Sex Offender Treatment Program Research Articles

Legal Perspectives on the Rehabilitation of Sex Offenders: Efficacy, Ethical Considerations, and the Pursuit of Recidivism Reduction

This dissertation critically examines the efficacy of group-based therapeutic interventions for sex offenders within correctional facilities, aiming to enhance rehabilitation and reduce recidivism. Despite contemporary treatment paradigms demonstrating some effectiveness, as indicated by lower recidivism rates among treated offenders, the success of these programs is not uniform, prompting a need for reevaluation. Treatment challenges include infrastructural limitations, the need for individualized approaches due to offenders' diverse psychosocial profiles, and the complexity of achieving group cohesion. Furthermore, high dropout rates and short assessment periods undermine the establishment of evidence-based practices. The dissertation advocates for a stratified approach to therapy, recognizing individual psychological profiles and tailoring treatment accordingly. It calls for advancements in cognitive-behavioral therapy (CBT) methodologies within Sex Offender Treatment Programs (SOTPs), considering ethical dimensions of interventions such as chemical castration, and employing Multisystemic Therapy (MST) with biometric monitoring to better assess and manage recidivism risks. This synthesis of academic literature and analysis of programmatic limitations highlights the necessity of refining sex offender rehabilitation to ensure public safety effectively.

Best practice in sexual offender rehabilitation and reintegration programs

PurposeThis paper aims to report on the results of a global search to identify the characteristics of successful sexual offender treatment programs, with a view to providing guidance for program development.Design/methodology/approachA keyword search was conducted of criminology and social science databases. Successful programs were selected on evaluations that used standard scientific designs.FindingsThis study identified 18 evaluations of 16 programs showing significant reductions in reconvictions. Most programs used cognitive behavioural therapy (CBT), with both group and individual sessions; and many evidenced multisystemic therapy (MST) approaches involving families and/or local communities. CBT-based approaches were also common in the 20 unsuccessful programs identified in the study, although fewer MST-oriented features were in evidence. Noncustodial settings, and combined custodial-noncustodial settings, were also more prominent in the successful programs.Research limitations/implicationsThere is a shortage of studies focused on the specific components of successful treatment programs for sexual offenders, including for subsets of offenders, such as ethnic minority groups and women.Practical implicationsThe findings demonstrate the need for more investment in treatment programs with strict evaluation processes. New and modified programs are likely to benefit from the application of CBT, MST and a community-based reintegration component. More research is needed on effective elements of sexual offender treatment programs.Originality/valueTo the best of the authors’ knowledge, this appears to be the first study that examines features of successful sexual offender treatment programs, compared to unsuccessful programs, using a case-study approach. The findings reinforce the known value of CBT and systemic approaches as core features of programs but raise important questions about what other components are key to activating success.

Community-Based Treatment for Individuals Convicted of Sexual Offenses Using the Integrated Risk Assessment and Treatment System Model Versus Standard Correctional Programming

The present investigation examined a group of 90 clients receiving treatment for issues related to sexual offending in The Central District (Ontario) Sex Offender Treatment Program operated by Correctional Service Canada (CSC). Treatment was provided in line with the Integrated Risk Assessment and Treatment System (IRATS) Model developed by the authors. A group of 55 individuals who had not received sexual offense–specific treatment but who received standard correctional programming offered by paraprofessionals were used as a basis of comparison. Risk assessment data were available for all clients included in the analyses. Results indicated that there were no differences between groups on the RRASOR (an actuarial instrument designed to assess risk of sexual offense recidivism) with reference to sexual offender recidivism risk. With reference to sexual offense recidivism, only one of the treated clients recidivated sexually over 8.17 years of follow-up versus four of the 55 comparison group who were followed for a significantly shorter period of time (i.e., 6.9 years).

Evaluation of an inpatient sex offender treatment programme for men with intellectual disabilities

Purpose The purpose of this paper is to report on an inpatient cognitive behavioural sex offender treatment group programme developed and provided to people with intellectual disabilities detained in medium and low security hospital settings. The programme was delivered five times between 2012 and 2020. This paper describes the integration of the programme within a wider treatment pathway model and provides analysis of outcome data. Design/methodology/approach The programme was evaluated over five group programmes using self-report psychometric measures related to treatment targets in the reduction of sexual offending risk, including cognitive distortions, sexual attitudes and knowledge and locus of control; recidivism data spanning up to 7 years post discharge is also provided. The treatment pathway and a description of the programme are provided. Findings The results of this paper showed improvements in sexual knowledge, cognitive distortions and locus of control, however not to a statistically significant degree. No recidivism was observed in the follow-up period. Originality/value This paper adds to the evidence base of interventions focused on cognitive behavioural approaches to the treatment and risk reduction of sexual offending in men with intellectual disabilities and adds to the debate regarding the effectiveness of such programmes with offenders with intellectual disabilities.

