Measurement of Change in Dynamic Factors Using the START:AV

Prospective Field Validation of the START:AV in a Dutch Secure Youth Care Sample

The Short-Term Assessment of Risk and Treatability: Adolescent Version (START:AV) is a risk assessment instrument for adolescents that estimates the risk of multiple adverse outcomes. Prior research into its predictive validity is limited to a handful of studies conducted with the START:AV pilot version and often by the instrument's developers. The present study examines the START:AV's field validity in a secure youth care sample in the Netherlands. Using a prospective design, we investigated whether the total scores, lifetime history, and the final risk judgments of 106 START:AVs predicted inpatient incidents during a 4-month follow-up. Final risk judgments and lifetime history predicted multiple adverse outcomes, including physical aggression, institutional violations, substance use, self-injury, and victimization. The predictive validity of the total scores was significant only for physical aggression and institutional violations. Hence, the short-term predictive validity of the START:AV for inpatient incidents in a residential youth care setting was partially demonstrated and the START:AV final risk judgments can be used to guide treatment planning and decision-making regarding furlough or discharge in this setting.

Provider challenges in responding to retrafficking of juvenile justice-involved domestic minor sex trafficking survivors

BACKGROUND

Domestic minor sex trafficking (DMST) survivors are disproportionately involved in the juvenile justice system, but frequently run away and experience retrafficking. However, little research explores how practitioners who work with juvenile justice-involved DMST survivors address such dynamics.

OBJECTIVE

This study examines challenges related to chronic runaway behaviors and related retrafficking of juvenile justice-involved DMST survivors from the perspective of practitioners.

PARTICIPANTS AND SETTING

35 in-depth interviews were conducted with social service and justice system practitioners working with DMST survivors in a Midwestern metropolitan area.

METHODS

Inductive analysis of the transcribed interviews involved a multi-phase, independent co-coding process conducted by three members of the research team, including selective coding, open coding, and taxonomic analysis to identify recurring themes and subthemes. Core themes that focused on challenges experienced by practitioners working with minors who chronically ran away and returned to a trafficking situation were further developed.

RESULTS

Practitioners reported that their ability to provide care to minors returning to trafficking situations was limited because of their informal authority in the juvenile justice system, inaccessibility of residential therapeutic care and drug treatment, and punitive measures directed toward parents seeking assistance from Children's Division. Provider narratives indicated that without effective interventions, minors typically exit a retrafficking situation only after experiencing emotional distress, extreme violence, pregnancy or birth, or contracting an STI.

CONCLUSIONS

Non-punitive responses to address chronic runaway behaviors and retrafficking of minors in the justice system include: placement with foster families trained in dynamics of sex trafficking, trauma, and runaway behaviors; safety planning including risk assessments and providing resource information about drop in centers and healthcare; revising hotlining procedures for concerned parents; and increasing minors' access to trauma-informed residential care, therapeutic care, and substance use treatment by legislatively expanding healthcare coverage under Safe Harbor laws.

Taking "the boss" into the real world: Field interrater reliability of the Short-Term Assessment of Risk and Treatability: Adolescent Version

There is emerging evidence that the performance of risk assessment instruments is weaker when used for clinical decision-making than for research purposes. For instance, research has found lower agreement between evaluators when the risk assessments are conducted during routine practice. We examined the field interrater reliability of the Short-Term Assessment of Risk and Treatability: Adolescent Version (START:AV). Clinicians in a Dutch secure youth care facility completed START:AV assessments as part of the treatment routine. Consistent with previous literature, interrater reliability of the items and total scores was lower than previously reported in non-field studies. Nevertheless, moderate to good interrater reliability was found for final risk judgments on most adverse outcomes. Field studies provide insights into the actual performance of structured risk assessment in real-world settings, exposing factors that affect reliability. This information is relevant for those who wish to implement structured risk assessment with a level of reliability that is defensible considering the high stakes.

Principles and practices of risk assessment in mental health jail diversion programs

Eligibility criteria for participation in mental health jail diversion programs often specify that, to be diverted, a candidate must not pose a level of threat to public safety that cannot be managed in the community. Risk assessment tools were developed to increase consistency and accuracy in estimates of threat to public safety. Consequently, risk assessment tools are being used in many jurisdictions to inform decisions regarding an individual's appropriateness and eligibility for mental health jail diversion and the strategies that may be successful in mitigating risk in this context. However, their use is not without controversy. Questions have been raised regarding the validity and equity of their estimates, as well as the impact of their use on criminal justice outcomes. The purpose of this review is to provide an overview of the science and practice of risk assessment to inform decisions and case planning in the context of mental health jail diversion programs. Our specific aims include: (1) to describe the process and components of risk assessment, including differentiating between different approaches to risk assessment, and (2) to consider the use of risk assessment tools in mental health jail diversion programs. We anchor this review in relevant theory and extant research, noting current controversies or debates and areas for future research. Overall, there is strong theoretical justification and empirical evidence from other criminal justice contexts; however, the body of research on the use of risk assessment tools in mental health jail diversion programs, although promising, is relatively nascent.