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  • 1. Belfrage, Henrik
    et al.
    Fransson, G
    Strand, Susanne
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Prediction of Violence Using the HCR-20: A prospective study in two maximum-security correctional institutions2000In: Journal of forensic psychiatry (Print), ISSN 0958-5184, E-ISSN 1469-9478, Vol. 11, no 1, p. 167-175Article in journal (Refereed)
    Abstract [en]

    The HCR-20 and the PCL:SV were used in a prospective study of 41 long-term sentenced offenders in two correctional, maximum-security institutions. The aim was to test the validity of these instruments in the prediction of institutional violence. All assessments were made by a comprehensive examination of the offenders’ files, completed with clinical interviews ranging from 1 to 3 hours. The mean follow-up time was 8 months. Our results show high predictive validity for the HCR-20’s clinical and risk management items, but for almost none of its historical items. The results suggest that violence inside correctional institutions can be predicted with a certain degree of validity by using the HCR-20 and the PCL:SV, even within a selective ‘high-risk’ group of offenders such as that under study here.

  • 2.
    Belfrage, Henrik
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Fransson, Göran
    Strand, Susanne
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Management of violent behaviour in the correctional system using qualified risk assessments.2004In: Legal and Criminological Psychology, ISSN 1355-3259, E-ISSN 2044-8333, Vol. 9, no 1, p. 11-22Article in journal (Refereed)
    Abstract [en]

    Purpose. This study focused on whether institutional violence in a maximum-security correctional institution could be prevented using comprehensive risk assessments followed by adequate risk management. And, could this be shown by a decrease in risk factors for violence according to the HCR-20 Risk Assessment Scheme in the study group? Methods. Offenders with a history of violent criminality were subject to real-life assessments using the HCR-20 Risk Assessment Scheme. The assessments were followed by discussions with members of staff, in which risk management strategies were designed. Thus, the members of staff were fully aware of every inmate's personality characteristics (e.g. psychiatric diagnoses), what risk factors for violence they displayed, and how best to manage those risk factors. With the aim of evaluating the possible effects of our interventions, approximately one third of the study group was reassessed after a mean of 12 months. Results. The follow-up showed no significant decrease in important risk factors for violence in the study group. However, the number of violent incidents showed a remarkable decrease during the study period. Conclusions. Not being able to reduce important risk factors for violence does not necessarily mean that one cannot decrease the risk for, or the incidence of, violence. This study indicates that proper and adequate risk management, using the best protective factors available, can reduce violence even though important risk factors cannot be decreased. The study also supports the theoretical assumption that changes in risk factors are more possible in some populations (e.g. general psychiatric) than in others (e.g. correctional) depending on the nature of the study group and the risk factors that are at hand (e.g. dynamic vs. static). This seems to be important to bear in mind when performing evaluation research using risk assessment instruments.

  • 3.
    Belfrage, Henrik
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Strand, Susanne
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Measuring the Outcome of Structured Spousal Violence Risk Assessments Using the B-SAFER: Risk in Relation to Recidivism and Intervention2012In: Behavioral sciences & the law (Print), ISSN 0735-3936, E-ISSN 1099-0798, Vol. 30, no 4, p. 420-430Article in journal (Refereed)
    Abstract [en]

    In this study, 216 risk assessments conducted by law enforcement officers in a suburb of Stockholm using the Brief Spousal Assault Form for the Evaluation of Risk (B-SAFER) were followed up and correlated to both recidivism and type of protective actions implemented by the police. The results showed high recidivism rates across all risk categories, except in the highest risk group, where the recidivism rate was significantly lower. This finding suggests a poor, and even negative, predictive power of the police risk assessments: the higher the police-assessed risk, the lower the recidivism rate. However, it was clear that the police did very little, or nothing, in cases not assessed as high risk. All resources appear to have been directed to the high-risk cases, which seems to have had a preventive effect. Our results point to the importance of studying the nature and extent of protective actions taken in response to risk assessment, before drawing conclusions about the predictive validity of risk assessment instruments. Copyright (C) 2012 John Wiley & Sons, Ltd.

  • 4.
    Belfrage, Henrik
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Strand, Susanne
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Structured spousal violence risk assessment: Combining risk factors and victim vulnerability factors.risk factors and victim vulnerability factors.2008In: International Journal of Forensic Mental Health, ISSN 1499-9013, E-ISSN 1932-9903, Vol. 7, no 1, p. 39-46Article in journal (Refereed)
  • 5.
    Belfrage, Henrik
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Strand, Susanne
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Utveckling av ett riskinstrument för polisiär bedömning av risk för upprepat partnervåld: Slutrapport från utvecklingsprojekt i Kalmar, Kronoberg och Blekinge län.2003Report (Other scientific)
  • 6.
    Belfrage, Henrik
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Strand, Susanne
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Validation of the Guide for Stalking Assessment and Management (SAM) in Swedish law enforcement.2009In: International Journal of Police Science and Management, ISSN 1461-3557, E-ISSN 1478-1603, Vol. 11, no 1, p. 67-76Article in journal (Refereed)
  • 7.
    Belfrage, Henrik
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Strand, Susanne
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Ekman, Linda
    Polismyndigheten Stockholm.
    Hasselborg, Anna-Karin
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    The PATRIARCH. Six years experiences from the use of a checklist for the assessment of risk for patriarchal violence with honor as motive.2012In: International Journal of Police Science and Management, ISSN 1461-3557, E-ISSN 1478-1603, Vol. 14, no 1, p. 20-29Article in journal (Refereed)
    Abstract [en]

