CONCURRENT SESSIONS & POSTERS AND PRODUCT SESSION

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EFCAP 2022 SESSIONS SCHEDULE

 

 

Wednesday 18 May 2022

10:45 - 12:15 Concurrent session 1

Juvenile Offender’s Risk Assessment protocol (VRAI): Overview and preliminary results

Individual presentation114Lorena Maneiro, University of Santiago de Compostela, Spain

Room 1AWed 10:45 - 12:15

The interest in the study of the predictors of juvenile antisocial behavior has increased over the last years, together with the use of risk assessment instruments which contribute to risk prediction and management. In order to overcome some of the limitations of previous instruments, a new risk assessment tool was developed in the Spanish context, namely the Juvenile Offender’s Risk Assessment (VRAI). The VRAI was developed as a risk assessment tool to serve as a guide for intervention with adolescents in the Juvenile Justice System, providing information about 24 risk factors (i.e., historical, psychosocial, and individual), three protective factors, and three other relevant variables. The information is collected, on the one hand, from the technical staff of the centers and, on the other hand, from self-reports by adolescents through an online questionnaire. Some preliminary results are presented as regards the differences and commonalities in all the factors between juvenile offenders and a sample of community adolescents from Galicia (NW Spain). Overall, juvenile offenders showed higher levels of risk in most of the risk factors and lower scores in the protective factors. A total of five profiles were identified based on the scores on a set of factors, namely, low-needs, socio-familiar, moderate needs, antisocial-drugs, and high-antisocial. These results are discussed regarding the relevance of evaluation of specific risk factors for risk management.
Co-author(s): Olalla Cutrín, Paul Vedder, Xosé Antón Gómez-Fraguela

Assessment and treatment of young and/or adolescent offenders
juvenile offenders, risk assessment, risk management, VRAI

Risk Assessment of Violence - doing with not just to!

Individual presentation117Rebecca Morland, Cambridgeshire and Peterborough NHS Foundation Trust, United Kingdom

Room 1AWed 10:45 - 12:15

Structured risk tools are commonly used when assessing violence in children and young people, however they can rely on third party information. Excluding the voice of the child means that information is missed, their views are lost, and formulation is therefore incomplete. This presentation will review the literature and research in relation to conducting structured forensic assessments for children and young people. It will also consider whatgood practice may look like when completing a child-centred risk assessment and the ethical dilemmas that can occur.
Co-author: Bethan Rawlins

Assessment and treatment of young and/or adolescent offenders
child-centred, collaborative, risk, violence

Patient satisfaction of adolescents and young adults in forensic psychiatry

Individual presentation121Wolfgang Weissbeck, Pfalzklinukum, Germany

Room 1BWed 10:45 - 12:15

Background: The German penal system is dividing between imprisonment and hospitalisation in a forensic-psychiatric hospital. Hospitalisation follows committing an unlawful act in a state of incapacity or diminished criminal responsibility. So far, there is hardly any research on patient satisfaction in forensic psychiatry, however questioning patient satisfaction is an important part of quality management. The goal of the present study was to assess patient satisfaction in adolescents and young adults in the years 2017 to 2019.Method: The present study was conducted with a total of 48 young offenders (16-25 years of age) from the adolescent forensic department in Klingenmünster, Germany. The self-report questionnaire consists of 41 items, identifying potentials for improvement in the care of forensic inpatients. The mean values are compared between the years 2017, 2018 and 2019. The relationship between specific patient satisfaction and global patient satisfaction will be investigated.Results. The patient satisfaction was high and stable in all three years (2017: M = 1.79; 2018: M = 1.95; 2019: M = 1.76). The results show that there are no significant differences in global patient satisfaction over the three years. The most dissatisfied category in all three years are housing and food. There is a significant correlation (r = .61) between therapeutic interventions and global patient satisfaction, F(1,46) = 60.85, p < .001. Further, the therapeutic interventions explained a variance of 56.95 % (R2 = 0.5695) of global patient satisfaction.Discussion. Adolescents and young adults in a forensic-psychiatric unit are mostly satisfied. To improve patient satisfaction, a continuing dialogue between staff and patients is necessary.
Co-author: Tina In-Albon Leiterin

Narratives in youth forensic psychiatry
Imprisonment

The role of client empathy in treatment outcome at youth forensic psychiatric services

Individual presentation5Minet de Wied, Utrecht University, The Netherlands

Room 1BWed 10:45 - 12:15

Therapist empathy is known to be essential in establishing a good therapeutic relationship and treatment success. Empathy is a dynamic interpersonal process, however, depending in part on the relationship between the empathizer en person being empathized. The current study explores the role of client empathy in treatment outcome among male and female adolescents receiving treatment as usual (TAU) at forensic psychiatric services. Client reported empathy was assessed at intake and again at six months of treatment. Therapeutic change was rated by their therapist. The following questions are addressed: (1) is client empathy at intake related to therapist reported change at six months? (2) Is client empathy subject to change during the first six months of treatment? (3) Is such change related to therapist reported outcome? (4) are therapist factors (as empathy, personality and gender) involved in client empathy change? Preliminary results reveal that empathy in forensic youth-psychiatric patients is subject to change, that gender can play a decisive role in this and that empathy improvement contributes to therapist reported behaviour change at six months.

Assessment and treatment of young and/or adolescent offenders
adolescents

Effects of traumatic experience on street connected youth's detention history

Individual presentation123Shorena Sadzaglishvili, Ilia State University, Tbilisi, Georgia

Room 1CWed 10:45 - 12:15

Street-connected youth are vulnerable to violence from caretakers, fellow street youth, police, and experience all forms of exploitation and abuse. The present study conducted structural interviews with N=80 street-connected youth (43.8% female; 56.3% male. M=13.56. Median= 13.50 years; SD=2.44) recruited from 10 social service centers in two cities located in Georgia in 2018. Trained interviewers administered a close-ended survey on demographics, detention history and traumatic experience. Traumatic experience was measured using adapted version of Adverse Childhood Experience (ACE) Questionnaire for Street Connected Youth (CDCP, 2014). The adapted ACE measured 3 personal (physical abuse, verbal abuse, sexual abuse) and 2 related to other family members’ abuse: a parent who’s an alcoholic and a family member in jail. Survey data were analyzed in SPSS 22. The study showed that youth’s history of detention is correlated with youth’s ACE. In particular, youth with the detention past showed higher ACE score compared to the youth who did not have history of detention (Mann-Whitney, Z=-2.23, p=0.026). History of detention was not associated with the age of the child, however it was correlated with youth’s gender. Male youth are more likely to be arrested in the jail or detention centers (Pearson Chi-Square= 6.198, p=0.012). The study was funded by the Shota Rustaveli National Science Foundation of Georgia (FR 17_31).

Assessment and treatment of young and/or adolescent offenders
detention, trauma

Social Brain responses in Antisocial Behavior Development

Individual presentation112Ilse van de Groep, Erasmus University Rotterdam, The Netherlands

Room 1CWed 10:45 - 12:15

Over the past few years, many efforts have been made to understand why some youth persist over time in showing antisocial behavior, whereas others do not. While various imaging studies have shown functional and structural impairments that may contribute to these different developmental trajectories, it is surprisingly that these studies often fail to consider that people do not act in a social vacuum, and specifically that one of the key features of antisocial behavior is that perpetrators often act in disregard of others. Here, we present results from 3 social information processing studies, in which we examined whether developmental heterogeneity can be explained by the social mechanisms of self-concept evaluation and reactive aggression (in response to social evaluation) and their neural correlates. Throughout this talk, we will use fMRI data from young adults with a childhood-onset history of antisocial behavior (n = 55) and young adults without a history of antisocial behavior (n = 40). We will show (1) how self-concept evaluation and aggression in response to social evaluations differ in these samples, (2) how these differences are reflected in differential neural activation in social brain regions such as the medial prefrontal cortex and (3) how these two social evaluative processes and their neural correlates relate to each other. This will help us to gain a better understanding of whether social mechanisms drive multi-finality in antisocial behavior, and whether this should be incorporated into prevention and intervention efforts.
Co-author(s): Marieke Bos, Lucres Nauta-Jansen, Arne Popma, Eveline A. Crone

Neurobiological & - psychological intervention studies
antisocial behaviour

Triggering Threat, Drive and Soothing: Differences in HRV patterns between forensic boys and male community adolescents

Individual presentation16Rúben Sousa, University of Coimbra, Portugal

Room 1CWed 10:45 - 12:15

The capacity for adaptive emotion regulation is paramount in adolescence. The tripartite model of affect regulation proposes the existence of three emotion regulation systems (i.e., Threat, Drive and Soothing), designed for survival. An unbalanced functioning of these systems associates with greater risk for the development of psychopathology, specifically Conduct Disorder (CD). Youths with CD generally develop in hostile environments, present higher levels of negative emotions and display different emotion regulation patterns when compared to their normative peers. On the other hand, heart rate variability (HRV) has been reported as an accurate index of emotion regulation. However, there is no study exploring specific HRV patterns for each system while comparing healthy and disturbed adolescents. This study aimed to explore differences in HRV patterns between community males (n = 97) and male young offenders (n = 99), aged between 14 and 18 years old, when triggering the three emotion regulation systems. Data was collected for resting, reactivity and recovering phases, following a standardized experimental procedure. Results showed that in both samples, the threat and drive systems were associated with decreased HRV. Remarkably, while for community males the soothing system associated with increases in HRV, young offenders displayed decreases in parasympathetic nervous system activity, which seems to mirror threat like physiological responses. These physiological findings suggest that young offenders seem to present an underdeveloped/suppressed soothing system when compared to their normative peers. Following these findings, at the beginning of the psychotherapeutic process, attempts to boost the soothing system of young offenders should be cautious.
Co-author(s): Daniel Rijo, Nicola Petrocchi, Paul Gilbert

Assessment and treatment of young and/or adolescent offenders
adolescence, heart rate variability, male young offenders, tripartite model of affect regulation

Optimizing reintegration and crime resistance by focusing on recovery: the theory, the practice, and the follow-up

Symposium72David Buitenweg, GGzE Institute for Mental Health Care, The Netherlands; Clare-Ann Fortune, Victoria Universit of Wellington, New Zealand; Colinda Serie, Belgium

Room 1DWed 10:45 - 12:15

In recent years, there has been an increasing focus on strength-based recovery for offenders in which individuals’ needs, skills and Quality of Life take a central role. An example of a theoretical reintegration framework is the Good Lives Model (GLM). Although promising in theory, empirical evidence for the GLM and its assumptions is still in its infancy, especially for young offenders. Therefore, the first presentation will provide an overview of the theoretical underpinnings of the GLM and developmental factors to consider when applying it to youth who have offended. The second presentation will examine the two main assumptions of the GLM for (detained) adolescents. The third presentation is on innovative and promising initiatives for persistent offenders to achieve personal recovery, in other words, to achieve a higher level of well-being. Finally, in the fourth talk, the life and Quality of Life after discharge from psychiatric residential care is presented.

Presentation 1: Strength based approaches to rehabilitation: theoretical considerations for applying the Good Lives Model to youth who offend
Strength based approaches to rehabilitation: theoretical considerations for applying the Good Lives Model to youth who offendHistorically, offender rehabilitation has taken a risk reduction focus. There is, however, increasing interest in expanding our understanding of effective strength-based rehabilitation approaches for youth who have offended. The Good Lives Model (GLM) is a strength-based rehabilitation framework which was originally developed for use with adults who had sexually abused children. Since its development there has been increasing interest in applying the GLM to an increasing range of offender populations including youth, females, and other offence types (e.g., general, violent). This presentation will consider the application of the GLM to youth who have offended including the theoretical underpinnings of its application. As the GLM is a rehabilitation framework, the GLMs alignment with risk reduction approaches (i.e. the RNR) will be considered, along with how it fits with existing, evidence based, interventions. A brief overview of the extant literature will also be provided. Issues to consider for those using the GLM with youth will be highlighted, including adapting the language to be developmentally appropriate.

Presentation 2: Primary goods, well-being and offending behaviour in (detained) adolescents: examing the assumptions of the Good Lives Model
Primary goods, well-being and offending behaviour in (detained) adolescents: examing the assumptions of the Good Lives ModelBackground: Current correctional and rehabilitation interventions for adolescent offenders tend to be problem- and risk-focused. Partly as a critique to this risk-focus, ‘the Good Lives Model (GLM)’ was developed. The GLM argues that in order to successfully and sustainably prevent recidivism, interventions should not only aim to reduce, avoid or eliminate offender’s (criminogenic) risks, problems, and deficits, but also focus on their (non-criminogenic) personal human needs, values, strengths, and capabilities to improve their well-being. This idea is based on two main assumptions. The first assumption holds that all human beings strive to obtain a universal set of life goals/human needs in order to achieve well-being, called ‘primary goods’. The second assumption states that a failure in pro-socially obtaining these primary goods (due to personal limitations and/or environmental disadvantages) can result in offending behaviour, as an alternative, anti-social attempt to pursue the valued goods. Although promising in theory, empirical evidence for the GLM and its assumptions is still in its infancy, especially for young offenders.Methods: This study therefore examined the two main GLM assumptions on the relationships between primary goods, well-being and offending behaviour in adolescents, based on self-report data from both a general population sample (from a large-scale school survey in Flanders, Belgium) and a sample of detained adolescents (from juvenile justice institutions in Belgium and the Netherlands).Results and conclusion: The preliminary results show that youngsters who report on having offended in the past year, indeed show a lower level of global well-being. The results will further show if and which primary goods are related to adolescent well-being and offending behaviour.

Presentation 3: Be a barista: Evaluation of innovative reintegration programs with recovery focus for persistent offenders
Be a barista: Evaluation of innovative reintegration programs with recovery focus for persistent offenders Background: Due to the high recidivism rates of persistent offenders, it is clear further developments in service initiatives are needed. Recently, several innovative initiatives came up to better suit the personal needs of persistent offenders to achieve more successful personal recovery and rehabilitation, and thereby reducing their recidivism risks. Previously, we studied nine of such innovative reintegration programs, that proved to be successful in practice, and identified a number of unique ingredients that contributed to the engagement and reintegration of persistent offenders. The aim of this follow-up study was to further build the evidence of these reintegration programs.Methods: A longitudinal, multiple case study design was used. Twenty persistent offenders were followed in the nine reintegration programs to collect data on changes in criminal behavior, personal recovery and rehabilitation at three moments: start, after 3 months, and after 12 months. Quantitative methods were used, including questionnaires and a diary method using the smartphone: experience sampling. Using semi-structured interviews we aimed to capture personal experiences with the program.Results: First, results based on the questionnaires and experience sampling data illustrate that persistent offenders are feeling empowered in the programs as they have gathered confidence in their own future. Second, the semi-structured interviews show that persistent offenders evaluate the reintegration programs as useful in building a bridge between society and their own (working) life.Conclusion: The included reintegration programs are positively evaluated by the persistent offenders as they fit their needs and contribute to their reintegration and rehabilitation.
Co-authors: Chijs van Nieuwenhuizen, Stefaan Pleysier, Diana Roeg, Johan Put

Assessment and treatment of young and/or adolescent offenders
recovery focus, rehabilitation, reintegration, risk-need-responsivity

Psychopathic traits and delinquency in juveniles

Symposium10Cyril Boonmann, Psychiatric University Hospitals, Switzerland; Tania Pérez, Psychiatric University Hospitals, Switzerland; Süheyla Seker, Psychiatric University Hospitals, Switzerland

Room 1FWed 10:45 - 12:15

Psychopathic traits (Grandiose-Manipulative, Callous-Unemotional and Impulsive-Irresponsible traits) seem to be overrepresented in juvenile delinquents in comparison to juveniles from the general population. Still, these traits are also present among juveniles in the general population. In this symposium the influence of psychopathic traits on offending behaviour is discussed from different perspectives.

