David S. Prescott, LICSW


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Book Review: The Risk for Sexual Violence Protocol (RSVP)

By Stephen D. Hart, P. Randall Kropp, & D. Richard Laws,
with Jessica Klaver, Caroline Logan, and Kelly A. Watt

Published jointly by the Mental Health, Law, and Policy Institute of Simon Fraser University, the Pacific Psychological Assessment Corporation, and the British Columbia Institute Against Family Violence

128 Pages, $50.00 USD
available from /www.pacific-psych.com

Review by David Prescott, Forum Editor

The assessment of dangerousness can, itself, be a dangerous undertaking. Disagreement and acrimony erupt throughout the literature. Despite evidence showing the improvement of empirically derived assessments over unstructured clinical judgments, numerous questions remain: How closely did the research conditions resemble current practice conditions? How closely did the tasks of research subjects match the referral questions of practitioners today? Armed with the recent research data, can’t clinicians now go about their assessments more effectively? Or is the fundamental problem that some clinicians are less motivated to base their assessments on what the research tells us?

The predictive validity of many current actuarial methods for assessing risk of sexual recidivism has already been described (Hanson & Morton-Bourgon, 2004). However, their utility beyond risk classification can be limited, albeit with some exceptions (Roberts, Doren, & Thornton, 2002; Doren, 2002). Many (e.g. Hart, Laws, & Kropp, 2003) highlight the potential shortcomings of these methods. Still others (e.g. Beech & Ward, in press; Zamble & Quinsey, 1997) offer ideas for further refinement and suggest that static factors are best considered as markers for underlying dynamic processes.

Ultimately, only one thing is clear: There are many reasons to assess risk, and many frameworks (clinical and forensic) in which to assess it. No assessment scheme speaks to every referral question, practice context, or legal application. In 2000, Serin & Brown developed their “10 Commandments of Risk Assessment”. These are:

1) Thou shalt know thy base-rate
2) Thou shalt use multi-method assessment strategies
3) Thou shalt not confuse shared method variance with increased validity (i.e. more information does not necessarily increase accuracy)
4) Thou shalt be wary of clinical overrides
5) Thou shalt heed statistical estimates
6) Thou shalt not covet thy neighbor’s data
7) Thou shalt know the limits of thy prediction
8) Thou shalt know thy false positive and false negative rates for specific cutoffs
9) Thou shalt provide conditional predictions
10) Thou shalt follow an aide-memoire

More recently, Webster, Hucker, & Bloom (2002) have offered five guidelines for “transcending the actuarial versus clinical polemic in assessing risk for violence”:

1. Understand the applicable legal framework
2. Make risk assessments evidenced-based
3. Provide an individualized statement of risk
4. Include steps to reduce that risk
5. Compare the individual case with scientific data when possible

The RSVP incorporates many, if not all, of these latter guidelines. It contributes to comprehensive risk assessment formulations beyond simple categorization. It is structured to distinguish between the identification of risk factors and determination of their relevance to future offending. While the implicit aim of most risk assessment is the prevention of further sexual abuse, their design tends to be limited to classification of risk or a probabilistic statement. The RSVP’s primary and explicit focus is in prevention, as well as protection of past and future victims.

The RSVP is designed to provide structure to professional judgement. It is not intended as a revision of the Sexual Violence Risk 20 (SVR-20; Boer, Hart, Kropp, & Webster, 1998) or the Sex Offender Risk Assessment (SORA; Atkinson, Kropp, Laws, & Hart, 1996), but has clearly evolved from both. The authors chose risk factors based on empirical, clinical, and legal criteria, selecting those associated with the nature, severity, frequency, imminence, and likelihood of sexual violence. They further attempted to conceptualize these factors at a basic level in order to provide clear definitions to help inform risk management decisions. The authors are clear that the RSVP represents their own opinions and judgments, and not necessarily those of any professional organization. There are no restrictions on purchasing the RSVP, but the authors state it “may be considered a psychological test” (P. 15).

Administration of the RSVP includes six steps:

1. Gathering and evaluating case information (including: gathering case information regarding the individual’s history of sexual violence, in multiple domains; using multiple methods from multiple sources, and concerning static and dynamic aspects. Information should be updated and documented, and its adequacy evaluated.)
2. Establishing the presence of risk factors (including coding some as provisional, or omitting them due to lack of information)
3. Establishing the relevance of risk factors
4. Establishing risk scenarios (including the questions: “What is it I’m trying to prevent? What exactly is it I’m worried the person might do?)
5. Development of risk management strategies (including monitoring, treatment, supervision, and victim safety planning)
6. Summary judgments (including: case prioritization from low/routine through moderate/elevated to high/urgent, with consideration given to risk of serious physical harm/need for immediate action and other risks that may be indicated)

Twenty-two risk factors are presented in five domains: Sexual Violence, Psychological Adjustment, Mental Disorder, Social Adjustment, and Manageability. Each factor is given a description with reference to literature that supports it. No specific protective aspects that might serve to mitigate risk are offered directly. Although the absence of some factors might serve a protective function (e.g. problems with intimate relationships), no discussion is provided on how best to understand the absence of risk factors. Also excluded is discussion related to the combination of psychopathy and sexual deviance (Quinsey, Harris, Rice, & Cormier, 1998; Serin, Mailloux, & Malcolm, 2001). While “treatment problems” are defined effectively, this factor could benefit from more consideration of how different treatment strategies apply to certain types of offenders. Examples might include empathy training for those high in psychopathic traits, or aversive reconditioning for those whose offending is related more to antisociality than sexual deviance. Finally, the RSVP does not discuss the need to anchor assessments in applicable base rate information.

