1. What Works: Effective Interventions with Sex Offenders R. Karl Hanson Public Safety Canada Presentation at the 13 th Annual Conference of the NYS Chapter of the Association for the Treatment of Sexual Abusers, May 14 th, 2008, Saratoga Springs, NY

5. History of Offender Rehabilitation Research Many studies; lots of variability Martinson (1974) “Nothing works” “What Works” –Lipsey (1989) –Andrews, Zinger et al. (1990) –Andrews, Bonta, Gendreau, Dowden

6. Sanctions or Service? Sanctions: 2003: r = -.03 (k = 101) Service: 2003: r = +.12 (k = 273)

7. Effective Correctional Interventions Risk –Treat only offenders who are likely to reoffend (moderate risk or higher) Need –Target criminogenic needs Responsivity –Match treatment to offenders’ learning styles and culture

8. Results Stable Across Studies Same results found in randomized clinical trials and non-random assignment studies (except those with obvious biases) Meta-analytic findings replicated by independent groups

9. Risk/Need/Responsivity and reductions in recidivism for general offenders r (k) Not at all-.02 (124) One element.03 (106) Two elements.17 (84) All three.25 (60)

10. Risk/Need/Responsivity and reductions in sexual recidivism for sex offenders r (k) Not at all-.03 (4) One element.05 (6) Two elements.14 (12) All three.16 (1)

11. Risk – Self-Evaluation Does your program select offenders based on risk? –Which measure? Sexual or general risk? –Average risk score is moderate or higher (e.g., Static-99 4+) –Are low risk offenders separated from high risk offenders?

12. Needs Self-Evaluation I What are the major criminogenic needs targeted in your program? – (i.e., what intermediate changes would you like to see in order to reduce the risk of recidivism?)

13. Criminogenic Needs (general recidivism) Antisocial Personality –Impulsive, adventurous pleasure seeking, restlessly aggressive, callous disregard for others Grievance/hostility Antisocial associates Antisocial cognitions Low attachment to Family/Lovers Low engagement in School/Work Aimless use of leisure time Substance Abuse

14. Non-criminogenic needs (general recidivism) Personal distress Major mental disorder Low self-esteem Low physical activity Poor physical living conditions Low conventional ambition Insufficient fear of official punishment

15. Criminogenic Needs for Sexual Recidivism A-list (3+ Prediction Studies) Deviant sexual interests –Children –Sexualized Violence –Multiple Paraphilias Sexual preoccupations Antisocial orientation –Lifestyle instability –Unstable employment –Resistance to rules and supervision –Antisocial Personality Disorder

16. Criminogenic Needs for Sexual Recidivism A-list (3+ Studies) Offence-Supportive Attitudes Intimacy deficits –Emotional congruence with children –Lack of stable love relationships –Conflicts in intimate relationships Negative Social Influences Poor Cognitive Problem-Solving Grievance/Hostility

17. Criminogenic Needs for Sexual Recidivism B-list (at least one prediction study) Sexualized coping Callousness/Lack of concern for others Poor emotional control Hostile beliefs about women Adversarial sexual orientation Machiavellianism

18. Possible Criminogenic Needs for Sexual Recidivism (some evidence) General and sexual entitlement Fragile narcissism Delinquent pride Loneliness

19. Factors Unrelated to Sexual Recidivism Victim empathy Denial/minimization of sexual offence Lack of motivation for treatment Internalizing psychological problems –Anxiety, depression, low self-esteem* Sexually abused as a child Low sex knowledge Poor dating skills/Social skills deficits Hallucinations/delusions

20. Needs Self-Evaluation II Is there empirical evidence demonstrating that the factor predicts recidivism? –(yes/no for each treatment target) Does your program predominantly target empirically supported criminogenic needs?

