phil rich © 2015 assessment of juvenile sexual risk phil rich, ed.d., licsw specialized...

Phil Rich © 2015

Assessment of Juvenile Sexual Risk

Phil Rich, Ed.D., LICSWSpecialized Consultation and Training

[email protected]

413-687-7098

June 2-4, 2015

Part V: The Assessment Process

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Comprehensive Assessment

•The risk assessment can be a one-step process, completed by administering a checklist or evaluation format…… or it can be the product of a multi-step process that involves different forms and facets of assessment that result in an estimated risk level.

•A broad and far-reaching process of evaluation built on the psychosocial assessment of the young person, and results in the final assessment of risk, and in the process incorporates…

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Record review Clinical interviews with the young person Collateral interviews with other/collateral informants Clinical observations

• It may also include, measures such as… Actuarial assessment Psychological testing Psychiatric evaluation Physiological testing such as polygraph and phallometric

examination

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•Comprehensive assessment refers to the range of information covered, more than the depth of information

•It addresses the young person’s history, social environment, thinking, and behaviors

•Explores and evaluates the circumstances that surrounded and continue to surround the life of the young person…… and thus surround and contribute to problematic behaviors.

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•Comprehensive assessment provides the evaluator with maximum information upon which to draw…… both with respect to understanding the young person and making informed decisions and recommendations about treatment needs and interventions.

•It provides a means by which to…

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1. Explore and understand the nature, development, and trajectory of sexually abusive behavior, as well as targets of sexual interest, sources of sexual arousal, and patterns of sexual behavior.

2. Estimate the risk for continued sexually abusive behavior, including the presence and influence of factors that may increase or decrease the chances for re-offense.

3. Recognize the presence and influence of historical and current environmental, social, and personal factors in the juvenile’s life, including learned social experiences that have influenced and shaped his or her thinking and behavior.

4. Assess motivation and capacity for treatment.

5. Build a formulation and understanding of the case from which to develop and launch interventions for management and treatment.

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Risk, Need, and Responsivity

•In addition to establishing a sound and well-described basis for risk assessment, the evaluation also meets the goals of the risk, need, and responsivity model.

It provides an estimate of risk for recidivism based on static and dynamic factors

Establishes an understanding of the dynamic and current treatment needs of the juvenile

Assesses the likely responsiveness and engagement of the young person to treatment interventions

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The Ecology of Sexually Abusive Behavior

•Further, the process of comprehensive assessment avoids a “piecemeal” approach to understanding the individual.

•It allows the evaluator to view the young person as a whole person functioning in a complex ecological environment, whose behavior is the result of a complex set of psychosocial interactions.

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Assessment and Disclosure

•Assessments are not intended to provide complete details of everything that actually occurred during sexual offenses.

•In fact, it’s virtually impossible, under any circumstances, to gather every detail about what happened, when, and why, and gain a full understanding of the “truth.”

•Disclosure often follows assessment. •Many things not disclosed during an initial assessment

emerge later in treatment. •Thus, the goal of full disclosure is usually a goal of treatment

and not assessment.

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Assessment and Disclosure

•“Clinical experience strongly suggests that the true number and extent of sexual crimes may be revealed only after several months of treatment.”-Baker et al., 2001

•“It is unreasonable to expect a sexual abuser to disclose his or her entire history of sexually deviant behaviors during an initial assessment. “Further disclosures are likely during the course of therapy if intervention is at all effective.”-Mussack & Carich, 2001

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AssessmentPhases

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Essential Functions

•The essential functions of the comprehensive assessment are those of

1. Data collection2. Analysis3. Synthesis

•This allows the evaluation to serve as the foundation upon which insight into the case may be developed and decisions rendered regarding treatment and intervention.

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Conducting the Risk Assessment

•However, just as there is no single method by which to complete an assessment, there is no universal structure by which to understand and organize the assessment process.

•Nor is there a uniform format or content by which the assessment is defined, physically organized, or made complete.

•However, assessment is a process with several distinct stages.

•We can thus describe ideas about the assessment process so that it may be more easily conceptualized in terms of structure, method, and content.

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Assessment Sequence

•As with all things, there is a beginning, middle, and end to assessment, regardless of how long it takes to complete.

•As such we can structure and sequence the process, and at the same time understand what tasks are most closely associated with different points in the assessment sequence.