    Few crimes are as complicated to investigate and understand as honour-based crimes.The planning and execution often involves multiple family members, usually without personality disorders or major mental disorders, and can include mothers, sisters, brothers, male cousins, uncles and grand- fathers whose actions are by many, themselves included, considered as good or necessary. Invest- igations often have to be carried out trans- national, involving many authorities and sometimes several countries. This paper describes the process of developing an evidence-based check- list which has been used for six years in Sweden

    as an aid for law enforcement and social author- ities in cases with suspected risk for honour-based violence. Data from 56 recent cases are presented and discussed.

  • 8.
    Belfrage, Henrik
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences. Forens Psychiat Ctr, Sundsvall, Sweden.
    Strand, Susanne
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences. Forens Psychiat Ctr, Sundsvall, Sweden.
    Storey, Jennifer E.
    Simon Fraser Univ, Dept Psychol, Burnaby, BC V5A 1S6, Canada.
    Gibas, Andrea L
    Simon Fraser Univ, Dept Psychol, Burnaby, BC V5A 1S6, Canada.
    Kropp, P Randall
    Simon Fraser Univ, Dept Psychol, Burnaby, BC V5A 1S6, Canada.
    Hart, Stephen D
    Simon Fraser Univ, Dept Psychol, Burnaby, BC V5A 1S6, Canada.
    Assessment and management of risk for intimate partner violence by police officers using the Spousal Assault Risk Assessment Guide2012In: Law and human behavior, ISSN 0147-7307, E-ISSN 1573-661X, Vol. 36, no 1, p. 60-67Article in journal (Refereed)
    Abstract [en]

    Intimate partner violence (IPV) is a crime that is present in all countries, seriously impacts victims, and demands a great deal of time and resources from the criminal justice system. The current study examined the use of the Spousal Assault Risk Assessment Guide, 2nd ed. (SARA; Kropp, Hart, Webster, & Eaves, 1995), a structured professional judgment risk assessment and management tool for IPV, by police officers in Sweden over a follow-up of 18 months. SARA risk assessments had significant predictive validity with respect to risk management recommendations made by police, as well as with recidivism as indexed by subsequent contacts with police. Risk management mediated the association between risk assessment and recidivism: High levels of intervention were associated with decreased recidivism in high risk cases, but with increased recidivism in low risk cases. The findings support the potential utility of police-based risk assessment and management of IPV, and in particular the belief that appropriately structured risk assessment and management decisions can prevent violence.

  • 9.
    Douglas, S Kevin
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Strand, Susanne
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Belfrage, Henrik
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Fransson, G
    Levander, S
    Reliability and validity evaluation of the psychopathy checklist: Screening version (PCL:SV) in Swedish correctional and forensic psychiatric samles2005In: Assessment (Odessa, Fla.), ISSN 1073-1911, E-ISSN 1552-3489, Vol. 12, no 2, p. 145-161Article in journal (Refereed)
    Abstract [en]

    This study evaluated the structural reliability, construct-related validity, and cultural validity generalization of the Hare Psychopathy Checklist: Screening Version (PCL:SV) in a sample of more than 560 male and female Swedish forensic psychiatric treatment patients, forensic evaluation patients, and criminal offenders. Structural reliability was excellent for most indices. PCL:SV scores were higher for males than females for total and Part 1 scores (interpersonal/ affective features) but not for Part 2 (behavioral features). With some exceptions, PCL:SV scores were meaningfully related to aggression to others, a measure of risk for violence, substance use problems, personality disorder (positive), and psychosis (negative). Correlations between PCL:SV and aggression were larger for females than males, although the difference was smaller when personality disorder was held constant. The structural reliability and pattern of validity coefficients were comparable in these Swedish samples to other non-North American samples. Implications for the cross-cultural manifestation and correlates of psychopathy are discussed.

  • 10.
    Kristiansen, Lisbeth
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Strand, Susanne
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Rättspsykiatri2010In: Omvårdnad vid psyskisk ohälsa - på grundläggande nivå / [ed] Ingela Skärsäter, Lund: Studentlitteratur, 2010, 1, , p. 484p. 279-303Chapter in book (Other academic)
  • 11.
    Kristiansen, Lisbeth
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Strand, Susanne
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Rättspsykiatrisk omvårdnad2006In: Psykiatrisk omvårdnad / [ed] Barbro Arvidsson, Ingela Skärsäter, Lund: Studentlitteratur, 2006Chapter in book (Other academic)
  • 12. Lewin, C
    et al.
    Strand, Susanne
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Belfrage, Henrik
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Skiljer sig offer som inte medverkar i polisutredningen avseende partnervåld från dem som medverkar?: En statistisk analys av ärenden anmälda till Polismyndigheten i Kalmar län under en ettårsperiod.2007Report (Other academic)
  • 13.
    McEwan, Troy E.
    et al.
    Monash Univ, Ctr Forens Behav Sci, Melbourne, Vic 3004, Australia.
    Strand, Susanne
    Mid Sweden University, Faculty of Human Sciences, Department of Social Sciences.
    The role of psychopathology in stalking by adult strangers and acquaintances2013In: Australian and New Zealand journal of psychiatry (Print), ISSN 0004-8674, E-ISSN 1440-1614, Vol. 47, no 6, p. 546-555Article in journal (Refereed)
    Abstract [en]

