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Psychological Services is an American Psychological Association Division publication. The official publication of the Division of Psychologists in Public Service (Division 18), Psychological Services publishes high-quality data-based articles on the broad

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Violence risk assessment and psychological treatment in correctional and forensic settings: Advances in research and practice.


This article is an introduction to the special section “Correctional and Criminal Justice Psychology.” The eight articles in this issue advance the goals of delivering and assessing psychological services within the legal and correctional systems and achieving lasting change in individuals, groups, and systems. (PsycINFO Database Record (c) 2016 APA, all rights reserved)(image)

Performance of recidivism risk assessment instruments in U.S. correctional settings.


With the population of adults under correctional supervision in the United States at an all-time high, psychologists and other professionals working in U.S. correctional agencies face mounting pressures to identify offenders at greater risk of recidivism and to guide treatment and supervision recommendations. Risk assessment instruments are increasingly being used to assist with these tasks; however, relatively little is known regarding the performance of these tools in U.S. correctional settings. In this review, we synthesize the findings of studies examining the predictive validity of assessments completed using instruments designed to predict general recidivism risk, including committing a new crime and violating conditions of probation or parole, among adult offenders in the United States. We searched for studies conducted in the United States and published between January 1970 and December 2012 in peer-reviewed journals, government reports, master’s theses, and doctoral dissertations using PsycINFO, the U.S. National Criminal Justice Reference Service Abstracts, and Google. We identified 53 studies (72 samples) conducted in U.S. correctional settings examining the predictive validity of 19 risk assessment instruments. The instruments varied widely in the number, type, and content of their items. For most instruments, predictive validity had been examined in 1 or 2 studies conducted in the United States that were published during the reference period. Only 2 studies reported on interrater reliability. No instrument emerged as producing the “most” reliable and valid risk assessments. Findings suggest the need for continued evaluation of the performance of instruments used to predict recidivism risk in U.S. correctional agencies. (PsycINFO Database Record (c) 2016 APA, all rights reserved)(image)

The increasing influence of risk assessment on forensic patient review board decisions.


Previous studies of decisions about forensic patients’ placement in secure hospitals indicate some changes over time in the use of empirically supported risk factors. Our aim was to investigate whether, in more recent cases, risk assessment instruments were cited by a forensic patient review board or by the clinicians who made recommendations to the board and whether there was evidence of an association between risk assessment results and either dispositions or recommendations. Among review board hearings held in 2009–2012 pertaining to 63 different maximum security patients found not criminally responsible on account of mental disorder in Ontario, Canada, dispositions were most strongly associated with psychiatrists’ testimony, consistent with previous studies. However, dispositions were associated with the scores on the Violence Risk Appraisal Guide (VRAG), such that transferred patients had a lower risk of violent recidivism than detained patients. An association between clinical opinions and risk assessment results was also evident and significantly larger than in previous research. There was no evidence that risk assessment was cited selectively in higher risk cases or when scores were concordant with the review board decision. This research may provide a baseline for studies of the effect of 2014 legislation introducing a high-risk designation for forensic patients in Canada. We recommend further efforts to measure the effect of nonpharmacological treatment participation and in-hospital security decisions on forensic decision-making. (PsycINFO Database Record (c) 2016 APA, all rights reserved)(image)

The predictive validity of the Two-Tiered Violence Risk Estimates Scale (TTV) in a long-term follow-up of violent offenders.


Over the past few decades many structured risk appraisal measures have been created to respond to this need. The Two-Tiered Violence Risk Estimates Scale (TTV) is a measure designed to integrate both an actuarial estimate of violence risk with critical risk management indicators. The current study examined interrater reliability and the predictive validity of the TTV in a sample of violent offenders (n = 120) over an average follow-up period of 17.75 years. The TTV was retrospectively scored and compared with the Violence Risk Appraisal Guide (VRAG), the Statistical Information of Recidivism Scale–Revised (SIR-R1), and the Psychopathy Checklist–Revised (PCL-R). Approximately 53% of the sample reoffended violently, with an overall recidivism rate of 74%. Although the VRAG was the strongest predictor of violent recidivism in the sample, the Actuarial Risk Estimates (ARE) scale of the TTV produced a small, significant effect. The Risk Management Indicators (RMI) produced nonsignificant area under the curve (AUC) values for all recidivism outcomes. Comparisons between measures using AUC values and Cox regression showed that there were no statistical differences in predictive validity. The results of this research will be used to inform the validation and reliability literature on the TTV, and will contribute to the overall risk assessment literature. (PsycINFO Database Record (c) 2016 APA, all rights reserved)(image)

Specialty courts: Who’s in and are they working?


