Sexual Risk Assessment Research Articles

Crime Scene Behaviors Indicate Risk-Relevant Propensities of Child Molesters

The current study used crime scene analysis (CSA) to identify the psychological characteristics of child molesters and examined the contribution of these behavioral themes for sexual offender risk assessment. CSA was conducted on a sample of 424 cases of child sexual abuse in Berlin (Germany) using non-metric Multi-Dimensional Scaling. The analysis revealed the behavioral themes of fixation, regression (sexualization), criminality, and (sexualized) aggression, consistent with previous theories and empirical research in child molestation. The construct validity of the four themes was demonstrated through correlational analyses with known sexual offending measures, ratings of offender motivation, and criminal histories. The themes of fixation and (sexualized) aggression were significant predictors of sexual recidivism and added incrementally to the Static-99 for the prediction of sexual recidivism. The results indicate that crime scene information can inform the assessment of child molesters’ risk-relevant propensities and improve the prediction of sexual recidivism.

Development and Validation of the Juvenile Sexual Offense Recidivism Risk Assessment Tool–II

This article describes the development and initial validation of the Juvenile Sexual Offense Recidivism Risk Assessment Tool-II (JSORRAT-II). Potential predictor variables were extracted from case file information for an exhaustive sample of 636 juveniles in Utah who sexually offended between 1990 and 1992. Simultaneous and hierarchical logistic regression analyses were used to identify the group of variables that was most predictive of subsequent juvenile sexual recidivism. A simple categorical scoring system was applied to these variables without meaningful loss of accuracy in the development sample for any sexual (area under the curve [AUC] = .89) and sexually violent (AUC = .89) juvenile recidivism. The JSORRAT-II was cross-validated on an exhaustive sample of 566 juveniles who had sexually offended in Utah in 1996 and 1997. Reliability of scoring the tool across five coders was quite high (intraclass correlation coefficient [ICC] = .96). Relative to the development sample, however, there was considerable shrinkage in the indices of predictive accuracy for any sexual (AUC = .65) and sexually violent (AUC = .65) juvenile recidivism. The reduced level of accuracy was not explained by severity of the index sexual offense, time at risk, or missing data. Capitalization on chance and other explanations for the possible reduction in predictive accuracy are explored, and potential uses and limitations of the tool are discussed.

Provider Barriers Prevent Recommended Sexually Transmitted Disease Screening of HIV-Infected Men Who Have Sex With Men

HIV-infected men who have sex with men (MSM) are at increased risk for transmitting and acquiring sexually transmitted diseases (STDs). Guidelines recommend at least annual screening of HIV-infected MSM for syphilis and for chlamydia and gonorrhea at exposed anatomical sites, to protect their health and their sexual partners' health. Despite these guidelines, STD screening has been suboptimal, with very low nongenital chlamydia and gonorrhea testing rates. Our objective was to better understand barriers encountered by HIV care providers in adhering to STD screening guidelines for HIV-infected MSM. We conducted 40 individual semistructured interviews with health care providers (physicians, midlevel providers, nurses, and health educators) of HIV-infected MSM at 8 large HIV clinics in 6 US cities. Providers were asked about their STD screening practices and barriers to conducting sexual risk assessments of their patients. Emerging themes were identified by qualitative data analysis. Although most health care providers reported routine syphilis screening, screening for chlamydia and gonorrhea at exposed anatomical sites was less frequent. Obstacles that prevented routine chlamydia and gonorrhea screening included time constraints, difficulty obtaining a sexual history, language and cultural barriers, and patient confidentiality concerns. Providers reported many obstacles to routine chlamydia and gonorrhea screening. Interventions are needed to help to mitigate barriers to STD screening, such as structural and patient-directed health services models that might facilitate increased testing coverage of these important preventive services.

