Download
1 / 38

The Classification of Violence Risk COVR Development Evaluation Michael Doyle Nurse Consultant Honorary Research Fel - PowerPoint PPT Presentation


  • 150 Views
  • Uploaded on

The Classification of Violence Risk COVR Development & Evaluation Michael Doyle Nurse Consultant & Honorary Research Fellow. Acknowledgements. National Forensic R&D Programme Professor Mairead Dolan Stuart Carter Professor John Monahan Rebecca Rowles Jenny Vo Des Kelly

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'The Classification of Violence Risk COVR Development Evaluation Michael Doyle Nurse Consultant Honorary Research Fel' - rolando


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
Slide2 l.jpg

The Classification of Violence Risk

COVR

Development & Evaluation

Michael Doyle

Nurse Consultant & Honorary Research Fellow


Acknowledgements l.jpg
Acknowledgements

  • National Forensic R&D Programme

  • Professor Mairead Dolan

  • Stuart Carter

  • Professor John Monahan

  • Rebecca Rowles

  • Jenny Vo

  • Des Kelly

  • Professor Jenny Shaw


Aims of presentation l.jpg
Aims of presentation

  • Describe development of the COVR

  • Highlight findings from recent European studies

  • Present findings from study of non-forensic discharged psychiatric patients in Greater Manchester, England

  • Discuss future research considerations


Background macarthur violence risk assessment study monahan et al 2001 l.jpg
BackgroundMacArthur Violence Risk Assessment Study(Monahan et al. 2001)

  • Examined 134 dispositional, historical, clinical, and situational risk factors

  • Compared factors assessed while inpatient with community violence

  • 939 male and female civil psychiatric patients

  • Comparison group of 519

  • Age 18 - 40

  • Time at risk 20 weeks post-discharge


Macvras big predictors 20 weeks post discharge l.jpg
MacVRAS Big Predictors20 weeks post-discharge


Slide7 l.jpg

Iteration #1

Total sample

n=939; 18.7% violent

Seriousness of Arrest

Property, minor, drugs

n=306; 20.3%

Seriousness of Arrest

Robbery, rape, assault, murder

n=208; 36.1%

Seriousness of Arrest

None

n=425; 9.2%

Father Used Drugs

No

n=255; 16.5%

Father Used Drugs

Yes

n=51; 39.2%

High Risk Group

Motor

Impulsiveness

High

n=66; 21.2%

Recent Violent

Fantasies

No

n=134; 26.9%

Recent Violent

Fantasies

Yes

n=74; 52.7%

Motor

Impulsiveness

Low

n=359; 7.0%

High Risk Group

Classification of Violence Risk

Monahan et al, 2005


Slide8 l.jpg

36.5%

26.4%

10.9%

6.7%

19.5%


Slide9 l.jpg

Monahan, J., Steadman, H., Appelbaum, P., Grisso, T., Mulvey, E., Roth, L., Robbins, P., Banks, S., & Silver, E. (2005). The classification of violence risk. Lutz, FL: Psychological Assessment Resources.


Classification of violence risk description l.jpg
Classification of Violence Risk Mulvey, E., Roth, L., Robbins, P., Banks, S., & Silver, E. (2005). Description

  • Interactive software programme

  • Estimate risk of post-discharge violence

  • Brief Chart review

  • 5-10 minute interview with participant

    • Self-report option


Categorical risk communication l.jpg
Categorical Risk Communication Mulvey, E., Roth, L., Robbins, P., Banks, S., & Silver, E. (2005).

  • Category 1: very low risk

    • [corresponding to a risk of 1%/1 of 100]

  • Category 2: low risk

    • [corresponding to a risk of 8%/8 of 100]

  • Category 3: average risk

    • [corresponding to a risk of 26%/26 of 100]

  • Category 4: high risk

    • [corresponding to a risk of 56%/56 of 100]

  • Category 5: very high risk

    • [corresponding to a risk of 76%/76 of 100]


Covr research evidence l.jpg
COVR: Research Evidence Mulvey, E., Roth, L., Robbins, P., Banks, S., & Silver, E. (2005).

  • Construction study (Monahan et al., 2001; Banks et al., 2004)

    • Estimated ten different risk assessment models

    • Different risk factors were chosen to be the lead variable upon which a classification tree was constructed

    • Five risk groups - likelihood of violence to others ranged from 1% to 76%.

