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      Risk assessment tools in criminal justice and forensic psychiatry: The need for better data

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          Abstract

          Violence risk assessment tools are increasingly used within criminal justice and forensic psychiatry, however there is little relevant, reliable and unbiased data regarding their predictive accuracy. We argue that such data are needed to (i) prevent excessive reliance on risk assessment scores, (ii) allow matching of different risk assessment tools to different contexts of application, (iii) protect against problematic forms of discrimination and stigmatisation, and (iv) ensure that contentious demographic variables are not prematurely removed from risk assessment tools.

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          Most cited references32

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          External validation of new risk prediction models is infrequent and reveals worse prognostic discrimination.

          To evaluate how often newly developed risk prediction models undergo external validation and how well they perform in such validations.
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            Stereotyping and evaluation in implicit race bias: evidence for independent constructs and unique effects on behavior.

            Implicit stereotyping and prejudice often appear as a single process in behavior, yet functional neuroanatomy suggests that they arise from fundamentally distinct substrates associated with semantic versus affective memory systems. On the basis of this research, the authors propose that implicit stereotyping reflects cognitive processes and should predict instrumental behaviors such as judgments and impression formation, whereas implicit evaluation reflects affective processes and should predict consummatory behaviors, such as interpersonal preferences and social distance. Study 1 showed the independence of participants' levels of implicit stereotyping and evaluation. Studies 2 and 3 showed the unique effects of implicit stereotyping and evaluation on self-reported and behavioral responses to African Americans using double-dissociation designs. Implications for construct validity, theory development, and research design are discussed. 2006 APA, all rights reserved
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              Use of risk assessment instruments to predict violence and antisocial behaviour in 73 samples involving 24 827 people: systematic review and meta-analysis

              Objective To investigate the predictive validity of tools commonly used to assess the risk of violence, sexual, and criminal behaviour. Design Systematic review and tabular meta-analysis of replication studies following PRISMA guidelines. Data sources PsycINFO, Embase, Medline, and United States Criminal Justice Reference Service Abstracts. Review methods We included replication studies from 1 January 1995 to 1 January 2011 if they provided contingency data for the offending outcome that the tools were designed to predict. We calculated the diagnostic odds ratio, sensitivity, specificity, area under the curve, positive predictive value, negative predictive value, the number needed to detain to prevent one offence, as well as a novel performance indicator—the number safely discharged. We investigated potential sources of heterogeneity using metaregression and subgroup analyses. Results Risk assessments were conducted on 73 samples comprising 24 847 participants from 13 countries, of whom 5879 (23.7%) offended over an average of 49.6 months. When used to predict violent offending, risk assessment tools produced low to moderate positive predictive values (median 41%, interquartile range 27-60%) and higher negative predictive values (91%, 81-95%), and a corresponding median number needed to detain of 2 (2-4) and number safely discharged of 10 (4-18). Instruments designed to predict violent offending performed better than those aimed at predicting sexual or general crime. Conclusions Although risk assessment tools are widely used in clinical and criminal justice settings, their predictive accuracy varies depending on how they are used. They seem to identify low risk individuals with high levels of accuracy, but their use as sole determinants of detention, sentencing, and release is not supported by the current evidence. Further research is needed to examine their contribution to treatment and management.
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                Author and article information

                Contributors
                Journal
                Eur Psychiatry
                Eur. Psychiatry
                European Psychiatry
                Editions scientifiques Elsevier
                0924-9338
                1778-3585
                1 May 2017
                May 2017
                : 42
                : 134-137
                Affiliations
                [a ]Oxford Uehiro Centre for Practical Ethics, Faculty of Philosophy, University of Oxford, Suite 8, Littlegate House, St Ebbes Street, Oxford OX1 1PT, United Kingdom
                [b ]Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford OX3 7JX, United Kingdom
                [c ]Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford OX3 7JX, United Kingdom
                Author notes
                [* ]Corresponding author at: Department of Psychiatry, Medical Sciences Division, University of Oxford, Warneford Hospital, Oxford OX3 7JX, United Kingdom.Department of Psychiatry, Medical Sciences Division, University of Oxford, Warneford HospitalOxfordOX3 7JXUnited Kingdom seena.fazel@ 123456psych.ox.ac.uk
                Article
                S0924-9338(16)30189-4
                10.1016/j.eurpsy.2016.12.009
                5408162
                28371726
                bfa3142a-fb0a-4d7d-92f9-0a401e393054
                © 2016 The Author(s)

                This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

                History
                : 17 September 2016
                : 4 December 2016
                : 11 December 2016
                Categories
                Original Article

                Clinical Psychology & Psychiatry
                violence,forensic psychiatry,ethics and human rights,risk assessment,crime prediction,racial profiling

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