Friday, October 21, 2016

The Inconceivable Legacy of Jacob Wetterling

If someone had told Jacob, when he was 11 years old, that he was destined to be world-famous someday, he might have dreamed that he was going to become an astronaut, maybe a pro football player, or perhaps a champion for human rights.   Millions of people know him for the latter – a posterchild for the prevention of missing or exploited children.  But fame came at a terrible cost.  On this weekend in 1989, Jacob was abducted and, now we know, murdered. 

On the morning of October 22, 1989, Jerry and Patty Wetterling could not have imagined how the course of their lives would change before the end of the day.  Perhaps not unlike 9/11, 10/22 marked a loss of innocence – families changed the way they lived.  Patty and Jerry asked neighbors to leave their porchlights on at night, with the hope that they might guide Jacob back home, or help protect other kids.  Now, 27 years later, porchlights are still on at night, in St. Joseph, Minnesota, and around the world.

I’ve often wondered, with the thousands of children that go missing every year, why Jacob’s story captured international attention.  I think there are three reasons: (1) Jacob wasn’t just missing; he was abducted, (2) the Wetterlings had great pictures of their winsome son, and (3) Patty’s undefeatable determination to find Jacob and prevent other families from a similar fate.   

New York Times writer David Brooks wrote a column in 2011, based on a commencement speech he titled, “It’s not about you.”  His thesis was that, concurrent with educational goals, people often set out to discover their calling in life, when actually, Brooks writes, a calling finds you… “Most people don’t form a self and then lead a life. They are called by a problem, and the self is constructed gradually by their calling.”

My undergraduate education was at a university in central Minnesota, just miles from the Wetterlings.  I had already been working with victims and offenders for several years, and followed this story from that fateful night.  Like many in this field, my career was influenced by Jacob and Patty.

It took nearly 27 years, but it seems that Patty’s invincible determination, and all those ‘porchlights,’ eventually led to Jacob’s recovery.  What many people don’t know is that Jacob was found as the direct result of the dogged efforts of another individual – a boy from the nearby town of Cold Spring, who had also been abducted 27 years ago, when he was 12.   Jared Scheierl, now 40, was released after being sexually assaulted nine months before Jacob.  Over the years, despite resistance from investigators, Jared believed his attacker was also Jacob’s assailant.  Jared caught a glimpse of his kidnapper’s face, and said he would never forget his voice, but his attacker remained unknown.
That changed in 2015, with a break in the case.  New technology was used to identify a trace amount of DNA on Jared’s sweatshirt, and led authorities to a known suspect.  Law enforcement executed a warrant for 52-year-old Daniel James Heinrich, and found child pornography in his residence.  The statute of limitations had run out for the kidnapping and assault of Jared.  There’s no statute of limitations for murder, but Jacob’s fate was still unknown, so authorities used child pornography charges to apply pressure to Heinrich.  After a year, Heinrich reached a plea agreement with state and federal prosecutors.
On September 3, 2016 authorities announced that Jacob’s remains had been found.   At a press conference on September 6, prosecutors said that, in consultation with the Wetterling family, they had two goals: to bring Heinrich to justice, and to bring Jacob home.  Patty said, “To us Jacob was alive, until… we found him.”  Jacob’s younger brother, Trevor and his friend, Aaron Larson who were biking home with Jacob that tragic evening, were once again gripped with survivor’s guilt.  

When Jared Scheierl got the news, he said he was overcome with emotional ironies - not only had Jared’s kidnapper confessed to also being Jacob’s assailant, but Jacob’s remains laid undiscovered for 27 years in Paynesville, where Jared had moved his young family, including his own son - now 12.   It was Jared and blogger Joy Baker who were relentless in connecting the links between Jared and Jacob.  It seems Jared’s calling had found both Jacob and their mutual assailant. 

As part of a plea agreement (20 years in prison for possession of child pornography), Heinrich provided chilling details in open court to kidnapping and assaulting both Jared and Jacob.  With the Wetterling family, Aaron, and Jared all in the courtroom, Heinrich recounted that, before he murdered Jacob, Jacob had asked, “What did I do wrong?”  Nothing, Jacob – only wrong place, wrong time.  And then you went on to be an unforgettable inspiration for a safer world for kids.

Jacob now has a date of birth and known date of death - bookends for his short but magnificent life.  A public memorial service, attended by thousands, was held on September 25.

No child wants to be the namesake for an Act of Congress to prevent child sexual abuse; and no parent expects to become a champion for the rights of missing and exploited children.  But that is the amazing legacy of Jacob and Patty Wetterling – “Jacob’s Hope.

