1. Marc Goldman & Dorothy M. Griffiths
Community Support for People at Risk of Criminal Behavior : IN MEMORY OF WILLIAM lINDSAY
Marc Goldman
&
Dorothy M. Griffiths

2. Agenda Part I: Assessment and Treatment of Criminal Behavior
Prevalence
Nature of Offences
Assessment
Treatment
Risk Assessment
Part II: Solutions for Community Support
Community Supports and Safety Planning
Matching Program to Needs
Creating a Good Life
Balancing Risks and Rights

3. PART I: ASSESSMENT AND Treatment OF CRIMINAL BEHAVIOR

4. PREVALENCE
Prevalence typically ranges between 1% to 8% (Winter et al., 1997; Gudjonsson et al., 1993 respectively)
Data from Police Screening for mental disorder reported that 8% answered one of the four questions affirmatively (Barron et al.,2002):
96% reported reading and writing difficulty
45% considered themselves to have a disability
40% had attended a special school
13% reported coexisting mental health problem
Up to 24% of defendants in the CJS may have intellectual disability, with higher rates were shown for Indigenous populations, for which the measure was not standardized (Hayes, 1997)
Rates in the prison population ranged from 0 to 9.5% (Murphy et al., 1995) ; Brown and Courtless, 1971 respectively).
Rates reported by probation were at 10% (Mason, 1998)

5. Questioning the incidence rates
Lindsay and Taylor (2008) noted the methodological differences, such as sample selection.
Once borderline levels of intelligence were partialized out of the equation, persons with intellectual disabilities actually have lower rates of crime and reconviction. However “there is a significant problem with offenders with ID that warrants our clinical attention” (Lindsay, 2009, p.11).

6. Then add vulnerabilities
Justice inequities
Arrest
Police Interaction
Trial
Culpability and mitigating circumstances

7. Recognition of different types of offenders
Day (1994), Holland et al. (2002) and Lunsky, Frijters, Watson, Williston, & Griffiths (2007) found there were different types of offenders with intellectual disabilities:
Holland et al. distinguished between those of with mental illness and social disadvantage and those whose challenges became criminalized.
Day and Lunsky et al. made distinctions with individuals who exhibited sexual offences between those who showed repeated patterns of offence and characteristics similar to nondisabled offenders, from those who were described more as naïve or counterfeit offenders.

8. Challenging behavior and antisocial/criminal behavior
Lack of proactive responding in some of the Social Service Network for challenging behaviour
Police as first defence
Political emphasis on public safety and punishment
Lack of multi-agency support networks to coordinate treatment and support following an ‘offence’ that can prevent a ‘reoffence’

9. ASSESSMENT

10. Cognitive Deficits Social Deficits Psychiatric Illness
Some Commonly Exhibited Characteristics Influence The Likelihood of Criminal/Criminal-Like Behavior
Cognitive Deficits
Poor problem solving skills
Poor judgment
Memory impairment
Social Deficits
Peer influence
Lack of social competence
Psychiatric Illness

11. Knowledge and expectations Segregation
Many External/Setting Characteristics Are Vulnerabilities to Aberrant Sexual Expression
Learning conditions
Victimization
Lack of privacy
Knowledge and expectations
Segregation
Denial and minimization of support system and other systems

12. External Variables Influencing Abnormal Sexual Development
Lack of Prevention Training
Under Treatment
Lack of bio-psycho-social based assessment & intervention
Reluctance of the support system to openly discuss/treat the aberrant behavior

13. The Counterfeit Deviance Hypothesis
Hingsburger, Griffiths, & Quinsey (1991)
Much of the inappropriate sexual behavior exhibited by individuals with Intellectual Disability is based on;
Lack of sexual knowledge
Poor understanding of social conventions
Lack of opportunity for prosocial sexual expression

14. Inappropriate partner selection Modeling Lack of prevention training
“Offending” Lacking Deviance; Counterfeit Deviance/Counterfeit Criminal Behavior
Learning history
Knowledge deficit
Lack of privacy
Inappropriate partner selection
Modeling
Lack of prevention training
Agency restrictions/Agency attitude
Psychiatric influence

