Upcoming trainings: Assessment; personal injury; sexual violence; ethics in diagnosis

If you are planning to be in or around Florida, New Jersey, Hawaii or London over the next few months, here are some recommended forensic trainings on the horizon:

April 19 and onwards: Sexual violence workshops (London) 

Building on the success of the 2011 sexual violence workshops sponsored by the British Psychological Society (at which I spoke), Middlesex University is hosting another round of BPS-sponsored workshops on various aspects of sexual violence. Multiple-perpetrator rape is the topic of the first workshop, coming right up on April 19. (Also check out the new book, the first-ever text on this topic.) Next up are a June 27 workshop on "negotiating ethical sexual relationships," a Sept. 17 workshop on "intersectionality and sexual violence," and a fourth workshop on the investigation and prosecution of rape (date yet to be decided). All the workshops will be held at Middlesex University's Hendon Campus. More details are HERE.

April 20: Assessing Emotional Damages in Personal Injury and Employment Discrimination Cases (New Jersey)

William Foote, president of the American Psychology-Law Society (APA Division 41), will be presenting a five-stage model for assessing psychological damages in personal injury and workplace discrimination cases at the spring conference of the New Jersey Psychological Association. To find out more about this all-day training, click HERE.

May 3-5: New Directions in Forensic and Clinical Assessment (Florida)

Many big names in forensic psychology will descend upon Miami for this training sponsored by Division 42 (Psychologists in Independent Practice) of the American Psychological Association. The three-day conference will feature trainings on risk assessment, malingering, trial consultation, the DSM-5, intellectual disability, and much more. Information and registration can be found HERE. 


July 31: Controversial Psychiatric Diagnoses in Legal Settings (Hawaii) 

Yours truly is the trainer at this all-day continuing education workshop at the American Psychological Association's annual conference, along Honolulu's idyllic Waikiki Beach. I will focus on the scientific and practical limits of psychiatric diagnoses in forensic cases, and provide ethics guidance on how to present diagnostic testimony in court. Details are HERE; I'd love to see you there!

Risk screening worthless with juvenile sex offenders, study finds

Boys labeled as 'sexually violent predators' not more dangerous

Juveniles tagged for preventive detention due to their supposedly higher level of sexual violence risk are no more likely to sexually reoffend than adolescents who are not so branded, a new study has found.

Only about 12 percent of youths who were targeted for civil commitment as sexually violent predators (SVP's) but then freed went on to commit a new sex offense. That compares with about 17 percent of youths screened out as lower risk and tracked over the same five-year follow-up period.

Although the two groups had essentially similar rates of sexual and violent reoffending, overall criminal reoffending was almost twice as high among the youths who were NOT petitioned for civil commitment (66 percent versus 35 percent), further calling into question the judgment of the forensic evaluators.

Because of the youths' overall low rates of sexual recidivism, civil detention has no measurable impact on rates of sexual violence by youthful offenders, asserted study author Michael Caldwell, a psychology professor at the University of Wisconsin and an expert on juvenile sex offending.

The study, just published in the journal Sexual Abuse, is one in a growing corpus pointing to flaws in clinical prediction of risk.

It tracked about 200 juvenile delinquents eligible for civil commitment as Sexually Violent Persons (SVP's). The state where the study was conducted was not specified; at least eight of the 20 U.S. states with SVP laws permit civil detention of juveniles, and all allow commitment of adults based on offenses committed as a juvenile.

As they approached the end of their confinement period, the incarcerated juveniles underwent a two-stage screening process. In the first phase, one of a pool of psychologists at the institution evaluated them to determine whether they had a mental disorder that made them "likely" to commit a future act of sexual violence. Just over one in every four boys was found to meet this criterion, thereby triggering a prosecutorial petition for civil commitment.

After the initial probable cause hearing but before the final civil commitment hearing, an evaluator from a different pool of psychologists conducted a second risk assessment. These  psychologists were also employed by the institution but were independent of the treatment team. Astonishingly, the second set of psychologists disagreed with the first in more than nine out of ten cases, screening out 50 of the remaining 54 youths. (Only four youths were civilly committed, and a judge overturned one of these commitments, so ultimately all but three boys from the initial group of 198 could be tracked in the community to see whether or not they actually reoffended.)

