Sexual violence prevention: Recommended journal issue

The current issue of the International Journal of Law and Psychiatry features an excellent collection of diverse scholarship on the prevention of sexual violence. Papers address the empirical and moral foundations of prevention from the perspectives of law, psychiatry, criminology, psychology, and public policy. Here's a preview of a couple of the articles I've read so far….
 

Paraphilia battle pivotal to future of U.S. civil liberties

Jerome Wakefield, a professor at New York University and an influential theorist of mental disorder, provides a searing analysis of the messy paraphilia debacle that the DSM-5 task force has waded into. After providing a brief history, he dissects the current proposals to show how their conceptual invalidity will open the door to widespread abuse in forensic practice:

 

Needless to say, prosecutors availing themselves of civil commitment processes and wishing to keep offenders from release find it in their interest to argue for the most expansive possible interpretation of the DSM criteria for paraphilic disorders -- lending enormous weight to the details of the diagnostic criteria…. The convenience of these criteria in forensic evaluations seems more than offset by the potential for prosecutorial abuse and the long-term undermining of the credibility of the distinction – sanctioned by the Supreme Court as a constitutionally crucial one – between mental disorder-driven behavior and other motives for criminal behavior.

Wakefield joins the ranks of other respected figures to recognize the high stakes involved in the battle over whether sex crimes equate to mental disorder. As he bluntly puts it, the struggle over how sexual paraphilias are defined is “tactically central to the future of civil liberties in our country.” If the government can indefinitely detain men who have served prison time for sex crimes based on bogus psychiatric labels that supposedly impair their volitional control, it's only a matter of time before other groups are rounded up, too. 

Of all of the controversial paraphilias, Wakefield asserts, the “most flawed and blatantly overpathologizing” is pedohebephilia, which would expand pedophilia to encompass attraction to pubescent minors. Arguments by its proponents are both weak and misleading, he writes:

The first argument for the expanded category is that hebephilia is similar to pedophilia in that both involve attraction to physically immature individuals. This is about as valid an argument as saying that both dyslexia and illiteracy involve difficulties reading, thus illiteracy should be considered a disorder. The kind of immaturity involved in pubescence is vastly different from the kind in prepubescence from the specific perspective of its ability to trigger normal sexual interest, so in fact the dissimilarity is more important than the similarity…. The other two arguments – that some prosecutors are currently using the diagnosis “Paraphilia Not Otherwise Specified (Hebephilia)” and that the ICD [the World Health Organization’s diagnostic system] allows sexual preference for early pubescence as a disorder – ignores the critical question of whether these uses are valid…. Hebephilia as a diagnosis violates the basic constraint that disorder judgments should not be determined by social disapproval. This is a case where crime and disorder are being hopelessly confused.

Although the sexual disorders work group has backed down on two of its three most controversial proposals, it is clinging tenaciously to pedohebephilia, the brainchild of the Canadian laboratory that employs two members of the work group. Hopefully, a newly established scientific review committee for the DSM-5 will heed the increasingly strong warnings emitting from mainstream social scientists and psychology-law practitioners such as Wakefield, and have the common sense to squelch this ridiculous proposal. Otherwise, as Wakefield puts it, “the forensic tail [will be] wagging the validity dog, and we are likely to get criteria that possess a misdirected pseudo-validity that will not serve us in the long run and set a dangerous precedent for future tensions between civil liberties and civil commitment for mental disorder.”

Inevitable recidivism: An urban legend

Tamara Rice Lave, a law professor at the University of Miami, tackles the essential premise underlying current social policy toward sex offending: that apprehended sex offenders (especially child molesters) will continue to re-offend. As Lave shows, the courts and the public accept this premise with an unquestioning and almost religious fervor, ignoring a growing body of empirical evidence to the contrary.

Inevitable recidivism has saturated the media, political and popular discourse, and thus it has become the dominant frame due to its availability…. This sets up a dialectical process in which the public believes that sex offenders inevitably recidivate; the media write stories that bolster this belief, and politicians pass laws that are responsive to this belief. The effect is to have inevitable recidivism become a socially constructed fact.

When actual evidence of sex offender recidivism is examined, a huge gap exists between what is assumed and what the data actually shows because most sex offenders do not in fact recidivate. Thus there is a galaxy of sexually violent predator laws and an entire branch of Supreme Court jurisprudence that is founded upon a demonstrable urban legend.

The special issue, Beyond Myth: Designing Better Sexual Violence Prevention, was co-edited by professors Eric Janus (author of Failure to Protect, an essential text on sex offender law and policy) and John Douard. Both are, like myself, firm believers that we should be focusing scarce resources on primary prevention of sexual violence rather than on misguided campaigns rooted in moral panic and hysteria. Such campaigns are not only ineffectual, but they may actually increase the very problems they are aimed at solving.

The articles are:

Jerome C. Wakefield:  DSM-5 proposed diagnostic criteria for sexual paraphilias: Tensions between diagnostic validity and forensic utility [request from author HERE]

Tamara Rice Lave: Inevitable recidivism: The origin and centrality of an urban legend  [full text available online HERE]

A preview of all of the articles in the special issue, Beyond Myth: Designing Better Sexual Violence Prevention, is HERE. Clicking on a preview of an article allows one to email the author to request a reprint.

Open letter opposing DSM-5 paraphilias expansion

Photo credit: Dr. Joanne Cacciatore

As readers of this blog are aware, proposals to expand the sexual disorders in the American Psychiatric Association's upcoming DSM-5 have generated significant controversy among forensic psychologists and psychiatrists. Now, forensic psychologists are banding together to urge APA President John Oldham to reject the proposed diagnoses of pedohebephilia, paraphilic coercive disorder and hypersexual disorder. The text of an open letter drafted by Richard Wollert, an Oregon psychologist with extensive experience in sex offender treatment and evaluation, follows. If, after reading it, you would like to become a signator, just click on the indicated link, and provide Dr. Wollert with your name and professional credentials. Don't delay, as I understand that this important letter is being submitted very soon. 

CLICK HERE TO ADD YOUR NAME TO THE LETTER

 

Dear Dr. Oldham:

As a mental health professional and/or sex educator I am writing to you to encourage the American Psychiatric Association to leave invalid sexual disorders out of DSM-5. 

