Putting the humans back into human services

The question of how and where psychologists draw the lines of ethical conduct has flourished in the news recently. Revelations of the American Psychological Association’s (APA) connections with the CIA interrogation-torture have surfaced both inside the Washington DC beltway (with the US Senate Select Committee’s report) and out (e.g., James Risen’s Pay and Price: Greed, Power, and Endless War, which inspired the APA to re-open their investigation).

Although the torture of detainees is very different from the treatment and supervision of people who have sexually abused, some points are worth noting as we consider the effects of our actions on our clients and society. CIA detainees and sexual offenders are often more vulnerable populations than they appear. It can be easy to feel an urgent need to use whatever means are necessary to reduce risks as quickly as possible. It can be easy for professionals to lose sight of just how much power they hold over the people in their charge. Finally, it can be easy to believe that one is not capable of causing harm to people in our care or custody. As one extreme example, CIA psychologist Kirk M. Hubbard stated in a journal article titled Psychologists and interrogations: What’s torture got to do with it?:

Constanzo (et al.) argue that ‘psychologists should not be involved in interrogations that make use of torture or other forms of cruel, inhumane, or degrading treatment’ . . . Their statement is ironic for torture is illegal in the United States. But even more importantly, it seems to come from and apply to a world that no longer exists. . . . We no longer live in a world where people agree on what is ethical or even acceptable, and where concern for other humans transcends familial ties. 

This statement does indeed contain ironies (e.g., it seems that no one is disputing that torture took place outside the US, or the belief that whatever happened could not be torture because that would be illegal, or that because it took place outside the US it was somehow less unethical).  This statement also illustrates how people in the helping professions can find or imagine exceptions to standards of professional conduct (e.g., behavior that would be unethical under other circumstances is ethical when the world is changing and we believe that old rules don’t apply). Certainly, the behavior of nations in wartime is beyond the scope of this blog and the expertise of this author. However, professionals at the intersection of mental health and the law will want to consider factors that influence our understanding of ethical conduct, as well as how these same factors may appear to change over time. Lost in the current media discussion are other discussions about the involvement of mental health professionals in interrogations (e.g., Chaffin, 2010).

A new article appeared in the Journal of the American Academy of Psychiatry and the Law, this time by psychiatrist and retired Brigadier General Stephen Xenakis, titled, The role and responsibilities of psychiatry in 21^st century warfare. In it, he states:

When I first worked with detainees at Guantanamo Bay, I was troubled by a peculiar and unsettling awareness . . . Here I was, focusing on torture and cruel, inhuman, and degrading treatment of prisoners and yet, these were the very men who were the “enemy.” As a career Army officer, I pledged to protect our nation against all enemies, foreign and domestic. As a physician, I pledged to care for all who were hurting and needed help. Facing some detainees who were tortured because they were our enemies, sometimes with the aid of military physicians, I felt I had entered a domain in which the old paradigms ceased to apply. Perhaps that is one of the fundamental problems with Guantanamo. . . . I have always believed that doctors are champions of human rights, no matter what role or assignment we accept. After all, every society endows their doctors and healers with special trust and confidence. We symbolically wear the white coat at all times, even as psychiatric experts for the prosecution or in military uniform.

What does this have to do with the treatment of sexual violence?

In 2010, the late psychiatrist Bill Glaser wrote (among other things) that in its current state, sex offender treatment is punishment and that professionals should not kid themselves about this.  Jill Levenson and I wrote a reply in which we argued that this is simply not the case, and that licensed professionals are bound by ethical codes that make it unlikely for treatment to be entirely punitive. Just the same, Glaser’s point was well-taken, in that our clients don’t always view their treatment to be as helpful as their therapists do (Beech and Fordham, 1997), even though consumer-satisfaction surveys of sex offenders have often produced positive results (e.g., Levenson, Prescott, & Jumper, 2013).

In 2011, Steve Sawyer and I published an article on boundaries and ethics in sex offender treatment. We observed that:

The licensed therapist treating sexual offenders has an ethical responsibility to the client, a legal responsibility to the court, and an ethical/moral responsibility to the community. Specifically, the therapist’s primary responsibility to the client’s welfare is checked in part by the standard of practice to share information with county/state corrections and/or the community as required by law or by contractual obligations or as needed to protect the community. This is done with informed consent from the client or as needed by law. Within these limits of confidentiality, however, the therapist’s focus is on the sexual offender client. This situation recognizes that the client is best served—and the public is best served—when the therapist and the client develop a therapist–client relationship that is separate from the sexual offender’s relationship with the probation officer and the court.

