Sexual Offenders

2023-5-31

KC

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�先說結論�

• 今天回顧，過去卅年，我們對 SO 做的，好比更早廿年，曾對 BPD 所做，就是把它變成，可處理 (manageable) 的難題。首先藉精算風險評估 (actuarial risk assessment)，進行分組，再以不同治療模型，進行處遇研究，當研究資料，累積相當數量，就開始反覆後設分析 (meta-analysis)，構建實證論述 (evidence-based discourse) 。�
• 與 BPD 不同的是，SO 非僅臨床現象，屬行為犯罪學 (Behavioral Criminology) 難題，牽涉立法執法，而且再犯 (recidivism) 風險和社會安全的顧慮，是很具體的。處遇重點，是高風險者，遂藉司法精神病房，取代監獄。至於長期住院期間，是否有治療可言，可想而知，反正住院等同羈押，住院一生，等同不可假釋的無期徒刑，就算解決了社會安全的難題。意思是說，精神醫學，就是社會控制 (social control)。至於假釋在外，或刑期已滿，仍續列管追蹤者，這些在社區走來走去的人，則交給心理師社工師提心吊膽。意思是說，社區處遇，就是社會監控 (social monitor)。

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大綱

• 風險評估 (Risk Assessment) (including Dynamic Risk Factors (DRFs) )
• RNR 原則 (Risk-Need-Responsivity principles)
• 高風險者 (High Risk Sexual Offender)
• 藥物治療 (Rx), CoSA (Circles of Support and Accountability), MI (Motivational Interviewing)
• Pedophilia

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Behavioral Criminology

• Book series
• SpringerBriefs in Behavioral Criminology
• https://www.springer.com/series/10850

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• Handbook of Behavioral Criminology, ed. by Vincent B. Van Hasselt, Michael L. Bourke, Springer, 2018

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• Chap 23: Forensic Assessment of Sex Offenders, in The American Psychiatric Association Publishing Textbook Of Forensic Psychiatry 3e, ed. by Liza H. Gold, Richard L. Frierson, APPI, 2018

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• Chap 70: Sex Offender Risk Assessment, in Principles And Practice Of Forensic Psychiatry 3e, ed. by Richard Rosner, Charles L. Scot, CRC, 2018

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Chap 70: Sex Offender Risk Assessment

• As with violence risk assessment, three generations of risk assessment for sexual offenders can be identified.
• The first involved unstructured methods not based on empirical data. Unfortunately, this method’s accuracy was no better than chance, and clinicians were wrong as often as they were right.
• Today it is broadly accepted that evaluations based on unstructured professional judgment are not as accurate as structured risk assessments (Janus and Prentky 2003; Andrews et al. 2006; Quinsey et al. 2006; Monahan 2007).
• In the late 1990s the second generation of risk assessment evolved with the creation of actuarial risk scales composed of static, historical factors (Bonta and Wormith 2007).
• The third generation of risk assessment involves the evaluation of dynamic needs, identifying risk factors amenable to change.
• These dynamic risk factors, also called long-term vulnerabilities or psychological risk factors, have been incorporated into structured instruments to assess relevant risk factors for sexual re-offending (e.g., Fernandez et al. 2012; Helmus et al. 2012a; McGrath et al. 2012).

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• Currently, the question is not whether risk assessments should be completed for sex offenders, but what methodology should be used.
• To evaluate this question Hanson and Morton-Bourgon (2009), using meta-analyses, examined 118 studies to determine the accuracy of each method of prediction.
• For all outcomes, the actuarial method was superior (Cohen’s d = 0.67 [a measure of the strength of the effect]). Unstructured professional judgment was sig- nificantly less accurate than actuarial methods (d = 0.42).
• The accuracy of structured professional judgment was slightly better than unstructured professional judgment (d = 0.46).
• It is now standard practice to use one or more actuarial instruments to evaluate static, or historical, risk factors, which rarely change and provide a baseline of risk for a sexual offender.
• These data suggest that contemporary risk assessment should include the use of validated actuarial instruments as well as a structured review of relevant dynamic risk factors.

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Determining Risk of Sexually Offending: Actuarial Instruments

• The most commonly used and best validated actuarial measures for assessing sexual recidivism risk are the Static-99R and the Static-2002R (Hanson and Thornton 2000; Hanson et al. 2010).

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Psychologically Meaningful Risk Factors (Dynamic Risk Factors)

• Although the static risk factors have long been established, the changeable risk factors that predict sexual re-offense have been subject to more recent research (Mann et al. 2010).
• Psychologically meaningful risk factors, also called dynamic risk factors and long-term vulnerabilities, are frequently the targets of treatment because of their amenability to interventions that presumably will decrease risk.
• Assessment of these risk factors is an integral part of a contemporary risk assessment.
• Although static risk cannot change, dynamic risk can lower overall risk.
• Although there are many single sample studies identifying potential changeable risk factors, the Mann et al. (2010) meta-analysis categorized potential risk factors according to the strength of the evidence of their relationship with offending.

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• Like static risk factors for sexual re-offense, many of the dynamic risk factors have low to moderate effect sizes, so evaluating them collectively will increase predictive accuracy. Currently there are four validated instruments that have been developed to assess psychologically meaningful risk factors in a structured way.
• Stable-2007
• Structured risk assessment-forensic version (SRA-FV)
• Violence risk scale-sexual offender version (VRS-SO)
• Sex Offender Treatment and Intervention Progress Scale (SOTIPS)

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Additional Risk Factors Not Contained In Structured Risk Assessment Instruments

• A contemporary risk assessment should consider psychopathy (as measured on the Hare Psychopathy Checklist Revised, Hare 2003), advanced age, level of community supervision, and sex offender treatment completion and treatment drop out.

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Summary

• Contemporary risk assessment for sex offender evaluations should include the use of multiple validated actuarial instruments and the most appropriate validated dynamic risk assessment instrument as outlined in this chapter.
• Evaluators need to avail themselves of formal training prior to use of these instruments to ensure the reliability and validity of scores.
• Because these instruments do not contain all relevant risk factors and contextual factors, additional empirically related factors may be considered.
• Risk assessment should be individualized to the offender although the evaluator is discouraged from overriding empirically validated assessments with risk factors not related to sexual recidivism.
• Finally, evaluators are encouraged to remain cur- rent on the research that supports instruments they use and on new, evolving research that informs sex offender risk assessment. As with all of the static and dynamic instruments, the evaluator is advised to participate in formal training before using the instruments.

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Summary Key Points

• Actuarial instruments are superior to unstructured clinical judgment when evaluating sex offender risk.
• The use of multiple actuarial instruments can provide enhanced predictive ability.
• Relative risk is stable over time and should be reported as nominal risk categories and percentiles.
• Instruments that assess dynamic risk factors are critical in determining the appropriate normative group and can also be used to develop treatment interventions aimed at risk reduction.
• Sex offender risk assessment should be individualized, but should not rely on idiosyncratic factors unrelated to sexual recidivism.

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�History of Risk Assessment�

• Modern-day assessments are more comprehensive in scope and systematic in nature.

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• In the current landscape, it is accepted practice to use actuarial calculations to classify individuals and customize the justice response to optimize outcomes.

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• This evolution from educated “guess” to evidence-based prediction occurred over four generations of risk assessment development, described in this section. 

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• https://bja.ojp.gov/program/psrac/basics/history-risk-assessment

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• First Generation: Professional Judgments

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• Second Generation: Actuarial Assessments of Static Factors

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• Third Generation: Actuarial Assessments of Static and Dynamic Factors

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• Fourth Generation: Integration of Case Management

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Risk vs. Need

• Risk is the likelihood of re-offense, and it tells the justice system who to focus on, whether for detention or release, level of supervision, or intervention.

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• Need factors provide targets for programming and services intended to change behavior and thereby reduce risk.

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• https://bja.ojp.gov/program/psrac/basics/what-we-mean-by-risk

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actuarial risk assessment approach

• The quantitative, tool-based method of risk prediction is called “actuarial” because it is based on examining data on populations to see what characteristics are predictive of the relevant outcome.

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• The actuarial approach is integral to evidence-based practice.

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• Actuarial assessment outperforms clinical judgment alone in predicting outcomes.

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• See also: https://www.advisoryexcellence.com/a-guide-for-risk-assessment-and-management-in-actuarial-science/

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��Conducting Risk Assessment (“Four Cs”)��

1. Collecting Information

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• Calculating Scores

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• Classifying Individuals

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4. Customizing Justice System Response

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• https://bja.ojp.gov/program/psrac/basics/what-is-risk-assessment

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Clinical Training Manual for Evaluating Dynamic Risk Factors (DRFs) Involved with Sexual Aggression  (Mark S. Carich, Jessie Huebner, 2020)

• Training Goals

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• Provide an overview of assessment
• Provide an overview of risk assessment
• Provide an overview of historical or static factors
• Provide comprehensive definitions
• Differentiating between static vs, dynamic factors
• Provide basic list of historical factors pertaining to risk

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• Provide detailed list of DRFs
• Provide list of Mann’s classic meaningful factors
• Provide in detail a meta revised list of DRFs
• Provide specific questions to elicit information on DRFs
• Detailed discussion of the “offending mind frame”
• Provide a life risk management plan

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Dynamic Risk Factors (DRFs)

• Dynamic Risk Factors (DRFs) are those factors that can change either slowly (stable factors) or acutely (rapidly).  These factors are used to mediate or clinically adjust actuarial based risk scores. 
• Although risk factors indicate potential risk, the authors emphasize that offenders do not offend all of the time.
• This protocol provides a compressive tool assessing clients along dynamic factors.  DRFs are translated into treatment targets.  Finally, a treatment plan is provided, based on the client’s needs. 
• The risk-needs-responsivity principle is applied.  The DRFs are a part of determining risk and the client’s needs.  Responsivity to the client is paramount for effective interviews and treatment that is, being responsive to the client’s needs, learning style and psychological framework.

