Untreated Offenders Research Articles

A cost–benefit analysis of a treatment program for adult males who have offended sexually

ABSTRACT In this paper, we estimate the financial benefits that can result from effective sexual offender treatment. We base our estimates on both an earlier outcome evaluation of a prison-based sexual offender programme and a report of the costs to the judicial system of reoffending. The outcome study reported significant reductions in re-offence rates compared to a matched group of untreated sexual offenders. We show that these reductions in reoffending not only saved a significant number of people from subsequently being abused by the offenders, it also resulted in very significant savings to the taxpayers to the tune of over $14 million Canadian. While these results are encouraging, additional studies are needed to extend the examination of these potential benefits.

Effectiveness of a risk–need–responsivity‐based treatment program for violent and sexual offenders: Results of a retrospective, quasi‐experimental study

PurposeRelapse prevention is an important goal in correctional settings. Although there is strong evidence for the effectiveness of certain treatment programs for juvenile offenders, those for adults lack such evidence. This study evaluated the effectiveness of a risk–need–responsivity (RNR)‐based intervention.MethodsA quasi‐experimental, observational study design and cox regression analysis were used to compare treated violent and sexual offenders (n = 171) with untreated offenders (n = 241).ResultsBoth groups were observed for an average of 7.9 years. Recidivism rates of treated offenders (11.7%, n = 20) were similar to those of control offenders (15.8%, n = 38; p = .25). When controlling for confounding variables, the hazard of recidivism in the treatment group was 5.2% lower than that in the control group. Subdividing the treatment group resulted in lower hazard ratios for offenders still in therapy when released and offenders cancelling therapy. However, none of the group differences was statistically significant.ConclusionOur results show that control and RNR‐based treatment groups had comparable recidivism rates with a trend towards a positive treatment effect, especially for people in outpatient treatment. However, criminal history, age at the start of follow‐up, and actuarial risk of recidivism were significantly associated with recidivism. Future research needs to apply elaborate methodological approaches to detect robust treatment effects and consider different criteria of treatment effectiveness. Furthermore, the influence of prison climate, motivational factors, intervention quality, and factors supporting the success of outpatient treatment should be considered in future studies of larger offender samples.

Sexual offender treatment for reducing recidivism among convicted sex offenders: a systematic review and meta‐analysis

Sexual offender treatment for reducing recidivism among convicted sex offenders: a systematic review and meta‐analysis

The effects of sexual offender treatment on recidivism: an international meta-analysis of sound quality evaluations

Sound evaluations of sexual offender treatment are essential for an evidence-based crime policy. However, previous reviews substantially varied in their mean effects and were often based on methodologically weak primary studies. Therefore, the present study contains an update of our meta-analysis in the first issue of this journal (Losel and Schmucker Journal of Experimental Criminology, 1, 117–146, 2005). It includes more recent primary research and is restricted to comparisons with equivalent treatment and control groups and official measures of recidivism as outcome criteria. Applying a detailed search procedure which yielded more than 3000 published and unpublished documents, we identified 29 eligible comparisons containing a total of 4,939 treated and 5,448 untreated sexual offenders. The study effects were integrated using a random effects model and further analyzed with regard to treatment, offender, and methodological characteristics to identify moderator variables. All eligible comparisons evaluated psychosocial treatment (mainly cognitive behavioral programs). None of the comparisons evaluating organic treatments fulfilled the eligibility criteria. The mean effect size for sexual recidivism was smaller than in our previous meta-analysis but still statistically significant (OR = 1.41, p < .01). This equates to a difference in recidivism of 3.6 percentage points (10.1 % in treated vs. 13.7 % in untreated offenders) and a relative reduction in recidivism of 26.3 %. The significant overall effect was robust against outliers, but contained much heterogeneity. Methodological quality did not significantly influence effect sizes, but there were only a few randomized designs present. Cognitive-behavioral and multi-systemic treatment as well as studies with small samples, medium- to high-risk offenders, more individualized treatment, and good descriptive validity revealed better effects. In contrast to treatment in the community, treatment in prisons did not reveal a significant mean effect, but there were some prison studies with rather positive outcomes. Although our findings are promising, the evidence basis for sex offender treatment is not yet satisfactory. More randomized trials and high-quality quasi-experiments are needed, particularly outside North America. In addition, there is a clear need of more differentiated process and outcome evaluations that address the questions of what works with whom, in what contexts, under what conditions, with regard to what outcomes, and also why.