    Objective: Individuals who stalk strangers and acquaintances are under-studied, although there is some evidence suggesting a greater prevalence of psychopathology than is present in those who stalk former partners. This study investigated the nature and prevalence of psychopathology in a sample of stranger and acquaintance stalkers and whether psychopathology was associated with increased duration or serial stalking in this group. It was hypothesised that mental illness, and specifically psychosis, would be more prevalent among strangers and acquaintances than among ex-intimate stalkers. Method: Two hundred and eleven stalkers (10% female; mean age = 35, SD = 10.8; 71 ex-intimates) were recruited between 2002 and 2007 from a specialist service in Melbourne, Australia. Each underwent psychiatric and psychological assessment and disorders were diagnosed according to DMS-IV-TR criteria. Non-parametric independent sample tests were used to examine associations between relationship type and psychopathology, and to identify individual and stalking-related characteristics associated with increased duration and serial stalking. Results: Axis I disorders were significantly more prevalent among strangers and acquaintances than ex-intimates (71% vs 48%, OR = 2.6, 95% CI = 1.4 to 4.7), as were psychotic disorders (29% vs 9%, OR = 4.4, 95% CI = 1.8 to 10.9). Psychosis was significantly associated with increased duration of stalking behaviour (U = 3043, p < 0.001). Those with a personality disorder were twice as likely to have stalked multiple times (OR = 2.4, 95% CI = 1.2 to 5.0). Conclusions: Those who stalk strangers and acquaintances are often mentally ill and psychopathology is associated with more persistent and recurrent stalking behaviour. Although limited by the use of clinical interview rather than structured assessment, these findings strongly support the argument for routine mental health assessment of stranger and acquaintance stalkers who become involved with the criminal justice system.

  • 14.
    Olsson, Helen
    et al.
    Dalarna University.
    Audulv, Åsa
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Strand, Susanne
    Mid Sweden University, Faculty of Human Sciences, Department of Social Sciences. Sundsvall Forensic Psychiatric Hospital.
    Kristiansen, Lisbeth
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Reducing or Increasing Violence in Forensic Care: A Qualitative Study of Inpatient Experiences2015In: Archives of Psychiatric Nursing, ISSN 0883-9417, E-ISSN 1532-8228, Vol. 29, no 6, p. 393-400Article in journal (Refereed)
    Abstract [en]

    Semi-structured interviews with 13 forensic psychiatric inpatients that had decreased their assessed risk of violence were analyzed using interpretive description. The main contribution from this study is a detailed description of patients' own strategies to avoid violence. Participants described having an ongoing inner dialog in which they encouraged themselves, thereby increasing their self-esteem and trying to accept their current situation. An unsafe and overcrowded ward with uninterested and nonchalant staff increased the risk of aggressive behavior. In the process of decreasing violence, the patients and the forensic psychiatric nursing staff interacted to create and maintain a safe environment.

  • 15.
    Olsson, Helen
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Strand, Susanne
    Mid Sweden University, Faculty of Human Sciences, Department of Social Sciences.
    Asplund, Kenneth
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Kristiansen, Lisbeth
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Turning points and treatment readiness in forensic patients: A study based on staff experiences.2014In: Nordisk sygeplejeforskning, ISSN 1892-2678, E-ISSN 1892-2686, Vol. 4, no 3, p. 175-188Article in journal (Refereed)
    Abstract [en]

    Many individuals sentenced to forensic psychiatric care fail in the rehabilitation process, resulting in long-term inpatient hospital care. The concepts of turning points and treatment readiness in forensic settings should therefore be afforded more attention. Much can be learned from the features that characterize trajectories of recovery and processes related to turning points. The aim of this study was to explore forensic nursing staff’s experiences of forensic psychiatric patients’ turning towards recovery. A qualitative content analysis was used to analyse interviews with 13 forensic psychiatric nursing staff. Analysis of the data revealed two main themes with implications for clinical practice: promoting a turning point and recognizing a turning point. In the first of these, the emphasis was on actions and conditions that must exist to promote a turning. In the second, the main experiences related to recognizing a turning point were stories about visible and perceptible changes in the patient. The experiences that stood out most distinctly were those of being able to wait out the patient, and having patience when there was a lack of progression. The composition of staff and patients contributed to whether or not the environment was perceived as salutary.

