Treatment for offenders with learning disabilities

1
Treatment for offenders with learning
disabilities

• Glynis Murphy, Tizard Centre, Kent Univ
  g.h.murphy_at_kent.ac.uk
• Alison Giraud-Saunders, Foundation for People
  with Learning Disabilities
• alisongs_at_btinternet.com

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Plan

• NOMS programmes
• Thinking Skills programme- Background- Process
  of negotiation with NOMS- State of play-
  Content of programme
• Sex offender programmes- Non-disabled disabled
  sex offenders- Treatment for non-disabled sex
  offenders- Treatment for sex offenders with
  learning disabilities

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NOMS programmes

• NOMS develops treatment programmes for people in
  prison and on probation
• Eg. Thinking Skills managing anger reducing
  substance misuse sex offending (SOTP)
• Very carefully vetted all developed in-house
• Accreditation system strict quality control
• BUT All programmes have IQ 80 cut-off
• Only widespread adapted programme is ASOTP
• Gill case made Ministry of Justice more aware
  motivated to solve problem

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Adapting delivery of the Thinking Skills Programme

• Alison Giraud-Saunders
• Foundation for People with Learning Disabilities
• www.learningdisabilities.org.uk

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• We promote the rights, quality of life and
  opportunities of people with learning
  disabilities and their families. We do this by
  working with people with learning disabilities,
  their families and those who support them

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Offending behaviour programmes
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Gaining entry for prisoners with learning
disabilities

• Inspired by No One Knows
• Glynis and Peter Oakes
• Proposal to DH
• Gill case
• Grant award April 2010

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Round and round.
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Negotiations with NOMS

• Adaptation delivery
• Evaluation feasibility
• Intellectual property
• Role of project worker

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The real start

• Project worker
• Training (project worker)
• Adapting
• Evaluation
• Theory
• Facilitator training

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Issues

• Theory based on WAIS
• Selection of participants WASI
• Fitting in with regime
• Accessibility vs programme integrity
• Volume of materials
• Measures of progress (participants)

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Outline

• Course materials cover
• Self control
• Problem solving
• Positive relationships
• Consent, 11s
• Conditions of success
• Facilitator instructions
• Realistic evaluation

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Were on the way!

• First pilot HMP Whatton
• Planning second pilot
• Sustainability

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Conclusion

• Routine availability of adapted programmes
• Custody and community
• Alternatives to prison
• and to hospital

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Sexual offending by non-disabled men disabled
men

• For both groups
• Grossly under-reported to police
• 90-95 of sex offenders are men
• Most perpetrators are known to victim
• Men often engage in grooming stalking of
  victims
• Men hold many cognitive distortions

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Treatment for non-disabled sex offenders recent
years

• 1960s 1970s Seen as result of deviant sexual
  interests arousal
• Led to behavioural techniques eg aversion
  therapy, orgasmic reconditioning covert
  sensitisation
• Belief in medical model anti-androgens
• Little evidence of effectiveness under-provision
  of treatment
• Move to CBT approach

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Marshalls model of sex offending
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Components of cognitive behavioural treatment

• Enhancing self-esteem
• Challenging changing cognitive distortions
• Developing victim empathy
• Developing social functioning
• Modifying sexual preferences
• Ensuring relapse prevention
• See Marshall et al.s 1999 book for an excellent
  guide

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Does it work for non-disabled men?

• Hanson et al, 2002 Meta-analysis of 43 CBT
  studies of sex offender treatment (over 9,000
  participants overall) - sexual offence recidivism
  rate 12 for treated men vs 17 for untreated
  men
• Aos, Miller Drake 2006 reviewed controlled CBT
  studies. CBT produced reduction in recidivism
  (31 reduction in community 15 in prison
  sample)
• Kenworthy et al, 2006 Cochrane review of 9 RCTs
  (over 500 offenders), mostly paedophiles variety
  of treatment methods- one large CBT trial
  showed a definite reduction in recidivism- one
  large group psychotherapy trial showed treatment
  increased risk.

