Psychometric evaluation of the Forensic Inpatient Observation Scale (FIOS) in youngsters with a judicial measure

<p>Abstract</p> <p>Background</p> <p>In this article, the psychometric properties of the Forensic Inpatient Observation Scale (FIOS) were examined. This instrument was developed to observe behavioral functioning of forensic psychiatric patients. Up till now, it has only been used among adult forensic psychiatric patients and this is the first study in which the FIOS is used with youngsters.</p> <p>Methods</p> <p>Data were gathered of 133 patients. The FIOS was routinely used to assess the psychiatric condition of youngsters at fixed intervals with a three-month time period between each measurement. Ward staff working in close contact with the patient conducted the assessments. Of these 133 patients, an YSR/ASR questionnaire was available for 96 of them and a TRF for 110 of the 133 patients. For the descriptive, reliability and validity analyses, SPSS version 16.0 was used. Factor analyses were performed by means of Mplus Version 5.2.</p> <p>Results</p> <p>A series of confirmatory and exploratory factor analyses revealed a five-factor structure for the FIOS. The five-factor structure consisted of the following scales: self-care, social behavior, oppositional behavior, verbal skills and distress. The insight scale of the original factor structure could not be replicated in the youth sample. Cronbach's alpha's of the five scales ranged from .70 to .85. The self-care, verbal skills and oppositional behavior scales of the FIOS showed no relation with emotional and behavior problems reported by the patients themselves or their teachers. The distress scale of the FIOS did show a relation with the emotional problems reported by patients themselves and the social behavior scale with behavioral problems as reported by teachers.</p> <p>Conclusions</p> <p>The internal consistency of the FIOS was sufficient and the factor structure in the present sample of youngsters was in general comparable to the original factor structure in an adult sample. Its value lies in the focus on behavioral functioning of youngsters with judicial measures. What remains to be seen is whether this instrument is sensitive enough to register all aspects of behavioral changes, whether the interrater reliability is sufficient, and whether it has predictive validity to relapse and recidivism.</p

I need to know:Using the CeHRes roadmap to develop a treatment feedback tool for youngsters with mental health problems

Patient-Reported Outcome Measures (PROMs) are often used to monitor treatment outcomes in youth mental health care. Unfortunately, youngsters are rarely informed about the results of their PROMs or, when they are, it is in an insufficient manner. Therefore, a web application was developed—together with youngsters—aimed at giving them feedback about their PROMs. The aim of this study is to describe the development process of the application. An expert panel consisting of youngsters, web designers and researchers, as well as a representative from a client organisation, developed the e-health application INK (short for ‘I Need to Know’) in an iterative process based on the Centre for eHealth Research roadmap (CeHRes roadmap). Youngsters prefer, among other aspects, a simple, easy-to-use e-health application with a colourful appearance and want to be able to compare their results across different time points and informants. The INK tool provides youngsters with insight into their PROM results. Based on the youngsters’ preferences, INK users can choose which feedback information is visible. INK facilitates youngsters’ active participation in their treatment as well as shared decision-making with their professional caregivers

Supervision trajectories of male juvenile offenders: growth mixture modeling on SAVRY risk assessments

