Learning From Consumers of Mandated Sex-Offending Programs: "It's Not Treatment, I Wish It Was."

The purpose of this qualitative study was to explore clients' perceptions of sex-offending treatment. The sample included 291 people required to register as sex offenders in the U.S. who answered an open-ended question in an online survey asking them to describe their positive and negative experiences in mandated treatment. Using qualitative analysis, three overarching themes (with several subthemes) were identified: (1) positive and (2) negative treatment experiences and (3) the affiliation between the criminal justice system and clinical services. Experiences in sex offending treatment were viewed as positive when clients had opportunities to learn about themselves, experience group cohesion, build a positive alliance with a caring therapist, learn tools and skills for emotional health, explore the roots of offense behavior, and create healthy life plans to reduce risk for re-offending. Negative themes emerged when treatments were viewed as coercive, confrontational, or demeaning; when therapists seemed inexperienced or unqualified; and when seemingly outdated or unscientific methods were emphasized without explanation or dialogue. The entanglement between court-mandated treatment providers and the criminal justice system led to concerns about confidentiality, conflicts of interest, and role ambiguity. Drawing upon literature related to therapeutic alliance, trauma-informed care, and Risk-Need-Responsivity models, we offer suggestions for integrating client feedback to improve treatment responsivity and prevent re-offending.

The Ripple Effects of Post-Conviction Traumatic Stress in People Required to Register as Sex Offenders and their Families.

Post-Conviction Traumatic Stress (PCTS) describes the cognitive, psychological, and physiological symptoms of trauma that result from a range of experiences with the criminal justice system. This pilot study aimed to empirically validate the construct of PCTS utilizing the Post-Traumatic Checklist (PCL-5), an existing measure of Post-Traumatic Stress Disorder (PTSD) according to DSM-5 diagnostic criteria. Using mixed methods, the survey asked about the traumagenic impact of arrests, court proceedings, incarceration, probation/parole supervision, and sex offender registration requirements in a sample of people required to register as sexual offenders (RSOs; n = 290) and their family members (n = 126). The PCL-5 was used to estimate the prevalence of PTSD and to explore the unique presentation of symptoms. Findings indicated that 69% of registrants and 62% of family members reported clinically significant indicators of PTSD. Examples of specific symptom presentations are illustrated through qualitative responses. Implications for clinical treatment, policy, and future research related to PCTS are discussed.

Trauma-informed and affirmative mental health practices with LGBTQ+ clients.

People with diverse sexual orientations, gender identities, and gender expression are at greater risk for trauma, discrimination, and victimization than heterosexual and cisgender populations. Trauma-informed care (TIC) provides a framework for providing lesbian, gay, bisexual, transgender, queer/questioning (LGBTQ +) mental health services. Substance Abuse and Mental Health Services Administration (SAMHSA)'s principles of TIC guide practitioners to create safety, trust, transparency, collaboration, and empowerment in helping relationships, and to ensure that services have cultural and gender relevance. This article first explores the role of trauma in contributing to behavioral health concerns presented by LGBTQ + clients. The application of TIC to mental health counseling and social services for LGBTQ + clients will then be described, with specific suggestions for translating TIC principles into affirmative practice. Through the lens of trauma, clinicians can improve clinical case conceptualization and effective treatment strategies for LGBTQ + clients. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Exploring Risk for Sexual Recidivism and Treatment Responsivity Through the Lens of Early Trauma.

Adverse childhood experiences (ACE) are common in the histories of individuals who have sexually offended. Many risk factors for sexual recidivism resemble symptoms of early trauma, and early trauma may present a responsivity barrier to engagement in offense-focused treatment. Using the ACE scale, the current study aimed to (i) examine relationships between ACE scores and static and dynamic risk assessment scores, (ii) examine whether ACE scores differ between treatment completers versus noncompleters, and finally (iii) examine whether ACE scores predict treatment noncompletion. ACE scores were retrospectively coded from files of adult men receiving community-based assessment and/or treatment in New Zealand for sexual offenses against children (N = 491; n = 185-411 for individual analyses). Although effect sizes were generally small, static risk and general self-regulation dynamic risk factors correlated positively with ACE scores, ACE scores were higher for treatment noncompleters versus completers, and higher dynamic risk assessment scores and ACE scores increased the odds of treatment noncompletion. Implications for future research and enhancing treatment responsivity are discussed.

