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1. 1. 11 Sex Offenders: Assessment and Treatment

Shahid M. Shahidullah and Diane L. Green

1. 1. INTRODUCTION

There has been a rapid growth and expansion of correctional institutions in America in the1980s and 1990s. Between 1982 and 2003, correctional expenditures for all levels of government, including federal, state, and local, increased 573 percent. In 1982, total correctional expenditures were about $9.1 billion. In 2003, they increased to about $60.9 billion (Bureau of Justice Statistics, 2006). This rapid growth in correctional expenditures was accompanied with rapid growth in incarcerated population. In 2004, there were about 7 million people in America who were in prison, or jail, or in probation. Between 1995 and 2005, the incarcerated population in America grew at an annual rate of about 3.4 percent (Bureau of Justice Statistics, 2005). In 2001, about $38.2 billion was spent by the state authorities for corrections, and out of that about $28.4 billion was spent for adult correctional facilities. In 2001, about 59 percent of the justice expenditures of the states were for corrections alone.

This growth and expansion in corrections has brought, particularly for the states, not only new prisons and prison jobs but also new responsibilities and concerns for offender management. In the context of the emerging policy model of prison reentry, correctional institutions are being increasingly asked to build a bridge between prison and communities, particularly through a model of offender management that can reduce recidivism and strengthen reentry and reintegration. A new managerial paradigm is currently growing in American corrections that emphasizes that offender management should be seen in terms of a more holistic and comprehensive perspective—a perspective that can combine risk assessment and treatment with new goals and planning for their reentry and offender management 

The core of the CSOM model is that sex offender management must begin with effective assessment and treatment of sex offenders inside the prison. Reentry and recidivism depend on whether the risk of reoffending was effectively assessed, and suitable treatment plans were made and offered. The postincarceration success of sex offender registration, notification, tracking, and management is now seen as intimately connected with effective sex offender assessment and treatment during incarceration in prison. It is because of this emerging comprehensive approach that correctional institutions are reexamining the existing methods of sex offender assessment and treatments. It is with these issues that this chapter is concerned. This chapter describes some of the existing methods of sex offender assessment and treatment, examines some of the new policy directions evolving in these areas of correctional management and counseling, and outlines some of the more evidence-based assessment and treatment approaches used in correctional settings.

1. 1. SEXUAL OFFENSES AND SEX OFFENDERS UNDER CORRECTIONAL SUPERVISION

The major governmental sources and surveys on sex offense data include the Uniform Crime Reports (UCR), National Crime Victimization Survey (NCVS), National Incidence-Based Reporting System (NIBRS), and the National Corrections Reporting Program (NCRP). Sex crimes data are also collected by many advocacy organizations such as the National Sexual Violence Resource Center (NSVRC), National Violence Against Women Survey, and the National College of Women’s Victimization Survey. The NCVS and NIBRS, however, collect and codify more reliable and comprehensive data on sexual offenses.

The Uniform Crime Reports collect sexual offense data in terms of two major categories: forcible rape and sex offences that include sodomy, statutory rape, and offences against chastity, decency, and morals. The National Crime Victimization Survey collects sexual offense data also in terms of two major categories: rape and sexual assault. The National Incidence-Based Reporting System divides sex crimes data into six major categories: forcible rape, statutory rape, forcible sodomy, forcible fondling including indecent liberties and child molestation, incest, and sexual assault. In addition to these national statistical surveys, there are also sex crimes categories defined and described by different state statutes. What is happening today is that law is increasingly defining a wide range of sexual acts, behavior, and sexual expressions as crimes (Table 1).

According to the National Crime Victimization Survey, about 50 percent of all violent crimes are not reported to law enforcement, and of all violent crimes, rape and sexual assaults are less likely to be reported. From 1992 to 2000, on average only 31 percent of rape and sexual assaults were reported to law enforcement (Bureau of Justice Statistics, 2003). Reporting of sexual offenses has increased by about 6 percent in between 1992 and 2000, but on average about 70 percent of cases remain unreported. The National Crime 

1. 1. TABLE 1 Major Categories and Types of Sex Crimes

Sex Crime Categories

Major Types of Sex Crime

Sex Crime Acts

Rape, Male Rape, Forcible Sodomy, Conspiracy to Commit to Forcible Sodomy, Attempt to Commit Forcible Sodomy, Marital Rape, Date Rape, Acquaintance Rape, Child Rape, Object Rape of a Child, Sodomy on a Child, Child Molestation, Forcible Fondling, Incest, Bestiality, Object Sexual Penetration, Adultery, and Prostitution

Sex Crime Behaviors

Sexual Harassment, Stalking, Indecent Exposure to Children, Exhibitionism, Fornication, Custodial Sexual Relations, Custodial Sexual Misconduct, Marital Sexual Assault, Spousal Violence, Lewdness Involving a Child, Enticing a Child Over the Internet, Attempt to Rape a Child, Conspiracy to Rape a Child, Attempt to Commit Object Rape, Conspiracy to Commit Object Rape, Solicitation to Commit Object Rape, Aggravated Kidnapping, Attempt or Conspiracy to Aggravated Kidnapping, Participation in Child Sex Tourism, Participation in Global Trafficking of Children and Women, Financing of Global Sex Tourism and Trafficking, Commercial Sexual Exploitation of Women, and Commercial Sexual Exploitation of Children at Home and Abroad

Sex Crime Expressions

Production and Sale of Child Pornography, Possession of Child Pornography, Financing of Child Pornography, Internet Child Pornography, Videotaping and Filming Minors for Sexual Purposes, Indecent Liberties, and Obscene Phone Calls

Majority of the victims of sexual offenses are juveniles. In his analysis of NIBRS data on reported sexual offences in 12 states covering the years 1991 through 1996, Snyder (2000) found that about 67 percent of all victims of sexual assault were juveniles under the age of 18, and 34 percent of all victims of sexual assaults were juveniles under the age of 12. One of every seven victims was under the age of 6.

Another report, funded by the National Institute of Justice and the Centers for Disease Control and Prevention, that analyzed the National Violence Against Women Survey [NVAW] date collected in 1995–1996, presents similar findings. The report finds that “many American women are raped at an early age. Thus, more than half (54 percent) of the female rape victims identified by the survey were younger than age 18 when they experienced their first attempted or completed rape” (Tjaden & Thoennes, 2000, p. iii–iv). The same report 

The Centers for Disease Control and Prevention and the National Center for Injury Prevention and Control analyzed the data provided by the National Violence Against Women Survey in 2004, and estimated that about 5.3 million women become the victims of intimate partner violence (IPV) in the United States every year. “The cost of intimate partner rape, physical assault, and stalking exceed $5.8 billion each year, nearly $4.1 billion of which is for direct medical and mental health care services” (Centers for Disease Control and the National Center for Injury Prevention and Control, 2004, p. 1). The same study also estimated that in the United States “nearly 7.8 million women have been raped by an intimate partner at some point in their lives, and an estimated 201,394 women are raped by an intimate partner each year” (Centers for Disease Control and the National Center for Injury Prevention and Control, 2004, p. 1). It is also estimated that intimate partners kill about 30 percent of female murder victims and 4 percent of male murder victims each year (Bureau of Justice Statistics, 2002, p. 1).

