Friday, May 26, 2017

Risk Assessment Promise and Peril: The Colorado Experience

By David S. Prescott, LICSW


The state of Colorado has long been at the forefront of attempts to develop effective methods for coming to terms with the risks posed by people who have sexually abused. In the days when each county or jurisdiction seemed to have different approaches, Colorado implemented the Containment Model. When there were no actuarial measures or other tools for structured professional judgment for grounding assessments, the Colorado Sex Offender Management Board (SOMB) assembled a list of 17 factors, which are a focus of the study below. For purposes of the study, these 17 items are treated as an alternative assessment measure, which was apparently not the original intention, although many evaluators have doubtless treated them as such. For its part, the SOMB is well aware that these 17 items are no longer the final word in assessments, even as they still receive consideration.

It seems important to note this background context, as Colorado’s efforts have indeed been pioneering over the years. In retrospect, it can seem easy to criticize the pioneering developments of groups of professionals. However, it should not be forgotten that when knowledge was scarce and approaches to sex crime resembled the Tower of Babel across the US, Colorado was among the first to develop approaches that numerous other states have emulated. Just the same, there is much we can learn from the study of these approaches, which is the subject of this blog.

The Research

An Online-First study by Katharine McCallum, Marcus Boccaccini, and Claire Bryson in the journal Criminal Justice and Behavior, offers fresh insight into the practical application of risk assessment research. The abstract describes their findings succinctly:

In Colorado, evaluators conducting sex offender risk assessments are required to assess 17 risk factors specified by the state’s Sex Offender Management Board (SOMB), in addition to scoring actuarial risk assessment instruments. This study examined the association between instrument scores, the 17 SOMB risk factors, and evaluator opinions concerning risk and need for containment in 302 Colorado cases. Evaluators’ ratings of risk indicated by noninstrument factors were often higher than their ratings of risk indicated by instrument results, but only their ratings of noninstrument factors were independently predictive of containment recommendations. Several of the most influential noninstrument factors (e.g., denial, treatment motivation) have been described by researchers as potentially misleading because they are not predictive of future offending. Findings highlight the need for more studies examining the validity of what risk assessment evaluators actually do, as opposed to what researchers think they should do.

This is not the first study finding that professionals often over-estimate risk across a range of conditions. The authors provide an eye-opening literature review, and Dr. Boccaccini has elsewhere found that the results of evaluations are often swayed according to who is paying for the service. For a context in which evaluators consider 17 items originally developed by the SOMB as a part of their evaluations over and above the far more scientifically proven actuarial measures, it is not surprising that evaluators would give extra weight to the SOMB measure and the items within it. In reading the study, several points become clear:

First, the evaluators in Colorado seem to face a difficult assignment, having historically assessed risk using items shown in research to have no predictive utility. What is the evidence-based assessor to do? Among the most heavily weighted items in the SOMB measure are defensiveness, psychopathology, and level of empathy, which are famously not associated with risk (and therefore with summary risk ratings), but are very likely strong responsivity factors to consider. This leads to questions as to what kinds of risk is actually being assessed, risk for sexual re-offense or risk for problematic adjustment to the conditions of community supervision. If it is the latter, perhaps the findings in this study might be more understandable – even appropriate – if the SOMB tool became more of a measure of risk, need, and responsivity? In this way, risk for sexual re-offense would be evaluated as a first hurdle, with treatment needs and the ability of the examinee to respond to treatment as the second and third hurdles of a more comprehensive assessment.  Whatever the case, this study suggests that many evaluators were not pursuing evidence-based approaches in making recommendations related to detention; this should be of concern to anyone interested in effective policy and human rights.

Adding to the complexity of the task, many of the SOMB items most considered in evaluations seem to overlap with items in actuarial scales such as Static-99r, the VRAG, and SORAG. Examples include criminal history, offense history and victim choice, and the nature of the person’s social support system. All of these lead to questions about conceptual double-dipping; how many times does one review criminal history before assessment results become skewed?

At the risk of appearing to be a Pollyanna, it is at least encouraging to see as much use of empirically validated measures as there is. It wasn’t that long ago that risk was assessed with little structure in the process and low accountability for the examiner (e.g., even including the physical attractiveness of the examinee). Although these findings point to much hard work ahead for professionals and policymakers alike, we can at least take heart that our methods have improved in many jurisdictions.

