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The use of psychological interventions for adult male sex offenders with a learning disability: a systematic review
Abstract
There is a drive to attend to the specific treatment needs of sexual offenders with a learning disability (LD) and increasing recognition of treatment limitations in this group. Cognitive behavioural therapy (CBT)-based sex offender treatment programmes (SOTPs) are being increasingly adapted for the LD population. This review systematically considers the evidence base for LD adapted CBT-based SOTPs. Ten studies together comprising 358 participants were reviewed. LD adapted SOTPs were conducted in prisons, secure settings and in the community. Within-treatment findings generally indicated positive cognitive shift, improvements in victim empathy and increased sexual knowledge on psychometric measures. Whilst findings are encouraging, many of the studies have methodological limitations. In particular, all studies used pre-test post-test study designs lacking control groups therefore restricting the evaluation of treatment outcomes. The LD sex offender literature remains underdeveloped and there is a strong case for further research to establish a valid evidence base for treatment.
... This chapter similarly examines the behavior of concern through a broad and practical conceptualization. While terms such as "sexual offending" are commonplace in the literature (e.g., Cohen & Harvey, 2016), this chapter uses the term "sexually abusive behaviour." Murphy et al. (2010) define sexually abusive behavior as: … any sexually related behaviour for which the other person was not consenting (or was unable to consent) and the behaviour would be defined as illegal within the jurisdiction in which it occurred. ...
... With a vast range of treatment approaches, both CBT and behaviorally orientated, it is not surprising that there have been several reviews on the effectiveness of treatments. In the past few years, there have been several systematic reviews examining the effectiveness of psychological treatment programs addressing "sexual offending" (Cohen & Harvey, 2016;Jones & Chaplin, 2017;Marotta, 2017;Patterson, 2018). The most comprehensive of these reviews was conducted by Marotta (2017), who reviewed 18 studies, conducted between 1994 and 2014, examining programs that aimed to address "problematic sexual behavior" in those with "developmental and intellectual disabilities." ...
... 175) but the significant methodological issues prevented any firm conclusion. Both Cohen and Harvey (2016) and Jones and Chaplin (2017), while examining overlapping studies, supported this finding and found treatment programs aimed at addressing sexual offending provided evidence of improved victim empathy and sexual knowledge, and reduced cognitive distortions. Examination of the studies being considered, especially those with greater methodological rigor, indicates that there appears a tendency for programs to adopt adapted relapseprevention approaches. ...
This chapter reviews the literature on the treatment of sexually abusive behavior with respect to both the general and cognitively disabled populations, and provides recommendations for a model of treatment and support for those with a disability. Developments in the psychological treatment of sexual offending in the general population has followed a path paralleling that of other psychological issues, transitioning from psychodynamic to behavior therapy and then cognitive-behavioral therapy (CBT). The literature and practice have become divergent, with a shift toward the use and evaluation of CBT in offender populations while studies of the general population appear to continue to employ behavioral interventions. The self-regulation model proposes pathways to offending. Offending may occur due to an inability to control behavior (underregulation), a desire to not offend but a use of ineffective strategies (misregulation), or a desire to offend in an individual whose self-regulation is intact but who has inappropriate goals
... It usually refers to individuals with an IQ quotient of below 70, and originates in childhood (American Psychological Association 2013). Within the research literature of individuals with intellectual disabilities, a common methodological flaw is that participants with an IQ score of between 70 and 80, indicating borderline intellectual disabilities, are recruited within the same sample (Cohen and Harvey 2016). However, studies will be included in this meta-analysis if participants had an IQ of below 80 and they were accessing learning disability services, as this is consistent with the existing literature. ...
... Most adapted programmes adopt similar treatment modules and methods to those used within Core SOTP (Cohen and Harvey 2016;Jones and Chaplin 2017;Marotta 2017;Lindsay et al. 2011) and therefore it is important to consider the treatment outcomes in relation to these programmes. ...
... There have been three recent systematic reviews examining the effectiveness of adapted SOTP for individuals with intellectual disabilities (Cohen and Harvey 2016;Jones and Chaplin 2017;Marotta 2017). Across the three reviews, 21 studies were identified which mainly incorporated CBT interventions adapted from mainstream SOTP. ...
Background
Data from sex offender treatment programmes (SOTP) on the re-offending of convicted sex offenders from the prison service in England and Wales was recently reviewed and found to be associated with no change in sexual reoffending. While this result is at variance with a number of other reviews it does give rise to concern as most programmes for individuals with intellectual disabilities adopt similar treatment methods. It is therefore important to consider the treatment outcomes for this client group by conducting a meta-analysis to examine treatment effects.
Method
A systematic search of PsychINFO, EMBASE, MEDLINE and CINAHL was conducted in February 2019 using specific inclusion and exclusion criteria. Eighteen papers were identified, and their quality was assessed using a risk of bias framework. Scores on cognitive distortions, sexual knowledge and victim empathy measures as well as reports of further sexually abusive behaviour were pooled together to run a meta-analysis which yielded effect sizes for each outcome.
Results
A large treatment effect was found for reducing cognitive distortions and increasing victim empathy, with a moderate effect found for improvements in sexual knowledge. This meta-analysis also found that 11.5% of individuals with intellectual disabilities who have completed these programmes will go on to display further sexually abusive behaviours.
Conclusions
The findings suggest that cognitive distortions are significantly reduced following treatment, there are also significant improvements in sexual knowledge and victim empathy. A rate of 11.5% for further reported sexually abusive behaviour during follow up periods was found, which is higher than the rate found for mainstream SOTP completers. Problems regarding the recording of sexually abusive behaviour are considered.
... Very few sites outside of prisons were permitted to run the programme and there was a dearth of treatment available in the community. Nevertheless, some reports of adapted CBT for such men have appeared, and according to four recent systematic reviews, there are promising results, but participant numbers are small and there is a distinct lack of controlled designs (Cohen & Harvey, 2016;Heppell et al., 2020;Jones & Chaplin, 2019;Marotta, 2017). ...
... Clearly there is a need for larger samples of men where regression analysis could be used to examine the impact of variables on further HSB. In addition, as a number of systematic reviews have concluded recently (Cohen & Harvey, 2016;Heppell et al., 2020;Jones & Chaplin, 2019;Marotta, 2017), it is time to undertake a proper randomized controlled trial. ...
Objectives
Men with intellectual disabilities and/or autism sometimes engage in harmful sexual behaviour (HSB), but it may be harder for them to access treatment, than it is for non‐disabled men. The aim of this study was to evaluate the effect of attending an adapted CBT group, known as SOTSEC‐ID, on men with intellectual disabilities and/or autism who had HSB.
Method
Ninety‐eight men from intellectual disability services, who had ID and/or autism and a history of HSB were recruited, and they received group CBT for a year (46 of these men have been previously reported). Harmful sexual behaviour, sexual knowledge, distorted cognitions and victim empathy were measured before and after treatment, and at 6 month follow‐up.
Results
There were low levels of further harmful sexual behaviour: 12% of men engaged in further HSB during the 1‐year period of the group, and 8% engaged in further HSB in the 6‐month follow‐up period. There were also significant improvements in sexual knowledge, distorted cognitions and victim empathy following treatment, maintained at 6‐month follow‐up. Men with autism showed significantly more non‐contact HSB, were less likely to have been interviewed by police and had higher rates of further HSB, compared to men without autism.
Conclusions
It is concluded that SOTSEC‐ID is a promising treatment for men with ID/autism and HSB. Nevertheless, the study had a number of limitations and lacked a control group, so there is now an urgent need for a proper controlled study.
... In the period 2019-2020, NHS England commissioned 1,042 secure hospital beds (high, medium and low) for adults with IDs (866, 83% for males); however, accurate data for the number of these beds occupied by those with known sexual offending risk is difficult to quantify. Over the past 15 years, increasing interest has been directed to the treatment and risk reduction of sexually harmful behaviour for individuals with ID, and recent literature reviews and summaries are offered by several authors (Cohen and Harvey, 2016;Marotta, 2017;Jones and Chaplin, 2017;Craig, 2020). The conclusion of these is that, whilst most studies in this area are small scale and lack methodological rigour, cognitive-behavioural-based approaches tend to demonstrate some positive effects in reducing recidivism and cognitive distortions and increasing sexual knowledge, self-esteem and a sense of agency. ...
