Offender personality disorder pathway: the impact of case consultation and formulation with probation staff

The latest government policies for personality disordered offenders emphasise the importance of a formulation-based approach to rehabilitation and pathway planning. However, research into forensic case formulation is limited. This paper examines the impact of consultation and formulation, on probation staff working with personality disordered offenders. Staff rated their knowledge, confidence, motivation, and understanding (of offenders), and satisfaction with management plans at three stages: pre-consultation, post-consultation and after receiving a written formulation. The analyses revealed that ratings on all variables examined increased after attending a consultation meeting, with no additional increase in scores following receipt of the formulation letter. The findings provide evidence that consultation has a range of benefits for probation staff, and offer support for the current model of joint-agency working. Further research is needed to clarify the benefits of providing written formulations after consultations, and to explore what features of a formulation are most useful to probation staff.     

Exploring the role of locus of control in sex offender treatment

Abstract

This study aims to investigate the concept of Locus of Control (LoC) and its relationship to risk, personality disorder and treatment outcome in sexual offenders. The sample was taken from referrals to a community treatment service for sexual offenders in south-east London. One hundred and eighty-five men completed a measure of LoC at the time of assessment, of whom 74 entered the treatment programme and 39 completed a post-treatment LoC measure. At assessment, child molesters and non-contact offenders had a significantly more external LoC than rapists, and LoC was also significantly associated with cluster A and C personality disorder traits, as well as the presence of traits in two or more personality disorder clusters. LoC was not associated with risk measures or compliance with treatment. Once outliers were removed, a significant change was seen in post-treatment LoC scores, with most change occurring in an increasingly internal direction.     

The impact of collaborative case formulation with high risk offenders with personality disorder

This study investigated the impact of completing collaborative case formulations (CFs) on the professional relationship between Offender Managers (OMs) and high risk offenders with personality disorder (PD). It was hypothesised that collaborative CFs would result in significantly improved professional relationships, offender engagement and OM confidence. Seventy-seven OMs were randomised into control and formulation groups and randomly allocated a high risk offender with PD. OMs in the formulation group attended advanced formulation training and constructed collaborative CFs. No collaborative CFs were constructed by the control group. All participants subsequently completed a measure of relationship quality. OMs also completed a perceived benefits rating scale evaluating perceived offender engagement and OM confidence. OMs in the formulation group reported significantly higher overall relationship quality, a stronger working alliance and greater confidence. Offenders in the formulation group reported significantly higher degrees of trust in their OMs. Results indicate that completing CFs collaboratively with high risk offenders with PD may have a small, beneficial impact on the quality of OM/Offender relationships and increase OM confidence.     

Effectiveness of modified therapeutic community treatment within a medium-secure service for personality-disordered offenders

There is debate as to whether secure hospital treatment for offenders with personality disorder can be effective relative to criminal justice interventions. This study examines the evidence for long-term treatment of such offenders in hospital within in a modified therapeutic community model including accredited offending behaviour programmes. A panel sample of 47 patients were followed up on measures of violence risk (HCR-20, VRS) and symptom severity (SCL90-R). Intention-to-treat analysis with reliability thresholds showed significant positive change between assessment and discharge in both violence risk (VRS) and symptoms (SCL90-R) indicating a positive treatment effect. Threshold effects for treatment effectiveness seemed to occur at 1?year of treatment for risk and 3?years for symptom reduction.     

Juvenile sex offenders: a complex population

Individuals who engage in sexual offending behavior represent a heterogeneous population. Recent research has found some success in categorizing sexual offenders based on a number of variables, particularly the type of victim. For example, differences have been found between those offenders who victimize adults when compared with those who victimize children. However, the research in this area has been conducted predominantly with adult samples. As the adult sex offender literature has progressed, it has become evident that risk assessment, treatment effectiveness, and risk management are dependent on such offender characteristics. Unfortunately, the relevance to juveniles of characteristics deemed to be important with adult sex offenders is limited due to the complexity of developmental processes, particularly with respect to mental disorders and personality formation. As such, the formulation and implementation of treatment and risk management strategies that will be effective with juvenile sex offenders are challenging. The goal of this paper is to review some of the complexities inherent in the juvenile sex offender population by focusing on specific areas of complication, including: classification systems, comorbid paraphilias and other mental illnesses, and maladaptive personality traits.     

