5 121 PERSONALIZED MONITORING AND FEEDBACK of their risk-relevant behavioral, psychological, and contextual features. Participants in this study already acquired awareness of their interrelated risk-relevant features during treatment before the start of the ESM measurement. Increased added value to case formulation is expected when ESM monitoring occurs at the start of treatment, where patients usually have less insight in their (interrelated) risk-relevant features. Despite these positive statements, none of the participants could recall newly acquired working hypotheses on the development and maintenance of his former sexual offending. This is understandable since the feedback-report was discussed with the participants only once, given the research protocol. Integrating ESM measurement of risk-relevant features not only within the case formulation, but also in the treatment process through for example routine outcome monitoring might increase the internalization of these features and their interrelationships. This is in concordance with scientific literature highlighting the need for proper integration of e-mental health in forensic treatment (Kip & Bouman, 2021). eHealth technology, like web-based application of ESM, will be more effective when it is easily adaptable to an individual patient, therapists are trained to deal with it flexibly, and when organizations adapt their strategies and structures to implement this technology (e.g., Kip et al., 2020). This study also evaluated to what extent participants are affected by ESM measurement of their risk-relevant features, perceive them as burdensome, adhere to the protocol, and are committed to the monitoring process. Although the participant who dropped out feared increased sexual (deviant) thoughts and behavior, participants experienced no major (positive or negative) effects on their emotions, sexual feelings, and sexual behavior as a result from ESM monitoring. They also did not perceive ESM monitoring as a burden in terms of item content, duration of completing each individual questionnaire, and the duration of the entire ESM data collection period (two weeks). Consistent with this, high degrees of cognitive and behavioral adherence and engagement were found. Participants expressed that using their own language in the item description motivated them to continue monitoring. However, personalizing to the item level has disadvantages. For example, it takes several weeks to include personalized items in the scoring program. Weeks in which the case formulation should already have been established, and treatment should have started. In addition, the way in which some ESM items were personalized turned out to negatively affect their variability. That is, it allowed values to approach the upper or lower limit of the item (respectively called the ceiling or floor effect). Items with a ceiling or floor effect cannot be interpreted in a bar graphs or time series plots and lead to problematic inferences in graphical networks. To overcome these shortcomings, a set of standard items with sufficient variability could be developed and used. Personalization of the ESM questionnaire remains possible by selecting those ESM items applicable to patients’ risk-relevant features and best fitting his preferred choice of words. A standard item set based on dynamic risk assessment instruments used to assess the risk of reoffending in adult male with a history of sexual
RkJQdWJsaXNoZXIy MjY0ODMw