Presentation 1: Psychopathic traits and offending behavior in at-risk and general population juveniles
Psychopathic traits and offending behavior in at-risk and general population juvenilesBackground: Youths with high levels of psychopathic traits are a particularly severe subgroup within the group of antisocial youths (e.g., their age of onset is lower and their levels of delinquent behavior are higher than those of youths with low levels of psychopathic traits). More research into the origin and development of these traits could help prevent future antisocial behavior. Therefore, the main aim of our research project was to examine the prospective relationship between psychopathic traits and delinquent behavior (i.e., convictions) in at-risk juveniles (e.g., youths in residential care) as well as in the general population.Methods: Participants were 452 juveniles in residential youth care (placed under civil or criminal law) and 835 juveniles from the general population (age range: 13-21). The Youth Psychopathic Traits Inventory (YPI) was used to assess psychopathic traits. Conviction data was provided by the Federal Statistical Office. The mean follow-up time was approximately 9 years in both samples. We set up survival functions (Kaplan-Meier) and calculated Cox proportional hazards regression to examine the relationship between YPI score and risk of being convicted for a violent and non-violent offence.Results: High YPI scores (i.e., top half) were associated with a higher hazard of violent and non-violent offence convictions in the at-risk sample, even when adjusting for various covariates. In the general population sample, high YPI scores were associated with a higher hazard of non-violent offence conviction. These results, however, did not remain significant when adjusting for covariates.Conclusions: In the current study, the predictive value of YPI scores for future convictions differed between samples. This should be taken into account when interpreting the generalizability of research results and transferring knowledge into clinical practice.

Presentation 2: Psychometric properties of the German Youth Psychopathic traits Inventory – Short Version
The aim of the current study is to examine the psychometric properties of the German Version of the Youth Psychopathic traits Inventory-Short Version (YPI-S). A sample of 856 adolescents (age: 15-19) from the german-speaking part of Switzerland was included. All participants completed the 50-item YPI, of which we derived the 18 items of the YPI-S. Furthermore, participants completed the Massachusetts Youth Screening Instrument-Version-2 (MAYSI-2), as well a self-report delinquency questionnaire. We were able to replicate a three-factor structure and found moderate to good internal consistency for the total score as well as for the three dimensions of the YPI-S. Furthermore, we found positive small to medium correlation with both internalizing and externalizing mental health problems, substance abuse problems, and offending behavior. Our results suggest that the German version of the YPI-S is a reliable and valid screening instrument for psychopathic traits in both boys and girls from the general population in the German-speaking part off Switzerland.

Presentation 3: Substance-use Disorders Among Child Welfare and Juvenile Justice Adolescents in Residential Care: The Role of Childhood Adversities and Impulsive Behavior

Background:
Adolescents in the child welfare (CW) and juvenile justice (JJ) systems show high rates of substance use disorders (SUD). The knowledge about personal (impulsive behavior) and interpersonal (adverse childhood experiences [ACE]) factors related to SUD in CW and JJ involved youths is still inconclusive.


Objective:
The aim of this study is to investigate the prevalence of SUD and its relationship with ACE and impulsive behavior among CW and JJ involved adolescents respectively.


Method:
A total of 386 adolescents in residential care ages (37.0% girls; age range = 10-18 years; mean age = 15.41 years) in Switzerland were assessed with well-established questionnaires (CW: n = 286; JJ: n = 100). Lifetime SUD and different types of ACE were categorically assessed with the Kiddie Schedule for Affective Disorders and Schizophrenia – Present and Lifetime Version. Impulsive-irresponsible behavior was dimensionally measured with the Youth Psychopathic traits Inventory. Logistic regression analyses were used to explore the relationship between ACE, impulsive-irresponsible behavior and lifetime SUD in CW and JJ involved youths separately.


Results:
JJ involved youths showed high rates of any SUD compared to CW involved youths (38% vs. 20%; (X2(1) = 22.21, p < 0.001). From the different types of ACEs, only physical abuse was associated with any SUD among CW involved youths (B = 1.31, SE = 0.41, p = 0.001), whereas impulsive-irresponsible behavior was related to any SUD among CW involved youths (B = 0.43, SE = 0.09, p < 0.001) and among JJ involved youth (B = 0.44, SE = 0.17, p = 0.01).
Conclusion:
Considering the high rates of SUD in CW and JJ involved adolescents, this study highlights that interpersonal ACE are related with SUD among CW involved youths and, additionally, incorporating impulsive behavior in the treatment and assessment may reduce SUD among CW and JJ involved youths.

Child and adolescent Psychiatric Research Department
childhood adversity, impulsive behavior, residential care, substance-use disorders

Quality Forensic Care-Youth: a selection of projects to improve the quality of the forensic youth care

Symposium122Ed Hilterman, Expertise centre of Forensic Psychiatry; Michiel de Vries Robbé, Anneke Kleeven, Amsterdam UMC; Brenda Riegman, Collin Hoogeveen, Jolien van Aar, Isa Eekhout, VanMontfoort; Kees Mos, Forensic Centre Teylingereind/RIJ De Hartelborgt, The Netherlands

Room 1GWed 10:45 - 12:15

"Together we are stronger": The Quality Forensic Care-Youth (KFZ-J) program was launched in 2018 with this idea in mind. Within the program the field of forensic youth care works together to increase the quality and effectiveness of interventions and treatments. The aim is providing better care for at-risk youth, and a safer society for everyone. Through a selection of three different projects that are financed within the program an overview of the available projects is given. The projects that will present itself are: 1) Risk Screener – Youth, a risk screener that was developed from scratch, 2) So-Cool, an intervention that is researched on effectiveness in the increase of social skills, social problem-solving and self-confidence, and the reduction of recidivism) and 3) MDFT, a family-based intervention that was further developed.

Presentation 1: What is Quality Forensic Care-Youth?

Background: The Quality Forensic Care-Youth (KFZ-J) program was launched in 2018 to unite strengths and to coordinate quality improvement in forensic care for juveniles. Within the program the field of forensic youth care works together to increase the quality and effectiveness of interventions and treatments. The aim is providing better care for at-risk youth, and a safer society for everyone.Objective: Present a short explanation of the program Quality Forensic Care-Youth (KFZ-J).Methods: Through directed and open calls KFZ-J invites institutions and professionals to participate in projects and to work on quality improvement of forensic care for juveniles. Results: KFZ-J finances and supervises different types of projects that are all directed towards the improvement of the quality of care in juvenile forensic care. Conclusion: Uniting knowledge and strengths leads to a focus on quality improvement: "Together we are stronger".

Presentation 2: Risk screening for (violent) recidivism by juveniles and young adults: introducing the new Risk Screener - Youth

Background: Juvenile justice seeks better insight into risk and protective factors for treatment planning, allocating interventions, triaging comprehensive assessment, measuring progress and informing release decision-making. However, comprehensive risk assessment is not always feasible, necessary, or desirable. Therefore, simplified risk evaluation was developed that includes risks and strengths regarding concerns about future violence and criminality.Objective: The newly development Risk Screener-Youth (RS-Y) is presented, providing easy-to-use screening as feasible alternative for juveniles and young-adult risk evaluation. The RS-Y contains a staff rated version and a self-assessment version, to help juveniles gain insight. Potential value for assessment and intervention in forensic practice is discussed.Method: The RS-Y was tested retrospectively and evaluated prospectively in clinical practice. For 98 individuals the RS-Y, SAVRY and SAPROF-YV were rated at discharge from Dutch juvenile justice institutions (30 cases double-rated).Results: The RS-Y interrater-reliability was excellent (ICC=.92). Predictive validity was moderate-good for general and violent recidivism within 1yr and long-term follow-up (AUC=.66-.79), comparable to comprehensive risk assessment tools. Prospective evaluation showed positive feedback from treatment providers and juveniles.Conclusion:The RS-Y offers a feasible easy-to-use screening alternative to evaluate risks and strengths to better inform intervention goals and ensure improved decision-making preventing violent and non-violent recidivism.

Presentation 3: So-Cool

Background: So-Cool (Sociaal-Cognitieve Oplossingen Leren; Social-Cognitive Solutions Training) is an individual behavioural intervention based on the social-information processing model, for young people aged from 12 to 23 years with a mild intellectual disability (IQ of 50-85) who commit offences. The main aim is to reduce recidivism among these delinquent youngsters, by increasing social skills, social problem-solving and self-confidence.Objectives: To test whether So-Cool indeed increases social skills, social problem-solving and self-confidence, and reduces recidivism.Methods: We compared pre- and post-measures of 411 youngsters who participated in So-Cool on social skills (TOPS-A), social problem-solving (SIVT) and self-confidence (CBSA). We also have data on the number of offences these youngsters committed three years after participation in So-Cool, which we compared to the number of offences of a matched control group (care as usual).Results: After participation in So-Cool, youngsters show better social skills, response generation and selection, and self-confidence (pre-post measures differ significantly). Recidivism analyses are still running.Conclusion: So-Cool seems effective in improving the social problem solving skills and self-confidence, which -if low- are considered risk-factors for recidivism. Whether So-Cool also reduces recidivism is still to be determined.

Presentation 4: Working from inside to outside: experiences with family therapy for young adults

Background: We will present results of a pilot-study focused on the further development of the family-/system-therapy Multidimensional Family Therapy (MDFT) for young adults of 18-23 years (funded by KFZ-J (Quality Forensic Care-Youth)). The project was in two Juvenile Justice Institutions (JJI) in the Netherlands, Teylingereind and Hartelborgt. Starting with family therapy in detention offers opportunities, research showed increased motivation to participate in family-therapy.Objectives: What are the developmental needs of emerging adults and outcomes of the pilot-study?Methods: In JJI’s the number of young adults (18-23yrs) has increased since in 2014 the age was raised at which this group could be treated as juveniles. This permits detention in JJI’s with the possibility of a more pedagogical approach.Results: We examined if MDFT could be implemented as effective treatment for young adults placed in a JJI. We followed a cohort of 20 males, who committed serious violence crimes. The results confirmed that MDFT improves social re-integration of convicted youths. During and after treatment, they hardly committed any offence. Positive changes were noted in substance use, school- and work-orientation and debt repayment.Conclusion: It’s feasible to implement system therapy in a JJI. First outcomes are promising, but more research is needed.

Assessment and treatment of young and/or adolescent offenders
family-based, intervention, risk screening, social skills

14:00 - 15:30 Concurrent session 2

Impact of an individual intervention programme with adolescents who engage in sexually abusive behaviour

Individual presentation97Ricardo Barroso, University of Porto, Portugal

Room 2AWed 14:00 - 15:30

Introduction and objective: The practices of sexual violence can be perpetrated by adolescents or adults, being mostly practiced by male aggressors. The PBX Programme (Barroso, Ramião, & Figueiredo, 2018) was built given the need to implement specialized interventions with adolescents who have committed sexual crimes, using the detention time to drive the desired behavioural change. Method: A group of male adolescents benefited from an individual intervention program, applied by clinical and forensic psychologists in a forensic setting. The PBX Programme was developed considering an initial phase of psychoeducational contents and a second phase of specialized therapeutic intervention, preparing for life in society. The experimental impact assessment included pre and post intervention data collection. An instrument protocol was applied, and a standardized qualitative clinical interview was conducted to find behavioural change. Results and Conclusion: Preliminary results gather sufficient evidence of the impact on juvenile’s behaviour change process and support the implementation of the program.
Co-author(s): Eduarda Ramião, Patricia Figueiredo, Ana Sousa

Assessment and treatment of young and/or adolescent offenders
experiment, PBX, sexual violence

Stalking in Adolescents - An attachment perspective

Individual presentation111Nina Champaneri, Sussex, United Kingdom

Room 2AWed 14:00 - 15:30

Stalking in adolescents is currently a poorly researched area and yet the consequences of this behaviour has far reaching effects on individuals, families and society as a whole. This workshop will address the assessment model for stalking in Adolescents and how this might inform intervention to reduce risk from an attachment perspective.Our aim is to understand the presentation, identify risk factors and discuss with the audience to develop a working intervention framework which can be used across all Forensic Child & Adolescent Mental Health Service (FCAMHS) services.We will first discuss definitions of harassment and stalking and review the current literature and legislation in the UK on adolescents who exhibit these behaviours.We will look in depth at clinical cases of both male and female stalkers identified from the West Midlands community FCAMHS in the UK to understand the similarities and differences in presentations between the two genders. We will also look at individual profiles of both the stalkers and their victims and identify themes which will aid future recognition of individuals with this pattern of behaviour.Some common themes identified from our current sample include comorbidity with Autism Spectrum Disorder, early attachment difficulties, the link with physical violence and the effect of social media.We hope the workshop will promote discussion but also allow clinicians to develop an understanding of the aetiology of stalking in Adolescents and identify key approaches to intervention.
Co-author: Tina Irani

Assessment and treatment of young and/or adolescent offenders
stalking in adolescent

ThePaS- A therapy program for adequate sexual behaviour: indication, contents and clinical application

Individual presentation101Leonardo Vertone, University Hospital of Psychiatry Zurich, Switzerland

Room 2AWed 14:00 - 15:30

The ThePaS - A therapy program for adequate sexual behaviour has been developed by combining cognitive behavioural and specific relapse prevention methods. It is in clinical practice in several forensic institutions and professionals in the German speaking part of Switzerland.

The results of our recently conducted study (Aebi et al., 2019) suggest – from a clinical point of view – that it makes sense to use specific relapse prevention techniques to address youth’s criminogenic needs (riskfactors) and to lower the risk of sexual recidivism. A combination of specific relapse prevention skills with elements of the good-lives model and with social and emotional skills trainings may further increase the commitment to therapy and improve mental health.

Based on research findings the revised ThePaS addresses the following topics: Analysis of the individual acts of crime, accounting consequences, empathy for the victim, relapse prevention techniques; life aims, personal skills and strengths, knowledge in the body-anatomy, sexuality, flirting, in engaging and holding relationship, mindfulness, reflecting own feelings, self-control, problem & conflict-solving, say “no”, moral judgment; country’s law, exam, certification, booster.

