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Assessment and risk
Risk and assessment are bound together. The most common historical method of assessment until recently was unstructured clinical judgment, which, though better at predicting recidivism than chance, has poor validity and reliability (Monaghan 1981), especially in view of inherent biases (Quinsey etal 1998).
The assessment process should include a short, structured professional judgment too! - a standardized checklist with both historical and dynamic factors. An example of this is the SVR-20 - if there is a risk of a contact offence – which is a validated scale that measures the risk of sexual violence in terms of psychosocial adjustment, sexual offences, future plans and other considerations. This measure has been validated to predict recidivism (De Vogei ef al 2004), A similar tool is the Child Abuse Potential Inventory (Milner 1986, 1989), White these and other similar actuarial instruments are based on predictive rather than explanatory factors in offending behavior, they are still seen as preferable to clinical interviews only. Clinical interviews will enable the clinician to understand the process of offending, and some sample questions on what to ask have been included in Quayle and Taylor (2002), Clinicians should also assess the client's motivation to change (Jones 2002).
The author is not aware of any validated scales for noncontact offences, although scales such as the Psychological Inventory of Criminal Thinking Styles (Walters 1995) may be of some use. This scale identifies eight styles of thinking that have been shown to be influential in criminal behavior. An example is 'power orientation', in which a client compensates for weak personal control by trying to exhibit control over his environment.
Once identified, the presence of these thinking styles in other areas can identify offence paralleling behaviors, which may highlight a continued risk. With all self-report questionnaires and clinical interview^/s it Is important to consider that socially desirable reporting - where clients distort their endorsements to how they would like to be seen - is common among offenders. Data should be verified where possible, which may be difficult if it is the client's first service contact. It is important for the practitioner to be aware that people with a high risk of offending may be detainable even if they have not committed an offence under the proposed Mental Health Act if they are deemed to have a Dangerous and Severe Personality Disorder (House of Commons Library 2002).
Relationship with contact offences
Since the advent of the internet, there has been an emergence of image collectors who do not commit contact offences (Holmes er at. 2003), Interviews appear to suggest some image collectors use images as a substitute for contact offending, while others use them as a blueprint for contact offending. Very little has been written about this but, clearly, separating these categories of offenders will be crucial in the future for healthcare professionals.
The process of arousal may lead to offending if any single fantasy is maintained, developed and acted on (Blundell 2002), although Seto er a/ (2001) note that in addition to arousal, the internet may also develop other possible mediating factors, such as offence-supporting attitudes, aggressiveness and anti-social personality. Other internet processes that may influence contact offending include imitation (social learning), permission giving (social support) and social reinforcement of existing values.
Treatment of issues relating to internet offending against children
Most non-medical treatment of behaviors requires client co-operation, and any treatment needs to address motivation to change. There may be no implicit reward for the client changing his behavior due to high rewards for offending and high cognitive distortions in victim impact (Brown 1997). The clinician should ensure any treatment program addresses distortions in motivation and pro-offending thinking, victim impact and the cycle of offending behavior (Burke ef a/ 2002).
Processes and supervision issues
Box1. Pitfalls in clinician-client relationships
Summary and conclusions
Treating the offending behavior is not the domain of the non-specialist clinician, but an understanding of the research on what is effective with this client group may help the clinician in ensuring clients receive suitable treatment- It is essential to request and receive supervision with this client group, and some of the most important processes have been considered above.
Reflection Exercise #2
Online Continuing Education QUESTION 9
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