Thursday, June 29, 2017

Bring me the Horizon! (and Kaizen)

By Kieran McCartan, Ph.D. and David S. Prescott, LICSW

Across the UK, but especially in England and Wales, the response to crime and management of those who break laws (especially those who sexually abuse) is shifting. The Conservative government has recently instituted changes to the management of offenders across the board with its transforming rehabilitation agenda. This agenda shifts the offender management landscape significantly, with one of the most contentious issues being the privatisation in the management of all low and medium risk offenders to Community Rehabilitation Companies on a payment-by-results model, with all high risk offenders remaining with a downsized, specialized probation service. Interestingly, this approach does not apply to all low and medium risk offenders. Sex offenders – regardless of their risk level – will be managed by a downsized probation service. In other words, all sex offenders are considered high risk regardless of the actual risk they pose.

In addition to these practical changes, there have been significant changes in policy and practice around sex offender treatment programmes. Up until recently, the cornerstone of sex offender treatment in the UK was linked to risk level, required that those entering treatment first admit guilt, and used cognitive-behavioural approaches. While there had always been a degree of scepticism about the impact and utility of sex offender treatment programmes, there was a view that programmes needed to be evidence based (Mann, 2014; Ministry of Justice, 2010) – or at least based on sound science – and that doing something was better than doing nothing. The Ministry of justice argued that:

·         Sex offender treatment models do not have a sufficient evidence base

·         They can therefore only be regarded as experimental

·         There are engagement issues with offenders participating

·        There are methodological limitations to the research and evaluation processes (especially  meta-analysis)

·         There is no clear consensus on the right way to treat sex offenders

                                                                                                (Mann, 2014; Ministry of Justice, 2010)

While some may argue with the Ministry of Justice’s perspective on sex offender treatment programmes in general, it was nonetheless respectable and defensible. However, this blog’s concern is that the demand for a solid evidence base seems to have started to dissolve. The swing from left to right with the conservative government, an increase in ideological (as opposed to science-based) policies, austerity and privatisation has brought about changes, but not necessarily what the Ministry advocated. What we have now is a change in the treatment of sexual offenders that might have its roots in research, but is not evaluated, evidenced based or necessarily coherent. Only time will tell; exit the “Sex Offender Treatment Programme” (SOTP) and enter “Horizon” and “Kaizen”.

Earlier this year (in March) the Ministry of Justice rapidly introduced two new sex offender treatment programmes: Kaizen (for high risk, high need, high priority offenders) and Horizon (for medium risk offenders) to replace existing SOTP programmes. Initially, it came as a surprise to many in the field, although there had long been murmurs of a change of direction, but recently it has emerged that there were issues relating to recent programmes and a related report was apparently suppressed (Daily Mail, 2017).

At first glance and on paper, the two new programmes look good enough. They appear to be strengths-based, positively orientated and focused on ideas found in the Good Lives Model and related approaches; this is certainly a welcome change from approaches of the past. The idea is that they build on and adapt the recently jettisoned SOTP – they are an update and remodelling of existing practices. As with previous versions of sex offender treatment in the UK neither Horizon or Kaizen are aimed at low risk sex offenders, but unlike previous programmes they have capacity for “Deniers”/”individuals who are maintain their innocence” which is a welcome shift. Both programmes are based on the sex offender treatment literature and pull together material from a range of sources.

-        Kaizen is based upon Risk, Need and Responsivity; multidimensional views of needs and interventions to be holistic, therefore incorporating biological, psychological and social aspects; strengths based approaches; desistance; and adaptive, appropriate and easy to engage with approaches to learning.


-        Horizon is based upon criminogenic needs and the recognition that sex offenders and non-sex offenders are similar and therefore addresses poor problem solving skills, poor self-regulation and relationship problems.

While these two new programmes are purportedly evidence based, it may be better to say they are evidence informed. In the pure research/evaluation/piloting sense they are not evidence based, having not been tested rigorously. This is ironic given the Ministry of Justice’s need for rigorous evidence in other areas of sex offender treatment/support (i.e., Circles of Support and Accountability). From our perspective, there are further ironies. New models often attract doubt and even scorn in the professional literature. There can be a paradox of putting down unproven innovation at the same time as there can be nothing proven until there is innovation. While we applaud the development of these new models and hope that they are successful, it is nonetheless strange to see that the Ministry of Justice’s complaints about unproven methods has led to more unproven methods being championed.

