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Best Practices for Assessment and Treatment Planning Presenter: Timothy L. Sinn. Overview of the Training. Role of assessment in evaluation and treatment. Creating and implementing a Treatment Plan of best practices for specific targets. Putting Assessment and Treatment Planning in Context .
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Best Practicesfor Assessment and Treatment PlanningPresenter: Timothy L. Sinn
Overview of the Training • Role of assessment in evaluation and treatment. • Creating and implementing a Treatment Plan of best practices for specific targets.
General Conclusions about the Utility of Y Testing To assess the validity of Y testing Meyer et al. (2001) reviewed 125 meta-analyses involving 800 samples and drew the final four conclusions – • Psychological test validity is strong and compelling; • Psychological test validity is comparable to medical test validity; • Distinct assessment methods provide unique sources of information; • Clinicians who rely exclusively on interviews are likely to have incomplete understanding.
Essential Role of Assessment for Correctional Samples and for Sex Offenders
Principles of Effective Correctional Treatment Andrews and Bonta (2006) have articulated the three primary principles for effective correctional treatment • The riskprinciple • treatment services should be directed at higher risk offenders • The needprinciple • target factors that are closely related to recidivism • The responsivityprinciple • use of treatment methods that are appropriate to the abilities, learning style, and personality characteristics of the clients treated
Risk • Unlimited resources: allocate offenders to differing levels of intensity of treatment depending on risk level; • Limited resources: treat only high risk offenders
Needs • Address all known criminogenic features; • Address only those non-criminogenic features that facilitate engagement
Responsivity • General: Core Correctional Practices; • Specific:adapt to each individual’s • learning capacity/style, • culture/socio-economic, • day-to-day fluctuations in mood/attention
General Responsivity Principle Select, train, and supervise therapists to: • Be warm, empathic, nonjudgemental, supportive; • Model and reinforce prosocial attitudes and behaviors.
Principles of Effective Correctional Treatment Andrews, Bonta, and Wormith (2011) have stressed that essential to the RNR program are: • reliable and valid assessment of offender risk traits; • description of the individual’s standing • relative to normative samples and • with reference to the recidivistic performance of others; and • feedback to the client on the results of structured assessments.
Hanson (2006) Summary of most recent findings from Andrews and Bonta (2006)
Adherence to Risk/Need/Responsivity(all criminal samples) No effect Small effect size Medium effect size Large effect size
Does this apply to sexual offenders? • Hanson, Bourgon, Helmas, and Hodgson (2009) examined whether the Andrews and Bonta’s principles apply to sexual offenders. • They identified 23 sex offender studies that met minimum methodological standards and could be re-organized to conform with R/N/R principles
Hanson et al., (2009) concluded: “Programs that adhered to the RNR principles showed the largest reductions in sexual and general recidivism . . . RNR principles should be a major consideration in the design and implementation of treatment programs for sexual offenders.”
Take home message Fixed or historical factors that cannot be changed (such as age at first offense) • The same three principles apply in treating sexual offenders. • Whereas static determinants may be helpful to determining risk, assessment of dynamic factors is essential for the needs and responsivity principles of intervention. Potentially changeable factors, both stable, but potentially changeable risk traits, and acute, rapidly changing factors.
Identifying Domains of Critical Dynamic Factors • What are the need domains that must be addressed in sexually aggressive individuals? • These are the core factors that increase the risk of recidivism. • Several studies help to identify these domains and suggest appropriate strategies of assessing and measuring them.
Identifying Domains of Critical Dynamic Factors • Hanson & Morton-Bourgon (2005) (H&M-B) • Douglas & Skeem (2005) (D&S) • Thornton (2002) (Thorn) • Craig, Thornton, Beech, & Brown (2007) (Craig) • Olver, Wong, Nicholaichuk, & Gordon (2007) (Olver) • Allan, Grace, Rutherford, & Hudson (2007) (Allan)
Domains: Self Report Inventories * * * * * ?