Оценка когнитивных искажений в сфере сексуальности у лиц, совершивших половые преступления против несовершеннолетних

We provide a definition of the concept of "cognitive distortions in the sexual sphere," reveal the relevance of the study of these distortions in the context of sexual offenses against minors. We briefly review the literature of research on the subject. We describe a research, the aim of which was to study a group of individuals who have committed sexual crimes against minors: how homogeneous is the sample in terms of the severity of the distortion. The group was divided into two subgroups: those who have been diagnosed with pedophilia, and those without pedophilia. The norm group also included persons who has never been prosecuted. To assess cognitive distortions in the sexual sphere we used SONAR method (The Sex Offender Need Assessment Rating). The obtained results confirm the importance of the factor of cognitive biases in the field of sexuality in the assessment of sexual crimes risk, as well as in the differential diagnosis of pedophilia.

EPA-1468 – Is hypersexuality a clinical reality

Hypersexuality can be defined as an uncontrollable sexual behaviour that causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. These out-of-control sexual behaviours can be described as compulsive, impulsive, or addictive. Some authors argue that it serves to anesthetize feeling of pain, inadequacy, low self-esteem, social and personal phobias, isolation, and loneliness. Hypersexuality is conceptualized as primarily a nonparaphilic sexual desire disorder, but paraphilic sexual fantasies, arousal, urges, and behaviours can co-occur. In the literature there is little evidence about a correlation between hypersexuality and sexual aggression. Even in a common risk assessment instrument, such as the SVR-20 (Sexual Violence Risk-20) manual, hypersexuality is not included as a risk factor for the assessment of sexual violence risk. However, the SAPROF (Structured Assessment of PROtective Factors for violence risk) manual has ‘a well developed self-control’ item as a protective factor against violence. It is obvious that people suffering from hypersexuality have developed no or poor self-control. Internalizing comorbid disorders are common in hypersexuality, but also externalizing comorbid disorders do occur. In this paper, scientific evidence for the relationship between hypersexuality and sexual aggression will be reviewed. Next, clinical vignettes and data from a Belgian sex offender population (at the University Forensic Centre, Antwerp University Hospital) will be presented. And finally, the importance of this topic for caregivers in general and forensic psychiatry will be discussed.

The development of the Crime Scene Behavior Risk measure for sexual offense recidivism.

The inclusion of crime scene behavior in actuarial risk assessment so far is insufficient, unsystematic, and neglecting factors theoretically relevant to sexual recidivism. Therefore, the goal of the current study was to develop a brief actuarial risk scale based on crime scene characteristics. The development sample consisted of data (police databases, paper records, and the National Conviction Registry) from 955 male sexual offenders (77% German citizens, 20% foreign nationals, mean age = 35 years, convicted for sexual abuse and/or sexual violence). Further, the independent cross-validation-sample consisted of data from 77 sexual offenders. The 7 items that are comprised by the Crime Scene Behavior Risk (CBR) measure showed high predictive accuracy for sexual recidivism with little variation between the development (c index = .72) and the replication sample (c index = .74). Further, the CBR was found to provide significant incremental validity and improve the predictive accuracy of the Static-99R risk assessment tool. Given the predictive and incremental validity of the CBR it is suggested that sexual offender risk assessment can be improved by utilizing crime scene behavior. The CBR is currently being used in addition to the Static-99R by the State Office of Criminal Investigations in Berlin to prioritize released sexual offenders for police supervision.

Incorporating Change Information Into Sexual Offender Risk Assessments Using the Violence Risk Scale–Sexual Offender Version

We examined the use of risk-change information in sexual offender risk assessments featuring the Violence Risk Scale-Sexual Offender version (VRS-SO), a sex offender risk assessment and treatment planning tool. The study featured a combined international sample of 539 sex offenders followed up an average of 15.5 years post-release. Pre- and posttreatment VRS-SO ratings were amalgamated from two treated samples of sex offenders from Canada and New Zealand. Analyses focused on examinations and applications of change data and its relationship to sexual and violent recidivism. VRS-SO change scores were significantly associated with decreases in these outcome criteria with, and without, controlling for indicators of pretreatment risk (e.g., Static-99R score) and individual differences in follow-up time. Applications of logistic regression using fixed 5-year follow-ups generated estimated rates of sexual and violent recidivism at different VRS-SO score thresholds. The use of logistic regression demonstrated a clinically useful and systematic means of combining risk and change information into posttreatment risk appraisals. Implications for the use of change information in the assessment and management of sexual offender risk are discussed.