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Goals of Risk Assessment

• Collecting data, both historical and dynamic information
• To gain basic understanding of risk levels
• To provide an understanding of the client & dynamics
• To provide some understanding “offending mind frame”
• To provide treatment targets
• Provide a life risk management plan
• Make recommendations

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Basics of Risks

• Assessing Levels of risk
• Not either/or prediction
• Not based on absolutes
• Based on probabilities
• Estimated rates of sexual recidivism
• Clinical opinion is not very accurate
• Actuarials more accurate than hunches
• Clinically adjusted actuarials is best practice

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• Intentions to offend override any risk scores
• Actuarials are empirically developed/driven
• Validated actuarials consist of static factors
• Static based instrument does not measure change
• Static instruments set the foundation
• Dynamic instruments are in their infancy

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Concerns statistical errors

• Type I Error (false positive) – offender dangerous when not

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• Type II Error (false negative) – offender low risk when very high risk

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Two Types of Risk Factors

• Static (historically based)

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• Dynamic (changeable) factors
• Stable (longer to change)
• Acute (immediate change)

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• Criminogenic needs- DRFs that are related to criminal activity & when changed, reduces the probability of recidivism (Oliver et al., 2014)
• Dynamic Risk Factor- changeable factor related to risk
• Psychological meaningful factors- enduring individual propensities or long-term vulnerabilities for sexual violence with 2 criteria:
• Risk factor serves plausible possible cause for sexual offending
• Risk factor reliably predicts risk to re-offend

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Overview of Dynamic Risk Factors (DRFs)

• These factors are based on the classical article by Mann, Hanson & Thornton (2010).
• They referred to these factors as Meaningful Risk Factors.
• … meaningful when there is plausible justification that the factor could be a cause of sexual reoffending.
• Is psychologically meaningful – Psychological meaningful requires:

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• A plausible rationale that the factor is a cause of sexual offending, and
• Strong evidence that it predicts sexual recidivism
• Could plausibly be a cause of sexual offending
• May be worth targeting in treatment or is already commonly targeted in treatment
• Is considered plausible in criminological or social learning theories

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five categories of meaningful factors based on the empirical literature and strength or lack of supporting research

• Research Supportive (studies show predictive values)
• Promising (at least one study shows predictive values)
• Unsupportive exceptions (small effect but at least one study shows an effect for sub-groups)
• Worth exploring (lacks evidence but other supporting evidence)
• Not risk factors (no relationship)

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Research Supported

• Sexual preoccupation
• Any deviant sexual interest
• Sexual preference for kids (PPG)
• Multiple paraphilias
• Offense-supported attitudes
• Emotional congruence with kids
• Lack of emotionally intimate relationships with adults
• Never married
• Conflicts in intimate relationships
• Lifestyle impulsivity

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• General self-regulation problems
• Impulsivity
• Recklessness
• Employment instability
• Poor problem-solving skills
• Resistance to rules and supervision
• Childhood behavior problems
• Non-compliance with supervision
• Violation of Conditional Release
• Grievance/hostility
• Negative social influence

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Promising

• Hostility toward women
• Machiavellianism
• Callousness/lack of concern for others
• Dysfunctional coping
• Sexualized coping
• Externalizing

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Unsupported exceptions

• Denial
• Increased risk with incest offending
• Depends on how it is defined in a continuum vs. a dichotomy
• Only Harkins found as a protective factor for high risk, not low risk
• Thornton/Knight found it protective of child molesters
• Overall increased risk with rapists
• Major mental illness
• Views of self as inadequate
• Loneliness

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• Worth Exploring
• Adversarial sexual orientation
• Fragile narcissism
• Sexual entitlement

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• Not Risk Factors
• Depression
• Poor social skills
• Lack of motivation for treatment at intake

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Meta-Categories of Risk Factors (Carich, Huebner, & Loy, 2020)

• Sexual and sexually deviant related risk factors
• Cognitive and responsibility related risk factors
• Interpersonal relationship related risk factors
• Emotion related risk factors
• General regulation skills and deficit related risk factors
• Lifestyle and antisocial behavior related risk factors i.e. impulsivity

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Assessing or Evaluating DRFs

• Key DRFs Categories

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• Sexual related factors
• Cognitive related factors
• Interpersonal related factors
• Emotional related factors
• Regulation skills/deficits factors
• Lifestyle factors- i.e, antisociality

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Concluding Comments

• Risk assessment involves evaluating the risk potential of re-offense
• Risk sometimes is not static, but changeable
• It is often a complex process involving collecting static & dynamic risk factors
• Then determining what’s risk neutral and protective
• Static provides the foundational risk level via risk tools (i.e.., Static 99R)
• DRFs helps mitigate the foundational level by capturing current risk
• DRF categories include: Sexual and sexually deviant related risk factors / Cognitive and responsibility related risk factors / Interpersonal relationship related risk factors / Emotion related risk factors / General regulation skills and deficit related risk factors / Lifestyle and antisocial behavior related risk factors (i.e. impulsivity)
• DRFs are often difficult to evaluate or assess without knowing what to ask
• Key questions were provided

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Assessing Risk in Sex Offenders: A Practitioner's Guide, by Leam A. Craig, Kevin D. Browne, Anthony R. Beech, Wiley, 2008�

• Sexual offenders who are assessed as low risk of re-offending may be treated and managed in the community, enhancing the chances of their rehabilitation.
• Individuals who are at high risk of violent and/or sexual offences require interventions while they are incarcerated in secure environments, such as young offender institutions, prisons and special hospitals.
• This dual track approach is likely to meet with more success in safeguarding children and vulnerable adults on a long-term basis. (p. xvi)

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Chap 6: Dynamic Factors Associated with Sexual Recidivism

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• what are the dynamic risk factors

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• whether there is any additive value in including dynamic factors into risk assessments

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• In the UK Craig, Browne and Stringer (2003a) examined 26 studies on sexual offence recidivism (n 1⁄4 33; 001) from which they identified 14 stable dynamic risk factors, as shown in Table 6.1, found to be associated with sexual offence recidivism.

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• It can be seen from Table 6.1 that the stable dynamic risk factors can be organised into the following groups: sexual, affective and clinical factors.

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Table 6.1 Stable dynamic risk factors associated with sexual offence recidivism (Craig et al., 2003)

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Table 6.4 Acute dynamic risk factors associated with sexual offence recidivism

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• Thornton (2002) has reported a useful framework for stable dynamic risk factors, suggesting that they fall into four specific domains:

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• sexual interests
• distorted attitudes
• socio-affective functioning
• self-management problems

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• Craig, Browne and Stringer (2003a) identified 13 acute dynamic risk factors (see Table 6.4) that have been found to be associated with sexual offence recidivism.

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• It can be seen from Table 6.4 that the acute dynamic risk factors fall into the following groups: sexual interests, treatment behaviour, clinical factors and contextual factors.

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• Common among the dynamic risk assessments systems reviewed here is a theoretical assumption that stable risk factors (for example, such as pro-sexual assault attitudes and sexual interest in children) interact with acute states (e.g., victim acquisition behaviours and deterioration in lifestyle stability) leading to an increased risk of sexual reoffending.

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Chap 7: Treatment and Sexual Recidivism

• Brown (2005) notes that the above broadly reflect the approaches to treatment in the broader criminogenic literature from ‘nothing works’ (Martinson, 1974), to ‘something works’ (Gendreau & Ross, 1979), to the current ‘What Works’ literature (Andrews & Bonta, 2003; McGuire, 1995), which is about what works, for whom, and in what circumstances.

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Psychopathy and Treatment

• Indeed, there are studies indicating that treatment may even make highly psychopathic sex offenders more likely to recidivate (Looman, Abracen, Serin & Marquis, 2005; Rice, Harris & Cormier, 1992; Seto & Barbaree, 1999).

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• Beech et al. (1999) identified psychopathy as a possible block to successful treatment groups. They noted that one very psychopathic man had a negative impact on the group he attended and that overall this group was not found to be very cohesive and only produced treatment change in 35% of its members (compared to over 60% in other sex offender groups).

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• Psychopaths have been identified as having more criminogenic needs than non-psychopaths, suggesting that psychopath should perhaps be viewed as a responsivity factor in which the learning styles of psychopaths could be used to guide treatment interventions (Serin, 1995; Simourd & Hoge, 2000; Templeman & Wolversheim, 1979).

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Motivation

• Much of the discussion of the impact of motivation on treatment effectiveness has been based on clinical experience, rather than empirical studies (Tierney & McCabe, 2002).

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Therapist Style

• Marshall & Serran et al. (2003) suggest aggressively confrontational approaches should be avoided and more empathic, respectful type of supportive, with a firm, challenging style, should be employed.

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• In addition, empathy, warmth, rewardingness and directiveness were related to positive indices of change (Marshall & Serran et al., 2003).

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• Methods of Evaluating and Detecting the Phoniness of Sex Offenders (Carich, 1991)

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Current Treatment Provision In The UK: Treatment for Sexual Offenders In Prison

• Sex Offender Treatment Programme (SOTP)
• assessment
• the Core Programme
• the Extended Programme

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• Here the offender is assessed for his suitability to undertake a group-work programme. Exclusions are made at this point, on the basis of the following:

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• he is in total denial of the offence;
• he is suffering from psychotic illness or was at the time of the offence;
• he has a high score (26 or above) on the Hare Psychopathy Checklist (Hare,1991). Suggesting that he has psychopathic characteristics, which would suggest that he would not benefit from the group-work programme currently provided for sexual offenders.

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• If a sexual offender is assessed as being suitable to take part in treatment and does not have learning difficulties5 he would first undertake the Core SOTP. The goals of this programme are:

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• to reduce denial and minimisation;
• to enhance understanding of victims’ experiences;
• to develop strategies to avoid reoffending (from Mann, 1999).

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• If an offender is assessed as having a lot of treatment needs he would also undertake a second stage of treatment, which is termed the EXTENDED Programme. The goals of this programme are (from Mann, 1999) to:

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• identify and challenge patterns of dysfunctional thinking;
• to improve the management of emotions;
• to improve relationship and intimacy skills;
• to address deviant fantasy and sexual arousal;
• to understand the links of all of the above to sexual offending.

