Assessing risk for adverse outcomes and clinically meaningful change: An examination of the SAVRY, START:AV, and VRS-YV in an adolescent residential treatment setting

The following dissertation addresses two important areas of consideration in adolescent risk assessment, namely the assessment of multiple adverse outcomes and the rating and formulation of change in risk for violence. Notwithstanding the strong empirical support for assessing risk for violence and general reoffending among adolescents, examinations of other adverse outcomes common among this age group are limited. To address this gap, the first study examined the predictive validity of the Structured Assessment of Violence Risk in Youth (SAVRY), Short-Term Assessment of Risk and Treatability (START:AV), and the Violence Risk Scale-Youth Version (VRS-YV) among a sample of 87 male and female adolescents referred to a residential treatment program. Using adverse outcomes coded from file, the SAVRY and VRS-YV achieved larger effects for outcomes related to harming others and rule violations (e.g., violence, non-violent offenses) relative to those involving harm to the adolescent (e.g., non-suicidal self-injury, victimization), whereas the START:AV demonstrated greater consistency in predicting outcomes across both domains. Focusing on violence and suicidal/non-suicidal self-injury, accuracy of the SAVRY, START:AV, and VRS-YV peaked within the first three months, with recurrent event survival analysis revealing that dynamic risk factors were superior in predicting repeated events involving violence relative to static/historical factors, whereas only dynamic factors associated with the START:AV were predictive of repeated events involving suicidal/non-suicidal self-injury. For the second study, two cases were selected for the purpose of conducting a case study and examination of current methods for reassessing risk for violence, with the introduction of a newly developed structured professional judgment framework for rating and formulating change in risk. Methods based on pre-post reliable change indices, stages of change, and the newly developed framework were exemplified using the SAVRY, VRS-YV, and START:AV, respectively. Although the findings of the study illustrate the capacity for each method/tool to detect change in dynamic factors, several meaningful differences emerged. The clinical and research implications of the two studies are discussed, with recommendations for future research being provided.