Adverse Childhood Experiences Among Sexual Offenders: Associations With Sexual Recidivism Risk and Psychopathology.

Adverse childhood experiences (ACEs) are increasingly recognized as a public health crisis. Cumulative effects of these experiences lead to a wide range of deleterious physical and psychological outcomes. Prior research has identified higher prevalence rates of ACEs and increased criminal behavior in samples of individuals who have committed sexual offenses. In a sample of civilly committed individuals who have committed sexual offenses (N = 317), we examined the prevalence of ACEs (cumulative scores and the two components of child harm and family dysfunction) and their association with risk for sexual recidivism and adult psychopathology. ACEs were much more prevalent in this sample compared with the general population and to lower risk samples of individuals who had committed sexual offenses. Although ACE scores were unrelated to risk for sexual recidivism, higher ACE scores were associated with increased risk of psychopathology, including anxiety disorders, depressive disorders, substance use disorders, and Antisocial Personality Disorder. ACEs related to family dysfunction were uniquely associated with Alcohol Use Disorder and the presence of a dual diagnosis of a paraphilia and personality disorder. Results suggest that higher risk individuals who commit sexual offenses may have greater need for trauma-informed models of care that recognize the effect of these experiences on their mental health and offense-related behavior.

Do Views on Sex Offending Vary by Nationality? A Comparative Analysis of Community Sentiment Toward Sex Offense Legislation in the United States and United Kingdom.

Much attention has been paid to the examination of community sentiment regarding convicted sex offenders and the policy that governs these offenders' behavior. This literature, however, has largely been absent of international comparisons of sex offender community sentiment. The current study seeks to fill this gap by drawing from the results of surveys (n = 333) conducted in both the United States (US) and the United Kingdom (UK). Results indicate that sex offender policy is generally supported in both the US and the UK. Contrary to our expectations, we found that participants from the UK were less tolerant of sex offenders residing in their neighborhoods than participants from the US. Additionally, there is support for the notion that sex offender policy holds a symbolic value for both study locations. Theoretical and practical implications of these findings are discussed.

Preventing Sexual Abuse: Perspectives of Minor-Attracted Persons About Seeking Help.

The primary aim of this exploratory research was to gain information from minor-attracted persons (MAPs) about their (a) formal and informal experiences with help-seeking for minor attraction, (b) perceived barriers to seeking help for concerns about minor attraction, and (c) treatment priorities as identified by consumers of these services. A nonrandom, purposive sample of MAPs (n = 293, 154 completed all questions) was recruited via an online survey. Results show that 75% of participants did seek formal help from a professional; however, just less than half of them found the experience to be helpful. Characteristics of helpful therapeutic encounters included nonjudgmental attitudes, knowledge about minor attraction, and viewing clients in a person-centered and holistic way. Barriers to help seeking included uncertainty about confidentiality, fear of negative reaction or judgment, difficulties finding a therapist knowledgeable about MAPs, and financial constraints. Understanding or reducing attraction to minors were common treatment goals, but participants also prioritized addressing general mental health and well-being related to depression, anxiety, loneliness, and low self-esteem. Implications for effective and ethical counseling and preventive interventions for MAPs are discussed.

Sex Offender Management Policies and Evidence-Based Recommendations for Registry Reform.

PURPOSE OF REVIEW: The goal of this paper is to improve evidence-based sex offender management systems through an understanding of the research findings related to the stated goals and unintended consequences of such laws. RECENT FINDINGS: Assessment tools using factors derived from research studies can improve the identification of higher-risk sex offenders, so that more intensive or restrictive interventions can be tailored to those who pose the highest threat to community safety. After substantial time offense-free in the community, even higher-risk offenders become less likely to reoffend, suggesting that registration durations can be modified to utilize resources more efficiently. Several strategies for applying the evidence base to inform the utility, efficiency, and cost-effectiveness of sex offender policies include (1) use of empirically derived risk assessment tools to classify offenders and modify registration requirements accordingly, (2) removal of juveniles from registries; and (3) elimination of residence restrictions.

