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5 9 5 4 0 4 SAXXXX10.1177/1079063215595404Viljoen et al.SexualAbuse
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Article
Changes in J-SOAP-II and SAVRY Scores Over the Course of Residential, Cognitive-Behavioral Treatment for Adolescent Sexual Offending

Sexual Abuse: A Journal of Research and Treatment 2017, Vol. 29(4) 342–­ 374 © The Author(s) 2015 Reprints and permissions:
sagepub.com/journalsPermissions.nav DOI: 10.1177/1079063215595404 journals.sagepub.com/home/sax

Jodi L. Viljoen1, Andrew L. Gray1, Catherine Shaffer1, Natasha E. Latzman2, Mario J. Scalora3, and Daniel Ullman4

Abstract Although the Juvenile Sex Offender Assessment Protocol–II (J-SOAP-II) and the Structured Assessment of Violence Risk in Youth (SAVRY) include an emphasis on dynamic, or modifiable factors, there has been little research on dynamic changes on these tools. To help address this gap, we compared admission and discharge scores of 163 adolescents who attended a residential, cognitive-behavioral treatment program for sexual offending. Based on reliable change indices, one half of youth showed a reliable decrease on the J-SOAP-II Dynamic Risk Total Score and one third of youth showed a reliable decrease on the SAVRY Dynamic Risk Total Score. Contrary to expectations, decreases in risk factors and increases in protective factors did not predict reduced sexual, violent nonsexual, or any reoffending. In addition, no associations were found between scores on the Psychopathy Checklist:Youth Version and levels of change. Overall, the J-SOAP-II and the SAVRY hold promise in measuring change, but further research is needed.

1Simon Fraser University, Burnaby, British Columbia, Canada 2Centers for Disease Control and Prevention, Atlanta, GA, USA 3University of Nebraska–Lincoln, NE, USA 4Lincoln Regional Centre, NE, USA
Corresponding Author: Jodi L. Viljoen, Department of Psychology, Simon Fraser University, 8888 University Drive, Burnaby, British Columbia, Canada V5A 1S6. Email: [email protected]

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Keywords dynamic factors, risk assessment, J-SOAP-II, SAVRY, sexual offending

Although adolescents who sexually offend are sometimes assumed to indefinitely pose a high risk to the public, adolescents’ risk can change substantially over time. Some youth show reduced risk and desistance from offending as a result of effective interventions (Letourneau, Henggeler, et al., 2013; Worling, Litteljohn, & Bookalam, 2010) or developmental maturation (Moffitt, 1993; Monahan, Steinberg, Cauffman, & Mulvey, 2013; Sweeten, Piquero, & Steinberg, 2013). Other youth continue to offend, engaging in increasingly severe forms of offending as they age (Loeber, Farrington, Stouthamer-Loeber, & White, 2008).
Given that risk may fluctuate, many widely used adolescent risk assessment tools, such as the Juvenile Sex Offender Assessment Protocol–II (J-SOAP-II; Prentky & Righthand, 2003) and the Structured Assessment of Violence Risk in Youth (SAVRY; Borum, Bartel, & Forth, 2006), were developed with an emphasis on dynamic risk factors (Vincent, Terry, & Maney, 2009). Dynamic risk factors are modifiable factors (e.g., anger management difficulties, limited parental supervision) that may change as a result of intervention, development, or life events. In contrast, historical factors, such as past offending, cannot be undone once they have occurred.
Despite risk assessment tools’ stated emphasis on dynamic factors, little research has been conducted on changes in risk. Thus, we examined the ability of the J-SOAP-II and the SAVRY to measure reliable change over the course of treatment (i.e., from admission to discharge) and whether adolescents who improved were less likely to reoffend. We also tested whether adolescents with psychopathic features showed lower levels of improvement during treatment than other adolescents.
Use of the J-SOAP-II and the SAVRY to Measure Change
The J-SOAP-II and the SAVRY are among the most widely used adolescent risk assessment tools (McGrath, Cumming, Burchard, Zeoli, & Ellerby, 2010; Viljoen, McLachlan, & Vincent, 2010). The J-SOAP-II was designed to assess risk for sexual and nonsexual reoffending among adolescents who have sexually offended (Prentky & Righthand, 2003). Although the SAVRY is not designed specifically for adolescents who have sexually offended (Borum et al., 2006), it may be relevant to this population as adolescents who have committed sexual offenses have some similarities to adolescents who have committed nonsexual offenses (e.g., antisocial attitudes and traits; Seto & Lalumière, 2010). Furthermore, adolescents who have committed sexual offenses are more likely to reoffend with nonsexual crimes (e.g., assaults, property crimes) than with sexual crimes (Caldwell, 2010), suggesting that tools like the SAVRY may be useful.
The J-SOAP-II and the SAVRY both include dynamic factors. On the J-SOAP-II, approximately half of the items are purported to be dynamic factors (i.e., 12/28 items = 43%),

