Nena L. Kircher, PsyD , LP Daeton H. DeGrant, MS, MA, LPC Center Hope solutions

1. Current Trends in Sex Offender Risk Assessment AND TreatmentThe American Counseling Association of Missouri’s 2019 Conference Nena L. Kircher, PsyD, LP Daeton H. DeGrant, MS, MA, LPC Center Hope solutions

2. Current Trends in Sex Offender Risk Assessment and Treatment Abstract: This presentation includes a review of the Risk-Needs-Responsivity Model, Historical and Dynamic Risk Factors associated with Sexual Violence Recidivism, Actuarial Risk Assessment Tools, the Good Lives Model for Sex Offender Treatment, and Current Trends related to managing sex offenders and digital technology. This is designed to provide an overview for clinicians of current best practices in the field of sexual offender treatment, risk assessment, and management. Objectives: • Participants will be able to identify appropriate treatment targets for sexual offenders. • Participants will be able to identify factors that influence treatment success for sexual offenders. • Participants will be able to identify factors that increase and decrease sexual violence recidivism. • Participants will be able to identify factors that influence community supervision success for sexual offenders. • Participants will be able to explain the difference between monitoring and blocking/filtering sex offenders access to digital technology.

3. A Few Basic Assumptions • SO Clients can return to society and become productive parts of the community. • Not All SO Clients (even those releasing for civil commitment) will have constant supervision for the rest of their lives. • It is naïve to expect that our clients will not have some access to the internet via their own (or someone else’s) cell phone, tablet, computer or other device when they return to the community. • Addressing/Understanding Internet Safety is an important part of community (re)integration.

4. Sexual Offense Recidivism • Recidivism is generally Defined as the Commission (not necessarily detection) of a Subsequent Offense. • The Longer the follow-up period the more time (increased likelihood) for a new offense to occur. • Sexual Assault is a highly underreported crime (Bureau of Justice Statistics), so recidivism is likely underestimated • However, sex offense recidivism is low in comparison to other violent crimes (e.g. Assault, Robbery) with the recidivism rate of the “typical” sex offender at around 7 to 10%.

5. Risk – Needs – Responsivity Model • Risk: Treatment Should Include an Assessment of risk via tools such as Static-99R, Stable 2007, SOTIPS, etc. • Higher Risk Patients Get More Treatment Resources • Lower Risk Patients Get Less Treatment Resources • Need: Treatment should target Criminogenic Need (AKA Dynamic Risk). • Treatment Targets should be Psychologically Meaningful • Treatment Targets need to be things we can actually change via treatment. • Responsivity: Treatment Should be matched to the Patients’ Individual Needs • Intellectual functioning • Motivation (stages of Change) • Severe and persistent Mental Illness • Trauma History • Learning Style • Cognitive Ability

6. How we assess risk • Structured risk assessment approaches using systematically-coded actuarial instruments are more accurate in predicting risk than unstructured clinical judgment. • Clinical/subjective judgment = worse than a coin toss (predicts less effectively than chance) • Risk assessments are more likely to be accurate when scored according to the defined coding rules Assessment Tools • Static 99R (Historical Factors) • Stable 2007 (Current Treatment Needs and Risk) • ACUTE (Immediate Issues) • SOTIPS (Current Treatment Needs and Risk) • ARMIDILO-S (DD) • SRA-FV (Used with another tool to increase accuracy)

7. Another way to think about Risk • When you purchase car insurance the insurance company a statistical formula to calculate how likely you are to get in an accident or what is the risk that you will wreck your car and that the auto insurance company will have to pay a claim on your policy. • The insurance agent may consider factors like your age, the type of car you drive, and the number of accidents you have been in before. These things may all affect how much you pay for your auto insurance

8. Assessment of Risk • Static Risk Factors = historical, generally unchangeable factors, not particularly suited for treatment intervention, associated with increased risk for recidivism • Static variables give us our “baseline” view of long-term risk • Examples include: • Youthful age • Limited history of normative intimate relationships • Multiple arrests or incidents of sexual offending • Victim-Related Variables (Strange, Unrelated, Male) • History of Violent Convictions • The Static 99R is a widely used and accepted actuarial instrument to assess static risk factors.