Just the same, the apparent conflation of responsivity and risk factors should cause any professional or lawmaker to be concerned. This comes along with the persistent overestimation of risk, and the means by which conclusions take shape. Further, as Boccaccini’s other research has shown, biases can enter the assessment process through any number of ways, whether explicitly or beyond the awareness of the examiner. This study reminds us that, for all of the rich scientific evidence at our disposal, we are still human beings, subject to being judgmental, opinionated, and biased.

Extending this last point further, one of the most interesting findings in this study was also one of the least explored. In the authors’ words: “In the current study, evaluator differences accounted for 8% of the variance in SOMB summarized risk ratings and 21% of the variance in summarized actuarial risk ratings” (p. 13). In other words, who the evaluator is can be a highly variable part of the equation. For all of our attempts to – and bluster about – the importance of impartiality, we have yet to reach the goal of remaining objective. In some cases, this may be an artifact of using relatively vague items. In other words, evaluator bias may even be akin to the famous country song: “Ya gotta dance with the one that brung ya.”

Final Implications

Reviewing both the study and the Colorado experience itself brought to mind a number of important reminders:

-          First, although these findings echo related findings elsewhere, it is still a single study
-         Second, it is always important to keep in mind that our best measures and best policies are always subject to bias at the hands of the individuals involved. Our ultimate work should be in the direction of professional self-development and consistency across groups of professionals.

Friday, May 19, 2017

Q & A with Christina Mancini entitled "Sexual Assault in the Ivory Tower: Public Opinion on University Accountability and Mandatory Reporting"

Mancini, C., Pickett, J. T., Call, C., McDougle, R. D., Brubaker, S. J., & Brownstein, H. H. (2017). Sexual Assault in the Ivory Tower: Public Opinion on University Accountability and Mandatory Reporting. Sexual Abuse: A Journal of Research and Treatment.

Highly publicized college sex crimes have recently captured public and policy attention. In response, greater discussion has turned to institutional accountability and controversial reforms such as mandatory reporting (MR). No study to date has measured public perceptions of campus sex assault procedures, however. This omission is notable because public opinion can directly and indirectly shape crime policy and because the topic has become increasingly politicized. Drawing on a 2015 poll of Virginia residents, this study evaluates views about campus sexual assault policy. Results indicate that two thirds of the public feel universities can effectively respond to sex crime and a large majority favors MR. Some differences in public opinion are evident. Research and policy implications are discussed.

Could you talk us through where the idea for the research came from?

The motivation of the study was to explore public attitudes toward a sensitive and increasingly politicized topic concerning sex crime, that is, perceptions of campus sex assault (CSA) policy in the U.S.  Our primary focus was on mandatory reporting and accountability views given growing public concern about how institutions of higher education (IHEs) are addressing and responding to CSA.  CSA affects everyone, not just those attending a college or university. IHEs are funded in part by public dollars and for that reason and others, the public would seem to be an important stakeholder in discussions and debates about how best to protect students and the campus community from sex crime.

We were fortunate to have access to a recent poll at the time, the Virginia Commonwealth University’s Commonwealth Education Poll conducted by the Wilder School of Government and Public Affairs in 2015.  The statewide survey included questions concerning resident support for MR and perceptions about CSA and accountability.  Virginia is one of the first states to adopt an MR policy and so it was a natural starting point for us.  Under the law, “responsible employees” at any public IHE (faculty, administrators) are required to report allegations that are disclosed to them to the university’s Title IX Coordinator.  From that point, the Coordinator, in consultation with a committee of the university community, determines if the allegation is serious enough to report to local law enforcement.  In such cases, victims are contacted by either the Title IX Office and/or law enforcement.  The law is controversial because some opponents view it as paternalistic as it reduces victim autonomy in reporting.  Others worry that is will divert valuable law enforcement resources for claims that are potentially falsified (e.g., say a student “discloses” sexual assault in a creative writing class assignment but the allegation is false) or unsubstantiated.

