Improving Practices of Risk Assessment and Intervention Planning for Persons with Intellectual Disabilities Who Sexually Offend

Abstract

Proactive assessment and intervention planning should be undertaken in cases of sexual behavior by persons with intellectual disability (ID) that is outside of acceptable norms. Although best practices in risk assessment for the general offender population are somewhat established, sexually inappropriate behavior among individuals with ID is distinct. Research in effective specialized risk assessment and intervention planning for this client group is an emerging area of focus. This article reviews contemporary academic research on this subject and highlights opportunities for improvement. First, research on risk factors for this client group was reviewed, observing the differences between empirically validated common factors and factors that are specific to the individual. Second, existing actuarial and structured clinical judgment approaches were evaluated. Third, the person‐centered planning approach to service planning for persons with ID was examined, highlighting how the principles of this approach may be used to enhance current practices in risk assessment and intervention planning. The author concludes that effective collaboration between support teams and clinical professionals, with focus maximized on individual risk factors and strengths, should lead to improved outcomes of risk assessment and intervention planning for persons with ID whose sexual behavior is inappropriate. A call to action is presented for the development of an enhanced, fourth‐generation, approach that embodies a collaborative framework.

Integrated responses for people with cognitive disability and complex support needs: Factors and principles

“…It has been found that these person-level difficulties are exacerbated by a lack of accessible or culturally relevant information (Bogenschutz, 2014;McIntyre et al, 2017;Olsen and Carter, 2016), a reluctance on behalf of the individual to engage with mainstream services (Day et al, 2016;de Vet et al, 2017;Dyer and Biddle, 2016) and negative experiences due to staff attitudes (Davies et al, 2016;Venville et al, 2016;Quirouette, 2016). Additionally, the evidence base consistently referenced reports of the person with complex support needs and/or their support networks experiencing marginalisation in decision-making processes relating to their needs (Keller, 2016;Kelly, 2017;Nicholas et al, 2017;van Rensburg and Fourie, 2016;Venville et al, 2015).…”

“…Key challenges that affected the capacity of practitioners and staff to successfully implement good practice were also a focus of the evidence. A lack of specialist clinical knowledge and expertise relating to complex populations was cited as a factor influencing fidelity to best practice (Day et al, 2016;Keller, 2016;Mason et al, 2018;Whittle et al, 2017). Clinical knowledge deficits were exacerbated by the additional complexity of rurality (Caxaj, 2016;Stephens et al, 2014), lack of guidance regarding how to engage necessary additional services to promote intersectoral collaboration (Duffy et al, 2016;Edgren and Barnard, 2015;Mason et al, 2018) and preconceived attitudes pertaining to complex populations, especially those in forensic settings (Davies et al, 2016;Dixon et al, 2016;Dyer and Biddle, 2016).…”

“…Barriers to the successful implementation of practice models at the service level included administrative and bureaucratic impediments such as an organisational culture unreceptive to relational approaches to complex populations (Keesler, 2014;Rhodes et al, 2013), rigid screening and assessment requirements and intake procedures that can result in the denial of services for those deemed too 'complex ' (Dyer and Biddle, 2016;Quirouette, 2016) and long waiting lists (Campbell et al, 2017;Kirst et al, 2015;Johnson et al, 2015). Also noted was an overemphasis on risk (Dyer and Briddle, 2016; Kelly, 2017), sometimes coupled with poor guidance regarding what constituted 'risk' (Keller, 2016). In addition, a lack of clarity around service 'readiness' was reported at the organisational level, often resulting in staff making arbitrary assessments of the likelihood of success or assigning 'red flags' that could disproportionately stigmatise and penalise individuals with complex support needs (Quirouette, 2016, 331).…”

“…Further identified barriers were lack of role clarity (Brown et al, 2016;Kirst et al, 2015;Mason et al, 2018;van Duijn et al, 2018;Urbis, 2015), poor interprofessional practices such as an unwillingness to share information between agencies (Dyer and Briddle, 2016; Mason et al, 2018) and subpar coworking between specialist clinicians and mainstream services (Hemmings et al, 2014). Also described was a lack of managerial guidance and support around policy and practice (Day et al, 2016;Keller, 2016). Additional interagency blockages included poor communication and information sharing due to untrusting attitudes or 'turf' wars (Dooris et al, 2013;Hoeft et al, 2018;Home Office, 2014;Mason et al, 2018;Stephens et al, 2014;van Rensburg and Fourie, 2016), incompatible communication or information technology systems (Kelly, 2016;van Duijn et al, 2018) and inadequate time allocated to coordinate across services (Day et al, 2016;Mason et al, 2018;Quinlan and Smele, 2017).…”

Understanding the Risk of Sexual Abuse for Adults With Intellectual and Developmental Disabilities from an Ecological Framework

“…The ARMIDILO‐S (Boer, Tough, & Haaven, ) is a dynamic risk assessment tool that has been found to be useful for predicting sexual recidivism for individuals with IDD (Lofthouse et al, ). Keller () proposes an integrative framework that relies on clinical judgment, actuarial tools, collaboration, a focus on individual factors, and strength‐based intervention. This framework uses person‐centered principles to advance dynamic risk assessment tools like the ARMIDILO‐S to develop more robust intervention procedures.…”