Translational Issues in Psychological Science

© 2019 American Psychological Association 2019, Vol. 5, No. 2, 154 –169

2332-2136/19/$12.00 http://dx.doi.org/10.1037/tps0000191

Development of a Risk/Treatment Needs and Progress Protocol for

Juveniles With Sex Offenses

Tamara Kang, Amanda Beltrani, Sue Righthand

Megan Manheim, Sharron Spriggs, University of Maine
Bridget Nishimura, Shantel Sinclair,
Marta Stachniuk, and Elise Pate
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

Fairleigh Dickinson University

This document is copyrighted by the American Psychological Association or one of its allied publishers.

James R. Worling Robert A. Prentky

Ontario, Canada Fairleigh Dickinson University

With the post-Gault trend toward the criminalization of the juvenile court, the demand
for risk prediction assessment scales took on newfound importance. The past several
decades of research have underscored the limitations of these scales. To address these
limitations, and to shift the focus from current and future risk to least restrictive
management strategies and effective treatment, we have developed and implemented a
new assessment protocol that relies on risk relevant dynamic factors to inform and
individualize treatment interventions as a vehicle for reducing recidivism and promot-
ing healthy development among juveniles with sex offenses—without focusing solely
on risk prediction. This Treatment Needs and Progress Scale (TNPS) is currently being
pilot tested in five states. This article reviews the methodological problems of the extant
risk assessment scales, discusses the development of the TNPS and how this protocol
seeks to address many of these problems, including shifting the outcome target from
reoffense to mitigation of risk factors through treatment and healthy growth and
adjustment. We conclude with discussing how the TNPS may improve decision making
regarding the management of juveniles with sex offenses, inform public policy and law,
and facilitate healthier outcomes.

What is the significance of this article for the general public?

Shifting the focus from risk prediction to treatment and remediation can benefit
public policy by improving juvenile outcomes, reducing management cost, and
providing substantially more reliable input for the court and all providers.

Keywords: juveniles, sex offenses, treatment, risk prediction, risk management

Tamara Kang, Amanda Beltrani, Megan Manheim, Shar-
ron Spriggs, Bridget Nishimura, Shantel Sinclair, Marta
Stachniuk, and Elise Pate, School of Psychology, Fairleigh
Dickinson University; Sue Righthand, Department of Psy-
chology, University of Maine; James R. Worling, Indepen-
dent Practice, Ontario, Canada; Robert A. Prentky, School of
Psychology, Fairleigh Dickinson University.
This Project was funded by the SMART Office, Office
of Justice Programs, U.S. Department of Justice (2016-
AW-BX-K004). Any opinions and recommendations ex-
pressed herein are those of the authors and do not
necessarily reflect the views of the SMART Office or the
U.S. Department of Justice.
Correspondence concerning this article should be ad-
dressed to Robert A. Prentky, School of Psychology,
Fairleigh Dickinson University, Williams Hall-T-
WH1-01, Teaneck, NJ 07666. E-mail: rprentky@fdu
.edu