Therefore we need to make sure that the treatment, rehabilitation and (re)integration is fit for fit for purpose, publically accountable, transparent and not directed by “political”; especially in the arenas of sex offending given the increased public, media and political visibility the issue has. As Ruth Mann observed in 2014, the evil twin of evidence-based policy-making is policy-based evidence-making. It is for exactly this reason that we need more dialog and debate and not less.  

Friday, June 23, 2017

Author Q & A with Sebastian Brouillete-Alarie discussing "Three Central Dimensions of Sexual Recidivism Risk: Understanding the Latent Constructs of Static-99R and Static-2002R"

Brouillette-Alarie, S., Proulx, J., & Hanson, K. (2017). Three Central Dimensions of Sexual Recidivism Risk: Understanding the Latent Constructs of Static-99R and Static-2002R. Sexual Abuse: A Journal of Research & Treatment. Online First.

The most commonly used risk assessment tools for predicting sexual violence focus almost exclusively on static, historical factors. Consequently, they are assumed to be unable to directly inform the selection of treatment targets, or evaluate change. However, researchers using latent variable models have identified three dimensions in static actuarial scales for sexual offenders: Sexual Criminality, General Criminality, and a third dimension centered on young age and aggression to strangers. In the current study, we examined the convergent and predictive validity of these dimensions, using psychological features of the offender (e.g., antisocial traits, hypersexuality) and recidivism outcomes. Results indicated that (a) Sexual Criminality was related to dysregulation of sexuality toward atypical objects, without intent to harm; (b) General Criminality was related to antisocial traits; and (c) Youthful Stranger Aggression was related to a clear intent to harm the victim. All three dimensions predicted sexual recidivism, although only General Criminality and Youthful Stranger Aggression predicted nonsexual recidivism. These results indicate that risk tools for sexual violence are multidimensional, and support a shift from an exclusive focus on total scores to consideration of subscales measuring psychologically meaningful constructs.

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

In French/European countries, professionals tend to be lukewarm towards structured risk assessment. As a native French speaker, I often became involved in debates about the pros and cons of actuarial assessment. By participating in these debates, I became cognizant of the conceptual limitations of this approach. Although many criticisms were warranted (e.g., limited predictive accuracy), one always “struck a nerve” with me: that risk factors are clinically meaningless statistical entities that do not enable a true comprehension of the offender.

Since the dawn of psychology, observable behaviors have been used to infer personality traits (or dynamics of the unconscious mind). In this context, why would risk factors, i.e., measures of criminogenic behaviors, be any different? Although risk factors are first and foremost statistical correlates of recidivism, they are also windows into the psychological and sociological mechanisms that lead individuals to commit crimes. This latent trait approach has been described in the works of Beech and Ward (2004) and Mann, Hanson, and Thornton (2010). Their theoretical frameworks for sexual offender risk assessment illustrated how to integrate static, stable, and acute risk factors in etiological models of risk that have far more clinical resonance than “dry” risk scales. Luckily for me, nobody had (yet) thought to empirically test these models. Thus, it became the overarching goal of my doctoral thesis.

At the start of my Ph.D., I had the luck of being put in touch with R. Karl Hanson and his research team (Kelly M. Babchishin, Maaike Helmus) by my director, Jean Proulx. It turned out that Karl had a project quite similar to mine; he wanted to explore the latent psychological constructs underlying the items in sexual offender risk scales. The goal was to shift practice from the assessment of unidimensional and “atheoretical” risk scores to the assessment of multiple risk-relevant psychological propensities. These constructs could then be combined in specific ways depending on the outcome of interest. In a way, we were exploring the building blocks of risk rather than its finite structure.

This lead to our factor analysis of the Static-99R and Static-2002R items (Brouillette-Alarie, Babchishin, Hanson, & Helmus, 2016). We quickly realized that the literature on this topic was substantive; we found 13+ studies on the factor structure of the Static-99/2002/R. Most studies obtained a solution of 3 factors (ours included): sexual criminality, general criminality, and a third factor related to age and victim characteristics. Unfortunately, none of the studies had conducted any convergent validity analyses. They interpreted the factors by looking at the items constituting each construct. Although this was a good start, we thought that more empirically grounded interpretations were necessary. This led us to the current paper.

What kinds of challenges did you face throughout the process?

