Juvenile General Violence Risk Assessments

Assessing risk in the presence of developmental change introduces great uncertainty with juveniles. Unlike adults, who typically present with long-standing behavior patterns, adolescents have minimal life experience and may offer little reliable evidence of a stable pattern helpful in gauging risk. As adolescents’ behaviors, emotional expressions, peer groups, and decision-making are inherently evolving, assessing risk within this population is akin to hitting a moving target.

Risk assessments essentially inform and guide management decisions and, as such, have often become a mechanism for denial of liberty by removing the youth from their caregivers and the community. Informed management decisions are crucial since incorrectly prescribing an intensive intervention, such as placement in correctional or residential settings for youth with relatively few risks, may result in iatrogenic treatment effects. Over-prescription of services not only depletes scarce resources but may do more harm than good. For example, when mixing individuals with few risk factors with more antisocial or sexually deviant youth, their developmental trajectory may be negatively altered. Researchers have proposed matching juveniles with tailored management plans that target individual risk and protective factors.

Adolescence is a period of significant flux that must be captured by factors capable of assessing change. The fickleness of behaviors, emotions, and decision-making during adolescence affects not just assessments of risk but also diagnostic and prognostic assessments. The challenges of assessing juveniles are myriad, including, most notably, the dynamic changes that occur with development and maturation irrespective of criminal behavior. In addition, juveniles are effectively subject to the potentially harmful, enduring effects of risk assessment, including stigmatizing labels, absent any procedural due process rights afforded by judicial review.

Decision points in which a juvenile’s risk may be assessed

• Dispositional planning during family court
• Requested by legal and correctional professionals before adjudication
• For the legal system, during the adjudicatory process
• Conducted by child welfare workers responding to reports of a child that is sexually abusive or aggressively acting out
• Mental health professionals considering placement or discharge from a residential facility
• Mental health facilities and professionals receiving post-adjudication referrals for treatment
• The Sex Offender Assessment Board or judges considering registration level
• Examiners evaluating a youngster for civil commitment

These decisions hinge on reliable, valid assessments of risk and needs. An evidence-driven risk and needs assessment can provide an empirically based roadmap for informing:

• Discretionary decisions about the safe management of juveniles, ensuring that the most intensive and restrictive interventions and placements are reserved for those who pose the most significant risk coupled with the least restrictive placement possible to assist with positive youth development
• Community-based aftercare planning from correctional facilities or treatment programs
• Treatment planning concerning risk-relevant needs can support youth in developing prosocial, healthy relationships and lifestyles 

Any progress that lays the groundwork for more effective (and more humane) management strategies, improved treatment interventions, and more accurate and informative screening tools that reduce contact with the juvenile justice or child welfare system is beneficial.

Numerous juvenile risk assessment measures are available, consistent with actuarial and structured professional judgment (SPJ) approaches. Such measures differ from adult risk assessment measures because they incorporate risk factors considered uniquely relevant to juveniles. As a result of the development of such measures, risk predictions in recent years have been more accurate than before their development.

The SPJ approach helps to focus the evaluator on relevant data to gather during interviews and record reviews so that the final judgment, although not statistical, is well informed by the best available research. 

The START:AV aims to facilitate and structure the prevention of harm. It guides each assessment of a youth’s vulnerabilities that contribute to adverse outcomes and their strengths that help protect against them. The START:AV includes assessing harm to others and rule violations, for example, violence, non-violent offenses, substance abuse, unauthorized absences such as running away and school drop-out, and harm to self, including suicide, non-suicidal self-injury, victimization, health neglect. It was adapted for adolescents from the START, a well-established adult measure. Research has demonstrated that the START:AV can predict adverse outcomes and assist in intervention planning.

The START:AV Is intended for use with male and female adolescents aged 12-18 in mental health and legal settings. It has several defining characters:

• Comprehensive and Integrative Examination of Risks
• Strengths and Vulnerabilities
• Individualized Assessments Taking into Account Context
• Focus on Intervention Planning
• Structured Yet Flexible

The START:AV is completed using information routinely collected in any competent assessment. Therefore, it can quite easily be integrated into routine practice. The developers of the instrument emphasized the importance of collecting information on each item from multiple sources, such as the adolescent, caregivers, other collaterals, and records.

Adolescents are embedded in their environment, more so than adults. Therefore, the START:AV emphasizes relationships and the environment more than some adult risk assessment instruments. The START:AV examines various areas of functioning such as behavioral, emotional, cognitive, and interpersonal functioning. In addition, relationships and the environment are also central. Therefore, relationships with caregivers and other involved adults, relationships with peers, and considering aspects of the community are integral to a comprehensive assessment.