The ThePaS is indicated for youth who sexually offended with contact. It is not indicated for youth with IQ < 70, severe crimes, severe psychotic / depressive disorders and full-blown paraphilias. Further clinical implications are discussed.
Co-author(s): Thomas Best, Daniela Imbach, Marcel Aebi, Cornelia Bessler

Assessment and treatment of young and/or adolescent offenders
sexual behaviour

Back to the future: identifying trends, scenarios and research themes for forensic youth care

Individual presentation67Ilja Bongers, GGzE Institute for Mental Health Care, The Netherlands

Room 2BWed 14:00 - 15:30

Background:
The future of forensic youth care is uncertain because of the constantly evolving environment. In order to improve the quality of forensic youth care, these uncertainties have to be taken into account in future research themes.

Aim:
The aim of this study is to identify research themes for the next ten years.

Method:
Using the scenario method, research themes for the future of forensic youth care were formulated. The research themes were determined with the help of 22 experts. Part of the scenario method was an investigation of future trends using a literature search and two workshops to develop four scenarios for the future and to establish the research themes.

Results:
The important trends for the future were: an increase in legislation and regulations, shifting from risk reduction to strengths-based care, a more prominent place for prevention and specialized health care, and changes in types of delinquent behavior. Based on these trends, four scenarios for the future were established. The scenarios were organized around two dimensions: (1) the use of data for treatment and restriction of individuals and (2) whether society is organized around groups or individuals. Based on these four scenarios, experts discussed how the quality of forensic youth care could be enhanced. This resulted in six research themes with underlying research questions: (1) alliance, (2) shared decision making, (3) instant feedback, (4) ethical questions in forensic health care, (5) positive psychology and (6) life course perspective.

Conclusion:
To enhance the quality of forensic youth care in the future, it is important to study the themes in different groups of forensic youth and institutions.
Co-author: Chijs van Nieuwenhuizen

Assessment and treatment of young and/or adolescent offenders
forensic youth care, research themes, scenario method

Tele-therapeutic care during Sars-Cov-2 pandemic in the Forensic Child and Adolescence Psychiatry Zurich

Individual presentation104Sebastian Wölfle, Psychiatric University Hospital Zurich, Switzerland

Room 2BWed 14:00 - 15:30

Abstract:
On account of the covid pandemic, conventional outpatient treatment of juvenile offenders was interrupted. Before the pandemic, empirical evidence already indicated that web-based or blended therapy comprises advantages (e.g. accessibility) and difficulties (e.g. withdrawal rate). With the present investigation we aimed to evaluate video- and telephone based interventions in the outpatient clinic in Zurich (CH) during the first covid lock down in 2020. We therefore analysed descriptive data on tele-therapeutic interventions and compared these to standard treatment. Further we (assessed individual experiences of therapists and clients. Results show that professionals had a more sceptical view compared to clients. Commitment of the clients to the setting (e.g. unexcused absences was equal to classical face to face settings. Our data indicate comparable outcomes to recent scientific findings in non-forensic settings. Findings may enhance the implementation of tele-therapeutic approaches during regular outpatient psychotherapeutic treatment with juvenile offenders.

Summary:
On account of the covid pandemic, conventional outpatient treatment of juvenile offenders was interrupted. Before the pandemic, empirical evidence already indicated that web-based or blended therapy comprises advantages (e.g. accessibility) and difficulties (e.g. withdrawal rate). With the present investigation we aimed to evaluate video- and telephone based interventions in the outpatient clinic in Zurich (CH) during the first covid lock down in 2020. We therefore analysed descriptive data on tele-therapeutic interventions and compared these to standard treatment. Further we (assessed individual experiences of therapists and clients. Results show that professionals had a more sceptical view compared to clients.During a time period of eight weeks, between march, and may, 2020 57% of our outpatient clients received tele-therapeutic treatment. We compared descriptive data of the tele-therapeutic treatment with data of the same cases in a preceding and comparable time period. Frequency (4.5 vs. 2.7 sessions) and duration (45 vs. 53 minutes) of the treatment sessions differ in a noteworthy way. In contrast unexcused absences wich were almost equal (22% vs. 19%). Overal clients were satisfied with tele-therapeutic setting. About 81% reported that they would be open for blended treatment - in the future. However therapeutic professionals valued the working alliance within a tele-therapeutic setting less profound compared to the clients. They enforced that i.a. using treatment materials was hindered (56%) because of the setting.These basic findings correspond with research in this field (e.g. Simpson und Reid, 2014). They showed that blending both settings could be an useful opportunity of recent pandemic days to be both satisfactory and accessible in treating adolescent offenders.

Assessment and treatment of young and/or adolescent offenders
blended treatment, sars-cov-2, tele-therapeutic care, working alliance

New insights on psychopathic traits in youth: Assessment, profiling and treatment

Symposium95Diana Ribeiro da Silva, University of Coimbra, Portugal; Daniel Rijo, University of Coimbra, Portugal

Room 2CWed 14:00 - 15:30

Research in adults has described different profiles of psychopathy in an attempt to delineate similarities and differences among constellations of psychopathic traits. Although such research in adolescents is limited, it is crucial as it can increase our understanding of youth psychopathic profiles and their associated risk/protective factors and etiology, as well as inform the development of tailored youth interventions. To assess these traits, the first presentation presents a new Flemish version of the Elemental Psychopathy Assessment (SF). The second presentation uses a person-centered approach to delineate different profiles in terms of delinquent behavior, internalizing symptoms, substance use and victimization, also arguing that these profiles might be related to different etiological precursors. The third presentation corroborates on this and reveals that psychopathic profiles indeed differed on evolutionary variables, highlighting their importance for treatment. The final presentation then specifically focuses on treatment, showing evidence for a new program for youth psychopathic traits.

Presentation 1: How different psychopathic severity profiles of forensic male youth differ on evolutionary relevant variables.

A new wave of research is interested in understanding how psychopathy could be seen as a useful heritage for people who have been raised in harsh rearing environments. Although some research using variable-centered methods already tested this hypothesis, to the best of our knowledge, there is a lack of person-centered approaches to compare how different psychopathic severity profiles differ on evolutionary relevant variables. This study aimed to contribute to a better understanding of psychopathy within an evolutionary framework. A latent profile analysis (LPA) based on the three-factor model of the Youth Psychopathic Traits Inventory-Short (YPI-S) was performed with a forensic sample of 459 male adolescents. Significant mean differences on evolutionary relevant variables across profiles were also tested using the modified BCH and the DCAT methods. Results revealed the existence of three psychopathic severity profiles: a low psychopathic traits profile, an average psychopathic traits, and a high psychopathic traits profile. The psychopathic profiles differed on evolutionary relevant variables including early warmth and safeness experiences, traumatic shameful experiences, shame, shame coping strategies, and subclinical paranoid ideation. Results are discussed within an evolutionary framework, highlighting the importance of considering evolutionary variables in the conceptualization and treatment of youth with conduct problems.

Presentation 2: Changeability of psychopathic traits and disruptive behavior in a juvenile detainee after the PSYCHOPATHY.COMP program
There is a long debate whether psychopathic traits are treatable or not. However, there are few studies focused on the treatment of psychopathic traits, especially in samples of young offenders. More problematic, is the absence of intervention programs specifically tailored to the intervention needs of young offenders with psychopathic traits. To overcome this gap in the literature and gathering theoretical, empirical, and clinical practice insights, a research team developed the PSYCHOPATHY.COMP, which is a 20-session individual intervention program based on Compassion Focused Therapy (an evolutionary based approach) that was specifically designed to reduce psychopathic traits and antisocial behavior among young offenders by developing a compassionate motivation in these youth. This clinical case study presents the treatment process of a juvenile detainee with Conduct Disorder (severe, childhood-onset type), a high psychopathic profile, and a very high risk for criminal recidivism using the PSYCHOPATHY.COMP program. The treatment outcome data showed a significant reduction in psychopathic traits and disruptive behavior in this youth. The treatment gains were maintained increased over time (3 months after program completion). This clinical case study demonstrates the feasibility and efficacy of the PSYCHOPATHY.COMP program in reducing psychopathic traits and disruptive behavior in a juvenile detainee.

Assessment and treatment of young and/or adolescent offenders
psychopathic traits

Connecting with youth at risk: who works and what works?

Symposium64Melissa van Dorp, Academic Workplace for At-risk Youth (AWRJ), The Netherlands; Eva Mulder, Academic Workplace for At-risk Youth (AWRJ), The Netherlands; Karin Nijhof, Pluryn, The Netherlands; Fleur Souverein, Academic Workplace for At-risk Youth (AWRJ), The Netherlands

Room 2EWed 14:00 - 15:30

Youth (at-risk to be) involved with the justice system pose a complex population: they display a large variety of cognitive, psychological and social problems. It is often difficult to engage these youth in treatment and motivate them to move towards behavioral change. Especially youth placed in secure residential youth care institutions pose a challenging group. In any setting youth care workers need to provide these youth with a context that is both safe and structured with boundaries as well as therapeutic and developmentally appropriate. The therapeutic alliance or the way staff-youth interaction is shaped is hereby paramount. In this symposium, we will focus on what works in connecting with this complex group of youth. Based on interviews and consultations with the youth themselves, we examined what is important in connecting with adolescents, how they perceive different forms of contact with care providers, and how the connection between the adolescent and the care provider can be used to ensure safety within the walls of the institutions.

Presentation 1:Small-scale groups as an alternative for secure residential care: What works according to professionals, parents and youth
Secure residential youth care is an intensive type of out-of-home care for children with serious behavioral and emotional problems, where they receive treatment in a secured environment. Despite that problems of children and youth that receive residential care are complex and treatment at home is no longer seen as an option, the design of secure residential care facilities is questionable.. Living groups in secure residential facilities usually consist of eight to ten children, and a large team of group care workers. Recently there is increasing attention for the development of small-scale groups that exist of a maximum of six – preferably four – children, and stability in group care workers. It is argued that a small-scale model supports an individualized, continuous and integrated care. However, it is not yet clear what the definition of small-scale is: how small is a small-scale group? What is the ratio of youth care workers to children? Further, how do children, parents and youth care workers experience living or working in a small-scale group. What are the key elements and possible benefits of small-scale care, as an alternative for large scale secure residential care facilities? The current presentation focuses on these questions that were explored in a research project in The Netherlands involving a literature study and interviews with youth, parents and youth care workers in small-scale residential care facilities. We would like to share these results with the public and engage in an interactive way about the recent development of small-scale care.

Presentation 2:Perspectives of adolescents and professionals on seclusion in secure residential youth care
Youth placed in secure residential youth care typically present a variety of challenging behaviors. In this context, seclusion is often seen as a “last resort” strategy to manage these challenging behaviors. The use of seclusion is controversial, as it can have negative physical and psychological consequences for both youth and professionals. More awareness of the detrimental effects of seclusion have led to efforts to reduce and prevent its use. However, there is a wide disparity in how seclusion is defined. This leads to a diffuse image of what is considered seclusion, complicates measuring its prevalence and the effect of reduction strategies, and hampers initiatives to reduce its use. Therefore, the objective of this study was to develop a shared definition of seclusion by examining how adolescent (ex-)patients and professionals in secure residential youth care organizations perceive (the use of) seclusion. This shared definition would enable monitoring the use of seclusion in secure residential youth care and as such serve as a tool to provide better care. The Delphi-method and focus groups were conducted with respectively 29 and 21 participants from eleven secure residential youth care organizations in the Netherlands. The process of defining seclusion was characterized by a diversity of opinions among participants and revealed the existence of various types of seclusion in practice. This lead to a broad definition of seclusion, which can be used to monitor the use of seclusion, learn from feedback on its use, and reduce seclusion in secure residential youth care.

Presentation 3:Providing youth with a secure and therapeutic environment: establishing relational security in juvenile justice institutions
Secure juvenile justice facilities need to provide youth with a structured, therapeutic, and above all safe environment. Given the complexity of the population within these institutions this is a challenging task: staff need to handle externalizing as well as internalizing problems, with incidence of aggression and violence on one hand and self-harm and suicidal behavior on the other. In managing this complex population, security provides the framework within which structure and care can be safely provided. In an institutional setting there are three distinct, but inter-related elements of security: physical security (e.g. locks and seclusion), procedural security (e.g. restrictions in visits) and relational security (a constructive alliance between youth and staff). There is ample literature showing that high physical and procedural security measures may have detrimental therapeutic effects and do not necessarily increase safety. On the other hand relational security may allow establishing both a supervised and structured as well as therapeutic and safe environment. However, the current scientific literature is lacking an unambiguous substantiated conceptualization of relational security, specifically its operationalization in the context of juvenile justice facilities. The current presentation focusses on extensive qualitative research in a semi-open small-scaled community based juvenile facility. This facility is grounded in a relation security approach. Integrating the perspective of both staff as well as youth and their parents from semi-structured interviews, the current paper presents a conceptualization of relational security and its facilitators and barriers.

Practices in ambulantory & residential care of children and youngsters
connecting, youth at risk

Pathways to a school shooting rampage: Does fiction reflect scientific evidence?

Symposium44Riitakerttu Kaltiala, Tampere University, Finland

Room 2FWed 14:00 - 15:30

Multiple victim shooting incidents in schools seem to have become more common during the era of the Internet. Subsequent shooters borrow features from previous incidents, widely described in the world wide web, up to the extent that a “cultural script” of a school shooting incident has been acknowledged and is considered one of the critical factors necessary for such incident. Research has identified risk factors for school shootings in both societal level, immediate psychosocial environment level and in the individual. Factors from all these three levels have also found their way to fiction. We shall discuss three portraits of adolescent school shooters in the novels We need to talk about Kevin by Lionel Shriver, Nineteen minutes by Jodi Picoult, and Störst av allt by Malin Persson Giolito. In line with scientific research, the novels imply three different developmental pathways to a killing spree. In one, appetitive violence, childhood psychopathic traits, cultural scripts and attachment trauma are the central topics. In another, bullying, peer rejection and lack of prosocial ties are presented as elements in causal role for a tragedy, in the context of cruel social pecking order in a school. In the third, inappropriate parenting and troubled family relationships pave way to deteriorating mental health, drug abuse and antisocial and narcissistic personality pathology. The narratives gain support from research. In light of these characters, we shall discuss early warning signs and entries for preventing the tragic development by supporting normative adolescent development.

