The Clinical Practice of Risk Assessment of Sexual Violence

1. The Clinical Practice of Risk Assessment of Sexual Violence Joe Judge

2. Introduction • There are significant literatures on risk factors for recidivism in sexual offenders and on the predictive accuracy of different types of risk assessment tool. • Less is known about how risk factors are used and combined in clinical practice. • This is especially true of Structured Professional Judgement approaches.

3. Risk Factors for Recidivism in Sexual Offenders • Hanson and Bussiere (1998) • Recidivism best predicted by sexual deviancy and general criminological factors. • Hanson and Morton-Bourgon (2004, 2005) • Uses cumulative meta-analytic technique • Recidivism predicted by sexual deviance and antisocial orientation. • Mann et al. (2010) • Conceptualises risk factors differently • “Psychologically meaningful risk factors”

4. Mann et al. (2010) Empirically Supported • Sexual preoccupation • Sexual preference for pubescent or prepubescent children • Sexualised violence • Multiple paraphilias • Offence supportive attitudes • Emotional congruence with children • Lack of emotionally intimate relationships with adults • Lifestyle impulsiveness • Poor problem solving • Resistance to rules and supervision • Grievance / hostility • Negative social influence Promising Hostile beliefs about women Machiavellianism Lack of concern for others Dysfunctional coping Sexualised coping Externalised coping

5. Mann et al. (2010) Little or no relationship to sexual recidivism • Depression • Social skills deficits • Poor victim empathy • Lack of motivation for treatment (as assessed pre-treatment) Unsupported but with interesting exceptions • Denial • Low self esteem • Major mental illness • Loneliness • Adversarial sexual orientation • Fragile narcissism • Sexual entitlement

6. Judge et al. • Sexual deviance is an evidence based risk factor • Psychopathy is an evidence based risk factor • Inconsistent findings with respect to denial. • Also some gaps in the literature.

7. How is this information used in clinical practice? • Looked at data from NHS Lothian Sex Offender Liaison Service (SOLS) • Regression analysis of summary risk judgements. • Are the factors that predict risk judgement the factors that predict recidivism? • Or is something else important?

8. NHS Lothian SOLS • Developed to provide clinical input to help criminal justice agencies manage sex offenders in the community. • Offers comprehensive clinical assessment of individuals whom CJ agencies are finding difficult to manage. • 78% have personality disorder diagnoses (Russell & Darjee, 2012) • Assessment and management advice structured using Risk for Sexual Violence Protocol (RSVP) • Assessment process described in detail elsewhere (Russell & Darjee, 2012) • Responses of 96 individuals used in data analysis

9. Hypotheses (Based on systematic review and previously existing meta-analyses) • Psychopathy will be a statistically significant predictor of sexual violence risk score. • Sexual deviance will be a statistically significant predictor of sexual violence risk score. • Denial will not be a statistically significant predictor of sexual violence risk score. • Sexual preoccupation will be a statistically significant predictor of sexual violence risk score. • Problems with intimate relationships will be a statistically significant predictor of sexual violence risk score.

10. Data analysis • Ordinal logistic regression • Dependent variables • MAPPA Risk Score • RMA Risk Score • Independent Variables • Psychopathy (RSVP Item 12 – Coded 0-2) • Sexual Deviance (RSVP Item 11 – Coded 0-2) • Denial (RSVP Item 6 – Coded 0-2) • Sexual Preoccupation (SARN-SO – Coded 0-2) • Problems with intimate relationships (RSVP Item 16 – Coded 0-2)

11. Results • Psychopathy significantly associated with risk score. • Sexual deviance was not significantly associated with risk score. • Denial significantly associated with risk score. • Sexual preoccupation was associated with risk score. • Problems with intimate relationships was not associated with risk score. • Best model accounted for only 40 percent of variance in risk score.

12. Sexual deviance is not a statistically significant predictor of risk score • Explained by difficulty in assessing and measuring sexual deviance? • Notoriously difficult task. • Do different types of sexual deviance operate differently? (eg. Sexual sadism vs. paedophilia) • Outcome variables take into account imminence of risk • For example, possible that offender may meet criteria for paedophilia but have no access to children – influences score on outcome variable.

13. Denial is a statistically significant predictor of risk score • Relationship between denial is complex • Harkins et al. (2010) – Denial protective? • Depends on whether denial viewed dichotomously or dimensionally. • Ware and Mann (2012) suggest overemphasis on challenging denial. • Blagden et al (2011) suggest professionals not always aware that they are challenging denial. • Is this operating in present study? • But again, denial difficult to assess and measure

14. Problems with intimate relationships not a statistically significant predictor of risk score • Closer scrutiny of the data revealed that only 5 percent of the offenders demonstrated no evidence of problems with intimate relationships • Unclear if this is true of sex offenders in general or limited to those referred to the SOLS.

15. Unexplained Variance • Best explanatory model accounted for only 40 percent of variance. • Possible that relevant independent variables not included in the analysis. • But what accounts for the other 60 percent? • The process of getting from item scores to formulation, risk scenarios is not well described. • Direction for future research?

16. Implications for research • Research investigating the process of SPJ risk assessment. • How are risk judgements arrived at using this method? • Hart and Boer (2010) suggest qualitative analysis might be helpful. • Specific focus on risk formulation? (Reliability, validity etc)

17. Implications for practice • Difficulty in measurement of relevant variables. • Revision of RSVP? • Debate about inclusion of denial as a risk factor.