A COMMUNITYBASED SEX OFFENDER TREATMENT GROUP FOR ADULTS WITH INTELLECTUAL DISABILITIES

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A COMMUNITY-BASED SEX OFFENDER TREATMENT GROUP
FOR ADULTS WITH INTELLECTUAL DISABILITIES

• John Rose (The University of Birmingham and
  Dudley NHS PCT)
• Caitlin Anderson (Sandwell Mental Health NHS and
  Social Care Trust)
• Cliff Hawkins (Wolverhampton City NHS PCT)
• David Rose (Dudley NHS PCT)

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BACKGROUND

• Most sex offender treatment groups for people
  with ID involve some degree of compulsion
• Most groups provide treatment to offenders with
  mild or borderline ID or special needs and low
  or normal intelligence
• Some offenders do not have CJS involvement and
  cannot access treatment
• Others are deemed too disabled for intervention
• Any one geographical area probably has only a few
  people with ID and a history of serious sexual
  offending

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OUR MOTIVATION

• Offenders were being sent out of area for
  expensive treatment programmes or
• Offenders were not being treated, due to their
  level of disability or because they were not
  charged, they were being managed through the
  provision of additional supervision
• We felt that there was expertise to provide
  treatment locally if we could create the right
  conditions
• A group of people from neighbouring NHS Trusts
  decided to try and run a group for sex offenders
  with an I.D. in a community setting

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OBJECTIVES

• Would a group treatment programme incorporating
  cognitive behavioural treatment approaches work
  with individuals with mild to moderate IDs?
• Would individuals be motivated to attend a
  lengthy community group work programme to address
  their sexual offending without any formal
  compulsion to attend?

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SO, WHAT WAS DIFFERENT ABOUT THIS GROUP?

• No formal compulsion to attend.
• Generally more severe ID (IQ range 49-70,
  mean 57) than is usual for such groups.
• Assessed deficits in adaptive as well as
  cognitive functioning
• Participants were supported by one of three
  different Health organisations
• Community based with practitioners who would see
  the participants for other aspects of care

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PARTICIPANTS

• Nine men started the group (age range 22-69 (mean
  39)) 2 dropped out early on
• All had been in contact with the criminal justice
  system for at least 1 sexual offence
• The victim and offence types varied across Group
  members
• 2 men lived in their family homes
• 3 men travelled to the Group independently

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DESIGN

• 38 weekly sessions, comprising 3 broad sections
• General sex education
• Education regarding sexual offences
• Development of individualised Keeping Safe
  plans

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PROGRAMME

• Sessions 1-13 Sex education
• 14-16 Recognition of emotions in self and others
• 16-19 Motivation to offend, including life
  stories
• 19-21 Describing offences in detail, including
  the offence cycle
• 22-24 Anger management

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PROGRAMME (continued)

• 24-27 Excuses/cognitive distortions/alternatives
• 28-31 Victim empathy
• 31-36 Relapse prevention
• 37 Review
• 38 Keeping Safe (and certificates and party!)

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ORGANISATION OF THE PROGRAMME

• The first part of the programme was based on an
  existing mens group for non offenders, this
  allowed relationships to develop
• After the initial stage participants were asked
  to opt in with the warning that things would
  become more personal
• The offences would be revisited regularly from
  different perspectives
• While individuals were regularly confronted other
  sessions were used to develop group alliances and
  functioning

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KEY ELEMENTS OF THE PROGRAMME

• Motivation-based (Whats in it for me to change
  my behaviour?)
• Victim empathy (What did it feel like for your
  victim?)
• Cognitive distortions such as minimisation (Is
  saying that you only had sex with the child once
  really a good excuse?)
• Relapse prevention (What are you going to do to
  keep yourself away from suspicion?)
• Provision of additional support by therapists
  outside of the group where necessary

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MAKING IT WORK FOR PEOPLE WITH SIGNIFICANT ID

• Use of different media, such as role play and
  comic strip cartoons
• Careful disclosure by facilitators
• Mix of different facilitation styles (didactic v.
  entertaining, gentle v. challenging)
• Lots of repetition
• Careful mixes in pairs and small groups
• Use of care staff as appropriate

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USING CARE STAFF SKILLS

• Many participants came with staff.
• The care staff were in the group but sat together
• They assisted with small group work and role play
• They also helped the people they came with to
  read and use some materials.
• They were able to discuss general aspects of the
  group with colleagues

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EVALUATION

• Pre and Post and follow up questionnaires
• SSKAAT-R.
• QACSO.
• N.S. LOC.
• Monitoring of individuals offences while in the
  group and after, as long as we are able to.

