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  1. How to Protect your Client from Bad Risk Assessments Thomas A. Powell, Ph.D. John C. Holt, Ph.D. Vermont Forensic Assessment, PLLC Shelburne, Vermont June 12, 2008 (C) 2008 Vermont Forensic Assessment All rights reserved

  2. Outline • How things are supposed to work • Static and dynamic measure of any type of criminal recidivism and offender needs • Level of Service Inventory - Revised • Assessment perspective • Risk principle • Need principle • Responsivity principle (C) 2008 Vermont Forensic Assessment All rights reserved

  3. Outline • Static actuarial measures of sexual recidivism risk • STATIC-99 • RRASOR • VASOR • Dynamic measures of sexual recidivism risk • SONAR • STABLE/ACUTE • Treatment Progress Scale (C) 2008 Vermont Forensic Assessment All rights reserved

  4. Outline Additional topics of interest • The use of multiple risk instruments: Static 99, RRASOR and VASOR as policy • “Denial” - a misleading predicator of recidivism. • Conflict of interest by assessors and treatment providers. • The DOC case staffing: Salem Witch Trials redux? (C) 2008 Vermont Forensic Assessment All rights reserved

  5. (C) 2008 Vermont Forensic Assessment All rights reserved

  6. How Things are Supposed to Work • PSI preparation - Policy 342.01 (rev. 4/9/07) • http://doc.vermont.gov/about/policies/rpd/final_commissioner-signed_psi_3.22.07.pdf • Prescriptive format • Defines LSI-R as “an objective, quantifiable instrument that provides a consistent and valid method of predicting risk to re-offend and a reliable means of measuring offedner change over time …” (C) 2008 Vermont Forensic Assessment All rights reserved

  7. How Things are Supposed to Work • RRASOR: “a four-item actuarial risk measure used to aid in assessing sexual recidivism risk …” • Static-99: “… a 10-item actuarial risk measure is used in a similar manner as the RRASOR.” • VASOR: “a risk assessment scale … designed to assist PO’s in making placement and supervision decisions.” (C) 2008 Vermont Forensic Assessment All rights reserved

  8. How Things are Supposed to Work • “A PSI provides the sentencing judge … with relevant information on which to base a sentencing decision. It also reflects a professional judgment of and assessment by the DOC regarding risk management of the defendant.” • “The PSI investigator can use information collected during the PSI, particularly during the defendant interview, to complete necessary risk assessment tools, e.g. the LSI-R.” (C) 2008 Vermont Forensic Assessment All rights reserved

  9. How Things are Supposed to Work • “Provide a narrative explanation of the numerical results of assessment tools (e.g. LSI-R), including an examination of key risk areas and a summary of any court-ordered clinical assessments.” • “Briefly summarize the major points of the report …” • “The report will conclude with a recommendation … based upon the defendant’s offense, background and assessed risk.” (C) 2008 Vermont Forensic Assessment All rights reserved

  10. How Things are Supposed to Work • “Note: Only if requested by the Court, the PSI investigator will include a recommended minimum and maximum term of incarceration or a minimum and maximum term of suspended sentence.” (emphasis not added by us) (C) 2008 Vermont Forensic Assessment All rights reserved

  11. General Risk Assessment Level of Service Inventory - Revised • Criminal History • Education/Employment • Financial • Family/Marital • Accommodation (the influence of address) • Leisure/Recreation (spare time use) • Companions (friends and associates) • Alcohol/Drugs (mostly looking at past year) • Emotional/Personal (psychological status) • Attitudes/Orientation (antisocial/prosocial views) (C) 2008 Vermont Forensic Assessment All rights reserved

  12. Risk Principle • Reserve intensive levels of corrections supervision and treatment for higher risk cases. • Do not use these levels of supervision and treatment for lower risk cases. • Use of valid and reliable risk assessment tools gives the criminal justice system a triage capability. (C) 2008 Vermont Forensic Assessment All rights reserved

  13. Need Principle • There are many needs and potential treatment targets identified in corrections populations. • Some are related to criminal risk; some are not. • Focus on those needs which are “criminogenic” (ie. causally related to crime) such as social affiliations, drugs and criminal attitudes. • When criminogenic needs are addressed, the risk of recidivism declines. (C) 2008 Vermont Forensic Assessment All rights reserved