The effectiveness of specialty courts has been well established in the literature; however, previous studies have not taken into account referral biases that may exist based on offenders’ race, socioeconomic status (SES), attorney status, and so forth. The current study hypothesized that (a) Participants who are racially diverse, of lower SES, and represented by privately retained attorneys would be referred less frequently to specialty courts, and (b) Participants in specialty courts would evidence reductions in missed court appointments and failed urinary analyses (UAs) compared with peers not enrolled in specialty courts. Participants (N = 274) were probationers who were involved in 1 of 3 specialty court programs (i.e., drug, driving while intoxicated [DWI], or reentry courts) or a matched sample of probationers not in specialty court services. Results indicated that, in general and with few exceptions, specialty courts did not have differential referral rates based on offender demographics including race, ethnicity, SES, or attorney status (court appointed vs. privately retained). Results examining the effectiveness of the specialty courts were mixed. Participants in the in-prison treatment program reentry court missed a greater proportion of scheduled court meetings than did their matched sample counterparts; however, the other specialty court programs did not significantly differ from their matched-sample counterparts. Participants in the DWI court had a significantly smaller proportion of UA failures to total UAs than did their matched sample peers; however, the drug court and reentry court programs did not significantly differ from their matched sample counterparts. Implications, future directions, and limitations are discussed. (PsycINFO Database Record (c) 2016 APA, all rights reserved)(image)

Evaluating the association between childhood sexual abuse and attempted suicide across the lifespan: Findings from a nationwide study of women in jail.


Previous studies have found childhood sexual abuse to predict suicidal behavior in adulthood. Women in jail suffer disproportionately high rates of childhood sexual abuse and attempted suicide relative to women in the general population. Thus, better understanding the association between childhood sexual abuse and attempted suicide among women in jail may inform prevention, assessment, and treatment initiatives for this at-risk population. This study examined the association between childhood sexual abuse and the onset of attempted suicide across the life span in a nationwide sample of women in jail. Participants included a randomly selected subsample of women (N = 115), drawn from a larger probability sample (N = 491), who completed Life History Calendars, which were coded for the presence/absence of attempted suicide and childhood sexual abuse across life history stages. Survival analysis and Cox regression indicated that women with histories of childhood sexual abuse perpetrated by an adult or a peer were significantly more likely to have attempted suicide across the life span, including increased risk for the onset of attempted suicide in adulthood. This study demonstrates the salience of childhood sexual abuse as a predictor of suicidal behavior among women in jail, and extends previous research by demonstrating the temporal sequence of childhood sexual abuse relative to attempted suicide across the life span. Given these findings, researchers, clinicians, and policymakers should consider further the influence of childhood sexual abuse with regard to the high rates of attempted and completed suicide among women in jail. (PsycINFO Database Record (c) 2016 APA, all rights reserved)(image)

Recidivism risk factors are correlated with a history of psychiatric hospitalization among sex offenders.


Sexual offenders are more likely to have a history of psychiatric hospitalization compared with the general population. This finding suggests that a history of psychiatric hospitalization is a plausible risk factor for the initiation of sexual crimes. It is less clear, however, whether psychiatric hospitalization is associated with risk factors for criminal recidivism. Consequently, the current study examined the correlates of psychiatric hospitalization and its relevance for risk assessment in a sample of sexual offenders on community supervision (N = 947). In this sample, a history of psychiatric hospitalization significantly increased the rate of sexual recidivism (hazard ratio = 1.95). After controlling for well-established risk factors, however, the association was no longer statistically significant. Consequently, this study supported an indirect effect of a history of psychiatric hospitalization, such that the association between psychiatric symptoms and recidivism was mediated by criminogenic needs (e.g., poor general self-regulation, loneliness, and social rejection). Replication studies are needed to confirm this association, and to further understand the link between mental illness and recidivism for sexual offenders. (PsycINFO Database Record (c) 2016 APA, all rights reserved)(image)

Effectiveness of a self-administered intervention for criminal thinking: Taking a Chance on Change.


