Sexual offenders with learning disabilities: risk,recidivism and treatment

Abstract

While the literature on the assessment, treatment and management of non-learning disabled sexual offenders is well established, it is only in recent years that researchers and clinicians have focused on sexual offenders with learning disabilities. In contrast to mainstream sex offender treatment programmes, there are few evaluated community-based treatment programmes for sexual offenders with learning disabilities, and of the small number of published studies that describe treatment programmes, most are based on small samples and few have been validated empirically. Sexual offenders with learning disabilities differ from their non-disabled counterparts in several important ways, having implications for management and treatment. Due to methodological differences between studies, the prevalence of sexual offending by men with learning disabilities is not clear. However, in some studies, the sexual recidivism rate of offenders with learning disabilities is 6.8 times and 3.5 times that of non-disabled sexual offenders at 2- and 4-years’ follow-up, respectively. Sexual offenders with learning disabilities are also at greater risk of re-offending in a shorter time period. There remains an urgent need for further research into the assessment of risk and whether components from mainstream treatment programmes can be adapted to meet the needs of learning disabled sexual offenders. Approaches to working with sexual offenders with learning disabilities and programme development are discussed.     

Predicting dropout from a residential programme for adolescent sexual abusers using pre-treatment variables and implications for recidivism

Abstract

This study addresses the prediction that dropout from a UK specialized residential treatment program for adolescent sexual abusers can be determined from pre-treatment variables. Participants were 49 adolescents aged 12–16?years, who had sexually abused children, peers/adults or both. Of the variables examined, 25 showed a significant association with treatment dropout. A scale, consisting of 20 items, was designed to predict treatment dropout. As a measure it showed internal consistency (alpha?=?0.84) and predictive validity. Treatment dropout was linked to a greater risk of recidivism: offences of a general; violent; and combined violent or sexual nature. Missing data confounded the overall small sample size; therefore, a brief checklist of factors associated with dropout was produced as a guide for treatment managers and clinicians.     

What has worked and what has not with Minnesota sex offenders: a review of the evidence

Abstract

Since the early 1990s, many states in the USA have attempted to control sexual offending and, more narrowly, sexual recidivism by implementing longer prison sentences for sex crimes, sex offender registration and notification, residency restrictions, involuntary civil commitment and lifetime probation and parole. The early 1990s also marked the beginning of a decline in official rates of sexual offending, including sexual recidivism. This study reviews recent research conducted on Minnesota sex offenders in an effort to identify which policies, programmes and practices might have contributed to the drop in sexual recidivism rates that have been observed over the last few decades. By assessing what has, and has not, worked with Minnesota sex offenders, this study discusses how lessons learned from the Minnesota experience may apply to broader efforts within the USA and abroad to control sexual offending.     

The process of change in offender rehabilitation programmes

Abstract

Whilst the overall effectiveness of offender rehabilitation programmes in reducing recidivism is now well established, there has been less discussion of the reasons why rehabilitation programmes may be unsuccessful for some offenders. In this paper we suggest that models of change developed in counselling and psychotherapy may have utility in explaining how offender rehabilitation programmes bring about change, and argue that the dominance of cognitive–behavioural treatments in the rehabilitation field means that those offenders who have particularly low levels of problem awareness may be at increased risk of treatment failure. Understanding more about the mechanisms by which programmes help offenders to desist from offending is likely to lead to the development of more responsive and, ultimately, more effective programmes. Some suggestions for those involved in the delivery of offender rehabilitation programmes include: being mindful of the sequence of components of programmes, the development of preparation (or readiness) programmes and offering a broad suite of programmes to cater for different stages of problem awareness and assimilation among offenders.     

The impact of pre-treatment responsivity and treatment participation on violent recidivism in a violent offender sample

This study assessed whether pre-treatment responsivity (psychopathy, motivation to attend treatment, denial and minimisation of offending behaviour, and feelings of guilt or shame) predicted violent recidivism and/or moderated the effectiveness of a violence intervention programme. Participants were 114 male violent offenders who were referred to a structured violent offender group treatment programme; 84 offenders commenced the programme. Results showed that treatment completion did not have a significant main effect on recidivism but that psychopathy scores moderated the effects of treatment. Offenders with high scores on the Psychopathy Checklist: Screening Version (PCL:SV) who were rated as having good engagement with treatment, or who completed treatment, had similar violent recidivism rates compared to offenders with low PCL:SV scores. In contrast, offenders with high PCL:SV scores who dropped out of treatment or were poorly engaged had significantly higher rates of violent recidivism. These findings indicate that treatment effectiveness could be enhanced, and greater reductions in recidivism achieved, if programmes find ways to engage and maintain psychopathic offenders in treatment.     