Obstacles to Help-Seeking for Sexual Offenders: Implications for Prevention of Sexual Abuse.

Persons with potentially harmful sexual interests such as attraction to minors are unlikely to seek or receive treatment before a sexual offense has been committed. The current study explored barriers to help-seeking in a sample of 372 individuals in treatment for sexual offending. Results revealed that the shame and secrecy resulting from stigma associated with pedophilic interests often prevented our respondents from seeking professional counseling, and only about 20% tried to talk to anyone about their sexual interests prior to their arrest. Barriers to seeking and receiving psychological services included concerns about confidentiality, fears of social and legal consequences, personal shame or confusion about the problem, affordability, and challenges finding competent therapists who were adequately equipped to help them. Understanding and ultimately reducing obstacles to help-seeking can improve the quality of life for people with harmful sexual interests and potentially prevent sexual abuse of children or other vulnerable individuals.

Linking Adverse Childhood Effects and Attachment: A Theory of Etiology for Sexual Offending.

Sexual violence continues to be a significant public health problem affecting significant portions of the population. Unfortunately, an agreed upon theory of etiology remains elusive leading to challenges in developing effective prevention and treatment interventions. Recently, there is a growing body of literature examining the role of adverse childhood experiences (ACEs) in the development of sexually violent behavior. This research has begun to explore the rates of various types of child maltreatments and family dysfunction in individuals who have been convicted of a sexual crime. These empirical inquiries have been primarily descriptive in nature and have not yet provided a cohesive theoretical model as to why the presence of ACEs might contribute to sexually abusive behavior. This article suggests that attachment theory offers an explanatory link between early adversity and sexually abusive behavior in adulthood. We first summarize important attachment theory concepts, then integrate them with research in the area of developmental psychopathology and ACEs, and finally propose a model by which attachment can be used as an explanatory theory for subsequent sexualized coping and sexually abusive behaviors. Finally, this article explores the implications for practice, policy, and research using this explanatory theory as a framework for understanding sexual violence.

The impact of trauma on the onset of mental health symptoms, aggression, and criminal behavior in an inpatient psychiatric sample.

Experiences of trauma and maltreatment are frequent predictors of poor physical and mental health outcomes in adulthood. Existing literature also suggests an impact of developmental adversity on criminality and aggressive behavior, though little research exists describing the effects of cumulative adversity in forensic mental health samples. In the current study of 381 forensic mental health inpatients, rates of trauma, neglect, and parental substance abuse are reported in comparison with community norms. Cumulative adversity and the occurrence of foster care placement are examined via linear and logistic regression analyses in relation to age at first arrest, first psychiatric hospitalization, and onset of aggression, as well as history of suicide attempts and non-suicidal self-injury. Results revealed that experiences of developmental adversity were more common among participants than have been reported in community samples using the ACE survey, and that there were differential effects of gender on the prevalence of traumas experienced. Cumulative adversity scores were significantly associated with all outcomes, though the addition of foster care placement to the model significantly contributed to understanding outcomes, and in some cases, removed the effect of cumulative adversity. Implications and direction for future study are discussed.

Adverse Childhood Experiences in the Lives of Male Sex Offenders: Implications for Trauma-Informed Care.

This study explored the prevalence of childhood trauma in a sample of male sexual offenders (N = 679) using the Adverse Childhood Experience (ACE) scale. Compared with males in the general population, sex offenders had more than 3 times the odds of child sexual abuse (CSA), nearly twice the odds of physical abuse, 13 times the odds of verbal abuse, and more than 4 times the odds of emotional neglect and coming from a broken home. Less than 16% endorsed zero ACEs and nearly half endorsed four or more. Multiple maltreatments often co-occurred with other types of household dysfunction, suggesting that many sex offenders were raised within a disordered social environment. Higher ACE scores were associated with higher risk scores. By enhancing our understanding of the frequency and correlates of early adverse experiences, we can better devise trauma-informed interventions that respond to the clinical needs of sex offender clients.

