Risk management in forensic and correctional populations has traditionally focused on decreasing risk factors for antisocial and aggressive behavior, without paying much attention to increasing protective, strength-based factors. A protective factor is any characteristic of an individual, his or her environment, or situation that reduces the risk of future adverse outcomes. In forensic work, the adverse outcome of interest is often reoffending. Protective factors moderate or buffer the impact of exposure to risk factors, leading to a lower reoffending risk. This entry reviews the relevance of protective factors for risk assessment in correctional and forensic psychiatric populations, including juvenile offenders and sexual offenders. In a case example, the utility of protective factors assessment for building a positive risk management plan is illustrated.
Risk Assessment and Management
A comprehensive and widely used risk assessment and management model based on theoretical principles is the Risk-Need-Responsivity (RNR) model. In the RNR model, the risk principle asserts that criminal behavior can be accurately predicted and that risk management interventions should focus on the higher risk offenders. According to the risk principle, societal resources should be directed to those offenders at moderate to high risk of reoffending, not to the low-risk cases. The need principle highlights the importance of criminogenic needs, also termed dynamic risk factors, because these are the risk factors amenable to change by intervention and risk management strategies. An example of a criminogenic need is substance abuse, and appropriate risk management strategies could be substance use treatment and random urine checks, for example. The responsivity principle describes how treatment should be tailored to the individual offender. Thus, an offender who is intellectually disabled would need a less verbal and more practical approach to effectively change risk factors, compared to an offender of average intelligence. Research has shown that offender rehabilitation programs that adhere to RNR principles are more effective in reducing offender recidivism than those that are not based on RNR.
The RNR model of offender rehabilitation has been complemented by the Good Lives Model (GLM), which is a strength-based approach. It offers guidance to target human goods (i.e., valued aspects of human functioning and living) in offender treatment. According to the GLM, experiences and activities that are likely to result in enhanced levels of well-being should be included when formulating plans for treatment and risk management.
The evidence base for the effectiveness of treatment programs designed according to the GLM is growing. Preliminary beneficial effects of treatments based on GLM principles are higher treatment motivation and engagement among offenders. More generally, higher subjectively experienced quality of life is associated with lower recidivism rates in male forensic outpatients. This implies that improving protective factors that inspire a good life and enhance quality of life leads to reductions in adverse outcomes.
Risk Versus Protection
Structured risk assessment tools have been developed to aid forensic and correctional staff in their day-to-day practice. Since the mid-1980s, the sheer number of forensic risk assessment instruments has increased substantially. There are now literally hundreds of risk assessment instruments for different outcomes including violent outcomes such as general violent offending, sexual offending, spousal assault, stalking, and workplace violence. These instruments have led to an increase in the level of transparency regarding proposed interventions and decision-making, compared to former unstructured clinical risk judgment approaches. However, this so-called culture of risk in forensic psychology and psychiatry has also met with criticism. An extreme focus on risk factors could contribute to professional nihilism and result in offender stigmatization. This has stimulated the development of structured tools for the assessment of protective factors for violence risk, such as the Structured Assessment of Protective Factors for violence risk (SAPROF) and the S hort-Term Assessment of Risk and Treatability (START), which in turn has facilitated research on protective factors for reoffending, including v iolent reoffending, since 2005.
Several studies have found that protective factors indeed provide a buffering effect: Individuals with moderate-to-high risk levels, who also possess high levels of protective factors, show significantly lower recidivism rates than high and moderate risk cases without protective factors. Examples of such buffering protective factors are commitment to structured leisure activities and commitment to school or work. Although research on protective factors in forensic mental health is still in its infancy, it should alert forensic mental health professionals to the importance of taking protective factors into consideration when performing risk assessments and when implementing risk management and rehabilitation interventions. In addition, a stronger focus on protective factors inspires treatment motivation and alliance for both the professional and the offender/patient.
Protective Factors in Adolescent Offenders
Adolescence is a formative developmental period that provides both obstacles and opportunities for psychological growth. The age range from 12 to 24 is the period when antisocial and criminal behavior peaks. Similar to adults, adolescents possess not only risk factors or vulnerabilities but also remarkable strengths. This was acknowledged in one of the earliest risk assessment tools for adolescents, first published in 2002: the Structured Assessment of Violence Risk in Youth. It includes 6 protective factors and 24 risk factors. The START: Adolescent Version is an adaptation from the START, using a developmentally informed approach. The START and START: Adolescent Version pose risks and strengths as opposing ends of a risk domain. These tools not only focus on risk of violence to others but also take into account other adverse outcomes, such as victimization and risk of suicide.
Contrary to common media images, adolescents who engage in violence are often quite vulnerable and are at high risk of self-injury and victimization. The SAPROF-Youth Version was published in 2014 and is intended to offer a positive addition to violence risk assessment with riskfocused tools in young offenders. It contains 16 dynamic protective factors for juvenile violence risk, such as self-control, school/work, and social support or professional care. The SAPROF-Youth Version and its adult predecessor, the SAPROF, focus entirely on protective factors that have been found to be linked to desistance from offending.
Sexual Offenders
Most life domains that are the focus in protective factors assessment are also valuable for the rehabilitation of people who have sexually offended. Indeed, the SAPROF factors have been shown to be equally predictive of desistance from sexually violent recidivism as well as violent recidivism. On the other hand, additional sexual offending–specific protective factors may also be important. The protective factors assessment tool for juvenile sexual offenders, the Desistance for Adolescents Who Sexually Harm-13, consists of both general protective factors and factors that promote healthy sexual interests, such as prosocial sexual attitudes. For adult sexual offenders, an additional manual to the SAPROF is also being developed and aims to assess specific protective factors that enhance desistance from further sexual offending.
