664379

research-article2016
IJOXXX10.1177/0306624X16664379International Journal of Offender Therapy and Comparative CriminologyYoon et al.

Article
International Journal of
Offender Therapy and
Factors Predicting Comparative Criminology
1­–21
Desistance From Reoffending: © The Author(s) 2016
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DOI: 10.1177/0306624X16664379
SAPROF in Sexual Offenders ijo.sagepub.com

Dahlnym Yoon1,2, Daniel Turner1, Verena Klein1,

Martin Rettenberger3, Reinhard Eher4,
and Peer Briken1

Abstract
The present study aims at validating the German version of the Structured
Assessment of PROtective Factors (SAPROF) for violence risk in a representative
sample of incarcerated adult male sexual offenders. Sexual offenders (n = 450) were
rated retrospectively with the SAPROF using the database of the Federal Evaluation
Centre for Violent and Sexual Offenders (FECVSO) in the Austrian Prison System.
Interrater reliability and predictive validity of the SAPROF scores concerning
desistance from recidivism were calculated. Concurrent and incremental validity
were tested using the combination of the SAPROF and the Sexual Violence Risk–20
(SVR-20). Interrater reliability was moderate to excellent, and predictive accuracy
for various types of recidivism was rather small to moderate. There was a clear
negative relationship between the SAPROF and the SVR-20 risk factors. Whereas the
SAPROF revealed itself as a significant predictor for various recidivism categories, it
did not add any predictive value beyond the SVR-20. Although the SAPROF itself can
predict desistance from recidivism, it seems to contribute to the risk assessment in
convicted sexual offenders only to a limited extent, once customary risk assessment
tools have been applied. Implications for clinical use and further studies are discussed.

1UniversityMedical Center Hamburg-Eppendorf, Germany

2Charité – Universitätsmedizin Berlin, Germany
3Kriminologische Zentralstelle e.V., Wiesbaden, Germany
4Austrian Ministry of Justice, Vienna, Austria

Corresponding Author:
Reinhard Eher, Director, Federal Evaluation Centre for Violent and Sexual Offenders, Austrian Ministry
of Justice, Gerichtsgasse 4, A-1210 Vienna, Austria.
Email: reinhard.eher@igf.or.at

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2 International Journal of Offender Therapy and Comparative Criminology 

Keywords
risk assessment, sexual offenders, protective factors, SAPROF, predictive validity

Although standardized approaches of assessing risk for recidivism in sexual offenders

have made great progress during the last two decades, most assessment tools still focus
on risk factors, and thus neglect protective factors, which might be important for risk
management as well. Rogers (2000), therefore, argued that an enumeration of risk fac-
tors alone would not only be insufficient but also biased because such an approach
ignores the effect of protective factors. Furthermore, focusing on protective factors
might not only improve risk assessment but could also help clients to achieve desis-
tance from reoffending and improve their own quality of life (Marshall, Marshall,
Serran, & Fernandez, 2006). In their Good Lives Model (GLM) of rehabilitation, Ward
and colleagues (Ward & Brown, 2004; Ward, Mann, & Gannon, 2007; Ward & Stewart,
2003) suggested that the goal of any treatment should be to provide offenders with
constructive suggestions for a fulfilling life and to explore personal needs and goals in
their lives rather than to solely focus on the deficits of an individual. Therefore, iden-
tifying empirically supported risk and protective factors in the individual might be
beneficial for successful interventions in offenders.
Starting with Clayton, Leukefeld, Donohew, Bardo, and Harrington (1995),
researchers have emphasized the importance of an empirical evaluation of changeable
and treatment-oriented factors, which could counteract risk factors (Gendreau, Little,
& Goggin, 1996; Quinsey, Jones, Book, & Barr, 2006; Rogers, 2000). The definition
of protective factors, however, still varies markedly among different researchers.
Some studies have conceptualized protective factors as absent risk factors (Zagar,
Busch, Grove, & Hughes, 2009) or as the opposite end of risk factors (Webster, Martin,
Brink, Nicholls, & Desmarais, 2009). However, other researchers have argued that any
factors with risk-reducing effects should be considered as protective (de Vogel, de
Ruiter, Bouman, & de Vries Robbé, 2009). Moreover, some researchers seem to agree
that protective factors either function as predictors for desistance from recidivism by
themselves or by reducing the impact of risk factors (Loeber & Farrington, 2012),
whereas other researchers rather consider protective factors as the opposite side of risk
factors (Harris & Rice, 2015). The interaction between risk and protective factors has,
nevertheless, not been empirically investigated yet.
Considering these suggested conceptualizations, previous studies on protective fac-
tors have mainly been focused on juvenile offenders and most of the longitudinal studies
published regarding protective factors of juveniles drive from nondelinquent school
populations (e.g., Loeber, Farrington, Stouthamer-Loeber, Moffitt, & Caspi, 1998;
Stouthamer-Loeber et al., 1993). These studies have found that factors like school
achievement, presence of a positive peer group, psychosocial health, residential treat-
ment, and social integration level seem to be relevant protective factors that predicted
desistance from criminal and/or violent behavior in adolescents (e.g., Borowsky, Hogan,
& Ireland, 1997; Calley, 2012; Hall & Barongan, 1997; Hoge, Andrews, & Leschied,
1996; Stouthamer-Loeber, Wei, Loeber, & Mastenb, 2004; Zagar et al., 2009).

