Forensic assessment with adolescent offenders (1):

Bridging the gap between science and practice

Corine de Ruiter, PhDMaastricht University

The Netherlands

Lecture presented at the EFCAP Finland Tampere, Finland

November 20, 2014

Goals of forensic mental health services

• Protection of society against future offending

• Rehabilitation of the individual offender

• Restitution of victim (in particular when victim is in offender’s social network)

ASSESSMENT CONTEXT

Forensic, mandated evaluation

ASSESSEE (Cluster B)

Personality traits Defensiveness,

Lack insight

Possible defensive

response style, distortion (faking

good/faking bad)

For instance: Risk assessment Criminal responsibility Treatment planning

FORENSIC PSYCHOLOGICAL

ASSESSMENT

-selfreport, with correction for distortion -non-transparant, indirect test methods -use of collateral information (file, significant others) -standardized forensic assessment instruments (FAIs)

Guidelines for forensic psychological assessment, in relation to the forensic setting, the forensic assessee and the psycholegal question (de Ruiter & Kaser-Boyd, 2015)

Psychological assessment in adolescents (pitfalls)

Heterotypic continuity: the same trait manifests itself differently at different agesEquifinality: different developmental trajectories, same outcomeMultifinality: same developmental trajectories, different outcomes (Hart, Watt, & Vincent, 2002)

EquifinalityDifferent early experiences in life (e.g., parental divorce, physical abuse, parental substance abuse) can lead to similar outcomes (e.g., childhood depression).

MultifinalityMultifinality literally means “many ends.” This refers to people having similar histories (e.g., child sexual abuse, death of a parent) yet their developmental outcomes can vary widely.

Heterotypic continuity

An underlying (developmental) process or impairment stays the same, but the manifestations do not stay the same over time. For example a child with autism might first show impairments of non-verbal skills and problems in eye-contact. In a later developmental stage the manifestations would be different, such as stereotypical behaviours or language problems.

Biggest problem in assessment with adolescents:

false positives

Many “normal” adolescents show behavior that is quite similar to behavior shown by antisocial peers (Seagrave & Grisso, 2002)

Egocentric behaviorImpulsivityIrresponsible behaviorImpersonal sexual relationshipsLack of ability to work for long-term goals

On the other hand:there is evidence for stability in antisocial behaviors

Salekin, 2008

Psychopathic traits in early adolescence predict general and violent recidivism 4 years later

On the other hand:evidence for longitudinal course of psychopathology

• ADHD and ODD at age 8 predicts Borderline Personality Disorder symptoms at age 14 in girls (Burke et al., 2012)

• ADHD and ODD at age 7 to 12 predicts Borderline Personality Disorder symptoms at age 24 in boys (Burke & Stepp, 2012)

• Depression and internalizing symptoms in adolescence predict BPD symptoms 5 to 7 years later (Lewinsohn et al., 1997; Arens et al., 2011)

Cascading effectsPatterson, Forgatch & DeGarmo (2010)

Cascading effectsPatterson, Forgatch & DeGarmo (2010)

Cascading effects: also for intervention efforts!Patterson, Forgatch & DeGarmo (2010)

ASSESSMENT CONTEXT

Forensic, mandated evaluation

ASSESSEE (Cluster B)

Personality traits Defensiveness,

Lack insight

Possible defensive

response style, distortion (faking

good/faking bad)

For instance: Risk assessment Criminal responsibility Treatment planning

FORENSIC PSYCHOLOGICAL

ASSESSMENT

-selfreport, with correction for distortion -non-transparant, indirect test methods -use of collateral information (file, significant others) -standardized forensic assessment instruments (FAIs)

Guidelines for forensic psychological assessment, in relation to the forensic setting, the forensic assessee and the psycholegal question (de Ruiter & Kaser-Boyd, 2015)

History of violence risk assessment in a nutshell1981 Monograph by John Monahan started a new generation of research into violence predictionMonahan’s conclusion: Clinical judgment is unreliable and largelyinaccurate (many false positives!)Need for empirical research

Violence risk research in the 1980’s-90’s: actuarial approaches• Predictor variables that

are quantified and can be rated reliably

• A formal method which uses a formula, actuarial table, etc. to arrive at a probability estimate

• Both predictor variables and weights are derived from empirical research

• Examples -VRAG

-Youth Level of Service-Case Management Inventory

Example actuarial instrument for sexual reoffending:STATIC-99

Factors add up to a total score between 0 and 12, resulting in 4 risk categories: low (0-1), medium low (2-3), medium high (4-5) and high (≥ 6)

