violence risk in adolescents dr charlotte rennie project funded by the national forensic mental...
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Violence Risk in Violence Risk in AdolescentsAdolescents
Dr Charlotte Rennie
Project funded by the National Forensic Mental Health Research and
Development Programme
PlanPlan Review of the Literature
Youth Level of Service/Case Management Inventory
Structured Assessment of Violence Risk in Youth
Psychopathy Checklist: Youth Version Study outline Study findings Conclusions Implications
Youth Level of ServiceYouth Level of Service Prior and Current
Offences/Disposals 3 or more prior conviction/episodes
of offending 2 or more failures to comply Prior supervision Ever in detention 3 or more current episodes of
offending
Family Circumstances/Parenting Inadequate supervision Difficulty in controlling behaviour Inappropriate discipline Inconsistent parenting Poor relations/father-child Poor relation/mother-child
Education/Employment Disruptive classroom behaviour Disruptive behaviour on school
property Low achievement Problems with peers Problems with teachers Truancy Unemployment/not seeking
employment
Peer Relations Some delinquent acquaintances Some delinquent friends Few or no positive
acquaintances Few or no positive friends
Youth Level of ServiceYouth Level of Service
Substance Abuse Occasional drug abuse Chronic drug abuse Chronic alcohol abuse Substance use interferes
with life Substance use linked to
offences
Leisure/Recreation Limited organised
activities Could make better use
of time No personal interests
Personality/Behaviour Inflated self esteem Physically aggressive Tantrums Short attention span Poor frustration tolerance Inadequate guilt feelings Verbally aggressive,
impudent
Attitudes/Orientation Antisocial/prosocial attitudes Not seeking help Actively rejecting help Defies authority Callous, little concern for
others
YLS/CMI Predictive YLS/CMI Predictive Validity Validity
Studies have found that the YLS/CMI can predict recidivism
Jung & Rawana (1999) Catchpole & Gretton (2003) Schmidt et al., (2005) Marshall et al., (2006)
SAVRYSAVRY Historical Risk Factors
History of Violence History of Non-Violent Offending Early Initiation of violence Past Supervision/Intervention
Failures History of Self-Harm or Suicide
Attempts Exposure to Violence in the Home Childhood History of Maltreatment Parental/Caregiver Criminality Early Caregiver Disruption Poor School Achievement
Social/Contextual Risk Factors Peer Delinquency Peer Rejection Stress and Poor Coping Poor Parental Management Lack of Personal/Social Support Community Disorganisation
Individual/Clinical Risk Factors Negative Attitudes Risk Taking/Impulsivity Substance Use Difficulties Anger Management Problems Callous/Lacking Empathy Attention Deficit/Hyperactivity
Difficulties Poor Compliance Low Interest/Commitment to School
Protective Factors Prosocial Involvement Strong Social Support Strong Attachment and Bonds Positive Attitude Towards
Intervention and Authority Strong Commitment to School Resilient Personality Traits
SAVRY Predictive SAVRY Predictive ValidityValidity
Studies have found the SAVRY Total and Risk Rating are able to predict violent offending
McEachran (2001) Gretton & Abramowiz (2002) Catchpole & Gretton (2003) Lodewijks, et al., (2008) Gammelgård et al., (2008) Meyers & Schmidt (2008)
Psychopathy as a Psychopathy as a predictor of violencepredictor of violence
Adult literature, psychopathy linked with violence and antisocial behaviour
UK studies indicate that psychopathy demonstrates similar predictive accuracy to those found in the US Dolan & Khawaja (2002) Doyle et al., (2002)
PCL:YVPCL:YV
Interpersonal Impression management Grandiose sense of self-
worth Pathological lying Manipulation for
personal gain
Affective Lack of remorse Shallow affect Callous/lack of empathy Failure to accept
responsibility
Behavioral Stimulation seeking Parasitic orientation Lacks goals Impulsivity Irresponsibility
Antisocial Poor anger control Early behavior problems Serious criminal behavior Serious violations of
conditional release Criminal versatility
PCL: YV Predictive PCL: YV Predictive ValidityValidity
Studies in North America and Netherlands have shown that the PCL: YV can predict recidivism and institutional infractions Corrado et al., (2004) Gretton et al. (2004) Schmidt et al., (2005) Das et al., (2007) Lodewijks et al. (2008)
Studies in the UK have also shown that the PCL: YV can predict institutional infractions Dolan & Rennie (2006b; 2006c) Marshall et al., (2006)
Comparative StudiesComparative Studies
Catchpole & Gretton (2003) YLS/CMI, SAVRY, and PCL:YV were able
to similarly predict general and violent reoffending in a group of 74 (male & female) violent young offenders.