This seems clear enough; professionals in our field are almost always involved in balancing the rights and welfare of others and develop specific practice skills for doing so. Yet the recent events involving large agencies and organizations (the APA, CIA, etc.) should still make us wonder if there aren’t other concerns to bear in mind. In what ways might we go wrong? What should we look out for in order to prevent harm to clients? How can we maintain the highest level of professional conduct?  Anecdotally, it seems to the author that the most common forms of grievances and ethics complaints (when they occur) are in the areas of misuse of evaluation measures, and coercive treatment experiences.  

Readers may be aware of an ongoing class-action suit in Minnesota. After 20 years of operation, only three people of a current census of over 700 have ever received provisional discharges (one within the past few days), raising inevitable questions of constitutionality of the program. The federal judge in the case established an expert panel to examine the program; their report was published recently. This expert panel consisted of four experts, three of whom have served as directors of civil commitment programs. After nearly a year of reviewing the program, they released a 108-page report with 44 broad recommendations. Within their (at times devastating) conclusions, the panel comments on the apparent failure of many clients to advance in treatment, although they note efforts to expand a pre-release portion of the program:

This delay appears to be a result of a pervasive belief on the part of MSOP administration and staff that it is not their responsibility to proactively petition and rigorously advocate for clients to advance in phases and to CPS. There is a shared belief of having no control because the structure of the law and its processes have created the inability to release clients. . . Clinical staff and clinical supervisors do not appear to be supported or encouraged to appropriately modify the treatment offered in order to appropriately respond to the individual and complex needs of these clients. From a clinical point of view, this population seems to be administratively unrecognized, misunderstood, and inappropriately served (or underserved). It was clear to the Panel that staff who work with these clients have genuine and compassionate concern for the wellbeing and future aspirations of their clients, in spite of feeling unsupported in their attempts to advocate for programmatic changes.

Although there is always more to any story, two themes emerge for purposes of this discussion:

·         One is the theme (often heard in discussions as diverse as CIA abuses and good programs that fall on hard times) of good, decent staff at the front lines feeling powerless and helpless (apparently, a parallel process to the experiences of the clients in the program).  

·         Another is the theme that apparently no one was advocating for the rights or wellbeing of the clients.

In my view, there may be two areas of focus for professionals that might be helpful and that are often outside strict interpretations of ethical codes.

The first is advocacy of quaternary prevention, as described in our field by Geral Blanchard and others. While primary, secondary, and tertiary efforts focus on preventing sexual violence among specific populations, quaternary prevention focuses on the prevention of harm being caused by these same efforts. Most, if not all professionals who enter our field want to practice ethically. Yet, many providers and treatments have caused harm under the mantle of helping others.

The second is that all people in our field should re-visit the idea of advocacy, alluded to recently in an article titled Where has all the psychology gone? by Gannon and Ward. Where our field once advocated for community safety to the point of placing clients’ needs second to community safety, it may be time to consider just how far back that second place is.  For example, the Texas Department of State Health Services defines sexual offender treatment, in part, as: “Sex offender treatment is different than traditional psychotherapy in that treatment is mandated, structured, victim centered, and the treatment provider imposes values and limits. Providers cannot remain neutral because of the risk of colluding with, adding to, and/or contributing to the offender’s denial” (Texas Department of State Health Services, 2012).

As an example of context of advocacy elsewhere, consider this section of the preamble of the NASW Code of Ethics:

Social workers promote social justice and social change with and on behalf of clients. “Clients” is used inclusively to refer to individuals, families, groups, organizations, and communities. Social workers are sensitive to cultural and ethnic diversity and strive to end discrimination, oppression, poverty, and other forms of social injustice. These activities may be in the form of direct practice, community organizing, supervision, consultation administration, advocacy, social and political action, policy development and implementation, education, and research and evaluation. Social workers seek to enhance the capacity of people to address their own needs. Social workers also seek to promote the responsiveness of organizations, communities, and other social institutions to individuals’ needs and social problems.

The mission of the social work profession is rooted in a set of core values. These core values, embraced by social workers throughout the profession’s history, are the foundation of social work’s unique purpose and perspective:

·         service

·         social justice

·         dignity and worth of the person

·         importance of human relationships

·         integrity

·         competence

The preamble to the APA Code of Ethics is more succinct: “Psychologists respect and protect civil and human rights.”