Presentation 1:Psychopathic traits and appetitive violence
Psychopathic traits in adolescence predict the occurrence of criminal behavior as well as instrumental violence, and some school shooters have been described as being callous-unemotional and showing a lack of empathy, features of narcissism, as well as feelings of superiority. Some school shootings have been associated with careful planning and ceremonial violence with special clothing and weapons. This way, they differ greatly from most homicides, which are impulsive manslaughters committed by marginalized males and characterized by alcohol intoxication. In this symposium we shall describe a fictive portrait of an adolescent school shooter named Kevin by Lionel Shriver (2003). In this novel, appetitive violence, etiology of child and adolescent psychopathic traits, cultural scripts and attachment trauma are the central topics. In light of this story and research knowledge, we shall discuss early warning signs and entries for preventing the tragic development by supporting normative adolescent development.

Presentation 1:Peer rejection, inappropriate parenting and lack of prosocial ties
Risk factors for school shootings in the immediate psychosocial environment have been suggested, for example, bullying and peer rejection, unlimited access to media violence, inappropriate parenting and troubled family relationships, lack of pro-social support systems, certain characteristics of schools, and availability of weapons. Even if research has actually demonstrated that the associations between subjection to bullying and becoming a school rampage shooter are far from that simple, and that many of the shooters have rather been feared, and rejected perhaps due to others feeling uneasy and afraid of them, Peter, the shooter in Jodi Picoult’s novel Nineteen minutes is portrayed straightforwardly as a victim on long-term and largescale bullying by the groups of “popular” kids whom “ordinary” kids do not dare resist. However, even if Peter’s parents are respectable members of the society and obviously sincerely attempt to provide a loving home, parents also altogether fail to understand the torments Peter goes through as the lonely, rejected and actively bullied kid in a school that allows a cruel pecking order to persist.
Inappropriate parenting is striking in the story of Sebastian in Malin Persson Giolitos Störst av allt. Sebastian is actively rejected by his parents, but also Maria, his girlfriend and finally the sole defendant in court, is, despite the wealthy and socially integrated family background, left totally alone facing and managing the increasing mental disturbance of Sebastian. The young perpetrators present with many personal characteristics associated with school shootings, such as anger, mental disorders, uncommitment to pro-social social systems, marginalization from meaningful social worlds, psychosocial problems, failure of surveillance systems and availability of weapons all apply.
Co-author: Nina Lindberg

Narratives in youth forensic psychiatry
fiction, risk factors, school shootings

Thursday 19 May 2022

10:30 - 12:00 Concurrent session 3

Assessing risk in justice-involved youth in transition to adulthood: Data from a 4-year national risk assessment study in the Netherlands

Individual presentation65Michiel de Vries Robbé, Amsterdam UMC/ VUmc, The Netherlands

Room 3AThu 10:30 - 12:00

In juvenile risk assessment, most assessment tools focus primarily on risk factors while little attention is being devoted to protective factors. It has been suggested that the emphasis on both risk factors and protective factors is crucial for an accurate prediction of risk level. This two-sided approach provides input for personalized care aimed at reducing risk of reoffending. Focusing on protective factors can provide additional treatment guidelines and may enhance treatment motivation amongst offenders and practitioners. Despite the positive influence of these protective factors, Dutch juvenile justice institutions previously had little emphasis on protective factors in risk assessment and risk assessment was mainly used to assess the risk of reoffending, while it’s potential for guiding treatment was not widely explored.

In 2016, the SAPROF-YV was implemented nationally in all juvenile justice institutions in the Netherlands in order to enhance the focus on protective factors and facilitate treatment guidance. A large-scale retrospective validation study was designed to evaluate the implementation process and assess the psychometric properties of the SAPROF-YV, SAVRY in juvenile as well as young adult offenders in transition to adulthood (N = 354; Age: 13 – 26 years, M = 18.5, SD = 2.06).

The body of literature on specifically the young adult population is surprisingly limited, which causes confusion in clinical practice about whether juvenile or adult assessment tools should be used. Therefore, this study was also designed to compare the predictive validity of the SAPROF-YV and SAVRY with adult versions of these tools (i.e. HCR-20V3 and SAPROF).

The SAVRY and SAPROF-YV provided moderate predictive validity for general violent and non-violent reoffending after release from the juvenile justice institutions. In addition, the SAPROF-YV provided incremental predictive validity over the SAVRY risk factors when assessing recidivism, and the predictive validity of the SAPROF-YV was found stronger for younger offenders. Finally, no differences were found in the predictive validity of juvenile and adult risk assessment tools when assessing recidivism in young adult offenders (18-26 years).

These findings provide important implications regarding the application of juvenile risk assessment in clinical practice suggesting that the SAVRY and SAPROF-YV are both valid tools for the assessment of violence risk in juvenile and young adult offenders released from juvenile justice institutions. Second, the findings in this study highlight the importance of protective factors for the predictive validity of risk assessment in young offenders, especially juvenile offenders up to the age of 18 years, for a wide range of criminal outcomes. As such, a balanced evaluation of strengths and weaknesses is recommended to arrive at the most accurate assessment of (violence) risk, and to determine effective personal guidelines for a strengths-based case management plan. Regarding young adult offenders, results suggest that juvenile and adult risk assessment tools appear equally applicable. This finding should offer flexibility regarding the application of these tools. Additional (prospective) research in different settings is warranted to determine whether these results translate to clinical practice and could be generalized to other young offender populations as well.
Co-authors: Anneke Kleeven, Eva Mulder, Arne Popma

Assessment and treatment of young and/or adolescent offenders
juvenile offenders, protective factors, risk assesment, young adult offender

Community Forensic Child and Adolescent Mental Health Services: insights after 18 months of service

Individual presentation62Rebecca Lane, Anna Freud National Centre for Children and Families, United Kingdom; Sophie D'Souza, Anna Freud National Centre for Children and Families, United Kingdom

Room 3AThu 10:30 - 12:00

Objectives:
Young people in contact with forensic child and adolescent mental health services present with more complex needs than young people in the general population. Recent policy in child and adolescent mental health has led to the implementation of new workstreams and programmes to improve service provision. This paper examines the characteristics and outcomes of children and young people referred to newly commissioned Community Forensic Child and Adolescent Services (F:CAMHS) and service activity during the first 18 months of service.

Design:
The study is a national cohort study to describe the population and investigate provision and service access across England.

Methods:
Routine activity data from 13 services has been collected for secondary analysis.

Results: Data on 1250 advice cases and 1303 referrals is included in analysis. Findings show that 73.1% of young people had accessed CAMHS before their referral, 13.7% of young people referred presented with a learning disability and 51.88% of young people presented with multiple problems. Mixed ANOVAs found significant reductions in overall clinician-rated HoNOSCA scores after referral to Community F:CAMHS.

Conclusions:
This research is the first study to describe the characteristics of children and young people referred to Community F:CAMHS and provides valuable information on pathways and needs to inform service policy and provision. The data suggests that Community F:CAMHS has a positive impact on mental health and risk outcomes of the children and young people referred to them. Limitations include a small sample at follow-up and using routine data for analysis.

Community based interventions with young offenders
community

Design, Implementation and Impact of the Interpersonal Violence Prevention Programme

Individual presentation96Ricardo Barroso, University of Porto, Portugal

Room 3AThu 10:30 - 12:00

Violent behaviours occur in everyday life and could result in physical or psychological harm, of greater or lesser severity. Research shows that these behaviours can arise early in the different types of relationships between young people leading to serious consequences for the development of prosocial behaviours. With the purpose of preventing the occurrence of violent behaviours, the Interpersonal Violence Prevention Programme (PREVINT) was developed in order to raise awareness and sensitise adolescents towards violence in interpersonal relationships and their functioning dynamics. The intervention is based on data from studies that reinforce the principle that by understanding how the processes of aggression work (initially psychological in scope, but which can move towards physical violence), we can increase individual’s capacity to anticipate and/or terminate these behaviors more quickly and effectively, thus avoiding their escalation.

Design and implementation of the Interpersonal Violence Prevention Programme (PREVINT)
The Interpersonal Violence Prevention Programme (PREVINT) was developed in order to raise awareness and sensitise adolescents towards violence in interpersonal relationships and their functioning dynamics. The aim is to promote the acquisition and development of skills to detect behaviors considered natural in everyday life and society (“just a joke”), but which are in fact personal attacks with an impact and often the beginning of an escalation process. Another aim is to train adolescents and young adults with response solutions in the event of such aggressions occur. In this first presentation we will show the characteristics, theoretical basis and contents of the programme.
Co-authors: Eduarda Ramião, Patrícia Figueiredo

Community based interventions with young offenders
PREVINT

Audit of the first 100 admissions to the first high-secure adolescent forensic mental health unit in Australia

Individual presentation30John Kasinathan, Justice Health Forensic Mental Health Network, Australia

Room 3BThu 10:30 - 12:00

The Austinmer Adolescent Unit (AAU) is a 6-bed mixed gender unit housed within the high secure Forensic Hospital in Sydney New South Wales (NSW), that opened to admissions in 2008. This is the first and for many years the only secure mental health facility in Australia designated for the assessment and treatment of young people aged 14-21 in NSW, who require mental health treatment and present a risk to others. Patients are admitted to the unit under the Mental Health Act, from custodial and community hospital settings.

The study aims to answer:

What are the mental health and risk characteristics of the first 100 young people admitted to the unit?

What are their demographics?

What are the primary psychiatric diagnoses and associated diagnoses and disorders?

What are the treatment pathways, length of stay and discharge settings?

This provides important understanding of the range of issues presented by this unique population and will assist how best to develop services to better meet the needs of this vulnerable and high-risk population.

Assessment and treatment of young and/or adolescent offenders
forensic mental health unit

Individual assessment of juvenile offenders in Croatia: the experts’ perspective

Individual presentation118Anja Mirosavljević, University of Zagreb, Croatia

Room 3BThu 10:30 - 12:00

The aim of this paper is to present the results of the project Procedural safeguards of accused or suspected children: improving the implementation of the right to individual assessment (IA-CHILD) funded by EC and EU. The main objective is to gain insight into the perspective of experts conducting and using the assessment of juvenile offenders in Croatia on the status of individual assessment and the implementation of the Directive 800/2016. Data was collected via three focus groups in three biggest Croatian cities. Overall, 17 experts doing the assessment of juveniles who are suspects or accused of perpetrating criminal offences (social pedagogues, psychologists and social workersemployed in state attorney’s offices, courts, educational institutions and social welfare centres) and 12 experts using this assessment (legal professionals working at the Municipal and County State Attorney’s Offices as deputies of the Municipal and County State Attorneys, and at the Municipal and County Courts as judges) participated in this study.

Data was analysed using deductive thematic analysis.

Results show that the legislation in Croatia respects the international guidelines and recommendations on procedures towards suspected or accused juveniles and integrates them in the contents of relevant acts. Individual assessment is recognized as an essential and indispensible and is implemented on different levels and in different phases of criminal proceedings. Furthermore, it is legally well standardized, implemented in practice for many years and in various institutions. On the other hand, there are still some shortcomings as well as possibilities for improvement: implementation of uniform process of individual assessment, harmonization of interventions with beneficiary needs and improving the quality of sanction implementation in practice.
Co-authors: Dora Dodig Hundric, Neven Ricijas, Sabina Mandic

Faculty of Education and Rehabilitation Sciences
IA-CHILD, legislation, procedural safeguards

Nearly every tenth of inpatients arrives in fetters to the restricted CAP ward in Hungary

Individual presentation9Sófi Gyula, Heim Pal's National Children's Hospital, Hungary

Room 3BThu 10:30 - 12:00

The psychiatric profile of Hungarian delinquent youths who need in-patient care.

The prevalence of mental disorders among delinquent youths is relatively well known, but the issue was poorly studied in Hungary. The presentation provides information on the issue by summarizing the experiences obtained at the Heim Pál Children Hospital, Budapest. Exceptional value of the observations collected during the past 10 years is that the delinquent and non-delinquent, same age-group juveniles came to the ward from the same geographical region with some kinds of behavioral manifestations of their mental disorders.

The study was based on the patient population diagnosed and treated over the last 10 years in the hospital. The average population size per year was 645, out of which on average 57/year were delinquents, aged 16,3 years on average. Diagnoses were based on the Hungarian version of the MINI International Neuropsychiatric Interview for Children and Adolescents.

Leading psychopathologies in delinquents were conduct-disorder (76,2% of cases), attention-deficit/hyperactivity disorder (17,6%) and oppositional-defiant (14,9%) syndrome. Substance using were a “general” comorbidity with 78,4% of cases within the delinquent group. An enormous rise of drug induced psychosis with 19,2% were seen in 2019 (detailed toxicological analysis of the samples is in progress actually). Comorbidities were also high, and were shown an average 36,8% of the sample, with the leading non-suicidal self-harm (NSSH) disorder by 83,8%! These figures were 2,1 (ADHD) – 8,7 (CD) times larger than in non-delinquent populations diagnosed and treated over the same period on the ward. Comorbidity of anxious disorder combined with ADHD and or CD/ODD were 3,2%, while the remaining ones have a higher anxiety with 10,1%.

Mental disorders involving externalizing behaviors were considerably more frequent in the investigated Hungarian delinquent population than in non-delinquents studied in parallel, but figures were overall similar to those reported in other countries. Earlier observation of Lichtenstein et al (2012, N. Engl. J. Med.) had a conclusion on reducing criminality recidivism by ADHD medications, what suggests the need for assess and offer for treatment of more delinquent juveniles than actually do.

Assessment and treatment of young and/or adolescent offenders
delinquent youths, mental disorder

Implementation of innovations, a world to win

Symposium68Ilja Bongers, GGzE Institute for Mental Health Care, The Netherlands; David Buitenweg, GGzE Institute for Mental Health Care, The Netherlands; Ruth Naus, GGzE Institute for Mental Health Care, The Netherlands

Room 3DThu 10:30 - 12:00

Implementation is key for innovations to achieve real impact. Innovations that are not properly implemented, are not as effective as they could be. Problems with implementation of innovations are not caused by one factor but by a multitude of factors. Starting point for successful implementation is to explore different stakeholders’ perspectives to implementation. In the first presentation, the ForCA QuickScan is presented. This QuickScan can be used to gain insight into the facilitators and barriers to implementation of for instance interventions. The second presentation is an evaluation recovery-oriented, peer-to-peer intervention, barriers and facilitators for the implementation of the intervention are investigated. The last presentation focuses on youngsters’ experiences with treatment feedback and their suggestions to improve the implementation of feedback-informed treatment. This symposium might be an inspiring example of youngsters’ powerful role and added value in the implementation of innovations.

Presentation 1: IMPROVING THE IMPLEMENTATION OF INNOVATIONS: A QUICKSCAN

Background:
Implementation of interventions is never easy and simple and the quality of the implementation is significantly related to the effectiveness of the intervention. To gain insight into the barriers and facilitators of an implementation process a screening instrument is developed, the ForCA QuickScan (www.forcaquickscan.nl). The purpose of the QuickScan is to quickly determine the barriers and facilitators that play a role when implementing interventions or innovations. The QuickScan is developed with professionals working with forensic youth. Implementation barriers related to the forensic setting are part of the QuickScan.

