Dynamic Risk Factors Research Articles

@myTabu—A Placebo Controlled Randomized Trial of a Guided Web-Based Intervention for Individuals Who Sexually Abused Children and Individuals Who Consumed Child Sexual Exploitation Material: A Clinical Study Protocol

Background: There is a high demand for evidence-based and cost-effective treatment concepts for convicted individuals who sexually abused children (ISAC) and individuals who consumed child sexual exploitation material (ICCSEM) under community supervision (CS). The @myTabu-consortium developed a guided web-based intervention for convicted ISAC and ICCSEM under CS consisting of six online modules targeting psychological meaningful risk factors. The study aims to evaluate the effectiveness of this guided web-based intervention in reducing dynamic risk factors and the risk to re-offend compared to a placebo condition. Furthermore, these dynamic risk factors are measured before and after every module to evaluate their individual effectiveness to reduce the respective risk factor as well as risk to re-offend. This clinical trial protocol describes the planned methods as well as the intervention concept.Methods: The methodological design is a placebo controlled randomized add-on trial (N = 582) with follow-ups at 8 points in time. The placebo condition controls for attention and expectation effects and comprises the same amount of modules with a comparable temporal effort as the experimental intervention. The trial is conducted as an add-on to community supervision as usually done. Primary outcomes are dynamic risk factors assessed by self-report risk assessment tools and officially recorded re-offenses.Discussion: To the best of our knowledge, the study is the first to compare the (cost-) effectiveness of a guided web-based intervention for convicted ISAC and ICCSEM under community supervision against a placebo condition. Methodological limitations (e.g., potential ceiling- or volunteers-effects) are discussed.Clinical Trial Registration: German Clinical Trial Register (DRKS 00021256). Prospectively registered: 24.04.2020.

The Cultural Agency-Model of Criminal Behavior

When it comes to the understanding and investigation of criminal behavior, the role of culture is often overlooked. Despite the fact that populations of individuals who offend are culturally diverse, theories, risk assessment procedures, and intervention methods in forensic psychology have been developed based on research with predominantly white, male, and Euro-American populations. In this paper we outline a preliminary model depicting hypothesized psychological processes that underpin criminal behavior, which can be applied within various cultural contexts: a perspective based on the construct of agency and its social and cultural underpinnings. The Cultural Agency-Model of Criminal Behavior (CAMCB) depicts the general processes underpinning human beings' goal-directed behavior and is intended to explain why there are variations in the relationship between dynamic risk factors and behavior across cultural contexts. In describing the model, we use a number of examples to illustrate the relationship between culture and offending related factors at the different phases of the offending action sequence. Following the depiction of the CAMCB, we discuss its research and practice implications.

Real-time road transportation safety risk evaluation model based on data-mining

Aiming at the shortcoming of the massive amount of manual work required and the result relay on the cognitive level of experts the process cannot be implemented dynamically. A real-time road transportation safety risk evaluation model based on data-mining is proposed in this paper. Firstly, the pre-processing of unstructured text contains process of adding custom item dictionary, deletion of stop words, word segmentation of text at the beginning process, then dynamic risk factors identification using TF-IDF on processed text. Secondly, accident chains extraction by cue words and causal sentence structure construction. Thirdly, the relevance mining among risk factors or accident states through Apriori-algorithm. Finally, real-time risk assessment is realised by classification of the product of obtained probability and severity degree result using K-means. Experiments are conducted on text data set, and the result shows that the accuracy of proposed model is 88%, which is an effective safety risk evaluation model.