... Of note, there were no observed significant improvements in distorted sexual attitudes, which is inconsistent with previously reported studies. Reviews of the literature by Marotta (2017), Cohen and Harvey (2016) and Jones and Chaplin (2017) have demonstrated that changes in attitudes consistent with sexual offending is a key treatment target and empirically supported factor associated with sexual offending. Whilst these have not been significantly ameliorated through the current BSOTP, there has been no further offending at follow-up. ...
Purpose
The purpose of this paper is to report on an inpatient cognitive behavioural sex offender treatment group programme developed and provided to people with intellectual disabilities detained in medium and low security hospital settings. The programme was delivered five times between 2012 and 2020. This paper describes the integration of the programme within a wider treatment pathway model and provides analysis of outcome data.
Design/methodology/approach
The programme was evaluated over five group programmes using self-report psychometric measures related to treatment targets in the reduction of sexual offending risk, including cognitive distortions, sexual attitudes and knowledge and locus of control; recidivism data spanning up to 7 years post discharge is also provided. The treatment pathway and a description of the programme are provided.
Findings
The results of this paper showed improvements in sexual knowledge, cognitive distortions and locus of control, however not to a statistically significant degree. No recidivism was observed in the follow-up period.
Originality/value
This paper adds to the evidence base of interventions focused on cognitive behavioural approaches to the treatment and risk reduction of sexual offending in men with intellectual disabilities and adds to the debate regarding the effectiveness of such programmes with offenders with intellectual disabilities.
... Evaluations of the effectiveness of psychological approaches in the treatment of sex offenders with intellectual disabilities tend to measure progress on several therapeutic outcomes, including victim empathy, sexual knowledge, changes in attitudes consistent with sex offending, cognitive distortions and problem sexual behaviours. However, there continue to be inconsistent findings in respect to reductions in sexual reoffending longer-term, leading the authors of three independent systematic reviews to conclude that there is currently limited evidence of the "effectiveness" of the programmes (Cohen and Harvey, 2016;Jones and Chaplin, 2017;Marotta, 2017). The literature in this field is assessed as underdeveloped, and these authors argue that there is a strong case for further research. ...
... Moreover, third, "desired behaviour change may be effected through cognitive change" (Dobson and Dozios, 2010, p. 4). CBT-based group programmes have first been used for offenders with IQ above 80 and then developed further to address the learning needs of those with IQ below 80 (Cohen and Harvey, 2016). Thus, there is nothing unusual about the Thurgau development of starting with a treatment that did not consider intellectual disabilities and then later expanding provision. ...
Purpose
The purpose of this paper is to provide a description of a Swiss outpatient group therapy for adolescent and young men with intellectual disabilities who have sexually offended.
Design/methodology/approach
The findings from two studies that examined the treatment independently from one another are brought together. These combine the qualitative methods of document analysis of programme tools, overt participant observations of treatment sessions and semi-structured interviews with programme designers.
Findings
At the heart of Forio treatment is a seven-step programme that aims to enable participants to increase their risk management capacities and foster pro-social behaviours. Responsivity issues are a key consideration, and the use of a traffic light system to distinguish acceptable, borderline and unacceptable behaviours provides a central reference point throughout treatment and beyond. Treatment relies on individuals practising newly learned pro-social behaviours in their daily life. To facilitate this, risks are managed, and support is provided via close networking between therapists and the supervision and social care network.
Practical implications
This paper offers detailed descriptions of the programme setting, structure and tools, which will allow international readers to adapt the techniques discussed to suit their specific treatment context. Particularly, the close networking between treatment providers and those managing risks in the community is commendable.
Originality/value
The Forio programme has not previously been described in English language papers. Even though it arises from the same evidence base as the internationally more widely known programmes, this paper offers unique insights into ways in which known concepts have been adapted to suit local circumstances.
... Very few sites outside of prisons were permitted to run the programme and there was a dearth of treatment available in the community. Nevertheless, some reports of adapted CBT for such men have appeared, and according to four recent systematic reviews, there are promising results, but participant numbers are small and there is a distinct lack of controlled designs (Cohen & Harvey, 2016;Heppell et al., 2020;Jones & Chaplin, 2019;Marotta, 2017). ...
... Clearly there is a need for larger samples of men where regression analysis could be used to examine the impact of variables on further HSB. In addition, as a number of systematic reviews have concluded recently (Cohen & Harvey, 2016;Heppell et al., 2020;Jones & Chaplin, 2019;Marotta, 2017), it is time to undertake a proper randomized controlled trial. ...
IntroductionPrevalenceCharacteristicsTreatmentThe SOTSEC-ID Model: PurposeThe SOTSEC-ID Model: Definitions and AssessmentThe SOTSEC-ID Model: TreatmentDiscussion
... Hanson et al. 2002;Schmucker and Lösel 2015) or clients with IDD (e.g. Cohen and Harvey 2016;Marotta 2017) -has shown a small but significant decrease in rates of reoffending for those who complete treatment. Theoretically, that would mean that waiting until sentence completion to offer treatment and then using SOCC on the back end may not be a reasonable expenditure of public funds. ...
... Since the Courtney and Rose review there have been three systematic reviews (Cohen & Harvey, 2016;Jones & Chaplin;2017;Marotta, 2017). The first of these was a review of 10 studies, published between 2006 and 2013, in relation to men with ID who received adapted group CBT-based interventions in either community or secure settings, including prisons. ...
Learning outcomes 1) To understand the relationship between intellectual disabilities and offending behaviour with reference to historical, policy and legal contexts. 2) To be able to identify adapted strategies for the assessment and formulation of offending behaviour by people with intellectual disabilities. 3) To be aware of and appreciate the use of evidence-based interventions to address different types of offending behaviour by people with intellectual disabilities. 21.
... An effective intervention follows the principles of Risk-Need-Responsivity (RNR) as determined for each individual (Andrews & Bonta, 2010). While the RNR approach is widely accepted as best practice in the treatment of adult sex offenders, to date it has not explicitly identified grooming behaviors as a "risk behavior" (see Cohen & Harvey, 2016;Hanson & Morton-Bourgon, 2005;Schwartz, 2012). ...
Grooming is a process whereby an individual who plans to commit a sexual crime uses deception with the victim as well as the people in the environment (such as the victim’s family members, the offender’s family, etc.) so that the crime goes undetected. Despite the overwhelming presence of grooming in sexual crimes, there is a dearth of research on sex offenders’ perceptions of their own grooming behaviors. This paper describes the psychometrics and lessons learned in the pilot study of testing and revising a new instrument for measuring sex offenders’ perceptions of their grooming behaviors (Sex Offenders Grooming Assessment; SOGA), with a sample (n = 50) of convicted male sex offenders in community based specialized therapy. Analyses suggest that using behaviorally-specific questions yielded more reliable results than general categorical grooming questions. Understanding how sex offenders perceive and report their grooming behavior provides valuable insight critical to treatment and assessment.
... Until recently the use of these groups for people with learning disabilities and autistic people has been common in many services, and a number of evaluations have suggested they do have a positive impact in reducing the risk posed by people who display harmful sexual behaviour who have learning disabilities (e.g. Cohen & Harvey, 2016;Marotta, 2017). The interventions were originally based on SOTP designed for non-disabled individuals and recent evaluations have suggested that similar interventions in the prison service may be ineffective (Mews, DiBella & Purver, 2017). ...
... The research methodology within this area has been found to be poor, with no randomised control studies and short follow up times to assess recidivism (Marotta, 2017). Nevertheless, systematic reviews focussing on therapeutic changes have found reductions in cognitive distortions on attitudes towards sexual offending and an increase in victim empathy and sexual knowledge following adapted sex offender treatment programmes, using cognitive behaviour therapy approaches (Cohen and Harvey, 2016;Jones and Chaplin, 2017). ...