Objective:
In this presentation the QuickScan will be explained which is illustrated with an example.

Method:The QuickScan was filled out by 13 professionals at the start of the implementation process of an innovative feedback tool INKT for youngsters in (forensic) mental healthcare.

Results:
The QuickScan describes barriers and facilitators on four domains; i.e. the youngster, organization, intervention, and professionals. Main barriers for the feedback tool were related to problems within the organization. According to the professionals the main facilitator was the understanding of their treatment progress for youngsters when using the feedback tool.

Conclusion: Using the results of the QuickScan an implementation strategy for the feedback tool was designed.

Presentation 2: Preliminary evaluation of Project Life: a recovery-oriented training for youngsters in forensic youth care

Background:
Youngsters with the skills and possibilities to fulfil their life goals contribute positively to society and show less delinquent behaviour (Barendregt, van der Laan, Bongers & van Nieuwenhuizen, 2018). In the Project Life intervention, young people think about what they want to achieve in life and set their own goals.

Objectives:
The current study examines the effectiveness of the recovery-oriented, peer-to-peer intervention Project Life. In addition, barriers and facilitators for the implementation of Project Life are investigated.

Methods:
Data will be collected in two ways. First, participants fill out three questionnaires on empowerment, hope and self-esteem during two moments: directly before (T0) and after the Project Life intervention (T1). The differences between the pre-measurement (T0) and post-measurement (T1) will be investigated using the Reliable Change index to determine the effectiveness of Project Life on an individual level. Second, the experiences of youngsters and trainers will be assessed through qualitative group- and individual interviews. In addition, a Quickscan will be used to identify factors that may act as barriers or facilitators for the implementation of the intervention. All qualitative data will be analysed thematically.

Results:
In this presentation, the preliminary results of both the quantitative and qualitative evaluation of Project Life will be reported. Specifically, the Reliable Change Index and qualitative results regarding the implementation of Project Life will be presented.

Conclusion: The suitability of the Project Life intervention for youngsters in forensic youth care and will be discussed.

References:
Barendregt, C. S., Van der Laan, A. M., Bongers, I. L., & Van Nieuwenhuizen, C. (2018). Quality of life, delinquency and psychosocial functioning of adolescents in secure residential care: testing two assumptions of the Good Lives Model. Child and Adolescent Psychiatry and Mental Health, 12(1), 4.

Presentation 3: WHAT DO ADOLESCENTS THINK ABOUT ROUTINE OUTCOME MEASURES AND THEIR USE?

Background:
Routine Outcome Monitoring (ROM) has become an integral part of Mental Health Care (GGZ). Feedback based on ROM during treatment is considered a successful addition to the overall treatment, which can lead to improved treatment outcomes. Research on feedback in adolescents, however, is scarce. From studies on adult-samples, feedback on treatment progress is related to improvement in daily functioning and a higher quality of life.

Objective:
The goal of this study is to explore adolescents’ experiences with feedback about results of routine outcome monitoring in their treatment and its influence on empowerment.

Method:
Two weeks to six months after adolescents filled out the ROM-questionnaires, in-depth interviews were conducted with eight adolescents aged 12-18. A thematic analysis was performed using Atlas.ti.

Results:
Five themes and corresponding subthemes were identified: (1) insight into functioning, (2) positive and negative effects of insight through routine outcome monitoring data, (3) feedback-informed treatment, (4) shared-decision-making and (5) sense of empowerment. Most adolescents emphasized the importance of feedback and wanted to see the results from the questionnaires they filled out.

Conclusion:
Adolescents’ narratives suggest that feedback is important in treatment. Furthermore, it helps adolescents to engage in treatment. These points stress the importance of the implementation of the feedback tool in the treatment.
Co-authors: Chijs van Nieuwenhuizen, Marilyn Peeters, Romy van Kuijk

Practices in ambulantory & residential care of children and youngsters
expert by experiences, feedback, implementation, routine outcome monitoring

Unravelling heterogeneity: the use of profiles among heterogeneous groups of adolescents with severe behavioural problems

Symposium71Lisette Janssen-de Ruijter, GGzE, The Netherlands; Alexa Rutten, GGzE/Tilburg University, The Netherlands; Sanne Hillege-van Woerden, Independent, The Netherlands

Room 3FThu 10:30 - 12:00

In the heterogeneous population of adolescents with severe behavioural and psychiatric problems, it is essential to identify specific combinations of characteristics that differentiate subgroups of adolescents. The identification of these subgroups may help clinicians to tailor interventions to the specific needs of these adolescents which consequently will improve care guidance and treatment. Furthermore, more insight into these subgroups and their risk on reoffending may improve risk assessment during treatment to, eventually, reduce recidivism. In this symposium, studies will be presented on the identification of subgroups in this heterogeneous population of adolescents with severe behavioural and psychiatric problems.

Presentation 1: Predicting reoffending of male adolescents with four different risk profiles
Background
Adolescents admitted to secure residential care have an elevated risk of persistent delinquent behaviour. However, this risk may differ between subgroups in this heterogeneous population of adolescents with severe psychiatric problems and disruptive problem behaviour. Identification of subgroups based on co-occurring risk factors in multiple domains might shed a light on the complexity of persistence in delinquent behaviour and might possibly predict which adolescents persist in their delinquent behavior after treatment. In this study, a person-centred approach was used to examine the predictive validity of risk profiles on reoffending after discharge from secure psychiatric residential care.

Methods
The sample of this study comprised 238 former male patients of the Catamaran, a hospital for youth forensic psychiatry and orthopsychiatry in the Netherlands. In a Poisson regression analysis, the relation between the four previously found risk profiles (dependent variables) and frequency and severity of reoffending (independent variables) —corrected for criminal history—was examined.

Results
Results show that the risk profiles significantly predict the frequency and severity of reoffending.

Conclusion
Conclusion of this study is that exposure to an accumulation of risk factors in multiple domains increases the rate of reoffending. This argues in favour of multisystemic interventions during residential treatment by also involving the domains peers, school, and family.

Presentation 2: Though boys though decisions
Background
Working with the heterogeneous population of serious juvenile offenders asks for broad knowledge and expertise to provide the best and individualized care. Knowledge is needed on combinations of problem and risk areas within this particular population of serious juvenile offenders. Because of the heterogeneity of the population, focus in treatment differs within this diverse population and evidence-based insights are not always easily applicable in clinical practice. Therefore, a combination of scientific and practical knowledge is needed to be able to tailor treatment.

Methods
We started in the clinical field of forensic youth care in the Netherlands to detect the most important domains for treatment. Besides focus on personal offender characteristics, clinicians pointed towards the overall importance of motivation for treatment in this population. Since the population is heterogeneous, we searched for subgroups of serious juvenile offenders (N = 2010) based on different (dynamic) risk factors.

Results
Seven subgroups were identified, based on different combinations of risk factors. To translate this knowledge into practice we looked for subgroups that had the highest risk to reoffend and the factors relating to this behavior, so clinicians know what factors need focus during treatment. Finally, input from clinical practice was used in combination with literature to distill motivational techniques for the different subgroups.

Conclusion
Successively these studies result in knowledge on what are points of focus in treatment for which specific serious juvenile offender.

Presentation 3: Profiles of juveniles with different symptoms of ASD, with and without delinquent behaviour
Background
It is well known that there are multiple phenotypes of autism spectrum disorder (ASD), also among juveniles with ASD and delinquent behaviour. Specific symptoms of ASD might increase the risk of offending behaviour while on the other hand some symptoms of ASD will protect youngsters with ASD against involvement in offending behaviour. The aims of this study were as follows: 1) Identifying subgroups, with or without autistic traits, based on subscales of the Autism Quotient (AQ), and 2) Identifying subgroups with specific symptoms of ASD which are related to either an increased risk of delinquent behaviour or a lower risk.

Methods
Male juveniles from an outpatient department of child and adolescent psychiatry or admitted to a secure residential care (N = 435) were included and assessed using the AQ. Delinquent behaviour and DSM-IV diagnoses were collected. By using a Latent Class Analysis (LCA), it was investigated whether different profiles of male juveniles could be identified. Severe behavioural problems and comorbidity were added to the LCA.

Results
This study identified different profiles based on the subscales of the AQ within male juveniles. The identified profiles differed on scores on the subscales of the AQ. Different relations of the profiles were found with delinquent behaviour and comorbidity.

Conclusion
This study demonstrates distinct subgroups of male juveniles with unique needs related to their profile of ASD symptoms. More insight is needed in the relation between specific symptoms of ASD and delinquent behaviour to adjust the treatment to their unique needs.

Assessment and treatment of young and/or adolescent offenders
autism, heterogeneity, latent class analysis, reoffending

14:00 - 15:30 Concurrent session 4

Coproducing a psychosocial intervention with young people transitioning from adolescent secure hospitals to adult services in England: Moving Forward intervention

Individual presentation41Maria Livanou, Kingston University, United Kingdom

Room 4AThu 14:00 - 15:30

Background:
Young people transitioning from secure adolescent services to adult care present with multiple and complex needs which often remain unmet during transition periods.

Aims:
This paper delineates the process of developing and coproducing the Moving Forward intervention (MFi) with “hard to reach groups” which aims to address the psychosocial needs of transitioning youth who have been systematically excluded from service and research development.

Methods:
Advisory Groups were conducted virtually during Covid-19 to design the MFi module content with 17 keyworkers, two parents and 13 young people aged 17-18 years across six adolescent secure hospitals in England. The intervention was informed by literature-driven themes and coproduced topics such as mentoring support, complex mental health needs, and attachment difficulties. Thematic analysis was used to reflect on the fieldnotes discussed during the Advisory Groups.

Results:
Three overarching themes pertinent to expectations in adult services, improving communication gaps between services and facilitating the letting go period emerged from the Advisory Groups. It was suggested the MFi is co-delivered by a peer with lived experience to build trust and create hopefulness amongst young people. The importance of promoting graded transitions through standardised procedures such as the proposed intervention was highlighted.

Conclusions:
The current findings promote evidence-base initiatives and build robust practice frameworks that inform treatment and policy guidelines. The young people, parents and keyworkers found the MFi supportive and valued the co-production experience. As such, reducing service inequalities especially in forensic settings should be prioritised by using the reflective tool of co-production and open responses.
Co-authors: Marcus Bull, Ifigeneia Manitsa, Rebecca Lane, Anya Heneghan

Neurobiological & - psychological intervention studies
adolescent secure services, co-production, intervention, transition

Mechanisms of experiential peer support for individuals engaging in criminal behaviour

Individual presentation120Margriet Lenkens, Company / Institute IVO Research Institute, The Netherlands

Room 4AThu 14:00 - 15:30

“You might think ‘hmm, that doesn’t sound nice, being locked up’. But the empty feeling when that cell door closes, the feeling you get when guards walk past your cell… You cannot feel that. You cannot understand that”, says an experiential peer.

Experiential peer support is increasing in the forensic youth field, because of an increased appreciation of the (ex-)client perspective in addition to clinical expertise and research. In addition, (perceived) similarities might lead to better working alliances and, in the end, better results. But what do experiential peers actually have to offer in the contact with clients? And is what they do fundamentally different from how formal care providers approach youngsters?

In our study we interviewed 17 experiential peers (EP) who provide individual support to adolescents and young adults with criminal behavior. We found that EPs identify with clients, leading to more empathy and a milder response towards criminal behavior. In addition, clients also seem to consider EPs as ‘one of them’, which makes EPs credible and respected as role models, and which can lead to more hope and perspective. Lastly, we found that, as a consequence of their own lived experiences, EPs strive to establish a humane relationship, characterized by equality, reciprocity, trust, sincerity and flexibility, and they tend to have a realistic view on desistance.

In this presentation, Margriet Lenkens will illustrate how these mechanisms play a role in the relationship between youngsters and EPs, and she will talk about the implications for the forensic youth psychiatry.

Life course perspectives in youth forensic psychiatry
desistance, experiential peer, peer mentoring, support

Young people's experiences of relationships with staff in the Children and Young People’s Secure Estate in England

Individual presentation90Sophie D'Souza, Anna Freud National Centre for Children and Families, United Kingdom; Rebecca Lane, Anna Freud National Centre for Children and Families, United Kingdom

Room 4AThu 14:00 - 15:30

Objectives:
This qualitative study aims to examine the experiences custody and relationships with staff amongst young people in five secure sites in the Children and Young People’s Secure Estate (CYPSE) in England. Despite relationships with staff being significant to young people’s overall experience in secure settings, little is known about them. Our primary question: what are young people’s experiences of their relationships with staff in secure settings? We aim to understand more about young people’s feelings of being understood by staff, trust, communication and the impact of the culture of secure settings.

Design:
In this cross-sectional study, we are using qualitative data from young people placed in secure settings on youth justice and/or welfare grounds.

Methods:
Qualitative semi-structured interviews were conducted with 14 young people in two Secure Children’s Homes, one Secure Training Centre and two Young Offender Institutions. In the next quarter, we will be analysing this data thematically to understand the nature of young people’s relationships with staff and experience of the culture of the secure estate.

Results:
Data collection will end for the current research in January 2020. Thematic analysis will follow this period.

Conclusions:
This study aims to understand the experiences of young people in CYPSE in England focusing on relationships with staff during the placement and their observations of the culture of the CYPSE. One limitation is that different young people may be interviewed over the course of the study and so individual differences over time may not be identified.

Narratives in youth forensic psychiatry
culture, custody, staff-client relationships

Parental readiness for behavior change and support of juvenile offenders – implications for complex intervention planning

Individual presentation110Gabrijela Ratkajec Gašević, University of Zagreb, Croatia

Room 4BThu 14:00 - 15:30

Since the purpose of interventions for juvenile offenders is behaviour change, the main question is which factors contribute to that process. Given the interdependence of family members, especially of children in relation to parents, it is interesting to see how readiness to change of juveniles involved in interventions is influenced by the support of the parents or whether the parents are ready to change their behaviour for the benefit of their child.

With the aim of understanding the relationship between the readiness to change of juveniles and their parents and providing and perceiving support, pairs of juveniles and parents were involved in research, at the beginning of intervention after committing the crime. Parallel forms of Readiness to Change Scale and Readiness to support (for parents) and Perception of parental support (for juveniles) were used. Data were processed on a sample of 56 pairs.

Statistically significant differences between parental and juvenile readiness for behaviour change speak in favour of a higher level of parental readiness. Such results have been found in identifying differences between the readiness for parental support and the juvenile's perception of that support, where parents express more support than juveniles perceive. Through regression analysis, it was found that the perception of parental support by the juvenile significantly contributes to the child's readiness for behaviour change, while other predictors such as age, self-efficacy, family and child risk levels, parental readiness to change were not significant.