In 1999, the Dangerous Sex Offender Task Force of the American Psychiatric Association issued a strongly worded statement about psychiatry's failed efforts to meaningfully define and classify sexual deviance. In contrast to the cautious approach advised by the Task Force, a Paraphilias Subworkgroup of the DSM-5 is vigorously lobbying for the adoption of three highly controversial expansions of sexual disorders (Hebephilia, Paraphilic Coercive Disorder, and Hypersexual Disorder). The expansions would be a major mistake, due to poor reliability, unproven validity and -- most of all -- the potential for vast and harmful unintended consequences. 

The Subworkgroup is now proposing to add a "Hebephilic" type to Pedophilia, extending the diagnosis of Pedophilia from covering those with sexual attractions to prepubescent children to those with sexual attractions to pubescent children under age 15. It also proposes to add new diagnoses of "Paraphilic Coercive Disorder" and "Hypersexual Disorder" to the Appendix as "Criteria Sets for Further Study." I am dismayed by each of these recommendations for the following reasons. 

Hebephilia lacks conceptual coherence. Most men are attracted to sexually maturing 14-year-olds, as reflected in the large number of industrialized countries where the age of sexual consent is 14 (Green, 2010). Normative attractions may be criminal when acted upon, but they should not be labeled as mental disorders. "Hebephilia" is an archaic term that languished in psychiatric obscurity until the passage of modern civil commitment laws in the United States (Franklin, 2010). Since then, some evaluators who confuse statutory rape with mental disorder have invoked Hebephilia as a condition that justifies civil commitment (Ewing, 2011). Such usages do not provide a cogent explanation for behavior that is illegal in the United States but legal in other countries being classified as a mental disorder. Finally, Hebephilia lacks adequate diagnostic reliability (Wollert and Cramer, 2011). Most of the research has been conducted by a single Canadian research team that is overly represented on the Paraphilias Subworkgroup. Although the DSM-5 Task Force has indicated that final decisions about proposed revisions will be made on the basis of field trial data, a November 2011 change in the proposed criteria for the diagnosis rules out the application of even this meager safeguard. 

Paraphilic Coercive Disorder (PCD) was initially proposed for inclusion in DSM-5 as a diagnosis that would be limited to men who preferred rape over consensual sex. Because only a very small percentage of rapists prefer rape over consensual intercourse (American Psychiatric Association, 1999), clinicians are unable to reliably apply this label (Wollert, 2011). This is one reason for the American Psychiatric Association's consistent rejection of rape-based paraphilias in three previous editions of the DSM (Zander, 2008). In the face of overwhelming opposition, the Subworkgroup has taken the fallback position of recommending PCD only for inclusion in the Appendix as a condition meriting "further study." However, this would confer an undeserved back-door legitimacy to the invalid construct. Rather than a mental disorder, rape is a crime for which the proper placement is prison. 

The proposed criteria for Hypersexual Disorder (HD) are the product of a recent ad hoc literature review by Martin Kafka, a member of the Subworkgroup. His review indicated their validity has not been empirically confirmed. Given the inherent difficulty in determining at what point a normal human drive becomes abnormal, it is not surprising that the proposed diagnosis is marred by conceptual confusion and vague verbal anchors (Moser, 2011). Its poor reliability and validity will translate to a high rate of false positives in both civil commitment trials and outpatient clinics that serve the community in general. With the proposal becoming a magnet for ridicule both by academic scholars and the popular press, it too has been relegated to the Appendix. However, the Appendix was not intended as a storage site for criteria sets that, like Hypersexuality Disorder, have never been tested. 

These three proposals all lack adequate empirical support. They will increase false positive diagnoses by labeling behaviors that are normative, developmental, or criminal as mental disorders. Promoting the misclassification of juveniles and other vulnerable populations as dangerous sex offenders, they will undermine the reputation of forensic practitioners and those who study sexual behavior. Collectively, professions that endorse the use of unreliable diagnoses run the risk of losing their credibility. 

The British Psychological Society, the American Counseling Association, and the Society for Humanistic Psychology and many other divisions of the American Psychological Association have all submitted petitions or letters of concern to the American Psychiatric Association regarding revisions proposed for the DSM-5. These documents express concerns about the lack of empirical support for many DSM-5 proposals, the likelihood of “false-positive epidemics” flowing from decreased diagnostic thresholds, and the negative effects of "over-medicalizing" human behavior. They also point out that the prevention of false-positive epidemics should take precedence over "nomenclatural exploration" and that the temptation to adopt new diagnoses should be tempered by the recognition that diagnostic labels tend to be confounded with normative social expectations. 

I share these concerns as they apply to sexual disorders. I further support the adoption of sexual disorder criteria sets only after they have been established to have high true positive rates and acceptable false positive rates. Therefore, I urge the DSM Task Force to remove the Hebephilia qualifier from the proposed diagnosis of Pedophilia, and to eliminate Paraphilic Coercive Disorder and Hypersexual Disorder from any inclusion in the DSM-5. 

Sincerely, 

CLICK HERE TO ADD YOUR NAME TO THE LETTER

(email your name and professional credentials to Dr. Wollert)

References 

American Psychiatric Association (1999). Dangerous sex offenders: A task forcereport of the American Psychiatric Association. Washington D. C.: American Psychiatric Association.

Ewing, C. P. (2011). Justice perverted: Sex offense law, psychology, and public policy. New York: Oxford University Press. 

Franklin, K. (2010). Hebephilia: Quintessence of diagnostic pretextuality. BehavioralSciences and the Law, 28, 751-768. 

Green, R. (2010). Sexual preference for 14-year-olds as a mental disorder: You can’t be serious!! [letter to the editor]. Archives of Sexual Behavior, 39, 585-586. 

Moser, C. (2011). Hypersexual Disorder: Just more muddled thinking [letter to theeditor]. Archives of Sexual Behavior, 40, 227-229. 

Wollert, R. (2011). Paraphilic Coercive Disorder does not belong in DSM-5 forstatistical, historical, conceptual, and practical reasons [letter to the editor]. Archives of Sexual Behavior, 40, 1097-1098. 

Wollert, R. & Cramer, E. (2011). Sampling extreme groups invalidates research on the Paraphilias. Behavioral Sciences and the Law, 29, 554-565. 

Zander, T. (2008). Commentary: Inventing diagnosis for civil commitment of rapists. The Journal of the American Academy of Psychiatry and the Law, 36, 459-469.