Background: Structured risk/need assessment tools are increasingly used to orientate risk reduction strategies with juvenile offenders. The assumption is that the risk/need items on these tools are sufficiently sensitive to measure changes in the individual, family and/or contextual characteristics of juvenile offenders. However, there is very little research demonstrating the capacity of these tools to measure changes in juvenile offenders. Congruent with the developmental and life-course criminology theories (DLC) the objective of this study is to explore the existence of heterogeneous trajectories of juvenile offenders across the juvenile justice system as measured through five empirical risk/need areas based on the Structured Assessment of Violence Risk in Youth (SAVRY), one of the most widely applied risk assessment tools for juveniles. Methods: This longitudinal study included 5205 male juvenile offenders who transitioned through the Catalan juvenile justice system between 2006 and 2014. During intervention they received at least two, and a maximum of seven, consecutive SAVRY risk/need assessments over an 18-month period. The heterogeneity of latent class trajectories was explored through growth mixture modeling (GMM). The trajectory class membership was linked to covariates through multinomial logistic regression analyses. Results: Through GMM three to four heterogeneous trajectories, with high quality of separation, were identified in each of the risk/need areas. The trajectories with low risk/needs (45–77% of the sample) remained low and presented a very limited increase in risk/needs during the 18-month period. The high risk/need trajectories (20–37% of the sample) showed a limited decrease or no change. Between 5 and 13% of the sample had large reductions in their risk/needs levels, and approximately 5% showed a large increase in risk/needs. Conclusions: In line with the DLC theories this study shows that trajectories on criminogenic risk/needs can be heterogeneous and indicate distinct rates of change over time. The results of this study also may suggest a limited sensibility to measure change over time of SAVRY’s risk and protective items. Suggestions to improve the sensitivity of measuring change over time, such as shorter time frames or future-oriented time frames for the scoring of the items, are offered.Medicine, Faculty ofNon UBCPsychiatry, Department ofReviewedFacult

Looking into the crystal ball:Quality of life, delinquency, and problems experienced by young male adults after discharge from a secure residential care setting in the Netherlands

Background: Adolescents in residential care are a vulnerable population with many problems in several life areas. For most of these adolescents, these problems persist after discharge and into adulthood. Since an accumulation of risk factors in multiple domains increases the likelihood of future adverse outcomes, it would be valuable to investigate whether there are differences in life after residential care between subgroups based on multiple co-occurring risk factors. Aims and hypothesis: The aim of this exploratory follow-up study is to explore differences between young adults—classified in four risk profiles—in relation to life after discharge from a secure residential care setting. It is hypothesised that young adults with a profile with many risks in multiple domains will experience more problems after discharge, such as (persistent) delinquency, compared to young adults with a profile with lower risks. Methods Follow-up data were collected from 46 former patients of a hospital for youth forensic psychiatry and orthopsychiatry in the Netherlands. In order to illustrate these young adults’ life after discharge, self-reported outcome measures divided into five domains (i.e., quality of life, daily life, social life, problems, and delinquency) were used. Differences between four classes based on pre-admission risk factors, which were identified in a previous study by latent class analysis, were explored by three (non-)parametric statistical tests. Results: Life after discharge for most young adults was characterised by close friends and a high quality of life, but also by substance abuse, professional support, debts, and delinquency. Only a few significant differences between the classes were found, primarily between young adults with risk factors in the individual, family, school, and peer domains and young adults in the other three classes. Conclusions: Young adults experience a high quality of life after discharge from secure residential care, despite the presence of persistent problems. Some indications have been found that young adults with risk factors in four domains are at greatest risk for persistent problems in young adulthood. Because of the high amount of persistent problems, residential treatment and aftercare should focus more on patients’ long-term needs

Looking into the crystal ball: Quality of life, delinquency, and problems experienced by young male adults after discharge from a secure residential care setting in the Netherlands

Background: Adolescents in residential care are a vulnerable population with many problems in several life areas. For most of these adolescents, these problems persist after discharge and into adulthood. Since an accumulation of risk factors in multiple domains increases the likelihood of future adverse outcomes, it would be valuable to investigate whether there are differences in life after residential care between subgroups based on multiple co-occurring risk factors. Aims and hypothesis: The aim of this exploratory follow-up study is to explore differences between young adults—classified in four risk profiles—in relation to life after discharge from a secure residential care setting. It is hypothesised that young adults with a profile with many risks in multiple domains will experience more problems after discharge, such as (persistent) delinquency, compared to young adults with a profile with lower risks. Methods Follow-up data were collected from 46 former patients of a hospital for youth forensic psychiatry and orthopsychiatry in the Netherlands. In order to illustrate these young adults’ life after discharge, self-reported outcome measures divided into five domains (i.e., quality of life, daily life, social life, problems, and delinquency) were used. Differences between four classes based on pre-admission risk factors, which were identified in a previous study by latent class analysis, were explored by three (non-)parametric statistical tests. Results: Life after discharge for most young adults was characterised by close friends and a high quality of life, but also by substance abuse, professional support, debts, and delinquency. Only a few significant differences between the classes were found, primarily between young adults with risk factors in the individual, family, school, and peer domains and young adults in the other three classes. Conclusions: Young adults experience a high quality of life after discharge from secure residential care, despite the presence of persistent problems. Some indications have been found that young adults with risk factors in four domains are at greatest risk for persistent problems in young adulthood. Because of the high amount of persistent problems, residential treatment and aftercare should focus more on patients’ long-term needs