Without a doubt the RSVP will assist many evaluators in structuring assessments, refining their formulations, and communicating their findings in this most important work. It is applicable to diverse situations. Further, it will assist in the construction of assessment-driven treatment plans. Its main advantage, beyond its explicit structure and focus on prevention, lies in its capacity to remind evaluators to consider aspects they might have forgotten, and to give thought to elements that they might otherwise not want to consider. Given its price and advantages, it will benefit anyone interested in risk assessment. It builds on the SVR-20 without negating it. It is a welcome contribution to the literature.

The RSVP would benefit from additional development in a number of areas. Discussion of current thought into risk, need, and responsivity (Andrews & Bonta, 1998) might help evaluators understand the contribution of risk factors that receive inconsistent support in the literature, and whose role in an offense may be less direct than others. Inclusion of current thought into the nature of acute and stable dynamic risk (as “states and traits”; Beech & Ward, in press) might also be helpful.

Those entering the unenviable world of risk assessment are implicitly asked to decide amongst a range of competing perspectives in high-stakes situations. Many have strong opinions about the meaning of research findings. There is still a dearth of recommendations for reconciling the diversity of thought in risk assessment. One might wish for a more integrated (but still structured and explicit) means to understand and communicate risk of harm for people across the life span. No method fully assists practitioners in making sense of what is known to this point.

Despite its appeal and comprehensive approach, the RSVP risks continuing much of the debate it might otherwise have resolved. Section titles such as “the alleged superiority of actuarial risk assessment do little to move past an arguably insubstantial debate. One could argue that the RSVP itself has not yet been demonstrated to be effective, either. Its predictive validity and inter-rater reliability remain unknown. In their introduction, the authors present their own perspective on the actuarial-versus-clinical controversy:

“Despite recent advances in research (or perhaps more accurately, because of them) there is considerable debate concerning best practices with respect to sex offender assessment… The optimistic view highlights the promise of risk assessment. The promise is that risk procedures can identify the specific or absolute probability that any given offender will commit another sexual offense… The optimists believe that such prognoses are stable and accurate, and will assist in making important decisions about sexual offenders. In contrast, pessimists highlight the peril. Their primary concern is that mental health professionals who conduct risk assessments over-rely on methods of unknown or limited value, pretending a degree of scientific support and precision that has not been attained… One potential consequence is that important decisions will be based on professional opinions of questionable value; another is that decision-makers are encouraged to think about management in very simplistic terms.” (P. 2)

Ultimately, one might hope that future manuals of this sort will offer resolution to both promise and peril, and offer greater insight into how we can best understand those factors whose empirical support is inconsistent. In the meantime, it is probably not enough to study risk assessment methods and their development. One should study how the field produces such diversity of thought. Despite the areas where the RSVP would be aided by further development, it will benefit those struggling with risk assessment, treatment planning, and other aspects of reducing the harm of sexual abuse.

References

Andrews, D.A. & Bonta, J.L. (1998) The Psychology of Criminal Conduct, Second Edition. Cincinnati: Anderson Publishing.

Atkinson, R.L., Kropp, P.R., Laws, D.R., & Hart, S.D. (1996). Scoring Manual for the Sex Offender Risk Assessment Guide (SORA). Vancouver: The British Columbia Institute Against Family Violence & The Mental Health, Law, and Policy Institute.

Beech, A.R. & Ward, T. (in press). The integration of etiology and risk in sexual offenders: A theoretical framework. Aggression and Violent Behavior.

Boer, D.P., Hart, S.D., Kropp, P.R., & Webster, C.D. (1998). Manual for the Sexual Violence Risk – 20: Professional Guidelines for Assessing Risk of Sexual Violence. Lutz, Florida: Psychological Assessment Resources, Inc.

Hanson, R.K., & Morton-Bourgon, K.E. (2004). Predictors of sexual recidivism: An updated meta-analysis. Available at: http://www.psepc.gc.ca/publications/corrections/pdf/200402_e.pdf .

Hart, S.D., Laws, D.R., & Kropp, R. P. (2003). The promise and peril of sex offender risk assessment, in Ward, T., Laws, D.R., & Hudson, S.M. (eds.). Sexual Deviance: Issues and Controversies. Thousand Oaks, CA: Sage Publications.

Quinsey, V.L., Harris, G.T., Rice, M.E., & Cormier, C.A. (1998). Violent offenders: Appraising and managing risk. Washington, D.C.: American Psychological Association.

Roberts, C.F., Doren, D.M., & Thornton, D. (2002). Dimensions associated with sex offender recidivism risk, Criminal Justice and Behavior, 29, 569-589.

Serin, R.C. & Brown, S.L. (2000). The clinical use of the Hare Psychopathy Checklist – Revised in contemporary risk assessment, in Gacono, C.G. (ed.), The Clinical and Forensic Assessment of Psychopathy. Mahwah, NJ: Lawrence Erlbaum Associates.

Serin, R.C., Mailloux, D.L., & Malcolm, P.B. (2001). Psychopathy, deviant sexual arousal, and recidivism among sexual offenders. Journal of Interpersonal Violence, 16(3), 234-246.

Webster, C.D., Hucker, S.J. & Bloom, H. (2002). Transcending the actuarial versus clinical polemic in assessing risk for violence, Criminal Justice and Behavior, 29 (5) 659-665.

Zamble, E., & Quinsey, V.L. (1997). The Criminal Recidivism Process. New York: Cambridge University Press.

 


David S. Prescott, LICSW – PMB 210 - 190 US Route 1 – Falmouth, ME 04105
Email: DSP@DavidPrescott.net

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