Ethical Standards & Practices in Risk Assessment

At PsychLaw.net we take note that there are no professional standards available that have been specifically developed for the assessment of violence risk.^[1] Nevertheless, there are general ethical principles and practice standards applicable to these assessments. Psychologists undertaking risk assessments are obviously obligated to comply with the Ethical Principles of Psychologists and Code of Conduct ^[2] (hereafter referred to as the “Ethical standards”)

The currently available instruments for assessing violence risk are administered and scored in essentially the same manner as psychological tests.  Consequently, the Standards for Educational and Psychological Testing^[3] are also applicable to mental health professionals engaged in risk assessments (hereafter referred to as the “Testing standards”) The relevant portion of the Introduction to the Testing Standards states:

“A test is an evaluative device or procedure in which a sample of an examinee’s behavior in a specified domain is obtained and subsequently evaluated and scored using a standardized process. While the label test is ordinarily reserved for instruments on which responses are evaluated for their correctness or quality and the terms scale or inventory are used for measures of attitudes, interest, and dispositions, the Standards uses the single term test to refer to all such evaluative devices.

A distinction is sometimes made between test and assessment.  Assessment is a broader term, commonly referring to a process that integrates test information with information from other sources (e.g., information from the individual’s social, educational, employment, or psychological history).  The applicability of the Standards to an evaluation device or method is not altered by the label applied to it (e.g., test, assessment, scale, inventory).”

Cross‑examination Re: Ethical and Testing Standards

1. (For psychologists) ‑ Dr X, in your professional conduct, you are obligated to comply with the 1992 version of the Ethical Principles of Psychologists and Code of Conduct ‑‑ Correct?
2. (For all mental health professionals) ‑ Your assessment work further obligates you to comply with the 1999 edition of the Standards for Educational and Psychologial Testing ‑‑ Correct?
3. The 1999 Testing Standards specifically state:

– [ read ] –

“The applicability of the Standards to an evaluation device or method is not altered by the label applied to it (e.g., test, assessment, scale, inventory)” ‑‑ Correct?

4. And given the statement I just cited from the 1999 Testing Standards, those Standards apply directly to your assessment work in this case ‑‑ Correct?
5. Relevant ethical standards and practice standards can assist this proceeding in identifying whether the assessment procedures you used in this case are generally recognized and accepted ‑‑ Correct?
6. For example, you would agree that phrenology is neither generally recognized, nor generally accepted, for assessing future violence risk ‑‑ Correct?
7. Because phrenology is a totally discredited method of measuring the shape and curvature of the head ‑‑ Correct?
8. And one of the questions this proceeding must address is whether the assessment instruments you used in this case are sufficiently more reliable than phrenology to support your expert testimony ‑‑ Correct?

Ethical Standard 2.02 (a).

Ethical standard 2.02 (a) states:

“Psychologists who develop, administer, score, interpret, or use psychological assessment techniques, interviews, tests, or instruments do so in a manner and for purposes that are appropriate in light of the research on or evidence of the usefulness and proper application of the techniques.”

Standard 2.02 (a) therefore obligates psychologists to carefully consider the consequences of dealing with predictive variables in a dichotomous context.  At PsychLaw.net we emphasize that in particular, risk assessments will lead to one of the following four outcomes:

1. The individual is correctly identified as someone who would commit future violence if released into the community.
2. The individual is correctly identified as someone who would not commit future violence if released into the community.
3. The individual is incorrectly identified as someone who would commit future violence if released into the community, but in fact would not commit such violence.
4. The offender is incorrectly identified as someone who would not commit future violence if released into the community, but in fact would commit such violence.