Treatment program for ex-jailed sex offenders in Uruguay: from knowledge to policy.

In this article, we discuss the process of implementing a pilot program of the treatment of sex offenders in Uruguay. We implemented an intervention-research based on the case study method delimited in terms of institutional and thematic scenarios; a national public institution whose main objective is the socio-labor and community inclusion of formerly incarcerated people. The data collection took place between February and October 2018, through group interviews with the technical team of the program and semi-structured interviews with the directorate. We present the analyzed theoretical and technical dimensions involved in the implementation of a community-based program for sexual offenders, according to two analytical lines: the specificity of the approach towards sexual offenders and the conceptions of the key institutional actors surrounding sexual violence.

Challenges and Solutions to Implementing a Community-Based Wellness Program for Non-Offending Minor Attracted Persons

ABSTRACT Child sexual abuse is a significant public health concern that has long-lasting consequences for victims and their families and poses a significant financial cost to the public. Prevention efforts, including sex offender treatment programs, are intended to prevent further instances of sexual abuse. Most sexual offenses, however, are committed by individuals who are not yet known as sexual offenders, and therefore traditional sex offender treatment programs fall short of this goal. It is crucial to provide services to people who may be at risk for committing a sexual offense and those who have not offended, including those individuals who are attracted to children. While primary prevention programs such as Prevention Project Dunkelfeld and Talking for Change have begun to address this issue internationally, there are significant barriers to providing preventive services of this nature to non-offending minor attracted persons (NOMAPs) in the United States. Barriers include concerns about mandated reporting laws, stigmatization, and lack of knowledge by therapists about MAPs. This paper explores these barriers and provides solutions for practitioners to offer services to this population. This paper includes the development of specific programming for non-offenders and specialized training for clinicians who work with non-offenders as used by The Global Prevention Project.

Beyond ‘what works’: implementing sex offender treatment programs in the ‘real world’

Extending the ‘what works’ tradition in correctional research, realist evaluation approaches champion the need to understand the nuances of program implementation and effectiveness, asking “what works, for whom, in what circumstances, in what respects, and how?”. This highlights the importance of understanding how programs work in ‘real world’ settings, and not simply whether or not they produce a positive outcome overall. Informed by this approach, the current study employed focus groups and interviews with corrective services programs staff in Australia, to explore factors that impact program success and key program implementation considerations. Findings reveal system-, program-, and individual- level factors that appear to impact program success, largely by constraining program delivery. Identified implementation considerations included program design and delivery, and staffing and resources. By examining the nuances of program delivery, this study provides a better understanding of the ‘real-world’ operation of custodial sex offender treatment programs, and adds important context to reported outcome studies.

Effectiveness of sexual offender treatment and reintegration programs: Does program composition and sequencing matter?

Using administrative data obtained from Queensland Corrective Services, we investigated the composition and sequencing of sex offender treatment and reintegration programs on recidivism outcomes. Outcomes were compared over an average of 4.8 years (SD = 29.20 months; range = 15 days to 9.25 years) on 2,407 adult males convicted of sexual offences and discharged from custody between 2010 and 2017. Controlling for risk, age, treatment location, and cultural heritage, those who completed a combination of preparatory programs, rehabilitation and reintegration programs were less likely to reoffend and had significantly better survival rates when they did reoffend, compared to those who did not complete—or partially completed—programs. However, reintegration programs, regardless of involvement with other correctional programming, also demonstrated success in reducing short-term recidivism. Combined, these findings indicate that the composition and sequencing of correctional programming likely plays an important role in enhancing outcomes and that engagement in reintegration programs post-incarceration may be pivotal to improving the outcomes for men convicted of sexual offences. Such sequencing, and program composition, warrants further investigation.