Doing convergent validity analyses was, in fact, the easy part. The hard part was coming up with the factor structure in the first place (in Brouillette-Alarie et al., 2016). Jean Proulx and I started the factor analysis project in the spring of 2011, as part of my master’s thesis. Then, we involved Karl’s team, who gave us access to worldwide validation studies of the Static-99. They also (rightfully) told us that our factor analytic procedures were outdated and that we needed to redo everything from scratch (a common occurrence according to Maaike!). We dutifully did so, which led to our 2016 paper.

What do you believe to be the main things that you have learnt about the nature of the risk dimensions of the Static-99R and Static-2002R?

First, we learnt that sexual deviance is not a cohesive whole. Variables concerning sexual criminality clustered in two negatively correlated factors: Persistence/Paraphilia and Youthful Stranger Aggression. These factors were associated with different ends of the agonistic continuum (Knight, Sims-Knight, & Guay, 2013). Persistence/Paraphilia was characterized by modus operandi devoid of physical coercion and intent to harm, while Youthful Stranger Aggression was associated with sexual sadism and hostility. Furthermore, these two dimensions did not predict the same types of recidivism: the former was exclusively related to sexual recidivism, while the latter was predictive of all types of recidivism (like General Criminality). Without surprise, Persistence/Paraphilia was more common in sexual aggressors of children, and Youthful Stranger Aggression was more common in sexual aggressors of women. In sum, our results encourage researchers and evaluators to clearly differentiate between pedophilic and sadistic tendencies, as they refer to substantially different constructs. More often than not, they will not characterize the same offenders. In some rare cases (e.g., sadistic pedophiles), they will nevertheless converge into a very high level of sexual recidivism risk.

Second, we found a strong General Criminality factor that naturally converged with antisocial/psychopathic traits and domains of the Level of Service/Case Management Inventory (LS/CMI; Andrews, Bonta, & Wormith, 2004). This confirms that sexual recidivism risk comprises a general deviance dimension that is common to sexual and nonsexual offenders. The generality of criminal behavior in sexual offenders has already been highlighted by numerous authors (e.g., Lussier, LeBlanc, & Proulx, 2005).

Now that you’ve published the article, what are some implications for practitioners?

Although it is not yet ready to be implemented in forensic practice, we hope that sexual offender risk scales (and those scoring them) will adopt dimensional scores in addition to total scores. Sexual recidivism risk is unanimously considered to be multidimensional, and our current risk tools do not convincingly reflect that. It is more clinically relevant to conceptualize risk as the interaction between psychological constructs and the social environment than the sum of discrete correlates. Our research program tries to bridge the gap between those two perspectives.

Tuesday, June 13, 2017

HR1761: Bad Policy on the Horizon

By David S. Prescott, LICSW

The US House of Representatives recently passed HR1761. Within a few days, ATSA’s Executive Board of Directors issued a cautionary statement. The latest in a long tradition of tough-on-crime measures, this law – now on its way to the Senate – imposes harsh mandatory sentences (15 years at a minimum) for distributing sexually explicit images of minors. It aims to "criminalize the knowing consent of the visual depiction, or live transmission, of a minor engaged in sexually explicit conduct." Certainly, there is no question that we need efforts to clamp down on the distribution of media depicting child sexual abuse; there’s a lot of it out there, and many professionals have seen the direct harm that it can cause. What’s the big deal with this becoming law?


Unfortunately, critics of the law, including many ATSA members, have noted that the wording of the law is so vague that it could easily lead to adolescents serving very serious prison sentences for sending pictures of themselves naked to their boyfriend or girlfriend. It might make sense for readers to stop, pause, and consider our own impulsive acts as teenagers. Smartphones are ubiquitous amongst teens, as are questionable decisions. In some imaginable scenarios, a more effective response might be to require parents to take away the smartphone and ground their son or daughter for a month. A 15-year mandatory minimum sentence? Even adults can be prone to stupid online mistakes, whether sharing pictures with the wrong person, sending angry emails without thinking, or making an impulse purchase that they later regret. Don’t kids need guidance and education more than punishment? Going to prison at 17 and coming out at 32?


Of course, it is easy to complain about the cavalier ways that unhelpful legislation gets passed. One is reminded of policymakers unconcerned when their wide-cast nets catch more dolphins than tuna. On the other hand, professionals in the field often express deep disillusionment that our knowledge and expertise are not tapped in the creation of these laws. For many years it has seemed that we have to be on constant guard against well-intended but ultimately ignorant legislation.


