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What Can We Learn from Criminal Background Checks?

An Interview with Forensic Psychologist Vern Quinsey

Concern 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.

When 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.

Although 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.

nexus: 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?

Vern 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 future recidivism.

nexus: How good is criminal history in predicting future dangerousness?

VQ: 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?

VQ: 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.

More 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).

nexus: 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 obstacle?

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?

VQ: 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.

nexus: The "popular wisdom" says that psychopaths can't be reformed. Can you start by defining what a psychopath is? Is it a form of mental illness?

VQ: 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?

VQ: 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.

nexus: In addition to psychopathology, what other factors increase the likelihood of recidivism?

VQ: 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 future dangerousness.

Factors 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.

nexus: 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?

VQ: 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.

nexus: According to your book, the effectiveness of clinically treating offenders is pretty dismal. Are there any promising approaches on the horizon?

VQ: 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.

nexus: How does substance abuse fit in with respect to criminality, recidivism, and treatment?

VQ: 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.

nexus: 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 of rehabilitation?

VQ: 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.

There 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.

nexus: How is that done?

VQ: 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.

nexus: 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 assisted?

VQ: 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.

nexus: 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?

VQ: 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.

nexus: If our readers need consultation or expert witnesses in predicting dangerousness in their communities, how would they find them?

VQ: Organizations like the American Psychological Association can help.

nexus: Any last suggestions for identifying dangerous caregivers?

VQ: 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 intervals.

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