UPDATE PPA CE AND ETHICS CONFERENCE Harrisburg PA March 31 2011 Bruce E Mapes PhD PO Box 1028 Exton PA 19341 6106968740 marojehotmailcom The frustrated judge asked How can two competent and respected PhD psychologists review the same data and reach two diametricall ID: 701608
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ASSESSING RISK OF HARM:ETHICAL AND PRACTICE ISSUESUPDATE
PPA CE AND ETHICS CONFERENCE
Harrisburg, PA
March 31, 2011Slide2
Bruce E. Mapes, Ph.D.PO Box 1028Exton, PA 19341
610-696-8740
maroje@hotmail.comSlide3
The frustrated judge asked …“How can two competent and respected PhD psychologists review the same data and reach two diametrically opposed opinions?”
“For every PhD there is an equal and opposite PhD”Slide4
PREDICTION V. ASSESSMENTPerson will or will not do something
Probability statements
Nomethetic
data
Individually basedSlide5
WHAT IS RISK?Hazard forecasted with uncertainty.
Ideas of nature, severity, frequency, imminence, and likelihood
Context specific
Only estimatedSlide6
RISK ASSESSMENT? Process of gathering information to assist decision-making.
It is not simply a diagnosis or prognosis.
It is not predetermined test items or risk factors.
It is an individualized process to assist in decision-making.Slide7
GOALS?To contain and reduce risk.
To guide interventions.
To improve consistency of decisions.
To improve the transparency of decisions.
To protect the rights of the individual, the community, and potential victims.Slide8
POPULATIONS STUDIEDOutpatient settingsInpatient settings
Minimum security prisons
Moderate security settings
Maximum security settings
Supermax
Settings
Forensic
settingsSlide9
CRITERION VARIABLERe-hospitalization (violence v. nonviolence)
Re-arrest (violence v. non-violence)
Re-conviction (violence v. nonviolence)Slide10
RESEARCH ISSUESLow base rates
Correlations
Retrospective v. Prospective studies
Changing base rates (decrease in violent crime)
What do low and high risk mean?
Imminent v. longer-term risk
Sample sizes
First offense v. recidivism
Self - ReportSlide11
VIOLENCE HETEROGENEITYRisk level varies as a function of instrument used
Sexual Deviancy v. Chronic
Antisociality
Wingspread Conference
Situational Couples Violence
Separation Instigated Violence
Coercive – Controlling ViolenceSlide12
MHP - HISTORYPrior violence and criminality more strongly associated with post-discharge violent behavior among all psychiatric patients, regardless of the diagnosis
(Monahan, et.al., 1996, 2001, 2003)Slide13
MHP – CHILDHOOD ABUSEPhysical abuse as a child and as an adolescent presented higher risk of post-discharge violence than did childhood limited abuse.
No significant relationship between sexual abuse as child and violence.Slide14
MHP - DIAGNOSISPatients with co-occurring personality disorders and adjustment disorders were higher risk than those with just major mental illness.
The presence of significant character pathology with
antisociality
was the most critical factor Slide15
MHP – CHARACTER PATHOLOGYLimited traits of
psychopathy
and / or antisocial behavior more predictive of future violence for all patients.
On Hare PCL-R, antisocial factor was more predictive of violence than was the emotional detachment factor.
Presence of Childhood Conduct Disorder and Schizophrenia 2X more likely to commit a violent offense than Schizophrenics without history of Conduct DisorderSlide16
HORMONESTestosterone levels may not be related to violence, but may influence whether violence is directly or indirectly expressed. (
Streuber
, 2007).
Competitive attitudesSlide17
NEUROLOGICAL FACTORSIs frontal lobe related to violence or getting caught? (Adrian
Raine
, et al, 2004)
Role of technology (Small and
Vorgan
, 2008)
Complex interaction between brain functioning and environment.Slide18
NEUROCRIMINOLOGYAmygdala - 18% volume reduction
Middle Frontal
Gyrus
– 18% volume reduction
Orbital Frontal
Gyrus
– 9% volume reduction
Lack of fear conditioning in 3 year oldsSlide19
PSYCHOLOGICAL FACTORS - HANSONGeneral family problems
Degree of physical contact
Presence or absence of empathy / remorse
Social Skill level
Sexual or physical abuse as child
General psychological problems
Substance abuseSlide20
Psych factors - continuedDenial
Cognitive Distortions
Low self-esteem
Psychological test results
(Hanson et. al.)Slide21
ATTACHMENT“It may become an empirically grounded truism years from now that attachment pathology is a centrally necessary but insufficient component to explain violence.”
