The long-term evaluation of a behavioral treatment program for child molesters

PROTOCOL: Risk and protective factors for child sexual abuse and interventions against child sexual abuse: An umbrella review

This is the protocol for a Campbell Collaboration systematic review. Our objective is to conduct an umbrella review to synthesize published and unpublished systematic reviews focused on risk and protective factors for child sexual abuse and effectiveness of interventions against child sexual abuse perpetration and victimization. Specific research questions are: (i) what are the risk and protective factors for child sexual abuse victimization, and what are their relative strength and/or magnitude for predicting child sexual abuse victimization? (ii) what are the risk and protective factors for child sexual abuse perpetration, and what are their relative strength and/or magnitude for predicting child sexual abuse perpetration? (iii) are interventions aimed at reducing and/or preventing child sexual abuse effective? (iv) what are the moderators that increase or decrease effectiveness of the interventions? Efforts to decrease child sexual abuse need to be based on research, but more accessible evidence regarding the breadth of risk and protective factors and effectiveness of interventions to reduce child sexual abuse needs to be provided to policymakers. This will be the first umbrella review that comprehensively synthesizes findings of the previous systematic reviews that focus on risk and protective factors for child sexual abuse and interventions to prevent or reduce child sexual abuse. The results will be able to inform enhanced prevention policy and programs, and regulatory measures for specific contexts of child sexual abuse.

Sex Offender Recidivism: Some Lessons Learned From Over 70 Years of Research

Sex offender recidivism (SOR) has been the subject of research for over 70 years. Myths, misconceptions, and erroneous conclusions about SOR, however, remain widespread, impeding the development of evidence-based policies aimed at preventing sexual offenses. To address the rich but uneven literature, a comprehensive review was conducted making it possible to provide a contextualized overview of scientific knowledge against the backdrop of methodological issues, challenges, and shortcomings. Over the years, researchers have been asked to provide a simple answer to a seemingly simple question: what are the recidivism rates for sexual offending? In response, the field has produced a wide range of findings making it difficult to draw firm conclusions, leaving room for interpretation and personal biases. The variations in recidivism rates are attributable to offender and methodological characteristics, both of which are embedded in a particular sociolegal context. As a result, the base rate of SOR is more effectively considered in terms of a series of questions that should include the type of recidivism, with whom, over what period, and in what context. Issues and debates that have marked the field and fueled its growth are highlighted. Research innovations and important areas of research are also discussed.

Moderators of Sexual Recidivism as Indicator of Treatment Effectiveness in Persons With Sexual Offense Histories: An Updated Meta-analysis

The present meta-analysis is an update of the meta-analysis by Schmucker and Lösel [Campbell Syst. Rev. 2017; 13: 1-75], which synthesized evidence on sexual recidivism as an indicator of treatment effectiveness in persons with sexual offense histories. The updated meta-analysis includes 37 samples comprising a total of 30,394 individuals with sexual offense histories, which is nearly three times the sample size reported by Schmucker and Lösel (2017: 28 samples, N = 9781). In line with Schmucker and Lösel (2017), the mean treatment effect was small with an odds ratio of 1.54 [95% CI 1.22, 1.95] (p < .001). A moderator analysis suggested three predictors of importance, i.e., risk level, treatment specialization, and author confounding. Greater treatment effectiveness was suggested in high- and medium-compared to low-risk individuals and in specialized compared to non-specialized treatments. Authors affiliated with treatment programs reported larger effectiveness than independent authors. These findings were overall in line with Schmucker and Lösel (2017), though the effects of risk level and treatment specialization were stronger in the current meta-analysis. The findings of the updated meta-analysis reinforce the evidence for the first and second principle of the Risk-Need-Responsivity model. The results may support researchers and decision-makers in interpreting the current evidence on sexual recidivism as an indicator of treatment effectiveness, and, based on that, implement and carry out informative, methodologically sound evaluations of ongoing treatment programs in persons with sexual offense histories.

The dark figure of sexual recidivism

Empirical studies of sexual offender recidivism have proliferated in recent decades. Virtually all of the studies define recidivism as a new legal charge or conviction for a sexual crime, and these studies tend to find recidivism rates of the order of 5-15% after 5 years and 10-25% after 10+ years. It is uncontroversial that such a definition of recidivism underestimates the true rate of sexual recidivism because most sexual crime is not reported to legal authorities, a principle known as the "dark figure of crime." To estimate the magnitude of the dark figure of sexual recidivism, this paper uses a probabilistic simulation approach in conjunction with the following: (i) victim self-report survey data about the rate of reporting sexual crime to legal authorities; (ii) offender self-report data about the number of victims per offender; and (iii) different assumptions about the chances of being convicted of a new sexual offense given that it is reported. Under any configuration of assumptions, the dark figure is substantial, and as a consequence the disparity between recidivism defined as a new legal charge or conviction for a sex crime and recidivism defined as actually committing a new sexual crime is large. These findings call into question the utility of recidivism studies that rely exclusively on official crime statistics to define sexual recidivism, and highlight the need for additional, long-term studies that use a variety of different measures to assess whether or not sexual recidivism has occurred.

