1. (C) 2008 Vermont Forensic Assessment All rights reserved How to Protect your Client from Bad Risk Assessments Thomas A. Powell, Ph.D. John C. Holt, Ph.D. Vermont Forensic Assessment, PLLC Shelburne, Vermont June 12, 2008

2. (C) 2008 Vermont Forensic Assessment All rights reserved Outline How things are supposed to work How things are supposed to work Static and dynamic measure of any type of criminal recidivism and offender needs Static and dynamic measure of any type of criminal recidivism and offender needs Level of Service Inventory - Revised Level of Service Inventory - Revised Assessment perspective Assessment perspective Risk principle Risk principle Need principle Need principle Responsivity principle Responsivity principle

3. (C) 2008 Vermont Forensic Assessment All rights reserved Outline Static actuarial measures of sexual recidivism risk Static actuarial measures of sexual recidivism risk STATIC-99 STATIC-99 RRASOR RRASOR VASOR VASOR Dynamic measures of sexual recidivism risk Dynamic measures of sexual recidivism risk SONAR SONAR STABLE/ACUTE STABLE/ACUTE Treatment Progress Scale Treatment Progress Scale

4. (C) 2008 Vermont Forensic Assessment All rights reserved Outline Additional topics of interest The use of multiple risk instruments: Static 99, RRASOR and VASOR as policy The use of multiple risk instruments: Static 99, RRASOR and VASOR as policy “Denial” - a misleading predicator of recidivism. “Denial” - a misleading predicator of recidivism. Conflict of interest by assessors and treatment providers. Conflict of interest by assessors and treatment providers. The DOC case staffing: Salem Witch Trials redux? The DOC case staffing: Salem Witch Trials redux?

5. (C) 2008 Vermont Forensic Assessment All rights reserved

6. How Things are Supposed to Work PSI preparation - Policy 342.01 (rev. 4/9/07) PSI preparation - Policy 342.01 (rev. 4/9/07) http://doc.vermont.gov/about/policies/rpd/fin al_commissioner-signed_psi_3.22.07.pdf http://doc.vermont.gov/about/policies/rpd/fin al_commissioner-signed_psi_3.22.07.pdf http://doc.vermont.gov/about/policies/rpd/fin al_commissioner-signed_psi_3.22.07.pdf http://doc.vermont.gov/about/policies/rpd/fin al_commissioner-signed_psi_3.22.07.pdf Prescriptive format Prescriptive format Defines LSI-R as “an objective, quantifiable instrument that provides a consistent and valid method of predicting risk to re-offend and a reliable means of measuring offedner change over time …” Defines LSI-R as “an objective, quantifiable instrument that provides a consistent and valid method of predicting risk to re-offend and a reliable means of measuring offedner change over time …”

7. (C) 2008 Vermont Forensic Assessment All rights reserved How Things are Supposed to Work RRASOR: “a four-item actuarial risk measure used to aid in assessing sexual recidivism risk …” RRASOR: “a four-item actuarial risk measure used to aid in assessing sexual recidivism risk …” Static-99: “… a 10-item actuarial risk measure is used in a similar manner as the RRASOR.” Static-99: “… a 10-item actuarial risk measure is used in a similar manner as the RRASOR.” VASOR: “a risk assessment scale … designed to assist PO’s in making placement and supervision decisions.” VASOR: “a risk assessment scale … designed to assist PO’s in making placement and supervision decisions.”

8. (C) 2008 Vermont Forensic Assessment All rights reserved How Things are Supposed to Work “A PSI provides the sentencing judge … with relevant information on which to base a sentencing decision. It also reflects a professional judgment of and assessment by the DOC regarding risk management of the defendant.” “A PSI provides the sentencing judge … with relevant information on which to base a sentencing decision. It also reflects a professional judgment of and assessment by the DOC regarding risk management of the defendant.” “The PSI investigator can use information collected during the PSI, particularly during the defendant interview, to complete necessary risk assessment tools, e.g. the LSI-R.” “The PSI investigator can use information collected during the PSI, particularly during the defendant interview, to complete necessary risk assessment tools, e.g. the LSI-R.”

9. (C) 2008 Vermont Forensic Assessment All rights reserved How Things are Supposed to Work “Provide a narrative explanation of the numerical results of assessment tools (e.g. LSI-R), including an examination of key risk areas and a summary of any court-ordered clinical assessments.” “Provide a narrative explanation of the numerical results of assessment tools (e.g. LSI-R), including an examination of key risk areas and a summary of any court-ordered clinical assessments.” “Briefly summarize the major points of the report …” “Briefly summarize the major points of the report …” “The report will conclude with a recommendation … based upon the defendant’s offense, background and assessed risk.” “The report will conclude with a recommendation … based upon the defendant’s offense, background and assessed risk.”

