Talking prevention with Charles Flinton - What it can mean when one ATSA member invest in prevention.

As co-chair of ATSA’s prevention committee, I am often asked by members, “What can I do to get involved in prevention?”  Charles (Chuck) Flinton has one unique answer for taking the knowledge and research in our field and applying that to a unique approach to preventing sexual abuse.   Chuck has invested significant time and some funding to develop the Blue Rock Institute (http://www.bluerockinstitute.com/index.htm), a resource for adults to access if they are concerned about their own fantasies or behaviors and want help before anyone is harmed.  Take a minute to look at this interesting website and this warm and positive approach to encouraging people to ask for help. 

The Blue Rock Institute is designed for people who know they have a problem and want help.  When someone does call and come in, the Institute begins with a comprehensive evaluation that involves a clinical interview and psychological testing, looking specifically for other co-occurring issues (e.g., food disorder and other compulsive behaviors).  A key portion of this evaluation is to also identify the strengths they bring to the table to help them move away from their shame.  At this point, the Institute may also prescribe medication as well as Individual and group treatment.

When I asked him how he started on this path, he said that “Over the years, I came across so many people who essentially lost everything in their lives due to their offense.  These were guys who knew they had a problem and many even were seeking help but were rejected – that is the truly sad part.” 

After conducting a number of focus groups, hiring consultants and developing the online resources, the program was ready to launch.  He found that people talked about their fear of “crossing the line” and a major motivator is possible financial ruin.  But getting the right message was only the first part of the challenge.  The next challenge is to encourage people to call and then walk in the door.  Much of that has happened organically with people telling others about the Blue Rock Institute.  For example, one client goes to SAA meetings and announces there that there is a new resource and how helpful it can be.  However, Chuck has also made a conscious effort to talk with everyone and anyone about this work.  He has presented at a variety of conferences and also regularly presents information to health centers and other medical venues.  In the spirit of talking with everyone, it was a connection at the gym that brought the program to Kaiser Permante, the largest health care provider in CA.  Chuck was working out and started talking with a workout buddy about his new project.  The workout buddy was also the chief psychologist for the entire state and invited Chuck to present to his staff.  From there Chuck was able to build an ongoing relationship with this provider for when people do come forward, they can get help. 

Chuck’s one piece of advice is to talk with anyone and everyone.  I asked him how he talks about it so that people will really listen.  He tries to engage people in the idea that this affects so many people they know and no one seems to talk about it.  Chuck moves them from “rubber-necking” and “gawking” at the problem to really talking and thinking about this issue.  And he does talk with everyone, presenting at conferences across the country, anyone interested in sexuality, addictions, and of course, a few ATSA chapters too.  If you want to read more, you can see information about his work in the most recent issue of Psychology Today. 

This is just one example of what one ATSA member is doing.  Think about what you might want to do to get involved in preventing sexual abuse before anyone is harmed. 

Joan Tabachnick

 

  

Discussing CoSA research & Evaluation with Martin Clarke & Mechtild Hoing, PhD

This author Q & A is a bit different as we have two separate authors (Clarke & Hoing) discussing two separate papers on CoSA in forthcoming editions on SAJRT.

Could you talk us through where the idea for the research came from?

Mechtild Höing: “Volunteers in Circles of Support and Accountability Job Demands, Job Resources, and Outcome"

When the Dutch CoSA project started in 2009, one of the first concerns of the project developers was: “Is it safe to employ volunteers in this work with sex offenders?” The Dutch CoSA project was driven by the Dutch Probation organization, and although originally this organization was founded in the end of 19^th century as a charity, completely driven by volunteer laymen and –women, the organization had become a completely professional institution, during the 20^th century. Employing volunteers had become an exception, and the expertise regarding volunteer recruitment, retention, support and supervision had to be built again at the start of the CoSA project. At the same time, in the Netherlands – as elsewhere- sex offenders were in the center of public attention – and vigilance, for that matter. While the CoSA pioneers from the Dutch Probation organization were very enthusiastic and almost passionate about this new, practice based approach, my co-authors and I (who had been involved in the Dutch CoSA project from the very beginning) realized that CoSA needed a broader basis of scientific evaluation, in order to support the project development and to inform project policy decisions, as well as to be able to answer to legitimate questions of professionals in the field. I was given the opportunity to do a PhD study on CoSA, and it was clear from the beginning that one of my research projects would focus on the impact of this work on volunteers. An extensive review of the literature on the impact of volunteering in general and of working with sex offenders, had given us a good idea of the main concepts that needed to be studied.