Sexual assaults take place at homes, schools, colleges, work, and a variety of custodial organizations such as day care centers, nursing homes, and prisons. About 70 percent of sexual assaults reported to law enforcement take place in the homes of the victims or the offenders. Snyder’s (2000) analysis of NIBRS data revealed that 83.3 percent of rape, 81.5 percent of forcible sodomy, and 82.4 percent of forcible fondling, where victims were ages 6 to 11, occurred within a residence. For juveniles ages 12 to 17, 68.7 percent of forcible rape, 72.7 percent of forcible sodomy, and 68.8 percent of forcible fondling occurred within a residence. Juvenile sexual offending, particularly the victimization of female juveniles ages 6 to 17, is more likely to occur within a residence (Snyder, 2000, p. 6).

The nation’s federal prisons house less than 2 percent of convicted sex offenders. In 2004, the number of total inmates sentenced in federal prisons was 169,370. Out of these inmates, only 1.1 percent of inmates were sentenced for sex offenses compared to 53.3 percent of inmates sentenced for drug offenses. However, there is a growing trend, since the middle of the 1990s, for increased federal involvement in prosecuting sex offence cases. Between 1995 and 2004, both sex offenses cases and defendants in federal courts “jumped 24 percent to 1,638 cases and 1,709 defendants. Defendants charged with sexual abuse rose 11 percent, and sexual abuse cases increased 10 percent” (Newsletter of the Federal Court, 2005, p. 4).

Rape and sexual assault comprise about 11 percent of all inmates sentenced for violent crimes in state prisons (Bureau of Justice Statistics, 2005, p. 9). There were about 624,900 inmates in state prisons who were sentenced for violent crimes in 2004. Out of those, 142,000 were sentenced for rape and sexual assault charges. Out of those 142,000 inmates, 140,500 were males, 1500 were females, 73,000 were Whites, 36,600 were Blacks, and 19,200 were Hispanics. However, the number of inmates sentenced for sex offences vary from state to state. In 2002, Montana had the highest percentage of inmates incarcerated (33 percent) for sexual offenses, followed by Vermont (29 percent), New Hampshire (27 percent), and Massachusetts (26 percent). In the same year, New Jersey and the District of Columbia had the lowest percentage (7 percent) of inmates incarcerated for sexual offenses (Table 2).

Since the definition of sexual offense is broadening, more sex offenses today are reported to law enforcement, more sex offenses are prosecuted in federal and state courts, and more sex offenders are sentenced to prison for longer terms. Felony sex offenses are 

1. 1. TABLE 2 High Rates of Incarceration of Sex Offenders in Selected States, 2000

States

Number of Incarcerated Sex Offenders

Percentage of Total Incarcerated Offenders

Alaska

  496

24%

California

22,720

15%

Colorado

 3,391

22%

Hawaii

   634

18%

Iowa

 1,228

17%

Kansas

 2,002

23%

Massachusetts

 2,769

26%

Michigan

 9,756

21%

Minnesota

 1,164

20%

Montana

   465

33%

New Hampshire

   633

27%

New Mexico

   910

18%

North Carolina

  5,101

16%

Ohio

  9,100

19%

Pennsylvania

  6,931

19%

South Dakota

  550

22%

Tennessee

 3,036

18%

Texas

25,398

17%

Vermont

   362

29%

Virginia

  5,400

18%

Washington

  3,117

22%

West Virginia

   518

17%

Wisconsin

 4,000

19%

Wyoming

   257

18%

Source: West, M., Hromas, C. S., & Wenger, P. (2000). State Sex Offender Treatment Program: 50-State Surveys.Colorado Springs: Colorado Department of Corrections.

1. 1. SEXUAL OFFENSES AND SEX OFFENDERS: POLICY AND LEGISLATIVE DEVELOPMENTS

The renewed interest in recent years for more effective sex offender assessment and treatment methods came not just in response to growing sexual crimes and the growth of sexual offenders in correctional population. It came also in response to the growth of a number of federal and state statutes and policy developments. Some of the major federal enactments 

All 50 states generally comply with these and other recently enacted federal sex offender laws and guidelines. In response to federal guidelines, the states have enacted their own laws and regulations for sex offender management. In 2005, more than 100 new sex offender laws were enacted by state legislatures. There were over 500,000 registered sex offenders in the nation in 2005. The Department of Justice formally announced the activation of a National Sex Offender Registry (NSOR) Web site in 2005—a requirement mandated by the Pam Lychner Act. The FBI’s Crimes Against Children unit is responsible for developing and coordinating the NSOR system. Currently, the NSOR Web site gives real-time access to public sex offender information from about 41 states. These legal and policy developments for the creation of a new national initiative and a model for sex offender management brought new mandates to federal and state correctional authorities for developing more effective methods of assessment, treatment, and management of sex offenders.

1. 1. SEX OFFENDER RISK ASSESSMENT: CHALLENGES, EXISTING METHODS, AND BEST PRACTICES

Sex offender assessment and treatment methods, which in the past were mostly done by correctional authorities in an isolated and disconnected way, have now become vital components in the whole national effort and a national model for sex offender management. The nature of compliance with sex offender registration, the length of time that an offender is required to remain under registration and notification, the length of sentencing, parole decisions, and planning for effective reentry—all are now seen as largely dependent on the success of risk assessment and treatment methods. Risk assessment and treatment in the past were based mostly on experience and traditional knowledge. They are now becoming issues of important scientific and professional concern in the context of the emerging national effort to control and contain sex crimes. This is evidenced not only by increased reliance of correctional authorities on external scientific and professional communities for evidence-based standards of assessment and treatments methods, but also internally by their own efforts to set up new 

1. 1. RISK ASSESSMENT CHALLENGES: SEX OFFENDER RECIDIVISM

Given the risk that sex offenders pose to the community, effective tools for assessing the probability of recidivism are crucial. Risk assessment usually refers to an uncertain prediction about a future harmful behavior, and an assessment of the frequency, impact, and likely victim(s) of the behavior (Kemshall, 2001). Reliable means of distinguishing between high- and low-risk individuals and the circumstances under which they are likely to reoffend are crucial for decisions about allocating program and human resources, the best point at which to release offenders, and subsequent supervisory processes (Hudson, Wales, Bakker, & Ward, 2002).