15. Explain, discuss, & interview collateral Socio-sexual history
Assessing for Counterfeit Deviance Should Always Be Part of The Evaluation Process
Explain, discuss, & interview collateral
Socio-sexual history
Probe for responsible/accountable behavior v history of antisocial behavior
Socio-Sexual Knowledge & Attitudes Assessment Tool-Revised (Griffiths & Lunsky, 2003)
Attitudes/denial/minimization of support network
Counterfeit deviance is a systemic issue; not a individual's shortcoming

16. RISK ASSESSMENT

17. There Are A Variety of Risk Assessments
Clinical judgment
Actuarial: Fixed variables of significance for male offenders
Deviance
Male victims
Stranger victims
Unrelated victims
Prior sex offenses
Personality Disorder/Antisocial PD
Non-sexual violence
< 25
Empirically Guided Clinical judgment

18. Dynamic Variables Appear to be Strong predictors of Risk (Lindsay, et, Al. 2008)
The Short Dynamic Risk Scale (SDRS: Quinsey)
Hostile attitude, coping skills, self care skills, consideration of others
Emotional Problems Scale (EPS Prout & Strommer)
A rating instrument for individuals w/ Mild ID
Thought disorder, physical aggression, non-compliance, anxiety, distractibility, depression ,hyperactivity ,withdrawal, self-esteem, verbal aggression, somatic concerns, sexual maladjustment
“- - the SDRS and EPS resulted in predictions for the following year which were as significant or more significant than established static risk assessments, then one might surmise that dynamic variables may be at least as important and perhaps more important with sex offenders with ID (Lindsay, 2009)

19. Dynamic Variables Victim access Substance abuse
Anger/hostility v Emotional control
Low self-esteem*
Responsibility/impulsivity
Positive coping skills v lack of such
Lack of consideration for others/”Antisocial attitude”*
Insulting, teasing, obnoxious verbal behavior
Poor; self care/personal hygiene/domestic activity
Compliance with supervision & treatment/low TX motivation*
Cognitive distortions/Attitudes tolerant of sexual crimes*
Denial of crime*
Staff complacency*
*Lindsay, Elliot, & Astell (2004)

20. TREATMENT

21. Sex Offender Treatment Literature
Treatments that consist of modification of a single defect or pathology are not likely to succeed (i.e. organic treatment.)
Programs that fail to identify the nature of the defect in need of modification are not likely to succeed.
Sexual crimes result from complex interaction of physiological, cognitive, and situational variables.
Self-reports are historically unreliable
Treatment does not eradicate deviant interest
Client is an active participant in treatment
Treatment must include generalization procedures
The offender is responsible and accountable

22. Treatment/Community Support
Consider peer, community, and support provider safety
Gather reliable historical information
Regardless of influential variables or counterfeit deviance, determine what protective supports and restrictions are indicated.
Determine variables influencing the dangerous behavior and develop supports; Multimodal Biopsychosocial Treatment
Consider limited confidentiality and network contact/support
"No more secrets!" Keep everyone informed of progress and set backs
Minimize the likelihood of staff complacency; Provide offense-specific training and ongoing supervision to those providing supports
Review all aspects of safety and treatment/support plans on a frequent and systematic basis
Treatment requires a respectful relationship and consists of numerous components that might include control and confrontation
Do not try this alone! Assessment, development of interventions, and implementation of safety and treatment plans require active network involvement

23. COFFEE BREAK
20 Minutes

24. PART ii: SOLUTIONS FOR COMMUNITY SUPPORT

25. COMMUNITY SUPPORTS AND SAFETY PLANNING

26. Treatment/Support/Safety Planning Is Likely To Conflict with Self-Determination
Primary goal (no more victims) is not determined by the individual
Limited confidentiality; No more secrets
Proactive restrictions go against our support philosophy
Treatment non-compliance might result in serious and long-term consequences
Therapist role includes judgments, enforcement, and coordination of the network. If therapist is not involved, someone must fill those roles.