9. Assessment of Risk • Dynamic Risk Factor • Also referred to as Criminogenic Needs • Psychological or Behavioral Features of Offender • Short or Long Term Influences on Risk Overtime. • Dynamic Factors are TREATMENT TARGETS, and are potentially modified through treatment intervention • If reduced in severity, the overall risk of recidivism should reduce.

10. Overview of Risk Factors Stable Risk Factors • Significant Social Influences • Capacity for Relationship Stability • Negative Emotionality (Grievance/Hostility or Victim Stancing) • Emotional Identification with Children (Emotional Congruence with Children) • Sex Drive Preoccupation • Sex as Coping (Sexualized Coping) • Deviant Sexual Preference (Deviant Interest) • Hostility Toward Women • Cooperation with Supervision (Resistance to Rules and Supervision – Includes Non-Compliance with Treatment) • General Social Rejection • Impulsivity (General Self-Regulation Problems • Lifestyle Impulsivity • Poor Problem Solving (Poor Cognitive Problem Solving) • Offense Supportive Attitudes

11. Overview of Risk Factors Acute Risk Factors • Employment Issues • Family Stress • Treatment (MH) Concerns • Triggers and Relapse Issues Unrelated to Risk • Denial • Social Skills Deficits • Loneliness • Low Self-Esteem • Victim Empathy

12. Overview of Risk Factors Mitigating Factors/Decrease Risk • (Older) Age • Completion of Sex Offender Specific Treatment • Health Problem (Making one unable or Un-attracted to Committing Sex Offense)

13. Sex Offender Specific Treatment • Traditional Goals (Avoidance Based) • Prevent or Reduce Sexual Offending • Control Sexual Behavior • Manage Deviant Sexual Interests, Thoughts, & Fantasies

14. Sex Offender Specific Treatment • Treatment Goals Based on Emerging Research (Approach Based) • Developing Appropriate Boundaries • Normative Relationships with Others • Forming Healthy Social Support Networks • Having Pro-Social Interests and Goals • Having Positive Skills and experiences in multiple areas of life • Job • Home • Recreation • Religion/Faith/Spirituality

15. Therapist Factors that Affect Treatment Outcome • The relationship: establishing a warm, respectful and collaborative working alliance with offenders • The structure of therapy: influence the direction of change towards the pro-social through appropriate modeling, reinforcement, problem-solving, etc. • Essential qualities for effective SO therapist • positive attitudes toward sex offender • self-evaluating approach (e.g., considering personal biases), • inquiring mind • warm interpersonal style • directive • Research indicates supportive approaches are more effective than confrontational

16. Good Lives Model GLM Suggests that individuals attempt to obtain 10 primary Goods in life. • Life: Healthy Living and Functioning • Knowledge: Information and understanding about self and the world • Excellence in work and play: Having a job and hobbies that your excel at • Excellence in agency: Includes Autonomy, Independence, Self-Directedness • Inner Peace: Freedom from Emotional Turmoil and Stress • Friendship: Intimate, Romantic, Familial and other Types of Close Relationships • Community: Belonging to a group with Shared Interests • Spirituality: Sense of Finding Meaning and Purpose in Life • Happiness: Overall Contentedness and the Experience of Pleasure • Creativity: Desire to have New or Innovative Things in One’s Life Modified Primary Goods for Adolescents • Having Fun • Being an Achiever • Being my Own Person • Being Connected to Other People • Having a Purpose • Meeting My Emotional Needs • Meeting My Sexual Needs • Being Physically Healthy

17. Good Lives Model (GLM) The GLM Assumes Problems Occur when There is a conflict in the way the patient is trying to achieve two or more goods, which makes it less likely that either will be accomplished. The patient simply doesn’t have the skill or opportunity to accomplish Certain primary goods in a healthy Manner. • The patient uses inappropriate or harmful strategies to obtain primary goods • The individual is addressing too few primary goods. (i.e. Too much focus on one Goal and not enough focus on others).