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including all of the items on the Intervention scale (e.g., empathy) and the Community Stability/Adjustment scale (e.g., management of sexual urges). On the SAVRY, approximately two thirds of the items are dynamic (i.e., 20/30 items = 67%), including items on the Social/Contextual section (e.g., peer delinquency), the Individual/Clinical section (e.g., anger management problems), and the Protective Factors section (e.g., prosocial involvement).
To date, numerous studies have been conducted to examine the predictive validity of the J-SOAP-II and the SAVRY. Across individual studies, the predictive validity of the J-SOAP-II is mixed (Hempel, Buck, Cima, & van Marle, 2013; Viljoen, Mordell, & Beneteau, 2012). However, when aggregated across studies, the J-SOAP-II total scores show a moderate ability to predict sexual and nonsexual reoffending (weighted area under the curve [AUC] = .67 and .66, respectively; Viljoen, Mordell, & Beneteau, 2012). Similarly, the SAVRY Risk Total Scores show moderate effect sizes in predictions of violent and general reoffending (weighted r = .30 and .32, respectively; Olver, Stockdale, & Wormith, 2009; see also Singh, Grann, & Fazel, 2011).
The dynamic sections on the J-SOAP-II and the SAVRY have also been found to predict reoffending (Guy, 2008; Viljoen, Mordell, & Beneteau, 2012; Vincent, Chapman, & Cook, 2011). However, we know very little about the ability of the J-SOAP-II and the SAVRY to measure changes in reoffense risk. This is because in the vast majority of studies, researchers have administered tools at a single time point. In one of the few studies to examine change, youth showed greater improvements on the J-SOAP-II when the treatment dose was moderate than when it was low or high (Rehfuss et al., 2013). In addition, in a conference presentation, Hilterman (2014) found different trajectories of change on the SAVRY, with some youth increasing and other youth decreasing in risk.
Given that in these two studies researchers focused mainly on the process of change rather than the ability of the J-SOAP-II and the SAVRY to measure change, a couple of key questions remain. First, can the J-SOAP-II and the SAVRY be used to reliably measure change? That is, do raters show adequate interrater reliability in assessing change? Second, when can we conclude that a reliable change has occurred on these tools? For instance, if an adolescent scores a couple of points lower on the J-SOAP-II or the SAVRY. this could simply be due to measurement error, as no tool has perfect reliability. To examine this, we used reliable change indices (RCIs) to estimate reliable or true change after taking into account measurement error (Jacobson & Truax, 1991). Although many scholars recommend increased use of RCIs (Duff, 2012; Marsden et al., 2011; Stein, Luppa, Brähler, König, & Riedel-Heller, 2010; Wise, 2004), as of yet, few studies have been conducted examining RCIs in the context of violence risk assessment (i.e., Draycott, Kirkpatrick, & Askari, 2012; Kroner & Yessine, 2013; Viljoen, Beneteau, et al., 2012).