27. Assessment Based Safety and Intervention Plan
Proactive Interventions:
Control social and environmental risk factors
Interventions designed to reduce/eliminate dynamic risk factors; teach adaptive behaviors
Establish crisis indicators
Interventions for when crisis indicators are observed
Established consequences of the target challenging behavior and make the individual very aware of such; Good Lives Model

28. Case Study
Steve is described as an outgoing and helpful man who is motivated to interact with others. He enjoys music, attending concerts, playing records, and looking at books about music. He likes spending leisure time in the community making purchases, eating out, and walking around the down town area. Steve is diagnosed with:
Autism Spectrum Disorder
Mood Disorder, Not Otherwise Specified
Mild Intellectual Disability
Steve has a long history of aberrant sexual expression with children. On multiple occasions he has engaged in touching a child's or adult's foot while masturbating.

29. Steve's Biomedical/Psychiatric Vulnerabilities
Steve's diagnosis of Autism Spectrum Disorder has a significant influence on Steve's aberrant sexual expression. People with Autism frequently focus on a part of something rather than the entire object. Such narrow focus has contributed to the development of Steve's focus on feet as erotic. His fetish for feet makes him vulnerable to aberrant sexual behavior. Although he prefers children's feet, it does not appear that he excludes other feet when children's feet are not available.
Steve is prone to manic-like behaviors and when such occur, he is more likely to engage in aberrant sexual expression
Steve is a sexual abuse survivor resulting in increased vulnerability to a variety of challenging behaviors

30. Steve: Psychological/Habilitative Vulnerabilities
Steve experiences significant anxiety; a frequently observed characteristic of individuals with Autism Spectrum Disorder. Many individuals not on the Spectrum obtain stress reduction through sexual activity. Many individuals who engage in aberrant sexual expression report that stress often proceeds planning and/or impulsively engaging in aberrant sexual expression. Steve's ability to recognize his anxiety fluctuates. On some occasions he recognizes his distress and he engages in self-calming activities. On other occasions, he does not recognize that he is anxious.

31. Steve: Social/Environmental Vulnerabilities
Aberrant sexual expression can only occur when a potential victim is within Steve's unsupervised environment. That is, a potential victim must be available when Steve is not under close supervision.
Autism Spectrum Disorder decreases Steve's ability to empathize with others. His lack of empathy results in an inability to comprehend the potential harm his behavior can have on victims and their families.

32. Steve: Selected Proactive Interventions
It is critical to Steve's support that everyone working directly with him be familiar with the goals of this behavior plan. These individuals include volunteers accompanying him in the community. Everyone involved must read and comply with this plan. Consistency is a crucial element in providing adequate behavioral support.
Support professionals will review the 6 Community Rules with Steve prior to every community outing. The rules are on a laminated card. Note that Steve has memorized the rule and will rapidly state them. Ask him to slowly read each rule. After reviewing the rules, ask Steve if he would like to carry the card and honor his choice. The rules on the card are as follows:

33. The Six Rules Do not touch other people inappropriately
Do not go into a kid’s store or a store with a kid’s department
Stay with the support professional
Keep hands out of pockets
Do not touch myself inappropriately
Look at people at head level

34. When in the Community, Signs that Steve is at Increased Risk of Engaging in Aberrant Sexual Expression
Maintains attention/focus on one selected individual 
Stares at the individual and/or looks at the individual "up and down."
Remains near the individual 
Indirect/covert looking/staring at a potential victim. Steve will roll his eyes, pace, and look downward as he keeps the individual in his peripheral line of sight.
When he calls attention to one or more individuals in his vicinity wearing flip flops or other shoes that expose their feet. 

35. When One or More of the Signs (previous slide) Are Observed
Say in a supportive but confident manner, "You are in a Danger Zone. What do you do? 
Steve will then typically walk away from the individual and engage in distraction techniques that he has found effective. Specifically, he will cross his arms on his chest, tell himself to "look at face" and/or repeat what others are saying. He might also say, "I'm doing OK. I have my hands out." 
If Steve does not immediately walk away, verbally prompt him to do so by saying, "You need to give him/her space." 
If Steve fails to walk away from the individual after two verbal prompts, terminate the trip and take him directly to his residence.
When Steve calls attention to someone wearing shoes that expose their feet, prompt him per the Danger Zone prompt above.

