Determination of future risk of violence is an important forensic task. It can contribute to decisions about the appropriate level of care or structure. Research has demonstrated repeatedly that clinical judgment about the risk of future violence is little better than chance. Tools to determine this risk affects a youth’s life significantly and should be reliable and valid. Tools developed to date to determine youth risk of future violence, delinquency, and behavior problems include the SAVRY, PCL-YV, YLS-CMI, CARE, RSTI (see table 1).
The Structured Assessment of Violence Risk in Youth (SAVRY) (Borum, Bartel, & Forth, 2002) is composed of 24 risk items (Historical, Social/ Contextual, and Individual) drawn from existing literature on adolescent development and on aggression in youth. An additional six Protective Factors are also provided. It was once thought that dangerousness was static and not subject to change, however more recently it is viewed as more contextual or dependent on situations. Additionally, the developers of the SAVRY have included dynamic risk factors because personality and behavior traits are not stable in adolescence. The theory underlying these assessments has shifted from a violence prediction model to a more clinical model of risk assessment and behavior management. The task is to determine the nature and degree of risk an individual may pose for certain kinds of behaviors, and under what conditions and contexts.
The SAVRY is for youth ages 12 to 18. It is professionally scored. The sample size is small. Studies have found correlations with past violence to be moderate to good (r = .32 to .56), explaining 18 to 20% of the variance, with an error rate of 21%. Reliability is good. It does not recommend level or types of services.
The Hare Psychopathy Check List: Youth Version (PCL: YV) (Forth, Kosson, & Hare, 2003) is a 20-item rating scale for the assessment of psychopathic traits in male and female offenders aged 12 to 18 years of age. While Drs. Forth, et al, believe that identifying youth with psychopathic traits is critical to understanding the factors that contribute to the development of adult psychopathy, the application of the concept of psychopathy to youth is very controversial. The youth PCL was adapted from the Hare Psychopathy Checklist –Revised (PCL-R), one of the most widely used measures of psychopathy in adults. Using a semi-structured interview and collateral information, the PCL: YV measures interpersonal, affective, and behavioral features related to the concept of psychopathy.
The PCL-YV is for youth ages 12 to 18. It is professionally scored. Studies have found correlations with past violence to be poor to good (r = .10 to .48), with an error rate of 21 to 37%. Reliability is excellent. It does not recommend level or types of services.
The CARE (Child and Adolescent Risk Evaluation, (Seifert, 2003) assesses the risk for violence and evaluates all possible problem areas, including past behavior, community, family, peer, job/school, neurological, and mental health. The first tool to be developed by Seifert (2003) was the CARE (Seifert, 2003). It is an easy to use tool for assessing the risk of youth violence and creating a multifaceted case management plan. More than 1000 youth with ethnically diverse backgrounds were in the first CARE sample. The ages ranged from 2 through 19 years, over half had a history of assaults. Significantly higher CARE scores were seen in those with assaultive histories and these youth were more likely to commit an assault within the next six months.
While it is true , as is suggested by Dr. Borum and others, that environmental stressors can predict the immediacy of a violent act, it is the development of interpersonal skills, personality, morality, and problem solving ability that can create the potential for violence to occur in the face of an environmental stressor. The CARE is based on developmental theory and suggests what areas of development may be delayed and in need of intervention.
The CARE assesses both risk and protective factors. As with the more commonly known adult actuarial risk tools, the CARE is based on the idea that the more risk factors that an offender has, the greater his risk for recidivism. No one factor predicts youth violence. Each additional factor increases the risk that a youth will be violent. The CARE is the only youth violence risk tools with a case management tool to determine the intensity and type of services needed.
The total CARE score appears to be significantly associated with a history of assaults (r = 62. p=.00) and assaults committed after the administration of the instrument (r = .62, p=.00). Split half reliability is .85 and Test-retest reliability is .75. The error rate is 13%. It recommends level and types of services needed.
There are 4 CARE Subscales. (Seifert, K. 2006) that are intended to be used with the original CARE (see above). These are: Chronic Violence, Attachment Problems, Psychiatric Problems and Sexual Behavior Problems. All use items from the CARE that are most highly correlated with the construct. The sample is 912 and is the same as the original CARE. It can asses the risk of future violence and sexual offending. While there is controversy about labeling children, this is seen as a prevention tool to ensure that children get the services they need as early as possible so they do not penetrate the juvenile justice system as deeply.
Traditional tests, such as the MMPI-A and the MACI, were not created nor have they been evaluated in terms of their association with risk of violence. Additionally, popular tools, such as the CAFAS (Hodges, 1990, 1994, 2003), CALOCUS (American Association of Community Psychiatrists, 1999) and MAYSI (Grisso, Barnum, Fletcher, Cauffman, & Peuschold, 2001) do not assess risk for violence.
The completion of the risk assessment tool first requires that the clinician gather a complete psychosocial history, based on record review, direct interviews with the child or adolescent, and interviews with collateral informants such as parents, teachers, therapists, social service agency workers, etc. (American Academy of Child and Adolescent Psychiatry; Rich, 2003). Each risk tool has characteristics that are unique to that tool. By comparing tools, a practitioner can determine which tool(s) are best suited to their needs and their population(s). There are a variety of ways to compare tools. This paper uses three sets of criteria to compare existing tools. The tools listed here are not exhaustive, but includes the tools most commonly used by practitioners.
The SAVRY and the EARL-20 are empirically-based, structured tools for guided clinical assessment. That is, the factors included in the tools are based on pertinent literature in the field, including published studies, and the instruments provide defined factors to be addressed and a specific structure to be followed by the clinician completing the evaluation (Rich, 2003). The PCL and the YLSI have empirically based scoring systems and cut off scores. The DVI is self-report and includes suggestions for treatment as does the YLS/CMI.
There is professional debate about the use of actuarial tools and risk assessment with juveniles. The argument against guided clinical judgment is the research demonstrating that for adults, clinical judgment of future risk of violence is no better than chance (Rice, Harris, Quinsey, 2002l). The argument against risk tools that go beyond a guided clinical assessment and use scoring systems and cut off scores similar to the adult risk tools are fears of labeling that does not change over time and the inability of existing tools to take into account the plasticity of youth development. This paper proposes that violence is an interpersonal behavior that has a developmental trajectory, influenced by environment, caregiver bonding, neurological development, and child characteristics, such as temperament, genetics, and intelligence. A risk tool that measures dynamic factors that change over time, as well as historical factors could capture a measure of risk at a particular point in time. The measure should present treatment options, rather than just measuring risk. The CARE is such a tool.