Sex Offender Treatment Outcome, Actuarial Risk, and the Aging Sex Offender in Canadian Corrections

The present study is an examination of sex offender treatment outcome in a large national cohort of Canadian Federally incarcerated sex offenders followed up an average of 11.7 years postrelease. A brief actuarial risk scale (BARS), which predicted sexual and violent recidivism, was created for the purposes of the present study to control for risk-related differences between treated and untreated offenders. In total, 732 offenders were identified as having completed (n = 625) or not attended (n = 107) a sex offender treatment program and for whom sufficient information was available to complete the scale. Controlling for risk and individual differences in follow-up time using Cox regression survival analyses and an 8-year fixed follow-up period, treated sex offenders demonstrated significantly lower rates of violent, but not sexual, recidivism. When the treated and untreated groups were stratified by risk level, significant differences were observed only among moderate or high risk offenders. Some significant group differences also emerged on indicators of recidivism severity, with treated offenders demonstrating slower times to sexual reoffense and lower scores on a quantified metric of sexual and violent recidivism severity after controlling for risk. Differences in recidivism base rates between treated and untreated offenders were also larger in magnitude for younger offenders (i.e., under age 50 at release), than for older offenders; however, interactions between age and treatment were not found. The findings are consistent with the risk principle and have possible implications regarding the dynamic nature of sexual violence risk.

P-655 - Cost efficiency of sex-offender treatment programs in switzerland

There is robust empirical evidence for the efficacy of offense-oriented treatment programs. These programs help reducing the rate of recidivism. In the case of sex-offender treatment, a lower rate of recidivism results in lower rate of victims. For the victims, experiencing sexual assaults is a relevant risk factor for the development of a series of mental health disorders. It is thus not surprising that sex-offenses lead to substantial financial costs and preventing sexual re-offending help reducing treatment costs. In Switzerland, a longitudinal study, that started in 2000, allowed to compare the outcome of more than 300 treated violent and sex-offenderswith a control group of untreated offenders. Though the risk for re-offending was estimated to be higher in the treatment group, the rate of recidivism was considerably lower. Using this difference of re-offending among the groups, it could be demonstrated that the treatment program was cost-efficient since the costs of the treatment programs were substantially lower than the expected treatment costs for the victims.

AS37-02 - Cost efficiency of sex offender treatment programmes in Switzerland

There is robust empirical evidence for the efficacy of offense-oriented treatment programs. These programs help reducing the rate of recidivism. In the case of sex-offender treatment, a lower rate of recidivism results in lower rate of victims. For the victims, experiencing sexual assaults is a relevant risk factor for the development of a series of mental health disorders. It is thus not surprising that sex-offenses lead to substantial financial costs and preventing sexual re-offending help reducing treatment costs. In Switzerland, a longitudinal study, that started in 2000, allowed to compare the outcome of more than 300 treated violent and sex-offenderswith a control group of untreated offenders. Though the risk for re-offending was estimated to be higher in the treatment group, the rate of recidivism was considerably lower. Using this difference of re-offending among the groups, it could be demonstrated that the treatment program was cost-efficient since the costs of the treatment programs were substantially lower than the expected treatment costs for the victims.

Tratamiento y cambio terapéutico en agresores sexuales

Este estudio analiza la relación entre participación de los agresores sexuales en un tratamiento y su disposición terapéutica. La perspectiva utilizada para ello es el modelo transteórico de Prochaska y DiClemente, que estructura la disposición al cambio de conducta en cuanto a estadios: precontemplación, contemplación, acción y mantenimiento. La muestra evaluada se dividió en tres grupos: grupo pre-tratamiento, integrado por 67 agresores no tratados; grupo tratamiento, formado por 33 delincuentes sexuales que recibían tratamiento; y grupo seguimiento, compuesto por 19 agresores sexuales que ya habían finalizado el tratamiento. La evaluación de la disposición para el cambio de conducta se realizó mediante la Escala de estadios de Cambios (SOCS). En consonancia con el modelo transteórico, los resultados evidenciaron una relativa correspondencia entre los diferentes momentos del tratamiento y los sucesivos estadios de cambio terapéutico. Se comenta la complejidad de este campo de análisis y las dificultades existentes para obtener resultados nítidos en la asociación tratamiento-cambio terapéutico.

