Although the Structured Assessment of Violence Risk in Youth (SAVRY) and the Youth Level of Service/Case Management Inventory (YLS/CMI) are among the most widely used adolescent risk assessment tools, they conceptualize and measure strengths differently. As such, in this study, we compared the predictive validity of SAVRY Protective Total and YLS/CMI Strength Total, and tested conceptual models of how these measures operate (i.e., risk vs. protective effects, direct vs. buffering effects, causal models). Research assistants conducted 624 risk assessments with 156 youth on probation. They rated protective factors at baseline, and again at 3-, 6-, 9-, and 12-month follow-up periods. The SAVRY Protective Total and YLS/CMI Strength Total inversely predicted any charges in the subsequent 2 years (area under the curve scores = 0.61 and 0.60, respectively, p < .05). Furthermore, when adolescents' protective total scores increased, their self-reported violence decreased, thus providing evidence that these factors might play a causally relevant role in reducing violence. However, protective factors did not provide incremental validity over risk factors. In addition, because these measures are brief and use a dichotomous rating system, they primarily captured deficits in protective factors (i.e., low scores). This suggests a need for more comprehensive measures.

Although experts recommend regularly reassessing adolescents' risk for violence, it is unclear whether reassessment improves predictions. Thus, in this prospective study, the authors tested 3 hypotheses as to why reassessment might improve predictions, namely the shelf-life, dynamic change, and familiarity hypotheses. Research assistants (RAs) rated youth on the Structured Assessment of Violence Risk in Youth (SAVRY) and the Youth Level of Service/Case Management Inventory (YLS/CMI) every 3 months over a 1-year period, conducting 624 risk assessments with 156 youth on probation. The authors then examined charges for violence and any offense over a 2-year follow-up period, and youths' self-reports of reoffending. Contrary to the shelf-life hypothesis, predictions did not decline or expire over time. Instead, time-dependent area under the curve scores remained consistent across the follow-up period. Contrary to the dynamic change hypothesis, changes in youth's risk total scores, compared to what is average for that youth, did not predict changes in reoffending. Finally, contrary to the familiarity hypothesis, reassessments were no more predictive than initial assessments, despite RAs' increased familiarity with youth. Before drawing conclusions, researchers should evaluate the extent to which youth receiving the usual probation services show meaningful short-term changes in risk and, if so, whether risk assessment tools are sensitive to these changes. Public Significance StatementIn this study, two adolescent risk assessment tools predicted reoffending among adolescent offenders. However, despite recommendations to reassess risk regularly, short-term reassessments did not improve predictions, suggesting a need for further research.

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Although many adolescent risk assessment tools include an emphasis on dynamic factors, little research has examined the extent to which these tools are capable of measuring change. In this article, we outline a framework to evaluate a tool’s capacity to measure change. This framework includes the following: (a) measurement error and reliable change, and (b) sensitivity (i.e., internal, external, and relative sensitivity). We then used this framework to evaluate the Structured Assessment of Violence Risk in Youth (SAVRY) and Youth Level of Service/Case Management Inventory (YLS/CMI). Research assistants conducted 509 risk assessments with 146 adolescents on probation (101 male, 45 female), who were assessed every 3 months over a 1-year period. Internal sensitivity (i.e., change over time) was partially supported in that a modest proportion of youth showed reliable changes over the 3-, 6-, and 12-month follow-ups. External sensitivity (i.e., the association between change scores and reoffending) was also partially supported. In particular, 22% of the associations between change scores and any and violent reoffending were significant at a 6-month follow-up. However, only 1 change score (i.e., peer associations) remained significant after the Bonferroni correction was applied. Finally, relative sensitivity was not supported, as the SAVRY and YLS/CMI was not more dynamic than the Psychopathy Checklist: Youth Version (PCL:YV). Specifically, the 1-year rank-order stability coefficients for the SAVRY, YLS/CMI, and PCL:YV Total Scores were .78, .75, and .76, respectively. Although the SAVRY and YLS/CMI hold promise, further efforts may help to enhance sensitivity to short-term changes in risk.

Although the Juvenile Sex Offender Assessment Protocol–II (J-SOAP-II) and the Structured Assessment of Violence Risk in Youth (SAVRY) include an emphasis on dynamic, or modifiable factors, there has been little research on dynamic changes on these tools. To help address this gap, we compared admission and discharge scores of 163 adolescents who attended a residential, cognitive-behavioral treatment program for sexual offending. Based on reliable change indices, one half of youth showed a reliable decrease on the J-SOAP-II Dynamic Risk Total Score and one third of youth showed a reliable decrease on the SAVRY Dynamic Risk Total Score. Contrary to expectations, decreases in risk factors and increases in protective factors did not predict reduced sexual, violent nonsexual, or any reoffending. In addition, no associations were found between scores on the Psychopathy Checklist:Youth Version and levels of change. Overall, the J-SOAP-II and the SAVRY hold promise in measuring change, but further research is needed.

Even when probation officers use risk assessment tools, many of their clients' needs remain unaddressed. As such, we examined whether the implementation of the Structured Assessment of Violence Risk in Youth (SAVRY) and a structured case planning form resulted in better case plans as compared to prior practices (i.e., a non-validated local tool and an unstructured plan). Our sample comprised 216 adolescents on probation who were matched via propensity scores. Adolescents in the SAVRY/Structured Plan condition had significantly better case plans than those in the pre-implementation condition. Specifically, following implementation, adolescents' high need domains were more likely to be targeted in plans. Plans also scored higher on other quality indicators (e.g., level of detail). These improvements appeared to be due primarily to the structured plan rather than the SAVRY. Overall, our findings highlight that, just as structure can improve risk assessments, so too might structure improve case plans.

Physician-assisted death (PAD) has been enacted in a number of international jurisdictions, with several extending access to PAD for persons whose condition is not terminal, including those with a mental disorder. We argue that based on the state of the literature, it is too early to make well-defined recommendations on how relevant fields can proceed legally, ethically, and clinically, particularly with regard to PAD for persons with a mental disorder. The aim of this paper is to introduce a framework for further discussions on PAD for persons with a mental disorder to stimulate thoughtful and considered debate in our field. We provide a brief discussion of the principles that guide regulatory frameworks on PAD practices worldwide, including a discussion of jurisdictions in Europe and North America that allow PAD for those suffering from an incurable nonterminal disease, illness, or disability. Next, we present a conceptual framework as a series of questions that address legal, ethical, and clinical dilemmas arising from this trend. We conclude with a summary of guidelines on the practice of PAD from international jurisdictions to assist in the development of potential legal and professional regulations.

Even though risk assessment tools are often intended to inform case planning, they do not provide much direct guidance. As such, we developed an intervention-planning tool called the Adolescent Risk Reduction and Resilient Outcomes Work-Plan (ARROW) to accompany the Structured Assessment of Violence Risk in Youth. The ARROW includes a decision support system, guide, and training, and is one of the first tools of its kind. To evaluate the ARROW, we conducted two studies: (a) a vignette study with 178 professionals and (b) a field study with 320 propensity-score matched adolescents. Most professionals (>98%) rated the ARROW as useful. Moreover, compared with (a) unstructured plans and (b) a simple form, ARROW plans were more likely to include supported interventions, adhere to best practices, and integrate culturally tailored approaches for Indigenous adolescents. Formulations also showed improvements. However, further research is needed on strategies to bridge risk assessment and risk management.