Forensic assessment with adolescent offenders (1): Bridging the gap between science and practice

1. Forensic assessment with adolescent offenders (1): Bridging the gap between science and practice Corine de Ruiter, PhD Maastricht University The Netherlands Lecture presented at the EFCAP Finland Tampere, Finland November 20, 2014

2. 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)

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

4. Psychological assessment in adolescents (pitfalls) • Heterotypic continuity: the same trait manifests itself differently at different ages • Equifinality: different developmental trajectories, same outcome • Multifinality: same developmental trajectories, different outcomes (Hart, Watt, & Vincent, 2002)

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

6. Multifinality Multifinality 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.

7. 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.

8. 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 behavior • Impulsivity • Irresponsible behavior • Impersonal sexual relationships • Lack of ability to work for long-term goals

9. 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

10. 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)

11. Cascading effectsPatterson, Forgatch & DeGarmo (2010)

12. Cascading effectsPatterson, Forgatch & DeGarmo (2010)

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

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

15. History of violence risk assessment in a nutshell • 1981 Monograph by John Monahan started a new generation of research into violence prediction • Monahan’s conclusion: Clinical judgment is unreliable and largely inaccurate (many false positives!) • Need for empirical research

16. 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 Violence risk research in the 1980’s-90’s: actuarial approaches

17. 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)

18. Actuarial Approaches • Predictionist approach • Passive, simple • Two time points, A and B • Constant risk P V (Life?) Time A Time B

19. 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 Violence risk research in the 1990’s-2000’s: SPJ approaches

20. 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

21. 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

22. 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

23. SPJ Approaches • Assessment/Management approach • Active, complex • Infinite time points • Variable risk P V Life! Time A Time  -1

24. Meta-analysis of sexual reoffending in juvenilesViljoen, 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

25. Meta-analysis of sexual reoffending in juvenilesViljoen, 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)

26. 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)

27. 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)

28. What is your focus? • Opportunities or threats? • Risk or protective factors? • Deficits or strengths?

29. Possible theoretical frameworks • Resilience (Sir Michael Rutter) • Protective factors (Jessor) • Positive psychology (Martin Seligman) • Good Lives Model (Tony Ward) • Quality of Life model

30. 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

31. 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).

32. 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?

33. 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.)

34. Empirical research on protective factors • Follow-up research on delinquent adolescents • Follow-up study on adult forensic patients

35. 1. Adolescent delinquentsLodewijks, 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

36. Measures • Independent variable: Structured Assessment of Violence Risk in Youth (SAVRY= SPJ instrument): 24 risk factors, 6 protective factors • Dependent variable: Recidivism data

37. 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).

38. Lodewijks, de Ruiter, & Doreleijers (2010). Results

39. 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

40. 2. Adult forensic patients • De Vries Robbé et al. (2011): forensic patients after release

41. Risk- & Protective factors Historical factors H1 Previous violence H2 Young age at first violence H3 Relationship instability H4 Employment problems H5 Substance use problems H6 Major mental illness H7 Psychopathy (PCL-R) H8 Early maladjustment H9 Personality disorder H10 Prior supervision failure Clinical factors C1 Lack of insight C2 Negative attitudes C3 Active symptoms of major mental illness C4 Impulsivity C5 Unresponsive to treatment Risk Management factors R1 Plans lacks feasibility R2 Exposure to destabilizers R3 Lack of personal support R4 Noncompliance with remediation attempts R5 Stress HCR-20 SAPROF Internal factors 1 Intelligence 2 Secure attachment in childhood 3 Empathy 4 Coping 5 Self-control Motivational factors 6 Work 7 Leisure activities 8 Financial management 9 Motivation for treatment 10 Attitudes towards authority 11 Life goals 12 Medication External factors 13 Social network 14 Intimate relationship 15 Professional care 16 Living circumstances 17 Supervision

42. 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, 2012 De Vries Robbé, De Vogel & Douglas, 2013

43. Predictive validity for violent recidivism Retrospective File Study of Violent + Sexual Offenders (N=188) HCR-SAPROF > HCR-20:χ² (1, N = 188) = 13.4, p < .001 (11 years) De Vries Robbé, De Vogel & Douglas, 2013

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

45. 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

46. 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

47. From risk and protective factors assessment to effective risk prevention assessment prevention

48. Hope is the dream of a waking man- Aristotle www.corinederuiter.eu