Changes in Risk Ratings and Reoffending
If the J-SOAP-II and the SAVRY are able to adequately capture changes in risk, one might expect that decreases in risk scores during treatment are predictive of lower

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rates of reoffending. Although this research question has not yet been explored in adolescent samples, a number of researchers have tested associations between changes in scores on risk assessment tools and reoffending in adult offenders. In one of the first studies, Olver, Wong, Nicholaichuk, and Gordon (2007) found small inverse associations between changes in scores on the Violence Risk Scale–Sexual Offender Version (VRS-SO; Wong, Olver, Nicholaichuk, & Gordon, 2003). This association did not reach significance in the full sample (r = −.09) or for the low-risk group (r = .01), but was significant for high-risk offenders (r = −.15, p < .05). In other words, high-risk offenders who showed greater reductions in risk scores were less likely to reoffend (see also Olver, Nicholaichuk, Kingston, & Wong, 2014). For low-risk offenders, the level of improvement may not matter as much as it does for high-risk offenders because low-risk offenders are already relatively unlikely to reoffend.
In several additional studies with the VRS-SO and other tools (e.g., VRS [Wong & Gordon, 2006]; Level of Service Inventory–Revised [Andrews & Bonta, 1995]), researchers have also reported small inverse correlations between change scores and reoffending (Beggs & Grace, 2011; Labrecque, Smith, Lovins, & Latessa, 2014; Lewis, Olver, & Wong, 2013; Olver et al., 2014; Vose, Lowenkamp, Smith, & Cullen, 2009; Vose, Smith, & Cullen, 2013). In other studies, however, reductions in risk factors have not translated into reduced reoffending (Barnett, Wakeling, MandevilleNorden, & Rakestrow, 2012, 2013; Bowen, Gilchrist, & Beech, 2008; Goodman-Delahunty & O’Brien, 2014; Kroner & Yessine, 2013; Serin, Gobeil, & Preston, 2009; Woessner & Schwedler, 2014).
In part, these nonsignificant findings could be due to methodological issues, such as small sample sizes. Beyond this, the inconsistent results could suggest that some tools do a better job than others at capturing changes related to reoffense risk. To add to this research, the current study is the first to focus on the relationship between changes on adolescent risk assessment tools and reoffending. Furthermore, it is one of the few studies in which changes in protective factors were examined.

Psychopathic Features and Changes in Risk Ratings
A final area of focus in the present study is the relationship between change scores and psychopathic features. Psychopathy is a set of traits that is characterized by callousness toward others, limited capacity to experience emotions, and impulsiveness (Skeem, Polaschek, Patrick, & Lilienfeld, 2011). Youth with psychopathic features show higher rates of offending than do other youth (Edens, Campbell, & Weir, 2007). Furthermore, they often show limited treatment compliance (Falkenbach, Poythress, & Heide, 2003; O’Neill, Lidz, & Heilbrun, 2003) and a diminished response to treatment (Manders, Deković, Asscher, van der Laan, & Prins, 2013; O’Neill et al., 2003).
That said, treatment appears to be more effective for these youth than incarceration (Caldwell, Skeem, Salekin, & Van Rybroek, 2006). Also, youth with psychopathic features appear to respond positively to certain forms of treatment (Salekin, Worley, & Grimes, 2010). Multisystemic Therapy, for instance, is associated with significant

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decreases in parent-reported psychopathic features (Butler, Baruch, Hickey, & Fonagy, 2011). Functional Family Therapy has been found to result in improved behavioral, emotional, and social adjustment in youth with callous-unemotional features (White, Frick, Lawing, & Bauer, 2012). In another study, adolescents with psychopathic features responded to a brief 12 session intervention that focused on motivational and cognitive-behavioral elements (Salekin, Tippey, & Allen, 2012).
Typically, researchers have measured the success of treatment via an examination of reoffense rates or changes in symptoms of psychopathy or conduct disorder (e.g., Butler et al., 2011; White et al., 2012). However, risk assessment tools may also provide a useful indicator of treatment-related improvement (see Olver, Lewis, & Wong, 2013). Thus, in the present study, we examined whether adolescents with psychopathic features demonstrate fewer reductions in risk factors and gains in protective factors during treatment than other adolescents.