Standard 2.02 (a) consequently necessitates that psychologists undertaking risk assessments address four questions corresponding to the outcomes identified above:

1. What is the sensitivity of the assessment procedure used for risk assessment, i.e., what percentage of individuals who will exhibit future violence are identified by this assessment procedure?
2. What is the specificity of the assessment procedure used for risk assessment? [i.e., what percentage of individuals who will not exhibit future violence are identified by this assessment procedure]
3. What is the frequency of false positive classifications associated with this assessment procedure? [i.e., people identified as likely to be violent when they are not]
4. What is the frequency of false negative classifications associated with this procedure? [i.e., people identified as likely not to be violent when they are]

 Cross‑examination Re Ethical Standard 2.02 (a)

1. (For psychologists) ‑ Ethical Standard 2.02 (a) of your 1992 ethical code states:

– [ read ] –

“Psychologists who develop, administer, score, interpret, or use psychological assessment techniques, interviews, tests, or instruments do so in a manner and for purposes that are appropriate in light of the research on or evidence of the usefulness and proper application of the techniques.” ‑‑ Correct?

2. And you are obligated to comply with this code ‑‑ Correct?
3. And when we apply Ethical Standard 2.02 (a) to this case, there are a total of four possible outcomes when undertaking the assessment of future of violence risk ‑‑ Correct?
4. This first possible outcome is ‑ The individual is correctly identified as someone who would commit future violence if released into the community ‑‑ Correct?
5. That’s what mental health professionals call a “true positive” ‑‑ Correct?
6. The second possible outcome is ‑ The individual is correctly identified as someone who would not commit future violence if released into the community ‑‑ Correct?
7. That’s what mental health professionals call a “true negative” ‑‑ Correct?
8. The third possible outcome is ‑ The individual is incorrectly identified as someone who would commit future violence if released into the community, but in fact would not commit such violence ‑‑ Correct?
9. That’s what mental health professionals call a “false positive” ‑‑ Correct?
10. And the fourth possible outcome is ‑ The offender is incorrectly identified as someone who would not commit future violence if released into the community, but in fact would commit such violence ‑‑ Correct?
11. That’s what mental health professionals call a “false negative” ‑‑ Correct?
12. Therefore, we need to know what is the sensitivity of the assessment procedure(s) you used in this case ‑‑ Correct?
13. In other words we need to know what percentage of individuals who will exhibit future violence are identified by the assessment procedure(s) you used in this case ‑‑ Correct?
14. And we need to know what is the specificity of the assessment procedure used for risk assessment ‑‑ Correct?
15. By specificity we mean what percentage of individuals who will not exhibit future violence are identified by the assessment procedure(s) ‑‑ Correct?
16. And we need to know what is the frequency of false positive classifications associated with the assessment procedure(s) you used in this case ‑‑ Correct?
17. And we need to know what is the frequency of false negative classifications associated with the assessment procedure(s) used in this case ‑‑ Correct?
18. Because the sensitivity of a procedure might appear quite impressive, but still lead to a high frequency of false positive classifications ‑‑ Correct?
19. Let me illustrate with this hypothetical:
20. Assume I have developed a procedure for identifying prostate cancer in males.  I simply classify all males, 50 years and older, as having prostate cancer ‑‑ OK?
21. And I can claim a sensitivity level of almost 99% ‑‑ Correct?
22. Because approximately 99% of the population with prostate cancer are males 50 years of age and older ‑‑ Correct?
23. Assume also that only 10% of the male population ever develops prostate cancer ‑‑ OK?

And now my question:  The specificity of my procedure ‑ how accurately it identifies males, 50 years and older, who do not have prostate cancer – is quite poor ‑‑ Correct?

20. For any assessment procedure, therefore, we need to know the levels of sensitivity and specificity related to that procedure ‑‑ Correct?
21. In other words, we need to know how accurately an assessment procedure rules in future violence ‑‑ Correct?
22. And we need to know how accurately an assessment procedure rules out future violence ‑‑ Correct?

Footnotes:

[1]. Borum, R. (1966). Improving the clinical practice of violence risk assessment.   American Psychologist, 51, 945-956.

[2]. American Psychological Association (2010). Ethical principles of, psychologists and code of conduct. Washington, DC: Author.

[3]. American Educational Research Association, American Psychological Association, National Council on Measurement in Education. (1999). Standards for educational and psychological testing. Washington, DC: Author.