One of the major challenges for effective sex offender assessment is to contain the high rate of recidivism among sex offenders. The key question basic to sex offender assessment is, What is the likelihood that a specific offender will commit sexual offenses again? What are the indicators in the past behavior of a specific offender and in the nature of his or her specific offenses, lifestyle, social and economic status, and childhood socialization that can help predict whether he or she is more likely to commit sex offenses again? The risk of sexual recidivism varies according to offender type. Rapists tend to be more criminally versatile than child molesters and are more likely to reoffend nonsexually than sexually. Among child molesters, the risk of sexual recidivism is higher for homosexual and extrafamilial sex offenders than for heterosexual and incest offenders.

Recidivist sexual offenders exhibit many of these characteristics, but specific predictors of sexual recidivism may include sexual deviancy; a history of sex offending, especially early onset of offending and engaging in a range of sexual crimes; diversity in offending, including violent and general crimes; psychological maladjustment, including substance use or abuse, antisocial attitudes, and personality disorders; childhood sexual victimization; presence of violent sexual fantasies; long-standing social isolation; use of sadomasochistic or pedophilic pornography; and failure to complete treatment (Gordon & Grubin, 2004).

The Bureau of Justice Statistics conducted a major study on sex offender recidivism in 2003 on the basis of a three-year follow-up of 9,692 male sex offenders, including 4,295 child molesters and 3,115 rapists, released from prison in 15 states in 1994. According to this study, which is the “largest follow-up ever conducted of convicted sex offenders following discharge from prison,” the released sex offenders, compared to released non-sex offenders, were 4 times more likely to commit sexual offenses. Within three years, 5.3 percent of male sex 

In 2003, the Washington State Institute for Public Policy conducted a six-year follow-up study of 89 sex offenders who were released from prison between 1990 and 1996 with recommendations for civil commitment by the Washington Department of Corrections. The study found that “high percentage (57 percent) of the subjects were convicted of new felony offenses, with 40 percent re-offending with against-person offenses, including sex offenses. Almost one-third of the group (29 percent) re-offended with a felony sex offense, and 16 percent failed to register as a sex offender” (Washington State Institute for Public Policy, 2003, p. 17). The study concludes that violent sexual offenders “have a high risk of a subsequent conviction for a felony offense, particularly a new against-person (including sex) offense” (Washington State Institute for Public Policy, 2003, p. 17).

It is this phenomenon of sex offender recidivism that is at the core of concern for effective methods of risk assessment. Even though there exists some empirical literature on sex offender recidivism (Center for Sex Offender Management, 2001), there is still a large gap in our understanding of the complexity of this phenomenon. The issues of psychopathology, endocrinology, brain development, and social and behavioral contexts are intertwined with sexual deviance and sexual violence in a hugely complex manners. It is for these multifaceted dimensions of the challenge of recidivism that there is now growing a new generation of sex offender risk assessment methods that are more scientific and more multidimensional in perspectives. The following is an analysis of some of these new generation of sex offender risk assessment methods, and their use and application in selected correctional settings.

1. 1. Risk Assessment and Sex Offender Classification

Sex offender risk assessment in the correctional setting begins with an evaluation of offender classification. All categories of offenders are classified for custody decisions, risk assessment, treatment, and service delivery, but it is a much more rigorous and statutorily mandated process for sex offenders. Many states in recent years have enacted specific statutes for sex offender classification. Presently, it is particularly guided by two federal laws—Jacob Wetterling Crimes against Children and Sexually Violent Offenders Registration Improvements Act of 1997 and the Adam Walsh Child Protection and Safety Act of 2006. The Jacob Wetterling Act of 1997 created the classification of sexual predators. Sexual predators are defined as violent and high-risk repeat sex offenders who have the characteristics of psychopathic personalities. However, the act requires that the determination of whether a sex offender is in the category of sexual predator be made by a court with the 

The Adam Walsh Child Protection and Safety Act further extended the Wetterling classification provisions and made a three-tier classification mandatory for sex offender sentencing, risk assessment, and treatment services. The act placed the repeat and violent sex offenders, defined as sexual predators by the Jacob Wetterling Act of 1997, in tier III. Tier II offenders are those who are convicted of federal offenses involving a minor such as coercion and enticement, transportation with the intent to engage in sexual activities, abusive sexual conduct, use of a minor in sexual conduct, solicitation of a minor to practice prostitution, and the production and distribution of child pornography. And those who are convicted for aggravated sexual abuse or sexual abuse, and kidnapping of a minor are placed in tier I.

Even before the enactment of the Adam Walsh Child Protection and Safety Act, most states adopted some versions of the three-tier system of classification of sex offenders. The Sex Offender Registration Act (SORA) of New York, for example, classifies sex offenders into three groups: Level I (low-risk), Level II (moderate-risk), and Level III (high-risk). Following the Jacob Wetterling Act of 1997, many states enacted specific legislations to define repeat and violent sex offenders as sexual predators. One of the significant policy developments in this area recently came through the enactment of Jessica Lunsford Act, commonly described as Jessica’s Law, in Florida in 2005. Under the Jessica Lunsford Act in Florida, the courts have been given the responsibility to define and classify violent and repeat sex offenders as sexual predators. The Jessica Lunsford Act made a provision of mandatory sentencing of 25 years to life in prison for first-time sex offenders and the molesters of children below the age of 12. The act also requires life-time electronic monitoring of sexual predators.

Alabama, Arkansas, Arizona, Georgia, Iowa, Nevada, Oklahoma, Indiana, Oregon, Virginia, and Wisconsin have laws similar to those of the Jessica Lunsford Act. In 2005, Michigan, following the Jessica Act, enacted a new law which had a provision that violent sex offenders can even be forced to wear GPS electronic devices for life. Following the Jessica’s Law, “Iowa mandates life sentence for certain sex crimes against children. Indiana authorized a life sentence for certain repeat sex offenders. Minnesota mandated life without parole for certain violent sex crimes” (National Conference of State Legislatures, 2005, p. 1). In 2006, Wisconsin and Kansas enacted new statutes similar to Jessica’s Law. In Georgia, the mandatory sentencing of 25 years in prison statute is applicable also for teen sex offenders, ages 13 through 15, who are tried as adults for forced rape, molestation, and sodomy of children. Jessica’s Law thus became a major focus for state policy makers in recent years to classify different categories of sex offenses and different types of sex offenders. Sex offender risk assessment in correctional settings presently thus begins through an evaluation of state-specific sex offender classification system. One of the dominant trends is the identification of high-risk violent sex offenders, and this poses a significant challenge for assessment methodologies.

