(C) 2008 Vermont Forensic Assessment All rights reserved How to Protect your Client from Bad Risk...

(C) 2008 Vermont Forensic Assessment All rights reserved

How to Protect your How to Protect your Client from Bad Risk Client from Bad Risk

AssessmentsAssessmentsThomas A. Powell, Ph.D.Thomas A. Powell, Ph.D.

John C. Holt, Ph.D.John C. Holt, Ph.D.Vermont Forensic Assessment, Vermont Forensic Assessment, PLLCPLLC

Shelburne, VermontShelburne, Vermont

June 12, 2008June 12, 2008


OutlineOutline

How things are supposed to workHow things are supposed to work

Static and dynamic measure of any Static and dynamic measure of any type of criminal recidivism and type of criminal recidivism and offender needsoffender needs Level of Service Inventory - RevisedLevel of Service Inventory - Revised Assessment perspectiveAssessment perspective Risk principleRisk principle Need principleNeed principle Responsivity principleResponsivity principle


OutlineOutline Static actuarial measures of sexual Static actuarial measures of sexual

recidivism riskrecidivism risk STATIC-99STATIC-99 RRASORRRASOR VASORVASOR

Dynamic measures of sexual recidivism Dynamic measures of sexual recidivism riskrisk

SONARSONAR STABLE/ACUTESTABLE/ACUTE Treatment Progress ScaleTreatment Progress Scale


OutlineOutlineAdditional topics of interestAdditional topics of interest

The use of multiple risk instruments: Static 99, The use of multiple risk instruments: Static 99, RRASOR RRASOR andand VASOR as policy VASOR as policy

““Denial” - a misleading predicator of recidivism.Denial” - a misleading predicator of recidivism.

Conflict of interest by assessors and treatment Conflict of interest by assessors and treatment providers.providers.

The DOC case staffing: The DOC case staffing: Salem Witch TrialsSalem Witch Trials redux?redux?


QuickTime™ and aTIFF (Uncompressed) decompressor

are needed to see this picture.


How Things are Supposed to WorkHow Things are Supposed to Work

PSI preparation - Policy 342.01 PSI preparation - Policy 342.01 (rev. (rev. 4/9/07)4/9/07) http://doc.vermont.gov/about/policies/rphttp://doc.vermont.gov/about/policies/rp

d/final_commissioner-signed_psi_3.22.07d/final_commissioner-signed_psi_3.22.07.pdf.pdf

Prescriptive formatPrescriptive format Defines LSI-R as “an objective, Defines LSI-R as “an objective,

quantifiable instrument that provides a quantifiable instrument that provides a consistent and valid method of consistent and valid method of predicting risk to re-offend and a reliable predicting risk to re-offend and a reliable means of measuring offedner change means of measuring offedner change over time …”over time …”



RRASOR: “a four-item actuarial risk measure RRASOR: “a four-item actuarial risk measure used to aid in assessing sexual recidivism risk used to aid in assessing sexual recidivism risk …”…”

Static-99: “… a 10-item actuarial risk measure Static-99: “… a 10-item actuarial risk measure is used in a similar manner as the RRASOR.”is used in a similar manner as the RRASOR.”

VASOR: “a risk assessment scale … designed VASOR: “a risk assessment scale … designed to assist PO’s in making placement and to assist PO’s in making placement and supervision decisions.”supervision decisions.”



““A PSI provides the sentencing judge … with A PSI provides the sentencing judge … with relevant information on which to base a relevant information on which to base a sentencing decision. It also reflects a sentencing decision. It also reflects a professional judgment of and assessment by professional judgment of and assessment by the DOC regarding risk management of the the DOC regarding risk management of the defendant.”defendant.”

““The PSI investigator can use information The PSI investigator can use information collected during the PSI, particularly during collected during the PSI, particularly during the defendant interview, to complete the defendant interview, to complete necessary risk assessment tools, e.g. the necessary risk assessment tools, e.g. the LSI-R.”LSI-R.”



““Provide a narrative explanation of the numerical Provide a narrative explanation of the numerical results of assessment tools (e.g. LSI-R), including results of assessment tools (e.g. LSI-R), including an examination of key risk areas and a summary an examination of key risk areas and a summary of any court-ordered clinical assessments.”of any court-ordered clinical assessments.”

““Briefly summarize the major points of the report Briefly summarize the major points of the report …”…”

““The report will conclude with a recommendation The report will conclude with a recommendation … based upon the defendant’s offense, … based upon the defendant’s offense, background and assessed risk.”background and assessed risk.”



