9Actuarial AssessmentAssessment based on research statistical analysis of factors strongly correlated with recidivism risk. This type of assessment is currently only available for adult male sexual offenders. Continuing research is needed before such tools will be available for minors and for females.
10Written reportThe product from the evaluation process. The report serves to document, educate and guide decisions regarding the client’s containment and treatment. It should be detailed and specific.
11Relevant Standards for sexual offender assessment Association for the Treatment of Sexual Abusers (ATSA)Illinois Sex Offender Management Board (SOMB)SOMB Standards include ATSA Ethics Code by reference
12Some relevant ATSA Ethics Guidelines “…there is no know psychological test, profile, evaluation procedure, of combination of such tools that prove or disprove whether an individual has committed a specific sexual act.”Follow all applicable reporting laws, including duty to warn or protect.
13ATSA Evaluation Standards: AOIC DVD - EvaluationsATSA Evaluation Standards:Apply to work with Adult Male offenders; there may be variations from these standards in work with juveniles or femalesDonya L. Adkerson, MA, LCPC
14Overview of ATSA Standards specific to Evaluations: AOIC DVD - EvaluationsOverview of ATSA Standards specific to Evaluations:2005 Edition (Note that Standards are revised regularly)Donya L. Adkerson, MA, LCPC
15Strive for Objective, fair, and impartial evaluations Informed consent (or at least assent)Right to refuseNature & purpose of evalWho gets the resultsUnderstand how legal status impacts evalDon’t overstate your information/findings
16Obtain comprehensive information, including: AOIC DVD - EvaluationsObtain comprehensive information, including:Community supportCriminal and other antisocial behavior,Access to potential victims,Developmental history and family background,Deviant sexual interests and arousal.Education and employment histories,Donya L. Adkerson, MA, LCPC
17Gather information about AOIC DVD - EvaluationsGather information aboutHistory of aggression or violence,History of sexually abusive behavior, including details about victims, tactics used in the commission of the offense, and the circumstances in which the sexual abuse occurred,Level of cognitive functioning,Medical and mental health histories,Official and unreported history of sexual and nonsexual crimes,Donya L. Adkerson, MA, LCPC
18Gather information about Peer and romantic relationship histories,Substance use/abuseRelevant personality traits such as, but not limited to suspiciousness, hostility, risk-taking, impulsivity, and psychopathy,
19Gather information about AOIC DVD - EvaluationsGather information aboutSexual history, including sexual fantasies, urges, and behavior, early sexual experiences; number and duration of sexual relationships; gender identity and sexual orientation; masturbation and intercourse frequency; sexual functioning; unusual sexual interests or behavior that are not sexually deviantUse of sexually arousing materials (e.g., magazines, videos, computer porn, internet sites, phone sex)Donya L. Adkerson, MA, LCPC
20Use multiple sources of information, NOT client self report alone! AOIC DVD - EvaluationsUse multiple sources of information, NOT client self report alone!Review of official documents, including criminal justice records, witness statements, previous assessment and treatment reports, medical records, and victim impact statements.Collateral interviews, as applicable (family members, romantic partner/spouse, employer, previous service providers, probation/parole officer),Donya L. Adkerson, MA, LCPC
21Use multiple sources of information AOIC DVD - EvaluationsUse multiple sources of informationSexual preference measuresRelevant psychometric testingRisk assessmentClient interviewDonya L. Adkerson, MA, LCPC
22Use multiple sources of information AOIC DVD - EvaluationsUse multiple sources of informationNote significant discrepancies between client self-report and collateral information in the evaluation report.Donya L. Adkerson, MA, LCPC
