Treatment Efficacy for Sex Offenders

Effects of Cognitive-Behavioral Treatment on Sex Offender Recidivism: Preliminary Results of a Longitudinal Study
Janice K. Marques, David M. Day, Craig Nelson, Mary Ann West
Criminal Justice and Behavior March 1994 vol. 21 no. 1 28-54
Abstract (note this is an older study)
Preliminary results from a longitudinal study of the effectiveness of cognitive-behavioral treatment with sex offenders are presented. The study’s research design includes three groups: a treatment group, a volunteer control group (those who volunteered for but did not receive treatment), and a nonvolunteer control group (subjects who refused the opportunity for treatment). Although the treatment group had the lowest reoffense rates for both sex and other violent crimes, main effects analyses did not yield conclusive results regarding the program’s effectiveness. The results highlight the importance of including appropriate comparison groups, managing attrition from both treatment and methodological standpoints, examining sex and other violent offenses separately as outcome variables, employing tests with adequate statistical power, and analyzing data while taking into account time at risk for reoffense.

Cognitive-behavioral treatment of sex offenders: a treatment comparison and long-term follow-up study
Robert J. McGrath, Stephen E. Hoke and John E. Vojtisek.  Criminal Justice and Behavior. 25.2 (June 1998): p203.
Abstract:
Recidivism rates were examined for the near-exhaustive sample of 122 sex offenders placed in a rural Vermont county under correctional supervision from 1984 through 1995. Participants were at risk for an average of 62.9 months. Of this sample, 71 nonrandomized participants enrolled in a comprehensive outpatient cognitive-behavioral and relapse-prevention-based treatment program, 32 participants received less specialized mental health treatment, and the remaining 19 participants received no treatment. Pretreatment, between-group comparisons identified that no-treatment group as having more extensive criminal histories. No other statistically significant between-group differences among factors related to re-offense risk were found. At follow up, the cognitive-behavioral treatment group demonstrated a statically significant treatment benefit. The treatment program is described.

Psychopathy, Treatment Behavior, and Sex Offender Recidivism
Michael C. Seto, Howard E. Barbaree.  J Interpers Violence December 1999 vol. 14 no. 12. p.1235-1248.
Abstract
Consistent with findings in other areas of clinical practice, it was predicted that good treatment behavior (in terms of in-session behavior, homework quality, and global ratings of motivation and change achieved) would be associated with parole success and lower recidivism in a sample of 283 sex offenders. This prediction was not supported: Good treatment behavior was unrelated to parole failure or general recidivism, and it was associated with higher serious recidivism (a new violent or sexual offense) after an average time at risk of 32 months. Further exploration revealed that men who scored higher in psychopathy and better in treatment behavior were the most likely to reoffend. These results could have important implications for risk management and treatment planning.

Refusers, Dropouts, and Completers: Measuring Sex Offender Treatment Efficacy
James A. Seager, Debra Jellicoe, Gurmeet K. Dhaliwal.
Int J Offender Ther Comp Criminol October 2004 vol. 48 no. 5 600-612
Abstract
A sex offender program delivered in a medium-security prison followed 109 treatment completers and 37 noncompleters for 2 years after release. Noncompleters, those who refused treatment or dropped out, had 6 times the rate of sexual and violent reoffending relative to completers. Among those who completed the program, however, positive evaluations of treatment change, such as quality of disclosure and enhanced victim empathy, found in posttreatment assessments did not correlate with recidivism. Furthermore, completers did not differ in their rates of recidivism from pretreatment rates predicted by the Static 99, an actuarial measure of anticipated sexual and violent recidivism. We conclude that the program did not influence propensities for sexual and violent recidivism but rather served as a prolonged screening instrument for sex offenders whose failure to comply with treatment attendance predicted higher rates of recidivism.

