Assessing Risk in ID Persons with Problem Sexual Behaviors Thomas Graves, M.S., M.Ed. Ed.D.(C), LPC
Risk of What? Sexual aggression Other sexual offense Nonsexual aggression Recidivism
What kinds of behavior? Sexual aggression Other sexual offense Nonsexual aggression Recidivism
So how are risk assessments used?
Characteristics* of Recidivists (Hanson & Brussiere, 1998) multiple victims diverse victims stranger victims juvenile sexual offenses multiple paraphilias history of abuse and neglect long-term separations from parents negative relationships with their mothers diagnosed antisocial personality disorder unemployed substance abuse problems chaotic, antisocial lifestyles *It should be noted that these are not necessarily risk factors.
Recidivist Characteristics (Hanson & Bussiere, 1998) DEMOGRAPHICS (consistent, but weak) young single CRIMINAL LIFESTYLE SEXUAL CRIMINAL HISTORY prior sex offenses * male victims * victimized strangers * extra-familial victims begun sexually offending at an early age * diverse sex crimes * non-contact offenses (Hanson, 2007) *
Recidivist Characteristics (Hanson & Bussiere, 1998, Hanson & Morton-Bourgon, 2007) SEXUAL DEVIANCY (strongest relationship) deviant sexual preferences * Children Paraphilias sexual interest in boys * sexual preoccupations * attitudes tolerant of sexual assault * intimacy deficits * Lack of stable love relationship Emotional identification w/ children * recidivist risk factors
Factors Unrelated to Sexual Recidivism Victim empathy Denial/minimization of sexual offense except low risk offenders, ex.: incest (Nunes, et al., 2007) Lack of motivation for treatment Internalizing psychological problems Anxiety, depression, low self-esteem Sexually abused as a child Sexual intrusiveness (e.g., intercourse) (Hanson & Morton-Bourgon, 2007)
Recidivism Rates
Risk Factors and Their Implications (Hanson & Harris, 1998; Hanson, 2006) Static: baseline risk Dynamic (changeable): Stable: treatment targets intimacy deficits deviant sexual preferences personality disorders (Antisocial) psychopathy (PCL-R) attitudes tolerant of sexual assault poor social supports poor self-management strategies difficulties cooperating w/ supervision androgen antagonists
Risk Factors and Their Implications (Hanson & Harris, 1998; Hanson, 2006) Acute: Warning when things could go wrong negative mood (anger, distress) intoxication victim access
History of Actuarial/Structured Clinical Risk Assessments SORA (1996): structured clinical RRASOR (1997): 4 item; empirical actuarial SVR-20 (1997): structured clinical; historical, dynamic (factors assoc w/ recidivism) SAC-J (1998): history, aggravating, current behavior/tx response MSOST-R (1998): static emp./concept.; prisoners in MN SORAG (1998): SO violence; static/dynamic, incl. unsupported STATIC-99 (1999): RRASOR+SAC-J Risk Matrix 2000 (2000): revised SAC-J; static, aggravating STABLE-2000 (2000): dynamic
History of Actuarial/Structured Clinical Risk Assessments ACUTE-2000 (2000): dynamic SONAR (2000/2002): dynamic-stable/acute VASOR (2001): static, dynamic, violence, structured clinical STATIC-2002 (2002): simplify, clarify, make scoring consistent SOTNPS (2003): dynamic, structured clinical RSVP (2003): structured clinical; domains: evolved from SVR-20+SORA RISK MANAGEABILITY PREDICTOR GUIDE (2004): static, dynamic, structured clinical/actuarial TIPS-ID (2005): SOTNPS for DD persons ARMIDILLO (2007?)
Problems and Limitations Defining and measuring deviant sexual preference (plethysmograph, Abel, clinical judgment) Relative risk vs. risk prediction Specificity (.97) vs. sensitivity (.15) RRASOR: 85% recidivists labeled non-recidivist Official recidivism events only Inter-rater reliability on dynamic and conceptual factors Unsupported factors (SORAG, VASOR, TIPS-ID) marital status denial limited sexual knowledge Campbell, 2000; Langstrom, 2004; CSOM, 2007; Mossman, 2006
Problems and Limitations Application to non-sample populations non-whites immigrants developmentally disabled (?) prison vs. community Limited information available Problem of low base rates Self-report (QACSO, dynamic, TIPS-ID, SONAR) Clinician/field bias (intimacy deficits as sex in uncommitted relationships or difficulties establishing relationships with adult females ) (CSOM, 2007; Lindsay, et al., 2006, Hanson & Harris, 2002)
Low Risk Versus High Risk Offenders (who offends more?) (Salter, n.d.) Risk Level N % Reoffend Total Re-offenses Risk Level N % Reoffend Total Re-offenses Low 900 30% 270 Low 900 30% 270 High 100 90% 90 High 100 90% 90 Total = 360 Total = 360
Adjusted Rates for Time Free (Harris, Phenix, Hanson, & Thornton, 2003) Years offence-free (no sexual/violent/serious nonviolent reconviction) in community Orig. 0 2 4 6 8 10 Static-99 Recidivism rates Sex Offence Convictions % Score 0-1 (n = 259) 5 year 5.7 4.6 4.0 2.0 1.4 1.4 10 year 8.9 6.4 4.6 3.3 3.2 (5.8) 15 year 10.1 8.7 9.5 7.7 (6.5) 2-3 (n =412) 5 year 10.2 6.8 4.4 3.1 5.5 5.3 10 year 13.8 11.1 9.1 8.1 8.2 8.4 15 year 17.7 14.5 13.6 13.9 (18.7) 4-5 (n = 291) 5 year 28.9 14.5 8.0 6.9 7.6 6.8 10 year 33.3 21.4 13.7 11.5 (13.1) (11.5) 15 year 37.6 22.8 (18.7) 6+ (n = 129) 5 year 38.8 25.8 13.1 7.0 9.4 13.2 10 year 44.9 30.3 23.7 16.0 (17.8) (17.8) 15 year 52.1 37.4 (27.5) Note: The total sample was 1,091. The number of cases available for each analysis decreases as the follow-up time increases and offenders recidivate. Values in parentheses were based on less than 30 cases and should be interpreted with caution.
