Keith R. Cruise

Assessing callous-unemotional traits in adolescent offenders : validation of the inventory of callous-unemotional traits.

The presence of callous-unemotional (CU) traits designates an important subgroup of antisocial youth. To improve upon existing measures, the Inventory of Callous-Unemotional Traits (ICU) was developed to provide an efficient, reliable, and valid assessment of CU traits in samples of youth. The current study tests the factor structure and correlates of the ICU scale in a sample (n=248) of juvenile offenders (188 boys, 60 girls) between the ages of 12 and 20 (M=15.47, SD=1.37). Confirmatory factor analyses are consistent with the presence of three independent factors (i.e., Uncaring, Callousness, and Unemotional) that relate to a higher-order callous-unemotional dimension. Also, CU traits overall showed associations with aggression, delinquency, and both psychophysiological and self-report indices of emotional reactivity. There were some important differences across the three facets of the ICU in their associations with these key external criteria.

COMPLEX TRAUMA AND AGGRESSION IN SECURE JUVENILE JUSTICE SETTINGS

Youth in secure juvenile justice settings (e.g., detention, incarceration) often have histories of complex trauma: exposure to traumatic stressors including polyvictimization, life-threatening accidents or disasters, and interpersonal losses. Complex trauma adversely affects early childhood biopsychosocial development and attachment bonding, placing the youth at risk for a range of serious problems (e.g., depression, anxiety, oppositional defiance, risk taking, substance abuse) that may lead to reactive aggression. Complex trauma is associated with an extremely problematic combination of persistently diminished adaptive arousal reactions, episodic maladaptive hyperarousal, impaired information processing and impulse control, self-critical and aggression-endorsing cognitive schemas, and peer relationships that model and reinforce disinhibited reactions, maladaptive ways of thinking, and aggressive, antisocial, and delinquent behaviors. This constellation of problems poses significant challenges for management, rehabilitation, and treatment of youth in secure justice settings. Epidemiological and clinical evidence of the prevalence, impact on development and functioning, comorbidity, and adverse outcomes in adolescence of exposure to complex trauma are reviewed. Implications for milieu management, screening, assessment, and treatment of youth who have complex trauma histories and problems with aggression in secure juvenile justice settings are discussed, with directions for future research and program development.

Assessment of Multiple Risk Outcomes, Strengths, and Change with the START:AV: A Short-Term Prospective Study with Adolescent Offenders

The Short-Term Assessment of Risk and Treatability: Adolescent Version (START:AV; Nicholls, Viljoen, Cruise, Desmarais, & Webster, 2010; Viljoen, Cruise, Nicholls, Desmarais, & Webster, in preparation) is a clinical guide designed to assist in the assessment and management of adolescents’ risk for adverse events (e.g., violence, general offending, suicide, victimization). In this initial validation study, START:AV assessments were conducted on 90 adolescent offenders (62 male, 28 female), who were prospectively followed for a three-month period. START:AV assessments had good to excellent inter-rater reliability and strong concurrent validity with Structured Assessment of Violence Risk in Youth assessments (SAVRY; Borum, Bartel, & Forth, 2006). START:AV risk estimates and Vulnerability total scores predicted multiple adverse outcomes, including violence towards others, offending, victimization, suicidal ideation, and substance abuse. In addition, Strength total scores inversely predicted violence, offending, and street drug use. During the three-month follow-up, risk estimates changed in at least one domain for 92% of youth, and 27% of youth showed reliable changes in Strength and/or Vulnerability total scores (reliable change index, 90% confidence interval; Jacobsen & Truax, 1991). While these findings are promising, a strong need exists for further research on the START:AV, the measurement of change, and on the role of strengths in risk assessment and treatment planning.

Race Differences in Mental Health Service Access in a Secure Male Juvenile Justice Facility

This study examined whether African American and Caucasian male youths had similar rates of referral to mental health services in a juvenile justice secure facility when controlling for differences obtained in the initial screening and assessment process. Data from the Massachusetts Youth Screening Instrument-2 (MAYSI-2), Initial Health Care Screening and Youth Level of Services/Case Management Inventory were analyzed from 937 male youths (12–18 years old) admitted to a secure care facility. There were few differences between African American and Caucasian youths on MAYSI-2 scales and no difference on the YLS total score. However, Caucasian youth reported higher frequencies of mental health treatment history than African American youth. Even when controlling for differences in MAYSI-2 elevations and history of receiving mental health treatment, Caucasian youths were provided access to mental health services at a greater rate than African American youth. This study indicates that race is a potential factor in mental health service access for youth in a secure care setting.

Violence risk assessment and women: predictive accuracy of the HCR-20 in a civil psychiatric sample.

Research to date has not adequately demonstrated whether the HCR-20 Violence Risk Assessment Scheme (HCR-20; Webster, Douglas, Eaves, & Hart, 1997), a structured violence risk assessment measure with a robust literature supporting its validity in male samples, is a valid indicator of violence risk in women. This study utilized data from the MacArthur Study of Mental Disorder and Violence to retrospectively score an abbreviated version of HCR-20 in 827 civil psychiatric patients. HCR-20 scores and predictive accuracy of community violence were compared for men and women. Results suggested that the HCR-20 is slightly, but not significantly, better for evaluating future risk for violence in men than in women, although the magnitude of the gender differences was small and was largely limited to historical factors. The results do not indicate that the HCR-20 needs to be tailored for use in women or that it should not be used in women, but they do highlight that the HCR-20 should be used cautiously and with full awareness of its potential limitations in women.

