The Short-Term Assessment of Risk and Treatability: Adolescent Version (START:AV; Nicholls, Viljoen, Cruise, Desmarais, & Webster, 2010; Viljoen, Cruise, Nicholls, Desmarais, & Webster, in preparation) is a clinical guide designed to assist in the assessment and management of adolescents’ risk for adverse events (e.g., violence, general offending, suicide, victimization). In this initial validation study, START:AV assessments were conducted on 90 adolescent offenders (62 male, 28 female), who were prospectively followed for a 3-month period. START:AV assessments had good to excellent inter-rater reliability and strong concurrent validity with Structured Assessment of Violence Risk in Youth assessments (SAVRY; Borum, Bartel, & Forth, 2006). START:AV risk estimates and Vulnerability total scores predicted multiple adverse outcomes, including violence towards others, offending, victimization, suicidal ideation, and substance abuse. In addition, Strength total scores inversely predicted violence, offending, and street drug use. During the 3-month follow-up, risk estimates changed in at least one domain for 92% of youth, and 27% of youth showed reliable changes in Strength and/or Vulnerability total scores (reliable change index, 90% confidence interval; Jacobsen & Truax, 1991). While these findings are promising, a strong need exists for further research on the START:AV, the measurement of change, and on the role of strengths in risk assessment and treatment-planning.
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.
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.
When an adolescent commits a crime, youth justice professionals must make important decisions about which interventions to provide. Judges must decide whether to incarcerate an adolescent or use community-based treatments. Youth probation officers and case managers face decisions regarding whether to refer the adolescent to therapy and, if so, what kind. Also, mental health professionals must make ongoing decisions about specific issues to address in therapy (e.g., anger management skills, problem-solving skills) and specific techniques to use (e.g., cognitive-behavioral therapy [CBT], specific skills training).The treatment-related decisions that professionals make have a tremendous impact; if effective and empirically supported approaches are used, many adolescents can successfully desist from offending and achieve important developmental milestones (e.g., complete high school, obtain a stable job, develop healthy relationships; Henggeler & Sheidow, 2012). Furthermore, preventing a single youth from engaging in a life of crime saves society $2.6 million to $5 million, including savings in the costs of operating the justice system (e.g., running youth detention facilities) and addressing harms that victims experience (e.g., providing medical and mental health treatment to victims; Cohen & Piquero, 2009).Conversely, if ineffective strategies are used, adolescents' criminal behavior can escalate, become entrenched, and spiral into other difficulties, such as substance abuse, unemployment, early parenthood, and perpetration of family violence, such as violence toward their children or intimate partners (Moffitt, Caspi, Harrington, & Milne, 2002). In fact, although theory from the 1990s asserted that most adolescent offenders are adolescent-limited offenders who desist from offending as they mature and enter adulthood, more recent research has shown that individuals who start offending during adolescence do not necessarily spontaneously desist (Moffitt et al., 2002;Piquero, Diamond, Jennings, & Reingle, 2013). Furthermore, individuals who begin offending at an earlier age, in childhood, show high persistence in reoffending. In other words, it is not feasible to simply wait until youths mature out of their offending behavior. Instead, implementation of effective interventions is essential.To guide intervention planning and delivery, two independent bodies of research have developed. The first focuses on risk assessment and risk management (Heilbrun, 2003). It is led primarily by forensic researchers, who have developed risk assessment tools and intervention-matching principles. The second body of research is often referred to as "what-works" research. It is led by intervention researchers and child clinical or developmental psychologists who have identified empirically supported intervention programs. In general, risk assessment and risk management research tends to focus heavily on front-line assessments by professionals from various disciplines (e.g., youth probation officers, psychologists) and overarching princip...
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