Sex Offender-Specific Treatment Outcome Research: Learning Objectives

1. Sex Offender-Specific Treatment Outcome Research: Learning Objectives • Describe the general findings of sex offender treatment outcome research • Articulate the problems with measuring treatment effectiveness • Describe the financial costs and benefits of sex offender treatment Long Version: Section 2

2. Does Treatment Reduce Recidivism in Sex Offenders? • Goal: to protect the community by reducing the likelihood of future sexual assaults Long Version: Section 2

3. Problems with Measurement of Treatment Effectiveness • Variations (sometimes extreme) in recidivism rates between different programs • Typically low recidivism rates make finding statistically significant results very difficult • Issue of base rates for measuring recidivism in treatment outcome studies • Because base rates for sexual reoffending fall between 10% and 25% in most studies, and sample sizes typically are small (fewer than 200 offenders), the treatment effect must be very large (greater than 50%) to observe significant differences between treated and untreated offenders Long Version: Section 2

4. Hanson & Morton-Bourgon, 2004 • Update of 1998 meta-analytic review of sex offender recidivism studies • Analyzed 95 studies containing 31,216 sex offenders • This study examined primarily dynamic (changeable) risk factors, rather than the static (unchangeable) factors reviewed in the 1998 study • 5-6 year follow-up Long Version: Section 2

5. Hanson & Morton-Bourgon, 2004 (cont.) • Results showed that the sexual recidivism rate across all studies was 13.7% • General recidivism rate was 36.9% • All types of recidivism were predicted by offenders having an unstable, antisocial lifestyle, or lack of self-control • Those individuals with deviant sexual interests, particularly in children, were most likely to reoffend sexually • High rates of sexual preoccupation were significantly related to all forms of recidivism Long Version: Section 2

6. Lösel & Schmucker, 2005 • First international meta-analysis of both published and unpublished sex offender biological and psychological treatment outcome studies • Included 69 studies with more than 22,000 subjects were analyzed—about one-third published since the year 2000 and one-third published outside North America • Recidivism was operationalized as broadly as possible, ranging from incarceration to lapses in behavior Long Version: Section 2

7. Lösel & Schmucker, 2005 (cont.) • 11% recidivism rate in treatment groups • 17.5% recidivism rate in control groups • Overall, treatment provides a 37% reduction in sexual recidivism • Cognitive-behavioral treatments had the most significant impact on sexual recidivism Long Version: Section 2

8. Lösel & Schmucker, 2005 (cont.) Long Version: Section 2

9. Marques et al., 2005 • Marques and colleagues employed an experimental design to evaluate the Sex Offender Treatment and Evaluation Project (SOTEP) • Stationed at Atascadero State Hospital in California, SOTEP operated from 1985 to June 1995 • Randomized clinical trial • 704 participants • 259 = relapse prevention program • 225 = untreated volunteer control • 220 = untreated non-volunteer control • 8 year follow-up Long Version: Section 2

10. Marques et al., 2005 (cont.) • Final results revealed no significant differences among the three groups in their rates of sexual or violent reoffending • 22% of the treatment group committed a subsequent sexual offense and 16.2% had a violent reoffense • 20% of the volunteer group reoffended sexually and 16.3% had a subsequent violent offense • 19.1% of the non-volunteer control group had a sexual reoffense and 15% had a violent reoffense • However, those who did well in treatment recidivated at lower rates than those who did not progress in treatment Long Version: Section 2

11. Marques et al., 2005 (cont.) Long Version: Section 2

12. McGrath et al., 2003 • Evaluation of a prison-based cognitive-behavioral, relapse prevention treatment program for adult sex offenders in the State of Vermont, which included a community aftercare component • 195 participants • 90 = no treatment • 56 = completed treatment • 49 = some treatment • 6 year follow-up Long Version: Section 2

13. McGrath et al., 2003 (cont.) • Results showed that almost one quarter of the total sample (23%) were found to have committed a new sex offense during the follow-up period • Sex offenders in the completed treatment group had a significantly lower sexual recidivism rate (5%) that both the some treatment group (31%) and the no-treatment group (30%) • The completed treatment group also had a significantly lower rate of violent recidivism than the no-treatment group Long Version: Section 2

14. McGrath et al., 2003 (cont.) Long Version: Section 2

15. Seager et al., 2004 • Seager et al. examined men over the age of 18 who were convicted of a sex offense and were offered the opportunity to participate in a manualized treatment program, in which offender progress was clinically evaluated • 177 participants • 81 successfully completed the treatment program • 28 were unsuccessful • 17 offenders dropped out • 19 refused to participate Long Version: Section 2

16. Seager et al., 2004 (cont.) • Overall, 12% of the offenders in this study were reconvicted for a sex or violent offense and 23% were charged with a new sex or violent offense • 4% of successful treatment completers and 7% of unsuccessful treatment completers were convicted for a new sexual or violent offense • 32% of those who dropped out, refused, or were terminated from treatment incurred a new conviction and 49% had new charges • Dropping out, refusing, or being terminated from treatment was related to higher risk for sexual and/or violent offending Long Version: Section 2