Prison-based chemical dependency treatment in Minnesota: An outcome evaluation

Using a retrospective quasi-experimental design, this study evaluated the effectiveness of prison-based chemical dependency (CD) treatment by examining recidivism outcomes among 1,852 offenders released from Minnesota correctional facilities during 2005. Because recidivism data were collected on the 1,852 offenders through the end of 2008, the average follow-up period was 42 months. To minimize the threat of selection bias, propensity score matching was used to create a comparison group of 926 untreated offenders who were not, for the most part, significantly different from the 926 treated offenders. Results from the Cox regression analyses revealed that participating in prison-based CD treatment significantly reduced the hazard ratio for recidivism by 17–25%. Although dropping out of treatment did not increase the risk of recidivism, completing treatment significantly lowered it by 20–27%. The findings also suggest that long-term treatment programs were not as effective as short- or medium-term programs in reducing the risk of recidivism. The study concludes by discussing the implications of these findings.

A Controlled Evaluation of a Prison-Based Sexual Offender Intervention Program

The effectiveness of a prison-based cognitive behavioral program designed to modify psychological risk factors associated with sexual offending was evaluated. The Irish Prison Service Sexual Offender Intervention Programme, is a manualized 10-month Cognitive Behaviour Therapy [CBT] program involving three 2-hour group sessions per week, which are facilitated by a team of clinical psychologists and probation officers. Improvements in 38 consecutive referrals to the program were compared with the status of 38 untreated offenders who were similar in marital status, age when they left school, occupational status prior to imprisonment, offence type, presence of previous convictions, and current sentence length. All research participants completed the same assessment protocol, which evaluated psychological factors associated with sexual offending at times equivalent to pre- and postintervention. Compared with the untreated control group, program participants showed statistically significant improvement on some but not all self-report measures of cognitive distortions, empathy, interpersonal skills, self-regulation, and relapse prevention. Motivation to change among the untreated control group was not associated with change in psychological functioning in the absence of the assistance of the treatment program. Implications for sexual offender intervention delivery are considered.

Treatment entry barriers among California's Proposition 36 offenders

To explore why some Proposition 36 offenders do not enter drug treatment, we analyzed self-reported and administrative data to compare the characteristics, perceptions, and rearrest rates of 124 untreated and 1,335 treated offenders assessed by 30 sites in five California counties. Offenders were comparable in many domains at assessment; however, untreated offenders were younger, not employed, more criminally severe, and less motivated for treatment. To avoid incarceration was the primary reason for choosing Proposition 36, but there were fewer untreated offenders who felt ready for treatment (12.9% vs. 35.7%) and there were more who accepted the Proposition 36 program only upon recommendation by others (37.9% vs. 11.7%). Reasons for not entering treatment included rearrest (31.6%), no desire for treatment (23.9%), and assignment to a program that was too far away (11.1%). Both groups had fewer total arrests after assessment, but recidivism was higher among untreated offenders. Understanding untreated Proposition 36 offenders can aid efforts to improve treatment entry rates and related outcomes.

Is treatment non-completion associated with increased reconviction over no treatment?

There is accruing evidence that offenders who do not complete treatment are at greater risk of recidivism than those who do complete treatment. Profiles of non-completers show them to be high risk of reoffending compared with completers, and differences in reconviction may be explained by these baseline levels. What is unclear is whether non-completion actually increases the risk of reoffending over no treatment at all. The purpose of this review was to examine the recidivism of non-completers compared with untreated offenders of comparable risk. A systematic search of the literature relating to cognitive–behavioural interventions revealed 16 relevant studies describing 17 samples. The mean effect size (d=−0.16) of differences in reoffending between untreated offenders and treatment non-completers suggests that failing to complete treatment is associated with elevated levels of reoffending, with this effect being more pronounced in community samples (d=−0.23) than institutional samples (d=−0.15). Methodological limitations include poor risk comparability between samples and heterogeneity of non-completers, nevertheless it is possible that treatment non-completion may make some offenders more likely to reoffend.

