1. ** SAPROF NEWSLETTER **
Winter 2011
Newsletter
This is the SAPROF Winter 2011 Newsletter, an update on the developments
around the Structured Assessment of PROtective Factors for violence risk
(SAPROF). The SAPROF is an SPJ checklist specifically designed to assess
protective factors for violent behavior and is intended to be used as a positive
addition to commonly used SPJ risk assessment instruments like the HCR-20.
With this newsletter we aim to keep those who are interested in protective
factors up to date on the latest developments with the SAPROF: research
projects, clinical experiences, publications and training opportunities. In doing
so, we hope to promote awareness of protective factors and create a network of
mental health professionals who value the importance of this additional positive
focus in the rehabilitation and risk management of violent offenders.
SAPROF translations
The SAPROF was first published in Dutch in 2007 (De Vogel, De Ruiter, Bouman
& De Vries Robbé) and subsequently translated into:
- English 2009
original authors
- German 2010
Aranke Spehr and Peer Briken, Hamburg
- Italian 2010
Margherita Spissu, Rome
- Spanish 2011
Ed Hilterman, Assumpta Poch & Rodrigo Venegas Cárdenas,
Barcelona/Chile
- French 2011 Jean-Pierre Guay & Tiziana Costi, Montréal
- Swedish 2011 Märta Wallinius, Helena Jersak & Staffan Anderberg, Malmö
- Norwegian 2011 Tone Sandbak, Knut Rypdal, Helge Andreas Hoff &
Erik Risnes, Bergen
- Portuguese Ana Cristina Neves & Cristina Soeiro, Lisbon (in press)
- Russian Vera Bulygina, Moscow (in preparation)
- Chinese Junmei Hu & Anita Chan, Cheng du / Hong Kong (planned)
- Danish Tine Wøbbe, Roskilde (planned)
We would like to thank all translators for their enthusiasm in working with the
SAPROF. Information on available translations can be found at:
www.forumeducatief.nl
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2. Workshops
Workshops in the SAPROF are offered in Dutch and English by authors Michiel de
Vries Robbé and Vivienne de Vogel, occasionally reinforced by experienced
clinician Ellen van den Broek. In the full-day workshop participants are trained in
the use of the SAPROF and its combined use with structured risk assessment
instruments like the HCR-20. Participants are informed about the additional
value of protective factors, latest research results and clinical implications.
International workshops have been offered over the past years in many different
countries by the authors.
Workshops are now or will soon also be offered by affiliated international
colleagues who have been trained in providing SAPROF workshops:
- London & Southern UK: Quazi Haque & Adrian Cree
- Mid & Northern UK: Mike Doyle, Andrew Brown & Richard Whittington
- Germany: Dahlnym Yoon & Peer Briken
- Italy: Margherita Spissu
- Spain: Ed Hilterman
- Norway: Tone Sandbak, Knut Rypdal, Helge Andreas Hoff & Erik Risnes
- Sweden: Märta Wallinius, Helena Jersak & Staffan Anderberg
- Portugal: Cristina Neves & Cristina Soeiro
- Canada: Simone Viljoen & Alana Cook
Recent SAPROF workshops
- October 11th 2011 Utrecht, The Netherlands
- October 22nd 2011 Prague, Czech Republic
- November 1st 2011 Edinburgh, Scotland
- November 18th 2011 Bergen, Norway
Upcoming open SAPROF workshops
• February 2012: half-day SAPROF workshop (Dutch)
Van der Hoeven Kliniek
Utrecht, The Netherlands
www.forumeducatief.nl
• February 24th 2012: full-day SAPROF workshop (English)
University of Manchester
Manchester, UK
http://estore.manchester.ac.uk
• February 29th 2012: full-day SAPROF workshop (English)
Simon Fraser University
Vancouver, Canada
For more information, please email: saprof.vancouver@gmail.com
• March 1st 2012: full-day SAPROF workshop (English)
King’s College Institute of Psychiatry
London, UK
https://www.kcl.ac.uk/prospectus/shortcourses/index/name/saprof
Youth version
There has been considerable interest from clinicians working with adolescent
populations in the development of a SAPROF youth version. Authors Michiel de
Vries Robbé and Vivienne de Vogel are planning to develop the youth version of
the SAPROF next year with the assistance from an international advisory group.
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3. SAPROF 2nd Edition
Since the initial English translation of the SAPROF in 2009, the SAPROF has been
adopted by clinicians and researchers around the globe and has been translated
into several different languages. Feedback from users and translators on the
manual has been collected over the past years. Since manual stock supplies
were running low and a reprint of the manual was needed we decided to
incorporate this feedback into a SAPROF 2nd Edition. In addition, an updated
research chapter is included, which has already been incorporated in most
translations. It should be noted that although we have provided more clarity
where users found this helpful, we did not in any way change the content of the
items in the SAPROF 2nd Edition. The item coding content of SAPROF version 1 is
thus identical and you do not need to replace your current manual for a new one.