Perhaps our next step as professionals is to ask ourselves:

·         Even though our clients provide informed consent to our treatments, how much duress must they be under to do so before it is not meaningful consent to treatment (e.g., “I am only consenting because if I don’t it’s four years added to my sentence”)

·         To what extent are we advocating for both our clients’ needs as well as community safety?

·         At what point is it acceptable for a mental health professional to induce suffering, whether directly or indirectly?

·         At what point do mental health providers in large institutions (such as civil commitment programs) have an ethical obligation to advocate for their clients over and above what the administration is (or is not) doing?

And in the shorter term, and against the backdrop of the axiom that the only thing necessary for the triumph of evil is that good men do nothing, how can professionals best discuss these topics publicly while maintaining the highest standards of professional conduct?

 David S. Prescott, LICSW

Connecting Sexual Violence Expertise with Bullying Prevention

A conversation with Ray Knight
Written by Joan Tabachnick

As part of our new prevention series, I had the chance to speak with one of my ATSA heroes, Ray Knight about his relatively new work and interest in bullying prevention.  Most people know Ray as a passionate public speaker who once literally presented on stage while in bed from a back injury. He is remarkable for his ability to race through 180 slides in an hour and still leave the audience wanting more.  If felt that way in my interview with him about this new avenue of his work. 

 

Ray’s relatively new focus on bully prevention grew out of his desire to apply what he has learned in aggression research to a practical prevention project.   It is also a great example of how ATSA members are using their skills and knowledge to have an impact on prevention in their community. 

 

A few years ago, Ray and his wife, Judith Sims-Knight, began working with the Foxboro School system, monitoring the effectiveness of a Caring School Community (CSC) program in grades K through 4^th.   The children are then followed up through high school.  In the K-4^th grade intervention, children are taught through cooperative learning about how to mediate conflict and through modeling and participation about the importance of prosocial behavior and community involvement.  Both teachers and children model these behaviors throughout the school.  In Ray’s own words, “So far, it is showing promise in reducing aggression as those that have experienced the program progress to higher grades.”   

 

Ray and Judith began their work in Foxboro as part of their work with a parent task force and then brought their well-regarded research skills to this project.  As parent-researchers, they are administering, scoring, and interpreting for the school system an annual computerized inventory that assesses the incidence of both perpetrating and being targeted for various forms of bullying.  If a respondent is identified as a bully or a target, the computer program asks more detailed questions about the circumstances and consequences of this behavior. Not only does this identify for the school system areas for potential intervention, but it also serves as a consistent monitor of the frequency of these behaviors so that they can determine whether programs that they implement to reduce aggression have any effect. 

 

The assessment protocol that Ray and Judith created, which is based upon the bullying literature, serves as a metric to measure the efficacy of this program. This protocol is, however, more than just a research tool; it also helps the school system identify problem areas they need to address.  For example, Ray described how the children identified a problem with the band room in the high school – significant bullying occurred there before, during, and after school. The administrators used the computer survey to examine what was happening and take steps to solve this problem. 

 

In addition to physical and verbal bullying, the research is also looking at relational aggression such as gossiping, telling stories about someone, exclusion behaviors such as who sits alone at lunch and who is invited to parties, and cyber bullying, which exclusively uses the internet and social media for bullying. In 2013, 5^th, 6^th, and 7^th grades had experienced varying amounts of CSC, and those experiencing the program could be compared to students who had not experienced CSC.

 

The initial data are showing that the intervention is working. Ray and Judith are also finding that physical bullying seems to break into two components, instrumental/proactive and reactive aggression.  For those who don’t know the terms, instrumental or proactive aggression is an aggressive act intended to achieve a goal, while reactive aggression is retaliatory and stems from anger or hurt. The CSC program does affect the anger and dysregulation that contributes to reactive aggression, but is less effective for reducing instrumental aggression.  The program also appears to reduce the active forms of relational aggression (rumors, gossiping) but not the more passive exclusionary types of relational aggression (not enough room for one more at the lunch table…). Direct meanness and verbal harassment also decrease. Next year, they will be able to analyze whether CSC also decreased sexual harassment, when the participating students reach the age at which these questions are asked.

 

 Overall, the initial results show that the Caring Schools Program is working.  It has had a huge impact on the community and the teachers.  What might be hardest to measure is how it also motivates and energizes the teachers so that the motivation and interest in the program keeps growing!  You can check out the feedback that Ray and Judy have given to the school committee and administrators, and a doctoral dissertation that has examined the first three years of the follow-up at http://www.raymondknightphd.com/research.