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Yoon et al. 3

The number of studies investigating protective factors against reoffending in adults

is small. However, factors such as self-regulation, empathy, coping skills, compliance,
vocational training, employment status, living situation, and social network are sug-
gested to be personal and environmental resources against recidivism (Brown, Harkins,
& Beech, 2012; DeMatteo, Heilbrun, & Marczyk, 2005; Gendreau, Goggin, & Gray,
2000; Miller, 2006; Ullrich & Coid, 2011). Recent studies also found risk-reducing
effects for treatment programs, reintegration plan quality, and a positive relationship
to correction officers as well (Beggs & Grace, 2010; Kennealy, Skeem, Manchak, &
Eno Louden, 2012; Marques, Wiederanders, Day, Nelson, & van Ommeren, 2005;
Olver, Stockdale, & Wormith, 2011; Scoones, Willis, & Grace, 2012; Willis & Grace,
2008). As these factors appear to overlap with the risk factors identified in large meta-
analyses (Hanson & Morton-Bourgon, 2005; Mann, Hanson, & Thornton, 2010), the
construct of protective factors remains unclear.
Similar to the course of this debate, several Structured Professional Judgment (SPJ;
Douglas & Reeves, 2010) instruments with different conceptualizations for the assess-
ment of protective and risk factors have been developed during the last years. For
instance, the Structured Assessment of Violence Risk in Youth (SAVRY; Borum,
Bartel, & Forth, 2006) assesses six protective factors against juvenile violence in addi-
tion to 24 risk factors. On the contrary, within the Short-Term Assessment of Risk and
Treatability (START; Webster, Martin, Brink, Nicholls, & Middleton, 2004; Webster
et al., 2009), all included factors can be assessed either positively (protective) or nega-
tively (risk) related to possible adverse outcomes for adult forensic patients on a
3-month basis. An official German version of the START was recently published in
spring 2015 (Webster, Martin, Brink, Nicholls, & Desmarais, 2009/2015). However,
the currently existing instruments capturing protective factors were criticized for not
considering the medium-term (e.g., over 1 year) treatment-related aspects in adult
forensic populations (de Vries Robbé, de Vogel, & de Spa, 2011). To overcome these
limitations, the Structured Assessment of PROtective Factors (SAPROF) for violence
risk (de Vogel et al., 2009) was developed as a structured assessment guideline for
protective factors against future violent (including sexually violent) behavior in crimi-
nal offenders and forensic-psychiatric patients. The SAPROF defines protective fac-
tors in a broader sense: “any characteristic of a person, his/her environment or situation
which reduces the risk of future violent behavior” (de Vogel et al., 2009, p. 25). The
initial sample used in the development process of the SAPROF consisted of violent
offenders, though the authors assumed that the found protective factors could be valid
for sexual violence as well. The authors suggested to use the SAPROF in combination
with another well-validated SPJ risk assessment tool (e.g., Sexual Violence Risk–20
[SVR-20] for sexual offenders; Boer, Hart, Kropp, & Webster, 1997) because the pur-
pose of assessing protective factors is to achieve a balanced view on a broader spec-
trum of recidivism-related factors of an individual (de Vogel et al., 2009). The initial
validation study of the SAPROF revealed good to excellent predictive validity for
desistance from reoffending in violent and sexual offenders (de Vries Robbé et al.,
2011; de Vries Robbe, de Vogel, Koster, & Bogaerts, 2015). Both total scores and final
protection judgments indicated a large effect size of the instrument in 126 violent

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4 International Journal of Offender Therapy and Comparative Criminology 

offenders after 1 year (area under the curve [AUC] = .82-.85, p < .01), 2 years (AUC
= .77-.80, p < .01), and 3 years (AUC = .71-.74, p < .01) after release from a forensic-
psychiatric institution. In sexual offenders (n = 83), the AUC values of the SAPROF
total scores were slightly lower for the follow-up period of 3 years (AUC = .76, p <
.05) and after 15 years (AUC = .71, p < .01). The final protection judgments turned out
to be nonsignificant (both AUCs = .65, p = ns). Another recently published study
found strong predictive power of the SAPROF regarding absence of violence (AUC =
.85) within a follow-up period of 6 months in a sample of 98 patients in a secure foren-
sic hospital setting (Abidin et al., 2013). In a sample of juveniles alleged for sexual
offending (n = 71), the sum scores of the German version of the SAPROF predicted
desistance from violent recidivism (AUC = .65, p < .05) but failed to achieve any
incremental predictability beyond the SAVRY in a mean follow-up period of 47.84
months (Klein, Rettenberger, Yoon, Kohler, & Briken, 2015).
Except for the above-mentioned initial validation study by the developers of the
SAPROF in a hospitalized sexual offender sample in the Netherlands (de Vries Robbe,
de Vogel, Koster, et al., 2015), there exist no published data about the influence of
protective factors on the risk of recidivism in adult sexual offenders. Preliminary
results of the German SAPROF version tested in a pilot study with 30 sexual offenders
(Yoon, Spehr, & Briken, 2011), which were currently integrated in an outpatient treat-
ment program, revealed a significant negative correlation between the SAPROF and
the risk measured with the SVR-20 (Boer et al., 1997). However, no correlation was
found between the SAPROF and the risk measured with the Static-99 (Hanson &
Thornton, 1999). The German version of the SAPROF exhibited negative correlations
with the actuarial risk measured by the Screening Tool for the Assessment of Young
Sexual Offenders’ Risk (STAYSOR; Klein et al., 2012) and the SAVRY risk factors in
another sample of accused juveniles (n = 66) who have sexually offended (Klein et al.,
2012). These results might indicate that the SAPROF corresponds better with SPJ
instruments measuring clinical, supposedly dynamic risk factors rather than certain
actuarial instruments with more historical factors, in accordance with the background
of its development.
Apart from the above-mentioned studies, however, there is a lack of assessment
tools for protective factors in general and their validation in German-speaking coun-
tries. Furthermore, previous studies do not provide sufficient information regarding
the influence of protective factors on recidivism in adult sexual offender populations.
Although the debate regarding the overlap in risk and protective factors cannot be
resolved, the utility and a possible additional benefit of the SAPROF upon existing
risk assessment are worth examining. The current study therefore aims at testing the
predictive relevance of protective factors as captured by the SAPROF in a representa-
tive correctional sample of sexual offenders. Therefore, assessing predictive validity
of the SAPROF factors regarding various types of recidivism after release was the
main focus of this study. Given the comprehensive definition of protective factors
within the SAPROF, this study premised that the SAPROF would predict desistance
from various types of recidivism. Furthermore, another focus of interest was to inves-
tigate whether the protective factors add predictive power beyond the risk factors. For

