Chapter 14: Assessing Violence Risk

Early landmark studies such as Kozol et al. challenged clinicians' ability to predict violence, though subsequent analysis revealed significant methodological flaws in these investigations, as the original judgments reflected release recommendations rather than absolute predictions and relied on unrepresentative populations. The chapter contrasts three major assessment approaches: unstructured clinical judgment, which offers individualized case analysis but lacks consistency and transparency; actuarial prediction, which provides numerical probability estimates through formal equations but suffers from sample dependence and inflexibility; and structured professional judgment, which systematically integrates evidence-based guidelines to classify individuals into risk categories while maintaining clinical flexibility. Empirical research spanning hundreds of studies demonstrates that structured professional judgment produces predictions as accurate as or superior to purely actuarial methods, with summary risk ratings demonstrating unique predictive validity. A comprehensive structured professional judgment assessment involves six integrated steps: gathering multisource information with emphasis on detailed violent history, identifying relevant risk factors using evidence-based instruments, evaluating how factors apply to the specific individual through decision theory, constructing plausible violence scenarios varying in imminence and severity, developing targeted management strategies including monitoring and treatment, and communicating definitive qualitative risk ratings. The chapter addresses legal dimensions, including the admissibility of risk assessment testimony under court standards such as Daubert, the evidentiary threshold of clear and convincing evidence for civil commitment under Addington v. Texas, and clinicians' duty to protect foreseeable victims as established in Tarasoff. Future directions emphasize investigating dynamic risk factors subject to change through intervention, conceptualizing protective factors that buffer against violence, and understanding how specific clinical interventions effectively reduce risk over time.