Blogger challenges my post on sex offender risk assessment

My report on a promising new method for assessing sex offender recidivism risk prompted a reaction from Robin Wilson over at a new blog by the publishers of Sexual Abuse, the journal of the Association for the Treatment of Sexual Abusers (ATSA).

My interest dissolved into disappointment when I realized that the response sidestepped substantive discussion of the new research, a collaborative project by scholars in the United States, New Zealand, and Australia finding that accuracy of risk prediction can be enhanced by using age-stratified tables.

Instead of engaging with the scientific merits of this study, Dr. Wilson focused on the Static-99 actuarial tool, chastising me for being overly critical of that approach:

Dr. Franklin has something of a penchant for the flamboyant. Actually, I often appreciate a bit of bluster, but I think we also need to avoid bias and unnecessary sideswipes at our colleagues. In the spirit of honesty, let me say that I work in a civil commitment center and that I am a certified trainer for the Static-99 group of measures. So, my potential bias is on the table.

Is having an opinion a form of bias?

The term bias refers to a partiality that interferes with the ability to be fair or objective. Expressing a point of view does not make one biased. Rather, the articulation of informed opinion advances professional practice. Indeed, such "expert opinion" is precisely what courts seek from forensic psychologists when they solicit our testimony. An expert witness is expected to have a firm grounding in the applicable science, and to be able to critically analyze its strengths and weaknesses as it applies to a specific issue or case.

It is that process of reflection -- invoking complementary theoretical perspectives from criminology, sociology, anthropology and international studies relevant to forensic psychology -- that germinates many an idea for this blog. I welcome critical engagement with these ideas, but hope that interlocutors can themselves refrain from diversionary ad hominem arguments.

Why pick on the Static-99?

Dr. Wilson's main theme is that I am unduly critical of the Static-99 and its developers.

The Static-99 website promotes the tool as "the most widely used sex offender risk assessment instrument in the world." As Dr. Wilson himself notes in another publication, its "prolific use in sexual offender civil commitment proceedings" is one reason it generates so much debate.

But Dr. Wilson is correct in pointing out that many of the Static-99's flaws apply equally to its cousins. In referencing the Static-99, I in no way intend to exempt other actuarials from critique. Indeed, in previous posts I have discussed problems with the MnSOST-R and have reported the results of studies on the relative accuracy of the Static-2002, Risk Matrix 2000, RRASOR and other actuarial tools.

Dr. Wilson makes an essential point in defense of the Static-99. By encouraging us to anchor our risk estimates in empirical data, he reminds us, actuarials serve as a counterbalance against clinicians' inherent tendency to vastly overestimate sex offender risk:

Maybe, what Dr. Franklin should be highlighting more is the fact that some evaluators are falling prey to partisan concerns. A well done sex offender risk assessment [using an actuarial instrument] should say the same thing, regardless of who you are working for.

In principle, Dr. Wilson is entirely correct. Sadly, from my vantage point as a forensic psychologist working in the courtroom trenches, I see endemic partisan allegiance in this arena. The Static-99 is being systematically deployed to provide a scientific veneer for highly questionable practices in the service of civil commitment.

The problem is not just a handful of rogue evaluators. The latest permutation of the Static-99 fosters such misuse. I am referring to the developers' advice to assign sex offenders to one of four categories with different levels of actuarial risk. As I pointed out in a previous post, this procedure introduces a large element of clinical judgment into a procedure whose very existence is predicated on doing away with such subjectivity. In the polarized Sexually Violent Predator arena, evaluators now have an easy way to elevate their estimate of an offender's risk by comparing the individual to the highest-risk group rather than to the lower recidivism figures for sex offenders overall. This practice reflects a tautology, or logical fallacy. In a civil commitment proceeding the evaluator essentially says: "This offender is high risk. Just look at the recidivism rates for offenders in the high-risk group to which I have assigned him."

The Static-99 developers may be quite well intentioned, as Dr. Wilson says. But subjective intent is far less important than real-life effects. The road to Hell, as they say, is paved with good intentions. I will not be alone in cheering when I hear that the Static-99 developers have stepped up and publicly condemned the systematic misuse of their instruments in courthouses all across the United States.

If Dr. Wilson's point was to chastise me for the use of the term reliability where I meant to say accuracy, I stand corrected. (I have made the correction to the original post.) However, I make no apologies for expressing an informed viewpoint and, indeed, I unflinchingly embrace such a role as part of my professional obligation. The goal of my blog is not to convince people that I have all the answers. Rather, I am happy if I encourage critical reflection and stimulate people to read the original source material. In so doing, I hope I am doing my part to advance science and combat bias.

The award-winning Texas blog Grits for Breakfast has a more favorable reaction, with links to additional topics of interest.

APA Dispatch II: Whither juvenile forensics?

The U.S. Supreme Court ruling this May in Graham v. Florida, restricting life without parole sentences for juveniles, relied in part upon scientific evidence from developmental psychology and neuroscience. In ruling that juveniles are categorically different from adults, the high court was assisted by amicus briefs from the American Psychological Association and other professional organizations including the American Psychiatric Association and the National Association of Social Workers.

The APA's position, which the Supreme Court also validated in its 2005 ruling in Roper v. Simmons outlawing the death penalty for juveniles, is that juveniles' diminished culpability is based on three basic differences from adults:

1. Immaturity: Juveniles are more impulsive and less likely to reason judiciously about risk
2. Vulnerability: They are more likely to be influenced by peer pressure
3. Changeability: They are still developing, and are more amenable to rehabilitation than adults

At this week's APA convention, the American Psychology-Law Society (Division 41) hosted a cutting-edge track on juvenile justice. The dynamic sessions raised intriguing issues about how the growing acceptance of adolescent immaturity and difference will affect forensic practice in the juvenile justice system.

Bryan Stevenson: "Huge implications" of Graham case

In an eloquent presentation, NYU law professor Bryan A. Stevenson, founder of Alabama's Equal Justice Initiative, expressed optimism that Graham and the twin case of Sullivan v. Florida, in which he was counsel, signal that the tide is turning away from the punitive Superpredator hysteria of the 1980s. He encouraged the APA to continue its public policy advocacy by bringing legal attention to the impacts of trauma, violence, and neglect on youngsters.

