Clinical Assessments

[From CSOM.org]

Mental health professionals are frequently called upon to conduct specialized clinical assessments of adult and juvenile sex offenders, oftentimes at an early point in the management process. Because these evaluators are responsible for illuminating some of the complex and unique dynamics involved with the offenders in these cases, and because of the considerable weight that is often placed on these evaluations, the practitioners who conduct psychosexual evaluations must have specialized training and experience in the field (see, e.g., ATSA, 2005; NAPN, 1993). The primary forms of clinical assessments include the following:

• Psychosexual or sex offender–specific evaluations;
• Psychiatric assessments; and
• Physiological assessments of deviant arousal, interests, and preferences.

Psychosexual Evaluations

During the sentencing or disposition phase of the court process, psychosexual evaluations (sometimes referred to as sex offender–specific evaluations) are often requested. Generally speaking, psychosexual evaluations are designed to identify the following (see ATSA, 2005):

• Level of risk for sexual and non–sexual recidivism;
• Recommended types and intensity of interventions that will be most beneficial, including level of care (e.g., community versus more secure placement);
• The specific dynamic risk factors or criminogenic needs to be targeted through interventions;
• Amenability to interventions;
• Responsivity factors that may impact engagement in and response to interventions; and
• Strengths and protective factors relative to the individual, as well as those that exist within family, peer, and other community support systems.

Conversely, psychosexual evaluations should never be used for any of the following purposes:

• Determining guilt or innocence (which is well outside of the scope and boundaries of the mental health professional’s role);
• Identifying whether an individual is or is not a “sex offender” (which is not an appropriate referral question, because no specific type of assessment or set of assessment tools is designed for making this determination); or
• Concluding whether an adult or juvenile meets the “profile” of a sex offender (which does not exist; research consistently demonstrates the diversity of adults and juveniles who have committed sex offenses).

Timing

Ideally, psychosexual evaluations are conducted pre–sentence or disposition and post–conviction or adjudication as a means of assisting judges and other interested parties with making well–informed disposition determinations. When conducted prior to the official ruling or finding by the trier–of–fact, several ethical and other controversies may arise. Included among these concerns are the potential for the defendant’s self–incrimination pertaining to current allegations, the possibility of additional charges being pursued because of disclosures of previously undetected offenses, and the introduction of overly prejudicial information that undermines the presumption of innocence or that otherwise influences the court’s finding.

In a limited number of circumstances, some of these concerns may be potentially mitigated, such as when the adult or juvenile admits to the allegations or agrees to the evaluation on the advice of counsel, when all parties agree to a pre–plea evaluation and agree to follow any recommendations as part of a plea negotiation process, or when the prosecution agrees not to file additional charges based on information disclosed during a pre–plea evaluation. Nonetheless, psychosexual evaluations are maximally useful and less subject to controversy when conducted following a conviction or adjudication.

Content and Strategy

Although similar to “general” psychological evaluations in some ways (e.g., conducting a social history, identifying potential mental health needs, using intellectual and/or personality testing, exploring harm to self or others), psychosexual evaluations are distinct in a number of ways. For example, the psychosexual evaluation is forensic in nature, which generally means that the subject is often non–voluntary and the referral stems from legal proceedings. In addition, a rather unique and critical component of the psychosexual evaluation is the detailed and thorough sexual history, which includes the exploration of sexual development, attitudes, fantasies, and adjustment. And as discussed later in this section, the selective use of physiological assessment tools (e.g., plethysmograph, viewing time, polygraph) to identify sexual arousal, interests, and preferences is specific to this specialized assessment process. Taken together, these and other elements set the psychosexual evaluation apart from the general psychological evaluation.

To enhance the reliability, comprehensiveness, and usefulness of psychosexual evaluations, multiple sources of data must be taken into account. Important sources of information include relevant documentation (e.g., police reports, victim statements, prior treatment records, school records), interviews with the adult or juvenile sex offender, interviews with non–offending partners (or parents, when a juvenile is the subject of the evaluation), and both general and sex offense–specific assess ment instruments.To enhance the reliability, comprehensiveness, and usefulness of psychosexual evaluations, multiple sources of data must be taken into account.