Case Example
John was a quiet boy who did well in elementary school. His father regularly used drugs and alcohol, which led to conflicts between his parents and ultimately to a divorce when he was around 15 years old. At age 12, John began to exhibit behavioral problems, showing oppositional behavior in school, using soft drugs, and hanging out with deviant peers. At the age of 16, he ended up in prison for the first time for theft. When he got out of prison at age 17, he went straight on to dealing drugs, which culminated in shipping drugs from a Caribbean island to Europe. At 24, he was arrested again, this time for extortion, robbery, and multiple other offenses. During his detention for the latter crimes, John was allowed to go on a leave, an occasion he seized to take a drug shipment to Germany. During this drug shipment, he committed his index offense: attempted manslaughter of a policeman. He was sentenced to 8-year imprisonment and mandatory inpatient treatment. During his treatment, he made a serious attempt to change his life in order to have a prosocial future. Several months ago, he was released on probation. The probation service commissioned a forensic psychologist to design a risk management plan to facilitate a safe return to society. Before developing the risk management plan, the psychologist performed a risk assessment, which included a focus on both risk factors (coded with the Historical-Clinical-Risk Management-20 Version 3) and protective factors (coded with the SAPROF).
Historical-Clinical-Risk Management-20 Version 3
The most salient historical risk factors that emerged from the Historical-Clinical-Risk Management-20 Version 3, risk-focused assessment, were past violence, past antisocial behavior, relationship problems, personality disorder, problems with substance use, employment problems, traumatic experiences, and prior supervision failure. The dynamic risk factors that still play an important role for John are lack of personal support (his current girlfriend has major mental health problems and he has no real friends) and lack of insight regarding the risk of substance use.
SAPROF
The most important protective factors that show from John’s SAPROF assessment are as follows:
- Secure attachment in childhood: John had a good relationship with his mother and his grandmother during childhood.
- Empathy: John shows sincere remorse for his actions and seems to realize that he hurt many known and unknown people.
- Self-control: He is effectively working to change his behavior; he has successfully participated in aggression management training and manages to remain calm when provoked or agitated.
- Motivation for treatment: John is highly motivated for ongoing voluntary outpatient treatment; he is actively looking for an outpatient therapist.
- Attitudes toward authority: John deals well with authority; he accepts guidance, shows initiative, and keeps agreements and promises.
- Life goals: He has a positive life goal to devote more time to his role as a father. He wants to be there for his children and provide a good example for them. John indicates he has a Christian faith, and he has received support from his conversations with the
- Professional care, living circumstances, and external control: John is currently living in an open rehabilitation home, with continuous monitoring, assistance, and guidance.
Risk Management Plan
To reduce John’s recidivism risk as much as possible and to strengthen the protective factors, the following plan was designed:
John currently has no stable employment and does not take part in structured social leisure activities, while these are important protective factors. Furthermore, his social support network is very limited. Although he is supported by his family members, most of them live far away. It would be valuable for him to build a local network of prosocial contacts who can support him in attaining his positive life goals. Participation in work or leisure activities could provide an opportunity to meet new people. His probation officer assists John in finding a suitable job. In addition, he is stimulated to join a football or baseball association, two sports that interest him. Perhaps John could acquire prosocial contacts via the church as well, for example, by participating in discussion groups. John wants to follow vocational training to become a plasterer. This goal seems realistic in relation to his skills and healthy work ethic. However, he has never worked in any steady, long-term employment, so finding a suitable position which is not overly demanding seems of vital importance. His probation officer will assist John in seeking an outpatient therapist and providing a gradual transfer of care.
The results from the risk and protective factor assessment were written up in a report, which were then discussed with John and shared with his new therapist, in order to ensure transparency and continuation of his positive development.
References:
- de Ruiter, C., & Nicholls, T. L. (2011). Protective factors in forensic mental health: A new frontier. International Journal of Forensic Mental Health, 10, 160–170. doi:10.1080/14999013.2011.600602 Psychoanalytic Theory of Crime
- de Vries Robbé, M., de Vogel, V., & Douglas, K. S. (2013). Risk factors and protective factors: A twosided dynamic approach to violence risk assessment. The Journal of Forensic Psychiatry & Psychology, 24, 440–457. doi:10.1080/14789949.2013.818162
- de Vries Robbé, M., de Vogel, V., Wever, E. C., Douglas, K. S., & Nijman, H. L. I. (2016). Risk and protective factors for inpatient aggression. Criminal Justice and Behavior, 43, 1364–1385. doi:10.1177/0093854816637889
- Lodewijks, H. P. B., de Ruiter, C., & Doreleijers, T. A. H. (2010). The impact of protective factors in desistance from violent reoffending: A study in three samples of adolescent offenders. Journal of Interpersonal Violence, 25, 568–587. doi:10.1177/0886260509334403
- O’Shea, L. E., & Dickens, G. F. (2014). Short-Term Assessment of Risk and Treatability (START): Systematic review and meta-analysis. Psychological Assessment, 26, 990–1002. doi:10.1037/a0036794
Websites
- BC Mental Health & Substance Use Services, START. Retrieved from www.bcmhsus.ca/start
- SAPROF: Structured Assessment of Protective Factors for violence risk. Retrieved from www.saprof.com