Prediction of Sexual Recidivism d (95% CI) N (k) Actuarial empirical factors Actuarial conceptual factors Structured judgement Unstructured.70 (.64-.75).67 (.58-.77).57 (.41-.73).43 (.28-.58) 13,594 (51) 4,184 (20) 965 (6) 1,723 (9) Hanson & Morton-Bourgon (2007) Unstructured and actuarial (STATIC-99, -2002) no better than chance in short term (2 yr.) prediction (N=121, Denmark). Bengston & Langstrom (2007)
Questions to Ask: (Boer, 2002, 2006) Who is the client being assessed? Violence vs. sexual Is the instrument validated for this client? What is the purpose of the assessment? Treatment needs: SONAR, STABLE, TIPS-ID Pre-release assessment: likelihood to re-offend/estimate of risk: STATIC-99, RRASOR change in dynamic factors: STABLE Actuarial or structured clinical? Both!
Assessing Risk in ID Persons Cautions: Few studies, no replications Small sample sizes Methodological *: definition (incl. borderline intellectual function?) assessment method (IQ, educational hx, adaptive scale) Historical Error *: changing definitions changing laws changing treatment in legal system * Lindsay & Taylor, 2005
Assessing Risk in ID Persons Cautions (cont d.): DD in legal system: (Hassan & Gordon, 2003) significant underreporting more likely convicted Adapting Actuarials: validity? (CSOM, 2007) RRASOR outperformed STATIC-99 (Tough, 2001)
Assessing Risk in ID Persons Additional Factors: (Hassan & Gordon, 2003; Lindsay, 2005, Michie, et al., 2006) sexual victimization- abusive-reactive vs. nondisabled: (Firth, et al., 2001, Balogh, et al., 2001) more likely to have male victims more likely to commit less serious offenses (Brown & Stein, 1997) younger child victims (Blanchard, et al., 1999) attitudes (QASCO): distinct categories, adult vs. child victim preference (Lindsay, et al., 2006)
Assessing Risk in ID Persons ID Persons and Sexuality DD recidivists (34%) vs. non-recidivists (N=76): little/no supervision younger at tx onset longer time at risk Non-significant findings: intellectual level medications (incl. androgen antagonists) deviant arousal (children) counterfeit deviance not supported (Tough, 2001) (Michie, et al., 2006) SSKAT to test sexual knowledge offenders (N=17) scores > non-offenders (N=20) knowledge still limited (intercourse)
Assessing Risk in ID Persons RISK MANAGEABILITY PREDICTOR GUIDE (Haaven, 2007) RRASOR STABLE and ACUTE Stable dynamic-manageability support persons/team environment Stable acute-manageability supports/observation environment/victim access
Self-Regulation Knowledge situation, context important details appropriate responses emotional vocabulary
Self-Regulation Awareness Internal body cues emotions thoughts External verbal cues nonverbal environmental
Self-Regulation Monitor in the moment Internal body emotions thoughts External verbal nonverbal environmental
Self-Regulation Adjust coping thoughts alternate plans review consequences relax ask for help change subject etc.
Self-Regulation (control of your own actions, thoughts, emotions) in tact regulation: adequate skills, good self-control, effective planning under-regulation: impulsive, loss of control, disinhibition mis-regulation: efforts fail due to skill/ ability deficits, poor strategies
Self-Regulation (control of your own actions, thoughts, emotions) Let s not forget: in tact regulation: adequate skills, good Over-regulation self-control, effective planning under-regulation: impulsive, loss of control, disinhibition mis-regulation: efforts fail due to skill/ ability deficits, poor strategies
Goal Types Approach: trying to get something (a college degree, sex from a child) Avoidance: trying to stay away from something (conflict with partner, sex with a child)
Offense Pathways SELF-REGULATION GOALS