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Evidence-Based Assessment & Treatment Services for Sexual Offenders. David Thornton, Ph.D. Outline. Part One: The Developing Evidence Base Mainly didactic Part Two: Good Practice Models Mainly interactional. Part One: The Developing Evidence Base. How RNR applies to Sexual Offenders.

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outline
Outline
  • Part One: The Developing Evidence Base
    • Mainly didactic
  • Part Two: Good Practice Models
    • Mainly interactional
risk needs responsivity
Risk/Needs/Responsivity
  • RNR is the only model for the effective reduction of recidivism that has substantial empirical support
  • Central claim is that the more closely you follow these three principles the larger the resulting reduction in recidivism
  • The model has been primarily developed and validated on general offenders and only recently tested with sexual offenders
risk principle
Risk Principle
  • Match intensity of service with risk level
    • Manage low risk offenders with a light touch; avoid creating interactions between them and higher risk offenders
    • Concentrate treatment and management resources on Moderate and especially High risk offenders
  • Central Claim: Providing intensive treatment to low risk offenders will be useless or harmful; the more you concentrate resources on higher risk offenders, the greater the reduction in recidivism
need principle
Need Principle
  • Treatment should comprehensively address the psychological factors that predispose towards the kind of recidivism you are trying to prevent
  • Treatment should move these factors in the direction of becoming strengths
  • Use recidivism studies to select these factors
    • If it is theoretically plausible and empirically correlated with recidivism you should target it; if there is no empirical evidence for its relation to recidivism you should leave it alone
  • Central claim: the more Needs you target the larger the resulting reduction in recidivism; targeting other factors will not reduce risk
the big three general criminogenic needs
The Big Three General Criminogenic Needs
  • These are Criminogenic Factors that have been determined to be relevant to general recidivism
antisocial personality pattern
Antisocial Personality Pattern
  • Elements
    • Impulsive
    • Adventurous pleasure seeking
    • Restlessly aggressive
    • Callous disregard of others
antisocial attitudes
Antisocial Attitudes
  • Cognitive Elements
    • Identifies with criminals
    • Values and Beliefs that favor crime
    • Rationalizes crime under a broad range of circumstances
    • Negative to attitude to law and justice systems
    • Belief that crime yields rewards
  • Affective Elements
    • Anger
    • Irritation
    • Resentment
    • Defiance
antisocial associates
Antisocial Associates
  • Elements
    • Criminal Friends
    • Isolation from Prosocial Others
responsivity principle
Responsivity Principle
  • General Responsivity: Use methods that have generally been shown to be effective with offenders (behavioral, social learning and cognitive-behavioral influence and skill building strategies
  • Specific Responsivity: adapt style and mode of service according to the setting and relevant characteristics of the individual such as their strengths, motivations, preferences, personality, age, gender, cultural identifications
  • Central Claim: the more your methods match the learning style and culture of the individual the greater the resulting reduction in recidivism
meta analysis of treatment outcome
Meta-Analysis of Treatment Outcome
  • Mean Effect Size (r) by Adherence to RNR Principles (k=374)
  • Risk Principle
    • Yes = 0.1 No = 0.03
  • Need Principle
    • Yes = 0.19 No = -0.01
  • Responsivity Principle
    • Yes = 0.23 No = 0.04
number of principles followed and tx impact
Number of Principles followed and Tx Impact
  • All three principles
    • 0.26 (60 tests)
  • Two principles
    • 0.18 (84 tests)
  • One principle
    • 0.02 (106 tests)
  • None of principles followed
    • -0.02 (124 tests)
similar results observed for
Similar results observed for
  • Male and Female offenders
  • Young and Adult offenders
  • Prisoners and Community Corrections
similar evidence for two implementation principles
Similar Evidence for Two Implementation Principles
  • Staffing:
    • Relationship skills Respectful, collaborative, caring staff that employ motivational interviewing (stages 1 and 2).
    • Structuring skills Use prosocial modeling, the appropriate use of reinforcement and disapproval, cognitive restructuring, and motivational interviewing (stages 3 – 6).
  • Management:
    • Promote the selection, training and clinical supervision of staff according to RNR and introduce monitoring and feedback and adjustment systems.
    • Build systems and cultures supportive of effective practice and continuity of care.
note 8 stages of mi learning
Note: 8 stages of MI Learning

(1) openness to collaboration with clients’ own expertise,

(2) proficiency in client-centered counseling, including accurate empathy,

(3) recognition of key aspects of client speech that guide the practice of MI,

(4) eliciting and strengthening client change talk,

(5) rolling with resistance,

(6) negotiating change plans,

(7) consolidating client commitment

(8) switching flexibly between MI and other intervention styles.

the sot evaluation literature is weak
The SOT Evaluation Literature is weak
  • Too few well controlled studies to allow us to draw firm conclusions
  • If only exclude the worst studies then there are enough for a meta-analysis looking at the application of RNR principles to SOT
  • Hanson, R.K., Bourgon, G., Helmus, L. & Hodgson, S. (2009). The principles of effective correctional treatment also apply to sexual offenders: A meta-analysis. Criminal Justice and Behavior, 36, 865-891.
selection of studies
Selection of Studies
  • ATSA’s Collaborative Outcome Data Committee, a committee of 12 experts in the area of sex offender research, developed a multidimensional way of classifying evaluation studies according to the degree to which different methodological problems applied
  • The authors use this framework to classify the strength of studies:
    • 105 were rated as Rejected as inadequate
    • 19 as Weak
    • 5 as Good
    • 1 as Strong
  • A pool of 23 “minimally adequate” studies were identified
slide20

Collaborative Outcome Data Committee. (2007a). Sexual offender treatment outcome research: CODC Guidelines for evaluation Part 1: Introduction and overview (Corrections Research User Report No. 2007-02). Ottawa, Ontario: Public Safety Canada.

