CSOM Training Curriculum: An Overview of Sex Offender Treatment for a Non-Clinical AudienceLong Version: Section 21 Sex Offender-Specific Treatment Outcome Research: Learning Objectives Describe the general findings of sex offender treatment outcome research Articulate the problems with measuring treatment effectiveness Describe the financial costs and benefits of sex offender treatment

CSOM Training Curriculum: An Overview of Sex Offender Treatment for a Non-Clinical AudienceLong Version: Section 22 Does Treatment Reduce Recidivism in Sex Offenders? Goal: to protect the community by reducing the likelihood of future sexual assaults

CSOM Training Curriculum: An Overview of Sex Offender Treatment for a Non-Clinical AudienceLong Version: Section 23 Problems with Measurement of Treatment Effectiveness Variations (sometimes extreme) in recidivism rates between different programs Typically low recidivism rates make finding statistically significant results very difficult Issue of base rates for measuring recidivism in treatment outcome studies Because base rates for sexual reoffending fall between 10% and 25% in most studies, and sample sizes typically are small (fewer than 200 offenders), the treatment effect must be very large (greater than 50%) to observe significant differences between treated and untreated offenders

CSOM Training Curriculum: An Overview of Sex Offender Treatment for a Non-Clinical AudienceLong Version: Section 24 Hanson & Morton-Bourgon, 2004 Update of 1998 meta-analytic review of sex offender recidivism studies Analyzed 95 studies containing 31,216 sex offenders This study examined primarily dynamic (changeable) risk factors, rather than the static (unchangeable) factors reviewed in the 1998 study 5-6 year follow-up

CSOM Training Curriculum: An Overview of Sex Offender Treatment for a Non-Clinical AudienceLong Version: Section 25 Hanson & Morton-Bourgon, 2004 (cont.) Results showed that the sexual recidivism rate across all studies was 13.7% General recidivism rate was 36.9% All types of recidivism were predicted by offenders having an unstable, antisocial lifestyle, or lack of self- control Those individuals with deviant sexual interests, particularly in children, were most likely to reoffend sexually High rates of sexual preoccupation were significantly related to all forms of recidivism

CSOM Training Curriculum: An Overview of Sex Offender Treatment for a Non-Clinical AudienceLong Version: Section 26 Lösel & Schmucker, 2005 First international meta-analysis of both published and unpublished sex offender biological and psychological treatment outcome studies Included 69 studies with more than 22,000 subjects were analyzed—about one-third published since the year 2000 and one-third published outside North America Recidivism was operationalized as broadly as possible, ranging from incarceration to lapses in behavior

CSOM Training Curriculum: An Overview of Sex Offender Treatment for a Non-Clinical AudienceLong Version: Section 27 Lösel & Schmucker, 2005 (cont.) 11% recidivism rate in treatment groups 17.5% recidivism rate in control groups Overall, treatment provides a 37% reduction in sexual recidivism Cognitive-behavioral treatments had the most significant impact on sexual recidivism

CSOM Training Curriculum: An Overview of Sex Offender Treatment for a Non-Clinical AudienceLong Version: Section 28 Lösel & Schmucker, 2005 (cont.)

CSOM Training Curriculum: An Overview of Sex Offender Treatment for a Non-Clinical AudienceLong Version: Section 29 Marques et al., 2005 Marques and colleagues employed an experimental design to evaluate the Sex Offender Treatment and Evaluation Project (SOTEP) Stationed at Atascadero State Hospital in California, SOTEP operated from 1985 to June 1995 Randomized clinical trial 704 participants 259 = relapse prevention program 225 = untreated volunteer control 220 = untreated non-volunteer control 8 year follow-up

CSOM Training Curriculum: An Overview of Sex Offender Treatment for a Non-Clinical AudienceLong Version: Section 210 Marques et al., 2005 (cont.) Final results revealed no significant differences among the three groups in their rates of sexual or violent reoffending 22% of the treatment group committed a subsequent sexual offense and 16.2% had a violent reoffense 20% of the volunteer group reoffended sexually and 16.3% had a subsequent violent offense 19.1% of the non-volunteer control group had a sexual reoffense and 15% had a violent reoffense However, those who did well in treatment recidivated at lower rates than those who did not progress in treatment

CSOM Training Curriculum: An Overview of Sex Offender Treatment for a Non-Clinical AudienceLong Version: Section 211 Marques et al., 2005 (cont.)