154
 TREATMENT NEEDS AND PROGRESS
Age-specific legal structures governing juve-
niles began to appear in the United States
around 1900, including compulsory education,
child labor laws, and the juvenile court (cf.
Melton, Petrila, Poythress, & Slobogin, 1987).
Juvenile Court, over the first half century of its
existence, was an exemplar of social virtue,
assuming the responsibility to protect adoles-
cents and providing them with care and treat-
ment required to reform themselves and become
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civilized members of society. The juvenile
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courts were, in effect, implementing the doc-
trine of parens patriae (Reppucci, 1999). How-
ever, by the 1960s a number of assumptions
(e.g., that the prevailing science of the day knew
how best to treat troubled youth and that clini-
cians were properly trained), led to a series of
legal challenges (Breed v. Jones, 1975; In re
Gault, 1967; In re Winship, 1970; Kent v.
United States, 1966; McKeiver v. Pennsylvania,
1971). The mission of the Juvenile Court was
increasingly being called into question, noting
that juvenile courts do not have unlimited pa-
rens patriae power (Kent v. United States,
1966). Most censoriously, Justice Abe Fortas
made reference to juvenile courts as “kangaroo
courts,” characterized by “arbitrariness,” “inef-
fectiveness,” and an “appearance of injustice”
(In re Gault, 1967). Post-Gault reforms led to a
“just deserts model of punishment,” the same as
existed in the adult courts (Reppucci, 1999, p.
314; cf. Grossi, Brereton, & Prentky, 2016, for
a more detailed history).
Two decades after Reppucci’s observation,
we still pay homage to the principled legacy of
Gault (that the Fourteenth Amendment to the
United States Constitution afforded juveniles
the same due process protections as adults),
while struggling with the ramifications of Gault
that are more draconian than anything in the
pre-Gault era. Especially for juveniles with sex
offenses, the criminalization of juvenile court
resulted in management strategies similar, if not
identical, to adults (e.g., mandatory registration
on public registries, in some cases lifetime reg-
istration, residency restrictions, day-to-life civil
commitment in some states).
One obvious and indeed ubiquitous outcome
of the criminalization of the juvenile court is
risk prediction. For a quarter of a century after
Gault, there still were no reliable means for
assessing risk in juveniles (National Adolescent
Perpetrator Network, 1993). The first such ef-
155
fort for juveniles with sex offenses (JSOs) com-
menced around 1994 (cf. Prentky & Righthand,
in press), with the first report of validated risk
prediction scales 6 years later (Prentky, Harris,
Frizzell, & Righthand, 2000; Worling & Cur-
wen, 2001), with other scales to follow shortly
thereafter (e.g., Epperson, Ralston, Fowers, De-
Witt, & Gore, 2006; Hiscox, Witt, & Haran,
2007; Prentky & Righthand, 2003; Rich, 2009).
Limitations of Extant Risk Assessment
Scales
Extensive research over the past 15 years
has shed light on the marked limitations of the
extant risk assessment scales used for JSOs,
including the three most commonly used
scales—the ERASOR, the J-SOAP-II, and the
JSORRAT-II. The methodological challenges
and the deficiencies of existing scales for these
juveniles have been discussed at length else-
where (Prentky, Righthand, & Lamade, 2016;
Righthand, Vincent, & Huff, 2017; Viljoen et
al., 2017; Viljoen, Mordell, & Beneteau, 2012;
Worling, 2017) and in the excellent review by
Vincent, Guy, and Grisso (2012) on assessing
the risk of delinquent youth in the juvenile
justice system. We briefly describe these chief
limitations below:
Developmental Immaturity
Almost 20 years ago, Reppucci’s (1999) tren-
chant observation: “The current ‘get tough’ re-
forms that treat youths as adults are not consis-
tent with the assumptions about age of maturity
that are made in other regulatory domains. A
youth can become eligible for the death penalty
5 years before he or she is old enough to pur-
chase alcohol, 2 years before the age of majority
in every state in every area of non-penal law,
and in Virginia, 2 years before he or she can get
a tattoo!” (p. 323). To date, no extant risk as-
sessment scale for JSOs has adequately ad-
dressed what the now extensive empirical liter-
ature, as well as SCOTUS (Graham v. Florida,
2010, 2011; Miller v. Alabama, 2012; Roper v.
Simmons, 2005) have underscored—the devel-
opmental immaturity of juveniles and its puta-
tive relevance to criminal responsibility (e.g.,
Prentky et al., 2016; Steinberg, 2009). Adoles-
cence is a period of significant flux that must be
captured by factors capable of assessing change.
 156 KANG ET AL.
Protective Factors
The relative absence of protective factors that
highlight what might mitigate or buffer risk has
not been adequately addressed. The most com-
mon risk prediction scales for JSOs reviewed by
Viljoen et al. (2012) contain only risk fac-
tors—no uniquely protective factors. There
have been recent advances in the field with
respect to protective factors, and it is now
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widely held that assessments for JSOs should
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include protective as well as risk factors (e.g.,
Worling & Langton, 2015).
Base Rates
An extensive empirical literature reveals that
known base rates of sexual reoffense among
juveniles are very low, typically ranging from
3% to 15% (e.g., Caldwell, 2016; Finkelhor,
Ormrod, & Chaffin, 2009; Reitzel & Carbonell,
2006). Such low base rates for sexual reoffense
result in very high false positive error rates (i.e.,
Type I errors; Evans, McGovern-Kondik, &
Peric, 2005). The net result is a ceiling effect on
accuracy of these scales, with area under the
curve (AUC) values ranging between .65 and
.70.
Heterogeneity
The classification category of JSO is so mark-
edly heterogeneous that it has virtually no value
other than as an administrative designation for
any sexual offense committed by an adolescent
(Chaffin, 2008). From the standpoint of risk, as
well as etiology, these youth are so varied
(Hunter, Figueredo, Malamuth, & Becker,
2003) that very little can be concluded other
than developmental change. Without taking het-
erogeneity into consideration, we are treating
every falling under this rubric as univocal with
respect to risk, prognosis, and clinical needs.
Age Range
Existing risk scales for JSOs target a narrow
age range (typically 12–17), excluding emerg-
ing adults (18 –25) that the empirical literature
indicates are much closer developmentally to
juveniles than to adults. This limitation has
made it impossible to follow-up older adoles-
cents over time using a consistent scale, as well
as mistakenly treating 20-year-olds as risk and
