Loren H. Roth

Publications (23)38.58 Total impact

• Article: A Classification Tree Approach to the Development of Actuarial Violence Risk Assessment Tools

  Henry J. Steadman, Eric Silver, John Monahan, Paul Appelbaum, Pamela Clark Robbins, Edward P. Mulvey, Thomas Grisso, Loren H. Roth, Steven Banks
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  ABSTRACT: Since the 1970s, a wide body of research has suggested that the accuracy of clinical risk assessments of violence might be increased if clinicians used actuarial tools. Despite considerable progress in recent years in the development of such tools for violence risk assessment, they remain primarily research instruments, largely ignored in daily clinical practice. We argue that because most existing actuarial tools are based on a main effects regression approach, they do not adequately reflect the contingent nature of the clinical assessment processes. To enhance the use of actuarial violence risk assessment tools, we propose a classification tree rather than a main effects regression approach. In addition, we suggest that by employing two decision thresholds for identifying high- and low-risk cases--instead of the standard single threshold--the use of actuarial tools to make dichotomous risk classification decisions may be further enhanced. These claims are supported with empirical data from the MacArthur Violence Risk Assessment Study.
  Law and Human Behavior 04/2012; 24(1):83-100. · 2.16 Impact Factor
• Source

  Available from: Eric Silver

  Article: The classification of violence risk.

  John Monahan, Henry J Steadman, Paul S Appelbaum, Thomas Grisso, Edward P Mulvey, Loren H Roth, Pamela Clark Robbins, Stephen Banks, Eric Silver
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  ABSTRACT: The Classification of Violence Risk (COVR) is an interactive software program designed to estimate the risk that a person hospitalized for mental disorder will be violent to others. The software leads the evaluator through a chart review and a brief interview with the patient. At the end of this interview, the software generates a report that contains a statistically valid estimate of the patient's violence risk-ranging from a 1% to a 76% likelihood of violence-including the confidence interval for that estimate, and a list of the risk factors that the program took into account to produce the estimate. In this article, the development of the COVR software is described and several issues that arise in its administration are discussed.
  Behavioral Sciences & the Law 02/2006; 24(6):721-30. · 0.96 Impact Factor
• Article: Coercion to inpatient treatment: Initial results and implications for assertive treatment in the community.

  John Monahan, Steven K. Hoge, Charles W. Lidz, Marlene M. Eisenberg, Nancy S. Bennett, William P. Gardner, Edward P. Mulvey, Loren H. Roth
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  ABSTRACT: summarize and integrate the findings to date from the MacArthur Coercion Study, and . . . speculate on the implications of these findings for mental health care delivered assertively in the community / interviewed 157 newly admitted patients within the 1st day after they were admitted to a mental hospital / patients had to be at least 17 yrs old (PsycINFO Database Record (c) 2012 APA, all rights reserved)
  10/1996;
• Article: Information disclosure, subject understanding, and informed consent in psychiatric research.

  Paul R Benson, Loren H Roth, Paul S Appelbaum, Charles W Lidz, William J Winslade
  Law and Human Behavior 01/1989; 12(4):455-75. · 2.16 Impact Factor
• Article: Trends in the social control of medical and psychiatric research.

  Paul R Benson, Loren H Roth
  Law and mental health 02/1988; 4:1-47.
• Article: Toward an informed discussion of informed consent: a review and critique of the empirical studies.

  Alan Meisel, Loren H Roth
  Arizona law review 02/1983; 25(2):265-346.
• Article: Psychiatric evaluation of patient decision-making: Informed consent to ECT