  • Collaborative Outcome Data Committee. (2007b). The Collaborative Outcome Data Committee’s guidelines for the evaluation of sexual offender treatment outcome research Part 2: CODC guidelines (Corrections Research User Report No. 2007- 03). Ottawa, Ontario: Public Safety Canada.
slide21

The 23 studies were coded according to whether they complied with these principles

  • Studies were classified according to the number of principles treatment followed and which specific principles were followed
  • Average treatment effect was then calculated as a function of the degree to which RNR principles had been followed
rating of adherence to the risk principle
Rating of Adherence to the Risk Principle
  • Programs adhered to the Risk principle when they provided intensive interventions to high risk offenders and little or no service to low risk offenders. In practice, however, no single study had differentiated treatment services. Studies were therefore coded as adhering to the Risk principle if their treatment group was high risk.
rating of adherence to the need principle
Rating of Adherence to the Need Principle
  • Adherence to the Need principle was met if the majority of the treatment targets were significantly related to sexual or general recidivism in previous meta-analytic reviews
  • For sexual offence recidivism, the main criminogenic needs were taken to be
    • sexual deviancy
    • antisocial orientation,
    • sexual attitudes
    • intimacy deficits.
  • Examples of factors coded as non- criminogenic needs were
    • denial
    • low victim empathy
    • social skills deficits
rating of adherence to the responsivity principle
Rating of Adherence to the Responsivity Principle
  • Treatment services were considered to meet the Responsivity principle when they provided treatment in a manner and style matched to the learning style of the clients.
  • For offenders, such programs are typically cognitive-behavioural programs run by pro-social therapists skilled at developing respectful (“firm but fair”) relationships
sources for rnr model and research
Sources for RNR Model and Research
  • Andrews, D. A., & Bonta, J. (2006). The psychology of criminal conduct (4 ed.). Cincinnati, OH: LexisNexis/Anderson. NB: 5th edition is now available
  • Bonta, J., & Andrews, D. A. (2007). Risk-need-responsivity model for offender assessment and rehabilitation. Corrections Research User Report No. 2007-06). Ottawa, Ontario: Public Safety Canada.
inter rater reliability
Inter-Rater Reliability
  • The reliability was good for the rating of adherence to the principles of Risk (Kappa = .73, 88% agreement), and Responsivity (Kappa = .82, 94% agreement), but only fair for rating of the Need principle (Kappa = .42; 75% agreement). Nevertheless, the reliability of the overall rating of adherence to the R/N/R principles was good (ICC = .80)
index of treatment effectiveness
Index of Treatment Effectiveness
  • Odds Ratio
  • Odds recidivism in the treatment group divided by odds recidivism in the comparison group
  • 1.0 = No effect of treatment
  • Ratios lower than 1.0 indicate that treatment reduced recidivism
  • “When the recidivism base rate is low, the odds ratio approximates the rate ratio. For example, given a base rate of 10%, an odds ratio of .70 can be interpreted as follows: for every 100 untreated sex offenders who recidivate, only 70 treated sex offenders will recidivate.”
meta analysis
Meta-Analysis
  • Fixed and Random Effects meta-analyses were calculated
results
Results
  • 22 studies
  • 3,121 treated offenders and 3,625 offenders in the comparison groups.
  • Treated recidivism ranged from 1.1% to 33.3%, with an unweighted mean of 10.9%.
  • Comparison group recidivism ranged from 1.8% to 75.0%, with an unweighted mean of 19.2%
there was more variability in treatment effect than would be expected by chance
There was more variability in treatment effect than would be expected by chance
  • Q = 47.17, df = 21, p < .001
treatment effect by application of specific principles
Treatment Effect by Application of Specific Principles
  • Risk Principle applied?
    • Yes  0.48
    • No  0.72
  • Need Principle
    • Yes  0.45
    • No  0.86
  • Responsivity
    • Yes  0.57
    • No  1.05
purpose of risk assessment
Purpose of Risk Assessment
  • To understand the concept of Risk in RNR you have to see the context in which SO Risk Assessment was developed
  • Promoting public safety
    • by allowing scarce resources to be concentrated on those groups of offenders with higher recidivism rates
  • What kind of resources
    • Detention
    • Intensity of Treatment
    • Intensity of Community Management
  • Must be practical and cost-effective so can be applied to large numbers of offenders based on available information
type of factors considered
Type of Factors Considered
  • In the RNR model “Risk” relates to assessment based on static actuarial factors
    • Simple facts from the offenders’ history that are known to be statistically correlated with sexual recidivism
  • In practice this means that “Risk” reflects three kinds of predictor
    • Prior sexual offending
    • Prior general offending
    • Youth
slide36

Youth

Static Risk

Sexual Criminality

General Criminality

slide38

History of Sexual Criminality relates specifically to future sexual recidivism and not to other kinds of outcome

  • History of General Criminality and Youth relate to sexual, non-sexually violent, and any recidivism
slide39

It is important to register that Risk in the RNR model does not include all the factors that might influence recidivism

  • Nevertheless prediction based on this limited kind of assessment has been consistently shown to be able to divide offenders into groups that differ in their rates of recidivism
  • This is illustrated in the next few slides
source
Source
  • Hanson, R.K., & Morton-Bourgon, K.E. (2009). The accuracy of recidivism risk assessments for sexual offenders: A meta-analysis of 118 prediction studies. Psychological Assessment, 21, 1-21.
slide41
1972-2008 (median 2004)
  • 151 documents; 110 studies; 118 samples
  • 37% published
  • Total n = 45,398 sexual offenders
  • 16 countries
    • Canada, US, UK, France, Netherlands, Germany, Denmark, Australia, Sweden, Austria, New Zealand, Belgium, Taiwan, Japan, Switzerland, Spain
    • English, French, Chinese, Spanish
d standardized mean difference
d “standardized mean difference”
  • How much are the recidivists different from the non-recidivists, in comparison to how much the recidivists and non-recidivists are different from each other.

.20 small

.50 medium

.80 large

slide45

The most commonly used Risk Assessment instrument is Static-99

  • As you probably know you are now recommended to use the revised version of this instrument
    • Static-99R
  • I am going to detour slightly to describe the items of Static-99 and then look at how and why we got to the R version
static 99
Male victims

Ever Lived With

Non-contact sex offences

Unrelated victims

Stranger victims

Prior sex offences (3 points)

Current non-sex violence

Prior non-sex violence

4+ sentencing dates

Age 18-24.99

STATIC-99
slide48
Risk InstrumentsU. S. Programs for Adult MalesMcGrath, Cumming, Burchard, Zeoli & Ellerby (2010). Safer Society Survey.
slide51
Risk InstrumentsCanadian Programs for Adult MalesMcGrath, Cumming, Burchard, Zeoli & Ellerby (2010). Safer Society Survey.