  • 16.
    Olsson, Helen
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Strand, Susanne
    Mid Sweden University, Faculty of Human Sciences, Department of Social Sciences.
    Kristiansen, Lisbeth
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Reaching a turning point – how patients in forensic care describe trajectories of recovery2014In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 28, no 3, p. 505-514Article in journal (Refereed)
    Abstract [en]

    In Sweden, the duration of treatment is increasing for patients admitted to forensic psychiatric care. To reduce the length of stay it is important for the forensic rehabilitation and recovery process to be effective and safe. Not much is known about how the process of recovery and transition begins and how it is described by the forensic patients. The purpose of this study was to explore how forensic patients with a history of high risk for violence experienced the turn towards recovery. A qualitative content analysis was used to analyze interviews with 10 patients who had decreased their assessed risk for violence on the risk assessment instrument HCR-20, and who were successfully managed a lower level of security. Three themes were identified: (1) the high risk phase; facing intense negative emotions and feelings (2) the turning point phase; reflecting on and approaching oneself and life in a new way (3) the recovery phase; recognizing, accepting and maturing. In the high risk phase chaotic and overwhelming feelings were experienced. The turning point phase was experienced as a sensitive stage and it was marked by being forced to find a new, constructive way of being. The recovery phase was characterized by recognizing personal circumstances in life, including accepting the need for structure, a feeling of maturity and a sense of responsibility for their own life. In order to ensure a successful recovery, the forensic nursing staff needs to recognize and support processes related to treatment motivation and turning points. Recommendations for best nursing practice are given accordingly.

  • 17.
    Olsson, Helen
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Strand, Susanne
    Mid Sweden University, Faculty of Human Sciences, Department of Social Sciences. Sundsvall Forensic Psychiatric Hospital, Sundsvall, Sweden.
    Kristiansen, Lisbeth
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Sjöling, Mats
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Asplund, Kenneth
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Decreased risk for violence in patients admitted to forensic care, measured with the HCR-202013In: Archives of Psychiatric Nursing, ISSN 0883-9417, E-ISSN 1532-8228, Vol. 27, no 4, p. 191-197Article in journal (Refereed)
    Abstract [en]

    Aim: To explore if patients admitted to forensic psychiatric care decreased their assessed risk for violence over time, to identify patients who decreased their assessed risk for violence exceptionally well (30% or more) on the Clinical (C) and Risk management (R) scales in the (HCR-20), and to compare them in terms of demographic data.

    Methods: The HCR-20 risk assessment instrument was used to assess the risk for violence in 267 patients admitted to a Swedish forensic psychiatric clinic between 1997 and 2010. Their assessments at admission were compared with a second, and most recent, risk assessment.

    Results: The risk for violence decreased over time. Demographic criteria had no impact on differences on decreased risk. Only two factors, namely gender and psychopathy showed a difference. Risk factors associated with stress and lack of personal support were the items that turned out to be the most difficult to reduce.

    Conclusion: The results show that risk prevention in forensic care does work and it is important to continue to work with risk management. The study highlights the importance of a careful analysis of the patient's risk for violence in order to work with the patient's specific risk factors to reduce the risk.

  • 18.
    Selenius, Heidi
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Strand, Susanne
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Superficiality in forensic psychiatric patients is related to superior phonological, semantic, and syntactic skills2015In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 69, no 5, p. 392-396Article in journal (Refereed)
    Abstract [en]

    Background: Psychopaths are reported to have unusual language processing, and they have been suggested to have better phonological awareness than do non-psychopaths. Phonological processing skills have not been studied among psychopathic persons, and it is unclear how the degree of psychopathy is related to such skills. Aims: One aim of the present study was to investigate this relationship. An additional aim was to investigate how affective-interpersonal traits and antisocial lifestyle of psychopaths are related to verbal skills such as reading and spelling, as well as to phonological processing skills. Material and methods: Forty (80% male) forensic psychiatric patients participated. They were all Swedish-speaking, and their mean age was 36 years. The patients performed reading and spelling tests as well as a battery of tasks assessing phonological processing. The patients were also assessed using the Psychopathy Checklist Screening Version (PCL:SV). Results: The patients scores on Factor 1 (affective and interpersonal traits) of the PCL:SV were significantly positively correlated with results on decoding of sentences and reading speed tests as well as with phonological processing skills. However, the only item that was significantly related to phonological processing skills as well as semantic and syntactic skills was Superficial. Conclusions: In general, psychopaths easily shift conversational topics, and it may be due to a certain cognitive skill such as rapid automatized naming. We suggest that further studies focus on rapid automatized naming in psychopaths to clarify whether their superficial character might be related to rapid naming.