The contribution of psychopathic traits and substance use in the prediction of recidivism of sexual offenders

Substance use and dependence may play an essential role in the risk of reoffending by sex offenders. Research examining the influence of substance use and dependence on the criminal behaviour of psychopathic sex offenders is limited. Alcohol and drug use have been identified as factors which promote criminal behaviour and are suspected to contribute, at least partially, to the probability of reoffending. For instance, previous research showed that elevated scores on the Michigan Alcohol Screening Test (MAST) contribute to the predictability of the Hare Psychopathy Checklist – Revised (PCL-R) on recidivism. The current study retrospectively evaluated a database of incarcerated high-risk offenders registered in the Regional Treatment Center, Sex Offender Treatment Program (RTCSOTP); in order to assess the contribution of self-disclosed histories of alcohol and substance use and dependency have, in concert with measures of psychopathic characteristics, on the predictability of recidivism. Results of the retrospective data identified PCL-R and DAST (Drug Abuse Screening Test) scores as significant predictors of sexual and violent recidivism of male inmates undergoing treatment in RTCSOTP within 5 years of their release. MAST scores, however, did not significantly contribute to the predictability of sexual and violent recidivism in this population. We conclude, drug use should be considered as an important factor when addressing recidivism in sexual offenders who demonstrate psychopathic characteristics.

A Pilot Study of the Swedish Sexual Offender Treatment Program

Purpose: The aim was to test whether dynamic criminogenic risk factors change after participation in a new cognitive-behavioral treatment program adhering to the Risk-Need-Responsivity (RNR) model, within a group of adult men convicted of a sexual offense in Sweden. Methods: Three psychometric tests from approximately 26 participants were completed. Therapists rated 46 participants using the Therapist Rating Scale-2 (TRS-2). Results: Participants reported a significant decrease in hypersexuality, small to medium effect size, a non-significant, increased, internal locus of control, but no change regarding attachment styles, posttreatment. Therapists rated significant decrease in all treatment needs posttreatment, medium to large effect size. Conclusions: The significant reduction of several criminogenic risk factors posttreatment indicates the treatment program may reduce problems related to increased risk of recidivism, especially hypersexuality. Moreover, treatment did not appear to have negative effects, motivating further implementation. However, to evaluate the effectiveness, more research is necessary.

“They’re the hardest group to treat, that changes the least”. Adapted sex offender treatment programmes for individuals with Autism Spectrum Disorders: Clinician views and experiences

AimsClinicians working with individuals with autism spectrum disorders (ASD) who display sexual offending behaviours may face challenges during treatment, as a result of the cognitive and behavioural profile associated with ASD. This research explored the views and experiences of those running adapted sex offender treatment groups with men with ASD. MethodSemi-structured interviews with group facilitators (n = 12) focused on service user engagement and response to the core components of the treatment programme (e.g. increasing victim empathy, addressing cognitive distortions, etc.), and gathered the experiences of those working with men with ASD who display sexual offending behaviours. ResultsGrounded Theory was used to develop a model conceptualising the potential impact of ASD on treatment outcomes, and this emerged predominantly through clinician’s views of risk of re-offending. Benefits of attending a group included: the presence of other group members, a forum to develop pro-social roles and relationships, and increased opportunity for monitoring. Challenges regarding empathy, specifically emotional empathy, and shifts in cognitive distortions were felt particularly pertinent to those with ASD, as well as questions over internalisation of therapy. ConclusionDespite identification of a number of challenges, adapted sex offender treatment programmes were considered beneficial for men with ASD, especially in light of a dearth of evidenced-based alternatives.

Interrater reliability, concurrent validity, and predictive validity of the risk for sexual violence protocol.

This study empirically evaluated risk judgments made using the Risk for Sexual Violence Protocol (RSVP; Hart et al., 2003), a widely used set of structured professional guidelines for assessing and managing sexual violence risk. Based on evaluations of other structured professional judgment guidelines, we hypothesized that judgments made using the RSVP would demonstrate good interrater reliability, concurrent validity, and predictive validity. Based on file review, research assistants made ratings using the RSVP and two commonly used actuarial tools for sexual violence risk assessment in a sample of 100 adult male sexual offenders who successfully completed a community-based sex offender treatment program. Recidivism information was obtained from official records 10 years after treatment completion. With respect to interrater reliability, judgments of the presence and relevance of individual risk factors ranged from moderate to almost perfect, and those for composite scores reflecting the sum of these ratings were almost perfect. Interrater reliability for integrative summary risk ratings was substantial to almost perfect. Regarding concurrent validity, the findings indicated that judgments made using the RSVP had moderate to large and statistically significant correlations with scores on the actuarial tools. Finally, with respect to predictive validity, RSVP presence total scores and summary risk ratings were predictive of new sexual violence over the follow-up, and the magnitude of their predictive validity effect sizes was similar to that of scores on the actuarial tools. The findings supported the potential utility of the RSVP in practice. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Academic oversight in policy research: questions arising from the Sex Offender Treatment Programme study

Academic oversight in policy research: questions arising from the Sex Offender Treatment Programme study

Learning from research: Adapting interventions for sexual offending to improve outcomes.