Adverse Childhood Experiences and Arrest Patterns in a Sample of Sexual Offenders.

Developmental psychopathology theories suggest that childhood adversity can contribute to antisocial conduct and delinquent activities. The purpose of this study was to explore the influence of adverse childhood experiences (ACE) on arrest patterns in a sample of sexual offenders (N = 740). Higher ACE scores were associated with a variety of arrest outcomes, indicating that the accumulation of early trauma increased the likelihood of versatility and persistence of criminal behavior. Rapists of adults had higher ACE scores, lower levels of specialization, and higher levels of persistence than sex offenders with minor victims only. Child sexual abuse, emotional neglect, and domestic violence in the childhood home were significant predictors of a higher number of sex crime arrests. For measures of nonsexual arrests and criminal versatility, it was the household dysfunction factors-substance abuse, unmarried parents, and incarceration of a family member-that were predictive, suggesting that family dysfunction and a chaotic home environment contributed significantly to increased risk of general criminal behavior. Sex offenders inspire little sympathy in our society but may be among those most in need of trauma-informed models of treatment that recognize the influence of early adversity on maladaptive schema and self-regulation deficits related to criminal behavior.

Community Protection Policies and Repeat Sexual Offenses in Florida.

The purpose of this study was to investigate the impact of sexual offender management policies on sex crime repeat arrest rates in Florida. Aggregate data for the period 1990 to 2010 were provided by the Florida Department of Law Enforcement. The repeat offense rate was defined as the proportion of arrests each year that were committed by individuals with a previous conviction in the same crime category. The average yearly repeat offense rate for sex crimes was 6.5%, which was consistently and significantly lower than rates for other crimes: 8.3% for non-sex assaults, 15.1% for robbery, 29.8% for drug offenses, and 11.6% for DUI. The average annual sexual repeat arrest rate prior to and after the implementation of sexual offender registration laws in 1997 was 4.9% and 7.5%, respectively, indicating a statistically significant increase. The average annual repeat arrest rates for non-sex assaults, robberies, drug crimes, and DUIs also increased after 1997. No significant differences were found when comparing the average annual percent change for sexual re-arrest (+3.47%) with non-sexual assault (+3.93%), robbery (-.73%), drug offenses (+1.59%), and DUI (+1.14). Sex crime repeat arrests in Florida do not appear to show a decline attributable to sex offender management policies implemented since 1997.

Adverse childhood experiences in the lives of female sex offenders.

This study explored the prevalence of early trauma in a sample of U.S. female sexual offenders (N = 47) using the Adverse Childhood Experiences (ACE) scale. Compared with females in the general population, sex offenders had more than three times the odds of child sexual abuse, four times the odds of verbal abuse, and more than three times the odds of emotional neglect and having an incarcerated family member. Half of the female sex offenders had been sexually abused as a child. Only 20% endorsed zero adverse childhood experiences (compared with 35% of the general female population) and 41% endorsed four or more (compared with 15% of the general female population). Higher ACE scores were associated with having younger victims. Multiple maltreatments often co-occurred in households with other types of dysfunction, suggesting that many female sex offenders were raised within a disordered social environment by adults with problems of their own who were ill-equipped to protect their daughters from harm. By enhancing our understanding of the frequency and correlates of early adverse experiences, we can better devise trauma-informed interventions that respond to the clinical needs of female sex offender clients.

"Brothers Under the Bridge": Factors Influencing the Transience of Registered Sex Offenders in Florida.

The transience of registered sex offenders (RSOs) is a major impediment to reentry success, particularly because it has been linked to increased absconding and recidivism, and thus decreased community safety. Unfortunately, there is limited existing research on what factors most influence this transience. The purpose of this study was to identify and explore the relative influence of factors predicting transience for RSOs. Using data gathered from the Florida sex offender registry and multiple supplemental state and federal data sources, the analysis revealed a number of county- and individual-level characteristics that are associated with the likelihood of RSO transience. At the county level, these include residence restriction coverage, housing affordability, and population density. At the individual level, these include age, minority status, victim type (minor vs. adult), risk level, supervision status, and prior failure to register convictions. Implications for policy and practice are discussed.