Hopefully, the capacity crowd of psychologists will attend to the implications of Stevenson’s other take-home messages: Mass incarceration has radically changed American society, creating a class of "new untouchables." And the victims of this sea change are overwhelmingly poor and minority. Indeed, he asserted, wealth -- not criminal culpability -- largely drives criminal sentencing. In Louisiana, for example, of the juveniles serving life without parole for crimes other than homicide at the time of the Graham decision, 94 percent are African American. Most are incarcerated for rape, with 71 percent of the victims being white.

Tom Grisso: "Forensic examiners beware"

Forensic psychology guru Tom Grisso sounded a more cautionary note about Graham's implications. The high court's adoption of a categorical approach to juveniles is at odds with the discretionary, individualized method at the core of forensic assessment, he pointed out.

Grisso demonstrated his point through a mock cross-examination. On the stand, the mock expert conceded that the research of Laurence Steinberg, Elizabeth Cauffman, and others on adolescent immaturity is now widely accepted in the field, as shown by Supreme Court's rulings in Graham and Roper. Next, Grisso produced a New York Times op-ed co-authored by Steinberg, reiterating Roper's conclusion that psychologists "are unable to distinguish between the young person whose crime reflects transient immaturity and the rare juvenile offender who may deserve the harsh sentence of life without parole." In the script, the expert was left speechless and incapable of defending her individualized opinions about risk.

Grisso said forensic psychologists must be aware of this debate, and think about how to answer such questions in court. The outlook for prediction is not as bleak as the APA's advocacy efforts might suggest, he asserted, as experts do have a reliable basis on which to give probability estimates, especially about more short-term risk.

Good news for juveniles with a sex crime

A panel of juvenile sex offender experts was more upbeat about the implications of the scientific research on adolescent difference. As with general criminality, they said, research has not identified methods to accurately predict which juveniles will reoffend sexually. Indeed, none of the factors that predict sex offender recidivism in adults (multiple victims, male victims, young child victims, personality disorder, sexual deviance, etc.) predict recidivism for juveniles.

But this inability to differentiate is not bad news, because what we can say is that the overwhelming majority -- 93 percent -- of juveniles who have committed a sex crime will not reoffend sexually as adults.

An audience member who works in the civil commitment industry expressed incredulity at the cumulative research, saying many of the men in his civil detention facility began their offending careers in their teens.

That may be true, responded researcher Michael Caldwell. But the directionality cannot be reversed. All NBA stars may have played basketball in the ninth grade. But we cannot predict by watching a group of ninth-graders play basketball which, if any, of the players will become basketball superstars.

(A summary of the presentation, "Juvenile Offenders are Ineligible for Civil Commitment as Sexually Violent Predators," is online HERE; it contains a slough of good references. The PowerPoint presentation is HERE.)

Judges launch crusade to save children of color

The most optimistic presentation I attended was a symposium of family court judges who are at the forefront of a movement to reduce the vastly disproportionate representation of minority children in the child welfare system, from which many graduate to juvenile delinquency and adult criminal courts.

The remarkable Hon. Katherine Lucero of San Jose, California said she became active in this movement when she realized she was serving as part of the vast "cradle-to-prison pipeline," processing children who would end up poor, homeless, drug addicted, illiterate, pregnant at a young age, delinquent, and -- ultimately -- incarcerated. When she looked out at her courtroom filled with children of color, her training that justice is blind was cognitively dissonant, making her feel like she was living "in a delusion."

The equally inspiring Hon. Nan Waller of Portland, Oregon said the movement challenges the basic historical tenet of the child welfare system, which promotes removal from families -- so-called "child rescue" -- rather than family strengthening. Most of the mothers who lose their children are suffering from severe trauma that they medicate with drugs. Rather than "cookie-cutter" quick-fixes, including automatic referrals for psychological evaluations and parenting classes, these women need support and help obtaining even basic resources such as housing, transportation, and health care, the judges said.

Assisted by a research and advocacy project of the National Council on Juvenile and Family Court Judges, these and other judges are using a combination of model courts, wraparound services, community interventions, training in implicit race bias at all levels of the system, and other creative methods to reduce the number of children who are placed in foster care. Already, their data show they are having an impact in their respective communities.

Alarming call for preventive detention of children

In the discussion period following their presentation, the judges said they are turning away from ordering psychological reports except when a parent has a genuine, severe mental disorder. They gave two reasons for this. First, psychological evaluations are costly. Second, and more important, the judges do not find it helpful to "slap" pathologizing psychiatric labels on parents. They expressed curiosity as to whether and how we in the field of psychology are working to address the effects of poverty and racism in the populations we serve.

Sadly, the honest answer is that many forensic practitioners and scholars are not adequately addressing the impact of larger social forces -- poverty, race, trauma -- on the people we evaluate, treat, and/or study. Perhaps the sparse attendance at the judges' presentation as compared with other seminars in the forensic juvenile justice track is an indicator of this neglect.

Indeed, at a more well-attended session came a chilling proposal at the polar opposite extreme: To establish a system to preventively detain dangerous juveniles. Raising this "public safety" proposal was attorney Christopher Slobogin, a co-author of the forensic psychology stalwart Psychological Evaluations for the Courts. It will formally air in a book, Juveniles at Risk: A Plea for Preventive Justice, forthcoming from Oxford University Press. Slobogin has good intentions, I am sure; he believes such a model will treat juveniles more fairly and help stem the erosion of the separate juvenile justice system.

But the proposal has potentially far-reaching unintended consequences. It myopically ignores what the family court judges and attorney Stevenson are so painfully aware of: The differential treatment of poor and minority children. It is hard to accurately predict juvenile risk, and actuarial risk prediction tools are especially inaccurate when applied to juveniles. This is just the type of nebulous decision-making situation in which implicit (unconscious) biases are most salient, research shows. Forensic psychological evaluations would provide a scientific veneer, masking racial and class biases in deciding who is labeled as dangerous and who is not.

Rather than locking up kids for crimes they have not (yet) committed, we should be working to give young victims of trauma and abuse -- and their families -- the practical resources and tools they need to lead productive lives. Let's hope the field of psychology and public policymakers heed the pleas of the judges and attorneys in the trenches who are fighting to save kids before they get sucked into the "cradle-to-prison pipeline" in the first place.

SVP industry sneak peek: Problems in Actuaryland

You psychologists and attorneys working in the trenches of Sexually Violent Predator (SVP) litigation will be interested in the controversy over the Static-99 and its progeny, the Static-2002, that erupted at the annual conference of the Association for the Treatment of Sexual Abusers (ATSA) in Dallas.

