1. Working with sex offenders with intellectual disabilities “Containment Is Not Our Friend” Equal Justice Conference Winnipeg, Manitoba September 17, 2015 James Haaven, MA jhaaven@comcast.net

2. Overview Overview of sexual offending problem in general Sexual profiles/characteristics of persons with developmental disabilities How do we get into the dilemma of over containment? What is the cost of over containment? What can we do about it?

3. Sexual Behavior Profiles Normal – sexual behavior mistaken as inappropriate or deviant. Inappropriate – sexual behavior reflecting: Environmental restrictions, Environmental restrictions, Poor modeling, Poor modeling, Limited sexual knowledge/courtship, Limited sexual knowledge/courtship, Learning history, Learning history, Lack of limit setting, and Lack of limit setting, and Other. Other. ‘Counterfeit Deviance’ Revisited, Griffiths, et. al, 2013

4. Sexual Offending – behavior motivated by sexually deviant (paraphilic) impulses. Victimless – problematic sexual behaviors including self-injurious auto erotic behavior. Sexual Behavior Profiles

5. Recidivism Recidivism is as great or greater than non-IDSO’s 19% after 4 yrs (51% non-SO) Lindsay, et al., 2004 24% after 12 yrs (59% non-SO) Lindsay, et al., 2006 60% recidivism reduction when receiving aftercare 16.7% (with aftercare) – OR Corrections Dept., 98 Prevalence Difficult to establish – conflicting information Characteristics of Sexual Offenses

6. More likely to target males and young children (especially children under 5) than non-ID sex offenders (Rice, 2006; Cantor, 2005) More likely to show sexual preference for prepubescent males (Rice, 2006) 50% offended against children and adults (Gilby, 2005) 55-78% more than one offense category (Day, 94, Oregon) Characteristics of Sexual Offenses

7. High rate of DD offenders were abused in past 50-85% sexually abused (Stermac) 50-85% sexually abused (Stermac) 77% abused in residences (Furey) 77% abused in residences (Furey) 28% abused by caregivers (Sobsey) 28% abused by caregivers (Sobsey) High rate of sexual abuse by DD abusers 35-42% (Oregon, Furey) 35-42% (Oregon, Furey) 44% of injuries of DD residents (UK study) 44% of injuries of DD residents (UK study) Characteristics of Sexual Offenses Similar rate of major mental illness with sex offenders and ID non-offenders (Lindsay, 2004)

8. ‘Brick and mortar’ institutions ‘Brick and mortar’ institutions ‘Positive programming’ institutions ‘Positive programming’ institutions Where do those who sexually offend go? Continuum service system – least restrictive Continuum service system – least restrictive

9. The problem we often face is this: irrespective of the level of risk that the consumer may present, their containment is usually the same.

10. Options for containment may be limited. Options for containment may be limited. “Only we know what to do”. “Only we know what to do”. “Give them to us and we will ‘guarantee’ “Give them to us and we will ‘guarantee’ community safety”. community safety”. How did we get into this dilemma?

11. Containment is ‘unwittingly’ fostered - $’s, fear, responsibility. Conflicting advocacy for the consumer and for the community. Lack dignity of risk. When in doubt – we contain. How did we get into this dilemma?

12. What is the cost of over containment? Reduces quality of life of the client May violate client’s rights Costly – staff intensive and increases liability Can increase risk for harm to peers, staff, and community: Trigger risk factors – emotional, self-regulation Trigger risk factors – emotional, self-regulation Increase staff complacency Increase staff complacency Create non-supportive environment Create non-supportive environment

13. Assess client for risk for sexually inappropriate behavior and develop a risk management plan. Train and maintain awareness by providers of risk management strategies. Provide clients with risk management skills. So, what can we do?

14. Utilize supervision reduction process. So, what can we do? Develop effective supervision/support systems. Expand containment options.

15. Use assessment tools that are appropriate for ID clients. Psycho-sexual assessment – what is the nature of the problem. Risk assessment – what risk is present. What are the risk factors that likely are associated with recidivism and what strategies might manage that risk. Assess for Risk and Develop a Plan

16. Static risk factors (actuarial) STATIC-99, STATIC-99R - best Rapid Risk Assessment for Sex Offender Recidivism (RRASOR) Risk Assessment Tools

17. Dynamic risk factors Assessment of Risk and Manageability for Intellectually disabled IndividuaLs who Offend Sexually (ARMIDILO-S), www.armidilo.net Sex Offender Treatment Intervention and Progress Scale (SOTIPS), rmcgrath@sover.net STABLE/ACUTE 2007, Harris, A. & Hanson, K., 2007 Risk Assessment Tools

18. Level of supervision needed in various settings Level of supervision needed in various settings Prevention and intervention of risk situations Prevention and intervention of risk situations Risk monitoring system Risk monitoring system Crisis response Crisis response Training required to initiate the plan Training required to initiate the plan Develop Risk Management Plan

19. Train everyone who needs to know – direct staff, family, vocational providers, other systems, etc. Awareness of risk factors and risk dynamics. Awareness of risk factors and risk dynamics. Train Providers in Risk Management Relationship between supervision and treatment Relationship between supervision and treatment Professional boundary maintenance Professional boundary maintenance Train teams how to effectively manage risk –aware of common errors.

20. Common over-looked risk management strategies Greatest risk for re-offense is in the home – housemates and staff. Train everyone who needs to know – what to do and clinical reason for doing it. It is assumed that staff understand the supervision expectations. Sexual problems should not be part of behavioral contingency plan that includes other non-sexual problems.

21. Overlook need to help front-line caregivers – clarity of roles and support. Daily monitor and report presence of acute risk indicators. Identify places/activities that reduced supervision can be used – be proactive, NOT reactive to outside requests. Common over-looked risk management strategies

22. Sex offender specific treatment Programming specific for persons with ID. Programming specific for persons with ID. Focus treatment on: Focus treatment on: Motivation to changeMotivation to change Develop a positive identity – a New MeDevelop a positive identity – a New Me Treatment relevanceTreatment relevance Generalization to various settingsGeneralization to various settings Basic skills: caring, seeking help and persistence (Hang-In)Basic skills: caring, seeking help and persistence (Hang-In) Provide Client Risk Management Skills

23. Develop supports for client various risk situations Community partnerships Community partnerships Multi-system collaboration works best Multi-system collaboration works best Analysis how systems are functioning Analysis how systems are functioning Develop Effective Support System Wrap-around supports Expand support systems Expand support systems Supports for affects of disability and risk factors Supports for affects of disability and risk factors User-friendly systems User-friendly systems Provide a range of monitoring systems

24. Provide continuum of security level settings. Provide various living opportunities – single and multiple person settings. Participate in other system contingencies. Expand Options for Containment

25. Is the suggested change in an environment that presents the least vulnerability for risk? What is the potential risk for harm? What ‘manageability’ factors effect the suggested change? What strategies are needed to manage presenting risk (manageability factors)? What training is needed to implement change? Supervision Reduction Process

26. Important Points Don’t be driven by assumptions but by evidence. Make changes in small steps – a little is a lot Stay alert – things do change, sometimes quickly. Put healthy sexuality on the ‘front burner’. Containment is not our ‘friend’. Only reduce supervision when client has demonstrated manageability of their risk – not as a reward or no ‘problems’ over a period of time.