  • Validation study (Monahan et al., 2005;2006)

    • Low Risk = 9% v High-Risk = 49%

    • Shrinkage in predictive power

    • “..validated only on samples of psychiatric inpatients in acute facilities in the United States who would soon be discharged into the community”.


Slide13 l.jpg
Prospective Validation of COVR Mulvey, E., Roth, L., Robbins, P., Banks, S., & Silver, E. (2005). Monahan, Steadman, Robbins, Appelbaum, Banks, Grisso, Heilbrun, Mulvey, Roth, and Silver (2005)


Concerns l.jpg
Concerns Mulvey, E., Roth, L., Robbins, P., Banks, S., & Silver, E. (2005).

  • McCusker, 2007

    • Clinical use questionable

    • ‘Shrinkage’ in predictive power as construction study fit the data too specifically

    • Unreliable responses in clinical setting

    • Environmental influences

    • Further validation required


Covr research evidence15 l.jpg
COVR: Research Evidence Mulvey, E., Roth, L., Robbins, P., Banks, S., & Silver, E. (2005).

  • Doyle et al. 2007

    • COVR strong correlation with Historical, Dispositional & Clinical factors previously found to be correlated with violence risk.

    • Good concurrent validity compared with established violence risk measures e.g. HCR-20, VRAG

  • Snowden and Gray, 2008

    • 52 inpatients in 4 medium secure units in Wales over 6 months

    • COVR good predictor of verbal and physical aggression

  • Lindqvist and Sturup, 2008

    • 352 civil psychiatric patients discharged into community

    • Only 3% high or very high risk

    • 5% committed violent act; base rate much lower than USA and UK

    • Uncertain benefits of COVR in Swedish population


Preliminary evaluation in a uk sample l.jpg

Preliminary Evaluation in a UK Sample Mulvey, E., Roth, L., Robbins, P., Banks, S., & Silver, E. (2005).


Rationale l.jpg
Rationale Mulvey, E., Roth, L., Robbins, P., Banks, S., & Silver, E. (2005).

  • Evidence supports structured professional judgement approach that combines static & dynamic factors (e.g. Doyle and Dolan, 2006)

  • COVR untested in UK population

  • Need for efficient decision support tool for use in clinical practice


Hypotheses l.jpg
Hypotheses Mulvey, E., Roth, L., Robbins, P., Banks, S., & Silver, E. (2005).

  • Participants with higher baseline rating on the COVR will be significantly more likely to be violent in the 20 weeks post discharge


Procedure 1 l.jpg
Procedure (1) Mulvey, E., Roth, L., Robbins, P., Banks, S., & Silver, E. (2005).

Baseline assessment

  • Current civil psychiatric inpatients

    • Interview

    • Case note review

    • Liaison with primary nurse

    • Staff rated measures

  • Administer COVR computerized programme


Procedure 2 l.jpg
Procedure (2) Mulvey, E., Roth, L., Robbins, P., Banks, S., & Silver, E. (2005).

Follow-up assessment

  • Violent behaviour in the community measured 20 weeks post discharge.

  • Interview with the participants, record review and speaking to someone who knows the person well (e.g. friend, relative, carer).

  • Baseline measure then compared with violence in the community post-discharge.


Violence definition l.jpg
Violence Definition Mulvey, E., Roth, L., Robbins, P., Banks, S., & Silver, E. (2005).

“ . . any acts that include battery that resulted in physical injury; sexual assaults; assaultative acts that involved the use of a weapon; or threats made with a weapon in hand.”

(Monahan et al, 2001)


Sample l.jpg
Sample Mulvey, E., Roth, L., Robbins, P., Banks, S., & Silver, E. (2005).

  • Sample size: 93

  • Age: Mean – 40 years (Range - 18-60)

  • White Caucasian 92.5% (n = 86)

  • Male 58% (54) Female 42% (39)

  • Mean length of Stay: 36.2 days Med = 19 days

  • Involuntarily detained: 36.6% (34)

  • Previous Serious Violence: 20.4%

  • Definite/Serious Substance Use Problems 31.2%


Primary chart diagnosis l.jpg
Primary Chart Diagnosis Mulvey, E., Roth, L., Robbins, P., Banks, S., & Silver, E. (2005).


Representativeness of sample l.jpg
Representativeness of Sample Mulvey, E., Roth, L., Robbins, P., Banks, S., & Silver, E. (2005).


Covr risk category l.jpg
COVR Risk Category Mulvey, E., Roth, L., Robbins, P., Banks, S., & Silver, E. (2005).