1. 1. Sex Offender Risk Assessment Methods: Clinical versus Actuarial Models

Risk assessment in general is one of the major tasks in corrections. The Report on State and Federal Corrections Information Systems, published by the Office Justice Programs of the Department of Justice in 1998, showed that the national correctional information system is 

1. 1. TABLE 3 Possible Outcomes of Risk Assessment

Source: Kemshell, 2001.

One of the key issues in sex offender risk assessment is avoiding underprediction and overprediction of offending. There are four possible outcomes of risk assessment. (Table 3) The most desirable outcome is an accurate prediction that sexual assault will occur (Box A), or a correct prediction that it will not occur (Box D).

The consequences of a false negative prediction (Box B, when a risk of harm is not identified but does occur) include a heightened risk of harm to future victims, as potential repeat offenders may not receive appropriate treatment or surveillance. Conversely, false positive predictions, (Box C, when harm is predicted but does not occur) wastes resources, impacts on civil liberties, and results in overintervention (Kemshall, 2001). These possibilities make reliance on evidence-based risk assessment methods much more important and significant. Correctional psychologists, counselors, and treatment service specialists increasingly are being demanded by correctional authorities and the court to choose the right methods and to avoid the error of making of false negative predictions.

During the 1990s, there was a rapid growth of literature on risk assessment of sex offenders. As number of sex offenses were growing and more sex offenders were being convicted and incarcerated, public fear of sexual killings and kidnappings was rising. Policy makers increased pressures on correctional authorities to be more accountable for sex offender classification, assessment, custody decisions, parole decisions, and decisions on treatment services (Janus, 2003; Robinson, 2003). This led to the growth of a new movement, from the beginning of the 1990s, to bring more objectivity and empirical analysis in the development of methods for sex offender risk assessment. There began to emerge a new professional community or a “paradigmatic community” of scholars who specialized in sex offender risk assessment. There also emerged many private professional groups of experts, such as Sinclair Seminars and Orange Psychological Services, who specialized in providing risk assessment services to correctional institutions.

There are two key issues that are raised and debated in choosing the right methodology for sex offender risk assessment. The first is that whether the methodology is based on static 

The second is about the method of analysis of the relationship between and among different static and dynamic factors and their impact on recidivism. The core question here is, How are these factors to be examined and analyzed to reach to predictions about recidivism? The concern is whether analysis should be based on clinical judgments, or if it should rely on statistical tools and methods to be more objective in making predictions. The literature on risk assessment of sex offenders is broadly divided into these two approaches—the clinical model and the actuarial model of analysis. Before the 1990s, the clinical model was the dominant form of risk assessment. Risk assessment at that time was generally done on the basis of clinical experience, and psychoanalytic understanding of repressive and neurotic behaviors of the offenders. The clinical model was a means to reach to behavioral predictions through introspections and the subjective understanding of the psychopathic behaviors of offenders.

From the beginning of the 1990s, the risk assessment research community began to move away from the clinical model, and the actuarial approach emerged as a new paradigm for predicting violent behavior in general, and sex offender recidivism in particular. Actuarial risk assessment is “based upon the risk factors which have been researched and demonstrated to be statistically significant in the prediction of re-offense or dangerousness” (Center for Sex Offender Management, 1999, p. 3). The actuarial risk assessment procedure “involves discerning the variables predictive of recidivism and assigning them relative weights to determine low-, medium-, and high-risk cases by score” (Craig, Browne, & Stringer, 2003a, p. 57). “In the clinical method the decision-maker combines information in his or her head. In the actuarial or statistical method the human judge is eliminated and conclusions rest solely on empirically established relations between data and the conditions or event of interests” (Dawes et al. as quoted in Janus & Prentky, 2004, p. 7).

Several actuarial sex offender risk assessment methods or scales are now available within the risk assessment community (Table 4). Some of them include PRASOR (Rapid Risk Assessment for Sex Offense Recidivism), STATIC 99/Static-2002, SVR-20 (Sexual Violence 

1. 1. TABLE 4 Some Selected Actuarial Risk Assessment Methods Used for Predicting Sex offender Recidivism

Actuarial Methods

Description of the Scales

PRASOR (Raid Risk Assessment For Sex Offenders)

Four-item recidivism scale measuring prior sex offenses, unrelated victims, male victims, age less than 25 (Hanson, 2000).

Static-99

Probability of recidivism is measured in terms of 10 static items (Hanson & Thornton, 1999).

SACJ (Structured Anchored Clinical Judgment)

Recidivism is measured in terms of a stage approach. The first stage examines offender’s conviction records including current sex offenses, prior sex offenses, current nonsexual offenses, and prior nonsexual offenses (Grubin, 1998).

MnSOST- R (Minnesota Sex Offender Screening Tool–Revised)

The MnSOST is 16-item scale (both static and dynamic factors are used to measure three levels of risk category–high, medium, and low) (Epperson, Kaul, & Hasselton, 1998).

SVR-20 (Sexual Violence Risk-20)

SVR-20 is a 20-item scale including 11 items to measure psychosocial adjustments, 7 items to measure sexual offenses, and 2 items to measure offender’s future plans (Boer, Hart, Kropp, & Webster, 1997).

SORAG (Sex Offender Risk Appraisal Guide)

SORAG–a 14-item scale-is a revised version of VORAG [The Violence Risk Appraisal Guide]. It also uses clinical records and Psychopathy Check List (Quinsey, Harris, Rice, & Cormier, 1998).

Source: Hanson, 2000; Craig, Browne, & Stringer, 2003a.

PRASOR is widely used in the United States and Canada (Hanson, 1997). It is brief four-item actuarial scale designed to measure sex offender recidivism among males who have at least one prior conviction for sex offense (Hanson & Bussiere, 1998). The four items are prior sex offenses, any unrelated victims, any male victims, and age less than 25. One of the unique features of PRASOR is that “it used data from seven different follow-up 

The Static-99 is an actuarial instrument created by Hanson and Thornton (1999) “by adding together the items from the PRASOR and SACJ-Min. The scale is called Static-99 to indicate that it includes only static factors and that the current version is this year’s version of work in progress” (Hanson & Thornton, 1999, p. 4). The Static-99 was designed to estimate the probability of sexual and violent recidivism among adult males who have already been convicted of at least one sexual offense against a child or non-consenting adult. The scale contains 10 static items: prior sexual offenses, prior sentencing dates, any convictions for noncontact sex offenses, current convictions for nonsexual violence, prior convictions for nonsexual violence, unrelated victims, stranger victims, male victims, young, and single. When the Static-99 scale is “tested in four diverse samples, the resulting scale predicted sexual offense recidivism (average r = .33) better than either original scale PRASOR or SAC-J)” (Hanson, 2000, p. 4).

