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Evidence-Based Assessment & Treatment Services for Sexual Offenders

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Evidence-Based Assessment & Treatment Services for Sexual Offenders

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  1. Evidence-Based Assessment & Treatment Services for Sexual Offenders David Thornton, Ph.D.

  2. Outline • Part One: The Developing Evidence Base • Mainly didactic • Part Two: Good Practice Models • Mainly interactional

  3. Part One: The Developing Evidence Base

  4. How RNR applies to Sexual Offenders

  5. Risk/Needs/Responsivity • RNR is the only model for the effective reduction of recidivism that has substantial empirical support • Central claim is that the more closely you follow these three principles the larger the resulting reduction in recidivism • The model has been primarily developed and validated on general offenders and only recently tested with sexual offenders

  6. Risk Principle • Match intensity of service with risk level • Manage low risk offenders with a light touch; avoid creating interactions between them and higher risk offenders • Concentrate treatment and management resources on Moderate and especially High risk offenders • Central Claim: Providing intensive treatment to low risk offenders will be useless or harmful; the more you concentrate resources on higher risk offenders, the greater the reduction in recidivism

  7. Need Principle • Treatment should comprehensively address the psychological factors that predispose towards the kind of recidivism you are trying to prevent • Treatment should move these factors in the direction of becoming strengths • Use recidivism studies to select these factors • If it is theoretically plausible and empirically correlated with recidivism you should target it; if there is no empirical evidence for its relation to recidivism you should leave it alone • Central claim: the more Needs you target the larger the resulting reduction in recidivism; targeting other factors will not reduce risk

  8. The Big Three General Criminogenic Needs • These are Criminogenic Factors that have been determined to be relevant to general recidivism

  9. Antisocial Personality Pattern • Elements • Impulsive • Adventurous pleasure seeking • Restlessly aggressive • Callous disregard of others

  10. Antisocial Attitudes • Cognitive Elements • Identifies with criminals • Values and Beliefs that favor crime • Rationalizes crime under a broad range of circumstances • Negative to attitude to law and justice systems • Belief that crime yields rewards • Affective Elements • Anger • Irritation • Resentment • Defiance

  11. Antisocial Associates • Elements • Criminal Friends • Isolation from Prosocial Others

  12. Responsivity Principle • General Responsivity: Use methods that have generally been shown to be effective with offenders (behavioral, social learning and cognitive-behavioral influence and skill building strategies • Specific Responsivity: adapt style and mode of service according to the setting and relevant characteristics of the individual such as their strengths, motivations, preferences, personality, age, gender, cultural identifications • Central Claim: the more your methods match the learning style and culture of the individual the greater the resulting reduction in recidivism

  13. Meta-Analysis of Treatment Outcome • Mean Effect Size (r) by Adherence to RNR Principles (k=374) • Risk Principle • Yes = 0.1 No = 0.03 • Need Principle • Yes = 0.19 No = -0.01 • Responsivity Principle • Yes = 0.23 No = 0.04

  14. Number of Principles followed and Tx Impact • All three principles • 0.26 (60 tests) • Two principles • 0.18 (84 tests) • One principle • 0.02 (106 tests) • None of principles followed • -0.02 (124 tests)

  15. Similar results observed for • Male and Female offenders • Young and Adult offenders • Prisoners and Community Corrections

  16. Similar Evidence for Two Implementation Principles • Staffing: • Relationship skills Respectful, collaborative, caring staff that employ motivational interviewing (stages 1 and 2). • Structuring skills Use prosocial modeling, the appropriate use of reinforcement and disapproval, cognitive restructuring, and motivational interviewing (stages 3 – 6). • Management: • Promote the selection, training and clinical supervision of staff according to RNR and introduce monitoring and feedback and adjustment systems. • Build systems and cultures supportive of effective practice and continuity of care.

