An annotated history of risk assessment: The emergence of the VRAG-R

Brian Judd & Vernon Quinsey

The 1966 U.S. Supreme Court Baxstrom v. Herolddecision resulted in 967 mentally disordered offenders being released into civil hospitals throughout New York State and provided the first challenge to the value of clinical judgment in the prediction of future violence. In the late 1970’s and early 1980s Quinsey and his colleagues determined that as a group, trained forensic experts asked to make decisions regarding the risk of future violence did not differ from lay people in their assessment of future risk and were prone to making false positive errors. These results, together with the findings of Lewis Goldberg and others demonstrating the low validity of mental health professionals’ clinical judgments in a variety of contexts, spurred the development and publication of the Violence Risk Appraisal Guide (VRAG) in 1993, the first risk assessment instrument with experience tables designed to assess risk for future violence. Subsequent research demonstrated the applicability of the VRAG to a broad range of offenders including forensic and general psychiatric samples, convicted offender, and developmentally handicapped samples with overall AUCs of .72 to .73 in standardization and cross-validation samples. However, relatively poor calibration in samples of sex offenders resulted in modification of the VRAG and the publication of the Sex Offender Risk Appraisal Guide (SORAG) in 1997. Like its predecessor, the SORAG demonstrated a robust AUC in the low to mid .70’s in both the standardization and cross-validation samples. In the mid 2000’s, aware that administration of the VRAG and SORAG were demanding of time and training, Dr. Grant Harris and Dr. Marnie Rice began the process of modifying the VRAG and SORAG to develop a single instrument, the VRAG-R, which could be used to assess risk in sex offenders and violent offenders, alike. This presentation will discuss the value of mechanical assessment of risk relative to unstructured clinical judgment, the emergence of the VRAG-R, and it applicability in modern clinical and forensic settings. 

Dr. Judd graduated in 1989 with his Ph.D. in psychology from the University of Houston. Dr. Judd specialized in and published in the area of neuropsychology throughout his graduate career and during the early years of his professional career, then began private practice with an emphasis on the application of neuropsychology in forensic settings. Since 1993, Dr. Judd's practice has predominantly focused on risk assessment and treatment of sex offenders, and the evaluation of both high-risk violent offenders and those adjudicated not guilty by reason of insanity. He has given multiple presentations to professional organizations on the application of actuarial assessment techniques in assessing risk for future violence and has extensive experience testifying in court.  Dr. Judd is an ATSA member, a former board member of the Washington Association for the Treatment of Sexual Abusers (WATSA) and a state certified sex offender treatment provider. At the present time approximately 60% of his clinical practice is devoted to the assessment and treatment of high risk sexual offenders. He currently practices and resides in Olympia, WA. 

Vern Quinsey was a psychologist at the maximum security Oak Ridge Division of the Mental Health Centre in Penetanguishene, Ontario, where he founded the Research Department and became its first Director in 1976. From 1984 to 1986 he was an invited researcher at the Phillippe Pinel Institute in Montreal. In 1988, he moved to Queen's University as a Queen's National Scholar and Professor of Psychology. Vern was subsequently cross-appointed in Biology and Psychiatry and served as Head of the Psychology Department from 2004-2008. 

He is a Fellow of the Canadian Psychological Association and has been on the editorial boards of the International Journal of Law and Psychiatry, the Journal of Interpersonal Violence, Sexual Abuse, the Journal of Forensic Psychiatry, and Aggression and Violent Behavior, among others. He has chaired research review panels of the National Institute of Mental Health and the Ontario Mental Health Foundation. 

Vern was awarded a Significant Achievement Award of the Association for the Treatment of Sexual Abusers in 1994, a Career Contribution Award from the Criminal Justice Section of the Canadian Psychological Association in 2005, and the Hebb Award from the Canadian Psychological Association for contributions to psychology as a science in 2008. He held a Senior Research Fellowship from the Ontario Mental Health Foundation from 1997 to 2003. 

His research interests include the prediction, modification, and management of antisocial and violent behavior, applied decision making, program development and evaluation, sexual deviance, and evolutionary explanations of sexual and aggressive behaviors. He has published nine books,  more than 130 papers in refereed journals, and 25 chapters in edited books on these topics.