Sex offender assessment: Clinical utility and predictive validity .

The research addressing sex offender assessment and treatment is an everevolving science. However, very little research has addressed psychological typologies associated with various types of sex offenders and treatment engagement. The current study examined assessment data of four sex offender groups, defined by victim type, to determine if a typological difference exists between groups of (N = 583) rapists (n = 129), statutory offenders (n = 140), intrafamilial/ incest perpetrators (n = 152), and extrafamilial (n = 162). Secondly, the study determined if a specific battery of psychological measures can predict treatment completion (n = 377). We also hypothesized there will be a negative relationship between psychopathy, as measured by the Hare Psychopathy Checklist-Screening Version, antisociality, aggression, and treatment rejection, as measured by the Personality Assessment Inventory, and treatment completion. As hypothesized, there were several significant differences seen between the sex offender groups. Rapists were significantly different from the other three sex offender groups and Extrafamilial Child Molester and Statutory Offender groups were similar to one another. The primary discriminating factors appeared to be the level of antisocial beliefs, attitudes and behaviors. Static-99 scores were highest for the Rapist group and post hoc analyses indicated that Extrafamilial Child Molesters with male or both sex victims had similar Static-99 scores to rapists. As hypothesized, psychopathy and PAI Antisocial and Aggression scales scores distinguished between treatment completers and non-completers, however, these variables were not predictive of treatment completion. Sex Offender Assessment 5 Acknowledgements This research was conducted through the Missouri Department of Corrections at the Farmington Correctional Center in Farmington, Missouri. Data for this research was collected for the Missouri Sex Offender Treatment Program housed primarily at the Farmington Correctional Center, Missouri. I extend my sincere thanks to the Missouri Sex Offender Program treatment and clerical staff for their dedication and assistance in collecting and monitoring the data. Most importantly, I am very grateful to Dr. David Suire, my mentor, for your dedication to the field of sex offender treatment and assessment and the guidance you provided for the initial construction of this research project. Thanks also to Dr. Ann Steffen, my research advisor and teacher. As I think back on my time in graduate school, your support and guidance provided a mechanism for growth. You have been my guide throughout this process, and I am forever grateful for your direction. I would also like to acknowledge the efforts of my dissertation committee: Dr. Robert Calsyn, Dr. Thomas Fletcher, and Dr. David Suire. This completed manuscript would not have been possible without your insightful suggestions and recommendations from the conception of the initial research proposal to the completion of this study. I would also like to take the opportunity to recognize my most important source of support in every respect: my family. Thank you for seeing me through the peaks and valleys of graduate school and every other experience. I am blessed to have a family that has never wavered in their support of my dreams. Sex Offender Assessment 6 Finally, this dissertation is dedicated to Jennifer, Kannen and Kieran: my family without whom none of this would be worth it. I would like to thank you all for your continuous encouragement and support during this process. And to Jennifer, I will always be immensely grateful to you for taking this and every journey with me. Sex Offender Assessment 7 Sex Offender Assessment: Clinical Utility and Predictive Ability During the last two decades, public concern about dangerous sexual offenders has become increasingly salient. Sex offenses, (e.g., child molestation and rape), are frequently considered among the most heinous of all crimes. Child molestation alone is a great strain on society, with 20% of girls and 10% of boys being victims of abuse (Hanson & Bussiere, 1998). In 1994, the distribution of state prisoners showed that 9.7% of 906,000 prisoners were incarcerated for a violent sex offense (APA, 1999). In addition, community concern at the damage caused by these atrocious acts, there are also laws in several states that emphasize the need for sex offenders to seek psychological and medical treatment while in prison and the community. In the case of Kansas vs. Hendricks in 1997, the United States Supreme Court upheld the lawful commitment of violent sexual predators to treatment in psychiatric institutions until their release (Bradford, 2000). The civilly committed offenders are selected through a rigorous process of assessment and court proceedings. The assessment entails the use of actuarial risk and personality measures and clinical interpretation to determine the offender’s