Patty is well-known to ATSA members.  For 27 years, she has poignantly spoken at numerous state, national, and international conferences on the prevention, treatment and management of sexual abuse.  Most people are surprised, and often tearful, to discover how Patty has turned her tragic loss into both responsible accountability and compassionate treatment for those who have sexually abused.  It’s one thing to be a champion for missing and exploited children; it’s another to be an advocate for sound public policies to effectively address child sexual abuse as a public health initiative.  Patty explains that ‘Jacob’s Hope’ for a better world would include not only prevention, but support and recovery for victims, abusers, their families, and friends.

Patty says that she gets her boundless energy from the indomitable spirit of Jacob, and the vital support of family, friends, and colleagues.  It would be difficult to find anyone who works in the field of the prevention of sexual harm that has not heard of Jacob Wetterling or found inspiration in Patty’s resolute determination.  Sometimes we don’t find a calling in life – a calling finds us.

Jon Brandt, MSW, LICSW

Cordelia Anderson, a colleague and friend of Patty Wetterling, wrote her own tribute to Jacob & Patty.

Friday, October 14, 2016

NOTA Annual Conference, Brighton 2016

The annual NOTA conference took place from the 28th – 30th September in Brighton, this year’s theme was "Sharing Practice and Research: Coming together to become more effective"; however, the underlying theme and narrative of the conference was about the prevention of sexual abuse. The conference was a real mix of research, practice and engagement with colleagues, as well as the general public. In this blog I am going to take you on a whistle stop tour of the event.

The 2016 plenaries combined research, practice and innovate approaches from a very international group of speakers. The plenary sessions covered a range of topics including from online behaviour and Child Sexual Abuse (David Delmonico, Andy Phippen), mental health and sexual offending (Jackie Craissati), the treatment of sexual abusers (Gwenda Willis; Clark Baim), the work of the Independent Inquiry into Child Sexual Abuse (IICSA) (Stephen Webster) and international approaches to sexual abuse prevention (Maia Christopher). Although these plenaries were on different topics, and from a national to an international viewpoint, they all talked to the reality of child sexual abuse and how we as individuals, professionals and a society could prevent it.

The workshops spanned a full range of topics including: Circles of Support and accountability (Martin Clarke and Kerry Earnshaw; Tracey Blackstock; Kieran McCartan Rebecca Milner); public health approaches to sexual abuse and prevention (Stephen Smallbone; Gwenda Willis; Kieran McCartan; Jon Brown); child sexual abuse material and online offenders (Danielle Kettlebrough; Daryl Mead and Mary Sharpe; David Delmonico; Vicky Young and Tom Squire; Marcella Leonard); youth who sexually harm (Pat Brangan; Susannah Bowyer; Simon Hackett; Valerie Sheehan and Eileen Kilpatrick; Helen Whittle; Kathryn Lawrence; Carlene Firmin); female sexual offenders (Andrea Darling); treatment (Clark Baim and Lydia Guthrie; Jacqueline Page), as well as  risk assessment and policing (Marcella Leonard; Duncan Sheppard). The workshops were a good mix of research, evaluation, practical working, professional learning and knowledge exchange.

In addition to the traditional conference activities NOTA 2016 also had a series of special interest activities and bespoke sessions. The conference hosted NOTA's second public engagement event which did not have many members of the public (a real learning point for NOTA 2017 and a different experience to NOTA 2016) but instead welcomed 30+ conference attendees (academics, stakeholders, professionals and therapists from across the UK and beyond to discuss how we can prevent Child Sexual Abuse. The session heard from national (Nina Burrows; Kieran McCartan) and international (Maia Christopher) speakers about the work that they were involved with in preventing child sexual abuse and their ideas for where NOTA and professionals in this arena go next. Interestingly, in the Q & A afterwards there was not consensus between the audience and panel, or even the audience themselves, that we have got prevention correct, that we are using the right language, hitting the target audience and that we as a professional body main need to do more amongst ourselves before moving into working with communities.

NOTA also had a session on the systematic review that the organisation was involved in around the development of the new NICE guidelines (Fiona Campbell and Simon Hackett) relating to assessment and treatment of youths with involved in sexually harmful behaviour. The conference also had the head of research from the IICSA (Stephen Webster) come and talk about the progress of the research strand and talking about some of the early projects and rapid evidence reviews (especially on the church, sex offenders with Learning Difficulties), in closing Stephen though that there was a lot more research to do and had a desire to link the IICSA work to that of the Royal Commission into institutional responses to sexual abuse just concluding in Australia. Last but not least NOTA held its first student event, which was an opportunity for students to meet there contemporaries in the field to discuss their research.

NOTA 2016 fitted a massive amount of material in across three days, which left me informed, refreshed and looking forward to next year’s meeting in Cardiff (20th – 22nd September 2017).