Effectiveness of sex offender treatment for psychopathic sexual offenders

Meta-analyses have suggested that sexual offender treatment (SOT) completion is associated with lowered sexual recidivism rates for convicted sexual offenders. The paucity of properly designed studies allows for the alternative explanation of less recidivism among treated samples as reflecting that lower risk offenders disproportionately self-select into treatment. A test of the "self-selection explanation" can occur by investigating treatment effect on known high-risk offenders. Psychopathy correlates with increased sexual recidivism risk, such that an exploration of the SOT effect on psychopathic offenders could clarify the accuracy of the self-selection hypothesis. Additionally, the debated degree to which psychopaths are treatable might obtain clarification by a research review. This article examines empirical findings concerning the effectiveness of SOT for psychopathic sexual offenders. Ten studies were found to meet the minimal quality standards used, stemming from only four data sources. Shortcomings of existing research precluded clear conclusions, though trends in the data are delineated.     

Understanding dynamic risk factors for violence

ABSTRACT

Recent years have seen a consensus emerge regarding the dynamic risk factors that are associated with future violence. These risk factors are now routinely assessed in structured violence risk assessment instruments. They provide a focus for treatment in structured group programmes. However, relatively little attention has been paid to risk-related theoretical issues, whether these dynamic risk factors are causally related or simply correlates of violent offending, or the extent to which they change as a consequence of treatment. More challenging is the lack of evidence to suggest that changes in these dynamic risk factors actually result in reductions in violent offending. In this paper we consider the meaning of the term dynamic risk, arguing that only those factors that, when changed, reduce the likelihood of violent recidivism, can be considered to be truly dynamic. We conclude that few of the violence risk factors commonly regarded as dynamic fulfil this requirement. There is a need to think more critically about assessment findings and treatment recommendations relating to dynamic risk, and conduct research that establishes, rather than assumes, that certain dynamic risk factors are directly related to violence. Some suggestions for advancing knowledge and practice are provided.     

Managing correctional treatment for reduced recidivism: A meta‐analytic review of programme integrity

Purpose. Although issues surrounding programme integrity and implementation seem intuitively appealing as important contributors to effective correctional programming, they have been relatively ignored within the extant literature. The present meta‐analysis provided the first systematic examination of these issues by exploring their impact on recidivism reduction in correctional treatment programmes. Methods. A meta‐analysis was conducted on 273 tests of the effectiveness of correctional treatment programmes that were extracted from various human service programmes. Indicators of programme integrity reviewed included several management variables (i.e. selection, training and clinical supervision of service deliverers), evaluator involvement, presence of training manuals, monitoring of treatment delivery, and using a small sample of clients. Results. Overall, the meta‐analyses revealed that programme integrity provided an independent source of enhanced programme effectiveness, even when controls were introduced for other variables (e.g. involved evaluator and sample size). Conclusions. Consistent with previous research, the present study demonstrated that the positive contributions of programme integrity were limited to the enhancement of the effects of human service programmes consistent with the principles of risk, need, and general responsivity. However, the relatively poor reporting of programme integrity indicators within primary studies necessitates that evaluators and programme deliverers alike ensure that this information is included in future evaluations to provide an even greater understanding of the influences of integrity.     

Every session counts: The differential impact of previous programmes and current programme dosage on offender recidivism

Purpose. The present study examined the impact of current treatment dosage on recidivism among offenders. Methods. Using a sample of dropouts from a community treatment programme, current treatment dosage and past completed programmes were used to predict criminal recidivism. Results. After statistically controlling for risk levels, only current dosage was predictive of recidivism. Conclusions. Offenders’ current direction, indicated by current dosage, is central to reducing recidivism. Strategies for offenders completing treatment sessions are discussed.     

How should we understand the effect of age on sexual recidivism?

Abstract

Research into the effect of age on sexual recidivism risk is a relatively new and developing area of interest and is likely to be of great interest for forensic practitioners responsible for the community supervision of sexual offenders. Meta-analytical and follow-up reconviction studies indicate an inverse relationship between age and sexual recidivism risk, where younger sex offenders pose a greater risk of reconviction than older sex offenders. This finding has led to the development of actuarial risk scales which identify younger sex offenders (<25 years) as posing the greatest risk. However, recent research studies have reported contradictory results to this assumption and found a non-linear relationship between age and sexual recidivism risk. Only a small number of studies have investigated the effect of age on sexual recidivism by comparing age bands and rates of sexual recidivism. Researchers have also considered the effect of age on actuarial risk, which risk factors are associated with which age bands and sexual recidivism rates between sex offender subgroups. The purpose of this paper is to integrate this research and to link commonalities between these studies. This paper organizes the effect of age on sexual recidivism into five categories: (i) the effect of age and actuarial risk; (ii) the effect of age on sexual arousal; (iii) the effect of age-at-release on sexual recidivism risk; (iv) the effect of age-at-first-offence on sexual recidivism risk; and (v) the effect of age on child molesters and rapists on sexual recidivism risk. Important differences were found between age bands of sexual offenders in terms of sexual recidivism risk and actuarial risk factors as well as differences between rapists and child molesters. The relative importance of factoring age when assessing risk in sex offenders is discussed.     