Outcome Evaluation of a High-Intensity Inpatient Sex Offender Treatment Program
Mark E. Olver, Stephen C. P. Wong, Terry P. Nicholaichuk.
J Interpers Violence March 2009 vol. 24 no. 3 522-536.
Abstract
The treatment outcome of a high-intensity inpatient sex offender treatment program was evaluated by comparing the sexual recidivism rates of 472 treated and 282 untreated sex offenders. The program is designed for moderate- to high-risk sex offenders and follows the principles of effective correctional treatment. The current investigation is an extension of an earlier study (Nicholaichuk et al., 2000) with the addition of 176 participants, an extra 4 years follow-up, and the use of Cox regression survival analysis to control for three potentially confounding variables: age of release, sexual offending history, and length of follow-up. Treated offenders sexually recidivated significantly less than the comparison group over nearly 20 years of follow-up, even after controlling for the aforementioned variables. The substantive findings suggest that treatment adhering to the what works principles can reduce long-term sexual recidivism for a moderate- to high-risk group of sex offenders.

(Excerpts from the article)

“Over the past several decades there have been a multitude of reviews of the sex offender treatment outcome literature. Following a descriptive review of the effectiveness of sex offender treatment, Furby, Weinrott, and Blackshaw (1989) concluded, “there is no evidence that treatment effectively reduces sex offense recidivism” (p. 25). Marshall and Pithers (1994) criticized the Furby et al. (1989) review on the ground that most of the study evaluations occurred on antiquated programs and/or had major methodological con- cerns such as small sample sizes, inadequate description of sample selec- tion procedures, lack of control groups, heterogeneity of sex offender samples, inconsistent definitions of recidivism, short follow-up times, vague descriptions of treatment programs, and insufficient ways to account for program attrition…

More recently, meta-analytic reviews have been the review of choice. Hall (1995) published the first meta-analysis of 12 sex offender treatment outcome studies and obtained a small but significant overall treatment effect (r .12), although this finding was tempered by the fact that in roughly half of the studies, the comparison groups consisted of individuals who had either refused or dropped out of treatment. Gallagher, Wilson, Hirschfield, Coggeshall, and MacKenzie (1999) later published a meta-analysis of 25 sex offender treatment outcome studies and found significant treatment effects in studies using some variation of cognitive–behavioral therapy, with or without relapse prevention. Studies employing hormonal approaches also had low recidivism rates, although the treatment effect did not obtain statistical significance. The same year, Alexander (1999) published a quasi-meta-analysis of 79 sex offender treatment outcome studies reporting descriptive trends in the data (no effect sizes or inferential statistics were computed) and found higher recidivism rates for untreated offenders (17.6%), in contrast to all treated offenders (13.2%) and those completing relapse prevention–based programs (7.2%). Most recently, Hanson et al. (2002) conducted a meta-analysis of 43 treatment outcome studies. Averaged across all studies, treatment groups evidenced slightly lower rates of sexual recidivism (12.3%) than comparison groups (16.8%). Current treatments (i.e., cognitive–behavioral, systemic), however, were associated with larger reductions in sexual recidivism, with an odds ratio (OR) of .60 obtained across 15 studies, interpreted by the authors to mean that for every 100 untreated sex offenders who sexually reoffend, only 60 treated offenders reoffend. Overall, quantitative reviews seem to support the efficacy of treatment for reducing sexual offense recidivism and larger treatment effects have been reported for evidence-based interventions, such as cognitive–behavioral or relapse prevention therapies.”  pp. 523-524

“…The present treated sample is a moderate- to high-risk group of sex offenders as demonstrated by sexual recidivism rates (even after treatment) of 17% to nearly 22% after 5 and 10 years, respectively, compared to recidivism rates in the low teens reported in recent meta-analyses (Hanson et al., 2002). As confirmation, a subsample (N =  321; Olver et al., 2007) of the entire cohort of 609 offenders from the Clearwater sample had a mean Static 99 score of 4.4 (SD =  2.0), placing this group in the moderate- to high-risk range. This higher risk group of sex offenders appeared to be responsive to sex offender treatment, demonstrating a significant reduction in sexual recidivism as evidenced by OR ranging from .40 to .63 suggesting that treatment has reduced sexual recidivism rates by about half compared to the untreated group. The treatment effect was further maintained over uniform follow-up windows of up to 10 years. The ORs obtained in the present study (ORs =  .40 – .63) are comparable to that reported by Hanson et al. (2002; .60 obtained across 15 studies) who suggested that current treatments (i.e., cognitive–behavioral, systemic) were associated with larger reductions in sexual recidivism. The Clearwater Program with its focus on the what works principles and the use of cognitive–behavioral and relapse prevention approaches can be considered as a program with a current treatment framework. The present results are consistent with the notion that more effective current treatment approaches are equally effective for moderate- to high-risk sex offenders.” p. 532

