Violence by Youth in Norway. Recent Cases

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2 Violence by Youth in Norway Recent Cases 2

3 Youth Violence Understanding Risk factors Reasons Risk Reduction Primary / Early / Triage Secondary / Assessment / Comprehensive Risk Assessment Intervention and Management 3

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5 Interpersonal Peers and family Societal Bonds to community Risk Mental Health Personality dysfunction, substance use, mental illness Developmental Psychosocial maturity

6 Risk Factor Violence Risk Factor No Violence

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8 The proximal cause of violence (or any behaviour) is an intention, choice, or decision Decisions are: Goal-directed Planful Decisions need not be: Conscious Rational

9 What is the goal, the benefit, the reward? VS What is the cost, the risk, the deterrent?

10 Rewards vs costs Motivators Destabilizers Disinhibitors

11 Risk Factor Motivator Violence Destabilizer Disinhibitor

12 Control Change Status Esteem Gain Profit Release Expression Justice Honor Arousal Activity Defense Distance Perceived Reward Proximity Affiliation

13 Alienation Nihilism Lack of Insight Lack of Empathy Negative Self- Concept Lack of Anxiety Negative Attitudes Perceived Cost Lack of Guilt

14 Impaired Intellect Impaired Memory Disturbed Perception Impulsive Thinking Disturbed Attention Careful Decisions Inflexible Thinking

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16 Definition an enduring pattern of inner experience and behavior (that deviates markedly from the expectations of the culture of the individual who exhibits it ) Pervasive, chronic, and rigid Impacts everything! Behaviour Interpersonal relations Emotion and emotion regulation Cognition Perceptions of others

17 Charismatic individual whose deviant behavior is undeterred by ordinary pangs of conscience. Readily manipulates others or engages in risky behaviors designed to satisfy his/her own personal needs, with little concern about the consequences to others. Relationships tend to be shallow and transient. Often meanders from one opportunistic relationship or setting to another without much concern for the long term consequences. (Poythress et al., 2001)

18 Psychopathy Factor 1 Factor 2 Interpersonal/ Affective Social Deviance 1. Interpersonal 2. Affective 3. Lifestyle 4. Antisocial Superficial charm Lacks remorse/guilt Stimulation seeking Poor beh. controls Grandiose Shallow affect Parasitic lifestyle Early beh. problems Pathological Lying Callous/lack empathy Lacks goals Youth delinquency Manipulative No responsibility Impulsivity Fail cond. release Irresponsibility Criminal versatility

19 Risk Factor (Psychopathy) Need for dominance; desire for material gain (increased benefit) Motivator Violence Destabilizer Disinhibitor Empathy, guilt, anxiety deficits (decreased cost)

20 Arrogance Desire to exert power; dominate; belittle Unemotionality Unempathic; uncaring; callous; no understanding of others Impulsivity Sensation-seeking, failure to consider alternatives/options Antisociality Dangerous lifestyle, antisocial attitudes, antisocial associates

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22 Academia: The fledgling psychopath (Lynam) Law In R. v. G. (T.T.) (1997), the judge reasoned that while the youth seems shy and unassuming, he has a monster cloaked within him and that at at any time that monster may well come alive

23 psychopathy instruments inevitably also will be used to try to identify, weed out, and indefinitely lock up those youths who are too far along in their psychopathic development for treatment efforts to be worthwhile Seagrave and Grisso (2002, p. 235)

24 Psychopathy is a personality disorder Stable, enduring pattern When does personality crystallize? How stable are youth psychopathic traits? Aren t some psychopathic traits just normal adolescent characteristics? Best to talk of personality traits or features

25 Psychopathic features in youth associated with Crime and violence Substance use Risky behaviour Poor treatment participation / antagonism in treatment Poor school performance Affiliation with antisocial peers Gang membership Evidence of moderate stability into adulthood

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27 Is there anything you wouldn t do if the price were right? Do you regret having committed your crime? Do you think you are smarter than most other people? Are other people easy to take advantage of? Do you ever do this? Are you good at it? How many close friends do you have? What makes a close friend? Have you ever been in love? What do you love about your partner? How many different jobs have you had? Have you ever quit one without another one lined up? How do you feel when you commit a crime?

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29 Triage Management / Intervention Assessment

30 Does this person need an evaluation of risk for violence? Do they have any primary or secondary warning signs?

31 Physical violence Forceful physical contact Other physical contact Threatened violence Threatening acts Threatening statements Thoughts of violence Interest in or preoccupation with violence Desire or willingness to use violence Are any of these recent, escalating, or serious?