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Cognitive behavioural treatment for men with
without LD in UK

• CBT widely available for non-disabled convicted
  sex offenders SOTP- in prison - in community
  (run by probation)
• Men with LD mostly excluded from these - some
  prisons run ASOTP - Janet Shaw clinic in
  Solihull (ASOTP), - Northgate hosp programme
  near Newcastle, - Bill Lindsays programme in
  Scotland, - our SOTSEC-ID programme (about 25
  sites across the country)

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Most adapted programmes have core assessments (eg
below is SOTSEC-ID list)

• Once only IQ, adaptive behaviour, language,
  autism
• Pre Post group treatment- Sexual Knowledge
  Attitude Scale (SAKS)- Victim Empathy scale,
  adapted (Beckett Fisher)- Sex Offender
  Self-Appraisal Scale (Bray Foreshaws SOSAS)-
  Questionnaire on Attitudes Consistent with Sex
  Offending (Bill Lindsay et al.s QACSO)
• Recidivism

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Treatment content (SOTSEC-ID)

• Group purpose, rule setting
• Human relations sex education
• The cognitive model (thoughts, feelings, action)
• Sexual offending model (based on Finklehor model)
• General empathy victim empathy
• Relapse prevention
• Compared to non-LD programmes Far more slow
  offence disclosure more on sex education far
  more pictorial material less sophisticated on
  cognitive side

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Does group CBT work for men with LD?

• Lindsay et al (1998a, b) showed some improvements
  in 6 men with LD paedophilic offences 4 men
  with LD exhibitionism, after CBT
• Lindsay Smith (1998) showed 2 years CBT was
  more effective than 1 yr CBT for men with LD on
  probation
• Rose et al (2002) CBT 2hrs/week for 16 weeks,
  for 5 men found reduced (improved) scores but
  changes not significant
• Craig et al 2006 no changes in cognitive
  distortions in 7mth CBT
• Lindsay et al 2006 70 harm reduction in 29
  repeat sexual offenders with ID, after CBT
• Williams et al, 2007 significant improvements in
  scores from pre-group to post-group in 150 men
  following CBT in ASOTP programmes in prisons (not
  all ID)

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Significant changes in cognitive distortions,
sexual knowledge empathy -SOTSEC-ID
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Further sexually abusive behaviour (SOTSEC-ID)

• During the year of the treatment group most men
  did not show further sexually abusive behaviour
  in 4 men (out of 48) they DID show non-contact
  offences
• In the 6 mths follow-up period most men did not
  show further sexually abusive behaviour in 7
  cases (5 men) DID show non-contact offences (5
  cases) or sexual touch through clothing (2 cases)
• Re-offending No relationship with pre- or post-
  group scores IQ, presence of mental health
  problems, personality disorder, living in secure
  setting, being victim of SA, history of
  offending.
• Poor prognosis Concurrent therapy diagnosis of
  autism / aspergers syndrome
• Longer follow-up data just collected (by Kathryn
  Heaton) above findings still hold

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Service user views (SOTSEC-ID)

• Good understanding of basic facts (duration,
  venue, facilitators, rules, e.g.
  confidentiality rule)
• Good understanding of why referred Because of
  my sex offence to see if it would do me any
  good To help my sex urges, keep them under
  control to be a better person when meeting women
  in the communityTo help us stop getting into
  trouble with the police because I go out to
  masturbate
• What they learntStopped me touching girls
  How people feel about us masturbating (in
  public) Learnt not to go after women Learnt
  to help other people in the group What the
  police do when they arrest you

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Service user views (contd)

• Best things
• Having support every week
• We talked about feelings about things, sorting
  the problems out
• Working together, helping each other
• We helped each other discuss ... work on ways of
  preventing problems in the future
• Worst things
• Telling people very private stuff, keeping
  people on trust
• Some didnt talk

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Thank you!

• Alison Giraud-Saunders
• alisongs_at_btinternet.com
• 07721 843290
• www.learningdisabilities.org.uk
• Glynis Murphy
• g.h.murphy_at_kent.ac.uk