By way of background, the Static-99 is -- as its website advertises -- "the most widely used sex offender risk assessment instrument in the world, and is extensively used in the United States, Canada, the United Kingdom, Australia, and many European nations." Government evaluators rely on it in certifying individuals as dangerous enough to merit civil commitment on the basis of possible future offending. Some states, including California, New York, and Texas, mandate its use in certain forensic evaluations of sex offenders.


Underlying the instrument's popularity is its scientific veneer, based on two simple-sounding premises:

1. that it represents a "pure actuarial approach" to risk, and

2. that such an approach is inherently superior to "clinical judgment."

But, as with so many things that seem deceptively simple, it turns out that neither premise is entirely accurate.

Why the actuarial approach?

An actuarial method is a statistical algorithm in which variables are combined to predict the likelihood of a given outcome. For example, actuarial formulas determine how much you will pay for automobile or homeowners' insurance by combining relevant factors specific to you (e.g., your age, gender, claims history) and your context (e.g., type of car, local crime rates, regional disaster patterns).

The idea of using such a mechanical approach in clinical predictions traces back to Paul Meehl's famous 1954 monograph. Reviewing about 20 studies of event forecasting, from academic success to future violence, Meehl found that simple statistical models usually did better than human judges at predicting outcomes. Over the ensuing half-century, Meehl's work has attained mythical stature as evidence that clinical judgment is inherently unreliable.

But, as preeminent scholars Daniel Kahneman (a Nobel laureate) and Gary Klein point out in the current issue of the American Psychologist, "this conclusion is unwarranted." Algorithms outperform human experts only under certain conditions, that is, when environmental conditions are highly complex and future outcomes uncertain. Algorithms work better in these limited circumstances mainly because they eliminate inconsistency. In contrast, in more "high-validity," or predictable, environments, experienced and skillful judges often do better than mechanical predictions:

Where simple and valid cues exist, humans will find them if they are given sufficient experience and enough rapid feedback to do so -- except in the environments ... labeled 'wicked,' in which the feedback is misleading.

Even more crucially, in reference to using the Static-99 to predict relatively rare events such as sex offender recidivism, Meehl never claimed that statistical models were especially accurate. He just said they were wrong a bit less often than clinical judgments. Predicting future human behavior will never be simple because -- unlike machines -- humans can decide to change course.

Predictive accuracy

Putting it generously, the Static-99 is considered only "moderately" more accurate than chance, or the flip of a coin, at predicting whether or not a convicted sex offender will commit a new sex crime. (For you more statistically minded folks, its accuracy as measured by the "Area Under the Curve," or AUC statistic, ranges from about .65 to .71, which in medical research is classified as poor.)

The largest cross-validation study to date -- forthcoming in the respected journal Psychology, Public Policy, & Law -- paints a bleaker picture of the Static-99's predictive accuracy in a setting other than that in which it was normed. In the study of its use with almost 2,000 Texas offenders, the researchers found its performance may be "poorer than often assumed." More worrisomely from the perspective of individual liberties, both the Static-99 and a sister actuarial, the MnSOST-R, tend to overestimate risk. The study found that three basic offender characteristics -- age at release, number of prior arrests, and type of release (unconditional versus supervised) -- often predicted recidivism as well as, or even better than, the actuarials. The study's other take-home message is that every jurisdiction that uses the Static-99 (or any similar tool) needs to do local studies to see if it really works. That is, even if it had some validity in predicting the behavior of offenders in faraway times and/or faraway places, does it help make accurate predictions in the here and now?

Recent controversies

Even before this week's controversy, the Static-99 had seen its share of disputation. At last year's ATSA conference, the developers conceded that the old risk estimates, in use since the instrument was developed in 1999, are now invalid. They announced new estimates that significantly lower average risks. Whereas some in the SVP industry had insisted for years that you do not need to know the base rates of offending in order to accurately predict risk, the latest risk estimates -- likely reflective of the dramatic decline in sex offending in recent decades -- appear to validate the concerns of psychologists such as Rich Wollert who have long argued that consideration of population-specific base rates is essential to accurately predicting an individual offender's risk.

In another change presented at the ATSA conference, the developers conceded that an offender's current age is critical to estimating his risk, as critics have long insisted. Accordingly, a new age-at-release item has been added to the instrument. The new item will benefit older offenders, and provide fertile ground for appeals by older men who were committed under SVP laws using now-obsolete Static-99 risk calculations. Certain younger offenders, however, will see their risk estimates rise.

Clinical judgment introduced

In what may prove to be the instrument's most calamitous quagmire, the developers instructed evaluators at a training session on Wednesday to choose one of four reference groups in order to determine an individual sex offender's risk. The groups are labeled as follows:

• routine sample
  
• non-routine sample
• pre-selected for treatment need
• pre-selected for high risk/need

The scientific rationale to justify use of these smaller data sets as comparison groups is not clear at this time, little guidance is being given on how to reliably select the proper reference group, and some worry that criterion contamination may invalidate this procedure. In the highly polarized SVP arena, this new system will give prosecution-oriented evaluators a quick and easy way to elevate their estimate of an offender's risk by comparing the individual to the highest-risk group rather than to the lower recidivism figures for sex offenders as a whole. This, in turn, will create at least a strong appearance of bias.

Thus, this new procedure will introduce a large element of clinical judgment into a procedure whose very existence is predicated on doing away with such subjectivity. There is also a very real danger that evaluators will be overconfident in their judgments. Although truly skilled experts know when and what they don’t know, as Kahneman and Klein remind us:

Nonexperts (whether or not they think they are) certainly do not know when they don't know. Subjective confidence is therefore an unreliable indication of the validity of intuitive judgments and decisions.

With the limited information available at the time, it is not surprising that some state legislatures chose to mandate the use of the Static-99 and related actuarial tools in civil commitment proceedings. After all, the use of mechanical or statistical procedures can reduce inconsistency and thereby limit the role of bias, prejudice, and illusory correlation in decision-making. This is especially essential in an emotionally charged arena like the sex offender civil commitment industry.

But if, as some suspect, the actuarials' poor predictive validity owes primarily to the low base rates of recidivism among convicted sex offenders, then reliance on any actuarial device may have limited utility in the real world. People have the capacity to change, and the less likely an event is to occur, the harder it is to accurately predict. In other words, out of 100 convicted sex offenders standing in the middle of a field, it is very hard to accurately pick out those five or ten who will be rearrested for another sex crime in the next five years.