Actuarial Approaches• Predictionist approach

• Passive, simple

• Two time points, A and B

• Constant risk

P V

Time A Time B

Violence risk research in the 1990’s-2000’s: SPJ approaches• Predictor variables derived

from empirical research and practice-based knowledge (clinician input)

• No formal method of adding and weighing of predictors

• Option of adding case-specific risk and protective factors

• Greater emphasis on dynamic (changeable) predictors

• Examples:– HCR-20– SAVRY– EARL-20B, EARL-

21G

Example SPJ instrument for sexual reoffending:SVR-20

Two-step process: Individual risk factors are rated: -Present (2)-Somewhat Present (1) -Absent (0) Weighing and integrating risk factors, resulting in Final Risk Judgment: -Low-Moderate-High

SPJ: A Model of Risk Assessment

• Relies on forensic-clinical expertise within a structured application

• Logical (not empirical) selection of risk factors

• Review of scientific literature (empirically-based)• Not sample-specific (enhances generalizability)• Comprehensive

• Operational definitions of risk factors• Explicit coding procedures• Promotes reliability

SPJ: A Model of Risk Assessment (2)

• Allowance for idiographic risk factors• Facilitates flexibility and case-specific

considerations

• Relevance to management and prevention

• Risk decisions are tied directly to risk reduction strategies

• Reflects current themes in the field• Risk is (1) ongoing, (2) dynamic, (3) requires

re-assessment

SPJ Approaches• Assessment/Management approach

• Active, complex

• Infinite time points

• Variable risk

P V

Time A Time -1

Meta-analysis of sexual reoffending in juveniles

Viljoen, Mordell, & Beneteau (2012)

• 33 studies on 31 separate samples• N = 6,196; median f.u = 6 years

Predictive validity for sexual reoffending for actuarial total scores

Meta-analysis of sexual reoffending in juveniles

Viljoen, Mordell, & Beneteau (2012)• Effect sizes were moderate• No single tool emerged as

significantly stronger• ERASOR and J-SOAP include

dynamic risk factors• Static-99 may overestimate risk in

adolescents (as they receive points on young age and unmarried)

BUT: predictive accuracy is not all that counts…

We want to prevent, not predict! Providing targets for treatment,

intervention, risk management Protecting the rights of the

offender/patient Particularly for individuals in the

criminal justice/forensic system, which tends to be punitive and repressive (safety first, treatment second)

Rogers (2000)

The uncritical acceptance of risk assessment in forensic practice, Law & Human Behavior, 24, 595 -605

Main points of criticism: “Most adult-based studies are unabashedly one-

sided; the emphasize risk factors to the partial or total exclusion of protective factors” (p. 597)

“Risk-only evaluations are inherently inaccurate” (p. 598)

“Overfocus on risk factors is likely to contribute to professional negativism and result in client stigmatization” (p. 598)

What is your focus?

• Opportunities or threats?

• Risk or protective factors?

• Deficits or strengths?

Possible theoretical frameworks

• Resilience (Sir Michael Rutter)• Protective factors (Jessor)• Positive psychology (Martin

Seligman)• Good Lives Model (Tony Ward)• Quality of Life model

Why protective factors in forensic mental health?

• More balanced risk assessment• More well-rounded view of the

patient• Positive approach to risk prevention:

motivating for both offender/patient and clinician

• Assistance in development of treatment goals

Protective factors:Definitional issues

• Those factors that decrease the likelihood of engaging in problem behavior; they moderate or buffer the impact of exposure to risk factors (Jessor, 1991)

• Any characteristic of a person, their environment or situation, which reduces risk of future (sexual) violence (De Vogel, De Ruiter, Bouman, & De Vries Robbé, 2007)

– includes the constellation of individual, family, and community characteristics (Rutter, 1985).

Questions about protective factors in forensic mental

health• Are there protective factors for violence

risk?• Are they not merely the opposite of risk

factors?• How do protective factors influence future

violence risk?– Direct relation to violence?

Mediating/moderating influence?– Combined effect of risk factor and protective

factor?

Protective factors-examples

• Positive attitudes, values or beliefs• Conflict resolution/problem-solving skills• Community engagement• Steady employment• Stable housing• Availability of services (social,

recreational, cultural, etc.)