Purpose
There is a national drive to transform services for individuals with intellectual disabilities (ID), to provide care within the community rather than hospital settings. However, there are limited community provisions for those with more complex care needs such as sexual offending. There has been limited research focussing on this client group’s experiences of inpatient services and the treatment they have received from their own perspective. This study aims to explore their experiences of living in a secure service focussing on treatment for sex offences.
Design/methodology/approach
In total, 10 men with ID and sexual offending histories took part in an interview designed to explore their experiences of living within a secure hospital setting. The data were analysed using thematic analysis.
Findings
Three key themes relating to the participants’ experiences within the hospital were identified. These were, namely, “hospital environment”, “personal journey through secure services” and “closeness to home”.
Practical implications
Men’s experiences at a secure hospital were generally positive in terms of a supportive staff approach. Difficulties existed around the hospital organisation affecting the support they received.
Originality/value
Some participants experienced a struggle to become more independent and move to less restrictive environments due to their perceived risk levels. Some participants found being away from home to be hard and longed to be closer to their families. Around half of the participants did not want to live near their hometown due to family difficulties, negative peer influences or fears of consequences for their sexual offending. Implications for community service planning are considered.
... Counseling Sexually Abused Children: Lessons from Ghana and Though some victims feel less threatened by their disclosure to the police the same sense of lack of security prevents detailed disclosure and hinders recovery. This finding corroborates conclusion drawn by [30] that distrust of, and poor experience with, state authorities and public services contributed to individuals abused not seeking help. ...
The scourge of child sexual abuse has been on the increase world over, Ghana and Zambia inclusive with millions of children being sexually abused every year at a global prevalence rate of 34.4%. Using the qualitative narrative approach, the interview guide was used to gather data purposively from 112 participants made up of 40 Domestic Violence and Victims Support Unit officers, 32 parents and 40 victims aged 8–17 years who reported their abuse at 15 police stations across Central Region and Lusaka Province of Ghana and Zambia respectively. Data were thematically analyzed. The study found among others that children in both countries received safety nets and pieces of advice on legal and medical procedures. It also found that some victims expressed happiness at their abuses being reported and heard. However, lack of professional counseling training and power imbalances inhibit the police officers’ efforts. The study concludes that though officers use some skills and provide a kind of trauma counseling more is needed in the areas of individual and group therapy for comprehensive and effective counseling. Skills such as encouragement, assertiveness, and re-assurance can lead to disclosure, prevent future sexual abuse, reduce anxiety and fear, promote healing and empowerment. When children receive adequate counseling immediately after abuse they do immediate damage repair both of their psychological and social “self”. The study recommends training in counseling for the officers in both countries for effective counseling of abused individuals. Additionally, officers should be linked with professional counsellors at universities to refer abuse cases for treatment.
... The main weaknesses of the reports discussed above are that they are small, uncontrolled, and have short follow-up times (for reviews, see Cohen & Harvey, 2015;Jones & Chaplin, 2017;Morratto, 2015). It is also possible that adapted-CBT programs used with sexual offenders with IDND, like the mainstream-CBT program Core-SOTP that has now been withdrawn, are actually increasing offending. ...
In this chapter, we review assessment, treatment, risk management, and service delivery as it applies to male sexual offenders with intellectual and neurodevelopmental disabilities. Treatment relapse is discussed from the perspective of recent research showing that relapse is related to the context in which the behavior is reinforced. The chapter discusses the applied behavior analysis (ABA)-based multicomponent behavioral treatment (MCBT) that we have developed in our residential program over the last 10 years. Further, we review case studies on the young people that we have supported and have been able to follow-up since their discharge from the program. The case studies highlight the need for all agencies to work together effectively to keep everyone safe and that for some clients, current time-limited, “treat and hope” programs are not always successful in the long term. The chapter concludes with legal and ethical issues faced by behavior analysts and suggestions for future research.
... In order to address issues faced by criminal offenders with mental illness, mental health providers in the forensic and/or correctional setting tend to rely upon highly structured, cognitive behaviorally informed treatment modalities (e.g., Campbell et al., 2016;Cohen & Harvey, 2016;Gannon et al., 2015;Lanza, Garcia, Lamelas, & González-Menéndez, 2014;Needham et al., 2015;Zlotnick, Johnson, & Najavits, 2009;Zlotnick, Najavits, Rohsenow, & Johnson, 2003). In fact, an overwhelming number of correctional psychologists identify as cognitive-behavioral practitioners (Bewely & Morgan, 2011;Boothby & Clements, 2000), yet these numbers may actually reflect the nature of the setting, rather than practitioner preference. ...
... Since the Courtney and Rose review there have been three systematic reviews: Cohen and Harvey (2016), Chaplin, 2017, andMarotta, 2017. The first of these conducted a systematic review of 10 studies, published between 2006 and 2013, that involved 358 men with ID/borderline ID and harmful sexual behaviour who received adapted group CBT-based Chapter 13 Sex Offender Treatment 25 interventions in either community or secure settings, including prisons (Cohen and Harvey, 2016). Across the studies there was evidence of pre-to post-treatment improvements on measures of sexual knowledge, victim empathy and cognitive distortions that were generally maintained at follow-up. ...
In this chapter the development of psychological interventions over the last 25‐30 years for men with intellectual and developmental disabilities (IDD) who display sexually offensive, inappropriate and harmful sexual behaviours is described. Difficulties with methodology, terminology and diagnostic inclusion/exclusion criteria in this filed are outlined. Early behavioural approaches to intervention and their limitations are briefly reviewed. The key components of manual‐guided cognitive‐behavioural interventions for harmful sexual behaviours are described in some detail. Finally, the emerging evidence base (and its limitations) to support the use of cognitive‐behavioural interventions for men with IDD who engage in these behaviours is discussed.
... The representation of men with intellectual disabilities within the established body of literature often focuses on them as victims of sexual abuse, vulnerable and open to exploitation (Cambridge, Beadle-Brown, Milne, Mansell, & Whelton, 2011). Another perspective emerging from the body of evidence, presents offending behaviours, some of which are sexual in nature and the available treatment options and interventions (Cohen & Harvey, 2016;Fisher et al., 2016). For some men, there are missed opportunities to fully explore and realise their sexuality and sexual potential and to experience intimate relationships (Wilkinson et al., 2015;Wilson & Plumber, 2014). ...
Abstract
Background
There is a growing and evolving research evidence base regarding sexuality issues and adults with intellectual disabilities. Individuals can face challenges, including the right to express their sexuality and to access necessary education and supports.
Aims
This systematic review explores sexuality experiences, the views and opinions of adults with intellectual disabilities and highlights areas for future practice developments.
Methods and procedures
A comprehensive search of relevant databases from January 2006 to December 2016 was carried out. Included studies had to address specific criteria including: peer reviewed papers, the use of appropriate research methods, and focused exclusively on the individual views and opinions of people with an intellectual disability. The search of relevant databases yielded 230 hits. Following the application of explicit inclusion and exclusion criteria, 23 papers were deemed suitable for the review.
Outcomes and results
The data were analysed and key themes were identified that included: autonomy v’s risk of harm, knowledge and sexuality, relationships and intimacy, self-determination and taking control, and encouragement and supports.
Conclusions and implications
Adults with intellectual disabilities need education and support to express their sexuality and to meet individual needs.
... Search strategy Electronic searching. The search strategy was refined using published search filters [35][36][37] and reviewed prior to searching by a professional medical librarian. Databases searched were as follows: MEDLINE, PsycINFO and Embase via OvidSP and CINAHL via EBSCO. ...
Background
Death anxiety is a common issue in adult patients with advanced cancer and can have a large impact on quality of life and end-of-life care. Interventions are available to assist but are scarcely used in everyday practice.
Aim
To assess quantitative studies on interventions for adult patients with advanced cancer suffering from death anxiety.
Data sources
MEDLINE, PsycINFO, Embase and CINAHL were searched to identify quantitative or mixed studies on death anxiety or relatable existential intervention studies in advanced cancer patients published from 1990 to December 2016. Two reviewers independently screened titles and abstracts and assessed relevant studies for eligibility. Data were then extracted from included studies for analysis.
