1. Treatment for offenders with learning disabilities Glynis Murphy, Tizard Centre, Kent Univ g.h.murphy@kent.ac.uk g.h.murphy@kent.ac.uk Alison Giraud-Saunders, Foundation for People with Learning Disabilities alisongs@btinternet.com

2. Plan NOMS programmes Thinking Skills programme - Background - Process of negotiation with NOMS - State of play - Content of programme Sex offender programmes - Non-disabled & disabled sex offenders - Treatment for non-disabled sex offenders - Treatment for sex offenders with learning disabilities

3. NOMS programmes NOMS develops treatment programmes for people in prison and on probation Eg. Thinking Skills; managing anger; reducing substance misuse; & sex offending (SOTP) Very carefully vetted; all developed in-house Accreditation system & strict quality control BUT: All programmes have IQ 80 cut-off Only widespread adapted programme is ASOTP Gill case made Ministry of Justice more aware & motivated to solve problem

4. Adapting delivery of the Thinking Skills Programme Alison Giraud-Saunders Foundation for People with Learning Disabilities www.learningdisabilities.org.uk

5. We promote the rights, quality of life and opportunities of people with learning disabilities and their families. We do this by working with people with learning disabilities, their families and those who support them

6. Offending behaviour programmes

7. Gaining entry for prisoners with learning disabilities Inspired by ‘No One Knows’ Glynis and Peter Oakes Proposal to DH Gill case Grant award April 2010

8. Round and round….

9. Negotiations with NOMS Adaptation – delivery Evaluation – feasibility Intellectual property Role of project worker

10. The real start Project worker Training (project worker) Adapting Evaluation Theory Facilitator training

11. Issues − Theory: based on WAIS − Selection of participants: WASI − Fitting in with regime − Accessibility vs programme integrity − Volume of materials − Measures of progress (participants)

12. Outline Course materials cover: Self control Problem solving Positive relationships Consent, 1:1s ‘Conditions of success’ Facilitator instructions Realistic evaluation

13. We’re on the way! First pilot – HMP Whatton Planning second pilot Sustainability

14. Conclusion Routine availability of adapted programmes Custody and community Alternatives to prison …and to hospital

15. Sexual offending by non-disabled men & disabled men For both groups Grossly under-reported to police 90-95% of sex offenders are men Most perpetrators are known to victim Men often engage in grooming & stalking of victims Men hold many cognitive distortions

16. Treatment for non-disabled sex offenders: recent years 1960s & 1970s: Seen as result of deviant sexual interests & arousal Led to behavioural techniques eg aversion therapy, orgasmic reconditioning & covert sensitisation Belief in medical model & anti-androgens Little evidence of effectiveness; under- provision of treatment Move to CBT approach

17. Marshall’s model of sex offending

18. Components of cognitive behavioural treatment Enhancing self-esteem Challenging & changing cognitive distortions Developing victim empathy Developing social functioning Modifying sexual preferences Ensuring relapse prevention See Marshall et al.’s 1999 book for an excellent guide

19. Does it work for non-disabled men? Hanson et al, 2002: Meta-analysis of 43 CBT studies of sex offender treatment (over 9,000 participants overall) - sexual offence recidivism rate: 12% for treated men vs 17% for untreated men Aos, Miller & Drake 2006: reviewed controlled CBT studies. CBT produced reduction in recidivism (31% reduction in community & 15% in prison sample) Kenworthy et al, 2006: Cochrane review of 9 RCTs (over 500 offenders), mostly paedophiles; variety of treatment methods: - one large CBT trial showed a definite reduction in recidivism - one large group psychotherapy trial showed treatment increased risk.

20. Cognitive behavioural treatment for men with & without LD in UK CBT widely available for non-disabled convicted sex offenders: SOTP - in prison - in community (run by probation) Men with LD mostly excluded from these: - some prisons run ASOTP - Janet Shaw clinic in Solihull (ASOTP), - Northgate hosp programme near Newcastle, - Bill Lindsay’s programme in Scotland, - our SOTSEC-ID programme (about 25 sites across the country)

21. Most adapted programmes have core assessments (eg below is SOTSEC-ID list) Once only: IQ, adaptive behaviour, language, autism Pre & Post group treatment: - Sexual Knowledge & Attitude Scale (SAKS) - Victim Empathy scale, adapted (Beckett & Fisher) - Sex Offender Self-Appraisal Scale (Bray & Foreshaw’s SOSAS) - Questionnaire on Attitudes Consistent with Sex Offending (Bill Lindsay et al.’s QACSO) Recidivism

22. Treatment content (SOTSEC-ID) Group purpose, rule setting Human relations & sex education The cognitive model (thoughts, feelings, action) Sexual offending model (based on Finklehor model) General empathy & victim empathy Relapse prevention Compared to non-LD programmes: Far more slow offence disclosure; more on sex education; far more pictorial material & less sophisticated on cognitive side

23. Does group CBT work for men with LD? Lindsay et al (1998a, b) showed some improvements in 6 men with LD & paedophilic offences & 4 men with LD & exhibitionism, after CBT Lindsay & Smith (1998): showed 2 years CBT was more effective than 1 yr CBT for men with LD on probation Rose et al (2002): CBT 2hrs/week for 16 weeks, for 5 men; found reduced (improved) scores but changes not significant Craig et al 2006: no changes in cognitive distortions in 7mth CBT Lindsay et al 2006: 70% harm reduction in 29 repeat sexual offenders with ID, after CBT Williams et al, 2007: significant improvements in scores from pre-group to post-group in 150 men following CBT in ASOTP programmes in prisons (not all ID)

24. Significant changes in cognitive distortions, sexual knowledge & empathy -SOTSEC-ID

25. Further sexually abusive behaviour (SOTSEC-ID) During the year of the treatment group: most men did not show further sexually abusive behaviour; in 4 men (out of 48) they DID show non-contact ‘offences’ In the 6 mths follow-up period: most men did not show further sexually abusive behaviour; in 7 cases (5 men) DID show non- contact ‘offences’ (5 cases) or sexual touch through clothing (2 cases) Re-offending: No relationship with pre- or post- group scores; IQ, presence of mental health problems, personality disorder, living in secure setting, being victim of SA, history of offending. Poor prognosis: Concurrent therapy & diagnosis of autism / aspergers syndrome Longer follow-up: data just collected (by Kathryn Heaton) & above findings still hold

26. Service user views (SOTSEC-ID) Good understanding of basic facts (duration, venue, facilitators, & rules, e.g. confidentiality rule) Good understanding of why referred: ‘Because of my sex offence to see if it would do me any good’; ‘To help my sex urges, keep them under control; to be a better person when meeting women in the community’ ‘To help us stop getting into trouble with the police because I go out to masturbate’ What they learnt: ‘Stopped me touching girls’; ‘How people feel about us masturbating’ (in public); ‘Learnt not to go after women’; ‘Learnt to help other people in the group’; ‘What the police do when they arrest you’

27. Service user views (cont’d) Best things ‘Having support every week’ ‘We … talked about feelings about things, sorting the problems out’ ‘Working together, helping each other’ ‘We helped each other discuss... work on ways of preventing problems in the future’ Worst things ‘Telling people very private stuff, keeping people on trust’ ‘Some didn’t talk’

28. Thank you! Alison Giraud-Saunders alisongs@btinternet.com 07721 843290 www.learningdisabilities.org.uk Glynis Murphy g.h.murphy@kent.ac.uk