chronic homelessness, unemployment)
Recidivism Risk Tools
Level of Service Inventory-Revised (LSI-R)
Wisconsin Risk and Need Assessment Scale (WRN)
Risk and Needs Triage (RANT)
Correctional Offender Management Profiling for Alternative
Sanctions (COMPAS)
Ohio Risk Assessment System – Community Supervision Tool
(ORAS-CST)
Post Conviction Risk Assessment (PCRA)
Criminogenic Needs
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Substance Dependence or Addiction
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Triggered binge response
Cravings or compulsions
Withdrawal symptoms
DSM-5 Criteria
Substance Use Disorder- 2 in 12 months
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Often taken in larger amounts than anticipated
Persistent desire or unsuccessful efforts to quit
Great deal of time obtaining or using the substance
Cravings
Failure to fulfill major role obligations
Persistent social or interpersonal problems
Important activities given up
Recurrent use in physically hazardous situations
Persistent physical or psychological problems
Tolerance
Withdrawal
}
Must be causal
Mild = 2 to 3
Moderate = 4 to 5
Severe ≥ 6
DSM-5 Criteria
Substance Use Disorder- 2 in 12 months
1.
Often taken in larger amounts than anticipated (i.e. binges)
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
Persistent desire or unsuccessful efforts to quit
Great deal of time obtaining or using the substance
Cravings
Failure to fulfill major role obligations
Persistent social or interpersonal problems
Important activities given up
Recurrent use in physically hazardous situations
Persistent physical or psychological problems
Tolerance
Withdrawal
}
Must be causal
Mild = 2 to 3
Moderate = 4 to 5
Severe ≥ 6
DSM-5 Criteria
Substance Use Disorder- 2 in 12 months
1.
Often taken in larger amounts than anticipated (i.e. binges)
2.
3.
4.
5.
6.
7.
8.
9.
10.
Persistent desire or unsuccessful efforts to quit
Great deal of time obtaining or using the substance
Cravings
Failure to fulfill major role obligations
Persistent social or interpersonal problems
Important activities given up
Recurrent use in physically hazardous situations
Persistent physical or psychological problems
Tolerance
11. Withdrawal
}
Must be causal
Mild = 2 to 3
Moderate = 4 to 5
Severe ≥ 6
DSM-5 Criteria
Substance Use Disorder- 2 in 12 months
1.
Often taken in larger amounts than anticipated (i.e. binges)
2.
3.
Persistent desire or unsuccessful efforts to quit
Great deal of time obtaining or using the substance
4.
Cravings
5.
6.
7.
8.
9.
10.
Failure to fulfill major role obligations
Persistent social or interpersonal problems
Important activities given up
Recurrent use in physically hazardous situations
Persistent physical or psychological problems
Tolerance
11. Withdrawal
}
Must be causal
Mild = 2 to 3
Moderate = 4 to 5
Severe ≥ 6
DSM-5 Criteria
Substance Use Disorder- 2 in 12 months
1.
Often taken in larger amounts than anticipated (i.e. binges)
2.
3.
Persistent desire or unsuccessful efforts to quit
Great deal of time obtaining or using the substance
4.
Cravings
5.
6.
7.
8.
9.
10.
Failure to fulfill major role obligations
Persistent social or interpersonal problems
Important activities given up
Recurrent use in physically hazardous situations
Persistent physical or psychological problems
Tolerance
11. Withdrawal
}
Must be causal
Mild = 2 to 3
Moderate = 4 to 5
Severe ≥ 6
Criminogenic Need Tools
Substance Dependence &Abuse Diagnostic Tools
• Global Appraisal of Individual Needs (GAIN)
• Structured Clinical Interview for the DSM-IV (SCID)
• Psychiatric Research Interview for Substance and Mental
Disorders (PRISM)
• Diagnostic Interview Schedule (DIS)
• Texas Christian University (TCU) Drug Dependence Screen-II
• Drug Abuse Screening Test (DAST-20)
Criminogenic Need Tools (cont.)
• Mental Illness
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Brief Jail Mental Health Screen (BJMHS)
GAIN-Q, GAIN-SS, ASI Psychiatric, etc.
• Severe Functional Impairment
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Low IQ, disinhibition
Lack of employable skills
Poor daily living skills (ADLs)
LSI-R
• Third Generation (3G) tool
• Meta-analyses: mean r = .36
– compared to .27 for 2G tools, and .10 for 1G judgments
• Kelly & Welsh (2008):
– N= 276 male drug offenders released from special prison
– Return to custody within approximately 15 months
– Total Score predicted return to custody: r = .25; r2 = .08.
– Drug & Alcohol Score also predicted return to custody:
r = .16; r2 = .04
LSI-R (cont.)
• Lowenkamp & Latessa (2002):
– Predictive validity highly variable across different
programs and populations
• Holsinger et al (2006):
– Not predictive for Native Americans
• Whiteacre (2006):
– Higher false positives and false negatives for AfricanAmericans
LSI-R (cont.)
• Fass et al. (2008):
– Total Score significantly predicted rearrest within 1 year
– AUC = .60; r2 = .03
– Higher false positives for African-Americans
COMPAS
• Fourth Generation (4G) tool
• Fass et al. (2008):
– 276 males released from halfway houses in NJ
– Not significantly predictive of re-arrest within 1 year
AUC = .53
– Significantly higher false positives and false negatives for
African-Americans
COMPAS (cont.)
• Brennan et al. (2009)
• Northpointe (test developers)
– 2,328 probationers, both male and female
– Rearrests within ~ 1 to 5 years
– All but three scales predicted felony recidivism
(AUC = .70 in combination)
– Recidivism Risk Index predicted felony recidivism
(AUC = .70)
– Equivalent prediction by gender, race and ethnicity