Domains: What to Include and Target * √ * * √ * √ * √ ?
Practice Standards and Guidelines • Availability of appropriate community supports, • Access to potential victims, • Criminal and other antisocial behavior and values, • Developmental history and family background, • Deviant sexual interests and arousal, • Education and employment histories, • History of aggression or violence, • History of sexually abusive behavior, including details about victims, tactics used in the commission of the offense, and the circumstances in which the sexual abuse occurred, • Insight into offense precursors and risk, • Level of cognitive functioning and other responsivity factors, • Level of self-disclosure and accountability, • Medical and mental health history, • Official and unreported history of sexual and nonsexual crimes, • Peer and romantic relationship history, • Relevant personality traits such as, but not limited to suspiciousness, hostility, risk-taking, impulsivity, and psychopathy, • Sexual history, including sexual fantasies, urges, and behavior, early sexual experiences; number and duration of sexual relationships; gender identity and sexual orientation; masturbation and intercourse frequency; sexual functioning; and unusual sexual interests or behavior that are not sexually deviant (as defined in this document) or illegal, such as cross-gender dressing, • Substance use, • Use of sexually arousing materials (e.g., magazines, computer pornography, books, videos, Internet sites, telephone sex services).
Treatment Targets • Availability of appropriate community supports, • Access to potential victims, • Criminal and other antisocial behavior and values, • Developmental history and family background, • Deviant sexual interests and arousal, • Education and employment histories, • History of aggression or violence, • History of sexually abusive behavior, including details about victims, tactics used in the commission of the offense, and the circumstances in which the sexual abuse occurred, • Insight into offense precursors and risk, • Level of cognitive functioning and other responsivity factors, • Level of self-disclosure and accountability, • Medical and mental health history, • Official and unreported history of sexual and nonsexual crimes, • Peer and romantic relationship history, • Relevant personality traits such as, but not limited to suspiciousness, hostility, risk-taking, impulsivity, and psychopathy, • Sexual history, including sexual fantasies, urges, and behavior, early sexual experiences; number and duration of sexual relationships; gender identity and sexual orientation; masturbation and intercourse frequency; sexual functioning; and unusual sexual interests or behavior that are not sexually deviant (as defined in this document) or illegal, such as cross-gender dressing, • Substance use, • Use of sexually arousing materials (e.g., magazines, computer pornography, books, videos, Internet sites, telephone sex services). Sexual Deviance
Treatment Targets • Availability of appropriate community supports, • Access to potential victims, • Criminal and other antisocial behavior and values, • Developmental history and family background, • Deviant sexual interests and arousal, • Education and employment histories, • History of aggression or violence, • History of sexually abusive behavior, including details about victims, tactics used in the commission of the offense, and the circumstances in which the sexual abuse occurred, • Insight into offense precursors and risk, • Level of cognitive functioning and other responsivity factors, • Level of self-disclosure and accountability, • Medical and mental health history, • Official and unreported history of sexual and nonsexual crimes, • Peer and romantic relationship history, • Relevant personality traits such as, but not limited to suspiciousness, hostility, risk-taking, impulsivity, and psychopathy, • Sexual history, including sexual fantasies, urges, and behavior, early sexual experiences; number and duration of sexual relationships; gender identity and sexual orientation; masturbation and intercourse frequency; sexual functioning; and unusual sexual interests or behavior that are not sexually deviant (as defined in this document) or illegal, such as cross-gender dressing, • Substance use, • Use of sexually arousing materials (e.g., magazines, computer pornography, books, videos, Internet sites, telephone sex services). Disinhibition/ Aggression