10. (C) 2008 Vermont Forensic Assessment All rights reserved How Things are Supposed to Work “Note: Only if requested by the Court, the PSI investigator will include a recommended minimum and maximum term of incarceration or a minimum and maximum term of suspended sentence.” (emphasis not added by us) “Note: Only if requested by the Court, the PSI investigator will include a recommended minimum and maximum term of incarceration or a minimum and maximum term of suspended sentence.” (emphasis not added by us)

11. (C) 2008 Vermont Forensic Assessment All rights reserved General Risk Assessment Level of Service Inventory - Revised Criminal History Criminal History Education/Employment Education/Employment Financial Financial Family/Marital Family/Marital Accommodation (the influence of address) Accommodation (the influence of address) Leisure/Recreation (spare time use) Leisure/Recreation (spare time use) Companions (friends and associates) Companions (friends and associates) Alcohol/Drugs (mostly looking at past year) Alcohol/Drugs (mostly looking at past year) Emotional/Personal (psychological status) Emotional/Personal (psychological status) Attitudes/Orientation (antisocial/prosocial views) Attitudes/Orientation (antisocial/prosocial views)

13. (C) 2008 Vermont Forensic Assessment All rights reserved Risk Principle 1. Reserve intensive levels of corrections supervision and treatment for higher risk cases. 2. Do not use these levels of supervision and treatment for lower risk cases. 3. Use of valid and reliable risk assessment tools gives the criminal justice system a triage capability.

14. (C) 2008 Vermont Forensic Assessment All rights reserved Need Principle 1. There are many needs and potential treatment targets identified in corrections populations. 2. Some are related to criminal risk; some are not. 3. Focus on those needs which are “criminogenic” (ie. causally related to crime) such as social affiliations, drugs and criminal attitudes. 4. When criminogenic needs are addressed, the risk of recidivism declines.

15. (C) 2008 Vermont Forensic Assessment All rights reserved Responsivity Principle 1. When providing treatment services for forensic or corrections populations, use methods which are matched to the learning style of the population. 2. Cognitive-behavioral, skill-building, and relapse preventing interventions fit this model. 3. Non-directive, non-specific “talk therapy” methods do not. 4. The use of appropriate intervention models lowers risk; other models have either no effect on recidivism or they may actually raise it.

16. (C) 2008 Vermont Forensic Assessment All rights reserved Sex Offense Specific Measures Static Actuarial Measures Static Actuarial Measures RRASOR RRASOR Static-99 Static-99 VASOR VASOR Dynamic/Treatment Measures Dynamic/Treatment Measures SONAR SONAR STABLE/ACUTE STABLE/ACUTE Sex Offender Treatment Needs and Progress Scale Sex Offender Treatment Needs and Progress Scale

17. (C) 2008 Vermont Forensic Assessment All rights reserved RRASOR Rapid risk assessment of sex offender recidivism Rapid risk assessment of sex offender recidivism ww2.ps-sp.gc.ca/publications/corrections/ 199704_e.pdf ww2.ps-sp.gc.ca/publications/corrections/ 199704_e.pdf Four item scale Four item scale All four are incorporated into the STATIC-99 All four are incorporated into the STATIC-99 Total score 0-6 Total score 0-6 0Low 0Low 1,2Moderate-Low 1,2Moderate-Low 3,4Moderate-High 3,4Moderate-High 5,6High 5,6High

18. RRASOR - Rapid risk assessment of sex offender recidivism

19. (C) 2008 Vermont Forensic Assessment All rights reserved STATIC-99 Ten item scale Ten item scale Total score 0-12 Total score 0-12 0,1Low 0,1Low 2,3Moderate-Low 2,3Moderate-Low 4,5Moderate-High 4,5Moderate-High 6+High 6+High

21. (C) 2008 Vermont Forensic Assessment All rights reserved STATIC-99 Widely used in criminal, forensic and correctional settings. Widely used in criminal, forensic and correctional settings. Instrumental in most sexually violent predator (SVP) determinations. Instrumental in most sexually violent predator (SVP) determinations. Not as easy to score as it seems. Many scoring rules to understand. Not as easy to score as it seems. Many scoring rules to understand.

