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Developing a clinically useful actuarial tool for assessing violence risk.

J Monahan, H J Steadman, P S Appelbaum

    The British Journal of Psychiatry : the Journal of Mental Science
    |May 29, 2000
    PubMed
    Summary

    A new violence risk assessment tool, the Iterative Classification Tree (ICT), can accurately identify low or high-risk patients. This method enhances clinical utility by using readily available data for violence risk assessment.

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    Area of Science:

    • Forensic Psychiatry
    • Clinical Psychology
    • Risk Assessment Methodologies

    Background:

    • A novel actuarial method, the Iterative Classification Tree (ICT), offers high accuracy for violence risk assessment.
    • The ICT can be time-consuming and resource-intensive to implement in clinical settings.

    Purpose of the Study:

    • To enhance the clinical utility of the ICT by simplifying its application.
    • To develop an actuarial tool using risk factors commonly found in hospital records or routinely assessed in practice.

    Main Methods:

    • 939 psychiatric patients (18-40 years old) were assessed on 106 risk factors.
    • Patients were monitored for violence to others for 20 weeks post-discharge.

    Main Results:

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  • The ICT successfully classified 72.6% of patients into low or high-risk categories.
  • Low risk was defined as less than half the base rate of violence, high risk as more than twice the base rate.

    • Conclusions:

    • A clinically practical actuarial method for violence risk assessment is now available.
    • The refined ICT method aids clinicians in identifying patients at risk of violence.