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Risk Assessment and Management of Serious Violent and Sexual Offenders: A review of current issues

CHAPTER FIVE: RISK MANAGEMENT OF SEXUAL AND VIOLENT OFFENDERS

5.1 The supervision of high-risk persons in the community is one of the most complex and difficult task facing criminal justice personnel at the present time. Certainly it is one where the credibility and effectiveness of criminal justice agencies is harshly measured, particularly in the light of serious incidents and risk management failures. However, the effective risk management of offenders is seen as central to public protection through the prevention or reduction of harmful behaviours (Home Office, 1997b; MacLean 2000).

5.2 Whilst risks cannot necessarily be prevented risks can be reduced (Laws, 1996; Ryan, 1996). Risk management should therefore be understood as risk reduction rather than prevention, that is, reducing:

• the factors which lead to risks occurring; or
• the impact of the risk once it has occurred.

5.3 This approach is more commonly known as 'harm reduction' (Laws 1996) and is widely used in the treatment of drugs and alcohol abuse. The key principle of harm reduction is that reduction in the frequency of harmful behaviours is a gain, as this reduces the number of victims, and, that any positive change in harmful behaviours will lessen the impact of such behaviours on others.

5.4 In addition, risk management plans should be proportionate to the risks assessed, involving transparent and accountable decisions, particularly about levels of restriction, control and intrusion on individual offenders. Such requirements are likely to be key features in ensuring that risk management plans are compliant with Human Rights legislation.

5.5 The chapter will cover the following areas:

• Intervention programmes.
• Intensive risk management strategies of community control using supervision, monitoring, surveillance, and enforcement.

INTERVENTION PROGRAMMES

5.6 These are defined as programmes designed to assist offenders to change their criminal behaviour through control and/or management of thinking patterns, feelings, drives and attitudes (SWSIS 1997: 34). Programmes may use a range of methods, but in practice have been based upon intensive cognitive-behavioural methods delivered both residentially (for example in custody) and within the community (Vennard and Hedderman, 1998).

Sex offenders

5.7 Beckett's survey of cognitive-behavioural programmes for sex offenders found that most programmes focused on four main areas:

• Changing patterns of deviant sexual arousal;
• Correcting distorted thinking and educating offenders in the 'cycle of abuse';
• Educating offenders about the effects and impact of abuse; and,
• Increasing social competence.
  (Beckett, 1994).

5.8 Proctor's study for the Association of Chief Officers of Probation in England and Wales found that probation programmes also contained the following key elements:

• Victim empathy;
• Controlling sexual arousal;
• Reducing denial; and,
• Improving family relationships.
  (Proctor 1996).

5.9 Grubin and Thornton (1994) found that the most effective treatments used cognitive behavioural techniques, utilising relapse prevention and the promotion of pro-social thoughts, feeling and attitudes. However, evaluation of programmes has been plagued by small numbers, variation in programme objectives and content, diverse offender and offence types in programmes, and differences in severity of offending (Quinsey et al 1993). Notwithstanding such difficulties, both evaluative studies (Barbaree, 1997; Barker and Morgan, 1993; Marshall and Barbaree, 1988; Marshall et al, 1991; Marshall et al, 1999) and meta-analysis (Hall, 1995; Nagayama Hall, 1995) have indicated that cognitive-behavioural programmes are the most promising, particularly for non-familial child molesters. Nagayama Hall's meta-analysis of twelve studies found that cognitive-behavioural treatments and hormonal treatments were significantly more effective than behavioural treatment alone, although not significantly different from one another. However, cognitive-behavioural treatment enjoyed better compliance rates than hormonal treatments (p.807). The effectiveness of treatment programmes with sex offending against children is less clear (Grubin 1998), and Hanson and Bussiere (1998) found that those who dropped out of such problems were more likely to reoffend. This reinforces that the appropriate use of sanctions and treatment compliance are essential to the success of such programmes (Kemshall 2001) coupled with long-term support and reinforcement (Powis 2002).

5.10 Based on these studies, and more recent evaluations such as Hedderman and Sugg's study for the Home Office (1996), Beckett et al (1994) on seven treatment programmes, and Beech et al's evaluation of the prison sex offender treatment programme (1999), it is possible to conclude that cognitive-behavioural methods have a growing track-record of effectiveness with sex offenders. The following limited conclusions can be drawn:

