Transcript People with learning disabilities at risk of committing

Treatment for offenders with
learning disabilities
Glynis Murphy, Tizard Centre, Kent Univ
[email protected]
Alison Giraud-Saunders, Foundation for People with
Learning Disabilities
[email protected]
Plan
 NOMS programmes
 Thinking Skills programme
- Background
- Process of negotiation with NOMS
- State of play
- Content of programme
 Sex offender programmes
- Non-disabled & disabled sex offenders
- Treatment for non-disabled sex offenders
- Treatment for sex offenders with learning disabilities
NOMS programmes
 NOMS develops treatment programmes for people
in prison and on probation
 Eg. Thinking Skills; managing anger; reducing
substance misuse; & sex offending (SOTP)
 Very carefully vetted; all developed in-house
 Accreditation system & strict quality control
 BUT: All programmes have IQ 80 cut-off
 Only widespread adapted programme is ASOTP
 Gill case made Ministry of Justice more aware &
motivated to solve problem
Adapting delivery of the
Thinking Skills Programme
Alison Giraud-Saunders
Foundation for People with Learning
Disabilities
www.learningdisabilities.org.uk
We promote the rights, quality of life and
opportunities of people with learning
disabilities and their families. We do this by
working with people with learning disabilities, their
families and those who support them
Offending behaviour
programmes
Gaining entry for prisoners with
learning disabilities
 Inspired by ‘No One
Knows’
 Glynis and Peter
Oakes
 Proposal to DH
 Gill case
 Grant award April
2010
Round and round….
Negotiations with NOMS
 Adaptation – delivery
 Evaluation – feasibility
 Intellectual property
 Role of project worker
The real start
 Project worker
 Training (project
worker)
 Adapting
 Evaluation
 Theory
 Facilitator training
Issues
− Theory: based on WAIS
− Selection of participants: WASI
− Fitting in with regime
− Accessibility vs programme integrity
− Volume of materials
− Measures of progress (participants)
Outline
 Course materials cover:
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Self control
Problem solving
Positive relationships
 Consent, 1:1s
 ‘Conditions of success’
 Facilitator instructions
 Realistic evaluation
We’re on the way!
 First pilot – HMP
Whatton
 Planning second
pilot
 Sustainability
Conclusion
 Routine availability
of adapted
programmes
 Custody and
community
 Alternatives to
prison
 …and to hospital
Sexual offending by
non-disabled men & disabled men
For both groups
 Grossly under-reported to police
 90-95% of sex offenders are men
 Most perpetrators are known to victim
 Men often engage in grooming & stalking of
victims
 Men hold many cognitive distortions
Treatment for non-disabled sex offenders:
recent years
 1960s & 1970s: Seen as result of deviant
sexual interests & arousal
 Led to behavioural techniques eg aversion
therapy, orgasmic reconditioning & covert
sensitisation
 Belief in medical model & anti-androgens
 Little evidence of effectiveness; underprovision of treatment
 Move to CBT approach
Marshall’s model of sex offending
Insecure
attachment
Low self -esteem, poor emotional regulation,
impaired problem solving, impulsivity,
emotional loneliness
loneliness
Seeking
Hostility to
intimacy &
those seen
pleasure
as rejecting
thru sexual
acts
Components of cognitive behavioural
treatment
 Enhancing self-esteem
 Challenging & changing cognitive distortions
 Developing victim empathy
 Developing social functioning
 Modifying sexual preferences
 Ensuring relapse prevention
See Marshall et al.’s 1999 book for an excellent guide
Does it work for non-disabled men?
 Hanson et al, 2002: Meta-analysis of 43 CBT studies
of sex offender treatment (over 9,000 participants
overall) - sexual offence recidivism rate: 12% for
treated men vs 17% for untreated men
 Aos, Miller & Drake 2006: reviewed controlled CBT
studies. CBT produced reduction in recidivism (31%
reduction in community & 15% in prison sample)
 Kenworthy et al, 2006: Cochrane review of 9 RCTs
(over 500 offenders), mostly paedophiles; variety of
treatment methods:
- one large CBT trial showed a definite reduction in
recidivism
- one large group psychotherapy trial showed
treatment increased risk.