1. 1. Actuarial Strategies: Empirical Assessment

There is some consensus among risk assessment researchers that the actuarial methods—the second-generation risk assessment methods—are much more able to produce high-validity predictions about recidivism than those of the first-generation methods of the clinical model. A considerable amount of empirical studies and meta-analysis has been done in recent years to test the reliability and the predictability of different actuarial methods (Bartosh, Garby, Lewis, & Gray, 2003; Craig, Beech, & Browne, 2006; Gottfredson & Moriatry, 2006; Looman, 2006). Janus and Prentky (2004) conducted a major study on the accuracy and reliability of different [a]ctuarial methods, and they conclude that “actuarial methods have proven equal to or superior to clinical judgment” (p. 4). However, within the risk assessment community, there still remain two competing perspectives. One group is for uncontaminated actuarial risk assessment methodology. This group believes that in making predictions for sex offender recidivism, we must rely solely on statistical inference and the mathematical degrees of probability. Risk assessment must be a truly scientific venture, and it should not be contaminated with the subjectivity of clinical judgment. “The ‘actuarial only’ proponents contend that accurate risk appraisal demands the use of statistically based models omitting clinical judgment” (Craig, Browne, & Stringer, 2003a, p. 62).

Another group within the risk assessment community claims that there should be a bridge of thought between actuarial assessment and clinical judgment (Jhonson, 2006). The actuarial methods are based primarily on the analysis of static factors. A large amount of risk assessment research in recent years has shown the empirical relevance of dynamic factors (Jhonson, 2006). The advocates of this perspective suggest that clinical and professional judgments must also be taken into consideration in making predictions and decisions about the future of incarcerated sex offenders. “By their nature, actuarial models tend to be limited to static or historical variables and are not targeted toward assessing patient treatment potential or management” (Craig, Browne, & Stringer, 2003a, p. 62). The actuarial methods are designed 

In order to address the limitations of the “actuarial assessment alone” approach, there has grown in recent years a third generation of sex offender risk assessment methods described as “structured professional judgment (SPJ).” The SPJ approach combines the first-generation methods of clinical judgment with those of second-generation actuarial assessments. In addition to using probabilities based on statistical inferences, the SPJ methods seek to integrate individual-specific factors and events, make judgments on the basis of case studies, and analyze the relevance of dynamic risk factors related to an offender’s life situations. Some of the third-generation sex offender risk assessment methods include SONAR (Sex Offender Need Assessment Rating), SAVRY (Structured Assessment for Violence Risk among Youth), SARA (Spousal Abuse Risk Assessment), PCL-R (Psychopathy Checklist-Revised), LSI-R (Level of Service Inventory-Revised), HCR-20 (Historical, Clinical Risk-20), ERASOR (Estimate of Risk of Adolescent Sexual Offenses Recidivism). MnSOST-R and SVR-20 can also be considered third-generation methods because they incorporate dynamic factors with actuarial assessments (Craig, Browne, & Stringer, 2003a). The general consensus both within the community of correctional practice and risk assessment studies today is that SPJ is more reliable for sex offender risk assessment. “Considering dynamic factors such as treatments effects, motivation, insight, sexual deviance, and general psychological problems, alongside actuarial risk classification may provide a more global and valid assessment of an offender’s risk for sexual recidivism” (Craig, Browne, & Stringer, 2003a, p. 63).

The second-generation actuarial assessment methods have generated a considerable amount of empirical studies, and they have made enormous contributions in the understanding of the complexity of sex offending and sex offender recidivism. More importantly, they have established sex offender risk assessment as a separate field of scientific research and professional specialty. But the advocates of the “actuarial assessment alone model” have made some errors. First, they defined the concept of recidivism from a narrow perspective. They failed to make distinctions between “dangerousness” and recidivist behavior. Recidivist behavior is a complex of attitudes and life situations, and it is much broader than the concept of violence or dangerousness. They also failed to see sex offender assessment in the context of correctional management and a comprehensive approach to sex offender management. By relying primarily on static factors, they ignored the social and psychological pathways related to the development of deviant sexual behavior (Craig, Browne, & Stringer, 2003a).

Secondly, the actuarial assessment advocates have also ignored the legal and human implications of their probabilistic assessments. If a sex offender is defined as a sexual predator, in most of the states today, he or she may remain in prison for life, or in civil commitment for life, or registered for life. On the other hand, if a violent sex offender is released into communities, public security will be threatened and comprised. Risk assessment of sex offenders in correctional settings is of high significance. It has legal and ethical considerations. It has 

The third issue with the “actuarial assessments alone” model is epistemological in nature. In post-positivist science, there is nothing called certainty in scientific research. In post-positivist science, “the notion of ‘observational facts’ as brute undeniable givens, wholly independent of our fragile and insecure interpretations of them was all but surrendered, and the idea that there was anything “given” in experience was thrown in jeopardy” (Shapere, 1985, p. 1) One of the critical notions in science today is the idea of uncertainty. The rise of quantum physics and the general acceptance of Hinesburg Uncertainty Principle (HUP) by the contemporary scientific community have permanently changed the notion of truth and certitude in modern science. The prevailing notion is that for any fact or an event at a given point of time, there may exist several probable explanations. In a quantum mechanical world, scientists cannot understand even the behavior of particles with 100 percent certainty. As Noble Laureate Physicist Richard Feynman said, “Philosophers have said that if the same circumstances don’t always produce the same results, predictions are impossible, and science will collapse. Here is a circumstance—identical photons are always coming down in the same direction to the same piece of glass—that produces different results. We cannot predict whether a given photon will arrive at A or B” (Feynman, 1983, p. 9). What this suggests is that uncertainties are bound to exist in assessing and predicting human behavior even with the help of high-mathematics. Given the enormous complexity of human sexuality, sex offender risk assessment methods and decisions are more vulnerable to uncertainties and, hence, they should be based on the complementarity of knowledge and experience from different professional groups and communities (Bonta, 2002; Gottfredson & Moriatry, 2006).

