Post on 22-Dec-2015
What Works: Effective Interventions with Sex Offenders
R. Karl HansonPublic 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?
Sanctions:
2003: r = -.03
(k = 101)
Service:
2003: r = +.12
(k = 273)
-0.04
-0.02
0
0.02
0.04
0.06
0.08
0.1
0.12
0.14Sanction
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 RecidivismA-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 RecidivismA-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 RecidivismB-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
0.1
0.2
0.3
0.4
0.5
0.6
0 0.1 0.2 0.3 0.4 0.5 0.6
Control Group
Tre
atm
ent
Gro
up
Example: treatment does not work
0
0.1
0.2
0.3
0.4
0.5
0.6
0 0.1 0.2 0.3 0.4 0.5 0.6
Control Group
Tre
atm
ent
Gro
up
Example: treatment really does not work
0
0.1
0.2
0.3
0.4
0.5
0.6
0 0.1 0.2 0.3 0.4 0.5 0.6
Control Group
Tre
atm
ent
Gro
up
Treatment Outcome Studies (k = 24) Sexual Recidivism
0
0.05
0.1
0.15
0.2
0.25
0.3
0.35
0.4
0.45
0 0.05 0.1 0.15 0.2 0.25 0.3 0.35 0.4 0.45
Comparison Group
Tre
atm
ent G
roup
Odds Ratio Lower CI Upper CI Q Study N .72 .62 .84 59.58*** 7, 751
"Better" Studies (k = 4) Sexual Recidivism
0
0.05
0.1
0.15
0.2
0.25
0.3
0.35
0.4
0.45
0 0.05 0.1 0.15 0.2 0.25 0.3 0.35 0.4 0.45
Comparison Group
Tre
atm
en
t G
rou
p
Odds Ratio Lower CI Upper CI Q Study N .99 .78 1.27 7.46*** 1,542
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) 5,147 (12)
All three 0.51 (.13-1.97) 106 (1)
Low Adherence to R/ N/ R (10)
0
0.05
0.1
0.15
0.2
0.25
0.3
0.35
0.4
0.45
0 0.05 0.1 0.15 0.2 0.25 0.3 0.35 0.4 0.45
Comparison Group
Tre
atm
en
t G
rou
p
Odds Ratio Lower CI Upper CI Q Study N .97 .76 1.23 15.42 10 (2409)
Some Adherence to R/ N/ R (k = 13)
0
0.05
0.1
0.15
0.2
0.25
0.3
0.35
0.4
0.45
0 0.05 0.1 0.15 0.2 0.25 0.3 0.35 0.4 0.45
Comparison Group
Tre
atm
en
t G
rou
p
Odds Ratio Lower CI Upper CI Q Study N .57 .46 .70 32.67*** 13 (5253)
Are we getting better?
-2.5
-2
-1.5
-1
-0.5
0
0.5
1
1.5
2
2.5
3
1960 1970 1980 1990 2000Year treatment delivered
Implementation is Difficult
Adherence to R/N/R
Demonstration r (k)
Realr (k)
Not at all .01 (1) -.02 (93)
One element .07 (7) .04 (71)
Two elements .31 (16) .09 (16)
All three .34 (23) .15 (10)
Effective Programs
Program r (k) Meta-analysis
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
r (k)
Yes
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 Risk-Need-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-need-responsivity 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, cognitive-behavioral programs for offenders. Criminal Justice and Behavior, 32 (2), 172-204.
Copies/Questions
Karl.Hanson@ps-sp.gc.ca
www.publicsafety.gc.caLook under “publications” “corrections
reports and manuals”