An overwhelming majority of the public, over 90 percent, in our study approved of Mandatory Reporting.  Factors associated with Mandatory Reporting support include believing in accountability, that institutions can reduce rape among students, and also, older age.  Less agreement surrounded the perception that university policy significantly reduces CSA.  Approximately two thirds of the public agreed that administrative action would reduce sexual assault among students.  The characteristics that influenced this perception of accountability included holding the belief that universities are generally unsafe places, higher education, and Democratic political ideology.

What kinds of challenges did you face throughout the process?

The greatest challenge was defending the scope and goal of the project.  All too often, there is a devaluing of public opinion research.  “Why care what the public thinks?”  “The public is ignorant.”  These statements illustrate the disdain I have run across in pursuing this strand of scholarship in academic circles.  Even colloquially, I have heard my students or others claim, “I don’t care what people think.”  But I would counter that as criminologists, we MUST care, we MUST measure, we MUST track perceptions, views, attitudes, and knowledge among the public.  Public perceptions, yes, are difficult to capture, but if we extended that logic to our subject matter, we would be out of business.  I would argue that public opinion research is no more elusive or less deserving of attention than tracking trends in sexual assault, evaluating the efficacy of treatment and intervention, or examining the criminal justice response to sexual offending.  Public views, for better or worse, matter in the creation of sex crime policy. 

Off the soap box for now, but the skepticism toward public opinion research was the major substantive challenge we ran across.  Our hope, to some small extent, is that we have made the case for why we MUST give serious empirical attention to a scholarly topic that is often ignored.

Of course, like other research, our focus could be further explored and refined.  We were challenged by some of the survey items which were general indicators of views about Mandatory Reporting and accountability, and also by the limited predictors of perceptions available in the poll.  The data were also from a single state and findings are not necessarily generalizable to national trends.  But challenges represent future opportunities, no?

What do you believe to be to be the main things that you have learnt about campus sexual assault?

The main contribution is that the public supports various efforts and measures to better respond to CSA.  Few divides in public attitudes toward Mandatory Reporting and accountability were evident.  Having said that, some members of the public held different perspectives concerning the law and administrative action.  These divides are deserving of additional examination.

Now that you’ve published the article, what are some implications for practitioners?

A policy lesson here is that the public appears concerned about CSA.  When do 90%+ of the public EVER agree on a controversial policy like Mandatory Reporting?  This large consensus, admittedly less so for accountability perceptions, suggests that administrators and policymakers consider efforts to engage the public in discussions and debates about CSA, particularly when it affects publicly-funded institutions. 

Christina Mancini, Ph.D.