(n=27)

problem
Problem
  • What to do with the older (50+) sexual offenders?
  • Aging offender population
  • Advanced age added incrementally to the prediction of sexual recidivism
solution static 99r
Solution: STATIC-99R
  • What to do with the older (50+) sexual offenders?
  • Add more weight to age

STATIC-99R

18 – 34.9 = 1

35 – 39.9 = 0

40 - 59.9 = -1

60 + = -3

STATIC-99

18 – 24.9 = 1

25+ = 0

static 99 static 99r
STATIC-99 → STATIC-99R
  • Original age item of Static-99 insufficient to capture relationship between age and sexual recidivism
  • New age item fully accounts for age in both rapists and child molesters
  • Static-99 over-predicts recidivism for older offenders; Static-99R correctly assigns a lower level of expected recidivism to them
risk instruments can be scored reliably
Risk instruments can be scored Reliably
  • Instruments like Static-99 can be scored fairly reliably
  • You do have to attend to the coding rules and scores depend on the data available to the scorer
standard error of measurement
Standard Error of Measurement

SD is the standard deviation of the predictor

rxx is the rater reliability (Pearson or ICC)

standard error of measurement static 99r assuming r xx 87
Standard Error of MeasurementSTATIC-99R (assuming rxx = .87)

SEM = Standard deviation x (1 – reliability)1/2

SEM = 2.48 (1 - .87)1/2 = .89

95% C.I. = 1.96 x .89 = 1.75

Result: 19 times out of 20, the offender’s “true” score will be within ± 1.8 points of the observed score

adversarial effects
Adversarial Effects
  • Just because these instruments can be scored reliably does not mean that they are scored reliably in routine practice
    • Adversarial effects
    • Sloppiness and drift
stability of results
Stability of Results
  • Stability of findings across settings and samples
  • Finding from meta-analysis (22 samples)
    • Relative risk is stable (no significant variability)
    • Absolute risk varies
validated as a measure of relative risk for sexual recidivism
Validated as a Measure of Relative Risk for Sexual Recidivism
  • Rapists
  • Child Molesters
  • Non-contact offenders
    • Exhibitionists, voyeurs
  • Prison samples
  • Community Samples
  • Treated
  • Untreated
validated as a measure of relative risk for sexual recidivism1
Validated as a Measure of Relative Risk for Sexual Recidivism
  • Canadian Aboriginals
  • Developmentally Delayed
  • Offenders with Major Mental Disorders
international validation studies
International Validation Studies
  • Canada
  • US
  • UK
  • Australia & New Zealand
  • Western Europe
inappropriate populations
Inappropriate Populations
  • Females
  • Juveniles
  • Offenders with 10+ years sex offence-free in the community
  • Not for making statements about possible guilt
  • Category B sex offences
    • No victims – e.g., consenting sex between similar age peers
    • No sexual motivation – e.g., urinating in public
slide68
Even through relative risk is consistent, absolute recidivism rates for Static-99R vary across samples
exploration of reasons for variation in base rate
Exploration of reasons for variation in base rate
  • Due to
  • Sample type
  • Not due to
  • Methodology
  • Era
  • Jurisdiction
  • Age
  • Ethnicity
  • Victim Choice
routine correctional samples
Routine Correctional Samples
  • 5 year estimates only
  • 8 samples of routine correctional sex offenders from Canada, the United States, England, Austria and Sweden.
  • n=2406
  • No screening procedures on risk or need factors.
  • No pre-selection for treatment, psychiatric admission or treatment or exceptional measures related to dangerousness.
  • Roughly representative of all adjudicated sex offenders.
preselected for treatment need
Preselected for Treatment Need
  • 5 years: k=11 n=1642
  • 10 years: k=6 n=866
  • Offenders referred for sex offender specific treatment during the current incarceration or a prior incarceration.
  • If offender is selected for treatment but does not receive it due to bed shortages he would still be considered preselected for treatment.
  • It is the selection that defines this sample not participation in treatment.
preselected for treatment need1
Preselected for Treatment Need
  • Includes referral for community sex offender treatment
  • Not considered:
    • Quality of the program
    • Jurisdiction of the program
    • Program structure (length or content)
    • Participation in or completion of the program. These factors would be an external factor to be taken into account by an evaluator.
pre selected for treatment need
Pre-selected for Treatment Need
  • Current samples were pre-selected for treatment need were selected during their current incarceration
  • Implies presence of an above average level of treatment needs
pre selected for high risk need
Pre-Selected for High-Risk/Need
  • 5 year: k=6 n=1,313
  • 10 year: k=5 n=722
  • A small subgroup of offenders selected on the basis of risk and need factors external to the Static-99R.
  • A small proportion of the sexual offender population being selected for extreme interventions
pre selected high risk need
Pre-Selected High-Risk/Need
  • Offenders referred to intensive treatment programs for the highest risk offenders
    • Sexually Violent Predators/Sexually Dangerous Persons
  • Offenders identified as high risk through a quasi-judicial or administrative process resulting in extended detention for dangerousness (e.g., preventative or indefinite detention, treatment orders, denial of statutory release).
slide81

The different base rates reflect the fact that Risk instruments don’t measure all the important influences on recidivism

  • Selection will change base rates when it changes the average level of these unmeasured factors
  • The most plausible of these unmeasured factors is Need
from an rnr point of view
From an RNR point of view
  • You only need to be able to assess relative risk to apply the Risk Principle
  • Percentiles and Relative Risk statements are sufficient for that
  • If you go to www.static99.org you will see that you are offered guidance on interpreting Static-99R scores in terms of Percentiles and Relative Risk statements
how do you identify something as criminogenic
How do you identify something as Criminogenic?