Presentation will provide the implications for complex interventions planning based on received results.
Co-author: Dora Dodig Hundrić

Assessment and treatment of young and/or adolescent offenders
behaviour change

Protective factors for children with serious problem behaviour: development of and initial findings with the SAPROF-Child Version

Individual presentation82Michiel de Vries Robbé, Amsterdam UMC/ VUmc, The Netherlands

Room 4BThu 14:00 - 15:30

Abstract:
The importance of protective factors for the effective assessment of serious problem behaviour in children is increasingly recognized. Complementing the existing risk-focused approach, the specific focus on protective factors offers new guidance to designing strength-based preventive interventions. In the footsteps of its older counterparts (SAPROF; SAPROF-Youth Version), a SAPROF-Child Version (SAPROF-CV) was developed explicitly for the assessment of protective factors for serious problem behaviour in children (age 6-15) to be used together with the risk-focused new version of the Early Assessment Risk List (EARL). In this presentation the SAPROF-CV is introduced and initial user experiences as well as interrater reliability findings with this new instrument are presented.

Presentation summary:
Risk assessment for children (age 6-15) is gradually being applied more widespread for children who display serious problem behaviour, such as aggressive and agitated behaviour or even violence towards others. In the development of the new version of the Early Assessment Risk List (EARL) for assessing risk factors for children there was also a clear demand from service providers for including a stronger focus on strengths or protective factors. The importance of protective factors for the effective assessment of violence risk in adults and juveniles has become increasingly recognized over the past decade. More and more research is becoming available to testify to the usefulness of protective factors in the risk assessment process. Following this approach, it also appears especially important in the assessment of serious problem behaviour in children to include a specific focus on protective factors and to offer guidance to designing strength-based preventive interventions, instead of a risk-only focused approach.

The request of clinicians for a specific protective factors assessment tool for younger individuals to be used alongside the (new) risk-focused EARL led to the development of the Structured Assessment of Protective Factors - Child Version (SAPROF-CV). The aim of the SAPROF-CV was to develop a checklist of protective factors empirically related to reduced future serious problem behaviour in children (6-15 years). In addition to the prerequisite that the factors in the SAPROF-CV are empirically well grounded, it was also considered important that the factors are of practical value for clinical and/or outpatient or supervision intervention practice.

In this session the SAPROF-CV will be introduced and its factors explained by means of a case example. In addition, initial user feedback will be shared, as well as findings from an interrater reliability study. The interrater reliability of the SAPROF-CV was tested on 40 case files of the Child Development Institute in Canada. Results from this study show good interrater reliability for the protective factors of the SAPROF-CV. Study results will be presented and the potential value of the SAPROF-CV for the treatment and supervision of children with serious problem behaviour will be discussed.
Co-authors: Ed Hilterman, Areti Smaragdi

Assessment and treatment of young and/or adolescent offenders
assessment, children, problem behaviour, protective factors

The role of self-control in understanding aggressive ideations and behaviors: An experience sampling method study

Individual presentation22Sébastien Urben, CHUV, Switzerland

Room 4BThu 14:00 - 15:30

Objective:
Through an experience sampling method (ESM), we aimed to examine the associations between aggressive ideations and behaviors in the everyday life as well as the role of processes related to self-regulation (i.e., self-control, ego depletion and emotional reactivity).

Method:
Sixty-two adolescent males undertook a baseline measure of aggression, violent ideations and an ESM assessment including four measures per day (i.e., aggressive ideations, behaviors, emotional reactivity, anger rumination, and self-control) for nine consecutive days (weekends excluded).

Results:
Aggressive ideations, in daily life, are explained by more negative emotions in the previous day (i.e., lag 4 of anger), lower self-control and stronger anger rumination. Aggressive behaviors in daily life are explained by higher anger rumination as well as by the aggressive ideations from the previous measure. Higher self-control is related to lower probability of aggressive behavior. The higher values of inter-individual variability in violent ideation (i.e., trait) is associated to higher probability of both aggressive ideation and behaviors.

Conclusion:
This study highlights the link between aggressive ideations and behaviors as well as the role of self-control in understanding aggressivity. Furthermore, we observed how anger (i.e., reactivity as well as rumination) plays an important role in aggressive ideations and behaviors in daily life. Thus, this study highlights the usefulness of using daily-life approach to understand the complex interrelationships between aggressive ideations, self-regulation and aggressive behaviors.
Co-authors: Lauriane Constantly, Seterah Ranjbar, Giorgia Miano, Fiorella Turri, Caroline Lepage, Kerstin Jessica Plessen

Assessment and treatment of young and/or adolescent offenders
adolescents, ecological momentary assessment, externalizing symptoms, self-regulation

It's innovative, but is it also effective? Evaluation of innovative tools and interventions targeting youngsters in (forensic) mental health

Symposium70David Buitenweg, GGzE Institute for Mental Health Care, The Netherlands; Ilja Bongers, GGzE Institute for Mental Health Care, The Netherlands; Ashley Parren, GGzE Institute for Mental Health Care, The Netherlands

Room 4CThu 14:00 - 15:30

Forensic psychiatry is positively influenced by developments such as digitalization and the growing focus on recovery. These changes have sparked the development of many innovative tools and interventions for use in adolescent psychiatry. These innovations and tools are attractive alternatives to existing solutions. Still, it is essential that their effectiveness is evaluated scientifically. This symposium covers three evaluations of innovative tools and treatment interventions.

The first presentation focuses on the evaluation of INKT, a digital tool that provides youngsters more insight into the outcomes of their treatment. The assessment of the psychometric quality of the QoL-ME, a personalized and visual quality of life assessment app for youngsters and adults with (forensic) psychiatric problems is discussed in the second presentation.

Presentation 1: Evaluation of a web application providing insight in treatment outcome – made by, for and with youngsters
Background:
Receiving feedback about treatment outcome is beneficial for patients in youth mental healthcare. Nevertheless, there is still a lot to gain when it comes to delivering feedback to youngsters. To provide youngsters with information about their treatment outcome, the innovative web-based feedback tool INKT (short for ‘I Need To Know’) has been developed together with youngsters.

Objective:
The aim of this study is to evaluate the INKT feedback tool.
Method: An observational design with a control and experimental condition in two matched cohorts was used to compare change in treatment outcome among youngsters who are being treated in (forensic) mental healthcare. In the control condition, feedback about treatment outcome was delivered as usual and in the experimental condition youngsters received feedback about treatment via the INKT tool. The primary outcome was behavioural change, measured by the Child Behavior Checklist and Youth Self Report (CBCL & YSR). The Positive Perception Program (PPP) was used to measure the satisfaction with delivered care.

Results:
Results indicate that, using the INKT feedback tool was not related to behavioural change on the subscales of the CBCL and YSR. Although the use of INKT did not influence behaviour. Youngsters who used the INKT feedback tool were more satisfied with treatment and routine outcome monitoring than youngsters in the control group.
Conclusion: The current study underlines the importance of receiving feedback in treatment. Feedback tools such as INKT – made by, for and with youngsters - are a promising way for youngsters to receive feedback.

Presentation 2: Evaluation of a digital, personalized and visual quality of life assessment instrument for youngsters and adults with (forensic)
Background:
Quality of Life (QoL) is an important outcome that contributes to the shift towards strength-based approaches in forensic youth mental health (Barendregt et al., 2018). Methods for QoL assessment, however, are not optimally accessible or personalized and do not always mesh with respondents. Recently, an innovative, digital, visual and personalized QoL assessment app for youngsters and adults with (forensic) psychiatric problems was developed: the QoL-ME (Buitenweg et al., 2019).

Objective:
The picture-based approach to QoL assessment employed in the QoL-ME is one of its main innovative features. This visual approach improves the accessibility of QoL assessment, but may have consequences for the psychometric quality of the QoL-ME. The aim of this study, therefore, was to evaluate the psychometric quality of the QoL-ME by assessing its reliability, validity and responsiveness.

Methods:
The reliability of the subscales of the QoL-ME was assessed using Cronbach’s Alpha. Correlations between the QoL-ME and the Manchester Short Assessment of Quality of Life (MANSA) were computed to assess the construct validity of the QoL-ME. External responsiveness was evaluated by correlating difference scores on the QoL-ME and the MANSA over a period of 6 months.

Results:
Reliability of the subscales of the QoL-ME ranged between .5* and .84*. In accordance with expectations, the language-based section of the QoL-ME correlated strongly (r = between .55 and .76) with the MANSA, whilst the picture-based additional modules of the QoL-ME correlated moderately (r = .3) with the MANSA. Difference scores between MANSA and QoL-ME were not significantly correlated.

Conclusions: The QoL-ME has adequate psychometric properties . In comparison with the psychometric properties of similar picture-based instruments, both the QoL-ME’s reliability and validity can be considered as strong. The responsiveness of the QoL-ME is insufficient, which limits its usefulness in practice.

Presentation 3: Ask me first! actively involving youngsters in risk assessment using the Transition Inventory
Background:
Youngsters in youth forensic psychiatry are generally not actively involved in risk assessment. This is a missed opportunity as active involvement may lead to an improved working alliance, more engagement and stronger predictive validity (Kroner et al., 2020). The Transition Inventory is a self-report instrument that directly involves youngsters in risk assessment (Kroner & Mills, 2015). Before the Transition Inventory can be used in clinical settings, however, more knowledge about its psychometric properties is necessary.

Objectives:
The aim of the current study is to evaluate the psychometric properties of the Dutch version of the Transition Inventory.

Methods:
To investigate the psychometric properties of the Transition Inventory, fifty youngsters aged 14 up to and including 22 years old admitted to the Catamaran, a hospital for youth forensic psychiatry and orthopsychiatry or to a Juvenile Justice Institution fill out the Transition Inventory. In addition, demographic information and results on conventional risk-assessment instruments will be collected. In this study, the reliability of the Transition Inventory will be assessed using Cronbach’s alpha. Convergent validity will be tested using the correlation between the Transition Inventory and conventional instruments for risk assessment such as the SAVRY or SAPROF-YV. Discriminant validity will be analysed through the correlation between the Transition Inventory and the Satisfaction with Life Scale, Empowerment Questionnaire and Cantril’s Ladder. Furthermore, confirmatory factor analysis will be used to assess the construct validity of the Transition Inventory.

Results:
In this presentation, the results of the psychometric evaluation of the Dutch Transition Inventory will be presented. Specifically, results regarding the reliability and validity of the instrument will be outlined and discussed.

Conclusion:
Based on the results regarding the psychometric properties of the Transition Inventory, a conclusion regarding its use in clinical practice will be drawn. In addition, possibilities for potential future research will be explored.
Co-author: Chijs van Niewenhuizen

Assessment and treatment of young and/or adolescent offenders
digital tools, intervention

Neurobiological assessment in screening and prediction

Symposium92Lucres Nauta-Jansen, AmsterdamUMC, The Netherlands; Helena Oldenhof, AmsterdamUMC, The Netherlands; Neeltje Blankenstein, AmsterdamUMC, The Netherlands

Room 4DThu 14:00 - 15:30

In the past decades, a wealth of knowledge has been gathered on neurobiological characteristics of antisocial youth. Among the most consistent findings is a general low arousal in antisocial youth, as can be measured on f.i. basal autonomic nervous system activity and reactivity to emotional cues. The main challenge for the upcoming years is to translate this knowledge to clinical practice.

In this symposium we will explore whether neurobiological measures can help us to gain insight in specific needs of subgroups of antisocial youth. We will discuss results of some recent neurobiological studies focusing on assessment of specific subgroups of antisocial youth and how the results may help us to better predict specific delinquent behavior an eventually tailor interventions to the specific needs of youth.

Presentation 1: Girls, just as fearless as boys? Comparing the automatic stress response between girls and boys with and without conduct disorder

Boys with Conduct Disorder (CD) demonstrate an attenuated neurobiological stress- response, which is suggested to index fearlessness. Fearlessness, in turn, may put children and adolescents at risk for engaging in antisocial behavior and to be more resistant to punishment. However, it is unclear whether this is also true for girls with CD, since there is evidence for sex-differences in the presentation and neurobiology of CD. Therefore, we investigated girls and boys with and without CD to identify sex-specific correlates of CD. This may aid the development of specific targets for interventions for girls and boys.

We investigated 108 girls and 72 boys with CD and compared them with 119 girls and 84 boys that were typically developing (TD). Heart rate (HR), Pre-ejection period (PEP), and Respiratory Sinus Arrhythmia (RSA) were assessed during a validated public speaking stress protocol (TSST). We distinguished between CD with/without Limited Prosocial Emotions (LPE), and CD with/without internalizing comorbidity (INT).

Results showed that CD youths reported similar levels of psychological stress, but exhibited diminished autonomic stress relative to TD youths, as indexed by HR, PEP and RSA. This was true for both boys and girls.

We conclude that impaired stress-regulation is a robust indicator of CD, irrespective of sex and CD-subgroup. These findings may suggest fearlessness as a specific mechanism underlying CD which may indicate specific treatment needs.

Presentation 2: Development of a biopsychosocial prediction model and practical tool for identifying subgroups of detained youth

Juvenile delinquents constitute a very heterogeneous group, with different needs for treatment and risk assessment. In clinical practice, mainly psychosocial characteristics are used to establish these needs, while neurobiological variables have not yet been integrated in this context. Therefore, we aimed to develop a model to identify clinically relevant subgroups associated with youth offending outcomes, based on psychosocial and neurobiological characteristics.

A group of 263 detained youth from juvenile justice institutions was studied. Latent class regression analysis was used to detect subgroups associated with offending outcome (recidivism at 12 month follow-up). As a proof of principle, it was tested whether individual cases could be assigned to the identified subgroups.

Three subgroups were identified: a ‘high risk – externalizing’ subgroup, a ‘medium risk – adverse environment’ subgroup, and a ‘low risk – psychopathic traits’ subgroup. Within these subgroups, both autonomic nervous system and neuroendocrinological measures added differentially to the prediction of types of reoffending (no, non-violent, violent). With the resulting model, it was possible to assign 92.1% of the participant to the correct subgroup.

This kind of model, which provides a practical decision tool, may in the future help to actually integrate neurobiological measures in clinical practice. After further development, the tool may be used in clinical practice to identify subgroups of detained youth with similar needs. This information can then be used to further tailor treatment to the specific needs and re-offending risk of individuals in that subgroup.

Presentation 3: Who is at risk? Using the biopsychosocial model to predict delinquency: A multi-sample latent-class regression study

Adolescents who show antisocial behavior are at high risk of developing problems throughout their lifetime, with major societal costs. The biopsychosocial model states that an interaction between biological (e.g. testosterone), psychological (e.g. empathy) and social environmental factors (e.g. trauma) contribute to the emergence and persistence of antisocial behavior in youth, such as non-violent and violent delinquency. Here we applied the biopsychosocial model to examine who is at risk for violent and non-violent delinquency. We harmonized five datasets of youth varying in antisocial behavior severity (total N=871, 82% male, M=17.67 years old, range 9-27 years), and applied latent class regression analyses to predict non, non-violent, and violent delinquency.

