An Interview with Forensic Psychologist
for the safety of frail seniors has prompted many states to pass
laws permitting home care agencies, nursing homes, and consumers
to check the criminal histories of prospective and current employees.
In doing so, they're finding that a disturbingly high number of
workers have committed crimes, many serious, and the number appears
to be rising.
the records of prospective in-home support service workers in
one California county were checked, over 15 percent were found
to have criminal records. In Texas, where certain convictions
bar employment in long-term care and home health care settings,
9 percent of applicants in 2000 were found to have convictions.
Last year, when New Jersey passed legislation requiring all home
care workers to have FBI fingerprint checks, four hundred current
employees, some of whom had been working for years, were found
to have committed disqualifying crimes.
state laws vary in the extent to which they grant employers discretion
in making hiring decisions, one fact is clear. With the current
shortage of workers and a burgeoning senior population, many employers
will have no choice but to hire people who have criminal histories.
In doing so, they will be forced to make predictions about the
threat these employees pose to frail clients, weighing such mediating
circumstances as the nature of the crimes, the length of time
since they were committed, and offenders' demonstrated rehabilitation.
Few employers have training in making these decisions, a fact
that has many worrying, particularly in light of the fact that
most caregivers spend extended, unsupervised, time alone with
frail, isolated seniors.
In this issue, nexus interviews Vernon Quinsey, an expert on predicting
the dangerousness of offenders in the criminal justice, mental
retardation, and mental health systems. Dr. Quinsey is Professor
of Psychology and Psychiatry at Queen's University in Kingston,
Ontario. His work includes the development of instruments for
predicting violent recidivism in selected subpopulations, including
sex offenders. He is coauthor of Violent Offenders: Appraising
and Managing Risk (American Psychological Association, 1998),
which describes a research program that began 25 years ago at
the maximum-security Oak Ridge Division of the Penetanguishene
Mental Health Centre in Ontario, Canada.
Although this topic is new to many of us who work with the elderly,
predicting dangerousness and recidivism is not a new field. Can
you describe how predictions are made?
Quinsey: Two approaches are generally used: clinical assessments
and actuarial assessments. In making clinical assessments, professionals
use offenders' histories and diagnostic tests to make clinical
judgments. Actuarial, or statistical, assessments are quantified,
impartial, and systematic reviews of offenders' characteristics
taken from their files or histories. Using an actuarial assessment
might lead to a conclusion like "75% of offenders released from
prison who were originally incarcerated for violent offenses,
who have no family or peer support network and no stable employment
upon release, will go on to commit further crimes." The Violence
Risk Appraisal Guide (VRAG), developed by my colleagues and I,
identifies characteristics of male offenders that differentiate
them from non-offenders as well as characteristics that predict
nexus: How good is criminal history in predicting
Criminal history per se is not the best predictor, but it isn't
bad. Other methods can assess future dangerousness fairly well
but may be too expensive for routine use.
nexus: With the current shortage of workers, few
agencies can disqualify all potential candidates because of past
criminal acts. Are there some "rules of thumb" they can use in
assessing risk? For example, are there certain types of criminals
you'd never want to go near an older disabled person?
Yes, employers should avoid hiring people who have committed crimes
against vulnerable populations. I would be particularly concerned
with crimes that involve betrayals of trust, including white-collar
crimes, fraud, scams of various sorts, and embezzlement. In addition,
criminal versatility (variety of offending) is a bad sign, young
age at first arrest is a bad sign, and, of course, the more offenses,
the worse the prognosis.
generally, the issue is a cost-benefit one. If you can hire enough
people without criminal records, don't hire any who have one.
If you don't have enough potential hirees, hire people with the
least history of criminal offending and the least recently recorded
last crime (provided they didn't commit crimes at very young ages).
Our criminal justice system sets up some roadblocks to obtaining
the information you're referring to. For example, juvenile offenders'
files are sealed. And plea-bargaining tends to downgrade the severity,
number, and even the nature of past crimes. How serious are these
VQ: Very serious. In my opinion, sealing records is a big
mistake. And arrest records are usually better predictors than
conviction records because of plea-bargaining and related issues.
nexus: You've made the point that few criminals
are specialists. In preparing for this interview, I talked to
several service providers who make hiring decisions. One described
an instance in which an applicant who'd been convicted of molesting
teen-age girls was turned down for a job, but the decision was
appealed to an administrative review board that ruled in the applicant's
favor. The rationale given was that someone who abuses young girls
will not necessarily abuse the elderly. Any truth to that?
Some types of offenders are more specialized than others. For
example, child molesters are much more likely to be specialists
than rapists. They're more likely than say, rapists, to have deviant
sexual interests. In general, I don't believe that a history of
sexual crimes places a potential hiree at greater risk of committing
elder abuse than one with a history of non-sexual crimes.