Cumulative Weight of Relevant Evidence

  • Plausible according to evidence-based theory
  • More common in offenders than non-offenders
  • More common in offenders with priors vs. first offenders
  • Plays role in chain of decisions leading to offending
  • More common in offenders who subsequently re-offend
criminogenic needs relevant to sexual recidivism1
Criminogenic Needs relevant to Sexual Recidivism
  • Smaller volume of research on psychological predictors of sexual recidivism
  • Meta-analytic review of recidivism studies
  • Mann, R.E., Hanson, R.K. & Thornton, D. (2010). Assessing risk for sexual recidivism: Some proposals on the nature of psychologically meaningful risk factors. Sexual Abuse: A Journal of Research and Treatment. 22, 191-217.
mean aucs for the four domains
Mean AUCs for the Four Domains
  • The lower AUC for Self-Management is probably because it was less well measured than the other domains in several of the studies
  • NB from LTV studies only
two ways of conceptualizing needs
Two Ways of Conceptualizing Needs
  • Long-term vulnerabilities
    • Life history focus
  • Stable dynamic risk factors
    • Recent focus
stable dynamic measures
STABLE-Dynamic Measures
  • STABLE (Hanson et al)
    • And to a lesser extent STABLE-2007
  • Therapist Rating Scale (Marshall & Marshall, 2010)
avoid overstating the difference
Avoid Overstating the difference
  • STABLE-2000 and the Therapist Rating Scale are more clearly stable-dynamic measures
  • STABLE-2007 has moved in the LTV direction both in the coding of some items and in how people are now trained
    • “Make judgments about how the person will be in the next 6 to 12 months” implies weighting recent functioning but can be informed by long-term behavior
    • Since 2007 training has more clearly emphasized this last point
methodological note construction and validation
Methodological Note: Construction and Validation
  • Scale construction may be based on the general literature and theory or by analyzing data from a construction sample
  • Something is a construction sample if analysis of the relationship between potential predictors and recidivism in that sample is used to
    • select items
    • determine how they are weighted in the overall scale
  • This process potentially exaggerates the relationship between the scale and recidivism in that sample
  • Unbiased estimates of the scale’s predictive accuracy may be obtained by testing this in a sample where recidivism data was not used to construct the scale. Samples of this kind are called validation samples
overall results for need assessment
Overall Results for Need Assessment
  • Included AUCs for all deliberate and emergent implementations of SRA Need Assessment
  • Included both stable-dynamic and LTV assessments but with AUCs separated
  • Used the full results from the Austrian cross-validation of STABLE
  • Excluded results from construction samples
  • Excluded SRA-FV validation results (to be shown later) and the earlier Knight & Thornton results from the same sample
  • The Combined results exclude the STABLE-2000 AUC from Austria; using just the STABLE-2007 results from that sample
  • Mean AUCS shown are unweighted means
a key issue
A Key Issue
  • Is whether Need is simply a repackaging of Risk into more psychologically meaningful categories or whether it includes something important for recidivism which goes beyond what is covered by Risk
  • Researchers refer to this as “incremental validity” – how far does combining Risk and Need allow you to improve prediction beyond what you could manage on the basis of Risk alone?
incremental predictive accuracy
Incremental Predictive Accuracy
  • Stable Dynamic
    • STABLE-2000 – very small; not significant in any individual study
    • STABLE-2007 – two studies (construction & validation <0.05 & 0.10 (Hanson et al & Austria)
    • TRS-2 (not directly tested but Static-99 not predictive at all in this study)
  • LTV (8 studies where tested)
    • Statistically significant in all studies
slide98

Going to look more closely at incremental validity for two measures of Need

    • STABLE-2007
    • SRA-FV
  • These two measures have fairly similar content
  • The specific scoring rules for particular content areas differ
  • SRA-FV uses the LTV conceptualization
dsp conscientious canadians
DSP- Conscientious Canadians
  • Hanson, R.K., Harris, A.J.R., Scott, T., & Helmus, L. (2007). Assessing the risk of sexual offenders on community supervision: The Dynamic Supervision Project. Public Safety Canada.
  • Sexual offenders under supervision in multiple Canadian jurisdictions (and a couple of US States); Ratings made by supervising agents.
  • Conscientious Canadians produce better results
  • N with 3 year sexual recidivism data and STABLE-2007 and Static-99R scores produced by Conscientious Canadian raters
    • 217 (13 recidivists)
austrian prisoners
Austrian Prisoners
  • Eher, R., Matthes, A., Schilling, F, & Rettenberger, M. (in prep). Dynamic Risk Assessment in Sexual Offenders Using the Stable-2000 and the Stable-2007.
  • Participants were 263 adult male sexual offenders who were evaluated between October 2001 and February 2005 at the Federal Evaluation Centre for Violent and Sexual Offenders (FECVSO) in the Austrian Prison System. Participants were included consecutively into the study, if they had a sexual crime as index offense and had been released for a minimum of 2 years as of August 1, 2010.
  • N with 5-year follow-up = 254 (24 recidivists)
selection for fecvso evaluation
Selection for FECVSO Evaluation
  • Since the end of 2001 every sexual offender convicted of an unconditional prison sentence by an Austrian court has to be reported to the FECVSO.
  • After a file based risk assessment of every offender a substantial proportion of these reported offenders (about 60%) routinely are seen for risk assessment by experienced forensic psychiatrists and psychologists at the FECVSO.
  • Selection of offenders for clinical forensic assessment is done by the following criteria:
    • a Static-99 total score of more than five,
    • an age under 25,
    • a prison sentence of more than four years,
    • a conviction for a child abuse
    • offense with a non-related victim,
    • any offender who is reconvicted for a sexual crime.
note on version of static
Note on version of static
  • In the Austrian sample age on release did not have incremental predictive value beyond Static-99 scores
  • The researchers decided to stick with the original version of Static-99 rather than moving to Static-99R
cox regressions in both samples
Cox Regressions in both samples
  • Showed incremental prediction from both Static and STABLE-2007 (marginal p<0.10 in the Austrian sample)
  • Logistic regression is required for projections; this limits the N to those with enough time at risk for the specified fixed follow up
reasons to expect projections to be below norms
Reasons to expect projections to be below norms
  • DSP
    • 3 years rather than 5 years follow up
  • Austrian
    • European sample
one standard deviation
+/- One Standard Deviation
  • DSP – STABLE -2007
    • Mean = 7
    • SD = 5
    • +/- 1 SD = 2 to 12
  • Austria – STABLE -2007
    • Mean = 10.09
    • SD = 2.9
    • +/- = 8.0 to 13.8
slide110

