Violence Risk in Adolescents

1. Violence Risk in Adolescents Dr Charlotte Rennie Project funded by the National Forensic Mental Health Research and Development Programme

2. Plan • Review of the Literature • Youth Level of Service/Case Management Inventory • Structured Assessment of Violence Risk in Youth • Psychopathy Checklist: Youth Version • Study outline • Study findings • Conclusions • Implications

3. Prior and Current Offences/Disposals 3 or more prior conviction/episodes of offending 2 or more failures to comply Prior supervision Ever in detention 3 or more current episodes of offending Family Circumstances/Parenting Inadequate supervision Difficulty in controlling behaviour Inappropriate discipline Inconsistent parenting Poor relations/father-child Poor relation/mother-child Education/Employment Disruptive classroom behaviour Disruptive behaviour on school property Low achievement Problems with peers Problems with teachers Truancy Unemployment/not seeking employment Peer Relations Some delinquent acquaintances Some delinquent friends Few or no positive acquaintances Few or no positive friends Youth Level of Service

4. Substance Abuse Occasional drug abuse Chronic drug abuse Chronic alcohol abuse Substance use interferes with life Substance use linked to offences Leisure/Recreation Limited organised activities Could make better use of time No personal interests Personality/Behaviour Inflated self esteem Physically aggressive Tantrums Short attention span Poor frustration tolerance Inadequate guilt feelings Verbally aggressive, impudent Attitudes/Orientation Antisocial/prosocial attitudes Not seeking help Actively rejecting help Defies authority Callous, little concern for others Youth Level of Service

5. YLS/CMI Predictive Validity • Studies have found that the YLS/CMI can predict recidivism • Jung & Rawana (1999) • Catchpole & Gretton (2003) • Schmidt et al., (2005) • Marshall et al., (2006)

6. SAVRY • Individual/Clinical Risk Factors • Negative Attitudes • Risk Taking/Impulsivity • Substance Use Difficulties • Anger Management Problems • Callous/Lacking Empathy • Attention Deficit/Hyperactivity Difficulties • Poor Compliance • Low Interest/Commitment to School • Protective Factors • Prosocial Involvement • Strong Social Support • Strong Attachment and Bonds • Positive Attitude Towards Intervention and Authority • Strong Commitment to School • Resilient Personality Traits • Historical Risk Factors • History of Violence • History of Non-Violent Offending • Early Initiation of violence • Past Supervision/Intervention Failures • History of Self-Harm or Suicide Attempts • Exposure to Violence in the Home • Childhood History of Maltreatment • Parental/Caregiver Criminality • Early Caregiver Disruption • Poor School Achievement • Social/Contextual Risk Factors • Peer Delinquency • Peer Rejection • Stress and Poor Coping • Poor Parental Management • Lack of Personal/Social Support • Community Disorganisation

7. SAVRY Predictive Validity • Studies have found the SAVRY Total and Risk Rating are able to predict violent offending • McEachran (2001) • Gretton & Abramowiz (2002) • Catchpole & Gretton (2003) • Lodewijks, et al., (2008) • Gammelgård et al., (2008) • Meyers & Schmidt (2008)

8. Psychopathy as a predictor of violence • Adult literature, psychopathy linked with violence and antisocial behaviour • UK studies indicate that psychopathy demonstrates similar predictive accuracy to those found in the US • Dolan & Khawaja (2002) • Doyle et al., (2002)

9. PCL:YV • Interpersonal • Impression management • Grandiose sense of self-worth • Pathological lying • Manipulation for personal gain • Affective • Lack of remorse • Shallow affect • Callous/lack of empathy • Failure to accept responsibility • Behavioral • Stimulation seeking • Parasitic orientation • Lacks goals • Impulsivity • Irresponsibility • Antisocial • Poor anger control • Early behavior problems • Serious criminal behavior • Serious violations of conditional release • Criminal versatility

10. PCL: YV Predictive Validity • Studies in North America and Netherlands have shown that the PCL: YV can predict recidivism and institutional infractions • Corrado et al., (2004) • Gretton et al. (2004) • Schmidt et al., (2005) • Das et al., (2007) • Lodewijks et al. (2008) • Studies in the UK have also shown that the PCL: YV can predict institutional infractions • Dolan & Rennie (2006b; 2006c) • Marshall et al., (2006)

11. Comparative Studies • Catchpole & Gretton (2003) • YLS/CMI, SAVRY, and PCL:YV were able to similarly predict general and violent reoffending in a group of 74 (male & female) violent young offenders. • Sample size was small • Statistical analyses restricted to total scores • Mixed sample • No incremental validity