36. Steve: Restrictions 18 offense-specific restrictions including;
Access to potential victims
Access/possession of pornography
Room searches
Unsupervised use of public restrooms
Toy stores/book stores w/ children's section
Housemates bedrooms
Swimming pools
Flip flops

37. MATCHING the PROGRAM TO the NEED

38. ONE SIZE DOES NOT FIT ALL

39. Prepackaged programs may miss the mark
Anger management….as an example.
The person is not typically angry, but responds to anger when presented with very specific events
What are the triggers?
What are the risk factors for this to occur?
What strengths does the person bring to the equation?
What function does the behavior serve?
What alternative approaches will assist the person to deal with anger in a nonoffending way?
What would be a reinforcement for the use of the new strategies?
What self-management approach could assist the person to not resort to offending as an anger response?
But anger is not the issue in some offences… determination of treatment components must be individualized.

40. Matching intervention to need and function
VULNERABILITIES
INTERVENTIONS
Escape
Control of Anger
Targeted Anger Management/ Assertiveness
Escape from stress
Emotional Regulation
Social Problem Solving/ Communication
Attention general
Lack of Social Competency
Social Skills Training
Attention from a person whom the person is attracted
Relationship Challenges
Socio-sexual Education
& Responsibility Training

41. Management is not treatment

42. CREATING A GOOD LIFE

43. THE TYPICAL PATH FOR THOSE WHO are at risk to offend or reoffend
PUNISHMENT
RESTRICTION
MANAGEMENT
LOSS OF PRIVILEGES
LOSS OF RELATIONSHIPS AND COMMUNITY…
…… NOTHING TO LOSE!!!

44. The effects of punitive management strategies on reoffence
3. Punishment provided for inappropriate behavior
& Restrictive Management
4. Loss of access to privileges .opportunities for social interactions, community engagement
5. Produces a void of environmentally rich opportunities, a state of deprivation of reinforcement , which enhances the evocative influences to increase the probability of a reoffence
1. Evocative influences precursor to an offence

45. Good lives model (GLM; Ward, 2003)
The GLM is a strengths-based approach to offender rehabilitation.
Fundamentals:
offending is essentially the product of a desire for something that is inherently human and normal
the desire or goal manifests itself in harmful and antisocial behaviours, due to a range of deficits and weaknesses within the offender and his/her environment 
these deficits prevent the offender from securing his desired ends in pro-social and sustainable ways, thus requiring that s/he resort to inappropriate and damaging means, that is, offending behaviour.
Rehabilitation therefore involves building capabilities and strengths in people, in order to reduce their risk of reoffending

46. The abative influences and repertoire altering effects of skill development and good life approach
2. Offence
3. Learning coping and replacement skills
4. Providing non contingent reinforcement through GLM
5. Produces an abative effect by reducing the probability of deprivation of access to reinforcement specific and general
1. Evocative influences precursor to an offence

47. Rehabilitation and/or habilitation
Quality of Life Elements
Good Life Elements
Healthy life
Being informed of things that are important
Recreation
Work
Agency
Freedom from Emotional Turmoil
Relationships
Community
Finding meaning and purpose
Pleasure
Creativity
BEING
Physical
Psychological
Spiritual
BELONGING
Social
Community
BECOMING
Practical
Leisure
Growth

48. Stability Strength-based Choice Enriched Positive-focused Resiliency
A LIFE WORTH LOSING
Stability
Strength-based
Choice
Enriched
Positive-focused
Resiliency

