Protective factors for sexual violence

Protective factors supporting desistance from general, violent and sexual offending have long remained understudied. Although the clinical value of a strengths focus has widely been acknowledged, until recently protective factors were virtually ignored in risk assessment practice. This is especially true for the risk assessment of those who previously committed sexual offenses. Desistance research and strengths based clinical experience sparked an interest in the value of protective factors for the prevention of recidivism among violent and sexual offenders alike. Very recently, a special issue of SAJRT was published focusing entirely on the potential value of protective factors for the risk assessment of individuals who offended sexually. Given the limited research on protective factors the evidence base for their value remains small. Especially when it comes to sexual recidivism, very little is know about factors enhancing desistance. Not surprising, few tools have been developed which specifically aim to assess protective factors for sexual offending.

Worling recently published a protective factors assessment tool for sexual violence risk in juveniles, the Desistence for Adolescents who Sexually Harm (DASH-13; Worling, 2013), intended as an additional tool to the risk focused ERASOR (Worling & Curwen, 2001). The DASH-13 includes two kinds of protective factors, those concerning general prosocial juvenile functioning and those relating specifically to future sexual health. Print and colleagues developed another juvenile sexual offending assessment tool named the AIM-2 (Print et al., 2009), which includes a substantial part on protective factors for general violent offending.

For adults, it seems no specific sexual offending protective factor assessment tools are available as of yet. However, there are tools focusing on protective factors for general violent offending (including sexual violence). The most prominent tool devoted entirely to the assessment of protective factors for (sexual) violence risk in adults is the Structured Assessment of Protective Factors for violence risk (SAPROF; de Vogel, de Ruiter, Bouman, & de Vries Robbé, 2009; 2^nd Edition 2012). This article aims to provide more insight into the clinical and empirical value of protective factors for the assessment of the risk of violent as well as sexual offending in adults who have previously sexually offended.

Exploring protective factors for sexual offending

The recently published SAJRT special issue on Protective factors included a paper which set out to explore potential protective factors that support desistance from sexual offending, by reviewing the available literature on this topic (de Vries Robbé, Mann, Maruna, & Thornton, 2015). The paper discusses the potential value of incorporating protective factors into the sexual violence risk assessment process. Three main reasons in particular are described why it may be important to consider protective factors as well as risk factors when assessing (sexual) violence risk. First, to do so could improve the predictive validity of the overall risk assessment. Second, a one-sided focus on risk can lead to over-prediction of violence risk, poor risk management and unbalanced treatment planning. Third, deficit-focused assessments can be stigmatizing for criminal justice clients. Protective factors are defined as strengths that lower the risk of reoffending. These factors may encompass personal, psychological and behavioral features as well as social, interpersonal and environmental factors. External or circumstantial features of an individual’s life situation may provide vital protection. Some protective factors operate at the opposing end of a risk domain (a clear distinction is drawn here between the opposite of a risk factor and the absence of a risk factor), while other protective factors do not have a risk factor counterpart. Regardless, the presence of a protective factor encompasses a risk reducing effect on future (sexual) violence (de Vries Robbé, 2014).

The aim in the sexual offending protective factor exploration paper was to integrate the findings from diverse sources to create a list of potential protective domains for sexual offending. Eight protective domains were proposed based on either being desistance factors for sexual offending or being healthy poles of well-established sexual offending risk domains. Additional support for the proposed domains was found in the general protective factors from the SAPROF, as this tool had proven to be predictive of sexual and violent re-offending by sexual offenders (de Vries Robbé, de Vogel, Koster, & Bogaerts, 2015). From this exploration of the literature, the following eight potential protective domains for sexual offending were proposed: Healthy sexual interests; Capacity for emotional intimacy; Constructive social and professional support network; Goal directed living; Good problem solving; Engaged in employment or constructive leisure activities; Sobriety; and Hopeful, optimistic and motivated attitude to desistance. Most of these domains actually concern factors which are also found to promote desistance from general violent offending in individuals with violent as well as sexually violent backgrounds. Only the healthy sexual interests domain seems to be specific to the desistance from sexual offending (de Vries Robbé et al., 2015e).

Recent empirical studies

Given the fact that most potentially protective domains are likely general domains which could enhance desistance from violent as well as sexual offending, it is not surprising that most studies described in the recent SAJRT Protective factors special issue attempted to include general protective factors measures in their sexual offender studies. Two papers in the special issue concerned the assessment of recidivism among adults with a history of sexual offending, while the other four concerned juveniles who sexually offended.