Results
Nine unique quantitative studies were identified, including five randomised controlled trials, involving a total overall of 1179 advanced cancer patients. All studies were psychotherapeutic in nature and centred on existential themes such as meaning, dignity, relationships and spiritual well-being. The therapies investigated shared overlapping themes but varied in duration, therapist experience, training required and burden on patient. Heterogeneity of studies and measures prevented determination of an overall effect size.
Conclusion
Interventions were identified for this clinical scenario of death anxiety in patients with advanced cancer. Therapies of short duration incorporating spiritual well-being and those evoking a sense of meaning were claimed to be the most beneficial, despite lacking rigorous statistical analysis. More high-quality studies with tailored outcome measures are required to fully evaluate the most effective interventions for death anxiety in patients with advanced cancer.
... In order to address issues faced by criminal offenders with mental illness, mental health providers in the forensic and/or correctional setting tend to rely upon highly structured, cognitive behaviorally informed treatment modalities (e.g., Campbell et al., 2016;Cohen & Harvey, 2016;Gannon et al., 2015;Lanza, Garcia, Lamelas, & González-Menéndez, 2014;Needham et al., 2015;Zlotnick, Johnson, & Najavits, 2009;Zlotnick, Najavits, Rohsenow, & Johnson, 2003). In fact, an overwhelming number of correctional psychologists identify as cognitive-behavioral practitioners ( Bewely & Morgan, 2011;Boothby & Clements, 2000), yet these numbers may actually reflect the nature of the setting, rather than practitioner preference. ...
In recent years, prisons and jails have become de facto psychiatric hospitals, responsible for the care and treatment of individuals with serious mental illness. Historically, cognitive-behaviorally informed therapeutic approaches have been the treatment of choice among mental health practitioners in correctional settings. However, inmate-clients often present with complex diagnostic issues that are arguably better served by long-term treatment options, such as psychodynamic psychotherapy. We first review the nature of psychotherapy in the correctional setting, as well as treatment barriers and challenges faced by both mental health providers and inmate-clients. We then review treatment studies that examine the efficacy of various therapeutic techniques in correctional/forensic contexts. Finally, we argue that, due to the complex nature of psychopathology, average length of time incarcerated, and treatment issues that arise in this multifaceted and challenging setting, mental health treatment providers should consider providing psychodynamic treatment modalities when working with incarcerated individuals. We also argue that more research is needed to examine the efficacy of these treatment approaches with inmate-clients.
There is an overrepresentation of people with intellectual disabilities in prison. People with learning disabilities face inequalities in the support provided in prison and throughout the Criminal Justice System and are therefore at a disadvantage compared to the general population. This chapter will commence with definitions of intellectual disabilities and the changes in these definitions due to changing legislation and policy, which is partially due to the changing societal attitudes towards people with intellectual disabilities. The use of different terminology will then be considered both in relation to international differences and variations in UK health and criminal justice service provision. Common physical and mental health comorbidities of people with intellectual disabilities will be discussed due to the inequalities in health outcomes compared with the general population. Then, presenting issues in the identification of prisoners with intellectual disabilities through screening and assessment will be examined. Finally, availability and provision of programmes and support for prisoners with intellectual disabilities will be presented, including the role of the learning disability nurse.KeywordsLearning disabilitiesIntellectual disabilitiesHealth inequalitiesPrison nurseScreening and assessmentScreening for cognitive declinePrison officersCase studies
Offending behaviour and intellectual and developmental disabilities have long been associated in the literature. This misattribution has had a significant impact on the development of services for this population. In this chapter, the relationship between intellectual disability, autism spectrum disorder and offending behaviour is described along with the impact on the care and treatment of people in this population. Developments in clinical interventions for sexual aggression, violent behaviour, firesetting and alcohol-related crime are outlined. Over the last 25 years there have been significant developments in clinical assessment and treatment approaches for people with intellectual disabilities who offend or are at risk of offending behaviour. However, more rigorous and larger scale research is required to support further advances.
In the decade since the publication of the first edition of The Cambridge Handbook of Forensic Psychology, the field has expanded into areas such as social work and education, while maintaining the interest of criminal justice researchers and policy makers. This new edition provides cutting-edge and comprehensive coverage of the key theoretical perspectives, assessment methods, and interventions in forensic psychology. The chapters address substantive topics such as acquisitive crime, domestic violence, mass murder, and sexual violence, while also exploring emerging areas of research such as the expansion of cybercrime, particularly child sexual exploitation, as well as aspects of terrorism and radicalisation. Reflecting the global reach of forensic psychology and its wide range of perspectives, the international team of contributors emphasise diversity and cross-reference between adults, adolescents, and children to deliver a contemporary picture of the discipline.
Offending behaviour and intellectual disabilities have long been associated in the literature. This erroneous linkage has had a significant influence on the development of services for this population. In this chapter, the relationship between intellectual disability and offending behaviour is outlined, along with legislative and criminal justice system issues that have impact on this client group. The historical and current policy context is described before the prevalence of offending and recidivism in this population is considered. Developments in risk assessment and clinical interventions for anger aggression, sexually harmful behavior and firesetting are briefly reviewed. Although over the last 20 years there have been significant developments in policy, service design, clinical assessment and treatment approaches for people with intellectual disabilities who offend or are at risk of offending, more rigorous and larger scale research is required to support further advances.
Sexual violence in close relationships is a serious social problem and we lack knowledge about the effect of treatment measures for perpetrators. The objective of this systematic
review was to examine the effect of treatments for persons who commit sexual violence in close relationships. We searched for randomized and non-randomized controlled trials in research databases. We screened the references, extracted data and analysed studies that met our inclusion criteria. We included three randomised trials and five non-randomized studies, which examined eight different interventions.
The main findings when it comes to new acts of sexual violence are:
• Multisystemic therapy may result in a slight reduction compared to cognitive behavioural group therapy.
• There is probably little to no difference between group cognitive behavioural therapy and mindfulness-based stress reduction
• There is probably little to no difference between pretrial diversion and no treatment.
• It is uncertain whether the Duluth model, specialist community-based treatment, Stichting Ambulante Prevention and group-based outpatient treatment have an
effect compared to no treatment.
We assessed the certainty of the evidence for these results as low or very low. The current evidence base is too limited to determine the effect of treatments for perpetrators of sexual violence in close relationships.
Individuals with fetal alcohol spectrum disorder (FASD), a neurodevelopmental disorder caused by prenatal exposure to alcohol, are overrepresented in criminal justice settings and have complex, forensically relevant clinical needs. This study surveyed 81 forensic clinicians recruited via international professional association listserv postings and social media about their assessment and intervention practices in providing services to clients with FASD and other neurodevelopmental disorders (NDDs), along with their training experiences and needs in this area. Results indicated that the majority of clinicians had forensic experience working with clients who had FASD and other NDDs, although most identified limited relevant training experiences, gaps in their readiness for service provision, and practice barriers in effectively working with these populations. Clinicians also reported seeing fewer clients with FASD relative to other NDDs, and feeling less prepared for forensic practice with this population. Most clinicians endorsed the need for additional training and supports to increase their competency and enhance their practice, such as the development of screening tools, clinical guidelines, and access to experts or specialists for consultation. As awareness about FASD continues to grow in legal contexts, additional research, training, and policy consideration is required to develop and implement evidence-based practice resources for forensic clinicians.
Occasionally, men with intellectual and/or developmental disabilities (IDD) engage in harmful sexual behaviour (HSB). Such behaviour is not always reported to the police but when it does come to their notice, men with IDD may be charged and may be convicted of having committed sexual offences. Some will receive community-based sentences or Mental Health Act disposals, and others may end up in prison. These two disposals seem to largely determine the type of treatment men receive, with some intervention programmes having been developed by health settings and some by prisons. This chapter examines what we know about men with IDD who engage in harmful sexual behaviour, both in terms of their characteristics and the effectiveness of interventions. The different approaches in prison and community settings are considered and the ways ahead examined.
Programmes for men with learning disability and learning challenges (LDC), who have committed sexual offences, have been available within Her Majesty’s Prison and Probation Service (HMPPS) since 1997 (Williams & Mann, 2010). The evidence base on what works in reducing sexual re-offending has developed (Mann & Carter, 2012); however, the evidence for people with LDC is still in its infancy (Cohen & Harvey, 2016). In 2016, HMPPS sexual offending behaviour programmes for people with LDC were redesigned and re-accredited in 2017. Drawing on the experience of one of the programme developers, this chapter will outline the evidence-based development of the programmes, with focus on strengthening responsivity for people with LDC.