23Do not base conclusions on Client self report alone Describe the sources of informationIdentify any significant missing information in the report and note the impact this information could have on results/recommendations
24ATSA Evaluation Guidelines AOIC DVD - EvaluationsATSA Evaluation GuidelinesUse extreme caution if interviewing the victim, due to potential to add to victim harm.Use caution to avoid conflict of interest if evaluating both the offender and his/her victim(s).Donya L. Adkerson, MA, LCPC
25ATSA Evaluation Guidelines AOIC DVD - EvaluationsATSA Evaluation GuidelinesPhysiological testingGet informed consentDo not use physiological testing as a as sole criteria for findings.Use appropriately trained examiners who follow their profession’s standards and guidelinesDonya L. Adkerson, MA, LCPC
26ATSA Eval - Special considerations Be trained for any special populations you evaluateAddress any biases/assumptions based on age, cultural differences, socioeconomic differences, education, language, level of intellectual functioning, and mental or physical disability
27Evaluation Guidelines AOIC DVD - EvaluationsEvaluation Guidelinescompared to the literature on adult male sexual abusers, less is known about the risk factors and prognosis for clients with developmental disability, offenders with major mental illnesses and female sexual abusers.Donya L. Adkerson, MA, LCPC
28ATSA Evaluation Guidelines AOIC DVD - EvaluationsATSA Evaluation GuidelinesIf you don’t speak the client’s language, refer to someone who does.If no native language evaluator is available, use a PROFESSINAL interpreter and document the use.Donya L. Adkerson, MA, LCPC
29ATSA Evaluation Guidelines AOIC DVD - EvaluationsATSA Evaluation GuidelinesClients who cannot read at a level sufficient for completing written measures can often be tested using an auditory (taped or read) version of the instrument where such versions exist. Meet the special needs of clients with mental or physical disabilities during evaluations (e.g., using taped versions of questionnaires for vision-impaired clients).Donya L. Adkerson, MA, LCPC
30ATSA Evaluation Guidelines Select tests and instruments appropriate for that client.Adapt for special needs (such as taped questionnaires for vision impaired or illiterate clients)Note that modifications of testing might affect validity or reliability of testing
31ATSA Evaluation Guidelines AOIC DVD - EvaluationsATSA Evaluation GuidelinesScreen for mental or physical disabilities, major psychiatric disorders, substance abuse, and suicide potential. These conditions may have to be dealt with before evaluation or treatment for sexually abusive behavior beginsRecognize that treatment for a concurrent disorder or condition is, in most cases, not a substitute for sex offense specific treatment.Donya L. Adkerson, MA, LCPC
32ATSA Evaluation Guidelines AOIC DVD - EvaluationsATSA Evaluation GuidelinesMake recommendations for treatment, case management or supervision in clear and specific language.Consider community safety and clients’ ability & willingness to manage their sexual offending when making recommendations.Donya L. Adkerson, MA, LCPC
33ATSA Evaluation Guidelines AOIC DVD - EvaluationsATSA Evaluation GuidelinesRelease evaluation results to others only with written consent from the clients, unless legally obligated to do so.Securely retain notes, raw test scores, and other documentation (including a copy of the evaluation report) for a minimum of five years after completing an evaluation.Donya L. Adkerson, MA, LCPC
34Illinois Sex Offender Management Board Practice Standards for Evaluation
35Illinois SOMB Evaluation Standards Public Act mandated use of the SOMB Standards and pre-sentencing eval for sex offenders considered for release to the community. It became effective January 1, 2004.
36P.A On EvaluationsEvals must be done by an SOMB approved evaluatorDone according to SOMB standardsMust be considered by the judge at sentencing
37Finding SOMB Evaluators & Treatment Providers A list of approved evaluators and Treatment providers is available on the Illinois Attorney General’s Website. The Standards are also available on the website.
