CAPÍTULO II. DIAGNÓSTICO DEL ESTADO ACTUAL DEL PROCESO DE EDUCACIÓN DEL VALOR RESPONSABILIDAD, EN LOS PROFESIONALES
5. Expresión de aprobación al tratamiento de la
2.3. Análisis de los resultados del diagnóstico
Psychometric Assessments
Sexual Attitudes and Knowledge Scale (SAKS); QACSO; SOSAS; VESA
Outcomes administration times
Pre- and post-treatment. Sexually abusive behaviour monitored for group duration, and six months following treatment completion.
Findings
Significant improvements in sexual attitudes and knowledge, and victim empathy. Non-significant improvements in attitudes consistent with sexual offending.
Reoffending and Sexually Abusive Behaviour
During treatment - No further non-sexual offences were
committed by any group participants. One participant engaged in sexually abusive behaviour during the groups in the form of non-contact behaviours.
At 6 month follow-up - No further sexual offences were
committed by any group participants. Three men committed sexually abusive behaviour. All were on the autism spectrum.
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Study Participants Study Design and Intervention Measures and Outcomes
Murphy et al. (2010) United Kingdom Quality Score = 69% 46 participants - history of sexual offending or sexually abusive behaviour (13 groups over 9 sites). 91% of group participants were receiving no other treatment for their sexual behaviour at the start of the group.
Mean age = 35.3 years (SD=12.0)
Average FSIQ = 68 (SD=7.6, range 52-83). Participants recruited from community ID teams, secure services, or a probation service.
Before-After Design
CBT for sexual offenders, or those who engaged in sexually abusive behaviour. Groups facilitated for two hours once per week, over one year. All facilitators had undertaken SOTSEC-ID training. Content Overview and Delivery Style
Described in SOTSEC-ID treatment manual. Content included: social and therapeutic
framework of group; sexual education; cognitions; victim empathy; sexual offending model – offence cycles; relapse prevention.
Assessment for Suitability
WAIS-III; VABS; BPVS-II; Mini-PAS-ADD; Diagnostic Criteria Checklist for Autism
Psychometric Assessments SAKS; QACSO; VESA; SOSAS Other Outcomes
Sexually abusive behaviour or convictions for sexual offences. Outcomes administration times
Pre- and post-treatment. Followed up at six months post- treatment.
Findings
Significant improvements in sexual attitudes and knowledge, and attitudes consistent with sexual offending from pre- treatment to follow up. Significant improvements in victim empathy, and cognitions related to sexual offending, however these results were non-significant at follow up.
Reoffending and Sexually Abusive Behaviour
During treatment year - No participants committed non-sexual
offences. Three engaged in sexually abusive behaviours; all non-contact behaviours.
During six-month follow-up - No participants committed non-
sexual offences. Four engaged in sexually abusive behaviours; some non-contact behaviours and others contact behaviours.
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Study Participants Study Design and Intervention Measures and Outcomes
Newton et al. (2011) United Kingdom Quality Score = 44% 13 participants. Refused to engage (n=2). Failed to complete (n=4). Participants recruited from regional community ID team. Treatment completers Mean age=32 years 5 months (range 22-47 years). Average IQ=61.6 (range 56-70).
Number of known sexual incidents=5.0 (range 1-11). Number of sexual offence convictions=1.2 (range 0- 3).
Participant’s residence
Supported living residential homes, a psychiatric unit, and independent
community living.
Before-After Design Content Overview
CBT intervention with drama/experiential techniques. Good lives philosophy. Duration
Year one – Group intervention four hours once a week (160 hours group work)
Year two – Group intervention two hours twice a week, with every fourth session as an individual session (120 hours group work, 20 hours
individual treatment). Assessment for Suitability
Eligibility criteria of the local community ID team (IQ under 70; deficits in social functioning; onset before age of 18)
Pre-intervention assessments
BPVS; P-Scan; STATIC-99; STABLE and ACUTE
Psychometric Assessments
STABLE and ACUTE; QACSO; VES Other Outcomes
Changes in care plans; levels of supervision; behavioural change; re-offending
Outcomes administration times
Pre-, mid-, and post-treatment. One year follow up. Findings
No significant change in cognitive distortions. No statistical analysis of victim empathy or risk. No consistent trends observed. Positive changes to care plans, and reductions in levels of support and supervision (n=5). Most demonstrated positive behavioural changes.
Re-offending
No treatment completers committed a sexual offence or harmful sexual behaviour during group or follow-up (1-2 years). Of the non-completers, three engaged in either an alleged sexual or violent offence. Of the refusers, one was re- arrested for an alleged sexual offence three years after having refused to engage.
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Study Participants Study Design and Intervention Measures and Outcomes
Rea et al. (2014) North America Quality Score = 52%
Ten participants recruited from specialist residential units treating ID sexual offenders.
All convicted of at least one sexual offence of child molestation. Six
participants also had at least one additional offence. Mean age = 23.8 (range 18- 28 years)
Average FSIQ = 63.1 (range 40–78)
Multiple case study design to evaluate the extent of compliance with relapse-prevention plans. The development of each relapse prevention plan (RPP) is not outlined within this study.
Compliance with RPPs coded by a companion supporting the community access. Companion was treatment staff (TS), non- treatment staff (NTS), or another adult not familiar to the patient (CA). Four probe sessions conducted; one with TS, then either with NTS or CA (and then the other), and the final session again with TS. Pre-assessment baseline was
established in the preceding six months. Compliance assessed in relation to 18 behaviours.