 

 

Sexual Violations and Sexual Violence

 

“When sexual abuse occurs in the absence of violence,

and in the presence of trust, kids may be totally disarmed.” 

 Early in my career, as a child protection social worker, I was dispatched to a school, accompanied by a police officer.  A school nurse had reported a 12-year-old girl who disclosed sexual abuse.  The nurse asked “Amy” if she would tell us how her father would come into her room at night and hurt her.   Amy quietly shook her head, “No.”  It seemed Amy was recanting.  Then the nurse asked, “Amy, do you remember telling me how your dad would come into your bedroom at night and touch you under your pajamas?”  Amy nodded, “Yes, but he didn’t hurt me.”  The ‘ah-ha’ moment struck all of us - the nurse had chosen words that conflicted with Amy’s experience.  Amy added tearfully but confidently, “I love my dad.  I just don’t want him to come into my room at night.”

In that short exchange, Amy conveyed two important lessons: first, that professionals should let victims tell us how they experienced sexual violations, and second, a victim will often have an otherwise valued relationship with their abuser.  This is especially true for child victims, when more than four out of five sexually abused kids are abused by a friend or relative.

Amy was indeed harmed, in ways that she would need help understanding, but she didn’t experience the kind of violence that immediately cues kids that something bad is happening.   When sexual violations occur with the recognizable violence of pain, bodily injury, force, or threats, even young children instinctively know that something is very wrong.  Sexual abuse that includes “violence” is easily recognizable, always harmful, and always against the law.  But when sexual violations occur without veritable violence, many children, predisposed to trust their abuser, often don’t recognize that they are in the midst of sexual abuse.  Sometimes sexual abuse is a violation of a relationship.

One insidious characteristic of non-violent sexual abuse is that it may be unrecognized.  When people are asked why they didn’t report the abuse, they sometimes say they felt duped, perhaps complicit, but mostly confused.  And when victims otherwise liked their offender, they often didn’t report because they were afraid of the uncertainty of the aftermath – for themselves and for the offender.

These are among the findings of research conducted by psychologist Susan Clancy.  Dr. Clancy interviewed hundreds of adult survivors of child sexual abuse for her 2009 book, The Trauma Myth; The Truth About the Sexual Abuse of Children – and Its Aftermath.  Clancy reported that the vast majority of sexual abuse of children occurs without violence, and, as a result, adult survivors typically expressed that, as children, they felt more confused than traumatized by the experience, especially if the abuser was someone who they otherwise liked and trusted.  Clancy suggested that children experience sexual abuse in a range of unique ways and that professionals should be supportive in letting kids tell us how they experienced sexual abuse, with cautious judgment.  Clancy validated Amy’s experience.

In the years after “lessons from Amy,” when I began to work with offenders, I discovered that offenders are similarly disabled by the other side of the same coin: offenders usually admit they knew they were taking advantage of another, but are slow to understand sexual harm that is not accompanied by violence.  Non-violent sexual violations often occur in a blind spot for both victims and offenders, especially when abuse is within families or between friends.

When people have an understanding of “sex offenders” as violent rapists, predatory child molesters, or otherwise “evil monsters,” and family or friends don’t fit that description, children are unguarded by familiar relationships.  When sexual abuse occurs in the absence of violence, and in the presence of trust, kids may be totally disarmed.  The “monster myth” and perceptions that sexual abuse must be “violent,” may obscure both victims and offenders from recognizing a broad range of sexual violations.

More than half of all children who are sexually abused, are abused by an older child.   Depending on the age difference between kids, sexual contact might be against the law in one state (or province), but not in another.  In many states, sex between teenagers might be “statutory rape,” even if it meets criteria for consent.   If certain sexual behaviors are “statutorily” proscribed, they are, by definition, illegal, but if it is truly consensual should it be called “rape,” which in any form is understood to embody violence?

Prevention of sexual abuse should begin by teaching kids about sexual respect, but teenagers need to also know local “statutory rape” laws, or risk becoming a “child molester” or “rapist” because they crossed a legal definition or jurisdictional line.  People are taught from a young age that violence is never okay, and that sexual violence is particularly reprehensible.  But in the absence of violence, the rules for interpersonal sex are often confusing for young people.  Teaching people about sexual respect goes beyond avoidance of sexual violence, and inoculates both future victims and would-be offenders.

