Predictive Validity of LSI-R Subscales in Mental Health Diversion Programs Daniel J. Baucom, Evan M. Lowder, & Sarah L. Desmarais North Carolina State University Robin P. Telford HealthFitness Corporation John Petrila University of South Florida Richard A. Van Dorn RTI International Forensic Psychology in the Public Interest Lab

Risk Assessment in Diversion Programs Important role in effective case management –Risk assessment completed at time of referral (Desmarais et al., 2012) –Used to assess risk for violence and criminal behavior (Skeem & Monohan, 2011) –Inform case management and treatment planning –Evaluate progress over time Few empirical investigations of risk assessments completed in this setting –START (Desmarais et al., 2012) –HCR-20 & PCL:SV (Barber-Rioja et al., 2012) –LS/RNR (Canales et al., 2014) Forensic Psychology in the Public Interest Lab

LSI-R in Diversion Programs Level of Service Inventory-Revised (LSI-R; Andrews & Bonta, 1998) –Actuarial risk assessment instrument Static & dynamic factors General recidivism risk –54 items within 10 subscales Financial, Criminal History, Education/Employment, Family/Marital, Accommodations, Leisure/Recreation, Companions, Alcohol/Drug Problem, Emotional/Personal, Attitudes/Orientation –Used in diversion programs, but no published studies on validity of LSI-R assessments in this setting Forensic Psychology in the Public Interest Lab

The Present Study Our prior investigation of LSI-R total scores in mental health diversion sample (Lowder et al., 2013) –Adequate to good predictive validity (AUCs = ) –Predictive validity 3-month > 6-month follow-up The present study examined predictive validity of LSI-R subscales, which map onto: –Central 8 risk factors (Andrews & Bonta, 2010) Criminal History, Education/Employment, Family/Marital, Leisure/Recreation, Companions, Alcohol/Drug Problem, Emotional/Personal, Attitudes/Orientation –Dynamic risk factors relevant to treatment Emotional/Personal, Financial Forensic Psychology in the Public Interest Lab

Participants 95 clients in a mental health jail diversion program 81.1% male 35.8% diagnosed with schizophrenia M age = years (SD = 12.46) 54.7% Hispanic or Latino M jail bookings in past 3 years = 6.69 (SD = 5.43) M = lifetime jail bookings (SD = 14.99) Forensic Psychology in the Public Interest Lab

Measures & Procedures Semi-structured interviews and official records collected at: –Baseline LSI-R assessment (IRR: ICC 2 =.87, 95%CI = , p <.001) –3-month follow-up Any arrest, number of arrests, any incarceration, days incarcerated –6-month follow-up Any arrest, number of arrests, any incarceration, days incarcerated Predictive validity examined using linear and logistic regressions as well as ROC curves Forensic Psychology in the Public Interest Lab

Descriptive Statistics Recidivism –3-month follow-up Any arrest 30.5% Number of arrests M = 0.53 (SD = 0.94, range = 0-4) Any incarceration 20.0% Days incarcerated M = 4.67 (SD = 14.35, range = 0-92) –6-month follow-up Any arrest 40.4% Number of arrests M = 0.83 (SD = 1.30, range = 0-7) Any incarceration 24.5% Days incarcerated M = 9.28 (SD = 28.49, range = ) Forensic Psychology in the Public Interest Lab

3-Month Results Forensic Psychology in the Public Interest Lab Criminal History  Any arrest (AUC =.67, p =.008, OR = 1.36, p =.009)  Number of arrests (B = 0.08, p =.081)  Any incarceration (AUC =.63, p =.081, OR = 1.29, p =.054) Family/Marital  Any arrest (AUC =.621, p =.068, OR = 1.53, p =.045) Attitudes/Orientation  Any arrest (AUC =.630, p =.047, OR = 1.47, p =.039) Alcohol/Drug Problem  Days incarcerated (B = 0.07, p =.055)

6-Months Results Forensic Psychology in the Public Interest Lab Criminal History  Any arrest (AUC =.606, p =.092, OR = 1.20, p =.083)

Summary of Findings Only 3 of 10 subscales predicted recidivism: –Criminal History –Family/Marital –Attitudes/Orientation Some evidence of validity in predicting: –Arrest –3-month follow-up Limited evidence of validity in predicting: –Incarceration –6-month follow-up Forensic Psychology in the Public Interest Lab

Implications Attitudes, family relationships may be important treatment targets for high risk, high needs mental health jail diversion clients –Consistent with prior research (e.g., Banse et al., 2013; Dirks-Linhorst & Linhorst, 2010; Spjeldnes et al., 2012) Criminal history robust predictor of recidivism –Consistent with research (e.g., Hiday et al, 2013; Lovell et al., 2002) Relevance of other Central 8 risk factors in this high risk sample? Forensic Psychology in the Public Interest Lab

Limitations Treatment effects –Behavioral health services –Jail diversion services Self-report and county-level records Low base rates of offending during follow-up Short follow-up period Forensic Psychology in the Public Interest Lab

Conclusions Further evaluation of LSI-R assessments in diversion settings needed Central 8 did not emerge as robust predictors in this sample –Contradicts prior research (Skeem et al., 2013) Future directions –Longer follow-up –Replication –Exploration of other risk factors Forensic Psychology in the Public Interest Lab

Acknowledgments We thank the 11 th Judicial District Criminal Mental Health Project (CMHP) for its cooperation and support as well as the Bristol-Myers Squibb Foundation for funding this project. Forensic Psychology in the Public Interest Lab

Thank you! Contact information: Daniel Baucom Lab Website: ncsuforensicpsychology.comncsuforensicpsychology.com Lab Facebook: facebook.com/fopsypifacebook.com/fopsypi Forensic Psychology in the Public Interest Lab

Results of Previous Study Forensic Psychology in the Public Interest Lab

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3-Month Results: Linear Forensic Psychology in the Public Interest Lab

3 Month Results: ROC Forensic Psychology in the Public Interest Lab

6-Month Results: Logistic Forensic Psychology in the Public Interest Lab

6-Month Results: Linear Forensic Psychology in the Public Interest Lab

6-Month Results: ROC Forensic Psychology in the Public Interest Lab