Martin Clarke: "Circles of Support and Accountability for Sex Offenders: A Systematic Review of Outcomes”

It was partly out of neccessity in preparation for a funding application. We wanted to produce an up to date review of the evidence for Circles. We focused on quantitative studies because we wanted to try to quantify the findings. That said, there is also a growing body of qualitative research in support of Circles – perhaps another paper is needed!

What kinds of challenges did you face throughout the process?

 Mechtild: Originally, this study was set up as a prospective study, with three measurements (pre-circle, after six months and after twelve months), and a comparison group of volunteers, doing other high impact work (a telephone help-line for suicidal people). However, recruitment of a sample that would be substantial enough for meaningful statistical analysis soon proved to be impossible, mainly because of the small scale of the CoSA project at the time. Also, recruiting volunteers from other volunteer projects was very time-consuming. Therefore we had to look for a more pragmatic solution. We decided to postpone the study for another year, expecting numbers of active volunteers would have risen by then. To make up for the time lost, we decided on a cross-sectional design, only targeting CoSA volunteers.  After one year, the population of Dutch CoSA volunteers had almost doubled, but was still small (little more than 100 active volunteers), and although the CoSA project organization very much supported this study by facilitating the recruitment of volunteers, response rates were low. The volunteers proved to be highly motivated to work with sex offenders, which not necessarily meant they were motivated to fill in a lengthy questionnaire about their work. Although a 37% response rate in a web-based questionnaire is not unusual, we had hoped for more.

 Martin: One of the main things was to put in context the research and the methodological limitations of the studies. Circles were a spontaneous response to improve reintegration back to community and research wasn’t at the forefront. There’s also flexibility in providing Circles and so there are differences  between (and within) Circles Projects even within the same country. Some of the outcomes were not reported in a way that made them comparable to other studies but authors willingly provided additional information which helped.

The reviewers’ comments were also helpful in shaping the paper. Initially we had intended to include a meta-analysis of recidivism data but there was only one RCT and three case control studies. We would have needed to include several caveats when reporting the meta-analysis. Even then, there was a risk of going beyond the data so we didn’t include one.

What kinds of things did you learn about co-authorship as a result of producing this article?

 

Mechtild: Since my co-authors were also my supervisors, it was clear from the beginning, that I was going to take the lead in all steps of the study, and they had an advisory role. Fortunately, all three of us had the same ideas about the changes in the research design, and that decision was made in mutual consent, once the problems emerged. The analyses of the results of the cross-sectional study were more heavily debated, since I was anxious to make most of the data, while my supervisors urged me to be less ambitious. Of course, they were right, and our discussions helped me to improve my statistical knowledge. Writing in English was a challenge for all three of us, and publishing in English without a native speaker in de group is one thing I would probably reconsider.

 Martin: The process worked well. I’ve usually written with more co-authors. In a way, I think it’s a little easier with fewer co-authors in that you’re not waiting for more people to respond. Birgit and Sue (my co-authors) are very knowledgable about Circles and Circles research.

What do you believe to be to be the main things that you have learnt about Cosa and its application in sex offender integration?