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Treatment For Sexual Offenders In The Community

• In terms of treatment provision in the community, three ‘pathfinder programmes’ have been accredited by the Joint Prison and Probation Services Accreditation Panel for England and Wales. The three programmes are the West Midlands Programme, the Thames Valley Programme (TV-SOGP) and the Northumbria Programme.

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Measuring Treatment Effectiveness

• While the most recent meta-analyses of a number of studies reporting outcome indicate an overall effect for treatment (Hanson et al., 2002; Losel & Schmucker, 2005), that is, a lower rate of recidivism in those who have undergone treatment compared to those who have not, these observed effect sizes are typically not large.

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Conclusions

• More recent meta-analytical reviews conclude that overall, sex offender treatment resulted in lowering sexual offending, and the typical cognitive-behavioral programme saves more than it costs.

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• While sexual offender treatment programmes appear to reduce sexual recidivism, what is not clear is whether this is specific to particular types of sex offenders (adult or adolescent offenders, exhibitionists, child molesters, rapists), which may in turn be limited to specific modalities of treatment (cognitive-behavioural, multisystemic therapy, chemical castration and behavioural therapy).

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• Treatment efficacy may be better served by exploring which dynamic factors affect recidivism in order to facilitate the forensic practitioner when assessing potential risk of re-offending if released back into the community (Hanson, 1998).
• Indeed, while there is a need to include dynamic risk factors, deviant sexual interests and appetites appear at the heart of sexual re-offending (see Chapter 6).
• Research on those dynamic factors associated with the environment, opportunity to offend and changes in criminogenic factors - attitudes, values and beliefs, moods and fantasies that influence offending behaviour, once integrated in treatment programmes, would contribute in reducing the recidivism risks (Mezzo & Gravier, 2001).

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• One reason why some studies fail to find significant treatment results is that the base rates for sexual re-offending are relatively small.
• By virtue of the sample, programmes that target lower-risk offenders are likely to have difficulty in demonstrating statistically significant treatment effects in already low rates of recidivism.
• While the definitive answer to the question ‘what works’ has yet to be found, what is clearer is that treatment modalities that utilise cognitive- behavioural techniques are more likely to reduce sexual re-offending than any other approach.

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Dynamic Risk Factors for Sexual Offending: Causal Considerations, by Roxanne Heffernan, Tony Ward, Springer, 2020�

• Dynamic risk factors (DRF) are the children of risk prediction. They were identified to help practitioners assess the risk of recidivism and then became treatment targets for interventions aiming to reduce this risk (Andrews & Bonta, 2010).
• The predictive nature of their legacy lies in their ability to provide reliable information about the likelihood of future reoffending.
• In this respect, DRF are useful complements to static risk factors such as age, gender, and history of offending and add incremental validity to recidivism prediction (Hanson & Harris, 2000).

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• Their treatment utility resides in the fact that practitioners increasingly rely on the identification of DRF to direct correctional assessment and interventions.
• In their book, The Psychology of Criminal Conduct, Andrews and Bonta (2010) use the term criminogenic needs to refer to those DRF that “when changed, are associated with changes in the probability of recidivism” (p. 49).
• In other words, they are viewed as potential causal factors that if effectively targeted by cognitive-behavioral techniques will reduce reoffending rates.

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• In a similar vein, Mann, Hanson, and Thornton (2010) identify a number of DRF, which they believe to be prima facie causes of sexual offending and validated predictors of recidivism.
• They refer to these factors as psychologically meaningful risk factors and propose that: “the causal factors for sexual recidivism will ultimately be drawn from variables similar to those included in our list. We believe that it is these variables that should be emphasized in treatment” (Mann et al., 2010, p. 210).

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• These include DRF such as deviant sexual interests, offence-supportive attitudes, lack of emotionally intimate relationships with adults, emotional congruence with children, lifestyle impulsivity, poor cognitive problem-solving, and general self-regulation problems (Mann et al., 2010).

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• Thus, in the correctional psychological literature, DRF have a dual status.
• They are viewed as: (1) useful predictors of reoffending and measures of risk status and (2) potential causes of reoffending, capable of serving an explanatory (i.e., causal) role as well as a predictive one.

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• It is a simple and powerful conceptualization that has streamlined forensic and correctional research, program development, and the delivery of treatment.
• Despite its conceptual elegance, we believe that the dual conceptualization conceptualization of DRF is fundamentally flawed and at best they can only function as markers of causality rather than being causes themselves (Ward, 2016; Ward & Beech, 2015; Ward & Fortune, 2016a).

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• If this assertion is true, then two questions arise:
• What role, if any, should they play in the development of explanations of crime (and reoffending)?
• And how can they assist practitioners in treatment?

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• In this book, we address these two questions.

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• First, we argue that the focus of explanatory theories in the forensic and correctional fields should be on causal mechanisms.
• Second, we propose that DRF should not be regarded as causes of crime because they cannot be coherently conceptualized as causal mechanisms and are best viewed as composite or summary constructs referring to processes, states, and entities.

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• Third, the question of how best to move from risk factor to causal status is examined and a number of methodological guidelines are suggested.
• Fourth, a conceptual framework for identifying the causal elements in crime-related problems is introduced and its application to DRF is outlined.

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• Finally, we discuss how best to utilize DRF in assessment contexts and intervention programs.
• Our conclusions are that DRF are valuable predictors of recidivism and that they can serve an important methodological function in identifying the causes of crime and reoffending.
• They are boundary riders that inform researchers and clinicians about the existence of problems; they do not specify what these problems are or how they cause crime.

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Chapter 1 Current Conceptualizations of Dynamic Risk Factors

• Abstract
• Dynamic risk factors (DRF) are arguably the most important construct in forensic and correctional psychology. They are the basis of risk prediction and management, and the foundation of intervention programs aiming to reduce crime.
• In this chapter we outline a number of influential contemporary views of DRF.
• First, we define DRF and discuss the various types of crime-related factors.

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• Next, we discuss their origins and conceptualization within the Psychology of Criminal Conduct (PCC), followed by a description of their dual roles in practice.
• Then we outline their place within explanations of offending, focusing mainly on theories of sexual offending.

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• We conclude this chapter by highlighting the importance of developing explanations of offending which rely upon causal mechanisms.
• This chapter is intended to emphasize the reliance on these foundational constructs in correctional practice aimed at reducing crime and the research which informs these crucial tasks.
• This highlights the critical nature of questions about what exactly DRF are, how they relate to behavior, and how we should use them within treatment and risk management.

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• Theories of offending DRF can be defined as changeable aspects of persons and their environments which are statistically associated with higher rates of recidivism in offending populations, they predict rates of reoffending (Bonta & Andrews, 2017).

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• They can be contrasted with static risk factors which also predict recidivism but are not able to be changed via intervention (e.g., age, sex, criminal history).

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• DRF can be divided into those factors which are stable (i.e., change relatively slowly) and those which are considered acute (i.e., can change rapidly) (Hanson & Harris, 2000).

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• The distinction between stable and acute factors is useful in guiding the day to day management of enduring vulnerabilities and responding to imminent risk (i.e., increases in risky states or contexts).

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• Theoretically, stable and acute DRF have been described as offence related vulnerability versus its manifestation in certain contexts (Beech & Ward, 2004).

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• This view of DRF is known as a ‘propensities model’; proposing that crime related traits (i.e., stable dynamic factors) may or may not lead to offending in various contexts (Mann, Hanson, & Thornton, 2010).

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• For example, while an individual may have a propensity to use substances or violence to deal with their emotions (traits/propensities), risk is heightened when they experience intense emotions and/or are intoxicated (states) and in the presence of a potential victim.

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• For this reason, stable DRF are most often the targets of intervention, they are thought to be enduring but changeable and causally linked with offending.

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• Thus, in addition to being used to predict likelihood of reoffending, DRF are used as the targets of treatment programs aiming to reduce recidivism, they occupy dual roles in practice (Ward & Fortune, 2016).

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• These roles are highlighted in structured risk assessment tools’ evolution over the past four decades (see below), from initially containing primarily static risk factors, to incorporating dynamic variables which can estimate risk but also provide guidance for intervention.

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• The use of DRF to classify individuals by risk level, allocate to treatment programs, formulate cases, and explain behavior is now standard practice (Heffernan & Ward, 2017).

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• In The Psychology of Criminal Conduct (PCC), Andrews and Bonta (2010) state that criminogenic needs are DRF which “when changed, are associated with changes in the probability of recidivism” (p. 49).

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• Andrews and Bonta (2010) identified a set of eight ‘central’ risk factors (seven are dynamic/criminogenic needs) which have the greatest empirical support in predicting reoffending: a history of criminal behavior (a static factor), antisocial attitudes, antisocial associates, antisocial personality pattern, marital and family factors, employment and school, leisure activities, and substance abuse.

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• Contained within the PCC is the widely used Risk-Need-Responsivity (RNR) model, which is built upon the predictive utility and presumed causal nature of DRF.
• The RNR is comprised of three main principles (and a number of less central ones); the risk, need, and responsivity principles (Bonta & Andrews, 2017).

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• The dual roles of DRF are reflected in these principles, they are both predictors of risk used to determine intervention dosage and criminogenic needs to target.

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• The development of risk assessment tools is typically described as four generations evolving over the past few decades in response to the needs of the field (Andrews & Bonta, 2010; Bonta & Andrews, 2017).

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• The first generation of risk assessment involved unstructured professional judgment, however, these predictions had poor accuracy and overall were no better than chance (Hanson & Morton-Bourgon, 2009; Hart, 2009)

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• The second generation was the rise of ‘actuarial’ or numerical mechanical risk assessment, involving the aggregation of mainly static risk factors to estimate the likelihood of recidivism. Actuarial assessment was (and continues to be) more accurate in predicting recidivism.
• However, second generation risk measures are poor guides for intervention and fail to detect treatment changes and inform the ongoing management of risk, as they typically do not include DRF (Andrews & Bonta, 2010; Beech & Craig, 2012).