22. (C) 2008 Vermont Forensic Assessment All rights reserved STATIC-99 The Static-99 scoring manual is 80 pages long. The Static-99 scoring manual is 80 pages long. http://ww2.ps- sp.gc.ca/publications/corrections/pdf/Static- 99-coding-Rules_e.pdf http://ww2.ps- sp.gc.ca/publications/corrections/pdf/Static- 99-coding-Rules_e.pdf http://ww2.ps- sp.gc.ca/publications/corrections/pdf/Static- 99-coding-Rules_e.pdf http://ww2.ps- sp.gc.ca/publications/corrections/pdf/Static- 99-coding-Rules_e.pdf Or google “Static-99” Or google “Static-99”

23. (C) 2008 Vermont Forensic Assessment All rights reserved STATIC-99 Issues Like most actuarial risk assessment instruments, it is only +/- 70% accurate. Like most actuarial risk assessment instruments, it is only +/- 70% accurate. False positives - over-predicting risk False positives - over-predicting risk False negatives - under-predicting risk False negatives - under-predicting risk Over-reliance on unchanging static risk factors to the exclusion of changing dynamic risk factors is a significant problem in Vermont (and elsewhere). Over-reliance on unchanging static risk factors to the exclusion of changing dynamic risk factors is a significant problem in Vermont (and elsewhere).

24. STATIC-99 - age and recidivism

25. “There were few sexual offenders of any type in the advanced age category (>50 years !!) … and their recidivism rates were generally low.” decreasing sex drive fewer opportunities Hanson, K.W. (2002). Recidivism and age. Journal of Interpersonal Violence, 17 (10), 1046-1062.

26. STATIC-99 - time at risk

27. Listserv communication from Hanson and Harris (3/10/08) “Recently, (we) found follow-up recidivism rates to be below that which would be expected given those found in the original STATIC-99 samples of origin. This has led to some question as to whether there has been a shift in the nature of sexual recidivism and whether the estimates generated from the samples of origin are still valid.” “Recently, (we) found follow-up recidivism rates to be below that which would be expected given those found in the original STATIC-99 samples of origin. This has led to some question as to whether there has been a shift in the nature of sexual recidivism and whether the estimates generated from the samples of origin are still valid.”

28. (C) 2008 Vermont Forensic Assessment All rights reserved VASOR Vermont assessment of sex offender risk Vermont assessment of sex offender risk Weighs 19 variables Weighs 19 variables 13 on the Reoffense Risk Scale 13 on the Reoffense Risk Scale 6 on the Violence Scale 6 on the Violence Scale According to the manual, scores are plotted on an overall risk chart According to the manual, scores are plotted on an overall risk chart Reoffense Risk Scale x Violence Scale Reoffense Risk Scale x Violence Scale

29. VASOR Prior sex offenses Prior sex offenses Prior adult convictions Prior adult convictions Court order violations Court order violations Force used during current arrest Force used during current arrest Relationship to victim Relationship to victim Male victim Male victim History of exhibitionism History of exhibitionism Deviant sexual fixation Deviant sexual fixation Alcohol of drug use (past five years) Alcohol of drug use (past five years) Address changes (past year) Address changes (past year) Time employed/ in school Time employed/ in school Past treatment success Past treatment success Amenability to treatment Amenability to treatment Prior convictions for violent crimes Prior conviction for crime involving deadly weapon Force used during current offense Sexual intrusiveness of current offense Physical harm to victim Victim 55, or handicapped

30. (C) 2008 Vermont Forensic Assessment All rights reserved

31. VASOR - Daubert criteria issues No peer-reviewed studies on its reliability and validity No peer-reviewed studies on its reliability and validity Manual relies on studies presented in poster format Manual relies on studies presented in poster format Manual clearly marks the VASOR as a “research version” Manual clearly marks the VASOR as a “research version” Not cited in major reviews of other actuarial scales Not cited in major reviews of other actuarial scales Used rarely outside of Vermont Used rarely outside of Vermont

32. (C) 2008 Vermont Forensic Assessment All rights reserved VASOR - Validity issue According to Georgia Cumming, new cases are being added to the VASOR database, and within “a couple of weeks” there will be new cut points for describing the risk level of cases, based on their scores. According to Georgia Cumming, new cases are being added to the VASOR database, and within “a couple of weeks” there will be new cut points for describing the risk level of cases, based on their scores.