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Assessment Sequence

Most typically, the process of evaluation begins with a review of all prior records and concludes with:

i. The establishment of a diagnosis (if this is part of the evaluation format)

ii. An assignment of risk level iii. A summary (and, ideally, formulation) of the case iv. Recommendations regarding management and

treatment individualized to the specific needs of the juvenile being assessed.

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Assessment Sequence

•When conceptualized this way the assessment can be seen to have not just a beginning, a middle, and an end…… but also particular elements, tasks, and outcomes associated with different aspects of the sequence.

•These not only build upon earlier elements, but also contribute to later elements and conclusions.

Assessment Sequence

PsychosocialAssessment

• Developmental history• Psychological tests• Prior and current treatment records• Court and police records• School records and reports• Social skills appraisal• Social functioing and relationships• Family history• Behavioral history• Living environment and social supports• Etc.

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Assessment Sequence


AssessingSexual Abuse


• What happened• When• How• Where• With whom• Circumstances • Motivation and reasons• Other important factors • Pathway to sexually abusive behavior • Etc.

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Assessment Sequence



Assessmentof Risk



• Potential for recurrence• Under what circumstances• With whom• Likely precipitants• Factors that may protect against risk• Necessary supervision and control• Etc.

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Assessment Sequence



Assessmentof Risk

Mental HealthDiagnosis(if relevant to assessment)

• Description of the juvenile• Etiology of behavior• Defining/shaping factors and forces• Explanation for behavior • Projections into future • Etc.

Formulation




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Assessment Sequence



Assessmentof Risk

Mental HealthDiagnosis(if relevant to assessment)

• Description of the juvenile• Etiology of behavior• Defining/shaping factors and forces• Explanation for behavior • Projections into future • Etc.

Formulation

• Implications for treatment • Projections of needs• Recommendations• Etc.

Closure




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Phases of the Assessment Process

•The assessment process into three distinct phases by which its general tasks from be clearly seen and organized.

•Thinking of the assessment in this way helps to further organize and structure the thinking and planning of the evaluator.

•It also clearly assigns the primary tasks of assessment into a sequential order, even though there may be overlap between phases in some cases.

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Phase 1. Pre-Assessment: Preparing for the Evaluation

• The evaluator… Develops a rudimentary understanding of the case by

reviewing all available materials Identifies gaps in the record, and requests and gathers

additional records or information missing from the current record

Identifies informants with whom to speak Distributes and collects necessary release of information

consent forms

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Phase 2. Active Assessment: Conducting the Evaluation

• This phase sees the active gathering of information that will be used to complete the risk assessment instrument.

• The evaluator…

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Phase 2. Active Assessment: Conducting the Evaluation

Fully engages with the young person and other related informants and parties

Ensures that release of information forms are signed by the legal guardian and young person, if necessary

Informs informants of confidentiality limits and the purpose of the evaluation

Interviews the young person Interviews collateral informants Provides or arranges for additional testing that falls outside

of record review, interviews, and observation Remains aware of the behaviors of the young person or

important events that occur during this phase of the assessment, and which may have a bearing on the assessment process

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Phase 3. Concluding the Assessment: Writing the Evaluation Report

• The evaluator… Ties the assessment process together Assesses and estimates risk Prepares the written assessment report

• The written report…

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Phase 3. Concluding the Assessment: Writing the Evaluation Report

Summarizes pertinent historical and current data Formulates hypotheses about the development of sexually

abusive behavior Formulates a description of the psychological profile of the

juvenile Formulates a description of the environment that shaped and

influenced the juvenile’s emotions, behavior, and ideation, and in which sexually abusive behavior developed and eventually occurred

If relevant to the particular assessment format, identifies diagnoses that address co-occurring psychiatric or substance abuse disorders

