Stephen C. P. Wong

The validity and reliability of the Violence Risk Scale: A treatment-friendly violence risk assessment tool

The development of risk assessment tools that use dynamic variables to predict recidivism and to inform and facilitate violence reduction interventions is the next major challenge in the field of risk assessment and management. This study is the first in a 2-step process to validate the Violence Risk Scale (VRS), a risk assessment tool that integrates violence assessment, prediction, and treatment. Ratings of the 6 static and 20 dynamic VRS variables assess the clients level of risk. Ratings of the dynamic variables identify treatment targets linked to violence, and ratings of the stages of change of the treatment targets assess the clients treatment readiness and change. The VRS scores of 918 male offenders showed good interrater reliability and internal consistency and could predict violent and nonviolent recidivism over both short- and longer term (4.4-year) follow-up. The probability of violent and nonviolent recidivism varied linearly with VRS scores. Dynamic and static variables performed equally well. The results support the contention that the VRS can be used to assess violent risk and to guide violence reduction treatment.

Outcome of an Institutional Sexual Offender Treatment Program: A Comparison Between Treated and Matched Untreated Offenders

Data from a sexual offender treatment program operated by the Correctional Service of Canada at the Regional Psychiatric Center (Saskatoon) supported the conclusion that cognitive behavioral treatment can reduce sexual offense recidivism. The study compared 296 treated and 283 untreated offenders followed for a mean of 6 years after their release. An untreated comparison subject was located for each treated offender on three dimensions: (a) age at index offense, (b) date of index offense, and (c) prior criminal history. Data were analyzed using tests of proportion, survival analysis, and analysis of offender Criminal Career Profiles. Over a mean follow-up period of almost 6 years, convictions for new sexual offenses among treated offenders were 14.5% versus 33.2% for untreated offenders. During the follow-up period, 48% of treated offenders remained out of prison compared to 28.3% of untreated offenders. Time series comparisons of treated and comparison samples also showed that treated men reoffended at significantly lower rates after 10 years. A Criminal Career Profile (CCP) was constructed by taking the Age at First Conviction and plotting the offenders successive lengths of time free against time incarcerated. Pre- and posttreatment slopes of the CCP were lower for both groups posttreatment; however, the degree of change was significantly greater for the treated group, indicating a greater reduction in criminal activity among these offenders. Taken together, the results of all three analytic techniques supported the efficacy of appropriate correctional treatment for effective reduction of recidivism.

Therapeutic Responses of Psychopathic Sexual Offenders: Treatment Attrition, Therapeutic Change, and Long-Term Recidivism.

The authors examined the therapeutic responses of psychopathic sex offenders (>or=25 Psychopathy Checklist--Revised; PCL-R) in terms of treatment dropout and therapeutic change, as well as sexual and violent recidivism over a 10-year follow-up among 156 federally incarcerated sex offenders treated in a high-intensity inpatient sex offender program. Psychopathy and sex offender risk/treatment change were assessed using the PCL-R and the Violence Risk Scale--Sexual Offender version (VRS-SO), respectively. Although psychopathic participants were more likely than their nonpsychopathic counterparts (<25 PCL-R) to drop out, almost 75% of the former completed treatment. Psychopathic offenders who failed to complete sex offender treatment were more likely to violently but not sexually recidivate than completers. Positive treatment changes were associated with reductions in sexual and violent recidivism after psychopathy and sexual recidivism risk were controlled. Overall, the results suggest that given appropriate treatment interventions, sex offenders with significant psychopathic traits can be retained in an institutional treatment program and those showing therapeutic improvement can reduce their risk for both sexual and violent recidivism.

Electrodermal and Cardiovascular Evidence of a Coping Response in Psychopaths

Hare (1978) has suggested that psychopaths may possess particularly effective coping mechanisms in the presence of impending aversive stimulation. These mechanisms may serve to attenuate anxiety so that the psychopaths behavior is less easily controlled by aversive consequences. To test this hypothesis, the heart rate (HR) and skin conductance level (SCL) of psychopaths and nonpsychopaths were compared across two countdown tasks. In Tasks 1, subjects heard a 120-db. tone following the countdown. In Task 2, subjects prevented the tone externally by pressing a button immediately following the countdown. The typical response pattern of psychopaths was present in Task 1, where they demonstrated increases in HR but relatively no increase in SCL. This response pattern dissipated, however, in Task 2 when the need to “cope” internally was removed. These results confirm the hypothesis that psychopaths may employ an effective coping response in anticipation of aversive stimuli.

A Comparison of Static and Dynamic Assessment of Sexual Offender Risk and Need in a Treatment Context

The authors investigated the efficacy of static versus dynamic approaches to risk assessment and the validity of the Risk Principle through comparing treatment changes made by high- versus lower-risk offenders. The investigations were carried out using a sample of 321 treated sex offenders followed up for an average 10 years postrelease. Risk was assessed using the Static 99, and treatment change was assessed using the Violence Risk Scale—Sexual Offender version. Actuarially high-risk/ low-change offenders had significantly higher rates of sexual recidivism than similarly high-risk offenders who had demonstrated greater treatment changes. The Static 99 predicted sexual recidivism well among sex offenders with smaller treatment change but demonstrated weaker prediction among offenders with greater treatment change, likely owing, in part, to the static nature of the risk predictors. Implications regarding the dynamic nature of risk and potential utility of incorporating treatment change—related information into sex offender risk assessments are discussed.

