Understanding Sex Offenders: An Overview for Direct Care Staff and Case Managers

1. Understanding Sex Offenders: An Overview for Direct Care Staff and Case Managers Jackson Tay Bosley, Psy.D. Specialized Sex Offender Treatment Services Rutgers University Behavioral Health Care rev 6/2014

2. Numbers • Between 15,600 and 16,000 Registered Sex Offenders in New Jersey • 5,600 under supervision with the State Parole Board (Community or Parole Supervision for Life). Newly convicted offenders are all under supervision. • Nationwide – about 9% of parolees are sex offenders. In New Jersey – 30%.

3. Sex Offenders Who are sex offenders? What does “Sex Offender” mean? Where do they live?

4. Heterogeniety • Statutory-type offender • Incest offender • Female offender • Exhibitionist • Date rapist/stranger rapist • Male-target pedophiles • Sadistic rape-murderer • Internet offender • Juveniles with sexual behavior problems

5. Commonalities • Broke a Municipal, State or Federal Law • Problems with sexual arousal (some) • Problems obeying the law (some) • Problems with social interactions (some) • Problems making a living (some) • Problems with drugs (some) • Problems with societal norms (some) next section: Semantics

6. Sexual Offender • Legal term (2C:14-2-4) • Broke a municipal, state or federal law • Aggravated Sexual Assault/Sexual Assault • Aggravated Criminal Sexual Contact/Criminal Sexual Contact • Endangering the Welfare of a Child • Kidnapping, Enticing or Luring, etc. • CSL/PSL (2C:43-6.4) • Sentencing provision

7. Statutory Age of Consent in New Jersey • In New Jersey, 16 is the age of consent: But, 13, 14 and 15 year olds can consent to sexual behavior with someone up to 4 years older than themselves (to the day). • Teachers/coaches/ministers (in loco parentis) are prohibited from being sexual with minors under their supervision. • New Proviso – Endangering Statute

8. Sexually Violent Predator • Legal term (C.30:4-27.24) • Civil commitment for sex offenders • Prior offense • Mental abnormality or personality disorder • High risk • Volitional impairment • 460 (or so) currently committed by court order, released when risk no longer reaches a statutorily- defined point.

9. Pedophilia Pedophilic Disorder (302.2) • Medical term (one of the paraphilias) • Diagnostic and Statistical Manual of Mental Disorders (DSM-5) • Over a period of at lest 6 months, recurrent, intense sexually arousing fantasies, sexual urges or behaviors involving sexual activity with a prepubescent child or children (generally age 13 and under). • The individual has acted on the urges, or the sexual urges or fantasies cause marked distress or interpersonal difficulty. • Person is at least 16 and at least 5 years older than the child or children in criterion A.

10. Rapist/Child Molester • Colloquial terms • Forcing someone to have sex • Engaging in sexual contact with someone too young to give legal consent • These terms do not appear in NJ state laws • Not all child molesters are pedophiles • Not all pedophiles are child molesters

11. Exhibitionistic Disorder (302.4) • Medical term (paraphilia) • Legal term – Indecent Exposure/Lewdness • DSM-5 • …recurrent and intense sexual arousal from the exposure of one’s genitals to an unsuspecting person as manifested by fantasies, urges or behaviors. • The individual has acted on these sexual urges with a non-consenting person, or the sexual urges or fantasies cause clinically significant distress or impairment in social, occupational or other areas…

12. Voyeuristic Disorder (302.82) • Medical term (paraphilia) • DSM-5 • Over a period of at least 6 months, recurrent and intense sexual arousal from observing an unsuspecting person who is naked, in the process of disrobing or engaging in sexual activity as manifested by fantasies, urges or behaviors. • Person has acted on these urges or the urges or fantasies cause marked distress or interpersonal difficulty. • The individual is at least 18 years of age.

13. Where do Sex Offenders live/work? • Short answer: everywhere • If under supervision, where they live/work is determined by their Parole Officer. • Supervision stipulation: can’t live in a home with children unless approved. • Supervision stipulation: employment must be approved. • But, many are low-SES, live in urban areas and depend on public transport.