““Note: Only if requested by the CourtNote: Only if requested by the Court, , the PSI investigator will include a the PSI investigator will include a recommended minimum and maximum recommended minimum and maximum term of incarceration or a minimum and term of incarceration or a minimum and maximum term of suspended sentence.” maximum term of suspended sentence.” (emphasis (emphasis notnot added by us) added by us)


General Risk Assessment General Risk Assessment Level of Service Inventory - RevisedLevel of Service Inventory - Revised

Criminal HistoryCriminal History Education/EmploymentEducation/Employment FinancialFinancial Family/MaritalFamily/Marital Accommodation (the influence of address)Accommodation (the influence of address) Leisure/Recreation (spare time use)Leisure/Recreation (spare time use) Companions (friends and associates)Companions (friends and associates) Alcohol/Drugs (mostly looking at past year)Alcohol/Drugs (mostly looking at past year) Emotional/Personal (psychological status)Emotional/Personal (psychological status) Attitudes/Orientation (antisocial/prosocial views)Attitudes/Orientation (antisocial/prosocial views)


ASSESSMENT PERSPECTIVE

Prediction2

1

Time

1: Primary objective is to understand factors linked to future behavior

2: Ultimate assessment objective is to estimate future behavior

Simourd, D.J. (1999, May), On a general forensic evaluation model: A practicalframework for offender assessment. Paper presented at the annual meeting of theCanadian Psychological Association, Halifax, N.S.

EnvironmentalContingencies

Ps ychologicalPredis pos ition

As s es s ment Behavior


Risk PrincipleRisk Principle

1.1. Reserve intensive levels of Reserve intensive levels of corrections supervision and corrections supervision and treatment for higher risk cases.treatment for higher risk cases.

2.2. Do not use these levels of Do not use these levels of supervision and treatment for lower supervision and treatment for lower risk cases.risk cases.

3.3. Use of valid and reliable risk Use of valid and reliable risk assessment tools gives the criminal assessment tools gives the criminal justice system a triage capability.justice system a triage capability.


Need PrincipleNeed Principle

1.1. There are many needs and potential There are many needs and potential treatment targets identified in treatment targets identified in corrections populations.corrections populations.

2.2. Some are related to criminal risk; some Some are related to criminal risk; some are not.are not.

3.3. Focus on those needs which are Focus on those needs which are “criminogenic” (ie. causally related to “criminogenic” (ie. causally related to crime) such as social affiliations, drugs crime) such as social affiliations, drugs and criminal attitudes.and criminal attitudes.

4.4. When criminogenic needs are addressed, When criminogenic needs are addressed, the risk of recidivism declines.the risk of recidivism declines.


Responsivity PrincipleResponsivity Principle

1.1. When providing treatment services for forensic When providing treatment services for forensic or corrections populations, use methods which or corrections populations, use methods which are matched to the learning style of the are matched to the learning style of the population.population.

2.2. Cognitive-behavioral, skill-building, and relapse Cognitive-behavioral, skill-building, and relapse preventing interventions fit this model.preventing interventions fit this model.

3.3. Non-directive, non-specific “talk therapy” Non-directive, non-specific “talk therapy” methods do not.methods do not.

4.4. The use of appropriate intervention models The use of appropriate intervention models lowers risk; other models have either no effect lowers risk; other models have either no effect on recidivism or they may actually raise it.on recidivism or they may actually raise it.


Sex Offense Specific MeasuresSex Offense Specific Measures

Static Actuarial MeasuresStatic Actuarial Measures RRASOR RRASOR Static-99Static-99 VASORVASOR

Dynamic/Treatment MeasuresDynamic/Treatment Measures SONARSONAR STABLE/ACUTESTABLE/ACUTE Sex Offender Treatment Needs and Sex Offender Treatment Needs and

Progress ScaleProgress Scale


RRASORRRASOR Rapid risk assessment of sex offender Rapid risk assessment of sex offender

recidivismrecidivism ww2.ps-sp.gc.ca/publications/ww2.ps-sp.gc.ca/publications/

corrections/ 199704_e.pdf corrections/ 199704_e.pdf Four item scaleFour item scale

All four are incorporated into the STATIC-99All four are incorporated into the STATIC-99 Total score 0-6Total score 0-6

00 LowLow 1,21,2 Moderate-LowModerate-Low 3,43,4 Moderate-HighModerate-High 5,65,6 HighHigh


RRASOR - RRASOR - Rapid risk assessment of sex Rapid risk assessment of sex

offender recidivismoffender recidivism


STATIC-99STATIC-99

Ten item scaleTen item scale Total score 0-12Total score 0-12

0,10,1 LowLow 2,32,3 Moderate-LowModerate-Low 4,54,5 Moderate-HighModerate-High 6+6+ HighHigh


STATIC-99STATIC-99

Widely used in criminal, forensic and Widely used in criminal, forensic and correctional settings.correctional settings.