21. Responsivity Cognitive-behavioural Therapist style – firm but fair Flexibility to address special needs Culturally specific elements Do offenders actually engage in treatment? –Low drop-out rates –Change on intermediate targets –Working with you, not against you

22. Hanson, Bourgon, Helmus & Hodgson, 2008 24 studies –Examined sexual recidivism as outcome criteria –Examined adult or adolescent sexual offenders –Compared offender assigned to a treatment program to offenders who received no treatment (or treatment that was expected to be inferior) –Met minimum criteria for study quality (CODC Guidelines)

23. 24 Studies 50% published (1983 – 2006) 23 English; 1 French Canada (13), US (5), England (3), New Zealand (2), Netherlands (1) Institution (12); Community (11); Both (1) Treatments delivered: 1966 - 2004

29. Adherence to R/N/R Risk Rarely (3/24) Need Sometimes (12/24) Responsivity Most programs (18/24)

30. Effect Size By R/N/R Adherence Odds ratio95% C.I.N (k) None1.05(.79-1.41)1,200 (4) One0.82(.55 –1.23)1,209 (6) Two0.57(.46-.70)5,147 (12) All three0.51(.13-1.97)106 (1)

34. Implementation is Difficult Adherence to R/N/R Demonstration r (k) Real r (k) Not at all.01 (1)-.02 (93) One element.07 (7).04 (71) Two elements.31 (16).09 (16) All three.34 (23).15 (10)

35. Effective Programs Program r (k) Meta- analysis Multisystemic Treatment.27 (7) Curtis et al. (2004) Moral Reconation Therapy.18 (6) Wilson et al. (2005) Reasoning & Rehabilitation.04 (25) Tong & Farrington (2006)

36. Keys to Effective Implementation Select staff for relationship skills Print/tape manuals Train staff Start small

37. No r (k) Yes r (k) Staff selected for relationship skills.07 (361).34 (13) Printed/taped manuals.05 (303).20 (71)

38. Characteristics of Effective Therapists with Offenders Able to form meaningful relationships with offenders –Warm, accurate empathy, rewarding Provide prosocial direction –Skills, problem-solving, values

39. How it goes wrong Risk –Same program for all, regardless of risk/need –Low risk offenders introduced to high risk offenders –High risk cases excluded from treatment (by self and program) Focus on non-criminogenic needs

40. How it goes wrong Offender feels judged/rejected Criminal thinking rewarded –Blind acceptance of “alternative” subcultures –Rewarding candour –Procriminal attitudes of staff –Bonding/collusion with offenders Punishing Prosocial Acts –Prosocial incompetence

41. Directions for Sexual Offender Treatment Risk –Treat only sex offenders who are likely to reoffend (moderate risk or higher) Need –Target criminogenic needs Responsivity –Match treatment to offenders’ learning styles and culture Use Skilled Therapists

42. Suggested Readings Andrews, D.A. (2006). Enhancing adherence to Risk- Need-Responsivity: Making quality a matter of policy. Criminology and Public Policy, 5, 595-602. Andrews, D.A., & Bonta, J. (2006). The psychology of criminal conduct (4 th ed.). Cincinnati: Anderson. Bonta, J., & Andrews, D.A. (2007). Risk-need- responsivity model for offender assessment and rehabilitation. Corrections User Report 2007-06. Ottawa: Public Safety Canada. Curtis, N.M., Ronan, K.R., & Borduin, C.M. (2004). Multisystemic treatment: A meta-analysis of outcome studies. Journal of Family Psychology, 18(3), 411- 419.

43. Suggested Readings Hanson, R.K., & Bourgon, G. (2008). A psychologically informed meta-analysis of sexual offender treatment outcome studies. In G. Bourgon et al. (Eds). Proceedings of the First North American Correctional and Criminal Justice Psychology Conference. Ottawa: Public Safety Canada. Landenberger, N.A., & Lipsey, M.W. (2005). The positive effects of cognitive-behavioral programs for offenders: A meta- analysis of factors associated with effective treatment. Journal of Experimental Criminology, 1, 451-476. Tong, L.S.J., & Farrington, D.P. (2006). How effective is the “Reasoning and Rehabilitation” programme in reducing reoffending? A meta-analysis of evaluations in four countries. Psychology, Crime & Law, 12(1), 3-24. Wilson, D.B., Bouffard, L.A., & Mackenzie, D.L. (2005). A quantitative review of structured, group-oriented, cognitive- behavioral programs for offenders. Criminal Justice and Behavior, 32 (2), 172-204.

44. Copies/Questions Karl.Hanson@ps-sp.gc.ca www.publicsafety.gc.ca www.publicsafety.gc.ca Look under “publications” “corrections reports and manuals”