“…In conclusion, the present study provides empirical support to indicate that a high-intensity treatment program for moderate- to high-risk sexual offenders that follows the what works principles can yield reductions in sexual recidivism in both the shorter and longer term, even after potentially confounding variables were carefully controlled for. In short, treatment appeared to “work” for this group of sex offenders.” p. 533

Recidivism among treated sexual offenders and comparison subjects: Recent outcome data from the Regional Treatment Centre (Ontario) high-intensity Sex Offender Treatment Programme
Jeffrey Abracen , Jan Looman , Meaghan Ferguson , Leigh Harkins & Donna Mailloux. Journal
Journal of Sexual Aggression, Volume 17, 2011 – Issue 2
Abstract
The present investigation examined a sample of 64 offenders treated at the Regional Treatment Centre (Ontario) Sex Offender Treatment Programme (RTCSOTP) and a sample of 55 untreated sexual offenders from the Ontario region of Correctional Service of Canada. Groups were matched on age at index offence, Hare Psychopathy Checklist–Revised (PCL-R) score and type of sexual offender (i.e. intrafamilial child molester, extrafamilial child molester and rapist). As well, the Rapid Risk Assessment of Sexual Offence Recidivism Scale (RRASOR) was scored on all offenders in the present investigation. Recidivism, based upon officially recorded conviction data, was used as the primary dependent measure. Results indicated that both treated offenders and comparison participants evidenced low sexual recidivism rates (approximately 10% over follow-up periods that extended beyond nine years for both treated and comparison offenders). With reference to high PCL-R treated and comparison offenders, both groups evidenced rates of sexual recidivism approaching zero (one offender in each group recidivated sexually). These data have important implications for those who view treatment with high PCL-R offenders as without hope for success. Both treated and untreated comparison offenders received a wide variety of non-sexual offender programmes directed at criminogenic need areas. Treated offenders who were rated as being higher risk on the RRASOR evidenced substantially lower than predicted rates of sexual offending.

Pharmacological treatment of sex offenders
Thibaut
Sexologies, Volume 20, Issue 3, July–September 2011, Pages 199-203
Summary
Sex offending is a major public health concern due to the potentially serious consequences for the victims (especially in case of rape or paedophilia). All care providers agree that imprisonment alone does not solve the question of repeat offences for these subjects and that a combined medical, psychological and social approach is needed for these offenders. A combination of psychotherapy (especially behavioral therapy) with pharmacological treatment is better than one or other therapy used alone. Two types of medication are used for these subjects; serotonergic antidepressants and antiandrogen treatments. Two antiandrogen treatments have obtained Health Agency approval in different European countries in this indication: cyproterone acetate and depot triptorelin (3-month formulation). Guidelines have been published in France by the National Health Authority and, at the international level, by the World Federation of Societies of Biological Psychiatry (www.wfsbp.org). In this paper, we will define the term paraphilia and report some epidemiological data, before summarizing the available literature about the efficacy of pharmacological treatment for paraphilias.

Comparing Recidivism Rates of Treatment Responders/Nonresponders in a Sample of 413 Child Molesters Who Had Completed Community-Based Sex Offender Treatment in the United Kingdom
Anthony R. Beech, Rebecca Mandeville-Norden, Alasdair Goodwill
Int J Offender Ther Comp Criminol February 2012 56 no. 1 29-49
Abstract
Analysis of psychometric data from a sample of 413 child molesters who had completed a U.K. probation-based sex offender treatment program was carried out to assess (a) the effectiveness of therapy in the short term and (b) the longer term implications of treatment in relation to sexual recidivism. It was found that 12% (51 offenders) of the sample had recidivated within 2 to 4 years. Of these recidivists, 86% (44 offenders) had been reconvicted for a sexually related offense. One hundred thirty-five offenders (33%) demonstrated a treated profile (i.e., demonstrated no offense-specific problems and few, or no, socioaffective problems at the posttreatment stage). This group was compared with a sample of offenders deemed as not responding to treatment, matched by their levels of pretreatment risk/need. It was found that a significantly smaller proportion (n = 12, 9%) of treatment responders had recidivated, compared to the treatment nonresponders (n = 20, 15%), indicating a 40% reduction in recidivism in those who had responded to treatment (effect size = .18). Matching length of treatment to the offenders’ level of pretreatment risk/need (i.e., higher risk/treatment-need offenders typically undertook longer treatment) reduced the rate of recidivism among this group to the level of recidivism observed among the lower risk/need offenders.