risk to reoffend sexually. Once committed these individuals are treated with pharmacological and psychological treatment, most commonly a variant of Cognitive Behavioral Therapy (CBT). The current study has two aims: (1) determine the utility of several commonly used psychological measures to distinguish between different categories of sex offenders; (2) determine if the same assessment battery can predict treatment completion. Sex Offender Assessment 8 Categories of Sex Offenders The current study will classify the offenders based on the offense committed, more specifically; we will classify the offenders into four different groups: (1) rapists, (2) statutory offenders, (3) extrafamilial child molesters, and (4) intrafamilial child molesters and incest perpetrators. Rapists have a victim, at least 14 years of age, in which the act occurred above and against the objections of the individual or the individual was not of sound mind to consent to sexual contact. Statutory offenders have had consensual sexual contact with an unrelated victim between the age of 13 and 17. Intrafamilial child molesters and incest perpetrators are classified together because they only have related victims. Extrafamilial child molesters have at least one unrelated victim under the age of 13; however, these offenders may have related victims as well. The recidivism literature has indicated significant differences in recidivism rates for type of offender based on victim choice. Not only have reoffense rate differences been seen between groups; differential levels of motivation and resistance to treatment are evident between rapists and child molesters (Beyko & Wong, 2005; Marques, Day, Nelsen, & West, 1994). Langevin and colleagues (2004), using a sample of released sex offenders with a follow-up period of at least 25 years, found similar results to previous recidivism literature. The average age for the incest perpetrators was the highest and exhibitionists were youngest while rapist and extrafamilial child molesters tended to be the best-educated (Langevin et al., 2004). When considering the age of criminal onset, the average for the group was 22.6 years old, with rapists being significantly younger at first offense (15.4 years of age.) According to the data, sexual aggressives spent a significant more time in prison (10.5 years) than any other group (Langevin et al., 2004). Sex Offender Assessment 9 Langevin et al. (2004) found over a twenty-five year follow-up that the overall average was 3.6 convictions and 1.2 charges dismissed for sexual crimes and 5.3 convictions and 2.0 dismissed non-sex offenses. Extrafamilial child molesters with male and both sex victims had the highest number of sexual reoffense. Sexual aggressives or rapists, polymorphous, and non-sexual violent offenders had the highest number amount of non-sexual criminal activity. Through further analysis, 80.4% of the sample criminally reoffended with 61.1% of those being sexual recidivists (Langevin et al., 2004). Extrafamilial child molesters and exhibitionists showed the highest sexual recidivism with 71.0%74.1% and 68.6%, respectively. This study did not address if the offenders were treated prior to release or if they had received community-based treatment, but considering the recidivism rates, treatment was probably not provided. These apparent differences in recidivism and treatment resistance suggest that measures, which identify differences between the groups, may assist clinicians with services and resource distribution. Meaning that at high-risk offenders with high treatment motivation would receive the greatest amount of existing treatments because these offenders and society would benefit the most from their treatment. In addition, clinicians and researchers might develop and evaluate new interventions aimed at offenders who were not interested in receiving existing treatment. Unfortunately, other systems of classifying offenders combine multiple dimensions, including victim selection, presumed etiology, offender type, or offender characteristics. For example, the American Psychiatric Association classifies sex offenders into four mental health categories (APA, 1999). The first group has an absence of any mental or physical abnormality. The second category contains individuals who Sex Offender Assessment 10 have the presence of a mental disorder or physical injury that limits cognitive functioning, such as Mental Retardation or traumatic brain injury. Individuals who have a diagnosable sexual paraphilia, exhibitionism or pedophilia, comprise the third group. The final category includes individuals who have another mental health condition that indirectly affects specific sexual behavior. These offenders would typically be diagnosed with a personality, psychotic or impulse control disorder (APA, 1999). The use of these categories requires diagnoses based solely on the DSM-IV (APA, 1994) which has serious flaws when pertaining to sex offenders. Doren (2002), as well as Campbell (1999), ci