An Etiological Approach to Sexual Offender Assessment: CAse Formulation Incorporating Risk Assessment (CAFIRA).

PURPOSE OF REVIEW: Case formulations (CF) have been the cornerstone of effective practice in clinical psychology since the 1950s and now form one of the core competencies in clinical and forensic assessment. The use of CFs within forensic settings is becoming more relevant when working with offenders who have experienced significant trauma, suffered from personality disorder, and have displayed sexually abusive behavior. Furthermore, most North American and European jurisdictions insist that expert witnesses adopt an idiosyncratic approach to risk assessment and consider the characteristics of the individual as part of a wider formulation of the problem behavior. This article focuses specifically on CF incorporating risk assessment procedures of sexual offenders. RECENT FINDINGS: While empirical support for the use of risk analysis and formulation in managing offending behavior generally, and sexual offending behavior in particular, is limited, there is mounting evidence to suggest that CF can improve understanding of an individual's problem sexual behaviors. We argue that by integrating risk formulations into the CF provides a conceptually robust link between the etiologically development of the problem sexual behavior and effective assessment and risk management of sexual offenders. As forensic treatment programs increasingly moved toward strength-based approaches, in keeping with the Risk-Need-Responsivity principles Andrews and Bonta (2004), and the Good Lives Model Ward and Stewart (Prof Psychol Res Pract 34:353-60, 2003) of offender rehabilitation, the use of CFs in the assessment, treatment, and management of sexual offenders is indispensable. We present an etiological framework for understanding risk in an individual sexual offender by integrating a case formulation model to include the use of (static, stable, and acute) actuarial and clinical risk assessment measures as well as protective risk factors, referred to as the CAse Formulation Incorporating Risk Assessment (CAFIRA) model.

Perceptions of Social Climate and Aggressive Behavior in Forensic Services: A Systematic Review.

Social climate is a term used to describe the environment of a particular setting which may influence the moods and behaviors of the people inhabiting that setting. This review explores perceptions of social climate in secure forensic services and the associations with aggression. Article searches were conducted using electronic databases, hand-searching reference lists, and contacting experts. Inclusion/exclusion criteria were applied to each study, and quality screens conducted on the remaining articles to establish those for inclusion. A total of seven studies were identified. Factors which were found to have an association with aggression included patients' perceptions of safety, the level of cohesion between patients, the atmosphere of the environment, and an open group climate. It is argued that services which create positive social climates for both staff and patients are more likely to observe lower levels of aggression.

Comparing intra-familial and extra-familial child sexual abusers with professionals who have sexually abused children with whom they work.

The aim of this study is to establish whether professionals who have sexually molested children with whom they work present as a homogeneous group identifiable by their personal histories, offending patterns, and profiles as distinct from other child molesters (intra-familial and extra-familial offenders). Participants were matched on age and IQ. It was found that child molesters who were professionals (similar to extra-familial offenders generally) were likely to have sexually abused male, or both male and female, children and had abused more than 20 child victims. Professionals were also significantly more likely to have offended against post-pubescent children than were extra-familial or intra-familial offenders. In terms of psychological profiles, professionals, like extra-familial offenders, were found to have a significantly higher level of reported sexual pre-occupation and emotional over-identification with children compared with intra-familial offenders and a significantly lower level of distorted sexual attitudes about their victims compared with extra-familial offenders. These results are discussed in the context of assessment that might be used to assess risk in those working with children in a professional capacity.

The effect of age on sexual and violent reconviction.

Although a number of research studies indicate an inverse relationship between age and sexual offence recidivism, the effect of age on sexual and violent reconviction remains unclear, with some studies producing contradictory results. In the present study, reconviction data were obtained for 131 offenders (85 sex offenders and 46 violent offenders) followed up over a 2- and 5-year period. The sample was grouped into four age bands (i.e., ≤24, 25-34, 35-44, and ≥45 years) and rates of sexual, violent, sexual and violent (combined), and any offence reconviction were compared. There was an almost linear relationship between age and rate of reconviction, with the youngest age band (≤24 years) presenting the greatest risk of reconviction and the older age bands (≥45 years) presenting the lowest reconviction rate. At the 5-year follow-up, the youngest age band was significantly more likely to be reconvicted of sexual and violent offences (combined) than any other age band. This age band was significantly more likely to be actuarially assessed (i.e., Static-99) as high risk (controlling for age) and was more likely to target strangers, be single, and display non-sexual violence during the index offence. In relation to sexual reconviction, there was a plateau effect in the middle-age band, with the oldest age band (≥45 years) obtaining the highest sexual reconviction rate compared with all other age bands at the 5-year follow-up. Although these findings support the view that lower-aged sexual and violent offenders pose greater risk than their older-aged counterparts, this was not true for sexual reconviction at the 5-year follow-up. Implications of these findings are discussed.

Sexual reconviction rates in the United Kingdom and actuarial risk estimates.