Evaluators typically did not rely on actuarial risk scales to reach their opinions, Caldwell noted, and their methods remained something of a mystery. Youths were more likely to be tagged for civil detention at the first stage if they were white, had multiple male victims, and had engaged in multiple instances of sexual misconduct in custody, Caldwell found.

However, no matter what method they used or which factors they considered, the psychologists likely would have had little success in predicting which youths would reoffend. Even "the most carefully developed and thoroughly studied" methods for predicting juvenile recidivism have shown very limited accuracy, Caldwell pointed out. This is mainly due to a combination of youths' rapid social maturation and their very low base rates of recidivism; it is quite hard to successfully predict a rare event.

Indeed, a recent meta-analysis revealed that none of the six most well-known and best-researched instruments for appraising risk among juvenile sex offenders showed consistently accurate results. Studies that did find significant predictive validity for an instrument were typically conducted by that instrument's authors rather than independent researchers, raising questions about their objectivity.

"Juveniles are still developing their personality, cognitions, and moral judgment, processes that reflect considerable plasticity," noted lead author Inge Hempel, a psychology graduate student in the Netherlands, and her colleagues. "There are still many possible developmental pathways, and no one knows what causes persistent sexual offending."

Caldwell agrees with Hempel and her colleagues that experts' inability to accurately predict which juveniles will commit future sex crimes calls into question the ethics of civil commitment.

"From the perspective of public policy, these results raise questions about whether SVP commitment laws, as written, should apply to juveniles adjudicated for sexual offenses," he wrote. "If SVP laws could be reliably applied to high risk juvenile offenders, the benefit of preventing a lifetime of potential victims makes for a compelling case. However, the task of identifying the small subgroup of juveniles adjudicated for sexual offenses who are likely to persist in sexual violence into adulthood is at least extremely difficult, and may be technically infeasible."

* * * * *

The articles are:

Michael Caldwell: Accuracy of Sexually Violent Person Assessments of Juveniles Adjudicated for Sexual Offenses, Sexual Abuse: A Journal of Research and Treatment. Request it from the author HERE.

Inge Hempel, Nicole Buck, Maaike Cima and Hjalmar van Marle: Review of Risk Assessment Instruments for Juvenile Sex Offenders: What is Next? International Journal of Offender Therapy and Comparative Criminology. Request it from the first author HERE.

Study links childhood trauma and adult aggression

Call for trauma-focused treatment of offenders

Children who experience abuse, neglect and family dysfunction have a heightened risk of developing health problems such as obesity, drug addiction, depression and heart disease in adulthood. That common-sense notion is widely accepted, and has been proven in a series of studies funded by the US Centers for Disease Control and Prevention (CDC) and Kaiser Permanente. The Kaiser-CDC project has amassed a large database of the life histories and health trajectories of middle-class residents of San Diego, California.

Now, a San Diego psychologist has deployed that project's Adverse Childhood Experiences (ACE) survey to link these negative childhood experiences with adult aggression and criminality, including domestic violence, sexual assault, stalking and child abuse.

In fact, the correlation is additive, the new study found: The more types of adversities a man underwent in childhood, the higher his likelihood of engaging in criminal aggression as an adult.

Men in the study who were referred to outpatient treatment following convictions for domestic violence, sexual offending, nonsexual child abuse or stalking reported about four times as many adverse childhood events as men in the general population. Men convicted of sex offenses and child abuse were especially likely to report being sexually abused as children.

The link between early damage and later aggression explains why treatment programs that focus primarily on criminal acts are not very effective, say psychologist James Reavis of San Diego, California and his colleagues.

"To reduce criminal behavior one must go back to the past in treatment, as Freud admonished us nearly 100 years ago," wrote Reavis and co-authors Jan Looman, Kristina Franco and Briana Rojas in an article slated for the Spring 2013 issue of The Permanente Journal. "Fortunately, evidence exists in support of both attachment-based interventions designed to normalize brain functioning and in the efficacy of psychoanalytic treatment."

