Are Sex Offender Treatment Programmes (SOTPs) effective?

Question

Background to my question on SOTPs

NOMS is the UKs National Offender Management Service, which is now called Her Majesty’s Prison and Probation Service.

If you look at the UKs official website on Offender Behaviour Progammes (OBPs) run by Her Majesty’s Ministry of Justice, it states

There is growing international evidence that the type of cognitive-behavioural techniques that NOMS accredited programmes apply are the most effective in reducing offending behaviour; evidence Fact Sheets are available from Interventions Unit.

Trying to find these fact sheets is difficult, but a document titled Suitability for Accredited Interventions (NOMS, 2010) has the following on page 5.

A number of offenders are either diagnosed with Personality Disorder or present complex needs linked to their risk. The degree of complexity may prevent them from engaging fully with a shorter programme or may make shorter interventions inadequate. In this instance, a referral should be considered for a Democratic Therapeutic Community (DTC).

Participation in a DTC can occur at any point during the sentence, depending on the needs of the offender. Some will benefit from completing shorter programmes, such as ETS/TSP first to support responsivity and engagement in the DTC. Other offenders may find the therapeutic community approach can prepare and support participation in future high-intensity offence-focussed interventions, if applicable. DTCs currently exist in the Category B and C closed prison estate.

Further information on DTCs can be found at Appendix D.

Appendix B (Page 45) covers all the tyes of SOTP in detail

Appendix D (Page 65) states

Democratic Therapeutic Communities (DTCs) (Custody)

Democratic TCs provide a living-learning intervention for offenders whose primary criminogenic risk factors need to be targeted whilst simultaneously addressing psychological and emotional disturbance.

This is followed by details of the risk assessments required, including a

Sexual Offences Attitude Questionnaire (Hogue & OBPU) (for male sex offenders only)

and the questionnaire

can be used independent of whether the victim or victims were male or female, adult or child. (Hogue, 1994)

My Question

Apart from what I mentioned above, I found the following:

• a study (Wakeling, et al., 2007) covering UK SOTPs by evaluating participants’ experiences using both qualitative and quantitative methods.
  
  The authors state that

  SOTP staff from the establishments conducted the interviews, most of whom were involved within treatment delivery. Participants’ responses may therefore have been more positive than they would have been if an independent party had interviewed them.

• Beech, et. al. (1998) again used offender questionnaires!

  Two approaches were used to evaluate treatment impact. The first approach examined the extent to which treated child abusers showed statistically significant changes in their levels of denial, pro-offending attitudes, and social competency/acceptance of accountability. Using this approach it was found that both shorter (80 hours) and longer treatment groups (160 hours) were effective in producing statistically significant reductions in these areas
  
  The second, and more sophisticated, analysis considered to what extent the child abusers had, by the end of treatment, a ‘treated’ profile.

Are there any studies which evaluated effectiveness using data on reoffending rates?

A study on Californian programmes (Marques, et al. 2005) states that:

The study was a randomized clinical trial that compared the reoffense rates of offenders treated in an inpatient relapse prevention (RP) program with the rates of offenders in two (untreated) prison control groups. No significant differences were found among the three groups in their rates of sexual or violent reoffending over an 8-year follow-up period.

Has there been any further evaluation, and is this the same with the UK SOTPs and the rest of the US?

References

Beech, A. et al. (1998). Evaluation of a National Prison-based Treatment Program for Sexual Offenders in England and Wales. Journal of Interpersonal Violence 18(7), 744—59
DOI: 10.1177/0886260503253236

Hogue, T. (1994). Sexual offence information questionnaire: assessment of sexual offenders' perceptions of responsibility, empathy and control. In: Rights and Risks: the application of forensic psychology. British Psychological Society, Leicester, pp. 68-75
Abstract available only - PDF RESTRICTED to Repository Staff, University of Lincoln
http://eprints.lincoln.ac.uk/2844/

Marques, J.K. et al. (2005) Effects of a Relapse Prevention Program on Sexual Recidivism: Final Results From California’s Sex Offender Treatment and Evaluation Project (SOTEP). Sexual Abuse: A Journal of Research and Treatment 17(1), 79–107
DOI: 10.1007/s11194-005-1212-x

NOMS. (2010). Suitability for Accredited Interventions [Word Document]
Available at: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/259175/annex-sotp-programmes.doc

Wakeling, H. et al. (2007) Sexual offenders' treatment experience: A qualitative and quantitative investigation. Journal of Sexual Aggression 11(2), 171—186
DOI: 10.1080/13552600412331321323

Answer 1

Short answer

Sex offending is high in the public consciousness, but people should know that the treatments offenders receive in prisons and secure hospitals lack evidence of efficacy (Ho, 2015), and ineffective treatment of sex offenders fails victims as a recent report (Mews, Bella & Purver, 2017) highlights worse risk rather than lower after treatment.