Present Study
Although the J-SOAP-II and the SAVRY were designed to measure change, there is, as of yet, little research on their ability to do so. Thus, we examined the interrater reliability of ratings of change on the J-SOAP-II and the SAVRY, the proportion of youth who showed reliable change in J-SOAP-II and the SAVRY risk scores during residential cognitive-behavioral treatment (CBT), and whether improvements (i.e., reduced risk scores and increased protective scores) were associated with lower reoffense rates. In addition, we examined whether youth with psychopathic features were less likely to show treatment-related improvements.
It was predicted that the J-SOAP-II and the SAVRY would show adequate reliability for measuring change. Given that CBT is associated with significant reductions in sexual reoffending when compared with treatment as usual (OR = 0.59; Reitzel & Carbonell, 2006), it was hypothesized that adolescents attending the program would show reductions in risk scores and increases in protective factors from admission to discharge. Consistent with adult studies, it was expected that, after controlling for risk level, adolescents who improved would be less likely to commit sexual and nonsexual reoffenses. Finally, it was hypothesized that adolescents low in psychopathic features would show more improvement than those high in these features.

Method
Participants
Potential participants included all of the 169 male adolescents who were discharged between January 1993 and December 2004 from a nonsecure residential sex offender treatment program in a medium-sized, mid-Western American city, namely, the Whitehall Psychiatric Residential Program in Lincoln, Nebraska. To be included in the present study, youth had to have remained in the program for a sufficiently long enough period of time (i.e., 30 days or more) that they had an opportunity to show

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change on the risk assessment tools. Six youth were omitted because they were discharged in less than 30 days after admission, resulting in a sample size of 163.
The mean age of the youth at the time of admission was 15.39 years (SD = 1.50). Although a large majority of the youth were non-Hispanic Caucasian (82.8%, n = 135), a small proportion were African American (8.6%, n = 14), Hispanic (4.9%, n = 8), American Indian or Alaskan Native (1.2%, n = 2), or biracial (2.5%, n = 4). The length of time youth spent in the program ranged from 31 days to 4.07 years; the mean number of years in the program was 1.13 (SD = 0.67). Youth had committed a variety of sexually abusive behaviors (i.e., index offenses) that led to treatment, including genital penetration (36.8%, n = 60), anal penetration (35.0%, n = 57), oral–genital contact (48.5%, n = 79), fondling (62.0%, n = 101), and exhibitionism (14.1%, n = 23).
In most cases, youth had at least one index offense victim who was three or more years younger than the youth (86.7%, n = 137). Approximately half of the youth had index offenses against female-only victims (46.3%, n = 74), 24.4% (n = 39) had maleonly victims, and 29.4% (n = 47) had both female and male victims. Many of the victims were related to the offender (71.9%, n = 115). Approximately half of the youth had committed prior sexual offenses (50.9%, n = 83) or were charged or convicted for nonsexual offenses (51.0%, n = 80).
This sample of youth has been included in previous research on risk and protective factors (Elkovitch, Viljoen, Scalora, & Ullman, 2008; Latzman, Viljoen, Scalora, & Ullman, 2011; Spice, Viljoen, Latzman, Scalora, & Ullman, 2013; Viljoen, Elkovitch, Scalora, & Ullman, 2009; Viljoen et al., 2008). However, the current study has a different focus (i.e., dynamic change) and does not include any analyses that are redundant with prior work.