Predictive validity of adult risk assessment tools with juveniles who offended sexually.

An often-held assumption in the area of sexual recidivism risk assessment is that different tools should be used for adults and juveniles. This assumption is driven either by the observation that adolescents tend to be in a constant state of flux in the areas of development, education, and social structure or by the fact that the judicial system recognizes that juveniles and adults are different. Though the assumption is plausible, it is largely untested. The present study addressed this issue by scoring 2 adult sexual offender risk assessment tools, the Minnesota Sex Offender Screening Tool-Revised and the Static-99, on an exhaustive sample (N = 636) of juveniles who had sexually offended (JSOs) in Utah. For comparison, 2 tools designed for JSOs were also scored: the Juvenile-Sex Offender Assessment Protocol-II and the Juvenile Risk Assessment Scale. Recidivism data were collected for 2 time periods: before age 18 (sexual, violent, any recidivism) and from age 18 to the year 2004 (sexual). The adult actuarial risk assessment tools predicted all types of juvenile recidivism significantly and at approximately the same level of accuracy as juvenile-specific tools. However, the accuracy of longer term predictions of adult sexual recidivism across all 4 tools was substantially lower than the accuracy achieved in predicting juvenile sexual recidivism, with 2 of the tools producing nonsignificant results, documenting the greater difficulty in making longer term predictions on the basis of adolescent behavior.

“There's an app for that”: an innovative tablet-based sexual risk assessment tool

Rectal and pharyngeal sexually transmitted diseases are more common, and more likely to be asymptomatic, than urethral infections in men who have sex with men (MSM). CDC recommends routine screening for these infections in sexually active MSM; however, sexual risk assessment (SRA) is needed to assess which tests are indicated. To overcome provider barriers to performing routine SRA, self-administered SRA may be a viable option. Self-administered tablet-based risk assessments have been utilized with success in adolescent healthcare settings and piloted in the MSM community. To facilitate routine and accurate sexual risk assessment among HIV+ MSM men, California STD/HIV Prevention Training Center adapted a mobile app that functions as an interactive SRA tool and produces a report for the clinician recommending appropriate screening and counseling steps.

To what extent does civil commitment reduce sexual recidivism? Estimating the selective incapacitation effects in Minnesota

PurposeThis study examines the selective incapacitation effects of civil commitment on sexual reoffending among 105 Minnesota sex offenders who were civilly committed between 2004 and 2006. MethodsThe Minnesota Sex Offender Screening Tool-3, a sexual recidivism risk assessment instrument, was used to estimate what the four-year sexual recidivism rate would have been for these offenders had they been released to the community. Integration of Survival with Quality of Life (iSQoL) software was used to extrapolate the survival curves over a 50-year period to develop a lifetime sexual recidivism estimate. ResultsIf the 105 civilly committed sex offenders had been released to the community, an estimated nine percent would have been reconvicted of a new sex offense within four years. Civilly committing these offenders therefore likely reduced the overall four-year sexual recidivism rate by 12 percent. The results further suggest that if these offenders had been released to the community, an estimated 28 percent would be rearrested for another sex offense within their lifetime. ConclusionsTo better align the costs of civil commitment with its public safety benefits, states operating these programs should emphasize the use of intermediate alternatives in the community for a more positive return on investment.