Long Answer

The recent widespread publicity surrounding well known public figures who have been accused or convicted of sex offenses^{examples: [1][2][3]} has indelibly etched sex offending into the UK public’s consciousness. Sex offending is not a new phenomenon. However, what is new is the revelation of these offenders’ profiles, their positions of influence, and the sheer number and duration of these offenses, which were perpetrated and undetected for so long. Even though many high profile cases have been classed as “historical offenses” many victims still experience consequences (Ho, 2015).

The Sex Offender Treatment Programme (SOTP) is the standard psychological talking therapy used in prisons and secure psychiatric hospitals in England and Wales since 1991. Mostly in groups, offenders follow a syllabus (Ho, 2015) that includes discussions about healthy relationships, triggers for sex offending, thinking styles, effects on victims, emotional management, and intimacy skills. The “core” group meets for six months (86 group sessions) and the “extended” group for an additional four months. After these sessions, if offenders have kept out of trouble they stand a better chance of early release from prison. Certainly, parole board hearings place some weight on offenders having completed “treatment” when considering whether to release them on licence.

In response to David Ho's review paper, Dr. Jamie Walton, employed in HM Prison Service and a current Treatment Manager of the Core Sex Offender Treatment Programme (SOTP) within a regional Treatment Management team at the time, said:

We believe that Ho’s conclusion is premature. Claiming that treatment is ineffective in the absence of consistent high quality evidence to support such a claim does not accurately convey the state of affairs in the field. Only through increasing the rigor of studies in the field together with efforts to identify the influence of residual bias on outcomes of interest can progress occur.
(Source: BMJ Rapid Responses)

No evidence from academic or policy research has shown that the treatment programme significantly reduces sexual reoffending (Dennis, et al. 2012; Lösel & Schmucker. 2005; Ho & Ross. 2012). Also, there was a damning report put together by HM Ministry of Justice Analytical Services (Mews, Bella & Purver, 2017), which highlighted that sexual reoffending rates are 2% higher after SOTP treatment and Child image reoffending rates are 1.6% higher indicating worse risk rather than lower after treatment:

The binary reoffending rates²³ over an average 8.2 year follow up period were mostly similar between the matched treatment and comparison groups (see Table A.8, parsimonious model²⁴). The only statistically significant differences emerged on the following outcomes:²⁵

• Sexual reoffending:²⁶ the reoffending rate for the treatment group was 2.0pp higher than the matched comparison group (10.0% vs. 8.0%);
• Child image reoffending: the reoffending rate for the treatment group was 1.6pp higher (4.4% vs. 2.9%).

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²³ Proportion of offenders who committed at least one reoffence during the follow-up period
²⁴ See Annex C for a description of the methods used to develop the parsimonious and less parsimonious models.
²⁵ Propensity score matching was performed in Stata with psmatch2 (Leuven and Sianesi, 2003). Although the statistical significance calculations in psmatch2 do not take account of the fact that the propensity scores themselves are estimated, very similar results were obtained using 95% CIs generated by bootstrapping, which does take account of propensity score estimation.
²⁶ Unless otherwise stated, the sexual reoffending measure used in this report includes all sexual offences except breaches

The frequency of reoffending²⁷ outcomes were also mostly equivalent between the matched groups (see Table A.9, parsimonious model), with statistically significant differences emerging only for:

• Sexual reoffending: the matched treatment group had 0.15 more reoffences per offender than the matched comparison group (0.59 vs. 0.45).
• Adult other: the matched treatment group had 0.02 more reoffences per offender than the matched comparison group (0.04 vs. 0.02).
• Non-sexual: the matched treatment group had 0.27 fewer reoffences per offender than the matched comparison group (0.98 vs. 1.25).
• Non-sexual non-violent: the matched treatment group had 0.27 fewer reoffences per offender than the matched comparison group (0.92 vs. 1.19). This seems to ‘drive’ the above difference in the overall non-sexual frequency of reoffending.

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²⁷ The number of reoffences per offender during the follow-up period.

More can be found in:

Forde, R. A. (2017). Bad Psychology: How Forensic Psychology Left Science Behind. Jessica Kingsley Publishers.

References

Dennis, J. A. & Khan, O., Ferriter, M., Huband, N., Powney, M. J. & Duggan, C. (2012). Psychological interventions for adults who have sexually offended or are at risk of offending. Cochrane Database of Systematic Reviews 12(1).
DOI: 10.1002/14651858.CD007507.pub2

Ho, D. K. (2015). Ineffective treatment of sex offenders fails victims. British Medical Journal 350.
DOI: 10.1136/bmj.h199 PMID: 25627560

Ho, D. K. & Ross, C. C. Cognitive behaviour therapy for sex offenders: too good to be true? Criminal Behaviour and Mental Health 22(1), 1—6.
DOI: 10.1002/cbm.1818

Lösel, F. & Schmucker, M. (2005).The effectiveness of treatment for sexual offenders: a comprehensive meta-analysis. Journal of Experimental Criminology 1(1), 117—46.
DOI: 10.1007/s11292-004-6466-7

Mews, A. Bella, L. D. & Purver, M. (2017). Impact evaluation of the prison-based Core Sex Offender Treatment Programme [Free PDF]
Available at: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/623877/sotp-report-print.pdf