This chapter reviews the literature on the treatment of sexually abusive behavior with respect to both the general and cognitively disabled populations, and provides recommendations for a model of treatment and support for those with a disability. Developments in the psychological treatment of sexual offending in the general population has followed a path paralleling that of other psychological issues, transitioning from psychodynamic to behavior therapy and then cognitive‐behavioral therapy (CBT). The literature and practice have become divergent, with a shift toward the use and evaluation of CBT in offender populations while studies of the general population appear to continue to employ behavioral interventions. The self‐regulation model proposes pathways to offending. Offending may occur due to an inability to control behavior (underregulation), a desire to not offend but a use of ineffective strategies (misregulation), or a desire to offend in an individual whose self‐regulation is intact but who has inappropriate goals.
Purpose of Review
To review non-behavioral and non-medical psychosocial therapies for individuals with intellectual disabilities to identify if any such approaches are effective.
Recent Findings
There are more randomized controlled trials (RCTs), systematic reviews, and meta-analyses than in the past; however, most RCTs are of poor quality.
Summary
Most research treatments such as cognitive behavior therapy and diagnoses such as depression and anger. There is limited research on other forms of psychotherapy and other diagnoses. Future research needs to include high quality RCTs of psychosocial treatments for common, socially significant problems.
Aims: Offending behaviour in adolescents with autism spectrum conditions (ASC) is rare. However, some theoretical links have been drawn between sexual offending and autism-typical deficits. Although research in this area is scarce, case-studies have begun to evaluate the impact of treatments for juvenile sexual offenders with ASC. This review aimed to summarise the available treatments for this group and their impact on young people (YP).
Methods: A systematic literature review was conducted. Six online data-bases were searched for studies detailing interventions with adolescent sexual offenders with ASC.
Results: Six case-studies were reviewed. Interventions consisted of detailed assessments, staff training, peer support, medication, and adapted cognitive-behavioural therapy. One case-study used narrative techniques. Only two studies reported on objective and measurable treatment effects whilst the remainder relied solely on anecdotal evidence. Studies presenting quantitative data found a decrease in sexual arousal, absconding, sexually harmful/inappropriate behaviour, and masturbation to deviant fantasies. Anecdotal evidence pointed to increased insight, flexibility, ability to open-up, and reintegration. The overall quality of studies was low with one exception. Research and clinical implications are discussed.
Conclusions: Whilst some benefitted from the currently used treatment options, results cannot be generalised due to methodological flaws.
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, un-weighted 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.
The psychological assessment and treatment of male sex offenders has been of increasing interest in recent years, and a substantial literature, primarily cognitive-behavioural in orientation, now exists. However, there is little information about the application of this literature to men with mild learning disabilities (previously known as mild 'mental handicap 7, who have impaired intellectual and social functioning and are at increased risk of additional dzficulties. This paper uses the cognitive-behavioural approach as a framework for presenting preliminary guidance on the assessment and treatment of men with mild learning disabilities. It should be emphasized that, at present, almost nothing is known about the outcome of attempts to intervene in the sex offending of this population.
The development of an adequate assessment instrument is a necessary prerequisite for social psychological research on loneliness. Two studies provide methodological refinement in the measurement of loneliness. Study 1 presents a revised version of the self-report UCLA (University of California, Los Angeles) Loneliness Scale, designed to counter the possible effects of response bias in the original scale, and reports concurrent validity evidence for the revised measure. Study 2 demonstrates that although loneliness is correlated with measures of negative affect, social risk taking, and affiliative tendencies, it is nonetheless a distinct psychological experience.
Although sex offender treatment is an established clinical specialty, evidence regarding its effectiveness has been slow to accumulate. One ongoing treatment outcome study, California's Sex offender Treatment and Evaluation Project (SOTEP), is used to highlight several problems that are inherent in this type of research, and to illustrate that even well-designed studies make only a limited contribution to our empirical database on treatment effectiveness. SOTEP findings are also used to show that the broad question, “Does sex offender treatment work?” needs to be broken down into a number of more specific and useful questions. Given the diversity of clients and programs in this field, outcome data are from a wide range of treatment programs that vary in approach, setting, intensity, and types of offenders treated. Program managers and clinicians are urged to evaluate the impact of their services in order to contribute to our knowledge base on treatment effectiveness.
Despite the development of programmes to address sexual offending behaviour in offenders with cognitive and social functioning deficits, there is a lack of available psychometric tools specifically designed for this group (W. R. Lindsay, Journal of Intellectual Disability Research, 46, 74–85, 2002). This study firstly examines the psychometric properties of six assessment measures, which were specifically adapted for the lower functioning offender from existing sexual offender assessments. A group of 211 men who had undertaken HM Prison Service's Adapted Sex Offender Treatment Programme (ASOTP) were used in this study. The assessments were found to have reasonable psychometric properties as determined by internal consistency and factor analyses. The second part of the study was an exploration of treatment change. Significant pre- to post-treatment change was found on five of the measures. However, the lack of a comparison group makes it difficult to draw firm conclusions about treatment change. Further evidence is also required to determine the link between self-report assessments and recidivism.
Background. A variety of research designs have been employed to explore the efficacy of the wide range of interventions for sex offenders with learning disabilities. This paper reviews these studies to consider the efficacy of such treatments. Methods. Computerized searches and less formal literature gathering led to the identification of 31 studies that reported outcome. Results. Many of the studies are methodologically flawed through failure to use a control group, small sample size, variations in inclusion criteria and definitions of learning disabilities and sexual offending, and lack of standardized outcome measures. Some credible studies have found better and more durable attitudinal change with treatment lasting at least two years. Conclusion. It is suggested that this area of work has still to establish a rigorous evidence base. The review concludes with some suggestions for future research and a consideration of the continued importance of this research.
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.
The psychological assessment and treatment of male sex offenders has been of increasing interest in recent years, and a substantial literature, primarily cognitive-behavioural in orientation, now exists. However, there is little information about the application of this literature to men with mild learning disabilities (previously known as mild ‘mental handicap’), who have impaired intellectual and social functioning and are at increased risk of additional difficulties. This paper uses the cognitive-behavioural approach as a framework for presenting preliminary guidance on the assessment and treatment of men with mild learning disabilities. It should be emphasized that, at present, almost nothing is known about the outcome of attempts to intervene in the sex offending of this population.
Purpose
– This paper aims to provide a rationale for the development of a community‐based group for men with intellectual disability who have been involved in sexually inappropriate behaviour but may not have been charged.
Design/methodology/approach
– The group was based on a cognitive behavioural model: group process and adaptations are briefly described. The group has been run on two occasions and preliminary data on outcome are provided.
Findings
– Participants show a reduction in attitudes consistent with offending, an increase in sexual knowledge, and a more external locus of control on completion of the group. One of the 12 men who attended was recorded as offending again within 18 months of group completion; however, three moved to less well supervised placements.
Originality/value
– It is concluded that this style of treatment has some advantages over other models and may be more effective, yet further research is required.
The authors wish to thank the Northamptonshire Probation Service for supporting this research.
Authors note: The opinions and conclusions stated in this paper are those of the authors only and do not represent the views of the National Probation Service or Her Majesty's Prison Service.
Declaration of conflicting interests: The author(s) declared no conflicts of interests with respect to the authorship and/or publication of this article. The author(s) received no financial support for the research and/or authorship of this article.
Purpose
This paper seeks to describe the introduction of a component designed to enhance empathy, to an established cognitive behavioural treatment program for sexual offenders with an intellectual disability.
Design/methodology/approach
The treatment group received an empathy component and was compared with a control group. Therapeutic efficacy was assessed pre‐ and post‐treatment and at follow‐up using the interpersonal reactivity index which assesses fantasy; perspective taking; empathic concern and personal distress experienced due to others' misfortune.
Findings
There were no significant differences between treatment and control groups at baseline. For the treatment group, significant differences were identified between pre, post and three‐month follow‐up assessments indicating an increased empathy at post‐treatment assessment, the treatment group had significantly improved over the controls.
