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Trauma and institutional risk in a secure developmental disorder service: does the SAVRY inflate risk in adolescents exposed to ACEs?

Elanor Lucy Webb (Elanor Lucy Webb and Deborah Morris are both based at Centre for Developmental and Complex Trauma, St Andrew’s Healthcare, Northampton, UK)
Deborah Morris (Elanor Lucy Webb and Deborah Morris are both based at Centre for Developmental and Complex Trauma, St Andrew’s Healthcare, Northampton, UK)
Abbey Hamer (Abbey Hamer is based at Medium Secure Division, St Andrew’s Healthcare, Northampton, UK)
Jessica Davies (Jessica Davies is based at Low Secure Division, St Andrew’s Healthcare, Birmingham, UK)

Journal of Intellectual Disabilities and Offending Behaviour

ISSN: 2050-8824

Article publication date: 3 December 2021

Issue publication date: 20 January 2022

48

Abstract

Purpose

Adverse childhood experiences (ACEs) are highly prevalent in people with developmental disorders who engage in offending behaviour. Many violence-based risk assessment tools include items pertaining to ACEs, and may inflate risk scores in trauma-exposed groups. This paper aims to explore the relationships between ACEs, risk assessment scores, incidents of risk and restrictive practices, in adolescents with developmental disorders in a forensic inpatient setting.

Design/methodology/approach

Secondary analysis was conducted on clinical data for 34 adolescents detained to a developmental disorder service. Data were extracted for Structured Assessment of Violence Risk in Youth (SAVRY) risk scores and risk behaviours and restrictive practices, as measures of observed risk.

Findings

Participants exposed to more ACEs had higher SAVRY risk scores (p < 0.001, two-tailed), with elevations specifically on the historical subscale (p < 0.001, two-tailed). Neither ACEs nor risk scores were associated with the frequency of risk behaviours. Nevertheless, participants exposed to four or more ACEs were secluded more frequently (p = 0.015, two-tailed), indicating a potential association between trauma and risk severity. Those with more complex developmental disorders experienced fewer ACEs (p = 0.02, two-tailed) and engaged in self-harm behaviours less frequently (p = 0.04, two-tailed).

Research limitations/implications

The inclusion of ACEs in risk assessment tools may lead to the inadvertent stigmatization of trauma-exposed individuals. Further investigation is necessary to offer clarity on the impact of early adversity on risk assessment accuracy and levels of institutional risk, and the role of developmental disorders in this relationship.

Originality/value

To the best of the authors’ knowledge, this study is the first to explore the relative associations between ACEs, risk assessment scores and observed institutional risk and does so in a highly marginalized population.

Keywords

Citation

Webb, E.L., Morris, D., Hamer, A. and Davies, J. (2022), "Trauma and institutional risk in a secure developmental disorder service: does the SAVRY inflate risk in adolescents exposed to ACEs?", Journal of Intellectual Disabilities and Offending Behaviour, Vol. 13 No. 1, pp. 32-44. https://doi.org/10.1108/JIDOB-09-2021-0015

Publisher

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Emerald Publishing Limited

Copyright © 2021, Emerald Publishing Limited

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