treatment-equivalent to 35-year-old offenders
with a track record of offenses as an adult.
Moreover, at the lower end of the age spectrum,
the decreasing age of onset of puberty requires
a reevaluation of what constitutes onset of ad-
olescence.
Coding Range
As Knight, Ronis, and Zakireh (2009)
pointed out, almost all commonly used risk pre-
diction scales use a truncated coding range of
0 –2, optimizing reliability while sacrificing pre-
dictive validity. As a result, the “0” and “2”
categories each have considerable within-group
variance with respect to not only risk but out-
come, prognosis, and treatment needs. The “1”
bin is a highly mixed category consisting of all
those with “minor” or “limited” behavioral in-
fractions that rule out “0” but seem to be insuf-
ficient for “2.”
Risk Groups
Categorical assignment to risk levels using
cut-off scores or professional judgment is com-
mon in risk prediction scales. Although classi-
fication to low-, moderate-, or high-risk bins
benefits judicial decision-making, these assign-
ments can be very misleading and frequently
erroneous with juveniles (Association for the
Treatment of Sexual Abusers, 2017). As Leh-
mann, Thornton, Helmus, and Hanson (2016)
stressed, there are vast differences in how peo-
ple interpret the arbitrary risk categories of
high, moderate, and low. Further, assigning ju-
veniles to a group that they might grow out of in
a matter of months is misleading at the very
least and potentially highly detrimental at worst,
resulting in suboptimal management decisions
and misguided treatment recommendations.
Remediation
All existing risk scales for JSOs focus pri-
marily or exclusively on likelihood of reoffense,
a task not only fraught with significant method-
ological problems but arguably detrimental for
the preponderance of juveniles. Promoting
health over the long term rather than managing
behavior over the short term is not only cost-
effective but far more effective if safekeeping
and victim reduction is our objective (e.g.,
Burns et al., 2003; Justice Policy Institute,
 TREATMENT NEEDS AND PROGRESS
2009; Petteruti, Walsh, & Velázquez, 2009;
Seigle, Walsh, & Weber, 2014; Tyler, Zieden-
berg, & Lotke, 2006). Shifting the focus to
remediation, however, requires that the scale
captures treatment needs.
Although the demand for risk prediction
appears undiminished, the pendulum seems to
have begun shifting slowly back in the treat-
ment direction, principally in response to de-
clining juvenile crime rates, with most juve-
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niles desisting by adulthood (e.g., Lussier &
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Chouinard-Thivierge, 2018), recognition that
incarcerating juveniles are yielding subopti-
mal results, and importantly, the impact of
developmental neuroscience (referenced
above, cf. Prentky et al., 2016, for a review;
Bonnie & Scott, 2013; Dahl, 2004; Engle,
2013; Steinberg, 2009). Strong empirical evi-
dence, although finding support from SCOTUS
(Graham v. Florida, 2010; Miller v. Alabama,
2012; Roper v. Simmons, 2005, currently ap-
pears to have had less impact on expert evalu-
ations that often are minimally based on the
extant research literature, with conclusions
drawn from results that occasionally misinter-
pret or distort the research, fail to address the
limitations of the evaluation, and fail to follow
practice guidelines (Zimring, 2004). In sum,
risk assessment with JSOs has frequently relied
on criminal history and nomothetic evidence,
focusing on one or more of the commonly used
scales. Risk prediction often becomes a tool for
justifying denial of liberty and removal from care-
givers and the community (Vitacco, Caldwell,
Ryba, Malesky, & Kurus, 2009).
Overall, the degree of accuracy achieved by
the existing risk prediction scales for JSOs,
combined with the occasional misuse of these
scales, is not commensurate with the gravity of
the decisions for which those scales are rou-
tinely used. In their meta-analysis of the re-
search regarding the predictive validity of the
J-SOAP-II, ERASOR, J-SORRAT-II, and the
Static-99, Viljoen et al. (2012) concluded that
all four measures provided estimates that were
above chance levels; “however, given that the
effect sizes were moderate, these tools may be
insufficient to make predictions that require a
high degree of precision” (p. 12). The subopti-
mal predictive accuracy of these risk assessment
scales should be disconcerting for stakeholders
who rely on these scales for high stakes deci-
sions regarding management of JSOs.
157
Low base rate problems associated with pre-
dicting risk of repeat offending is not unique to
juveniles with sex offenses. Only modest pre-
dictive validity has been demonstrated for a
variety of highly infrequent human behaviors,
including sexual and nonsexual recidivism in
juveniles and sexual recidivism in adults (Vil-
joen et al., 2012). What is unique regarding
sexual offenses, however, are the consequences
of offending, occasionally associated with very
long-term, in some cases lifelong, penal sen-
tences, as well as highly restrictive, onerous
management strategies in the community. Al-
though JSOs may be subject to the same statu-
tory management strategies as adults with sex
offenses (community notification, housing re-
striction, civil commitment, etc.), juveniles dif-
fer from adults in two critical ways: (a) the
window of behavior available for sampling ju-
venile behavior is much narrower than it is for
adults, and as previously noted (b) the innate
developmental immaturity of juveniles dictates
expected change in behavior rather than the
stability of behavior assumed with adults. The
developmental changes that occur in adoles-
cence include impaired poor decision-making,
volitional dysfunction, and emotional dysregu-
lation, all of which are potentially risk-relevant
and all of which are subject to change as a
function of maturity.
The Treatment Needs and Progress Scale
Project
In 2016 we began the design, development,
and implementation of the Treatment Needs and
Progress Scale (TNPS) that focuses on dynamic
risk and protective factors that enabled users to
assess change as a function of intervention and
that provided risk relevant information to a wide
range of stakeholders. Although a number of
dynamic assessment tools are available to assess
youth with nonsexual offenses, JSOs are often
statutorily unique in terms of mandated man-
agement provisions, including community noti-
fication and civil commitment. JSOs, unlike
their counterparts who offend nonsexually, may
be subject to being labeled as a “sex offender”
on public registries, experience barriers to at-
tending public school and gaining employment,
and be barred from living in homes with chil-
dren, including their own siblings. All of these
managerial provisions are predicated on an as-
 158 KANG ET AL.