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Yoon et al. 5

this purpose, we tested concurrent validity of the protective factors measured by the
SAPROF against the risk factors measured by the SVR-20 and incremental validity of
the SAPROF above and beyond the SVR-20 regarding various types of recidivism.

Method
Sample
The sample of the current study is part of a larger sample of an ongoing research proj-
ect using inmate evaluation reports of the Federal Evaluation Centre for Violent and
Sexual Offenders (FECVSO; Eher, Matthes, Schilling, Haubner-Maclean, &
Rettenberger, 2012; Mokros, Schilling, Weiss, Nitschke, & Eher, 2014) in the Austrian
Prison System, a department within the Austrian Ministry of Justice. The FECVSO
collects and evaluates data of all incarcerated sexual offenders in the Austrian Prison
System. The SAPROF, however, is not part of the routine assessment. It was coded
retrospectively based on file analyses in 467 sexual offenders who had undergone
clinical diagnostics and forensic risk assessment between 2001 and 2007 at the
FECVSO. This sample represents approximately 60% of all offenders reported to the
FECVSO and referred to further clinical assessment due to one of following criteria:
(a) Static-99 total score of more than 5, (b) age younger than 25, (c) prison sentence of
more than 4 years, (d) conviction for a child abuse offense with a nonrelated victim, or
(e) reconviction for a sexual crime. However, because the SAPROF was originally
developed to assess protective factors regarding desistance from violent (including
sexual) recidivism, 17 individuals with noncontact offenses only (e.g., exhibitionism,
child pornography abuse) were excluded, and a final count of 450 cases was included
into further analyses (see Table 1).

Measures
Recidivism. To enhance objectivity of the outcome measure, recidivism was defined as
any official reconviction after discharge. Reconviction data were collected in four dif-
ferent recidivism categories: general, nonsexual violent, sexual, and violent (including
sexual) recidivism. These recidivism categories were generated adopting the defini-
tions of the most commonly used risk assessment tools, such as the Historical Clinical
Risk–20 (HCR-20; Webster, Douglas, Eaves, & Hart, 1997), the SVR-20 or the Sex-
ual Offender Risk Appraisal Guide (SORAG; Quinsey, Grant, Rice, & Cormier,
2006). In the present study, general recidivism was defined as any conviction of a new
criminal offense, nonsexual violent recidivism as any new conviction of an offense
causing physical harm or threat to a person with no sexual intention, and sexual recidi-
vism as any new conviction of an offense involving sexual contact with a nonconsent-
ing person. Violent (including sexual) recidivism comprises both nonsexual and sexual
violent recidivism. In other words, while the sexual recidivism category contains only
crimes with a sexual component, the violent (including sexual) recidivism category
consists of any violent crime with or without a sexual component. The average

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6 International Journal of Offender Therapy and Comparative Criminology 

Table 1. Sample Description.

M SD Minimum Maximum
Age at time of release (in years) 42 12.7 16 72
Imprisonment duration (in months) 34 22.6 4 156
Follow-up period (in years) 5.8 1.4 3 10

n %
Index crime
Rape, sexual assault 201 44.7
Child molesting 249 55.3
Previous crime
Any conviction 227 50.4
Any conviction of nonsexual violent crime 161 35.8
Any conviction of sexual offense 59 13.1

follow-up time was 5.8 years after release from prison (SD = 1.4; see Table 1). The
base rates for recidivism were as follows: 34.2% for general recidivism (n = 154),
16.9% for nonsexual violent recidivism (n = 76), 8.4% for sexual recidivism (n = 38),
and 22.2% for violent (including sexual) recidivism (n = 100). The follow-up period
refers to the time after release and not to the time after the assessment.

SAPROF. The 17 items of the SAPROF are categorized into three subscales: Internal
Items (intelligence, secure attachment in childhood, empathy, coping, and self-
control), Motivational Items (work, leisure activities, financial management, moti-
vation for treatment, attitudes toward authority, life goals, and medication), and
External Items (social network, intimate relationship, professional care, living cir-
cumstances, and external control). Except for the first two internal items (intelli-
gence, secure attachment in childhood), all other SAPROF items are dynamic by
definition. In the present study, the SAPROF items were coded retrospectively based
on the assessment reports of the FECVSO. The case reports were approximately 20
to 30 pages and were evaluated by three of the authors all with different professional
backgrounds (criminology, medicine, and psychology). The raters had extensive
experience and trainings in risk assessment as well as in the SAPROF and treatment
of sexual offenders. All three raters were blinded concerning the recidivism out-
come. Because the file information was insufficient for coding certain SAPROF
items—Item 7 “leisure activities” and Item 8 “financial management”—these items
were coded as missing in many cases (see Table 2). Other three items of the SAP-
ROF were excluded from reliability and validity analyses on the item level—Item 12
“medication” due to the rarity of medication in this prison sample, Item 16 “living
circumstances,” and Item 17 “external control”—since by item definition, these
items have to be coded with “2 (clearly present)” for an incarcerated person. The
items can be briefly described as follows:

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Yoon et al. 7

Table 2. Overview on the SAPROF Item Values and Interrater Reliability Measures.

