Overview of Correctional Psychology Focus: Psychopathy

1
Overview of Correctional PsychologyFocus
Psychopathy Clinical-Forensic Risk Assessment

• Barry Cooper, Ph.D.
• Psychology Department
• Kent Institution
• Correctional Service of Canada
• boobooc_at_telus.net

2
Overview

• Context
• Duties of institutional psychologists
• Focus of intervention by security level
• Psychopathy Clinical Forensic Risk Assessment

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Psychology Behind Bars The Context

• High rate of mental illness
• Environment
• Difficult, anti social (con code)
• Constant threat of violence (riot, weapons)
• Adjustment
• Inmates view of psychology
• Difficult context to practice

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Duties of Institutional Psychologists
Assessment

• Short-term risk for self-harm/other harm
• admission, crisis, PFV, unit transfer
• risk management recommendations
• Long-term risk/management for recidivism
• intake, DO annual review, detention, statutory
  release (residency)
• treatment/risk management recommendations
• Psychodiagnostic
• Psych Profiles
• Segregation (mental status)
• Re referral to HC, Psychiatry
• Re emergency transfer to Regional Treatment Center

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Duties of Institutional Psychologists
Intervention

• Core correctional programming (VOP/SOP)
• group (CBT based)
• Relapse prevention
• group (CBT based)
• Crisis counseling
• Short-term counseling (e.g., supportive
  psychotherapy, CBT, REBT)

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Focus of Intervention by Security Level

• Maximum Non-disruptive behavior
• Goals Keep them alive, control behavior
  (violence, drugs/brew), lower security
• Medium Rehabilitation
• Goals Successful rehabilitation (core programs)
• Focus on risk factors/crime cycle
• Treat/manage symptoms of mental illness
• Minimum Integration
• Goals Successful integration/generalization of
  treatment effects/transfer of training
• RP

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Duties of Institutional Psychologists Staff

• CISM
• Staff Training
• Staff Consultation
• Brief Counseling/EAP

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Psychopathy Clinical- Forensic Risk Assessment
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What is a risk assessment?

• involves the prediction that a given individual
  will act a certain way in the future
• re CJS, the individual is an offender a certain
  way is violently (either to themselves of
  others) the future could either be the distal or
  proximal future (e.g., ob cell vs detained)

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The heterogeneous roles of risk assessments

• Civil-psychiatric- is the patient a risk to harm
  himself or others?
• Correctional- is the offender a risk to violently
  recidivate upon release?
• Many contexts e.g., National Parole Board
  hearing, Dangerous Offender hearing, Detention
  Review, Conditional Release (e.g., day/full
  parole)

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Brief History of Risk Assessment

• First Generation
• Clinical judgment
• Second Generation
• Actuarial assessment (e.g., VRAG/SORAG/Static 99)
  
• Third Generation
• Actuarial assessment clinical judgment (e.g.,
  VPS)
• Structured Clinical Guidelines (e.g., HCR-20,
  SVR-20, SARA)

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First Generation Approach1960s and 1970s

• mental health professionals relied heavily on
  unsubstantiated clinical judgment (e.g.,
  impressions clinical experience Webster,
  1998)
• substantial false positive errors violence was
  overpredicted (e.g., Steadman Cocozza, 1974).
• Monahan (1981) psychologists and psychiatrists
  were accurate in their predictions of violent
  behavior in no more than one in three predictions
  of violence

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American Psychiatric Association (1974)

• the state of the art regarding predictions of
  violence is very unsatisfactory. The ability of
  psychiatrists or any other professionals to
  reliably predict future violence is unproved

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American Psychological Association (1978)

• It does appear from reading the research
• that the validity of psychological predictions of
• dangerous behavior, at least in the sentencing
  and
• release situation we are considering, is
  extremely
• poor, so poor that one could oppose their use on
• the strictly empirical grounds that psychologists
  
• are not professionally competent to make such
• judgments

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The Failure of the 1st Generation Approach to
Risk Assessment

• (1) examined heterogeneous clinical samples
• (2) examined studies with low base rates of
  violence
• (3) criterion measure was official rates of
  violence
• (4) approach was essentially clinical-subjective
  in nature (process?)

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2nd Generation Approach to Risk Assessment

• Utilized actuarial or historical/static schemes
  to assess for risk for violence
• actuarial formulas, formulated by multivariate
  statistics (e.g., discriminant function analysis
  and logistic regression), stem from empirical
  relationships between certain (static) risk
  variables and the criterion variables (e.g.,
  violence)
• e.g., predicting weather (Monahan, 2002)
• More accurate estimates of risk were facilitated
  (see Borum, 1996 Douglas Webster, 1999
  Ogloff, 1995 Serin, 1995)

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The Risk Violence Risk Appraisal Guide (VRAG) An
Actuarial Scheme for the Prediction of Violent
Recidivism

• Harris, Rice, Quinsey (1993)
• used a linear combination of gt40 variables to
  retrospectively predict violent recidivism in a
  sample of 618 mentally disordered offenders
  released from a maximum-security psychiatric
  institution in Ontario.
• sum of 12 variables, weighted accordingly, were
  found to be significantly associated with violent
  recidivism (R .459)

