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2	Does Treatment Reduce Recidivism in Sex Offenders? Goal: to protect the community by reducing the likelihood of future sexual assaults
3	Problems with Measurement of Treatment Effectiveness Variations (sometimes extreme) in recidivism rates between different programs Typically low recidivism rates make finding statistically significant results very difficult Issue of base rates for measuring recidivism in treatment outcome studies Because base rates for sexual reoffending fall between 10% and 25% in most studies, and sample sizes typically are small (fewer than 200 offenders), the treatment effect must be very large (greater than 50%) to observe significant differences between treated and untreated offenders
4	Hanson & Morton-Bourgon, 2004 Update of 1998 meta-analytic review of sex offender recidivism studies Analyzed 95 studies containing 31,216 sex offenders This study examined primarily dynamic (changeable) risk factors, rather than the static (unchangeable) factors reviewed in the 1998 study 5-6 year follow-up
5	Hanson & Morton-Bourgon, 2004 (cont.) Results showed that the sexual recidivism rate across all studies was 13.7% General recidivism rate was 36.9% All types of recidivism were predicted by offenders having an unstable, antisocial lifestyle, or lack of self-control Those individuals with deviant sexual interests, particularly in children, were most likely to reoffend sexually High rates of sexual preoccupation were significantly related to all forms of recidivism
6	Lösel & Schmucker, 2005 First international meta-analysis of both published and unpublished sex offender biological and psychological treatment outcome studies Included 69 studies with more than 22,000 subjects were analyzed—about one-third published since the year 2000 and one-third published outside North America Recidivism was operationalized as broadly as possible, ranging from incarceration to lapses in behavior
7	Lösel & Schmucker, 2005 (cont.) 11% recidivism rate in treatment groups 17.5% recidivism rate in control groups Overall, treatment provides a 37% reduction in sexual recidivism Cognitive-behavioral treatments had the most significant impact on sexual recidivism
8	Lösel & Schmucker, 2005 (cont.)
9	Marques et al., 2005 Marques and colleagues employed an experimental design to evaluate the Sex Offender Treatment and Evaluation Project (SOTEP) Stationed at Atascadero State Hospital in California, SOTEP operated from 1985 to June 1995 Randomized clinical trial 704 participants 259 = relapse prevention program 225 = untreated volunteer control 220 = untreated non-volunteer control 8 year follow-up
10	Marques et al., 2005 (cont.) Final results revealed no significant differences among the three groups in their rates of sexual or violent reoffending 22% of the treatment group committed a subsequent sexual offense and 16.2% had a violent reoffense 20% of the volunteer group reoffended sexually and 16.3% had a subsequent violent offense 19.1% of the non-volunteer control group had a sexual reoffense and 15% had a violent reoffense However, those who did well in treatment recidivated at lower rates than those who did not progress in treatment
11	Marques et al., 2005 (cont.)
12	McGrath et al., 2003 Evaluation of a prison-based cognitive-behavioral, relapse prevention treatment program for adult sex offenders in the State of Vermont, which included a community aftercare component 195 participants 90 = no treatment 56 = completed treatment 49 = some treatment 6 year follow-up
13	McGrath et al., 2003 (cont.) Results showed that almost one quarter of the total sample (23%) were found to have committed a new sex offense during the follow-up period Sex offenders in the completed treatment group had a significantly lower sexual recidivism rate (5%) that both the some treatment group (31%) and the no-treatment group (30%) The completed treatment group also had a significantly lower rate of violent recidivism than the no-treatment group
14	McGrath et al., 2003 (cont.)
15	Seager et al., 2004 Seager et al. examined men over the age of 18 who were convicted of a sex offense and were offered the opportunity to participate in a manualized treatment program, in which offender progress was clinically evaluated 177 participants 81 successfully completed the treatment program 28 were unsuccessful 17 offenders dropped out 19 refused to participate
16	Seager et al., 2004 (cont.) Overall, 12% of the offenders in this study were reconvicted for a sex or violent offense and 23% were charged with a new sex or violent offense 4% of successful treatment completers and 7% of unsuccessful treatment completers were convicted for a new sexual or violent offense 32% of those who dropped out, refused, or were terminated from treatment incurred a new conviction and 49% had new charges Dropping out, refusing, or being terminated from treatment was related to higher risk for sexual and/or violent offending
