The Dynamic Risk Assessment and Management System: An Assessment of Immediate Risk of Violence for Individuals with Offending and Challenging Behaviour

Abstract

Purpose Research on dynamic risk assessment has developed over the last 10 years and a number of variables have emerged as being possible predictors of future sexual and violent offences. These variables include hostile attitude/anger and compliance with routine. In 2002, Thornton (Sexual Abuse: A Journal of Research & Treatment 14, 139) developed a framework for dynamic risk assessment which also includes distorted and dysfunctional attitudes, socio-affective functioning, self-management and, for sex offenders, sexual interests. In 2000, Hanson & Harris (Criminal Justice & Behaviour 27, 6) provided empirical support for the predictive power of a number of dynamic factors which they split into stable and acute variables. In their research they found poor social supports, antisocial lifestyle, and poor self-management strategies to be important in addition to cooperation with supervision and hostile attitude. The present report describes the development of the Dynamic Risk Assessment and Management System (DRAMS) -an assessment for dynamic/proximal risk factors in people with intellectual disabilities. Method In a field trial, the DRAMS was administered by staff unfamiliar with the formal requirements of the assessment. They were familiar with other ward-based assessments. Ten subjects were assessed for reliability purposes (total of 45 assessments) and five subjects were assessed consistently over a 3-month period. Eighteen aggressive incidents were recorded in these five subjects and the relationship between DRAMS assessments and the incidents was calculated. Assessments were recorded on the day of the incident, the day before the incident and on a control day, which was at least 7 days before or after an incident. Results Four items achieved high reliability -mood, psychotic symptoms, self-regulation, compliance with routine -in addition to total score. Two items achieved intermediate reliability -antisocial behaviour and problems with thinking/attitudes, and three items were not applicable to this client group in that none of the participants was ever rated on them -substance abuse, renewal of emotional relationships and victim access. One item had poor reliability -therapeutic alliance. There were significant differences between the DRAMS assessment on the control day and assessments both on the day prior to the incident and the day of the incident for three of the six subscales and total score. Conclusion Initial results would suggest that the DRAMS is a reliable instrument apart from the therapeutic alliance category. Initial signs suggest that it may be predictive of aggressive incidents in residential settings. Several developments to other settings and the client groups are discussed.

Assessment implications of “What Works” research for Dangerous and Severe Personality Disorder (DSPD) service evaluation

“…Although static risk factors such as personal demographic and criminal history variables are robust predictors, particularly over the long term, there are data to suggest that dynamic risk factors that are also prominent clinical features of mentally disordered and learningdisabled offenders can be identified, shown to change over short time periods (Lindsay et al, 2004), and found to predict elopement and criminal recidivism (Quinsey, Coleman, Jones, & Altrows, 1997). This is of considerable importance in secure settings where the principle focus of violence risk assessments is the more immediate timeframe rather than years after transfer and release, and where the aim is to identify targets that might be amenable to intervention in order to lower the risk of violence.…”

Risk Assessment in Intellectually Disabled Offenders: Validation of the Suggested ID Supplement to the HCR-20

“…For example, the HCR-20 considers romantic and intimate relationships to assess an individual's ability to form and maintain stable relationships (Webster et al, 1997). One limitation of this item for ID offenders is that reportedly as few as 2% of male ID offenders have experienced intimate relationships, possibly due to a Downloaded by [Computing & Library Services, University of Huddersfield] at 22:06 26 December 2014 lack of opportunity to develop such relationships, not inability to develop stable relationships (Lindsay et al, 2004, cited in Boer et al, 2010. For an ID population, the ID Supplement recommends other forms of social relationships should be considered to assess stability to reduce false-positive assessments of risk (Boer et al, 2010).…”

“…While one study did explore ID offenders in the community, idiosyncratic changes were made by the authors to the HCR-20 scoring criteria, which may have limited generaliszbility of the results and influenced the reliability of scoring (Boer et al, 2010). Despite increased research on ID offenders, the lack of standardization in this research leaves many questions unanswered about the risk factors for violence for this population (Boer et al, 2010;Lindsay et al, 2004).…”

Characteristics, etiology and assessment of sexual offending in persons with intellectual disability

“…Autor ističe značaj neadekvatnog socioafektivnog funkcionisanja kao prediktivnog faktora, naročito hostilnosti i agresivnosti, kao i siromašnih socijalnih veza i nedostatka bliskosti sa primarnom porodicom. Komentarišući rezultate istraživanja Lindzija i saradnika (Lindsay et al, 2004, prema Lindsay, 2012, koje se bavilo prediktivnim značajem različitih varijabli na uzorku od 52 seksualna prestupnika sa IO, od kojih je 18 recidivista i nakon tretmana, Lindzi navodi da su najjaču prediktivnu vrednost imale sledeće varijable: antisocijalni stavovi, nisko samopoštovanje, tolerantni stavovi prema seksualnim zločinima, niska motivacija za tretman, dozvole od strane osoblja i nedostatak bliskosti s majkom.…”

“…Među instrumentima za procenu dominiraju oni koji detektuju dinamičke faktore rizika, stabilne (seksualna interesovanja, stavovi, problemi samokontrole i samousmeravanja) i fluktuirajuće (zloupotreba psihoaktivnih supstanci, raspoloženje), zbog toga što su oni podložni promeni i što se tretmani i zasnivaju upravo na uticanju na dinamičke faktore rizika (Thornton, 2002). Primer jednog od takvih instrumenata, koji je namenjen određivanju dinamičkih prediktora prestupničkog ponašanja, jeste Sistem za procenu dinamičkog rizika i kontrole (Dynamic Risk Assesment and Management System -DRAMS), kojim se procenjuju stabilni dinamički faktori (samoregulacija, intruzivne seksualne misli, emocionalne veze) i akutni dinamički faktori (antisocijalno ponašanje, zloupotreba supstanci, pristup žrtvi, seksualno neadekvatno ponašanje) (Lindsay et al, 2004).…”