Unfortunately, with its modest accuracy at best, its complex statistical language and, now, its injection of clinical judgment into a supposedly actuarial calculation, the Static-99 also has the potential to create confusion and lend an aura of scientific certitude above and beyond what the state of the science merits.

The new scoring information is slated to appear on the Static-99 website on Monday (October 5).

Related resource: Ethical and practical concerns regarding the current status of sex offender risk assessment, Douglas P. Boer, Sexual Offender Treatment (2008)

Photo credit: Chip 2904 (Creative Commons license).
Hat tip to colleagues at the ATSA conference who contributed to this report.

Static-99: A bumpy developmental path

By Brian Abbott, PhD and Karen Franklin, PhD* 

The Static-99 is the most widely used instrument for assessing sex offenders’ future risk to the public. Indeed, some state governments and other agencies even mandate its use. But bureaucratic faith may be misplaced. Conventional psychological tests go through a standard process of development, beginning with the generation and refinement of items and proceeding through set stages that include pilot testing and replication, leading finally to peer review and formal publication. The trajectory of the Static-99 has been more haphazard: Since its debut 15 years ago, the tool has been in a near-constant state of flux. Myriad changes in items, instructions, norms and real-world patterns of use have cast a shadow over its scientific validity. Here, we chart the unorthodox developmental course of this tremendously popular tool.
  

Static-99 and 99R Developmental Timeline

Date	Event
1990	The first Sexually Violent Predator (SVP) law passes in the United States, in Washington. A wave of similar laws begins to sweep the nation.
1997	The US Supreme Court upholds the Constitutionality of preventive detention of sex offenders.
1997	R. Karl Hanson, a psychologist working for the Canadian prison system, releases a four-item tool to assess sex offender risk. The Rapid Risk Assessment for Sex Offence Recidivism (RRASOR) uses data from six settings in Canada and one in California.[1]
1998	Psychologists David Thornton and Don Grubin of the UK prison system release a similar instrument, the Structured Anchored Clinical Judgment (SACJ- Min) scale.[2]
1999	Hanson and Thornton combine the RRASOR and SACJ-Min to produce the Static-99, which is accompanied by a three-page list of coding rules.[3] The instrument's original validity data derive from four groups of sex offenders, including three from Canada and one from the UK (and none from the United States). The new instrument is atheoretical, with scores interpreted based on the recidivism patterns among these 1,208 offenders, most of them released from prison in the 1970s.
2000	Hanson and Thornton publish a peer-reviewed article on the new instrument.[4]
2003	New coding rules are released for the Static-99, in an 84-page, unpublished booklet that is not peer reviewed.[5] The complex and sometimes counterintuitive rules may lead to problems with scoring consistency, although research generally shows the instrument can be scored reliably.
2003	The developers release a new instrument, the Static-2002, intended to "address some of the weaknesses of Static-99."[6] The new instrument is designed to be more logical and easier to score; one item from the Static-99 – pertaining to whether the subject had lived with a lover for at least two years – was dropped due to issues with its reliability and validity. Despite its advantages, Static-2002 never caught on, and did not achieve the popularity of the Static-99 in forensic settings.
2007	Leslie Helmus, A graduate student working with Karl Hanson, reports that contemporary samples of sex offenders have much lower offense rates than did the antiquated, non-US samples upon which the Static-99 was originally developed, both in terms of base rates of offending and rates of recidivism after release from custody.[7]
September 2008	Helmus releases a revised actuarial table for Static-99, to which evaluators may compare the total scores of their subjects to corresponding estimates of risk.[8] Another Static-99 developer, Amy Phenix, releases the first of several "Evaluators’ Handbooks."[9]
October 2008	At an annual convention of the Association for the Treatment of Sexual Abusers (ATSA), Andrew Harris, a Canadian colleague of Hanson's, releases a new version of the Static-99 with  three separate "reference groups" (Complete, CSC and High Risk) to which subjects can be compared. Evaluators are instructed to report a range of risks for recidivism, with the lower bound coming from a set of Canadian prison cases (the so-called CSC, or Correctional Service of Canada group), and the upper bound derived from a so-called "high-risk" group of offenders. The risk of the third, or "Complete," group was hypothesized as falling somewhere between those of the other two groups.[10]
November 2008	At a workshop sponsored by a civil commitment center in Minnesota, Thornton and a government evaluator named Dennis Doren propose yet another new method of selecting among the new reference groups.  In a procedure called "cohort matching,” they suggest comparing an offender with either the CSC or High-Risk reference group based on how well the subject matched a list of external characteristics they had created but never empirically tested or validated.[11]
December 2008	Phenix and California psychologist Dale Arnold put forth yet a new idea for improving the accuracy of the Static-99: After reporting the range of risk based on a combination of the CSC and High-Risk reference groups, evaluators are encouraged to consider a set of external factors, such as whether the offender had dropped out of treatment and the offender's score on Robert Hare's controversial Psychopathy Checklist-Revised (PCL-R). This new method does not seem to catch on.[12] [13]
2009	An official Static-99 website, www.static99.org, debuts.[14]
Winter 2009	The Static-99 developers admit that norms they developed in 2000 are not being replicated: The same score on the Static-99 equates with wide variations in recidivism rates depending on the sample to which it is compared. They theorize that the problem is due to large reductions in Canadian and U.S. recidivism rates since the 1970s-1980s. They call for the development of new norms.[15]
September 2009	Hanson and colleagues roll out a new version of the Static-99, the Static-99R.[16] The new instrument addresses a major criticism by more precisely considering an offender's age at release, an essential factor in reoffense risk.  The old Static-99 norms are deemed obsolete. They are replaced by data from 23 samples collected by Helmus for her unpublished Master's thesis. The samples vary widely in regard to risk. For estimating risk, the developers now recommend use of the cohort matching procedure to select among four new reference group options. They also introduce the concepts of percentile ranks and relative risk ratios, along with a new Evaluators’ Workbook for Static-99R and Static-2002R. Instructions for selecting reference groups other than routine corrections are confusing and speculative. Research is lacking to demonstrate that selecting other than routine corrections reference group produces more accurate risk estimates.[17]
November 2009	Just two months after their introduction, the Evaluators’ Workbook for Static-99R and Static-2002R is withdrawn due to errors in its actuarial tables.[18] The replacement workbook provides the same confusing and speculative method for selecting a nonroutine reference group, a method that lacks scientific validation and reliability.
2010	An international team of researchers presents large-scale data from the United States, New Zealand and Australia indicating that the Static-99 would be more accurate if it took better account of an offender's age.[19] The Static-99 developers do not immediately embrace these researchers' suggestions.
January 2012	Amy Phenix and colleagues introduce a revised Evaluators’ Workbook for Static-99R and Static-2002R.[20] The new manual makes a number of revisions both to the underlying data (including percentile rank and relative risk ratio data) and to the recommended procedure for selecting a reference group. Now, in an increasingly complex procedure, offenders are to be compared to one of three reference groups, based on how many external risk factors they had. The groups included Routine Corrections (low risk), Preselected Treatment Need (moderate risk), and Preselected High Risk Need (high risk). Subsequent research shows that using density of external risk factors to select among the three reference group options is not valid and has no proven reliability.[21]A fourth reference group, Nonroutine Corrections, may be selected using a separate cohort-matching procedure. New research indicates that evaluators who are retained most often by the prosecution are more likely than others to select the high-risk reference group, [22]  which has base rates much higher than in contemporary sexual recidivism studies and will thus produce exaggerated risk estimates.[23]
July 2012	Six months later, the percentile ranks and relative risk ratios are once again modified, with the issuance of the third edition of the Static-99R and Static-2002R Evaluators’ Handbook.[24] No additional data is provided to justify that the selection of nonroutine reference groups produces more accurate risk estimates than choosing the routine corrections reference group.
October 2012	In an article published in Criminal Justice & Behavior, the developers concede that risk estimates for the 23 offender samples undergirding the Static-99 vary widely. Further, absolute risk levels for typical sex offenders are far lower than previously reported, with the typical sex offender having about a 7% chance of committing a new sex offense within five years. They theorize that the Static-99 might be inflating risk of reoffense due to the fact that the offenders in its underlying samples tended to be higher risk than average.[25]
2012	The repeated refusal of the Static-99 developers to share their underlying data with other researchers, so that its accuracy can be verified, leads to a court order excluding use of the instrument in a Wisconsin case.[26]
October 2013	At an annual ATSA convention, Hanson and Phenix report that an entirely new reference group selection system will be released in a peer-reviewed article in Spring 2014.[27] The new system will include only two reference groups: Routine Corrections and Preselected High Risk High Need.  An atypical sample of offenders from a state hospital in Bridgewater, Massachusetts dating back to 1958 is to be removed altogether, along with some other samples, while some new data sets are to be added.
October 2014	At the annual ATSA convention, the developers once again announce that the anticipated rollout of the new system has been pushed back pending acceptance of the manuscript for publication. Helmus nonetheless presents an overview.[28] She reports that the new system will abandon two out of the current four reference groups, retaining only Routine Corrections and Preselected High Risk Need.   Evaluators should now use the Routine Corrections norms as the default unless local norms (with a minimum of 100 recidivists) are available. Evaluators will be permitted to choose the Preselected High Risk Need norms based on “strong, case-specific justification.” No specific guidance nor empirical evidence to support such a procedure is proffered. A number of other new options for reporting risk information are also presented, including the idea of combining Static-99 data with that from newly developed, so-called "dynamic risk instruments."
January 2015	At an ATSA convention presentation followed by an article in the journal Sexual Abuse,[29] the developers announce further changes in their data sets and how Static-99R scores should be interpreted. Only two of the original four "reference groups" are still standing. Of these, the Routine group has grown by 80% (to 4,325 subjects), while the High-Risk group has shrunk by 35%, to a paltry 860 individuals. Absent from the article is any actuarial table on the High-Risk group, meaning the controversial practice by some government evaluators of inflating risk estimates by comparing sex offenders' Static-99R scores with the High-Risk group data has still not passed any formal peer review process. The developers also correct a previous statistical method as recommended by Ted Donaldson and colleagues back in 2012,[30] the effect of which is to further lower risk estimates in the high-risk group. Only sex offenders in the Routine group with Static-99R scores of 10 are now statistically more likely than not to reoffend. It is unknown how many sex offenders were civilly committed in part due to reliance on the now-obsolete data.