Treatment Targets • Availability of appropriate community supports, • Access to potential victims, • Criminal and other antisocial behavior and values, • Developmental history and family background, • Deviant sexual interests and arousal, • Education and employment histories, • History of aggression or violence, • History of sexually abusive behavior, including details about victims, tactics used in the commission of the offense, and the circumstances in which the sexual abuse occurred, • Insight into offense precursors and risk, • Level of cognitive functioning and other responsivity factors, • Level of self-disclosure and accountability, • Medical and mental health history, • Official and unreported history of sexual and nonsexual crimes, • Peer and romantic relationship history, • Relevant personality traits such as, but not limited to suspiciousness, hostility, risk-taking, impulsivity, and psychopathy, • Sexual history, including sexual fantasies, urges, and behavior, early sexual experiences; number and duration of sexual relationships; gender identity and sexual orientation; masturbation and intercourse frequency; sexual functioning; and unusual sexual interests or behavior that are not sexually deviant (as defined in this document) or illegal, such as cross-gender dressing, • Substance use, • Use of sexually arousing materials (e.g., magazines, computer pornography, books, videos, Internet sites, telephone sex services). Social Competence
Treatment Targets • Availability of appropriate community supports, • Access to potential victims, • Criminal and other antisocial behavior and values, • Developmental history and family background, • Deviant sexual interests and arousal, • Education and employment histories, • History of aggression or violence, • History of sexually abusive behavior, including details about victims, tactics used in the commission of the offense, and the circumstances in which the sexual abuse occurred, • Insight into offense precursors and risk, • Level of cognitive functioning and other responsivity factors, • Level of self-disclosure and accountability, • Medical and mental health history, • Official and unreported history of sexual and nonsexual crimes, • Peer and romantic relationship history, • Relevant personality traits such as, but not limited to suspiciousness, hostility, risk-taking, impulsivity, and psychopathy, • Sexual history, including sexual fantasies, urges, and behavior, early sexual experiences; number and duration of sexual relationships; gender identity and sexual orientation; masturbation and intercourse frequency; sexual functioning; and unusual sexual interests or behavior that are not sexually deviant (as defined in this document) or illegal, such as cross-gender dressing, • Substance use, • Use of sexually arousing materials (e.g., magazines, computer pornography, books, videos, Internet sites, telephone sex services). Responsivity/ Treatment Motivation
Treatment Targets • Availability of appropriate community supports, • Access to potential victims, • Criminal and other antisocial behavior and values, • Developmental history and family background, • Deviant sexual interests and arousal, • Education and employment histories, • History of aggression or violence, • History of sexually abusive behavior, including details about victims, tactics used in the commission of the offense, and the circumstances in which the sexual abuse occurred, • Insight into offense precursors and risk, • Level of cognitive functioning and other responsivity factors, • Level of self-disclosure and accountability, • Medical and mental health history, • Official and unreported history of sexual and nonsexual crimes, • Peer and romantic relationship history, • Relevant personality traits such as, but not limited to suspiciousness, hostility, risk-taking, impulsivity, and psychopathy, • Sexual history, including sexual fantasies, urges, and behavior, early sexual experiences; number and duration of sexual relationships; gender identity and sexual orientation; masturbation and intercourse frequency; sexual functioning; and unusual sexual interests or behavior that are not sexually deviant (as defined in this document) or illegal, such as cross-gender dressing, • Substance use, • Use of sexually arousing materials (e.g., magazines, computer pornography, books, videos, Internet sites, telephone sex services). Abuse Hx
SRA:FVL – Structured Risk Assessment Need assessment: Forensic Version LitE David Thornton, Ph.D.
Relational Style RSD • LEIRA – Lack of Emotionally Intimate Relationships with Adults RSD1 • Emotional Congruence with Children RSD2 • Grievance Thinking RSD4 Internal Grievance Thinking Poorly-Managed Anger
Self-Management SMD • Dysfunctional Coping SMD3
LS/CMI – Level of Service/Case management inventoryD.A. Andrews, ph.d.James L. Bonta, Ph.d.J. Stephen Wormith, Ph.D.
OVERALL Risk/Need Level: Very Low Low Medium High Very High_____________________________________________________________________________Total Section 1 Score 0-4 5-10 11-1920-29 30-43