Sample size was small Statistical analyses restricted to total
scores Mixed sample No incremental validity
Comparative StudiesComparative Studies
Walsh et al., (2008) YLS/CMI, SAVRY and PCL: YV were
able to predict general and violent recidivism to varying degrees of accuracy, but the SAVRY offered the most in incremental validity in a group of 105 young offenders (male and female)
Mixed sample Retrospective study SAVRY protective factors
AimsAims
To examine the ability of the YLS/CMI, SAVRY and PCL: YV to predict the occurrence of institutional infractions and community recidivism
To examine incremental validity of the YLS/CMI, SAVRY and PCL: YV
ParticipantsParticipants 135 males - mean age 16.14 (SD 0.93)
years
114 (84.4%) White British
Index offence - 60% violent
Age 1st arrest - 12.77 (SD = 1.73) years
Age 1st AS behaviour - 11.07 (SD = 2.52) years
Sentence length 17.62 (SD = 12.09) months
ResultsResults
YLS/CMI Total Score – 23.62 (SD 7.42)
SAVRY Total Score – 25.60 (SD 8.21) SAVRY Risk Rating
10.4%- low risk37.8% - moderate risk51.9% - high risk
PCL: YV Total Score – 21.08 (SD 6.72)
Results: Institutional Results: Institutional violence & rule breakingviolence & rule breaking
6 month follow-up Institutional violence
actual assaults on others rather than property damage or threats of violence
Rule breaking security breaches, substance misuse,
property damage, attempted escapes Of the 135, 61 were still in custody 20 (32.8%) institutional violence 22 (36%) rule breaking
AUC - Institutional AUC - Institutional ViolenceViolence
SAVRY Historical – AUC .70** (95%CI .55 - .84)
SAVRY Risk Total - AUC .67* (95%CI .52 - .82)
PCL: YV Interpersonal - AUC .73** (95%CI .59 - .87)
PCL: YV Total - AUC .71** (95%CI .56 - .85)
***p<0.001; **p<0.01; *p<0.05
Rule BreakingRule Breaking
SAVRY, PCL: YV and YLS/CMI could not predict rule breaking behaviour over 6 month follow-up
Regression Analysis Regression Analysis
Regression analysis revealed that the SAVRY Risk Total and the PCL: YV Total could add to the incremental validity of the YLS/CMI Total for the prediction of institutional violence, but did not add to the incremental validity of each other
Results: RecidivismResults: Recidivism 12 month follow-up Home Office Police National Computer
(HOPNC) Violent
robberies, assaults, murder, sexual assaults kidnapping and all weapons charges
Non-violent Drug offences, burglary/theft, negligence,
frauds, escapes, arson, obstructions of justice, and minor offences were classed as non-violent
Of the 135, 111 followed-up 41 (36.9%) violent offences 77 (69.4%) any offence
AUC - Violent RecidivismAUC - Violent Recidivism
SAVRY Historical – AUC .66** (95%CI .54 - .77)
SAVRY Risk Total – AUC .64** (95%CI .54 - .74)
SAVRY Risk Rating – AUC .63** (95%CI .54 - .74)
***p<0.001; **p<0.01; *p<0.05
AUC - Any RecidivismAUC - Any Recidivism Area 95% CI
Lower Bound Upper Bound
SAVRY Historical .69** .58 .79
SAVRY Individual .67** .56 .78
SAVRY Risk Total .68** .57 .80
SAVRY Risk Rating
.68** .57 .80
SAVRY Protective .71***
.61 .81
PCL: YV Affective .64* .52 .75
PCL: YV Lifestyle .67** .55 .79
PCL: YV Total .62* .50 .74
YLS Offending .68** .57 .78
YLS Total .64* .52 .75
YLS Summary .67** .56 .78
Regression AnalysisRegression Analysis
SAVRY Risk Total added incremental validity to the PCL: YV Total and YLS/CMI Total for violent and general recidivism
SAVRY Risk Rating added incremental validity to the PCL: YV and YLS/CMI for violent and general recidivism
SAVRY Protective factor added to the incremental validity of the SAVRY Risk Total for the prediction of general recidivism
Survival Analysis Survival Analysis
Outcome - time to an event To determine the proportion of
participants who have not re-offended at each month of the follow-up period (“survival”)
Offending patterns over time to see not only whether certain risk groups re-offend in greater proportions but whether they do so more quickly
Censored data
Survival AnalysisSurvival Analysis
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Time period to first violent offence (months)
100
80
60
40
20
0
Pro
port
ion n
ot
com
mit
ting a
vio
lent
off
ence %
moderate-censoredlow-censoredhigh-censoredmoderatelowhigh
SAVRY Risk Rating
Kaplin-Meier Survival Curve for violent recidivism over 12 months
Survival AnalysisSurvival Analysis
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Time period to first general offence (months)
100
80
60
40
20
0
Proportio
n n
ot c
om
mit
tin
g a
ny o
ffence %
moderate-censoredlow-censoredhigh-censoredmoderatelowhigh
SAVRY Risk Rating
Kaplin-Meier Survival Curve for general recidivism over 12 months
MSR were 5.7 times more likely to re-offend sooner than LSR and the HSR were 8.4 times more likely to re-offend sooner than the LSR
ConclusionsConclusions
SAVRY was a better predictor of violent infractions than the YLS/CMI but comparable to the PCL: YV
SAVRY was a better predictor of violent and general recidivism then the PCL: YV and YLS/CMI
SAVRY Risk Total and Risk Rating performed equally well
Protective factors should be incorporated into risk management
LimitationsLimitations
High risk sample Reporting of institutional
infractions Reliance on criminal records data High levels of re-offending rates Severity of violence
Clinical Implications Clinical Implications
Quantity and quality of clinical information
Improvements in file recording and report writing
Discharge planning Categorise those who are likely to
require more intensive monitoring and targeted interventions
Case formulation
ImplicationsImplications
Labelling
Misclassification
Future ResearchFuture Research
Gender Mental Health Transitional Period Change over time/intervention Implementation into services