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• The third generation of risk measures largely overcame the limitations of the previous generation by including the assessment of DRF within actuarial tools, thereby adding incremental validity to static risk assessment (Olver & Wong, 2019).

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• The fourth generation extended the purpose of risk assessment from merely predicting risk to informing decisions relating to case management, for example the level of service/case management inventory (LS/CMI; Andrews, Bonta, & Wormith, 2010).

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• The items in these risk assessment measures tend to correspond to the central eight (Andrews & Bonta, 2010; Bonta & Andrews, 2017).

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• It has been suggested that a potential fifth generation may use more complex analyses and utilize machine learning to predict risk in the moment (Lovins, Latessa, May, & Lux, 2018).

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five influential theories of sexual offending

• Finkelhor (1984) four preconditions
• Marshall and Barbaree’s (1990) integrated theory
• Hall and Hirschman’s (1992) quadripartite theory
• Ward and Siegert’s (2002) pathways model
• Ward and Beech’s (2006) integrated theory of sexual offending (ITSO)

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Recent Theoretical Developments: Agency

• The theories discussed above are centered upon combinations of empirically supported DRF for sexual offending; they combine problems such as sexual deviance, cognitive distortions, interpersonal difficulties, and poor self-regulation.
• They aim to explain how these problems can lead to sexual offending, but they tend to overlook critical sources of motivation and agency, and overall lack depth in being able to explain why persons have the problems exhibited and how exactly they lead to offending for some individuals but not others.

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• We believe that due to their focus on DRF and specific outcomes (i.e., illegal sexual behavior) they have inadvertently ignored important determinants of behavior.
• They are incomplete explanations because they focus on negative outcomes and correlates but do not include normative or adaptive aspects of human functioning, those psychological mechanisms which influence behavior more generally.
• For example, motivation, values, attributions, expectations, and so on.

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• More recently authors have begun to develop theories which conceptualize DRF in a different way. It has been suggested that DRF are “symptom-like” aspects of persons which often co-occur with criminal behavior but do not cause it (Ward & Beech, 2015; Ward & Fortune, 2016).

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• A number of recent theories have drawn from the concept of agency and developed explanations of offending as a form of goal-directed behavior.
• From this perspective behavior is motivated by particular needs or desires, and then a set of psychological mechanisms or capacities (e.g., attention, memory, control, schemas) allows individuals to engage with their environment in goal-directed action.

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• The agency model of risk (AMR; Heffernan & Ward, 2015)
• Thornton (2016) developed a theory of DRF based on the good lives model (GLM; Ward & Maruna, 2007), schema modes (Beck, 1996), and the theory of reasoned action (TRA; Fishbein & Ajzen, 2010)
• Thornton, Kelley, and Nelligan (2017) developed a theory of protective factors (PF)
• Durrant (2017) presents an evolutionary perspective on DRF and PF
• Serin, Chadwick, and Lloyd’s (2016) agency filter model

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• DRF are used in practice both to predict and reduce the likelihood of further offending. We suggest that while the first role of DRF (as predictors) is justified, their transportation into the realm of treatment relies on the assumption that they have a causal relationship with offending; this relationship has not been proven.
• Historically explanations of offending have relied on DRF as causes, the belief in this relationship is so strong that it is rarely questioned. As is the belief that changing these factors is the key to reducing recidivism.

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• We suggest that within forensic and correctional practice DRF are best viewed as predictive constructs that are generally effective in assigning probabilities to individuals based on group membership (e.g., risk bands such as low, medium, or high), but on their own are unable to tell us what might influence individual risk.
• We argue that at present the relationship between predictors and causes (i.e., treatment targets) is unclear, and that the role of DRF in treatment depends on their ability to explain why individuals offend and what might facilitate desistance.

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• In our view DRF are best viewed as boundary riders; they tell us that there are a number of possible problems operating within a particular domain such as crime supportive beliefs, contextual features, mental states, social situations, and psychological dispositions.

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• But they do not tell us what the specific problems are.

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• For that we need to enlist explanatory theories and move beyond “one size fits all” approaches to assessment and treatment.

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myths and erroneous ideas about sexual offending and perpetrators of sexual offenses

• One of the most persistent ideas is that sexual offending is something inherently part of the person who perpetrates such actions. In fact, it defines the perpetrator; the person is reduced to the act they commit.

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• Among the misconceptions and myths that are widespread, the following are particularly prevalent (see also Lussier, 2017; Lussier & Cale, 2013):

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• Perpetrators of sex offenses are generally portrayed according to the adage that “once a sex offender, always a sex offender,” yet research shows that sexual offending tends to be circumscribed to a very short period of the life course.

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• Adolescents who have committed a sexual offense are considered to be the adult perpetrators of sex offenses of tomorrow, yet empirical research clearly shows that such adolescents rarely continue to sexually offend in adulthood.

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• Individuals convicted of a sex crime are often portrayed as sex crime “specialists,” which means that their criminal activity is limited to sex crimes, whereas the extant research shows that the criminal history of these individuals mainly consists of a variety of non-sex offenses (e.g., theft, drug trafficking, noncompliance to their legal conditions, car theft, burglary, etc.).

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• Individuals who have committed a sexual offense are often portrayed as individuals with “sexual deviance” requiring psychosexological expertise, while clinical and empirical research shows that sexual offending is only rarely motivated by underlying deviant sexual urges and sexual fantasies.

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• Perpetrators of sexual offenses are often portrayed as representing a high-risk of sexual recidivism, while longitudinal research shows that the risk of reoffending is relatively low.

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• Individuals who have committed a sexual offense are often perceived as predators who attack strangers using different subterfuges to confuse victims and police, while research has shown for years that sexual offending is more commonly committed by people well known to their victim (e.g., father, stepfather, partner, ex-partner, neighbor, co-worker, new acquaintance).

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• The risk of sexual recidivism of individuals convicted for a sexual offense is presented as fixed and stable over their life course, while research shows that the risk is dynamic and it fluctuates over time; even those nowadays considered considered “high-risk sex offenders” are not always high-risk offenders.

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• Popular belief suggests that all perpetrators of sexual offenses require specialized sex offender therapy given their mental health problems that fuel their sexual and behavioral problems; this belief, however, is not based on empirical observations or findings, but rather on ideological views about perpetrators of sex crimes.

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• Concentrating preventive actions by targeting individuals convicted of a sex crime is seen as a reasonable, valid, and effective preventative approach, while research shows that repeat offenders are responsible for a very small proportion of sex crimes in society.

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• This is not to say that there are no dangerous, life-course persistent offenders repeatedly involved in sex crimes.

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• This phenomenon does exist, but it is certainly the exception rather than the rule.

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�Responding to Sexual Offending: Perceptions, Risk Management and Public Protection, by K. McCartan, Palgrave Macmillan, 2014�

• The absence of well-designed outcome studies of sexual offending treatment programmes does not equate to concluding that programmes do not work.

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• Chap 6: Sexual Offending Treatment Programmes: The Importance of Evidence-Informed Practice

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114

�Unmasking the Sexual Offender, by Veronique N. Valliere, Routledge, 2022�

• This book unmasks the sexual offender by providing clear, comprehensible information about the motivations, techniques, and dynamics of sexual offenders and their behavior. It not only explores the biases and myths that the reader may rely upon to understand deviance but also explains pathways to offending, the distorted thinking and relating that offenders engage in, and the ways offenders manipulate and exploit others. Sexual offenders are surrounded by mythology, fascination, and revulsion. People who commit sexual offenses present difficult and complicated issues interpersonally, as well as in treatment and management; denial, victim-blaming, aggression, and blatant chronic deception are inherent in interactions with them. Unfortunately, the failure to truly understand their motives and techniques helps provide excuses for and further camouflage of their deviance.

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Myth-Information: Our Misinformed Beliefs about Sexual Offenders (Veronique N. Valliere, 2023)

• Not Always Monsters – The Insidious Normalcy of the Sex Offender
• The Most Feared – The Pedophile and the Psychopath
• Lack of Empathy?
• Sex Maniacs?
• The Mythos of False Allegations
• “Boys Will Be Boys” and Myth of the Unmanageable Arousal
• “The Devil Made Him Do It” – The Fable of “It Wasn’t Me”
• Curiosity and Impulse
• Alcohol and Sex Offending

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• The Fiction of Low Self-Esteem, Immaturity, or Sexual Deprivation
• “He Is Crazy/Sick/Sex Addicted” – The Myth of Mental Illness and Sexual Offending
• “That’s Not His Type” – The Problem with Typologies
• “Hurt People Hurt People” – The Problem of the Victimized Victimizer
• Myth: Consent Is Too Complicated

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117

In conclusion:

• Myths cloud our judgment and true understanding of sexual offending and sexual offenders. Believing misinformation can have serious consequences, hinder cases and investigations, and result in bad judgments.
• Offenders utilize these myths readily, sometimes interchangeably depending on the victim and the circumstances. If we don’t buy that the victim consented, we will hear that he was drunk too. If that does not work, he was confused, depressed, or just does not understand how he could do such a thing.

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• Acute mental illness does not cause sexual offending. There are diagnosable disorders that can serve as the impetus for offending, but these are chronic and pervasive con- ditions, like personality disorders or paraphilic disorders. Unmanaged mental illness in those individuals who are at risk for committing a sexual assault can add risk issues. However, the most important thing to remember about mental illness is that it is much more highly associated with being victimized. Up to 40% of women with mental illness have been sexually assaulted.
• Being educated, challenging myths, and not reacting emotionally in evaluating sexual offenders or assault allegations will decrease our error rates.
• Remember to rely on your common sense instead of getting distracted by your other needs, including a lack of understanding of deviance.

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• Section 3: Prevention, Intervention, and Managing Relationships with Offenders (Veronique Valliere, 2023)

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Chap 11: Assessing Promises What Does Real Change Look Like?

• The Stable-2007 and Acute-2007 (Hanson et al., 2007) are designed to capture the presence of fluctuations in risk factors in an offender.

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• However, true change is not just the assessment of risk factors.

