Title: Realist Evaluation of Adapted Sex Offender Treatment Programs for Men with Intellectual Disability
Funder: Economic and Social Research Council

Abstract: Adapted Sex Offender Treatment Programs (ASOTPs) have, as their name implies, been modified from mainstream treatment to meet the learning needs of offenders with intellectual disability (ID). They are designed to increase the offender's sexual knowledge, understanding of victim harm, ability to recognise feelings in themselves and others, to modify offence-justifying thinking and to support individuals to develop relapse prevention skills. In this project I will explore what works on ASOTPs, for whom, in what contexts, why and how. I seek to make sense of these programs in the contexts in which they take place, in order to illuminate what social factors may help or hinder treatment success. In particular, I will examine how effective links between these forensic healthcare interventions and the offender's living context and social care provision, for instance the nature and level of supervision they receive to manage risk, during and after treatment can enhance outcomes. I aim to translate this knowledge into policy and practice recommendations, in order to inform the future targeting of public resources on the most effective treatment, supported by social care packages that can enhance effectiveness. I will evaluate two ASOTPs, one in the UK and one in Switzerland. Both deliver group cognitive behavioural therapy, lasting about 18 months. The evaluation will entail three phases. First, a literature review will be followed by interviews with twelve international key academics and practitioners who designed ASOTPs. This will illuminate in what ways ASOTPs are intended to work. Second, I will explore case studies of men who have attended ASOTPs to explain the impact the program had on them, whether and how it worked and in what contexts. There will be three types of data collection. Four focus groups with altogether 24 participants will look at the user experiences of treatment. Eighty patient files will be reviewed to examine how well the treatment worked for each person. From this a sample of 20 participants, ten for whom the treatment worked and ten for whom it did not, will be followed up through interviews with offenders and practitioners, to find out in more detail why the program did (not) work. Third, the twelve key practitioners will be revisited. Ideas that were developed from phase 1 and 2 on what works, for whom and in what circumstances will be presented to them and they will offer expert commentary. They will examine the case studies from the UK and Switzerland and tease out how wider social contexts, such as public policy and social care practice, impact on treatment success by comparing the case studies to their local contexts. From this a set of recommendations will be derived on most useful policy and practice scenarios and successful social care packages that can enhance treatment success for a particular type of person. Sex offender treatment seeks to change harmful behaviours and has the potential to contribute towards the prevention of maltreatment towards vulnerable populations. It is therefore a social issues, which is in line with the ESRC strategic priority "influencing behaviour and informing interventions". Moreover, The ESRC review of strategic priorities 2013 identified "innovation in health and social care" as a focus for the next 24 months. This project can inform this by making suggestions on better collaborations between health and social care, an issue that has also been prioritised by UK central government. In addition, penal responses to people with ID are currently being reformed. This background and the current age of austerity make this project timely, as it can inform contemporary debates and the targeting of scarce public resources on treatment that works. Throughout the project I will network with policy makers, practitioners, disabled people's organisations and interested members of the public to maximise opportunities to impact on practice and policy development.


Research activity codes: 5.6 PSYCHOLOGICAL AND BEHAVIOURAL;8.3 POLICY, ETHICS AND RESEARCH GOVERNANCE
Health categories: MENTAL HEALTH