17	Seager et al., 2004 (cont.)
18	Problems with Measurement of Treatment Effectiveness (cont.) Differences in laws, policies about sex offending Difficulty in following subjects who move Different sex offender populations Duration of follow-up Attrition of sample subjects Definitions of what constitutes reoffense Differences in treatment program intensity, location (prison, community), and methods
19	Barbaree and Marshall, 1988 126 treated (cognitive-behavioral methods) and untreated child molesters in a community sample 4 year follow-up Recidivism (measured by official police records and unofficial police and child protective agency reports) rates quite different between the treated and untreated groups
20	Barbaree and Marshall, 1988 (cont.) Extra-familial female-target child molesters Recidivism rates over four years for treated group: 18%; for untreated group: 43% Extra-familial male-target child molesters Recidivism rates for treated group: 13%; for untreated group: 43% Incest female-target child molesters Recidivism rates for treated group: 8%; for untreated group: 22%
21	Barbaree and Marshall, 1988 (cont.)
22	Rice, Quinsey, and Harris, 1991 Studied 136 extrafamilial child molesters from a maximum security psychiatric hospital over a 6 year follow-up period Found no treatment effect
23	Hall, 1995 Performed meta-analysis on 12 sex offender treatment outcome studies Total sample size of 1,313 sex offenders Recidivism: formal legal charge for a new sex offense after the completion of treatment for the treatment group Mean length of treatment 18.5 months
24	Hall, 1995 (cont.) Mean follow-up period across studies was 6.85 years Found small but significant recidivism-reducing treatment effect for treatment versus no-treatment or comparison treatment conditions Overall recidivism rate for treated sex offenders: 19% Recidivism rate for untreated group: 27%
25	Hall, 1995 (cont.)
26	Hall, 1995 (cont.) Greatest treatment effects were in studies with Longer follow-up periods Higher base rates of recidivism Outpatient services Cognitive-behavioral treatment or anti-androgen treatment
27	General Accounting Office, 1996 Summarized 22 reviews of research on sex offender treatment covering 550 studies between 1977 and 1996 Report concluded that the results are promising but inconclusive
28	Alexander, 1999 Examined data from 79 sex offender treatment outcome studies encompassing 10,988 subjects Divided offenders and offenses into subtypes by age of offender, age of victim, offense type, type of treatment, location of treatment, years in which treatment occurred, and length of follow-up Recidivism typically defined as subjects who were rearrested for a new sex offense
29	Alexander, 1999 (cont.) Offenders who participated in relapse prevention treatment programs had a rearrest rate of 7% compared to 18% for untreated offenders 528 adult male rapists: 20% of the treated group reoffended; 24% of the untreated group
30	Alexander, 1999 (cont.)
31	Alexander, 1999 (cont.)
32	Alexander, 1999 (cont.) 2,137 child molesters: 14% of the treated group reoffended; 26% of the untreated group Treatment effect was especially strong for the 331 exhibitionists: 20% of the treated group reoffended; 57% of the untreated group For all 10,988 study subjects combined, 13% of the treated group reoffended; 18% of the untreated subjects reoffended
33	Alexander, 1999 (cont.)
34	Hanson et al., 2002
35	Hanson et al., 2002 (cont.)
36	Seto and Barbaree, 1999 Evaluated the relationship of clinical ratings of treatment behavior to recidivism (in-session behavior, homework quality, motivation and change achieved) Found good treatment behavior was unrelated to general recidivism but associated with higher serious violent or sexual recidivism Men who scored higher in psychopathy and better in treatment behavior were the most likely to reoffend
37	Serious Sex Offender Recidivism Related to Treatment Behavior and Psychopathy
38	Financial Costs/Benefits of Treatment Any reduction in recidivism is significant in terms of reduction of harm to victims and costs to society In tangible financial costs, Prentky and Burgess (1990) estimated the costs per sex offense for offender-related and victim-related expenses totaled $183,333 Therefore, if there are eight fewer offenses for every 100 sex offenders, the tangible financial savings is $1,466,664 If we think treatment of sex offenders is expensive, compare it to the cost of not treating sex offenders
39	Summary Early evaluations of sex offenders programs found no evidence that treatment works The most recent, largest scale, and best designed treatment outcome study to date found that treatment works When all studies are reviewed, sex offender treatment reduces sexual recidivism in adult males about 5 to 10% Any reduction in reoffense rates can result in very significant cost savings and—more critically—a reduction in harm