Profiles of SAVRY risk and protective factors within male and female juvenile offenders:A latent class and latent transition analysis

This longitudinal study explored the existence of, and the transition between, latent classes based on risk/need domains of the Structured Assessment of Violence Risk in Youth (SAVRY). The study included 4,267 male and 661 female justice-involved juveniles who had at least one SAVRY assessment completed between 2006 and 2011. A three-step approach was used for the latent class analyses (LCA): (1) A standard LCA estimated the classes; (2) the class-membership was determined; and (3) latent transition analyses estimated the likelihood of transition between the subgroups. For male adolescents, five latent classes were identified: (a) low risk/needs (36%); (b) low-moderate risk/needs (26%); (c) moderate risk/needs (11%); (d) moderate-high risk/needs (19%); and (e) high risk/needs (8%). For female adolescents, three subgroups were identified: (a) low risk/needs (30%); (b) moderate risk/needs (51%); and (c) high risk/needs (19%). Recidivism rates differentiated the subgroups, and the likelihood of transition within a 12-months timeframe was low

Likelihood of identifying autistic traits with the autism spectrum quotient (AQ) in male juveniles with autism spectrum disorder (ASD) and severe behavioral problems (SBPs)

Abstract Background When screening for autism spectrum disorders (ASD), the Autism Spectrum Quotient (AQ) is generally considered to be useful. Whether the AQ is also a suitable screener for ASD in juveniles with severe behavioral problems (SBPs) is unknown. Due to the overlap of symptoms between ASD and SBPs, particularly in juveniles low on empathy, the screening capacity of the AQ might be constrained. The aim of the present study was to investigate whether (comorbid) SBPs affect the screening capacity of the AQ. The hypothesis is that male juveniles with SBPs - but without a diagnosis of ASD - will score higher than male juveniles without both SBPs and ASD. Method The AQ was completed by 216 male juveniles aged 15–18 years treated at an outpatient department of child and adolescent psychiatry. The 216 participants were categorized into four groups according to a clinical diagnosis of ASD and SBPs (defined as disruptive behavior disorder and/or delinquent behavior). Using multinomial logistic regression, we investigated whether the four identified groups, based on a diagnosis of ASD and SBPs, scored differently for the total score and subscales of the AQ. Results Participants in the group with ASD (ASD+) but without SBPs (SBP-) were more likely to report higher levels of autistic traits than the reference group without both ASD and SBPs (ASD-SBP-), except for the subscale on attention to detail (ASD+SBP- OR = 1.04; 95%CI = 0.98–1.11). Participants in the group with both ASD and SBPs were more likely to report higher levels for the total AQ score (ASD+SBP+ OR = 1.03; 95%CI = 1.00–1.05) and the communication subscale of the AQ (ASD+SBP+ OR = 1.18; 95%CI = 1.07–1.31) than the reference group without both ASD and SBPs. Conclusion In outpatient male juveniles, SBPs do not affect the screening capacity of the AQ for autistic traits. In spite of the well-known overlap of symptoms between ASD and SBPs, male juveniles with SBPs but without a diagnosis of ASD do not score higher on the AQ than male juveniles without SBPs and without a diagnosis of ASD