Assigns a level of risk for sexual re-offense Proposes treatment needs and identifies suggested treatment

goals

PreliminaryPreparation

IdentifyingInformation Sources

Information andReport Reading

Phase 1. Pre-Assessment.Preparing for the Assessment

Phase 2. Active-Assessment.Conducting the Assessment

Developing Psychosexual History

Testing andEvaluation

Interviewing the Juvenile and Collateral Informants


WritingPsychosocial History

Establishing and Assigning Risk

RecommendingTreatment Interventions

Phase 3. Post-Assessment.Writing the Assessment Report

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PreliminaryPreparation

IdentifyingInformation Sources

Information andReport Reading

Phase 1. Pre-Assessment.Preparing for the Assessment

Phase 2. Active-Assessment.Conducting the Assessment

Developing Psychosexual History

Testing andEvaluation

Interviewing the Juvenile and Collateral Informants


WritingPsychosocial History

Establishing and Assigning Risk

RecommendingTreatment Interventions

Phase 3. Post-Assessment.Writing the Assessment Report

Integrating the RiskAssessment Instrument

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Phases Overlap

• Like all phased models, these phases may overlap with another.

• For instance, although the evaluator may be well into the active phase of the assessment…

… he or she may also be engaging in aspects more closely related to the first phase, such as collecting and reviewing additional case records or identifying additional informants who should be contacted.

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Phases Overlap

• Similarly, even though in the middle, or active, phase of the assessment, the evaluator may start to write the assessment report even though it cannot be completed until the final phase of the process.

• And, even during the third and final phase, the evaluator may find it necessary to return to the active phase and re-interview the juvenile or another informant, or the first phase in order to re-read records.

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Assessment in Practice

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Comprehensive Assessment in Practice

“Obtaining a clear, behavioral description of the sexual behaviors involved…… “when they began, how frequently they occur, and how and whether they have progressed or changed over time…… “is a core assessment component.” - Chaffin et al., 2006

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“It is important to understand the chronological sequence and development of sexual behavior over time, juxtaposed against key events and circumstances in the child’s life… …“Good assessment should attempt to identify situations or circumstances under which sexual behavior problems seem to occur.”-Chaffin et al., 2006

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•This typically involves psychosocial assessment, a process designed to explore and understand critical factors, events, and points in the developmental and social context.

•However, Long, Higgins, and Brady (1988) describe psychosocial assessment as much more than series of questions used to collect information.

•It is a process by which the evaluator comes to understand the individual through the multiple domains in which he or she has developed and currently lives.

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•Thus, understanding the individual’s psychosocial functioning “requires multiple observations of the client and his or her life for it to be as complete as possible.”- Long, Higgins, & Brady, 1988

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The Funnel of Assessment

•Regardless of how we conceptualize and operationalize it, comprehensive assessment involves a series of steps, from questioning and information collection to case formulation and prognosis.

•These steps necessarily involve a sequence of activities that both describe and structure the entire process.

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•Ultimately, in a comprehensive assessment there are a series of stages that pass through:1. Data gathering2. Data organization3. Data consolidation4. Data integration5. Data interpretation6. The assignment of meaning (and risk, in the case of risk

assessment) 7. The development of interventions, from incarceration to

treatment

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•Through this process, information is refined and synthesized, and case formulation provides a concise summary and overview.

•It offers a basis for the prediction of future behavior if things remain unchanged and current trajectory persists.

•In a comprehensive assessment there is a “funneling” and synthesis of information from the first step to the last, that defines and describes the sequence, content, and goals of the process.

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RiskAssessment

RecommendationsFor Intervention

Projecting trends, if thingsremain unchanged Prognosis Projecting TrendsPrognosis

Organizing Information

Structuring DataConsolidating andsynthesizing Information

Formulation Explaining DataSynthesis, conceptualization,and explanation

Diagnosis Labeling DataRecognizing symptoms that signaland identify psychosocial problems

InterpretingInformation Analyzing Data

Recognizing interconnectivityof data and drawing meaning

Gathering Information Data CollectionDeveloping and

posing questions

Data Collection

Data Organization

Data Analysis and Interpretation

Diagnosis

Formulation

Prognosis

The Assessment “Funnel”

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Sources and the Basis of Information

•It is clear that comprehensive assessment is neither limited to the type of material gathered, nor to a single means for gathering or analyzing data.

•It must not only recognize and understand the development of emotion, cognition, and behavior in the individual…… but also the multiple domains in which emotional, cognitive development occurs, at the individual, family, and social level.

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•In so doing, the comprehensive assessment will call upon different sources of information, including: the juvenile and his or her family and other informants, prior written records, and prior and current formal evaluations of various forms of

social adjustment, psychological functioning, behavioral self-regulation, and cognitive processes and capacities.