• Overall, cognitive-behavioural programmes can have a positive effect on offenders' attitudes and recidivism rates. This is supported by the Home Office longitudinal study limited to child sex offenders (Hedderman and Sugg, 1996; Beckett et al., 1994, Beech et al., 1999);
• Amenability to treatment is important. Certain patterns of sex offending are more difficult to treat than others. For example, serious and well-established behaviours involving penetrative sex and violence (e.g. rape) are less amenable to treatment (Waterhouse et al, 1994). Waterhouse et al, (1994) therefore suggested the following factors are significant in establishing treatability:
  • the nature of the offence;
  • the acceptance of responsibility by the offender;
  • the motivation to change by the offender; and,
  • the type of offender.
    (adapted from A Commitment to Protect 1997) ¹².
• Timing of interventions can be crucial. Beckett et al, (1994) have argued that intensive challenge during 'denial' can be counter-productive as this reduces the likelihood of establishing victim empathy. They noted that improvement required a significant therapeutic input, and that 25 per cent of the offenders actually got worse in terms of victim empathy. They attributed this to the early timing of the work before offenders had come to terms with the consequences of their actions. In this climate of challenge to their activities, offenders developed a strategy of blaming victims in order to cope with confrontation.
• Programme integrity is also important. In a small-scale assessment of a community-based treatment programme for sex offenders, Allam (1998) found that programmes must be delivered as specified and that skills for offender self-risk management and relapse prevention are often inadequate when an offender leaves the programme. However, the majority of sex offenders did improve with treatment.
• Treatment is less successful for those who have committed violent penetrative sexual offences (Kemshall 2001).

5.11 The more recent evaluation of the prison Sex Offender Treatment Programme (SOTP) (Beech et al, 1999) supports the view that cognitive-behavioural treatments are particularly effective with child abusers. Four main areas were subject to psychometric testing before and after treatment: denial/admittance of sexual deviance and offending; pro-offending attitudes; predisposing personality factors; relapse prevention skills (p.6). The impact of treatment upon denial and deviancy levels was analysed with greater effectiveness for low deviancy/low denial men (59% showing an overall treatment effect and 84% showing a significant reduction in pro-offending attitudes); low deviancy and high denial men were less successful (17% showing an overall treatment effect and 71% showing a significant reduction in pro-offending attitudes); high deviancy and high denial were the least successful (with 14% showing an overall treatment effect with 43 % showing a significant reduction in pro-offending attitudes) (p.7). The study also showed that the longer 160-hour programme was more effective. Whilst some prisoners have since been followed up in the community, it is too early for longer-term evaluation, based upon reconviction rates.

5.12 Social stigma, social exclusion and the challenges presented by the resettlement of sex offenders particularly post-release have resulted in the recent initiative 'Circles of Support' originally imported from the USA via the Wolvercote specialist clinic in England. In brief, the initiative recognises that many sex offenders are social isolates and provides a 'circle' of supportive people to whom the offender can turn once released from either prison or a treatment centre. Such circles are made up of volunteers with whom the offender will have significant contact (in effect they act as mentors), and such volunteers are trained to provide relapse prevention and to identify warning signals for risky behaviour. They will also inform the statutory authorities if the risky behaviour warrants it. At present there are two pilot schemes in the UK and long-term evaluation of the initiative is awaited.

Violent offenders

5.13 The evaluation of risk management strategies for violent offenders is also restricted by the low volume of outcome studies and by the severe ethical and methodological difficulties in constructing control groups. Studies have mostly occurred within psychiatric residential hospitals (Rice, 1997; Rice et al, 1992; Webster et al, 1995), or the case management of mentally ill persons in the community (Dvoskin and Steadman, 1994) or the evaluation of domestic violence programmes (Dobash et al, 1999). Rice's study of interventions in a mental health hospital has also suggested that some interventions can have unintended consequences, for example the exacerbation of violence amongst psychopaths. Rice contended that this negative outcome was due to treatment raising their self-esteem and thus fuelling their aggression. In addition, psychopaths tended to be 'false compliers', learning to fake empathy and deceive others (Harris et al, 1994). This strongly indicates that risk management interventions must be well matched to the risk of violence presented and the offender group in question.

5.14 Cognitive-behavioural methods have achieved growing success and have two objectives: to change the violent cognitions of the individual and to change violent behaviour (Browne and Howells, 1996; Hollin, 1993). Anger management programmes have been developed to address cognitions (Howells 1989), and social learning and problem solving programmes to address the latter. Whilst there has been some limited evaluation of success (Glick and Goldstein, 1987), Browne and Howells (1996) concluded that whilst 'Controlled outcome studies to date are encouraging…few studies have been conducted in which serious violence itself has been the outcome measure' (p.205-206).

5.15 More recently the 'cognitive restructuring' and the skills training pioneered by Glick and Goldstein has been incorporated into an intensive Cognitive Self-Change programme for violent men piloted and evaluated in Vermont, Canada (Bush, 1995). The programme targets the:

• Distorted cognitions of violent offenders;
• Deconstructs the 'anti-social logic' of offenders, particularly the logic of self-justification (the 'victim stance') for violence and victim blaming;
• Reinforcement and reward for violent behaviour;
• Promotion of alternative/pro-social thinking patterns; and,
• Teaching problem solving skills.
  (Bush, 1995: 142-148).