Psychiatric aspects of the assessment and treatment of sex offenders

Training in general and forensic psychiatry in the assessment and treatment of sex offenders is in need of considerable improvement. Although most sex offenders are not mentally ill, many are subject to substance misuse, abnormal personality traits, personality disorder, learning disability or dysphoric mood, and in some organic factors will be involved. Comprehensive assessment of sex offenders includes a full history and mental state evaluation, obtaining a collateral history from other sources, observation, psychometric testing, and psychophysiological methods of assessment, including penile plethysmography. Trials of the use of the polygraph are also under way. The treatment of sex offenders, especially those with paraphilias, may include medication with selective serotonin reuptake inhibitors or anti-libidinal agents. Ethical considerations can be problematic, but a balance can often be found between the welfare of the offender and the safety of the public.

A Dynamic Risk Factors-Based Typology of Sexual Offenders

The purpose of this article was to develop an Spanish psychometric typology of sexual offenders taking into account dynamic risk factors. The sample comprised 94 sex offenders imprisoned in Spain (52 rapists and 42 child molesters). The analysis yielded two different offender categories based on the subjects' criminogenic needs level (high and low). The results also showed that social desirability has a strong influence on the developed typologies, whereas the offence type, sociodemographic characteristics, and criminal history do not. A dynamic risk factors typology, such as the one proposed here, could help criminal and correctional facilities to fulfill their remit. It could also be useful for linking treatment intensity to offenders' criminogenic needs, as well as providing a platform for recidivism risk assessments.

Validity in Phallometric Testing for Sexual Interests in Children: A Meta-Analytic Review

Valid assessment of pedohebephilic interests (i.e., sexual interest in children) is fundamental to forensic clinical practice. Phallometric testing-which measures changes in penile circumference or volume, while stimuli depicting different ages and sexual activities are presented-is widely used in clinical and research settings to detect such interests. This meta-analysis summarizes studies comparing sexual offenders against children and various types of controls on phallometric tests for pedohebephilic interests (37 samples; N = 6,785) and studies examining the relationship between phallometric test scores and sexual reoffending (16 samples; N = 2,709). The findings suggest that several phallometric testing procedures are valid indicators of pedohebephilic interest. Certain methodological features of phallometric tests were associated with greater validity, such as, slide or audio-plus-slide stimuli and z-score-based indices. In addition, phallometric tests for pedohebephilic, pedophilic, and hebephilic interests predicted sexual reoffending which provides further evidence that phallometric test scores are valid indicators of sexual interest in children. In general, the interpretation of phallometric test scores as indicators of pedohebephilic interests is supported.

Prevention of Child Sexual Abuse by Targeting Pre-Offenders Before First Offense

The population of potential child abuse offenders has largely been unstudied. In the current study, we examine whether a six-component model used for primary diabetes prevention could be adapted to child sexual abuse pre-offenders, whereby individuals who are prone to sexual abuse but have not yet committed an offense can be prevented from committing a first offense. The six components include: define and track the magnitude of the problem, delineate a well-established risk factor profile so that at-risk persons can be identified, define valid screening tests to correctly rule in those with the disease and rule out those without disease, test effectiveness of interventions-the Dunkelfeld Project is an example, produce and disseminate reliable outcome data so that widespread application can be justified, and establish a system for continuous improvement. By using the diabetes primary prevention model as a model, the number of victims of child sexual abuse might be diminished.

Will They Do It Again?

This article reviews the empirical research on the prediction of reoffending among sexual offenders. The major predictors of sexual-offense recidivism are factors related to sexual deviance (e.g., deviant sexual preferences, previous sex crimes) and, to a lesser extent, criminal lifestyle (e.g., antisocial personality disorder, total number of prior offenses). The factors that predict general recidivism among sex offenders are the same as the factors that predict general recidivism among nonsexual criminals (e.g., juvenile delinquency, prior violent offenses). Given that there are special predictors of sexual recidivism, evaluators should consider separately the risk for sexual and non-sexual recidivism.

The Effectiveness of Psychological Treatment for Reducing Recidivism in Child Molesters: A Systematic Review of Randomized and Nonrandomized Studies

In this systematic review, the effectiveness of psychological treatment interventions for child molesters was examined. Studies were restricted to randomized control trials (RCTs), controlled trials, and cohort designs where recidivism had been used as the outcome variable. ASSIA, NCJRS, Medline, PsychINFO, EMBASE, Pro-requests Dissertations and Theses A&I, and the Cochrane Library were searched. Ten experts were contacted and the reference lists of 12 systematic reviews and 40 primary studies were observed. The number of hits was 3,019, of which 564 duplicates, 2,388 irrelevant references, and 38 that did not meet the inclusion criteria were removed. Fourteen studies using mixed samples had to be omitted because it was not possible to determine the recidivism rates of child molesters in the samples described. One RCT and 9 cohort studies were included in the data synthesis, providing 2,119 participants. In all, 52.1% received the intervention under investigation and 47.9% did not. The reported recidivism rates were 13.9% for the treated child molesters compared to 18.6% for the untreated child molesters. Three studies reported statistically significant lower recidivism rates for treated child molesters. Eight studies were assessed as weak. Four studies were assessed as having bias which increased the chance of finding a treatment effect and four studies were assessed as having bias which reduced the chance of finding a treatment effect. It was not possible to determine the direction of bias for two studies.