Friday, May 12, 2017

Evidence-based practice for juveniles in 2017

For those of us who treat juveniles with sustained sexual offenses (JWSSO) a challenge is to identify the best methods. One common approach is to develop your own curriculum through trial and error, and good judgment, and find out what works for your clients and setting. These types of curricula are often "one-of-a-kind" developed locally, not using an existing model. I know numerous examples of these "Homebrewed" models that appear to be successful, and staff and client friendly.
This "Homebrewed" approach now is operating in an environment where an alternative, and possibly competing approach is Evidence-based Practice (EBP). The logic of the EBP approach is that resources are finite, and treatment models which are validated by appropriate research methods are the best choice. As I noted in an article (Ralph, 2012), this approach was delineated by Cochran and others. It was adopted by national organizations such as the Institute of Medicine, the American Psychological Association, and the Association for the Treatment of Sexual Abusers. Many county probation departments now require the use of EBP for programs they will fund.
A significant issue is what constitutes EBP? And can EBP be reconciled with the "Homebrewed" approach that appears to produce good outcomes? I noted (Ralph, 2012) there are several approaches to defining EBP. The traditional approach classifies treatment methods in terms of their research basis. The California Evidence-based Clearinghouse for Child Welfare (CEB4CW, 2012) developed one definition derived from the Institute of Medicine (2001), who defined EBP as: (1) best research evidence, (2) best clinical experience, and (3) consistent with patient values. CEB4CW's highest level of evidence for programs was described as, "Well-Supported by Research Evidence" which involved in part at least two randomized controlled trials published in peer-reviewed journals, documented in manualized form, and effective beyond a year. Only one program met those criteria for JWSSO, Multisystemic Therapy (MST) (Borduin, Schaffer, and Heiblum, 2009). Practically it is viewed as not a viable option for many counties because of the expense, extensive staff training, and supervision required. Also it was designed for high risk populations, where most JWSSO youth now are viewed as having relatively low risk (Caldwell, 2016).
Are there viable alternatives to the CEB4CW model and similar approaches? The most comprehensive research is regarding the general juvenile probation population, of which JWSSO is a subset. Dr. Lipsey at Vanderbilt University, and his colleagues, have carried out research using meta-analytic procedures (Lipsey, 2009). Their approach identified several factors connected with positive outcomes for programming for juveniles on probation. Notably they found positive outcomes, not only in "Namebrand" programs like MST, but also "Homebrew" or generic programs. Lipsey's group believes that an exclusive focus on methods with randomized trials, or other approaches using "Namebrand" programs, may leave out consideration of "Homebrewed" programs which may be of good quality, effective, and low cost. The importance of implementing programs with fidelity has been subsequently validated (Goense, Assink, Stams, Boendermaker, and Hoeve, 2016). Using Lipsey's research, and other studies, a list of program characteristics associated with positive outcomes, can be delineated. I will refer to this approach as Evidence-based Program Characteristics (EBPC) which can be described as follows:
 1. The risk level and needs of the target population is assessed using reliable measures.
2. A treatment approach addresses the risk level and needs of the target population, and  includes a sufficient amount of treatment to be effective.
3. The treatment approach uses social skill building, problem-solving, and counseling approaches.
4. The treatment method is manualized to reliably administer it.
5. Training and supervision is given regarding fidelity to the method.
6. Fidelity checks are "baked in" in and part of implementation of the method.
7. Reliable outcome pre/post measures are used to assess treatment effectiveness.
The opinion of the Lipsey group is these types of criteria are associated with a positive treatment effect.
While Lipsey's (2009) research is on the general juvenile probation population, what is evidence for JWSSO treatment? The best summary of existing research is by Reitzel and Carbonnel (2006). Every study in their research had a positive effect. While it was expected from previous studies that cognitive-behavioral programs would be more effective, also many locally developed "Homebrew" models also were. Kim, Benekos and Merlo (2015) studied the effect size of treatments for juvenile and adult sexual offending for reducing recidivism using meta-analysis of meta-analysis studies. They identified a medium effect size for adolescent programs, -.51.
Given the above findings, what are rational choices for the average county? The Reitzel and Carbonnel (2006), and Kim, Benekos and Merlo (2015) studies gives us cautious confidence that well designed studies, can show good outcomes. Likewise, if programs are implemented consistent with the criteria described above, can they be considered comparable to "Name brand" programs? I would tentatively assert this is correct. If these local "Homebrewed" programs also had conducted simple pre/post test studies showing effectiveness, and demonstrated low levels of recidivism compared to baselines, this would further strengthen the case for their appropriateness. Further, if they could also use experimental or quasi-experimental designs to assess outcomes, this would also help validate effectiveness.
This model for EBP, EBPC, is a reasonable approach for decision-making regarding JWSSO programs. While EBP may be seen as a competitor to "Homebrew" programs, these approaches may in fact be complementary if the approach described above is used to design those programs.
Norbert Ralph, Ph.D.
California Evidence-based Clearinghouse for Child Welfare. (2012). Scientific Rating Scale. Retrieved 6/1/12 from
Borduin, C. M., Schaeffer, C. M., & Heiblum, N. (2009). A randomized clinical trial of multsystemic therapy with juvenile sexual offenders: Effects of youth social ecology and criminal activity. Journal of Consulting & Clinical Psychology, 77, 26 - 37.
Caldwell, M. F. (2016). Quantifying the Decline in Juvenile Sexual Recidivism Rates. Psychology, Public Policy, and Law. Advance online publication.
Goense, P. B., Assink, M., Stams, G. J., Boendermaker, L., & Hoeve, M. (2016). Making ‘what works’ work: A meta-analytic study of the effect of treatment integrity on outcomes of evidence-based interventions for juveniles with antisocial behavior. Aggression and Violent Behavior, 31, 106-115.
Institute of Medicine. (2001). Crossing the quality chasm: A new health system for the 21st century. Washington, DC: National Academy Press.
Kim, B., Benekos, P., & Merlo, A. (2015). Sex offender Recidivism revisited: Review of recent Meta-analyses on the effects of sex offender treatment. Trauma, Violence & Abuse, 17(1), 105–17.
Lipsey, M. W. (2009). The primary factors that characterize effective interventions with juvenile offenders: A meta-analytic overview. Victims and Offenders, 4, 124-147.
Ralph, N. (2012). Evidence-based practice with juveniles. ATSA Forum, XXIV(3).
Reitzel, L.R., & Carbonell, J.L. (2006). The effectiveness of sexual offender treatment for juveniles as measured by recidivism: A meta-analysis. Sexual Abuse, 18, 401–421.