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• Adjusting our idea of change must incorporate the belief that the offender will be responsible for monitoring and managing their deviance for the rest of their life.

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• It is the same as people with addiction must recognize the possibility of relapse and return to addiction for the rest of their lives.

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Chap 12: “But I Am Telling the Truth!” Suggestions for Investigation, Supervision, and Treatment of Offenders

• Investigating, treating, and supervising sexual offenders are very difficult. You must agree to absorb terrible information accompanied by vivid imagery. You have to maintain vigilance, be on the receiving end of hostility, and expect your clients to deceive you about things that can result in harm to others. It takes a particular kind of willingness and dedication to do the work. It impacts us and our sense of safety in the world. Sometimes it affects our parenting, sex lives, and decisions about where to go. Sometimes, being what the offender requires taxes our sense of self.

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• Because of the significant challenges a sex offender bring to supervision and treatment, our requirements are different from what is necessary in more traditional roles.
• A treatment provider unwilling to challenge and address the offender’s denial, manipulations, and decep- tion will be weakened in efforts to help the offender change (Flora, 2001).

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• In the decision to be a thorough, dedicated investigator, supervisor, or treatment provider to sexual offenders, you are promising to go above and beyond your traditional roles. You are making a commitment to keep the community safe, to gain skills at dealing with manipulation and deception, and to forge ahead in spite of numerous disappointments and failings.
• John Connolly (2007) wrote, “It has always seemed to me that there are two types of people in this world: those rendered impotent by the sheer weight of evil it contains, and who refuse to act because they see no point, and those who choose their battles and fight them to the end as they understand that to do nothing is infinitely worse than to do something and fail.”
• This is one job where this quote aptly applies, as there is hardship in our willingness to truly see the damage from and deviance in sexual offending.

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• The Overvalued Interview
• Challenge and Confrontation
• Accountability and Agency
• The Team Approach
• Dynamic Risk Factors
• Change Is Meaningful, But What Does It Mean?
• The Myth of the Supervised Visit
• Dynamics Define the Offender, Not the Victim

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• I will reiterate this. It is the sexual offense dynamics that are of critical importance in the treatment and management of the offender. These dynamics appear pervasively and repeatedly. They are what make the offender cross age and gender barriers. They are why an offender can be a risk to someone other than his one or two identified victims. An offender’s victim pool is more extensive than his convictions show. Supervising him and managing based only on the information known from his conviction is a mistake. Making rules or restrictions based only on the victim we know of is a mistake. It is tempting to rely on the polygraph to tell us about the offender. Still, it is more important to identify and address the dynamics that the offender is exhibiting throughout his treatment.

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In conclusion

• You have to be willing to go outside your comfort zone to ensure the offender goes outside his and cannot control you. You have to challenge and confront and view the offender’s presentation with you in the proper perspective.
• Accountability and agency are important pillars to change and improvement. Getting an offender motivated to change and be accountable requires challenging him.
• A team approach is critical for the prevention of triangulation and manipulation. Each player on the offender’s team has vital information to share.
• It is imperative to be aware of the dynamic or changeable factors related to risk in offenders. Being mindful of these factors will allow you to assess the offender in real- time, all the time.
• An offender’s changes should be understood and make sense. You should scrutinize sud- den or random changes in the offender’s presentation or lifestyle as they may be related to risk situations.
• Contact between an offender and victim or potential victim is fraught with hazards for the offender and the victim. Carefully consider any decision to allow contact between an offender and a potential victim.

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Chap 13: Prevention Tips and Strategies (Veronique Valliere, 2023)

• As discussed in the early chapters of this book, we have a society that supports beliefs and values that facilitate sexual maltreatment and abdicate the offender’s responsibility.
• Unfortunately, I believe our good intentions in providing prevention tips that focus on victims’ choices contribute to the problem, even while offering some sound advice.

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• Our reaction to any victim risks conveying criticism and judgment, or worse the disbelief that can be more traumatic than the assault itself.

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• And do not rely on legislation or laws to prevent sexual violence. There is little evidence that community notification, registries, or housing ordinances prevent sexual assault (Zgoda & Mitchell, 2021). What they do, however, is give us a false sense of security.

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• Be Aware of Your Biases – Confront Your Subtle Blaming
• Educating Our Children
• Role Modeling: Violence Is Learned, So Is Respect
• Make Conflict Your Friend
• Being a Proactive Bystander
• Learning to Say Yes – Healthy Sexuality
• Accepting No Excuses for Abuse

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Chap 14: Community Dynamic Risk Management of Persons Who Have Sexually Offended

• The Wiley Handbook of What Works with Sexual Offenders: Contemporary Perspectives in Theory, Assessment, Treatment, and Prevention, First Edition. Edited by Jean Proulx, Franca Cortoni, Leam A. Craig, and Elizabeth J. Letourn, Wiley, 2020

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What Works? Dynamic Approaches to Risk Management

• Canadian psychologist Karl Hanson has been at the forefront of efforts to devise risk-assessment frameworks, both in regard to static‐historical variables (Static‐99R; Hanson et al., 2014) and dynamic variables (sometimes referred to as criminogenic needs; see Hanson, Harris, Scott, & Helmus, 2007). Hanson has used meta‐analysis to identify risk factors for sexual reoffending (Hanson & Morton‐Bourgon, 2005), as well as to demonstrate that the principles of risk, need, and responsivity also apply to persons convicted of sexual offenses (Hanson, Bourgon, Helmus, & Hodgson, 2009). Further, Hanson’s meta‐analytic work has assisted the field in better understanding the likelihood, or possibility, of desistance over time (Hanson, Harris, Letourneau, Helmus, & Thornton, 2018).

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• Like most psychological evaluations, a review of pertinent background information and a clinical interview are important sources of detail; however, practical experience has sug- gested that there is also a need for objective measures of risk potential (Monahan, 1981).
• Presently, the most commonly used actuarial risk assessment instrument (ARAI) used in sexual violence prevention is the Static‐99R (Hanson et al., 2014).

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• Three popular measures constructed to assess dynamic risk (or criminogenic need) among men are the Stable‐2007 (Hanson et al., 2007), Sex Offender Treatment Intervention and Progress Scale (SOTIPS; McGrath, Lasher, & Cumming, 2012), and Violence Risk Scale: Sex Offender version (VRS:SO; Olver, Wong, Nicholaichuk, & Gordon, 2007).
• These scales consider personality variables, lifestyle-management issues, intimacy deficits, and general and sexual self‐regulation to assess the current likelihood of sexual recidivism over and above that which might be accounted for by a static measure.
• Research has consistently found a small, but significant, incremental degree of predictive validity added by dynamic measures over static measures alone (Hanson, Helmus, & Harris, 2015; Sowden & Olver, 2016; van den Berg et al., 2017).

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• In the recent past, treatment interventions in sexual violence prevention have focused on holistic, strength‐based approaches (Marshall, Marshall, Serran, & O’Brien, 2011) emphasizing consideration of difficulties clients experience in regard to the same sorts of variables we noted above as being pertinent in dynamic risk assessment (i.e., focus on criminogenic needs).

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• Furthermore, such scales are ideally scored in a team fashion. Whereas clinicians and supervisors once conducted their businesses in relative obscurity from each other, tools like Stable‐2007, SOTIPS, and VRS:SO have promoted joint training and close collaboration (scoring, interpretation) among persons of various disciplines who are working concurrently with the same client(s).
• Indeed, the breakdown of the artificial wall between what were traditionally viewed as the clinical and security facets of risk management has led to greater reciprocal understanding and joint efforts to ensure comprehensive risk management.

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• What we are starting to see internationally is a recognition that community reintegration and effective risk management need to be responsive and fit for purpose. We need to move away from one‐size‐fits‐all policies in favor of more inclusive wraparound approaches.
• We are seeing this through the increase in quaternary prevention strategies aimed at helping individuals to desist from future sexual offending through the provision of a supportive, inclusive environment that offer supports and guidance (Martins, Godycki‐Cwirko, Heleno, & Brodersen, 2018; McCartan, Prescott, & Gotch, 2019), an example of which being CoSA (see Wilson & McWhinnie, 2013).

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CoSA (Circles of Support and Accountability)

• In the Circles of Support and Accountability model, four to six members of the volunteer support group visit the offender daily; assist him in living tasks, such as obtaining housing and employment; and mediate if necessary with police, media, and concerned citizens.
• These volunteers are given training about sexual offending (e.g., potentially high-risk situations) and the relevant law and are able to consult with professionals, such as police officers, psychologists, and other members of an advisory board.

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• https://d2rn9gno7zhxqg.cloudfront.net/wp-content/uploads/2020/03/24193347/ANORWS-Richards-CoSA-Fact-Sheet.pdf
• https://www.cosacanada.com/
• https://circles-uk.org.uk/��

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�Treating Sex Offenders: An Evidence-based Manual, By Jill D. Stinson, Judith V. Becker, The Guilford Press, 2018�

• At present, what we do with sex offenders seems driven primarily by social control policies that have been enacted in an effort to make society safer.

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• Yet the effectiveness of such policies in reducing the rate of sexual crime has not yet been empirically validated.

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multi-modal self-regulation theory

• self-regulation and self-regulatory deficits underlie sexual offending as well as other types of maladaptive or problematic behavior (Stinson, Sales, & Becker, 2008)

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safe offender strategies (SOS)

• From this theory, we have developed a corresponding intervention approach, called safe offender strategies (SOS).

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• This treatment has been in the pilot stages at three sites since the fall of 2007, with client populations consisting of forensic mental health inpatients, persons with intellectual and develop- mental disabilities, and high-risk sex offenders.

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• As treatment providers, we see ourselves as consultants to the patients; our role is to help motivate them, help them identify areas of potential change, and help them work through complex, interactive areas of need.

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• Our basic philosophical premise is that people can change, and that our clients can reach the readiness to change in an environment of collaboration that will facilitate such a process.

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• Key elements of this treatment include developing adaptive self-regulation skills, self-monitoring and self-management, forming healthy and normative interpersonal boundaries and social bonds, and addressing important life needs like emotional stability, balanced thinking, and a sense of self-control.

