The authors of Violent Offenders: Appraising and Managing Risk have been very active contributors to progress in risk assessment. Indeed, this volume describes a research enterprise that began more than 25 years ago. After discussing historical and methodological contexts in which their work has occurred, the authors describe their work in violence risk appraisal with three populations: mentally disordered offenders, fire setters, and sexual offenders. The authors appropriately assume that risk factors for one of these populations may be different, or arrayed differently, than for others. Next, they describe the development of the Violence Risk Appraisal Guide, a tool designed for the relatively long-term prediction of who will be violent. Although the authors offer data, and summarize arguments, relevant to the VRAG=s use, any observer of the violence risk literature over the past decade will be aware that the VRAG is undoubtedly the tool of choice when the aim is the prediction of violent behavior over a relatively long time (mean outcome period of 88 months for the construction sample), especially for mentally disordered offenders.

This book also describes another major contribution to the violence prediction and risk reduction literature. In a chapter on reducing the likelihood of future violence, the authors summarize the results of an empirical approach to treatment planning for mentally disordered offenders that is more sophisticated than the current approach of selecting dynamic (i.e., potentially changeable through planned intervention) risk factors from among the predictors in the literature, and constructing a risk-reduction program around them. Instead, the approach outlined in this book comprised an empirical study of risk relevant treatment needs for the particular hospitalized population under study. This method resulted in the following target areas for intervention: (1) management problems, (2) aggression, (3) anger, (4) substance abuse, (5) life skills deficits, (6) active psychotic symptoms, (7) social withdrawal, and (8) family problems. In spite of the greater methodological sophistication of this approach, their study yielded a familiar-looking list of areas that is not unlike that which could be derived from a review of the current broader violence literature. This consistency should serve to remind those who work with mentally disordered offenders that designing a treatment program with a primary goal of reducing future crime and violence is something that is currently reasonably achievable. It should also highlight the importance of questions about risk reduction which must be answered in order for the field to move forward. Issues such as efficacy vs. effectiveness designs, treatment integrity, sensitivity of outcome measures of crime and violence, and sufficient numbers of participants across sites must be all taken into consideration if we are to learn what reduces violence risk for whom, at what level of effectiveness, and in what context.

Violent Offenders: Appraising and Managing Risk is a significant book. Its strengths include the extensive description of a research program on violence using diverse populations, and the derivation of an instrument (the VRAG) that is both effective to use and relatively accurate for long-term predictions of violence among mentally disordered offenders. It also cogently summarizes the arguments in favor of using an actuarial approach, addressing many of the concerns that clinicians reluctant to consider such approaches have raised, and presents readers with a descriptive model of an empirical approach to measuring risk-relevant treatment needs and designing interventions to address them. There are limits to the application of this material, which are for the most part, carefully acknowledged by the authors. The authors would not advocate the use of the VRAG for predicting violence and crime for individuals not involved in the criminal justice system. The VRAG allows an individual being assessed to be placed in one of nine overall risk levels, but it is relatively insensitive to identifying specific risk-relevant intervention areas or change in risk status (since VRAG level is determined almost completely by unchangeable historic and clinical factors). Therefore, clinicians seeking to develop risk-reduction programs or individual risk-reduction interventions must use the VRAG in combination with other approaches that address these questions. How a clinician, or a decision-maker, can validly determine when risk has been reduced is not a question that the VRAG can answer B but it remains a critical area for investigation, perhaps employing strategies such as those outlined by the authors in their chapter on reducing risk.

This book is recommended for attorneys, clinical administrators, clinicians, researchers, judges, and others who must be concerned with the risk of future violence among their clientele. It offers a model for those looking for ways to the operationalize and measure of violence risk, and highlights important considerations for the field as it weighs how such scientific advances will be applied.

Kirk Heilbrun, Ph.D., is currently Professor and Chair of the Department of Clinical and Health Psychology, MCP Hahnemann University, and is Co-Director of the Law-Psychology Program at MCP Hahnemann and Villanova School of Law. He is actively involved in research and training in the areas of risk assessment and risk communication. He can be reached at Kirk.Heilbrun@drexel.edu. This review is adapted from that which appeared in Psychiatric Services.

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