Recent Research on Sex Offenders with Intellectual and Learning Disability

Prof. Bill Lindsay Danshell Health Univ Abertay,Dundee, Bangor Univ.

Deakin Univ. Melbourne

Recent Research on Sex Offenders with Intellectual and Learning Disability

Prof. Bill Lindsay Danshell Health Univ Abertay,Dundee, Bangor Univ.

Deakin Univ. Melbourne

Email : [email protected]

Community and Security?

• • • • • • Many clinical developments are about security.

Access to an ordinary life.

Communities, GP surgeries, sports, public transport, shops, pubs, entertainment, education.

Courts, criminal justice, disposals.

Vulnerabilities, exploitation.

Lund (1990). Denmark, 1970s to 1980s – doubling of the incidence of sex offenders with ID.

Referral source percentages by year.

90 80 30 20 10 0 70 60 50 40 Court Community Other

Lindsay, Haut and Steptoe,

,

J Foren. Psychiat Psychol. 2011

1990-1995 1996-2002

N=309

2003-2008

Characteristics – change setting only

(Hogue Lindsay, Taylor et al 2006 Criminal Behaviour and Mental Health)

50 45 40 35 30 25 20 15 10 5 0 N=212 Offences across lifespan.

High Med/low community Sex offence Violent offence* Bodily harm* Weapon use

Characteristics – change setting only

(Hogue Lindsay, Taylor et al 2006 CBMH)

50 45 40 35 30 25 20 15 10 5 0 Sexual assault Violent assault* Arson Alcohol Index offence High Med/low community

1988- 2008 Lindsay, Steptoe, Haut, Brewster (2013)

CBMH

20 year follow up of 309 p community forensic ID service Individual treatment motivation social skills and offence related thinking.

Treatment of criminal issues, ISB, anger, fire interest Psychiatric review and management Offender treatment.

Community integration, family social contact..

Work and occupation

Percent of each cohort reoffending (any reported incident) up to 20 year follow up. Lindsay, Haut et al (2013), CBMH

60 50 40 30 20 10 0

Sex offenders N=156 Other off.

N=126 Females N=27

Reoffending

Harm Reduction (Lindsay, Haut, Steptoe and Brewster 2013):

Reduction in number of incidents (total cohort) 1400 1200 1000 800 600 400 200 0 * * 2 YEARS BEFORE UP TO 20 YRS AFTER SEX OFF OTHER OFF WOMEN

Assessment Issues in Inappropriate Sexual Behaviour (ISB) • • • • • • • Cognitive ability Sexual Knowledge Abuse in childhood Mental health issues Social background and family attachment issues Emotional stability Cognitions consistent with ISB

Pathways through forensic ID services (Lindsay, Holland et al 2010, AmJ IntDevDis). n=197.

Inappropriate Sexual Behaviour

• • • • SSKAAT-R (Griffiths & Lunsky 2002).

SEXKEN (McCabe, Cummins & Deeks. RIDD, 1999, 241 54).

ASK (Galea, Butler, Lambrick et al.. JIDD, 2004, 350-65).

Puberty, parts of the body, sexual health, contraception, having sex, relationships, use of alcohol, safety, pregnancy and childbirth, masturbation, legal issues (ASK).

Counterfeit Deviance

Counterfeit Deviance (Griffiths, Hingsburger) – Sexual Knowledge. Sex Offenders V Non Sex Offenders.

(Michie et al 2006 Sexual Abuse. Lunsky et al 2007 JIDD)

50 40 30 20 10 100 90 80 70 60 Anatomy Birth Control Dating Intercourse Assessment areas STD Menstruation Sex Off(24) Non-Sex Off(41) 45 40 35 30 25 20 anatomy BC boundaries total Type 1 D Type 2 I Controls

60 20 10 0 50 40 30

Abuse in childhood in Offenders with ID.

(Lindsay, Steptoe and Haut 2011. J.Int.Dis.Res.)

* * *

Male Sex Off Other Male Off.

Females CSA NAI

Cognitive Distortion – Faulty Thinking Mechanisms (Ward et al., 1997. Clinical Psychology Review) • • • • • • Denial of an offence Denial of intent Mitigation of responsibility through victim action- victim

shares the blame, victim encouragement

Mitigation of responsibility through life events – life stress,

lack of sexual outlets, work stress

Minimisation of incident/consequences – little harm, victim

enjoyed experience,learning experience for victim

Denial of normal state – alcohol, mental illness

Lindsay, Whitefield & Carson (2007), Legal & Criminological

Psychology

1 0 6 5 4 3 2 Rape Voyeur Exhib.

Children SO/ID ))/ID NO/ID Mainsream

QACSO Scores (n=10, Sex Off. gps.)