Changing blood donor screening criteria from permanent deferral for men who have sex with men to individual sexual risk assessment: no evidence of a significant impact on the human immunodeficiency virus epidemic in Italy.

In 2001, the criteria for blood donor eligibility in Italy were modified by a ministerial decree from a permanent deferral for "men who have sex with men" to an individual risk assessment of sexual behaviours. The aim of this study was to evaluate the impact of this change in donor screening criteria on the human immunodeficiency virus epidemic among blood donors in Italy. We used the data obtained from the Italian blood donor epidemiological surveillance system. We compared data collected in 2009 and 2010, when the individual risk assessment policy was applied, with data collected in 1999 when permanent deferral was applied for men who have sex with men based on a declaration of sexual orientation. We evaluated the change over time in the relative proportion of HIV antibody-positive donors who likely acquired the infection from men who have sex with men vs heterosexual sexual exposure; the relative risk was calculated using 1999 as the reference year. In all 3 years, the majority of HIV antibody-positive donors reported sexual exposure as a risk factor for HIV infection; this proportion increased over time, although not statistically significantly. Heterosexuals always accounted for at least 40% of all HIV antibody-positive cases. The rate of HIV antibody-positive donors increased similarly in men who have sex with men and heterosexuals; specifically, the rate of HIV antibody-positive cases per 100,000 donors was more than 2-fold higher among men who have sex with men in 2009-2010 than in 1999 (2009-2010 vs 1999, RR =2.8; P =0.06), and that among heterosexuals was 1.5 fold higher (P =0.18). When comparing the period before (1999) and after (2009-2010), the implementation of the individual risk assessment policy in 2001, no significant increase in the proportion of men who have sex with men compared to heterosexuals was observed among HIV antibody-positive blood donors, suggesting that the change in donor deferral policy did not lead to a disproportionate increase of HIV-seropositive men who have sex with men.

Psychosocial risk factors for HIV sexual risk among Indian men who have sex with men

Indian men who have sex with men (MSM) are at increased risk for HIV compared to the general Indian population. Psychosocial factors may be uniquely associated with HIV risk among Indian MSM and may moderate the beneficial impact of standard HIV prevention approaches. Psychiatric diagnostic interviews and psychosocial and sexual risk assessments were conducted among 150 MSM in Mumbai, India. Logistic regression was employed to examine the association of psychiatric disorders and psychosocial problems to recent sexual risk behavior. Twenty-five percent of participants reported engaging in unprotected anal sex (UAS) during their last sexual contact with a man. Men who were married to a woman were more likely to have engaged in UAS during their last sexual contact with a man (35% vs. 17%, p=0.018). In multivariable models, significant predictors of engaging in UAS were current major depression (adjusted odds ratio [AOR]=2.61; 95% confidence interval [CI] 1.07, 6.39) and number of stressful life events (AOR=0.91; 95% CI 0.83, 0.99). Alcohol dependence, anxiety, and self-esteem were not associated with engaging in UAS. Indian MSM with depression are at higher odds of engaging in UAS compared to MSM without depression. HIV prevention programs for Indian MSM may benefit from incorporating treatment or triage for mental health problems.

Informal confidential voting interviewing in a sexual risk assessment of men who have sex with men (MSM) and transgenders (hijra) in Bangalore, India

ObjectiveThe accuracy of self-reporting sensitive sexual risk behaviours is highly susceptible to misreporting. Informal confidential voting interviews (ICVIs) may minimise social desirability bias by increasing the privacy of the interview...