Research limitations/implications
Future research could compare empathy measures and investigate specifically the relationship between what is taught in empathy programs and what is measured by empathy assessments. Difficulties with the study are discussed.
Originality/value
The empathy component appears to enhance empathic responses.
How would a good lives model of sex offender treatment differ from a risk-need model? In the good lives model, risk factors are viewed as obstacles that erode individuals' capacities to live more fulfilling lives. The therapeutic focus is thus on implementing offenders' good lives plans rather than simply managing risk. To develop our argument, we first outline the risk-need approach and briefly comment on its core assumptions. We then present the good lives model and discuss the clinical utility of an integrated approach by way of a case example. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Intellectual disability services in the UK have frequently provided services to people who offend or engage in behaviours that would have resulted in convictions if the individuals did not have intellectual disabilities. This project aimed to get a clearer idea of the numbers of individuals with an intellectual disability who offend and live in a single health district or were originally resident but have been placed outside the district. This was done with a view to developing and reorganising services. An audit was conducted using case notes and registers in the intellectual disability service, including information from health and social services, the private and voluntary sector. Forty-seven people were identified who met the criteria for inclusion. Of these, 23 were sex offenders , 10 individuals presented with violent behaviour, 6 were fire setters, 4 were involved with theft or burglary, 2 were involved in property destruction and 2 with other behaviours. Nine of the individuals were currently living out of district, including five that were in secure units. While the needs of this group are diverse, a number of suggestions are made for developing services by both commissioning new services and reorganising existing services.
Purpose. The rate of sexual reconviction for sexual offenders is known to be low. Sexual reconviction, however, is currently the most commonly used outcome measure in sex offender treatment evaluation studies. It is expected that sex offender treatment programmes will reduce the likelihood of reconviction amongst participants. A low base rate of sexual reconviction means that any reduction in reconviction (which could be attributed to treatment) will be small and unlikely to be statistically significant. This study aimed to assess other offence‐related outcomes for sexual offenders, in addition to reconviction.
Methods. The sample comprised 173 sexual offenders who had completed a community sex offender treatment programme. Follow‐up information was collected forthe sample from programme files containing multi‐agency information. Official reconviction rates were also calculated using both Home Office and police data.
Results. Collecting evidence of any offence‐related sexual behaviour during this study multiplied the sample's sexual reconviction rate by a factor of 5.3.
Conclusions. The results show that broadening the outcome measure under observation indicates a higher level of offence‐related sexual behaviour displayed by sexual offenders than reflected by reconviction data. These results have implications for the outcomes measured in treatment evaluation research for sexual offenders.
The failure of offenders to complete psychological treatment can pose significant concerns, including increased risk for recidivism. Although a large literature identifying predictors of offender treatment attrition has accumulated, there has yet to be a comprehensive quantitative review.
A meta-analysis of the offender treatment literature was conducted to identify predictors of offender treatment attrition and examine its relationship to recidivism. The review covered 114 studies representing 41,438 offenders. Sex offender and domestic violence programs were also examined separately given their large independent literatures.
The overall attrition rate was 27.1% across all programs (k = 96), 27.6% from sex offender programs (k = 34), and 37.8% from domestic violence programs (k = 35). Rates increased when preprogram attrition was considered. Significant predictors included demographic characteristics (e.g., age, rw = -.10), criminal history and personality variables (e.g., prior offenses, rw = .14; antisocial personality, rw = .14), psychological concerns (e.g., intelligence, rw = -.14), risk assessment measures (e.g., Statistical Information on Recidivism scale, rw =.18), and treatment-related attitudes and behaviors (e.g., motivation, rw = -.13). Results indicated that treatment noncompleters were higher risk offenders and attrition from all programs significantly predicted several recidivism outcomes ranging from rw = .08 to .23.
The clients who stand to benefit the most from treatment (i.e., high-risk, high-needs) are the least likely to complete it. Offender treatment attrition can be managed and clients can be retained through an awareness of, and attention to, key predictors of attrition and adherence to responsivity considerations.
Thesis--University of Texas at Austin. Vita. Includes bibliographical references (leaves 209-219).
In order to assess a criminal suspect's ability to make a reliable statement, performance on three measures--interrogative suggestibility, confabulation and acquiescence--may be used. This paper presents preliminary data on these measures for people with mild learning disabilities (Full Scale IQ [FSIQ]: 57-75). It was found that they were more suggestible than their average ability counterparts (FSIQ: 83-111) because they were much more susceptible to 'leading questions'. They also confabulated more and were more acquiescent. Overall, the data emphasized their potential vulnerability to giving erroneous testimony during interrogations.
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.
To facilitate a multidimensional approach to empathy the Interpersonal Reactivity Index (IRI) includes 4 subscales: Perspective-Taking (PT) Fantasy (FS) Empathic Concern (EC) and Personal Distress (PD). The aim of the present study was to establish the convergent and discriminant validity of these 4 subscales. Hypothesized relationships among the IRI subscales between the subscales and measures of other psychological constructs (social functioning self-esteem emotionality and sensitivity to others) and between the subscales and extant empathy measures were examined. Study subjects included 677 male and 667 female students enrolled in undergraduate psychology classes at the University of Texas. The IRI scales not only exhibited the predicted relationships among themselves but also were related in the expected manner to other measures. Higher PT scores were consistently associated with better social functioning and higher self-esteem; in contrast Fantasy scores were unrelated to these 2 characteristics. High EC scores were positively associated with shyness and anxiety but negatively linked to egotism. The most substantial relationships in the study involved the PD scale. PD scores were strongly linked with low self-esteem and poor interpersonal functioning as well as a constellation of vulnerability uncertainty and fearfulness. These findings support a multidimensional approach to empathy by providing evidence that the 4 qualities tapped by the IRI are indeed separate constructs each related in specific ways to other psychological measures.
IntroductionCognitive DistortionsVictim EmpathyRelapse PreventionTreatment Style and Therapy ProcessRisk and Need Assessment and Treatment PlanningRecommended Content for a Comprehensive Programme for Sexual OffendersFuture Directions?
Background For non‐disabled men, group cognitive‐behaviour therapy is a successful form of treatment when men have committed sexual offences. However, men with intellectual disabilities and sexually abusive behaviour are rarely offered treatment for their sexual behaviour and little research data on the effectiveness of such treatment has been collected.
Method Nine collaborating sites ran 13, 1‐year long cognitive‐behavioural treatment groups for men with intellectual disabilities and sexually abusive behaviour. The men came from both community and secure provision and were assessed for sexual knowledge, victim empathy and cognitive distortions before and after the group treatment. Treatment was guided by a common treatment manual.
Results Forty‐six men consented to take part in the research. Most men (83%) had engaged in more than one incident of sexually abusive behaviour but only 57% of the men who came for treatment were required by law to attend. Almost all the men (92%) who began treatment (and consented to take part in the research) completed treatment 1 year later, indicating considerable motivation amongst the men to get treatment for their difficulties. Over the period of treatment, the men showed statistically significant increases in sexual knowledge and victim empathy, as well as reductions in cognitive distortions. These changes were still significant at 6‐month follow‐up for sexual knowledge and cognitive distortions. Few men showed further sexually abusive behaviour during the 1‐year period when they were attending treatment (three men) or during the 6‐month follow‐up period (four men). Only the presence of autistic spectrum disorders appeared to be related to re‐offending (though this result should be treated with caution, given the small numbers who re‐offended).
Conclusions This large treatment trial provides some evidence of the effectiveness of such treatment for men with intellectual disabilities but there remains a need for a longer follow‐up period and a randomized controlled trial.
Purpose
– Offenders who have intellectual disabilities like any one else may deny their offence. This paper reports a case study of a man who admitted his offence and them accepted probation with a condition of treatment. However, when he attended treatment he denied the offence. Thus do those providing treatment send them back into the criminal justice system or work with them try and help them accept what they have done and provide appropriate treatment to help them reduce future risk of offending.
Design/methodology/approach
– In this case study the assimilation model was used to understand the process of change and monitor change through exploratory psychotherapy. The psychotherapeutic model was psychodymnamic.