38SOMB Eval Standards Overlaps with ATSA Standards – Get informed consent & waivers of confidentialityBe sensitive to diversity issues
39SOMB: Purpose of Evaluation Document treatment needs (offense specific and other)Re-offense risk & amenability to treatmentHelp determine setting, intensity, and level of supervisionIdentify needs for supervision & support for community safety
40SOMB: Areas to Assess Mental & Organic disorders Drug & Alcohol use IQ Organic Brain SyndromeMental IllnessDrug & Alcohol useUse/abuse historyNumber of relapses
41SOMB: Areas to Assess Degree of Psychopathology Stability of FunctioningMarital/Family stabilityEmployment & EducationSocial skills, including dating history
42SOMB: Areas to Assess Developmental History Self-image & self-esteem Medical screening
43SOMB: Areas to Assess Sexual Evaluation Sexual history Reinforcement of deviant behaviorCulture, environment, cults, gangsArousal pattern
44SOMB: Areas to Assess Specifics of sexual crimes Sexual deviance patternsSexual dysfunctionSexual preferencesSexual practicesAttitudes and cognitions (thoughts) about sexuality & offending
45SOMB: Areas to Assess Level of denial and deception Level of violence and coercionEvaluation of risk
46Factors Evaluator Must Consider in Making Recommendations Admission of offensesAccountabilityCooperationOffense history & victim choiceEscalation patterns; violence & dangerous behaviors
47Factors Evaluator Must Consider in Making Recommendations Sexual deviance, arousal, interest patternsSocial interestLifestyle characteristics & PsychopathologyDevelopmental markersHistory of criminal behaviorSubstance abuse
48Factors Evaluator Must Consider in Making Recommendations Social support systemsOverall control and interventionsMotivations of treatment and recoveryPrevious treatmentVictim impact and victim accessAvailability of treatment & supervision in the community
49Recommendations Must Address: Level & intensity of offense specific treatment needsAssessment or treatment needs for co-existing conditionsMethods to lessen victim impactAppropriateness of community based placement
50Recommendations Must Address: Appropriateness of community placement with emphasis on the risks associated with the home, neighborhood, school or communityLevel and intensity of behavioral monitoring needed
51Recommendations Must Address: External controls that should be considered specifically for that sex offender (e.g., controls of work environment, access to children, leisure time, or transportation; life stresses; or other issues that might increase risk and require increased supervision)
52Preparing yourself for the evaluation AOIC DVD - EvaluationsPreparing yourself for the evaluationThe right preparation makes all the differenceDonya L. Adkerson, MA, LCPC
53Structuring the Evaluation Safe and comfortable settingFull days vs. multiple short sessionsCollateral before client interviewsStart with low defense areas, move to difficulty subjects later
54As the Evaluator, you should: AOIC DVD - EvaluationsAs the Evaluator, you should:Know your subject – sexual offenders – before doing any S.O. evaluationGet education, training, supervision and experienceDonya L. Adkerson, MA, LCPC
55As the Evaluator, you should: AOIC DVD - EvaluationsAs the Evaluator, you should:Do your homework. There is no substitute for thorough background research before your client interviewThink Kojak/Columbo/C.S.I. – NOT Carl Rogers!Understand your client’s agenda; it will not be the same as yoursRespect the client as a person capable of positive changeDonya L. Adkerson, MA, LCPC
56Evaluation Interview skills AOIC DVD - EvaluationsEvaluation Interview skillsTake thorough notes. Get the name, age, gender of every person the client mentionsDon’t give away what you know.Rephrase and re-ask questions at different points in the interview.Bring your poker face. Smile pleasantly at appropriate opportunities to help put the client at ease.Donya L. Adkerson, MA, LCPC
57Evaluation Interview skills Use education to facilitate comfort and honesty; beware of over-educating in the evaluation – don’t teach them how to ‘fake good’Keep a time line in mind – ask age, grade, place of residence or other markers to help the client provide a time frame. Be aware that low functioning clients will be poor at this even when honest
58Watch the NONVERBAL language Words are not the only way people communicate, and nonverbal communication becomes very important when working with people who may be motivated to be dishonest.No matter how good you are at reading nonverbals, you still won’t catch every lie.