Kieran McCartan, Ph.D

Friday, October 7, 2016

Introducing Raliance – A New Prevention Initiative to End Sexual Violence in One Generation

Three leading national organizations have joined forces to establish a visible presence for sexual violence prevention. With multi-year funding from the National Football League (NFL), the National Sexual Violence Resource Center (NSVRC), PreventConnect/California Coalition Against Sexual Assault (CALCASA), and the National Alliance to End Sexual Violence have established an office in downtown Washington DC. In July, the collaborative announced its new name and tagline – Raliance: Ending Sexual Violence in One Generation. It conveys the conviction and urgency of the mission and the need to “rally” partners and “align” goals.
In July Raliance also announced its first round of grants with nearly $1.2 million being awarded to 27 programs across the country who are helping to advance Raliance goals in a variety of ways and settings.  One thing that is unique about Raliance is that it marks the first time victim advocacy organizations have prioritized funding for projects specifically working to prevent perpetration. Raliance has established reducing the likelihood of perpetration of sexual violence as one of the top three priorities for its grant program. As staff at leading national organizations (NSVRC and PreventConnect/CALCASA) and as members of ATSA, we are excited to see ending perpetration as a key element of our ambitious, yet, important goal to end sexual violence in one generation.
The NFL became interested in learning more about domestic and sexual violence a few years ago as a result of some high profile incidents that attracted media attention. As an institution, they are certainly not alone in dealing with such behaviors; however they took a far different approach than most organizations. They invested considerable time, effort, and resources into learning about the issues and trying to figure out how to best use their influence to become part of the solution. They made internal changes in policies and practices, met with many experts from across the country, provided trainings and resources to staff, teams, and players, provided funding to the Domestic Violence Hotline, and provided start-up funding to Raliance to build capacity in the field for preventing sexual violence. This type of corporate responsibility and leadership is what is needed to change our culture.  We invite other corporate partners to join our efforts. 
ATSA has been at the forefront in collaborative work to bring victim advocates and sex offender treatment providers together to share their expertise in order to develop more comprehensive and effective responses to sexual violence when it occurs.  Through extensive conversations (while exploring definitions, acronyms, and research findings) we have come to realize that we share the same goals – particularly around preventing first-time and subsequent acts of sexual abuse.  Thus the ATSA prevention committee was created and continues to be a lively forum for exploring promising strategies. We are both active members of the ATSA prevention committee where committee members demonstrate that same passion for prevention and commitment to collaboration as Raliance.
Prevention advocates are pleased for the sustained national attention on the issue of sexual violence among young adults (such as college campuses, military, and NFL). The Raliance collaborative knows that in order to make lasting changes in this culture (sometimes referred to as “rape culture”), we must change the behavioral norms at much younger ages.  By doing that, and aligning our collective goals and strategies, we know that we can continue the prevention momentum and, in fact, accelerate the positive changes.
In addition to awarding grants to build capacity in the field, Raliance has several other initiatives in the works including a report on the recent progress made to prevent sexual violence, mapping prevention assets in sports and athletics, a policy think tank, media training, and a youth leadership summit. For a complete list of current grantees visit Additional grants will be awarded annually, with the process opening in May or June and the projects beginning the following April. 

Karen Baker, National Sexual Violence Resource Center,  and David S. Lee, CALCASA-PreventConnect, members of the ATSA Prevention Committee

Monday, September 26, 2016

Sexual Harm: Multifaceted Problems, Interdisciplinary Solutions

Welcome, to our special 100th blog as a team. I would like to take this opportunity to thank the Journal, ATSA, the blogging team [thanks David and Jon] and all contributors, as well as everyone who reads the blogs. Here's to the next 100 blogs. Thanks. - Kieran

It was a little over two years ago that Robin Wilson handed over the reins of the SAJRT Blog to Kieran, who along with David and Jon have continued to shine a light on the challenges of mitigating sexual harm.  Since then, this blog marks number 100; so we thought it would be a good time to reflect on ‘the big picture,’ if you will – how the etiologies, treatment, management, and prevention of sexual harm are a multifaceted, interdisciplinary matter.  The links in this special, 100th blog are to selected SAJRT blogs that have been published over the last two years.