Cognitive-Behavioral Rehabilitation for High-Risk Violent Offenders

Rehabilitation programs for adult violent offending are still novel, and few published studies examine the recidivism outcomes of those who complete such programs. This study describes a New Zealand prison program for high-risk violent men. The program is intensive and cognitive behavioral. Preliminary outcome data are presented for three indices during 2 or more years of follow-up: nonviolent reconviction, violent reconviction, and subsequent imprisonment. In comparison with untreated offenders, treated men were less likely to be reconvicted of a violent offense, and those who were took longer to fail. There was also a 12% difference in favor of the treated men on the two other indices, nonviolent reconviction and reimprisonment. The authors conclude that the program shows early promise and that further evaluation with a larger sample of treated men will be important in clarifying whether the program is having a differential impact on violent versus nonviolent offending.

The effectiveness of treatment for sexual offenders: A comprehensive meta-analysis

The article reports a meta-analysis on controlled outcome evaluations of sexual offender treatment. From 2,039 documents published in five languages, 69 studies containing 80 independent comparisons between treated and untreated offenders fulfilled stepwise eligibility criteria (total N = 22,181). Despite a wide range of positive and negative effect sizes, the majority confirmed the benefits of treatment. Treated offenders showed 6 percentage points or 37% less sexual recidivism than controls. Effects for violent and general recidivism were in a similar range. Organic treatments (surgical castration and hormonal medication) showed larger effects than psychosocial interventions. However, this difference was partially confounded with methodological and offender variables. Among psychological programs, cognitive–behavioral approaches revealed the most robust effect. Nonbehavioral treatments did not demonstrate a significant impact. There was no outcome difference between randomized and other designs, however, group equivalence was associated with slightly larger effects. Various other moderators had a stronger impact on effect size (e.g., small sample size, quality of outcome reporting, program completion vs. dropout, age homogeneity, outpatient treatment, and authors’ affiliation with the program). More differentiated, high-quality evaluations are needed to clarify: What works for whom under which circumstances?

The targets of violence committed by young offenders with alcohol dependence, marijuana dependence and schizophrenia‐spectrum disorders: findings from a birth cohort

Estimates of who is most at risk from violence by people with mental illness rest mainly on identified patient samples. This study, without such selection bias, examined the targets of violence committed by young adults with as-yet untreated alcohol dependence, marijuana dependence, or schizophrenia-spectrum disorders, to determine the extent to which their victims were co-residents or non-household members. In a total birth cohort of 21-year-olds (n=956), past-year prevalence of alcohol dependence, marijuana dependence and schizophrenia-spectrum disorders were diagnosed using standardized DSM-III-R interviews. None of the people with schizophrenia-spectrum disorder has been hospitalized in the past year. Past-year violence and victim targets were measured using self-reports. Compared with controls, cohort members with substance dependence or schizophrenia-spectrum disorders had higher prevalence and frequency rates of assault against co-residents, against non-household members, and also robbery and gang fights. Out of 39, five individuals with schizophrenia-spectrum disorder committed violent street crimes. Persons with substance dependence had similar proportions of violence against co-resident and non-household members, but persons with schizophrenia-spectrum disorders tended to victimize co-residents more than others. At the age when they are most likely to contribute to the community's violence burden, young untreated offenders with alcohol or marijuana dependence or with schizophrenia-spectrum disorders assault not only co-residents, but others as well, and commit violent street crimes. Families, schoolteachers and primary care physicians have an important potentially preventive role in early identification and treatment of the disorders.

Methodological issues concerning evaluation of treatment for sexual offenders: randomization, treatment dropouts, untreated controls, and within-treatment studies.

The value of randomized controlled trials in evaluation of sexual offender treatment has been questioned. Concern was expressed that randomization fails to produce equivalent samples, without apparent appreciation this is inevitable when variables are distributed by chance; lack of equivalence is controlled by use of tests of significance. A further uncriticized and inappropriate procedure in treatment evaluation is separation of the results of subjects who did not complete treatment from those who did, when the outcome of the former group was known. Despite an APA Task Force recommendation, no attention has been given to the consistent finding that no treatment is less effective than placebo psychological therapies. The significance of Type II errors is discussed and the recommendation criticized that within-treatment research be encouraged as an alternative to outcome research. Demonstrating a within-treatment response when that response is associated with a better outcome does not necessarily mean that the treatment was effective. Subjects with a good prognosis could be more able to demonstrate a within-treatment response to the treatment. Nonrandomized matched samples do not adequately control all sample differences. The post hoc statistical reversal of a reported trend for sexual offenders treated with relapse prevention to show a worse outcome than untreated offenders, in order to correct lack of equivalence of the two groups, is considered inappropriate. That relapse prevention was found less effective than no treatment raises the possibility that it has a negative effect. To continue the use of relapse prevention other than in randomly controlled evaluative studies would appear to be unethical.