sumption of risk that overshadows other consid-
erations. Not only are these assumptions often
flawed, as noted above, but they shift the focus
away from health to pathology. This 3-year
national study shifts the focus on magnitude of
risk to remediation of risk.
Prentky et al. (2016) attempted to articulate
an agenda for a change in direction that inte-
grated rational management policies with as-
sessment of risk that paralleled, and was in-
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risk temperature, protective factors, and re-
quired (needed) treatment intensity (or dosage).
These decisions should favor, whenever possi-
ble, the least restrictive placement. Thus, Figure
1 (Prentky et al., 2016) provides an overview of
key parts of the TNPS goals: (a) adoption of the
risk-need-responsivity (RNR) model (Andrews
& Bonta, 1994) as the theoretical foundation for
the TNPS, (b) the experimental role of taxo-
nomic differentiation, (c) the putative role of

formed by, individualized evaluations focusing protective factors, and (d) the translation of risk
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on risk management and risk reduction, rather
than risk prediction. Figure 1 illustrates this
strategy diagrammatically with a hypothetical
integration of four subtypes of JSOs based on
the work of Hunter (Hunter et al., 2003) and
Lussier (Lussier, Van Den Berg, Bijleveld, &
Hendriks, 2012). Each subtype is associated
with hypothetical levels of risk and protective
factors, leading to a theoretically optimal man-
agement plan. Court decisions would be in-
formed by clinical input regarding the current
factors into treatment needs.
Project Goals
The project had five goals: (a) develop and
test an evidence-informed treatment needs and
progress scale (hereafter referred to as TNPS)
for assessing—primarily— dynamic risk and
protective factors and limited experimental his-
torical items empirically associated with sexual
and nonsexual reoffending by JSOs and identi-

