Performance of Protective Factors Assessment in Risk Prediction for Adults: Systematic Review and Meta-Analysis

Assessing Protective Factors for Adolescent Offending: A Conceptually Informed Examination of the SAVRY and YLS/CMI

Although the Structured Assessment of Violence Risk in Youth (SAVRY) and the Youth Level of Service/Case Management Inventory (YLS/CMI) are among the most widely used adolescent risk assessment tools, they conceptualize and measure strengths differently. As such, in this study, we compared the predictive validity of SAVRY Protective Total and YLS/CMI Strength Total, and tested conceptual models of how these measures operate (i.e., risk vs. protective effects, direct vs. buffering effects, causal models). Research assistants conducted 624 risk assessments with 156 youth on probation. They rated protective factors at baseline, and again at 3-, 6-, 9-, and 12-month follow-up periods. The SAVRY Protective Total and YLS/CMI Strength Total inversely predicted any charges in the subsequent 2 years (area under the curve scores = 0.61 and 0.60, respectively, p < .05). Furthermore, when adolescents’ protective total scores increased, their self-reported violence decreased, thus providing evidence that these factors might play a causally relevant role in reducing violence. However, protective factors did not provide incremental validity over risk factors. In addition, because these measures are brief and use a dichotomous rating system, they primarily captured deficits in protective factors (i.e., low scores). This suggests a need for more comprehensive measures.

European Psychiatric Association (EPA) guidance on forensic psychiatry: Evidence based assessment and treatment of mentally disordered offenders

Forensic psychiatry in Europe is a specialty primarily concerned with individuals who have either offended or present a risk of doing so, and who also suffer from a psychiatric condition. These mentally disordered offenders (MDOs) are often cared for in secure psychiatric environments or prisons. In this guidance paper we first present an overview of the field of forensic psychiatry from a European perspective. We then present a review of the literature summarising the evidence on the assessment and treatment of MDOs under the following headings: The forensic psychiatrist as expert witness, risk, treatment settings for mentally disordered offenders, and what works for MDOs. We undertook a rapid review of the literature with search terms related to: forensic psychiatry, review articles, randomised controlled trials and best practice. We searched the Medline, Embase, PsycINFO, and Cochrane library databases from 2000 onwards for adult groups only. We scrutinised publications for additional relevant literature, and searched the websites of relevant professional organisations for policies, statements or guidance of interest. We present the findings of the scientific literature as well as recommendations for best practice drawing additionally from the guidance documents identified. We found that the evidence base for forensic-psychiatric practice is weak though there is some evidence to suggest that psychiatric care produces better outcomes than criminal justice detention only. Practitioners need to follow general psychiatric guidance as well as that for offenders, adapted for the complex needs of this patient group, paying particular attention to long-term detention and ethical issues.

Predictive validity of the Short-Term Assessment of Risk and Treatability (START) for multiple adverse outcomes: The effect of diagnosis

The Short-Term Assessment of Risk and Treatability (START) assists risk assessment for seven risk outcomes based on scoring of risk and protective factors and assignment of clinically-informed risk levels. Its predictive validity for violence and self-harm has been established in males with schizophrenia, but accuracy across pathologically diverse samples is unknown. Routine START assessments and 3-month risk outcome data of N = 527 adult, inpatients in a UK secure mental health facility were collected. The sample was divided into diagnostic groups; predictive validity was established using receiver operating characteristics regression (rocreg) analysis in which potential covariates were controlled. In most single-diagnosis groups START risk factors ('vulnerabilities'), protective factors ('strengths'), and clinically-informed estimates predicted multiple risk outcomes with effect sizes similar to previous research. Self-harm was not predicted among patients with an organic diagnosis. The START risk estimates predicted physical aggression in all diagnostic groups, and verbal aggression, self-harm and self-neglect in most diagnostic groups. The START can assist assessment of aggressive, self-harm, and self-neglect across a range of diagnostic groups. Further research with larger sample sizes of those with multiple diagnoses is required.