  14. Responsivity Principle • When providing treatment services for forensic or corrections populations, use methods which are matched to the learning style of the population. • Cognitive-behavioral, skill-building, and relapse preventing interventions fit this model. • Non-directive, non-specific “talk therapy” methods do not. • The use of appropriate intervention models lowers risk; other models have either no effect on recidivism or they may actually raise it. (C) 2008 Vermont Forensic Assessment All rights reserved

  15. Sex Offense Specific Measures • Static Actuarial Measures • RRASOR • Static-99 • VASOR • Dynamic/Treatment Measures • SONAR • STABLE/ACUTE • Sex Offender Treatment Needs and Progress Scale (C) 2008 Vermont Forensic Assessment All rights reserved

  16. RRASOR • Rapid risk assessment of sex offender recidivism • ww2.ps-sp.gc.ca/publications/corrections/ 199704_e.pdf • Four item scale • All four are incorporated into the STATIC-99 • Total score 0-6 • 0 Low • 1,2 Moderate-Low • 3,4 Moderate-High • 5,6 High (C) 2008 Vermont Forensic Assessment All rights reserved

  17. RRASOR - Rapid risk assessment of sex offender recidivism

  18. STATIC-99 • Ten item scale • Total score 0-12 • 0,1 Low • 2,3 Moderate-Low • 4,5 Moderate-High • 6+ High (C) 2008 Vermont Forensic Assessment All rights reserved

  19. STATIC-99 • Widely used in criminal, forensic and correctional settings. • Instrumental in most sexually violent predator (SVP) determinations. • Not as easy to score as it seems. Many scoring rules to understand. (C) 2008 Vermont Forensic Assessment All rights reserved

  20. STATIC-99 • The Static-99 scoring manual is 80 pages long. • http://ww2.ps-sp.gc.ca/publications/corrections/pdf/Static-99-coding-Rules_e.pdf • Or google “Static-99” (C) 2008 Vermont Forensic Assessment All rights reserved

  21. STATIC-99 Issues • Like most actuarial risk assessment instruments, it is only +/- 70% accurate. • False positives - over-predicting risk • False negatives - under-predicting risk • Over-reliance on unchanging static risk factors to the exclusion of changing dynamic risk factors is a significant problem in Vermont (and elsewhere). (C) 2008 Vermont Forensic Assessment All rights reserved

  22. STATIC-99 - age and recidivism

  23. STATIC-99 - age and recidivism • “There were few sexual offenders of any type in the advanced age category (>50 years !!) … and their recidivism rates were generally low.” • decreasing sex drive • fewer opportunities • Hanson, K.W. (2002). Recidivism and age. Journal of Interpersonal Violence, 17 (10), 1046-1062.

  24. STATIC-99 - time at risk

  25. Listserv communication from Hanson and Harris (3/10/08) “Recently, (we) found follow-up recidivism rates to be below that which would be expected given those found in the original STATIC-99 samples of origin. This has led to some question as to whether there has been a shift in the nature of sexual recidivism and whether the estimates generated from the samples of origin are still valid.”

  26. VASOR • Vermont assessment of sex offender risk • Weighs 19 variables • 13 on the Reoffense Risk Scale • 6 on the Violence Scale • According to the manual, scores are plotted on an overall risk chart • Reoffense Risk Scale x Violence Scale (C) 2008 Vermont Forensic Assessment All rights reserved

  27. Prior sex offenses Prior adult convictions Court order violations Force used during current arrest Relationship to victim Male victim History of exhibitionism Deviant sexual fixation Alcohol of drug use (past five years) Address changes (past year) Time employed/ in school Past treatment success Amenability to treatment Prior convictions for violent crimes Prior conviction for crime involving deadly weapon Force used during current offense Sexual intrusiveness of current offense Physical harm to victim Victim <5, >55, or handicapped VASOR

  28. (C) 2008 Vermont Forensic Assessment All rights reserved

  29. VASOR - Daubert criteria issues • No peer-reviewed studies on its reliability and validity • Manual relies on studies presented in poster format • Manual clearly marks the VASOR as a “research version” • Not cited in major reviews of other actuarial scales • Used rarely outside of Vermont (C) 2008 Vermont Forensic Assessment All rights reserved

  30. VASOR - Validity issue • According to Georgia Cumming, new cases are being added to the VASOR database, and within “a couple of weeks” there will be new cut points for describing the risk level of cases, based on their scores. (C) 2008 Vermont Forensic Assessment All rights reserved

  31. Dynamic Measures of Sexual Recidivism Risk • SONAR: Sex offender need assessment rating • Stable 2007 and Acute 2007 • Treatment Progress Scale (Vermont-specific) (C) 2008 Vermont Forensic Assessment All rights reserved