Mechtild: CoSA seems to be a rather robust model. One of the main results of our study was, that not only sex offenders profit from CoSA, but volunteers seem to do so as well. The strength of the model is its focus on building relationships of trust, openness and accountability, not only between the sex offender and the volunteers, but also among  the volunteers themselves and between volunteers and the professional staff. The social support both from co-volunteers and from the circle-coordinator increase feelings of connectedness and competence, thereby adding to the well-being of volunteers. The current policies in Dutch CoSA projects regarding selection, training and supervision of volunteers seem to work. One must keep in mind though, that the role and quality of the circle –coordinator is a critical element in the model, one that needs further evaluation.

Martin: The evidence is supportive of Circles and there has also been nothing to suggest that Circles have an adverse effect on outcomes. We know social exclusion and isolation are risk factors to reoffending and so intuitively it makes sense to provide support to such offenders. That said, there is clearly more that can be done to strengthen the evidence base. We still need larger samples with control groups and longer term follow-ups given what we know about the low and slow rates of reconviction for sexual offences. We also need agreement on which short term outcomes would be useful.

We need more evidence on the accountability aspect of Circles. Clearly Circles offer an extra layer of surveillance which could lead to detecting recidivism which might otherwise not have been detected. So I think the role a Circle had in outcomes needs to be better documented, whether this is a positive outcome such as finding employment or a less successful outcome such as recidivism. Even then, outcomes such as being recalled to prison are not necessarily negative if that prevented further victims.

 

Reflecting back, moving forward: Part 2 – Looking forward to 2016

Welcome to part 2 of our New Year’s blog! In this part we will address what we think are some of the salient issues facing the sexual harm field as we move into 2016.

Kieran McCartan: The thing that really strikes me, and it’s something that I have written about on the blog quite a bit in 2015, is the continued need for cross disciplinary collaboration and looking outside of our silo. This is really starting to happen now, which is great but we need to do more. Looking to other areas of psychology, criminology, social policy, public health, biology and neuro-science [to cite a few disciplines that we have seen the field of sexual harm successfully utilize] has lead us to some really interesting places including conversations about prevention, desistence, trauma informed care, and mindfulness; all of which have really helped our field look at the population that we work with in a different way. What’s next? What is the next area of social, human and biological sciences going to bring to the table? In addition to looking at other research and theories we should also consider what different disciplines can offer us in terms of new methodologies, new forms of data analysis and new places to present our data [in terms of conferences, journals and forums – maybe we go to a specialist conference and present our work rather than inviting the most amenable to ours]. By embracing the fact that sexual harm is a topic that can unite us all together as a common topic of endeavor, rather than isolate us out as a specialist field, we can make great leaps forward.

As a research field we have started to move further away from the mainstream of sexual harm perpetrator to look at female offenders, offenders with learning difficulties, minority groups and sexual harm and so on. This is great, we are no longer playing the game of “erase male, white sex offender and replace with xxxx”, we are really getting into the nuts and bolts of the array of groups that commit sexual harm and seeing what is unique about them that is different to the mainstream [as well as recognizing what is the same] which will help us design treatment programs, risk assessment, management strategies and prevention plans that are fit for purpose. This is “what works” in action!!

I suppose that my main point in all of this is “look outside the defined sexual harm box”, look to other places for inspiration, for knowledge and to see if what we already know works with everybody that we engage with; as I said before we already do this but we can do it much more and reap greater rewards because of it.

David Prescott: In a powerful speech at the Evolution of Psychotherapy conference in 2009, Phil Zimbardo (principle actor in the infamous Stanford Prison Experiment and later President of the American Psychological Association) offered a definition of evil: “When you know better and you still do worse.”

The past 30 years have seen an explosion of science-based knowledge in our field. From Freund’s pioneering research using phallometrics to the certificate-of-confidentiality research of Gene Abel and his colleagues that did much to reveal what people do and don’t get caught for, to the remarkable Hanson and Bussiere meta-analysis of 1998 and the others it spawned and the exploration of therapeutic and protective factors offered by Bill and Liam Marshall, Calvin Langton, James Worling, and others too numerous to mention.