5.16 The follow-up evaluation has tracked offenders from 1988 and has compared the recidivism rates of those who completed the programme and those who did not (recidivism is defined broadly as any accusation as opposed to conviction). The differences in recidivism rates are statistically significant, with 45.5 per cent of those experiencing the programme presenting with a new accusation after three years as compared to 76.6 per cent who had not experienced the programme (p.152-153). In the UK violent offender programmes based on cognitive-behavioural methods are being used in prisons and probation, and are subject to development and evaluation under the Home Office 'Pathfinder' programme in England and Wales.

5.17 An important feature of the programme is its integration into a broader risk management strategy, which emphasises intensive supervision comprising: surveillance, alcohol and drug testing, reincarceration for any violations, and high enforcement of rules and requirements. These features of risk management will be discussed in the next section.

COMMUNITY RISK MANAGEMENT: SUPERVISION, MONITORING, SURVEILLANCE AND ENFORCEMENT

5.18 The Vermont programme importantly recognises that the promotion of offender internal controls needs to be balanced with the implementation of external controls. Key features of the system are early response to signs of relapse (such as failure to attend appointments) and systematic monitoring of progress including behaviour checks and the use of self-report on activities and thinking patterns. Treatment interventions and control are integrated into a broader risk management strategy, in which the supervisor is responsible for co-ordinating the strategy, ensuring appropriate monitoring and surveillance, and action to enforce conditions and controls as appropriate.

5.19 In addition, some offenders are not amenable to treatment, or their motivation to comply with treatments/programmes remains low. In these cases, high levels of community control may be the only risk management option coupled with strict enforcement of any conditions and the appropriate use of sanctions (such as parole recall or returns to court for violations of community penalties) (HMIP, 1998b)

5.20 Similar risk management strategies exist for high-risk sex offenders, such as the Sexually Violent Predator programme in Phoenix, Arizona (MacLean, 2000). In addition to a therapeutic component, such programmes emphasise:

• Strong incentives for individuals to manage their own behaviour;
• Strong incentives to attend and comply with therapy/programmes;
• A thorough system of supervision with regular re-assessment;
• Clear boundaries for acceptable behaviour and enforcement; and
• Integrated management of custody, therapy and community services.
  (From MacLean, 2000:59).

5.21 In a review of intensive case management for the reduction of violence by mentally ill persons in the community, Dvoskin and Steadman (1994) make a number of useful points which could also be applied to community case management of high-risk offenders. These include:

• regular monitoring is needed to note changes in and to take action on individual and situational factors which result in violence or sexual harm;
• offenders should be assisted in gaining insight into high-risk situations and to develop techniques for self-risk management;
• case management responsibility should be clearly vested in one person;
• there should be continuity of case management, both in terms of personnel and intervention strategies;
• there should be speedy access to support services (e.g. appropriate mental health care); and,
• there should be appropriate power and authority to limit risky behaviours and to enforce requirements which diminish risk (e.g. parole recall, breach of community orders).

5.22 In their report, Exercising constant vigilance: The role of the Probation Service in Protecting the Public from Sex Offenders (1998), Her Majesty's Inspector of Probation (HMIP) also stressed the importance of multi-agency co-operation, constant vigilance, monitoring and enforcement. A position reinforced in Scotland by the findings and recommendations of the Cosgrove Committee Reducing the Risk. The MacLean Committee also recommended that 'community services for high-risk offenders should develop techniques for intensive supervision and surveillance' in particular:

• use of electronic monitoring technology;
• regular unannounced and announced visiting;
• regular drug and alcohol testing;
• strict conditions, including as to the place of residence, and participation in treatment;
• a 'halfway house' offering semi-secure facilities and intensive treatment, (comparable to the 'less restrictive alternative' operated by the Arizona Community Protection and Treatment Centre); and
• rapid and predictable return to conditions of greater security in the event of non-compliance.
• 
  (MacLean Committee, 2000: Recommendation 45, page 60).

5.23 In addition, the importance of stable accommodation has been recognised (SWSIS 1997; MacLean 2000), particularly for sex offenders but for all high-risk offenders. Such provision requires a mixed range of accommodation, comprising specialist hostels, halfway houses, supported tenancies and intensive support to individual offenders both by the statutory services and initiatives like 'Circles of Support'.

5.24 Circles of Support was started by religious communities in America. In brief the initiative recognises that many sex offenders are social isolates and literally provides a circle of support in the community for the offender once released from prison or treatment centre. Such circles are made up of volunteers with whom the offender will have significant contact (for example church leaders and mentors), and in addition to social support the volunteers are trained to identify 'warning signals' of relapse as well as informing the statutory authorities should the offender's behaviour warrant it. At present there are two pilots in the UK and long-term evaluation is awaited.

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