Psychological Treatment of the Paraphilias: a Review and an Appraisal of Effectiveness

Initially, this paper notes that treatment for the paraphilias has been most thoroughly described and evaluated within the context of treating sex offenders (i.e., child molesters, rapists, and exhibitionists). We note that the literature does not always carefully distinguish "pedophiles" from other child molesters and that rapists are often identified as having a "Not Otherwise Specified" paraphilia. Both these practices appear problematic. We then outline current approaches to the treatment of sex offenders which have typically been seen as relevant to dealing with all types of paraphilias. The historical emergence of sex offender treatment is noted, leading to an outline of current approaches that address known problematic issues by employing established procedures and by delivering treatment in an empirically based manner. We conclude with a description of evaluations of the effectiveness of these treatment approaches which indicate overall positive outcomes.

Evaluation of Attributional Change in a Relapse Prevention Program for Child Molesters

Relapse prevention is a multimodal, cognitive-behavioural approach to treating, among other types of clients, child molesters. Rather than positing a cure as the outcome of treatment, it emphasises self-management and personal responsibility for avoiding or coping with situations that threaten self-control. The motivation to use these self-control strategies is likely to vary according to beliefs about the causes of their offending behaviour, particularly as a function of the degree to which they are seen as controllable. Fifteen child molesters, classified as preferential or situational type, and familial or nonfamilial, from the Kia Marama unit at Rolleston Prison reported on their causal beliefs concerning their offence-related behaviour at four points in their description of their most typical or recent relapse. This assessment was carried out at four points in the 35-week relapse-prevention based treatment program.

All participants made clinically positive changes in their causal ascriptions over treatment. Preferential participants judged the cause of their offending to be less controllable, and more stable at the time of offence, and more global than situational offenders. Compared with non-familial participants, incestuous participants evaluated the cause of their offending to be less stable at the time of their offence and less global across all the assessment points. The results are discussed in terms of the utility of attributional assessment as an interim measure of progress, particularly with respect to motivation to avoid reoffending.

Age, actuarial risk, and long-term recidivism in a national sample of sex offenders

Age at release has become an increasing focus of study with regard to evaluating risk in the sex offender population and has been repeatedly shown to be an important component of the risk assessment equation. This study constitutes an extension of a study of sex offender outcomes prepared for the Evaluation Branch, Correctional Service of Canada. The entire cohort of 2,401 male federally incarcerated sexual offenders who reached their warrant expiry date (WED) within 1997/1998, 1998/1999, and 1999/2000 fiscal years were reviewed for the study. Sexual and violent reconviction information was obtained from CPIC criminal records over an average of 12.0 years (SD = 1.7) follow-up. This study focused upon the cohort of sex offenders who were 50 years or older at time of release (N = 542). They were stratified according to risk using a brief actuarial scale (BARS) comprising six binary variables. For the most part, older offenders showed low base rates of sexual recidivism regardless of the risk band into which they fell. The exception was a small group of elderly offenders (n = 20) who fell into the highest risk band, and who showed high levels of sexual recidivism. The results of this combination of cross-sectional and longitudinal analyses of elderly sexual offenders may have important implications for offender management, particularly in light of the increasing numbers of offenders in Canada who fall into the over 50 age cohort.

[Injunction to care. Results of a study carried out in the regions of Alsace and Lorraine]

INTRODUCTION

The act of June 17, 1998 created a new form of compulsory treatment: the injunction to care. This is a legal measure intended to fight against recidivism of offenders and sex offenders through medical measures. The only therapies that have demonstrated partial efficacy are cognitive behavioural therapy and treatment with anti-hormone. In France, psychodynamic therapies are paramount in the treatment of perpetrators of sexual violence, although such treatments have not demonstrated effectiveness in reducing sexual recidivism. Very few studies are available regarding the implementation of court-ordered treatment in France. The recent report by the General Inspectorate of Social Affairs (IGAS) in 2011 confirms the absence of medical statistics on the implementation of court-ordered care.

OBJECTIVE

We conducted a study on the procedure of the injunction to care in the regions of Alsace and Lorraine. The aim of the study is to develop an inventory coordinator for practitioners (number, type of exercise) and the profile of patients undergoing the injunction of care (type of offense convicted for, psychiatric comorbidity identified for example).