Before After imputation Reliability measures

imputation (n = 450) (n = 30)

N M SD M SD ICC 95% CI
Internal items
Intelligence 420 .93 .53 .93 .54 .91** [0.83, 0.96]
Secure attachment 433 .76 .73 .77 .73 .66** [0.46, 0.81]
Empathy 443 .48 .60 .48 .60 .23* [0.00, 0.48]
Coping 438 .35 .50 .35 .50 −.10 [−0.26, 0.13]
Self-control 444 .39 .52 .39 .51 .43** [0.19, 0.65]
Motivational items
Work 441 .88 .79 .88 .79 .54** [0.32, 0.73]
Leisure activities 235 .38 .56 .39 .56 .21 [−0.21, 0.75]
Financial management 389 .66 .69 .66 .69 .63** [0.31, 0.86]
Motivation for 438 .79 .74 .79 .74 .69** [0.49, 0.84]
treatment
Attitudes toward 442 .76 .54 .76 .54 .56** [0.34, 0.74]
authority
Life goals 427 .56 .60 .56 .60 .51** [0.27, 0.73]
Medication — — — — — — —
External items
Social network 327 .41 .53 .38 .51 .28* [−0.03, 0.59]
Intimate relationship 442 .38 .55 .38 .55 .29** [0.05, 0.53]
Professional care 444 .42 .65 .41 .64 .28** [0.04, 0.53]
Living circumstances — — — — — — —
External control — — — — — — —

Note. SAPROF = Structured Assessment of PROtective Factors; ICC = intraclass correlation coefficient;
CI = confidence interval.
*p < .05. **p < .01.

1. Intelligence: IQ based on the results of a reliable and valid instrument. If the

file ruled out IQ testing as it was not indicated, an average intelligence was
assumed.
2. Secure attachment in childhood: A close bond with at least one prosocial adult
before the age of 18. The biography was provided in all case files for rating any
prosocial role models in childhood.
3. Empathy: Cognitive and emotional empathic ability in reaction to others and
their situations. This item is considered as a dynamic factor in the SAPROF
and coded based on behavioral and emotional responses of offenders toward
other people and their situations, particularly toward past and potential
victims.
4. Coping: Effective coping skills and strategies to appropriately manage stress-
ful situations in daily life and risk-related circumstances. Reports on behaviors

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8 International Journal of Offender Therapy and Comparative Criminology 

within an inmate community, therapeutic group, or external social networks

were used to code the level of coping with stressful circumstance.
5. Self-control: Behavioral and emotional controls to reach goals and/or meet
expectations. Similar to the coping item, the self-control was coded based on
reports on behavioral aspects. Furthermore, institutional misconducts were
also evaluated as a possible indicator for self-control and self-discipline.
6. Work: Regular and suitable occupation regardless of payment.Consistency and
responsible work behavior in work history and intramural vocational status
were evaluated for coding this item.
7. Leisure activities: Structured use of leisure activities not only within social
contacts but also within inmate communities was evaluated for coding this
item.
8. Financial management: Steady income and sound financial management
regardless of the source of income were documented in the files and evaluated
for the coding.
9. Motivation for treatment: Positive attitudes toward treatment and compliance.
Because attitudes toward therapeutic intervention were elaborated in detail in
the file, the openness toward treatment and motivation for changes in own
behavior were used for coding motivation for treatment.
10. Attitudes toward authority:Acceptance and tolerance toward authority figures.
This item refers to accepting decision by authority figures, including rule-
obeying behaviors. Thus, complying with prison regulations was also evalu-
ated next to the attitudes toward own convictions.
11. Life goals: Prosocial life goals provide positive meaning of life. Positive life
goals were assumed when an individual has clear resources providing meaning
of life such as religion, ideology, being a parent, or pursuing social or cultural
ambitions.
12. Medication: Motivation for intake and responsiveness of primarily psycho-
pharmacological medication. Medications are not frequently indicated in
German correctional settings. In case of indicated or prescribed medications,
acceptance of side effects, compliant intake, and responsiveness documented
in the file were evaluated.
13. Social network: Prosocial, supportive, and stable social network (friends or
relatives). As all visitors are documented in prisoner’s files, the characteristics
of the networks were described in the case reports.
14. Intimate relationship: Stable intimate relationship of good quality for at least 1
year. Similar to the social network, relationship status was elaborated in the
case reports.
15. Professional care: Availability and the intensity of appropriate treatment mea-
sures. History of treatment and current treatment status in the case reports were
evaluated for the rating.
16. Living circumstances: Living circumstances that are intensively supervised by
mental health care professionals. As mentioned above, this item was coded
with “2 (definitely present)” according to the item definition.

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Yoon et al. 9

17. External control: Mandatory treatment order, probation, or other institutional

monitoring measures. As mentioned above, this item was coded with “2 (defi-
nitely present)” according to the item definition.

As in most other SPJ instruments, the items can be rated on a 3-point scale reaching
from 0 (clearly absent) to 2 (clearly present). It was recommended to rather use the
total scores for research purposes than for any clinical decision making because
“scores are not related to norms or criteria” similar to other SPJ instruments such as
the HCR-20 (de Vogel et al., 2009, p. 24; Webster et al., 1997). In a clinical context,
after all items are rated and weighted concerning their relevance for the treatment
planning process, a final judgment for protection can be made. An integrative judg-
ment about the recidivism risk counterbalanced by the protective factors should be
made as the final step. These two clinical judgments were not included into this study
because the file analyses did not provide sufficient information to make an overall
clinical judgment.

