Implementation Potential of Structured Risk Assessments for Criminal Recidivism in the Veterans Health Administration: Qualitative Perspectives From Providers

• Published date: 01 July 2019
• Author: Christine Timko,Ava C. Wong,Luisa Manfredi,Andrea Nevedal,Joel Rosenthal,Allison L. Rodriguez,Daniel M. Blonigen
• DOI: 10.1177/0887403417725567
• Date: 01 July 2019
• Subject Matter: Articles

https://doi.org/10.1177/0887403417725567

Criminal Justice Policy Review

2019, Vol. 30(6) 819 –839

© The Author(s) 2017

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DOI: 10.1177/0887403417725567

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Article

Implementation Potential of

Structured Risk Assessments

for Criminal Recidivism

in the Veterans Health

Administration: Qualitative

Perspectives From Providers

Allison L. Rodriguez1, Luisa Manfredi1,

Ava C. Wong1, Andrea Nevedal1, Christine Timko1,2,

Joel Rosenthal3, and Daniel M. Blonigen1,2,4

Abstract

Utilization of tools to evaluate recidivism risk among justice-involved individuals

is central to the risk-need-responsivity model of offender rehabilitation. Veterans

Health Administration’s (VHA) Veterans Justice Programs (VJP) Specialists link

justice-involved veterans to appropriate services, aiming to reduce recidivism risk.

To explore the implementation potential of structured risk assessments (SRAs)

within VJP, semistructured telephone interviews were conducted with 63 VJP

Specialists and qualitatively analyzed. While SRAs were not reported to be utilized

as part of Specialists’ formal duties, many Specialists indicated such a tool would

be valuable for efficient triage, separation of clients by risk level, client feedback,

and data collection for quality improvement purposes. Perceived barriers to SRA

implementation included lack of time and resources, misinterpretation of scores,

and concerns regarding documentation of risk level. Potential facilitators included

leadership support, education, and training. Findings highlight potential pitfalls and

promises of implementing SRAs within large, integrated health care systems such as

VHA.

1Veterans Affairs Palo Alto Health Care System, Menlo Park, CA, USA

2Stanford University School of Medicine, Palo Alto, CA, USA

3Veterans Justice Programs, Veterans Health Administration, Washington, DC, USA

4Palo Alto University, Palo Alto, CA, USA

Corresponding Author:

Daniel M. Blonigen, Research Scientist, HSR&D Center for Innovation to Implementation, Veterans

Affairs Palo Alto Health Care System, 795 Willow Road (152), Menlo Park, CA 94025, USA.

Email: Daniel.Blonigen@va.gov

725567CJPXXX10.1177/0887403417725567Criminal Justice Policy ReviewRodriguez et al.

research-article2017

820 Criminal Justice Policy Review 30(6)

Keywords

recidivism, veterans, risk assessment, implementation potential

Mass incarceration and cyclical engagement with the U.S. criminal justice system are

major public health problems gaining significant attention in recent years (American

Public Health Association, 2014; Aufderheide, 2014; Dumont, Brockmann, Dickman,

Alexander, & Rich, 2012). Not only are the costs of maintaining and staffing correc-

tional facilities high (Pew Center on the States, 2011b), but the growing incarcerated

population has not been matched by sufficient treatment services that aim to assist

with reentry and reduce risk for recidivism (Gannon & Ward, 2014; James, 2009). A

sizable subgroup of offenders are U.S. military veterans, who comprise as much as 8%

of the correctional population in the United States (Bronson, Carson, Noonan, &

Berzofsky, 2015). Like other justice-involved individuals, recidivism is common

among veteran offenders. For example, between 2011 and 2012, nearly 70% of male

veteran inmates in jails had been incarcerated at least once before, and more than 40%

of incarcerated male veterans had at least four prior arrests (Bronson et al., 2015).

One primary way to address the issue of recidivism and the low availability of treat-

ment services is to moderate intensity of treatment depending on level of client risk.

Research demonstrates that low-risk offenders need fewer and less intensive services

than high-risk individuals, and this directed method of treating offenders lessens the

burden on the system to provide the same high-level services to all justice-involved

individuals. This concept is grounded in the risk-need-responsivity (RNR) model

(Andrews & Bonta, 2010), which states that services and treatment should be concen-

trated around those at highest risk for reoffending, should target risk factors that are

the strongest predictors of criminal recidivism (i.e., antisocial attitudes, behaviors, and

associates; substance abuse; family/marital dysfunction; lack of positive school or

work involvement; lack of prosocial activities) and that treatment should be respon-

sive, or tailored, to each individual’s needs. In other words, recommendations are that

clinicians working with justice-involved individuals titrate the level of treatment

offered in such a way that high-risk offenders receive more frequent and intensive

supervision and care, while low-risk offenders receive less intensive supervision and

care. Adherence to RNR principles has consistently resulted in lower rates of recidi-

vism among justice-involved individuals and demonstrates effectiveness among

women and men, juveniles and adults, and sex offenders and general offenders

(Andrews & Dowden, 2006; Andrews et al., 1990; Blodgett, Fuh, Maisel, & Midboe,

2013; Bonta & Andrews, 2007; Hanson, Bourgon, Helmus, & Hodgson, 2009;

Lowenkamp, 2006).

To adhere to the RNR model, risk assessment is a first step. Standardized tools,

called structured risk assessments (SRAs), or actuarial risk assessments, have been

developed to fill this need. These tools work by assessing the presence or absence of

static (e.g., history of substance use) and/or dynamic (i.e., modifiable) factors (e.g.,

current employment status and substance use; current antisocial attitudes and associ-

ates) that have been shown to significantly predict risk for future recidivism, assigning