METHODS

We first identified the practicing coordinator doctors by contacting the High Courts in the geographic area studied. We then sent out a questionnaire by post to coordinator doctors to profile their patients on care injunctions.

RESULTS

We identified 16 practicing coordinator doctors in two study areas: 13 are state hospital doctors and three are private practice. Of the 16 doctors contacted, six returned the completed questionnaires (38% of the sample). This allows characterizing a sample of 50 patients on care injunctions. The majority of convicted crimes are of a sexual nature (92% of cases). This is mostly for crimes or sexual offenses involving minors aged under 15 (83% of cases). Psychiatric comorbidity is the most frequently identified paedophile primary (38%) followed by mental retardation (14%), dissocial personality disorder (6%) and a borderline personality, and emotional liability (6%). Other comorbidities are divided between paranoid schizophrenia, chronic alcoholism, or other personality disorder. The follow-up is monitored by a physician in 82% of cases, while it is provided by a psychologist in 18% of cases. The management consists of a simple psychotherapy in 66% of cases. Pharmacological treatment is most often prescribed with antipsychotics (26% of cases), followed by anti-depressants (4%) and the anti-hormone (4%).

CONCLUSION

Our study confirms that the majority of patients on care injunctions are sexual offenders involving minors under the age of 15. The most implemented treatment is a simple psychotherapy. The pharmacological option is infrequent and generally involves the use of inappropriate treatment (neuroleptics). Suppressive libido treatment (antidepressants and anti hormone) remains an exception in France.

Community solutions for the community's problem: an evaluation of three New Zealand community-based treatment programs for child sexual offenders

The recidivism rate of 203 people mandated by the courts to attend three community-based child sexual offender treatment programs (175 treatment cases and 28 assessment-only cases) was assessed and compared with a probation comparison group. The recidivism rate was 8.1% for all participants treated in the community-based programs and 5.2% for participants who completed treatment. The recidivism rate for program attendees was approximately half that of those in the probation comparison group. The drop-out rate for treatment appears to be relatively high (45%) and noncompletion was associated with higher recidivism. These results indicate significantly better outcomes for offenders receiving specialized treatment and are consistent with, and toward the lower end of, recidivism rates reported in local and international evaluation studies.

Sampling Extreme Groups Invalidates Research on the Paraphilias: Implications for DSM-5 and Sex Offender Risk Assessments

Psychiatrist and Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) text editor Michael First has criticized the addition of victim counts to criteria proposed by the Paraphilia Sub-Workgroup for inclusion in DSM-5 because they will increase false-positive diagnoses. Psychologist and Chair of the DSM-5 Paraphilia Sub-Workgroup, Ray Blanchard, responded by publishing a study of pedohebephiles and teleiophiles which seemed to show that victim counts could accurately identify pedohebephiles who were selected per self-report and phallometric testing. His analysis was flawed because it did not conform to conventional clinical practice and because he sampled groups at opposite ends of the clinical spectrum. In an analysis of his full sample, we found the false-positive rate for pedohebephilia at the recommended victim count selection points was indeed very large. Why? Because data analyses that eliminate intermediate data points will generate inflated estimates of correlation coefficients, base rates, and the discriminative capacity of predictor variables. This principle is also relevant for understanding the flaws in previous research that led Hanson and Bussiere to conclude that sexual recidivism was correlated with "sexual interest in children as measured by phallometric assessment." The credibility of mental health professionals rests on the reliability of their research. Conducting, publishing, and citing research that reflects

Optimizing risk mitigation in management of sexual offenders: a structural model

Sexual violence is an insidious and pervasive problem that insinuates itself into all aspects of contemporary society. It can neither be mitigated nor adequately controlled through current socio-legal practices. A more promising approach must embrace four integrated elements: (1) public policy, (2) primary prevention, (3) statutory management, and (3) secondary intervention. In the present paper we tackle the 3rd and 4th elements by proposing an integrated model for reducing and managing sexual violence among known sex offenders. Relying on the highly effective Risk-Need-Responsivity (RNR) model as the core of our Sex Offender Risk Mitigation and Management Model (SORM(3)), we draw together evidence based practices from clinical interventions and risk assessment strategies. Developed by Andrews & Bonta (2006), RNR has a strong empirical track record of efficacy when applied to diverse samples of offenders, including sex offenders (Hanson, Bourgon, Helmus, & Hodgson, 2009). We offer a detailed structural model that seeks to provide a more seamless integration of risk assessment with management and discretionary decisions, including a primary focus on RNR-based post-release aftercare. We end with the mantra that sex offender treatment alone will never effectively mitigate sexual violence in society, since the problem is not confined to the handful of offenders who spend time in prison and are offered some limited exposure to treatment. Any truly effective model must go well beyond the management of those known to be violent and embrace a comprehensive and integrated approach that begins by recognizing the seeds of sexual violence sown by society. Such a public health paradigm places victims - not offenders - at the center, forcing society to come to address the full gamut of hazards that fuel sexual violence.