Cognitive behavioural treatment for men
with & without LD in UK
 CBT widely available for non-disabled
convicted sex offenders: SOTP
- in prison
- in community (run by probation)
 Men with LD mostly excluded from these:
- some prisons run ASOTP
- Janet Shaw clinic in Solihull (ASOTP),
- Northgate hosp programme near Newcastle,
- Bill Lindsay’s programme in Scotland,
- our SOTSEC-ID programme (about 25 sites
across the country)
Most adapted programmes have
core assessments (eg below is SOTSEC-ID list)
 Once only: IQ, adaptive behaviour, language,
autism
 Pre & Post group treatment:
- Sexual Knowledge & Attitude Scale (SAKS)
- Victim Empathy scale, adapted (Beckett &
Fisher)
- Sex Offender Self-Appraisal Scale (Bray &
Foreshaw’s SOSAS)
- Questionnaire on Attitudes Consistent with
Sex Offending (Bill Lindsay et al.’s QACSO)
 Recidivism
Treatment content (SOTSEC-ID)
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Group purpose, rule setting
Human relations & sex education
The cognitive model (thoughts, feelings, action)
Sexual offending model (based on Finklehor model)
General empathy & victim empathy
Relapse prevention
Compared to non-LD programmes: Far more slow
offence disclosure; more on sex education; far more
pictorial material & less sophisticated on cognitive
side
Does group CBT work for
men with LD?
 Lindsay et al (1998a, b) showed some improvements in 6 men
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with LD & paedophilic offences & 4 men with LD &
exhibitionism, after CBT
Lindsay & Smith (1998): showed 2 years CBT was more
effective than 1 yr CBT for men with LD on probation
Rose et al (2002): CBT 2hrs/week for 16 weeks, for 5 men;
found reduced (improved) scores but changes not significant
Craig et al 2006: no changes in cognitive distortions in 7mth
CBT
Lindsay et al 2006: 70% harm reduction in 29 repeat sexual
offenders with ID, after CBT
Williams et al, 2007: significant improvements in scores from
pre-group to post-group in 150 men following CBT in ASOTP
programmes in prisons (not all ID)
Significant changes in cognitive distortions,
sexual knowledge & empathy -SOTSEC-ID
60
50
40
Pre
Post
6-month
30
20
10
0
VES
SAK
SOSAS
QACSO
Further sexually abusive behaviour (SOTSEC-ID)
 During the year of the treatment group: most men did not show
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further sexually abusive behaviour; in 4 men (out of 48) they
DID show non-contact ‘offences’
In the 6 mths follow-up period: most men did not show further
sexually abusive behaviour; in 7 cases (5 men) DID show noncontact ‘offences’ (5 cases) or sexual touch through clothing (2
cases)
Re-offending: No relationship with pre- or post- group scores;
IQ, presence of mental health problems, personality disorder,
living in secure setting, being victim of SA, history of offending.
Poor prognosis: Concurrent therapy & diagnosis of autism /
aspergers syndrome
Longer follow-up: data just collected (by Kathryn Heaton) &
above findings still hold
Service user views
(SOTSEC-ID)
 Good understanding of basic facts (duration, venue,
facilitators, & rules, e.g. confidentiality rule)
 Good understanding of why referred: ‘Because of my
sex offence to see if it would do me any good’; ‘To
help my sex urges, keep them under control; to be a
better person when meeting women in the community’
‘To help us stop getting into trouble with the police
because I go out to masturbate’
 What they learnt:
‘Stopped me touching girls’; ‘How people feel about us
masturbating’ (in public); ‘Learnt not to go after
women’; ‘Learnt to help other people in the group’;
‘What the police do when they arrest you’
Service user views (cont’d)
Best things
 ‘Having support every week’
 ‘We … talked about feelings about things, sorting
the problems out’
 ‘Working together, helping each other’
 ‘We helped each other discuss ... work on ways of
preventing problems in the future’
Worst things
 ‘Telling people very private stuff, keeping people on
trust’
 ‘Some didn’t talk’
Thank you!
Alison Giraud-Saunders
[email protected]
07721 843290
www.learningdisabilities.org.uk
Glynis Murphy
[email protected]