The SAJRT blog has offered discussions, broadly, about ‘sex offender’ research, risk, treatment, management, prevention, policies, and practices.  Guest bloggers have included researchers and practitioners from across the field of sexual harm and from around the world. The blog has highlighted how a multitude of voices (including victims, advocates, professionals in many fields, media, even perpetrators…) are central to understanding how to mitigate or prevent sexual abuse.  
Sexual harm is often discussed in the stark, polarizing terms of ‘victim’ and ‘offender’ (abuser or perpetrator), which is problematic for many reasons.  Not only does every incident of sexual harm reach far beyond the two individuals involved, the language of sexual harm tends to reduce two people to their regrettable ‘roles’ – a “victim” of sexual abuse, or a “sex offender.”  At a minimum, sexual harm involves victims, perpetrators, families, friends, peers, institutions, and communities.  Broadly speaking, sexual harm is never about just two people – it involves all of society, and therefore prevention requires public engagement on a global level. 
Sexual offending is a generic term for a continuum of mismanaged sexual behaviours.  Typically we think of sexual misconduct as being criminal behaviour, but sometimes it is a muddled breach of social rules – nearly always it is a violation of relationships.  Sexual offending between juveniles is often categorically different from sexual misconduct by adults.  Not all sexual abusers are male.  Sometimes, sexual misconduct calls for a measured response, while the most egregious cases of sexual violence force difficult discussions about the use of civil commitment, or perhaps even euthanasia.  Non-contact sexual offenses are among the most perplexing.  Getting the right messages to juveniles is imperative.    
The origins of sexual harm are multifaceted, cross all races and cultures, and is a world-wide problem.  Because the etiologies of sexual harm are multidimensional, solutions must be interdisciplinary.  For example, in the UK, the Multi-Agency-Public-Protection-Arrangement (MAPPA) helps to ensure coordination between many stakeholders.   While, historically, ATSA focused more on the research and treatment of sexual abusers, it evolved in understanding the interdisciplinary need for many professionals to work together toward a common goal – the prevention of sexual harm. 
It’s important to recognise that understanding and mitigating sexual harm requires social policies that draw on perspectives from (at least) psychology, sociology, criminology, health (mental-physical-public health), and even economics.  Each of these disciplines deserve a place at any table where sexual harm is discussed.  While some professionals are concerned primarily with perpetrators of sexual harm in clinical and treatment terms, colleagues in other areas may be more involved with victims, or the economics of treatment, maybe the practicalities of housing sex offenders, or perhaps the political ramifications of sexual offending.  Although these are somewhat different matters, they are all valid perspectives on the same broad issues – multiple stakeholders, nationally and internationally, coming together, sharing information, developing a more complete picture of sexual abuse, enabling us to provide the best responses – preventative or reactive. Multiple disciplines and professional perspectives all bring something different, and important, to the table - they open our eyes to different ways of developing and applying best practices to the effective intervention, treatment, and prevention of sexual harm.  
Over the last 100 blogs we have tried to spotlight the professional, social, and practical issues of mitigating sexual abuse, by promoting new research, challenging colleagues to think outside the box, to consider new approaches to treatment, broaden our understanding of ‘interventions,’ and be aware of the consequences of misguided public policies.  Reducing and resolving sexual harm not only requires collaboration between many professions, but more engagement with the public.
By understanding the history, evolution, and politics of sexual misconduct, knowing the latest research, sharing information, and working together between disciplines, we can develop a ‘big picture’ about sexual abuse, more effectively balance competing concerns, and promote best practices that truly lead to both better lives and safer communities.   
100 Blogs, and counting…
From the SAJRT Bloggers - Kieran McCartan, David Prescott, and Jon Brandt

Friday, September 16, 2016

Returning to What’s Real

The elephant in the closet in the treatment and supervision of people who have sexually abused is the voice of the clients themselves. The service user (or in this instance the person who has sexually abused) is at the center of the work that we do, but there perspectives and views of the services that they are subject to are not always present. We need to hear the views, attitudes and perspectives of the service user regarding the work that they are part of (that is listening to the service user voice); we do it in health, business, marketing and other areas of life, but why not sex offender treatment and management? There is an inherent view in some sectors of our field that people who have sexually abused are manipulative, deceptive, and therefore not trustworthy; which means that their views of the service they are part of is unreliable at best and suspect at worst. This is a real issue when one considers that people who have sexually abused are the users of multiple services including counseling, psychology, health, social services, and the criminal justice system. Other users of these services often have mechanisms through which to have their voices heard and participate in the processes that have an impact on their lives. This might take the form of client advisory councils, satisfaction surveys, or feedback-informed treatment.

One has to wonder why a lack of a coherent client/service-user voice is uncommon for one population (e.g., people who have abused) and not another (e.g., people in substance abuse treatment). Perhaps more importantly, do professionals all too often come to think of treatment of people who have sexually abused as something we do to and on our clients rather than with and for them (Miller & Rollnick, 2013)? Do we dictate that treatment must take place in the fashion that we want or one that is most effective for the client? How do we know when we are meeting both the need and responsivity principles in a way that is meaningful for the client? Or is it that we are just as susceptible to bias, misperception, stereotypes and misunderstandings as the public and politicians? Do you “fall in line” with biases that we argue against?  This is an international dilemma, as this problematic approach to the person who has abused as a disenfranchised and unrecognized service user is not just a western problem. Let’s explore this further.

