Guest Blog: Dr Ruth Tully
This is the second blog in our ongoing series looking at tools featured in RATED (Risk Assessment Tools Evaluation Directory). In this article, Consultant Forensic Psychologist Dr Ruth Tully explores some of the similarities and differences between popular structured professional judgment (SPJ) risk assessment tools often used in clinical forensic practice to assess violence risk. Ruth uses these tools day in, day out, and we’re thrilled to welcome her to share some knowledge and experience with us.
assessing risk the spj way!
WHAT ARE SPJ TOOLS?
SPJ tools are very useful because they are dynamic, follow guidance on including risk relevant factors, yet are flexible enough to be able to consider additional factors and really individualise the risk assessment process.
WHAT DO THEY HAVE IN COMMON?
These tools often have several ‘items’ which are risk factors, and the assessor is asked to rate each item as definitely present, partially/possibly present, or absent. This could easily be mistaken for a checklist type approach, but each item requires evidence and careful judgment and later in the assessment clinical case formulation allows the assessor to explore these factors, how they might link together, and how they relate to the individual being assessed. From this, ‘scenarios’ of risk (should it reoccur in the future) are generated so that risk management plans can be formulated around the scenarios. Finally, an overall risk judgment is given allowing the assessor to make recommendations related to the nature of their report which might be a parole report, a community management plan where frequency of visits might need to be determined, or suitability / level of priority for treatment might be being considered.
WHAT DIFFERENCES ARE THERE BETWEEN THESE TOOLS?
Tools are developed to assess a specific type of risk. As such, the items included in these tools differ as they include risk factors that the empirical literature has linked in some way to the type of violence being assessed. Here are some common tools:
- HCR-20v3 – This is a violence SPJ risk tool. Its definition includes general, sexual, and partner violence but there are other tools specific to these risks also available. The HCR-20v3 is the most commonly used tool in the world, available in several languages, and well validated.
- RSVP – This is a sexual offending SPJ risk tool. It specifically explores sexual risk factors but does not consider general violence. A person’s risk management might require a HCR-20v3 as well as the RSVP.
- SARAv3 – This assesses risk of partner violence. It differs from the above 2 tools because as well as risk factors of the perpetrator, it includes consideration of victim vulnerability factors that can be relevant to victimisation in a specific identified relationship. This can also help identify patterns of vulnerabilities in past victims if there is more than one, so that risk management plans can take this into account.
- VERA-2R – This is a very specialist assessment tool used for extremist / ideology-based violence risk assessment. It contains risk factors and protective factors designed to assist assessors in considering the management and risk of people with either terrorism / extremism related convictions or potential related risks.
- SAM / SRP – These are risk tools designed to assess stalking risk. The SAM includes victim factors in a similar way to SARAv3 as well as risk factors. The SRP differs to other SPJ tools in that it guides the assessor to identify typology of stalking as well as risk factors e.g. ‘rejected’ stalker or ‘predatory’ stalker. It also considers specific factors for ‘public figures’ which is useful.
CLINICAL PRACTICE ISSUES
In practice, training is really important for SPJ tools. This is because there is some subjectivity to some items and it is crucial that items are coded as much as possible in line with the tool’s manual, due to this being how the tools were developed and therefore validated and researched. My company offers training on these tools so you may consider me biased, but I have seen some excellent practice and less good practice in the application of these tools and good training is central to starting out as you mean to go on!
I often get asked how long an assessment, e.g. HCR-20v3, takes in practice. The answer is easy – it’s how long is a piece of string! It depends on so many factors including the available documentation, interviewing the person being assessed, speaking to others involved in the case, coding the items, formulating risk, and generating the scenario plans. This can take a variable amount of time from person to person. What I can say is that the assessment is designed to be a thorough and comprehensive assessment and therefore shouldn’t be rushed or treated like a tick list.
It can be a barrier when a person who may pose risk of violence doesn’t want to engage with assessment. Or, the person being assessed might be too unwell to engage in the case of severe mental illness. This is not ideal because in cases where the assessment still needs to be conducted, such as where public protection is at stake, the person’s views aren’t represented in the assessment, and they don’t have the opportunity to show their insight into risk and treatment needs, or indeed progress they have made through time, treatment, and other factors. However, the assessment can still be completed as thoroughly as possible, acknowledging the limitation of not having interviewed the person being assessed. The person should always be offered an interview to help you produce the most reliable assessment possible.
Another interesting issue in practice is that if 2 assessors do the same assessment on the same person, they may assess risk similarly but come to different conclusions about recommendations for risk management. For example, in parole assessments of one individual, one assessor might use the HCR-20v3 tool and they say that risk is such that it can be safely managed in an open prison or the community, and another assessor might also have used the tool, and they disagree saying that risk can’t be managed safely in a less secure setting. This isn’t uncommon and can relate to each professional’s professional background, judgment on imminence of the risk, or assessment of the risk items. Importantly, each assessor’s view is equally valid and can help decision makers decide on what to do.
Finally, to mention here, SPJ tools don’t often include protective factors. An exception is the SAVRY which assessed violence risk in young people, but also in existence is the SAPROF which is a protective factors SPJ assessment that is used alongside (not instead of) SPJ risk tools. A balanced risk assessment should, in my view, include risk and protective factors. This can also be really motivational for the person being assessed and give a positive focus. The research on protective factors, especially the SAPROF tool is generally positive and is developing fast. Perhaps that’s another blog in itself for the future!
Dr Ruth Tully is a Consultant Forensic Psychologist in the UK. She is experienced in completing, supervising, and training others in the ethical and competent use of a range of SPJ tools. Ruth has also published widely in this area in peer reviewed journals and books. She is an author-approved training for various SPJ tools. In clinical practice Ruth’s specialism is violent, sexual, and extremist ideology/terrorism based violence assessment.
Potential conflict of interest declaration: Dr Tully’s company provides paid-for training in SPJ tools.