Empirical research on protective factors

1. Follow-up research on delinquent adolescents

2. Follow-up study on adult forensic patients

1. Adolescent delinquents

Lodewijks, de Ruiter, & Doreleijers (2010), Journal of Interpersonal Violence, 25, 568-587

• Three samples of Dutch juvenile offenders

• All convicted for violent offending• Time at risk averaged 13-22

months in the 3 samples

Measures

• Independent variable: Structured Assessment of Violence Risk in Youth (SAVRY= SPJ instrument): 24 risk factors, 6 protective factors

• Dependent variable: Recidivism data

Results

• Failure rates: – Sample 1 ‘Pretrial assessment’: 19% (official

reconvictions)

– Sample 2 ‘Institutional assessment’: 49% (violence in the institution)

– Sample 3 ‘Assessment prior to release’: 36% (police register)

Lodewijks, de Ruiter, & Doreleijers (2010).

ResultsLodewijks, de Ruiter, & Doreleijers (2010).

Results (protective item level)

• In all 3 samples– P2 (strong social support; AUCs ranging from .32 to .36, p < .05) – P3 (strong attachments; AUCs from .30-.35, p

< .05) had significant predictive value

• In the institutional violence sample– P5 (strong commitment to school; AUC = .28, p

= .001)– P4 (positive attitude towards intervention and

authority; AUC = .35, p < .05) were significant protective predictors

2. Adult forensic patients

– De Vries Robbé et al. (2011): forensic patients after release

Risk- & Protective factors

Historical factorsH1 Previous violenceH2 Young age at first violenceH3 Relationship instabilityH4 Employment problemsH5 Substance use problemsH6 Major mental illnessH7 Psychopathy (PCL-R)H8 Early maladjustmentH9 Personality disorderH10 Prior supervision failure

Clinical factorsC1 Lack of insightC2 Negative attitudesC3 Active symptoms of major mental illnessC4 ImpulsivityC5 Unresponsive to treatment

Risk Management factorsR1 Plans lacks feasibilityR2 Exposure to destabilizersR3 Lack of personal supportR4 Noncompliance with remediation attemptsR5 Stress

HCR-20 Internal factors1 Intelligence2 Secure attachment in childhood3 Empathy4 Coping5 Self-control

Motivational factors6 Work7 Leisure activities8 Financial management9 Motivation for treatment10 Attitudes towards authority11 Life goals12 Medication

External factors13 Social network14 Intimate relationship15 Professional care16 Living circumstances17 Supervision

SAPROF

Research HCR-20 & SAPROFVan der Hoeven Kliniek, The Netherlands

Retrospective file study- N = 188 violent + sexual ♂ offenders- Treatment length: 5.7 years- Outcome: Reconvictions for violent offense- Follow-up in community after discharge:

- 1 year- 3 year- 11 year (M)

De Vries Robbé & De Vogel, 2012De Vries Robbé, De Vogel & Douglas, 2013

Predictive validity for violent recidivismRetrospective File Study of Violent + Sexual Offenders (N=188)

AUC 1 year follow-up 14 recidivists

AUC 3 years follow-up 34 recidivists

AUC 11 years follow-up 68 recidivists

SAPROF (total)

.85*

.75*

.73*

HCR-20 (total) .84* .73* .64*

HCR-SAPROF (total)

.87* .76* .70*

N = 188, * p < .01

HCR-SAPROF > HCR-20: χ² (1, N = 188) = 13.4, p < .001 (11 years)

De Vries Robbé, De Vogel & Douglas, 2013

0102030405060708090

100

1 year 3 year 11 year

Lowprotection

Moderateprotection

0

10

20

30

40

50

60

70

80

90

100

1 year 3 year 11 year

Lowprotection

Moderateprotection

Highprotection

Moderate risk High risk

Differentiation of risk groups

Final Protection JudgmentLow

Moderate

High

Final Risk JudgmentLow

Moderate

High

Logistic regression at all f-u: sign. incremental predictive validity of FPJ over FRJ De Vries Robbé, De Vogel & Douglas, 2013

Recently developed instruments for assessment of protective

factors in adolescent offenders• START-Adolescent Version (Viljoen et

al., 2012)– 23 dynamic, treatment-relevant items, rated for

Strength and Vulnerability, on a 3-point scale– SPJ approach

• Predictive validity findings (3 months follow-up):– Total Strength AUC=. 73 for nonreoffending– Total Vulnerability AUC= .70 for reoffending

Recently developed instruments for assessment of protective

factors in adolescent offenders

SAPROF-Adolescent Version (de Vries Robbé et al., 2014)

Available through www.saprof.com

From risk and protective factors assessment to effective risk

prevention

assessment

prevention

Hope is the dream of a waking man- Aristotle

www.corinederuiter.eu