A discussion of the role of Volunteer Probation Officers (VPOs) recently took place at the United Nations Asia and Far East Institute in Tokyo. VPO’s are typically older and well-established citizens who mentor young offenders, from around Japan.  The role of the VPO’s is to assist the young offenders with their behavior, actions, and plans for the future. It is a system designed to provide support and bring about hope and accountability, even as the young offenders can be at risk for disengaging and participating minimally. During the panel discussion, one attendee asked what regrets the VPOs had about their work. The answers were as heart-rending as they were similar; each participant described a time when they had listened more effectively, worked harder to understand the young person, or helped them to achieve the goals that were meaningful to them and not just the legal system.

On their own, these responses are unsurprising, and resemble other human situations where desired outcomes aren’t achieved, such as parents whose children haven’t lived to their full potential or whose lives have ended early. What was striking among the VPOs was what was not said. Reflecting on their failures, no VPO regretted that their young charges had not gotten the diagnostic clarity, effective medication regimes, or the correct empirically supported protocols they needed. In further discussion of this fact, the VPOs acknowledged, as do all professionals, that diagnostic and treatment considerations are vital to success, but that the prevention of failure can reside in the moment-by-moment interactions that all professionals have with their clients.

Likewise, as we go to press with this blog, the Australian Psychological Society has just issued an apology to the indigenous peoples of that country. They state:

To demonstrate our genuine commitment to this apology, we intend to pursue a different way of working with Aboriginal and Torres Strait Islander people that will be characterized by diligently:

·         Listening more and talking less
·         Following more and steering less
·         Advocating more and complying less
·         Including more and ignoring less
·         Collaborating more and commanding less

This sounds like good, old-fashioned therapy to us.

Underneath all of our clinical practices – indeed all helpful interactions – lies a particular kind of conversation. Our field is replete with examples of how professionals should speak with and be with clients. This can be a source of great fascination, from the earliest authors, through Carl Rogers’ core conditions, Berg and de Shazer’s focus on the seemingly simple search for solutions, and beyond. Wampold and Imel (2015) referred to the conversation as “perhaps the ultimate in low technology” (p. ix).

Obviously, not all conversations are helpful, even as they are central to all bona fide forms of psychotherapy (Wampold & Imel, 2015). Indeed, Lilienfeld (2007) has highlighted how some treatments can cause harm. What was central to the Japanese VPOs’ assessment of their failures reflects what has been found in research into the therapeutic alliance (Hubble, Duncan, & Miller, 1999; Duncan, Miller, Wampold, & Hubble, 2010). That is, that the most helpful clinical practice takes place when there is agreement, from the client’s perspective, on the nature of their relationship, the goals of their work, and the means by which they go about it. This view of the working alliance dates back decades (Bordin, 1979), although research has also emphasized the importance of delivering treatment in accordance with strong client values and preferences (e.g., Norcross, 2010). Indeed, importance of the alliance has long been recognized (Orlinsky & Rønnestad, 2005).

These points seem worthwhile in the wake of recent discussions on ATSA’s listserv regarding whether treatment “works” and with whom it is most likely to be effective. It often seems odd that professionals in our field rarely ask their clients about their beliefs as to whether the services they receive are helpful. Perhaps this is due to many professional’s beliefs that asking about what does and doesn’t work in treatment would open the door to discord or attempts at manipulation.  Perhaps it’s because many of us couldn’t handle what our clients really think.

Likewise, as professionals we seem hesitant to get into debates about the service user voice evidence-based practices. In a recent conversation on the ATSA listserv a member noted the differences between the American Psychological Association’s definition (“the integration of the best available research with clinical expertise in the context of patient characteristics, culture and preferences”) and the more stringent standards for empirically supported protocols such as EMDR and DBT. In the end, understanding the treatment experience from the perspective of the client and working to ensure agreement on the goals and tasks of treatment as well as the nature of the working relationship may have as strong an evidence base as any other approach in the helping professions.

The need to understand, process and reflect upon the service user raises the important question - what is an appropriate evidence base? We spend a lot of time discussing the merits of psychometrics, clinical trials, Randomized Control Trails and downplay the importance of qualitative research. The common narrative in the field is about levels of significance and outcome measures, not necessarily about what was said in and about the treatment. Maybe the first think that we need to do, before listening to and acting, is to recognize the service user voice.

David S. Prescott, LICSW
Kieran McCartan, PhD


Goldberg, S.B., Miller, S.D., Nielsen, S.L., Rousmaniere, T., Whipple, J., & Hoyt, W.T. (2016). Do Psychotherapists Improve with Time and Experience? Journal of Counseling Psychology, 63, 1-11.

Lilienfeld, S.O. (2007). Psychological treatments that cause harm. Perspectives on Psychological Science, 2, 53-70. Retrieved September 16, 2016 from 

Norcross, J. C. (2010). The therapeutic relationship. In B. L. Duncan, S. D. Miller, B. E. Wampold, & M. A. Hubble (Eds.), The heart and soul of change: Delivering what works in therapy (2nd ed.)(pp. 113- 141). Washington, DC: American Psychological Association.