The SAVRY incorporates risk factors related to assessing generalized violence potential in adolescent populations, ranging in age from 12 to 18 years. Based on their summary risk scores, it is designed to help categorize those likely to require more intensive monitoring and targeted interventions.

The SAVRY was developed to address the need for an instrument to assess generalized violence risk in an adolescent population. Implementation research detected violence in adolescent populations. The SAVRY was modeled after the HCR-20, and modifications were made in the item content to include risk factors derived from research and literature on child development, violence, and aggression specific to adolescence. It has 24 items that are divided into three scales:

• Historical 
• Social/Contextual
• Individual/Clinical 

The Minnesota Multiphasic Personality Inventory MMPI-A (and MMPI-A-RF)

The MMPI was published in 1943, and by the mid-1980s, it was the third most frequently used test for adolescents. Due to concerns about the length, the norms, and the wording of the tool, the MMPI-A was developed in 1992. The MMPI-A is shorter, normed on 14–18-year-olds, and contains scales specific to adolescents. More recently, the MMPI-A-RF was created, as the length of the MMPI-A was still viewed by some as a significant disadvantage. 

While the MMPI is not a risk assessment tool, it may be helpful to incorporate the MMPI-A/MMPI-A-RF in juvenile forensic evaluations. For example, in a risk assessment, considering the individual’s current functioning and their response style might not be captured when using just a formal risk assessment instrument. In addition, the MMPI-A-RF has juvenile forensic comparison groups of males and females in various parts of the United States and other standard comparison groups (e.g., medical setting, school setting). 

The MMPI-A-RF thoroughly assesses mental health treatment needs and potential personality/behavioral barriers. These assessment instruments also have scales that have empirical correlates and diagnostic and treatment considerations.

For example: 

• The Behavioral/Externalizing Dysfunction scale has empirical correlates with difficulties associated with under-controlled behavior (e.g., school suspensions or running away). Elevations suggest the adolescent should be evaluated for externalizing disorders such as conduct disorder and opposition-defiant disorder.
• The Antisocial Behavior scale has similar empirical correlates and diagnostic considerations. Elevations on this scale also suggest that youth is evaluated for substance-related disorders and that initial targets for treatment interventions should focus on impulsive and conduct disordered behaviors.

Administration of the MMPI-A/MMPI-A-RF

• The adolescent should be 14-18 years old
• The adolescent must be able to read and comprehend the items 
  • Administrations should review the instructions with the adolescent
  • Administrations should not explain test items to the youth
• The adolescent should be in an appropriately supervised environment 
  • Provide a noise-free environment
  • The booklet can not go home with the youth
• The adolescent must be willing to tolerate testing
  • Establish rapport before testing

Psychopathy Checklist: Youth Version (PCL:YV)

The PCL:YV was primarily designed as a measure of psychopathic traits rather than a risk assessment tool, although it has been shown to be associated with violent behavior in several studies. Therefore, it is not surprising that research has found other assessment tools better predictors of recidivism than the PCL:YV.

Psychopathy is conceptually different from other disorders in youth, necessitating using assessment measures to tap into adolescent psychopathic traits. Currently, the most commonly used assessment instruments have been interview and file review ratings using a modified version of the PCL-R, known as the Psychopathy Checklist: Youth Version (PCL:YV).

The PCL:YV attempts to tap into the critical interpersonal and behavioral traits associated with the construct of psychopathy. Research utilizing the PCL:YV strongly suggests that psychopathic traits can be observed and measured. Using these measures has given researchers and clinicians the ability to understand specific personality correlates associated with psychopathic-like behavior in adolescents. 

Like the adult PCL-R, the PCL:YV is a rating scale designed to assess the 20 core characteristics of psychopathy in youth ages 12 to 18. Psychopathy is assumed to manifest in the same way in juveniles as adults, but modifications to scoring criteria to achieve a sharper focus on adjustment. While it is based on the PCL-R, the PCL:YV items are specific to adults and added in items more appropriately tailored to youth life experiences, such as family life, school, and peer relationships.

For example, unstable personal relationships replaced many short-term marital relationships, and items like impression management were added while glibness/superficial charm was removed.

Why Assess for Psychopathy

Developmental research on emotions and conscience suggests that psychopathy may emerge early. Research findings suggest that psychopathic features may be markers for youth at relatively higher risk for severe and prolonged antisocial behavior. Identifying those at-risk youth may also lead to earlier treatment at a time when adolescents, whose personalities are not yet fully formed, would theoretically be more amenable to treatment. 