12. Comparative Studies • Walsh et al., (2008) • YLS/CMI, SAVRY and PCL: YV were able to predict general and violent recidivism to varying degrees of accuracy, but the SAVRY offered the most in incremental validity in a group of 105 young offenders (male and female) • Mixed sample • Retrospective study • SAVRY protective factors

13. Aims • To examine the ability of the YLS/CMI, SAVRY and PCL: YV to predict the occurrence of institutional infractions and community recidivism • To examine incremental validity of the YLS/CMI, SAVRY and PCL: YV

14. Participants • 135 males - mean age 16.14 (SD 0.93) years • 114 (84.4%) White British • Index offence - 60% violent • Age 1st arrest - 12.77 (SD = 1.73) years • Age 1st AS behaviour - 11.07 (SD = 2.52) years • Sentence length 17.62 (SD = 12.09) months

15. Results • YLS/CMI Total Score – 23.62 (SD 7.42) • SAVRY Total Score – 25.60 (SD 8.21) • SAVRY Risk Rating 10.4%- low risk 37.8% - moderate risk 51.9% - high risk • PCL: YV Total Score – 21.08 (SD 6.72)

16. Results: Institutional violence & rule breaking • 6 month follow-up • Institutional violence • actual assaults on others rather than property damage or threats of violence • Rule breaking • security breaches, substance misuse, property damage, attempted escapes • Of the 135, 61 were still in custody • 20 (32.8%) institutional violence • 22 (36%) rule breaking

17. AUC - Institutional Violence • SAVRY Historical – AUC .70** (95%CI .55 - .84) • SAVRY Risk Total - AUC .67* (95%CI .52 - .82) • PCL: YV Interpersonal - AUC .73** (95%CI .59 - .87) • PCL: YV Total - AUC .71** (95%CI .56 - .85) • ***p<0.001; **p<0.01; *p<0.05

18. Rule Breaking • SAVRY, PCL: YV and YLS/CMI could not predict rule breaking behaviour over 6 month follow-up

19. Regression Analysis • Regression analysis revealed that the SAVRY Risk Total and the PCL: YV Total could add to the incremental validity of the YLS/CMI Total for the prediction of institutional violence, but did not add to the incremental validity of each other

20. Results: Recidivism • 12 month follow-up • Home Office Police National Computer (HOPNC) • Violent • robberies, assaults, murder, sexual assaults kidnapping and all weapons charges • Non-violent • Drug offences, burglary/theft, negligence, frauds, escapes, arson, obstructions of justice, and minor offences were classed as non-violent • Of the 135, 111 followed-up • 41 (36.9%) violent offences • 77 (69.4%) any offence

21. AUC - Violent Recidivism • SAVRY Historical – AUC .66** (95%CI .54 - .77) • SAVRY Risk Total – AUC .64** (95%CI .54 - .74) • SAVRY Risk Rating – AUC .63** (95%CI .54 - .74) • ***p<0.001; **p<0.01; *p<0.05

22. AUC - Any Recidivism

23. Regression Analysis • SAVRY Risk Total added incremental validity to the PCL: YV Total and YLS/CMI Total for violent and general recidivism • SAVRY Risk Rating added incremental validity to the PCL: YV and YLS/CMI for violent and general recidivism • SAVRY Protective factor added to the incremental validity of the SAVRY Risk Total for the prediction of general recidivism

24. Survival Analysis • Outcome - time to an event • To determine the proportion of participants who have not re-offended at each month of the follow-up period (“survival”) • Offending patterns over time to see not only whether certain risk groups re-offend in greater proportions but whether they do so more quickly • Censored data

25. Survival Analysis Kaplin-Meier Survival Curve for violent recidivism over 12 months

26. Survival Analysis Kaplin-Meier Survival Curve for general recidivism over 12 months • MSR were 5.7 times more likely to re-offend sooner than LSR and the HSR were 8.4 times more likely to re-offend sooner than the LSR

27. Conclusions • SAVRY was a better predictor of violent infractions than the YLS/CMI but comparable to the PCL: YV • SAVRY was a better predictor of violent and general recidivism then the PCL: YV and YLS/CMI • SAVRY Risk Total and Risk Rating performed equally well • Protective factors should be incorporated into risk management

28. Limitations • High risk sample • Reporting of institutional infractions • Reliance on criminal records data • High levels of re-offending rates • Severity of violence

29. Clinical Implications • Quantity and quality of clinical information • Improvements in file recording and report writing • Discharge planning • Categorise those who are likely to require more intensive monitoring and targeted interventions • Case formulation

30. Implications • Labelling • Misclassification

31. Future Research • Gender • Mental Health • Transitional Period • Change over time/intervention • Implementation into services

32. Contact Details • charlotte.rennie@manchester.ac.uk • charlotte.rennie@merseycare.nhs.uk • Tel: 0151 471 2628