Tuesday, April 9, 2024

The Adolescent Risk Assessment Paradox

 By David S. Prescott, LICSW

A recent conversation among ATSA members on risk assessment with adolescents sparked both new ideas and old memories.

It all seemed so simple a few decades ago. Science was marching forward in developing methods to assess dangerousness among people who had been violent toward others. There were even references to “hitting the forensic sound barrier,” with the development of high-quality measures. Understandably, the most pressing issue was how we could best classify people according to risk. Entire books were written on the topic; many of the older writings are still worth a read. It was only after we had a solid understanding of risk assessment methods in forensic settings that we could focus more on other areas. Our understanding of dynamic risk naturally led to a clearer understanding of treatment needs. Fast forward to the present, and we have promising measures for assessing protective factors. It is now thirty years since Chris Webster and his colleagues (Vern Quinsey, Grant Harris, Marnie Rice, and Catherine Cormier) published the first version of the Violence Risk Assessment Guide. It may not seem so now, but it has been an exciting few decades to be alive and watching these developments.

It has been equally exciting to watch similar efforts in the adolescent world, but for very different reasons. It was natural that researchers would attempt to develop risk assessment measures for youth. The first version ot the JSOAP was described in April 2000 in what is now Sexual Abuse, affectionately known as “the ATSA Journal.” At around the same time, James Worling and Tracey Curwen made the ERASOR available. In 2003, Drs. Prentky and Righthand published the JSOAP—II, this time with a caution that has been quoted many times in conference presentations and conversations: “No aspect of their development… is fixed or stable. In a very real sense, we are trying to assess the risk of ‘moving targets.’”

These developments were welcome. Other scales came along as well, including the JSORRAT—II, the SAVRY, the MIDSA, and others. The authors of the JSORRAT—II, JSOAP–II, MIDSA, and ERASOR earned reputations for making themselves available to questions, ideas, and discussions in both public and private settings. The results seemed consistently good but not great. The tentative progress of the adult world led these same authors to urge great caution. However, the contexts in which professionals worked soon came to expect a lot from risk assessments. Behind the scenes, I’ve heard of cases where judges would order assessments using a specific measure, causing dilemmas for evaluators who felt the tools were helpful but not the final word in assessment.

Over time, professionals noticed that the ultimate referral questions seemed to be different for kids than for adults. While adult risk assessments often focused on establishing a baseline of likelihood for future sexually violent acts, the implicit question for many professionals assessing juveniles was often closer to, “What do we need to do the help this kid make it into adulthood without hurting more people?”

As all of this was happening, thought leaders in the adolescent world had been talking about areas like the neurological impact of trauma since the 1990s. Some authors, including Janice Bremer and Jane Gilgun, began publishing on protective factors as long ago as the late 1990s (although not with the same rigor that the adult world does now). Kevin Creeden was among the first to question why we were focusing on risk when there was so much work to do with trauma and neurodevelopment. Most importantly, Gail Ryan and her colleagues (including Sandy Lane and Tom Leversee) published articles and entire books on the importance of understanding the developmental processes and environmental context of youth to best serve them. These are all ideas that gained greater credibility in the adult world later.

While this may all seem like a history lesson, some of the questions involved along the way have been maddening:

 - Given the meta-analyses by Michael Caldwell, which argues that recidivism rates have decreased since 2000, and Patrick Lussier (et al.), which argues that in fact recidivism rates have been low all along, what can any professional meaningfully say about risk for sexual re-offense?

- If we recognize that adolescents are far more likely to re-offend non-sexually, shouldn’t we abandon our sole focus on risk for future sexual harm? Or at least put it in the context of other potential harms? And strengths? And possibilities?

- How do we best understand a young person’s risk when it is so dependent on the environments in which they live, go to school, etc.? How much noise is there in the system that makes any form of prediction impossible?

Even today, a conference presenter quipped that, “Kids change so fast. Even when I go back and interview them a week later, it seems like they’ve gotten a foot taller.”

These are major reasons why the change in focus of recent years has been so welcome. The newest generation of measures, based both on research and experience, are focused far more on understanding adolescents, including their development, context, protective factors, needs, progress already made, etc. Important questions remain as to their various properties, but the thought that has gone into their development is encouraging. Their structure enables clinicians to reflect on and understand clients while developing recommendations. They help us to see past the age-old questions of risk and focuses on what professionals and caregivers can meaningfully do to mitigate whatever risks exist.

Sometimes the highest risk that adolescents pose is not to live up to their full adult potential.

The most recent conversations have focused on what to call our reports. The most common answers seem to center on the idea of needs assessments, as a few predicted many years ago.

Perhaps our greatest risk is forgetting that across world history, including time, place, and cultures, adults have always had trouble predicting how kids will turn out. The current focus in many quarters on helping kids become adults may be what we were best suited for all along.

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