Treatment of Sex Offenders

64
R.J.B. Lehmann et al.
Importantly, therapeutic change (i.e., positive change in dynamic items) was
found to be significantly related to reduction in sexual recidivism after controlling
for risk and follow-up time (Beggs & Grace, 2011 ; Olver et al., 2007 , 2014 ). In their
most recent risk communication efforts, Olver et al. ( 2015 ) applied an intuitively
useful method of conceptualizing and communicating change to the VRS-SO. Olver
and colleagues used the Clinically Significant Change model, which incorporates
offenders’ change relative to external standards of what is “functional” and takes
into account whether the change is reliable (i.e., likely accounted for by more than
measurement error). Using this technique, the authors found that Clinically
Significant Change provided some unique information in predicting recidivism
beyond pretreatment risk scores, and they offered examples of how this approach
can facilitate risk communication.
Survey Findings: What Is Used in Applied Practice?
Several surveys have been conducted to assess practical applications of risk assessment
(e.g., what scales are used and how the information is incorporated).
Examining 111 risk assessment reports for preventative detention hearings in
Canada (intended for offenders at high risk of violent recidivism), Blais and Forth
( 2014 ) found that over 90 % of experts (appointed by either the prosecution or
appointed by the court) used an actuarial risk assessment scale, compared to 53 %
who used an SPJ scale. The PCL-R (Psychopathy Checklist-Revised) , designed to
assess the construct of psychopathy (not as a risk assessment scale), was used in
over 95 % of risk assessment reports. In terms of scales designed to assess risk of
recidivism, the most commonly used scale was the Static-99, used in over 60 % of
cases, which is surprising given that not all candidates for preventative detention
are sex offenders. The next most commonly used scales were the VRAG (Violence
Risk Appraisal Guide; 48 % of reports) and the SORAG (Sex Offender Risk
Appraisal Guide; 42 % of reports), both of which are actuarial. Other risk scales
were used in one quarter or less of cases.
In a particularly large study, Singh and colleagues ( 2014 ) surveyed 2135 mental
health professionals who had conducted at least one violence risk assessment. Half
of the respondents were from Europe, followed by 21 % from North America, 5 %
from Australasia, and 3 % each from South America and Asia. Among this diverse
sample, over 400 different instruments were reported as being used for violence risk
assessment, although roughly half had been developed specifically for personal or
institutional use only. Among the 12 most frequently used risk scales, half were
actuarial and half were SPJ, with the HCR-20 (Historical Clinical Risk Management
20, an SPJ scale) reported as the most commonly used, followed by the PCL-R.
Neal and Grisso ( 2014 ) surveyed 434 psychologist and psychiatrist members of
various professional associations, mostly from the United States, Canada, Europe,
Australia, and New Zealand, who described 868 cases they had completed. The
most common types of referrals these professionals dealt with included competence