Assessment of Risk and Need

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Assessment of Risk and Need
Douglas B. Marlowe, J.D., Ph.D.
National Association of Drug Court Professionals
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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

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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

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Prognostic Risk
Any validated recidivism risk tool
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Prognostic Risk

• Any validated recidivism risk tool
• Prior criminal history
• Current age lt 25 years
• Delinquent onset lt 16 years
• Substance abuse onset lt 14 years
• Prior rehabilitation failures
• Antisocial Personality
• Criminal values
• Familial history of crime or addiction
• Criminal associations
• Instability (chronic homelessness, unemployment)

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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)    
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Criminogenic Needs

• Substance Dependence or Addiction
• Triggered binge response
• Cravings or compulsions
• Withdrawal symptoms

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DSM-5 Criteria

• Substance Use Disorder- 2 in 12 months
• 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
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DSM-5 Criteria

• Substance Use Disorder- 2 in 12 months
• Often taken in larger amounts than anticipated
  (i.e. binges)
• 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
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DSM-5 Criteria

• Substance Use Disorder- 2 in 12 months
• Often taken in larger amounts than anticipated
  (i.e. binges)
• 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
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DSM-5 Criteria

• Substance Use Disorder- 2 in 12 months
• Often taken in larger amounts than anticipated
  (i.e. binges)
• 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
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DSM-5 Criteria

• Substance Use Disorder- 2 in 12 months
• Often taken in larger amounts than anticipated
  (i.e. binges)
• 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
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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)

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Criminogenic Need Tools (cont.)

• Mental Illness
• Brief Jail Mental Health Screen (BJMHS)
• GAIN-Q, GAIN-SS, ASI Psychiatric, etc.
• Severe Functional Impairment
• Low IQ, disinhibition
• Lack of employable skills
• Poor daily living skills (ADLs)

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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

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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
  African-Americans

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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

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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

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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