  • 19.
    Sheperd, S M
    et al.
    Centre for Forensic Behavioural Science, Swinburne University of Technology, Australia.
    Strand, Susanne
    Mid Sweden University, Faculty of Human Sciences, Department of Social Sciences. Centre for Forensic Behavioural Science, Swinburne University of Technology, Australia.
    The utility of the psychopathy checklist: Youth Version (PCL: YV) and the Youth Psychopathic Trait Inventory (YPI)-is it meaningful to measure psychopathy in young offenders?2016In: Psychological Assessment, ISSN 1040-3590, E-ISSN 1939-134X, Vol. 28, no 4, p. 405-415Article in journal (Refereed)
    Abstract [en]

    This study examined the convergent validity of 2 youth psychopathy instruments, the Psychopathy Checklist: Youth Version (PCL: YV) and the Youth Psychopathic Trait Inventory (YPI) and their relationship with problem behaviors and recidivism in an Australian sample of young offenders in custody. The PCL: YV demonstrated a capacity to identify severely antisocial youth; however, the tool was unable to differentiate between potentially psychopathic and nonpsychopathic antisocial youth. The YPI was receptive to a wide variety of problem behaviors which precluded the unique identification of core psychopathic traits in the sample. Both instruments were unable to meaningfully distinguish between recidivists and nonrecidivists. As such, the PCL: YV and the YPI demonstrate limited utility for antisocial young offenders in custody. Further research on the durability and developmental manifestation of psychopathy in adolescents is necessary before these instruments are employed in similar contexts. Implications for the clinical use of psychopathy measures are discussed.

  • 20.
    Storey, Jennifer E.
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Social Sciences. Department of Psychology, Simon Fraser University, 8888 University Drive, Burnaby, BC V5A 1S6, Canada .
    Strand, Susanne
    Mid Sweden University, Faculty of Human Sciences, Department of Social Sciences.
    Assessing violence risk among female IPV perpetrators: An examination of the B-SAFER2013In: Journal of Aggression, Maltreatment & Trauma, ISSN 1092-6771, E-ISSN 1545-083X, Vol. 22, no 9, p. 964-980Article in journal (Refereed)
    Abstract [en]

    Intimate partner violence (IPV) is a global problem and one in which frontline assessment and management falls primarily to police. Although IPV is often conceptualized as a male-perpetrated crime, evidence substantiates female IPV perpetration and increased arrest rates, raising important issues for police. This article examines police use of the Brief Spousal Assault Form for the Evaluation of Risk (B-SAFER; Kropp, Hart, & Belfrage, 2005, 2010), a violence risk assessment tool for IPV. The B-SAFER was used to assess and manage 52 women arrested for IPV. When compared to Belfrage and Strand (2008), who examined men arrested for IPV in the same sample, women possessed fewer risk factors. Risk factors were related to summary risk judgments, although differences existed between genders and risk judgments were not related to management recommendations. Results suggest that risk factors, in addition to those in the B-SAFER, are required to assess risk for female IPV. © 2013 Copyright Taylor and Francis Group, LLC.

  • 21.
    Storey, Jennifer E.
    et al.
    Simon Fraser Univ, Dept Psychol, Burnaby, BC V5A 1S6, Canada .
    Strand, Susanne
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    The characteristics and violence risk management of women arrested by the police for intimate partner violence2012In: European Journal of Criminology, ISSN 1477-3708, E-ISSN 1741-2609, Vol. 9, no 6, p. 636-651Article in journal (Refereed)
    Abstract [en]

    Research and management efforts in the area of intimate partner violence (IPV) have primarily focused on male perpetrators and female victims, resulting in more limited knowledge of female IPV perpetrators and their male victims. In the current study the violence risk assessments of police officers were examined in order to outline the characteristics of female perpetrators of IPV and their male victims. In addition, the officers' assessments of violence risk and proposed risk management strategies are presented. Results reveal some similarities between the female perpetrators and male victims and their more studied counterparts. However, differences appear to be present in the perceived violence risk posed by the perpetrators and the violence risk management strategies proposed to reduce that risk and protect the victim. The results suggest a need for further research in the area, particularly with respect to the violence risk assessment and management of female IPV perpetrators.

  • 22.
    Storey, Jennifer
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Social Sciences. Department of Psychology, Simon Fraser University, Canada .
    Kropp, P. Randy
    British Columbia Forensic Psychiatric Services Commission, Canada.
    Hart, D. Stephen
    Department of Psychology, Simon Fraser University, Canada.
    Belfrage, Henrik
    Mid Sweden University, Faculty of Human Sciences, Department of Social Sciences. University of Bergen, Norway .
    Strand, Susanne
    Mid Sweden University, Faculty of Human Sciences, Department of Social Sciences. Forensic Psychiatric Centre, Sundsvall, Sweden.
    Assessment and Management of Risk for Intimate Partner Violence by Police Officers. Using the Brief Spousal Assault Form for the Evaluation of Risk (B-SAFER).2014In: Criminal justice and behavior, ISSN 0093-8548, E-ISSN 1552-3594, Vol. 41, no 2, p. 256-271Article in journal (Refereed)
    Abstract [en]

    The management of intimate partner violence (IPV) typically falls to police. For assistance, officers are increasingly using violence risk assessment tools like the Brief Spousal Assault Form for the Evaluation of Risk (B-SAFER). This study replicates the methodology of Belfrage et al. but examines the B-SAFER as used by Swedish police officers when assessing and managing IPV. Results revealed a positive relationship between risk and management. Total scores and overall risk ratings predicted recidivism (AUC [Area under the curve] = .70 and .69, respectively). Finally, a pattern where management recommendations were associated with decreased recidivism in high risk perpetrators but increased recidivism in low risk perpetrators was found. Results validate the use of the B-SAFER by police and reveal mostly comparable findings between the B-SAFER and the Spousal Assault Risk Assessment Guide, as examined by Belfrage et al., but suggest that the B-SAFER may be better suited for police.