Even with the limited incremental validity shown by STABLE-2007, relatively common variation in degree of Need is sufficient to radically change the meaning of a Static-99R score

comment
Comment
  • Incremental validity is suggested rather than established for STABLE-2007
    • The DSP sample was used for scale construction (and retrospective identification of Conscientious raters)
    • The effect was only marginally significant in the Austrian sample
  • Nevertheless the relative degree of consistency between Austrian and DSP result is encouraging
sra fv need assessment
SRA-FV: Need Assessment
  • Data from a HRN sample
  • Calculate projected recidivism rates for combinations of risk and need
  • Determine how much difference in projected Static recidivism base rates is associated with common variation in Need (-1SD vs. +1SD)
bridgewater analysis of the sra fv need assessment
Bridgewater Analysis of the SRA-FV Need Assessment
  • Knight & Thornton
  • Sexual offenders referred for an early SVP program
  • 418 with 5 years follow up (83 recidivists)
  • Logistic regression analysis of 5-year sexual recidivism
conclusions about need
Conclusions about Need
  • We have identified a number of important Criminogenic Needs relevant to sexual recidivism
  • Each of the four domains defined by SRA is predictive
  • Level of overall Need has incremental validity relative to standard measures of Risk
  • Systematic assessment of these Criminogenic Needs could be used to implement the RNR Need Principle
more credible need assessment instruments
More Credible Need Assessment Instruments
  • All of these instruments have weaknesses so you might want to consider more than one of them
  • STABLE -2007
  • VRS-SO
  • SRA-FV
stable 2007
STABLE-2007
  • Designed to be user-friendly in a community treatment setting
  • Complications if you want to use it with offenders who have served more than about 4 years in custody
  • Lower AUC than other Need Assessment
  • Incremental validity small and not fully established (increase in AUC 0.01)
vrs so
VRS-SO
  • The best validated instrument
  • More time-consuming and cumbersome to apply
  • Need component shows clear incremental predictive validity
  • Tested in a HRN and TX Need institutional samples
  • Not clear how you would apply it with offenders who aren’t participating in a high intensity treatment program
sources
Sources
  • Olver, M.E., Wong, S.C.P., Nicholaichuk, T., & Gordon, A. (2007). The validity and reliability of the Violence Risk Scale – Sexual Offender Version: assessing sex offender risk and evaluating therapeutic change. Psychological Assessment, 19, 318-329.
  • Beggs, S.M. & Grace, R.C. (2010). Assessment of dynamic risk factors: an independent validation study of the Violence Risk Scale: Sexual Offender Version. SA:JRT, 22, 234-251
sra fv need assessment1
SRA-FV Need Assessment
  • Tested with an earlier HRN sample
  • Works under adversarial conditions
  • Need component shows clear incremental predictive validity
slide122

This next series of slides suggests a deeper way of understanding Long-Term Vulnerabilities

overview
Overview

LTV

&

Active LTV

slide124

Origins of

LTV

LTV

&

Active LTV

risk factors exist as propensities which can be activated
Risk factors exist as Propensities which can be activated

Propensities

Long term vulnerabilities

Currently Active LTV

ltv differ in their strength
LTV differ in their Strength

SexInt

DisAtt

RelatStyle

SM

degree of activation of ltv depends on strength of ltv and triggers
Degree of Activation of LTV Depends on strength of LTV and Triggers

SexInt

DistAtt

RelatStyle

SM

T2

T4

T1

T3

the development of propensities
The Development of Propensities

Biology

(Brain systems supporting psychological functions)

Genetic Vulnerabilities

(Main Effects

Gene/Gene Interactions)

Biology

Schema

(Cognitive/Motivational structures that interpret the environment & generate impulses)

Coping Style

(Ways of coping with schema activation)

Developmental Environment

Recurrent Experience

schema can differ in a number of ways
Schema can Differ in a Number of Ways
  • The more psychologically interesting schema tend to
    • Be more generally applicable
    • Incorporate social/emotional information
    • Integrate motivation
    • Be centrally relevant to the person
  • They can involve representations of events, of specific persons, of categories of person, of the self or the world in general
  • Depending on the kind of schema, different brain systems are called on to support its operation
classic schema model
Classic Schema Model

SCHEMA

Orienting Schema

Core Beliefs

Rules

The Environment

Events

AUTOMATIC REACTIONS

Thoughts

Impulses & Inhibitions

Feelings

Physiological Reactions

Behaviour

CONSCIOUS SELF-CONTROL

Meta-cognition

Problem-solving

the environment is not independent of the individual
The Environment is not independent of the individual
  • Once Schema are established individuals tend to recreate their own environment by
    • Biased perception
    • The reactions their behaviour elicits from others
    • Deliberately seeking familiar settings
people respond to schema activation in different ways
People respond to Schema activation in different ways
  • Coping Style (after Young)
    • Schema surrender (accepts schema as true; allows automatic reactions to directly control behaviour)
    • Schema avoidance (runs life to avoid schema activation)
    • Schema Overcompensation / Counter-attack (fights to make the opposite of the schema true)
    • Healthy, Flexible, Balanced Coping
  • Repeated coping responses will gradually occur more and more automatically with reduced conscious awareness and effort
development
Development

Over-reactive Amygdala

&

Persistent Stress neurotransmitters

Low Activity Allele of the MAO-A Gene

Recurrent overwhelming threat

&

Reactive Aggression

Adverse Childhood Environment

pag response selection blanchard et al 1977
PAG Response Selection(Blanchard et al, 1977)
  • Mammalian (PAG) Threat Response Continuum
    • Freeze to Moderately Distant Threats
    • Attempt to Escape Close Threats
    • Launch Explosive Attacks when Threats can’t be Avoided
biological threat response system too intensely persistently activated
Biological Threat Response System too intensely & persistently activated
  • Several consequences result from this biological threat response system being overactive
  • Threats are over-identified and experienced as more dangerous and prolonged than they are
  • Frequent control transfer to PAG
    • Freeze, Flight, or Fight
  • Over-estimation of threat and inability shut off threat response makes selection of Fight (Explosive Attacks) more probable
development1
Development

