Risk Assessment in Juvenile and Young Adult Offenders: Predictive Validity of the SAVRY and SAPROF-YV.

Most juvenile risk assessment tools heavily rely on a risk-focused approach. Less attention has been devoted to protective factors. This study examines the predictive validity of protective factors in addition to risk factors, and developmental differences in psychometric properties of juvenile risk assessment. For a national Dutch sample of 354 juvenile and young adult offenders (16-26 years) risk and protective factors were retrospectively assessed at discharge from seven juvenile justice institutions, using the Structured Assessment of Violence Risk in Youth (SAVRY) and Structured Assessment of Protective Factors for violence risk - Youth Version (SAPROF-YV). Results show moderate validity for both tools predicting general, violent, and nonviolent offending at different follow-up times. The SAPROF-YV provided incremental predictive validity over the SAVRY, and predictive validity was stronger for younger offenders. Evidently both the SAVRY and SAPROF-YV seem valid tools for the assessment of recidivism risk in juvenile and young adult offenders. Results highlight the importance of protective factors, especially in juvenile offenders, emphasizing the need for a balanced risk assessment.

Towards Integrated Youth Care: A Systematic Review of Facilitators and Barriers for Professionals.

To overcome fragmentation in support for children and their families with multiple and enduring problems across life domains, professionals increasingly try to organize integrated care. However, it is unclear what facilitators and barriers professionals experience when providing this integrated care. Our systematic review, including 55 studies from a broad variety of settings in Youth Care, showed that integrated care on a professional level is a multi-component entity consisting of several facilitators and barriers. Findings were clustered in seven general themes: 'Child's environment', 'Preconditions', 'Care process', 'Expertise', 'Interprofessional collaboration', 'Information exchange', and 'Professional identity'. The identified facilitators and barriers were generally consistent across studies, indicating broad applicability across settings and professional disciplines. This review clearly shows that when Youth Care professionals address a broad spectrum of problems, a variety of facilitators and barriers should be considered.Registration PROSPERO, registration number CRD42018084527.

What Do Parents Expect in the 21st Century? A Qualitative Analysis of Integrated Youth Care.

INTRODUCTION: To provide integrated Youth Care responsive to the needs of families with multiple problems across life domains, it is essential to incorporate parental perspectives into clinical practice. The aim of this study is to advance our understanding of key components of integrated Youth Care from a parental perspective. METHODS: Semi-structured interviews were administered to 21 parents of children receiving Youth Care from integrated care teams in the Netherlands. Qualitative content analysis was conducted by means of a grounded theory approach following qualitative reporting guidelines. RESULTS AND DISCUSSION: Parental perspectives were clustered into six key components: a holistic, family-centred approach; addressing a broad range of needs in a timely manner; shared decision making; interprofessional collaboration; referral; and privacy. Parents emphasized the importance of a tailored, family-centred approach, addressing needs across several life domains, and active participation in their own care process. However, they simultaneously had somewhat opposing expectations regarding these key components, for example, concerning the changing roles of professionals and parents in shared decision making and the value of involving family members in a care process. Professionals should be aware of these opposing expectations by explicitly discussing mutual expectations and changing roles in decision making during a care process. To enable parents to make their own decisions, professionals should transparently propose different options for support guided by an up-to-date care plan.

How Do Forensic Clinicians Decide? A Delphi Approach to Identify Domains Commonly Used in Forensic Juvenile Treatment Planning.

Adolescents in forensic care display wide varieties of complex psychiatric, psychological, and contextual problems. Based on large amounts of information, clinicians need to consider, integrate, and prioritize these offender characteristics to construct individual treatment trajectories. So far, scientific knowledge on how these treatment decisions take place is scarce. Current study uses a qualitative design for detecting implicit knowledge of clinicians on which offender characteristics they consider while making treatment decisions. Using the Delphi method, 34 experienced clinicians working in forensic care facilities in the Netherlands were asked about the most important domains of offender characteristics that influence their treatment planning. Eight domains were identified as being crucial in treatment planning: Mental health problems, Personal characteristics, Family, Offense, Motivation, Treatment, School/Work/Housing, and Peers/Spare time. Based on current results, focus on a broad spectrum of individual and contextual characteristics is recommended. Moreover, protective factors and comorbid problems on multiple domains should be considered.

Many, more, most: four risk profiles of adolescents in residential care with major psychiatric problems.