SVR-20. The SVR-20 was constructed to assess the clinical risk of sexual violence in adult
sexual offenders. The instrument consists of 20 items and is divided into three subsections:
psychosocial adjustment (sexual deviation, victim of child abuse, psychopathy, major
mental illness, substance use problems, suicidal/homicidal ideation [ideas], relationship
problems, employment problems, past nonsexual violent offenses, past nonviolent
offenses, past supervision failure), sexual offenses (high-density sex offenses, multiple sex
offense types, physical harm to victim(s) in sex offenses, use of weapons or threats of death
during sex offenses, escalation in frequency or severity of sex offenses, extreme minimiza-
tion or denial of sex offenses, attitudes that support or condone sex offenses), and future
plans (lacks realistic plans, negative attitude toward intervention). According to the survey
of Archer et al. (2006), the SVR-20 is one of the most frequently used instruments for risk
assessment in adult sexual offenders in North American and European countries. Also in
the German-speaking part of Europe, the SVR-20 is commonly used in different forensic
settings. There are recent cross-validation studies from Germany, Austria, and Switzerland
(Dietiker, Dittmann, & Graf, 2007; Rettenberger, Boer, & Eher, 2011; Rettenberger,
Hucker, Boer, & Eher, 2009; Stadtland et al., 2005).
The SVR-20 was part of the initial diagnostic and risk assessment process and was
rated prospectively during the offenders’ stay at the FECVSO (Rettenberger et al.,
2011). An excellent interrater reliability of the sum score of the SVR-20 in this sample
was reported elsewhere for an overlapping sample (Rettenberger et al., 2011; intra-
class correlation coefficient [ICC] = .84, p < .001). The AUC values of the SVR-20
sum scores ranged from .68 (p < .01) regarding violent recidivism to .72 (p < .01)
regarding sexual recidivism in the aforementioned study.

Statistical Analyses
The first part of analyses was conducted to offer descriptive information concerning
the distribution of the SAPROF ratings within the present sample of incarcerated male

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10 International Journal of Offender Therapy and Comparative Criminology 

sexual offenders. To measure interrater reliability, single ICCs with a two-way random
effects model for absolute agreements in sum scores as well as in each item were cal-
culated. All three above-mentioned raters independently coded 30 randomly selected
cases. These 30 cases were included into the further analyses after being recoded with
the average scores of the three raters. For further analyses, the sum scores of the
SAPROF were calculated after adjusting the missing values via multiple imputation
procedures using SPSS (IBM SPSS Statistics 22.0.0 for Windows, SPSS, Inc.,
Chicago, IL, USA). In other words, the missing item values were filled with estimates
based on present values.
Predictive accuracy of the SAPROF and its items regarding absence of recidi-
vism was analyzed by calculating the AUC based on the receiver operating charac-
teristics (ROC; Hanley & McNeil, 1982). A number of researchers have suggested
ROC analyses as a standard measure of testing predictive accuracy in the field of
forensic research (Hanson, 2009; Mossman, 1994; Rice & Harris, 1995). ROC
analyses provide information on the discriminative performance of a test for each
possible cutoff score. The level of accuracy of the test performance is revealed by
the AUC values. An AUC value of 1 represents a perfect predictive performance,
while a value of .5 indicates a prediction at chance level and a value below .5 indi-
cates negative accuracy (i.e., the variable is related to the outcome in the direction
opposite of what was anticipated).
The convergent validity of the SAPROF was tested against the SVR-20 by Pearson
product–moment correlation analyses with two-tailed test of significance.
For the calculation of the incremental validity, sequential regression models are
generally the method of choice (e.g., Hunsley & Meyer, 2003). Because of the sub-
stantial variability in the follow-up periods due to unequal follow-up time periods,
we calculated Cox regression models. Cox regression estimates hazard ratios which
are similar to risk ratios associated with one or more predictor variables from data
with unequal follow-up times (Allison, 1984; Hanson, 2006). For the purposes of
the present study, sequential Cox regression models with the SAPROF and the
SVR-20 as independent variables, and the dichotomous recidivism criteria as the
dependent variable were calculated to observe if the SAPROF protective factors
add predictive power above and beyond the SVR risk factors. For this purpose, the
SVR-20 was entered as a covariate in the first block to control for risk, followed by
the SAPROF in a second block. All statistical analyses were conducted using SPSS
version 22.0.0.

Results
Risk and Protection Scores
The average total score of the SVR-20 was M = 19.01 (SD = 6.78, range = 2-36; pos-
sible total sum = 40), the average total score of the SAPROF was M = 12.95 (SD =
4.11, range = 4-25; possible total sum = 34). The average item values before and after
the imputation procedures are demonstrated in Table 2.

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Yoon et al. 11

Interrater Reliability
The ICC single measure for the SAPROF total scores was ICC = .72** (95% confi-
dence interval [CI] = .[56, .85]). According to the critical values proposed by Fleiss
(1986; ICC ≥ .75 = excellent; .60 ≤ ICC < .75 = good; .40 ≤ ICC < .60 = moderate;
ICC < .40 = poor), this number indicates a good interrater reliability. Both Internal and
Motivational subscales revealed good to excellent reliabilities as well (Internal sub-
scale: ICC = .73** and Motivational subscale: ICC = .79**), whereas the ICC for the
External subscale was rather poor (ICC = .31**). Although eight of 14 analyzed items
showed at least moderate reliability values, six items showed rather weak reliability
values. Only intelligence showed an excellent interrater reliability and secure attach-
ment, financial management, motivation for treatment revealed good interrater reli-
ability. ICC values for self-control, work, attitudes toward authority, and life goals
were moderate. Empathy, social network, intimate relationship, and professional care
showed rather poor ICC values. ICC measures for coping and leisure activities were
not significant, and interrater reliability for the Coping item was even lower than
chance. The ICC values of each item are displayed in Table 2 next to the average item
values.