•It must also take into account information that ranges from facts to impressions.

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•The comprehensive assessment thus must not only approach different sources of information, but must also utilize different means for gathering such information.

•The clinical assessment may also include the use of tools designed to explore and yield information about many facets of the individual’s personality, functioning, thinking, attitudes, and propensities.

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Multiple Data Sources

A comprehensive assessment of risk may include: • Record review.• Clinical interviews with the juvenile and other collateral

informants, such as parents, social service agency case workers, current and former therapists, probation/parole officers, etc.

• The use of a structured risk assessment instrument.• Testing measures such as psychological testing,

psychiatric evaluation, and physiological testing such as polygraph and phallometric examination.

• Self-reported measures and inventories of psychosocial functioning, non-sexual and sexual interests, etc.

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Assessment Tools and Types

•Psychosocial Assessment. •Psychosexual Assessment. •Clinical Interview. •Mental Status Examination. •Risk Assessment. •Psychological Functioning. •Educational Testing. •Neuropsychological Tests. •Psychometric Tests. •Measures of Function and Interest.•Psychiatric Evaluations. •Physiological Measures.

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COMPREHENSIVE ASSESSMENT

RecordReview

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Mental StatusExamination

PsychosexualAssessment

ClinicalInterview



RecordReview

Juvenile

CollateralInformants

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ClinicalInterview



PsychologicalEvaluation

Measures of Function/Interest

EducationalTesting

PsychometricTests

NeuropsychologicalTesting

RecordReview

Juvenile


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ClinicalInterview


PsychiatricEvaluation




EducationalTesting

PsychometricTests


RecordReview

Juvenile


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ClinicalInterview


PsychiatricEvaluation

PhysiologicalMeasurement




EducationalTesting

PsychometricTests


RecordReview

Juvenile


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Use of a RiskAssessment Instrument



ClinicalInterview


RiskAssessment Psychiatric

Evaluation

PhysiologicalMeasurement




EducationalTesting

PsychometricTests


RecordReview

Juvenile


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Assessment Content Domains

•Comprehensive assessment attempts to fully understand the young person, and place his or her behavior in the context of his or her whole life.

•With respect to the goal of estimating risk, the comprehensive assessment provides a formulation about: The circumstances of the sexually abusive behavior, Its natural history Its likely prognosis if things remain unchanged…

as well as Recommendations for treatment and management

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20 Assessment Content Domains

•The assessment should include material in at least 20 domains.

•Together, these domains subsume relevant, detailed, and specific content, providing definition for the material included in the comprehensive psychosocial assessment.

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1. Relevant background and identifying information2. Cognitive functioning and intellectual capacity3. Social, developmental, and medical history4. Educational history 5. Trauma history6. Mental health history/psychological functioning7. Personality characteristics8. Social relationships and social functioning9. Family history10. Current family functioning

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11. History of non-sexual problem behavior12. History of substance abuse13. Sexual development and sexual interests14. History of sexually abusive behavior15. Details of index and related sexual offenses16. Offender’s description of index sexual offense17. Assessment of risk for sexual re-offense18. Environmental concerns19. Availability of environmental support20. Amenability to treatment…

and perhaps…21. Recommendations

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Practice Guidelines

•Guidelines represent a means for conceptualizing, organizing, and ensuring a well-developed risk assessment process.

•Additionally, they reflect our current knowledge base, embrace our current ideas about assessment, and meet our current expectations.

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Practice Guidelines

1. The evaluator should adopt a non-judgmental and patient stance in the evaluation, remaining persistent and focused.

2. The evaluator must be aware of the individual's cognitive functioning and provide alternative means for gathering information directly from the juvenile if cognitive, intellectual, and/or language skills are poor.

3. Informed consent for the assessment is required, which in the case of juvenile must include consent of legal guardians.

4. The purpose, use, and possible outcome of the evaluation should be described to the juvenile and the juvenile’s legal guardians.

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Practice Guidelines

5. All parties must be aware of any limits to confidentiality, and especially if there is any possibility or likelihood that evaluation results will be shared with external agencies such as police, court, or social services.

6. The evaluator must be prepared for the evaluation, and ensure a thorough review of existing documentation prior to the assessment.

7. The evaluator must be aware that information available in prior reports may be incomplete, incorrect, or not fully understood, and take care to not simply pass along inaccurate or poorly understood information.