Outcome Evaluation of a High-Intensity Inpatient Sex Offender Treatment Program

The treatment outcome of a high-intensity inpatient sex offender treatment program was evaluated by comparing the sexual recidivism rates of 472 treated and 282 untreated sex offenders. The program is designed for moderate- to high-risk sex offenders and follows the principles of effective correctional treatment. The current investigation is an extension of an earlier study (Nicholaichuk et al., 2000) with the addition of 176 participants, an extra 4 years follow-up, and the use of Cox regression survival analysis to control for three potentially confounding variables: age of release, sexual offending history, and length of follow-up. Treated offenders sexually recidivated significantly less than the comparison group over nearly 20 years of follow-up, even after controlling for the aforementioned variables. The substantive findings suggest that treatment adhering to the what works principles can reduce long-term sexual recidivism for a moderate- to high-risk group of sex offenders.

The Effectiveness of Violence Reduction Treatment for Psychopathic Offenders: Empirical Evidence and a Treatment Model

Psychopathy, a personality disorder, is characterized by dysfunctional and externalizing affective and interpersonal traits that can be manifested as violent and antisocial behaviors. Psychopathic individuals are often referred for treatment in criminal justice or forensic mental health settings to reduce the harm they may inflict on themselves and others. While the ‘what works’ treatment approaches to reduce recidivism and violence have enjoyed widespread support, therapeutic nihilism for psychopathy abounds. A two-component model is proposed to provide a conceptual framework for the treatment of psychopathy. Three studies on the treatment of psychopathic offenders to reduce violence and offending behaviors are reviewed and show positive treatment outcomes. The study results support the efficacy for the treatment of psychopathic individuals and for the proposed model.

The psychopathy checklist: Youth version and adolescent and adult recidivism: Considerations with respect to gender, ethnicity, and age

The present study investigated the predictive accuracy of the Psychopathy Checklist: Youth Version (PCL: YV; A. E. Forth, D. S. Kosson, & R. D. Hare, 2003) for youth and adult recidivism, with respect to gender, ethnicity, and age, in a sample of 161 Canadian young offenders who received psychological services from an outpatient mental health facility. The PCL: YV significantly predicted any general, nonviolent, and violent recidivism in the aggregate sample over a 7-year follow-up; however, when results were disaggregated by youth and adult outcomes, the PCL: YV consistently appeared to be a stronger predictor of youth recidivism. The PCL: YV predicted youth recidivism for subsamples of female and Aboriginal youths, and very few differences in the predictive accuracy of the tool were observed for younger vs. older adolescent groups. Both the 13-item (i.e., D. J. Cooke & C. Michie, 2001, 3-factor) and the 20-item (i.e., R. D. Hare, 2003, 4-factor) models appeared to predict various recidivism criteria comparably across the aggregate sample and within specific demographic subgroups (e.g., female and Aboriginal youth). The Antisocial facet contributed the most variance in the prediction of adult outcomes, whereas the 3-factor model contributed significant incremental variance in the prediction of youth recidivism outcomes. Potential implications concerning the use of the PCL: YV in clinical and forensic assessment contexts are discussed.

Short- and long-term recidivism prediction of the PCL-R and the effects of age: a 24-year follow-up.

We prospectively examined the short- and long-term prediction of several recidivism outcomes as a function of psychopathy and age in a sample of 273 Canadian federal inmates with an average 24 years post-release follow-up. Offenders were rated using the original 22-item Hare Psychopathy Checklist (PCL: Hare, 1980) based on extensive archival file information, and the ratings were used to compute the Psychopathy Checklist-Revised (Hare, 2003) and the 4 facet scores. PCL-R total scores and the Lifestyle and Antisocial facets, but not the Interpersonal and Affective facets, showed mostly small and some moderate predictive efficacy for general and nonviolent recidivism over 3-, 5-, 10-, and 20-year fixed follow-ups, and predicted violence recidivism at shorter follow-ups. Age at release was negatively correlated with all recidivism outcomes and follow-up periods for both high and low PCL-R rated offenders, and uniquely predicted all recidivism outcomes after controlling for the PCL-R using Cox regression survival analysis. Increased age was consistently linked to recidivism reduction even for psychopathic offenders. The results showed that both PCL-R scores and age contributed to the prediction of recidivism; however, the PCL-R facets made differential contributions that varied with the type of offense (violent vs. nonviolent) and follow-up time (shorter vs. longer). The results have implications for both risk assessment using the PCL-R and potentially for risk reduction interventions.

A multisite examination of sexual violence risk and therapeutic change.

OBJECTIVE We conducted a prospective multisite examination of sexual offender risk and treatment change on a large federal Canadian sample of 676 treated sex offenders followed up for an average of 6.31 years post release. METHOD The present study featured the clinical application of a risk assessment and treatment planning tool, the Violence Risk Scale-Sexual Offender version (VRS-SO; Wong, Olver, Nicholaichuk, & Gordon, 2003). The VRS-SO was rated pre- and posttreatment by sex offender treatment providers on the sample of men who were attending institutionally based sex offender programs across the 5 regions of the Correctional Service of Canada. The Static-99 (Hanson & Thornton, 1999) was also rated as part of routine services, and the Static-99R was used for substantive analyses. RESULTS The VRS-SO dynamic factors and the Static-99R demonstrated significant predictive accuracy for sexual, violent, and general recidivism (area under the curve = .65 to .78). Significant pre-post changes on the VRS-SO dynamic factors were observed, ranging from small to moderate in magnitude (d = 0.22 to 0.62) across low, moderate, and high intensity programs. The change scores, in turn, were associated with decreases in the 3 recidivism outcomes; the majority of relationships examined attained significance after partialing out of pretreatment scores. Cox regression survival analyses, controlling for pretreatment risk, further demonstrated change scores to have associations with postrelease recidivism outcomes to varying degrees. CONCLUSIONS The results are consistent with the dynamic nature of sexual violence risk and suggest that risk-relevant changes associated with participation in sexual offender treatment are linked to reductions in sexual offender recidivism.