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• Such needs cannot be met without compassionate and involved clinicians.

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• Sex offender treatment is undoubtedly one of the more difficult and controversial areas of behavioral or mental health intervention.

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• Treatment providers are faced with a number of challenges: sexual crimes that generate strong emotions and negative public sentiment, clients who are reluctant to participate in treatment and divulge deeply personal information about their sexual and violent behaviors, legislative policies that may stigmatize clients and detract from a focus on treatment, personal reactions and frustrations with the treatment process, ongoing concerns about victims and risk management, and questions regarding the effectiveness of available treatment approaches.

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Sex Offender Treatment: Where We Have Been

• Current forms of sex offender treatment include cognitive-behavioral approaches, relapse prevention, the good lives model, the risk–needs– responsivity model, sexual addictions, and pharmacological interventions.

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RNR

• The RNR model, in brief, posits that there are three crucial elements to be addressed during the course of offender treatment.

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• First, the risk principle holds that we must tailor our interventions to the client’s risk of future offending. Those at the highest level of risk should receive the most intensive and structured treatments, while those at the lowest levels of risk should receive less intensive and perhaps less restrictive or supervised forms of treatment and risk management.

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• The needs principle examines the role of criminogenic needs, or targets associated with criminal and sexual offending like offense-supportive attitudes and sexual fantasies, poor social sup- port networks, substance abuse, or other risky behaviors.

• And finally, the responsivity principle refers to factors that impact the individual’s response to treatment, including motivation, engagement, cognitive or learning impairments, level of insight, and general progress in treatment.

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148

Associations Between Self-Regulation, Experiences of Childhood Adversity, and Problematic Sexual and Aggressive Behaviors (2022)

• Abstract
• Problems with self-regulation are often theoretically and empirically linked to sexually abusive behavior, as is also true of experiences of early childhood abuse and maltreatment. Questions remain regarding how indicators of dysregulation and self-regulatory deficits interact and are associated with prior maltreatment. In the current study, a range of variables potentially indicative of emotional, cognitive, interpersonal, and behavioral dysregulation and adverse childhood experiences (ACEs) were examined using the frame of the multimodal self-regulation theory among 156 adult men residing in secure forensic care who were receiving treatment for prior sexual offenses. Data were subjected to principal components analysis, resulting in four components that described varying aspects of dysregulated behavior and experiences: Problematic Sexual Behavior (PSB)-Impulsivity, Serious Mental Illness (SMI)-Aggression, ACEs-Suicidality, and Paraphilic Interests-Behavioral Stability. One component comprised of variables associated with maltreatment was associated with impulsivity and PSBs, as well as SMI and violence via linear regression analysis. Theoretical and clinical implications are discussed.
• https://journals.sagepub.com/doi/abs/10.1177/10790632211058067

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�Treatment of High Risk Sexual Offenders: An Integrated Approach, by Jeffrey Abracen, Jan Looman, Wiley, 2016�

• why we decided to write this text
• Although it may seem an odd thing to say, neither of us wanted to write this book and we have assiduously avoided writing a book on the treatment of high-risk offenders for several years. We kept on hoping that somebody else would take up the mantle and write a practical guide to working with high-risk sexual offenders. Further, we hoped that the person(s) writing the book would have sufficient practical experience of managing sex offender treatment programs both in institutions and in the community to make the advice that they were offering germane to those who work with these populations on a day-to-day basis. Although we have seen some articles on the treatment of high-risk sexual offenders, we have not seen a text that directly confronts these issues, written from the perspective of someone who works with such groups on an ongoing basis. It is for this reason that we have decided to write this book.

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Critique of Good Lives Model (GLM)

• Although we believe there are some very positive aspects to the GLM, we also believe that, as applied to high-risk offenderstypically seen in the institution and the community, this approach may obscure the focus from specific treatment targets that have been identified in the literature over the past number of years. The focus of treatment, in our view, becomes less on specific criminogenic needs from a GLM perspective. Rather, several laudatory but poorly defined goals, such as achieving “happiness,” become the emphasis within this model.

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• There have been a number of efforts to review the efficacy of treatment of sexual offenders (e.g., Hall, 1995; Marshall & Anderson, 1996; Alexander, 1999; Marshall et al., 1999; Hanson et al., 2002; Lösel & Schmucker, 2005; Quinsey et al., 2006). One of the reasons that there have been a large number of such reviews is the ongoing debate regarding whether treatment ofsexual offenders is effective. Nonetheless, in all but the review by Quinsey et al. (2006) the authors concluded that there is reason for optimism regarding treatment of sexual offenders.

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Psychopathy Checklist-Revised (PCL-R )

• A variety of reviews have shown that the PCL-R score is among the best predictors of both general and violent recidivism (Salekin et al., 1996; Hemphill et al., 1998; Leistico et al., 2008). The PCL-R is a 20-item measure, with each item rated between 0 and 2 and total scores ranging from 0 to 40. The PCL-R items assess two independent but related factors. The first of these includes the personality features that have been historically linked to psychopathy, such as shallow affect, manipulative behaviors, pathological lying, and lack of remorse or guilt. The behavioral correlates of the disorder, such as need for stimulation and proneness to boredom, parasitic lifestyle, impulsivity, juvenile delinquency, and revocation of conditional release, were described as a second factor. Hare (2003) recommends a cut score of 30+ for diagnosing psychopathy.

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• There is a growing body of research that is beginning to show consistent findings to the effect that, with appropriate types of treatment (e.g., cognitive-behavioral incorporating RNR principles, and of sufficient length), highly psychopathic offenders are responsive to treatment as evidenced by lower recidivism rates.This is not to say that treated psychopathic offenders are low-risk once they have completed treatment, only that their risk may well be moderated by appropriate treatment protocols.

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high-risk, high-need

• The complex histories with which such clients present cannot be reduced to eight criminogenic needs, as suggested by Andrews and Bonta (2010).

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The Integrated Risk–Need–Responsivity (RNR-I) Model

• We have believed that addressing the principles of risk–need–responsivity (RNR) was necessary but not sufficient to meet the needs of the clients with whom we worked. Aside from incorporating issues associated with new domains, we believed that, even with reference to the “Big 8” criminogenic needs (Andrews and Bonta, 2010), there was a lack of attention being paid to the way in which risk factors interact with one another. Given the manner in which these factors were presented, it probably encouraged (albeit unintentionally) the view that risk factors could be treated in isolation from one another.

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• While sexual offending is a multiply determined phenomenon, there are three factors in particular that inform our perspective on sexual offending. These are attachment theory (Bowlby, 1969 ; Bartholomew & Horowitz, 1991 ; Main, 1996), complex post-traumatic stress disorder (PTSD; Courtois & Ford, 2009 ), and a history of mental disorders.

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• We believe that a new model of sexual offending is needed, one that incorporates issues associated with insecure patterns of attachment, intimacy deficits and serious mental illness, as well as the “Big 8” risk factors identified by Andrews and Bonta. We have called this new approach to assessment and treatment the Integrated Risk–Need–Responsivity (RNR-I) Model ( Looman & Abracen, 2013a; Abracen & Looman, 2013).
• We have included the RNR-I Model in Figure 7.1. For readers interested in a more detailed discussion regarding the origins of the model, we have published two reviews (Abracen & Looman, 2013; Looman & Abracen, 2013a) that specifically discuss our approach.

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• In one sense the fact that mental illness is not viewed as relevant from the RNR perspective is certainly understandable. When one reads earlier versions of the Psychology of Criminal Conduct (Andrews & Bonta, 1989), it becomes apparent that the approach advocated by these authors was, at least in part, a reaction to the medical model that viewed criminal behavior as an outgrowth of one or more psychiatric conditions. Andrews and Bonta were, in our view, correct in suggesting that there are a variety of dynamic risk factors that need to be considered in any comprehensive approach to the management of sexual and violent non-sexual offending.

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• At present, the criminal justice system is being asked to address the needs of two diverse but overlapping populations. Those of us tasked with working with clients involved in the criminal justice system are being asked to manage groups that may be described as “typical” or, more specifically, individuals whose criminal behavior is largely unrelated to mental illness. That being said, especially when discussing groups of high-risk, high-need offenders, more and more clients are presenting with issues associated with serious mental illness. The available data, which has not been acknowledged by Andrews and Bonta (2010), clearly points to both the direct and indirect influence that serious mental illness and complex trauma have on the genesis of criminal behavior. These clients cannot be understood simply in reference to dynamic factors unrelated to mental illness.

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��The World Federation of Societies of Biological Psychiatry (WFSBP) 2020 guidelines for the pharmacological treatment of paraphilic disorders�

• Abstract

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• Objectives: The primary aim of these guidelines is to evaluate the role of pharmacological agents in the treatment and management of patients with paraphilic disorders, with a focus on the treatment of adult males. Because such treatments are not delivered in isolation, the role of specific psychotherapeutic interventions is also briefly covered. These guidelines are intended for use in clinical practice by clinicians who diagnose and treat patients, including sexual offenders, with paraphilic disorders. The aim of these guidelines is to bring together different views on the appropriate treatment of paraphilic disorders from experts representing different countries in order to aid physicians in clinical decisions and to improve the quality of care.
• Methods: An extensive literature search was conducted using the English-language-literature indexed on MEDLINE/PubMed (1990-2018 for SSRIs) (1969-2018 for hormonal treatments), supplemented by other sources, including published reviews.

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• Results: Each treatment recommendation was evaluated and discussed with respect to the strength of evidence for its efficacy, safety, tolerability, and feasibility. The type of medication used depends on the severity of the paraphilic disorder and the respective risk of behaviour endangering others. GnRH analogue treatment constitutes the most relevant treatment for patients with severe paraphilic disorders.
• Conclusions: An algorithm is proposed with different levels of treatment for different categories of paraphilic disorders accompanied by different risk levels.