  • 23.
    Strand, Susanne
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Kvinnliga psykopater2007In: Genusmaraton 2007: Mittsveriges genusforskare på frammarsch, Östersund: Mittuniversitetet , 2007, p. 54-62Conference paper (Other academic)
  • 24.
    Strand, Susanne
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Using a Restraining Order as a Protective Risk Management Strategy to Prevent Intimate Partner Violence2012In: Police Practice & Research, ISSN 1561-4263, E-ISSN 1477-271X, Vol. 13, no 3, p. 254-266Article in journal (Refereed)
    Abstract [en]

    The police play an important role in implementing risk management strategies to prevent intimate partner violence (IPV). The focus of this study was to investigate the use of a restraining order (RO) as a risk management strategy and its crime preventive effect. Two hundred and fourteen male spousal assaulters assessed with the B-SAFER in a Swedish police county between 2005 and 2007 were followed up in 2009. Thirty- one per cent received a RO of which 44% relapsed into new IPV. There were no differences in recidivism between those who received a RO and those who did not. However, those assessed as low or medium risk for IPV were less likely to recidivate if they had a RO issued upon them than those assessed as high risk. These results indicate that the RO may be a useful crime preventive strategy for IPV in those spe- cific cases, but not in general, and not for those assessed to present a high risk of future violence.

  • 25.
    Strand, Susanne
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Violence risk assessment in male and female mentally disordered offenders: differences and similarities2006Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    When assessing the risk of violence, increasing interest has been shown in bringing science and practice closer together. Moving from clinical intuition in the first generation of risk assessment via actuarial scales in the second generation to the structured professional judgments where risk assessments are today produces better, more valid results when assessing the risk of violence. One of the best predictors of violence is gender. Approximately 10% of the violent criminality can be attributed to women; even so, it is increasing, especially among young women. It is therefore important to examine risk assessments from a gender perspective. Another important factor when assessing the risk of violence is psychopathy and there are indications that there might be gender differences in this diagnosis. Thus, a special interest has been focused on psychopathy in this thesis. The purpose with this work is to explore the similarities and differences in assessing risk for violence in male and female mentally disordered offenders, while the overall aim is to validate the violence risk assessment instrument HCR-20 for Swedish offender populations. The risk assessments for all six studies in this thesis were made by trained personnel using the HCR-20 instrument, where psychopathy was diagnosed with the screening version of the Psychopathy Checklist (PCL:SV). The study populations were both male and female mentally disordered offenders in either the correctional or the forensic setting.

    The findings show that both the validity and the reliability of the HCR-20 and the PCL:SV were good and the clinical and risk management subscales were found to have better predictive validity than the historical scale. Another finding was that there were more similarities than differences between genders in the HCR-20, while the opposite applied to the PCL:SV, where the antisocial behavior was performed in a different manner. Moreover, it was found that the gender of the assessor might be a factor to take into account when

    assessing the risk of violence in women, where the recommendation was that at least one assessor should be female. The conclusions were that the HCR-20 and the PCL:SV can be used In Swedish offender populations with valid results. For female offenders, there are differences in the antisocial behavior that is assessed in order to diagnose psychopathy and these differences tend to underestimate psychopathy among female offenders. Furthermore, the gender of the assessor might be of greater importance than has previously been realized. The overall conclusion was that this thesis supports the structural professional judgment method of making risk assessments in order to prevent violence in the community.

  • 26.
    Strand, Susanne
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Belfrage, Henrik
    Comparison of HCR-20 scores in violent mentally disordered men an women: Gender differences and similarities2001In: Psychology, Crime and Law, ISSN 1068-316X, E-ISSN 1477-2744, Vol. 7, no 1-4, p. 71-79Article in journal (Refereed)
  • 27.
    Strand, Susanne
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Belfrage, Henrik
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Female spousal assault offenders2007In: Female spousal assault offenders, 2007Conference paper (Refereed)
  • 28.
    Strand, Susanne
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Belfrage, Henrik
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Gender differences in psychopathy in a Swedish offender sample2005In: Behavioral sciences & the law (Print), ISSN 0735-3936, E-ISSN 1099-0798, Vol. 23, no 6, p. 837-850Article in journal (Refereed)
    Abstract [en]

    In this study we examined gender differences in the PCL:SV employing a variety of statistical methods with two subsets of psychopathic individuals drawn from larger samples of 129 female and 499 male Swedish offenders. The larger samples included forensic psychiatric patients, forensic psychiatric evaluees and criminal offenders. We found gender differences in antisocial behavior, as defined in factor 2 of the PCL:SV, with female psychopaths (PCL:SV ≥ 18) displaying significantly more lying, deceitfulness and lack of control, while male psychopaths were more antisocial as measured by the PCL:SV. We conclude that it might be meaningful to use gender specific definitions in the assessment of psychopathy or, alternatively, slightly revise the diagnostic tools. Our results support the use of the three-factor model of the PCL-R and PCL:SV introduced by Cooke and Michie (2001) in female populations.