The current status of static and dynamic factors in sexual offender risk assessment

PurposeThe aim of this paper is to provide up‐to‐date discussion of the types of factors used to assess sexual offenders risk.Design/methodology/approachThe current status of the factors used to assess risk in sexual offenders is examined.FindingsRisk factors broadly fall into two categories: static factors (i.e. generally unchangeable information such as previous offence history) from which a number of actuarial scales have been developed; and dynamic factors (i.e. psychological dispositions) that are typically identified in treatment. It is suggested that these risk factors are artefacts of the same behavioural and psychological vulnerabilities at different stages of assessment, with static factors acting as markers for underlying dispositions, while dynamic factors are the underlying dispositions.Practical implicationsThe paper discusses in some detail the status of age as a risk factor, where even though it is typically considered a static risk factor in a number of actuarial scales (allowance typically being made if individuals are over/under 25), there is a dynamic element (i.e. change with age or the passage of time) to this aspect of assessment.Originality/valueThis paper may be useful to practitioners working in the field, in terms of providing a useful heuristic framework for risk conceptualisation.

Sexual Risk Assessment Using Event History Calendars With Male and Female Adolescents

IntroductionThe purpose of this study was to explore male and female adolescents' perceptions of and differences in Event History Calendar (EHC) sexual risk assessment in a clinical setting. MethodThis study is a secondary analysis exploring male and female qualitative data from a mixed methods study of adolescent and provider communication. Participants included 30 sexually active 15- to 19-year-old male (n = 11) and female (n = 19) patients at a school-linked clinic. The adolescents completed a pre-clinic visit EHC and then discussed it with a nurse practitioner during their visit. The adolescents shared their perceptions of the EHCs in a post-clinic visit interview. ResultsConstant comparative analyses revealed gender differences in: (a) adolescents' perceptions of how EHCs helped report, reflect on, and discuss sexual risk histories; (b) how adolescents self-administered EHCs; and (c) the histories they reported. DiscussionThe EHC was well received by both male and female adolescents, resulting in a more complete sexual risk history disclosure. Self-administration of the EHC is recommended for all adolescents, but further sexual risk assessment by nurse practitioners who use EHCs is needed.

Sexual Violence Risk Assessment: An Investigation of the Interrater Reliability of Professional Judgments Made Using the Risk for Sexual Violence Protocol

The RSVP is a set of structured professional judgment guidelines for assessing risk of sexual violence. We investigated the interrater reliability (IRR) of judgments made using the RSVP in a multidisciplinary forensic-clinical context. Raters were 28 forensic mental health and intellectual disability professionals with diverse training and experience. They used the RSVP to evaluate six case vignettes that varied with respect to offense characteristics, clinical complexity, and level of risk. The IRR of ratings for individual risk factors was generally fair. There was a good level of interrater reliability on Summary Judgments and Supervision Recommendations. Interrater reliability was highest when used by professionals who were highly trained in forensic risk assessment. On average, professionals with lower levels of specialist training agreed less with their colleagues and experts, and provided higher estimations of sexual violence risk. Lower levels of agreement were found in cases with moderate levels of complexity and risk. The RSVP can be used to make judgments of risk with adequate levels of interrater reliability. However, this is dependent on the training and expertise of professionals who use the tool. Methodological strengths and limitations are considered, followed by a discussion of implications for training, practice, and future research.

Assessment of Accused Juvenile Sex Offenders in Germany: A Comparison of Five Different Measures

The present study examines the relationship between risk and protective factors among young alleged sexual offenders (N = 66) in pre-trial and pre-treatment settings. For risk assessment purposes, the Screening Tool for the Assessment of Young Sexual Offenders' Risk (STAYSOR), the Structured Assessment of Violence Risk in Youth (SAVRY), and the Structured Assessment of Protective Factors for violence risk (SAPROF) were used. Psychopathological indicators measured with the Basis Raads Onderzoek (BARO) and the German adaption of the Reynolds Adolescent Adjustment Screening Inventory (RAASI) were used to examine the relationship between the risk assessment scales and instruments measuring risk-relevant psychopathological constructs. Risk and protective factors were significantly negatively correlated. Psychopathological measures were positively correlated with risk factors and negatively with protective factors. Although further studies on the predictive validity of the instruments are needed, the results of the present explorative pilot study indicate that the use of all five instruments may be clinically meaningful for the assessment of young persons who are at risk of sexual offending.