1. 1. Sex Offender Risk Assessment in Corrections and the Court

In most correctional settings, the actuarial assessment approach is applied in combination with clinical and other assessment approaches. Sex offender risk assessment in most states is a legislative mandate, and in many states there are specialized boards, agencies, or commissions, as we mentioned before, responsible for developing evidence-based assessment approaches. One of the best examples can probably be drawn from the Virginia Criminal Sentencing Commission. In 1999, the Virginia General Assembly (Senate Joint Resolution 333) instructed the Virginia Criminal Sentencing Commission to develop evidence-based sex offender risk assessment methods for the purpose of integrating them in sentencing guidelines. In 2001, the Virginia Criminal Sentencing Commission published a report based on both prior research and an independent study conducted by the commission. The commission tracked 579 felony sex offenders, released from prison between 1990 and 1993, on average for eight years. The study defined recidivism specifically to mean a new arrest for a sex offense or against-person offenses. Three independent analyses of the data were done, by applying three statistical techniques: logistic regression, survival analysis, and classification tree analysis. On the basis of three independent analyses, two models emerged that displayed 

In Ohio, a separate committee, the Correctional Institutions Inspection Committee (CIIC), is statutorily mandated to study the problem of prison management and improvement. In 2006, the CIIC published a report on sex offender classification and treatment in Ohio prisons. The report documented a study on recidivism of sex offenders done by the Ohio Department of Rehabilitation and Correction (ODRC). The ODRC study is based on a 10-year follow-up of 879 sex offenders released from Ohio prisons in 1989. The study found that the baseline rate of recidivism was 34 percent, and the total sexual offense–related recidivism rate was 11 percent (Correctional Institutions Inspections Committee Report, 2006, p. 16). The ODRC conducted a separate study of 5,045 sex offenders released from Ohio prisons between 1989 and 1993. Based on this study, ODRC developed an eight-item risk assessment method following the actuarial approach of STATIC-99. These items are prior adult-sex related arrests, prior sex-related felony convictions, any evidence of sexual offending without arrest, use of illicit drug and alcohol, victim sex of all adult sex crime convictions, victim under the age of 13, total number of victims of all adult sex crime convictions, and weapons used at the time of the commission of crime. The CIIC report, however, cautioned ODRC about the limitations of STATIC-99. As the report said: “Considering the heavy weight that is given to the risk assessment determined by STATIC-99, including whether or not the inmate is even provided treatment within the institution, an intra-Departmental study should be conducted to determine the accuracy of the STATIC-99 in predicting sexual recidivism.” (Correctional Institutions Inspection Committee Report, 2006, p. 23.)

The Vermont Assessment of Sex Offender Risk (VASOR) is based on two scales: a 13-item reoffense scale and a 6-item violence scale. The 13-item scale is designed to measure the rate of sex offender recidivism. A statistical and reflective study of VASOR conducted in 2001 suggests that “[b]ecause the VASOR does not provide a comprehensive survey of all factors relevant to sexual offending, it is best used as a decision aid along with professional judgment and other appropriate tools” (McGrath & Hoke, 2001, p. 1).

In Texas, the Council Sex Offender Treatment has recently undertaken a new Dynamic Risk Assessment Project. The project goal “is to collect data from a variety of assessment tools which in turn can be used when considering deregistration issues. The Council is to provide to the Governor and to the Legislature a project status report by November 6, 2006” (Texas Department of State Health Services, 2006, p. 1).

The Colorado Sex Offender Management Board (SOMB) has legislative mandates to work on the development of sex offender risk assessment tools and management strategies. In 1998, the SOMB, in cooperation with the Colorado Parole Boards (which supplied the clinical criteria) and the Colorado Division of Criminal Justice’s Office of Research and Statistics (which offered actuarial research assessments), developed an assessment scale described as Colorado Sexually Violent Predator Assessment Instrument (SVPAS). The SVPAS explicitly recognized the significance of integrating motivational factors in developing sex offender risk assessment scales. The motivational scale of the SVPAS includes such factors as verbalized desire for treatment, compliance to court order for interventions, positive attitudes towards evaluation, and active participation in evaluation. In 2003, the SOMB and the Office of Research and Statistics conducted an evaluation of the SVPAS (Colorado 

In 2006, the Washington State Institute for Public Policy conducted an evaluation, under a mandate from the Washington State Legislature, of the Washington State Sex Offender Risk Level Classification Tool developed in 1997 by State End of Sentence Review Committee (ESRC). On the basis of an empirical study of 684 sex offenders released from Washington state prisons between 1997 and 1999, the study found that within five years 22 percent recidivated with a felony offense, and 3 percent with a felony sex offense (Washington State Institute for Public Policy, 2006). The study also found that “recidivism rates do not consistently increase when the assessment scores 25 point increase” (Washington State Institute for Public Policy, 2006, p. 3). The study “could not identify sex offenders with a high risk for either violent or felony sex reoffending” (Washington State Institute for Public Policy, 2006, p. 3) In order to develop a new instrument, the study recommended a rigorous assessment of existing risk assessment literature and “involvement of clinicians.”

The same trend for the use of multiple risk assessment strategies (Correctional Institutions Inspection Committee Report, 2006) and the inclusion of both actuarial and clinical approaches is observed in a proceeding of the Commission to Improve Community Safety & Sex Offender Accountability of the State Maine. “The evaluation should include a review of the specific factors for each individual. Actuarial and assessment tools must be used, but practitioners must recognize the weakness of these tools. There must be a comprehensive and collaborative approach” (Commission to Improve Community Safety and Sex Offender Accountability, 2003, p. 1).

For correctional institutions to search for and rely on balanced, comprehensive, and evidence-based assessment methods is significant not just for the improvement of sex offender management and treatment. It has legal implications as well. As more states are enacting sexual predator laws, and laws for civil commitment of sexually violent predators [SVP], the methods and tools of sex offender classification and risk assessments are being increasingly challenged in the court. The issues related to scientific evidence in the court today are settled not by scientists and professionals alone. A turning point in the admissibility of scientific evidence in the court in America came in 1993. Before 1993, the acceptance of scientific evidence and methodology was based on the “general acceptance test,” described as the “Frye test,” which came from the 1923 Frye v. United States case. The Frye test is that “expert opinion based on scientific technique is admissible if it is generally accepted as a reliable technique among the scientific community.”

In 1993, the Supreme Court, in the case of Daubert v. Marell Dow Pharmaceuticals, ruled that it is not the experts but trial judges who should be the gatekeepers of science in the court. Daubertbrought a fundamental change in the way American courts respond to science 

In 1997, the U.S. Supreme Court, in Kansas v. Hendricks, for the first time made ruling on the constitutionality of civil commitment. The Kansas civil commitment statute requires that sexual offenders who are convicted of violent sex crimes or those who committed violent sex crimes but are found to be not guilty by reason of insanity are placed, with a unanimous jury trial, in secure confinement after their release from prison. A Kansas man, named Leroy Hendricks, was repeatedly convicted for child molestations and taking indecent liberties with minors since 1957. Before he was to be released from prison in 1994, after serving a 10-year prison term for taking indecent liberties with minors, a unanimous jury found him mentally abnormal, and a Kansas court sent him for civil commitment in 1995. Hendricks appealed the lower court decision to send him to civil commitment on the claim that Kansas Act is in violation of the U.S. Constitution’s due process clause, double jeopardy, and ex post facto clauses.