33. (C) 2008 Vermont Forensic Assessment All rights reserved Dynamic Measures of Sexual Recidivism Risk SONAR: Sex offender need assessment rating SONAR: Sex offender need assessment rating Stable 2007 and Acute 2007 Stable 2007 and Acute 2007 Treatment Progress Scale (Vermont-specific) Treatment Progress Scale (Vermont-specific)

34. SONAR - sex offender needs assessment rating rates dynamic factors related to recidivism improves the predictive accuracy and utility of actuarial (historical factors) instruments by considering changing circumstances in the offender’s life (ie. dynamic factors) http://ww2.ps- sp.gc.ca/publications/corrections/200001b_e.asp http://ww2.ps- sp.gc.ca/publications/corrections/200001b_e.asp

36. (C) 2008 Vermont Forensic Assessment All rights reserved

37. Stable and Acute - 2007 Stable factors Stable factors Significant social influences Significant social influences Capacity for relationship stability Capacity for relationship stability Emotional identification with children Emotional identification with children Hostility toward women Hostility toward women General social rejection General social rejection Lack of concern for others Lack of concern for others Impulsive Impulsive Poor problem solving skills Poor problem solving skills

38. (C) 2008 Vermont Forensic Assessment All rights reserved Stable and Acute - 2007 Stable factors (cont.) Stable factors (cont.) Negative emotionality Negative emotionality Sex drive preoccupation Sex drive preoccupation Sex as a coping mechanism Sex as a coping mechanism Deviant sexual preference Deviant sexual preference Deviant sexual interests in possible remission Deviant sexual interests in possible remission Cooperation with supervision Cooperation with supervision

39. (C) 2008 Vermont Forensic Assessment All rights reserved Stable and Acute - 2007 Acute factors Acute factors Victim access Victim access Hostility Hostility Sexual preoccupation Sexual preoccupation Rejection of supervision Rejection of supervision Emotional collapse Emotional collapse Collapse of social supports Collapse of social supports Substance abuse Substance abuse

40. (C) 2008 Vermont Forensic Assessment All rights reserved Stable and Acute - 2007 The most recent version incorporates the Static-99 variables and the most risk- relevant dynamic variables to describe both risk level and supervision intensity needs for a client. The most recent version incorporates the Static-99 variables and the most risk- relevant dynamic variables to describe both risk level and supervision intensity needs for a client. This represents best evidence-based practice at this time. This represents best evidence-based practice at this time.

41. (C) 2008 Vermont Forensic Assessment All rights reserved Vermont Treatment Progress Scale http://www.csom.org/pubs/SexOffTreatScale.pdf http://www.csom.org/pubs/SexOffTreatScale.pdf McGrath & Cumming (2003) McGrath & Cumming (2003) Bob McGrath, MA, licensed psychologist, clinical director, Vermont Treatment Program for Sexual Aggressors Bob McGrath, MA, licensed psychologist, clinical director, Vermont Treatment Program for Sexual Aggressors Georgia Cumming, administrative director, Vermont Treatment Program for Sexual Aggressors Georgia Cumming, administrative director, Vermont Treatment Program for Sexual Aggressors

42. (C) 2008 Vermont Forensic Assessment All rights reserved Vermont Treatment Progress Scale Sexual deviancy Sexual deviancy Criminality Criminality Self-regulation Self-regulation Treatment and supervision cooperation Treatment and supervision cooperation Lifestyle stability Lifestyle stability Social supports Social supports

43. (C) 2008 Vermont Forensic Assessment All rights reserved Multiple Static Assessments DOC uses three static actuarial scales RRASOR, STATIC-99, VASOR RRASOR, STATIC-99, VASOR It is unnecessary to use more than one static actuarial assessment It is unnecessary to use more than one static actuarial assessment “...combining scales did not provide a statistically significant or consistent advantage over the single best actuarial risk scale in predicting either serious or sexual recidivism.” Seto (2005)

44. (C) 2008 Vermont Forensic Assessment All rights reserved Multiple Static Assessments So why does DOC policy require the use the Static-99, RRASOR and VASOR on all sex offenders? So why does DOC policy require the use the Static-99, RRASOR and VASOR on all sex offenders? The HIGHEST of the three ratings is used The HIGHEST of the three ratings is used Low Medium low Medium Medium high High Fishing for the highest score?