Instrumental in most sexually violent Instrumental in most sexually violent predator (SVP) determinations.predator (SVP) determinations.

Not as easy to score as it seems. Not as easy to score as it seems. Many scoring rules to understand.Many scoring rules to understand.


STATIC-99STATIC-99

The Static-99 scoring manual is 80 The Static-99 scoring manual is 80 pages long.pages long.

http://ww2.ps-sp.gc.ca/publications/corrhttp://ww2.ps-sp.gc.ca/publications/corrections/pdf/Static-99-coding-Rules_e.pdfections/pdf/Static-99-coding-Rules_e.pdf

Or google “Static-99”Or google “Static-99”


STATIC-99 IssuesSTATIC-99 Issues

Like most actuarial risk assessment Like most actuarial risk assessment instruments, it is only +/- 70% accurate. instruments, it is only +/- 70% accurate.

False positives - over-predicting riskFalse positives - over-predicting risk False negatives - under-predicting riskFalse negatives - under-predicting risk

Over-reliance on unchanging static risk Over-reliance on unchanging static risk factors to the exclusion of changing factors to the exclusion of changing dynamic risk factors is a significant dynamic risk factors is a significant problem in Vermont (and elsewhere).problem in Vermont (and elsewhere).


STATIC-99 - age and recidivismSTATIC-99 - age and recidivism


STATIC-99 - age and recidivismSTATIC-99 - age and recidivism

“There were few sexual offenders of any type in the advanced age category (>50 years !!) … and their recidivism rates were generally low.”

• decreasing sex drive• fewer opportunities

Hanson, K.W. (2002). Recidivism and age. Journal of Interpersonal Violence, 17 (10), 1046-1062.


STATIC-99 - time at riskSTATIC-99 - time at risk


Listserv communication from Hanson and Listserv communication from Hanson and Harris Harris (3/10/08)(3/10/08)

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


VASORVASOR

Vermont assessment of sex offender Vermont assessment of sex offender riskrisk

Weighs 19 variablesWeighs 19 variables 13 on the Reoffense Risk Scale13 on the Reoffense Risk Scale 6 on the Violence Scale6 on the Violence Scale

According to the manual, scores are According to the manual, scores are plotted on an overall risk chartplotted on an overall risk chart Reoffense Risk Scale x Violence ScaleReoffense Risk Scale x Violence Scale


VASORVASOR Prior sex offensesPrior sex offenses Prior adult convictionsPrior adult convictions Court order violationsCourt order violations Force used during current Force used during current

arrestarrest Relationship to victimRelationship to victim Male victimMale victim History of exhibitionismHistory of exhibitionism Deviant sexual fixationDeviant sexual fixation Alcohol of drug use (past Alcohol of drug use (past

five years)five years) Address changes (past Address changes (past

year)year) Time employed/ in schoolTime employed/ in school Past treatment successPast treatment success Amenability to treatmentAmenability to treatment

Prior convictions for violent Prior convictions for violent crimescrimes

Prior conviction for crime Prior conviction for crime involving deadly weaponinvolving deadly weapon

Force used during current Force used during current offenseoffense

Sexual intrusiveness of Sexual intrusiveness of current offensecurrent offense

Physical harm to victimPhysical harm to victim Victim <5, >55, or Victim <5, >55, or

handicappedhandicapped


VASOR - Daubert criteria issuesVASOR - Daubert criteria issues

No peer-reviewed studies on its No peer-reviewed studies on its reliability and validityreliability and validity

Manual relies on studies presented in Manual relies on studies presented in poster formatposter format

Manual clearly marks the VASOR as a Manual clearly marks the VASOR as a “research version”“research version”

Not cited in major reviews of other Not cited in major reviews of other actuarial scalesactuarial scales

Used rarely outside of VermontUsed rarely outside of Vermont


VASOR - Validity issueVASOR - Validity issue

According to Georgia Cumming, new According to Georgia Cumming, new cases are being added to the VASOR cases are being added to the VASOR database, and within “a couple of database, and within “a couple of weeks” there will be new cut points weeks” there will be new cut points for describing the risk level of cases, for describing the risk level of cases, based on their scores.based on their scores.