The current study tested the effectiveness of a self-administered, cognitive–behavioral intervention targeting criminal thinking for inmates in segregated housing: Taking a Chance on Change (TCC). Participants included 273 inmates in segregated housing at state correctional institutions. Reductions in criminal thinking, as assessed by the Psychological Inventory of Criminal Styles-Simplified Version, were found in the general criminal thinking score as well as the proactive and reactive composite scores. Examination of demographic predictors of change (i.e., age, years of education, length of sentence) revealed older and more educated participants decreased in criminal thinking more than younger and less educated participants. For a subset of 48 inmates, completion of TCC was associated with significant reduction of disciplinary infractions. Reductions in reactive criminal thinking predicted reductions in disciplinary infractions. Although further research is needed to determine the effectiveness of TCC in reducing recidivism, the reductions in criminal thinking and disordered conduct suggest this is a promising intervention and mode of treatment delivery. By utilizing self-directed study at an accessible reading level, the intervention is uniquely suited to a correctional setting where staff and monetary resources are limited and security and operational issues limit the feasibility of traditional cognitive–behavioral group treatment. (PsycINFO Database Record (c) 2016 APA, all rights reserved)(image)

Connecting the disconnected: Preliminary results and lessons learned from a telepsychology initiative with special management inmates.


The use of telepsychology, such as videoconferencing (VC) systems, has been rapidly increasing as a tool for the provision of mental health services to underserved clients in difficult to access settings. Inmates detained in restrictive housing appear to be at an increased risk of experiencing emotional and behavioral disturbances compared to their general population counterparts, yet they are less likely to receive appropriate treatment due to security constraints. The primary purpose of this article is to describe the process of implementing a novel telepsychology intervention specifically designed to offer group therapy to high-security, administratively segregated inmates. In addition, preliminary results on treatment and therapeutic process outcomes in a sample of 49 participants are reported. Although some evidence indicated that telepsychology was less preferred than in-person sessions, group differences on measures of psychological functioning and criminal thinking were not found across 3 conditions (telepsychology, in-person, and a no-treatment control). Furthermore, a number of limitations associated with program implementation and study design suggest that results be interpreted with caution and should not be used to discount the use of telepsychology as a viable treatment delivery option. Recommendations for future development and evaluation of telepsychological programs are discussed within the context of correctional settings and beyond. (PsycINFO Database Record (c) 2016 APA, all rights reserved)(image)

Effectiveness of a social robot, “Paro,” in a VA long-term care setting.


Interest in animal assisted interventions (AAI) has grown over the years, but acceptance of AAI by the clinical and research community has been hampered by safety, hygiene, and logistical concerns. Advances in the field of social robotics have provided a promising route to deliver AAI while avoiding these aforementioned obstacles. Although there has been promising initial research on social robotics in older adults, to date there has been no such research conducted with a veteran population. The present pilot study followed 23 veteran residents of a Veterans Affairs (VA) geropsychiatric long-term care facility over the span of approximately a year and a half. It was found that use of Paro, a social robot, resulted in increased observed positive affective and behavioral indicators, with concomitant decreases observed in negative affective and behavioral indicators. The authors concluded that Paro is likely an effective nonpharmacological approach for managing dementia-related mood and behavior problems with veterans in VA long term care facilities. They additionally observed that Paro is best presented to residents who are relatively calm and approachable, as opposed to actively exhibiting behavior or mood problems. Future research directions are discussed in light of both the positive results noted and the inherent limitations of our pilot study. (PsycINFO Database Record (c) 2016 APA, all rights reserved)(image)

Self-stigma, personality traits, and willingness to seek treatment in a community sample.


Stigma has received attention as a major barrier toward effective mental health service delivery, and previous research has demonstrated that the Five-Factor Model (FFM) domain of Openness to Experience is negatively correlated with stigmatized views of mental health. However, a lack of established relationships between personality and self-stigma, as well as how these concepts affect an individual’s treatment-seeking intentions, has left a gap in the literature. To address this, our study recruited a low-income community sample and tested (a) the relationship between self-stigma of mental health treatment and the FFM, (b) the relationship between self-stigma and treatment-seeking intentions, and (c) the incremental validity of FFM personality beyond stigma in the prediction of treatment seeking. Results suggest that there is some incongruence with previous research on personality’s relationship to stigma, personality does not act as an additive component in the prediction of the relationship between stigma and treatment seeking, and stigma is related only to the perceived need for mental health treatment but not to an individual’s openness to seek that treatment. The discussion concludes with implications for the contextualization and treatment of stigma as a barrier for mental health treatment and a general synthesis of the personality trait profiles for those holding stigmatizing views of mental health. (PsycINFO Database Record (c) 2016 APA, all rights reserved)(image)

Addressing the gender gap: Prolonged exposure for PTSD in veterans.