45. (C) 2008 Vermont Forensic Assessment All rights reserved Multiple Static Assessments If there are going to be multiple instruments, why use three static factor assessments? If there are going to be multiple instruments, why use three static factor assessments? Why exclude dynamic variables? Why exclude dynamic variables? Sonar Stable/Acute 2007 Vermont Treatment Progress Scale Evidence-based practice vs. not

46. (C) 2008 Vermont Forensic Assessment All rights reserved Denial “Denial” vs. minimization “Denial” vs. minimization Weak predicator of recidivism and treatment compliance Weak predicator of recidivism and treatment compliance Hanson and Morton-Bourgeon (2005) article p. 1158 Hanson and Morton-Bourgeon (2005) article p. 1158

48. (C) 2008 Vermont Forensic Assessment All rights reserved Conflict of Interest DOC relies on a network of providers who provide both forensic assessments and clinical interventions. DOC relies on a network of providers who provide both forensic assessments and clinical interventions. “Irreconcilable conflict between therapeutic and forensic roles” (Greenberg & Shuman, 1997). “Irreconcilable conflict between therapeutic and forensic roles” (Greenberg & Shuman, 1997). “Failure to maintain adequate separation of roles has a number of counter-therapeutic consequences in sex offender management” (Covell & Wheeler, 2006). “Failure to maintain adequate separation of roles has a number of counter-therapeutic consequences in sex offender management” (Covell & Wheeler, 2006).

49. (C) 2008 Vermont Forensic Assessment All rights reserved Conflict of Interest National professional organizations specifically highlight the importance of avoiding dual roles National professional organizations specifically highlight the importance of avoiding dual roles American Psychological Association American Psychological Association American Academy of Psychiatry & the Law American Academy of Psychiatry & the Law Association for the Treatment of Sexual Abusers (ATSA) Association for the Treatment of Sexual Abusers (ATSA)

50. (C) 2008 Vermont Forensic Assessment All rights reserved Conflict of Interest “Members recognize that there may be potential conflicts of interest when they provide both evaluation and treatment services to the same person. When it is necessary to fulfill both functions (for example, in rural settings or institutions), members take reasonable steps to manage and resolve any conflicts in the best interest of the client and the community.” “Members recognize that there may be potential conflicts of interest when they provide both evaluation and treatment services to the same person. When it is necessary to fulfill both functions (for example, in rural settings or institutions), members take reasonable steps to manage and resolve any conflicts in the best interest of the client and the community.” ATSA practice standards and guidelines (2005)

51. (C) 2008 Vermont Forensic Assessment All rights reserved DOC Case Staffings 2 to 10 P.O.’s gathered with a supervisor to discuss a case. 2 to 10 P.O.’s gathered with a supervisor to discuss a case. Victims’ advocates, others, included? Victims’ advocates, others, included? Referred to, in policy, as a “peer review process” Referred to, in policy, as a “peer review process” No record or transcript. No record or transcript.

52. (C) 2008 Vermont Forensic Assessment All rights reserved DOC Case Staffings “This is an opportunity for the PSI investigator to present the information collected to fellow staff members for comment and advice on further areas of investigation, additional needed information, and a sentencing recommendation decision.” “This is an opportunity for the PSI investigator to present the information collected to fellow staff members for comment and advice on further areas of investigation, additional needed information, and a sentencing recommendation decision.”

53. (C) 2008 Vermont Forensic Assessment All rights reserved DOC Case Staffings This is not considered best-practice for improved decision-making. This is not considered best-practice for improved decision-making. Nationally, reviews typically involve small panels of higher-trained professionals who critically consider the evidence and determine whether to override lower level decisions. Nationally, reviews typically involve small panels of higher-trained professionals who critically consider the evidence and determine whether to override lower level decisions. In Vermont there is a strong tendency toward peer group-think. In Vermont there is a strong tendency toward peer group-think.

54. (C) 2008 Vermont Forensic Assessment All rights reserved DOC Case Staffings “I have heard of a very similar process occurring in Boston relative to their civil commitment process. (It) was thought to be so bad that a local TV station did an "expose" on the process and how political and poor the decision making was - despite needing to emphasize during he program that the network was not trying to protect sex offenders by making the expose. They instead pointed out that there were obvious errors in decisions in both directions - holding people who should not be held, and letting others go who should not have been let go.” Listserv colleague, commenting on Vt case staffing process

56. (C) 2008 Vermont Forensic Assessment All rights reserved How to Protect your Client from Bad Risk Assessments Presented by Vermont Forensic Assessment, PLLC Thomas A. Powell, Ph.D. & John C. Holt, Ph.D. 4281 Shelburne Road Shelburne, VT 05482 802-985-2412www.vtfa.com