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SOCIO-SEXUAL KNOWLEDGE ATTITUDES ASSESSMENT
TOOL REVISED (SSKAAT-R)

• A normed instrument designed for people with ID
• Administered pre-and post-group to 6 participants
• Pre-Group mean 142 (sd 31)
• Post-Group mean 158 (sd 24)
• Compared with t test p.059

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QUESTIONNAIRE ON ATTITUDES CONSISTENT WITH SEX
OFFENCES (QACSO)

• Attitudinal questions Do women make too much
  fuss about sexual assault?
• Administered pre- and post-Group to six
  participants
• Total Scale
• Pre-Group mean 39.17 (sd 8.30)
• Post-Group mean 28.75 (sd 12.85)
• The score decreased for five of the six
  participants p.042
• A Items
• Pre-Group mean 21.50 (sd 4.90)
• Post-Group mean 15.33 (sd 9.97)
• The score decreased for four of the six
  participants p.103

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LOCUS OF CONTROL

• Nowicki-Strickland LOC Scale
• Administered pre-and post-Group to 5 participants
• Pre-Group mean 13.7 (sd 5.01)
• Post-Group mean 17.9 (sd 3.01)
• LOC score became more external for all
  participants p .033

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LOCUS OF CONTROL

• Why does locus of control become more external?
• Is it that Group members learnt that they are
  under more scrutiny than they had realised
  previously?
• Or, do they realise that they have less control
  over their lives more generally than they had
  thought previously?
• Or something else?

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BENEFITS

• No known sexual offending over 2 years since
  the start of the group
• Education for some carers
• Individualised Keeping Safe plan to take away
  and implement
• Follow up and monitoring by the therapists
  directly involved in the group
• Increased community access and reduced
  restrictions for some course completers

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NON-SPECIFIC BENEFITS

• Increased ability to admit offending behaviour in
  an appropriate forum and in front of women
• Experience of completing a lengthy programme
  and getting through the tough times
• Participation in a group providing an opportunity
  to reflect on their behaviour (most participants
  would have welcomed a longer group)
• Collaboration across Health organisations

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QUESTIONS

• Who benefited most from which components?
• Is this programme best for people with moderate
  ID?
• Whats happening with locus of control?
• What about use of carers?
• How experienced do the facilitators need to be?
• How many people would benefit from this
  programme?
• How long does the programme need to be?

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CONCLUSIONS 1

• Its possible to provide a successful sex
  offender treatment group in the community without
  compelling people to attend
• Group members remained engaged in all other
  aspects of their daily lives including engaging
  in occupational, leisure and social activities
  maintaining their quality of life and community
  presence and identity
• Supports Lindsays (2005) model of two strands to
  treatment intervening with sexual offending
  focusing on self-restraint and control whilst
  encouraging engagement and commitment to society

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CONCLUSIONS 2

• People with moderate ID can benefit from this
  programme at least as much as people with mild ID
• Involvement of carers in the group supports
  relapse prevention model, assisting offenders to
  identify warning signs to potential offending
• For people with very specialist psychological
  health needs, it makes sense to collaborate
  across organisations

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Contacts

• John Rose j.l.rose_at_bham.ac.uk
• Caitlin Anderson
• Caitlin.Anderson_at_smhsct.nhs.uk
• Cliff Hawkins Cliff.Hawkins_at_wolvespct.nhs.uk
• David Rose David.Rose_at_dudley.nhs.uk