Procedure
Ethics approval was obtained from the University of Nebraska–Lincoln, Simon Fraser University, and the research site. This study had a quasi-prospective design with the risk assessments being made in the context of research rather than clinical practice. Three trained research assistants rated the J-SOAP-II and the SAVRY for each youth based on archival file information. Youth’s admission ratings on these tools were made using the file information available at admission, and youth’s discharge ratings were made using the file information available at discharge. After all J-SOAP-II and SAVRY ratings were completed, two different research assistants separately completed ratings on the Hare Psychopathy Checklist:Youth Version (PCL:YV; Forth, Kosson, & Hare, 2003). By rating the PCL:YV separately, it minimized the possibility that PCL:YV ratings might influence assessments of how much a youths’ risk and protective factors changed.
Research assistants followed the rating guidelines in the manuals for the J-SOAP-II, the SAVRY, and the PCL:YV; no adaptations or changes were made to any rating criteria. In coding the measures, research assistants were blind to youths’ subsequent charges and convictions. All research assistants were PhD students in clinical forensic psychology, had completed graduate coursework on risk assessment, and had been

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employed in clinical practicum positions with offenders. Prior to commencing coding, raters underwent didactic training, received readings, and completed five practice cases with the study measures using case files.
Given that the youth in this sample had, on average, spent approximately 1 year in the residential treatment program, the file information available to code the study measures was comprehensive. On average, files were over 600 pages in length and included psychiatric assessments, psychological assessments, nursing records, medical examination information, social work reports, teacher assessments, school records, treatment plans and records, progress notes, physician orders, arrest records, and other materials. Raters coded the quality of each file on a scale of 1 to 10, with 1 being extremely poor in quality and 10 being extremely good in quality. The modal quality rating was generally good (Mode = 8.00, Mdn = 7.00, M = 7.29, SD = 1.31), with only five files receiving scores of five or less. As the files generally contained the necessary information for coding tools, missing data were scarce; no youth were missing data on the J-SOAP-II, and only one youth was missing information for items on the SAVRY (this case was prorated for the one missing item at admission and four missing items at discharge). To examine interrater reliability of the risk assessment tools, a random sample of files (22.7%, n = 37) was selected and separately coded by a second rater. As described in the “Results” section, interrater reliability was generally good to excellent.
Approximately 1.37 years after completing the coding of the study measures, youths’ postdischarge juvenile justice and adult criminal records were obtained through statewide law enforcement and probation. Records were available for all participants in our sample. The average length of the postdischarge follow-up period was 8.07 years (SD = 3.50), but ranged from 2.18 years to 13.56 years as youth were discharged at different dates. During the follow-up period, 7.4% of youth were arrested for sexual reoffenses (n = 12), 12.9% for violent nonsexual reoffenses such as assault (n = 21), and 46.0% for any reoffense (n = 75). This latter category included property offenses, violent nonsexual offenses, sexual offenses, and miscellaneous offenses (e.g., mischief) but did not include traffic offenses (e.g., speeding tickets). A reoffense was defined as an arrest rather than conviction, as sexual offenses are sometimes reduced to nonsexual offenses through plea bargains (Letourneau, Armstrong, Bandyopadhyay, & Sinha, 2013). To ensure a consistent and transparent reporting of methodology and results, this manuscript adheres to the Risk Assessment Guidelines for the Evaluation of Efficacy (RAGEE) Statement (Singh, Yang, Mulvey, & the RAGEE Group, 2015), a 50-item reporting checklist.

Description of Treatment Program
The Whitehall Psychiatric Residential Treatment Program is a specialized, community-based residential program that provides treatment to youth adjudicated for a sexual offense. To be admitted into the program, youth had to meet the following admission criteria: between 13 and 17 years of age, intellectual and adaptive functioning at least at the borderline level, adjudicated of a sexual offense and mandated to receive