Female sex offender recidivism: a large-scale empirical analysis

Using a sample of 1,466 females convicted of a sexual offense in New York State, the current study explored the following: (a) offending prior to the commission of the offenders' first sexual offense, (b) rates of recidivism following their first sexual offense conviction, and (c) factors associated with the likelihood of sexual recidivism. Results showed the recidivism rates of female sex offenders to be lower than those of male sex offenders for all types of recidivism studied (any rearrest, felony rearrest, violent [including violent sexual] felony rearrest, and sexual rearrest). Several significant differences were found between the group of female sex offenders who sexually recidivated and the group who did not, including crime of first sexual conviction and measures of prior offending.

The impact of prison-based treatment on sex offender recidivism: evidence from Minnesota

Using a retrospective quasi-experimental design, this study evaluates the effectiveness of prison-based treatment by examining recidivism outcomes among 2,040 sex offenders released from Minnesota prisons between 1990 and 2003 (average follow-up period of 9.3 years). To reduce observed selection bias, the authors used propensity score matching to create a comparison group of 1,020 untreated sex offenders who were not significantly different from the 1,020 treated offenders. In addition, intent-to-treat analyses and the Rosenbaum bounds method were used to test the sensitivity of the findings to treatment refuser and unobserved selection bias. Results from the Cox regression analyses revealed that participating in treatment significantly reduced the hazard ratio for rearrest by 27% for sexual recidivism, 18% for violent recidivism, and 12% for general recidivism. These findings are consistent with the growing body of research supporting the effectiveness of cognitive-behavioral treatment for sex offenders.

Sexual offender treatment: a positive approach

This article describes a treatment program for sexual offenders that is a modification of cognitive-behavioral therapy (CBT) and that emphasizes a positive approach. Several issues that characterize most CBT programs for sexual offenders are challenged and alternatives are offered. The overall features of the positive approach are then described. Finally outcome evaluations of the effects of CBT programs are described and compared with the long-term outcome of the current positive program. This comparison suggested that the positive program is more effective than the traditional CBT approach.

Reducing Housing Options for Convicted Sex Offenders: Investigating the Impact of Residency Restriction Laws Using GIS

Sex offender registries have been established throughout the United States. To date, 16 states have adopted additional residency restriction policies, precluding registered sex offenders from living within a certain distance of places where children gather. This study quantifies the impact of residency restrictions on housing options for registered sex offenders using Orange County, Florida, as a case study. A Geographic Information System (GIS) is employed to identify all occupied residential properties using parcel-level zoning data as well as those that fall within the 1,000-foot restricted buffer zones around attractions, bus stops, daycares, parks, and schools. Results indicate that housing options for registered sex offenders within urban residential areas are limited to only 5% of potentially available parcels and that bus stop restrictions impact the amount of livable area the most, followed by daycares, schools, parks, and attractions. The limited options to establish residency exist mostly in low-density rural areas. This supports the argument that residency restrictions for sexual offenders are a strong contributing factor to their social and economic isolation. The impacts of increasing the buffer to a proposed 2,500-foot zone are discussed, and a comparison of the individual restriction categories is presented.

Sexual reconviction rates in the United Kingdom and actuarial risk estimates

OBJECTIVE

Assessing the risk of further offending behavior by adult sexual perpetrators of children is highly relevant and important to professionals involved in child protection. Recent progress in assessing risk in sexual offenders has established the validity of actuarial measures, although there continues to be some debate about the application of these instruments. This paper summarizes the debate between clinical and actuarial approaches and reviews the "base rate" for United Kingdom sexual offense reconviction.

METHOD

A review of the literature revealed 16 UK sexual reconviction studies, 8 using incarcerated samples (N=5,915) and 8 using non-incarcerated samples (N=1,274). UK estimates of sexual reconviction rates are compared with European and North American studies.

RESULTS

The mean sexual reconviction rates for the incarcerated sample at 2 years (6.0%), 4 years (7.8%) and 6 years or more (19.5%) were higher than that of the comparative non-incarcerated sample at 2 years (5.7%), up to 4 years (5.9%), and 6 years or more (15.5%). The overall sexual reconviction rate for both samples combined was 5.8% at 2 years, and 17.5% at 6 years or more.

CONCLUSIONS

The sexual reconviction rate for incarcerated sexual offenders is higher than that of non-incarcerated sexual offenders. The UK sexual reconviction rates were comparable with European and North American studies.

In-prison treatment for sexual offenders in Taiwan

The present study was designed to investigate the current status of mandated treatment in prison for sexual offenders in Taiwan. The information-gathering methods were composed of two parts: questionnaires and interviews. The results showed the difficulties of mandated treatment in prison, including poor client adherence, the lack of consistent disciplines for the therapists, a standardized algorithm, and explicit laws and rules, the safety concerns of the therapists, and a shortage of staff. The development of mandated treatment in prison of sexual offenders in Taiwan is still in its early stage, and the treatment models have not yet been integrated. A cooperative and collaborative center for the mandated treatment in prison of sexual offenders and an integrated rule and treatment model should be set up in the future.