Friday, May 5, 2017

Cross border management of serious sexual and violent offenders

The ever increasing expansion of travel and the relocation of citizens for employment has resulted in vast movements of persons across the globe.  As people move so does crime, both organised crime penetrating across borders, but also the single transient offender seeking crime opportunities, the avoidance of regulations and management, and escape from stigma and surveillance at home.  A recent project completed for the European Union examined current issues and potential solutions for effective information exchange and management of serious sexual or violent offenders who move across EU borders.  Significant issues are presented by this group, not least because different EU states have differing risk assessment procedures, and differing categorisations of such offenders.  A number of Member States do not particularly identify such offenders, and in some Member States they are not subject to post sentences licences or sex offender registration.  This means in effect, that such persons are free to move across the EU without their Home Member State knowing where they are going, and can enter countries appearing as a ‘clean sheet’, with no notification to the receiving state about previous offences and current risks.  This has resulted in a number of tragic cases where EU nationals with significant previous convictions have re-offended seriously in the country they enter (e.g. Marek Harcar and the murder of Moira Jones in Scotland; or Robert M and the commission of 67 counts of rape of a minor in the Netherlands).

How can this situation be improved so that citizens are better protected? Firstly, it is possible to notify Member States about convictions. ECRIS (European Criminal Records Information System) can be used to notify a home state if a national commits a crime in another state (for example whilst on holiday or in employment).  This notification means the conviction can be known and appear on their record should they again come to notice at home.  For sexual offenders engaging in ‘sexual tourism’ this can be important to later risk assessments and court appearances.  Previous convictions can be requested on foreign nationals from their home state, again significant for accurate risk assessment, and critical for court appearances.  In terms of prevention, information can be exchanged via police personnel in Europol with designated officers passing information back to Member States, or by probation services.  This can be done even if a sentence has been completed, so long as the risk justifies it, and the exchange occurs in order to prevent crime.  A common approach to risk is required to facilitate such exchanges across a range of jurisdictions, and guidance with relevant templates can be found at:   An overview of the information exchange mechanisms can also be found at:

Data protection, confidentiality and privacy laws are often presented as barriers to effective information exchange in the European arena. However, there is a presumption for exchange if it is to prevent crime, and the potential harm and the vulnerability of victims (often children) can outweigh rights to privacy.  Practitioners should justify their decisions to disclose with reference to well evidenced risk assessments and that such a disclosure is necessary to the effective management of the person.  Further information can be found at:

Professor Hazel Kemshall (De Montfort University, UK) and Sarah Hilder, Ph.D., (Nottingham Trent University, UK).

For further information contact:

Additional references:

ECRIS (European Criminal Records Information System)

EU (2017) Combating sexual abuse of children Directive 2011/93/EU. European Implementation Assessment.

Friday, April 28, 2017

Communication and collaboration in sexual abuse working

Over the last couple of months, we have participated in conferences, meetings and collaborations in our home regions of the UK and US as well as abroad (Netherlands, Latvia, Australia, Canada, Germany, Romania, Namibia); a central theme in each location has been that collaboration is the key to working in the field of sexual abuse. We have been amazed by how this most simple aspect of our work is often the most challenging; one would think that something as simple as collaboration would be easy to achieve, but this is not always the case!