Dynamic Measures of Sexual Dynamic Measures of Sexual Recidivism RiskRecidivism Risk

SONAR: Sex offender need assessment SONAR: Sex offender need assessment ratingrating

Stable 2007 and Acute 2007Stable 2007 and Acute 2007

Treatment Progress Scale (Vermont-Treatment Progress Scale (Vermont-specific)specific)


SONAR - SONAR - sex offender needs assessment sex offender needs assessment ratingrating

rates dynamic factors related to recidivism

improves the predictive accuracy and utility of actuarial (historical factors) instruments by considering changing circumstances in the offender’s life (ie. dynamic factors)

http://ww2.ps-sp.gc.ca/publications/http://ww2.ps-sp.gc.ca/publications/corrections/200001b_e.aspcorrections/200001b_e.asp


Stable and Acute - 2007Stable and Acute - 2007

Stable factorsStable factors Significant social influencesSignificant social influences Capacity for relationship stabilityCapacity for relationship stability Emotional identification with childrenEmotional identification with children Hostility toward womenHostility toward women General social rejectionGeneral social rejection Lack of concern for othersLack of concern for others ImpulsiveImpulsive Poor problem solving skillsPoor problem solving skills



Stable factors (cont.)Stable factors (cont.) Negative emotionalityNegative emotionality Sex drive preoccupationSex drive preoccupation Sex as a coping mechanismSex as a coping mechanism Deviant sexual preferenceDeviant sexual preference Deviant sexual interests in possible Deviant sexual interests in possible

remissionremission Cooperation with supervisionCooperation with supervision



Acute factorsAcute factors Victim accessVictim access HostilityHostility Sexual preoccupationSexual preoccupation Rejection of supervisionRejection of supervision Emotional collapseEmotional collapse Collapse of social supportsCollapse of social supports Substance abuseSubstance abuse



The most recent version incorporates The most recent version incorporates the Static-99 variables and the most the Static-99 variables and the most risk-relevant dynamic variables to risk-relevant dynamic variables to describe both risk level and describe both risk level and supervision intensity needs for a supervision intensity needs for a client.client.

This represents best evidence-based This represents best evidence-based practice at this time.practice at this time.


Vermont Treatment Progress ScaleVermont Treatment Progress Scale

http://www.csom.org/pubs/http://www.csom.org/pubs/SexOffTreatScale.pdfSexOffTreatScale.pdf

McGrath & Cumming (2003)McGrath & Cumming (2003) Bob McGrath, MA, licensed psychologist, clinical Bob McGrath, MA, licensed psychologist, clinical

director, Vermont Treatment Program for Sexual director, Vermont Treatment Program for Sexual AggressorsAggressors

Georgia Cumming, administrative director, Georgia Cumming, administrative director, Vermont Treatment Program for Sexual Vermont Treatment Program for Sexual AggressorsAggressors


Vermont Treatment Progress ScaleVermont Treatment Progress Scale

Sexual deviancySexual deviancy CriminalityCriminality Self-regulationSelf-regulation Treatment and supervision Treatment and supervision

cooperationcooperation Lifestyle stabilityLifestyle stability Social supportsSocial supports


Multiple Static AssessmentsMultiple Static AssessmentsDOC uses three static actuarial scalesDOC uses three static actuarial scales

RRASOR, STATIC-99, VASORRRASOR, STATIC-99, VASOR It is unnecessary to use more than one It is unnecessary to use more than one

static actuarial assessmentstatic actuarial assessment “...combining scales did not provide a

statistically significant or consistent advantage over the single best actuarial risk scale in predicting either serious or sexual recidivism.” Seto (2005)


Multiple Static AssessmentsMultiple Static Assessments So why does DOC policy require the use So why does DOC policy require the use

the Static-99, RRASOR and VASOR on all the Static-99, RRASOR and VASOR on all sex offenders?sex offenders?

The HIGHEST of the three ratings is usedThe HIGHEST of the three ratings is used Low Medium low Medium Medium high High

Fishing for the highest score?


Multiple Static AssessmentsMultiple Static Assessments If there are going to be multiple If there are going to be multiple

instruments, why use three instruments, why use three static factorstatic factor assessments?assessments?

Why exclude Why exclude dynamic variablesdynamic variables?? Sonar Stable/Acute 2007 Vermont Treatment Progress Scale

Evidence-based practice vs. not


DenialDenial

““Denial” vs. minimizationDenial” vs. minimization

Weak predicator of recidivism and Weak predicator of recidivism and treatment compliancetreatment compliance

Hanson and Morton-Bourgeon (2005) Hanson and Morton-Bourgeon (2005) article p. 1158article p. 1158


Conflict of InterestConflict of Interest

DOC relies on a network of providers who DOC relies on a network of providers who provide both forensic assessments and provide both forensic assessments and clinical interventions.clinical interventions.