During 2015, our field saw three sex offender civil commitment programs declared unconstitutional, two by federal judges. Perhaps just as importantly, we also saw several world-class programs (at least two in Canada and at least one in the USA) shut down or restructured and handed over in lowest-bid situations. In some cases, programs have opted to use highly scripted curricula instead of ensuring the effectiveness of each clinician. On one hand, professionals needn’t be surprised; cost-cutting measures in the human services are by now familiar. On the other hand, one wonders to what extent therapists are now finding themselves colonized by curriculum developers from well outside the circumstances in which they work. Research consistently highlights the same factors that define evidence-based practice: clinical experience in combination with the best available research and client characteristics. In light of these events, can we really say that our field was better off in 2015 than it was in 2005?

Surprisingly, these recent events have garnered little discussion within ATSA’s membership. Recent listserv discussion has centered more on what goes well within these programs than their shortcomings, with only one suggestion for policy that might be more effective (and even in that case, the author of the post expressed concerned that such policy could also be misused for political ends). One comment dismissed a recent finding of unconstitutionality as resulting from just “a low level federal judge.” One wonders at what point we should all become outraged by the public-safety and human rights implications of our circumstances. How much energy should we spend defending the status quo? Or should we take more of a stand? Questions abound: how do individuals and organizations best put their money where their mouth is? Given that so few policymakers are swayed by actual evidence, how do we influence decision-makers?

The above are questions our field has asked for a long time. Perhaps it’s time for new questions: At what point do we stop accepting the status quo? At what point do we start to wonder whether we’ve lowered our standards of care? At what point do we start advocating for the rights of all people in the equation, including our clients? And at what point do we look in the mirror and ask whether we are doing worse even as we know better?

Jon Brandt: The dark era of “nothing works” with sex offenders introduced a false doctrine that today is still influencing public policy around the treatment and management of sexual offenders (Mancini & Budd, 2015). 

It is now more than four years since the US District Court for Minnesota agreed to consider the constitutionality of sexual offender civil commitment (SOCC) in Minnesota.  Last June, Federal Judge Donovan Frank determined that both the program and underlying statutes are unconstitutional.  Almost simultaneously, another federal court found Missouri’s SOCC program unconstitutional.  In 2015 a Texas state court judge released the first client from Texas’ SVP program, citing unconstitutional confinement.  A Texas appeals court reversed the ruling and the client was returned to custody.

These court rulings did not say that these SVP programs are not providing credible treatment, but rather that the programs, which have almost no releases, are constitutionally compromised.  Over the last year, David Prescott and I wrote a series of blogs on the MSOP lawsuit.  My personal position is not that SVP programs shouldn’t exist, but rather that, in many states, SOCC is overreaching and/or compromised by the failure to effectively move clients through the system. 

On 10/28/15 Judge Frank issued an order for constitutional remedies in Minnesota.  On 12/15/15, the US Court of Appeals stayed Judge Frank’s order.  The Eighth Circuit agreed to hear oral arguments in St. Louis on 4/12/16.  What seems shortsighted about the Appeals Court ruling is that the crux of Judge Frank’s remedies order is that MSOP must begin evaluations to determine which clients meet criteria for SOCC.  Whether or not the rulings of the US District Court of Minnesota are upheld by the Eighth Circuit, there are hundreds of clients at MSOP who must be evaluated, and even under Judge Frank’s timeline, some might not be evaluated until 2018. 

Parties to the Minnesota lawsuit largely agree on one point: there are clients at MSOP who deserve a reduction in custody or a less restrictive alternative.  If that is the case, such clients are being unconstitutionally incarcerated.  Some clients have been at MSOP for more than 20 years, some are intellectually disabled, more than 60 are juvenile-only offenders, and some are elderly and infirmed.  The oldest is 93.  For over 700 clients at MSOP, the New Year marks another year that the exits are blocked and clients are caught in an endless loop of treatment.  If Minnesota is unable or unwilling to comply with a judicial order to evaluate, and annually reevaluate all 700+ MSOP clients, it would seem that Minnesota’s SOCC scheme is still on a collision course with the US Constitution, and perhaps a review by SCOTUS.

