Written by Dr. Michiel de Vries Robbé, Senior Researcher at Forensic Psychiatric Hopsital Van der Hoeven Kliniek, the Netherlands.
The Structured Assessment of Protective Factors for violence risk (SAPROF; de Vogel, de Ruiter, Bouman, & de Vries Robbé, 2007; 2012) is a risk assessment tool developed specifically for the structured assessment of protective factors for violence risk. The SAPROF was designed to complement existing structured risk-focused risk assessment tools, such as the HCR-20 / HCR-20V3, the LS/CMI, the Static/Stable and others. The SAPROF aims to contribute to an increasingly accurate and comprehensive risk assessment, and is intended for use in combination with other tools.
Mental health care professionals have welcomed the additional protective factors approach into their risk assessments and clinical practice in varying jurisdictions and settings around the globe. The value of the tool is recognised by long term mental health professionals and psychiatrists, also those working with patients in long term forensic care facilities, due to the dynamic nature of protective factors: The tool can be used throughout the course of treatment at different points in time, in order to assess patients’ progress. The SAPROF can be used for positive treatment planning, risk management and clinical evaluation. The tool assists in formulating treatment goals, atoning treatment phasing and facilitating risk communication. The tool was originally developed in the Netherlands and subsequently translated into various languages. The tool is now available in 15 languages, including: English, Dutch, German, French, Spanish, Italian, Swedish, Norwegian, Danish, Portuguese, Greek, Polish, Romanian, Russian and Japanese.
As shown in the coding sheet (see Figure 1) the SAPROF is an SPJ tool containing 17 protective factors organized within three scales: five Internal factors (e.g., Intelligence, Coping and Self-control), seven Motivational factors (e.g., Work, Leisure activities and Life goals) and five Externalfactors (e.g., Social network, Professional care and External control). The factors are rated on a three-point scale (0-1-2), with higher scores indicating presence of protective factors. Most of the factors in the SAPROF are dynamic and thus have the potential to change throughout the course of treatment. After rating all of the items, the assessor has the option to indicate items as particularly important for the individual: items may be marked as Key factors (providing vital protection for the individual) or Goal factors (those items most relevant as treatment goals for the near future). Following this, a Final Protection Judgment is made on a five-point scale regarding the protection that is available for the patient in the assessed context (low-high). Finally, the results from the SAPROF and from the risk-focused tool (e.g., the HCR-20V3) are integrated to produce an overall Final Risk Judgment of future violent behaviour (violence risk).
For use with specific populations, several additions and adaptations to the SAPROF are being developed. In the UK a group of Learning Disabilities (LD) experts is currently working on the development of an addition to the SAPROF for the LD patient population (SAPROF-LD). An international collaboration of sexual offender experts from New Zealand, the UK, the US and the Netherlands are contemplating the development of a version for use with sex offenders, which would involve the addition of sexual offending specific protective factors (SAPROF-SO). Although the general SAPROF performs well, the addition of sexual offending specific factors may be useful in a sexual offender risk assessment where healthy sexual interests are of particular concern. A self-appraisal questionnaire has been developed in the Netherlands, which allows patients and offenders to rate their own protective factors, alongside of staff ratings, providing valuable insights and from different perspectives. This SAPROF self-appraisal interview (SAPROF-ISA) is freely available from the authors. Very recently, an altogether new version of the SAPROF has been developed, specifically for the assessment of protective factors for violence risk in juveniles: the SAPROF – Youth Version (SAPROF-YV; de Vries Robbé, Geers, Stapel, Hilterman, & de Vogel, 2014), which is available in English (and currently being translated into more languages). The SAPROF-YV contains 16 dynamic protective factors for juvenile violent behaviour, and is intended for use in combination with another juvenile risk-focused tool, such as the SAVRY, the YLS/CMI or the J-SOAP. Validation studies on the SAPROF-YV will be carried out in the Netherlands, Singapore, the UK, the US and Canada.
Research on the psychometric properties of the adult SAPROF shows that the protective factors in the SAPROF have good predictive validity, both for the absence of violent incidents during Long Term Forensic Psychiatric Care (LFPC) and for desistance from violent re-offending after discharge from LFPC (for an overview see de Vries Robbé, 2014 or www.saprof.com). The SAPROF is reliable across different countries and groups of patients. It has been used with violent offenders, sexual offenders, males, females, patients with major mental illnesses, with personality disorders, and with high psychopathy scores. Two findings are especially meaningful:
- Protective factors demonstrate to provide incremental predictive validity over risk factors in predicting violent recidivism. In other words, future violent behavior can be assessed more accurately when protective factors are incorporated in the risk assessment;
- Improvement on protective factors throughout the course of treatment is correlated with a decrease in violent recidivism after treatment. In other words, the more protective factors are developed during the course of treatment, the less likely the patient is to recidivate after treatment.
These results demonstrate the value of the SAPROF. It is a protection-focused assessment tool, which has the potential to increase the accuracy, and provide additional insights, to violence risk assessments and treatment evaluations. It may be used to guide effective treatment interventions and risk management strategies for violent and sexual offenders in varying jurisdictions, countries and settings, including patients in Long Term Forensic Psychiatric Care.