Typology of female sex offenders: a test of Vandiver and Kercher

Using all 390 female sex offenders registered in New York State, this study attempted to test the analyses and findings of Vandiver and Kercher (2004). Although the current sample varied geographically from Vandiver and Kercher's sample, they were remarkably similar on key demographic variables (e.g., offender age and race, victim age), allowing for close comparison of the findings. Results of the hierarchical loglinear modeling analysis reinforced the importance of variables such as victim and offender ages to categorizing offenders. The present cluster analysis indicated the existence of six distinct types of female sex offender (with the clusters themselves differing substantially from those found by Vandiver and Kercher), supporting the view that female sex offenders are a heterogeneous group.

Treating sexual offenders with learning disabilities in the community: a critical review

This study offers a critical review of a treatment group for sexual offenders with learning disabilities. The participants were diverted from criminal proceedings due to their level of cognitive functioning and attended a 7-month treatment program comprising of four main components: sex education, cognitive distortions, offending cycle, and relapse prevention. A number of psychometric assessments were administered immediately before and after intervention. Although no significant differences were found in attitudes toward sexual offending following treatment, the trend was for improvements in sex knowledge and honesty of sexual interest. Improvements in socialization skills (leisure time and interpersonal skills) were significant. No further incidents of sexual offending have been reported during a 12-month follow-up. A number of explanations for the nonsignificant improvement in attitudes are considered and recommendations for future treatment evaluation studies are made. The development of specific questionnaires and treatment programs for sexual offenders with learning disabilities is discussed.

Violent sex offenses: how are they best measured from official records?

In the United States, sexually violent predator (SVP) commitment statutes generally require assessment of an offender's risk of subsequent sexual violence. Current actuarial methods for predicting sexual reoffending were actually designed to predict something else-charges or convictions for offenses deemed sexual based on information obtained from police "rapsheets" alone. This study examined the referral and past offenses of 177 sex offenders. Results showed that police rapsheets (and data based on them) underestimated the number and severity of sexually motivated violent offenses for which sex offenders were actually apprehended. Rapsheet violent offenses seemed a more accurate index of the conduct addressed by SVP legislation than were rapsheet sex offenses. We suggest that, when evaluating sex offenders for SVP status, actuarial instruments designed to predict violent recidivism (as measured by rapsheet violent reoffenses) might be preferable to those designed to predict sexual recidivism (as measured by rapsheet sexual reoffenses).

Relapse prevention for sexual offenders: considerations for the "abstinence violation effect"

Relapse Prevention (RP) is a cognitive-behavioral approach originally developed for treatment of addictions and has since become an effective and popular method for treating sexual offenders. The Abstinence Violation Effect (AVE) is a pivotal RP construct describing one's cognitive and affective response to re-engaging in a prohibited behavior. We review the literature on the AVE in both addiction and sexual offender applications. We summarize the original and subsequent formulations of the AVE for addictions and modifications adopted for its application to sexual offenders. We argue that these modifications have generally failed to characterize sexual offense relapse cycles accurately or comprehensively. In particular, these modifications fail to specify accurately the AVE's occurrence and influence in the offense cycle. In response to these limitations, we suggest future directions for AVE research in sexual offenders.

Cross-validation of the risk matrix 2000 sexual and violent scales

The predictive accuracy of the newly developed actuarial risk measures Risk Matrix 2000 Sexual/Violence (RMS, RMV) were cross validated and compared with two risk assessment measures (SVR-20 and Static-99) in a sample of sexual (n= 85) and nonsex violent (n= 46) offenders. The sexual offense reconviction rate for the sex offender group was 18% at 10 years follow-up, compared with 2% for the violent offenders. Survival analyses revealed the violent offenders were reconvicted at twice the rate compared to sexual offenders. The RMV significantly predicted violent recidivism in the sex and combined sex/violent offender groups. Although the RMS obtained marginal accuracy in predicting sexual reconviction in the sex offender group, none of the scales significantly predicted sexual reconviction. An item analysis revealed four factors not included in the risk scales that were significantly correlated with sexual and violent reconviction. Combining these factors with Static-99, RMV, and RMS increased the accuracy in predicting sexual reconviction.

Differences in personality and risk characteristics in sex, violent and general offenders

BACKGROUND

Studies examining the characteristics of sex and violent offenders have found differences in personality and offence characteristics. However, none of these studies has examined differences in personality characteristics between violent, sex and general offenders using the Special Hospitals Assessment of Personality and Socialization (SHAPS).

METHOD

Using a retrospective archival research design, data on 153 male offenders were divided into three groups, sexual (n = 85), violent (n = 46) and general offenders (n = 22). Of the sample 139 offenders had completed the SHAPS. The Sexual Violence Risk-20 (SVR-20) measure was used to categorize levels of risk. Reconviction data collected over a 10-year follow-up period were analysed using the receiver operating characteristic analysis.