Findings
Main Effect of Companion - 100% compliance with RPPs
when accompanied by TS. 55% compliance with NTS. 44% compliance with CA. Compliance significantly better with TS than NTS or CA.
Generalisation - Most behaviours proximal to re-offending
showed high generalisation. High generalisers were
significantly younger. Low generalisers had a more diverse sexual offending history.
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Study Participants Study Design and Intervention Measures and Outcomes
Rose et al. (2012) United Kingdom Quality Score = 48% 12 participants with a history of sexual offending. Mean age = 39.5 (range 20- 65 years).
Average FSIQ = 58 (range 49-70).
Referrals from local clinicians.
Participants living in
parental home or residential care/supported living.
Before-After Design
Treatment adapted from existing CBT
programme. Weekly group for two hours, over 40 weeks.
Content Overview
Sex education and relationships; emotion recognition; life stories; motivation to offend; offence analysis; offence cycle; anger
management; cognitive distortions; victim empathy; relapse prevention.
Delivery Style
Adapted materials developed and used. Use of role plays and modelling.
Assessment for Suitability WAIS-III
Psychometric Assessments
QACSO; Nowicki-Strickland Locus of Control Scale (NS); SSKAAT-R
Outcomes administration times
Pre-and post-treatment, and six-month follow-up. 18 month follow-up for further offending.
Findings
Significant improvements in attitudes consistent with sexual offending, and sexual knowledge. More external locus of control noted following treatment.
Number of participants showing reliable change on each assessment varied.
Reoffending
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Study Participants Study Design and Intervention Measures and Outcomes
Sakdalan and Collier (2012) New Zealand Quality Score = 54%
Three participants with a history of sexual offending and sexually abusive behaviours.
Client 1
Mid-30’s male, mild to moderate ID.
Client 2
Mid-20’s male, mild ID. Client 3
Mid-30’s male, placed in ID community secure facility. Recruited from a secure ID hospital and a secure ID residential setting. Conducted in a secure setting.
Multiple case study design, Before-After Design Content Overview
SAFE-ID programme, based on SOTSEC-ID programme (Murphy et al., 2010).
Content included: sexual education; relationships; cognitions; sexual offending model; empathy; relapse prevention; adapted DBT coping skills – focus on emotion regulation, frustration tolerance and interpersonal effectiveness.
Participants received individual psychotherapy to reinforce learning.
Duration
Group delivered weekly for two hours, over a seven month period.
Individual sessions delivered weekly for one hour.
Psychometric Assessments
ASK; SOSAS; QACSO; Victim Empathy Scale (VES) Other Outcomes
Sexually abusive behaviours, physical and verbal aggression from incident logs.
Risk Assessments SVR-20
Outcomes administration times
SVR-20 administered pre-, post- and at one-year follow-up. Findings
Decrease in SVR-20 scores post-treatment and at follow-up. All showed improvements in sexual knowledge and victim empathy. Reductions in cognitive distortions, and attitudes consistent with sexual offending (n=2). Improved insight, and reduction in sexually inappropriate behaviours (n=2). Gains maintained at follow up. Decrease in masturbation, sexual excitability, and improved emotion regulation (n=1). One client had an incident during treatment where he took photographs of teenage females in public. He continued to demonstrate cognitive distortions.
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Study Participants Study Design and Intervention Measures and Outcomes
Singh et al. (2011) North America Quality Score = 41%
Three participants with a history of sexual offending, and a mild ID.
Client 1
34 year old male. Client 2
23 year old male. Client 3
25 year old male. All resided in a forensic mental health facility for ID clients.
Multiple case study design, Before-After Design Content Overview
Mindfulness training. Participants taught two skills referred to as “meditation on the soles of the feet” and “mindful observation of thoughts”. Duration
Training delivered in sessions lasting between 30 minutes and one hour, four times per week. Duration of intervention varied per participant (35-40 weeks).
Participants also seen individually by the therapist during the study.
Facilitators
Facilitated by two therapists. Primary therapist had ample experience in mindfulness.
Assessments
Self-report data relating to level of sexual arousal, on a four point rating scale.
Outcomes administration times Pre-treatment baseline established.
Arousal levels assessed at four stages throughout the treatment. Assessment points different for each participant. Findings
Reduction in reported sexual arousal for all three participants. Self-reported use of mindfulness procedures in daily life. Participants reported feelings of empowerment.
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Study Participants Study Design and Intervention Measures and Outcomes
Williams et al. (2007) United Kingdom Quality Score = 56% 211 participants detained across eight HMP Services. All participants excluded from the CORE SOTP due to their IQ.
Mean age (206) = 40.3 (SD=12.1)
Average FSIQ (211) = 71.9 (SD=5.8)
Most serious sexual offence Rape 39.8% Indecent assault 35.5% Buggery 7.8% Before-After Design Content Overview
Adapted SOTP - manualised group treatment programme.
Content areas: old me; sex education; modifying offence justifying thinking; offence accounts; victim awareness; risk awareness; developing relapse prevention skills.
Course Duration
Intervention delivered across 89 treatment
sessions with additional diary sessions. Average of approximately 200 hours of treatment.
Assessment for Suitability
WAIS-R; Psychopathy Checklist; RM2000
Psychometric Assessments
SOSAS; SOOT; Adapted Victim Empathy Consequences Tasks; Adapted Relapse Prevention Interview; Adapted Self- Esteem Questionnaire; Adapted Emotional Loneliness Scale Outcome administration times
Pre- and six weeks post-treatment. Findings
Significant improvements in sexual knowledge, attitudes, relapse prevention awareness, and self-esteem. No significant change in emotional loneliness.
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