Transcript Document

What Works: Effective
Interventions with Sex
Offenders
R. Karl Hanson
Public Safety Canada
Presentation at the 13th Annual Conference of
the NYS Chapter of the Association for the
Treatment of Sexual Abusers, May 14th, 2008,
Saratoga Springs, NY
History of Offender
Rehabilitation Research
• Many studies; lots of variability
• Martinson (1974) “Nothing works”
• “What Works”
– Lipsey (1989)
– Andrews, Zinger et al. (1990)
– Andrews, Bonta, Gendreau, Dowden
Sanctions or Service?
0.14
Sanctions:
2003: r = -.03
(k = 101)
0.12
0.1
0.08
0.06
Service:
0.04
2003: r = +.12
0.02
(k = 273)
0
-0.02
-0.04
Sanction
Service
Effective Correctional Interventions
• Risk
– Treat only offenders who are likely to
reoffend (moderate risk or higher)
• Need
– Target criminogenic needs
• Responsivity
– Match treatment to offenders’ learning
styles and culture
Results Stable Across Studies
• Same results found in randomized
clinical trials and non-random
assignment studies (except those
with obvious biases)
• Meta-analytic findings replicated
by independent groups
Risk/Need/Responsivity and reductions in
recidivism for general offenders
r (k)
Not at all
-.02 (124)
One element
.03 (106)
Two elements
.17 (84)
All three
.25 (60)
Risk/Need/Responsivity and reductions in
sexual recidivism for sex offenders
r (k)
Not at all
-.03
(4)
One element
.05
(6)
Two elements
.14 (12)
All three
.16
(1)
Risk – Self-Evaluation
• Does your program select offenders based
on risk?
– Which measure? Sexual or general risk?
– Average risk score is moderate or higher (e.g.,
Static-99 4+)
– Are low risk offenders separated from high risk
offenders?
Needs Self-Evaluation I
• What are the major criminogenic needs
targeted in your program?
– (i.e., what intermediate changes would you like
to see in order to reduce the risk of recidivism?)
Criminogenic Needs
(general recidivism)
• Antisocial Personality
– Impulsive, adventurous pleasure seeking,
restlessly aggressive, callous disregard for
others
•
•
•
•
•
•
•
Grievance/hostility
Antisocial associates
Antisocial cognitions
Low attachment to Family/Lovers
Low engagement in School/Work
Aimless use of leisure time
Substance Abuse
Non-criminogenic needs
(general recidivism)
•
•
•
•
•
•
•
Personal distress
Major mental disorder
Low self-esteem
Low physical activity
Poor physical living conditions
Low conventional ambition
Insufficient fear of official punishment
Criminogenic Needs for Sexual Recidivism
A-list (3+ Prediction Studies)
•
Deviant sexual interests
–
–
–
•
•
Children
Sexualized Violence
Multiple Paraphilias
Sexual preoccupations
Antisocial orientation
–
–
–
–
Lifestyle instability
Unstable employment
Resistance to rules and supervision
Antisocial Personality Disorder
Criminogenic Needs for Sexual Recidivism
A-list (3+ Studies)
• Offence-Supportive Attitudes
• Intimacy deficits
– Emotional congruence with children
– Lack of stable love relationships
– Conflicts in intimate relationships
• Negative Social Influences
• Poor Cognitive Problem-Solving
• Grievance/Hostility
Criminogenic Needs for Sexual Recidivism
B-list (at least one prediction study)
• Sexualized coping
• Callousness/Lack of concern for
others
• Poor emotional control
• Hostile beliefs about women
• Adversarial sexual orientation
• Machiavellianism
Possible Criminogenic Needs for Sexual
Recidivism (some evidence)
•
•
•
•
General and sexual entitlement
Fragile narcissism
Delinquent pride
Loneliness
Factors Unrelated to
Sexual Recidivism
•
•
•
•
Victim empathy
Denial/minimization of sexual offence
Lack of motivation for treatment
Internalizing psychological problems
– Anxiety, depression, low self-esteem*
•
•
•
•
Sexually abused as a child
Low sex knowledge
Poor dating skills/Social skills deficits
Hallucinations/delusions
Needs Self-Evaluation II
• Is there empirical evidence demonstrating
that the factor predicts recidivism?