Despite the known associations between psychopathy and antisocial behavior, there are concerns about the use of this construct in adolescents. For example:

• Insufficient evidence of this construct
  • Unlike adults, youth cannot demonstrate a long-term stable personality
  • The ability to use good judgment, understand other’s perspectives, and have a stable sense of self are all in flux, which makes it challenging to assess traits such as lack of empathy and grandiosity   

• Developmental appropriateness
  • Some degree of delinquent behavior is developmentally normal
  • Antisocial behaviors that are associated with a psychopath may be transitory

• Stigmatizing nature of this construct

• Adolescents may be mislabeled as a psychopath, and this label may be a lifelong high stigmatized burden
• Clinicians, families, and the courts may all assume a poor prognosis for those youth identified with psychopathic traits. As a result, these youth may lose out on resources and opportunities for treatment as they’re categorized as “psychopaths.”

Psychopathy versus conduct disorders

• Symptom constellation beyond what is  included in the criteria sets of DSM diagnoses
• Researchers found conceptual differences between psychopathy and conduct disorders: types of aggressive behaviors (e.g., reactive and proactive aggression), social skills, and intellectual and emotional functioning
• Beyond APD and its childhood variants and overt behavioral symptoms, factor analyses of the construct of psychopathy revealed an interpersonal affective facet as well as behavioral/antisocial components
  

Administration

• Decisions made by expert raters who are specifically trained in the measure.
• Involves a face-to-face, structured interview where raters can conduct behavioral observations. 
• These evaluators meet the juvenile for the sole purpose of conducting the interview, so they are not involved with the juvenile, allowing for less subjectivity. PCL:YV ratings are based on the combination of information from various sources. Data from interviews, behavioral observation, and file reviews are integrated, making the scores less subjective than individual ratings. 

Pros

• Research has found that the PCL:YV significantly predicted any general, non-violent, and violent recidivism in the aggregate sample over a 7-year follow-up
• Predicted youth recidivism for subsamples of female and Aboriginal youths
• Very few differences in the predictive accuracy of the tool were observed for younger vs. older adolescent groups

Cons

• Resource intensive and require several hours for completion and specialized training
• Limited to use with institutionalized populations for whom there is access to files of past behaviors, and even in a forensic or prison setting, the file is not always complete or accessible
• Questions about the applicability of PCL measures to noninstitutionalized populations for whom there is no history of criminal behavior or institutional files
• Research has found that the lack of long-term predictive power for the PCL:YV and psychopathy designations varied with different measures is concerning when the use of such efforts is the basis for legal or clinical treatment decisions

Although some similarities exist between sexual and non-sexual offenders, sexual offenders have some unique characteristics. Therefore, the best practice is to use specialized sexual offending tools with individuals at risk of sexual offending.

Although psychosocial and psychosexual assessments are routinely sought at the time of commitment, examinations executed to aid or assist with legal decisions typically focus on the presumptive risk posed by the adolescent. Development and testing of risk scales for juvenile sex offenders began in earnest in the mid-1990s, with the first scale reaching publication in 2000.

Beyond registration and community notification, juveniles can be civilly committed in some states under a Sexually Violent Predator (SVP) statute. SVP commitments occur after an individual has been incarcerated for a sexual offense, and thus SVP commitments do not require a recent crime to have occurred.

J-SOAP-II is a risk assessment scale routinely used to assess risk among juvenile sex offenders. The J-SOAP Manual explicitly states that the J-SOAP has no cut-off scores (i.e., no designation of low-, moderate- or high-risk levels is provided). Instead, users are instructed to report results as “proportions of observed risk” by dividing the rated score by the total possible score. 

Pros

• Total scores on the J-SOAP-II predicted sexual recidivism with relatively equal efficacy as other youth and adult sexual risk assessment scales
• Widespread use of the scale, nationally and internationally – standardizing the assessment of risk factors
• Adequate interrater reliability

Cons

• Well over half of the items are static 
• The typical 3-point ratings may optimize inter-rater reliability but at the price of sacrificing a range of severity needed for a more accurate prediction
• Low base rate of sexual offending limits predictive validity and increases the risk of making a false positive decision (e.g., saying youth is high risk when they are not)
• Scale 3 of the J-SOAP was intended to capture change as a treatment function. However, while it is theoretically essential, the research found that it was suboptimal in predictive accuracy.
• J-SOAP II does not directly assess the presence of protective factors

Want something more in depth Interested professionals are also encouraged to check out the Juvenile Forensic Assessment Certificate, a curriculum comprised of 70 hours of foundational training in forensic psychology and 80 hours of specialty training in juvenile forensic assessments!