Figure 1. How the Treatment Needs and Progress Scale fits into the empirically supported
Risk-Need-Responsivity model of offender rehabilitation (Prentky et al., 2016). See the online
article for the color version of this figure.
 TREATMENT NEEDS AND PROGRESS
fying related intervention needs associated with
those factors; (b) develop a user-friendly data
entry software program that enables evaluators
to rate risk-relevant factors in their initial as-
sessments, design treatment or case manage-
ment plans accordingly, monitor progress, and
assess readiness for discharge via periodic reas-
sessments, and may assist with internal program
evaluations; (c) test the scale with 400 –500
youth at multiple sites across the United States
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and examine reliability and validity of the
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TNPS items, for example, by analyzing com-
parisons of scores on the TNPS with de-
identified, electronic, routinely collected data
reflecting the juveniles’ overall functioning
prior to and during the course of treatment; (d)
revise the scale accordingly to produce a final
version of the TNPS and revise the data entry
program; and (e) provide sites with training on
the final version of the TNPS, including a train-
the-trainers component that can ensure sustain-
ability.
Scale Development
The first goal of the project was to develop an
empirically derived list of dynamic risk and
protective factors that reflected relevant treat-
ment needs.
Step 1. We conducted an exhaustive review
of the empirical literature (e.g., Heilbrun, De-
Matteo, & Goldstein, 2016; Righthand, Baird,
Way, & Seto, 2014; Righthand & Murphy,
2017), as well as reviewing the items, factors,
and domains included on a half-dozen or so
assessment scales developed for juveniles with
sexual offenses (e.g., AIM-2, ERASOR 2.0,
J-RAT, J-SOAP-II, J-SORRAT-II, VRS:YSO)
and scales developed for youth with nonsexual
offenses (e.g., YLS-CMI, SAVRY, START:
AV, PSL:YV, OYAS).1 Potential risk and pro-
tective factors and possible treatment response
needs were translated into a series of detailed
Excel tables. The Excel tables were indepen-
dently reviewed by members of the project’s
core team (Robert A. Prentky, Sue Righthand,
James R. Worling, & Tamara Kang). Each
member of the core team independently selected
40 –50 dynamic factors and any historical items
with theoretical, empirical, or clinical rele-
vance. A list of 54 dynamic factors and 27
historical factors were selected based on the
overlap between the four lists.
159
Step 2. After deliberation on challenges
posed to validity and reliability, we settled on a
formula for operationalizing the dynamic fac-
tors using a 4-point ordinal scale. Each core
team member was assigned items and indepen-
dently applied this formula. After further delib-
eration, the 54 dynamic factors and 27 historical
factors were operationalized using this 4-point
scale that replaced “risk” with “concern” (de-
fined as need for treatment, not concern about
reoffense).
Step 3. These items were passed along to a
seven-member advisory board, all esteemed au-
thorities on children, juveniles, and adults with
sex offenses. The members of this advisory
board and the members of core team (total N ⫽
11) independently rated each item on: (a) im-
portance in assessing risk-related treatment
needs (drop, maybe, keep), (b) level of empiri-
cal support (none, some, strong), and (c) rele-
vance by age (10 –14, 15–17, 18 –25), gender
(males, females, cannot say), and contact versus
noncontact offending.
Feedback from all 11 raters was analyzed
using SPSS. Not surprisingly, there was not
100% agreement among all 11 raters to keep
any single item, requiring the use of cut offs for
percent of agreement: (a) ⱖ8 (73% of 11)
agreed to keep the item (Criterion 1), or (b) all
11 rated the item keep or maybe and no one
rated drop (Criterion #2). This procedure re-
duced the number of dynamic items by 50%
(from 54 to 27) and the number of historical
items by one third (from 27 to 18) and served as
the foundation for the test version of the scale
(TNPS; cf. Figure 3 for a list of all factors in the
test version). The finalized version will be items
selected through data analysis.
Step 4. We created a draft manual that em-
phasizes the importance of gathering multiple
source information and provides instruction on
how to rate each item.
Step 5. The TNPS items and instructions
on how to rate each item were programmed into
REDCap, a secure web application.
Step 6. We assisted each of the pilot sites in
integrating the TNPS into their assessment and
treatment practices by providing 3 days of on-
site training, webinars on using REDCap, and
1
Full references for all aforementioned scales are avail-
able upon request.
 160 KANG ET AL.
monthly teleconferencing. A 12-month trial is
presently underway with data collection due to
end April 1, 2019.
Administration and implementation. To
assure that the TNPS is implemented with fi-
delity, we are conducting monthly consultations
with pilot site treatment providers who rate the
scale. Consultations frequently focused on how
to use the TNPS item ratings to inform treat-
ment planning and decision making and trou-
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bleshoot implementation issues. Raters and
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treatment directors were also provided one-on-
one assistance as requested, participated in re-
fresher webinars, and provided detailed feed-
back in REDCap for each of the TNPS items.
To further increase uniformity of administration
at each of the sites, we developed a FAQ bul-
letin to discuss frequent questions and have
addressed additional questions during monthly
consultations.
Feasibility of assessing interrater reliability on
20% of randomly selected cases is presently being
discussed. It may be possible for two treatment
providers who work with the youth to indepen-
dently rate the TNPS. Because it is not possible to
assume comparability of knowledge of the youth
between the two raters, information about famil-
iarity and length and nature of contact with the
youth would be requested. Rating discrepancies
could be identified and discussed with the treat-
ment providers as part of regular monthly consul-
tations. The intent would be to differentiate be-
tween discrepancies due to differences in
familiarity with the youth as opposed to discrep-
ancies due to the item itself (e.g., ambiguity of
language or intent of the item).
In Summary
The Treatment Needs and Progress Scale was
designed to address many of the aforementioned
limitations in existing risk assessment scales used
with JSOs. Broadly, we hope to accomplish the
same goal, optimal management of JSOs, but
through a treatment lens rather than through a
punitive lens. Further, although our mission is not
focused on taxonomic differentiation of JSOs, we
cannot ignore that JSOs are a markedly heteroge-
neous group. Thus, although not central to this
project, we will investigate taxonomic differenti-
ation empirically. Figure 2 attempts to connect
some of the limitations mentioned above with the
changes that the TNPS protocol seeks to address.
Age, developmental immaturity, and dy-
namic risk. Between 30% and 100% of the
risk factors on the commonly used risk predic-
tion scales studied by Viljoen et al. (2012) are
static; juveniles are not (Worling, 2017). Static
factors will neither reflect change during the
course of development nor change during
the course of any intervention. Given the fact of
change across all domains of normative adoles-
cent development, irrespective of any interven-
tion, it is problematic to evaluate juveniles with
a scale that is wholly (or predominantly) based
on static risk factors. Further, risk on largely
static risk assessment scales may appear to in-
crease as a result of treatment when youth dis-
close new historical information that increases
the ratings of static risk factors (Worling, 2017).
As noted, the test version of TNPS relies
primarily on 27 items designed to assess dy-
namic risk and protective factors and treatment
response needs that cover multiple domains:
1. attitudes and beliefs (e.g., criminogenic or
positive social attitudes and beliefs),
2. interpersonal relations (e.g., interpersonal
and social skills strengths and deficits, in-
volvement with criminogenic and/or pos-
itive peers or social isolation),
3. behavior (e.g., excessive risk-taking, im-
pulsivity, delinquency, substance use, ef-
fective behavior regulation, school stabil-
ity, work stability), emotional regulation
(e.g., anger management),
4. familial/situational (e.g., caregiver sup-
port or disengagement),
5. community (positive or negative supports
or influences), and
6. psychological functioning (e.g., problem solv-
ing, co-occurring mental health challenges).
The protocol instructs users to reassess needs
at least every 3 months to capture change that
may have occurred as a result of any applied
(treatment) or unanticipated (major impactful
event) intervention, or maturation.2 The ques-
tion of flux, however, extends well beyond de-
2
Three months was chosen because the average length of
sex offense specific treatment is often 14 months for ado-
lescents and 10 months for children (McGrath, Cumming,
Burchard, Zeoli, & Ellerby, 2010).
 TREATMENT NEEDS AND PROGRESS
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This document is copyrighted by the American Psychological Association or one of its allied publishers.
Figure 2. Features of the Treatment Needs and Progress Scale designed to address some
limitations of existing risk and needs assessment instruments. See the online article for the
color version of this figure.
velopmental change, reflecting a high degree of
potential instability, necessitating frequent reas-
sessment. The lives of juveniles often seen in
juvenile court are almost by definition defined
by instability, dysfunction, and chaos (Prentky
et al., 2014). Treatment needs are understood to
be risk-relevant, and, when adequately treated,
decrease the likelihood of reoffending (An-
drews & Bonta, 1994). Thus, the scale directly
links risk with treatment interventions (An-
drews, Bonta, & Wormith, 2011).
The dynamic items are intended to address
markedly diverse adverse life experiences that
many of these youth have been exposed to,
pathways that may have contributed to the same
or similar outcome (equifinality), underscoring
different treatment needs (e.g., emotional dys-
regulation, antisocial attitudes and beliefs, poor
social skills, residual effects of trauma, etc.)
even though the outcome is— or appears—the
same. Unique treatment needs highlight the im-
portance of individualizing interventions by ad-
dressing factors related to treatment engage-
ment, such as the mode of intervention and
using tailored approaches that make sessions
161
more conducive to learning (i.e., responsivity;
Bonta & Andrews, 2017; Bourgon & Bonta,
2014) while addressing criminogenic needs.
Specific responsivity needs, when not ad-
dressed, may become barriers for youth to fully
benefit from the interventions (Bonta & An-
drews, 2017) and thus are included in the TNPS.
Moreover, for all juveniles, and especially for
younger ones, the window within which to sam-
ple behavior can be very small, frequently ren-
dering assessments unreliable due to the lack of
temporal stability of unwanted sexual behavior.
By marked contrast, assessing risk of adults
who offend sexually may provide an additional
20 years or more to sample such behavior.
One of the main reasons that we extended the
upper age range to 24 was that it permitted a
longer follow-up period, as well as potentially
providing an assessment resource that spanned
the intermediate period of development, re-
ferred to as ‘emerging adulthood’ (Arnett,
1999). This latter issue was discussed earlier as
a developmental concern, namely that the ado-
lescent brain continues to mature well into the
midtwenties (e.g., Johnson, Blum, & Giedd,
 162 KANG ET AL.