The "popular wisdom" says that psychopaths can't be reformed.
Can you start by defining what a psychopath is? Is it a form of
Psychopathy is an extreme manifestation of Antisocial Personality
Disorder as defined in the Diagnostic and Statistical Manual (DSM)
of the American Psychiatric Association. There is disagreement
about whether psychopathy is a form of mental illness, but there
is no disagreement that psychopaths exist and are quite different
from non-psychopaths. There is no evidence that they can be reformed.
nexus: How do you know if you're dealing with a
psychopath? Is there anything in a criminal record that would
tip you off?
You can't tell for sure, but psychopaths tend to have committed
more offenses than others, they tend to start earlier, and they
commit a wider variety of offenses. Folks that start early and
are still committing crimes in adulthood are much more persistent
than the bulk of offenders, who typically start in mid-adolescence
and quit in their early to mid-twenties.
In addition to psychopathology, what other factors increase the
likelihood of recidivism?
It depends on the offense. The probability of recidivism in sexual
offenses, for example, is related to the number of previous sexual
offenses, the age, gender, and relationship of previous victims,
and phallometrically measured sexual deviance. This measurement
uses a machine that measures genital arousal in response to sexual
stimuli. It indicates age and gender preference as well as interest
in sexual violence. Inappropriate sexual age preference and a
preference for sadism or violence during rape are indicators of
that clinicians have traditionally believed were related to recidivism,
such as a history of having been sexually abused as a child and
general psychological problems, have weak relationships with recidivism.
Some states allow offenders of certain crimes to work as caregivers
if they've gone five years without re-offending. Why five years?
Is this grounded in research?
There's no magic in this benchmark. One must assume the offender
has had an opportunity to re-offend (i.e., was in the country
or state from which the records are received) and was not incarcerated
or hospitalized during that period. Some offenders are luckier
or more competent in avoiding arrest than others.
According to your book, the effectiveness of clinically treating
offenders is pretty dismal. Are there any promising approaches
on the horizon?
Current treatment methods appear to work okay for offenders of
moderate risk, but they're not very effective in reducing the
likelihood of violent recidivism among serious adult offenders,
particularly psychopaths—the most persistent and dangerous guys.
I don't know of any magic bullets on the horizon.
How does substance abuse fit in with respect to criminality, recidivism,
Substance abuse, like so many other things, is a correlate and
predictor of recidivism. If an offender committed his offence
while intoxicated, it may indicate that alcohol treatment is warranted
to reduce the likelihood of re-offending.
When New Jersey passed legislation last year requiring home care
workers to have FBI fingerprint checks, four hundred current employees,
some of whom had been working for years, failed and were told
they could no longer work. Some are now appealing the decision
and will be rehired if they can demonstrate that they've been
rehabilitated. What would you consider to be compelling evidence
Other than an absence of offending, it's pretty tough. Of course,
a long record of providing service in a similar work environment
without committing any abuse provides strong inductive grounds
that there is no cause for concern.
are attitudinal measures that are related to criminal offending
that could be used as evidence of rehabilitation, but these are
quite transparent and easily faked. It would be possible, however,
to develop a simple actuarial risk scheme.
How is that done?
By gathering relevant information on a large group of workers
and following them for enough time to identify a group that abuses
elders and contrast them with a group that does not. In developing
a scheme, I would start by using variables that are readily available
and are already known to predict beginning a criminal career and/or
re-offending. The best strategy is to conduct a retrospective
study (starting with a group of cases where the outcome is known)
and then follow it up with a prospective study using the predictors
identified in the first study. A study of this nature would require
collaboration between agency folks (those that hire the workers
and have the records) and academics or professional researchers.
The fact that people with little clinical training are increasingly
making decisions about which offenders should be given second
chances is the cause of some concern in our field. But your book
seems to suggest that lay people (non-clinicians) actually do
pretty well in making predictions. Are there ways they can be
Lay people are no worse than clinicians, but clinicians aren't
very good. An actuarial risk scheme that is simple, empirically
validated, and yields a numerical score is the way to go.
Policy makers will increasingly be forced to balance the civil
liberties of offenders who have paid their debts to society against
the potential hazards former criminals pose. Any thoughts on how
you balance safety and civil liberties in these matters?
It depends upon the magnitude of the problem and societal tolerance.
A consensus among the people making the policy is required. One
can say that one is not willing to make these decisions, but then
one must live with the consequences.
If our readers need consultation or expert witnesses in predicting
dangerousness in their communities, how would they find them?
Organizations like the American Psychological Association can
Any last suggestions for identifying dangerous caregivers?
A little supervision goes a long way. One could, for example,
encourage unscheduled visits by advocates/supervisors, emergency
call buttons, monitoring of vulnerable people's bank accounts,
and having cameras in care areas that can be monitored at random
to the nexus "reading room"