Strengthening the integration of actuarial risk assessment with clinical judgment in an evidence based practice framework

Traditional discussions of actuarial risk assessment utility in child welfare and juvenile justice emphasizes its comparative predictive validity with clinical methods of prediction. While important, it ignores how actuarial risk assessment instruments actually influences the clinical deliberations of their users. Recent literature extends the discussion of their clinical utility by invoking evidence based practice principles. Implicit in this discussion is a traditional model of structured decision making, common in child welfare and juvenile justice agencies, whereby actuarial risk assessment is supplemented with contextual needs assessment. This article critiques the traditional model of structured decision making and argues that its limitations are inconsistent with the spirit of evidence based practice. Instead, a revised model of structured decision making, grounded in research on risk and resilience, promises a more complete integration with evidence based practice.