BACKGROUND: The development of delinquent behaviour is largely determined by the presence of (multiple) risk factors. It is essential to focus on the patterns of co-occurring risk factors in different subgroups in order to better understand disruptive behaviour. AIMS AND HYPOTHESIS: The aim of this study was to examine whether subgroups could be identified to obtain more insight into the patterns of co-occurring risk factors in a population of adolescents in residential care. Based on the results of prior studies, at least one subgroup with many risk factors in multiple domains and one subgroup with primarily risk factors in a single domain were expected. METHODS: The structured assessment of violence risk in youth and the juvenile forensic profile were used to operationalize eleven risk factors in four domains: individual, family, peer and school. Data from 270 male adolescents admitted to a hospital for youth forensic psychiatry and orthopsychiatry in the Netherlands were available. Latent class analysis was used to identify subgroups and significant differences between the subgroups were examined in more detail. RESULTS: Based on the fit statistics and the clinical interpretability, the four-class model was chosen. The four classes had different patterns of co-occurring risk factors, and differed in the included external variables such as psychopathology and criminal behaviour. CONCLUSIONS: Two groups were found with many risk factors in multiple domains and two groups with fewer (but still several) risk factors in single domains. This study shed light on the complexity of disruptive behaviour, providing a better insight into the patterns of co-occurring risk factors in a heterogeneous population of adolescents with major psychiatric problems admitted to residential care.

Serious juvenile offenders: classification into subgroups based on static and dynamic charateristics.

BACKGROUND: The population in juvenile justice institutions is heterogeneous, as juveniles display a large variety of individual, psychological and social problems. This variety of risk factors and personal characteristics complicates treatment planning. Insight into subgroups and specific profiles of problems in serious juvenile offenders is helpful in identifying important treatment indicators for each subgroup of serious juvenile offenders. METHODS: To identify subgroups with combined offender characteristics, cluster-analyses were performed on data of 2010 adolescents from all juvenile justice institutions in the Netherlands. The study included a wide spectrum of static and dynamic offender characteristics and was a replication of a previous study, in order to replicate and validate the identified subgroups. To identify the subgroups that are most useful in clinical practice, different numbers of subgroup-solutions were presented to clinicians. RESULTS: Combining both good statistical fit and clinical relevance resulted in seven subgroups. Most subgroups resemble the subgroups found in the previous study and one extra subgroups was identified. Subgroups were named after their own identifying characteristics: (1) sexual problems, (2) antisocial identity and mental health problems, (3) lack of empathy and conscience, (4) flat profile, (5) family problems, (6) substance use problems, and (7) sexual, cognitive and social problems. CONCLUSIONS: Subgroups of offenders as identified seem rather stable. Therefore risk factor scores can help to identify characteristics of serious juvenile offenders, which can be used in clinical practice to adjust treatment to the specific risk and needs of each subgroup.

Childhood traumatic experiences and mental health problems in sexually offending and non-sexually offending juveniles.

OBJECTIVE: To examine the relationship between a history of childhood abuse and mental health problems in juveniles who sexually offended (JSOs) over and above general offending behavior. METHODS: A sample of 44 JSOs incarcerated in two juvenile detention centers in the Netherlands between May 2008 and March 2014 were examined for childhood abuse history (Childhood Trauma Questionnaire-Short Form) and mental health problems (Massachusetts Youth Screening Instrument-Version 2). Furthermore, the connection between childhood abuse and mental health problems in JSOs was compared to a sample of 44 propensity score matched juveniles who offended non-sexually (non-JSOs). RESULTS: In JSOs, sexual abuse was related to anger problems, suicidal ideation, and thought disturbance. These associations were significantly stronger in JSOs than in non-JSOs. CONCLUSIONS: Our results suggest that the relationship between childhood abuse and both internalizing and externalizing mental health problems is of more salience for understanding sexual offending than non-sexual offending, and should, therefore, be an important focus in the assessment and treatment of JSOs.

The association between childhood maltreatment, mental health problems, and aggression in justice-involved boys.

The link between childhood maltreatment and adolescent aggression is well documented; yet, studies examining potential mechanisms that explain this association are limited. In the present study, we tested the association between childhood maltreatment and adolescent aggression in boys in juvenile justice facilities (N = 767) and examined the contribution of mental health problems to this relationship. Data on childhood maltreatment, mental health problems, and aggression were collected by means of self-report measures and structural equation models were used to test mediation models. We found that mental health problems mediated the link between maltreatment and aggression. Results demonstrated different pathways depending on the type of aggression examined. The association between childhood maltreatment and reactive aggression was fully mediated by a variety of mental health problems and for proactive aggression the association was partially mediated by mental health problems. We also found that reactive and proactive aggression partially mediated the association between maltreatment and mental health problems. These findings suggest that a transactional model may best explain the negative effects of childhood trauma on mental health problems and (in particular reactive) aggression. In addition, our findings add to the existing evidence that reactive and proactive aggression have different etiological pathways.