Threat response system too intensely and persistently activated

Over-reactive Amygdala &

Persistent Stress neurotransmitters

Low Activity Allele of the MAO-A Gene

Hostile World;

Scripts for Reactive Aggression

Recurrent overwhelming threat &

Reactive Aggression

Adverse Parenting

slide144

LTV typically involve ongoing interactions between

    • Biology
    • Schema, Scripts & Skills
    • Self-created Micro-Environments
  • These interact with the larger setting
    • Warmth
    • Structure
    • Responsiveness
how might these kinds of risk factor interact
How might these kinds of risk factor interact?
  • Active LTVs and situations/events pose a motivational problem for the individual – how do I get my needs met in this situation?
  • Offending is one way of “solving” this problem
  • More frequent offending will lead to
    • Increased salience of offending as a possibility
    • Increased skill and confidence in offending
  • Consequences of offending may activate and/or strengthen LTVs
slide148

Active

LTVs

Offending

Settings,

Situations

&

Events

Salience of,

Skill at

& Confidence in Offending

Further Offending

dynamic change process
Dynamic Change Process

Behavioral Intentions

Sustained Strivings

Building Resources

Internal Resources

Identity

Self-Management

Supporting Schema

External Resources

Social Networks

Opportunities

surprising parts of this model
Surprising Parts of this model
  • The role of intentions
  • The role of Social Networks
  • The role of Identity
  • Going to spend a little time talking about each of these
agency lies with the offender
Agency lies with the Offender
  • An important aspect of this model is that it emphasizes the role of an active intentional process on the part of the offender
  • At any time the offender may be in one of three motivational states
slide152

Behavioral Intention to Offend

No Effective Intention

Behavioral Intention to go straight

going straight
Going Straight
  • Living a valued law-abiding life
    • Of value to him or to other people
these intentions drive the development of resources
These intentions drive the development of resources
  • Internal resources
    • Identity
    • Self-management
    • Supportive Schema
  • External resources
    • Opportunities
    • Supportive Social Networks
  • These resources make it easier to sustain the behavioral intention
where do behavioral intentions come from
Where do Behavioral Intentions come from
  • Fortunately we have available a well established empirically supported model of how behavioral intentions are formed (The Theory of Planned Behavior)

Influences on Intentions

  • Attitudes (what is this going to do for me)
  • Subjective Norms (whose opinion do I care about? what would they think of my doing this? would they know?)
  • Subjective Control (Can I do it if I try?)
important to note
Important to Note
  • This model does NOT assume a process of conscious reflection
  • The determinants of intention typically run behind the scenes and may present themselves in consciousness as feelings or attitudes
  • Implicit processes strongly influence the salience of outcomes, others’ views, effective control and consequently may lead to changed intentions
  • Similarly schema activation may dramatically change what is salient and what is valued
implicit and conscious processes may conflict
Implicit and Conscious Processes may conflict
  • Conscious self-control processes may, of course, involve reflection, self-talk etc
  • The literature on the social psychology of attitudes highlights that we typically have
    • Conscious attitudes that are subject to self-reflection and conscious determination
    • Implicit attitudes that reflect implicit associations, schemas etc
at this point you may well be wondering whether intentions are really this important
At this point you may well be wondering whether intentions are really this important
  • There is some evidence to suggest that they are
only a certain kind of behavior is predictive
Only a certain kind of behavior is predictive
  • The intention must be
    • to behave in a particular way
    • directed towards a specified target
    • in a specified context
  • Vague general intentions are not predictive
do behavioural intentions really predict behaviour
Do Behavioural Intentions really predict behaviour?

Intentions can change

Sometimes there is no opportunity to follow through on an intention

Sometimes a general intention is different from a specific intention in a context

People sometimes lie about their intentions

magnitude of these correlations
Magnitude of these correlations
  • These correlations are much larger than you normally see in behavioral research
  • They demonstrate a really strong relationship between intentions assessed under research conditions and behavior
deliberate manipulation of intentions changes behavior
Deliberate manipulation of intentions changes behavior
  • Brief motivational interventions of a kind designed to shift intentions have proved remarkably effective in changing well established behavior patterns
monti et al 1999 journal of consulting and clinical psychology 67 989 994
Monti et al., 1999Journal of Consulting and Clinical Psychology, 67:989-994
  • Design Randomized clinical trial
  • Population Emergency room
  • Nation US (Providence, RI)
  • N 94 adolescents (18-19)
  • MI 1 session (35-40 min)
  • Comparison Standard care
  • Follow-up 6 months
monti et al 1999
Monti et al., 1999

p<.05

p<.05

p<.01

bernstein et al 2005 drug alcohol dependence 77 49 59
Bernstein et al., 2005Drug & Alcohol Dependence, 77:49-59
  • Design Randomized clinical trial
  • Population Heroin/cocaine using medical

patients (not treatment-seeking)

  • Nation USA (Boston)
  • N 1175 adults
  • MI 20-min individual MI, referral,

and list of treatment resources

  • Comparison List of treatment resources
  • Follow-up 6 months
brown miller 1993 psychology of addictive behaviors 7 211 218
Brown & Miller, 1993Psychology of Addictive Behaviors, 7:211-218
  • Design Randomized clinical trial
  • Population Inpatient alcohol
  • Nation US (Albuquerque, NM)
  • N 28 adults
  • MI 1 session MET (+ TAU)
  • Comparison TAU
  • Follow-up 3 months post discharge
aubrey 1998 doctoral dissertation university of new mexico
Aubrey, 1998Doctoral dissertation, University of New Mexico
  • Design Randomized clinical trial
  • Population Adolescent drug abuse treatment
  • Nation US (Albuquerque, NM)
  • N 77 adolescents entering treatment
  • MI 1 individual session + TAU
  • Comparison TAU
  • Follow-up 3 months
is recidivism really related to active striving
Is recidivism really related to active striving?

