Don’t know” scores should be considered when assessing violence risk for youth in acute institutions

Commonly, relevant information to score violence risk assessment instruments is missing at the time of assessment. While there are indications that lack of information to score items, or "Don't know" scores, has clinical relevance, these items are commonly omitted or treated as "No" scores in research. The Violence Risk Assessment Checklist for Youth (V-RISK-Y) is a screening instrument designed to identify violence risk in youth aged 12-18. The aim of this study is to assess whether "Don't know" scores on V-RISK-Y are associated with increased risk for registered violent events for youth during acute institutional stays as compared to "No" scores. This study utilized data from the V-RISK-Y multicenter study, consisting of a sample of 517 youth from child and adolescent psychiatry and residential youth care institutions. The following secondary analyses were performed: (i) the frequencies of "Don't know" and "No" scores for each item and registered violent events, and (ii) effect sizes from item-level logistic regression analyses of "Don't know" scores with "No" scores as reference, controlling for sex and type of institution. Findings show more registered violent events for youth during institutional stay when items were scored as "Don't know" as compared to "No". Nine of the 12 items had odds ratios (ORs) above 1 for "Don't know" for recorded violence when controlled for sex and type of institution. One item, "Lack of empathy", reached significance. The positive ORs indicate that "Don't know" scores may have clinical relevance despite not reaching statistical significance and that these scores should be considered both in clinical practice and in research

Checklist · Injury prevention · Logistic regression · Odds · Odds ratio · Poison control · Risk assessment · Suicide prevention · Bullying, Victimization, and Aggression · Child Abuse and Trauma · Gun Ownership and Violence Research

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  Open Access•John Olav Roaldset, Anniken L W Laake et al.•Child & Youth Care Forum•2026

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• A comparative study of violence risk assessment tools

  Open Access•Jay P Singh, Martin Grann et al.•Clinical Psychology Review•2011

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• A review of progress in violence risk assessment methods

  Open Access•Xindi Ling, Haozhe Li et al.•Forensic Sciences Research•2025

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• Validation of a violence risk screening for youth in psychiatric inpatient care—a pilot study of V-Risk-Y

  Open Access•John Olav Roaldset, Carina Chudiakow Gustavsen et al.•Frontiers in Psychiatry•2023

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• Implementing a Violence Risk Screening Protocol in a Civil Psychiatric Setting

  Open Access•Merrill Rotter, Bryn Rosenfeld et al.•Community Mental Health Journal•2018

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