Why the link between abuse and aggression?

Cumulative experiences of abuse and neglect disrupt both a child's ability to form secure attachments to others and his ability to regulate his emotions, the researchers posit. Thus, men abused as youngsters tend to either avoid intimacy altogether or are at risk to become violent in intimate relationships, due to a "bleeding out" of their suppressed inner rage.


Not only must treatment of offenders focus on healing their "neurobiological" wounds, the researchers say, but the findings also point to the need for more early childhood interventions to stop child abuse before its victims grow up to victimize others.

Stay tuned: A second article being prepared for publication will explore the link between early adversity and dysregulation in the hypothalamic-pituitary-adrenal axis that modulates stress responses.

The article, "Adverse Childhood Experiences and Adult Criminality: How Long Must We Live before We Possess Our Own Lives?" can be requested from the first author, psychologist James Reavis of San Diego (HERE). The article includes a copy of the ACE questionnaire, which is potentially useful in forensic cases as a means of quantifying experiences of child abuse and neglect.

Evaluating juveniles: Grisso's classic updated for new era

In the 1990s a moral panic swept through the United States over juvenile "super-predators," ruthless youngsters devoid of empathy or morality who would terrorize the good citizenry -- raping, looting and murdering with abandon. Although the hysterical, racially coded predictions proved unfounded (the spike in violent crime was just a historical blip on the radar screen), politicians passed harsh new laws that set the U.S. apart from all other nations in the magnitude of penal warehousing of children.

At the pinnacle of this frenzied "get-tough era" in juvenile justice, the eminent forensic psychologist Tom Grisso authored Forensic Evaluation of Juveniles, a groundbreaking text that guided practitioners into the burgeoning niche of psychological evaluations in delinquency cases.

Now, in a major overhaul of that influential 1998 text, Grisso writes optimistically of a new trend in juvenile justice that he labels the "developmental era." Social science evidence about adolescent brain development and social maturation will contribute to greater judicial and societal recognition that much delinquency is time-limited, he believes. Although this new direction comes too late for the youths and families shattered by the get-tough policies of the past few decades, Grisso hopes that forensic psychology can help judges, probation officers and policy makers understand the potential of rehabilitation for today's wayward youth.

Photo from Richard Ross's Juvenile In Justice photography project

I'm a little less sanguine about a newer, gentler era. Yes, the U.S. Supreme Court has outlawed the death penalty for juveniles, life without parole for crimes other than murder, and mandatory sentences of life without parole for murder.* But such reversals are a drop in the bucket so long as the punitive architecture remains in place that allows, for example, prosecutorial "direct-files" of juvenile cases to adult courts. We are living in an increasingly repressive culture. About 70,000 young people -- disproportionately poor and non-white -- are currently incarcerated in the U.S., many serving ridiculously long sentences that give them no chance of ever leading productive lives. 

Grisso's practical guide strikes a humanistic tone, refreshing in a field increasingly infiltrated by a gloomy, pathologizing, technocratic worldview. The award-winning director of the Law-Psychiatry Program at the University of Massachusetts Medical School for example cautions evaluators to avoid simple tallies of actuarial risk factors in informing the court of a youth's risk. Rather, evaluators should understand and incorporate the two broad, and complementary, theories of delinquency: The biological and personality-oriented theories of psychology, and the social-environmental theories of criminology, such as the notion of "drift" into delinquency. Evaluators should also understand the individual child's context, and the factors that contribute not only to pathology but also to resilience in the face of adversity.

Perhaps the most radical departure from the first edition is a newfound emphasis on understanding racial, ethnic and cultural factors, historically a major blind spot in forensic psychology. With non-white children comprising the overwhelming majority of those incarcerated in America, this principle cannot be overstated. Grisso addresses the barriers to even basic communication that will become all the more challenging as young immigrants arrive from far-flung lands, many carrying inside them the weight of untold traumas. Although he proffers no facile solutions, he preaches greater awareness of cultural blinders and of the inherent limitations of forensic tools that were not normed on diverse populations.

