actuarial versus spj risk instruments with sommi - wi-atsa · actuarial versus spj risk instruments...
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ActuarialversusSPJRiskInstrumentswithSOMMIDAVID THORNTON
PRESENTAT ION AT THE ATSA 36 TH ANNUAL RESEARCH AND TREATMENT CONFERENCE , OCTOBER 26 TH
2017 , KANSAS C I T Y, M I SSOUR I
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FinancialDisclosureIhavenodirectfinancialinterestsinthetopicscoveredbythispresentation
Imayonoccasionbepaidfeesforprovidingtrainingonrelatedtopics
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Goals/ObjectivesParticipantswillbeabletodescribethepredictiveaccuracyoftheStatic-99/Static-99RwithSOMMIbyusingtheAreaUndertheCurve(AUC)statisticandtheprevalenceofSOMMIintheStatic-99Rnormativesamples.
ParticipantswillbeabletoprovidetheAUCrangeforstructuredandSPJmeasures
ParticipantswillbeabletodescribethreewaysMMIsymptomscanaffectsexualoffendingrisk.
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BackgroundProfessionalsmaybecalledtoassesstheriskpresentedbymenwithahistoryofsexualoffendingandmajormentalillness(SOMMI)foranumberofreasons◦ Tofacilitateconcentratingresourcesonthosewhopresentthegreatestrisk◦ Todeterminewhethersomeabsoluteriskthresholdismet◦ Tofacilitateriskmanagement
Thetaskischallengingbecauseexistingtoolsdonotfitverywell◦ SOMMIareonlyaverysmallpartofthepopulationofmenadjudicatedforsexoffendingsotoolsdesignedforthatgroupmaynotfitSOMMI
◦ Similarly,toolsdesignedforthosewithMMI,eventhosewithMMIandahistoryofcrime,maynotfitwellsincethekindsofcrimeinvolvedaremoreusuallynon-sexualviolence
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PotentialInfluenceofMMIonRiskFollowingKelley&ThorntonKelley,S.&Thornton,D.(2015)Assessingriskofsexoffenderswithmajormentalillness:integratingresearchintobestpractices.JournalofAggression,ConflictandPeaceResearch,7,258-274.
WecandistinguishthreepotentialinfluencesofMMIonsexualrecidivismrisk◦ MMIsymptomsreduceriskbydisruptingabilitytopursueoffendingintentions◦ MMIsymptomsareirrelevant◦ MMIsymptomscanworsenrisk
Actuarialinstrumentsdesignedtoassesssexualrecidivismriskpresently◦ DonottakeintoaccountthepresenceofMMI◦ Donotdistinguishthedifferentkindsofinfluenceitmayhave
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ImplicationsThissuggeststhatactuarialinstrumentsmaybelessusefulwithSOMMIandraisesthepossibilityofSPJallowingbetterprediction
SPJallowsmoreflexibilityandSPJinstrumentsliketheSVR-20includeanitemforMMI
ThislineofthoughtmayexplainwhySPJismorecommonlyusedinforensicmentalhealthsettings
Buthowwellfoundedisthis?
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Outline◦ ReviewofStatic-99/RpropertieswithSOMMI
◦ SOMMIinnormativesamples?◦ AUCinsampleswithmoreSOMMI
◦ ReviewofSPJpropertieswithSOMMI◦ AUCinsampleswithmoreSOMMI◦ AUCgenerally
◦ Implications
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PrevalenceofMMIin2009Static-99RNormativeSamples:Routine
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STATICMeasuresinNormativeSamplesØOriginalStatic-99(Hanson&Thornton,2000):◦ Basedon4samples;onepsychiatricsampleincludedpsychosisasprimarydiagnosis◦ Frequenciesofdxnotdescribed,but…◦ Static-99predictedriskinpsychiatricsampleequallywhencomparedwiththeotherthreesamples(AUC=.67vsAUCs=0.65-0.73)
ØCurrentStatic-99R:◦ Natureofincludedpsychiatricdisorderswasnotspecifiedorreported◦ PrevalenceofSOMMIinnormativesampleofStatic-99RwaseitherunspecifiedorknowntobelowinsomeHRHNsamples(under15%).