Despite our field’s progress with assessment and treatment technology, we are all still human beings for whom miscommunication can come quite naturally. Collaboration may be the most important tool we have, and perhaps the least expensive, and yet it is highly dependent on the capacities and interpersonal skills of those who engage in it. Sometimes, we forget to simply pick up the phone and contact people.

Collaboration is vital: we work in consistently changing environments with practical challenges and related issues. For instance, in the multi-disciplinary/multi-agency UK, some current issues are:

-          The introduction of new sex offender treatment programmes in the UK known as the Kaizen  (a replacement treatment program for high or very high risk sex offenders) and Horizon (a replacement treatment program for medium risk sex offenders) roll out.

-          Upcoming Brexit negotiations and the impact upon movement, sentencing and punishment of sexual offenders – especially monitoring and data sharing.

-          An ongoing conversation about how to respond to increasing numbers of online offenders entering the Criminal Justice System.

-          Evolving sex education and sexual abuse safeguarding in schools.

-          Changes to the funding of state services, like probation, and the impact that this has on the management of offenders.

However, these are not only UK issues. Other countries have these issues and more, including:

-          Differences within the same country on viability of using the same sex offender risk assessment scales (USA and elsewhere)

-          Getting different organisations, especially within the public health system, to work effectively together (Latvia and many Eastern European Countries)

-          Getting criminal justice systems interested in providing treatment to people who have abused in the first place, when moral and religious beliefs can interfere with developing an empirically sound understanding of these individuals (Eastern Europe and elsewhere).

-          Ensuring that agencies that can disseminate information that can aid in the prevention of sexual abuse and sexually transmitted infections actually reach their target audiences (Namibia and elsewhere). 

All of these situations reflect a lack of professional collaboration. Often, they reflect the disagreements in the processes and practices of sexual offended management which can lead to poor practice and bad policy. Sometimes they reflect the strong beliefs – even egos – of those involved. We often say that we collaborate with others, but our practices, organisations, and/or tasks can get in the way of this. We are sure that we are not alone in having attended meetings that trumpet good collaborative working, but nothing gets carried forward as no-one is really listening.  This is frustrating (and a possible compromise of public health and safety) because a lot of these issues are well within our sphere of influence to change through better, more honest, and more open communication, as well as collaboration. By working together in a more constructive, multi-faceted, multi-disciplinary we can reduce sex offending, improve risk management, improve public protection and improve the prevention of sexual abuse in the first instance… but it begins with us. So how should we do this?

-          Communication with other professionals, the public, policy makers and the media. Always leave the door open and be willing to have the conversation from a place of wanting to learn, not a place of seeking confirmation of your practices.

-          Actively check in with others and cultivate an openness to feedback.

-          Always share good practice with others, do not be covetous of your only good practice. If something works, share.

-          Debate bad/poor practice within your own work and in the projects that you are working within; don’t be afraid to say that something is not working and needs to change. If there is anything we have learned from recent worldwide elections it’s that we are not as effective at changing our minds in the face of evidence as we think.

-          Collaborate with other related individuals within the field; this will lead to a multi-disciplinary approach that will improve the situation of everyone.

-          Never, ever forget the importance of developing and maintaining professional relationships. As they say in David’s agency, a little love can go a long way.

Kieran McCartan, PhD, and David Prescott, LISCW.

Monday, April 24, 2017

The 2017 ATSA Adolescent Practice Guidelines

The ATSA Adolescent Practice Guidelines (APG) has finally been published!  The APG addresses the expected areas of best practices, but also offers progressive perspectives on many related issues.  To obtain a copy of the 85-page 2017 APG, please see the end of this blog.  

Sexual offending by teenagers, as a class, is materially different from adults.  The APG boldly addresses these differences, proficiently noting distinctions of adolescence, understanding youthful etiologies of sexual violations, and offering cogent recommendations for sound assessments and appropriate treatment.  Such discernments are essential for systemic integrity in managing responsible interventions and successful recovery for teenagers and their families

Tom Leversee and Jacque Page co-chaired the committee that developed the APG.  Because Tom was invited to co-author this blog and it would be unseemly for him to gush about the excellent product that was crafted by the APG team, Tom’s comments are deliberately separated from the discussion by SAJRT blogger, Jon Brandt.  Tom writes…
In addition to Tom and Jacque, the Adolescent Practice Guidelines were primarily authored by a committee that included Kevin Creeden, Elizabeth Letourneau, Sue Righthand, and Daniel Rothman. The revision and final approval process involved the ATSA Board and a response period for ATSA membership.  Maia Christopher provided her unwavering support, persistence, and guidance. 