Dynamic psychosocial risk and protective factors associated with mental health in Emergency Medical Service (EMS) personnel

BackgroundEMS personnel have a heightened risk of developing posttraumatic stress disorder (PTSD) and major depression relative to other occupational populations necessitating a greater understanding of the risk and protective factors that operate each day in relation to this risk. This study examined dynamic psychosocial factors and their relationship with daily mental health symptoms among EMS workers. The psychosocial factors examined consisted of occupational stressors, sleep disturbance, social conflict, meaning made from the day's challenges, recovery activities, social support, and perceived prosocial impact. MethodSeventy-nine EMS workers recruited from an emergency medical service provider in Central New York completed a daily assessment for 8 days asking questions about occupational stressors encountered, sleep efficiency, social conflicts, meaning made from the day's challenges, recovery activities engaged in, social support received, and perceived prosocial impact. ResultsDaily occupational stressors were associated with elevated daily PTSD symptom severity (b = 0.13, SE = 0.06, p = .023). Social conflicts were associated with greater depression symptom severity (b = 0.75, SE = 0.14, p < .001); the meaning made from day's stressors (b = -0.17, SE = 0.05, p = .002) and the recovery activities engaged in (b = -0.30, SE = 0.07, p < .001) were associated with lower daily depression symptom severity. LimitationsA relatively modest sample size and small sampling window may constrain the generalizations made from this study. ConclusionsOccupational stressors and social conflicts are key risk factors related to the daily expression of PTSD and depression symptom severity in EMS workers. The meaning made from the day's challenges and the recovery activities engaged in may protect against depression. These results reveal several dynamic psychosocial factors that aid in understanding features of the work day that contribute to the mental health burden observed among EMS personnel.

Gender and Community Supervision: Examining Differences in Violations, Sanctions, and Recidivism Outcomes

While correctional scholarship emphasizes the importance of addressing dynamic risk factors in changing behavior, a debate continues on the role of gendered effects relating to such factors and supervision strategies. This study advances the debate and approach to violators by examining factors that reduce recidivism among technical violators. Using a large purposive sample of people on supervision, this study assesses differences between men and women in violating behavior, the sanctions used, and subsequent responses. To isolate effects of gender, we employ propensity score modeling coupled with a doubly robust design. Findings suggest that while some gendered differences exist, effect sizes are generally small and suggest responses to violators may be best focused on dynamic factors generally, rather than gender specific.

Does Reassessment Improve Prediction? A Prospective Study of the Sexual Offender Treatment Intervention and Progress Scale (SOTIPS)

This prospective study examined the predictive validity of the Sex Offender Treatment Intervention and Progress Scale (SOTIPS; McGrath et al., 2012), a sexual recidivism risk/need tool designed to identify dynamic (changeable) risk factors relevant to supervision and treatment. The SOTIPS risk tool was scored by probation officers at two sites (n = 565) for three time points: near the start of community supervision, at 6 months, and then at 12 months. Given that conventions for analyzing dynamic prediction studies have yet to be established, one of the goals of the current paper was to demonstrate promising statistical approaches for the analysis of longitudinal studies in corrections. In most analyses, static SOTIPS scores predicted all types of recidivism (sexual, violent, and general [any]). Dynamic SOTIPS scores, however, only improved the prediction of general recidivism, and only when the analyses with the greatest statistical power were used (Cox regression with time dependent covariates).

Factors associated with homelessness referrals for an acute young adult psychiatric unit.

Homelessness is correlated with significant mental illness. Homelessness is a key psychosocial issue leading to significant use of hospital resources outside medical intervention. This study examines the characteristics, post-discharge pathway and length of stay of individuals presenting with homelessness in an acute young adult psychiatric ward. Prospective chart audit was conducted to assess the demographic information, acute presentation, clinical risk and length of stay for homelessness referrals to Social Work. Participants (N = 88) were aged 18 to 25 years old and admitted to a tertiary level psychiatric ward specifically for this age group. Acute risk presentations of all psychiatric conditions, such as Schizophrenia, Emotionally Unstable Personality Disorder, Bipolar Affective Disorder, Drug Induced Psychosis and Anorexia Nervosa, may be admitted to the unit. Descriptive statistics, one sample t-tests and Pearson's correlations were completed. No homeless patient was accommodated by local area services due to lack of availability. Change in homelessness status tended to worsen during hospitalisation, with 24% having worse accommodation upon discharge compared to 13% who improved. Length of stay was significantly longer for homeless patients compared to non-homeless patients, but not when excluding the length of time spent attempting to address homeless risk. Homeless patients presenting with an eating disorder acute presentation spent longer time in hospital, and those with psychotic acute presentations had more dynamic risk factors. Length of stay and static risk factors were positively correlated with government mental health community follow-up. Hospitalisation is not an effective intervention for homelessness and the Gold Coast Mental Health units are not resourced or linked to provide accommodation outcomes in a positive or economic manner. Future consideration should be given to health and community resources around homelessness, including health-specific housing interventions and community mental health teams incorporating homelessness risk vulnerability into their ongoing clinical risk mitigation.

