Thursday, July 21, 2016

(re)Integration, Risk Management & Public Protection

Recently, I have been in conversations with academics and professionals about the effectiveness of offender reintegration programmes, risk management and public protection. There seems to be an idea that “risk management” is an evil concept and a by-line for punitive state control, which is worrying. A notion that public protection means a dictatorial system, with no flexibility, originality and a preserved need for rhetoric as well as justification – which is also concerning. The most disturbing  though, which I have heard from professionals on both sides of the Atlantic, is the notion that reintegration is returning offenders to communities for them to get kept separate from said communities and not being allowed to interact with them because of risk management and public protection concerns. Which creates a perfect storm; for a lack of integration, support and partnership working can result in an increased likelihood of re-offending. The question that I have been pondering is whether we have become jaded by the system and that we cannot see the interrelated beneficial outcomes of these terms?

The big debate is reintegration versus integration. I think that these are two different things that often get confounded. The idea behind reintegration is to return someone to the same point in a situation that they were at before they were removed from that situation; but that is not what we want with offenders or sex offenders. We want to return them to society to a new, improved more adaptive situation. We do not want them falling into old habits, bad ways or being more likely to reoffend. We want them to develop good relationships, new relationships and positive social capital. Therefore, it’s not really reintegration as much as integration. It’s integration informed by treatment, risk management, social support and adaptive thinking. This is important because this perspective means that sex offender integration is a  group activity involving the criminal justice system, the offender and the community; it is not simply “review, release and go,” instead it's more “review, release and support.”

Successfully integrating offenders into communities means that risk management is important, as it’s a proactive and forward-looking endeavour rather than a reactive and negative one. Risk management is not, and should not be, a one-size-fits-all model. Different individuals pose different risks and need different responses; additionally, over time, the same individual's risk can change and therefore so too will their risk management needs. Risk is fluid and, therefore, so should be risk management! However, there is a view that risk management is fixed, bureaucratic, autocratic and unchanging. If our role is to integrate ex-offenders, especially sex offenders, with all the labels that they bring with them, we have to change this view of risk management.  We need risk management to work on an individual level so that offenders can get the best from the system and increase their likelihood of returning to the community and living offence free. 

Both offender integration and positive risk management tie in with ideas of public protection. Generally when we talk of public protection in respect to sex offenders we are talking about proactive policing, social work, and probation; we are talking about how the system can limit the freedom of known offenders to protect the public from victimisation. Again, this form of public protection is not necessarily a bad thing in regard to certain offenders, but it cannot be a blanket approach, it needs to be a more individually driven approach that takes into account the individual offender. As risk management can be proactive in helping sex offenders integrate into communities post release, so too can public protection strategies, especially those that involve the community, multi-agency working and reflect the notion that people can change.

We have to reconsider the interrelationship between integration, risk management and public protection; they are not separate (but interrelated). They are not always negative (they can be, but they can be positive too). They can give us freedom to help offenders re-entering communities in a productive, individualistic way (so move away from one-size-fits-all models to more individualistic ones). If we as the people who work with these terms, concepts, guides, and frameworks on a daily basis see them as negative, undermining and problematic, imagine the impact that this has on the offender that has to live by them; therefore it would be worthwhile to reconsider how, why and in what way we use them.

Kieran McCartan, Ph.D

Friday, July 15, 2016

Yoga informed treatment

The topic of using yoga as an adjunctive treatment for traumatized people has recent come up on ATSA’s listserv and at a number of conferences (e.g., the National Adolescent Perpetration Network, the Massachusetts Adolescent Sex Offender Coalition). In case it helpful, I am summarizing some recent discussion for this blog.

In 2014, Bessel van der Kolk and his colleagues produced a fascinating randomized controlled trial on a specific kind of yoga practice for people who have experienced trauma. There has been increased empirical attention to the use of movement therapies such as yoga and tai chi, as well as mindfulness and meditation in recent years, and many within these fields have noted that the work of van der Kolk and his colleagues has moved the field forward a little more. Despite this empirical attention, it may be more helpful to consider yoga more as a source of practice-based evidence than an evidence-based practice. By this, I mean that yoga is clearly not for everyone; in the experience of many, when it is helpful it can be extraordinarily helpful. If it’s not for you, it’s probably best not to practice it.