  Caroline L. Kaufmann, Loren H. Roth
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  ABSTRACT: Informed consent is a legal doctrine particular to Anglo-Saxon law. The doctrine specifies the rights of patients to receive information about medical treatment prior to making a decision to consent to or refuse a procedure. The application of informed consent to psychiatry has provoked controversy and confusion. The ability of some mental patients to understand the nature of recommended treatment and to make a knowing, rational decision in their best interests may be questioned. This paper presents preliminary results from an empirical study of psychiatrists' evaluation of mental patients' capacity to consent to or refuse electroconvulsive treatment (ECT). Thirty-two psychiatrists from the United States were asked to evaluate patient decision-making and understanding of treatment which was documented in videotaped interviews with the patient. Observers were shown videotaped interviews of three hospitalized patients, all referred for ECT. Patients varied in terms of their apparent degree of mental illness, status on admission to the hospital (voluntary vs. involuntary), and their decisions to consent to or refuse the procedure. Results indicated that most psychiatrists rejected the patient as the final decision-maker about treatment. They preferred that either a medical professional or the patient's relatives make the final treatment decision for the patient. Negative evaluations of patient decision-making were justified by clinical assessments of the nature and severity of the patient's illness. Positive evaluations were based on the patients apparent specific understanding of the risks, benefits, and alternatives to ECT. The findings suggest that complex ethical decision problems mix questions of fact and questions of value.
  Social Psychiatry and Psychiatric Epidemiology 02/1981; 16(1):11-19. · 2.70 Impact Factor
• Article: Competency to decide about treatment or research: an overview of some empirical data

  Loren H. Roth, Charles W. Lidz, Alan Meisel, Paul H. Soloff, Kenneth Kaufman, Duane G. Spiker, F. Gordon Foster
  Charles W. Lidz.
• Article: Perceptions of coercion in the admission of voluntary and involuntary psychiatric patients

  Steven K. Hoge, Charles W. Lidz, Marlene M. Eisenberg, William Gardner, John Monahan, Edward P. Mulvey, Loren H. Roth, Nancy Bennett
  Charles W. Lidz.
• Article: Informed consent and patient decisionmaking: the reasoning of law and psychiatry

  Caroline L. Kaufmann, Loren H. Roth, Charles W. Lidz, Alan Meisel
  Charles W. Lidz.
• Article: The therapeutic misconception: informed consent in psychiatric research

  Paul S Appelbaum, Loren H. Roth, Charles W. Lidz
  Charles W. Lidz.
• Article: Family, clinician, and patient perceptions of coercion in mental hospital admission. A comparative study

  Steven K. Hoge, Charles W. Lidz, Marlene M. Eisenberg, John Monahan, Nancy Bennett, William Gardner, Edward P. Mulvey, Loren H. Roth
  Charles W. Lidz.
• Article: Coercion and commitment: understanding involuntary mental hospital admission

  John Monahan, Steven K. Hoge, Charles W. Lidz, Loren H. Roth, Nancy Bennett, William Gardner, Edward P. Mulvey
  Charles W. Lidz.
• Article: The rights of juveniles in "voluntary" psychiatric commitments: some empirical observations

  Charles W. Lidz, E. Gross, Alan Meisel, Loren H. Roth
  Charles W. Lidz.
• Article: Tests of competency to consent to treatment

  Loren H. Roth, Alan Meisel, Charles W. Lidz
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  ABSTRACT: The authors describe the various tests of competency to consent to treatment used today, which include the following: 1)evidencing a choice, 2)"reasonable" outcome of choice, 3)choice based on "rational" reasons, 4)ability to understand, and 5)actual understanding. They analyze the applicability of these tests to patients' decisions to accept or refuse psychiatric treatment and illustrate the problems of ap-lying these tests by citing clinical case examples. They find that the circumstances in which competency becomes an issue determine which elements of which tests are stressed and which are underplayed.
  Charles W. Lidz.
• Article: Toward a model of the legal doctrine of informed consent

  Alan Meisel, Loren H. Roth, Charles W. Lidz
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  ABSTRACT: The authors draw together the disparate scholarly and judicial commentaries on consent to medical treatment to develop a model of the components in the decision-making process regarding consent to or refusal of psychiatric treatment. The components consist of the precondition of voluntariness, the provision of information, the patient's competency and understanding, and, finally, consent or refusal. They offer two models of valid consent: the objective model, which focuses on the congruence or lack of it between the patient and a "reasonable" person, and the subjective model, which focuses entirely on the patient's actual understanding.
  Charles W. Lidz.
• Article: Confidentiality: an empirical test of the utilitarian perspective

  Paul S Appelbaum, G. Kapen, B Walters, Charles W. Lidz, Loren H. Roth
  Charles W. Lidz.
• Article: False hopes and best data: consent to research and the therapeutic misconception