Findings
– The client demonstrated gains through the stages of the model toward acceptance of his problematic behaviour and continued to work on this through further psychotherapy.
Originality/value
– The assimilation model offers a useful approach to monitor change in psychotherapy; but especially when the client does not accept the problem the rest of the world feels they have.
There have been a number of studies of treatment for men with intellectual disabilities and sexually abusive behaviour but few follow-up studies. Our aim was to follow up men with intellectual disabilities who had attended group cognitive behavioural treatment (CBT) for sexually abusive behaviour.
Thirty-four men (from seven treatment sites) were followed up. All had attended SOTSEC-ID groups. The mean length of follow-up, since the end of the treatment group, was 44 months (SD 28.7, range 15-106 months).
The statistically significant improvements in sexual knowledge, empathy and cognitive distortions that occurred during treatment were maintained at follow-up. In all, 11 of the 34 (32%) men showed further sexually abusive behaviour, but only two of these men received convictions. Analyses of the variables associated with further sexually abusive behaviour indicated that a diagnosis of autism was associated with a higher likelihood of further sexually abusive behaviour.
This study provides some evidence of the longer-term effectiveness of group CBT for men with intellectual disabilities and sexually abusive behaviour.
Approximately one third of adults with intellectual and developmental disabilities have emotion dysregulation and challenging behaviors (CBs). Although research has not yet confirmed that existing treatments adequately reduce CBs in this population, dialectical behavior therapy (DBT) holds promise, as it has been shown to effectively reduce CBs in other emotionally dysregulated populations. This longitudinal single-group pilot study examined whether individuals with impaired intellectual functioning would show reductions in CBs while receiving standard DBT individual therapy used in conjunction with the Skills System (DBT-SS), a DBT emotion regulation skills curriculum adapted for individuals with cognitive impairment. Forty adults with developmental disabilities (most of whom also had intellectual disabilities) and CBs, including histories of aggression, self-injury, sexual offending, or other CBs, participated in this study. Changes in their behaviors were monitored over 4 years while in DBT-SS. Large reductions in CBs were observed during the 4 years. These findings suggest that modified DBT holds promise for effectively treating individuals with intellectual and developmental disabilities.
A new national prison strategy for the assessment and treatment of sex offenders in England is described. Its main features are the potential inclusion of all convicted sex offenders sentenced to 4 or more years in prison, a coordinated and systematized assessment and treatment package, reliance on nonspecialist personnel to deliver treatment, and the integration of population and program research. Individuals are allocated to treatment depending on an assessment of the seriousness of their offending and their risk of reoffending, using an algorithm based on conviction history. The rationale underlying key decisions is described, and issues raised by the program are discussed.
The development of comprehensive treatment services for intellectually disabled sex offenders has been slow in comparison with mainstream sex offender treatment services, which have now achieved Home Office accreditation within the National Probation Service. The author discusses some of the reasons for this failure to keep pace, focusing on the relative absence of an expertise spanning the fields of sex offender work and intellectual disabilities. Attention is focused on the particular challenges of targeting treatment, measuring change and evaluating programmes delivered to these individuals. The author reports on steps that have been taken toward overcoming these obstacles and makes recommendations about further work to be done.
Clinical and research work on offenders with intellectual and developmental disabilities has developed considerably in the last 20 years. This editorial places the papers in this special issue into the relevant research contexts. We note the work that has been conducted in the areas of prevalence of offenders with intellectual disability, and risk assessment.
In the wake of the recent awareness of the sexual abuse of people with learning disabilities is the recognition that a small number of men with learning disabilities are themselves sexually abusing. The need to understand the men's behaviour and provide effective responses is pressing yet the search for an ethical course of enquiry appears illusory. The two conflicting dilemmas which make this task so difficult are whether the men's learning disabilities preclude their giving informed consent to the research process, and/or whether men who are sexually abusing have lost some rights to exclude themselves from research which is intended to prevent further abuse. This paper explores in depth these dilemmas and describes the authors' attempts to resolve them as they attempted to devise a protocol for consent to involvement in a qualitative study of men with learning disabilities who sexually abuse. Issues raised in this particular context have relevance to many other issues in learning disability services where robust ethical debate is needed, but often glossed over.
Purpose
This is the second of two papers which aims to describe the development of a sex offender assessment and treatment service for men with intellectual disability (ID) within a community ID service. The first paper by McBrien et al. in 2010 described the mapping of need, the assessment methods and results.
Design/methodology/approach
This paper describes how decisions were made about whether or not to enrol 20 assessed men on group treatment and outlines the treatment group and outcomes.
Findings
None of the seven men who completed treatment had committed a further sexual offence at 12‐24 months follow‐up. Other outcomes are discussed including the outcomes for the men who did not start or complete treatment. The available measures are not sufficiently sophisticated to detect change in individuals.
Originality/value
This paper contributes to the literature that describes the assessment and treatment of men with an ID who have committed sexually harmful behaviours. It describes one community service's response to the complex needs of this client group.
Adults with intellectual disability who commit sexual offences against children are prosecuted and sometimes diverted to mental health facilities for training and treatment. Of the few treatment modalities used with this population, cognitive–behavioral approaches appear to hold most promise. In a preliminary study, we assessed whether three adult sexual offenders with intellectual disability could learn to control their deviant sexual arousal. Using a multiple-baseline design, we evaluated the individuals' ability to use self-control methods, Meditation on the Soles of the Feet, and a Mindful Observation of Thoughts meditation procedure to control their deviant sexual arousal when given relevant printed stimulus materials. Our data show that the individuals were minimally successful when they used their own self-control strategies, more effective with Meditation on the Soles of the Feet, and most effective with Mindful Observation of Thoughts meditation. We discuss the limitations of the study, as well as some reasons why mindfulness-based procedures may be worthy of future investigation for adult sexual offenders with intellectual disability.
The authors bring the "person" back into criminology by focusing on understanding individual differences in criminal conduct and recognizing the importance of personal, interpersonal, and community factors. What results is a truly interdisciplinary general personality and social psychology of criminal behavior that is open to a wide variety of factors that relate to individual differences - a perspective with both theoretical and practical significance in North America and Great Britain.The book is now organized into four parts: (1) The Theoretical Context and Knowledge Base to the Psychology of Criminal Conduct, (2) The Major Risk/Need Factors of Criminal Conduct, (3) Applications, and (4) Summary and Conclusions. Chapters include helpful Resource Notes that explain important concepts. A selection of technical notes, separated from the general text, allows the advanced student to explore complex research without distracting readers from the main points. Resource notes throughout explain important concepts. Technical notes at the back of the book allow the advanced student to explore complex research without distracting readers from the main points. An acronym index is also provided.
Examined factors associated with criminal convictions for sexually inappropriate behavior in males with learning disabilities. 19 care professionals (mean age 43 yrs) completed interviews concerning the extent, nature, and victims of inappropriate sexual behavior of 16 criminally convicted and 30 non-convicted males (mean age 35.7 yrs) with learning disabilities. Care professionals completed an adapted and expanded version of the Structured Anchored Clinical judgement risk assessment protocol (R. Hanson and D. Thornton, 2000) for each offender. Results show that comparisons between the criminally convicted and non-convicted Ss revealed few differences on factors associated with sexual recidivism. However, convicted Ss were more likely to have targeted children and males as victims, and these Ss had perpetrated more serious sexual offences. Significant predictors of convicted status were child victim and, less reliably, emotional loneliness. It is concluded that the decision to prosecute a male with learning disabilities who displays sexually inappropriate behavior is based more on the identity of the victim than on the nature of the offence. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Background Several studies have shown the positive effects of sex offender treatment for men with intellectual disabilities who have perpetrated sex offences or inappropriate sexual behaviour. The present study investigates the process of treatment change and compares two groups of offenders against adults and offenders against children.Method Participants comprised of 15 men who had offended against adult women and 15 who offended against children. All were treated for 36 months. Groups were compared with repeated measures using the Questionnaire on Attitudes Consistent with Sexual Offending.Results At baseline, offenders against women had higher scores than offenders against children on the Rape scale while on the offences against children scale the opposite was the case. Both groups showed significant improvement with scores reducing to levels consistent with non-offenders by 36 months. Significant improvements were still recorded from 18 to 36 months of treatment. Re-offending across both groups was 23%.Conclusion Sex offender treatment can produce significant reductions in cognitive distortions in sex offenders with intellectual disabilities. The importance of continuing treatment for longer than 12 months was endorsed by the results.
