iassid 2004 presentation

Group cognitive-behavioural treatment for men with ID at risk of sexual offending: 

Group cognitive-behavioural treatment for men with ID at risk of sexual offending G. Murphy*, N. Sinclair, S-J Hays, G. Offord, P. Langdon, J. Scott, J. Williams, J. Stagg, J. Tufnell, T. Lippold, K. Mercer, G. Langheit *g.h.murphy@lancaster.ac.uk Institute for Health Research, University of Lancaster, UK

The plan: 

The plan What is known about non-disabled sex offenders Treatment for non-disabled sex offenders: what it consists of and whether it works What is known about sex offenders with intellectual disabilities Treatment for sex offenders with intellectual disabilities

Sexual offending by non-disabled men: 

Sexual offending by non-disabled men Grossly under-reported to police Victim surveys suggest very high rates andgt; 95% of sex offenders are men Offenders often engage in grooming andamp; stalking of victims; may do complex planning Used to be thought sex offenders had one paraphilia (deviant sexual interest), targeted 1 age group, had victims either inside or outside family. Recent data challenges these views.

Treatment for non-disabled sex offenders: 

Treatment for non-disabled sex offenders 1960s andamp; 1970s: Sexual abuse seen as result of deviant sexual interests andamp; arousal Led to behavioural techniques techniques andamp;/or anti-androgens Then in 1980s: Wolf’s model of cycle of offending, Abel’s work on distorted cognitions (denial, minimisation, victim-blaming), Finkelhor’s four stages of offending, Marshall’s model of sexual offending All led to group cognitive-behavioural treatment

But does it work? (Hanson et al, 2002): 

But does it work? (Hanson et al, 2002) Meta-analysis of 43 studies of sex offender treatment (over 9,000 participants overall) Sexual offence recidivism rate: 12% for treated men vs 17% for untreated men General offence recidivism rate: 28% for treated men vs 39% for untreated men Early forms of treatment ineffective; but current cognitive-behavioural treatment seems effective: 10% vs 17% treated vs untreated recidivism

Men with intellectual disabilities at risk of sexual offending: 

Men with intellectual disabilities at risk of sexual offending Uncertain prevalence, but probably high recidivism rates Types of offence: all kinds, but maybe fewer penetrative offences History of abuse: more likely in sex offenders with ID (c.f. non-sex offenders) Victims mainly children or other people with ID (less often non-disabled adults)

Men with intellectual disabilities at risk of sexual offending : 

Men with intellectual disabilities at risk of sexual offending Victims likely to be known to the perpetrator Offences more opportunistic andamp; less planned (less grooming andamp; stalking) Often long history of sexual problems andamp; multiple placements Often not reported to police andamp; mostly not prosecuted nor treated

Does group CBT work for men with ID?: 

Does group CBT work for men with ID? Lindsay et al (1998a, b) some improvements in 6 men with ID andamp; paedophilic offences andamp; 4 men with ID andamp; exhibitionism, after CBT Lindsay andamp; Smith (1998): showed 2 years CBT was more effective than 1 yr CBT for men with ID on probation Rose et al (2002): CBT 2hrs/week for 16 weeks, for 5 men; found reduced (improved) scores but changes not significant

SOTSEC-ID: 

SOTSEC-ID Sex Offender Treatment Services Collaborative - Intellectual Disability About 12 sets of therapists providing sex offender treatment for people with intellectual disabilities in England Sex offender treatment groups (last 1 year; 2hr sessions, once per week, closed groups) Sharing core assessments measures Recruiting control group (waiting list) Research funded by DoH

Core assessments: 

Core assessments Once only: measures of IQ, adaptive behaviour, language, andamp; autism Pre andamp; Post group treatment: - Sexual Knowledge andamp; Attitude Scale (SAKS) - Victim Empathy scale, adapted (Beckett andamp; Fisher) - Sex Offender Self-Appraisal Scale (Bray andamp; Foreshaw’s SOSAS) - Questionnaire on Attitudes Consistent with Sex Offending (Bill Lindsay et al.’s QACSO) Recidivism

Treatment content: 

Treatment content Group purpose, rule setting Human relations andamp; sex education The cognitive model Sexual offending model General empathy andamp; victim empathy Relapse prevention Groups last ~52 weeks; mostly 2 hour sessions; closed groups

Results: first 5 groups (31 men): 

Results: first 5 groups (31 men) About 60% men offered treatment not required to come by law Mean IQ is approx 60 About 30% have Asperger’s syndrome or on autistic continuum; few with mental illness Offences: stalking, sexual assault, exposure; rape; victims kids/adults

Cognitive distortions, sexual knowledge & empathy: 

Cognitive distortions, sexual knowledge andamp; empathy Sexual Attitude and Knowledge Scale (SAKS)* Significant increases by end of group QACSO (Lindsay)* Significant improvements in men’s scores Sex Offenders Self- Appraisal Scale (Bray) Reductions in most men’s scores (not signif yet) Victim Empathy (Beckett andamp; Fisher)* Significant reduction in scores

Service user views from first group: 

Service user views from first group Good understanding of basic facts about group andamp; why referred What they learnt: ‘Stopped me touching girls’ ‘How people feel about us masturbating’ ‘Learnt not to go after women’ ‘Learnt to help other people in the group’ ‘What the police do when they arrest you’ Best things: ‘support every week’; sorting out problems’; ‘helping each other’ Worst things: ‘telling very private stuff’

Conclusions: 

Conclusions Men with learning disabilities do commit sexual offences Exact prevalence is not known but seems to be broadly similar to non-disabled men Offences more opportunistic but otherwise similar to non-disabled men Treatment using cognitive behaviour therapy really only just getting going – SOTSEC-ID only controlled trial as yet

Key references: 

Key references Hanson, R.K. et al (2002) 1st report of the collaborative outcome data project (etc.) Sexual Abuse: Journal of Research andamp; Treatment, 14, 169-94. Journal of Applied Research in Intellectual Disabilities (Several articles in issue, 15 (2), 2002) Lindsay, W. R. (2002) Research andamp; literature on sex offenders with intellectual and developmental disabilities. Journal of Intellectual Disability Research, 46, 74-85. Marshall, W. L. et al. (1999) Cognitive Behavioural Treatment of Sexual Offenders. Wiley.