Lindsay et al (2006) JARID

25 20 15 10 5 0 Rape Type of Of f ence Children Vchild Vadult

QACSO results replicated by: Rose et al 2002, 2012 Langdon et al 2007 Craig et al 2013 Murphy et al 2011 Heaton and Murphy 2013

exhibit.

nonOff (n=19)

Sex offending pathways (Hudson and Ward)

• • • • Avoidant active Avoidant passive Approach explicit Approach automatic

Keeling and Rose(2005) Sexual Abuse

Hypothesis : passive and automatic pathways

25 20 15 10 5 0 45 40 35 30

Sex offending pathways

Keeling, Rose and Beech(2006) Sexual Abuse (n=16)

Mainstream

Bickley and Beech (2002),n=87

60 Special needs Active V Passive Approach V Avoid Avoid A 50 Avoid P 40 30 20 10 0 Appr. Ex Appr. Au

Sex offending pathways

Langdon,et al (2007 JIDD) Lindsay et al 2009 SAJRT

Active V Passive Approach V Avoid 45 40 Active/Ex

Higher IQ Greater sex K LowerQACSO

35 30 25 20 Approach

Higher IQ Greater denial

15 10 5 0 Avoid A Avoid P Appr. Ex Appr. Au 60 50 40 30 20 10 0

Russell - Avoidant Active

Risk of Re-offending

(Elliot, Lindsay & Astell, 2004, J.App.Res.Int.Dis.)

• • • • Offence involving violence, r=0.295* Juvenile crime, r=0.284* Sexual abuse ,r=0.327,* Poor relationship with mother, r=0.346* • • • • • • •

Anti-social attitude, r=0.309* Low self-esteem, r=0.374** Poor response to treatment, r=0.45** Denial of Crime, r=0.335* Low treatment motivation, r=0.303*

Poor compliance with man/treat routine, r=415* Allowances made by staff, r=0.409**

Risk Prediction – Receiver Operator Characteristics (ROC)

• • • • • Auc =.5 – toss a coin Auc= 1 - perfect Auc =.65 - ok Auc = .75 - good Auc - .85 – very good

RISK PREDICTION – auc. (Lindsay, Hogue et al, in press,

Int J Off Ther Comp Crim.)

VRAG HCR20 HCR -H HCR - C HCR-R RM2000S RM2000V RM2000C STATIC99 SDRS EPS 50 55 60 65 70 75

ARMADILO - Boer, Tough & Haaven (2004)

Journal of Applied Research in Intellectual Disabilities

• First complete the Static-99 • • • • Stable Client Items - 12 Items Stable Environment Items – 5 items Acute Client Items – 9 Items Acute Environment Items – 4 Items • All of the validating research has been done on this version. The 2010 vision retains the original structure but changes the items.

Stable Client Items

Attitude towards compliance with supervision and treatment Knowledge of faulty thoughts/crime cycle/risk factors/relapse prevention plan

Stable Environment Items

Attitudes towards sex offenders with ID Communication amongst supervisory staff

Acute Client Items

Changes in social support Changes in substance use

Acute Environment Items

New supervisory staff Monitoring of offender by staff

Recent studies

27

Blacker, Beech, Wilcox & Boer. Psychology Crime & Law, 2011

• • ARMIDILO-S stable unofficial AUC 0.56; Official AUC 0.61 n=44 ARMIDILO-S Acute unofficial AUC 0.76; Official sexual AUC 0.73

All special needs sex offenders but Offenders with ID n=10 (IQ < 75) ARMIDILO-S stable AUC 0.86. ARMIDILO-S acute AUC 0.75

Sindall & Murphy, unpublished

N=16 Stable client. – Auc= .85 Acute client. - Auc = .46

Stable environment – Auc= .41

Acute environment Auc =.50

Armadilo total - Auc= .83

Lofthouse, Lindsay, Totsika, Hastings et al. JARID, 2013.

• • • • • • • • 64 sexual offenders with ID Average age 32 94% referred through community services Average IQ 67; range 54-75 4% were in-patients 96% lived in the community 21 engaged in ISV throughout follow-up Follow up – 6 years

ARMADILO – auc. (Lofthouse, Lindsay, Hastings et al, 2013. JARID)

VRAG = .55

Static – 99 = .72

Armidilo = .91

1 - Specificity

Treatment studies

Early work was case studies Lambrick and Glaser (2002) Rose et al (2002) O’Conner (1996) Lindsay et al (1998)

Treatment studies Early work was case studies

Danny

Lambrick and Glaser (2002) Rose et al (2002) O’Conner (1996) Lindsay et al (1998)

Celia IN THE STREET VALENTINE IN THE PUB

D

Y

Lindsay et al. (1998), Research in Developmental Disabilities

Frank Lambrick and co workers. Melbourne, Victoria corrections.