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treatment, and demonstrated self-control that would allow functioning in an open, unlocked treatment program. The program is staffed by a multidisciplinary team including a licensed clinical psychologist, a psychiatrist, master’s level mental health clinicians, nurses, occupational therapists, recreational therapists, and bachelor’s level direct care staff.
At intake, all youth undergo a comprehensive psychological evaluation, and throughout treatment, both youth and treatment staff complete ongoing assessments that assess behavioral and emotional symptomatology. Treatment plans are individualized to meet each youth’s strengths and treatment needs, although they tend to focus on similar themes: insight and accountability for past offenses, problem-solving skills, skill building and promotion of positive relationships, development of relapse prevention plans, enhancing awareness of victim impact, reduction of psychopathology, and educational success. These areas are addressed via several modalities, including individual, group, and family therapy, as well as school-based interventions and recreational and occupational therapy. Youth attended individual therapy two to five times a week, as well as a relapse prevention group (three times a week), occupational therapy, and recreational therapy. Depending on the youth’s needs, they also attended trauma-focused, coping skills, and relationship skills groups all with a CBT, skillbuilding orientation.
The Whitehall Program is an unlocked program. The daytime level of supervision is comparable with a day treatment program and youth have more community contact than a traditional secure or correctional facility. For instance, depending on their progress in the program, youth can go home with their family for a weekend or go on a community outing (e.g., out for lunch with their family). Also, at the time period captured by the current study, some youth in the program were attending public schools and/or church in the community.

Measures
J-SOAP-II. The J-SOAP-II (Prentky & Righthand, 2003) is a 28-item checklist designed to aid in assessing risk for sexual violence and general delinquency. It is intended for use with adolescents, aged 12 to 18, who have a history of sexually coercive behavior. In the present study, we focused on the Intervention and Community Stability/Adjustment scales, as the J-SOAP-II authors conceptualize these scales as dynamic. These scales contain seven and five items, respectively, which are rated on a 3-point scale (absent, possibly present, clearly present) and are summed to create a Dynamic Risk Total Score. The J-SOAP-II does not have cutoff scores or yield probability estimates.
In the J-SOAP-II manual, the authors state to omit the Community Stability/ Adjustment scale if a youth is “incarcerated in a correctional facility or a secure residential treatment program” (p. 25). However, this scale can be rated for youth in nonsecure residential settings (Prentky et al., 2010). The residential treatment program in this study was nonsecure and unlocked. For instance, youth in the program had numerous outings in the general community, such as home visits and attendance at school

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and church. Thus, similar to Prentky et al. (2010), we rated this scale for the youth in our study.
A meta-analysis indicated that the J-SOAP-II’s Intervention and Community Stability/Adjustment scales significantly predicted sexual and nonsexual reoffending with small to moderate effect sizes (Viljoen, Mordell, & Beneteau, 2012). In prior studies, researchers have found the Intervention scale to have good to excellent interrater reliability and the Community Stability/Adjustment scale to have fair to excellent interrater reliability (e.g., Aebi, Plattner, Steinhausen, & Bessler, 2011; Caldwell, Ziemke, & Vitacco, 2008; Martinez, Flores, & Rosenfeld, 2007; Rajlic & Gretton, 2010). In the present study, internal consistency was adequate (α > .77; see Table 1) except for the Community Stability/Adjustment scale at admission (α = .60).
SAVRY.  The SAVRY (Borum et al., 2006) is a 30-item checklist that was designed to assess violence risk in male and female adolescents. The SAVRY is based on a structured professional judgment (SPJ) model and does not have cutoff scores. In the present study, we focused on the Social/Contextual, Individual/Clinical, and Protective Factors sections, as the SAVRY authors conceptualize these sections as dynamic. The Social/Contextual and Individual/Clinical sections contain six and eight items, respectively, which are rated on a 3-point scale (with ratings of low, moderate, or high risk). The Protective Factors section contains six items, which are rated dichotomously (present or absent). Consistent with other research on the SAVRY (e.g., Lodewijks, de Ruiter, & Doreleijers, 2010), we summed items to form scores for each section and created a Dynamic Risk Total Score by summing scores on the Social/Contextual and Individual/Clinical sections.
In a meta-analysis examining the predictive validity of SPJ-based risk assessment tools, Guy (2008) reported that the SAVRY Social/Contextual, Individual/Clinical, and Protective Factors sections significantly predicted physical and sexual violence and nonviolent reoffending, with weighted AUC scores ranging from .64 to .75 (see also Lodewijks et al., 2010; Vincent, Guy, Gershenson, & McCabe, 2012). Researchers have found these sections to have good to excellent interrater reliability (e.g., intraclass correlation coefficients or ICC > .80; Lodewijks, Doreleijers, de Ruiter, & Borum, 2008). Internal consistency was generally acceptable in the present study but was low for the Social/Contextual and Protective Factors sections (α < .70; see Table 1).
PCL:YV.  The PCL:YV (Forth et al., 2003) is a 20-item rating scale designed to measure psychopathic traits. This measure was adapted for adolescents from the PCL-Revised (PCL-R; Hare, 1991, 2003). Each PCL:YV item is rated on a 3-point scale (i.e., 0, 1, 2), with higher scores indicating a larger number of psychopathy-related traits. Consistent with the PCL:YV manual, items were summed to form a PCL:YV Total Score and scores on four facets. The Interpersonal facet includes four items (e.g., grandiose sense of self-worth), the Affective facet includes five items (e.g., callous/lacking empathy), the Behavioral facet includes five items (e.g., irresponsibility), and the Antisocial facet includes five items (e.g., early behavior problems).

