Translating risk factors into treatment needs for juveniles with sex offenses
Shifting the focus from risk prediction to treatment and remediation can benefit public policy by improving juvenile outcomes, reducing management cost, and providing substantially more reliable input for the court and all providers. This is the bottom line of a recently published article in Translational Issues in Psychological Science. Below is a summary of the research and findings as well as a translation of this research into practice.
Featured Article | Translational Issues in Psychological Science | 2019, Vol. 5, No. 2, 154-169
Tamara Kang, Fairleigh Dickinson University
Amanda Beltrani, Fairleigh Dickinson University
Megan Manheim, Fairleigh Dickinson University
Sharron Spriggs, Fairleigh Dickinson University
Bridget Nishimura, Fairleigh Dickinson University
Shantel Sinclair, Fairleigh Dickinson University
Marta Stachniuk, Fairleigh Dickinson University
Elise Pate, Fairleigh Dickinson University
Sue Righthand, University of Maine
James R. Worling, Ontario, Canada
Robert A. Prentky, Fairleigh Dickinson University
With the post-Gault trend toward the criminalization of the juvenile court, the demand for risk prediction assessment scales took on newfound importance. The past several decades of research have underscored the limitations of these scales. To address these limitations, and to shift the focus from current and future risk to least restrictive management strategies and effective treatment, we have developed and implemented a new assessment protocol that relies on risk relevant dynamic factors to inform and individualize treatment interventions as a vehicle for reducing recidivism and promoting healthy development among juveniles with sex offenses—without focusing solely on risk prediction. This Treatment Needs and Progress Scale (TNPS) is currently being pilot tested in five states. This article reviews the methodological problems of the extant risk assessment scales, discusses the development of the TNPS and how this protocol seeks to address many of these problems, including shifting the outcome target from reoffense to mitigation of risk factors through treatment and healthy growth and adjustment. We conclude with discussing how the TNPS may improve decision making regarding the management of juveniles with sex offenses, inform public policy and law, and facilitate healthier outcomes.
juveniles, sex offenses, treatment, risk prediction, risk management
Summary of the Research
“Extensive research over the past 15 years has shed light on the marked limitations of the extant risk assessment scales used for Juvenile Sex Offenders (JSO), including the three most commonly used scales—the ERASOR, the J-SOAP-II, and the JSORRAT-II. The methodological challenges and the deficiencies of existing scales for these juveniles have been discussed at length elsewhere and in the excellent review by Vincent, Guy, and Grisso (2012) on assessing the risk of delinquent youth in the juvenile justice system” (p. 155).
“In 2016 we began the design, development, and implementation of the Treatment Needs and Progress Scale (TNPS) that focuses on dynamic risk and protective factors that enabled users to assess change as a function of intervention and that provided risk relevant information to a wide range of stakeholders. Although a number of dynamic assessment tools are available to assess youth with nonsexual offenses, JSOs are often statutorily unique in terms of mandated management provisions, including community notification and civil commitment. JSOs, unlike their counterparts who offend nonsexually, may be subject to being labeled as a “sex offender” on public registries, experience barriers to attending public school and gaining employment, and be barred from living in homes with children, including their own siblings. All of these managerial provisions are predicated on an assumption of risk that overshadows other considerations. Not only are these assumptions often flawed, as noted above, but they shift the focus away from health to pathology. This 3-year national study shifts the focus on magnitude of risk to remediation of risk” (p. 157).
The project had five goals: (a) develop and test an evidence-informed treatment needs and progress scale (hereafter referred to as TNPS) for assessing—primarily— dynamic risk and protective factors and limited experimental historical items empirically associated with sexual and nonsexual reoffending by JSOs and identifying related intervention needs associated with those factors; (b) develop a user-friendly data entry software program that enables evaluators to rate risk-relevant factors in their initial assessments, design treatment or case management plans accordingly, monitor progress, and assess readiness for discharge via periodic reassessments, and may assist with internal program evaluations; (c) test the scale with 400–500 youth at multiple sites across the United States and examine reliability and validity of the TNPS items, for example, by analyzing comparisons of scores on the TNPS with deidentified, electronic, routinely collected data reflecting the juveniles’ overall functioning prior to and during the course of treatment; (d) revise the scale accordingly to produce a final version of the TNPS and revise the data entry program; and (e) provide sites with training on the final version of the TNPS, including a train-the-trainers component that can ensure sustainability.