RESULTS

Violent offenders had significantly more chaotic lifestyles, displayed greater psychopathology than sex or general offenders, and were most likely to reoffend, with over a quarter committing further violent offences. The sexual offender group share more in common with the general offenders, in terms of personality characteristics and recidivism rates, than with the violent offenders. More of the violent offenders were categorized as at medium or high risk of recidivism than any other group. The SVR-20 significantly predicted any reconviction over five- and 10- year follow-up periods.

DISCUSSION

The results from this study support the use of self-report inventories in assessing differences between offender groups. Such information may assist clinicians in prioritizing management and intervention strategies for those offenders, and in turn lower the risk of further offending.

Predicting sex offender treatment entry among individuals convicted of sexual offense crimes

This study examined what factors were predictive of who volunteers for sex offender treatment (self-selection) as well as who enters treatment after volunteering (administration selection). Research participants included 404 treatment volunteers and 387 nonvolunteers to treatment who were convicted of a sexual offense involving minors within the federal prison system. Maximum likelihood probit estimation procedures indicated that when compared with nonvolunteers, treatment volunteers were more likely to be recommended by a judge to receive treatment at the time of sentencing, had received prior treatment for sexually deviant behavior, reported higher levels of motivation to change their sexually deviant behavior, and had lower rates of a substance use disorder in the year prior to incarceration. Of those persons who initially volunteered, 62% were accepted and entered treatment, 16% were denied entry to treatment by program staff, and 22% refused treatment after being accepted to the waiting list. When compared with those who were accepted and entered treatment, motivation was the only predictor of being denied admission into treatment by program staff and for refusal of treatment once accepted. The findings emphasize the need to control for selection bias in treatment outcome studies and the importance of examining the role of motivation in treatment volunteerism and treatment entry for sexual offenders.

Model Underpinning Treatment for Sex Offenders With Mild Intellectual Disability: Current Theories of Sex Offending

Although many writers have provided a theoretical framework for treatment of mainstream sex offenders, this research has not been extended to sex offenders with mild intellectual disability. My purpose here is to bring together several research strands to provide a theoretical model for working in this field, including theories of sex offending, developmental theories for offending, and work on quality of life. In addition to dealing with issues of sex offending, researchers should also investigate developmental and societal issues crucial in the genesis of sex offending and offending in general. Because societal issues are also important for treatment, engagement and identification with society are suggested. Quality of life and issues directly related to sex offending are of central importance.

The Characteristics of Persistent Sexual Offenders: A Meta-Analysis of Recidivism Studies

A meta-analysis of 82 recidivism studies (1,620 findings from 29,450 sexual offenders) identified deviant sexual preferences and antisocial orientation as the major predictors of sexual recidivism for both adult and adolescent sexual offenders. Antisocial orientation was the major predictor of violent recidivism and general (any) recidivism. The review also identified some dynamic risk factors that have the potential of being useful treatment targets (e.g., sexual preoccupations, general self-regulation problems). Many of the variables commonly addressed in sex offender treatment programs (e.g., psychological distress, denial of sex crime, victim empathy, stated motivation for treatment) had little or no relationship with sexual or violent recidivism.

Interpersonal factors and personality disorders as discriminators between intra-familial and extra-familial child molesters

This article presents the results of research investigating the relation between interpersonal factors and personality disorders and intra-familial versus extra-familial child molesters. The sample contained 41 intra-familial and 43 extra-familial child molesters as well as a matched comparison group of 80 subjects. The analysis of the research results show that interpersonal factors, such as parental sensitivity, trust, and adult romantic attachment, discriminate between intra-familial and extra-familial child molesters. These findings structure the heterogeneous field of child molesters, as intra-familial child molesting seems to be related to relational attitude as well as personality disorders, whereas extra-familial child molesting is mainly related to personality disorders without showing significant deficits in the interpersonal factors that were measured. These results contribute to the explanation of this deviant sexual conduct and to the development and differentiation of the treatment of child molesters.

Effect sizes in the treatment of sexual offenders

This article considers the benefits of sexual offender treatment in terms of the magnitude of the effect size produced by these interventions. Comparisons are made of the effect sizes with those generated by treatment of other offenders, by treatment for mental health problems, and by treatment for physical health problems. In all cases, effect sizes with sexual offenders are comparable to (and in some cases better than) effect sizes for the treatment of the other groups. As a final note, it is suggested that using a harm reduction index to estimate effect sizes for treatment with sexual offenders would produce more meaningful results.

Evaluation of a national prison-based treatment program for sexual offenders in England and Wales

Treatment efficacy is described for a sample of sexual offenders who had undertaken treatment in United Kingdom prisons (N = 647) and for a retrospectively selected comparison group (N = 1,910). The outcomes under observation in this study were sexual, sexual and/or violent, and general reconviction. Treatment impact was also examined in relation to offenders' risk of reconviction. The treatment group had slightly lower 2-year sexual reconviction rates than the comparison group, but these differences were not statistically significant. Significant differences were found between the treatment and comparison group for sexual and/or violent reconviction. Further analysis suggested that treatment produced a reduction in the probability of sexual and/or violent reconviction (p <.05) when other relevant variables were controlled for. General reconviction rates were consistently lower in the treatment group, but these differences were not significant.