  • 29.
    Strand, Susanne
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Belfrage, Henrik
    Fransson, G
    Levander, S
    Clinical and risk management facotrs in risk prediction of mentally disordered offenders - More important than historical data?: A retrospective study of 40 mentally disordered offenders assessed with the HCR-20 violence risk assessment scheme1999In: Legal and Criminological Psychology, ISSN 1355-3259, E-ISSN 2044-8333, Vol. 4, no 1, p. 67-76Article in journal (Refereed)
    Abstract [en]

    Purpose. The predictive validity of the risk prediction instrument HCR-20 was studied. Methods. Two matched groups of discharged forensic psychiatric patients, one who had recidivated into violent criminality and the other not, were assessed with the HCR-20. This was done retrospective and blind to the outcome. Results. The results show an overall high predictive validity (AUC = .80). However, historical data had none, or a low, validity while clinical and risk management data had a very high validity. Conclusions. One of the most interesting findings in this study is that clinical and risk management factors came out as more predictive of future violence than historical factors, which is very much contrary to findings in past research. We think that one has to bear in mind that both clinical and risk management factors are heavily influenced by historical information. Thus, historical data are probably as important as is generally shown in follow-up studies of violence in various offender groups. However, using the HCR-20, which allows systematic and reliable coding of clinical and risk management factors, seems to make it possible to use these factors more successfully than has been hitherto possible.

  • 30.
    Strand, Susanne
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Holmberg, Gunnar
    Justitiedepartementet.
    Söderberg, Erik
    Rättspsykiatriska regionkliniken Sundsvall.
    Den rättspsykiatriska vården2009Book (Other academic)
    Abstract [sv]

    Falun, Åkeshov, Knutby, Gamla Stan, NK, Arvika, Norrahammar är namnen på några av de platser som har varit föremål för massmedias och allmänhetens intresse under senare år efter vad som betecknats som vansinnesdåd.Alla dessa vansinnesdåd har begåtts av gärningsmän som lider av psykiska problem. När problemen är så stora att tillståndet motsvarar det som i lagen benämns en allvarlig psykisk störning och gärningsmannen är i behov av vård kan domstolen överlämna gärningsmannen till rättspsykiatrisk vård i stället för att döma till fängelse. Boken beskriver de insatser som görs av dem som arbetar inom den rättspsykiatriska vården, vårdens organisation och även de lagar och regler som omger denna komplexa verksamhet. Den rättspsykiatriska vården är ingen lärobok i psykiatri, men ger en översikt över grundläggande begrepp och psykiatriska diagnoser, hur dessa manifesteras och representeras inom den rättspsykiatriska vården. Omvårdnad, behandling och etiska dilemman beskrivs också, liksom vårdens skyldigheter och patientens rättigheter. Säkerhet och riskbedömning är andra viktiga begrepp som belyses. En redogörelse för hur gärningsmän med svåra psykiska störningar bedöms och tas om hand i vår omvärld finns med för att illustrera att vårt nuvarande svenska sätt att döma och ta hand om sådana gärningsmän inte är det enda möjliga alternativet.Boken är främst avsedd för grundutbildningen av personal inom det rättspsykiatriska området och angränsande verksamheter samt för fortbildningsändamål, men den kan även vara en källa till ökad kunskap för andra som är intresserade av att ta del av detta komplexa och svåra, men samtidigt fascinerande område i korsningen mellan hälso- och sjukvården och rättssamhället.

  • 31.
    Strand, Susanne
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Johansson, P
    Belfrage, Henrik
    The assessment of psychopathy in female offenders: How important is the gendre of the assessor?Manuscript (Other academic)
  • 32.
    Strand, Susanne
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    McEwan, T E
    Monash University, Australia.
    Violence among female stalkers2012In: Psychological Medicine, ISSN 0033-2917, E-ISSN 1469-8978, Vol. 42, no 3, p. 545-555Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Female stalkers account for 10-25% of all stalking cases, yet little is known about risk factors for female stalking violence. This study identifies risk factors for female stalking violence and contrasts these with risk factors for male stalking violence.MethodSeventy-one female and 479 male stalkers presenting to police in Sweden and a specialist stalking clinic in Australia were investigated. Univariate comparisons of behaviour by gender, and comparisons between violent and non-violent female stalkers, were undertaken. Logistic regression was then used to develop a predictive model for stalking violence based on demographic, offence and clinical characteristics. RESULTS: Rates of violence were not significantly different between genders (31% of males and 23% of females). For both men and women, violence was associated with a combination of a prior intimate relationship with the victim, threats and approach behaviour. This model produced receiver operating characteristic (ROC) curves with area under the curve (AUC)=0.80 for female stalkers and AUC=0.78 for male stalkers. The most notable gender difference was significantly higher rates of personality disorder among women. High rates of psychotic disorder were found in both genders. Stalking violence was directly related to psychotic symptoms for a small number of women. CONCLUSIONS: Similar risk factors generally predict stalking violence between genders, providing initial support for a similar approach to risk assessment for all stalkers. The most notable gender difference was the prevalence of personality and psychotic disorders among female stalkers, supporting an argument for routine psychiatric assessment of women charged with stalking.