Assessing Violence Risk in Stalking Cases: A Regression Tree Approach

Advances in the field of risk assessment have highlighted the importance of developing and validating models for problematic or unique subgroups of individuals. Stalking offenders represent one such subgroup, where fears of and potential for violence are well-known and have important implications for safety management. The present study applies a Classification and Regression Tree (CART) approach to a sample of stalking offenders in order to help further the process of identifying and understanding risk assessment strategies. Data from 204 stalking offenders referred for psychiatric evaluation to a publicly-funded clinic were used to develop and assess putative risk factors. A series of nested models were used to generate tree algorithms predicting violence in this sample of offenders. Both simplified and more extensive models generated high levels of predictive accuracy that were roughly comparable to logistic regression models but much more straightforward to apply in clinical practice. Jack-knifed cross-validation analyses demonstrated considerable shrinkage in the CART, although the models were still comparable to many other actuarial risk assessment instruments. Logistic regression models were much more resilient to cross-validation, with relatively modest loss in predictive power.     

Treatment effectiveness for offenders with autism spectrum conditions: a systematic review

Theoretical suppositions suggest a potential vulnerability in some individuals with autism spectrum conditions (ASCs) to displaying offending behaviours. Additionally, it is recognised that the features of ASCs may result in possible barriers to treatment. A systematic review was undertaken to identify empirical evidence examining the effectiveness of treatment programmes for offenders with ASCs and to explore the potential impact of ASC symptoms on treatment outcomes. The studies identified consisted of a small number of case series and a collection of case reports with little or no direct comparisons to offenders without ASCs. A synthesis of the findings highlighted variability in treatment approach and impact. Effectiveness was primarily defined by reduction in further offending behaviours and was found to be variable across the data. The potential relationship between the symptoms of ASCs and treatment outcome was explored with all case reports identifying the need for adaptations to treatment programmes, necessitated by the symptoms of ASCs. This systematic review joins an existing body of literature emphasising need for more controlled research into the effectiveness of offending behaviour treatment programmes for individuals with ASCs, and for further investigation into the impact of the clinical features of ASCs on treatment outcomes.     

The implementation of case formulation by probation officers: service user and carer views

Background: The recent UK Government strategy on high-risk offenders with personality disorders (PD) proposes improved identification of this group, assessment of their treatment needs through case formulation (CF) and the subsequent provision of treatment pathways. Little is known about service user and carer views on this strategy. Aims/Hypotheses: This study sought to identify the views of personality-disordered (PD) offenders and carers on the proposed role of Probation staff in CF. Methods: Three focus groups were carried out, two with service users and one with carers, with a total of 10 participants overall. Results: Five themes emerged: ‘power’, ‘conflicting roles’, ‘trust’, ‘building a relationship through consistency of care’ and ‘hope and possibility’. Conclusions/Practical implications: Offenders and carers were sceptical regarding the proposed role of Offender Manager (OMs) in CF and this could pose a potential barrier to the successful implementation of the strategy.     

Sexual predator civil commitment: a comparison of selected and released offenders

This study compared two groups of sex offenders who were considered for civil commitment under Florida's Jimmy Ryce Act: Two hundred twenty-nine sex offenders who were recommended by forensic evaluators to be civilly committed and 221 sex offenders who were recommended for release. It was hypothesized that selected offenders would be more likely to display risk factors for sex offense recidivism than those who did not meet criteria. Data analyses revealed that selected offenders, as a group, scored significantly higher on actuarial risk assessment instruments. There were also significant differences between the groups on other risk factors that have been empirically correlated with sexual recidivism. Selected offenders had higher frequencies of paraphilia diagnoses and antisocial personality. These findings supported the hypotheses and suggested that evaluators are correctly selecting for civil commitment those sex offenders who have a mental abnormality predisposing them to sexual violence and who are at higher risk for reoffense.     

Neuropsychological and Criminological Features of Female Homicide Offenders

Few studies have examined life history and cognitive characteristics unique to female homicide offenders. Understanding these characteristics could aid in risk assessment for extreme violence in this group of offenders. The current study utilized t‐tests or chi‐square tests to compare 27 female and 81 male homicide offenders on psychiatric, neurologic, criminal, and cognitive characteristics. Additionally, we explored the role of abuse history in female offenders through Kruskal–Wallis or Fisher's exact tests. Results indicate that in comparison with male counterparts, females are more likely to have history of mood disorder, borderline personality disorder, and abuse. Cognitively, female homicide offenders exhibit circumscribed cognitive impairment in verbal abilities and perform similarly to male homicide offenders across most cognitive tasks. Within the female offender group, history of sexual abuse is associated with higher rates of impulsive homicide and poorer verbal abilities. These findings provide preliminary evidence for distinct factors associated with homicide in women.     