In summary, sexual violence is not a synonym for sexual abuse – it is a subset.  When we describe all sexual abuse as sexual assault or sexual violence, we risk losing recognition by victims as well as offenders.  We also lose the critical importance of context and the actual continuum of sexual abuse.  Perhaps in our zeal to convey that sexual abuse is a serious matter, we use “sexual violence” as an attention-getting, generic term, however, using “sexual violence” to describe all sexual violations might exacerbate deceptive myths, and unwittingly hinder public education and prevention efforts.

Jon Brandt, MSW, LICSW

 

 

ATSA 33rd Annual Conference – San Diego 2014 (Part 2 of 2)

Welcome back to part 2 of our review of the ATSA conference, this week myself and David Prescott will discuss some of the material that we think might be of interest to the wider SAJRT community.

 

An area of research that I (Kieran) have been involved in for a while is SORN, particularly the public notification aspect of it, and as such I attended a session looking at preliminary data from a National Institute of Justice funded study looking at law enforcement attitudes to it (Jill Levenson, Andy Harris & Chris Lobanov-Rostovsky). The data that was discussed was based on approximately 100 interviews with law enforcement officers across four states (California, Massachusetts, Florida & Colorado) each with a different approach to sex offender registration and notification. The preliminary data indicates that law enforcement believes that registration can have its benefits in enabling them to do their job effectively but that the data and the computer systems being used currently are problematic, unhelpful and do not map together well. In addition, it was felt that in the main the majority of sex offenders complied with their registration requirements and when they did not it was not necessarily a purposive breach indicating a return to offending, but rather individual human error and/or carelessness. The authors will be discussing this research again in a more expanded fashion over the next couple of years and it will be interesting to see what else it brings to light. (KM)

 

One of the benefits of this structure of ATSA this year (i.e., that there was only one plenary on the Thursday and Friday morning) was that there were more research, as well as treatment, papers to attend and often times these papers where allowed more space for discussion. I attended a session on the health and social cost of prevention and heard two radically different papers, one on the cost of sexual abuse in the UK (Carol McNaughton Nicholls) and one on trauma informed treatment (Liam Marshall). At first these two papers may seem to be poles apart but in reality they talked to the same pertinent issue, which the negative impact is being a victim of sexual abuse has you individually and how this impacts your future mental, physical as well as emotional health. Both papers talked to the importance of recognizing abuse early on people’s lives and intervening to prevent it from continuing as well as enabling the victim to start the healing process before the abuse severely impacts their long term development. In addition the two papers, but particularly McNaughton Nicholls, talked about the inter-relationship between different types of vulnerability and being a victim of abuse suggesting that we could maximize the limited resources that we have in a more effective interrelated approach. (KM)

 

The past two decades have seen dramatic changes to our understanding of psychopathy. With the first waves of higher-quality research, concerns emerged about whether or not treatment had any effect on criminal re-offense, or whether it would actually make matters worse. A study by Seto and Barbaree (1999) came to prominent international attention, suggesting that treatment could make matters worse. A follow-up investigation by the same authors with Calvin Langton using more sophisticated techniques, a longer follow-up, and expanded sample found less reason for alarm and yet did not garner the same amount of attention. At around the same time, many professionals became concerned that the marketing efforts of measures of psychopathy were outpacing the actual accumulation of knowledge, and that extending the construct to juveniles could do more harm than good. This year, Paul Frick, Michael Caldwell, and Mark Olver offered fascinating perspectives on people with high levels of psychopathic traits across the lifespan. (DP)

 

An entertaining presenter, Paul Frick summarized years of research on callous/unemotional traits in children. He noted that although response to treatment can be a challenge among these children, reward-oriented parenting approaches, cognitive-behavioral treatment, and interventions targeting social skills appear to be promising. Michael Caldwell then described the treatment of adolescents with high levels of psychopathic traits at the Mendota Juvenile Treatment Center in Madison, Wisconsin. Caldwell’s research in this area has been compelling, with significant reductions in violence. Finally, Mark Olver presented the current state of research on the treatment of adults who score high on the PCL-R and concluded that there is currently no evidence that appropriate correctional treatment makes psychopathic offenders worse, that risk reduction assessed during treatment is linked to reduced sexual and violent recidivism, and that risk reductions can be found among offenders with significant psychopathic traits. (DP)

 

The findings of each of these presenters are important for a number of reasons. The first is that there is increased reason for optimism that the right treatment can work under the right conditions for even the most challenging of clients in treatment. While much more research is needed, Frick, Caldwell, and Olver have certainly added to our knowledge and practice. (DP)

 

This completes the SAJRT brief review of the ATSA conference. This review is by no means comprehensive or extensive so please have a look at the conference brochure on the ATSA website to see what some of the other interesting and informative papers were.