References

---

[1] Hanson, R. K. (1997). The development of a brief actuarial risk scale for sexual offense recidivism. (Unpublished report 97-04). Ottawa: Department of the Solicitor General of Canada.

[2] Grubin, D. (1998). Sex offending against children: Understanding the risk. Unpublished report, Police Research Series Paper 99. London: Home Office.

[3] Hanson, R.K. & Thornton, D. (1999).  Static 99: Improving Actuarial Risk Assessments for Sex Offenders. Unpublished paper

[4] Hanson, R. K., & Thornton, D. (2000). Improving risk assessments for sex offenders: A comparison of three actuarial scales. Law and Human Behavior, 24(1), 119-136.

[5] Harris, A. J. R., Phenix, A., Hanson, R. K., & Thornton, D. (2003). Static-99 coding rules: Revised 2003. Ottawa, ON: Solicitor General Canada.

[6] Hanson, R.K., Helmus, L., & Thornton, D (2010). Predicting recidivism amongst sexual offenders: A multi-site study of Static-2002. Law & Human Behavior 34, 198-211.

[7] Helmus, L. (2007). A multi-site comparison of the validity and utility of the Static-99 and Static-2002 for risk assessment with sexual offenders. Unpublished Honour’s thesis, Carleton University, Ottawa, ON, Canada.

[8] Helmus, L. (2008, September). Static-99 Recidivism Percentages by Risk Level. Last Updated September 25, 2008. Unpublished paper.

[9] Phenix, A., Helmus, L., & Hanson, R.K. (2008, September). Evaluators’ Workbook. Unpublished, September 28, 2008

[10] Harris, A. J. R., Hanson, K., & Helmus, L. (2008). Are new norms needed for Static-99? Workshop presented at the ATSA 27th Annual Research and Treatment Conference on October 23, 2008, Atlanta: GA. Available at www.static99.org.

[11] Doren, D., & Thornton, D. (2008). New Norms for Static-99: A Briefing. A workshop sponsored by Sand Ridge Secure Treatment Center on November 10, 2008. Madison, WI.