Predictive Validity
Table 3 shows the predictive accuracy of the SAPROF items, the total score and the
subscales’ scores in terms of the AUC values. According to the critical values pro-
posed by several researchers (Cohen, 1992; Dahle, Schneider, & Ziethen, 2007; Rice
& Harris, 2005; AUC ≥ .72 = large effect size; .64 ≤ AUC ≤ .71 = moderate; .56 <
AUC < .64 = small), the results showed overall a rather small to moderate predictive
accuracy of the SAPROF concerning the prediction of desistance from various forms
of recidivism. Two items showed significant moderate AUC values for general, non-
sexual violent, and violent including sexual violent recidivism: work and financial
management (AUC = .64**-.71**). There were two items with small but significant
AUC values: self-control and life goals for the same recidivism categories (AUC =
.58*-.63**). However, only secure attachment in childhood was significantly linked to
sexual recidivism (AUC = .61*). The item life goals also approached statistical signifi-
cance (AUC = .59; p = .62) for sexual recidivism. The rest of the items did not predict
sexual recidivism and overall, nine of the 13 items examined did not significantly
predict any of the four recidivism outcomes. On the subscale level, small predictive
powers of the internal scores (AUC = .57*-.58*) and small to moderate predictive
powers of the motivational scores (AUC = .63**-.67**) were observed for the three
above-mentioned recidivism types. External scores could not predict any recidivism
category. The total scores of the SAPROF predicted desistance from the three afore-
mentioned recidivism categories but with small effect sizes (AUC = .61*-.63**).
Neither the total score nor the scores of the subscales could significantly predict desis-
tance from sexual recidivism.

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12 International Journal of Offender Therapy and Comparative Criminology 

Table 3. Summary of ROC Analyses.

General Nonsexual violent Sexual Violent (including
recidivism recidivism recidivism sexual) recidivism

AUC 95% CI AUC 95% CI AUC 95% CI AUC 95% CI

Intelligence .52 [0.47, 0.58] .53 [0.46, 0.62] .47 [0.37, 0.57] .50 [0.44, 0.57]
Secure attachment .50 [0.44, 0.55] .50 [0.43, 0.57] .61* [0.55, 0.70] .54 [0.48, 0.61]
Empathy .55 [0.49, 0.60] .55 [0.48, 0.63] .48 [0.38, 0.57] .54 [0.47, 0.60]
Coping .53 [0.48, 0.59] .55 [0.47, 0.61] .49 [0.39, 0.58] .53 [0.47, 0.59]
Self-control .61** [0.55, 0.66] .63** [0.57, 0.70] .49 [0.39, 0.59] .59** [0.53, 0.66]
Work .64** [0.58, 0.69] .65** [0.60, 0.72] .57 [0.48, 0.66] .64** [0.58, 0.70]
Leisure activities .52 [0.45, 0.60] .50 [0.50, 0.60] .52 [0.41, 0.63] .50 [0.42, 0.59]
Financial management .67** [0.62, 0.72] .71** [0.64, 0.77] .57 [0.47, 0.68] .69** [0.63, 0.75]
Motivation for treatment .51 [0.46, 0.57] .52 [0.45, 0.59] .48 [0.38, 0.57] .50 [0.43, 0.56]
Attitudes toward authority .55† [0.50, 0.61] .54 [0.47, 0.62] .49 [0.39, 0.59] .54 [0.47, 0.60]
Life goals .58* [0.52, 0.63] .59* [0.52, 0.66] .59† [0.50, 0.69] .60** [0.53, 0.66]
Medication — — — — — — — —
Social network .55† [0.50, 0.61] .55 [0.47, 0.63] .51 [0.40, 0.63] .56 [0.49, 0.63]
Intimate relationship .53 [0.48, 0.59] .52 [0.45, 0.59] .56 [0.47, 0.65] .54 [0.48, 0.61]
Professional care .46 [0.41, 0.52] .48 [0.41, 0.55] .46 [0.37, 0.56] .46 [0.40, 0.52]
Living circumstances — — — — — — — —
External control — — — — — — — —
Sum score Internal items .57* [0.52, 0.63] .58* [0.51, 0.66] .54 [0.44, 0.63] .57* [0.51, 0.64]
Sum score Motivational items .65** [0.59, 0.70] .67** [0.60, 0.73] .55† [0.48, 0.65] .63** [0.57, 0.69]
Sum score External items .54 [0.48, 0.59] .54 [0.48, 0.61] .52 [0.43, 0.61] .54† [0.47, 0.60]
Sum score SAPROF .62** [0.56, 0.67] .63** [0.56, 0.70] .53 [0.44, 0.64] .61* [0.55, 0.68]

Note. ROC = receiver operating characteristics; AUC = area under the curve; CI = confidence interval; SAPROF =
Structured Assessment of PROtective Factors.
†p < .10. *p < .05. **p < .01.

Criterion-Related Validity
The SAPROF total score was negatively correlated with the SVR-20 total score with
a Pearson’s r of −.66** (p < .01), which represents a large effect size according to the
Cohen convention (Cohen, 1992).

Incremental Validity
Cox regression analyses revealed that the SAPROF scores did not add any predictive
power above and beyond the SVR-20 scores (see Table 4). The hierarchical analyses
revealed that in the first block, the SVR-20 contributed significantly to the prediction
of all recidivism categories with hazard ratios of 1.09-1.12 (p < .01), which means that
an increase of each 1 point in the SVR-20 was associated with an increase of 9% to
12% in the rates of recidivism. However, adding the SAPROF into the model to test
whether decreases of SAPROF scores become a unique predictor of recidivism after
controlling for the SVR-20 scores, the model did not explain additional variation in
recidivism.