The SAPROF partnership
Over the past two years researchers and clinicians enthusiastic about the
SAPROF’s positive approach have come together to form an international
network. At the IAFMHS conference in Barcelona this summer a joint SAPROF
symposium was held with speakers from five different countries. It was decided
to attempt formalization of the SAPROF network and utilize European funding to
promote the implementation of the additional strengths based approach to
different treatment practices across Europe. The network is coordinated by Prof.
Richard Whittington from Liverpool University and involves researchers from the
UK, the Netherlands, Germany, Italy and Spain. Others are welcome to join the
collaboration.
Research
Retrospective studies violent offenders & sex offenders
Previous retrospective studies on the SAPROF with samples of violent offenders
and sexual violent offenders showed good results in terms of interrater reliability
and predictive validity of the SAPROF for no (sexual) violent recidivism after
treatment. Results showed that for both offender groups recidivism predictions
were significantly more accurate for combined SAPROF/HCR-20 scores,
compared to predictions by the HCR-20 (and for sexual offenders the SVR-20)
alone. Although results from these studies were equally good for violent and
sexual offenders, analyses revealed different SAPROF factors that were most
predictive of no future (sexual) violence for the two offender groups: Self-
control, Work and Finances for the violent offenders; Coping, Self-control,
Motivation and Attitudes for the sexual offenders. Moreover, comparisons
between pre-treatment ratings and post-treatment ratings showed the
changeability of the dynamic protective factors of the SAPROF and their potential
usefulness for positive treatment evaluation and risk management planning.
Prospective clinical studies
More recently, a large prospective study in clinical practice has been conducted.
The study included real-life assessment data from 850 assessments during
different stages of clinical treatment at the Van der Hoeven forensic psychiatric
hospital in The Netherlands. Interrater reliability analyses over 250 cases of
multidisciplinary triple SAPROF codings showed good interrater reliability for the
SAPROF items in clinical practice. The final consensus rating of all assessments
composed in a consensus meeting was related to incidents during treatment in
the year following the assessments.
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4. For the 315 cases for which sufficient follow-up time was available (10-12
months) SAPROF total scores proved to have good predictive validity for no
violent incidents for different groups of patients including violent offenders,
sexual offenders and female offenders. Overall, the combined SAPROF/HCR-20
was again the most accurate predictor. Like in the retrospective studies it was
different factors that were best predictors for the different groups: Self-control,
Attitudes, Work, Motivation and Medication for male violent offenders; Coping,
Leisure activities, Attitudes and Network for male sexual offenders; Intelligence,
Coping, Work and Finances for the female offenders. Moreover, the consensus
rating predicted violent incidents better than any of the individual ratings.
Like in the retrospective studies, the SAPROF proved dynamic and patients’
protective factors showed to be growing as treatment progressed (see figure
below). At the same time the ratings on the dynamic C and R risk factors of the
HCR-20 showed to decrease over time. Together the improved protective factors
and the diminished risk factors resulted in an overall reduction in violence risk. It
was found that there were far fewer incidents of violence at the later stages in
treatment and that predictions of no violent incidents by the SAPROF factors
were particularly good at these later stages in treatment, when patients had had
more chance to build up their protective factors during treatment. Overall these
results show the applicability of the SAPROF to forensic clinical practice and it’s
usefulness for measuring treatment progress.
35
HCR-20
30
SAPROF
25
HCR-SAPROF
20 = violence risk
15
10
5
0
Intramural Supervised Unsupervised Community
leaves leaves supervision
International studies
Studies are currently being carried out or planned in several countries and
settings including the UK, Germany, Spain, Italy, Portugal, Ireland, Norway,
Sweden, Denmark, Belgium, France, Switzerland, Canada, United States,
Australia, Hong Kong and China. Results from these studies will become
available over the next few years and hopefully contribute to a solid body of
evidence for the value of protective factors for the balanced structured
assessment of violence risk and the additional guidelines this can offer for risk
management.
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5. Recent publications & presentations
November 2010:
- Addendum to the SAPROF Manual. Updated research chapter. De Vries Robbé
& De Vogel (Van der Hoeven Stichting). Free download from:
www.forumeducatief.nl.
March 2011:
- Protective factors for violent and sexual offenders: Retrospective results with the
SAPROF. De Vries Robbé & De Vogel (poster presented at the APLS conference
in Miami).
June 2011:
- Assessing protective factors: The SAPROF. New prospective results. De Vries
Robbé & De Vogel (paper presented at the IAFMHS conference in Barcelona)
September 2011:
- Assessing protective factors in forensic psychiatric practice. Introducing the
SAPROF. De Vogel, De Vries Robbé, De Ruiter & Bouman (International
Journal of Forensic Mental Health)
- Protective factors for violence risk in forensic psychiatric patients. A
retrospective validation study of the SAPROF. De Vries Robbé, De Vogel & De
Spa (International Journal of Forensic Mental Health)
October 2011:
- Protective factors for violent behavior: Clinical results with the SAPROF. De Vries
Robbé & De Vogel (poster presented at the ECVCP conference in Prague).
November 2011:
- Protective factors for violence risk: SAPROF prospective results. De Vries Robbé
(poster presented at the ATSA conference in Toronto).