Correlates of school gun carrying among black, hispanic, and white male adolescents: Evidence from a nationally representative sample of youth

Previous studies have found that individual, environmental, geographic, and demographic factors correlate with adolescent gun carrying. Comparatively less research has focused on identifying correlates of adolescent gun carrying to schools. The current study examined whether previously identified factors associated with adolescent gun carrying similarly predict adolescent school gun carrying. Logistic regression models were used to predict risk of school gun carrying among a nationally representative sample of adolescent males (n = 4559). Results revealed that a range of individual- and environmental-level factors increased the odds of school gun carrying, including a 13% increased likelihood of carrying a gun to school among individuals with more symptoms of anxiety and depression. Additionally, analyses indicated that several individual- and environmental-level factors differentially increase the likelihood of school gun carrying across race and ethnicity. Policies aimed at reducing gun carrying in schools should address both the known correlates of adolescent school gun carrying broadly and the specific correlates of gun carrying as they vary across particular groups of youth. Future research should attempt to replicate these and other studies findings across diverse samples of adolescents and identify other potential correlates of adolescent school gun carrying not previously addressed. Public significance statementMental health, school-level, and geographic factors are associated with school guncarrying differentially across race and ethnicity. Programming efforts may benefit fromconsidering the influence of race/ethnicity on dynamic risk factors for school guncarrying when designing and implementing school safety measures.

Are Psychological Treatments for Adults With Histories of Violent Offending Associated With Change in Dynamic Risk Factors? A Meta-Analysis of Intermediate Treatment Outcomes

This meta-analysis examined whether psychological treatments delivered to adults with histories of violent offending in correctional and forensic mental health settings were related to change in dynamic risk factors. Twenty-two controlled studies (86% comprised male samples) were identified via a comprehensive search. Treatments had a significant effect overall, with small to moderate improvements in trait anger, social problem solving, impulsivity, and general social skill. The treatment effect for antisocial cognitions was nonsignificant. There were a small number of significant moderators, which provide preliminary indications of treatment features that may promote greater change. However, small sample sizes and difficulties disentangling moderating effects preclude drawing firm conclusions. While these results are useful and promising, the field remains limited by few high-quality outcome studies, disparate outcome/measure selection, inconsistent/incomplete reporting of evaluations, and limited information about whether change in dynamic risk factors predicts reductions in recidivism. Suggestions for advancing the field are provided.

Developing a personalized outcome prediction tool for knee arthroplasty.

The purpose of this study was to develop a personalized outcome prediction tool, to be used with knee arthroplasty patients, that predicts outcomes (lengths of stay (LOS), 90 day readmission, and one-year patient-reported outcome measures (PROMs) on an individual basis and allows for dynamic modifiable risk factors. Data were prospectively collected on all patients who underwent total or unicompartmental knee arthroplasty at a between July 2015 and June 2018. Cohort 1 (n = 5,958) was utilized to develop models for LOS and 90 day readmission. Cohort 2 (n = 2,391, surgery date 2015 to 2017) was utilized to develop models for one-year improvements in Knee Injury and Osteoarthritis Outcome Score (KOOS) pain score, KOOS function score, and KOOS quality of life (QOL) score. Model accuracies within the imputed data set were assessed through cross-validation with root mean square errors (RMSEs) and mean absolute errors (MAEs) for the LOS and PROMs models, and the index of prediction accuracy (IPA), and area under the curve (AUC) for the readmission models. Model accuracies in new patient data sets were assessed with AUC. Within the imputed datasets, the LOS (RMSE 1.161) and PROMs models (RMSE 15.775, 11.056, 21.680 for KOOS pain, function, and QOL, respectively) demonstrated good accuracy. For all models, the accuracy of predicting outcomes in a new set of patients were consistent with the cross-validation accuracy overall. Upon validation with a new patient dataset, the LOS and readmission models demonstrated high accuracy (71.5% and 65.0%, respectively). Similarly, the one-year PROMs improvement models demonstrated high accuracy in predicting ten-point improvements in KOOS pain (72.1%), function (72.9%), and QOL (70.8%) scores. The data-driven models developed in this study offer scalable predictive tools that can accurately estimate the likelihood of improved pain, function, and quality of life one year after knee arthroplasty as well as LOS and 90 day readmission. Cite this article: Bone Joint J 2020;102-B(9):1183-1193.