Adult offenders

Miller (2015) wrote an article in which self-perceived protective strengths, as measured by a general violence self-appraisal questionnaire the Inventory of Offender Risks Needs and Strengths (IORNS; Miller, 2006), were related to recidivism in adults who sexually offended. It was found that the strengths scale of the IORNS was predictive of general, violent and sexual recidivism in sexual offenders. Moreover, the protective strengths accounted for unique variance in sexual recidivism while controlling for overall risk. De Vries Robbé and colleagues (2015b) studied the predictive validity of the SAPROF for violent and sexually violent recidivism among adults with a history of sexual offending. The SAPROF contains 17 protective factors for general violent recidivism (including sexual violence), and is generally used in addition to risk focused risk assessment tools (such as the HCR-20^V3, SVR-20 or STABLE-2007). The study on adults who sexually offended showed good predictive validity of the SAPROF factors for short term (1-3 years) as well as long term (15 years) recidivism. This was true for violent as well as sexually violent recidivism. Moreover, the SAPROF remained a statistically significant predictor of future violence and sexual violence even after controlling for the various risk measures.

Several other studies also investigated the value of the SAPOROF for adults who sexually offended. A recent study by Turner and colleagues (2015) examined the assessment of risk in different groups of child sexual abusers (CSA), including several risk tools and one protective factors tool (SAPROF). The protective factors of the SAPROF showed to be predictive of desistance from any recidivism across all CSA. Prospective clinical studies into the predictive validity of the protective factors of the SAPROF for no violent incidents towards others during treatment, also demonstrated good results for those patients convicted of sexual offending (de Vries Robbé, de Vogel, Wever, Douglas, & Nijman, 2015). Moreover, a study into repeated risk assessments for adult violent and sexual offenders showed that the SAPROF factors were changeable during treatment, and that improvements on the protective factors during treatment were related to reduced (sexually) violent recidivism after treatment (de Vries Robbé, de Vogel, Douglas, & Nijman, 2015; de Vries Robbé, 2014).

Juvenile offenders

Van der Put and Asscher (2015) examined the impact of dynamic protective factors for delinquency in male adolescents with a history of sexual and/or violent offending as measured with a self-appraisal questionnaire the Washington State Juvenile Court Assessment (WSJCA; Barnoski, 2004). They found the protective factors of the WSJCA to be especially important for juveniles with a history of sexual offending, as the protective factors added to the predictive accuracy of general recidivism over and above risk factors.

Worling and Langton (2015) studied the impact of the strength scale of the parent-completed Behavioral and Emotional Rating Scale (BERS-2; Epstein, 2004) for adolescents who had sexually offended. Significant results were found for the predictive validity of the strengths scale for sexual recidivism and partly for that of nonsexual recidivism. Klein and colleagues (Klein, Rettenberger, Yoon, Köhler, & Briken, 2015) studied general protective factors for accused juveniles who sexually offended, as measured by the protective factors scale of the Structured Assessment of Violence Risk in Youth (SAVRY; Borum, Bartel, & Forth, 2006) and by the SAPROF (adult version). Although the SAVRY protective factors scale did not show significant predictive validity, the SAPROF was shown to be partially predictive of general and violent recidivism. No significant results were found specifically for sexual recidivism. Zeng, Meng Chu and Lee (2015) published a study on juveniles who sexually offended in Singapore. They also used the SAPROF (adult version), in addition to the DASH-13.

Although both protective factors tools were inversely related to the risk focused tool the ERASOR, neither tool demonstrated adequate predictive validity for sexual or general recidivism. Both the study by Klein and colleagues and the study by Zeng and colleagues unfortunately utilized the adult version of the SAPROF in their juvenile studies. In future studies on juvenile sexual offending it would be preferable to include the newly developed juvenile specific version of the SAPROF: the SAPROF – Youth Version (de Vries Robbé, Geers, Stapel, Hilterman, & de Vogel, 2015).

Clinical implications and further recommendations

The inclusion of notions of desistance and strengths may provide additional guidance to the assessment and treatment of those who sexually offend. The described recent articles have argued for a greater focus on protective factors in risk assessment, research and practice. From the literature review it seems most proposed strength domains influencing desistance from sexual offending are in fact reflected in general protective factors for violence risk, such as those assessed in the SAPROF. One protective domain in particular may yield additional promise for supporting desistance specifically from sexual offending: the domain of healthy sexual interests. Part of the juvenile protective factors tool, the DASH-13, specifically focuses on this domain, which could provide inspiration to the development of a similar additional tool for the assessment of healthy sexual interests in adult sexual offenders.

Further research investigations are recommended in order to consolidate the preliminary conclusions from recent studies regarding the nature and influence of protective factors in enabling individuals to desist from further offending. As described in the protective factors exploration paper, in recent years those who work in sexual offender treatment have shown an extensive interest in the Good Lives Model of offender rehabilitation (Ward & Gannon, 2006). As a strengths-based approach to understanding and treating sexual offending this has played an important role in enabling treatment practice to move away from more confrontational approaches. However, the field of sexual offending risk assessment still employs a predominantly deficit-focused approach. Given the recent advances in protective factors research and experience in clinical practice with newly developed strengths based tools, it seems the additional assessment of protective factors for (sexual) violence risk could further increase the predictive validity of our risk assessments, provide positive and potentially promising treatment goals, and enhance treatment motivation and service user involvement. Mental health care professionals engaged in sexual offender assessment and treatment are therefore advised to seriously consider incorporating the notion of protective factors into their assessments, research and treatment practice.