FAM
We would like to take this opportunity to introduce a newly developed risk
assessment tool specifically for the assessment of female offenders: the Female
Additional Manual (FAM). The FAM is an addition to the HCR-20 (or related risk
focused SPJ tools) and aims to make risk assessment more gender sensitive.
With the addition of specific risk factors for women and some additional
guidelines to existing factors the authors hope to bring more guidance to gender
informed risk assessment and treatment. The FAM was developed by SAPROF
authors Vivienne de Vogel and Michiel de Vries Robbé, in collaboration with co-
authors Willemijn van Kalmthout and Caroline Place. The tool has been published
in Dutch and will soon be available in English as well. For more information on
the FAM please contact Vivienne at: vdevogel@hoevenstichting.nl.
Contact
To order the SAPROF guidelines you may contact Forum Educatief at:
disc@forumeducatief.nl (40€). In the UK the SAPROF guidelines may also be
ordered from the Cognitive Centre Foundation: wendy@cognitivecentre.com.
Several translations can be purchased locally from the different translators.
For additional information, articles, research projects, workshops, translations or
future correspondence about the SAPROF or if you would like to be removed
from this mailing list, please contact Michiel: mdevriesrobbe@hoevenstichting.nl.
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6. References on the SAPROF
Broek, E. van den & Vries Robbé, M. de (2008). The supplemental value of the
SAPROF from a treatment perspective: A counterbalance to risk? Paper
presented at the eight Conference of the International Association of Forensic
Mental Health Services, Vienna, Austria.
Vogel, V. de, Ruiter, C. de, Bouman, Y., & Vries Robbé, M. de (2007). Handleiding bij
de SAPROF. Structured Assessment of PROtective Factors for Violence Risk.
Versie 1. Utrecht: Forum Educatief.
Vogel, V. de, Ruiter, C. de, Bouman, Y., & Vries Robbé, M. de (2009). SAPROF.
Guidelines for the assessment of protective factors for violence risk. English
Version. Utrecht, The Netherlands: Forum Educatief.
Vogel, V. de, Vries Robbé, M. de, Kalmthout, W. van, & Place, C. (2011). FAM.
Female Additional Manual: Een aanvulling op de HCR-20 voor het inschatten
van gewelddadig gedrag bij vrouwen FAM. [Female Additional Manual:
Additional guidelines to the HCR-20 for assessing risk for violence in women.]
Utrecht: Forum Educatief.
Vogel, V. de, Vries Robbé, M. de, Ruiter, C. de, & Bouman, Y.H.A. (2011). Assessing
protective factors in forensic psychiatric practice. Introducing the SAPROF.
International Journal of Forensic Mental Health, 10, 171-177.
Vries Robbé, M. de, & Vogel, V. de (in press). Protective factors for violence risk.
Bringing balance to risk assessment. In L. Johnstone, & C. Logan (Eds.),
Managing Clinical Risk: A guide to effective practice.
Vries Robbé, M. de, & Vogel, V. de (2009). Assessing protective factors for violence
risk. American Psychology-Law Society News, 29, 11-12.
Vries Robbé, M. de, & Vogel, V. de (2009). Protective factors for (sexual) violence.
Results with The SAPROF in a sample of (sexually) violent offenders. Fuller
version abstract for the sixth European Congress on Violence in Clinical
Practice, Stockholm, Sweden.
Vries Robbé, M. de, & Vogel, V. de (2010). Addendum to the SAPROF Manual.
Updated research chapter. Utrecht, The Netherlands: Van der Hoeven Stichting.
Vries Robbé, M. de, & Vogel, V. de (2010). Protective factors for violence risk:
SAPROF prospective results. Paper presented at the tenth Conference of the
International Association of Forensic Mental Health Services, Vancouver,
Canada.
Vries Robbé, M. de (2011). Protective factors for violence risk: SAPROF prospective
results. Poster presented at the thirtieth Annual Research and Treatment
Conference of the Association for the Treatment of Sexual Abusers, Toronto,
Canada.
Vries Robbé, M. de, & Vogel, V. de (2011). Protective factors for violent and sexual
offenders: Retrospective results with the SAPROF. Poster presented at the
fourth International Congress of Psychology and Law, Miami, United States.
Vries Robbé, M. de, & Vogel, V. de (2011). Protective factors for violent behavior:
Clinical results with the SAPROF. Poster presented at the seventh European
Congress on Violence in Clinical Psychiatry, Prague, Czech Republic.
Vries Robbé, M. de, & Vogel, V. de (2011). Assessing protective factors: The
SAPROF. New prospective results. Paper presented at the 11th Conference of
the International Association of Forensic Mental Health Services, Barcelona,
Spain.
Vries Robbé, M. de, Vogel, V. de, Koster, K., & Bogaerts, S. (in preparation).
Protective factors for sexually violent offenders.
Vries Robbé, M. de, Vogel, V. de, & Spa, E. de (2011). Protective factors for violence
risk in forensic psychiatric patients. A retrospective validation study of the
SAPROF. International Journal of Forensic Mental Health, 10, 178-186.
Vries Robbé, M. de, Vogel, V. de, Wever, E., & Douglas, K.S. (in preparation). The
value of the SAPROF in clinical practice.
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