  Paul S Appelbaum, Loren H. Roth, Charles W. Lidz, Paul Benson, William J Winslade
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  ABSTRACT: Using examples from psychiatric research, the authors explore the ethical dilemma of the "therapeutic misconception," where, despite explanation, patient-subjects believe that research protocols are designed to benefit them directly rather than to test or compare treatment methods. Even potential subjects who demonstrate an understanding of randomization, double-blinded studies, and the use of placebos frequently persist in a belief that they purposely will receive the treatment most likely to benefit them. They expect the standards of personal care that characterize the therapeutic relationship to carry over to the clinical trial, failing to understand that the need for valid research results makes this impossible. Appelbaum et al. suggest ways in which patients can be made to understand the differences between treatment and research, and the disadvantages and advantages of participation in the latter.
  Charles W. Lidz.
• Source

  Available from: Eric Silver

  Article: Rethinking Risk Assessment: the MacArthur Study of Mental Disorder and Violence

  John Monahan, Henry J Steadman, Eric Silver, Paul S Appelbaum, Pamela Clark Robbins, Edward P. Mulvey, Loren H. Roth, Thomas Grisso, Steven M Banks
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  ABSTRACT: Citation: Monahan, J., Steadman, H., Silver, E., Appelbaum, P., Robbins, P., Mulvey, E., Roth, L., Grisso, T., & Banks, S. (2001). Rethinking risk assessment: The MacArthur study of mental disorder and violence. New York: Oxford University Press. ISBN 0195138821, 9780195138825. Winner of the American Psychiatric Association's Manfred S. Guttmacher Award, 2002. Publisher summary: The presumed link between mental disorder and violence has been the driving force behind mental health law and policy for centuries. Legislatures, courts, and the public have come to expect that mental health professionals will protect them from violent acts by persons with mental disorders. Yet for three decades research has shown that clinicians' unaided assessments of "dangerousness" are barely better than chance. Rethinking Risk Assessment: The MacArthur Study of Mental Disorder and Violence tells the story of a pioneering investigation that challenges preconceptions about the frequency and nature of violence among persons with mental disorders, and suggests an innovative approach to predicting its occurrence. The authors of this massive project -- the largest ever undertaken on the topic -- demonstrate how clinicians can use a "decision tree" to identify groups of patients at very low and very high risk for violence. This dramatic new finding, and its implications for the every day clinical practice of risk assessment and risk management, is thoroughly described in this remarkable and long-anticipated volume. Taken to heart, its message will change the way clinicians, judges, and others who must deal with persons who are mentally ill and may be violent will do their work. Preview available via Google Books.
  Thomas Grisso.
• Article: An actuarial model of violence risk assessment for persons with mental disorders

  John Monahan, Henry J Steadman, Pamela Clark Robbins, Paul S Appelbaum, Steven M Banks, Thomas Grisso, Kirk Heilburn, Edward P. Mulvey, Loren H. Roth, Eric Silver
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  ABSTRACT: OBJECTIVES: An actuarial model was developed in the MacArthur Violence Risk Assessment Study to predict violence in the community among patients who have recently been discharged from psychiatric facilities. This model, called the multiple iterative classification tree (ICT) model, showed considerable accuracy in predicting violence in the construction sample. The purpose of the study reported here was to determine the validity of the multiple ICT model in distinguishing between patients with high and low risk of violence in the community when applied to a new sample of individuals. METHODS: Software incorporating the multiple ICT model was administered with independent samples of acutely hospitalized civil patients. Patients who were classified as having a high or a low risk of violence were followed in the community for 20 weeks after discharge. Violence included any battery with physical injury, use of a weapon, threats made with a weapon in hand, and sexual assault. RESULTS: Expected rates of violence in the low- and high-risk groups were 1 percent and 64 percent, respectively. Observed rates of violence in the low- and high-risk groups were 9 percent and 35 percent, respectively, when a strict definition of violence was used, and 9 percent and 49 percent, respectively, when a slightly more inclusive definition of violence was used. These findings may reflect the "shrinkage" expected in moving from construction to validation samples. CONCLUSIONS: The multiple ICT model may be helpful to clinicians who are faced with making decisions about discharge planning for acutely hospitalized civil patients.
  Thomas Grisso.