The Supreme Court of Kansas reversed the lower court decision and invalidated the Kansas Sexually Violent Predator Act on the ground, that “the preeminent condition of ‘mental abnormality’ did not satisfy what is perceived to be the ‘substantive’ due process requirement that involuntary civil commitment must be predicated on a ‘mental illness’ finding.” But on appeal, the U.S Supreme Court reversed the decision of the Kansas Supreme Court, and ruled that the Kansas act was not in violation of the due process clause. The majority opinion noted that the “Act’s definition of ‘mental abnormality’ satisfies ‘substantive’ due process requirements. An individual’s constitutionally protected liberty interest in avoiding physical restraint may be overridden even in civil context.” The majority opinion also added: “The Act does not violate the Constitution’s double jeopardy prohibition or its ban on ex post facto lawmaking. The Act does not establish criminal proceedings, and involuntary confinement is not punishment.”

In 2002, the U.S. Supreme Court made another ruling about the Kansas Sexually Violent Predator Act. In Kansas v. Crane the Supreme Court extended the definition of the concept of “mental abnormality” and argued that for the act to remain within the due process clause, the state must prove that one is suffering not only from “mental abnormality” but also an inability to control his or her behavior. There “must be a ‘lack-of-control’ determination.”

In recent years, number of cases went to the court challenging particularly the admissibility of actuarial risk assessment methods. In Carlos Ortega-Mantilla v. Florida in 2005, the District Court of Appeal of Florida held that “We agree with the appellant that the actuarial instruments are scientific evidence, and, therefore, in order for them to be admissible, they must pass the Frye test.” In re Simon in 2004, the Illinois Supreme Court held the same view that in order for actuarial assessments to be admissible in the court, they must pass the Frye test. In Collier v. State, in 2003, the Fourth District Court of Appeals of Florida held that “Frye requirements were applicable to the SVR-20, the state did not establish the Frye requirements, 

1. 1. SEX OFFENDER TREATMENT: ISSUES AND EVIDENCE-BASED PRACTICES
   2. State Treatment Statutes and Types

Formal psychiatric treatment for incarcerated sex offenders has long been a policy to combat sex offender recidivism. The advocates of the Progressive Movement in the beginning of the 20th century thought that sexual offending was a sickness that could be treated through the application of biology, psychology, and psychiatry. In the 1940s and 1950, many states enacted psychopathic laws. Psychopathic laws defined sexual offenders as individuals who have psychopathic personalities—a concept currently defined by psychiatry as antisocial personality disorder. The enactment of psychopathic statutes in the 1950s by different states came in the context of increasing public fear of child molesters, and the growth of a movement, particularly in psychiatry, for the medicalization of deviance (Cole, 2000; Galliher, 1985; Sutherland, 1950). In the 1980s and 1990s, however, sex offender policy began to move away from treatment and rehabilitation to incarceration, registration, and community notification. A belief began to emerge among many policy makers that sex offenders cannot be cured, and sex crimes must be controlled and contained though the model of “just deserts.” From the late 1990s, treatment again began to be seen as a viable option for dealing with sex offenders, particularly in the context of the rise of a new comprehensive approach to sex offender management advanced by the Center for Sex Offender Management (CSOM). Sex offender treatment currently is not seen as a single approach to sex offender rehabilitation, but as an integral part linked to other components of sex offender management: incarceration, registration, notification, tracking, and civil commitment.

As of 2000, 34 states had formal psychiatric treatment methods available for their sex offenders. Eight states including the District of Columbia—Alabama, California, Delaware, Florida, Mississippi, New Mexico, and Oregon—do not have any formal treatment options available for their incarcerated sex offenders (Colorado Department of Corrections, 2000). In some states, as in Minnesota, incarceration times are extended for failure to participate in treatment programs. As of 2001, only six states had policies for mandatory participation in sex offender treatment: Iowa, Missouri, New York, North Dakota, Rhode Island, and South Carolina. In two states, the court mandates participation: Alaska and New Hampshire.

A number of sex offender treatment methods are now available (Table 5). These methods suggest four broad approaches to treatment: psychological, pharmacological, biological, and sociological. “In practice, these approaches are not mutually exclusive and treatment programs are increasingly utilizing a combination of these techniques” (Center for Sex Offender Management, 2001, p. 16). The most commonly used method in corrections is 

1. 1. TABLE 5 Some Selected Approaches to Sex Offender Treatment and Treatment Methods

Treatment Approaches

Treatment Methods

Psychological

Cognitive-Behavioral Therapy

Relapse Prevention Techniques

Psychoeducational Methods

Pharmacological

Cyproterone Acetate Treatment (CPA)

Medroxyprogesterone Acetate (MPA)

Luteinizing Hormone-releasing Hormone (LHRH)

Serotonin Re-uptake Inhabitors (SSRIs)

Biological

Stereotoxic Neurosurgery

Surgical Castration

Electrical Aversion

Penile Plethysmograph

Sociological

Family-System Intervention

Group Therapy

Therapeutic Communities

Faith-Based Interventions

Morality Training

Work-Based Interventions

Twenty states—“almost 50% of the programs—offer more intensive forms of this approach through therapeutic communities or residential programs” (Colorado Department of Corrections, 2000, p. 5). In addition to cognitive-behavioral modification, treatment of sex offenders in therapeutic communities is based on a psychoeducational approach aimed at reducing the risk of recidivism through the use of effective self-management. The emphasis is on the need for offenders to take responsibility for their actions recognize the behavioral progression that proceeded and followed sexual offenses, identify situations that place them at risk to reoffend, and assist them to develop strategies to prevent recidivism. Core focus areas of treatment are defining and taking responsibility, victim empathy; social skills, sex education, anger management, arousal reconditioning, overcoming past trauma, and relapse prevention. The general duration of the treatment in 28 states is over one year. North Dakota, Arizona, and Massachusetts provide treatments over five years. The cognitive-behavioral therapy and psychoeducational therapeutic community approaches are primarily based on the theories and concepts of psychology, psychiatry, sociology, social work, and other human sciences.

A

The Florida statute mandates that repeat sex offenders are given court-ordered weekly injections of hormones and antiandrogenes drugs, such as DepoProvera and Depo-Lupron, that reduce sex drives. Under the Florida statute, chemical castration can be a part of sentencing given to sex offenders. Mandatory court-ordered chemical castration is also part of the castration law in Montana. In Montana, a judge can legally require a repeat violent sex offender to undergo chemical castration. In Texas, both chemical and surgical castrations are voluntary, and juvenile sex offenders are not considered for castrations. The Texas statute describes that castrations are legally allowed when the offender is a repeat child molester, and it is recommended through psychiatric evaluations and in combination with offender treatments. The California law mandates chemical castration even for a first-time sex offender if the victim is below 12 years of age (Table 6).