My involvement with trauma-sensitive yoga (TSY) in treatment goes back about 10 years to when I was overseeing the front end of treatment at Wisconsin’s civil commitment program, Sand Ridge. Much has changed there since, but at the time I was frustrated by the fact that we had clients in treatment who could do all the cognitive exercises in the world and run groups about cognitive skills better than many facilitators. The problem was that they could examine their cognitions and actions after the fact, but they just couldn’t observe them in the moment as they were happening.

In many cases, they came by this honestly. Years of abuse, neglect, and other trauma, sometimes before they could even talk, left them in the states you might expect: scanning their environment for threats, scanning the staff for evidence of bad intent, and never scanning themselves. One ATSA-lister quipped with me that this apparent absence of curiosity in many of our clients can seem to disprove the Socrates dictum that the unexamined life is not worth living. In fact, it seems that many of our clients have never had the opportunity to develop self-observation skills because they were too busy surviving.

On top of this, it has become obvious to many of us treating adults and adolescents that not only do our clients very often not examine their thoughts and actions, many of them outright hate their lives, their futures, their sexuality, and their own bodies. In the programs where I’ve worked, this has been evident way beyond the periodic self-injurious behaviors that programs often experience. A turning point for me was the day that a client who knew more about cognitive-behavioral treatment than most of the clinicians left group and impulsively assaulted a uniformed staff. He was as surprised as anyone by the assault; in essence, he knew the words but not the music about managing his behavior.

Rob Longo, Kevin Creeden, John Bergman and I worked together some years back on using brain-based interventions in the treatment of trauma and violence. Reviewing the research inevitably led to an interest in yoga and other movement therapies as a means to deepen the impact of therapy. In my case, I joined up with Bessel van der Kolk’s JRI group and became one of their first certified instructors. We’ve used a specific form of trauma-sensitive yoga (see in our programs, on and off, for some time now with positive overall results. I mention some key points below.

Yoga, like other movement therapies and many forms of meditation can be an excellent means by which people can develop the self-observation skills that will make it easier to access treatment. Many have found it to be a transformative start to reclaiming their bodies and their lives. I park it under the responsivity principle generally, but note that for some people it can have dramatic effects beyond being merely an adjunctive treatment.

Trauma-sensitive yoga generally eschews some of the more obvious pitfalls of doing yoga in settings such as those in which many of us work. Simply bringing in a teacher and hoping for the best is unlikely to work out very well. Not only can many of the usual trappings actually become distracting from its purpose (lavender oil, eye pillows, etc.), some of them can be triggering (e.g., the use of straps and many of the “poses” such as happy baby and down dog).
Ultimately, key elements in the way that we use this kind of yoga include:

1)      Just noticing…

2)      …and practicing making choices based on what one notices (e.g., if stretching your neck feels different on one side or another, you might try altering how how you stretch)

3)      An investigation of each experience

4)      Being highly sensitive to dosage. Getting in touch with body sensations can be much scarier than most of us realize. For people who are traumatized, even a focus on the breath can be triggering.

5)      This is judgment free: This is not about trying to do anything better, comparing yourself to others, etc.

6)      This kind of yoga should never, ever be compulsory. Directing people to do yoga without it being completely their choice is itself an abuse dynamic. All too often, we’ve been stymied by the past experiences of clients who have been hospitalized and gently coerced into yoga by staff who remind them that it will help them earn points, levels, privileges, etc. Bad practice.

My colleague David Emerson and I have noticed that although we’ve worked with similar groups of adolescent clients we tend to use different formats. I have no problem teaching classes of 35-40 minutes, while he often gets better results from very brief individual interactions. I’ve chalked this up to small differences between us more than differences in clientele.

I urge all readers to look further into the possibility of movement therapies and meditation practices as adjunctive treatments for trauma!

David Prescott, LISCW


Thursday, July 7, 2016

Prevalence of Perpetration

There is no simple answer to the question, “How many sexual crimes are committed each year?”  It is extremely difficult to find any reliable measure for many reasons – sexual crimes are rarely reported; the definitions of sexual assault, rape, child sexual abuse, statutory rape, and other crimes vary from state to state; and how sexual crimes are recorded may vary from one municipality to another and even from person to person.  Even with these challenges, current measures of the incidence and prevalence of sexual violence provides important information necessary for better policies, more effective interventions, and evidence based prevention programs.   