Active Striving to Offend

  • Hanson et al (2007)’s finding that victim access behaviors were a risk factor
  • Hanson & Thornton (2003)’s finding that recency of past sexual offenses predicts future recidivism
  • Heil, Harrison, English, & Ahlmeyer (2009)’s finding that sexual offenses committed in prison raise the probability of sexual offenses committed after release

Active Striving to Go Straight

  • Hanson et al (2002)’s finding that treatment completion is associated with reduced recidivism
  • The inclusion of attitude to treatment items in empirically-validated risk assessment instruments (the SVR-20; the VRS-SO).
what about the building of social networks
What about the building of Social Networks

Antisocial Networks

  • The general criminological finding of Associates as one of the Big Four predictors of recidivism (Andrews & Bonta, 2006)
  • Hanson et al (2007)’s finding that Associates is predictive of sexual recidivism

Prosocial Networks

  • The more general criminological literature that has implicated the active use of prosocial networks in desistance (e.g. Laub and Sampson, 2003; Giordano, Cernkovich and Rudolph (2002)).
what about identity
What about Identity?
  • Maruna (2001)

Deviant, Criminal Identity

  • Persisting offenders tended to have developed a life-narrative that he characterized as a “condemnation script”.
    • Seeing a deviant criminal self as who they really were;
    • Seeing their past bad acts as due to their being this criminal self;
    • Feeling helpless or disinterested in changing this.

Prosocial Identity

  • Desisting offenders tended to have developed a “redemption script”.
    • Having constructed a prosocial identity with which they increasingly identify;
    • Believing their prosocial identity is who they had always really been and explaining their past bad behaviour as due to external factors that in some way repressed their real selves
    • Determinedly asserting control of their current and future conduct.
the responsivity principle requires
The Responsivity Principle requires
  • Using methods and a treatment style that generally works with offenders
  • Tailoring treatment to respond to how this individual learns and responds
    • This means understanding offender characteristics that may affect these things
do the same general responsivity factors apply for sexual offenders
Do the same general responsivity factors apply for sexual offenders?
  • As far as we can tell Responsivity Factors are similar for sexual and general criminality
therapist style research
Therapist Style Research
  • Similarly, research into therapist style during SOT is also consistent with the more general literature
  • Helpful Features
    • Relationship Skills: Warmth & Empathy
    • Structuring Skills: Rewardingness & Directiveness
  • Unhelpful Features
    • Aggressive Confrontation
sources1
Sources
  • Marshall, W.L., Serran, G., Moulden, H., Mulloy, R., Fernandez, Y.M., Mann, R.E., & Thornton, D. (2002). Therapist features in sexual offender treatment: Their reliable identification and influence on behaviour change. Clinical Psychology and Psychotherapy, 9, 395-405.
  • Marshall, W.L., Serran, G.A., Fernandez, Y.M., Mulloy, R., Mann, R.E., & Thornton, D. (2003). Therapist characteristics in the treatment of sexual offenders: Tentative data on their relationship with indices of behaviour change. Journal of Sexual Aggression, 9, 25-30.
  • Marshall, W.L., Fernandez, Y.M., Serran, G.A., Mulloy, R., Thornton, D., Mann, R.E., & Anderson, D. (2003). Process variables in the treatment of sexual offenders: A review of the relevant literature. Aggression and Violent Behavior: A Review Journal, 8, 205-234.
  • Marshall, W.L. (2005) Therapist Style in Sexual Offender Treatment: Influence on Indices of Change. Sexual Abuse: A Journal of Research and Treatment, 17, 109-116.
strategies for developing style
STRATEGIES FOR DEVELOPING STYLE
  • Video-monitoring
  • STICS
video monitoring example
Video Monitoring Example
  • SRSTC
    • Trained staff using role play
    • Videoed sessions
    • Supervisors reviewed samples of tapes and gave feedback
    • Process continued over two years
    • Clinical staff were divided into very experienced therapists and novices
  • Samples of tapes were scored by an independent rater against the Target Matrix
    • Each feature scored on a 0,1,2 scale (Absent; Sometimes; Usually)
target matrix for treatment style
Desirable Features