59Watch the NONVERBAL language Eye contact/changes notedVoice tone/changes notedTearfulnessPower/control behaviors (i.e., walks around office during interview, handles objects from desk, tries to direct interview, silence)
60Watch the NONVERBAL language Nervous behaviors (i.e., leg shaking, tapping)Defensive/evasive posturing (arms tightly closed, refuses to remove coat, gaze fixed to side or ceiling)Destructive (to body, clothing, furniture, office objects, other)Intimidation (i.e., invades space, covert threats, finger shaking, yells/curses at examiner, unwarranted touch, hostile stare)
61Watch the NONVERBAL language Aggressive (breaks objects, makes overt threats, assaults examiner)Sexually suggestive/seductive behaviors or commentsOvert/covert exposureErection during interviewObserved or suspected masturbation“Accidental" rubbing against examiner/staff
62Creating Comfort with the Client AOIC DVD - EvaluationsCreating Comfort with the ClientAssure the client of your knowledge, experience, comfort with the issues to help decrease embarrassment.Choose language appropriate for the client’s developmental age and functioning. Be sure terms are understood.Use the client’s terms whenever possible.Donya L. Adkerson, MA, LCPC
63Using Discomfort in the Interview Use silence to your advantage when you want the client to tell more. Don’t rush to speak.Use hints of your information without details to elicit information in areas the client first omits.
64Questioning Styles Open–ended vs. closed-ended Forced choice questions Open: “Tell me about your marriage.”Closed: “Do you have a good marriage?”Forced choice questions“Is your marriage good or bad?”
66Mind-readingUsing info you know about the person/problem to tell the client what he is thinking/feeling.This can help the client feel you understand, and feel that pretenses and denial won’t work with you.
67Mind-reading examples “I’m sure you don’t want to be here right now. I imagine you are worried about whether you will say and do the right things to make a good impression in this evaluation.”“You’ve been thinking if you can just get through this it will never happen again; that you’ll find a way to make it up to (the victim).”
68PredictionLaying groundwork for positive movement in the evaluation and treatment.This can create hope for recovery. It is most effective when coupled with mind-reading.
69Prediction Examples“You will find yourself feeling increasing anxiety and discomfort as we start talking about the sexual offenses today. What you will find is, as you begin to talk honestly about the problem here with someone who understands, you will become more comfortable as you talk more openly.”
70Prediction Examples(for offenders claiming memory loss) “I know you don’t want to remember and that is why it is hard for you right now. But as we talk, bits and pieces will of your memory will return, triggered by my questions. Those bits & pieces will come faster as we go along.”
71LeadingLeading presupposes a given direction for the answer. This technique often goes against the therapist’s training.In SO evals, it models the acceptability of talking about specifics and communicates the therapist expects and will not be shocked by even the most extreme answers.
72Leading Examples “Which of your children did you touch most often?” “How long before the incident had you been spending time in the park?”“Which part was more exciting to you – when you had your mouth on his penis or when you were rubbing his penis with your hand?”
73Use Caution with Leading ! Low functioning individuals may be led into admitting erroneous information. Leading should be used very cautiously with such people. Double check information obtained by trying to lead the client in the opposite direction and see if they remain consistent or simply follow the lead.
74Additional cautions with low functioning clients Expect poor time framesExpect inconsistent estimations of frequency or number of occurrencesInconsistent information may be a function of the person trying to be compliant rather than being misleading.
75Testing which may be used in evaluations AOIC DVD - EvaluationsTesting which may be used in evaluationsPhysiologicalClinicalCollateral completed inventoriesSelf- Report tests and inventoriesDonya L. Adkerson, MA, LCPC
76Physiological Testing types AOIC DVD - EvaluationsPhysiological Testing typesVisual Reaction Time (Abel Screen)PlethysmographPolygraphHistoryMaintenanceSpecific issueDonya L. Adkerson, MA, LCPC
78Collateral Testing examples For parents of minors:Behavior System Assessment for ChildrenChild Sexual Behavior InventoryAdkerson Information & Beliefs Questionnaire for ParentsFor partners:Adkerson Partner Information & Beliefs Questionnaire
79Self- Report Testing examples Attitudes/beliefs about offendingMultiphasic Sex InventoryAbel & Becker Cognitions ScaleBumby Sexual Attitudes ScalesBurt Rape Myth Acceptance InventoryRemorse or empathy measuresCarich-Adkerson Victim Empathy Scale
80Self- Report Testing examples Depression, anxiety or traumaBeck Depression ScaleSexual fantasiesWilson Sexual Fantasy QuestionnaireHostility or violenceBuss-Durkee Hostility InventoryOtherSex Offender Incomplete Sentence Blank
81Actuarial Risk Assessment Think insurance tables – taking aggregate data about risk is how insurance companies know to charge more for car insurance for a 18 year old male, single, D-student living on Elm St. than a 34 year old married female college graduate living on Maple St.