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VRAG Items

• (1) Psychopathy Checklist-Revised Score (PCL-R
  Hare, 1991)
• (2) Elementary school maladjustment
• (3) DSM diagnosis of any personality disorder
• (4) Age at index offence
• (5) Lived with both parents to the age of 16
• (6) Failure on conditional release
• (7) Criminal history score for non-violent
  offences
• (8) Marital status
• (9) DSM diagnosis of schizophrenia
• (10) Victim injury
• (11) History of alcohol problems
• (12) Female victim

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VRAG Scoring

• an offender is placed into one of the nine bins.
• The higher the bin number, the higher the risk of
  violent recidivism.
• using the middle bins (5-6) as a cutoff, Harris
  et al. (1993) reported that those scoring above
  the cutoff violently recidivated at 69 those
  offenders scoring below the cutoff recidivated
  at 31.
• Each bin number indicates a probability of
  violent recidivism over the periods of 7 and 10
  years post release from incarceration.
• 3rd bin likelihood of violent recidivism .12
  and .24
• 8th bin likelihood of violent recidivism .76
  and .82

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Limitations of the VRAG

• Nature of normative sample
• Purely static
• Does not examine dynamic factors
• Harts example
• Authors caution against use of clinical/dynamic
  factors!
• what we are advising is not the addition of
  actuarial methods to existing practice, but
  rather the complete replacement of existing
  practice with actuarial methodsactuarial methods
  are too good and clinical judgment too poor to
  risk contaminating the former with the latter
  (Quinsey et al.,1998, p. 171)

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Psychopathy The most potent VRAG Item

• r .34 with violent recidivism in VRAG normative
  sample (Harris et al., 1993)
• a personality disorder
• Originally described by Cleckley (1941) in The
  Mask of Sanity
• Operationalized by Hare (1980, 1991, 2003) The
  Psychopathy Checklist-Revised (PCL-R)
• unique interpersonal, affective, and behavioral
  traits
• not in the DSM-IV or DSM-IV-TR
• Asymmetrical relationship with APD
• 15-25 vs. 50-80 of incarcerated populations
• Approximately 1 in general pop.

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The PCL-R (Hare, 2003) Items 2 vs. 3 vs. 4
factor structure

• Factor 1
• interpersonal/affective
• failure to accept responsibility for own actions
• pathological lying
• lack of remorse/guilt
• glibness/superficial charm
• shallow affect
• grandiose sense of self-worth
• conning/manipulative
• callous/lack of empathy

• Factor 2
• behavioral
• early behavioral problems
• lack of realistic, long-term plans
• parasitic lifestyle
• poor behavioral controls
• impulsivity
• irresponsibility
• juvenile delinquency
• need for stimulation
• revocation of conditional release

3 non loading items (1) promiscuous sexual
behavior, (2) many short-term marital
relationships, (3) criminal versatility
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The PCL-R

• used only by qualified and trained mental health
  professionals
• items are scored on a 3 point scale (0, 1, 2)
• can omit 4 items
• Items are summed to reach a total score (0-40)
  30 for a Diagnosis in North America 25 for a
  Diagnosis is Scotland
• scores are reported as percentile ranks (for
  total, Factor 1 and Factor 2)

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Psychopathy Research

• Relationship to recidivism
• 4 times more likely than non-psychopaths
• especially, instrumental violence
• PCL-R is item on VRAG/SORAG, HCR-20, SVR-20
• Relationship to treatment effectiveness
• Affective deficit
• Neurological research
• Emotional processing
• Factor Structure
• Etiology
• Subtypes
• Memory

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The 3rd Generation Approach to Risk Assessment
(1) Examine Static Dynamic Factors (2)
Structured Clinical Judgment

• Schemes that Examine Static Dynamic Factors
• Violence Prediction Scheme Webster et al. (1994)
  
• VRAG and ASSESS list
• (1) Antecedent history
• (2) Self-presentation
• (3) Social and psychosocial adjustment
• (4) Expectations and plans
• (5) Symptoms
• (6) Supervision
• (7) Life factors
• (8) Institutional management
• (9) Sexual adjustment
• (10) Treatment progress

• Structured Clinical Judgment
• (1) Historical Clinical Risk Management-20
  (HCR-20 Webster et al., 1997)
• (2) Sexual Violence Risk-20 (SVR-20 Boer et
  al.,1997)
• (3) Spousal Assault Risk Assessment Guide (SARA
  Kropp et al., 1995)

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The HCR-20 A Structured Clinical Rating Scale
for Risk for Future Violence (Webster et al.,
1997)

• Historical items
• (1) Previous violence
• (2) Young age at first violent incident
• (3) Relationship instability
• (4) Employment problems
• (5) Substance use problems
• (6) Major mental illness
• (7) Psychopathy
• (8) Early maladjustment
• (9) Personality disorder
• (10) Prior supervision failure