– (yes/no for each treatment target)
• Does your program predominantly target
empirically supported criminogenic needs?
Responsivity
•
•
•
•
•
Cognitive-behavioural
Therapist style – firm but fair
Flexibility to address special needs
Culturally specific elements
Do offenders actually engage in treatment?
– Low drop-out rates
– Change on intermediate targets
– Working with you, not against you
Hanson, Bourgon, Helmus &
Hodgson, 2008
• 24 studies
– Examined sexual recidivism as outcome
criteria
– Examined adult or adolescent sexual
offenders
– Compared offender assigned to a treatment
program to offenders who received no
treatment (or treatment that was expected
to be inferior)
– Met minimum criteria for study quality
(CODC Guidelines)
24 Studies
• 50% published (1983 – 2006)
• 23 English; 1 French
• Canada (13), US (5), England (3), New
Zealand (2), Netherlands (1)
• Institution (12); Community (11); Both (1)
• Treatments delivered: 1966 - 2004
Example: treatment works
0.6
Treatment Group
0.5
0.4
0.3
0.2
0.1
0
0
0.1
0.2
0.3
Control Group
0.4
0.5
0.6
Example: treatment does not work
0.6
Treatment Group
0.5
0.4
0.3
0.2
0.1
0
0
0.1
0.2
0.3
Control Group
0.4
0.5
0.6
Example: treatment really does not work
0.6
Treatment Group
0.5
0.4
0.3
0.2
0.1
0
0
0.1
0.2
0.3
Control Group
0.4
0.5
0.6
Treatment Outcome Studies (k = 24) Sexual Recidivism
Treatment Group
0.45
0.4
0.35
0.3
0.25
0.2
0.15
0.1
0.05
0
0
0.05
0.1
0.15
0.2
0.25
0.3
0.35
0.4
Comparison Group
Odds Ratio
.72
Lower CI
.62
Upper CI
.84
Q
Study N
59.58*** 7, 751
0.45
"Better" Studies (k = 4) Sexual Recidivism
Treatment Group
0.45
0.4
0.35
0.3
0.25
0.2
0.15
0.1
0.05
0
0
0.05
0.1
0.15
0.2
0.25
0.3
0.35
0.4
Comparison Group
Odds Ratio
.99
Lower CI
.78
Upper CI
1.27
Q
7.46***
Study N
1,542
0.45
Adherence to R/N/R
• Risk
• Need
• Responsivity
Rarely
(3/24)
Sometimes
(12/24)
Most programs (18/24)
Effect Size By R/N/R Adherence
Odds ratio
95% C.I.
N (k)
None
1.05
(.79-1.41)
1,200
(4)
One
0.82
(.55 –1.23)
1,209
(6)
Two
0.57
(.46-.70)
All three
0.51
(.13-1.97)
5,147 (12)
106
(1)
Low Adherence to R/N/R (10)
Treatment Group
0.45
0.4
0.35
0.3
0.25
0.2
0.15
0.1
0.05
0
0
0.05
0.1
0.15
0.2
0.25
0.3
0.35
0.4
Comparison Group
Odds Ratio
.97
Lower CI
.76
Upper CI
1.23
Q
15.42
Study N
10 (2409)
0.45
Some Adherence to R/N/R (k = 13)
Treatment Group
0.45
0.4
0.35
0.3
0.25
0.2
0.15
0.1
0.05
0
0
0.05
0.1
0.15
0.2
0.25
0.3
0.35
0.4
Comparison Group
Odds Ratio
.57
Lower CI
.46
Upper CI
.70
Q
32.67***
Study N
13 (5253)
0.45
Are we getting better?