18. Good Lives Model (GLM) Components of Treatment • Sexual Self-Regulation Including Deviant Sexual Fantasy, Arousal, & Interests • Cognitive Distortions and Thinking Errors • General Entitlement • Belief that Children are Appropriate Sexual Objects • Belief that Sexual Urges Cannot Be Controlled • Belief that One is Entitled to Sex with a Spouse EVEN IF S/HE says “No.” • Social Functioning, Attachment, & Relationships • Healthy VS. Unhealthy Relationships • How to Make Relationships and connect to others. • Emotion Regulation (Much more than just anger Management) • Distress Tolerance • Mindfulness • General Empathy (Not just Victim Empathy) • Vignettes and Case Studies • Understanding Perspective and Experiences of Others • Relapse Prevention • Community Safety Plan • Internet Safety

19. Overview of Best Practices Regarding Sex Offender Specific Treatment • Risk Assessment • Have an understanding of the client’s risk so that you know how much treatment he needs • Risk is best assessed using a structured risk assessment with empirically validated actuarial risk assessment tools. • Treatment • Treatment Goals are Consistent with Current Empirical Research (ATSA.com) • Treatment Goals are Tailored to the specific needs of the client (e.g. learning style, cognitive functioning, SPMI, etc.) • Therapeutic Relationship • Therapist has a warm, directive and collaborative style. • Therapist has the ability to be self-reflective and explore his/her biases which will occur when working with this population • Change Occurs best through the Group Therapy process as the interaction between clients and staff allows for modeling and mentoring as growth occurs over time.

20. The Good Lives Model • Therapy Focuses on Helping Patient Understand: • What life Goals (Primary Goods) are most valuable to him (on an individual Level). • How he works to meet these goals in healthy and unhealthy ways • What happens when he tries to meet these goals in an unhealthy way (Be Specific). • What are the things that used to be important in life that are not important now? • Why did they become less important? • How are these things related to criminal behavior or harming others?

21. Internet as a Human Right • The Following have identified the Internet as a basic Human Right • UN Human Rights Commission • US Court of Appeals in DC • US Federal Trade Commission • These organizations compare the internet to basic utilities such as access to clean water and electricity which are necessary for participation in society.

22. Internet as a human Right • Why is the internet really necessary? • Job Applications • Housing Applications • Communication with Healthcare Providers • Education • Internet for Those with Transportation or Mobility Limitations • Shopping (e.g. Amazon & Wal-Mart) • Groceries • Meal Delivery Services • Medication Delivery/Management

23. Sex Offenders and Internet Safety • THIS applies to any CLIENT who will not spend the rest of his/her life with 24/7 care. • Internet has been described as a Basic Human Right (similar to access to clean water and electricity) that is a necessity for participation in society. • Access to healthcare • Access to community activities • Religious Services • Substance Abuse Recovery and Other Support Groups. • Access to Employment Postings and Job Applications • Shopping, including groceries for those with limited Mobility or limited access to Transportation

24. Sex Offenders and Internet Safety • It is naïve to expect that our clients will not have some form of internet access via cell phone, Tablet, computer or other media device upon their return to the community. • In many cases, we have not explored or addressed Healthy Vs Unhealthy Internet Use with our clients in the context of their History of having caused Sexual Harm. • Addressing Internet Safety is an Important Component of Addressing Community Safety. • Example: Sex Offenders who have never offended online will discover that the internet is the primary source of deviant and non-Deviant Erotic material (both visual and written).

25. Why do we worry about internet safety with SO Clients? • Similar to going to the grocery store without a shopping list, getting online without a clear plan can cause problems for our clients. • Clients need to: • Identify Triggers and Unhealthy Online Situations (e.g. Casual Browsing) • Identify Healthy and Appropriate ways to use the Internet • Structure Time • Have a Plan and a Reason for getting online • Have a plan for coping with and reporting unhealthy online situations • Have a plan for dealing with accidental clicks

26. Sex offenders could Access the internet via • Cell Phones • Computers (General) • Email • Social Media • Video Game Systems • Virtual Machines

27. How to keep CLIENTS and the Public Safe Blocking and filtering • Blocking and filtering are useful tools/techniques to protect computer from malicious software. • Recent research notes that blocking and filtering does not effectively prevent individuals from accessing various inappropriate and dangerous content (Przybylski & Nash, 2018). • Blocking and filtering works in two ways: • One is “blacklist” of all known inappropriate websites. They are ether blocked completely or blocked by a rating system (E= Everyone, 9+ =ages 9 and older, M= Mature). Blocking and Filtering software also uses the Entertainment Software Rating Board (ESRB) . • The second method uses software that uses “on-the-fly” content analysis. If a site is not on a black/white list the software reads the text and if the text contains key words such as porn, the website is blocked (Behun, Sweeney, Delmonico, &Griffin, 2012).