The prediction and control of organized crime: A risk assessment instrument for targeting law enforcement efforts

Linking isolated instances of organized crime in a systematic way can inform law enforcement in identifying high-risk activities and markets and prioritizing them according to objective factors known to be associated with organized crime. There are five ways in which risk assessment organized crime can be achieved. Improvements to data collection, utilizing a team approach to gather information, identifying common elements in organized crime incidents, understanding the parameters of a risk assessment instrument, and connecting organized crime risk assessment to the implementation of law and policy are practical ways in which organized crime activity can be better anticipated, investigated, and prevented. Connecting isolated incidents to organized crime through better information from offenders, victims, and police is possible with teams of investigators, researchers, and analysts. An organized crime risk assessment tool is presented that offers systematic analysis of opportunity factors, the criminal environment, and harm potential among the seventeen risk factors identified. Risk assessment can be used to evaluate the influence of organized crime in local jurisdictions, and the impact of new laws and policies that affect commerce and criminal opportunities.     

Dangerous and severe personality disorder: An investigation of the construct

Introduction of the construct “Dangerous and Severe Personality Disorder” (DSPD) by the UK Home Office and Department of Health has provoked strong debate and opposition. Its aims and that of proposed subsequent legislation was to enhance public protection by identifying and detaining a minority of persons with severe personality disorder who pose a high risk of serious sexual/violent offending. The most serious criticism was the ethical implication of allowing indefinite detention of people without criminal convictions. More recently, policy emphasis has shifted towards treatment. 1396 male prisoners serving sentences of 2+ years for sexual/violent offenses were prospectively interviewed (personality disorders, psychopathy, and risk) at a mean follow-up of 2 years. The prevalence of DSPD was 15%. Significantly more re-offended. Five DSPD offenders would need treatment to prevent one violent act. Based on an estimate of attributable risk, successful treatment of DSPD could reduce violent re-convictions among DSPD offenders by 71% and violent/sexual re-offenses in the prison population by 27%. DSPD criteria correctly identify high risk prisoners but primarily through risk-related demographic features. DSPD does not accurately identify serious sexual/violent re-offenders. The DSPD programme may reduce major violent re-offending if treatment interventions prove effective.     

On risking risk assessment of delinquent juveniles: some questions concerning the role of psychopathy

In recent years much research effort has been directed at assessing psychopathic personality disorder in juveniles and at devising structured assessment procedures for recidivism risk. Clinicians, however, are often reluctant to incorporate this recent research into their practice. While accepting the importance of a better understanding of the development of psychopathic personality disorder, we discuss three arguments against the uncritical application of current research findings concerning the disorder and its clinical value as a risk factor. We briefly review empirical evidence for the role of the disorder in risk assessment. A developmental psychopathology argument against current thinking about juvenile psychopathic personality disorder, and a criminological argument against risk assessment but in favor of a desistance approach to delinquency are discussed.     

Using a cognitive analytic approach to formulate a complex sexual and violent offender to inform multi-agency working: developing a shared understanding

Abstract

Cognitive Analytic Therapy (CAT) is a collaborative time-limited psychotherapy developed by Ryle. The approach aims to formulate how early experiences influence the development of unhelpful patterns that maintain a person's current difficult experiences. Within the UK, forensic services personnel are increasing their uses of CAT approaches within contextual, i.e. treatment teams, settings. Offending behaviour is relational (perpetrator to victim), and CAT is a relational model. Within the context of National Health Service consultation service (Serious Offender Liaison Service) working with the Police and Criminal Justice Social Work to assess, formulate and give advice regarding working with serious sexual and violent offenders, often with personality disorders, a case example is presented. The paper suggests that utilising a relational model, such as CAT, and applying one of the main the tools of this approach, through diagrammatic representations (maps) of the formulation, can enable agencies working with an individual to share a common formulation and language.     

Risk of harm: inmates who harm themselves while in prison psychiatric treatment

In this study, 242 randomly selected male offenders who were receiving psychiatric treatment in prison were administered psychological and neuropsychological evaluations and were followed during their treatment in a prison psychiatric hospital. Offenders who harmed themselves in treatment were compared to those who did not harm themselves. Eighteen percent of offenders harmed themselves, the severity of which required medical intervention. Young age, drug abuse, absence of Axis I mental disorder but presence of Axis II borderline personality disorder identified offenders who harmed themselves. Psychopathy checklist-revised (PCL-R) total rating > or = 30 and PCL-R Factor 2 (antisocial lifestyle) rating also identified offenders who harmed themselves. Additionally, offenders who harmed themselves also were 8.36 times more likely than their cohorts to harm treatment staff. Theoretical understanding of offenders who harm themselves, the importance of considering the environmental context in identifying risk factors for self-harm, and implications for treatment are suggested.     