Dynamic Risk Factors for Handgun Carrying: Are There Developmental or Sex Differences?

ABSTRACT Objective: This study examines the effects of dynamic risk factors on handgun carrying from adolescence into young adulthood. Method: A nationally representative sample of 8,679 individuals (ages 12–26; 51.1% male; 58% White, 26.8% African American; 21.2% Hispanic ethnicity) from the National Longitudinal Survey of Youth (1997 cohort) interviewed at least three times across nine annual waves is used to estimate effects on handgun carrying. Key predictors include gang membership, selling and using drugs, violent crime, and arrest. Using mixed effects models, we focus on within-individual effects across three timeframes from ages 12 to 26: 1) predictors and handgun carrying measured concurrently, 2) predictors measured across one year and handgun carrying measured in the final month of the same year, and 3) predictors measured in the wave before handgun carrying. We also contrast estimates by sex and age. Results: All theoretically relevant predictors statistically significantly predict handgun carrying across the first two timeframes. However, none are statistically significant predictors of handgun carrying in the following year. Few significant sex and age differences emerge. Conclusions: Handgun carrying is an ephemeral behavior particularly during adolescence. The predictors of handgun carrying, which are grounded in gangs, drug use/sale, and crime involvement, appear to have short-term impacts that are consistent across age as well as across sex. Consequently, future work should focus on shorter-term changes in models and there is no evidence that intervention efforts must take fundamentally different approaches to reduce handgun use among males versus females or adolescents versus adults.

Hemodynamic changes between different anatomically designed stents after carotid stenting: a prospective multicenter study

The aim of this study was to investigate differences in the dynamic changes and risk factors of hemodynamic depression (HD) between straight and tapered carotid stenting (SCS and TCS, respectively). A total of 148 and 167 patients were included in TCS and SCS groups in this study, respectively. All clinical data were collected and analyzed for differences in HD and primary endpoint events at 12months. The SCS procedure had a lower predilation rate and a higher incidence of intra- and postprocedure HD; furthermore, the decline in heart rate in the SCS procedure was higher in patients with intra- and postprocedure HD (P < 0.05). Right stenosis [odds ratio (OR) 1.67] and stent type (ev3) (OR 2.31) were confirmed as risk factors, and older age (> 70years) was accompanied by a lower risk (OR 0.58; P < 0.05). The SCS procedure had a higher incidence of bradycardia and hypotension after 24h and a longer duration of hypotension (P < 0.05). Stenosis (> 80%) (OR 1.68), the SCS procedure (OR 1.72), and alcohol intake (OR 2.38) were defined as risk factors. There was no difference in the complications or clinical endpoint events in either procedure, and the restenosis rate was lower in the TCS procedure (1.35% vs 5.42%). Our results reveal that TCS has a lower incidence of HD and that intra- and postprocedure HD have different manifestations and risk factors.

Risk-Need-Responsivity (RNR) classification models: Still evolving

The RNR (Risk-Need-Responsivity) Framework identifies principles to facilitate assigning individuals to appropriate programs by triaging program placement based on static and dynamic risk factors that influence offending behavior (dynamic risk factors) through programming. This well-accepted framework has resulted in justice agencies adopting risk and need assessment (RNA) tools, but the tools themselves present barriers to a classification system. RNA tools suffer from methodological weaknesses that affect the valuation of the information gleaned from the tool. Six classification schemes are based on the RNR principles, and they vary on consistency with the small body of empirical studies conducted to identify statistically-based risk-need profiles. Furthermore, the models are weakly coupled with the criteria for good classification systems. The question that emerges is whether there is a theoretically sound classification system or if the field would be better off creating levels of care scaffolding based on the risk-need profile clusters. Addressing the methodological issues associated with the RNA tools will remove stumbling blocks to a meaningful classification system.