OBJECTIVE: Assessing the risk of further offending behavior by adult sexual perpetrators of children is highly relevant and important to professionals involved in child protection. Recent progress in assessing risk in sexual offenders has established the validity of actuarial measures, although there continues to be some debate about the application of these instruments. This paper summarizes the debate between clinical and actuarial approaches and reviews the "base rate" for United Kingdom sexual offense reconviction. METHOD: A review of the literature revealed 16 UK sexual reconviction studies, 8 using incarcerated samples (N=5,915) and 8 using non-incarcerated samples (N=1,274). UK estimates of sexual reconviction rates are compared with European and North American studies. RESULTS: The mean sexual reconviction rates for the incarcerated sample at 2 years (6.0%), 4 years (7.8%) and 6 years or more (19.5%) were higher than that of the comparative non-incarcerated sample at 2 years (5.7%), up to 4 years (5.9%), and 6 years or more (15.5%). The overall sexual reconviction rate for both samples combined was 5.8% at 2 years, and 17.5% at 6 years or more. CONCLUSIONS: The sexual reconviction rate for incarcerated sexual offenders is higher than that of non-incarcerated sexual offenders. The UK sexual reconviction rates were comparable with European and North American studies.

Treating sexual offenders with learning disabilities in the community: a critical review.

This study offers a critical review of a treatment group for sexual offenders with learning disabilities. The participants were diverted from criminal proceedings due to their level of cognitive functioning and attended a 7-month treatment program comprising of four main components: sex education, cognitive distortions, offending cycle, and relapse prevention. A number of psychometric assessments were administered immediately before and after intervention. Although no significant differences were found in attitudes toward sexual offending following treatment, the trend was for improvements in sex knowledge and honesty of sexual interest. Improvements in socialization skills (leisure time and interpersonal skills) were significant. No further incidents of sexual offending have been reported during a 12-month follow-up. A number of explanations for the nonsignificant improvement in attitudes are considered and recommendations for future treatment evaluation studies are made. The development of specific questionnaires and treatment programs for sexual offenders with learning disabilities is discussed.

Differences in personality and risk characteristics in sex, violent and general offenders.

BACKGROUND: Studies examining the characteristics of sex and violent offenders have found differences in personality and offence characteristics. However, none of these studies has examined differences in personality characteristics between violent, sex and general offenders using the Special Hospitals Assessment of Personality and Socialization (SHAPS). METHOD: Using a retrospective archival research design, data on 153 male offenders were divided into three groups, sexual (n = 85), violent (n = 46) and general offenders (n = 22). Of the sample 139 offenders had completed the SHAPS. The Sexual Violence Risk-20 (SVR-20) measure was used to categorize levels of risk. Reconviction data collected over a 10-year follow-up period were analysed using the receiver operating characteristic analysis. RESULTS: Violent offenders had significantly more chaotic lifestyles, displayed greater psychopathology than sex or general offenders, and were most likely to reoffend, with over a quarter committing further violent offences. The sexual offender group share more in common with the general offenders, in terms of personality characteristics and recidivism rates, than with the violent offenders. More of the violent offenders were categorized as at medium or high risk of recidivism than any other group. The SVR-20 significantly predicted any reconviction over five- and 10- year follow-up periods. DISCUSSION: The results from this study support the use of self-report inventories in assessing differences between offender groups. Such information may assist clinicians in prioritizing management and intervention strategies for those offenders, and in turn lower the risk of further offending.

Cross-validation of the risk matrix 2000 sexual and violent scales.

The predictive accuracy of the newly developed actuarial risk measures Risk Matrix 2000 Sexual/Violence (RMS, RMV) were cross validated and compared with two risk assessment measures (SVR-20 and Static-99) in a sample of sexual (n= 85) and nonsex violent (n= 46) offenders. The sexual offense reconviction rate for the sex offender group was 18% at 10 years follow-up, compared with 2% for the violent offenders. Survival analyses revealed the violent offenders were reconvicted at twice the rate compared to sexual offenders. The RMV significantly predicted violent recidivism in the sex and combined sex/violent offender groups. Although the RMS obtained marginal accuracy in predicting sexual reconviction in the sex offender group, none of the scales significantly predicted sexual reconviction. An item analysis revealed four factors not included in the risk scales that were significantly correlated with sexual and violent reconviction. Combining these factors with Static-99, RMV, and RMS increased the accuracy in predicting sexual reconviction.

Comparing sex offender risk assessment measures on a UK sample.

The purpose of this study on 139 sex offenders was to consider the application of six measures of risk: Static-99, SACJ-Min (Structured Anchored Clinical Judgment Scale-Minimum), RRASOR (Rapid Risk Assessment for Sexual Offence Recidivism), Risk Matrix 2000-Sexual/Violent, and SVR-20 (Sexual Violence Risk-20) and to compare risk assessments conducted by a Regional Secure Unit (RSU) and the Probation Service. Levels of risk for the RSU sample ranged from 1% to 42% low risk to 1% to 66% high risk compared with the Probation sample of 8% to 43% low risk to 4% to 70% high risk. Offenders with adult victims obtained significantly higher scores using the RM2000/S and SACJ-Min than did those with child victims who obtained significantly higher scores on the RRASOR. Sex offenders referred to a RSU scored significantly higher on RRASOR and RM2000/S than did sex offenders supervised by the Probation Service. Forensic practitioners may be better served if risk measures assess specific subcategories of sexual offenders.