Revisiting prediction models in policing: Identifying high-risk offenders

The use of prediction models for classifying offenders has been a common practice by the criminal justice system. Given the recent developments in criminal career research and continuing evidence that a small proportion of chronic offenders are responsible for the majority of crime, there is a continued need to identify high-risk offenders early on in their offending careers. The present study provides support for the accuracy of an innovative prediction instrument that was developed for identifying high-risk offenders in a rural county in a southern state. Offender risk classification was found to be associated with reoffending across different dimensions of assessment and the high-risk offenders had accumulated a greater mean number of arrests upon six-month follow-up when compared to the medium and low-risk offenders. Policy implications and directions for future research incorporating prediction models in policing are also discussed.     

Sex offender risk assessment: Consideration of human rights in community protection legislation

Objectives. Risk assessments provided to judicial decision makers as a part of the current generation of legislation for protecting the public from sexual offenders can have a profound impact on the rights of individual offenders. This article will identify some of the human rights issues inherent in using the current assessment procedures to formulate and communicate risk as a forensic expert in cases involving civil commitment, preventive detention, extended supervision, or special conditions of parole. Method. Based on the current professional literature and applied experience in legal proceedings under community protection laws in the United States and New Zealand, potential threats to the rights of offenders are identified. Central to these considerations are issues of the accuracy of current risk assessment measures, communicating the findings of risk assessment appropriately to the court, and the availability of competent forensic mental health professionals in carrying out these functions. The role of the forensic expert is discussed in light of the competing demands of protecting individual human rights and community protection. Conclusion. Actuarial risk assessment represents the best practice for informing judicial decision makers in cases involving sex offenders, yet these measures currently demonstrate substantial limitations in predictive accuracy when applied to individual offenders. These limitations must be clearly articulated when reporting risk assessment findings. Sufficient risk assessment expertise should be available to provide a balanced application of community protection laws.     

社区矫正的安全价值及其实现

社区矫正蕴涵重要的安全价值。它一方面通过疏散监狱人口、激发罪犯的改造动力促进了监狱的安全,另一方面通过加强对罪犯的社会控制、促进罪犯人格的改善维护了社会的安全。为充分实现这一价值,首先要完善社区矫正危险管理体系,以避免罪犯违法犯罪行为的发生;其次采取行之有效的矫正方案,促进罪犯心理、行为的良性发展;再次要着力解决罪犯的生活困难,以产生长久的安全效应。     

Global risk factors and the prediction of recidivism rates in a sample of first-time misdemeanant offenders

This article examines the prediction of recidivism using the Global Risk Assessment Device (GRAD), a reliable and valid measure of dynamic factors associated with family characteristics, peers, mental health, substance abuse, trauma exposure, educational concerns, accountability, and health risks. Using a sample of adult caregivers of first-time misdemeanant offenders, two factors-education and accountability-were significantly associated with recidivistic behavior, supporting the use of GRAD data in correctly identifying first-time offenders who have the greatest and the least likelihood for future offending behavior. Additional analyses utilizing parent reports on African American males indicate that the GRAD provides discrimination in the prediction of recidivism in a group typically seen as being high risk simply because of their gender and race. The assessment drives intervention approach of the GRAD is discussed in terms of using reports from adults to accurately place youth into appropriate levels of supervision and treatment.     

Predicting successful outcomes for serious and chronic juveniles in residential placement

In the past decade, juvenile justice agencies have become more reliant on objective risk scales based on an actuarial approach to assessing risk. Risk assessment scales are used as decision-making guides at multiple points in the juvenile justice system. However, little research has focused on assessment of more serious offenders facing removal from the community. Enormous benefits can be derived, both in public safety and cost savings, from successful interventions with these offenders. Identifying offenders most amenable to intervention and at lowest risk for offending upon leaving placement represents a significant challenge. In this study, a placement risk screen was developed that assesses amenability to treatment in a residential treatment program and later risk for adult criminality. The relationship between suspected risk factors, success in a residential treatment program, and adult offending was assessed in a population of 81 male delinquent youths. Many factors are believed to have a bearing on success in treatment and later offending behavior, but only a small number of these were statistically significant. The results suggest that success in residential placement can reduce future offending, but that youth should first be screened for amenability to the program so scarce resources can be conserved. The proposed placement risk screen can assist juvenile court judges, officers, and residential treatment staff in identifying youth most suitable for treatment and who represent a lower risk to the community.