Orlinsky. D.E., Rønnestad. M.H. (2005). How Psychotherapists Develop. A Study of Therapeutic Work and Professional Growth. Washington D.C.: American Psychological Association.

Wampold, B. E., & Imel, Z. E. (2015). The great psychotherapy debate: Research evidence for what works in psychotherapy (2nd ed.). New York, US: Routledge.

Friday, September 9, 2016

Balancing the books? Starting to understand the reality of sexual harm in the UK

A recent report from the Crown Prosecution Service [CPS] for England and Wales shows an upturn in reporting, recording, prosecutions and convictions in sexual harm [including, Rape, Child Sexual Abuse, Prostitution, Honour based offences, etc.] for the year 14/15 for women and girls. Although the report indicated that the largest increases were for women and girls as victims of sexual harm and for males as perpetrators, it does also show that there was an increase for men and boys as victims as well as for females as perpetrators too. The data came from the CPS case management system, which means that the results and analysis were based upon what was recorded by CPS staff via the existing databases and systems.

The report signals that:
- The volume of referral’s to the CPS for Sexual Abuse, Domestic Violence and Rape decreased by 3.3% to 124,737 compared to 14/15;
 The volume of individuals charged with Sexual Abuse, Domestic Violence and Rape by the CPS increased by 0.5% to 86,067 compared to 14/15;
- The volume of individuals prosecuted by the CPS for Sexual Abuse, Domestic Violence and Rape increased by 9.8%, to 117,568 defendant’s, from 14/15 to the highest level ever recorded; and
- The volume of individuals convicted of Sexual Abuse, Domestic Violence and Rape also rose by 10.8%, to 87,275, from 14/15 to 87,275 in 15/16, to the highest level ever recorded.

The main take-home message from the report is that the volume of prosecutions and convictions across the violence against women and children spectrum is the highest that they have been over the last nine years that the CPS has been recording them in this fashion and that new, as well as relatively new, offences (e.g., Female Genital Mutilation, Honour Based crimes and revenge porn offences) have shown increasing referral’s, charges, prosecutions and convictions. The report highlights, what we have often suspected, that the rates of sexual harm and violence against women and children do not match the reality of sexual harm in society. However, it’s important to put these findings into context as we need to recognise that 15/16 was not necessarily a peak year for sexual harm, but rather that it is an indication of a turning tide in society;

- There seems to be a growing trust in the Criminal Justice System epically the police; the public seems to be more willing to report crime and seek prosecutions.
- An increased awareness of violence against women and children in society because of high profile media cases, the IICSA investigation and a series government reviews (inc, prostitution, hate crime, etc).
Updates and changes to crime recording (including, the recording of new crimes and a change in terminology in existing ones) means that some offences may have not been recorded previously, or if they had been recorded they may have been recorded in a different category.
- A review of sentencing guidelines for sexual offences.
- The increase in historical sexual harm offences being reported and processed by the police, CPS and Courts.
- A commitment from the CPS to offer more support to victims of sexual harm, with the former Prime Minister calling  sexual abuse a national threat.
- An increase in funding to understand, prevent and respond to FMG, honour-based violence and trafficking from the UK government.

This highlights a commitment from the Criminal Justice System in England & Wales and UK government to respond to sexual harm, and related offences, resulting in increased reporting, recording, prosecutions and convictions. The increase revealed by the CPS report is not surprising given the under-reported nature of sexual harm and starts to help us understand the nature of these offences in society; the take-home message seems to be the more we talk, the more we see and the clearer picture we get. Therefore it’s not so much an increase, potentially, but rather a reality check and call for more preventive work and public/societal engagement work to be done.

Kieran McCartan, PhD

Friday, September 2, 2016

Mitigating Sexual Recidivism: ‘Treatment’ or ‘Intervention’?

Trending research demonstrates low rates of sexual recidivism for nearly all juveniles and most adult sexual offenders.  Many studies have been aimed at trying to determine whether ‘sex offender’ treatment is effective at reducing recidivism.  But there is growing evidence that most sexual offenders will not reoffend, regardless of treatment, and moreover, that treatment has only a small or moderate effect on recidivism.  If treatment isn’t as effective as we want it to be, what do we do with such ‘inconvenient’ data?  We can consider elements of an effective intervention, and uniquely tailor individual pathways for clients to recover.  When indicated, it should include sex-specific treatment.

A recent, large meta-analysis by Schmucker and Lösel (2015) reports sexual recidivism of 13.7% for untreated offenders, and 10.1% for clients who completed treatment - an absolute reduction in recidivism of 3.6%, and a relative reduction of 26.3%.  Previous studies by Lösel and Schmucker (2005), (2008) showed a slightly stronger, but still low-moderate treatment effect.  Duwe and Goldman (2009) found a 13.4% sexual reoffense rate for treated clients versus 19.5% sexual recidivism for offenders who did not participate in treatment.  Many other studies have found similar results.