 

Kieran McCartan & David Prescott

ATSA 33rd Annual Conference – San Diego 2014 (Part 1 of 2)

The ATSA conference has come to a close for another year, thank you San Diego and we are looking forward to Montreal next year. We (that is Jon, David and myself) thought that we would reflect upon the conference and highlight some of the interesting sessions and papers that were presented, for the benefit of those could and could not make the conference…

Jesse Bering opened the conference on Thursday morning with a plenary session that was as provocative as the title: Does Lust Make Us Stupid? The Effects of Sexual Arousal on Decision Making. Bering is the author of Perv, the Sexual Deviant in All of Us. Bering presented an extensive literature review that suggests, as one might suspect, that lust does indeed make us stupid. Again, not surprisingly, it appears that males are more lustful, and “stupid,” than females. Bering suggested that significant “lustful differences” between genders have biological and evolutionary explanations. He also explained how social rules for interpersonal sexual behaviors, with historical and cultural roots, are constantly evolving. Despite efforts, beginning with Kinsey, to understand the range of human sexual behaviors, we don’t have sufficient research to know what variants of sexual arousal are truly within the range of “normal.” In contrast, Bering offered compelling illustrations for how our knowledge of deviant sexual behaviors is little more than anecdotal. Bering’s presentation was a captivating, if not unsettling, sequel to last year’s keynote by Ogi Ogas and Sai Gaddam, on A Billion Wicked Thoughts – what the Internet tells us about sexual behavior and relationships. (JB)

On the Thursday evening there was a special interest group session by Berkley Media Studies Group on their NSVRC/ATSA backed study examining the representations of sexual abuse and sex offenders in the media. Their findings, so far, are that the media typically frames sexual offenders as predominantly a monster narrative that is mainly reactionary, criminal justice orientated and negative. They suggested that we need to reframe our sexual violence narrative in terms of prevention and bring that to the media in order to enable them to reframe the conversation. There was also a discussion of the changing sites of media engagement with blogs, twitter and social networking needing to be used more effectively. In addition, there was a discussion of how long-running stories could be utilized to change the conversation, so the 3rd or 4th day story could be about prevention rather than trying to get in on the page on day one. Finally, there was a conversation about how we should be more strategic in talking with the media, both in terms of talking to them where they live (their conferences, at media “camps” at big stories) and bringing them to where we live (having the media representative on boards being a journalist). (KM)

If anyone has not attended a recent workshop by Phil Rich, they might not be up-to-speed on the latest research and best practices for the treatment of adolescents who have sexually offended. I once asked Phil how he keeps up with the literature, which he seems to devour. He replied that he’s driven by the constant concern that there might be some breaking research that he should be aware of. Phil presented three different workshops at ATSA; one, as a co-presenter, on neurodevelopmental research, and two solo: A Contemporary Approach to the Treatment of Sexually Abusive Youth: A Relational Approach, and The Role of Case Formulation in the Treatment of Sexually Abusive Behavior. Every workshop that Phil presents is a densely-packed compendium of the latest research applied to best practices. Phil also draws on his extensive experience in the field, to account for all the moving parts of effective treatment. When Phil presents, the only thing that moves faster than his Powerpoint slides is his mind. Phil offers so much content in his presentations that many attendees can’t take notes fast enough. Those who know that his Powerpoint handouts contain most of the content, can spend more time trying to absorb the wealth of wisdom. (JB)

On the Friday afternoon there was a CoSA panel (Ian Elliott, Kathy Fox, Andrew McWhinnie & Robin Wilson) which updated us on where Circles of Support and Accountability research was currently at across the USA as well as Canada. The panel indicated that CoSA was developing numerous programs across the USA and that, despite small local statewide differences to implementation, that there was capacity for USA wide evaluation, with data from some states (especially Vermont) that CoSA was assisting sex offenders to desist as well as increase their levels of community engagement. The session highlighted the capacity building in respect to CoSA nationally and internationally, with a number of international researchers talking about ongoing evaluations and evidenced-based work in their areas. (KM)

Please come back next week for more reflections upon the conference.

Kieran McCartan & Jon Brandt