As the proportion of women serving in the United States military continues to increase, more female veterans are being treated for posttraumatic stress disorder (PTSD) in Department of Veterans Affairs (VA) health care settings. Prolonged Exposure (PE) therapy is an evidence-based treatment for PTSD and is often used in VA settings. However, only a few studies have investigated the effectiveness of PE specifically for female veterans with appropriate power. Results of these studies have varied, with similar effects between female and male veterans on par with civilian effects, and more recently, better outcomes for female veterans receiving PE compared with male veterans. The current study contextualizes the evidence from those studies and considers new data regarding clinical outcomes pre- and posttreatment for a large (N = 325) sample of male and female veterans treated with PE in a PTSD specialty clinic. Results indicate a large statistically significant decrease in PTSD as measured by PTSD Checklist (PCL) scores for both male and female veterans treated with PE (d = 1.33). No difference in effectiveness and no difference in treatment completion rates were found between male and female veterans. Our findings support the effectiveness of PE for the treatment of PTSD in female as well as male veterans. Results are compared and contrasted to previous findings in the literature taking into account heterogeneity in methodological and ecological factors among the studies. Emphasis is placed on context of care issues to further the empirical conversation regarding meeting the mental health needs of female veterans. (PsycINFO Database Record (c) 2016 APA, all rights reserved)(image)

Relationships between racial/ethnic minority status, therapeutic alliance, and treatment expectancies among veterans with PTSD.


Our objective was to examine the relationships between veterans’ racial/ethnic minority status, components of therapeutic alliance (bond, tasks, and goals) with former outpatient providers, and expectancies for Department of Veterans Affairs (VA) posttraumatic stress disorder (PTSD) residential treatment. Veterans (N = 819; 37% minority, 63% White) completed surveys at intake into VA PTSD residential treatment programs. As hypothesized, racial/ethnic minority status was related to weaker overall alliance, therapeutic bond, and goal agreement with former outpatient provider. Alliance with former provider was also associated with expectancies for residential treatment. After controlling for other variables, task agreement (not therapeutic bond) and racial/ethnic minority status were linked to higher expectancies. However, effect sizes were small. Thus, we found little evidence of clinically significant differences by racial/ethnic minority status on expectancies of VA PTSD residential treatment. Future research should investigate these relationships among veterans with PTSD not admitted to VA PTSD residential treatment and in other treatment settings, as well as nonveteran racial/ethnic minorities with PTSD. (PsycINFO Database Record (c) 2016 APA, all rights reserved)(image)

Providers’ perspectives of factors influencing implementation of evidence-based treatments in a community mental health setting: A qualitative investigation of the training–practice gap.


This study aims to elucidate relations between provider perceptions of aspects of the consolidated framework for implementation research (Damschroder et al., 2009) and provider attitudes toward the implementation of evidence-based treatments (EBTs) in an ethnically diverse community health setting. Guided by directed content analysis, we analyzed 28 semistructured interviews that were conducted with providers during the pre-implementation phase of a larger implementation study for cognitive processing therapy for posttraumatic stress disorder (Resick et al., 2008). Our findings extend the existing literature by also presenting provider-identified client-level factors that contribute to providers’ positive and negative attitudes toward EBTs. Provider-identified client-level factors include the following: client motivation to engage in treatment, client openness to EBTs, support networks of family and friends, client use of community and government resources, the connection and relationship with their therapist, client treatment adherence, client immediate needs or crises, low literacy or illiteracy, low levels of education, client cognitive limitations, and misconceptions about therapy. These results highlight the relations between provider perceptions of their clients, provider engagement in EBT training, and subsequent adoption of EBTs. We present suggestions for future implementation research in this area. (PsycINFO Database Record (c) 2016 APA, all rights reserved)(image)