  17. Note: 8 stages of MI Learning (1) openness to collaboration with clients’ own expertise, (2) proficiency in client-centered counseling, including accurate empathy, (3) recognition of key aspects of client speech that guide the practice of MI, (4) eliciting and strengthening client change talk, (5) rolling with resistance, (6) negotiating change plans, (7) consolidating client commitment (8) switching flexibly between MI and other intervention styles.

  18. The SOT Evaluation Literature is weak • Too few well controlled studies to allow us to draw firm conclusions • If only exclude the worst studies then there are enough for a meta-analysis looking at the application of RNR principles to SOT • Hanson, R.K., Bourgon, G., Helmus, L. & Hodgson, S. (2009). The principles of effective correctional treatment also apply to sexual offenders: A meta-analysis. Criminal Justice and Behavior, 36, 865-891.

  19. Selection of Studies • ATSA’s Collaborative Outcome Data Committee, a committee of 12 experts in the area of sex offender research, developed a multidimensional way of classifying evaluation studies according to the degree to which different methodological problems applied • The authors use this framework to classify the strength of studies: • 105 were rated as Rejected as inadequate • 19 as Weak • 5 as Good • 1 as Strong • A pool of 23 “minimally adequate” studies were identified

  20. Collaborative Outcome Data Committee. (2007a). Sexual offender treatment outcome research: CODC Guidelines for evaluation Part 1: Introduction and overview (Corrections Research User Report No. 2007-02). Ottawa, Ontario: Public Safety Canada. • Collaborative Outcome Data Committee. (2007b). The Collaborative Outcome Data Committee’s guidelines for the evaluation of sexual offender treatment outcome research Part 2: CODC guidelines (Corrections Research User Report No. 2007- 03). Ottawa, Ontario: Public Safety Canada.

  21. The 23 studies were coded according to whether they complied with these principles • Studies were classified according to the number of principles treatment followed and which specific principles were followed • Average treatment effect was then calculated as a function of the degree to which RNR principles had been followed

  22. Rating of Adherence to the Risk Principle • Programs adhered to the Risk principle when they provided intensive interventions to high risk offenders and little or no service to low risk offenders. In practice, however, no single study had differentiated treatment services. Studies were therefore coded as adhering to the Risk principle if their treatment group was high risk.

  23. Rating of Adherence to the Need Principle • Adherence to the Need principle was met if the majority of the treatment targets were significantly related to sexual or general recidivism in previous meta-analytic reviews • For sexual offence recidivism, the main criminogenic needs were taken to be • sexual deviancy • antisocial orientation, • sexual attitudes • intimacy deficits. • Examples of factors coded as non- criminogenic needs were • denial • low victim empathy • social skills deficits

  24. Rating of Adherence to the Responsivity Principle • Treatment services were considered to meet the Responsivity principle when they provided treatment in a manner and style matched to the learning style of the clients. • For offenders, such programs are typically cognitive-behavioural programs run by pro-social therapists skilled at developing respectful (“firm but fair”) relationships

  25. Sources for RNR Model and Research • Andrews, D. A., & Bonta, J. (2006). The psychology of criminal conduct (4 ed.). Cincinnati, OH: LexisNexis/Anderson. NB: 5th edition is now available • Bonta, J., & Andrews, D. A. (2007). Risk-need-responsivity model for offender assessment and rehabilitation. Corrections Research User Report No. 2007-06). Ottawa, Ontario: Public Safety Canada.

  26. Inter-Rater Reliability • The reliability was good for the rating of adherence to the principles of Risk (Kappa = .73, 88% agreement), and Responsivity (Kappa = .82, 94% agreement), but only fair for rating of the Need principle (Kappa = .42; 75% agreement). Nevertheless, the reliability of the overall rating of adherence to the R/N/R principles was good (ICC = .80)

  27. Index of Treatment Effectiveness • Odds Ratio • Odds recidivism in the treatment group divided by odds recidivism in the comparison group • 1.0 = No effect of treatment • Ratios lower than 1.0 indicate that treatment reduced recidivism • “When the recidivism base rate is low, the odds ratio approximates the rate ratio. For example, given a base rate of 10%, an odds ratio of .70 can be interpreted as follows: for every 100 untreated sex offenders who recidivate, only 70 treated sex offenders will recidivate.”