Taking stock and taking steps: the case for an adolescent version of the Short-Assessment of Risk and Treatability

The field of violence risk assessment has matured considerably, possibly advancing beyond its own adolescence. At this point in the fields evolution, it is more important than ever for the development of any new device to be accompanied by a strong rationale and the capacity to provide a unique contribution. With this issue in mind, we first take stock of the field of adolescent risk assessment in order to describe the rapid progress that this field has made, as well as the gaps that led us to adapt the Short-Term Assessment of Risk and Treatability (START; Webster, Martin, Brink, Nicholls, & Desmarais, 2009) for use with adolescents. We view the Short-Term Assessment of Risk and Treatability: Adolescent Version (START:AV; Nicholls, Viljoen, Cruise, Desmarais, & Webster, 2010; Viljoen, Cruise, Nicholls, Desmarais, & Webster, in progress) as complementing other risk measures in four primary ways: 1) rather than focusing solely on violence risk, it examines broader adverse outcomes to which some adolescents are vulnerable (including self-harm, suicide, victimization, substance abuse, unauthorized leave, self-neglect, general offending); 2) it places a balanced emphasis on adolescents’ strengths and vulnerabilities; 3) it focuses on dynamic factors that are relevant to short-term assessment, risk management, and treatment planning; and 4) it is designed for both mental health and justice populations. We describe the developmentally-informed approach we took in the adaptation of the START for adolescents, and outline future steps for the continuing validation and refinement of the START:AV.

Pilot Implementation and Preliminary Evaluation of START:AV Assessments in Secure Juvenile Correctional Facilities

The Short-Term Assessment of Risk and Treatability: Adolescent Version (START:AV) is a new structured professional judgment guide for assessing short-term risks in adolescents. The scheme may be distinguished from other youth risk assessment and treatment planning instruments by its inclusion of 23 dynamic factors that are each rated for both vulnerability and strength. In addition, START:AV is also unique in that it focuses on multiple adverse outcomes—namely, violence, self-harm, suicide, unauthorized leave, substance abuse, self-neglect, victimization, and general offending—over the short-term (i.e., weeks to months) rather than long-term (i.e., years). This article describes a pilot implementation and preliminary evaluation of START:AV in three secure juvenile correctional facilities in the southern United States. Specifically, we examined the descriptive characteristics and psychometric properties of START:AV assessments completed by 21 case managers on 291 adolescent offenders (250 boys and 41 girls) at the time of admission. Results provide preliminary support for the feasibility of completing START:AV assessments as part of routine practice. Findings also highlight differences in the characteristics of START:AV assessments for boys and girls and differential associations between the eight START:AV risk domains. Though results are promising, further research is needed to establish the reliability and validity of START:AV assessments completed in the field.

PROMOTING SELF-AWARENESS AND ROLE ELABORATION: USING REPERTORY GRIDS TO FACILITATE THEATRICAL CHARACTER DEVELOPMENT

Repertory grid techniques have had unique and novel applications in a variety of settings. This article reports on the use of the repertory grid with a group of adolescent high school drama students involved in a theater production of The Boys Next Door by Tom Griffin. Repertory grids were completed across three time periods to achieve three separate objectives: (1) exploring the relationship between the self and the character role, (2) promoting sociality among cast members and important character relationships, and (3) investigating similarities/differences in cast members’ constructions of each other as characters versus as actors. Qualitative examples as well as illustrative repertory grid patterns will be discussed regarding each objective. Analogue implications for promotion of individual self-awareness and constructivist applications are also reviewed.

The Use of Risk Assessments to Inform the Treatment of Adolescents Who Have Committed Sexual Offenses

Risk assessments of adolescents who have committed sexual offenses are often used to guide court decisions about dispositions. Beyond their use in legal decision making, risk assessments can also be helpful in treatment planning. In this article, we describe how risk assessments may be used to plan level of care, develop an individualized treatment plan, and evaluate treatment progress for juveniles who have committed a sexual offense. We include a brief overview of research on juvenile risk assessments, provide a clinical case example to demonstrate the process of integrating risk assessments into treatment planning, and conclude with practice recommendations for forensic mental health practitioners.

Predictive Validity of the J-SOAP-II: Does Accuracy Differ Across Settings?

Court and mental health workers are frequently asked to determine which juvenile sex offenders (JSOs) are most likely to reoffend. One instrument commonly used to guide decision making with JSOs is the Juvenile Sex Offender Assessment Protocol-II (J-SOAP-II). However, research utilizing this instrument has often generated contradictory results, perhaps related to the types of samples studied. The current study sought to compare the predictive accuracy of the J-SOAP-II across two samples of JSOs (a medium-security correctional setting versus an unlocked residential sex offender treatment program). Although the overall predictive accuracy for identifying post-release arrests for sexual offenses (i.e., sexual recidivism) was modest (AUC = .64) and not statistically significant, differences emerged with regard to the accuracy of some individual scales and subscales. Similarly, while no significant differences in predictive accuracy were observed between the two study sites, a number of interesting findings were observed. These findings highlight the need to consider risk assessment measures in light of the setting in which they are used in order to maximize predictive accuracy and optimize treatment and dispositional decision making.