1. 1. TABLE 6 Methods of Sex Offender Treatment in Selected States

States

Cognitive Therapy

Relapse Prevention

Group Therapy/Counseling

Therapeutic Community

Alaska

Arizona

Arkansas

Colorado

Connecticut

Georgia

Hawaii

Illinois

Indiana

Iowa

Kansas

Kentucky

Maine

Massachusetts

Michigan

Minnesota

X

Missouri

Montana

Nebraska

Nevada

New Hampshire

New Jersey

New York

North Carolina

North Dakota

Ohio

Oklahoma

Pennsylvania

Rhode Island

South Carolina

South Dakota

Tennessee

Texas

Vermont

Virginia

Washington

West Virginia

Wisconsin

Wyoming

Source: Colorado Department of Corrections (2000).

1. 1. Sex offender Treatment and Recidivism

The field of empirical studies on relations between treatment and sex offender recidivism is still in its infancy (Quinsey, 1998). “There have been very few studies of sufficient rigor (e.g., employing an experimental and quasi-experimental design) to compare treated to untreated sex offenders” (Center for Sex Offender Management, 2001, p. 13). However, as interests are growing on expanding sex offender treatments in corrections in the context of the comprehensive approach to sex offender management model, studies are also currently growing on understanding the relations between treatment and recidivism, particularly through Sexual Abuse: Journal of Research and Treatment, published by the Association for the Treatment of Sexual Abusers (ATSA) (Beech & Hamilton-Giachritsis, 2005; Studer, Aylwin, & Reddon, 2005). Many empirical studies are also being done by criminal justice agencies in different 

On the basis empirical studies, the advocates of pharmacological interventions claim, that antiandrogens and hormonal agents is successful in reducing sex offender recidivism. “There is empirical evidence that CPA and sertraline have a differential effect on the sexual arousal pattern of pedophiles suppressing the pedophilic arousal and enhancing the arousal toward adult consensual sexual activity” (Bradford & Kaye, 2006, p. 3). Studer, Aylwin, and Reddon (2005), in their study on the effect of testosterone treatment on sex offender recidivism, found that “serum testosterone remained significantly predictive of sexual recidivism for the treatment non-completer group” (p. 1).

Among all other psychological and sociological treatment methods, cognitive-behavioral approaches have been found to have positive effects on reducing recidivism. But it has also been found that cognitive-behavioral therapy is more effective if it is combined with psychoeducational and sociological approaches. “Cognitive-behavioral approaches appear most promising and a combination of educational, cognitive-behavioral, and family system interventions can be effective” (Center for Sex Offender Management, 2003, p. 2) McGrath, Cumming, Livingston, and Hoke (2003) conducted a study of the rate recidivism of 195 adult sex offenders, drawn from the Vermont Department of Correction’s computerized offender records, who were referred to receive prison-based cognitive-behavioral therapy. Out of 195 referred sex offenders, 56 completed treatments, 49 received some treatments but did not complete the treatment schedule, and 90 refused to participate in treatment services. On the basis of a mean follow-up period of more than six years, the study found that the “number of sexual reoffenders in the completed treatment group (5.4%) was significantly lower than that of the some-treatment group (30.6%) and no-treatment group (30.0%)” (p. 10), and those completed the treatment also had a lower number of violent reoffenders. Similar findings came from the Seager, Jellicoe, and Dhaliwal (2004) study of 177 adult sex offenders recommended for treatment in a Canadian federal prison. Out of 177 offenders, 146 were released into the community, and out of them, 81 completed treatments, 28 were unsuccessful completers, 17 dropped out of treatment, and 19 did not participate in treatment program before they were released. On the basis of a two-year follow-up, the study found that those who did not complete the program had a higher rate of recidivism, “that is 18%, 42%, and 100% of men who dropped out, refused, or were terminated, respectively, incurred a new conviction” (p. 606). A number of major reviews and meta-analytic studies on relations between sex offender recidivism and treatments have shown that treatments reduce the rate of recidivism (Alexander, 1999; Gallagher et al. 1999; Hall, 1995; Hanson et al. 2002; Polizzi et al., 2002). Alexander (1999) reviewed 79 studies [N = 10,988] and found that “sex offenders who participated in relapse treatment programs had a combined rearrest rate of 7.2 percent, compared to 17.6 percent for untreated offenders” (Center for Sex Offender Management, 2001, p. 14) Hanson et al. conducted a meta-analysis of 43 treatment studies (N = 5,078 treated; N = 4,376 untreated), and found that “those who dropped out of treatment had consistently higher rates of sexual recidivism” (Craig, Browne, & Stringer, 2003b).

Positive results of sex offender treatments have also been found by many empirical studies done by many state criminal justice agencies. A study conducted by the Iowa Department of Corrections (2006) reports that the offenders who successfully completed sex offender treatment program “have a lower rate of rearrest for sex offenses than other 

1. 1. CONCLUSION

Sex offender risk assessment and treatment today are not isolated policy instruments or scientific constructs. They are an integral part of a new comprehensive sex offender management model. The success of all other components of the model—incarceration, registration, community notification, civil commitment, and reentry management—largely depends on risk assessment and treatment success. The sex offender risk assessment methods have evolved through three stages. The first-generation assessment methods of the 1970s and 1980s were mostly clinical in orientations.

From the late 1980s and early 1990s, a second-generation assessment methods—described as actuarial assessment methods—began to emerge. From that time risk assessment began to grow as a separate specialty in scientific research, particularly in psychology, psychiatry, social work, counseling, and other human sciences. Borrowing methodological tools from mathematics and statistics, the advocates of this new movement of actuarial assessment created a new paradigmatic community. The new advocates of the movement firmly belied that risks can be scientifically and objectively measured with a high degree of certainty, and that measurements should not be contaminated with the subjectivity of clinical judgments.

From the late 1990s, however, the paradigm of actuarial assessment began to be questioned. Its assumptions of objectivity began to be challenged, and it its relevance in correctional settings began to be reexamined. From the late 1990s, a third-generation of assessment methods—described as structured professional judgment (SPJ)—began to grow. The third-generation methods seek to combine static with dynamic factors, and actuarial assessments with clinical judgments. The values of actuarial assessments are not ignored but assessments began to be seen also in a broader perspective of clinical experience, and collective institutional knowledge of correction professionals.

Like sex offender risk assessment approaches, sex offender treatment methods have also gone through a process of change and evolution. In the 1940s and 1950s, sex offenders were generally seen as psychopathic personalities, and many states enacted psychopathic laws. Treatments based on Freudian psychoanalysis were generally prescribed for sex 

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