Translating Research into Practice
“Through development of a TNPS, we hoped to shift the goalpost from an outcome focused exclusively on risk of sexual reoffense (or any nonsexual criminal offense) to an outcome focused on adjustment and health. Although many of the dynamic items used in the TNPS are found in extant juvenile sexual and nonsexual risk assessment scales, our objective in including such items in the TNPS is not to capture risk of reoffense but to guide individualized treatment to reduce risk and develop behaviors and lifestyles that are incompatible with delinquent or criminal behavior. The considerable item overlap with other scales is not coincidence. Understanding risk is a sine qua non for reducing risk; accurately assessed risk is our best guide for identifying optimum interventions tailored to individual needs. In sum, we have argued that our efforts to predict risk reliably have fared poorly and that a far more expedient longterm strategy is to mitigate risk. Further, inclusion of protective factors (items that may mitigate or buffer risk, as well as others that are important for improving treatment response), is intended to promote a dynamic and holistic approach to facilitating positive development, healthy transitions into adulthood, and prosocial lives. By shifting the focus to risk mitigation through treatment we are hoping to influence not just practice but the policy driving practice” (p. 164).
“The TNPS and its guiding principles are not an attempt to devalue assessment of risk, and we are not recommending abandoning risk assessment. Risk is a sensitive barometer for what must be targeted in treatment. However, lessons learned from the past is that risk assessment with juveniles, when treated as an endpoint, is fraught with problems, both substantive (methodological) and practical (management). What we recommend is that risk take its place embedded in the matrix of an idiographic assessment that focuses, as a midpoint, on mitigation through treatment and other interventions that foster health rather than as an end goal of prediction” (p. 164).
“Although the data from our pilot sites will hopefully shed light on our basic assumptions about the efficacy and merits of the TNPS, these assumptions must continue to be examined empirically well after the pilot phase. We should emphasize, however, that the TNPS alone can never mitigate risk, and its assistance with guidance, treatment, and management can be no better than the fidelity with which it is used. The potential implications described below refer to how, if implemented with fidelity, the TNPS might inform decision-making and impact juveniles, their parents and caregivers, child welfare system case workers, law enforcement, probation officers, juvenile court judges and attorneys, teachers and school administrators, clinicians/treatment providers, public policy advocates, and researchers” (p. 164-165).
Other Interesting Tidbits for Researchers and Clinicians
“We have sought to develop and test a different model for addressing the needs of juveniles with sex offenses. This model has three overarching goals: (a) reverse the prevailing standard of practice that understands risk prediction as the quintessential purpose of assessment, (b) reintroduce treatment as the principal objective of sound management, and, in so doing, (c) potentially reduce the large number of false positive decisions (i.e., classifying low risk youth as presenting a high risk), that pose a financial burden on society and may further cripple already troubled youth” (p. 165).
“Our proposal is not novel. Over two decades ago, Chaffin and Bonner (1998) penned their oft-cited Editor’s introduction: “Don’t Shoot, We’re Your Children:” Have we gone too far in our response to adolescent sexual abusers and children with sexual behavior problems? Ten years later Chaffin (2008) wrote his reprise focusing on the continued disconnect between policy-based misperceptions of high risk, homogeneity, and intransigence (the belief that sexually offending behaviors in juveniles are ‘tenacious and difficult to change and require not just specialized intervention but lots of it . . . delivered over a long period of time . . . and should involve more intensive, restrictive, and expensive elements’ [pp. 118–119]). As Chaffin pointed out in 2008, there was no scientific support for those beliefs, a finding that continues to be true today” (p. 165).
“In the decade since Chaffin’s (2008) article, there has been a wealth of empirical literature documenting: (a) heterogeneity among juveniles with sex offenses, (b) low sexual recidivism base rates, implying a low risk of new sex offenses, (c) marked developmental immaturity, indicating that change is inevitable as a mere function of growth, and (d) amenability to short-term treatment; indeed there is evidence that high intensity treatment for low-risk youth may actually increase the likelihood of reoffending. Thus, the TNPS is not an experiment with a new risk assessment scale for JSOs, but rather a structural attempt – and an opportunity – to align policy and practice with scientific evidence. Any steps, even preliminary ones, that lay groundwork for empirically informed policies, management strategies, and treatment methods that reduce a youth’s contact with the juvenile justice or child welfare system will be beneficial for everyone—our juvenile clients, their families and communities, and our society: (p. 165-166).
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Authored by Amanda Beltrani
Amanda Beltrani is a current doctoral student at Fairleigh Dickinson University. Her professional interests include forensic assessments, professional decision making, and cognitive biases.