CSOM Training Curriculum: An Overview of Sex Offender Treatment for a Non-Clinical AudienceLong Version: Section 212 McGrath et al., 2003 Evaluation of a prison-based cognitive- behavioral, relapse prevention treatment program for adult sex offenders in the State of Vermont, which included a community aftercare component 195 participants 90 = no treatment 56 = completed treatment 49 = some treatment 6 year follow-up

CSOM Training Curriculum: An Overview of Sex Offender Treatment for a Non-Clinical AudienceLong Version: Section 213 McGrath et al., 2003 (cont.) Results showed that almost one quarter of the total sample (23%) were found to have committed a new sex offense during the follow-up period Sex offenders in the completed treatment group had a significantly lower sexual recidivism rate (5%) that both the some treatment group (31%) and the no-treatment group (30%) The completed treatment group also had a significantly lower rate of violent recidivism than the no-treatment group

CSOM Training Curriculum: An Overview of Sex Offender Treatment for a Non-Clinical AudienceLong Version: Section 214 McGrath et al., 2003 (cont.)

CSOM Training Curriculum: An Overview of Sex Offender Treatment for a Non-Clinical AudienceLong Version: Section 215 Seager et al., 2004 Seager et al. examined men over the age of 18 who were convicted of a sex offense and were offered the opportunity to participate in a manualized treatment program, in which offender progress was clinically evaluated 177 participants 81 successfully completed the treatment program 28 were unsuccessful 17 offenders dropped out 19 refused to participate

CSOM Training Curriculum: An Overview of Sex Offender Treatment for a Non-Clinical AudienceLong Version: Section 216 Seager et al., 2004 (cont.) Overall, 12% of the offenders in this study were reconvicted for a sex or violent offense and 23% were charged with a new sex or violent offense 4% of successful treatment completers and 7% of unsuccessful treatment completers were convicted for a new sexual or violent offense 32% of those who dropped out, refused, or were terminated from treatment incurred a new conviction and 49% had new charges Dropping out, refusing, or being terminated from treatment was related to higher risk for sexual and/or violent offending

CSOM Training Curriculum: An Overview of Sex Offender Treatment for a Non-Clinical AudienceLong Version: Section 217 Seager et al., 2004 (cont.)

CSOM Training Curriculum: An Overview of Sex Offender Treatment for a Non-Clinical AudienceLong Version: Section 218 Problems with Measurement of Treatment Effectiveness (cont.) Differences in laws, policies about sex offending Difficulty in following subjects who move Different sex offender populations Duration of follow-up Attrition of sample subjects Definitions of what constitutes reoffense Differences in treatment program intensity, location (prison, community), and methods

CSOM Training Curriculum: An Overview of Sex Offender Treatment for a Non-Clinical AudienceLong Version: Section 219 Barbaree and Marshall, treated (cognitive-behavioral methods) and untreated child molesters in a community sample 4 year follow-up Recidivism (measured by official police records and unofficial police and child protective agency reports) rates quite different between the treated and untreated groups

CSOM Training Curriculum: An Overview of Sex Offender Treatment for a Non-Clinical AudienceLong Version: Section 220 Barbaree and Marshall, 1988 (cont.) Extra-familial female-target child molesters Recidivism rates over four years for treated group: 18%; for untreated group: 43% Extra-familial male-target child molesters Recidivism rates for treated group: 13%; for untreated group: 43% Incest female-target child molesters Recidivism rates for treated group: 8%; for untreated group: 22%

CSOM Training Curriculum: An Overview of Sex Offender Treatment for a Non-Clinical AudienceLong Version: Section 221 Barbaree and Marshall, 1988 (cont.) Recidivism Rates

CSOM Training Curriculum: An Overview of Sex Offender Treatment for a Non-Clinical AudienceLong Version: Section 222 Rice, Quinsey, and Harris, 1991 Studied 136 extrafamilial child molesters from a maximum security psychiatric hospital over a 6 year follow-up period Found no treatment effect

CSOM Training Curriculum: An Overview of Sex Offender Treatment for a Non-Clinical AudienceLong Version: Section 223 Hall, 1995 Performed meta-analysis on 12 sex offender treatment outcome studies Total sample size of 1,313 sex offenders Recidivism: formal legal charge for a new sex offense after the completion of treatment for the treatment group Mean length of treatment 18.5 months

CSOM Training Curriculum: An Overview of Sex Offender Treatment for a Non-Clinical AudienceLong Version: Section 224 Hall, 1995 (cont.) Mean follow-up period across studies was 6.85 years Found small but significant recidivism-reducing treatment effect for treatment versus no- treatment or comparison treatment conditions Overall recidivism rate for treated sex offenders: 19% Recidivism rate for untreated group: 27%

CSOM Training Curriculum: An Overview of Sex Offender Treatment for a Non-Clinical AudienceLong Version: Section 225 Hall, 1995 (cont.)

