What’s Up, Doc?What’s Up, Doc? Innovations and Lessons Learned Innovations and Lessons Learned in the Treatment of Sexual Abusersin the Treatment of Sexual Abusers

NYSATSA / NYSASOSPNYSATSA / NYSASOSP

Saratoga SpringsSaratoga Springs

June 11, 2009June 11, 2009

Robin J. Wilson, PhD, ABPPRobin J. Wilson, PhD, ABPPClinical Director

The GEO Group, Inc. / Florida Civil Commitment Center

Assessing RiskAssessing Risk

Static-99 Risk LevelsStatic-99 Risk Levels

STATIC-99STATIC-99Sexual Reconviction Sexual Reconviction

RatesRates

0

0.2

0.4

0.6

0.8

1

0 3 6 9 12 15 18 21 24

Years after release

Low

Medium-Low

Medium-High

High

New Norms: SummaryNew Norms: Summary• Sexual Recidivism

– Recidivism rates significantly lower than original norms

– Differences are meaningful: E.g., scores of 6+• 39% versus 26% at five years (survival analysis)• 45% versus 35% at ten years (survival analysis)

• Violent Recidivism– Recidivism rates significantly lower than original

norms• Differences not as apparent in the graphs due to suppression

from increased proportion of rapists in new samples

10 Year Sexual Recidivism 10 Year Sexual Recidivism Rates Rates

(from logistic regression (from logistic regression estimates)estimates)

0

10

20

30

40

50

60

70

0 1 2 3 4 5 6 7 8 9 10

STATIC-99 score

High RiskCSCOriginal

10 Year Sexual Recidivism 10 Year Sexual Recidivism Rates Rates

(from logistic regression (from logistic regression estimates)estimates)

0

10

20

30

40

50

60

70

80

0 1 2 3 4 5 6 7 8 9 10

STATIC-99 score

High Risk (n = 790)

Routine CSC (n =342)

Relapse Relapse PreventionPrevention

vs. vs. Good Lives Good Lives

ModelModel

Shortcomings of Relapse Shortcomings of Relapse Prevention ApproachPrevention Approach

Theoretical problems with the model Originally designed for use with alcoholic

patients motivated to change Principally conceptualized as

maintenance program to follow treatment, not as model of treatment or supervision (but became both in SO treatment)

Lack of standardization across programs, sometimes even within programs

Comparing RP and SRM Comparing RP and SRM ApproachesApproaches

One versus four pathways Attempts at self-regulation can result in

deficits or intact achievement Avoidance and approach goals Positive and negative affect Cognitive dissonance and goal

congruence Focus is beyond solely risk management

Good Lives Model Good Lives Model (GLM)(GLM)

The basic premise of the Good Lives Model is the development of a “balanced, self-determined lifestyle”.

Borrows from self psychology and Life Skills modelTreatment approaches are multi-modal and holistic

The GLM suggests that successfully-treated offenders strive to lead lives that are healthy, productive, and free of risk as a natural consequence of the stability that comes with leading a “good life”.

Is TreatmentIs TreatmentEffective?Effective?

Is Treatment Effective?Is Treatment Effective?

In the USA, costs of sexual assault are enormous. This situation is certainly paralleled in other western nations. The cost associated with each sexual offender has been estimated as being in excess of $1.5 million. Therefore, a reduction in recidivism of merely 1%, while not likely statistically significant, is certainly significant in terms of cost and harm reduction.

California Sex Offender California Sex Offender Treatment & Evaluation Treatment & Evaluation

ProjectProject

The results of the SOTEP study showed no differences in sexual reoffending between treatment participants, volunteer controls, and non-volunteer controls. Follow-up was just over eight years and rates of sexual reoffending were in the 20% range for all groups.

Effective ProgramsEffective Programs The consistency of the outcome studies

accentuates the need to move beyond simple questions as to whether treatment works (Abracen & Looman, 2004).

There are a number of significant questions which have yet to be answered with reference to sex offender treatment.

For example, do higher risk clients receive more treatment programs than lower risk clients?

Assessment of In-Treatment Assessment of In-Treatment Change Change

with Sexual Offenderswith Sexual Offenders

We need to ... Make sure that the treatment targets

addressed are actually related to recidivism

Need to make sure that targets are actually being addressed

Community-Community-based Risk based Risk

ManagementManagement

StakeholdersStakeholders

victims citizens law enforcement legal and correctional personnel mental health personnel the media

offenders

Mission statementMission statement

To substantially reduce the risk of future sexual victimization of community members by assisting and supporting released men in their task of integrating with the community and leading responsible, productive, and accountableaccountable lives.

Circles of Support & Circles of Support & AccountabilityAccountability

Core member Volunteers Professionals

Why do Circles Work?Why do Circles Work?

Offender Social SupportReleased sexual offenders who have positive, pro-social support in their community are at less risk of re-offending than those who have no such support, or whose supports are anti-social in nature.

StakeholdersStakeholders

victims citizens law enforcement legal and correctional personnel mental health personnel the media offenders

Outcome – Recidivism Outcome – Recidivism datadata

Ontario Pilot SampleOntario Pilot Sample(Wilson, Picheca, & Prinzo, 2005)(Wilson, Picheca, & Prinzo, 2005)_______________________________________________________________________________________

Circles (60)Circles (60) Control (60)Control (60)_______________________________________________________________________________________

M(SD) age 47.47 (12.27) 43.62 (10.84) M(SD) STATIC-99 5.60 (2.22) 5.00 (1.96) M(SD) RRASOR* 3.18 (1.65) 2.12 (1.31) M(range–mos) follow-up 54.67 (3-123) 52.47 (3-124) M(mos) until 1st failure 22.10 18.54Recidivism Sexual* 5.00% (3) 16.67% (10)

Expected sexual 28.33% (17)** 26.45% (16) Violent* 15.00% (9) 35.00% (21) General ‡ 28.33% (17) 43.44% (26) Dispositions 38 49 _______________________________________________________________________________________

* p < .05 ** p < .01 ‡ p < .10

Outcome – Recidivism Outcome – Recidivism datadata

Canadian National Replication Canadian National Replication SampleSample

(Wilson, Cortoni, & McWhinnie, 2009)(Wilson, Cortoni, & McWhinnie, 2009)_______________________________________________________________________________________

Circles (44)Circles (44) Control (44)Control (44)_______________________________________________________________________________________

M(SD) age 42.6 (9.6) 42.9 (8.4)M(SD) STATIC-99** 4.9 (2.1) 6.1 (1.5)M(SD) RRASOR 2.7 (1.5) 2.7 (1.3)M (mos; range) follow-up 35.8 (9-86) 38.6 (8-96) M (mos) until 1st failure 9.59 16.72Recidivism Sexual* 2.27% (1) 13.67% (6) Any Violent ** 9.09% (4) 34.09% (15) Any ** 11.36% (5) 38.64% (17)Total # (conv + chgs)** 17 73_______________________________________________________________________________________

* p < .05 ** p < .01

Contact InformationContact Information

Robin J. Wilson, PhD, Robin J. Wilson, PhD, ABPPABPP

Clinical DirectorThe GEO Group, Inc.Florida Civil Commitment Center13619 SE Highway 70Arcadia, FL 34266

863 491 4805

rwilson@geocareinc.com