The real story behind the news item is how difficult it is to fully grasp the complexities involved. The world has a long and unfortunate history of causing harm when attempting to legislate sexual behavior. Again, there is no question that young people should be protected from abuse. This outcome virtually always means more to professionals in our field, by far, than the income we receive. Still, the fact remains that sexuality is complicated. Adults sexting each other may seem “deviant” to some and yet is very common. The bright line is consent: one person’s intrusion is another’s intimacy. Who gets to make the call? I am quite certain that the restrictive nature of mandatory minimum sentences will not clarify this.


One colleague wondered aloud whether one purpose of the law might be to make it easier for prosecutors to negotiate ever-more-stringent plea agreements. If this is the case, one wonders to what extent this constitutes own form of bullying of young people by adults. It is the author’s belief that we will all benefit more from earnest attempts to help young people, including both those who abuse as well as those who are victimized than we will from this kind of punitive approach. Judicial discretion, assessment, and treatment where it is needed may not be perfect, but all of the indicators are that these are more effective approaches than mandatory minimum sentences for sexting.


Frankly, the author applauds ATSA’s board of directors not so much for writing their response, but for the restraint they showed in doing so. It is difficult to imagine how lawmakers would not imagine the downside impact of their actions or recognize how imprecisely they’ve defined their intentions.


For all of the above reasons, I know I speak for many when I urge readers in the US to contact their senator. Perhaps someday our lawmakers can use empirical measures of likely effectiveness of proposed laws similar to the ways that the Congressional Budget Office uses expert review to evaluate budgets.

Monday, June 5, 2017

Bridging the Gap: The Intersection Between Victim and Offender Treatment. A Conversation with Alison C. Hall

By Candice Christiansen, M.Ed., LCMHC, CSAT-S, EMDR Certified, Forensic Evaluator.

Historically, there has been a significant divide in the therapeutic community between professionals working those harmed by sexual violence and those who have caused the harm. However, for one professional, Alison C. Hall, the Executive Director of the Pittsburgh Action Against Rape (PAAR), the importance of understanding the treatment needs of both victims and offenders including the benefits of collaborating between both types of treatment providers has been her lifelong mission and vision.  
I recently had the privilege of interviewing Alison about her unique perspective and work with both victims of sexual violence, sex offenders, and bystanders. I was impressed by her dedication to the field of prevention.

Alison spoke passionately about how the movement towards primary prevention is one that revolves around social change. While Alison is a firm believer that rape crisis centers across the United States have indeed reduced sexual violence, she stressed the importance of collaborating with sex offender treatment providers. As she explained, “We can’t do this work alone. It is essential that we partner with others who want to end sexual violence.”

In 2006, Alison’s passion and determination to bridge the gap between treatment providers of sexual assault and sex offenders led to her efforts to establish the first sex offender court in the state of Pennsylvania. She convened a meeting with victim services, prosecutors, police investigators, public defenders, judges and treatment providers to discuss issues pertinent to sexual abuse and to understand each other’s work. She shared, “This was the first time these professionals were in the same room together discussing sexual abuse in Allegheny County.” As a result of that meeting, strong relationships developed and the first Sex Offender Management & Containment (SOMAC) Task Force was formed and continues to meet regularly.  

In recognition of her leadership in convening the first sex offender court in Pennsylvania she was awarded the Gail Burns-Smith Award in 2011. As she humbly stated, “It was the strength of the relationships of this task force that led to the creation of the first sex offender court in the state of Pennsylvania.”

Alison has worked at PAAR for 14 years in various capacities; she has been the Executive Director for almost 9 years. PAAR is dedicated to assisting victims of sexual abuse and ending sexual violence in the community. PAAR has served victims in Allegheny County for over 45 years, and is one of the first agencies in the US to serve victims of sexual assault. She shared, “It is the most motivating place I have ever worked.”

Alison was especially proud to share that through PAAR’s on-going outreach, each college in Pittsburgh currently recognizes PAAR as an important partner in the prevention and treatment of sexual abuse, and seeks PAAR’s direction to help develop appropriate responses to victims of sexual violence on their campuses.

As a member of the ATSA Prevention Committee, Alison has decided to run as the prevention representative to the ATSA board. When asked what her vision for ATSA’s future is, should she be accepted, Alison shared, “I believe that when those who specifically treat individuals who have sexually offended collaborate with professionals working with victims, we make greater strides in bringing about the social change required to end sexual violence.”

To learn more about PAAR, visit