““Irreconcilable conflict between Irreconcilable conflict between therapeutic and forensic roles” therapeutic and forensic roles” (Greenberg & (Greenberg & Shuman, 1997).Shuman, 1997).

““Failure to maintain adequate separation Failure to maintain adequate separation of roles has a number of counter-of roles has a number of counter-therapeutic consequences in sex offender therapeutic consequences in sex offender management” management” (Covell & Wheeler, 2006).(Covell & Wheeler, 2006).


Conflict of InterestConflict of Interest

National professional organizations National professional organizations specifically highlight the importance of specifically highlight the importance of avoiding dual rolesavoiding dual roles

American Psychological AssociationAmerican Psychological Association American Academy of Psychiatry & the LawAmerican Academy of Psychiatry & the Law Association for the Treatment of Sexual Association for the Treatment of Sexual

Abusers (ATSA)Abusers (ATSA)


Conflict of InterestConflict of Interest ““Members recognize that there may be potential Members recognize that there may be potential

conflicts of interest when they provide both conflicts of interest when they provide both evaluation and treatment services to the same evaluation and treatment services to the same person. When it is necessary to fulfill both person. When it is necessary to fulfill both functions (for example, in rural settings or functions (for example, in rural settings or institutions), members take reasonable steps to institutions), members take reasonable steps to manage and resolve any conflicts in the best manage and resolve any conflicts in the best interest of the client and the community.”interest of the client and the community.”

ATSA practice standards and ATSA practice standards and guidelines (2005)guidelines (2005)


DOC Case StaffingsDOC Case Staffings

2 to 10 P.O.’s gathered with a 2 to 10 P.O.’s gathered with a supervisor to discuss a case. supervisor to discuss a case.

Victims’ advocates, others, included?Victims’ advocates, others, included? Referred to, in policy, as a “peer Referred to, in policy, as a “peer

review process”review process” No record or transcript.No record or transcript.


DOC Case StaffingsDOC Case Staffings

“ “This is an opportunity for the PSI This is an opportunity for the PSI investigator to present the information investigator to present the information collected to fellow staff members for collected to fellow staff members for comment and advice on further areas of comment and advice on further areas of investigation, additional needed investigation, additional needed information, and a sentencing information, and a sentencing recommendation decision.”recommendation decision.”


DOC Case StaffingsDOC Case Staffings This is not considered best-practice for This is not considered best-practice for

improved decision-making.improved decision-making. Nationally, reviews typically involve small Nationally, reviews typically involve small

panels of higher-trained professionals who panels of higher-trained professionals who critically consider the evidence and determine critically consider the evidence and determine whether to override lower level decisions.whether to override lower level decisions.

In Vermont there is a strong tendency toward In Vermont there is a strong tendency toward peer group-think.peer group-think.


DOC Case StaffingsDOC Case Staffings““I have heard of a very similar process occurring I have heard of a very similar process occurring in Boston relative to their civil commitment in Boston relative to their civil commitment process. (It) was thought to be so bad that a local process. (It) was thought to be so bad that a local TV station did an "expose" on the process and TV station did an "expose" on the process and how political and poor the decision making was - how political and poor the decision making was - despite needing to emphasize during he program despite needing to emphasize during he program that the network was not trying to protect sex that the network was not trying to protect sex offenders by making the expose. They instead offenders by making the expose. They instead pointed out that there were obvious errors in pointed out that there were obvious errors in decisions in both directions - holding people who decisions in both directions - holding people who should not be held, and letting others go who should not be held, and letting others go who should not have been let go.”should not have been let go.”

Listserv colleague, commenting on Vt case staffing processListserv colleague, commenting on Vt case staffing process


How to Protect your Client from Bad How to Protect your Client from Bad Risk AssessmentsRisk Assessments

Presented byPresented byVermont Forensic Assessment, Vermont Forensic Assessment, PLLCPLLC

Thomas A. Powell, Ph.D. & John C. Holt, Thomas A. Powell, Ph.D. & John C. Holt, Ph.D.Ph.D.

4281 Shelburne Road4281 Shelburne RoadShelburne, VT 05482Shelburne, VT 05482

802-985-2412802-985-2412www.vtfa.comwww.vtfa.com

(C) 2008 Vermont Forensic Assessment All rights reserved How to Protect your Client from Bad Risk...

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