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• Keywords: Paraphilic disorder; sex offender; antiandrogen treatment; SSRI; GnRH agonist.
• https://pubmed.ncbi.nlm.nih.gov/32452729/

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Motivational Interviewing With Offenders: Engagement, Rehabilitation, and Reentry

• Motivational Interviewing With Offenders: Engagement, Rehabilitation, and Reentry, by Jill D. Stinson, Michael D. Clark, The Guilford Press, 2017

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Where Did MI Come From?

• MI emerged from the field of addiction treatment in the United States in the 1980s. William Miller coined the term “MI” to describe a way of working with people in which he did not confront or disagree with the client’s “resistance” but instead responded in a way that seemed to diminish resistance, primarily through the use of reflective listening (Miller, 1983).
• He arranged the conversation in such a way that the cli- ent made the arguments for change, rather than falling into a pattern in which the therapist pushed for change and the client argued against it.
• While on sabbatical in Australia in 1989, Miller met Steve Rollnick, who had been expanding this work in the United Kingdom.
• Together they wrote the first edition of the now-classic text on MI (Miller & Rollnick, 1991).

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• The most persistent criticism of RNR is that its application seems to assume “one size fits all”; how to include and harness human motivation and individual differences is vague or lacking (Ward & Maruna, 2007).

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• MI, in contrast, offers teachable methods for including individual differences and establishing the working relationship—vital ingredients for positive outcome.

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What Makes This Approach So Popular In Offender Work?

• 1. There are limits to the coercive approach
• 2. Agents of offender systems want to be more helpful
• 3. People recognize MI
• 4. MI helps you do your job better
• 5. Positive outcomes for offenders: Since 1990, the number of scientific publications on the effectiveness of MI has doubled about every 3 years. There are currently more than 1,300 publications on this approach with offenders.
• 6. Adherence to core correctional practice

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• More than 30 nations have adopted MI for use within their courts, prisons, and community corrections and supervision agencies, as is evidenced by the availability of trainers and trainings in multiple languages and locations (www.motivationalinterviewing.org).

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Reasons for increased use of MI among offender service agencies

• 1. MI aligns your department or agency with evidence-based practice
• 2. MI gets you back in the game of behavior change
• 3. MI prepares offenders for the work of change
• 4. MI shifts the balance of responsibility, making us agents of change rather than responsible for change
• 5. MI suggests effective ways of handling resistance and can keep difficult situations from getting worse

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RNR

• Any review of evidence-based practice in corrections and criminal justice invariably includes the risk– needs–responsivity (RNR) model (Andrews, Bonta, & Hoge, 1990; Bonta & Andrews, 2007).
• This model recommends that the level of service should match an offender’s risk of reoffending, that offender agencies should assess an offender’s criminogenic needs (i.e., dynamic risk factors) and focus treatment efforts on those issues, and that treatment should be matched to an offender’s learning style, strengths and abilities, and inherent motivation to assist positive behavior change.
• This model clarifies who we should treat (i.e., risk), what we should do in treatment (i.e., needs), and most importantly, how we should treat (i.e., responsivity).

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• The most oft-cited critiques are that it can be more about programs than people, and that there’s a lack of clear guidance for day-to-day implementation of the RNR principles across diverse programs and offender groups (Polaschek, 2012).

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• MI can then provide not only an opportunity for empirically based service delivery, but also a method for increasing individualized treatment planning and enhancing service implementation in accordance with the fundamental principles of RNR.

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• As a result, the most widely accepted RNR programs within the last decade have also taught MI as an important component (e.g., EPICS, University of Cincinnati Correctional Institute; STARR, Robinson, VanBenschoten, Alexander, & Lowenkamp, 2011; see Gleicher et al., 2013) to better facilitate a cli-mate of behavior change.

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PACE: Four interconnected elements of the spirit of MI

• Partnership
• Acceptance: Four key components of acceptance are crucial: absolute worth, accurate empathy, autonomy, and affirmation.
• Compassion
• Evocation: The mind-set for evocation aligns with strengths-based approaches in that you trust that people already have within them what is needed for positive change. The goal is to help them activate it. … Our field is held hostage by the deficit model (Clark, 1995). There is a core belief that offenders come to us deficient: they lack skills, they lack insight, and their values are somehow askew. The proof is in their behavior—just look at what they’ve done. Surely they are the ones with the “problems.” Their criminal behavior is symptomatic of a deeper problem.

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Motivational interviewing techniques Facilitating behaviour change in the general practice setting (2012)

• OARS: Ask Open-ended questions, Make Affirmations, Use Reflections, Use Summarising
• RULE: Resist the righting reflex, Understand the patient's own motivations, Listen with empathy, Empower the patient
• RULE is a useful mnemonic to draw upon when implementing the spirit of MI in general practice. If a practitioner has more time, four additional principles (Table 5) can be applied within a longer therapeutic intervention. Express empathy, Develop discrepancy, Roll with resistance, Support self efficacy
• https://www.racgp.org.au/afp/2012/september/motivational-interviewing-techniques

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Motivational interviewing: The RULES, PACE, and OARS

• https://go.gale.com/ps/i.do?p=HRCA&u=googlescholar&id=GALE%7CA572716209&v=2.1&it=r&sid=HRCA&asid=3459fb36

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• The terms “change talk” and “sustain talk” denote the differing facets of ambivalence. A part of the person is motivated to change, while another part either does not want to or simply does not know how. It is important to recognize both.
• There are two primary types of change talk (Miller & Rollnick, 2013). The first of these is preparatory change talk, or statements that suggest motivations for change.
• There are four types of preparatory talk — desire, ability, reason, and need—which we will collectively refer to using the acronym DARN.

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Motivational interviewing in the treatment of sexual abusers (David S. Prescott, 2009)

• Abstract: Motivational interviewing is a person-centered counseling approach in which the practitioner uses a guiding style to enable the client to build and strengthen his or her own motivation for change. Although Miller (1983) and Miller and Rollnick (1991) first coined the term, many others have helped to develop motivational interviewing into its current form (e.g., Moyers, Martin, Manuel, Miller, and Ernst, draft manuscript). This chapter describes ways that professionals can use motivational interviewing in their work with people who have sexually abused. It is by no means the final word on the topic, and appears with the hope that readers will explore this topic further through training and other venues where they can receive helpful feedback on their practice. Since most treatment with this population takes place in group therapy settings, a separate chapter with specific applications appears in this volume (i.e., Prescott and Ross). As one reads the literature about it, motivational interviewing appears easy to do, but it becomes more complex in actual practice. Professionals commonly believe they already know how to do it. In fact, they usually do. The problem is that many professionals who know how to use motivational interviewing do not actually use it in practice as much as they think. As a result, they may be helping clients less than they believe. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
• Prescott, D. S. (2009). Motivational interviewing in the treatment of sexual abusers. In D. S. Prescott (Ed.), Building motivation for change in sexual offenders (pp. 160–183). Safer Society Press. 
• https://psycnet.apa.org/record/2013-22525-006
• See also
• https://www.davidprescott.net/articles/pub_41.pdf

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• Motivational interviewing with offenders: A systematic review (Mary McMurran, 2009)
• https://dbhds.virginia.gov/library/forensics/ofo%20-%20ebp%20motivational%20interviewing%20with%20offenders%202009.pdf

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• The Process of MI with offenders (Kevin Paul Austin, 2012)
• https://mro.massey.ac.nz/bitstream/handle/10179/4173/02_whole.pdf

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�Pedophilia and Sexual Offending Against Children: Theory, Assessment, and Intervention, by Michael C. Seto, American Psychological Association, 2e, 2018�

• Chap 5: Etiology of Pedophilia
• I discuss two main approaches to explaining pedophilia. The first explains pedophilia as a neurodevelopmental disorder, encompassing evidence of prenatal and perinatal risk factors and evidence of differences in brain structure and/or function.
• The second views pedophilia as a behavioral disorder related to perturbations in social and sexual development, beginning with early exposure to sex, childhood sexual abuse, and then later onset of peer relationships.

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Is Pedophilia A Mental Disorder?

• However, the designation of a phenomenon as a disorder can be made on the basis of biological pathology , which can be defined as a disturbance in a mechanism or process that interferes with the ability of that mechanism or process to perform as designed by natural selection (Spitzer & Wakefield, 2002; Wakefield, 1992).
• Under this definition, I believe pedophilia qualifies: Pedophilia is statistically rare in the general population; it interferes with reproductively viable sex, especially in its exclusive form; and it has been negatively sanctioned across time and cultures.

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• Both pedophilia and sexual offending against prepubescent children are puzzling from a Darwinian perspective.

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• If pedophilia is indeed maladaptive, how does it persist over time?

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• A major puzzle is how to explain pedophilia from a Darwinian perspective, because persons with pedophilia have fewer sexual contacts with sexually mature partners and, by definition, they are interested in nonfertile children. How could a condition that appears to be maladaptive be maintained in the general population?

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Chap 7: Risk Assessment

• Multiple quantitative reviews of decades of sex offender recidivism research have shown two major risk dimensions that can be described as atypical sexual interests and antisociality (Hanson & Bussière, 1998;Hanson & Morton-Bourgon, 2004, 2005).

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Risk Assessment Toolbox

• I do not go into as much detail here as in the 2008 edition on individual measures other than the Static family of measures because the field is constantly advancing in terms of research on reliability and validity in different populations and contexts. The Static family of measures—Static-99, Static-99R, Static- 2002R—are the best cross-validated measures, and the Static-99R in particular shows robust predictive validity across jurisdictions and settings for predicting both sexual and nonsexually violent recidivism up to 15 years (Hanson et al., 2009). Also, the Static-99 is the most widely used, with 80% of residential programs and 71% of community programs in the United States reporting that they used this risk measure (McGrath et al., 2010).

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• The Static-99 was developed for adult male sex offenders. It has 10 items: offender age; ever lived with lover for at least 2 years; index conviction for nonsexual violence; prior nonsexual violence; prior sexual offenses; prior sentencing dates; any convictions for noncontact sexual offenses; any unrelated victims; any stranger victims; any male victims. Total scores can range from 0 to 12 and offenders are assigned to one of seven risk categories based on their score; individuals with scores of 6 or more are combined into one group. The Static-99R has the same items, except the weighting of the offender age item is different. Readers are referred to the Static-99 website ( http://www.static99.org ) for more information about these measures, including the latest version of the coding guide and an ongoing bibliography of validation studies.