No Possible/Minimal Moderate Strong

Possible Concern Treatment Treatment Treatment Treatment
Need Need Need Need
1. Frequency of Sexual Thoughts 0 1 2 3
2. Sexual Interests 0 1 2 3
3. Self-Sexual Regulaon 0 1 2 3
4. Understanding Appropriate 0 1 2 3
Sexual Behavior
5. Understanding the 0 1 2 3
Consequences of Problemac Sexual
Behavior
6. Sexual Atudes and Beliefs 0 1 2 3
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

7. Behavioral Self-Regulaon 0 1 2 3
This document is copyrighted by the American Psychological Association or one of its allied publishers.

8. School and/or Work 0 1 2 3

9. Free me 0 1 2 3
10. Law abiding behavior 0 1 2 3
11. Atude and Beliefs regarding 0 1 2 3
Non-sexual Rule Violang and Illegal
Behavior
12. Peer-Aged Friendships 0 1 2 3
13. Peer-Associaons 0 1 2 3
14. Relaonship with Primary 0 1 2 3
Caregiver (Client’s Perspecve)
15. Adult Mentors (Client’s 0 1 2 3
Perspecve)
16. Social Skills 0 1 2 3
17. Problem Solving 0 1 2 3
18. Emoon Management 0 1 2 3
19. Self-efficacy 0 1 2 3
20. Compassion 0 1 2 3
21. Coping with Sexual Abuse 0 1 2 3
22. Coping with Non-sexual 0 1 2 3
Negave Life Experiences
23. Atudes Toward 0 1 2 3
Intervenons
24. Management of Co-occurring 0 1 2 3
Psychological and Behavioral Health
Challenges
25. Supporve Caregiver or 0 1 2 3
Significant Other
26. Stability in Living Situaon 0 1 2 3
27. Community Support 0 1 2 3

Figure 3. List of the 27 dynamic risk and protective factors and treatment needs on the
Treatment Needs and Progress Scale. The items are currently being tested.