The APG integrates a historical context, unique features of the adolescent population, empirical underpinnings, and foundational concerns.  The APG addresses interventions including Assessment, Treatment, Special Populations, and Policy considerations. 

A historical review of the treatment and supervision of those who have sexually offended reveals how policies and practices for adults gradually migrated into the juvenile system.  A survey of policies and practices in various jurisdictions, agencies, and individual practitioners would surely find that vestiges of adult models continue to impact the adolescent field.  The inclusion of a Policy section notes that the application of adult policies to adolescents is not only ineffective at reducing the low base rate for sexual recidivism, but comes with unintended consequences that can produce more harm than good. 

The APG seeks to further reverse this historical trend by offering an empirically grounded, caregiver-involved, developmentally appropriate approach for addressing abusive sexual behavior with adolescents.  This includes an emphasis on the social ecology in which adolescents reside and on the importance of therapeutic relationships.  Effective practices and policies reflect the heterogeneity that has been found in the research and the need for comprehensive assessments and individualized treatment plans.  Four fundamental aspects of effective public policy for adolescents are offered.

The enthusiastic response to the workshop on the APG that Jacque and I presented at the 2016 ATSA conference in Orlando suggests an excitement that goes beyond individual practitioners and programs.  Workshop participants spoke of a desire to utilize the APG to educate important participants, including probation and parole officers, human services caseworkers, attorneys, and judges.  Many have expressed the hope that the APG will not only be utilized to inform significant change in clinical practice and policy, but to inform legislation.  Meaningful change will require effective collaboration between a broad range of interdisciplinary stakeholders.
The APG sensibly expects assessments to be empirically informed, and logically expects treatment to be “assessment informed.”  The APG points to the Risk-Need-Responsivity model as the gold-standard for guiding assessments and treatment.   With a 3% base-rate for sexual recidivism, as a practical matter, nearly all juvenile offenders are at low risk for sexually reoffending.  Therefore, exploring Needs and Responsivity may be vastly more beneficial than diligently trying to micromanage Risk.  The APG correctly notes that general delinquency correlates with sexual offending and therefore certain dynamic risk factors may be valid targets for treatment.

With the backdrop of sexual safety, personal accountability, and social justice, the APG supports the principles of Good Lives, positive psychology, and building on protective factors.  It encourages a pro-social, holistic reconciliation of individual needs, aspirations, human agency, family involvement, and community support – a synergistic milieu within which young clients can recover and prosper.

The APG confidently weighs-in on many competing concerns and perplexing controversies. It also acknowledges that some complex issues cannot be resolved by science alone.  Therein lies the intersecting domains of clinical judgement and professional ethics.  Being mindful of the involuntary nature of clients, and the value of well-informed assessments, the APG discusses many concerns that are ethically tinged, including: being part of a team intervention, managing unprivileged communication, determining when an assessment or treatment are (not) indicated, acknowledging the limitations of forensic psychology, challenging unwarranted legal interventions or sanctions, avoiding unnecessary conditions or undue burdens on clients, promoting least-restrictive placements, and supporting least-intrusive methods.  The APG, with participation from the ATSA Board, recommends against the use of the polygraph and PPG for clients under 18.*

With an eye on standards for practitioners, the APG expects clinicians to be qualified and technically skilled.  But it also wants clinicians to recognize that the therapeutic relationship is not only central to inspiring motivation and hope for recovery, but that it might be a therapist’s greatest asset.  The APG bravely comments on how unwarranted social controls and misguided policies may interfere with rehabilitation efforts.  The final section suggests that engaged practitioners can help to inform colleagues, mediate public policies, and perhaps intercede on behalf of clients.  Public safety is a systemic concern, and many stakeholders participate in reducing recidivism, but the clinician may be uniquely positioned to not only guide clients through recovery but to advocate for their well-being.