In 2008, Eric Janus and Robert Prentky wrote a twenty-year retrospective on the use of SOCC in the US, arguing that civil controls of sexual offenders, including sexual offender civil commitment (SOCC), are misguided and more about moral panic than sound public policies for public safety.  Perhaps we should acknowledge what Judge Frank has referred to as “society’s opprobrium” for sexual offenders – and that, in many cases, unwarranted civil regulations are impeding, rather than facilitating recovery of those who have sexually offended.   Do such public policies make society safer?

In Part 1 of this blog, I gave a shout-out to Elizabeth Mustaine and her colleagues for their 2015 journal article on how professionals might be contributing to misguided polices of civil regulations of sexual offenders, including residency restrictions, community notification, and the sex offender registry.  When residency restrictions amount to banishment, there are thousands of juveniles on the sex offender registry, and research concludes that the vast majority of sexual offenders (even SVP’s) will not reoffend, it is time to challenge public policies that are not only unwarranted, but largely counterproductive, if not outright unconstitutional.  Aside from civil rights violations and collateral consequences, one of the many unfortunate side effects of misguided public policies is that they fuel unwarranted public fear.

When the ethical concerns of working with those who have sexually offended are so difficult to reconcile with laws, court rulings, victim rights, public safety, and public opinion (which at times can be at odds with each other), it seems more important than ever that professionals who work in the field of the treatment and prevention of sexual harm are current on research and guided by best practices.

Kieran McCartan, PhD; David Prescott, LISCW; Jon Brandt, LICSW

Reflecting back, moving forward: Part 1 – Highlights 2015

Welcome back to the SAJRT blog and happy new year! 

The first blog of the year is going to be in two parts, one looking back at 2015 and the other looking forward to 2016. We are going to select what we consider to be some of the standout articles from the 2015 across the sexual harm field.

David Prescott - SAJRT’s February 2015 special edition on protective factors propelled our field forward in a vital direction. It captured the imagination of our organization as a whole and inspired important discussion at conferences and on ATSA’s listserv. All too often in this author’s experience, professionals acknowledge the importance of such ideas as resilience and desistence without being able to put these concepts meaningfully into practice.

Of note, many ATSA members, like the contributors to the special issue themselves, have noted that there has long been no secret of the importance of this avenue for inquiry and understanding. This was the first collection of articles in our field on the topic. Adding even greater appeal is that the guest editors are experts in assessing and treating adults and juveniles respectively (Calvin Langton and James Worling).

The issue begins with an excellent overview from Langton and Worling (Introduction to the Special Issue on Factors Positively Associated With Desistance for Adolescents and Adults Who Have Sexually Offended), in which they offer defining features of protective factors (e.g., those attributes that enhance competencies, ameliorate specific risks, stabilize or enhance functioning, and are associated with desistence). Langton and Worling also discuss two domains of protective factors. The first involves factors that are at the other end of a continuum with a corresponding risk factor (e.g., early versus late adulthood, social isolation versus interpersonal competence). The other domain involves factors for which there is only a positive association with desistance (the authors offer the example of religiousness).

In the end, the idea of protective factors is not new, but this collection of studies provides an important way forward for those concerned with assessment, treatment, and prevention.

Kieran McCartan –  One of my stand out articles comes from the same edition of the journal as David’s, the February special edition on protective factors [which was a sterling edition across the board], with the article by de Vries Robbé, Mann,  Maruna, and Thornton on Protective Factors Supporting Desistance From Sexual Offending. This article talks about the need to reconsider risk, risk management and treatment, emphasizing that we need to be proactive. As the article states, in general, risk assessment focuses on the issues that the offender poses to themselves and to the public, so that their behavior can be limited and controlled; therefore, the core of risk assessment is preventing future harm, which is not necessarily the same as changing the personal insights of people who have committed sexual harm. Placing a conversation about proactive factors within the context of desistence from sexual harm is important as it emphasizes the role of the individual, the capacity for the individual to adapt and grow. This article reinforces a greater move going on in the sexual harm field to change the narrative from a reactionary one to a proactive one (i.e., public health models, prevention, desistence) recognizing that the individual who has committed sexual harm to be proactive in changing their behavior, they are active agents in their own change not passive recipients directed by others (.e., police, probation, treatment providers and the wider community). What makes this article more powerful in its discussion pf proactive factors and there role in desistence is the creditability and power of the authors, leading researchers in the field giving important insights to help us prevent as well as responding to sexual harm