  • 33.
    Strand, Susanne
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    McEwan, Troy E.
    Centre for Forensic Behavioral Sciences, Monash University, Victorian Institue of Forensic Mental Health, Australia.
    Same-Gender Stalking in Sweden and Australia2011In: Behavioral sciences & the law (Print), ISSN 0735-3936, E-ISSN 1099-0798, Vol. 29, no 2, p. 202-219Article in journal (Refereed)
    Abstract [en]

    This study examined the phenomenon of same-gender stalking and sought to identify differences between same-and opposite-gender stalking cases. Ninety-four same-gender and 160 opposite-gender stalking cases from Sweden and Australia were compared on demographic, offense, clinical, and behavioral characteristics. The groups were largely similar, differing mainly in the nature of the prior relationship between stalker and victim and the stalker's motivation. The most notable distinction was the significantly greater prevalence of ex-intimate partner stalkers in the opposite-gender group (65%) versus the same-gender group (32%), leading to the exclusion of ex-intimates from the subsequent analysis to remove this potentially confounding variable. Amongst non-ex-intimates, same-gender stalkers were significantly more likely to be female and to stalk out of a sense of resentment and grievance. The results showed that the gender of the victim and perpetrator was less important to the course and conduct of a stalking episode than were the stalker's motivation and the nature of the prior relationship to the victim. Copyright (C) 2011 John Wiley & Sons, Ltd.

  • 34.
    Strand, Susanne
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Olsson, Helen
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Kristiansen, Lisbeth
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    To decreas the risk for violence for patients sentenced to forensic psychiatric care- personnel and patient´s views2009Conference paper (Refereed)
  • 35.
    Strand, Susanne
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Social Sciences.
    Selenius, Heidi
    Mid Sweden University, Faculty of Human Sciences, Department of Social Sciences.
    Uppföljning av patienter som har överförts eller skrivits ut från Rättspsykiatriska regionkliniken i Sundsvall under tidsperioden 2005-20102013Report (Other academic)
    Abstract [sv]

    Bakgrund. Vid den Rättspsykiatriska regionkliniken i Sundsvall, som har den högsta säkerhetsnivån, vårdas personer i behov av psykiatrisk tvångsvård. Patientgruppen består av psykiskt störda lagöverträdare som är överlämnade till rättspsykiatrisk vård (LRV), särskilt vårdkrävande patienter som vårdas enligt psykiatriskt tvångsvård (LPT) och klienter från Kriminalvården som har behov av psykiatrisk tvångsvård. Då den regionkliniken har denna mycket höga säkerhetsnivå överförs ibland patienter i behov av högkvalificerad specialistvård från andra rättspsykiatriska avdelningar med lägre säkerhetsnivå till regionkliniken. Patienterna kan sedan överföras tillbaka till den avdelning som de har kommit ifrån då deras behov av den högkvalificerade specialistvården inte längre föreligger. Även Kriminalvården har olika säkerhetsnivåer och detta innebär att regionkliniken tar emot klienter som dels är i behov av psykiatrisk tvångsvård och dels har bedömts vara de mest riskfyllda inom kriminalvården.

    Syftet. Syftet med föreliggande pilotstudie var att genom en registerstudie följa upp patienter som har överförts, skrivits ut eller vårdats inom mer öppna former från Rättspsykiatriska regionkliniken i Sundsvall under åren 2005-2010.

    Metod. I studien ingick 173 deltagare (13% kvinnor och 87% män), vilka var dömda till rättspsykiatrisk vård eller fängelse. Samtliga 173 inkluderade deltagare har lämnat regionkliniken under åren 2005 till 2010. Genom registerstudier samlades data in gällande demografiska variabler och riskbedömningar med HCR-20 (Webster et al. 1997). Därtill följdes patienterna upp i Brottförebyggande rådets lagföringsregister.

    Resultat. Studien visade att 43% av patienterna har skrivits ut eller är fortsatt inskrivna under mer öppna former vid regionkliniken. Vidare har 44% av patienterna överförts till sina hemlandsting för fortsatt vård under hemlandstingens ansvar. Därtill har 11% av patienterna överförts tillbaka till kriminalvården och 2% av patienterna har blivit utvisade ur riket. Utifrån de riskbedömningar som har gjorts med HCR-20 kan konstateras att patienterna hade många riskfaktorer för våld då de lämnade kliniken, och då framförallt de som återgår till kriminalvården. Uppföljningen i lagföringsregistret visade att 22% av patienterna var lagförda för nya brott, varav 12% var lagförda för nya våldsbrott. De flesta patienter som har blivit lagförda för nya brott var de patienter som överförts till kriminalvården. De patienter som återfaller gör det inom 4 månader från att de har lämnat den högkvalificerade slutna specialistvården vid Rättspsykiatriska regionkliniken i Sundsvall.

    Slutsats. Majoriteten av patienterna, som har lämnat den högkvalificerade slutna specialistvården vid Rättspsykiatriska regionkliniken i Sundsvall inte är färdigbehandlade. De fortsätter sin vård vid andra institutioner eller under mer öppna former. Det innebär att de som övertar vården av patienterna behöver arbeta med riskhantering i större utsträckning för att kunna förhindra återfall i nya brott.

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