CSOM Training Curriculum: An Overview of Sex Offender Treatment for a Non-Clinical AudienceLong Version: Section 226 Hall, 1995 (cont.) Greatest treatment effects were in studies with Longer follow-up periods Higher base rates of recidivism Outpatient services Cognitive-behavioral treatment or anti- androgen treatment

CSOM Training Curriculum: An Overview of Sex Offender Treatment for a Non-Clinical AudienceLong Version: Section 227 General Accounting Office, 1996 Summarized 22 reviews of research on sex offender treatment covering 550 studies between 1977 and 1996 Report concluded that the results are promising but inconclusive

CSOM Training Curriculum: An Overview of Sex Offender Treatment for a Non-Clinical AudienceLong Version: Section 228 Alexander, 1999 Examined data from 79 sex offender treatment outcome studies encompassing 10,988 subjects Divided offenders and offenses into subtypes by age of offender, age of victim, offense type, type of treatment, location of treatment, years in which treatment occurred, and length of follow-up Recidivism typically defined as subjects who were rearrested for a new sex offense

CSOM Training Curriculum: An Overview of Sex Offender Treatment for a Non-Clinical AudienceLong Version: Section 229 Alexander, 1999 (cont.) Offenders who participated in relapse prevention treatment programs had a rearrest rate of 7% compared to 18% for untreated offenders 528 adult male rapists: 20% of the treated group reoffended; 24% of the untreated group

CSOM Training Curriculum: An Overview of Sex Offender Treatment for a Non-Clinical AudienceLong Version: Section 230 Alexander, 1999 (cont.)

CSOM Training Curriculum: An Overview of Sex Offender Treatment for a Non-Clinical AudienceLong Version: Section 231 Alexander, 1999 (cont.) Recidivism Rate

CSOM Training Curriculum: An Overview of Sex Offender Treatment for a Non-Clinical AudienceLong Version: Section 232 2,137 child molesters: 14% of the treated group reoffended; 26% of the untreated group Treatment effect was especially strong for the 331 exhibitionists: 20% of the treated group reoffended; 57% of the untreated group For all 10,988 study subjects combined, 13% of the treated group reoffended; 18% of the untreated subjects reoffended Alexander, 1999 (cont.)

CSOM Training Curriculum: An Overview of Sex Offender Treatment for a Non-Clinical AudienceLong Version: Section 233 Alexander, 1999 (cont.) Recidivism Rates

CSOM Training Curriculum: An Overview of Sex Offender Treatment for a Non-Clinical AudienceLong Version: Section 234 Hanson et al., 2002 Collaborative research project to: Define standards for research on treatment outcomes for sex offenders Summarize existing research Promote high quality evaluations The 2002 ATSA Report on the Effectiveness of Treatment for Sexual Offenders

CSOM Training Curriculum: An Overview of Sex Offender Treatment for a Non-Clinical AudienceLong Version: Section 235 Hanson et al., 2002 (cont.)

CSOM Training Curriculum: An Overview of Sex Offender Treatment for a Non-Clinical AudienceLong Version: Section 236 Seto and Barbaree, 1999 Evaluated the relationship of clinical ratings of treatment behavior to recidivism (in-session behavior, homework quality, motivation and change achieved) Found good treatment behavior was unrelated to general recidivism but associated with higher serious violent or sexual recidivism Men who scored higher in psychopathy and better in treatment behavior were the most likely to reoffend

CSOM Training Curriculum: An Overview of Sex Offender Treatment for a Non-Clinical AudienceLong Version: Section 237 Serious Sex Offender Recidivism Related to Treatment Behavior and Psychopathy Recidivism Rates High20.4%3.6% Low5.0%2.0% GoodPoor Treatment Behavior Seto and Barbaree, 1999 Psychopathy

CSOM Training Curriculum: An Overview of Sex Offender Treatment for a Non-Clinical AudienceLong Version: Section 238 Financial Costs/Benefits of Treatment Any reduction in recidivism is significant in terms of reduction of harm to victims and costs to society In tangible financial costs, Prentky and Burgess (1990) estimated the costs per sex offense for offender-related and victim-related expenses totaled $183,333 Therefore, if there are eight fewer offenses for every 100 sex offenders, the tangible financial savings is $1,466,664 If we think treatment of sex offenders is expensive, compare it to the cost of not treating sex offenders

CSOM Training Curriculum: An Overview of Sex Offender Treatment for a Non-Clinical AudienceLong Version: Section 239 Summary Early evaluations of sex offenders programs found no evidence that treatment works The most recent, largest scale, and best designed treatment outcome study to date found that treatment works When all studies are reviewed, sex offender treatment reduces sexual recidivism in adult males about 5 to 10% Any reduction in reoffense rates can result in very significant cost savings and—more critically—a reduction in harm