A consumer satisfaction survey of civilly committed sex offenders in Illinois.

The purpose of this study was to obtain feedback from civilly committed sex offenders (N = 113) about the components of treatment that they believed to be most important and helpful in preventing reoffense. Participants were also asked to rate their satisfaction with the treatment process and therapists. Victim empathy and accountability were rated as the most important elements of treatment, along with skills for preventing relapse and methods for controlling sexual arousal. There was a fairly robust correlation between client perceptions of importance and satisfaction on most treatment components. Some clients expressed concerns about respect, confidentiality, and judgmental attitudes of some therapists. Because civilly committed sex offenders are considered to be among the most likely to reoffend, strategies are discussed for engagement of this population in a meaningful process of change.

Catch me if you can: an analysis of fugitive sex offenders.

The presumed dangers presented by sex offenders who have absconded from authorities have played a prominent role in public discourse surrounding state and federal sex offender management policy. The current study is the first to empirically investigate the characteristics of absconded sex offenders and explore how this group compares to other groups of sex offenders. Utilizing data from the Florida sex offender registry (N = 23,557), this exploratory study compares the characteristics and risk factors of absconders with those of compliant and noncompliant (nonabsconding) registrants as well as with those with convictions for failure to register (FTR). Absconders, as a group, were less likely than compliant registrants to be listed as predators, and less likely than both compliants and noncompliants to have a minor victim or to be a repeat sex offender. Absconders were also least likely to have a prior FTR conviction, but those with a previous FTR conviction were more likely to abscond from registration than probation. The findings fail to support the hypothesis that fugitive sex offenders are more sexually dangerous (especially to children), and suggest a multitude of explanations for absconding.

The good lives model (GLM): an evaluation of GLM operationalization in North American treatment programs.

The good lives model (GLM) has become an increasingly popular theoretical framework underpinning sex offender treatment programs, and preliminary research suggests that the GLM may enhance the efficacy of programs that adhere to the Risk, Need, and Responsivity (RNR) principles. However, this potential rests on the appropriate operationalization of the GLM in practice. Operationalized appropriately, the GLM aims to facilitate risk reduction alongside equipping clients with the tools to live personally meaningful and fulfilling lives. However, misguided operationalization of the GLM could result in ineffective treatment and ultimately higher rates of reoffending. This article presents findings from a multisite study exploring how the GLM has been operationalized and the degree to which the GLM has been integrated in a sample of 13 North American treatment programs. A comprehensive coding protocol was developed that included items related to program aims and client induction/orientation, assessment, intervention planning, intervention content, and intervention delivery. Each site was visited and items were rated through a review of program documentation, interviews with program directors/managers, and observations of treatment groups. Findings from inductive (how the GLM was operationalized) and deductive (the extent to which the GLM was integrated) analyses are presented and GLM consistent and inconsistent practices are highlighted. The article concludes with suggestions for ways in which program responsiveness to the GLM could be enhanced.

Failure-to-register laws and public safety: an examination of risk factors and sex offense recidivism.

The goals of this study were to describe the characteristics of a sample of sex offenders charged with failure to register (FTR) in New York State, compare the FTR and non-FTR groups on relevant risk factors, identify risk factors associated with failing to register, and investigate the relationship between registration noncompliance and both general and sexual rearrest. FTR offenders were found to be younger, more likely to be a minority race, and have more extensive and varied prior criminal histories as well as a record of supervision violations. Results also indicated that FTR was more strongly correlated with nonsexual recidivism (r = .44) than sexual recidivism (r = .09). FTR contributed to the likelihood of sexual recidivism for rapists of adult victims, but not for sex offenders with child victims, and occurred in combination with a history of prior sexual crimes and versatility in criminal offending.