A review of dynamic variables and their relationship to risk prediction in sex offenders

In recent years, a good deal of attention has been paid to the question of recidivism in sex offenders, with an emphasis on the pool of identified static variables associated with risk. The paper aims to review the developing evidence-base for dynamic (changeable) variables, describing their clinical and research characteristics. It also considers the relationship between dynamic domains and apparently fixed developmental variables, such as attachment and victimization experiences. Three main models are presented, and examined in terms of their ability to enhance static prediction models. Results would suggest that there are four dynamic domains, which can predict sexual recidivism independently of static risk prediction, and that these domains should be of central consideration in the continuing development of treatment programmes.     

Intensive psychological treatment of high-risk violent offenders: Outcomes and pre-release mechanisms

Research on correlates of intervention programmes that reduce expected reconviction rates (‘what works’ literature, Risk–Need–Responsivity model) has been highly influential in criminal justice systems throughout much of the western world. But while this psychological research has been acquiring widespread recognition, a deeper understanding of how programmes work and of mechanisms for desistance more generally, has still to develop. This research reports results of a quasi-experimental recidivism outcome study for a series of prison units that provide intensive psychological treatment to high-risk, persistently violent prisoners. Four outcomes were examined over the first 12 months following release on parole: parole violations, new convictions, new convictions for violence, and imprisonment sentences resulting from new convictions. Alongside these results, we conducted preliminary analyses of two potential pre-release mechanisms for surviving the first 12 months on parole without reconviction: lower dynamic risk for violence, and greater release readiness. We found that dynamic violence risk fully accounted for differences between treatment completers and comparison prisoners in proportions reconvicted for violence. However, in all other cases, the proposed mechanisms did not significantly explain treatment-related differences. We close by considering possible explanations for these unexpected results, and reiterating the importance to our field of more sophisticated treatment outcome research.     

Rehabilitating serious violent adult offenders: an empirical and theoretical stocktake

Extensive meta-analyses of the correctional programme evaluation literature have generated developments in the technology of programme design. However, the risk, need and responsivity principles do not constitute a rehabilitation theory and cannot answer specialist offender programme design questions. After more than a decade of involvement in programmes for seriously violent offenders, we decided to reassess the empirical evidence underpinning violence rehabilitation in adult men. We focused on both mixed and violent offender samples, reviewing the outcome data from nine evaluations of cognitive–behavioural interventions. Despite a plethora of methodological difficulties, it appears that most of the programmes had small to large effects on violent and non-violent recidivism. Little could be concluded from these evaluations about the most promising theoretical framework for future programme development. Most programmes contained only scant information on their underlying theory base. None referred to multivariate aggression or crime theories. We conclude that there is a pressing need for additional evaluative research, and theory development. To date, the case for specialist violent offending programmes has not been made.     

New Zealand's special treatment units: the development and implementation of intensive treatment for high-risk male prisoners

In the late 1980s, New Zealand developed two highly innovative residential treatment programmes for serious offenders that blended together the strengths of structured cognitive behavioural group programmes and therapeutic community approaches. Since the mid-1990s this hybrid model – recently advocated as a fruitful direction for future offender programme development – was adopted and further refined for use in New Zealand's four high-risk special treatment units (HRSTUs). We outline the HRSTU model, noting the challenges and potential benefits of providing an intervention that integrates therapy, resocialisation and reintegration experiences for high-risk, high need, low responsivity clients: many with significant psychopathic features. On average, the majority of those referred to HRSTUs complete the programme and make small but significant amounts of change on important treatment goals. But most changes remain tentative, suggesting the importance of more supportive aftercare. Although an earlier evaluation of the first unit to open found the programme to be modestly effective in reducing recidivism, an outcome evaluation currently underway will help establish whether improvements since that time are associated with reductions in disciplinary infractions and recidivism.     

Responding to youth sexual offending: a field-based practice model that “closes the gap” on sexual recidivism among Indigenous and non-Indigenous males

Abstract

Most studies that have explored the impact of youth sexual offender treatment on recidivism have not assessed whether effectiveness varies for important subgroups. The present study evaluated the impact of treatment provided by the Griffith Youth Forensic Service (GYFS) on 104 adjudicated youth sexual offenders referred between 2006 and 2012. Sexual, violent and “other” offending outcomes were examined, based on Australian Indigenous cultural heritage and whether the youth resided in a remote community, over an average 2.5-year follow-up timeframe. The findings indicated that GYFS treatment was equally effective for Indigenous and non-Indigenous youth for preventing sexual recidivism and, for youth residing in remote and non-remote locations, for preventing sexual, violent and “other” recidivism. Treatment was less effective in preventing violent and “other” recidivism for Indigenous youth. The core components of the GYFS treatment programme therefore appear particularly well suited for reducing sexual recidivism by Indigenous offenders and those residing in remote communities.     