• Clinical variables
• (1) Lack of insight
• (2) Negative attitudes
• (3) Active symptoms of major mental illness
• (4) Impulsivity
• (5) Unresponsive to treatment.
• Risk management items
• (1) Plans lack feasibility
• (2) Exposure to destabilizers
• (3) Lack of personal support
• (4) Non-compliance with remediation attempts
• (5) Stress

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HCR-20 Research

• Douglas (1996)
• followed 200 involuntary committed civil
  psychiatric Canadian patients (X 690 days)
• total HCR-20 scores were strongly predictive of
  community violence (violent crime .78,
  physical violence .73, all violence .73
• Douglas, Ogloff, Nicholls, Grant (1999)
• followed 193 civilly committed psychiatric
  patients (X 626 days)
• patients who scored above the median on the
  HCR-20 were between 6 to 13 times more likely
  than those scoring below the median to be violent
  after their release into the community

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The SVR-20 A Structured Clinical Rating Scale
for Risk for Future Violence (Boer et al., 1997)

• Psychosocial adjustment
• (1) Sexual deviation
• (2) Victim of child abuse
• (3) Psychopathy
• (4) Major mental illness
• (5) Substance abuse problems
• (6) Suicidal/homicidal ideation
• (7) Relationship problems
• (8) Employment problems
• (9) Past nonsexual violent offences
• (10) Past nonviolent offences
• (11) Past supervision failure

• Sexual offence
• (12) High density sex offences
• (13) Multiple sex offence types
• (14) Physical harm to victim(s)
• (15) Use of weapons or threats of death in sex
  offences
• (16) Escalation in frequency or severity of sex
  offences
• (17) Extreme minimization or denial of sex
  offences
• (18) Attitudes that support or condone sex
  offences (e.g., social vs moral conflicted)
• Future plans
• (19) Lacks realistic plans
• (20) Negative attitude towards intervention

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The SARA A Structured Clinical Rating Scale for
Risk for Domestic Violence (Kropp et al., 1995)

• Criminal history
• (1) Past assault of family members
• (2) Past assault of strangers or acquaintances
• (3) Past violation of conditional release
• Psychosocial adjustment
• (4) Recent relationship problems
• (5) Recent employment problems
• (6) Victim of and/or witness to family violence
  as a child or adolescent
• (7) Recent substance abuse/dependence
• (8) Recent suicidal or homicidal ideation/intent
• (9) Recent psychotic and/or manic symptoms
• (10) Personality disorder with anger,
  impulsivity, or behavioral instability

• Spousal assault history
• (11) Past physical assault
• (12) Past sexual assault/sexual jealousy
• (13) Past use of weapons and/or credible threats
  of death
• (14) Recent escalation in frequency or severity
  of assault
• (15) Recent violation of no contact orders
• (16) Extreme minimization or denial of spousal
  assault history
• (17) Attitudes that support or condone spousal
  assault
• Alleged (current) offence
• (18) Severe and/or sexual assault
• (19) Use of weapons and/or credible threats of
  death
• (20) Violation of no contact order

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SARA Research

• Kropp et al. (1996)
• those rated as high risk on the SARA were found
  to be over five times more likely to re-offend
  than those rated as a low or a moderate risk (n
  50)
• designation of high risk was based only on
  summary ratings, not on the basis of the sum of
  the SARA items or the number of positive SARA
  items (as with research on HCR-20 and SVR-20)

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My Approach To Risk Assessment

• File review (Psychology, Case management,
  Discipline and Dissociation, SIO)
• Staff Consultations
• Interview
• Report
• Identification
• Reason for referral
• Database
• Criminal History (index and all violent/sexual
  offences are reviewed)
• Social history (formative years, substance abuse,
  employment, relationships) tell the story
• Actuarial and Clinical Rating scales (PCL-R,
  VRAG, Static 99, SVR-20, HCR-20, SARA)
• Clinical Impression/Observations
• Summary and Recommendations

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Risk Assessment Caveats

• evaluation of 3rd generation approach is in its
  infancy
• limited formal guidelines defining appropriate
  practice for forensic clinicians (depends on
  country/region/senior psych)
• results of risk assessments are not entirely
  accurate
• the state of the art will never advance to that
  point - human behavior is inherently complex
• - the prediction of violent behavior, behavior
  with a relatively small base rate, adds to the
  complexity

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Monahan (1981)

• All a person predicting violence can hope to do
  is to assign a probability figure to the
  occurrence of violent behavior by a given
  individual during a given time period. The figure
  may be expressed in either arithmetic (e.g., 75
  percent likely) or in prose form (e.g.,
  substantially likely, more likely than not).
  In either case, the question remains, is this
  degree of relationship sufficiently great to
  justify preventative intervention?, whether that
  intervention is in the form of civil commitment,
  denial of parole release, or informing a
  potential victim (p. 34).

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Volunteer Experience?822-6130today at 1130
(room 1115)

• Memory for Mayhem
• Transcribing/coding
• Credibility assessment
• Follow-up study (SFU)
• Risk assessment validation studies
• Memory and PTSD in sex trade workers (summer)