Karl Hanson and colleagues (2014) confirmed a low rate of reoffending (1%-5%) for low risk sexual offenders, and a 22% rate of reoffending for high-risk offenders after five years, but then discovered that after ten years offense-free in the community, high-risk offenders effectively became low recidivism offenders.  Michael Caldwell (2016) completed the largest meta-analysis to date, which revealed current sexual recidivism rates for juveniles is likely to be less than 3%.  In both studies, if clients reoffended, it was likely to occur within the first few years after intervention.  Authors in both studies were unable to determine WHY recidivism was low and desistance was stronger over time; yet it seems that effective treatment might enhance outcomes. 

Risk for reoffending, as part of a psychosexual assessment, seems to have become overly simplified into essentially three categories: low, medium, and high risk, which then often determines outcomes: everything from plea agreements, to incarceration, treatment, and perhaps conditions of supervision or imposition of civil regulations. So how can we analyze the cost-benefit of interventions to clients, and to public interests? 

Gregory DeClue has suggested an empirical process from the world of medical treatment might be helpful to determine the cost-benefit of treatment.  Dr. DeClue points to statistical concepts known as “Number Needed to Treat” (NNT), and “Number Needed to Harm” (NNH). Together, NNT and NNH provide an empirical way to consider, in an aggregate manner, the cost-benefit to “treat” or “not to treat.”  According to DeClue, using data from Schmucker and Lösel (2015), NNT reveals that only about one person in 28 is likely to not reoffend as the direct result of treatment.  That seems like a weak return on the investment, but more troubling is the counterbalance:  to what extent is treatment actually unwarranted, counterproductive, or indeed harmful to individuals and their families – known as iatrogenic consequences?

A meta-analysis by Kim, Benekos, & Merlo (2016) found “that sex offender treatments can be considered proven or at least promising.” They also determined that ages of clients and types of interventions influence the success of treatment.  This study also suggests that outpatient treatment may be more effective than treatment in prison, “If community treatment is more effective than institutional treatment, then a review of existing sentencing statutes and policies might be appropriate.”  So if treatment is not the primary change agent, what is?  It might be, broadly, the intervention.

Most individuals arrested for sexual offending do not sexually reoffend, and treatment effect alone doesn’t account for low recidivism rates; so what else might broadly mitigate reoffending?  Research indicates that civil regulations (the registry, residency restrictions, etc.) are not only ineffective, they might be counterproductive.  More and more, civil regulations are being challenged by the judiciary in state and federal courts as not only being ineffective, but unconstitutional.   Caldwell wrote, “The bulk of available evidence indicates that the decline in adult and juvenile sexual recidivism rates has occurred, unrelated to, and perhaps despite, these recent policy trends.”  The sex offender registry is especially harmful to juvenilesBirgden and Cucolo (2011) argue that treatment as management, rather than treatment as rehabilitation, panders to public policy and puts unwarranted concerns about public safety ahead of effective treatment.  CSOM promotes a systems approach to interventions, including effective supervision, and that recovery is not all about ‘treatment.’

We should be mindful that reducing risk is not the only aim of treatment, and only tells part of the story about an effective intervention.  And how do we determine what kind of treatment experiences we should offer?  For example, Levenson and Prescott (2013), discuss many benefits that may be derived from treatment, resulting in improved outcomes for clients, victims, and their families - better lives AND safer communities.  Indeed, the same authors have published three studies indicating that people who have sexually abused typically believe their treatment experiences to be worthwhile (e.g., Levenson & Prescott, 2009).  Perhaps one avenue for professionals to consider is moving beyond treatment interventions that focus on reducing risk and help people remain at low risk.  Another treatment target might be helping clients adjust to the social consequences of being publically labeled a “sex offender.” Still another focus of treatment might be “cognitive transformation” – promoting desistance by helping clients view themselves as having become a different (better) person.

When recidivism rates are low, and treatment effect is weak, it raises questions about when sex offender ‘treatment’ is indicated – effectively begging the question: “to treat” or “not to treat.”  The answers are only partially informed by risk/recidivism studies. Many questions abound, including the influence of treatment on the nature, severity, imminence, and frequency of re-offense, if it does occur. Further, while it makes sense to ask whether treatment works, we are still in need of research into the effective components of both treatment and treatment providers. In addition to psychological factors, we should consider situational factors that might contribute to re-offending after treatment completion.