82Clinical vs. Actuarial Risk Assessment Actuarial Risk assessments are based on aggregate data, as obtained through meta-analysis studies. Their overall accuracy is better than clinical judgment alone.Current SO-specific actuarial tools use STATIC (unchangeable) data to determine risk levelThey do not give info on treatment needs
83Clinical vs. ActuarialClinical risk assessment is the judgment of a clinician, based on training and experience, of the risk presentedThis judgment can include DYNAMIC (changeable) factors as well as static factorsClinically-Adjusted Actuarial Assessment combines both techniques and allows for individuation with a solid research base
84Important Points about Actuarial Assessment in 2005 Current tools are validated only with ADULT MALESAlthough there are currently no true actuarial tools for juvenile sex offenders, there are guided clinical toolsAdditional instruments continue to be researched
85Actuarial Assessment Tools Some of the most common actuarial assessment instruments currently in use are:RRASORStatic-99VRAG & SORAGLSI- Revised
86RRASOR: Rapid Risk Assessment for Sexual Offense Recidivism 4 items, all static factorsEasily scoredModerately accurate predictor of sex offense recidivism, little relationship to general or non-sexual recidivism
87Static- 99 (revised scoring 2003) Incorporates and expands on the RRASORUses only static risk factorsGreater predictive validity than RRASOR alone for sexual recidivismModerate accuracy for predicting any violent recidivism
88Sex Offender Risk Appraisal Guide (modified from Violence RAG) VRAG is one of best measures for general violence recidivism, but not designed to assess sexual recidivismSORAG is also a good predictor of violence recidivismSORAG only moderate predictor of sexual recidivismRequires sophisticated administration (includes the PCL-R)
89Level of Service Inventory- Revised Designed to measure general criminal recidivismIncludes dynamic as well as static factorsNOT designed for sex offense specific use; omits important factors with strong correlation to sexual recidivism (e.g., relationship to the victim)
90Static Factors Associated with Increased Recidivism Prior charges or convictions for sex offense (higher # = higher risk)Violence in current or past offenseYoung age (under 25)Never had a live-in partner (for at least 2 years)
92Static Factors Associated with Increased Recidivism Physiological assessment shows deviant arousalPersonality disorder (esp. Antisocial)History of anger problemsDiverse sex crimes
93Static Factors Associated with Increased Recidivism Early onset of offendingFailure to complete treatmentPrior non-sexual offenses
94Some Dynamic Factors Associated with Increased Recidivism Intimacy deficitsNegative peer influencesNoncompliant with treatment/supervisionAttitudes tolerant of sexual assault
95Pitfalls to watch out for in evaluation interviews AOIC DVD - EvaluationsPitfalls to watch out for in evaluation interviewsInterviewing without background infoRevealing what you know prematurelyTalking over the client’s headDonya L. Adkerson, MA, LCPC
96Pitfalls to watch out for AOIC DVD - EvaluationsPitfalls to watch out forAllowing parent or other collateral to set tone of denial in front of clientEngaging in power strugglesAddressing the offense history too earlyDonya L. Adkerson, MA, LCPC
97Pitfalls to watch out for AOIC DVD - EvaluationsPitfalls to watch out forAccepting vagueness or generalitiesShowing embarrassment, discomfort or disgustGiving up too soonDonya L. Adkerson, MA, LCPC