14. Why do Sex Offenders Commit Sex Crimes? • Variety of theories • Personal factors • Finkelhor’s 4 factors: Sexual arousal (deviant) Blockages Disinhibitors Emotional congruence • Biological contributors (sexual arousal) • Contextual factors • “Rape culture” (socialized norms) • Factors are unique to the individual

15. Why do Sex OffendersCommit Sex Crimes? (cont.) • Individual etiology • Ascertained through individual assessment • Empirical factors (Stable/Acute -2007) • ACE (Adverse Childhood Experiences) • Criminal/social/sexual history • Treatment is (should be) based on assessment

16. Legal Consequences of Sexual Offending on the Offender • Criminal sanctions • Charges, trial, probation, incarceration • Megan’s Law • Registration • Community Notification • Community/Parole Supervision for Life • Supervision Conditions • Mandated treatment

17. Emotional/Social Consequenceson the Offender • The label “sex offender” • Self-esteem • Family shame • Community scorn • Problems/limitations obtaining- • Employment • Housing • Problems forming new relationships

18. Take home messages • Sex offenders are a wide variety of people. • Sex offenders have a wide variety of problems. • Sex offenders have a wide variety of recidivism rates (next section). • Sex offenses have serious consequences. • The topic is interesting and complicated.

19. Who is Likely to “Do It Again”? What Science says about Recidivism

20. Factor Analysis (what the science says) • Sexual Deviance • Sexual preference for pre-pubertal sexual partners (pedophilia) • Sexual preference for cues of pain/fear • Strength of sexual urges (hypersexuality) • Antisociality • Enjoyment of illegal activity • Impulsive • Criminal value system

21. Actuarials • Rapid Risk Assessment for Sexual Offense Recidivism (1997) • Minnesota Sex Offender Screening Tool – Revised (1998) • STATIC-99 and STATIC-99R • Sex Offender Needs Assessment Rating -SONAR (Stable and Acute-2007) • Others • Sexual Reoffense CARAT, SORAG, JSORRAT-II, VASOR, SVR-20 (Risk for Sexual Violence Protocol), Risk Matrix-2000, RSVP • Violent Reoffense VRAG, LSI-R, PCL-R, SAVRY

22. Actuarial Item Analysis • Actuarial items are chosen based on their empirical link to recidivism (atheoretical) • Static Factors - Fixed, easy to code, most researched - priors, age/gender of victim • Dynamic Factors – Changeable, harder to code (constructs: empathy, stability, psychopathy), what we target in treatment – indicators of imminent sexual recidivism

23. Static Risk Items • Age (youth) • Prior criminal behavior • Non-sexual crimes • Sexual crimes • Number of sentencing occasions • Supervision violations • Sexual offense victim choice • Unrelated, Stranger, Male, Indiscriminate

24. Static Risk Items (cont.) • Relationship history • Treatment history • Completion • Failure/termination • Substance abuse history • Adverse childhood environment • Psychological factors/Dx • ASPD, psychosis, DD/MR, pedophilia

25. Factors Associated With Recidivism(Hanson & Morton-Bourgon, 2004): Specific interest in boys measured by ppg r = .30 Deviant sexual preference dx of any paraphilia .40 Sexual Preoccupations .51 Emotional identification with children .63

26. Dynamic Risk Items (from Stable-2007) • Stable (score 0, 1, or 2) • Significant social influences • Capacity for relationship stability • Emotional identification with children (<13) • Hostility toward women • General social rejection • Lack of concern for others • Impulsive

27. Dynamic Risk Items (from Stable-2007) • Stable (cont.) • Poor problem-solving skills • Negative emotionality • Sex Drive/Preoccupation • Sex as coping • Deviant sexual preference • Cooperation with supervision

28. Dynamic Risk Items (from Acute-2007) type of recidivism • Acute sexual general • Victim access x x • Hostility x x • Sexual preoccupation x x • Rejection of supervision x x • Emotional collapse x • Collapse of social supports x • Substance abuse x

29. Other Potential Risk Indicators • Plethysmograph results • Abel Assessment of Sexual Interest • Polygraph results • Treatment response • Categorical denial • (In)ability to empathize • Psychosis

30. Percentage Rates of Sex Offender Recidivism (Harris & Hanson, 2004): Type 5yr10yr15yr All 14 20 24 Rapists 14 21 24 Incest 6 9 13 Female target CM 9 13 16 Male target CM 23 28 35 w/out prior offense 10 15 19 w/ prior offense 25 32 37 Offender over 50yrs 7 11 13 k=95 n=31,000

31. Criminal Recidivism Rates • US Dept. of Justice (Bureau of Justice Statistics, 2002) 3 year follow-up • Burglary 74% • Larceny 75% • Auto theft 70% • DUI 51% • Sex offenses 5.3% n=9691

32. Megan’s Law Tiering • Registrant Risk Assessment Scale (adults) • Juvenile Risk Assessment Scale (juveniles) • These are not purely risk (recidivism) scales, but factor in seriousness of the offense if reoffense occurs. • These scales have shown moderate concurrent validity with actuarials. • Scores based on all credible information.