How should new data on the weak effectiveness of ‘treatment’ guide interventions with individual clients?  How should public policies be reviewed in light of new research?   Collectively, new data, and anecdotal evidence, provides strong evidence that the “sex offender system” might be mired not just in ‘old research’ about what works in the treatment and management of sexual offenders, but that public policies are straining valid concerns for public safety.   As a result, systems are overreaching and over-treating individuals, in large numbers, from juveniles to the civilly committed.  The consequences to individuals and families, and the costs to public interests, are incalculable.

Why are so many people ending up in the “sex offender system”?  Perhaps one reason is a tendency to conflate “seriousness” of a sexual offense with “dangerousness.”  This results in catching too many individuals in the “sex offender net,” regardless of “dangerousness” and, out of fear of any risk of reoffending, the system is reluctant to let them go.  In order to avoid any true positives (predicted to reoffend and does), or false negatives (predicted to NOT reoffend but does), the system is willing to tolerate a high percentage of false positives (predicted to reoffend but doesn’t).  Or simply stated, “Better to lock up ten sex offenders than one might reoffend.”  The fallacy is that about nine out of ten offenders are not likely to sexually reoffend, yet we commit vast, unwarranted public resources to nine out of ten sexual offenders, as an unwarranted hedge against possible recidivism.

In the UK, with the introduction of the transforming rehabilitation agenda, distinguishing between low and high risk offenders is becoming more salient in community management.  It distinguishes between sex offenders and non sex offenders, by risk categories and management.  All sex offenders are now managed by a streamlined probation services, while low/medium risk non sex offenders are managed by private Community Rehabilitation Companies (on a payment-by-results scheme).  All high/very high risk offenders are managed by traditional probation.  This suggests that the UK government perceives low risk sex offenders as generally more dangerous than low-risk non sex offenders.

Interestingly, in the UK (and elsewhere outside the USA) not all sex offenders receive treatment – it is based on their level of risk and whether or not clients deny their offence.  In the UK, it is usually medium, high and very high risk sex offenders that receive Sex Offender Treatment Programmes (SOTP); with low risk offenders receiving a form of cognitive skills program.  Putting low-risk sex offender in SOTP could actually make clients worse and increase their likelihood of offending. Practitioners and policymakers suggest that we look at alternatives to traditional SOTP, and Ruth Mann points to a wide-range of psycho-social treatment interventions.  With skepticism about whether sex offender treatment works, in the UK, treatment must be evidence-based.  

So what are the takeaways here?   One is to avoid the tendency to measure the success of ‘treatment’ in a dichotomous manner - whether or not clients reoffend.   There is much more to consider in decisions about treatment, e.g. when is treatment indicated?  Should treatment be compulsory?  If so, where should treatment take place (institution or in the community)?  What are the specific treatment targets to measure progress and determine completion?   What kind of treatment is effective for a particular client?   How much treatment is enough?  Principles of Risk-Need-Responsivity and Good Lives are able to empirically guide the application of aggregate data and other research to individual clients.  Sometimes, when empirical evidence suggests treatment is not indicated, we still need to intervene, but find the courage to not put clients through unwarranted or lengthy ‘treatment.’ 

By all indications, a wide-range of interventions seems to effectively mitigate recidivism, so perhaps rather than focusing on “does treatment work,” what might be needed is to fine-tune characteristics of interventions that are demonstrated to be effective with specific types of clients, e.g. juveniles, low risk, non-contact, females, repeat offenders, etc.  Not all sexual offending is rooted in sexual deviancy, sexual compulsion, or sexual violence.  Sometimes people simply lose their sexual boundaries, and it’s not likely to happen again.  While it may be useful to trace pathways to sexual offending, not every sexual offender has a sexual offense “cycle.”  With half of all sexual assaults occurring under the influence of alcohol, treatment for chemical abuse or addiction might be primary.  Not everyone who sexually offends needs sex-specific treatment.  A large percentage of adolescent offenders, and their families, might be well-served by participation in a time-limited psycho-sexual education program.

Because sexual offending is often more about relationship violations than sexual violence, interventions might focus much more on managing social damage, repairing relationships, and restoring families.  When there is so much that can be accomplished by creating a recovery plan that is unique to individuals and their families, it’s unfortunate that there is so much emphasis placed on “relapse prevention,” strict compliance with supervision, or criminal enforcement of civil regulations. Effective interventions can build on the optimism of protective factors, use positive psychology to build social skills, competency, and resiliency, and embrace strength-based principles of Good Lives.

When sexual misconduct occurs, intervention is almost always warranted – ‘treatment’ might not be.  Interventions can be empirically guided by a client’s Risk-Need-Responsivity and principles of Good Lives, and perhaps by uniquely tailoring interventions to individual clients, with consideration of the five “W’s”: who, what, when, where, and why.

Jon Brandt, David Prescott, and Kieran McCartan

Appreciation to Greg DeClue, Ph.D. and Michael D. Thompson, Psy.D. for contributions to this blog.

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