First we formed classes based on biological factors (heart rate indices, skin conductance, testosterone, cortisol (awakening)) and incorporated psychological predictors (empathy; psychopathic traits; internalizing, externalizing, attention problems; proactive, reactive aggression), thus taking into account that the influence of psychological variables may differ within the biological classes. Next, we predicted delinquency (non, non-violent, violent delinquency) from these psychologically-informed biological classes, moderated by social environmental factors (age, sex, SES, ethnicity, IQ, trauma, substance use).

This study revealed four classes of youth; the ‘biological susceptible - high psychopathic traits’ group, the ‘low problem group’, the ‘high problem – high psychopathic traits’, and the ‘biological susceptible – externalizing, reactive’ who differ on their biological and psychological profiles, which are differentially related to violent and non-violent delinquent outcomes depending on the social environment.

These results thus highlights the complicated interplay between biological, psychological, and social factors in assessing who is truly at risk. Together, we echo the need for a comprehensive, fine-mazed biopsychosocial approach in research and clinical and forensic practice.
Co-author: Eshter de Ruigh

Neurobiological & - psychological intervention studies
biopsychosocial, neurobiology, prediction

Community Forensic Child and Adolescent Mental Health Services in London and commissioning across England

Symposium103Heidi Hales, West London NHS Trust, United Kingdom; Abiha Bhatti, West London NHS Trust, United Kingdom; Emily Curtis, West London NHS Trust, United Kingdom; Andrew Nicols-Clarke, NHS England, United Kingdom

Room 4EThu 14:00 - 15:30

This workshop comprises of 4 presentations regarding Community Forensic Child and Adolescent Mental Health Services in England. Forensic Adolescent Mental Health Services provide assessment, care and support for young people who present with high risk behaviours, significant emotional and mental health difficulties and/or young offenders. In this symposium, we will discuss the development of our North West London Forensic CAMHS and discuss the characteristics of the patients referred to this service. We will consider in particular their sensory and OT needs and impact of cultural and racial differences. We will then place this in context of development of adolescent forensic mental health services commissioning across England.

Presentation 1: Unpacking the complex overlay of services commissioned in London to support young people at risk of violence
Background: Serious violence perpetrated by young people has been increasing in London. Young people are known to be victims of Child Criminal Exploitation by gangs run by adults, using young people to transport and sell drugs. This is causing much concern and has been high on the agenda of the London Assembly, Metropolitan Police, NHS England and Government. A Public Health Approach to knife crime is the favoured approach.

Services are being commissioned by different National and Local Government agencies to support young people to try to reduce this wave of violence in London. Our North West London FCAMHS service offers advice, consultation, assessments and coproduced interventions to professionals working with young people across 8 London Boroughs.

Presentation: We will produce a mapping of services for young people across several levels:

  • Within the individual 8 Boroughs in which our FCAMHS service works, such as the individual statutory agencies of CAMHS, social care, education, Youth Offending Services and smaller voluntary agencies.
  • Across several Boroughs as joined services, such as Speech and Language teams working across 2 or 3 boroughs and Hospital Trusts working across several boroughs.
  • Pan London services, such as the Metropolitan Police or voluntary sector agencies.Commissioning agencies include:
  • NHS England
  • MOPAC (the London Mayor’s Crime and Policing Commissioners)
  • Local Government
  • Charities

We will consider our FCAMHS referrals since the service started in August 2018 and consider the agencies with which we liaise to consider the needs of young people in London.

Discussion: One ex-gang member noted how the communication in local gangs is more effective than communication across different children’s agencies in London. We will discuss how to ensure that our services work effectively together.

Presentation 2: Community Forensic CAMHS in London

The North West London Forensic Child and Adolescent Mental Health Service (NWL FCAMHS) is a community-based service covering a population of approximately 2 million people.

Our FCAMHS service received 378 referrals between August 2018 and December 2021. Of these referrals, 138 (37.2%) young people were of a White ethnic background, 169 (45%) young people were of a Black and Minority Ethnic (BAME) background and 64 (17.3%) young people were of a dual heritage background. The disproportionate number of referrals received for young people of a BAME background relative to the demographics of the 8 London Boroughs our service covers poses the question as to the cause of this disproportionality.

In this workshop, we consider the following questions in an attempt to explore the complex relationship between the ethnic background of young people and disproportionate number of referrals received by our Forensic Child and Adolescent Mental Health Service:

  • Did the route of referral to our FCAMHS service differ for those from a White ethnic background compared to those from a BAME background?
  • Was there a difference in the number of other services involved in the young person’s care prior to their referral to our FCAMHS service based on their ethnic background?
  • Was placement of a young person in a secure or custodial setting more likely than a community or hospital based setting based on their ethnic background?
  • Was there a correlation between risk (on referral to FCAMHS, risk on discharge from FCAMHS and overall risk reduction) and ethnic background?

    Presentation 3: Sensory needs in the forensic CAMHS population – what are we doing to highlight and address these

    Background:
    There is currently little data on the percentage of young people in the criminal justice system in the UK with diagnoses of ASD, LD or sensory needs, however local observation puts it at at least double that of the general population, and data shows over 60% of young people in the criminal justice system have speech language and communication needs. This is a high need cohort, with low rates of assessment and intervention in place. As an Occupational Therapist (OT), new to the FCAMHS role, this was notable.

    This review aims to:

  • Assess the number of YP’s referred into FCAMHS with sensory needs
  • Highlight those with unmet sensory needs
  • Identify pathways for these YP’s to receive appropriate assessment
  • Offer assessment and treatment to those who can not access elsewhere.Method:
    A ‘moment in time’ caseload audit was used, from December 2021. The 48 young people that were active on the FCAMHS caseload were reviewed. The OT met with the case holders and enquired about any sensory needs mentioned on the initial referral or subsequently highlighted.

    Result and discussion:
    From the 48 cases reviewed, 17 had suspected sensory needs 35%, 12 (25%) also would benefit from Occupational therapy (sleep hygiene and routine, activity of daily living support, social skills). These results were subjective to the case holder/ OT discussion and identification, and real need is likely to be higher.

    This review has raised a number of questions and development opportunities. What are the needs we are seeing? What can be done to address them? What benefits will addressing them have on the young person. Future work needs to evaluate the impact of sensory intervention on reducing risk and increasing young people’s participation in pro social lifestyles and occupations.

Presentation 4: The National Community FCAMHS network in England
Background:
In 2018 NHS England commissioned 13 new Community Forensic Child and Adolescent Mental Health Service (Community FCAMHS) Teams, covering the whole of England. These are tertiary services accessible to all agencies (e.g. CAMHS, social services, YOTs, prisons, courts, solicitors, education, health commissioners etc.) within a region that may have contact with young people exhibiting high risk of harm to others or young people in the youth justice system who have mental health difficulties.

Presentation:
We will outline the National Community FCAMHS provision in England including:

  • Development of the Community FCAMHS service model.
  • How the service model has been implemented differently across the country based on local need.
  • How the 13 services work together and via the development of the National Community Forensic CAMHS Clinical Network.
  • Current national referral data and implications from the national evaluation.
  • Further planning around complex needs and integration of service framework.
Assessment and treatment of young and/or adolescent offenders
CAMHS, community, FCAMHS, services

Adverse Childhood Experiences, Personality, and Crime: Distinct Associations Among a High-Risk Sample of Institutionalized Youth

Individual presentation98Delfine D'Huart, Psychiatric University Hospitals. The Netherlands

Room 4FThu 14:00 - 15:30

Background:
Despite high rates of adverse childhood experiences (ACEs) and personality-related disturbances among delinquent juveniles, associations among ACEs, youth personality, and juvenile crime involvement are still unclear. High-risk samples of institutionalized youth are in specific need of a comprehensive assessment of ACEs and personality features in order to broaden the current knowledge on the occurrence and persistence of juvenile crime and to derive implications for prevention and intervention.

Aims: This talk will focus on the question of whether and how ACEs and different aspects of youth personality influence future crime involvement.

Methods:
342 adolescents (35.1% females) aged between 12 and 18 years (M = 15.74, SD = 1.61 years) living in child-welfare or juvenile-justice institutions, were examined regarding cumulative ACEs, psychopathic traits, temperament, clinical personality disorder ratings, and criminal involvement before and up to 10 years after assessment.

Results:
We found considerable rates of ACEs, although cumulative ACEs did not predict future crime. Latent Profile Analysis based derived six distinct personality profiles, which were differently related to ACEs, personality disturbances, clinical psychopathology, and future delinquency. A socially difficult personality profile was associated with increased risk of future crime, whereas avoidant personality traits appeared protective.

Conclusion: Findings indicate that the role of ACEs in the prediction of juvenile delinquency is still not sufficiently clear and that relying on single personality traits alone is insufficient in the explanation of juvenile crime.
Co-author: Steffen Barra, Marcel Aebi, Klaus Schmeck, Marc Schmid, Cyril Boonmann

Life course perspectives in youth forensic psychiatry
adverse childhood experiences, child welfare and juvenile-justice institutions, delinquency, personality

Personality Functioning in self-report and informant report in a sample of juvenile delinquents

Individual presentation73Marc Birkhölzer, University Psychiatric Clinic Basel, Switzerland

Room 4FThu 14:00 - 15:30

The diagnostic system to diagnose Personality Disorders (PD) is fundamentally changing with the ICD-11. Almost identical to the Alternative Model of Personality Disorders (AMPD) and herein the Levels of Personality Functioning (LPF) concept, that was first introduced in Section III of the DSM 5 in 2013, PD is characterised by problems in functioning of aspects of the self (e.g., identity, self-worth, accuracy of self-view, self-direction), and/or interpersonal dysfunction (e.g., ability to develop and maintain close and mutually satisfying relationships, ability to understand others’ perspectives and to manage conflict in relationships). Also, there will no longer be any age limit to diagnose PD.

Methods:
Inspired by the DSM 5 LPF concept, our workgroup developed the LoPF-Q 12-18 self-rating questionnaire (published in 2018) and the LoPF-Q 6-18 parent report to capture impairment in personality functioning in children and adolescents. Both inventories were used in a mixed clinical and school sample of more than 400 children and adolescents.

Result:
Scale reliabilities for the parent report total score are α .97 and α .89 (ID), α .91 (SD), α .92 (EMP) and α .91 (INT) for the subdomains. The LoPF-Q 6-18 parent report distinguishes between students (n=172) and PD patients (n=22) with d=2.4 standard deviations (p .000). Concerning conduct disorder (CD) and Antisocial Personality Disorder (APD) no differences in LoPF-Q self-rating scores were found compared to students. However, these groups largely differed using the LoPF-Q parent report.

Conclusion: Both, the LoPF-Q 12-18 self-report and the LoPF-Q 6-18 informant report distinguish well between PD patients (except APD) and students. However, patients with externalizing disorders seem far less impaired in self-rating than in informant rating. This generally calls into question the validity of self-rating questionnaires in suspected CD or APD cases and highlights the importance of informant ratings in this group.

Assessment and treatment of young and/or adolescent offenders
assessment, personality disorders, personality functioning

The role of ACE and mental health care use in psychological dysfunction of male multi-problem young adults

Individual presentation32Laura van Duin, Amsterdam University Medical Centers, The Netherlands

Room 4FThu 14:00 - 15:30

Adverse childhood experiences (ACEs) are associated with severe problem development. This study examines how eleven types of ACEs and mental health care use history are related to current psychological dysfunction among multi-problem young adults with extensive criminal careers. 643 multi-problem young adult men (age 18-27) gave informed consent for us to collect retrospective data and filled out questionnaires. ACEs were highly prevalent (mean 3.6, SD 2.0). Logistic regression analysis showed that compared with participants who experienced other ACEs, participants who experienced psychological problems in their family and grew up in a single-parent family were more likely to have used mental health care, and physically abused participants were less likely to have used mental health care. Linear regression analyses showed a dose-response relationship between ACEs and internalizing and externalizing problems. Linear regression analyses on the single ACE items showed that emotional abuse and emotional neglect were positively related to internalizing problems. Emotional and physical abuse and police contact of family members were positively related to externalizing problems. While multi-problem young adults experienced many ACEs, only a few ACEs were related to mental health care use in childhood and adolescence. Long-term negative effects of ACEs on psychological functioning were demonstrated; specifically, emotional abuse and emotional neglect showed detrimental consequences. Since emotional abuse and emotional neglect are not easily identified and often chronic, child health professionals should be sensitive to such problems.
Co-authors: Floor Bevaart, Josjan Zijlmans, Marije Jolette Luijks, Theo Doreleijers, André Wierdsma, Albertine Oldehinkel, Reshmi Marhe, Arne Popma

Life course perspectives in youth forensic psychiatry
ACE, multi-problems

Friday 20 May 2022

14:30 - 15:15 Posters and Product session

Adverse Childhood Experiences in Juvenile Offenders: Investigating an Instrument of Comprehensive Assessment and Associations with Psychopathology

Poster presentation26Felix Euler, University Hospital of Psychiatry, Switzerland

Room P1Fri 14:30 - 15:15

Adverse childhood experiences (ACEs) predict juvenile offending and are associated with specific patterns of aggressive behavior. Nonetheless, adolescents in forensic psychiatry rarely meet diagnostic criteria for trauma related psychiatric disorders. Adequate assessment of ACEs in youths comprises a number of specific challenges. As a consequence, psychopathology related to ACEs is often insufficiently recognized. In the present study we applied a comprehensive instrument to assess ACEs and investigated associations of ACEs with psychopathology and personality dimensions. We included data from 99 male adolescent offenders. Results show that the severity of ACEs was significantly associated with higher scores on psychopathology and related personality dimensions. Findings indicate that adequate assessment of ACE is highly relevant for a better understanding and treatment of psychopathology in delinquent youths.

Summary:
Background:
Adverse childhood experiences (ACEs) predict juvenile offending (Fox et al., 2015). Moreover, ACEs are associated with specific patterns of aggressive behavior (Fitton et al, 2020). Nonetheless, adolescents in forensic psychiatry rarely meet diagnostic criteria for trauma related psychiatric disorders. Adequate assessment of ACEs in youths comprises a number of specific challenges (White et al., 2021). As a consequence, psychopathology related to ACEs is often misinterpreted and insufficiently recognized in adolescent offenders. The Maltreatment Classification System (MCS; Barnett et al., 1993) is an empirically validated coding system that integrates different sources of information to capture ACEs comprehensively. Application of the MCS might overcome the aforementioned discrepancies.

Aims:
The first aim of the present study was to apply the MCS in a forensic youth sample and to compare the results with standard assessment of ACEs. The second aim was to investigate associations of ACEs with internalizing and externalizing psychopathology and personality dimensions in the study sample.