Lambrick & Glaser (2002) SAJRT

Sex Offender Response to Treatment (Lindsay & Smith, 1998. Journal of Intellectual Disability Research)

100 80 60 40 20 0

Re-offending 1 Year Probation: 64% 2 Year Probation: 0%

Pre-treatment Post-treatment Follow-up QACSO Assessment Scores 1 Year Probationary Sentence 2 Year Probationary Sentence

Status Following Discharge From Treatment (Lindsay et al., 2002. Journal of Applied Research in Intellectual Disability)

100 80 60 40 20 0 Planned Discharge Unplanned Discharge Discharge Details Reoffending Documented / Suspected No reoffending

55 50 45 40 35 30 25 20

*

QACSO

Murphy et al SOTSEC ID

J. App.Res.Int.Dis., 2010

N = 46 9% reoffending

*

SAKS SOSAS VES Baseline Post Treatment F.U. 6 Mths

Responses on QACSO Offences against children scale

Lindsay, Michie et al 2011 JARID

25 20 15 10 5 F. U. 6 Years Reoffending – 23% 0 Baseline 6mth 12mth 18mth 24mth 30mth Assessment areas 36mth Adults.n=15 Children.n=15

35 30 25 20 55 50 45 40

Rose et al 2012 J. Foren. Practice *

N = 12 1 reoffended

*

Baseline Post Treatment F.U. 12 Mths QACSO SSKATT

A MODEL UNDERPINNING TREATMENT FOR SEX OFFENDERS WITH MILD INTELLECTUAL DISABILITIES ( Lindsay 2005, Int. & Dev. Dis., 2009)

1. Motivation 2. Strategies for offending

3. General theories of criminality 4. Community engagement

Conclusion

• • • Good evidence for first 2 strands: Cognitive intervention Self-restraint Motivation and strategies • • Good evidence for second 2 strands: Community engagement Q.O.L.

CAUTION

R.P. and contact with victims

Community engagement why would we tolerate sexual offenders in the community? • • • • • Sex offenders have a lower reoffending rate than violent offenders. 20% V 75% We are more afraid of stranger rape than most other crime.

We are more afraid of child abduction than most other crime Stranger rape is relatively uncommon. If you are raped it is most likely to be by a friend or acquaintance. A child is far more likely to be sexually abused by her/his father, brother, uncle or grandad.

Attachments, Relationships and QOL

Steptoe, Lindsay, Forrest & Power, (2006) JIDD

Significant Other Scale (Power et al., 1988) L. E. C. (Ager, 1988)

6 5 4 3 2 1 0 ** 2.5

2 1.5

1 Relationships Domain Sex Offenders Control 0.5

0 Offenders only Support (SOS) Actual SOS Ideal

Relationships and Personal wellbeing

Wheeler et al, (2013) JARID

• • Personal Wellbeing Index (Cummins) • L. E. C. (Ager, 1988)

7 6 5 4 3 2 1 0 ** Relationships Domain Offenders * PWI Control

Community Engagement – GLM (Tony Ward) • • • • • Control theory – masses of evidence to support the importance of community engagement to cut crime. Good Lives Modal (GLM) – Ward’s theory of human needs and sexuality. The importance of fulfilling human needs without diminishing risk management.

Most sex offenders live in the community anyway.

Treatment in the community is far more realistic. Treatment in secure settings is always second best.

Even if we wanted to the cost of locking everyone up for life is prohibitive.

PREDICTIONS

• • • Appropriate engagement alone will not produce reduction in recidivism Treatment in isolation (institution) is unlikely to produce gains in recidivism Both are needed – address primary motivation and social engagement

1990 - 2008 Individual treatment motivation social skills and offence related thinking.

Treatment of criminal issues, ISB, anger, fire interest Psychiatric review and management Offender treatment.

Community integration, family social contact..

Work and occupation.

Harm Reduction (Lindsay, Haut, Steptoe and Brewster 2013): Reduction in incidents (total cohort)

1400 1200 1000 800 600 400 200 0 * * 2 YEARS BEFORE UP TO 20 YRS AFTER SEX OFF OTHER OFF WOMEN

Responsivity to criminogenic need.

Lindsay, Carson, Holland, Taylor et al 2013,

Journal of Intellectual Disability Research

Referred ISB Violence Treatment Alcohol Firesetting 12 mths 24 mths Treatment

Treatment across 24 months: Sexual index offence

(Lindsay, Carson, Holland, et al 2012)

35 30 25 20 15 10 5 0 Gen. Community Referred 12 Mths 24 Mths Foren. Community Low/Med secure High Secure

• • • • • • • •

CONCLUSIONS.

Research has been developing at a steady pace across the field.

This research has high social validity and is in response to cultural and societal changes – very important.

Research suggest treatment is highly effective Important to develop reliable, valid assessments.

Risk assessment research has been conducted and seems promising.

Treatment work on sexual offending has long follow up. Treatment is most likely to happen in a designated forensic community service.

We should consider comprehensive service evaluations as legitimate and theoretically sound research.

Recent research on sex offenders with intellectual & learning disability.

Prof Bill Lindsay Danshell Health.

Univ. Abertay, Dundee Bangor Univ. Deakin Univ., Melbourne

Email: [email protected]