The Clinical Practice of Risk Assessment of Sexual Violence

1
The Clinical Practice of Risk Assessment of
Sexual Violence

• Joe Judge

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Introduction

• There are significant literatures on risk factors
  for recidivism in sexual offenders and on the
  predictive accuracy of different types of risk
  assessment tool.
• Less is known about how risk factors are used and
  combined in clinical practice.
• This is especially true of Structured
  Professional Judgement approaches.

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Risk Factors for Recidivism in Sexual Offenders

• Hanson and Bussiere (1998)
• Recidivism best predicted by sexual deviancy and
  general criminological factors.
• Hanson and Morton-Bourgon (2004, 2005)
• Uses cumulative meta-analytic technique
• Recidivism predicted by sexual deviance and
  antisocial orientation.
• Mann et al. (2010)
• Conceptualises risk factors differently
• Psychologically meaningful risk factors

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Mann et al. (2010)

• Empirically Supported
• Sexual preoccupation
• Sexual preference for pubescent or prepubescent
  children
• Sexualised violence
• Multiple paraphilias
• Offence supportive attitudes
• Emotional congruence with children
• Lack of emotionally intimate relationships with
  adults
• Lifestyle impulsiveness
• Poor problem solving
• Resistance to rules and supervision
• Grievance / hostility
• Negative social influence

• Promising
• Hostile beliefs about women
• Machiavellianism
• Lack of concern for others
• Dysfunctional coping
• Sexualised coping
• Externalised coping

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Mann et al. (2010)

• Unsupported but with interesting exceptions
• Denial
• Low self esteem
• Major mental illness
• Loneliness
• Adversarial sexual orientation
• Fragile narcissism
• Sexual entitlement

• Little or no relationship to sexual recidivism
• Depression
• Social skills deficits
• Poor victim empathy
• Lack of motivation for treatment (as assessed
  pre-treatment)

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Judge et al.

• Sexual deviance is an evidence based risk factor
• Psychopathy is an evidence based risk factor
• Inconsistent findings with respect to denial.
• Also some gaps in the literature.

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How is this information used in clinical practice?

• Looked at data from NHS Lothian Sex Offender
  Liaison Service (SOLS)
• Regression analysis of summary risk judgements.
• Are the factors that predict risk judgement the
  factors that predict recidivism?
• Or is something else important?

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NHS Lothian SOLS

• Developed to provide clinical input to help
  criminal justice agencies manage sex offenders in
  the community.
• Offers comprehensive clinical assessment of
  individuals whom CJ agencies are finding
  difficult to manage.
• 78 have personality disorder diagnoses (Russell
  Darjee, 2012)
• Assessment and management advice structured using
  Risk for Sexual Violence Protocol (RSVP)
• Assessment process described in detail elsewhere
  (Russell Darjee, 2012)
• Responses of 96 individuals used in data analysis

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Hypotheses (Based on systematic review and
previously existing meta-analyses)

1. Psychopathy will be a statistically significant
   predictor of sexual violence risk score.
2. Sexual deviance will be a statistically
   significant predictor of sexual violence risk
   score.
3. Denial will not be a statistically significant
   predictor of sexual violence risk score.
4. Sexual preoccupation will be a statistically
   significant predictor of sexual violence risk
   score.
5. Problems with intimate relationships will be a
   statistically significant predictor of sexual
   violence risk score.

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Data analysis

• Ordinal logistic regression
• Dependent variables
• MAPPA Risk Score
• RMA Risk Score
• Independent Variables
• Psychopathy (RSVP Item 12 Coded 0-2)
• Sexual Deviance (RSVP Item 11 Coded 0-2)
• Denial (RSVP Item 6 Coded 0-2)
• Sexual Preoccupation (SARN-SO Coded 0-2)
• Problems with intimate relationships (RSVP Item
  16 Coded 0-2)

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Results

• Psychopathy significantly associated with risk
  score.
• Sexual deviance was not significantly associated
  with risk score.
• Denial significantly associated with risk score.
• Sexual preoccupation was associated with risk
  score.
• Problems with intimate relationships was not
  associated with risk score.
• Best model accounted for only 40 percent of
  variance in risk score.

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Sexual deviance is not a statistically
significant predictor of risk score

• Explained by difficulty in assessing and
  measuring sexual deviance?
• Notoriously difficult task.
• Do different types of sexual deviance operate
  differently? (eg. Sexual sadism vs. paedophilia)
• Outcome variables take into account imminence of
  risk
• For example, possible that offender may meet
  criteria for paedophilia but have no access to
  children influences score on outcome variable.

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Denial is a statistically significant predictor
of risk score

• Relationship between denial is complex
• Harkins et al. (2010) Denial protective?
• Depends on whether denial viewed dichotomously or
  dimensionally.
• Ware and Mann (2012) suggest overemphasis on
  challenging denial.
• Blagden et al (2011) suggest professionals not
  always aware that they are challenging denial.
• Is this operating in present study?
• But again, denial difficult to assess and measure

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Problems with intimate relationships not a
statistically significant predictor of risk score

• Closer scrutiny of the data revealed that only 5
  percent of the offenders demonstrated no evidence
  of problems with intimate relationships
• Unclear if this is true of sex offenders in
  general or limited to those referred to the SOLS.

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Unexplained Variance

• Best explanatory model accounted for only 40
  percent of variance.
• Possible that relevant independent variables not
  included in the analysis.
• But what accounts for the other 60 percent?
• The process of getting from item scores to
  formulation, risk scenarios is not well
  described.
• Direction for future research?

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Implications for research

• Research investigating the process of SPJ risk
  assessment.
• How are risk judgements arrived at using this
  method?
• Hart and Boer (2010) suggest qualitative analysis
  might be helpful.
• Specific focus on risk formulation? (Reliability,
  validity etc)

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Implications for practice

• Difficulty in measurement of relevant variables.
• Revision of RSVP?
• Debate about inclusion of denial as a risk factor.