Assessment and Management of sexual risk

1. Assessment and Management of sexual risk • Keith Reid

2. references • Don Grubin’s review for the police on CSA • http://library.npia.police.uk/docs/hopolicers/fprs99.pdf • Downey and Friedman 2009 Psychiatry online • http://focus.psychiatryonline.org/cgi/content/full/7/4/435

3. My Aims • Reflect on sexual history for improvement • Demographics of sexual risk • Actuarial and Dynamic Risk concepts generally • specifically for sexual offending • Make a sensible referral • Statutory management (UK)

4. Your Aims • pass the exam (be a fluent, confident, generalist SpR) • have an interesting afternoon • not have a sexual homicide inquiry

5. content • Taking a sexual history • Demographics of sexual risk • Actuarial and Dynamic Risk concepts • compare and contrast two tools • Management • Quiz - based on areas of discussion

6. TAKING A SEXUAL HISTORY • What do you ask • Sexual elements of other history topics • “the sexual history” itself • Always ask - abuse, sexual function, major relationships, convictions

7. Downey + Friedmann sexual history schema

8. demographics of sexual risk • 60 to 70% of child molesters target only girls, about 20 to 33% boys, and about 10% children of either sex • 80% of offences taking place in the home of either the offender or victim • estimated that in only about 25 to 40% of offenders is there a recurrent and intense sexual attraction to children that would attract a label of “paedophilia”

9. demographics continued • Sex offenders against children have a rate of nonsexual criminal convictions only slightly greater than men in the population in general • Adolescent sex offenders probably account for up to a third of all sex crime • Less than 5% of sex offences against children are known to have been committed by women • The vast majority of sex offenders against children typically act alone

10. Demographics • a history of sexual abuse as a child is neither necessary nor sufficient to lead to adult sexual offending • About 20% of those who are convicted of sexual offences against children are reconvicted for similar offences • research published by the Home Office found that in 1993 over 100,000 individuals in the population had convictions for sexual offences against children (P. Marshall, 1997)

11. demographics • girls between the ages of 10 and 15 were at the highest risk of all females of being the reported victims of rape, with a rate of 59 cases per 100,000 girls in that age range. This compares with a rate of 58 cases per 100,000 for the next highest age band (16 to 24), and a rate of about 18 per 100,000 for females of all ages (HO, 1997) • a review of surveys carried out in 21 countries, including UK, Finkelhor (1994) found that seven to 36% of adult women , and three to 29% of adult men, reported being sexually abused as children.

12. demographics • Analysis of crime survey self-completion module showed that only 11 per cent of victims of serious sexual assault told the police about the incident (Smith et al., 2011)

13. actuarial and dynamic risk assessment • car insurance • treatment needs

14. compare and contrast two tools • RM-2000 • SARN • also be aware of Finkelhor’s model

15. Finkelhor 1984 • Precondition I — The perpetrator must be motivated to sexually abuse a child; • Precondition Il — The perpetrator must overcome internal inhibitions against such abuse; • Precondition Ill — The perpetrator must overcome external inhibitions to abuse; and • Precondition IV — The perpetrator must overcome the child's resistance.

16. management • biological • psychological • Sex Offender Treatment Programmes/ 1:1 /motivational interviewing • social • social specifically criminal justice/protection (UK)

17. Biological management • treat destabilising mental illness or PD • SSRIs for compulsive element • antilibidinal agents for hypersexuality • Leuprorelin injection GNrH receptor • Cyproterone testosterone blocker

18. a note on statute (UK) • determinate or indeterminate sentencing • licence • restriction orders • sex offenders register • sex offenders probation orders

19. True/false questions