Methods:
We included data from a total of 99 male adolescent offenders. We applied the MCS, the Childhood Trauma Questionnaire, the Youth Self Report, the Inventory of Callous-Unemotional Traits and the Junior Temperament and Character Inventory.

Results:
We did not find significant differences between the two instruments assessing ACEs. Nonetheless, severity of ACEs was significantly associated with higher scores on psychopathology and related personality dimensions.

Conclusion:
Comprehensive and valid assessment of ACEs is highly relevant for a better understanding and treatment of psychopathology in delinquent youths. Further research on instruments used to caputre ACEs in adolescent forensic psychiatry is needed.

References:

Barnett, D., Manly, J. T., & Cicchetti, D. (1993). Defining child maltreatment: The interface between policy and research. In D. Cicchetti & S. L. Toth (Eds.), Child abuse, child development, and social policy (Vol. 8, pp. 7-73). Ablex.

Fitton, L., Yu, R., & Fazel, S. (2020). Childhood maltreatment and violent outcomes: A systematic review and meta-analysis of prospective studies. Trauma, violence, & abuse, 21(4), 754-768.

Fox et al. (2015). Trauma changes everything: Examining the relationship between adverse childhood experiences and serious, violent and chronic juvenile offenders. Child Abuse & Neglect, 46, 163-173.

White, et al. (2021). Assessment of Maltreatment in Childhood and Adolescence. Praxis für Kinderpsychologie und Kinderpsychiatrie, 70(1), 24-39.
Co-author: Elissa Belinda Martin

Assessment and treatment of young and/or adolescent offenders
adverse childhood experiences, assessment, callous-unemotional traits, temperament and character

Community Based Interventions for "pre"-forensic boys with severe psychopathology - the STABIL project in Lucerne

Poster presentation2Oliver Bilke-Hentsch, Switzerland

Room P1Fri 14:30 - 15:15

Male adolescents with severe comorbid psychopathology such as ASS oder ADHD or PTSD and impulsity often fall between the concepts of psychiatry and institutional care. If delinquency is not severe enough for "regular" forensic services, many different helpers can be concerned und there is a mix of approaches and methodology. Therewfore interventions often are disrupted in theses adolescents.

To Change the course of these so called "heavy users " of both health and forensic services with poor prognosis due to social and labour integration , a regional psychiatry (lups, LuzernerPsychiatrie, catchment area 600.00 inhabitants in central switzertland) and a well established youth care system (Jugenddorf Knutwil) developed an interdisciplinary in-patient approach to tackle the combined problems of these youngsters. This project is supported, financed and monitored by the cantonal youth care authority.

After almost one year of work data and experiences are presented, the proof of concept is done and further developments are outlined. Ther first eight patients showed long term psychiatric and youth care interventions and several methodological approaches , one after the other. In stabil they got integrated interventions and a daily routine which served well as a basis for psychotherapy and work. due to the quite remote area of Knutwil there were less seductive situations as in city settings and the adolescents focused on the internal education and work possibilities. personalized and monitored pharmacotherapy developed as a useful tool as well.

After almost a year of work the interdiscipinary in patient stabil -project in Lucerne/CH allows male adolescents with severe psychopathology and minor delinquency the return to less intensive forms of treatment and the possibilty to get a qualified education.
Co-authors: Tobias Stegmann, Christian Thalmann, Benjamin Barmettler, Eshter Klein, Kathrin Burckhardt

Community based interventions with young offenders
comorbidity, impulsivity, in patient intervention

Psychometric Properties of the Portuguese Teacher-Version of the Inventory of Callous-Unemotional Traits for Preschool Children

Poster presentation69Ricardo Barroso, University of Porto, Portugal

Room P2Fri 14:30 - 15:15

Psychopathy refers to a multidimensional construct that encompasses affective, interpersonal and behavioral dimensions. The affective dimension has been named Callous-unemotional (CU) Traits, constituting the first extension of the concept of psychopathy attributed to children. Although the literature shows more evidence for the characteristics of CU in adolescence, it is in the preschool period that aggressive behavior is prominent, and feelings of guilt and empathy begin to develop. Some researchers suggest that even younger children may have excessive dominance as well as telling strategically intentional lies and deliberately deceive others. The aim of this study is to analyze the factor structure of the Portuguese version of the teacher-report ICU for preschool-age children, and to examine its psychometric properties, such as internal consistency and convergent validity, in a community sample of children. The sample was collected in public schools and comprises the responses of 46 teachers in relation to 131 children (62 girls), between three and six years of age. A confirmatory factor analysis produced two factors: callous and uncaring. The results of the present study showed that the Portuguese version of the ICU scale (teacher’s version) seems to be reliable and valid to evaluate CU traits in preschool children.
Patrícia Figueiredo, Eduarda Ramião, Diana Moreira, Fernando Barbosa

Assessment and treatment of young and/or adolescent offenders
callous-unemotional traits, children, ICU, psychometric proprieties

Psychometric Properties of the Portuguese Teacher-Version of the Social Emotional Assets and Resilience Scales

Poster presentation52Ricardo Barroso, University of Porto, Portugal

Room P2Fri 14:30 - 15:15

Research in psychology has evolved over the decades creating a movement of greater emphasis on the assessment of strengths and positive characteristics, rather than focusing on risk factors and the diagnosis of pathology. The Social-Emotional Assets and Resilience Scale (SEARS) is an instrument for assessing the children’s strengths, resilience and adaptability in daily life, presenting a form completed by teachers. This study presents the factorial structure of the Portuguese version of teacher-report of SEARS and examines its psychometric properties, namely internal consistency and convergent validity, with a sample of 235 children (116 boys and 119 girls) aged between 5 and 10 years (M= 7.51, SD = 1.63). The factorial structure suggested by Merrell et al. (2011) was tested through a Confirmatory Factor Analyzes, with 41 items making up four factors (responsibility, social competence, self-regulation, and empathy). The first factor (α= .92) was labeled empathy related child’s ability to understand to empathize with others’ situations and feelings. The second factor (α= .89) was labeled Social Competence and consisted of nine items related to child’s ability to maintain friendships with his or her peers, engage in affective verbal communication, and feel comfortable around group of peers. The third factor (α= .90) was labeled Responsibility and its concerning to student’s ability to accept responsibility, behave conscientiously, and ability to think before acting. Lastly, the fourth factor (α= .91) was labeled Self Regulation with seven items related to child’ self-awareness, metacognition, interpersonal insight, self-management, and direction. In general, our findings support a final structure of 40 items divided into four subscales and provides evidence on the psychometric quality of this instrument. Limitations and future research needs are discussed.
Co-authors: Andreia Azeredo, Patrícia Figueiredo, Fernando Barbosa

Assessment and treatment of young and/or adolescent offenders
children, psychometric proprieties, SEARS

Study to identify the skills level, experience and training needs of foster carers in regards to high-risk self-harming behaviours

Poster presentation84Stephen Gethin-Jones, University of Central Lancashire, United Kingdom

Room P3Fri 14:30 - 15:15

Foster carers play a valuable role in meeting the needs of children who are “looked after” with Foster Care in the U.K. being the chosen method of care for children who have not been adopted or cared for by their families. This papers purpose was the evaluation of the training needs of foster carers in the North West of England with a view to examining their learning needs around self-harming behaviours, as this appeared to the local government as a major cause of placement breakdowns. The study utilised a mixed methods approach with the use of two self-administered questionnaires. The sample consisted of 48 Foster carers, who were subject of two questionnaires. The data was then analysed by the use of SPSS and qualitatively utilising thematic analysis. The research established that fosters carers regardless of their experience had major training needs around coping with self-injurious self –harming behaviours and that it was the anxiety this caused that was seen as the most likely cause of placement breakdown. This paper provides an insight into how self-injurious behaviour has the greatest impact on the foster parent’s ability to deal with self-harming behaviour, and this paper in the development of appropriate support and training will assist that professionals and agencies.

Practical implications
This paper will assist professionals and agencies to understand the profound impact that self-injurious behaviour specifically has and its impact for the potential breakdown of foster placement and will assist all those involved in foster care to develop appropriate training and support strategies for the foster carers.

Peer & family perspectives
foster children, foster families, self injurious behaviour, training needs

The management of aggressive behavior at schools: differential effects of intervention with students and teachers

Poster presentation87Daniel Rijo, University of Coimbra, Portugal

Room P3Fri 14:30 - 15:15

Aggressive behavior has a strong impact on adolescent’s psychosocial adjustment and school arenas. The Social information processing model not only explains the aggressive behavior but also their maintenance factors. Intervention programs based on this model are mainly applied to aggressive adolescents. Interventions for all the roles included in the interpersonal cycle of the aggressive behavior has not yet been investigated.

The present study aims to present the development and design of two group intervention programs for aggressive behaviors in school contexts, one for adolescents and other for teachers. Adolescents’ program is composed by 14 weekly sessions and teachers’ program include 7 sessions. Both interventions will occur simultaneously by following the same timeline.

This study has a quasi-experimental design with three assessment moments for all participants: pre, post and three months follow-up. In these time points, all participants will answer self-report questionnaires. The efficacy of the intervention programs will be assessed through the comparison of four between subjects conditions: a combined intervention condition (both adolescents and their teachers receive the intervention); two individual conditions (one targeted to adolescents and other targeted only to teachers) and a control group condition. In order to assess qualitatively the innovation moments throughout the intervention, a focus group will be conducted.

The expected results are the reduction of aggressive behaviors, the increase of prosocial behaviors and also more assertive interpersonal styles, with higher effects on the combined intervention condition. . Finally, it is also expected that both programs can be useful and worth for school contexts.
Co-author: Ana Maria Xavier, Paula Vagos

Assessment and treatment of young and/or adolescent offenders
aggression, school

Risk profiles among juvenile justice-involved youth and associations with adverse childhood experiences

Poster presentation115Lorena Maneiro, University of Santiago de Compostela, Spain

Room P4Fri 14:30 - 15:15

Adverse childhood experiences (ACEs) are overrepresented in youth involved in the juvenile justice system. Yet there is limited research on the role of ACEs and how they relate to specific risk profiles in this population. This might help practitioners not only in the identification of “high-risk” profiles but also in the adaptation of trauma-informed interventions. The aim of the current study is to identify different subgroups of youth involved in the juvenile justice system based on a set of factors (e.g., family, peers, individual) and analyze their associations with ACEs (i.e., exposure to domestic violence, physical and emotional abuse, and neglect). The sample was composed of 231 juvenile offenders (73.2% males), aged 14-21. Data were collected by means of the Juvenile Offender’s Risk Assessment protocol (VRAI). The results of the latent profile analysis (LPA) showed a better fit for the five-class model, which classified individuals in five different subgroups according to their scores in ten risk and protective factors: 1) low-needs; 2) moderate-needs; 3) socio-familiar needs; 4) antisocial/drugs; and 5) high-antisocial. Some differences among subgroups emerged regarding ACEs. Specifically, the high-antisocial and antisocial/drugs scored higher in exposure to domestic violence, and in emotional abuse and physical abuse, respectively. Interestingly, the socio-familiar needs subgroup scored higher in neglect. These results are discussed in terms of implications for risk management.
Co-authors: Olalla Cutrín, Patricia Navas, Laura López-Romero

Assessment and treatment of young and/or adolescent offenders
adverse childhood experiences, juvenile offenders, risk management, risk profiles

The utility of the Developmental Propensity Model to differentiate among diverse forms of disruptive behaviors

Poster presentation119Lorena Maneiro, University of Santiago de Compostela, Spain

Room P4Fri 14:30 - 15:15

Early-onset disruptive behavior can negatively impact children’s development by becoming, in some cases, the precursor of later developmental trajectories characterized, long-term, by more severe and harmful forms of antisocial behavior. Advancing towards sound etiological models that could inform early preventive interventions is, therefore, of paramount importance. Lahey & Waldman (2003) have proposed that high Negative Emotionality (NE), high Daring (DAR) and low Prosociality (PROS), are the main components of an “antisocial propensity”, suggesting that these temperament dimensions should be necessarily examined simultaneously when studying the risk for disruptive behavior, because of their additive, and possible interactive, effects. Similarly, the environmental transactions (i.e. family interactions) through which they operate. Our objectives were: 1) to study the separate and combined contribution of the temperamental dimensions (i.e. NE, DAR, PROS) to predict distinct forms of child disruptive behavior (e.g. ADHD, ODD, CU traits), and 2) to analyze the possible interactive effects between these temperament dimensions and different parenting styles. We used parent-reported data on child temperament, disruptive behavior, and parenting practices from the third data wave of ELISA Project, a large-scale ongoing longitudinal study conducted in Galicia (NW Spain). The initial community sample was composed of 2467 preschoolers (48% girls), aged 3-6 (Mean=4.25; SD=0.91). We tested different structural equation (SEM) models in Mplus.7. Our findings support the convenience of considering not only the three temperamental dimensions, but including also parenting practices for their utility to better account for levels of child disruptive behaviors through their interactive specific associations with the dispositional antisocial propensity.
Co-authors: Beatriz Domínguez-Álvarez, Aimé Isdahl-Troye, Patricia Navas, Laura López-Romero, Estrella Romero

Life course perspectives in youth forensic psychiatry
children, disruptive behaviour, parenting, temperament

Sharing experiences with implementing the Neurosequential Model of Therapeutics in the health care system

Show your product4Roland Verdouw, TeamNEXT, The Netherlands

Room P5Fri 14:30 - 15:15

Looking at Western Europe in general, and particularly in the Netherlands the Neurosequential Model of Therapeutics (NMT) is still in a pre-stage of development and implementation. In Europe there are several institutions in the certification process and a handful individuals certified, but in the field of child psychiatry there is still little known about this new approach of clinical problem solving.

The Neurosequential Model of Therapeutics (NMT) is a developmentally sensitive, neurobiology- informed approach to clinical problem solving. As described by Brandt and colleagues (2012) – “The Neurosequential Model of Therapeutics (NMT) (Perry, 2006) provides an integrated understanding of the sequencing of neurodevelopment embedded in the experiences of the child, and supports biologically informed practices, programs, and policies.

Results will be shown about individual cases where NMT was used as a tool for clinical problem solving. This individual presentation wil be coupled with a workshop from colleagues using the recommendations from a NMT assessment (e.g. somatosensory and attachment enriching interventions).

As a global evidence-based practice (EBP) and coupled with the NMT’s brain mapping matrix, the model supports providers in identifying specific areas for therapeutic work and in selecting appropriate therapies, including evidence-based therapies (EBTs), within a comprehensive therapeutic plan.

The Neurosequential Model of Therapeutics has a more developmentally informed, biologically respectful approach to clinical work. It is therefore a useful alternative model to complement and restructure therapeutic interventions in working with traumatized children. Organized NMT-based intervention models, such as NMT therapeutic child care, can be EBTs.”

Neurobiological & - psychological intervention studies
development, neurobiology, timing of interventions, trauma