Race and Demographic Factors in Treatment Attendance for Domestically Abusive Men

This study examined the influence of race and other demographic characteristics on session attendance and dropout from a cognitive-behavioral treatment program for male domestic abusers (N = 101). Multiple regression analyses revealed that lower session attendance was significantly predicted by unemployed status and African American (versus Caucasian) race. Other demographic factors could not account for the race differences in session attendance. Race was the strongest predictor of dropout and session attendance in all analyses. Racial composition of treatment groups was not significantly related to number of sessions attended for Caucasian or African American clients. Although the combined (interactive) effect of race and referral source on number of sessions was not statistically significant, the pattern of means suggested that self-referred African Americans were at the greatest risk for dropout. Results suggest that race differences in dropout, and the mechanisms that account for these differences, deserve more clinical and research attention in treatment for domestic abusers.     

LEVELS AND PREDICTORS OF RECIDIVISM: THE MALTA EXPERIENCE*

Research on recidivism has been confined primarily to a few highly industrialized Western nations (e.g., United States, Great Britain, Canada, and Australia) in which the data and resources needed for such research are readily available. The restriction of recidivism research to such a small number of nations begs the question: Do these results reflect patterns of offending and products of the criminal justice systems unique to these nations, or do they describe patterns of recidivism across a much wider range of social and cultural contexts? In this study I extend the scope of recidivism research by examining levels and patterns of recidivism in the Republic of Malta, a small Mediterranean island that differs considerably from the typical context in which recidivism is studied. Specifically, I examine the likelihood of recidivism among persons released from Malta's only prison between 1976 and 1994. In addition, I examine factors shown in previous research to be strong predictors of recidivism to assess their value as predictors of recidivism among Maltese prisoners. Proportional hazards regression models reveal that levels and predictors of recidivism in Malta approximate those observed in societies that are socially and culturally quite different. The findings suggest that the role of social institutions in reintegrating offenders into society may be more complex than commonly believed.     

The impact of judge–defendant communication on mental health court outcomes

Previous research has shown that mental health courts have been successful in reducing the rates of recidivism among mentally ill offenders. However, none of these studies, to date, have examined exactly what aspects of the courts reduce these rates of recidivism and what makes them successful. The current study utilized a sample of 291 mentally ill criminal offenders participating in a mental health court to examine whether those participants who were addressed by and communicated with the judge had a reduction in recidivism rates and the severity of new charges in comparison to those who did not. The hypotheses regarding greater judge–defendant communication and recidivism were not supported. This suggests that communication in and of itself is not sufficient to reduce recidivism. Future research of a qualitative nature is essential to identify if the frequency, tone, and valence of the communication results in improved outcomes. In addition, these results may indicate a necessity for more stringent training and guidelines for the maintenance of Mental Health Courts. Results of the current study suggested differences between genders, such that females were spoken to by the judge more frequently than were men.     

Intensive supervision programs: Does program philosophy and the principles of effective intervention matter?

Although traditional intensive supervision programs that have aimed at increasing control and surveillance in the community have not been shown to reduce recidivism, prior research indicates that intensive supervision programs that are based on a human service philosophy and provide treatment to offenders offer more promise. The current research examined the effectiveness of fifty-eight intensive supervision programs and sought to determine whether program philosophy and treatment integrity are associated with reductions in recidivism. The results indicated that both program philosophy and treatment integrity vary independently of one another and are related to the ability of programs to produce meaningful effects on recidivism.     

Experiences of engaging in psychotherapeutic interventions for sexual offending behaviours: A meta-synthesis

Abstract

This meta-synthesis explores individuals' experiences of engaging in psychotherapeutic interventions for sexual offending. The findings of ten qualitative studies were integrated and five over-arching concepts emerged: (1) incentives and inhibitions: to engage or not to engage?; (2) help or hindrance: the impact of others in therapy; (3) the abused and the abuser: perspectives for transformation; (4) struggling and striving: dealing with distress and difficulties and (5) what works: inside and outside. A line of argument derived from these concepts is proposed as a framework for understanding sex offenders' experiences of therapy and highlights aspects of treatment programmes that need further exploration or emphasis. Using qualitative accounts can improve the responsiveness of treatment programmes, but such research is currently limited. Future qualitative studies and reviews could help further improve the effectiveness of treatment programmes, and thereby reduce the rate of sexual reoffending.