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Which Risk Scale Is Best?

• Hanson and Morton-Bourgon (2009) reported the results of a meta- analysis comprising 118 different samples, representing more than 45,000 sex offenders in 16 countries. In this meta-analysis, they compared unstructured, structured, and actuarial risk assessment approaches.

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• Unstructured risk assessment fared the worst and actuarial risk measures were the most accurate, on average, with moderate to large effect sizes by conventional guidelines; structured risk measures fell in the middle.

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Dynamic Risk Assessment

• Actuarial risk scales are exclusively or near-exclusively composed of static or historical risk factors that cannot change (e.g., prior criminal history) or that are very unlikely to change over time, at least with our current knowledge (e.g., having pedophilia). Dynamic risk factors, in contrast, are changeable factors that fluctuate over time (e.g., expression of antisocial attitudes and beliefs about sex with children) that can, at least in principle, be the targets of treatment or supervision.

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• Static risk factors are more helpful than dynamic risk factors when answering the question of who is more likely to sexually reoffend within a known group of offenders followed for a specified period of time.
• Dynamic risk factors are more helpful than static risk factors when answering the question of when someone is more likely to sexually reoffend, given a specified long-term likelihood.

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• Whether someone should be released or not should be more influenced by static risk factors; what needs to be in place in terms of intervention should be more influenced by dynamic risk factors.

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• Dynamic risk research is difficult to conduct, which may explain why knowledge about dynamic risk factors lags the field’s knowledge about static risk factors.

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• Dynamic risk research with sex offenders in the community suggests that the following factors distinguished sex offenders who reoffended from those who did not, even after the recidivists and nonrecidivists were matched on a set of static risk factors: compliance with supervision; ability to regulate sexual thoughts, fantasies, and urges; attitudes tolerant of sexual offending; and associating with antisocial peers (Hanson & Harris, 2000; Hanson, Harris, Scott, & Helmus, 2007). This information is captured in the Stable-2000 and Stable-2007 measures.

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Time Offense-Free

• Analyzing recidivism data from a cumulative sample of 7,740 sex offenders followed for 20 years, Hanson et al. (2014) found that the probability of a new sexual offense decreased dramatically with time spent offense-free in the community. Indeed, the probability was approximately halved for every 5 years an offender remained offense-free.

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• In the first edition of this book, I was excited about the “actuarial revolution” in sex offender risk assessment and hoped it would spread to other sex offender populations (female sex offenders, juvenile sex offenders), other offenders, and then to other areas of forensic and clinical practice.

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Chap 8: Treatment

• Although many programs still identify their approach as relapse prevention, more programs now identify as espousing a self-regulation or good lives model (GLM).

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• Correctional research has repeatedly demonstrated that treatments are more effective to the extent that they adhere to the risk–need–responsivity (RNR) framework (Andrews & Bonta, 2010).

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• The risk principle suggests that the intensity of intervention should be matched to the offender’s risk for recidivism (Andrews & Bonta, 2010). The most intensive services should be directed at higher risk offenders, and minimal levels of service should be assigned to low-risk offenders.

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• As I reviewed in the previous chapter, sex offender risk assessment has advanced greatly in the past decade, with many empirically and independently validated structured or actuarial risk scales (Hanson, Morton, & Harris, 2003; Seto, 2005). The focus has shifted to the assessment of dynamic risk, protective factors, and how to best communicate risk information to influence decision making. Using risk scales could greatly increase the efficiency and effectiveness of decisions about treatment intensity and type.

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• Some evidence indicates that the risk principle is influencing sex offender practices.
• Sex offender treatment standards were established in Canadian federal corrections in 2000, and these standards prescribe different amounts of treatment according to offender risk level.
• High-intensity programs provide between 360 and 540 hours of treatment, moderate-intensity programs provide between 160 and 200 hours of treatment, and low-intensity programs provide between 24 and 60 hours of treatment (see W. L. Marshall & Yates, 2005).

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• The needs principle suggests that interventions are more likely to have a significant impact when they target changeable factors associated with recidivism—such as antisocial attitudes, beliefs, and values; substance abuse; and self-regulation skills—in contrast to noncriminogenic needs, such as poor self-esteem, anxiety or mood problems, and subjective distress.

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• The responsivity principle recognizes that treatments are more likely to be effective when tailored to the individual’s learning style and capacity. This often includes the use of behavioral and social learning techniques that involve modeling prosocial behavior, graduated rehearsal of problem-solving and other skills, role-playing, and reinforcement.

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• The core of any effective sex offender treatment program is the RNR model.

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• The question then becomes, What else might be needed to address distinctive risk factors, especially atypical sexual interests and/or excessive sexual preoccupation?

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• TABLE 8.2 Examples of Dynamic Risk Factors and Some Corresponding Indicators (Seto, 2e, 2018, p. 283)

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• Biomedical treatments are available for pedophilia, particularly among offenders against children.

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• Drugs can include antiandrogens, selective serotonin reuptake inhibitors (SSRIs), and gonadotropin-releasing hormone (GnRH) agonists.

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• The World Federation of Societies in Biological Psychiatry has produced guidelines for the pharmacological treatment of paraphilias, including pedophilia (Thibaut, Bradford, et al., 2016; Thibaut, De La Barra, et al., 2010). (Seto, 2e, 2018, p. 268, Tab 8-1)

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• Methodologically rigorous evaluations are needed to answer these important questions, and theoretically informed treatment models that draw from general offender intervention research and specific research on pedophilia are needed to develop empirically supported treatments to reduce child sexual abuse.
• Until the results of such research are available, how should clinicians proceed?

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• I believe a conservative approach is warranted, guided by the scientific knowledge that is available. Based on the research reviewed here, some recommendations are summarized in Table 8.1 and Exhibit 8.1 . Intervention for sex offenders should be preceded by an actuarial or structured risk assessment, to prioritize cases according to risk to reoffend and to guide subsequent decisions. For sex offenders against children, the options range from minimal intervention for the lowest risk individuals to long-term incapacitation for the highest risk individuals. The clinician should also monitor potentially worrisome behaviors, such as access to child pornography, unsupervised contacts with children, and alcohol or drug consumption that leads to disinhibition of behavior (e.g., Abracen, Looman, & Anderson, 2000). Ongoing assessment with validated dynamic risk measures is needed to monitor changes in imminent risk. Clinicians and other professionals should rely on sources of information other than self- report whenever possible.

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Exhibit 8.1 Recommendations For Treatment Pedophilic Sex Offenders

• 1. Risk assessment using a well-supported measure, for the purpose of triaging individuals in terms of placement, security, and intensity of any treatment and supervision.
• 2. Education of the client, his spouse or partner, family members, and close friends regarding risky situations and potential precursors for sexual offenses against children (e.g., the offender being alone with a child or consuming alcohol).
• 3. Behavioral treatments targeting pedophilic sexual arousal, when applicable, with “booster” sessions as needed on an ongoing basis.
• 4. Monitoring of access to child pornography, unsupervised contacts with children, and alcohol or drug use.
• 5. Anti-androgen treatments targeting sexual drive for higher-risk individuals who are not suitable for incapacitation. Though the evidence for such treatments is not strong, compliance with the regimen is a positive treatment-related indicator and could be used to adjust the intensity of other interventions.
• 6. Cognitive-behavioral and behavioral treatments targeting dynamic risk factors for general criminal behavior such as antisocial attitudes and beliefs, association with antisocial peers, and substance abuse.
• 7. Incapacitation of high-risk pedophilic sex offenders, especially those who have committed many sexual offenses against children or who have committed violent sexual offenses.

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Reference

• Dynamic Risk Factors for Sexual Offending: Causal Considerations (SpringerBriefs in Psychology), by Roxanne Heffernan, Tony Ward, Springer, 2020
• Clinical Training Manual for Evaluating Dynamic Risk Factors (DRFs) Involved with Sexual Aggression, by Mark Carich, Jessie Huebner, Kory May, Independently published, 2020
• Responding to Sexual Offending: Perceptions, Risk Management and Public Protection, by K. McCartan, Palgrave Macmillan, 2014
• Sexual Offending: Predisposing Antecedents, Assessments and Management, ed. by Amy Phenix, Harry M. Hoberman, Springer, 2016
• The Psychology of Criminal Conduct, by James Bonta, D.A. Andrews, Routledge, 6e, 2016
• What Works (and Doesn't) in Reducing Recidivism, by Edward J. Latessa, Shelly J. Listwan, Deborah Koetzle, Routledge, 2e, 2020

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• Understanding Sexual Offending: An evidence-based response to myths and misconceptions, by Patrick Lussier, Evan C. McCuish, Jesse Cale, Springer, 2021
• The Wiley Handbook of What Works with Sexual Offenders: Contemporary Perspectives in Theory, Assessment, Treatment, and Prevention, ed. by Franca Coroni, Jean Proulx, Leam A. Craig, Elizabeth J. Letourneau, Wiley-Blackwell, 2020
• Assessing Risk in Sex Offenders: A Practitioner's Guide, by Leam A. Craig, Kevin D. Browne, Anthony R. Beech, Wiley, 2008
• Unmasking the Sexual Offender, by Veronique N. Valliere, Routledge, 2022
• Pedophilia and Sexual Offending Against Children: Theory, Assessment, and Intervention, by Michael C. Seto, American Psychological Association, 2e, 2018
• Chap 23: Forensic Assessment of Sex Offenders, in The American Psychiatric Association Publishing Textbook Of Forensic Psychiatry 3e, ed. by Liza H. Gold, Richard L. Frierson, APPI, 2018
• Chap 70: Sex Offender Risk Assessment, in Principles And Practice Of Forensic Psychiatry 3e, ed. by Richard Rosner, Charles L. Scot, CRC, 2018
• 性侵害犯罪防治學: 理論與臨床實務應用, 二版, 周煌智等, 五南, 2018

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