[12] Phenix, A. & Arnold, D. (2008, December). Proposed Considerations for Conducting Sex Offender Risk Assessment Draft 12-14-08. Unpublished paper.

[13] Abbott, B. (2009). Applicability of the new Static-99 experience tables in sexually violent predator risk assessments. Sexual Offender Treatment, 1, 1-24.

[14] Helmus, L., Hanson, R. K., & Thornton, D. (2009). Reporting Static-99 in light of new research on recidivism norms. The Forum, 21(1), Winter 2009, 38-45.

[15] Ibid.

[16] Hanson, R. K., Phenix, A., & Helmus, L. (2009, September). Static-99(R) and Static-2002(R): How to Interpret and Report in Light of Recent Research. Paper presented at the 28th Annual Research and Treatment Conference of the Association for the Treatment of Sexual Abusers, Dallas, TX, September 28, 2009.

[17] DeClue, G. & Zavodny, D. (2014). Forensic use of the Static-99R: Part 4. Risk Communication. Journal of Threat Assessment and Management, 1(3), 145-161.

[18] Phenix, A., Helmus, L., & Hanson, R.K. (2009, November). Evaluators’ Workbook. Unpublished, November 3, 2009.

[19] Wollert, R., Cramer, E., Waggoner, J., Skelton, A., & Vess, J. (2010). Recent Research (N = 9,305) Underscores the Importance of Using Age-Stratified Actuarial Tables in Sex Offender Risk Assessments. Sexual Abuse: A Journal of Research and Treatment, 22 (4), 471-490. See also: "Age tables improve sex offender risk estimates," In the News blog, Dec. 1, 2010.

[20] Phenix, A., Helmus, L., & Hanson, R.K. (2012, January). Evaluators’ Workbook. Unpublished, January 9, 2012.

[21] Abbott, B.R. (2013). The Utility of Assessing “External Risk Factors” When Selecting Static-99R Reference Groups. Open Access Journal of Forensic Psychology, 5, 89-118.

[22] Chevalier, C., Boccaccini, M. T., Murrie, D. C. & Varela, J. G. (2014), Static-99R Reporting Practices in Sexually Violent Predator Cases: Does Norm Selection Reflect  Adversarial Allegiance? Law & Human Behavior. To request a copy from the author, click HERE.

[23] Abbott (2013) op. cit.

[24] Phenix, A., Helmus, L., & Hanson, R.K. (2012, July). Evaluators’ Workbook. Unpublished, July 26, 2012.

[25] Helmus, Hanson, Thornton, Babchishin, & Harris (2012), Absolute recidivism rates predicted by Static-99R and Static-2002R sex offender risk assessment tools vary across samples: A meta-analysis, Criminal Justice & Behavior. See also: "Static-99R risk estimates wildly unstable, developers admit," In the News blog, Oct. 18, 2012.

[26] State of Wisconsin v. Homer L. Perren Jr., La Crosse County 2010-CI000003. See Franklin, K. "Judge bars Static-99R risk tool from SVP trial: Developers staunchly refused requests to turn over data" (2012, Dec. 14), In the News blog.

[27] Hanson, R.K. & Phenix, A. (2013, October). Report writing for the Static-99R and Static-2002R. Preconference seminar presented at the 32nd Annual Research and Treatment Conference of the Association for the Treatment of Sexual Abusers, Chicago, IL, October 30, 2013. See also: "Static-99 'norms du jour' get yet another makeover," In the News blog, Nov. 17, 2013.

[28] Helmus, L.M. (2014, October). Absolute recidivism estimates for Static-99R and Static-2002R: Current research and recommendations. Paper presented at the 33rd Annual Research and Treatment Conference of the Association for the Treatment of Sexual Abusers, San Diego, CA, October 30, 2014.

[29]

Hanson, R. K., Thornton, D., Helmus, L-M, & Babchishin, K. (2015). What sexual recidivism rates are associated with Static-99R and Static-2002R scores? Sexual Abuse: A Journal of Research and Treatment, 1-35.

[30]

Donaldson, T., Abbott, B., & Michie,  C. (2012). Problems with the Static-99R prediction estimates and confidence intervals. Open Access Journal of Forensic Psychology, 4,

1-23.

* * * * *

*Many thanks to Marcus Boccaccini, Gregory DeClue, Daniel Murrie and other knowledgeable colleagues for their valuable feedback.  

This timeline can be downloaded in pdf format for easy reference.

Another online version can also be found at my website.

* * * * *

Related blog posts: ·        Static-99 "norms du jour" get yet another makeover (Nov. 17, 2013) ·        Static-99 developers embrace redemption: Sex offender risk plummets over time in community, new study reports (Nov. 5, 2013) ·        Black swan crash lands on Florida SVP program: Audit finds low recidivism, critiques reliance on inflated Static-99 risk estimates (Oct. 27, 2013) ·        'Authorship bias' plays role in research on risk assessment tools, study finds: Reported predictive validity higher in studies by an instrument's designers than by independent researchers (Sept. 4, 2013) ·        Miracle of the day: 80-year-old man recaptures long-lost youth (Or: How committing a new sex crime can paradoxically LOWER risk on the Static-99R) (March 25, 2013) ·        Remarkable experiment proves pull of adversarial allegiance: Psychologists' scoring of forensic tools depends on which side they believe has hired them (March 5, 2013) ·        Showdown looming over predictive accuracy of actuarials: Large error rates thwart individual risk prediction (Jan. 27, 2013) ·        Static-99R risk estimates wildly unstable, developers admit (Oct. 18, 2012) ·        Violence risk instruments overpredicting danger: Tools better at screening for low risk than pinpointing high risk (Aug. 2, 2012) ·        SVP risk tools show 'disappointing' reliability in real-world use (May 29, 2012) ·        MnSOST-3: Promising new actuarial for sex offenders to debut (Nov. 27, 2011) ·        Age tables improve sex offender risk estimates (Dec. 1, 2010) ·        Systems failure or black swan? New frame needed to stop "Memorial Crime Control" frenzy (Oct. 19, 2010) ·        New study: Do popular actuarials work? (April 20, 2010) ·        Delusional campaign for a world without risk (April 3, 2010) ·        Study: Actuarials fail to predict sexually violent recidivism (March 5, 2010) ·       SVP industry sneak peek: Problems in Actuaryland (Oct. 4, 2009)