This chapter contains section titled:
Trailing behind the recent acknowledgement of the high incidence of sexual abuse amongst people with intellectual disabilities is a recognition of men with intellectual disabilities as perpetrators of sexual abuse. This paper reviews the North American, Australian and British literature published in this area. It demonstrates that both theoretical understandings and clinical interventions with men with intellectual disabilities are often discordant with wider perspectives of work with sexual abusers. The effect of this is shown to be common discriminatory practice received by men with intellectual disabilities which at times shows poor regard for their rights.
The aim of this paper is to review various methods of examining treatment effectiveness. A number of research methods used to examine the overall effectiveness of sex offender treatment, such as random assignment, risk band analysis, and matched control groups are discussed. Each of these designs offer advantages, but also have methodological shortcomings. While there are those who feel that only the most scientifically rigorous methodology must be employed if one hopes to draw meaningful conclusions, others feel that less stringent criteria in terms of comparison groups can yield meaningful inferential results. As a means of overcoming some of the shortcomings of recidivism outcome studies discussed, we suggest that the examination of more proximate outcomes, such as change within treatment, provide a useful addition to studies of treatment effectiveness.
Research on offenders with intellectual disabilities (IDs) in the criminal justice arena is on the rise, reflected by a growing number of relevant publications each year. However, there is a long recognized methodological problem that hampers the comparability of empirical studies and that raises doubts about the accuracy of prevalence rates, comorbidities, and various correlates and characteristics. In this paper we will argue that the crux of the problem can, on the one hand, be found in the plurality of assessment methods for intelligence and adaptive functioning, which are not all sufficiently reliable and valid. On the other hand, assessment of IQ in criminal justice and mental health-related areas appears to be informed more by practical aspects and needs rather than grounded in a solid theoretical model. Hence, we suggest that the Cattell-Horn-Carroll (CHC) model of intelligence has potential value in this regard, and deserves a closer look. Finally, we will discuss its incorporation into, and possible implications for, criminal justice practice and future study designs.
Background This report employs a recently developed assessment on attitudes consistent with sexual offending [Questionnaire on Attitudes Consistent with Sexual Offences (QACSO)] to compare different groups of sex offenders with intellectual disability.
Method Two studies are reported each from a different region and each conducted by different individuals. Study 1 compared 12 sex offenders against adults with 12 offenders against children. The six-scale version of the QACSO was administered including rape and attitudes to women, voyeurism, exhibitionism, dating abuse, homosexual assault and offences against children. Study 2 employed three groups of 10 participants each: offenders against adults, exhibitionists and offenders against children. The seven scale version of the QACSO (stalking added) was used. All questionnaires were administered individually.
Results In both studies, the offenders against adults reported higher levels of attitudes consistent with sexual offending in the area of rape and attitudes to women with medium to large effect sizes and a significant difference in study 1. In both studies, offenders against children reported significantly higher levels of cognitive distortions (large effect sizes) in the area of offences against children. Both differences were in the predicted direction and there were no other significant differences on other sections. In general, all three groups reported higher levels of cognitive distortions than non-offenders.
Conclusions There would appear to be some specificity particularly for the rape and attitudes to women scale, and the offenders against children scale. The same specificity does not emerge from other scales of the QACSO. The study also lends support to the inclusion of techniques which explore and challenge attitudes consistent with offending both generally and in relation to specific offences.
Vineland Adaptive Behavior Scales represent a revision of the Vineland Social Maturity Scale, which, over the last sixty years, has made major contributions to our knowledge of adaptive behavior assessment and our understanding of mental retardation
characteristics of adaptive behavior / construction of the Vineland Adaptive Behavior Scales / validity assessments of the Vineland Adaptive Behavior Scales / administration / scoring / interpretation / case examples / uses of the Vineland Adaptive Behavior Scales (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Sexual abuse has come to public attention so rapidly and is such a difficult problem to deal with that many observers are concerned that the quality of child protective intervention in these cases has been haphazard and indiscriminate. This article analyzes data on all 6,096 cases of child sexual abuse which were "officially reported" in 1978 to see what kinds of intervention were made. The data show that foster placement occurred in more cases of sexual abuse than physical abuse, and was concentrated among cases of older children who reported their own victimization. Criminal action was taken almost five times more often in cases of sexual abuse than in cases of physical abuse, and occurred more often among cases which were directly reported to police and involved offenders with prior criminal records. Black families and poorer families did not seem to be the objects of obvious discrimination in the disposition of these cases.
The aims of this study were: (I) to identify all adults with learning disabilities living in residential homes or attending day services in the Cambridge Health District in contact with the criminal justice system during 1992; (2) to evaluate the responses of services involved; and (3) to investigate the attitudes of staff and the policies of the services to 'offending behaviour'. Details of offences committed and the response of the police, health and social services, and other agencies were obtained by direct interview with the senior staff and through examination of case records. The attitudes of staff to offending behaviour was investigated by the use of a semi-structured questionnaire. Seven (2%) out of 358 adults with learning disabilities were reported to have had contact with the police during 1992. The eight offences allegedly committed by the seven people were two acquisitive offences, two sexual offences, one assault, one wasting of police time, one offence against the Public Order Act and one traffic offence. One offender was cautioned after the Crown Prosecution Service discontinued the case because of lack of evidence, while the other alleged offenders received informal warnings. None of the seven alleged offenders were prosecuted. Three alleged offenders lived in hostel accommodation, yet hostel accommodation only accounts for 7.8% of adults with learning disabilities living in the Cambridge Health District. Because of a lack of operational policies on offending behaviour, there were no existing referral structures for people who might need specialist health service support. Referrals tended to be inconsistent, with a considerable time-lag between offence and referral. Tolerance levels towards offending behaviour were extremely high in the two hostels, 20 group homes and day centres which were included in this study. Theft and criminal damage was hardly ever reported. Thirty establishments were visited during the course of this study. Of these establishments, staff in 12 said they would always report a major assault. In only three would a sexual assault or indecent exposure always be reported if it was to occur. Staff at one residential establishment said they would hesitate to report rape and the staff in another two would consider the circumstances before reporting it to the police.
The Psychiatric Assessment Schedule for Adults with Developmental Disability (PAS-ADD) is a semi-structured clinical interview designed for use with respondents who have learning disability. The first version was based on the Present State Examination. The revised version was derived from the Schedules for Clinical Assessment in Neuropsychiatry (SCAN), and makes ICD 10 diagnoses using the SCAN diagnostic program. This current version has a 4-point scale of severity, compared with the 3-point scale of the first version. It also has a new module relating to psychotic disorders. The sample consisted of 40 individuals representing a spectrum of neurotic, depressive and psychotic disorders. Videotapes of 40 PAS-ADD interviews were re-rated by trained interviewers who had not been involved in the original study in which the videotapes were produced. The mean Kappa across all individual item codes was 0.65, ranging from 0.94 to 0.35. The mean Kappa agreement on item groups was 0.66. Correlation between total symptom scores was 0.74. Agreement on index of definition was Kappa 0.70. We concluded that, agreement was generally lower than for the ICD 9 version. This was probably due mainly to the increase in the severity categories from three to four. However, the new items (most of which related to psychosis) were of comparable reliability to other items.
A systematic review of research on offenders with intellectual disability (ID) was conducted. In the present study, the first of a two-part presentation of the findings, the authors outline the methodology of the review and present data on the prevalence of offending by adults with ID. The review highlights the methodological problems of the research and the low level of rigour in many of the studies. The organization of the penal and 'care' systems are seen to have a huge impact on research findings. In addition, studies which adopt an IQ-based concept of ID show low rates of offending, whilst those which use wider definitions (e.g. attendance at special school) show higher ones. There is also preliminary evidence for believing that the prevalence of arson and sexual offences may be higher relative to other kinds of crimes for people with ID than for other offenders.