  32. SONAR - sex offender needs assessment rating • rates dynamic factors related to recidivism • improves the predictive accuracy and utility of actuarial (historical factors) instruments by considering changing circumstances in the offender’s life (ie. dynamic factors) • http://ww2.ps-sp.gc.ca/publications/corrections/200001b_e.asp

  33. (C) 2008 Vermont Forensic Assessment All rights reserved

  34. Stable and Acute - 2007 • Stable factors • Significant social influences • Capacity for relationship stability • Emotional identification with children • Hostility toward women • General social rejection • Lack of concern for others • Impulsive • Poor problem solving skills (C) 2008 Vermont Forensic Assessment All rights reserved

  35. Stable and Acute - 2007 • Stable factors (cont.) • Negative emotionality • Sex drive preoccupation • Sex as a coping mechanism • Deviant sexual preference • Deviant sexual interests in possible remission • Cooperation with supervision (C) 2008 Vermont Forensic Assessment All rights reserved

  36. Stable and Acute - 2007 • Acute factors • Victim access • Hostility • Sexual preoccupation • Rejection of supervision • Emotional collapse • Collapse of social supports • Substance abuse (C) 2008 Vermont Forensic Assessment All rights reserved

  37. Stable and Acute - 2007 • The most recent version incorporates the Static-99 variables and the most risk-relevant dynamic variables to describe both risk level and supervision intensity needs for a client. • This represents best evidence-based practice at this time. (C) 2008 Vermont Forensic Assessment All rights reserved

  38. Vermont Treatment Progress Scale • http://www.csom.org/pubs/SexOffTreatScale.pdf • McGrath & Cumming (2003) • Bob McGrath, MA, licensed psychologist, clinical director, Vermont Treatment Program for Sexual Aggressors • Georgia Cumming, administrative director, Vermont Treatment Program for Sexual Aggressors (C) 2008 Vermont Forensic Assessment All rights reserved

  39. Vermont Treatment Progress Scale • Sexual deviancy • Criminality • Self-regulation • Treatment and supervision cooperation • Lifestyle stability • Social supports (C) 2008 Vermont Forensic Assessment All rights reserved

  40. Multiple Static Assessments DOC uses three static actuarial scales • RRASOR, STATIC-99, VASOR • It is unnecessary to use more than one static actuarial assessment • “...combining scales did not provide a statistically significant or consistent advantage over the single best actuarial risk scale in predicting either serious or sexual recidivism.” Seto (2005) (C) 2008 Vermont Forensic Assessment All rights reserved

  41. Multiple Static Assessments • So why does DOC policy require the use the Static-99, RRASOR and VASOR on all sex offenders? • The HIGHEST of the three ratings is used • Low • Medium low • Medium • Medium high • High • Fishing for the highest score? (C) 2008 Vermont Forensic Assessment All rights reserved

  42. Multiple Static Assessments • If there are going to be multiple instruments, why use three static factor assessments? • Why exclude dynamic variables? • Sonar • Stable/Acute 2007 • Vermont Treatment Progress Scale • Evidence-based practice vs. not (C) 2008 Vermont Forensic Assessment All rights reserved

  43. Denial • “Denial” vs. minimization • Weak predicator of recidivism and treatment compliance • Hanson and Morton-Bourgeon (2005) article p. 1158 (C) 2008 Vermont Forensic Assessment All rights reserved

  44. Conflict of Interest • DOC relies on a network of providers who provide both forensic assessments and clinical interventions. • “Irreconcilable conflict between therapeutic and forensic roles” (Greenberg & Shuman, 1997). • “Failure to maintain adequate separation of roles has a number of counter-therapeutic consequences in sex offender management” (Covell & Wheeler, 2006). (C) 2008 Vermont Forensic Assessment All rights reserved

  45. Conflict of Interest National professional organizations specifically highlight the importance of avoiding dual roles • American Psychological Association • American Academy of Psychiatry & the Law • Association for the Treatment of Sexual Abusers (ATSA) (C) 2008 Vermont Forensic Assessment All rights reserved

  46. Conflict of Interest • “Members recognize that there may be potential conflicts of interest when they provide both evaluation and treatment services to the same person. When it is necessary to fulfill both functions (for example, in rural settings or institutions), members take reasonable steps to manage and resolve any conflicts in the best interest of the client and the community.” ATSA practice standards and guidelines (2005) (C) 2008 Vermont Forensic Assessment All rights reserved