Disappointingly, given this humanistic tenor and discussion of racial and cultural issues, Grisso soft-pedals criticism of the growing practice of labeling juveniles as psychopaths. He describes evidence for the validity of the psychopathy construct in juveniles as "mixed," yet omits mention of the calamitous -- and often self-fulfilling -- consequences to youths when the psychopathy label is introduced in court.

Like the first edition, this is a practical manual that provides a clearly written historical overview of the field for novice practitioners, and useful review material for more seasoned juvenile evaluators. Chapters address specific types of evaluations, including competency to stand trial, waiver of Miranda rights, risk assessment, waiver to adult court, and rehabilitation and treatment recommendations. New statutes, case law, scientific findings and assessment methods are interwoven throughout, making this an indispensable addition to the juvenile evaluator's bookshelf.

If you found this review helpful, I would appreciate your taking a moment click to visit my Amazon review (HERE) and click on the "YES" button at the bottom ("this review was helpful"). This helps boost the review's ranking. Thanks in advance. 

*The cases are Roper v. Simmons (2005), Graham v. Florida (2010), and Miller v. Alabama (2012), respectively.

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)

"How old is the offender?"

 Age is an essential variable in many forensic contexts. Older people are at lower risk for criminal recidivism. Antisocial behaviors, and even psychopathic character traits, diminish as criminals reach their 30s and 40s. Men who have committed sex offenses become at considerably lower risk for further such misconduct, due to a combination of decreased testosterone levels and the changes in thinking, health, and lifestyle that happen naturally with age.

Calculating a person's age would seem very straightforward, and certainly not something requiring a PhD: Just look up his date of birth, subtract that from today's date, and -- voila! Numerous published tests provide fill-in-the-blank boxes to make this calculation easy enough for a fourth-grader.

One forensic instrument, however, bucks this common-sense practice. The developers of the Static-99R, the most widely used tool for estimating the risk of future sexual recidivism, have given contradictory instructions on how to score its very first item: Offender age.

In a new paper, forensic evaluator Dean Cauley and PsyD graduate student Michelle Brownfield report that divergent field practices in the scoring of this item are producing vastly different risk estimates in legal cases -- estimates that in some cases defy all logic and common sense.

Take Fred. Fred is 80 years old, and facing possible civil commitment for the rapes of two women when he was 18 years old. He served 12 years in prison for those rapes. Released from prison at age 30, he committed several strings of bank robberies that landed him back in prison on six separate occasions.

At age 80 (and especially with his only known sex offenses committed at age 18), his risk for committing a new sex offense if released from custody is extremely low -- something on the order of 3 percent. But evaluators now have the option of using any of three separate approaches with Fred, with each approach producing quite distinct opinions and recommendations.

Procedure 1: Age is age (the old-fashioned method)

The first, and simplest, approach, is to list Fred's actual chronological age on Item 1 of the Static-99R. Using this approach, Fred gets a three-point reduction in risk for a total of one point, making his actuarial risk of committing a new sex offense around 3.8 percent.

Evaluators adopting this approach argue that advancing age mitigates risk, independent of any technicalities about when an offender was released from various periods of incarceration. These evaluators point to the Static-99R's coding manuals and workbook, along with recent publications, online seminars, and sworn testimony by members of the Static-99 Advisory Committee. Additionally, they point to a wealth of age-related literature from the fields of criminology and psychology to support their scoring.

Procedure 2: Reject the Static-99R as inappropriate

A second approach is not to use the Static-99R at all, because Fred's release from prison for his "index offenses" (the rapes) was far more than two years ago, making Fred unlike the members of the samples from which the Static-99R's risk levels were calculated. Evaluators adopting this approach point to publications by members of the Static-99 Advisory Committee, generally accepted testing standards and actuarial science test standards to support their choice to not use the test at all.

Procedure 3: The amazing elixir of youth

But there is a third approach. One that magically transports Fred back to his youth, back to the days when a career in bank robbing seemed so promising. (Bank robbery is no longer alluring; it is quietly fading away like the career of a blacksmith.) The last five decades of Fred's life fade away, and he becomes 30 again -- his age when he was last released from custody on a sex offense conviction.