3
2.5
2
1.5
1
0.5
0
-0.5
-1
-1.5
-2
-2.5
1960
1970
1980
1990
Year treatment delivered
2000
Implementation is Difficult
Not at all
Demonstration Real
r (k)
r (k)
.01 (1)
-.02 (93)
One element
.07 (7)
.04 (71)
Two elements
.31 (16)
.09 (16)
All three
.34 (23)
.15 (10)
Adherence to
R/N/R
Effective Programs
Program
r (k)
Metaanalysis
Multisystemic
Treatment
.27 (7)
Curtis et al.
(2004)
Moral Reconation
Therapy
.18 (6)
Wilson et al.
(2005)
Reasoning &
Rehabilitation
.04 (25)
Tong &
Farrington
(2006)
Keys to Effective
Implementation
•
•
•
•
Select staff for relationship skills
Print/tape manuals
Train staff
Start small
No
Yes
r (k)
r (k)
Staff selected for
relationship skills
.07 (361) .34 (13)
Printed/taped
manuals
.05 (303) .20 (71)
Characteristics of Effective
Therapists with Offenders
• Able to form meaningful
relationships with offenders
– Warm, accurate empathy, rewarding
• Provide prosocial direction
– Skills, problem-solving, values
How it goes wrong
• Risk
– Same program for all, regardless of
risk/need
– Low risk offenders introduced to high
risk offenders
– High risk cases excluded from
treatment (by self and program)
• Focus on non-criminogenic needs
How it goes wrong
• Offender feels judged/rejected
• Criminal thinking rewarded
– Blind acceptance of “alternative”
subcultures
– Rewarding candour
– Procriminal attitudes of staff
– Bonding/collusion with offenders
• Punishing Prosocial Acts
– Prosocial incompetence
Directions for Sexual Offender
Treatment
• Risk
– Treat only sex offenders who are likely
to reoffend (moderate risk or higher)
• Need
– Target criminogenic needs
• Responsivity
– Match treatment to offenders’ learning
styles and culture
• Use Skilled Therapists
Suggested Readings
Andrews, D.A. (2006). Enhancing adherence to RiskNeed-Responsivity: Making quality a matter of policy.
Criminology and Public Policy, 5, 595-602.
Andrews, D.A., & Bonta, J. (2006). The psychology of
criminal conduct (4th ed.). Cincinnati: Anderson.
Bonta, J., & Andrews, D.A. (2007). Risk-needresponsivity model for offender assessment and
rehabilitation. Corrections User Report 2007-06.
Ottawa: Public Safety Canada.
Curtis, N.M., Ronan, K.R., & Borduin, C.M. (2004).
Multisystemic treatment: A meta-analysis of outcome
studies. Journal of Family Psychology, 18(3), 411-419.
Suggested Readings
Hanson, R.K., & Bourgon, G. (2008). A psychologically informed
meta-analysis of sexual offender treatment outcome studies. In
G. Bourgon et al. (Eds). Proceedings of the First North
American Correctional and Criminal Justice Psychology
Conference. Ottawa: Public Safety Canada.
Landenberger, N.A., & Lipsey, M.W. (2005). The positive effects
of cognitive-behavioral programs for offenders: A meta-analysis
of factors associated with effective treatment. Journal of
Experimental Criminology, 1, 451-476.
Tong, L.S.J., & Farrington, D.P. (2006). How effective is the
“Reasoning and Rehabilitation” programme in reducing
reoffending? A meta-analysis of evaluations in four countries.
Psychology, Crime & Law, 12(1), 3-24.
Wilson, D.B., Bouffard, L.A., & Mackenzie, D.L. (2005). A
quantitative review of structured, group-oriented, cognitivebehavioral programs for offenders. Criminal Justice and
Behavior, 32 (2), 172-204.
Copies/Questions
[email protected]
www.publicsafety.gc.ca
Look under “publications” “corrections
reports and manuals”