Treatability evaluations for young offenders: an exploration of decision-making in context

The objective of this study was to develop a model that describes clinicians' treatability decision-making for young offenders in the Ontario judicial system. A mixed methodological approach was used to quantitatively identify the variables clinicians consider when evaluating treatability and qualitatively explain why clinicians consider specific variables in their judgments. A series of complementary investigations were conducted. In Study 1, psychologists, psychiatrists, and social workers were interviewed to determine the variables they consider in assessing treatability and what factors influence these judgments. Clinicians considered diagnostic, criminogenic, contextual, and attitudinal variables. Youth, clinician, and assessment context characteristics influenced judgments. In Study 2, the same clinicians ranked 17 variables in order of importance when evaluating treatability in young offenders. Inter-clinician differences were apparent in the ranking of variables and rankings were significantly influenced by clinical orientation. Clinicians who were strongly influenced by empirical research ranked Criminal History as more important while clinicians who primarily adhered to a clinical model ranked Mental Health History as more important. In Study 3, 348 assessment reports were examined to determine the variables considered in actual treatability decisions, whether judgments are influenced by profession, and whether judgments change over time. Clinicians weighed different variables when assessing treatability. For psychiatrists, a youth's presentation, presence of Antisocial Personality Disorder, denial of difficulties, and mental and criminal history predicted optimistic or pessimistic judgments while presentation and decade of an assessment predicted psychologists' judgments. Professional influences were also evident by the finding that psychologists offered optimistic judgments and treatment recommendations significantly more often than psychiatrists. The hypothesis that judgments would become pessimistic over time was not supported. The collective findings led to the development of a treatability decision model that characterized this judgment as considering different treatability criteria that, in turn, are based on factors associated with the youth, clinician, and assessment context. Findings suggest that there is no standard approach for assessing treatability and that judgments vary depending on who conducts the assessment. Areas of focus for standardization of treatability are delineated and suggestions for the content of a treatability scale, consistent with the judgment model, are offered. (PsycINFO Database Record (c) 2016 APA, all rights reserved)

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