By Ron Grooters, MSW
I have been conducting psychosocial or structured clinical risk assessments and providing treatment for juveniles with sexual behavior problems for almost thirty years. During that time tools such as the ERASOR, JSOAP, and JSORAT were initially used to make risk determinations such as “low, medium and high risk,” similar to how it was in the adult assessment world. They were also used to make placement decisions. Although not explicit in these older instruments, many clinicians, probation officers and judges assumed the risk terms were the same as or similar to adults and indicated a degree of antisocial personality traits, psychopathy, and/or deviant sexual interests. These traits are not that prevalent in most adult convicted of sexual offenses and are even less prevalent among children and adolescents.
Throughout my career I have used the former instruments to identify treatment targets and dynamic risk factors (or “needs” in adult assessment language) unique to the offending pathway of each adolescent. However, I was often compelled to use the terms of “low, medium and high” in my evaluations implying a static or actuarial “predicted risk” and my focus on dynamic risk factors (needs) was often overlooked.
Young men and male teens who commit sexual offenses have such low recidivism rates that the only meaningful statistical data to report is the base rate of re-offending. This group is heterogeneous not homogeneous, and only a small portion of the individuals engaging in this behavior present as criminally-oriented or sexually deviant, needing a treatment focus.
Research is telling us that a focus on dynamic risk factors, non-sexual risk issues, mental health, social skills, relationship choices, boundaries etc., are more important than a primary focus on denial or relapse prevention intended for sexual deviance, sexual compulsion, or antisocial personality characteristics. Juvenile assessments and treatment have been shifting back onto the dynamic risk factors and building strengths. This has resulted in more individualized treatment, fewer residential placements, and more diverse treatment in outpatient settings throughout the state of Michigan.
What is still needed however is for the criminal justice system to catch up to this trend, an understanding that juveniles recidivism risk is very low, that they rarely grow up to become adult sexual abusers, and that they can primarily be treated within the community.
Dr. James Worling has now published the Protective + Risk Observations For Eliminating Sexual Offense Recidivism (PROFESOR) assessment instrument to replace his ERASOR assessment tool. The PROFESOR is a structured checklist to assist professionals identifying protective and risk factors for adolescents and emerging adults (i.e., individuals aged 12 to 25) who have offended sexually.
The PROFESOR contains 20 bipolar factors (i.e., protective and risk) that were chosen based on a review of the available literature and on clinical experience. These protective and risk factors are summarized into one of five categories. The categories are intended to reflect the intensity of services that may be required. For example, those in Category 1 (Predominantly Protective) would likely require little or no intervention focused on building the capacity for sexual and relationship health, whereas those in Category 5 (Predominantly Risk) would likely require considerable intervention.
Dr. Worling states that the goal of the PROFESOR is to provide information regarding the nature and intensity of interventions that will facilitate sexual and relationship health and further reduce sexual offense recidivism. The manual states the following: The PROFESOR contains only dynamic factors – individual, interpersonal, and environmental factors that are focused on the client’s current functioning (throughout the past 2 months). Therefore, the PROFESOR can be used regardless of the nature of the illegal or otherwise problematic sexual behavior (i.e., contact vs. noncontact, possession or distribution of child abusive images, etc.) and regardless of the level of acknowledgement by the individual (i.e., full acknowledgement, minimization, or categorical denial). Given that the PROFESOR contains only dynamic factors, it can also serve as a measure of change over time.
I have been using this assessment tool during the past three months as a part of my assessment process with adolescent boys that have been referred for sexual behavior problems. The strengths of this assessment tool are how it helps guide clinical assessment and judgment, it focuses on specific dynamic risk factors, and it provides new terms to communicate a broader understanding of the adolescent’s strengths and vulnerabilities rather than the nominal terms from the past.
In my opinion, the format of the PROFESOR also helps provide some justification for the length of treatment or counseling services as well as give potential justifications for the need of residential services. In addition, the instrument gives the treatment team working with each adolescent specific dynamic risk factors (needs) to target in treatment and monitor treatment efficacy and progress.
A critique of the PROFESOR is that the terms “protective” and “risk” are used in the adult risk assessment field but lack the scientific evidence to be used with juveniles. Using the term “risk” runs the chance of being understood as “predicted risk” in adult assessments. Nonetheless, it is the first instrument to not offer the terms of “low, medium, and high” that implied the risk level for a given adolescent is clearly different than the recidivism base rate for the group. The language of a ratio between protective strengths and risks (needs) is real progress for discussing juvenile sexual offending.
Overall, this assessment tool is a good example of what is needed in the field of treatment and assessment of young men and boys with sexual behavior problems – a primary focus on individual-specific dynamic risk factors or “needs” that can be targeted in treatment and produce a more individualized process of assessment and treatment. The best assessment direction is to focus on a structured checklist of risk and protective factors that include a client’s current social, emotional, familial, and sexual functioning. The adult assessment world is now focusing on the STABLE 2007 which is an assessment tool that focuses on dynamic risk factors or “needs.” The PROFESOR is an excellent example of this type of tool in juvenile assessment and treatment.