Offence type and neurodiversity: A comparison of 12‐17‐year‐old boys charged with a criminal offence by diagnosis of autism spectrum disorder, attention deficit hyperactivity disorder or both

Background Autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD) have been evidenced as common among adolescents with delinquent behaviour. Less is known, however, about the relationship between these disorders and type of alleged offence, when the adolescent is involved with the criminal justice system. Aim Our aim was to investigate whether the type of alleged index offences among 12–17-year-olds differ between those diagnosed with ASD, ADHD or ASD + ADHD. Method The sample was selected for ASD and/or ADHD diagnoses from a database of all pre-trial forensic psychiatric and psychological assessments of male adolescents of 12–17 years old in the Netherlands for the years 2013 and 2014. For each record, independent researchers scored a 76-item checklist encompassing health and offending characteristics. Sixty-nine of the 1799 pre-trial assessments of these male adolescents had a diagnosis of ASD, 90 of ADHD and 29 had been diagnosed with both; these 188 cases formed our sample. Results The rate of sex offences was significantly higher among those with ASD (N = 20, 29%) than those with ADHD (N = 10, 11%) or both (N = 4, 14%; Fisher's exact test = 8.54; p = 0.014). By contrast, the rate of property offences without violence was significantly higher among those with ADHD (N = 22, 24%) than those with ASD (N = 4, 6%) or both (N = 5, 17%; Fisher's exact test = 10.50, p = 0.004), whereas violent offending rates did not differ between the three groups. Conclusion Specific offence types were not equally distributed among male adolescents with different psychiatric diagnoses. In our sample of male adolescents suspected of an offence nearly one-third of those diagnosed with ASD were convicted of a sex offence, suggesting highly specialised needs for further assessment and intervention. Among those diagnosed with ADHD, significantly more adolescents were charged with non-violent property offences. Such unequal distribution of alleged offence types among adolescents with different psychiatric diagnoses justifies tailor-made attention for offending adolescents with different psychiatric diagnoses

Do risk profiles moderate the relation between age of onset of disruptive behaviour and two types of externalising problems among adolescents admitted to secure residential care?

Background:  Adolescents with externalising problems in secure residential care differ in age of onset of disruptive behaviour and in cumulative risks in several domains. In order to reduce negative consequences of externalising behaviour for society and the adolescents themselves, it is important to gain more insight into the complexity and heterogeneity of disruptive behaviour in these adolescents. To look beyond the influence of single risk factors, the aim of this study is to investigate the moderator effect of co-occurring risk factors in multiple domains on the relation between age of onset of disruptive behaviour and two types of externalising problems in adolescence.  Methods:  Retrospectively collected data of 225 adolescents admitted to secure residential care were analysed. The four risk profiles were based on co-occurring pre-admission risk factors in four domains, which were identified in a previous study by latent class analysis. Multiple regression models were used to test whether the independent variable age of onset and dummy-coded moderator variable risk profiles had statistically significant associations with aggressive behaviour and rule-breaking behaviour of the adolescents, as reported by professional caregivers in the first months of admission.  Results:  Risk profiles moderated the relation between age of onset of disruptive behaviour and rule-breaking behaviour. Adolescents with childhood-onset disruptive behaviour within the risk profile with mainly family risks showed more rule-breaking behaviour in the first months of their admission to secure residential care than adolescents with an onset in adolescence within the same risk profile. Risk profiles, however, did not moderate the relation between age of onset of disruptive behaviour and aggressive behaviour.  Conclusion:  Heterogeneity of aggressive and rule-breaking behaviour was established in this study by finding differences on these two types of externalising behaviour between the childhood- and adolescence-onset groups and between the four risk profiles. Furthermore, risk profiles moderated the effect between age of onset of disruptive behaviour and rule-breaking behaviour—not aggressive behaviour—in adolescents admitted to secure residential care. While respecting the limitations, adolescents’ childhood-onset disruptive behaviour within a profile with mainly family risk factors appear to be distinctive from adolescents with adolescence-onset disruptive behaviour within the same risk profile