Sexual offender treatment efficacy revisited

Several authors have recently addressed current views of sexual offender treatment efficacy. Some maintain that offenders can gain from treatment while others argue that the vast majority cannot. Some researchers say that the field of sexual offender treatment is too new to be able to determine whether or not treatment works. This latter group notes that most studies in this field have not yet reached the point at which meta-analytic techniques can be applied; for this reason no definitive statements can be made about the utility of treatment. The present analysis examines the issues from a slightly different perspective. Data from a large group of studies are combined to identify patterns which can be examined later in more detail. More specifically, 79 sexual offender treatment outcome studies are reviewed, encompassing 10,988 subjects. Recidivism rates for treated versus untreated offenders are investigated according to age of offender, age of victim, offense type, type of treatment, location of treatment, decade of treatment, and length of follow-up. Each study is used as the unit of analysis, and studies are combined according to the number of treated versus untreated subjects who reoffended in each category. Clinical implications are drawn from these results.

Evaluating treatment efficacy with sexual offenders: The insensitivity of recidivism studies to treatment effects

Treatment programs for sexual offenders have been implemented in prison settings with the objective of reducing recidivism among released offenders. Reviews of the literature evaluating the efficacy of treatment have not found convincing evidence that institutional treatment reduces recidivism. However, these reviews have been most concerned with the possibility of a Type I error in hypothesis testing: specifically, that we might reject the null hypothesis when it is true, concluding that recidivism among treated offenders has been reduced compared with that of untreated offenders and concluding that treatment is effective when it is not. The present paper explores the risks of Type II error by examining the sensitivity of recidivism studies to treatment effects and the power of statistical tests of treatment hypotheses in recidivism studies. Using a series of “what if” analyses and power calculations, the sensitivity of statistical hypothesis testing was explored in recidivism studies under a variety ofN's, base rates, and treatment effects. The size of treatment effects required for significance at thep<.05 level at variousN's and base rates was calculated and theN required to obtain significance at thep<.05 level in the “average” recidivism study was estimated. This paper examines the sensitivity of statistical hypothesis testing in three of the most oft-cited recidivism studies of institutional sexual offender treatment. Recidivism studies were found to be quite insensitive to the effects of treatment and these findings are discussed with respect to the likelihood of a Type II error. Alternative methods of assessing sexual offender treatment efficacy are described and recommended.

Evaluating Treatment Efficacy with Searual Offenders: The Insensitivity of Recidivism Studies to Treatment Effects

Treatment programs for sexual offenders have been implemented in prison settings with the objective of reducing recidivism among released offenders. Reviews of the literature evaluating the efficacy of treatment have not found convincing evidence that institutional treatment reduces recidivism. However, these reviews have been most concerned with the possibility of a Type I error in hypothesis testing: specifically, that we might reject the null hypothesis when it is true, concluding that recidivism among treated offenders has been reduced compared with that of untreated offenders and concluding that treatment is effective when it is not. The present paper explores the risks of Type II error by examining the sensitivity of recidivism studies to treatment effects and the power of statistical tests of treatment hypotheses in recidivism studies. Using a series of "what if" analyses and power calculations, the sensitivity of statistical hypothesis testing was explored in recidivism studies under a variety of N's, base rates, and treatment effects. The size of treatment effects required for significance at the p &lt; .05 level at various N's and base rates was calculated and the N required to obtain significance at the p &lt; .05 level in the "average" recidivism study was estimated. This paper examines the sensitivity of statistical hypothesis testing in three of the most oft-cited recidivism studies of institutional sexual offender treatment. Recidivism studies were found to be quite insensitive to the effects of treatment and these findings are discussed with respect to the likelihood of a Type II error. Alternative methods of assessing sexual offender treatment efficacy are described and recommended

The treatment of exhibitionists: A focus on sexual deviance versus cognitive and relationship features

Two studies compared treatment of exhibitionists aimed at either: (1) modifying deviant sexual preferences; or (2) changing cognitions, enhancing relationship and interpersonal skills, and improving awareness of relapse prevention issues. Recidivism rates of these two programs were compared with each other and with the rates observed in untreated offenders. Results supported the focus on broader cognitive and social issues. Clearly exhibitionists can be treated effectively.