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Marc Goldman & Dorothy M. Griffiths

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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,


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