2009). In particular, the region of the brain re-
sponsible for sound judgment and volitional con-
trol, the prefrontal cortex, does not mature until
early adulthood (e.g., Diamond, 2002; Walsh,
2004). As noted earlier, the empirical literature
clearly suggests those in the age range of 18 to 24
are much closer developmentally to adolescents
than to adults. At the opposite end of the age
range, onset of puberty has been dropping for both
girls and boys. For boys, puberty is generally
considered precocious (too early) before age nine.
In boys, onset of puberty ranges from 9 to 14, with
an average onset of 11 to 12 (Adkins, 2013).
Although we have formally set the lower bound at
age 12 during this pilot phase, we will test the
utility of the TNPS with younger boys and girls if
they are available at our pilot sites.
The importance of embedding developmental
immaturity into any juvenile assessment is em-
pirically underscored. The developmental liter-
ature is extensive. Although we cannot do jus-
tice to the literature in this forum, it is discussed
at length elsewhere (e.g., Bonnie & Scott, 2013;
Bostic, Thurau, Potter, & Drury, 2014; Dahl,
 TREATMENT NEEDS AND PROGRESS
2004; Engle, 2013; Luna & Wright, 2016;
Prentky et al., 2016; Steinberg, 2009; van den
Bos, van Dijk, Westenberg, Rombouts, &
Crone, 2011).
Taxonomic differentiation. Although em-
pirical research on taxonomies within this pop-
ulation is minimal, we intend to explore possi-
ble taxonomic differences adapted from the
aforementioned work of Hunter and his col-
leagues (2003). Simple taxonomic differentia-
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tion suggests that most JSOs’ offenses are situ-
This document is copyrighted by the American Psychological Association or one of its allied publishers.
ational and transitory, some may go on to
engage in nonsexual delinquency, whereas a
small group persists with sexual reoffending.
Lussier et al. (2018) found support for dual
trajectories reflecting the same adolescence-
limited and persistent pathways originally de-
scribed by Moffitt (1993). Although the scope
of this project does not include formal taxo-
nomic analysis, recognition of the marked het-
erogeneity of JSOs and any attempt to address it
is a step in the right direction. These points are
consistent with the RNR model (Andrews &
Bonta, 2010), which has empirical support in
reducing sexual offending (Hanson, Bourgon,
Helmus, & Hodgson, 2009).
Four-point rating scale. The TNPS uses a
4-point rating scale in which all four points have
discrete, independent meaning and follow a gra-
dient of concern. With a 3-point scale, the 0 is
clearly absent, the 2 is clearly present, and the 1
is often a gray area. By using a 4-point rating
scale, we attempted to capture the gray area, in
a more meaningful way, by measuring the de-
gree of risk (concern) or protection. The con-
tinuum pertains not to risk but to the intensity of
treatment need, that is, 0 reflects no treatment
need, whereas 3 reflects the greatest treatment
need. We developed a scale that is intended to
capture change in risk as a function of growth/
adolescent development and/or intervention
(e.g., treatment). Although risk is inevitably im-
plied, our intent is to shift the focus to treatment
needs related to mitigation and ultimately
healthier, prosocial outcomes. The nature of the
scale, hopefully, is its intended flexibility; as
with mercury in a thermometer, risk is a dy-
namic state that rises and falls, all of which can
be captured and viewed by the user. The con-
trast here is with extant risk scales for JSOs in
which the common interpretation of risk is not
merely a static condition but is a temporally
stable condition (i.e., the implied assumption
163
being that risk assessed at age 15 will be the
same when risk is revisited years later).
Linking risk to treatment needs/intervention.
The 0 –3 scale associated with each factor has
anchor points that correspond to the recom-
mended level of intervention intensity (i.e., no
need, possible/minimal need, moderate need, or
strong need), adhering to RNR’s risk principle,
and is consistent with RNR’s need principle
(pointing to risk relevant treatment targets)
and the responsivity principle (identifying fac-
tors that may influence treatment response), and
thereby addressing the frequent disconnect be-
tween assessment and interventions in RNR
programs (DeMatteo, Hunt, Batastini, &
LaDuke, 2010). As DeMatteo et al. noted,
“there is often a weak link between the assess-
ment of risk and the selection of needs-
appropriate intervention strategies for specific
offender populations. This disconnect can re-
duce the likelihood of achieving optimal or even
minimal reductions in re-offense rates” (p. 62),
underscoring the critical importance of identi-
fying treatment needs based on the assessment
of specific problem areas, strengths, and weak-
nesses.
Software program. As the judgment and
decision-making literature suggests, humans
tend to favor visually appealing, clear, under-
standable presentations over strictly numeric
presentations (e.g., Fagerlin, Wang, & Ubel,
2005). As such, we used Research Electronic
Data Capture software (REDCap), which,
among many other features, provides a table
that clearly displays each factor across the top
of the page and prior results from each reassess-
ment in consecutive rows to help users visually
gauge progress (or lack thereof) and tailor in-
terventions accordingly. REDCap will not be an
option at the expiration of this project, and we
are exploring proprietary options.
Outcome assessment. As noted in our dis-
cussion of limitations, overall predictive accu-
racy for scales designed to predict risk with
juveniles (as well as adults) with sex offenses is
suboptimal, with mean predictive accuracy
yielding AUC values approximating .65. The
accuracy of predicting sexual recidivism has hit
something of a glass ceiling and will likely
never be improved relying on prediction of risk
of reoffense as the prime indicator of outcome.
This is the case for a variety of reasons, includ-
ing, most importantly, the low base rate, as well
 164 KANG ET AL.
as the numerous factors potentially mitigating
and/or aggravating risk that are unaccounted for
in risk scales, the highly imperfect reporting and
conviction rates for real offenses, and the meth-
odological limitations noted above. As long as
the detection rate (as opposed to whatever the
real recidivism rate is) is quite low and thus
constitutes a very small outcome target, we will
be assured of high false positive error rates.
From the standpoint of predictive efficacy,
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we certainly would not want to increase the base
This document is copyrighted by the American Psychological Association or one of its allied publishers.
rate of the traditional outcome target—reoff-
ense, but we may be able to increase the base
rate for an alternative outcome target—
behavioral and emotional adjustment. Rather
than asking whether the youngster reengaged in
unwanted sexual behavior, we favor asking
whether he or she has engaged in positive,
healthier behavior, defined by several dimen-
sions comprising overall adjustment. We are
experimenting with alternative outcomes; each
outcome holds both positive and negative va-
lence and is thus dimensional rather than bivari-
ate. This approach not only focuses on an ex-
pectation of positive change, rather than
reinforcing an expectation of a negative out-
come, but dimensionalizes the outcome. As
Fisher and Keil (2018) pointed out, when
weighing the value of new data, we veer in the
direction of a binary bias, a heuristic that leads
us to impose categorical assignments on contin-
uous data. Although the outcome can easily be
stated in binary terms (Did the criminal justice
system detect a new criminal offense: yes or
no), predicting the likelihood or probability of
that outcome reliably requires accurately pre-
dicting human behavior, and that is not a binary
decision. The outcomes that we are experiment-
ing with reflect degrees of social, interpersonal,
emotional, and behavioral adjustment. Not only
will these yield much larger outcome targets,
they directly inform treatment needs, and they
provide decision-makers with useful input,