32 Primary warning signs? Y or P Recent, serious, or escalating? Y Positive N N P Negative Negative Possible

33 Health Problems Physical health problems Mental health problems Adjustment Problems Crisis in personal relationships Crisis in living situation Conduct Problems Disrespectful conduct Disruptive conduct Helps to determine urgency of response

34 Thoughts Harm Realistic, Explicit, Acute, Targeted, Studied of that are and

35 Involves preoccupation with violent ideas, fantasies, images, urges, or plans Especially if frequent, persistent, or intrusive

36 Involves serious injury to others Especially life-threatening injury

37 Is feasible or possible Especially if it demonstrates the capacity to carry out violence Knowledge Skills Experience

38 Is detailed and specific Especially if it demonstrates planning or forethought

39 Involves imminent harm Especially if unconditional

40 Threats involve identified victims Especially if they demonstrate access to or personal knowledge of victims

41 Involves planned or progressive action Especially if preliminary steps have already been taken

42 When Where Who What Why Reaction Date, time Location, context Perpetrator(s), victim(s), relationships Acts, attempts, consequences Motivations, precipitants, goals Remorse, empathy

43 Severity Chronicity Diversity Escalation Consequences Duration, frequency Nature, types Trajectory

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45 1 Gather information 2 Determine presence of risk factors 3 Determine relevance of risk factors 4 Develop formulation of violence risk 5 Develop scenarios of violence 6 Develop case management plans 7 Conclusory opinions

46 Why has the person done what they ve done? (Steps 1-4) What are you worried they will do in the future? (Step 5, 7) What are you and others going to do about it? (Step 6)

47 Repeat Any past violence, not just most recent Twist Change in motivation, victimology, behavior Escalation Lethal, lifethreatening, or worst case

48 Monitoring Treatment Supervision Victim Safety Planning Surveillance or repeated assessment Rehabilitation, including further assessment Imposition of controls or restriction of freedoms Enhancement of security resources for identifiable targets

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50 Principles of effective correctional treatment ( RNR ) Risk Need Responsivity

51 Adherence to RNR principles Social learning Behavioural principles (reinforcement, modeling, shaping) Cognitive skills training Problem solving, coping skills Anger management / stress inoculation Personal anger provocation hierarchy Education about anger, stress Self-monitoring of triggers, intensity, frequency Alternative responses, relaxation training

52 Attention to psychiatric factors Medication compliance training Therapist and staff factors Training in crisis de-escalation Warm, respectful, enthusiastic style Clear program rules Concrete, graded guidance through program Authoritative, not authoritarian

53 The more of the RNR principles followed, the greater the crime reduction The more criminogenic needs targeted, the greater the crime reduction Criminal recidivism reduced 25-50%

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55 Arrogance Unemotionality Impulsivity Dominance, suspiciousness, manipulativeness, failure to acknowledge adjustment problems Lack of prosocial peers, poor affective empathy, poor treatment alliance, lack of distress that motivates change Poor perseverance, prone to sudden change in lifestyle Antisociality Criminal lifestyle, criminal associates

56 Special Considerations: Treatment Does treatment make psychopaths worse? At least two studies have found this But poor studies, and poor treatment Psychopathic features associated with... Disruptive behaviour in treatment More treatment violations Shorter stay in treatment Lower effort in treatment Slower progress in treatment

57 N = 141 young male offenders, very high psychopathic traits 2 year follow-up Compared high-intensity treatment to treatment as usual CBT / Social Bonding 57

58 Less recidivism in intensive tx % Recidivism 3.3 times less likely to violently recidivate Decreased rate and seriousness of recidivism Intensive TAU 58

59 Focuses only on psychiatric factors Focus on non-criminogenic needs Get tough programs Boot camps; scared straight Must address dynamic (changeable) violence risk factors, as well as psychiatric factors, if mental illness is present

60 Violence is a result of a choice or decision Risk factors cause violence by influencing decisions, by Motivating: increasing the perceived reward Disinhibiting: decreasing the perceived cost Destabilizing: impairing careful thinking

61 Psychopathic features exert a strong influence on decisions and behaviour, elevating risk for violence and complicating risk reduction efforts Triage full assessment risk reduction Higher doses of risk reduction can reduce violence risk in high risk youth, including those with psychopathic features These youth need MORE of our attention, not less