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Practice Guidelines

8. Interviews are used to gather specific data, and also to observe, supplement, question, review, and clarify information obtained from other sources. These should include meetings with the young person, as well as in-person or phone interviews with collateral informants.

9. The evaluator should be aware that information provided directly by the juvenile may not be true, complete, or sufficiently detailed…… and recognize the possibility that the juvenile may lie, deny, distort, or minimize…… and that the same may be true of informants in the juvenile’s family.

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Practice Guidelines

10. Psychological, physiological, and other objective and subjective measures are used to gather additional information outside of the process of record review and psychosocial assessment.

Neither psychological nor physiological testing can be used to prove or disprove that an individual will engage or re-engage in sexual offending behavior.

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Content Guidelines

1. Information should be gathered from multiple sources, including family members, probation and parole officers, current or former treatment practitioners such as therapists and psychiatrists, teachers, and treatment staff in former treatment programs or hospitals.

2. The assessment should employ multiple evaluation methods, if available and appropriate, including clinical interviews, psychological and educational testing, and physiological testing.

3. The evaluator should seek multiple types of information, including, but not limited to, early developmental history, intellectual and cognitive skills, social functioning and relationships, development and acquisition of social skills, etc.

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Content Guidelines

4. If possible, the evaluator should assess sexual interests and patterns of arousal in the juvenile, recognizing that such assessment does not necessarily indicate the presence of sexual deviance or prove that the juvenile will engage in future sexual offenses.

5. Assessment of treatment needs and the development of treatment goals should be based on an understanding of the juvenile’s needs, including both strengths and weaknesses, as well as an assessment of risk based on the juvenile’s history and current level of functioning.

6. The evaluator must recognize that evaluations without broad and supporting collateral information should be interpreted with caution, and such caution should be noted in the written evaluation report if the assessment was conducted and completed in absence of such information.

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Content Guidelines

7. An assessment of risk should not be made in the event that adequate information is not available from which to draw such estimates.

8. Placement and/or treatment recommendations must be based on the assessment of risk and public safety, the treatment needs of the juvenile, and the young person’s motivation to engage in treatment.

9. The written report must be accurate, complete, transparent, and free of speculation and judgment.

10. The evaluation report should…

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Content Guidelines

a. Note all records reviewed and informants interviewed. b. Note any limitations on the assessment, including lack of

collateral or supporting information that may affect the ability to make informed judgments about the juvenile, the reported offenses, or the risk for future sexual offending.

c. Describe that consent was given for the evaluation, and any limits to confidentiality explained to the juvenile and legal guardian.

d. Ensure a non-judgmental and impartial style, and that all data presented are objective and accurate.

e. Avoid making speculative statements, except when stating clinical formulations and when ample evidence exists to adequately support the hypotheses of the formulation.

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Content Guidelines

f. Document any denial of offenses that the young person may make, as well as his or her explanation, if any, for inaccurate or false allegations.

g. Provide a clear explanation in the event that it is not possible to make an assessment of future risk.

h. Neither written nor verbal results of the assessment should be released to anyone without the express written consent of the appropriate party, which in the case of juveniles will be the legal guardian, other than when a report is legally required to be released.

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Implications of Risk Assessment

•Ideas about risk are usually tied to how best to respond and manage risk.

•It is likely that some form of activity will occur after risk assessment, designed to curb risk and thus prevent harm.

•An assessment of low risk may yield a limited response, and hence a more limited form of management or treatment…… whereas and assessment of high risk results in greater concern about the individual’s potential to harm others and more intensive responses that are designed to protect against or eliminate harm.

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Implications of Risk Assessment “Treatment” Continuum

ModelSafety through Environmental

and Social Control

FocusPublic Safety

and Containment

Primary MethodIncarceration, Probation,

Community Monitoring, etc.

ModelSafety through Improved MentalHealth and Social Functioning

FocusImprovement of

Individual Well-Being

Primary MethodSocial Skill Development,

Mental Health Treatment, etc.

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Implications of Risk Assessment

•In conducting the risk assessment process…

“Practitioners… most importantly, (must) make sure that the assessment process culminates in an etiological formulation that is based around the individual’s features alongside those they share with other offenders.”

-Ward, Gannon, & Birgden, 2007

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