When conducting psychosexual evaluations, assessors should explore offense–related factors such as the frequency, chronicity, and range of sexually abusive behaviors, the targets of the sex offenses, the individual’s (and victim’s) account of the offense, potential motivators and disinhibitors, and any previously undetected sexually abusive behaviors. Also important to consider are the presence or absence of social supports, current living arrangements—particularly with respect to access to victims or potentially vulnerable persons—and the ability and willingness of other responsible adults within the home to provide adequate safeguards as necessary.

Effective interviewing techniques are a vital aspect of the psychosexual evaluation. Because an overarching goal of an assessment is to collect quality information, evaluators must adopt a style and approach (e.g., non–adversarial, respectful, non–judgmental) that will ultimately facilitate engagement, active participation, and disclosure throughout the evaluation process. As highlighted previously, Motivational Interviewing offers a valuable framework for practitioners responsible for assessment and intervention with sexually abusive individuals (Miller & Rollnick, 2002; Ginsburg et al., 2002).

As is the case with all clinical assessments, informed consent should be obtained from the individual (and from parents/guardians of youth or developmentally disabled persons). Practitioners must ensure that the subject understands the nature and purpose of evaluation, various techniques utilized, limits of confidentiality, and risks and benefits associated with participating.The use of tools designed for juveniles is critical, given the developmental and other differences between juveniles and adults.

Empirically–validated actuarial tools (e.g., RRASOR, STATIC–99) should be used to estimate risk for adult sex offenders and, for youthful sex offenders, the best empirically–supported tools (presently the ERASOR, J–SOAP–II, or J–SORRAT–II) should be used to inform risk determinations, keeping in mind the strengths and limitations of these tools. In addition, because researchers have identified dynamic variables that are linked with sexual recidivism among individuals who have committed sex offenses, evaluators should consider those variables as well. Research–based assessment instruments such as the Sex Offender Treatment Needs and Progress Scale (McGrath & Cumming, 2003), and the Psychopathy Checklist–Revised (PCL–R; Hare, 2003) could be used to identify these types of risk factors with adults.

Juvenile–Specific Considerations

With respect to evaluating juveniles who have committed sex offenses, many of the previously identified dynamic risk factors (e.g., deviant sexual interests, antisocial values and behaviors, pro–offending attitudes, impulsivity) are important to consider because of their identified or suggested relationship with recidivism among youth (see Hunter, Figueredo, Malamuth, & Becker, 2003; Prescott, 2006; Worling & Langstrom, 2006). In addition, assessors of juvenile sex offenders should also take into account factors such as problematic parent–child relationships, social isolation, poor social skills, negative peer relationships, exposure to violence in the home, and access to sexually exploitative materials (see Hunter et al., 2003; Prescott, 2006; Worling & Langstrom, 2006).

Moreover, the multiple systems that have important influences on youths’ development, such as family, school, peer, and community, must be carefully examined during the psychosexual evaluation process with juvenile sex offenders (see, e.g., Hunter, 2006; Prescott, 2006). For example, an assessment of a youth’s parents or caregivers should be included as part of the psychosexual evaluation, including any parental risk factors (e.g., substance abuse, domestic violence, unaddressed mental health needs, criminal justice involvement), the level of structure and supervision within the home, and their willingness and ability to support intervention efforts.

As emphasized earlier, the use of tools designed for juveniles is critical, given the developmental and other differences between juveniles and adults and the need to increase the reliability and validity of assessment results (Fanniff & Becker, 2006b; Prescott, 2006; Worling & Langstrom, 2006). In addition to juvenile sex offense–specific tools (e.g., CANS–SD, ERASOR, J–SOAP–II), several non sex offense–specific instruments for youth can be useful for evaluators as they attempt to explore multiple areas of risk and needs. For example, the Structured Assessment of Violence Risk in Youth (SAVRY; Borum, Bartel, & Forth, 2002) and the Psychopathy Checklist–Youth Version (PCLYV; Forth, Kosson, & Hare, 2003) can be used to estimate violent recidivism (not specific to sexual recidivism) and to identify the presence of psychopathic traits among juveniles, respectively.

At all times, evaluators must take into account the age, maturity, and level of functioning of the youth, not only in terms of selecting assessment tools, but also with respect to their interactions with the youth during the course of the evaluation and as they synthesize and present the findings in the written report.