Jon Brandt - My pick for a noteworthy journal article of 2015 is Criminal Justice Officials’ Views of Sex Offenders, Sex Offender Registration, Community Notification, and Residency Restrictions by Mustaine, Tewksbury, Connor, andPayne.

Mustaine and colleagues reviewed existing literature, and conducted their own survey of more than 1,100 public officials across five domains: community corrections, prosecution, law enforcement, parole boards, and prison wardens, to measure attitudes about sexual offenders and beliefs about both the fairness and the efficacy of certain civil regulations for sexual offenders.  Using the CATSO (Community Attitudes Toward Sex Offenders) Scale, and a 43-item survey, the authors compiled a multivariate analysis of various domains, including the number of years of professional experience, amount of education, age, gender, race, marital status, political views, and geographic regions.  Then the authors delved into respondents’ beliefs about both the fairness and efficacy of SORN and residency restrictions.

Among noteworthy findings is an inverse correlation between how closely professionals work with sexual offenders and whether they tend to support civil regulations.  Prosecutors and police are perhaps influenced by their unique responsibilities for public safety and contact with victims. “Law enforcement officers held more negative views of sex offenders than the general public and were less likely to believe in the possibility of their rehabilitation… 83% reported that they would still support at least some SORN policies, even without scientific evidence to support the efficacy.”  “The negative and cynical views that law enforcement officers and prosecutors have about sex offenders appear to transfer over to sex offender policies.” As education and experience increased, the more that professionals questioned both the fairness and efficacy of SORN and residency restrictions.  The more contact that professionals had with sexual offenders, the more positive and optimistic were their views.  Probation agents and psychologists held the most positive and optimistic collection of views.

This research is vital to understanding how public policies are influenced by those who work with sexual offenders; “Criminal justice officials’ perspectives regarding sex offenders and sex offender policies may be especially valuable to policy makers and the public because of their direct experience with both.”  The authors also note that, “it is the sum of actions by officials across the criminal justice system that influences the criminal justice experience for sex offenders (and perhaps their rehabilitation).”    Knowing how criminal justice professionals view sexual offenders and understand the efficacy of SORN laws will help us to target education and shape more effective public policies in the future. “Education aimed at criminal justice officials that debunks misconceptions and affirms the value of rehabilitated sex offenders should not be underestimated.”

The next blog post will continue this discussion focusing on what we think some of the main issues facing the field of sexual harm will be in 2016.

Kieran McCartan, PhD; David Prescott, LISCW; & Jon Brandt, MSW, LICSW

References

Langton, C. M., & Worling, J. R. (2015). Introduction to the Special Issue on Factors Positively Associated With Desistance for Adolescents and Adults Who Have Sexually Offended. Sexual Abuse: A Journal of Research and Treatment, 27: 3-15.

de Vries Robbé, M., Mann, R. E.,  Maruna, S.,  and Thornton, D. (2015]. An Exploration of Protective Factors Supporting Desistance From Sexual Offending. Sex Abuse: A Journal of Research and Treatment, 27: 16-33.

Mustaine, E. E., Tewksbury, R., Connor, D. P., & Payne, B. K. (2015). Criminal Justice Officials Views of Sex Offenders, Sex Offender Registration, Community Notification, and Residency Restrictions. Justice System Journal, 36:1, 63-85.  (Note: this link is to the full article.)