Journal articles and text books are vital conveyances of knowledge that help to build a sound framework for practicing in our field, but best practices depend on the skilled, ethical applications of knowledge, experience, and the ‘professional self,’ uniquely applied to each client.  The 2017 Adolescent Practice Guidelines is a compendium of wisdom.  Potentially, it will help good practitioners become great clinicians, and interventions with adolescents will be more empirically rich and ethically sound.

Jon Brandt, MSW, LICSW
Tom Leversee, LCSW

*Note: these and other controversial areas of juvenile practices are topics for future SAJRT blogs.

The Adolescent Practice Guidelines is available free to ATSA members by logging into the Member’s Page.  When the APG is available for purchase by non-members, information will be posted here. 

Thursday, April 13, 2017

Risk and those who experience harm

A friend of one of the authors was a forensic psychologist in a European country and gave permission to share her story. The short version is that she was on her way to meet her son and took a shortcut through a park. There, she was raped by a stranger. It was a nasty assault that could have ended much worse due to a health condition. Thanks to her quick thinking and smartphone, her son helped the police to apprehend the person before he left the park. He apparently had a lengthy criminal record, including similar assaults. There is little question that he was a high-risk, high-velocity person in need of outside forces to stop him.

To hear her tell the story, it seems that the most devastating effects of this life-threatening experience actually occurred in its aftermath. The nature of the local police department, and her work at the intersection of law and psychology, meant that all of her colleagues had access to every detail of her experience, and were unafraid to express judgment about her circumstances. This serious breach of privacy was a primary motivator in her leaving her country and relocating elsewhere. Once resettled, her primary concerns for getting on with her life typically had more to do with her children and pets. Any lingering bitterness had more to do with the response from the legal system than the assault itself. It’s quite possible that the presence and actions of her son prevented years of more serious problems. 

On the other hand, a pioneer in the field of prevention (no longer active) used to publicly describe how her father molested her growing up, and the devastating after-effects that lasted across the rest of her life. She was a force of nature as she described how the only thing she ever wanted was for the abuse to end. As one might imagine, she had few places to go, and fewer people to whom she could turn to make her father stop. By all appearances, had her father come to the attention of the legal system, his risk would have been low in accordance with actuarial risk measures. For that matter, so would many famous people who have abused, including Jeffrey Dahmer, Jimmy Savile, and Jerry Sandusky; and yet the harm in their wake has been horrific. 

The narratives that we hear from people who have experienced sexual abuse reflects these experiences. Often we hear that they did not report as they felt that they would not be believed or that nothing would be done. Often, they believed that they type of abuse perpetrated, their relationship with the perpetrator or the context of the abuse [in their eyes or their beliefs around the perceptions others] mitigated the abuse. In some cases, people don’t report because they are afraid that it will lead someone to cause harm to the person who abused. All of this highlights the complexity in experiencing and living with sexual abuse, especially if the individuals involved are in close proximity to each other and therefore have to come into contact frequently; in that sense no risk is low risk to the victim, more a constant low-level trauma.

All too often, it seems that in our rush to improve risk classification, we also create an appearance of uncaring and benign neglect of the experiences of those who are abused. What is striking is how the harm of abuse was mitigated by family relationships in the first case and aggravated in the second. And yet from a purely risk-based perspective, the second case involved a lower-risk abuser.

This, in turn, creates terrible dilemmas. As the saying goes, bad cases can result in bad laws, and the authors certainly advocate for reserving the most intensive interventions who pose the highest risk. At the same time, however, our field creates risks of its own at those moments when we appear disconnected from the relational harm of trauma.

At a time when we advocate person-first language for people who have abused, it’s vital that we have the same consideration for those who have been harmed. Not everyone who has experienced abuse wishes to be called a “survivor” or “victim”. Taking this further, however, the above vignettes who how important it is that all professionals communicate in a way that demonstrates respect for all who have experienced sexual abuse, without creating the appearance of being dismissive of harm or of overstating risk for future abuse. In the end, skills for demonstrating respect, understanding, and effective communication are intertwined.

David Prescott, LISCW, and Kieran McCartan, Ph.D.