The SOMAPI report from the DOJ SMART Office begins with a chapter by Jane Wiseman that provides an excellent overview of what is known about the incidence and prevalence of sexual crimes in the US [].  The chapter documents the wealth of information from a variety of different data sources including the Uniform Crime Report (UCR) data to the Federal Bureau of Investigation (FBI), National Crime Victimization Survey (NCVS) data, National Violence Against Women Survey (NVAWS), among many others.  Most of these sources report out information about the extent of victimization.  For example, incidence is defined as the number of separate victimizations and prevalence is defined as the number of people within a demographic group (e.g., women or men) who are victimized during a specific time period.  And advocates will quote statistics that state how many women are sexually assaulted in their college years (one-in-five; Not Alone) [] or how many children are sexually abused before the age of 18 (one-in-five girls and one-in-20 boys; Finkelhor) [].

However, given the growing focus on preventing the perpetration of sexual abuse and in particular ATSA’s focus on what we know about those who cause the harm, what do we know about the incidence and prevalence of sexually abusive behavior? 

Through NEARI Press, David Prescott, Steve Bengis and I reviewed a 2013 JAMA article by Michele Ybarra and Kimberly Mitchell on the prevalence of sexual abuse perpetrated by boys and girls. The authors found that 1 in 10 youths (9%) reported some type of sexual violence perpetration in their lifetime.  And for those who did perpetrate some form of sexually abusive behaviors, 16 years was the most common age of onset.  Here is the link to that NEARI Press commentary:

I have also looked into this question during my fellowship with the DOJ SMART Office and found that in the US, we rarely ask these questions about perpetration but in other countries, these questions are asked -- especially in war-torn countries. I would recommend an article by Jewkes, Fulu, Roselli & Garcia –Moreno that discusses this from a global perspective.

If we begin to look at the rates of perpetration (much higher than most people would expect, especially if the broader definition from public health is used) then we see the importance of early intervention with all youth, and especially with boys at the middle and early high school ages.

As ATSA members, we are constantly trying to say that one-size-does-not fit all; that people who abuse are people we know, etc.  If we begin to ask question about the rates of perpetration and begin using these statistics, it highlights a key role for those who work with offenders and youth with sexual behavior problems.  We have a unique skill in identifying behaviors that are healthy and also those of concern.  And even more, as clinicians, probation and parole officers, and other professionals in this field, we know how to talk about our concerns and also how to confront behaviors that may give us some concern.  As the focus of prevention slowly shifts towards preventing the perpetration of sexual harm, there is a growing need for these important skills. 

Joan Tabachnick

Friday, July 1, 2016

David Lee talks sexual harm prevention with Jon Brown

People throughout the world are taking action to prevent sexual violence.  As a global problem, we need to learn from each other to develop and implement prevention strategies and approaches. ATSA’s Prevention Committee includes members from all over the world, including Jon Brown from the National Society for the Prevention of Cruelty toChildren (NSPCC) in the United Kingdom.  I recently had the opportunity to interview Jon about sexual violence prevention work in the United Kingdom (UK).

Drawing on knowledge from his work to prevent child sexual abuse and from the ATSA Prevention Committee, Jon chairs the prevention committee of the National Organization for the Treatment of Abusers (NOTA).  Jon describes the committee as moving toward primary prevention to “get on the front foot and address the drivers of sexual abuse and sexual violence before they actually manifest themselves in crimes against adults and children.” In July 2016, NOTA will be hosting a prevention conference where prevention experts will explore how to build primary prevention effort. In addition NOTA is creating public events and facilitating conversations about primary prevention of sexual violence.

Jon is committed to building a prevention infrastructure in the UK.  He says that “we need to translate the momentum that is beginning to grow into a real national strategy.” In order to support the investment in prevention it is necessary to recognize that “if we can intervene early and can actually prevent abuse in the first place, then you are saving huge amounts of money. Obviously you are saving huge amounts of distress and trauma to the victims, but importantly, to government, you are saving many millions of pounds a year.”

Jon is working toward establishing prevention centers throughout the UK to provide advice and information to local providers and community members on how to prevent sexual violence.

Learn more about Jon’s work to prevent sexual violence by watching the full interview at

David S. Lee
Director of Prevention Services
Manager, PreventConnect
California Coalition Against Sexual Assault (CALCASA)