Improving the Predictive Accuracy of Static-99 and Static-2002 With Older Sex Offenders: Revised Age Weights
Leslie Helmus, David Thornton, R. Karl Hanson.
Sex Abuse February 2012 vol. 24 no. 1 64-101
Abstract
Actuarial risk assessment scales and their associated recidivism estimates are generally developed on samples of offenders whose average age is well below 50 years. Criminal behavior of all types declines with age; consequently, actuarial scales tend to overestimate recidivism for older offenders. The current study aimed to develop a revised scoring system for two risk assessment tools (Static-99 and Static-2002) that would more accurately describe older offenders’ risk of recidivism. Using data from 8,390 sex offenders derived from 24 separate samples, age was found to add incremental predictive validity to both Static-99 and Static-2002. After creating new age weights, the resulting instruments (Static-99R and Static-2002R) had only slightly higher relative predictive accuracy. The absolute recidivism estimates, however, provided a substantially better fit for older offenders than the recidivism estimates from the original scales. We encourage evaluators to adopt the revised scales with the new age weights.

Treatment behind bars: the effectiveness of prison-based therapy for sex offenders
Deanna M. Pérez et al.
Journal of Crime and Justice, Published online: 10 Sep 2012
Abstract
The purpose of this evaluation was to examine the effectiveness of prison-based treatment for sex offenders to reduce recidivism. The study compared a group of 95 inmates who received sex offender treatment, with 67 treatment completers and 28 non-completers, to a comparison group of 64 inmates who did not receive treatment. The results demonstrated that offenders who completed sex offender treatment had the lowest prevalence of post-release sex re-arrests followed by treatment non-completers and control group subjects. Furthermore, survival analysis results showed that average time to first re-arrest after release from incarceration was longest for treatment completers in comparison to the treatment non-completers and the control group but this difference was not statistically significant. Study limitations and directions for future research are also discussed.

Pharmacologic Treatment of Sex Offenders With Paraphilic Disorder
Frederico Duarte, Garcia Heloise, Garcia Delavenne, Lessandrade Fátima, Almeida Assumpção, Florence Thibau. Current Psychiatry Reports, May 2013, 15:356
Abstract
Sexual offending is both a social and a public health issue. Evidence demonstrates that a combination of pharmacological and psychotherapeutic approaches may reduce or even eliminate deviant sexual behavior in sex offenders with paraphilic disorders. In this article, we will review pharmacological treatment options for sex offenders with paraphilias. Both serotonin selective reuptake inhibitors (SSRIs) and antiandrogen treatments have been used with reported success in decreasing recidivism. SSRIs have been used in mild types of paraphilias and juvenile paraphilias. Antiandrogen treatments seem to be effective in severe sex offenders with paraphilic disorders in order to reduce victimization. Combined pharmacological and psychotherapeutic treatment is associated with better efficacy. Imaging studies may improve the knowledge of paraphilic disorders and the mechanisms of action of current treatments. In spite of existing evidence, there is a need for independent, large-scale and good quality studies assessing the long-term efficacy and tolerance of treatments.

Assessing Sex Offender Recidivism Using Multiple Measures: A Longitudinal Analysis
Lawrence L. Bench, Terry D. Allen.
The Prison Journal December 2013 vol. 93 no. 4 411-428
Abstract
While the recidivistic activity of sex offenders has received considerable attention from researchers, most studies have been limited by using a single measurement of recidivism. Using arrest/conviction episodes as the unit of analysis, the present study tracked 389 convicted sex offenders for up to 10 arrest/conviction episodes using 11 different measurements of recidivism for an average of 15.7 years. Logistic regression was used to create a model that successfully predicted recidivism with approximately 70% accuracy. The rate of recidivism as defined by new convictions for sex offenses was approximately 10% overall.