Forensic prevention outpatient clinic: a treatment evaluation study

ABSTRACT In forensic psychiatry, secondary prevention implies avoiding offences in individuals who are at high risk but have not committed serious offenses in the past. For this purpose, the forensic prevention outpatient clinic at the Ansbach District Hospital was established to provide risk assessment and treatment. To test the treatment effect of the forensic prevention outpatient clinic in terms of dynamic risk factors and global level of functioning, an observational study with a prospective longitudinal design (up to two years) was conducted, which included treatment (n = 70) and control (n = 52) groups. After Holm-Bonferroni correction, the treatment interaction effect (time × group) was significant for one of the three dependent variables (i.e., the Historical Clinical Risk Management-20 [HCR-20] Clinical and Risk as well as the Global Assessment of Functioning’s [GAF] subtotals). The dynamic risk operationalized by the R-scale of the HCR-20 decreased at a significantly higher rate across time in the treatment than in the control group. However, this effect was not robust against propensity score matching. The findings highlight the potential of secondary prevention for individuals who are at a high risk of committing serious offenses. Replications in larger samples are needed, ideally in randomized controlled trials.

Denial in Sex Offending Treatment: Examining Criminal Career Diversity

ABSTRACT Sex offenders commonly exhibit some degree of denial of their offending. Past research has shown that denial conflicts with treatment completion, but does not necessarily increase sexual reoffending risk. This study explores whether the impact of denial upon the treatment of sex offenders is unequivocal or influenced by other factors, such as criminal career variables and dynamic risk. Thirty-five convicted male sex offenders in Italy were assessed for criminal career characteristics (e.g., heterogeneous versus specialized offending), for the nature of denial, and for dynamic risk factors. Interventions for sex offenders may be more effective if they are designed to differentiate between heterogeneous offenders who are difficult to engage in treatment, and specialized sex offenders who are more likely to engage in and complete treatment, regardless of their level of denial. Heterogeneous and specialized sex offenders pose different risks and these differences need to be taken into account in treatment.

Reassessment improves prediction of criminal recidivism: A prospective study of 3,421 individuals in New Zealand.

A dynamic risk factor is a variable that can change across time, and as it changes, there is a corresponding change in the likelihood of the outcome. In corrections, there is evidence for dynamic risk factors when relatively more proximal reassessments enhance predictive validity for recidivism. In this article, we tested the proximity hypothesis with longitudinal, multiple-reassessment data gathered from 3,421 individuals supervised on parole in New Zealand (N = 68,667 assessments of theoretically dynamic risk factors conducted by corrections case managers). In this sample, reassessments consistently improved prediction as demonstrated by (1) incremental prediction over initial baseline scores and (2) improved model fit of the most recent assessment compared with the average of earlier scores. These results contribute to a growing body of evidence that support community corrections agencies conducting repeated assessments of the risk for imminent recidivism using a dynamic risk instrument. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Dynamic risk factors amongst Parolees: Perspective of Parole staffs