Overview of rehabilitative efforts in understanding and managing sexually coercive behaviors

In reviewing approaches to rehabilitative efforts in understanding and managing sexually coercive behaviors within the past two decades, one is struck by the development of two totally divergent paths. In 1971, there were a few civil commitment programs operated by mental health departments-most notably were the Sexual Psychopath Program at Western State Hospital in Fort Steilacoom, Washington, and the Massachusetts Treatment Center for Sexually Dangerous Persons. There were a few programs in prisons started by therapists who were interested in this population but given little recognition and even fewer resources. Additionally there were a handful of community-based programs including the J.J. Peters Institute in Philadelphia and PASO (Positive Approaches to Sex Offenders) in Albuquerque, New Mexico. Today there are thousands of specialized sexual offender treatment programs treating sexual abusers of every age, gender, ethnicity, and with a wide range of comorbid conditions. They are treated in the community, prisons, mental hospitals, residential facilities, and private practices. There is an international organization, a specialized research journal, and a specialized branch of the Department of Justice, the Center for Sex Offender Management. This chapter will provide an overview of the developments in the field, primarily covering the last 25 years. It will look at the evolution of theoretical approaches, the development of specialized approaches for subpopulations, significant landmarks, and possible future trends.

A multivariate analysis of sex offender recidivism

Sex offender recidivism risk is a multifaceted phenomenon requiring consideration across multiple risk factor domains. The impact of treatment involvement and subsequent recidivism is given limited attention in comparison to other forensic mental health issues. The present analysis is a retrospective study of sex offenders treated at a secure facility utilizing a cognitive-behavioral program matched with an untreated correctional sample. Variables studied included demographic, criminal history, offense related, and treatment progress. Recidivism was assessed through arrest data. Multivariate analysis suggests that recidivism is significantly related to quality of treatment involvement, offender demographics, offense characteristics, and criminal history. Successfully treated offenders were significantly less likely to subsequently reoffend. Recidivists were also significantly younger, less likely married, had engaged in more victim grooming or less violent offending behavior, and had significantly more prior property charges. The authors discuss the clinical and policy implications of the interrelationship between treatment involvement and recidivism.

Dosage of treatment to sexual offenders: are we overprescribing?

A sample of 337 offenders who received treatment in a variety of sex offender treatment programs in the Ontario region of Correctional Service Canada between 1993 and 1998 were divided based on the highest intensity sex offender programming that they received (low, moderate, and high). The three groups were compared with reference to a variety of actuarial risk assessment measures, criminogenic factors, and the number and type of treatment programs completed. It was hypothesized that the high-intensity group would have more criminogenic risk factors, higher actuarial scores, and participate in more treatment programs than both the moderate- and low-intensity groups. The results indicate that in general, the hypotheses were supported. Nonetheless, the results suggest that the low-intensity group may be receiving too much sex offender-specific treatment.

Violent adolescent sexual offenders

The past 20 years have brought a significant increase in the general knowledge about adolescent offenders and sexual offenders and the potential harm that they cause to victims. Currently, however, we are left with perhaps more questions than answers in several important areas. We have concluded that there is no single cause or etiologic agent common to all sexual offenders. Sexual offenders are by nature a complex and a heterogeneous group, and sexual offending is likely caused by multiple causation and interactive factors. Awareness has spread as to the necessity of providing appropriate assessment and treatment facilities for adolescents. The limited outcome studies indicate a lower recidivism rate for adolescent offenders than adult offenders. This may reflect a better prognosis for adolescent offenders who have not had years of reinforcement of deviant sexual arousal patterns and whose personality traits are more malleable than those of adult offenders. Further research is needed in the area of subclassification of sexual offenders, controlled treatment studies, and prospective longitudinal studies to determine more accurate risk assessment.

First report of the collaborative outcome data project on the effectiveness of psychological treatment for sex offenders

This meta-analytic review examined the effectiveness of psychological treatment for sex offenders by summarizing data from 43 studies (combined n = 9,454). Averaged across all studies, the sexual offence recidivism rate was lower for the treatment groups (12.3%) than the comparison groups (16.8%, 38 studies, unweighted average). A similar pattern was found for general recidivism, although the overall rates were predictably higher (treatment 27.9%, comparison 39.2%, 30 studies). Current treatments (cognitive-behavioral, k = 13; systemic, k = 2) were associated with reductions in both sexual recidivism (from 17.4 to 9.9%) and general recidivism (from 51 to 32%). Older forms of treatment (operating prior to 1980) appeared to have little effect. Future directions for improving the quality of sex offender treatment outcome evaluations are discussed.