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Yoon et al. 13

Table 4. Summary of Cox Survival Analyses at Instrument Level.

Regression Hazard
Chi-square changes coefficient ratio

Change df p B SE Wald p Exp(B) 95% CI

General recidivism
Stepwise
  Block 1
   SVR-20 52.61 1 .00 .09 .01 50.30 .00 1.10 [1.07, 1.12]
  Block 2
   SVR-20 .09 .02 32.18 .00 1.10 [1.06, 1.13]
   SAPROF 0.00 1 .96 .00 .03 0.00 .96 1.00 [0.95, 1.05]
Nonsexual violent recidivism
Stepwise
  Block 1
   SVR-20 23.12 1 .00 .08 .02 22.20 .00 1.09 [1.05, 1.13]
  Block 2
   SVR-20 .07 .02 10.20 .00 1.08 [1.03, 1.13]
   SAPROF 0.71 1 .40 −.03 .04 0.71 .40 0.97 [0.90, 1.04]
Sexual recidivism
Stepwise
  Block 1
   SVR-20 21.29 1 .00 .12 .03 19.91 .00 1.12 [1.07, 1.18]
  Block 2
   SVR-20 .14 .03 19.02 .00 1.15 [1.08, 1.22]
   SAPROF 1.35 1 .25 .06 .05 1.39 .24 1.06 [0.96, 1.18]
Violent (including sexual) recidivism
Stepwise
  Block 1
   SVR-20 32.17 1 .00 .09 .02 30.74 .00 1.09 [1.06, 1.13]
  Block 2
   SVR-20 .08 .02 17.21 .00 1.09 [1.04, 1.13]
   SAPROF 0.20 1 .65 −.02 .03 0.20 .66 0.99 [0.93, 1.05]

Note. CI = confidence interval; SVR-20 = Sexual Violence Risk–20; SAPROF = Structured Assessment of
PROtective Factors.

Discussion
The present study represents the first empirical evaluation of the reliability and valid-
ity of the German version of the SAPROF in a correctional sample of adult male sex-
ual offenders.
The offenders in the present study varied considerably from the German-speaking
populations assessed in previous studies concerning the presence of protective factors
(M = 12.95, SD = 4.11). For example, an outpatient community sample of sexual

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14 International Journal of Offender Therapy and Comparative Criminology 

offenders (Tozdan, Briken, Yoon, & von Franqué, 2015; Yoon et al., 2011) revealed
substantially more protective factors as measured with the SAPROF (M = 14.60, SD =
5.06; M = 17.35, SD = 5.64). The results of the present study might resemble the fact
that offenders of this study were (a) higher on risk in general and (b) evaluated in their
early stage of incarceration by the FECVSO, which usually is accompanied by lower
level of protection. However, the samples might also differ on various other issues
(e.g., incarcerated vs. outpatient setting). On the contrary, the SAPROF mean scores
of the present study were comparable to a sexual offender sample (M = 12.25, SD =
5.91) of a forensic mental health hospital in the Netherlands (de Vries Robbe, de Vogel,
Koster, et al., 2015).
Despite the multidisciplinary composition of the rater team, the ICC measures on
the total scores and scores for the Internal and Motivational subscales indicated a rea-
sonable raters’ agreement (ICC = .72-.79**). However, two of five internal items
(empathy, coping), one motivational item (leisure activities) and all the external items
(social network, intimate relationship, professional care) noticeably varied among rat-
ers showing poor or nonsignificant interrater reliability. Coping revealed the weakest
reliability that was even below chance level. A possible explanation could be that the
archival data were insufficient to code this item properly because the manual suggests
“to include information from the individual’s daily life” (de Vogel et al., 2009, p. 43),
which was not available in most cases. However, it is possible that this item gives
leeway to raters to evaluate certain behavioral observation as an effective coping
mechanism or not. Regarding the items “leisure activities” and “social network,” it
should be noted that these items had the most missing values. It can be assumed that
these items are difficult to rate in an early stage of incarceration because the inmates
were removed from their social contexts. Further prospective studies are warranted to
address the interrater reliability issue within a setting that allows more intensive case
information including daily behavioral observations.
Taking one of the first validation studies from Utrecht into account, which yielded
a good to excellent predictive validity of the SAPROF total scores for violent and
sexual recidivism in sexual offenders (de Vries Robbe, de Vogel, Koster, et al., 2015),
the present study found only small to moderate predictive validity indices for the
instrument. The sum score of protective factors was, nevertheless, found to be a rea-
sonable predictor for desistance from at least general, nonsexual, and sexual violent
recidivism in sexual offenders. The predictive power for the sexual recidivism cate-
gory was not significant. These results at least partially correspond with the results of
the initial sexual offender validation study conducted by the Utrecht research group
showing that the SAPROF predicts violent recidivism better than sexual recidivism
(de Vries Robbe, de Vogel, Koster, et al., 2015). This finding might originate from the
general characteristics of the SAPROF items, which are primarily related to general
and violent criminality and less to sexual criminality (cf. Babchishin, Hanson, &
Helmus, 2012). As Seto and Fernandez (2011) postulated distinctive dynamic risk
groups depending on sexual deviance and criminogenic needs, it is possible that the
SAPROF might perform better in violent sexual offenders with high antisociality than
in sexually deviant offenders. Some subscales of the SAPROF exhibited significant