Setiap banduan yang dikenakan hukuman pemenjaraan di atas kesalahan jenayah yang dilakukan akan kembali kepada masyarakat kecuali bagi pesalah hukuman mati. Proses integrasi semula ke dalam masyarakat umum bukanlah suatu proses yang mudah. Terdapat pelbagai cabaran yang perlu dihadapi oleh bekas banduan. Sekiranya mereka gagal dalam proses tersebut, kemungkinan bekas banduan akan terlibat semula dalam tingkah laku jenayah atau residivisme. Perkara ini menimbulkan kebimbangan terutamanya kepada agensi yang terlibat secara langsung dalam rehabilitasi banduan dan Orang DiParol (ODP). Pelaksanaan sistem parol di Malaysia pada tahun 2008 adalah antara usaha pihak kerajaan khususnya Jabatan Penjara dalam membantu ODP berjaya dalam proses integrasi semula. Kakitangan parol merupakan individu yang paling hampir dengan ODP dan bekas banduan selain keluarga. Oleh itu, kajian ini dilakukan untuk meneroka pandangan kakitangan parol tentang faktor risiko dinamik residivisme yang dihadapi oleh klien mereka. Kajian kualitatif ini melibatkan temu bual secara mendalam dengan 13 kakitangan parol Jabatan Penjara Malaysia. Hasil kajian mendapati bahawa terdapat empat faktor risiko dinamik residivisme yang perlu diberi perhatian iaitu kegagalan mendapatkan pekerjaan, stigma dan sikap masyarakat yang ragu-ragu serta tertutup terhadap bekas banduan, faktor diri sendiri dan kesediaan untuk berubah, serta penolakan keluarga. Hasil kajian ini adalah signifikan terutamanya kepada agensi kerajaan yang terlibat secara langsung dalam sistem keadilan jenayah, ahli akademik, pengamal bantuan seperti pekerja sosial, kaunselor dan pegawai psikologi penjara serta Badan Bukan Kerajaan.

Referral for group or individual treatment? Factors for consideration in the case of self-referred individuals with a sexual interest in minors.

In Germany, several treatment programs offer psychotherapy for individuals with a sexual interest in minors (SIM) who are currently not in contact with the criminal justice system. The patients present anonymously in relation to the health insurance and judicial system. Group therapy plays an important role in these programs. However, to date there is poor empirical evidence on indication criteria for group vs. individual treatment for this specific group of individuals. This study examined individuals with SIM who voluntarily participated in a treatment program in Hamburg. We investigated via post-hoc analysis whether there were significant differences regarding readiness to participate in group therapy, dynamic risk factors, psychopathic characteristics, impulsivity and empathy between individuals indicated for group therapy (n = 26) and individuals referred for individual therapy (n = 47). Results show that individuals referred for individual therapy were significantly more impulsive than individuals referred for group therapy, but comparable in respect to readiness to participate in group therapy, dynamic risk, psychopathy, and empathy. These findings suggest that assignment to group vs. individual therapy is mainly based on other criteria than these characteristics. Implications for clinical practice and future research are discussed.

The contribution of dynamic risk factors in predicting aggression: A systematic review including inpatient forensic and non-forensic mental health services

Aggression in inpatient mental health services is more likely when dynamic risk factors escalate, but there has been no systematic review of individual factors and their relevance in different inpatient settings. This systematic review identifies: i) which dynamic risk factors are associated with inpatient aggression, ii) their temporal relationship with aggression, iii) their overlap with aggression outcomes, and iv) differences between forensic and non-forensic mental health services. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, six databases were searched in November 2019. Twenty-five primary studies were included, reporting 74 statistically significant dynamic risk factors. Thirty-five percent were significantly associated with aggression in at least two studies, and 94% with more than one aggressive outcome. Statistically significant risk factors overlapped greatly between forensic and non-forensic services (82%), and included individual cognitive, affective, behavioural, and situational factors which may be amenable to rehabilitative support. Studies were evaluated for methodological rigour, with few studies in non-forensic services of high methodological quality. Future research should include assess risk factors closer in-time to aggressive outcomes, employ prospective designs, and incorporate service users' perspectives.

The Application of Network Analysis to Dynamic Risk Factors in Adult Male Sex Offenders

Although dynamic risk factors are considered important in the assessment and treatment of adult male sex offenders, little is known about their interrelationships. We apply network analysis to assess their associations and to provide an analysis of their shortest pathways to sexual and violent (including sexual contact) recidivism. Analyses revealed a central position for general rejection/loneliness (in all networks), poor cognitive problem solving (in networks containing sexual or violent—including sexual contact—recidivism), and impulsive acts (only in the network including sexual recidivism). These variables represented links between clusters of dynamic risk factors composed of factors relating to sexual self-regulation, emotionally intimate relationships, antisocial traits, and self-management. Impulsive acts showed the strongest independent association with sexual and violent (including sexual contact) recidivism.