Covr risk category comparison with macvras l.jpg
COVR Risk Category Mulvey, E., Roth, L., Robbins, P., Banks, S., & Silver, E. (2005). Comparison with MacVRAS


Prevalence of violence l.jpg
Prevalence of Violence Mulvey, E., Roth, L., Robbins, P., Banks, S., & Silver, E. (2005).


Frequency of violence 40 incidents l.jpg
Frequency of Violence Mulvey, E., Roth, L., Robbins, P., Banks, S., & Silver, E. (2005). 40 incidents


Covr risk category violence 20 weeks l.jpg
COVR Risk Category Mulvey, E., Roth, L., Robbins, P., Banks, S., & Silver, E. (2005). Violence 20 Weeks


Macvras category violence at 20 weeks l.jpg
MacVRAS Category & Violence at 20-weeks Mulvey, E., Roth, L., Robbins, P., Banks, S., & Silver, E. (2005).


Covr risk category violence 20 weeks x 2 6 024 df 2 p 0 049 l.jpg
COVR Risk Category Mulvey, E., Roth, L., Robbins, P., Banks, S., & Silver, E. (2005). Violence 20 Weeksx2 = 6.024, df, 2, p = 0.049*


Summary of preliminary findings l.jpg
Summary of Preliminary Findings Mulvey, E., Roth, L., Robbins, P., Banks, S., & Silver, E. (2005).

  • Insufficient sample size

  • Lower risk scores compared to MacVRAS

    • Different sample characteristics e.g. nationality, age, diagnosis, length of stay

    • Self-report with no adjustment

    • High-Very High risk participants identified and managed

  • Predictive accuracy not replicated although trend

  • Women more likely to be violent in 20 weeks post-discharge


Future research l.jpg
Future Research Mulvey, E., Roth, L., Robbins, P., Banks, S., & Silver, E. (2005).

  • Repeat with larger sample

  • Concurrent ‘clinical’ rating by 1 or more raters

  • ? Link with structured professional judgement

  • Examine integration in clinical practice

  • Investigate the relative contribution of COVR & established tools in predicting violence

  • Examination of the validity of the tools based on

    • (i) gender

    • (ii) treatment, support and supervision available

  • Trial in forensic population


  • There is an obvious conclusion but we re not allowed to jump to it webster 2008 l.jpg

    “…there is an obvious conclusion, but we’re not allowed to jump to it!”Webster, 2008


    Slide35 l.jpg

    C/O Coronation Street allowed to jump to it!”


    Final thoughts l.jpg
    Final Thoughts allowed to jump to it!”

    • …We can never prove how many people we have prevented from being violent..

    • Good judgement comes from experience, and experience comes from bad judgement

    • Tools and scales don’t make decisions...people do!!


    References l.jpg
    References allowed to jump to it!”

    • Banks, S., Robbins, P. C., Silver, E., Vesselinov, R., Steadman, H. J., Monahan, J., et al. (2004). A multiple-models approach to violence risk assessment among people with mental disorder. Criminal Justice and Behavior, 31, 324–340.

    • McCusker, P. J. (2007) Issues regarding the Clinical Use of the COVR Assessment Instrument. International Journal of Offender Therapy & Comparative Criminology. Doi:10.1177/0306624x07299227

    • Monahan, J., Steadman, H., Appelbaum, P., Grisso, T., Mulvey, E., Roth, L., Robbins, P., Banks, S., & Silver, E. (2005). The classification of violence risk. Lutz, FL: Psychological Assessment Resources.

    • Monahan, J, Steadman, H., Robbins, P., Appelbaum, P., Banks, S., Grisso, T., Heilbrun, K., Mulvey, E., Roth, L., & Silver, E. (2005b). An actuarial model of violence risk assessment for persons with mental disorders. Psychiatric Services, 56, 810–815.

    • Monahan, J., Steadman, H. J., Silver, E., Appelbaum, P. S., Robbins, P. C., Mulvey, E. P., et al. (2001). Rethinking risk assessment: The MacArthur study of mental disorder and violence. New York: Oxford University Press.


    Contact details l.jpg
    Contact Details allowed to jump to it!”

    Dr Michael Doyle

    Nurse Consultant, Professional Lead, Hon Research Fellow

    Adult Forensic Mental Health Service

    Edenfield Centre

    Greater Manchester West NHS Mental Health Trust

    Bury New Road

    Prestwich

    Manchester

    England

    M25 3BLTel: 0161 772 4611/3879

    Email: [email protected]


    ad