17. Seager et al., 2004 (cont.) Long Version: Section 2

18. Problems with Measurement of Treatment Effectiveness(cont.) • Differences in laws, policies about sex offending • Difficulty in following subjects who move • Different sex offender populations • Duration of follow-up • Attrition of sample subjects • Definitions of what constitutes reoffense • Differences in treatment program intensity, location (prison, community), and methods Long Version: Section 2

19. Barbaree and Marshall, 1988 • 126 treated (cognitive-behavioral methods) and untreated child molesters in a community sample • 4 year follow-up • Recidivism (measured by official police records and unofficial police and child protective agency reports) rates quite different between the treated and untreated groups Long Version: Section 2

20. Barbaree and Marshall, 1988 (cont.) • Extra-familial female-target child molesters • Recidivism rates over four years for treated group: 18%; for untreated group: 43% • Extra-familial male-target child molesters • Recidivism rates for treated group: 13%; for untreated group: 43% • Incest female-target child molesters • Recidivism rates for treated group: 8%; for untreated group: 22% Long Version: Section 2

21. Barbaree and Marshall, 1988 (cont.) Recidivism Rates Long Version: Section 2

22. Rice, Quinsey, and Harris, 1991 • Studied 136 extrafamilial child molesters from a maximum security psychiatric hospital over a 6 year follow-up period • Found no treatment effect Long Version: Section 2

23. Hall, 1995 • Performed meta-analysis on 12 sex offender treatment outcome studies • Total sample size of 1,313 sex offenders • Recidivism: formal legal charge for a new sex offense after the completion of treatment for the treatment group • Mean length of treatment 18.5 months Long Version: Section 2

24. Hall, 1995(cont.) • Mean follow-up period across studies was 6.85 years • Found small but significant recidivism-reducing treatment effect for treatment versus no-treatment or comparison treatment conditions • Overall recidivism rate for treated sex offenders: 19% • Recidivism rate for untreated group: 27% Long Version: Section 2

25. Hall, 1995(cont.) Long Version: Section 2

26. Hall, 1995(cont.) • Greatest treatment effects were in studies with • Longer follow-up periods • Higher base rates of recidivism • Outpatient services • Cognitive-behavioral treatment or anti-androgen treatment Long Version: Section 2

27. General Accounting Office, 1996 • Summarized 22 reviews of research on sex offender treatment covering 550 studies between 1977 and 1996 • Report concluded that the results are promising but inconclusive Long Version: Section 2

28. Alexander, 1999 • Examined data from 79 sex offender treatment outcome studies encompassing 10,988 subjects • Divided offenders and offenses into subtypes by age of offender, age of victim, offense type, type of treatment, location of treatment, years in which treatment occurred, and length of follow-up • Recidivism typically defined as subjects who were rearrested for a new sex offense Long Version: Section 2

29. Alexander, 1999(cont.) • Offenders who participated in relapse prevention treatment programs had a rearrest rate of 7% compared to 18% for untreated offenders • 528 adult male rapists: 20% of the treated group reoffended; 24% of the untreated group Long Version: Section 2

30. Alexander, 1999(cont.) Long Version: Section 2

31. Alexander, 1999(cont.) Recidivism Rate Long Version: Section 2

32. Alexander, 1999(cont.) • 2,137 child molesters: 14% of the treated group reoffended; 26% of the untreated group • Treatment effect was especially strong for the 331 exhibitionists: 20% of the treated group reoffended; 57% of the untreated group • For all 10,988 study subjects combined, 13% of the treated group reoffended; 18% of the untreated subjects reoffended Long Version: Section 2

33. Alexander, 1999(cont.) Recidivism Rates Long Version: Section 2

34. Hanson et al., 2002 The 2002 ATSA Report on the Effectiveness of Treatment for Sexual Offenders • Collaborative research project to: • Define standards for research on treatment outcomes for sex offenders • Summarize existing research • Promote high quality evaluations Long Version: Section 2

35. Hanson et al., 2002(cont.) Long Version: Section 2

36. Seto and Barbaree, 1999 • Evaluated the relationship of clinical ratings of treatment behavior to recidivism (in-session behavior, homework quality, motivation and change achieved) • Found good treatment behavior was unrelated to general recidivism but associated with higher serious violent or sexual recidivism • Men who scored higher in psychopathy and better in treatment behavior were the most likely to reoffend Long Version: Section 2

37. Serious Sex Offender Recidivism Related to Treatment Behavior and Psychopathy Psychopathy Seto and Barbaree, 1999 Long Version: Section 2

38. Financial Costs/Benefits of Treatment • Any reduction in recidivism is significant in terms of reduction of harm to victims and costs to society • In tangible financial costs, Prentky and Burgess (1990) estimated the costs per sex offense for offender-related and victim-related expenses totaled $183,333 • Therefore, if there are eight fewer offenses for every 100 sex offenders, the tangible financial savings is $1,466,664 • If we think treatment of sex offenders is expensive, compare it to the cost of not treating sex offenders Long Version: Section 2

39. Summary • Early evaluations of sex offenders programs found no evidence that treatment works • The most recent, largest scale, and best designed treatment outcome study to date found that treatment works • When all studies are reviewed, sex offender treatment reduces sexual recidivism in adult males about 5 to 10% • Any reduction in reoffense rates can result in very significant cost savings and—more critically—a reduction in harm Long Version: Section 2