References

Barnoski, R. (2004). Assessing risk for re-offense: Validating the Washington State Juvenile Court Assessment (Report No. 04-03-1201). Olympia, WA: Washington State Institute for Public Policy.

Borum, R., Bartel, P., & Forth, A. (2006). Manual for the Structured Assessment for Violence Risk in Youth (SAVRY). Odessa, FL: Psychological Assessment Resources.

de Vogel, V., de Ruiter, C., Bouman, Y., & de Vries Robbé, M. (2009). SAPROF: Guidelines for the assessment of protective factors for violence risk. English version. Utrecht, The Netherlands: Forum Educatief.

de Vogel, V., de Ruiter, C., Bouman, Y., & de Vries Robbé, M. (2012). SAPROF: Guidelines for the assessment of protective factors for violence risk. 2^nd Edition. Utrecht, The Netherlands: De Forensische Zorgspecialisten.

de Vries Robbé, M. (2014). Protective factors. Validation of the structured assessment of protective factors for violence risk in forensic psychiatry. Utrecht, The Netherlands: Van der Hoeven Kliniek.

de Vries Robbé, M., de Vogel, V., Douglas, K.S., & Nijman, H.L.I. (2015a). Changes in dynamic risk and protective factors for violence during inpatient forensic psychiatric treatment: Predicting reductions in post-discharge community recidivism. Law and Human Behavior, 39, 53-61.

de Vries Robbé, M., de Vogel, V., Koster, K., & Bogaerts, S. (2015b). Assessing protective factors for sexually violent offending with the SAPROF. Sexual Abuse: A Journal of Research and Treatment, 27, 51-70.

de Vries Robbé, M., de Vogel, V., Wever, E.C., Douglas, K.S., & Nijman, H.L.I. (2015c). Risk and protective factors for inpatient aggression. Manuscript submitted for publication.

de Vries Robbé, M., Geers, M.C.K., Stapel, M., Hilterman, E.L.B., & de Vogel, V. (2015d). SAPROF - Youth Version. Guidelines for the assessment of protective factors for violence risk in juveniles. Utrecht, The Netherlands: Van der Hoeven Kliniek.

de Vries Robbé, M., Mann, R.E., Maruna, S., & Thornton, D. (2015e). An exploration of protective factors supporting desistance from sexual offending. Sexual Abuse: A Journal of Research and Treatment, 27, 16-33.

Epstein, M.H. (2004). Behavioral and emotional rating scale. A strengths-based approach to assessment (2nd ed.). Austin, TX: PRO-ED.

Klein, V., Rettenberger, M., Yoon, D., Köhler, N., & Briken, P. (2015). Protective factors and recidivism in accused juveniles who sexually offended. Sexual Abuse: A Journal of Research and Treatment, 27, 71-90.

Miller, H.A. (2006). Inventory of Offender Risk, Needs, and Strengths (IORNS). Professional manual. Lutz, Florida: Psychological Assessment Resources Inc.

Miller, H.A. (2015). Protective strangths, risk, and recidivism in a sample of known sexual offenders. Sexual Abuse: A Journal of Research and Treatment, 27, 34-50.

Print, B., Griffin, H., Beech, A. R., Quayle, J., Bradshaw, H., Henniker, J. & Morrison, T. (2009). AIM2: An initial assessment model for young people who display sexually harmful behaviour [unpublished scoring manual]. Available from www.aimproject.org.uk.

Turner, D., Rettenberger, M., Yoon, D., Klein, V., Eher, R., & Briken, P. (2015). Risk assessment in child sexual abusers working with children. Sexual Abuse: A Journal of Research and Treatment, online first.

van der Put, C.E., & Asscher, J.J. (2015). Protective factors in male adolescents with a history of sexual and/or violent offending. A comparison between three subgroups. Sexual Abuse: A Journal of Research and Treatment, 27, 109-126.

Worling, J.R. (2013). Desistence for Adolescents who Sexually Harm (DASH-13). [unpublished scoring manual]. Available from: www.erasor.org/new-protective-factors.html.

Worling, J.R., & Curwen, T. (2001). Estimate of Risk of Adolescent Sexual Offense Recidivism (ERASOR; Version 2.0). In M.C. Calder (Ed.), Juveniles and children who sexually abuse: Frameworks for assessment (pp. 372-397). Lyme Regis, Dorset, UK: Russell House Publishing.

Worling, J.R., & Langton, C.M. (2015). A prospective investigation of factors that predict desistance from recidivism for adolescents who have sexually offended. Sexual Abuse: A Journal of Research and Treatment, 27, 127-142.

Zeng, G., Chu, C.M., & Lee, Y. (2015). Assessing Protective Factors of Youth Who Sexually Offended in Singapore Preliminary Evidence on the Utility of the DASH-13 and the SAPROF. Sexual Abuse: A Journal of Research and Treatment, 27, 91-108.