  28. Meta-Analysis • Fixed and Random Effects meta-analyses were calculated

  29. Results • 22 studies • 3,121 treated offenders and 3,625 offenders in the comparison groups. • Treated recidivism ranged from 1.1% to 33.3%, with an unweighted mean of 10.9%. • Comparison group recidivism ranged from 1.8% to 75.0%, with an unweighted mean of 19.2%

  30. There was more variability in treatment effect than would be expected by chance • Q = 47.17, df = 21, p < .001

  31. Effectiveness of treatment increased according to the total number of principles adhered to

  32. Treatment Effect by Application of Specific Principles • Risk Principle applied? • Yes  0.48 • No  0.72 • Need Principle • Yes  0.45 • No  0.86 • Responsivity • Yes  0.57 • No  1.05

  33. Understanding Risk

  34. Purpose of Risk Assessment • To understand the concept of Risk in RNR you have to see the context in which SO Risk Assessment was developed • Promoting public safety • by allowing scarce resources to be concentrated on those groups of offenders with higher recidivism rates • What kind of resources • Detention • Intensity of Treatment • Intensity of Community Management • Must be practical and cost-effective so can be applied to large numbers of offenders based on available information

  35. Type of Factors Considered • In the RNR model “Risk” relates to assessment based on static actuarial factors • Simple facts from the offenders’ history that are known to be statistically correlated with sexual recidivism • In practice this means that “Risk” reflects three kinds of predictor • Prior sexual offending • Prior general offending • Youth

  36. Youth Static Risk Sexual Criminality General Criminality

  37. Cox Regressions (Static-2002 Validation)(Data Set as Strata)

  38. History of Sexual Criminality relates specifically to future sexual recidivism and not to other kinds of outcome • History of General Criminality and Youth relate to sexual, non-sexually violent, and any recidivism

  39. It is important to register that Risk in the RNR model does not include all the factors that might influence recidivism • Nevertheless prediction based on this limited kind of assessment has been consistently shown to be able to divide offenders into groups that differ in their rates of recidivism • This is illustrated in the next few slides

  40. Source • Hanson, R.K., & Morton-Bourgon, K.E. (2009). The accuracy of recidivism risk assessments for sexual offenders: A meta-analysis of 118 prediction studies. Psychological Assessment, 21, 1-21.

  41. 1972-2008 (median 2004) • 151 documents; 110 studies; 118 samples • 37% published • Total n = 45,398 sexual offenders • 16 countries • Canada, US, UK, France, Netherlands, Germany, Denmark, Australia, Sweden, Austria, New Zealand, Belgium, Taiwan, Japan, Switzerland, Spain • English, French, Chinese, Spanish

  42. d “standardized mean difference” • How much are the recidivists different from the non-recidivists, in comparison to how much the recidivists and non-recidivists are different from each other. .20 small .50 medium .80 large

  43. Prediction of sexual recidivism

  44. Results for Commonly used measures (Sex Recidivism)

  45. The most commonly used Risk Assessment instrument is Static-99 • As you probably know you are now recommended to use the revised version of this instrument • Static-99R • I am going to detour slightly to describe the items of Static-99 and then look at how and why we got to the R version

  46. Male victims Ever Lived With Non-contact sex offences Unrelated victims Stranger victims Prior sex offences (3 points) Current non-sex violence Prior non-sex violence 4+ sentencing dates Age 18-24.99 STATIC-99

  47. Static-99 has become very widely used

  48. Risk InstrumentsU. S. Programs for Adult MalesMcGrath, Cumming, Burchard, Zeoli & Ellerby (2010). Safer Society Survey.