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
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)
Guidelines for forensic psychological assessment, in relation
to the forensic setting, the forensic assessee and the
psycholegal question (de Ruiter & Kaser-Boyd, 2015)
FORENSIC
PSYCHOLOGICAL
ASSESSMENT
ASSESSMENT
CONTEXT
Forensic,
mandated
evaluation
ASSESSEE
(Cluster B)
Personality traits
Defensiveness,
Lack insight
Possible
defensive
response style,
distortion
(faking
good/faking bad)
-selfreport, with correction
for distortion
For instance:
-non-transparant, indirect
test methods
Risk
assessment
-use of collateral
information (file, significant
others)
Criminal
responsibility
-standardized forensic
assessment
instruments (FAIs)
Treatment
planning
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)
Equifinality
Different early experiences in life (e.g., parental
divorce, physical abuse, parental substance
abuse) can lead to similar outcomes (e.g.,
childhood depression).
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.
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 eyecontact. 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 behavior
Impulsivity
Irresponsible behavior
Impersonal sexual relationships
Lack 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 effects
Patterson, Forgatch & DeGarmo (2010)
Cascading effects
Patterson, Forgatch & DeGarmo (2010)
Cascading effects: also for
intervention efforts!
Patterson, Forgatch & DeGarmo (2010)
Guidelines for forensic psychological assessment, in relation
to the forensic setting, the forensic assessee and the
psycholegal question (de Ruiter & Kaser-Boyd, 2015)
FORENSIC
PSYCHOLOGICAL
ASSESSMENT
ASSESSMENT
CONTEXT
Forensic,
mandated
evaluation
ASSESSEE
(Cluster B)
Personality traits
Defensiveness,
Lack insight
Possible
defensive
response style,
distortion
(faking
good/faking bad)
-selfreport, with correction
for distortion
For instance:
-non-transparant, indirect
test methods
Risk
assessment
-use of collateral
information (file, significant
others)
Criminal
responsibility
-standardized forensic
assessment
instruments (FAIs)
Treatment
planning
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
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 ServiceCase 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
Time A
V
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 casespecific 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
Time A
V
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 onesided; 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).
Lodewijks, de Ruiter, & Doreleijers (2010).
Results
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
HCR-20
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
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
Research HCR-20 & SAPROF
Van 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
Predictive validity for violent recidivism
Retrospective File Study of Violent + Sexual Offenders
(N=188)
AUC 1 year
follow-up
AUC 3 years
follow-up
AUC 11 years
follow-up
14 recidivists
34 recidivists
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
Differentiation of risk groups
Final Risk Judgment
Final Protection Judgment
Low
Low
Moderate
Moderate
High
High
Moderate risk
100
90
80
70
60
50
40
30
20
10
0
High risk
Low
protection
Moderate
protection
High
protection
1 year
3 year
11 year
100
90
80
70
60
50
40
30
20
10
0
Low
protection
Moderate
protection
1 year
3 year
11 year
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