(
Meloy
, 2003)Slide22
D&A – SEX OFFENDERS“Substance abuse does not often, if ever – at least by itself – predispose a person to commit sexually violent acts.”
“Although alcohol for example may increase one’s desire for sex, there is no known ‘pathological intoxication’ that causes sexual fantasies or urges of an illegal nature.”
(
Doren
, 2002, pp. 101-102)Slide23
D&A – NONSEXUAL VIOLENCESubstance abuse in and of itself does not have a strong relation to violence. Chronic substance use exposes the individual to antisocial peers, attitudes, and environments. It is this complex interaction which is important.
(Andrews and
Bonta
, 2010, pp. 293 – 294)Slide24
PROFILES?There was no accurate or useful profile.
Rarely sudden, impulsive act.
Others often knew of plans / idea
Rarely was plan directly communicated to victim
Most displayed some type of behavior of concern prior to the attack
Most had difficulty coping with significant losses or personal failures. Slide25
ProfilesMany attackers had previously considered or attempted suicide.
Many attackers felt bullied, persecuted, or injured by others prior to the attack.
Most had access to and had used weapons prior to the attack.
(Safe School Initiative, 2002)Slide26
COMPUTERSChatrooms
Education on any type of violence
Many “sick people” willing to help
May normalize violent behavior
Increasing role in violent behaviorSlide27
INTERNET PORNOGRAPHYLoss of satisfaction with current partner
Normalize very deviant acts
Chatrooms
normalizing Pedophilia
File sharing
Accidently downloading is rareSlide28
CHILD PORNOGRAPHYIf the interest in child pornography meets the DSM-IV TR criteria for the diagnosis of
Pedo-philia
, it is appropriate to give this diagnosis.
(
Seto
, et. al., 2010)
59% + who are Pedophiles based on child pornography have had a contact offense.Slide29
A COMPLEX ALGEBRASexual and nonsexual violent
behavior involve
the complex, cumulative interaction of bio-chemical, genetic, structural brain, psychological, and environmental factors across the lifespan. Slide30
ANTISOCIAL DECISION-MAKINGRarely a random act – one decides to engage in antisocial behavior.
Considers the potential for success.
Considers potential to overcome internal inhibitions.
Considers potential to overcome external obstacles.Slide31
DECISION-MAKING EVOLVESOur own experiences and those of others.
Decision-making process reflects adaptations to changing circumstances as different behavioral options are considered.Slide32
THREE COMPONENTS
To formulate and use equations.
The ability to learn from experience.
The ability to see different options.Slide33
DECISION-MAKING PATTERNSNormal
Avoider
Limit Testers
Opportunist
Antisocial GeneralistSlide34
RISK FACTORSStatic – historical factors (don’t change)
Dynamic – can be modified but are stable for weeks, months, years (e.g., association with violent individuals).
Acute – immediate situations (e.g., associates) or immediate emotional state such as anger, resentment, revenge.Slide35
CENTRAL EIGHT RISK-NEED FACTORSChronic history of antisocial behavior
Conduct Disorder / Antisocial Personality Pattern
Antisocial Cognitions (attitudes, justification)
Antisocial AssociatesSlide36
Central EightFamily / Marital Relationship qualitySchool / Work: quality of relationships and performance
Leisure / Recreation: level of involvement and satisfaction in
prosocial
activities
Substance Abuse (especially environmental factors such as associates)
(Andrews and
Bonta
, 2010)Slide37
ASSESSING RISKWhat precipitated referral?
What is the intent or goal?
Does the person have a plan?
Does the person have the means?
Does the person have the opportunity?Slide38
DESIRED INFORMATION BASEHistory of violent and nonviolent antisocial behavior
Internal factors
External FactorsSlide39
WHAT PRECIPITATED REFRRAL?Verbal or written comment?
Some type of action by the subject?
What was the situation?Slide40
INTENT?What does person gain?Let off steam?
Attention?
Harass?
Expression of anger?
Hostility or Instrumental Aggression?
Revenge?Slide41
PLAN?Does the person have a plan?
How detailed is the plan?
How long has it been developing?
What resources have aided the development?
How realistic is the plan?
What is the pool of potential victims?Slide42
MEANSDoes the person have the means to carry out the plan?How quickly can the person access the means?
How serious might the violence be (level of lethality?)
Has the person practiced?Slide43
OPPORTUNITY?Availability of victim(s)?
Likelihood of situation presenting itself?
Ability to make situation occur?
Likelihood of detection?