Sexual behaviour towards another person who does not or cannot consent to it causes serious harm to its victims. Understandable tendencies towards isolating or shaming the offenders, however, may actually increase risks of recidivism and further such harms. The study aims to consider evidence for the effectiveness of interventions for sex offenders, mainly in a U.K. context, across four areas: criminal justice system programmes, medication, interventions for sex offenders with personality disorder and a community-based model for the reintegration-Circles of Support and Accountability, and identify key evidence gaps. We searched for reviews in the following four strands of work-psychosocial programmes, medication, personality focused therapies, and Circles of Support and Accountability-and identified gaps in knowledge. Randomised controlled trials in this field are rare but have been achieved. Findings from more naturalistic outcome studies of sex offender treatment programmes are disappointing, but recidivism rates among released sex offender prisoners are low, regardless. Medication relying on substantial physiological change raises substantial ethical concerns. Not all sex offenders have a mental disorder but up to half have been diagnosed with a personality disorder, which may need specific treatment. Evidence is growing that lay work such as Circles of Support and Accountability is a valuable adjunct to other interventions. In this field, where tensions between attributions swing between "madness" and "badness," there is growing evidence for optimism that complexity of history and presentation can be met through cooperation between the many disciplines, integrative strategies, and wider community engagement. The need now is for large, prospective controlled trials of interventions, with long periods of follow-up. Perhaps, the most exciting developments have come from the wider public. More research into the qualities of these volunteers might inform public education and health strategies supporting wider safety.

"I feel that if I didn't come to it anymore, maybe I would go back to my old ways and I don't want that to happen": Adapted sex offender treatment programmes: Views of service users with autism spectrum disorders.

The cognitive and behavioural profile associated with autism spectrum disorders (ASD) includes difficulties with social interaction, communication and empathy. Each of these may present barriers to effective participation in sexual offending treatment, leading to poorer outcomes. Semi-structured interviews were conducted with 13 men with autism and an intellectual disability (including the borderline range) who had completed an adapted sex offender treatment programme. Grounded Theory was used to explore the men's experiences of treatment and perceptions of risk. The men's perceptions of sexual risk were inextricably linked to constructs of identity and shaped their opinions of treatment effectiveness. Risk of reoffending was conveyed through narratives of changes in self and circumstances and included notions of blame and culpability. The findings illustrated some clear benefits for men with ASD associated with attending adapted sex offender treatment programmes, including delivery of treatment within groups and opportunities for social development. The study supports the view that difficulties with empathy and cognitive flexibility complicates treatment for sexual offending.

State of the Art Treatment Options for Actual and Potential Sexual Offenders and New Prevention Strategies.

Sexual violence is a significant and devastating issue for men and women throughout the world. Its consequences are not only disastrous for victims of sexual violence but are also extremely costly (estimated cost of $41,000 per rape) for society. Successful treatment of sexual offenders is therefore an important goal for society as well as for victims and offenders themselves. Over the years, multiple treatment approaches for sex offenders have been developed. Treatment programs range from the risk-need-responsivity (RNR) model, which focuses on providing tailored treatment for high-risk and low-risk offenders, to psychodynamic models. This article presents an overview for clinicians of state-of-the-art offender treatment, describing the most common treatment approaches, in particular the RNR model, cognitive-behavioral programs (relapse prevention programs, sexual offender treatment programs), psychodynamic approaches (transference-focused psychotherapy, mentalization-based therapy), the Good Lives Model, as well as pharmacological options. In addition, it provides an evaluation of the various treatment programs. However, given the fact that most acts of sexual violence will never be reported to the police, the question arises if treating convicted perpetrators is enough. Do we need rather-in terms of preventive work-a program for potential sexual offenders and men with delinquent sexual fantasies? Given the prevalence of sexual violence and its impact on victims, society, and the medical community, it would be remiss not to try to reach potential/unconvicted perpetrators. This article offers novel ideas and a project the goal of which is to prevent sexual offenses against women by introducing the "I CAN CHANGE" program from Hannover Medical School.

