Trauma and institutional risk in a secure developmental disorder service: does the SAVRY inflate risk in adolescents exposed to ACEs?

Abstract

Purpose Adverse childhood experiences (ACEs) are highly prevalent in people with developmental disorders who engage in offending behaviour. Many violence-based risk assessment tools include items pertaining to ACEs, and may inflate risk scores in trauma-exposed groups. This paper aims to explore the relationships between ACEs, risk assessment scores, incidents of risk and restrictive practices, in adolescents with developmental disorders in a forensic inpatient setting. Design/methodology/approach Secondary analysis was conducted on clinical data for 34 adolescents detained to a developmental disorder service. Data were extracted for Structured Assessment of Violence Risk in Youth (SAVRY) risk scores and risk behaviours and restrictive practices, as measures of observed risk. Findings Participants exposed to more ACEs had higher SAVRY risk scores (p < 0.001, two-tailed), with elevations specifically on the historical subscale (p < 0.001, two-tailed). Neither ACEs nor risk scores were associated with the frequency of risk behaviours. Nevertheless, participants exposed to four or more ACEs were secluded more frequently (p = 0.015, two-tailed), indicating a potential association between trauma and risk severity. Those with more complex developmental disorders experienced fewer ACEs (p = 0.02, two-tailed) and engaged in self-harm behaviours less frequently (p = 0.04, two-tailed). Research limitations/implications The inclusion of ACEs in risk assessment tools may lead to the inadvertent stigmatization of trauma-exposed individuals. Further investigation is necessary to offer clarity on the impact of early adversity on risk assessment accuracy and levels of institutional risk, and the role of developmental disorders in this relationship. Originality/value To the best of the authors’ knowledge, this study is the first to explore the relative associations between ACEs, risk assessment scores and observed institutional risk and does so in a highly marginalized population.

Risk and protective factors for self-harm in secure mental health hospitals: a systematic review

“…Theme 6: Constraints of a secure environment and lack of control (11 articles, 19%) There were various factors deemed important in the secure environment that increased the risk of self-harm. For example, waiting for things (Selenius and Strand, 2017), use of restraints and penal measures (S ˇendula-Jengi c et al, 2004;Webb et al, 2022) and not having access to preferred items or substances, such as nicotine (Zhong et al, 2019). Further factors included being locked in (Liebling et al, 1997) and isolation (Challinor et al, 2021).…”

“…Approximately a fifth of articles identified that those who engaged in self-harm also engaged in aggression directed at others and objects, termed dual harm (Hillbrand et al , 1994; Nijman and à Campo, 2005; Selenius and Strand, 2017; Šendula-Jengić et al , 2004; Verstegen et al , 2020; Webb et al , 2022). It was noted that this was especially the case for those who repeatedly engaged in self-harm, with the aggression they displayed more severe than for those who did not self-harm (Hillbrand et al , 1996; O’Shea et al , 2014) Long et al (2012) noted that those who were transferred from prison to a secure hospital also displayed elevated levels of aggression to others, during the first six months following transfer.…”

Violent behaviour in adolescents: assessment and formulation using a structured risk assessment tool

“…Similarly, some have argued that those risk factors involving adverse childhood events (Webb 2022) (e.g. early caregiver disruption) erroneously cause higher risk ratings in those with developmental disorders, as these populations are known to experience higher rates of traumatic events.…”