Now Fred not only loses his three-point age reduction, but he gains a point for being between the ages of 18 and 34.9. A four point difference! The argument for this approach is that it most closely conforms to the scoring methods used on the underlying samples of sex offenders, who were scored based on their date of release from their index sexual offense. These evaluators can correctly point to information imparted at training seminars, advice given by some members of the Static-99R Advisory Committee, and sworn testimony by developers of the test itself. They can also point to an undated FAQ #27 on the Static-99 website to support their opinion.

Fred could rape someone to reduce his risk!

Back-dating age to the time of the last release from a sex offense-related incarceration allows for a very bizarre twist:

Let's say that after Fred was released from prison on his most recent robbery stint, back when he was a vigorous young man of 61, he committed another rape. Being 60 or over, Fred would now get the four-point reduction in risk to which his age entitles him. This would cut his risk by two-thirds -- from 11.4 percent (at a score of 5) all the way down to a mere 3.8 percent (at a score of 1)!

While such a scenario might seem far-fetched, it is not at all unusual for an offender to be released from prison at, say, age 58 or 59, but to not undergo a civil commitment trial for a couple of years, until age 60 or 61. Such an offender's score will vary by two points (out of a total of 12 maximum points) depending upon how the age item is scored. And, as Cauley and Brownfield describe, the members of the Static-99R development team have, at different times, given contradictory advice on how to score the age item.

By completely negating the very substantial body of research on age and crime, this technocratic method creates other very concerning -- and paradoxical -- implications, Cauley and Brownfield argue: As the risk estimate for a more persistent offender is lowered, the offender who does not reoffend is stuck with a risk score that is forever jacked up.

Back-dating an offender's age is also at odds with the research that generated the test itself, they say, because the offenders in the samples used to construct the Static-99R had finished serving their sentences on their index sexual offenses within two years of being studied. In other words, none of the offenders had been released many years earlier, and there was none of this curious time-travel business in regard to their ages. As the instrument's developers noted in a publication just last year, the Static-99 "was developed on, and intended for, sexual offenders with a current or recent sexual offense."

So, if you are evaluating an old geezer in the local pen and he tells you that he is only 30 years old, don't assume that he has a delusional belief that he has discovered the elixir of youth -- or that he's pulling your leg. He just might be reciting the age that he was just assigned by a technocratic Static-99R evaluator.

The paper, "Static-99R: Item #1 -- What is the Offender's Age? A lack of consensus leads to a defective actuarial," is available for download both HERE and HERE.

California high court upholds parolee confidentiality right

Two years ago, I reported on a California appellate opinion upholding the sacredness of patient-therapist confidentiality even for convicted felons who are mandated to treatment as a condition of parole. Today, the California Supreme Court upheld the gist of the ruling -- but with a proviso. Using strained logic, the court held that the breach of confidentiality was not so prejudicial as to merit overturning Ramiro Gonzales's civil commitment, as the Sixth District Court of Appeal had done.

Gonzales is a developmentally disabled man whose therapist turned over prejudicial therapy records to a prosecutor seeking to civilly detain him as a sexually violent predator (SVP). Forensic psychology experts Brian Abbott and Tim Derning testified for the defense; called by the prosecution were psychologists Thomas MacSpeiden and Jack Vognsen.

As I wrote two years ago, the ruling is good news for psychology ethics and should serve as a reminder that we are obligated to actively resist subpoenas requesting confidential records of therapy.

Today's California Supreme Court ruling is HERE. My prior post, with much more detail on the case, is HERE. The Sixth District Court of Appeal opinion from 2011, available HERE, provides a nice overview of both federal and California case law on confidentiality in forensic cases.

 

Hat tip: Adam Alban

Related blog posts:  

• Do sex offenders have right to confidential therapy? (Feb. 22, 2008)

• Confession to prison psychiatrist not confidential (Dec. 11, 2007)

• Treating therapist as police interrogator (Nov. 30, 2008)

• Abandon ethics, all ye who enter here: Special ethics exemption sought for SVP work (Oct. 6, 2010)