28. How to keep CLIENTS and the Public Safe Monitoring Monitoring software allows the observer to view what the client is actually doing on their electronic devices. Viewing the Internet History Determining whether Social Media was accessed Viewing EVERTHING that has been downloaded Observing whether a peer to peer network was used Monitoring allows the person who is evaluating the computer and mobile devices to have real time view of the users actions. Monitoring could assist the clinician to gain an understanding of what material their client is accessing.

29. Monitoring vs. Blocking & Filtering • Monitoring can show whether clients are accessing deviant material, practicing coping skills, and applying treatment concepts. • Blocking and filtering will prevent them from accessing any inappropriate material. • However, it will be unknown if they are utilizing their coping skills to manage triggers. • Just by simply prohibiting access to Internet and electronic devices is teaching avoidance. Eventually, clients will have access to the Internet and electronic devices in order to function in today’s society.

30. Monitoring • Monitoring can show whether clients are accessing deviant material, practicing coping skills, and applying treatment concepts. • Blocking and filtering will prevent them from accessing any inappropriate material. • However, it will be unknown if they are utilizing their coping skills to manage triggers. • Just by simply prohibiting access to Internet and electronic devices is teaching avoidance. Eventually, clients will have access to the Internet and electronic devices in order to function in today’s society. • This takes us back to the old model of saying DON'T DO THAT while forgetting the important piece of DO THIS INSTEAD.. • We should view monitoring as extension of the clients‘ Risk Management plan.

31. Benefits of Monitoring • Patient/Client • Gains access to skills in a structured environment, with the opportunity for trial and error practice. • Learns to recognize and avoid sites that may contain unhealthy stimuli. • Get the opportunity to process any unhealthy online situations in group. • Learn to have a plan for internet use (similar to having a plan with going to the grocery store). This will become apart of their Risk Managment plan. Casual Browsing in either location can cause problems with this population

32. Benefits of monitoring • Treatment Teams • Have the opportunity to identify treatment targets related to internet use and provide a plan for coping with any concerns before the individual returns to the community. • Observe the offender/patient utilizing his risk management plan. • Provide the offender/patient with scaffolding as he moves toward reintegration to the community

33. Benefits of monitoring • Evaluators • Gain access to current information about offender/patient's ability to manage risk factors, including: • Impulsivity • Problem Solving • Sexual Deviance

34. Devices that might be monitored • The Most Common are • Smart Phones • Computers and Tablets (ipad, kindle, etc) • Video Game Systems

35. Some Basic Monitoring Tips • First, Remember that information obtained through monitoring is meant to assist treatment not to “catch the client” in the act of wrongdoing. • Monitoring Tools: • Keyloggers • Google Activity • Physical Check of Device • Monitoring Software

36. Some Basic Monitoring TIps • Google Activities • Checking the client‘s Google activities provide a detailed search history. • This includes what they searched for, videos they have looked at, and the GPS location of where they were when they searched for the information. • Shopping • Shopping sites such as Amazon.com or Walmart.com keep their own history. • Checking this could give the Monitor insight regarding what the client is looking at. • For example, movie trailers can be viewed via Amazon.

37. Questions to Ask Regarding SO Clients and internet Use? • The client must always consider these questions regarding any internet activity • Is it a Secret? Anything that you would not want others to know you are doing on the internet is solid indication that perhaps you should not engage that behavior. • Is it Abusive to self or others? Anything that is exploitive or harmful to others or degrades oneself is unhealthy and possibly illegal sexual behavior. • Is it Healthy? The internet is an amazing tool that can connect a person to host of information but this information can also be harmful or encourage deviant behavior. Ensure you always have a plan for using the internet and the follow that plan.

38. Prevention • This is the ultimate goal of those who work with this population… • Medical Model for Chronic Disease (e.g. diabetes, cancer, arthritis). • Primary Prevention: Trying to avoid the disease (harm) • Secondary Prevention: Using early detection to minimize impact of the disease • Tertiary Prevention: Improving quality of life and focusing on reducing symptoms or minimizing the impact of symptoms. • The same strategies apply for the prevention and reduction of sexual harm. • Historically, most of our field’s work has been focused on Tertiary & Secondary Prevention • More recently, focus is shifting to Primary Prevention.

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40. Thank you Nena L. Kircher, Psy.D., L.P. 573 218 6034 nenaleann@gmail.com Daeton H. DeGrant, M.S., M.A., L.P.C. 573 218 6670 Daeton27@gmail.com