Prediction of adolescent sexual reoffending: A meta-analysis of the J-SOAP-II, ERASOR, J-SORRAT-II, and Static-99.

Several risk assessment tools, including the Juvenile Sex Offender Assessment Protocol-II (Prentky & Righthand, 2003), the Estimate of Risk of Adolescent Sexual Offense Recidivism (Worling & Curwen, 2001), the Juvenile Sexual Offense Recidivism Risk Assessment Tool-II (Epperson, Ralston, Fowers, DeWitt, & Gore, 2006), and the Static-99 (Hanson & Thornton, 1999), have been used to assess reoffense risk among adolescents who have committed sexual offenses. Given that research on these tools has yielded somewhat mixed results, we empirically synthesized 33 published and unpublished studies involving 6,196 male adolescents who had committed a sexual offense. We conducted two separate meta-analyses, first with correlations and then with areas under the receiver operating characteristic curve (AUCs). Total scores on each of the tools significantly predicted sexual reoffending, with aggregated correlations ranging from .12 to .20 and aggregated AUC scores ranging from .64 to .67. However, in many cases heterogeneity across studies was moderate to high. There were no significant differences between tools, and although the Static-99 was developed for adults, it achieved similar results as the adolescent tools. Results are compared to other meta-analyses of risk tools used in the area of violence risk assessment and in other fields.

Developing Non-Arbitrary Metrics for Risk Communication: Percentile Ranks for the Static-99/R and Static-2002/R Sexual Offender Risk Tools

The aim of this article was to advance risk communication by examining percentile ranks as a non-arbitrary metric for quantifying risk. Although percentile ranks have a simple meaning, their calculation is complicated by ties (i.e., more than one offender having the same score). The strengths and weaknesses of percentile ranks are discussed, as are the options for calculating and presenting them in applied risk communication. As a demonstration, percentile ranks for Canadian sexual offenders were computed for the most popular sexual offender risk assessment tools (Static-99, Static-99R, Static-2002 and Static-2002R). The distribution of Static-99 scores was highly stable in international comparisons of sexual offenders from Canada (1990 to 2005; n = 2,011), Sweden (1993 to 1997; n = 1,278) and California (2008 to 2010; n = 37,600). The major limitation of percentile ranks is that they measure the “unusualness” of scores in a particular reference group, and may not correspond to other indicators of relative or absolute risk. Consequently, we recommend that evaluators presenting percentile ranks should consistently provide recidivism base rate information so that decision makers do not confuse the rarity of a score with estimates of absolute recidivism risk.

Review of Risk Assessment Instruments for Juvenile Sex Offenders

Risk assessment is considered to be a key element in the prevention of recidivism among juvenile sex offenders (JSOs), often by imposing long-term consequences based on that assessment. The authors reviewed the literature on the predictive accuracy of six well-known risk assessment instruments used to appraise risk among JSOs: the Juvenile Sex Offender Assessment Protocol-II (J-SOAP-II), Juvenile Sexual Offence Recidivism Risk Assessment Tool-II (J-SORRAT-II), Estimate of Risk of Adolescent Sexual Offence Recidivism (ERASOR), Juvenile Risk Assessment Scale (JRAS), Structured Assessment of Violent Risk in Youth (SAVRY), and Hare Psychopathy Checklist:Youth Version (PCL:YV). Through a systematic search, 19 studies were reviewed. Studies showed differences in the predictive accuracies for general, violent, and sexual recidivism, and none of the instruments showed unequivocal positive results in predicting future offending. Not unexpectedly, the accuracy of the SAVRY and PCL:YV appeared to be weaker for sexual recidivism compared with specialized tools such as the J-SOAP-II or the ERASOR. Because of the rapid development of juveniles, it is questionable to impose long-term restrictions based on a risk assessment only. New challenges in improving risk assessment are discussed.