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Table 1.  Interrater Reliability and Internal Consistency of J-SOAP-II and SAVRY Scores.

Internal consistency (Cronbach’s α)

Interrater reliability (n = 37)

Increase or decrease required to classify change as reliable (95% CI)

Measure

Admission Discharge Admission Discharge Change RCIα

J-SOAP-II

 Intervention

.77

.89

.64

.82

.82 4

  Community stability/ .60

.72

.52

.77

.64 4

adjustment

  Dynamic risk total

.80

.91

.65

.84

.82 6

SAVRY

 Social/contextual

.62

.68

.70

.89

.46 4

 Individual/clinical

.73

.85

.73

.86

.71 5

  Protective factors

.58

.68

.68

.62

.24 3

  Dynamic risk total

.80

.87

.70

.88

.66 7

RCIIRR
5 4
8
4 5 2 8

Note. The column titled Change refers to the interrater reliability of the change scores (i.e., Change score = Score at Admission − Score at Discharge for risk scales, and Score at Discharge − Score at Admission for the SAVRY protective factors section). RCIs are rounded up or down to the nearest integer, as scale scores are in full numbers versus decimal points. J-SOAP-II = Juvenile Sex Offender Assessment Protocol–II; SAVRY = Structured Assessment of Violence Risk in Youth; CI = confidence interval; RCIα = reliable change index based on internal consistency; RCIIRR = reliable change index based on interrater reliability coefficient.

In prior studies, researchers have found that the PCL:YV is a valid and reliable measure available for assessing psychopathic features (Edens et al., 2007; Salekin, Leistico, Neumann, DiCicco, & Duros, 2004). Furthermore, the PCL:YV was found to be a significant predictor of some forms of reoffending in a sample of adolescents who sexually offended (Gretton, McBride, Hare, O’Shaughnessy, & Kumka, 2001). Similar to other studies (Forth et al., 2003; O’Neill et al., 2003), internal consistency in the present study was acceptable for the total score (α = .80). However, it was modest for the facet scores (α = .59, .64, .51, and .68 for Interpersonal, Affective, Behavioral, and Antisocial facets, respectively) possibly due to the small number of items in each facet (i.e., 4 or 5 items each; see Cortina, 1993). Consistent with previous research (e.g., Spain, Douglas, Poythress, & Epstein, 2004), the interrater reliability of the PCL:YV total and facet scores generally fell in the excellent range (ICC for single raters, absolute agreement, two-way random effects model = .89 for total score, and .83, .89, .68, and .85 for Interpersonal, Affective, Behavioral, and Antisocial facets, respectively, based on a random sample of 25 cases from the present study). The mean PCL:YV score was 17.25 (SD = 6.00). This is consistent with prior research with samples of adolescents in residential treatment programs (e.g., Marshall, Egan, English, & Jones,
YouthSavryAdolescentsStudyRisk