pointing to relative risk mitigation and healthier
outcomes.
Translation to Policy and Practice
Through development of a TNPS, we hoped
to shift the goalpost from an outcome focused
exclusively on risk of sexual reoffense (or any
nonsexual criminal offense) to an outcome fo-
cused on adjustment and health. Although many
of the dynamic items used in the TNPS are
found in extant juvenile sexual and nonsexual
risk assessment scales, our objective in includ-
ing such items in the TNPS is not to capture risk
of reoffense but to guide individualized treat-
ment to reduce risk and develop behaviors and
lifestyles that are incompatible with delinquent
or criminal behavior. The considerable item
overlap with other scales is not coincidence.
Understanding risk is a sine qua non for reduc-
ing risk; accurately assessed risk is our best
guide for identifying optimum interventions tai-
lored to individual needs. In sum, we have ar-
gued that our efforts to predict risk reliably have
fared poorly and that a far more expedient long-
term strategy is to mitigate risk. Further, inclu-
sion of protective factors (items that may miti-
gate or buffer risk, as well as others that are
important for improving treatment response), is
intended to promote a dynamic and holistic
approach to facilitating positive development,
healthy transitions into adulthood, and prosocial
lives. By shifting the focus to risk mitigation
through treatment we are hoping to influence
not just practice but the policy driving practice.
The TNPS and its guiding principles are not
an attempt to devalue assessment of risk, and
we are not recommending abandoning risk as-
sessment. Risk is a sensitive barometer for what
must be targeted in treatment. However, lessons
learned from the past is that risk assessment
with juveniles, when treated as an endpoint, is
fraught with problems, both substantive (meth-
odological) and practical (management; cf. Vil-
joen, Cochrane, & Jonnson, 2018). What we
recommend is that risk take its place embedded
in the matrix of an idiographic assessment that
focuses, as a midpoint, on mitigation through
treatment and other interventions that foster
health rather than as an end goal of prediction.
In this final section, we address the question
of how we might translate theory into practice
and policy. Although the data from our pilot
sites will hopefully shed light on our basic as-
sumptions about the efficacy and merits of the
TNPS, these assumptions must continue to be
examined empirically well after the pilot phase.
We should emphasize, however, that the TNPS
alone can never mitigate risk, and its assistance
with guidance, treatment, and management can
be no better than the fidelity with which it is
used (Viljoen et al., 2018). The potential impli-
cations described below refer to how, if imple-
 TREATMENT NEEDS AND PROGRESS
mented with fidelity, the TNPS might inform
decision-making and impact juveniles, their
parents and caregivers, child welfare system
case workers, law enforcement, probation offi-
cers, juvenile court judges and attorneys, teach-
ers and school administrators, clinicians/
treatment providers, public policy advocates,
and researchers.
Individualizing Optimal Treatment
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Interventions
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As illustrated in Figure 1 and supported by
the work of Hunter and his colleagues (2003),
there are distinct typological differences among
JSOs. This heterogeneity underscores the need
for individualized analysis of risk and protec-
tive factors and of treatment needs. Effective
treatment must target accurately assessed risk
factors and facilitate strengths and factors that
protect against or mitigate risk; this is a cost-
effective strategy for reducing sexual and non-
sexual offending. Facilitating movement along
a developmental continuum from often impul-
sive, poorly considered behavior, to improved
judgment, and thoughtful weighing of potential
consequences to self and others, and ultimately
to a healthier adaptation is not only humane but
a cost-effective response. The stakeholders ref-
erenced above can potentially benefit from a far
more accurate appraisal of risk and protective
factors and a targeted intervention plan that is
individualized to maximize a positive treatment
response.
Understanding How Best to Manage and
Mitigate Risk and Facilitate Change
Risk is not fixed in juveniles; only change can
be expected with any certainty. It is change that
the TNPS endeavors to capture through assess-
ment of dynamic treatment needs over serial
assessments during treatment. Measurement of
change can help decision-making for frontline
responders (therapists, social workers, case
managers) as they update treatment plans, as-
sess readiness for discharge, and improve com-
munication with probation officers, parents, and
child protective workers. Visualizing change,
progressive as well as regressive, or absence of
change, can inform decision-making and assist
with amending interventions. The case manage-
ment plans developed by probation officers or
165
child protective workers are no less mutable
than the treatment plans of clinicians. The
TNPS can be as vital for case management as it
is for treatment planning. In a complex, inter-
dependent multisystem societal response, the
TNPS is designed to standardize communica-
tion about individualized risk and needs across
a broad spectrum of stakeholders.
Concluding Remarks: Pondering Policy and
Practice
We have sought to develop and test a differ-
ent model for addressing the needs of juveniles
with sex offenses. This model has three overar-
ching goals: (a) reverse the prevailing standard
of practice that understands risk prediction as
the quintessential purpose of assessment, (b)
reintroduce treatment as the principal objective
of sound management, and, in so doing, (c)
potentially reduce the large number of false
positive decisions (i.e., classifying low risk
youth as presenting a high risk), that pose a
financial burden on society and may further
cripple already troubled youth.
Our proposal is not novel. Over two decades
ago, Chaffin and Bonner (1998) penned their
oft-cited Editor’s introduction: “Don’t Shoot,
We’re Your Children:” Have we gone too far in
our response to adolescent sexual abusers and
children with sexual behavior problems? Ten
years later Chaffin (2008) wrote his reprise fo-
cusing on the continued disconnect between
policy-based misperceptions of high risk, ho-
mogeneity, and intransigence (the belief that
sexually offending behaviors in juveniles are
“tenacious and difficult to change and require
not just specialized intervention but lots of it . . .
delivered over a long period of time . . . and
should involve more intensive, restrictive, and
expensive elements” [pp. 118 –119]). As Chaf-
fin pointed out in 2008, there was no scientific
support for those beliefs, a finding that contin-
ues to be true today.
In the decade since Chaffin’s (2008) article,
there has been a wealth of empirical literature
documenting: (a) heterogeneity among juve-
niles with sex offenses, (b) low sexual recidi-
vism base rates, implying a low risk of new sex
offenses, (c) marked developmental immaturity,
indicating that change is inevitable as a mere
function of growth, and (d) amenability to
short-term treatment; indeed there is evidence
 166 KANG ET AL.
that high intensity treatment for low-risk youth
may actually increase the likelihood of reoff-
ending (Lowenkamp & Latessa, 2004). Thus,
the TNPS is not an experiment with a new risk
assessment scale for JSOs, but rather a struc-
tural attempt - and an opportunity - to align
policy and practice with scientific evidence.
Any steps, even preliminary ones, that lay
groundwork for empirically informed policies,
management strategies, and treatment methods
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that reduce a youth’s contact with the juvenile
This document is copyrighted by the American Psychological Association or one of its allied publishers.
justice or child welfare system will be beneficial
for everyone— our juvenile clients, their fami-
lies and communities, and our society.
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Received June 27, 2018
Revision received February 6, 2019
Accepted February 26, 2019 䡲