33. Tiers and Notification • Tier 1. Low risk • Police notified (with registration) • Tier 2. Moderate risk • Police and community groups notified • Internet notification (except incest) • Tier 3. High risk • Police, community groups and general public • Internet notification • GPS tracking

34. Take Home Message: • Adults: • Baseline risk is determined by actuarials. • Dynamic factors determine ongoing risk, imminence of reoffense and targets of treatment interventions. • Juveniles: • The research is less definite, but structured empirically-based instruments are essential. • Contextual issues are of major importance in determining ongoing risk.

35. What Can We Do About It? Characteristics of Effective Sexual Offender Treatment

36. Basic Elements • Community safety is an overarching goal • Not voluntary – Motivation is a major issue • Group-based • Challenging • Directed towards specific problems of sex offenders – Criminogenic needs • Developmental/Contextual model • This is NOT standard counseling (but has many aspects of general counseling)

37. Treatment Models • Legacy models • One size fits all • Harsh and confrontational • Relapse Prevention (still used) • Modern understanding • Based on Risk/Need/Responsivity • More risk – more (intensive & lengthy) treatment • Address treatment to specific problem areas • Provide treatment in a way that client can understand

38. Specific Problems of Sexual Offenders • Deviant sexual arousal • Distorted cognitions/attitudes • Antisocial value system • Poor interpersonal functioning • Poor problem-solving skills • Poor coping mechanisms • Denial

39. Protective Factors • Pro-social attitudes • Respect for the law • Desire to live a law-abiding lifestyle • Lifestyle stability • Steady, safe, affordable housing • Living wage job • Community supports • Reasonable legal supervision • Family/colleagues (non-criminal)

40. Intervention Philosophy • Collaborative effort (client onboard?) • Accountability • Limited confidentiality • Skill building (work & social relationships) • Risk/Need/Responsivity principle • Accurate feedback • Reinforce positive behaviors • Challenge antisocial thinking/lifestyle

41. Intervention Techniques • Explicit CBT • Examine distorted cognitions • Enhance positive behavioral repertoire • Ancillary techniques • Polygraph • Collaborative surveillance • Medications (SSRIs and antiandrogens) • Relapse Prevention • Good Lives Model (strengths based)

42. Relapse Prevention • Offending behavior does not just “happen.” • Offenders make a series of choices. • Treatment teaches offenders to recognize those choices. • Intervention: • Offenders learn about their offense cycles. • Offenders learn to identify risk factors. • Offenders learn to respond appropriately. CSOM Long Version: Section 3 42

43. Modern Sexual Offender Treatment Approaches • Treatment based on assessment • Treatment targets vary with individual • Treatment that teaches new skills • Teach better coping skills • Teach new social-interactional skills • Time in treatment varies • Short for some (statutory-type offenders) • Long time/forever for some (psychopaths and pedophiles)

44. Treatment Effectiveness • Treatment has a positive effect for reducing recidivism (40% reduction). • Failing treatment is a very poor prognosticator (200% increase in recid.). • Treatment “works” for those who are invested in the process and “work the program”. • Treatment has less effect for those who attend, but are not invested.

46. Other Treatment Effectiveness Studies • Furby, L., Weinrott, M.R., & Blackshaw, L. (1989) • SOTEP study “…there is as yet, no evidence that that clinical treatment reduces rates of sexual reoffenses.” • Hanson, R. K., Gordon, A., Harris, A. J. R., Marques, J. K., Murphy, W., Quinsey, V. L., & Seto, M. C. (2002) • 10% Treated • 17% Untreated n = 9454 • Hanson, R. K., Bourgnon, G., Helmus, L., & Hodgson, S. (2009) • 10.9% Treated • 19.2% Untreated n = 6746

47. Take Home Message • Treatment works (most of the time). • Treatment is lengthy and difficult. • The early stages are particularly difficult. • Denial is an important issue. • Treatment is usually based on Cognitive/Behavioral Principles. • Risk/Need/Responsivity (triage) is an abiding principle.

48. Honor the efforts you make to reduce suffering in the world. • Contact Information: • Jackson Tay Bosley, Psy.D. • (609) 984-6280 Cell (201) 259-5228 • bosleyjt@ubhc.rutgers.edu