Warm

Directive

Systematic Reward

Balanced Participation

Socratic Qs

Undesirable Features

Collusive

Failure to Challenge

Confrontational

Hostile

TARGET MATRIX FOR TREATMENT STYLE
observations
Observations
  • Compliance in the first year was moderate
    • 70 – 75%
  • In the second year it improved significantly (p<0.006) to 84-85%
  • Still room for improvement
results for specific features
Results for Specific Features
  • Some negative features were virtually absent
    • Collusion
    • Hostility
    • Aggressive Confrontation
  • Only Warmth was reliably and completely present in the first year
  • Other positive features were only partly achieved in the first year
observations1
Observations
  • Improvement on some features
    • Failure to Challenge is less common now
    • Encouraging Balanced Participation more common
    • Use of Open Socratic Qs more common
  • Areas where there is still room for improvement
    • Systematic Use of Reward
    • Being Directive
    • Challenging more
  • Both novice and experienced therapists improved
stics
STICS
  • Program for training Supervising Officers to adopt an RNR supervision practice developed by Jim Bonta (read about it on the Public Safety Canada website)
stics skill maintenance
STICS Skill Maintenance
  • Three days of training is not enough for new learning to be maintained over a period of months so supplement by monthly small group meetings to discuss their use of STICS concepts and skills. These included
    • Practice exercises
    • Clinical supervision by teleconference
    • Review of audiotapes of sessions and feedback (oral/written)
  • One-day refresher course after 12 months
evaluation
Evaluation
  • Random assignment to STICS or Control
  • Session audiotapes
    • Prior to training
    • Soon after intake assessment
    • After 3 months supervision
    • After 6 months supervision
results1
Results
  • STICS trained officers
    • Focused more of sessions on criminogenic needs, especially procriminal attitudes
    • Higher quality use of RNR skills and techniques
    • Higher participation in technology transfer process was associated greater acquisition of skills and more focus on addressing criminogenic factors
    • Some loss of new approach over time
    • Diversity of response – some officers “got it” and maintained while others didn’t and returned to previous behavior
two year recidivism data
Two Year Recidivism Data
  • STICS Clients
    • 25%
  • Earlier clients of the same officers
    • 47%
  • Random Controls
    • 41%
analysis of individual responsiveness factors
Analysis of Individual Responsiveness Factors
  • This means understanding offender characteristics that may affect how individual offenders learn and respond
  • What follows is based on research with the WI SVP population
    • Almost all WI SVPs failed in DOC treatment programs so part of our process is identifying what blocked their earlier response to treatment
cognitive factors
Cognitive Factors
  • Patients whose response was impaired by cognitive factors
    • Overall low functioning (IQ etc around 60)
    • Working Memory and Processing Speed suppressed
    • Verbally fluent but poor fluid intelligence
    • Poor Verbal Skills but good fluid intelligence
      • Reading Disorder
some of these factors require accommodations but others can be remediated
Some of these factors require accommodations but others can be remediated
  • Poor reading is typically the joint product of interrupted or poor education and poor processing of phonemes
  • Both these can be effectively addressed, even for adults
  • This produces a profound change in the nature of the world the person inhabits
psychopathy related tifs
Psychopathy-Related TIFs
  • Tx Process
    • Teach to recognize and call each other on TIFs
    • Teach to recognize TIFs in self and intervene
    • Develop / Reinforce display of Target Factors
  • Based on
    • Thornton, D. & Blud. L. (2006). The influence of psychopathic traits on response to treatment. H.F. Hervé & J. Yuille (Eds.). (2006). The Psychopath: Theory, Research, and Practice . Lawrence Erlbaum Associates.
observed tifs associated with psychopathy
Observed TIFs associated with Psychopathy
  • Compared clinician’s ratings of treatment behaviors of patients in the higher psychopathy track (CT) to ratings of treatment behaviors of patients in the track for less psychopathic patients (Conventional)
content covered by superficial engagement with treatment scale
Content covered by Superficial Engagement with Treatment Scale
    • Using emotional displays to manipulate people
    • Lying
    • Failure to follow through on commitments
    • Playing dumb
    • Not interested in others’ perspectives
    • Attention seeking
    • Agreeing without meaning it
  • 16 items gave Alpha Reliability = 0.9
topics covered by oppositional scale
Topics covered by Oppositional Scale
    • Disrespect for Authority Figures
    • Oppositional Reactions to Directions
    • Fears others having control over him
    • Manipulates to recover lost control
    • Avoids being held accountable by shifting blame
    • Belligerence
  • 8 items gave an Alpha Reliability = 0.91
topics covered by poor motivation scale
Topics covered by Poor Motivation Scale
    • Self-satisfaction: sees no need for significant change
    • Low Motivation
    • Inconsistent Motivation
  • 3 Items gave Alpha Reliability of 0.75
shallow engagement with treatment
Shallow Engagement with Treatment

Treatment providers rate CT patients as showing engagement with treatment that is significantly more shallow than that of patients from the Conventional track (p<0.009).

In contrast there was little difference in patients’ self report of their treatment engagement.

oppositional reactions
Oppositional Reactions

CT patients were rated as significantly (p<0.001) more oppositional than Conventional patients.

Patients from the two tracks self-reported similar levels of Oppositional Reactions

poor motivation
Poor Motivation

CT patients were rated as showing significantly (0.028) poorer motivation than Conventional track patients.

CT and Conventional track self-reported similar levels of motivation

independent evaluation
Independent Evaluation
  • An independent evaluation by Leslie Harkins of the University of Birmingham found that
    • Early in treatment groups for the more psychopathic offenders showed markedly less group cohesion than groups for the less psychopathic offenders
    • By Phase Two of the program this difference had gone away with the more psychopathic groups attaining the same level of cohesion as other patients
how past deviance is understood metaphors beliefs
How past deviance is understood: Metaphors & Beliefs
  • Identity
  • Entity vs. Incremental Theory
the core issue here
The core issue here
  • Is developing an understanding of the factors that led to past offending that
    • Enables you to identify something appropriate to work on
    • Makes it plausible to you that you can (or have) changed)
identity
Identity
  • Condemnation vs. Redemption Script
    • This was examined earlier
    • The Redemption Script attributes past deviance to situation and/or changeable factors while attributing current behavior to internal and changeable factors
    • The Condemnation Script attributes past and future deviance to unchangeable internal factors
  • This model makes sense of the finding (Knight & Thornton, 2007) that among higher risk offenders taking responsibility for past deviance is associated with increased recidivism while denial of responsibility is protective.
entity vs incremental theories
Entity vs. Incremental Theories
  • This model was developed for understanding the effect of children’s implicit theories of intelligence on their response to task-failure.
  • It was then shown to apply to many other social traits
two theories about intelligence
Two Theories about Intelligence
  • Entity Theory
    • Intelligence is fixed and unchangeable
  • Incremental Theory
    • Intelligence is a changeable quality that can be developed
  • These theories lead to different responses to challenges and setbacks
consequences of different theories of intelligence
Incremental TheoryConsequences of Different Theories of Intelligence
  • Focus: Do I have enough ability to do this?
  • Belief: Effort is futile
  • Attributes failure to insufficient ability
  • Responds to setbacks with Helpless strategies (stop trying or persist with ineffective learning strategy)
  • Focus: How do I learn to do this better?
  • Belief: Effort is useful
  • Attributes failure to insufficient effort
  • Responds to setbacks with Mastery strategies (Try harder or try a different learning strategy)

Entity Theory

results2
Results
  • Similar Math achievement at start of 7th grade
  • By the Spring of the 8th grade the children holding an Incremental theory had developed significantly higher Math scores
  • Note this population was overall relatively high achieving to start with
intervention
Intervention
  • Taught the Incremental Theory to 7th grade children with relatively low initial achievement, compared their later Math achievement to that of control group children who were taught about memory strategies instead.
results3
Results
  • Prior to the intervention both Experimental and Control children had been showing falling grades
  • Children taught the Incremental Theory showed increased classroom effort and their grades stopped falling and improved slightly
  • Children taught the memory tricks continued to show a further deterioration in grades
slide217

So differences in the Implicit Theories (Schema) children hold can profoundly impact how they function in response to challenges posed by their environment

  • What would an Entity Theory or an Incremental Theory of sexual deviance look like?
  • What implication would holding this theory have for engagement in treatment>