◦ Static-99R(aswellasStatic-2002R)bothpredictiveofrecidivism(AUCsin0.7s)inindividualswithpsychiatrichistoryasdefinedbyDSPproject
(Helmus,2012)
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SummaryofActuarialResultsInpopulationsidentifiedasMIorhavingahigherconcentrationofMI:◦ Static-99AUC0.67(original)◦ Static-99AUC0.65Craissati &Blundell(2013) mentallydisorderedsexoffendersplacedincommunity◦ STABLE-2007AUC0.63Craissati &Blundell(2013)◦ Static-99R0.74DSP(Helmus,2012)psychiatrichospitalization◦ Static-2002R0.73(Helmus,2012)psychiatrichospitalization
◦ AUCsrangedfrom0.63to0.74forstaticanddynamicactuarialinstruments
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SPJThreeSPJmeasuresthatmayberelevanttoassessingriskintheSOMMIpopulation:
ØSexualViolenceRiskManagement- 20(SVR-20)(Boer,etal,1997)
ØRiskforSexualViolenceProtocol(RSVP)(Hart,etal,2003)◦ Bothofaboveintegratedynamicandstaticrisk;allowforanexplicitassessmentofindividual’smentalillness;andallowscliniciantogiveweighttomentalillnessinmakingfinalriskassessment
ØAssessmentandRiskManageabilityforIndividualswhoOffendSexually(ARMIDILO-S)(Boer,etal,2004)◦ Firstofitskindtoidentifyandassessindividualaswellenvironmentalfactors
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NumbersofSPJRecidivismStudiesforSOMMISVR-20◦ 3sampleswithsubstantialproportionofSOMMI(56%,19%+,43%;2ofthe3studiesinvolvedcasesreferredforNGIassessment)
RSVP◦ NostudiesbutishighlycorrelatedwithSVR-20sopropertiesprobablytransfer
ARMIDILO-S◦ NostudieswithSOMMIbutseemstoworkwellwithDDsamples
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AUCsforSPJInstruments
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SummaryofSPJResultsRangeofAUCsforSVR-20withSOMMI◦ 0.48– 0.80◦ Median0.52
MedianAUCforallSVR-20Studiesis0.63◦ 0.80,0.83◦ 0.74,0.71◦ 0.63,0.66,0.68◦ 0.59,0.58,0.52,0.58◦ 0.48,0.49,
SPJsseemtogivehighlyvariableresultsingeneralandwithSOMMI
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ConcludingThoughtsWeproperlyhaveconcernaboutthevalueofexistinginstrumentswiththemostsevereMMIpresentationswheresymptomsimpactriskindirectlyordirectly
TodatestaticactuarialinstrumentsseemtodookayinsampleswithsignificantnumbersofSOMMIbutstudiesofsevereSOMMIareabsent
SPJinstruments(oratleasttheSVR-20),althoughtheyexplicitlytakeintoaccountMI,seemtobelesssuccessfulinassessingsexualrecidivismrisk,eveninMIpops
Wemaywellneedtoaddsomethingtostaticactuarials forthemoresevereSOMMIbutSPJinstrumentsliketheSVR-20aremorelikelytomisleadthantoassistusinthis
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IntroductiontoSOMMIProject
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GoalsCharacterizetheSOMMIpopulation◦ DefinedasindividualswithahistoryofsexualoffendingandMajorMentalIllnessmeaningBipolarIorPsychoticDisorders
FindwaysofreliablyidentifyingdifferencesbetweenSOMMIsothatriskmanagementcanbebetterindividualized
Thisincludesspecifically:◦ DeterminewaysofreliablyidentifyingLTVsinSOMMIpopulation◦ StudyingtherelationshipofMMIsymptomstosexualoffending◦ Developingwaysofreliablycharacterizingthedifferentformsthisrelationshipcantake
Ultimategoalistobehelpfultocliniciansworkingwiththispopulation
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SOMMIPopulation(s)WewillneedgoodsizedsamplesdrawnfromSOMMIpopulations
WewillneedtodrawfromSOMMIpopulationsaccumulatedinthedifferentinstitutionalcontextsinwhichcliniciansmightencounterthem
Thisisanongoingproject
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SelectionofIndividualswithahistoryofSOMMIfromWISVPProgramAllWISVPsarere-evaluatedeveryyearandtheseevaluationsincludeDSMdiagnoses.TheSRSTCResearchUnitmaintainsspreadsheetscontainingthisdiagnosticinformation.WeidentifiedindividualsforthestudybasedonDSM-IVTR/DSM-5diagnosesindicatingBipolarIorPsychoticDisorders.
Wetriedtobemoreinclusive(someindividualshaddiagnosesthatvariedovertheyears)
WhenthecasefileswerebeingratedtheratingpsychologistidentifiedcaseswheretherewasquestionaboutwhethertheyreallywereSOMMI(aboutafifthwerequestionable)
Some55caseshavebeenratedwith30ofthesecasesbeingratedbytwoindependentraters
NotethatexactNsmayvaryforspecificanalysesdependingonmissingdata
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SelectionfromtheBridgewaterPoolThesewereapoolofindividualswhoreceivedtreatmentatBridgewaterandforwhomRayKnighthadaccumulatedelectronicfiledata
DSM-IIIAxis1diagnoseshadbeenmadeandwereviewedthosetodeterminewhichparticulardiagnosesbestcorrespondedtomodernconceptionsofPsychosisorBipolarI
WhenthecasefileswerebeingratedtheratingpsychologistidentifiedcaseswheretherewasquestionaboutwhethertheyreallywereSOMMI(aboutathirdwerequestionable)
Some25caseshavebeenratedsofarwith20ofthesecasesbeingratedbytwoindependentraters
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Whatfollowsareprogressreportsonthedifferentfocioftheproject