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Yoon et al. 15

predictive power. In particular, Internal and Motivational subscales predicted general,

nonsexual violent, and violent recidivism. None of the subscales predicted sexual
recidivism, and, external factors did not predict any recidivism category. Corresponding
to this result, some of the individual items of the SAPROF showed meaningful predic-
tive accuracy: “self-control,” “work,” and “financial management” were the most pre-
cise predictors with small to moderate effect sizes in all recidivism categories except
for sexual recidivism. These factors were also identified in the Dutch validation study
as the strongest predictors for violent recidivism (de Vries Robbé et al., 2011). The
“secure attachment in childhood” was the only item that significantly predicted desis-
tance from sexual recidivism. In the SAPROF, secure attachment in childhood refers
to being attached to at least one prosocial role model before adulthood rather than
indicating a secure or insecure attachment type as described by Bowlby (Bowlby,
1969, 1973; de Vogel et al., 2009). The association of this item with desistance from
sexual recidivism might indicate that the risk of sexual (re)offending might be reduced
by keeping bonds toward others with prosocial characteristics over developmental
periods. However, as running 13 analyses might yield in a significant result by chance
from the default Type I error rate (.05), the significance of this finding needs to be
considered with caution. The predictive power of “life goals” might reflect the positive
motivation for a satisfying life being a strong protective factor against recidivism risk.
Although the offenders only partially showed explicit motivation for treatment (see
Table 2), those willing to reach distinct meaningful goals were found to be lower on
risk for recidivism in this study.
Although the above-mentioned results indicated that the SAPROF scores them-
selves showed significant predictive power for several recidivism categories, the
SAPROF did not exhibit any incremental validity above and beyond the SVR-20 for
any of the recidivism criteria. The overall results parallel those from the German vali-
dation study of the SAPROF in a juvenile sample by Klein et al. (2015). Following the
conceptualization of Loeber and Farrington (2012), it could be assumed that the
SAPROF factors represent protective factors by themselves predicting desistance
from criminal behaviors and/or lower probability of recidivism, but do not outweigh
the effect of risk factors measured by the SVR-20. One of the most obvious explana-
tions for the lack of incremental effect of the SAPROF is that the SAPROF might not
measure unique constructs that are not contained in the SVR-20, which was also indi-
cated by the highly significant correlation between the two instruments (r = .66**) in
the present study.
One of the strongest limitations and a possible explanation for the low predictive
accuracy found in our study might be the fact that the SAPROF ratings were based on
archival information, which did not include treatment-relevant information. The
SAPROF is described as an instrument, which is helpful for observing treatment
changes of clients and for predicting recidivism risk when used in combination with
other (SPJ) risk assessment tools. The positive values in the 15 dynamic factors of the
SAPROF might require at least some progress within the therapeutic intervention.
Overall, the current study examined the reliability and the validity of the SAPROF
using the item and total scores and therefore cannot claim that it reflects a clinical

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16 International Journal of Offender Therapy and Comparative Criminology 

setting in which the usual SPJ assessment is administered. Thus, it can be assumed that
applying the SAPROF for posttreatment ratings or during treatment might lead to a
higher predictive accuracy than in the present study (e.g., de Vogel et al., 2009).
Furthermore, the present study tested an instrument originally developed for forensic
hospital populations in a correctional offender sample. Therefore, it cannot be ruled out
that there exist specific factors that can only be applied in correctional populations. In
the same context, the SAPROF was developed primarily within a violent offender pool
and was designed to assess factors against future violence including sexual violence
and not specifically sexual violence. Thus, the low predictive accuracy of the tool par-
ticularly for sexual recidivism seems to have a plausible background. However, it is
also possible that the SAPROF is missing certain factors relevant for desistance from
recidivism in sexual offenders. For instance, Willis and Grace (Willis & Grace, 2008)
underlined the importance of the quality of reintegration planning in sexual offender
risk management. Another study suggested that victim-specific empathy is a stronger
predictor for sexual recidivism than general empathy (Brown et al., 2012). A more
recent review regarding protective factors in sexual offending has identified healthy
sexual interests as possible protective factors against sexual offending (de Vries Robbe,
Mann, Maruna, & Thornton, 2015). As the SAPROF items do not contain these specific
aspects, it is possible that the items need further clarifications for certain sexual offend-
ers, whose nature of offending is rather deviant than violent (Seto & Fernandez, 2011).
Overall, the significant predictive power of the SAPROF as an instrument and cer-
tain factors of the SAPROF might indicate that the inclusion of positive aspects in
individuals in risk assessment procedures could be beneficial. The SAPROF factors
seem to have protective effects regarding general, nonsexual violent, and sexual vio-
lent criminality. As sexual offenders are very heterogeneous in nature, further analyses
in various risk groups are needed to differentiate their risk traits and strengths, which
could be helpful to provide indications for more appropriate intervention programs for
specific types of sexual offenders. Also, items with lower interrater reliability need
further examination for the usage in the correctional population, especially in a pro-
spective setting with a more sufficient information basis for the rating. Discrepancies
between this study using a correctional admission sample and previous forensic post-
treatment samples need to be addressed in further studies. A prospective design with
more sufficient information to code the SAPROF items in a clinical setting, which
would correspond with the development purpose, might result in a stronger validity of
the instrument. Moreover, as recently examined in their studies (de Vries Robbe, de
Vogel, Douglas, & Nijman, 2015; Tozdan et al., 2015), an examination regarding the
relationship between therapeutic changes and posttreatment scores measured by the
SAPROF with desistance from various recidivism types in a representative correc-
tional sexual offender sample is warranted.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship,
and/or publication of this article.

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Yoon et al. 17

Funding
The author(s) disclosed receipt of the following financial support for the research, authorship,
and/or publication of this article: This study was realized within the MiKADO project, funded
by the German Federal Ministry of Family Affairs, Senior Citizens, Women and Youth.

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