Young adult sexual offenders with emerging personality disorders: developmental and offence-related characteristics and treatment engagement

ABSTRACTIn the context of the UK Government’s Offender Personality Disorder (OPD) Strategy, large numbers of high-risk young adult sexual offenders with emerging personality disorders are being screened for inclusion onto specialist intervention pathways (the OPD Pathway). However, little is currently known about the clinical and offence-related needs of this population or their impact on treatment engagement. The current study investigated the developmental, personality and offence-related characteristics of 87 incarcerated young adult sexual offenders, comparing those screened in to the pathway and those not screened in. Fifty per cent of the sample were potentially eligible for the OPD pathway. OPD eligible cases were found to have significantly higher rates of parental difficulties, developmental trauma, and childhood behavioural difficulties and to present with significantly higher rates of previous violent and sexual offences, previous allegations of sexual offences, and to have used physical coercion in their offences. The OPD sample was also significantly less likely to have pre-pubescent victims and more likely to refuse treatment, with over 70% failing to engage with the Sex Offender Treatment Programme (SOTP). SOTP non-engagement among OPD cases was most strongly predicted by categorical offence denial. Comparisons are made with the broader adolescent sexual offender literature.

Forio: a Swiss treatment program for young sex offenders with intellectual disabilities

PurposeThe purpose of this paper is to provide a description of a Swiss outpatient group therapy for adolescent and young men with intellectual disabilities who have sexually offended.Design/methodology/approachThe findings from two studies that examined the treatment independently from one another are brought together. These combine the qualitative methods of document analysis of programme tools, overt participant observations of treatment sessions and semi-structured interviews with programme designers.FindingsAt the heart of Forio treatment is a seven-step programme that aims to enable participants to increase their risk management capacities and foster pro-social behaviours. Responsivity issues are a key consideration, and the use of a traffic light system to distinguish acceptable, borderline and unacceptable behaviours provides a central reference point throughout treatment and beyond. Treatment relies on individuals practising newly learned pro-social behaviours in their daily life. To facilitate this, risks are managed, and support is provided via close networking between therapists and the supervision and social care network.Practical implicationsThis paper offers detailed descriptions of the programme setting, structure and tools, which will allow international readers to adapt the techniques discussed to suit their specific treatment context. Particularly, the close networking between treatment providers and those managing risks in the community is commendable.Originality/valueThe Forio programme has not previously been described in English language papers. Even though it arises from the same evidence base as the internationally more widely known programmes, this paper offers unique insights into ways in which known concepts have been adapted to suit local circumstances.

A Long-Term Outcome Assessment of the Effects on Subsequent Reoffense Rates of a Prison-Based CBT/RNR Sex Offender Treatment Program With Strength-Based Elements

This article describes an evaluation of the effects of an early version (1991-2001) of Rockwood's prison-based Cognitive Behavioral Therapy/Risk-Needs-Responsivity (CBT/RNR) sex offender program that had emerging elements of a strength-based approach. This program was implemented under contract to Correctional Service of Canada (CSC) and continued to evolve in response to emerging evidence until it closed in 2013. Thus, the program as evaluated here did not involve a fixed approach as did the comparison CSC program (hereafter referred to as SOTP). Long-term reoffense data, from Rockwood's program (n = 579), were compared with SOTP (n = 625) and with a group of untreated men (n = 107) sentenced for sex offenses. A modified brief actuarial risk scale (BARS-M) was used to control for baseline risk among the three groups, along with additional controls for age at release, victim type, and individual differences in the length of long-term follow-up period. Both treatment groups displayed lower rates of both sexual and violent reoffending when compared with the no-treatment offenders. Overall, the Rockwood program generated the lowest recidivism rates. The results demonstrate that prison-based sex offense-specific treatment can be effective. We discuss the strengths and limitations of the current design through the Collaborative Outcome Data Committee's guidelines.

A Call for Research on Sex Offender Treatment Programs.

The effects of sex offender treatment programs have been addressed in the literature, but there are opportunities to expand research and potentially improve existing sex offender treatment programs. The Federal Bureau of Prison's Sex Offender Treatment Program gives offenders the opportunity to change their behavior by reducing criminality and recidivism, and receive transition services as offenders exit the prison system and reenter society. This program is evidence-based and utilizes landmark research in sex offender treatment, however there are a few details that may present limitations to the effectiveness of the treatment program within the Federal Bureau of Prisons. Entry requirements, such as literacy, cognitive, and remaining sentence requirements, as well as the treatment program environment, present opportunities for research to evaluate the effects of these variables on the convicted sex offender population.