49. Weaving solutions
Towards a logical functional model (GRIFFITHS, THOMSON, IOANNOU, HOATH AND WILSON, IN PROGRESS)

50. 8 STEPS TO DEVELOP A LOGICAL FUNCTIONAL APPROACH (GRIFFITHS ET AL
8 STEPS TO DEVELOP A LOGICAL FUNCTIONAL APPROACH (GRIFFITHS ET AL., IN PROGRESS)
IDENTIFY THE SETTTING EVENTS AND MOTIVATING OPERATIONS THAT CAN SET OCCASION FOR THIS PERSON TO OFFEND? HOW CAN THEY BE ALTERED OR PREVENTED?
WHAT ANTECEDENTS PRECEDED THE BEHAVIOR? HOW CAN THEY BE ALTERED?
WHAT FUNCTION DOES THE OFFENSE ACHIEVE FOR THIS PERSON?
HAS THE STAGE BEEN SET FOR SUCCESS?
WHAT REPLACEMENT OR COPING SKILLS CAN BE TAUGHT TO THE PERSON TO ACHIEVE PERSONAL GOALS IN AN APPROPRIATE WAY?
WHAT ELEMENTS CAN BE ADDED TO THE PERSONS LIFE TO ALLOW THEM TO GAIN A RICH LIFE THAT WILL PROVIDE REINFORCING AND POSITIVE QUALITIES AND ENHANCE QUALITY OF LIFE?
WHAT CONSEQUENCES NEED TO BE PUT IN PLACE TO ENSURE POSITIVE BEHAVIORS ARE ENHANCED AND INAPPROPRIATE EXPRESIONS ARE DISCOURAGED?
WHAT STRATEGIES ARE IN PLACE TO GENERALIZE THE BEHAVIORS ACROSS SETTINGS AND PEOPLE TO TRAP THE BEHAVIOURS TO NATURAL ENVIRONMENT, WHILE MINIMIZING RISKS?

51. BALANCING RISKS AND RIGHTS Bill Lindsay always said that sexual offence was the one behavior for which there is zero tolerance for recidivism

52. THE 3 RS: Rights risks and responsibility (GRIFFITHS ET AL., 2011)

53. RIGHTS-BASED COMMMUNITY SERVICES OFTEN EMPHASIZE RIGHTS OVER RISKS
Responsibility

54. TREATMENT BASED SERVICES OFTEN EMPHASIZE RISKS MORE THAN RIGHTS
Responsibility

55. Weaving solutions
INDIVIDUALIZED
HOLISTIC
MULTIDIMENSIONAL
VALUE-BASED

56. THANK YOU

57. REFERENCES
Barron, P., Hassiotis, A., & Banes, J. (2002). Offenders with intellectual disabilities: the size of the problem and therapeutic outcomes. Journal of Intellectual Disability Research, 46(6), Brown, B.S. & Courtless, T.F. (1971). The mentally retarded offender. Department of Health Education and Welfare Publication No. (HSM) , IS Government Printing Office, Washington DC. Day, K. (1994). Male mentally handicapped sex offenders. British Journal of Psychiatry, 165, Griffiths, D. M., Owen, F., & Watson, S.,. (Eds.) (2011). The Rights Agenda: An action plan to advance the rights of persons with intellectual disabilities. Welland, ON: 3Rs Community University Research Alliance. Griffiths, D. & Lunksy, Y. (2003). Sociosexual Knowledge and Attitudes Assessment Tool- R. Wooddale Ill.; Stoelting. Gudjonsson, G.H., Clare, I., Rutter, S., & Pearse, J. (1992). Persons at risk during interview in police custody: The identification of vulnerabilities. Research Study No 12, The Royal Commission on Criminal Justice, HMSO, London. Hayes, S. (1997). Prevalence of intellectual disability in the courts. Journal of Intellectual and Developmental Disabilities,22, Hingsburger, D., Griffiths, D. & Quinsey, V. (1991, September). Detecting counterfeit deviance. Habilitative Mental Healthcare, 9,

58. references
Holland, T., Clare, I.C, & Mukhopadhya, T. (2002)Prevalence of ‘criminal offending’ by men and women with intellectual disability and the characteristics of ‘offenders’: implications for research and service development. Journal of Intellectual Disability Research, 46(1), Lindsay, W.R., (2009). The treatment of Sex Offenders with Developmental Disabilities; A Practice Workbook. Wiley-Blackwell, West Sussex, UK. Lindsay, W.R., Elliot, S.F., & Astell, A.(2004). Predictors of sexual offense recidivism in people with intellectual disabilities. Journal of Applied Research in Developmental Disabilities, 17, Lunsky, Y., Frijters, J., Watson, S., Willison, S. & Griffiths, D. (June 2007). Sexual knowledge and attitudes of men with intellectual disabilities who sexually offend. Special issue on offenders with ID/DD. Journal of Intellectual and Developmental Disabilities, 32(2), Mason, J. (1998). Understanding and responding to people with learning disabilities in the probation service. PhD Thesis, University of Canterbury, Canterbury. Murphy, G., Harnett, H. & Holland, A. (1995)A survey of intellectual disabilities amongst men ion remand in prison. Mental Health Research,