THE EVALUATION OF TREATMENT NEEDSOF SEXUAL OFFENDERS
recidivists from the non-recidivists . Criminal
lifestyle variables were found to be the strongest
predictors of recidivism . However, these resultsmust be interpreted with caution due to methodological limitations .

n order to determine the treatment needs of anindividual, an exhaustive assessment must firsttake place . During the assessment, clinicians
will examine a broad range of variables in order toidentify the factors that place an individual at riskof committing sexual abuse . While there is no universally accepted assessment paradigm, mental
health professionals are likely to assess risk throughactuarial and clinical means .

JOnce the differentiation has been made between
static and dynamic factors, research has illustrated
that specific factors contribute to offending behavior. Brown et al . (1998) found that in a sample of
98 sex offenders, treatment drop out was best predicted by having spent time in prison, having committed a violence-related index offense, having
committed non-contact offenses, unemployment,
substance abuse and delinquent/disruptive behavior
during treatment . Hanson and Harris (2000) concluded that recidivists had poor social support, attitudes tolerant of sexual assault, antisocial lifestyles,
poor self-management strategies and difficulties
complying with supervision . The recidivists showedsimilarities with the non-recidivists concerning general mood, but the recidivists displayed more anger
and subjective distress before reoffending . Prentky
et al . (1997) provided evidence illustrating that thestrongest predictors of sexual offense recidivism
include the degree of sexual preoccupation withchildren, presence of paraphilias and the number ofprior sexual offenses . The meta-analysis conductedby Hanson and Bussiere (1998) illustrated that thebest predictors of recidivism were sexual deviancy
as measured by PPG, history of sex crimes, psychological characteristics, negative relationship withmother, failure to complete treatment and the presence of depression and anxiety .

Actuarial assessments seek to evaluate an individual
through interpretation of standardized scores on
various risk assessment instruments whereas clinical assessments are based upon the mental healthprofessional's personal judgment and knowledge .
Grubin (1997) argues that actuarial instruments
provide little information pertaining to the causation and management of sexual offending and say
nothing about the individual . While clinical assessments can provide greater detail, Grubin provides
evidence that it is a paradigm essentially based
upon "untested and unsound theoretical foundations ." The available literature suggests that one
possible solution to the shortcomings of these models is to utilize a hybrid of the two in order to render a comprehensive report .
When interpreting risk factors, it is imperative thatthe mental health professional specifies both thestatic and dynamic factors applicable to the individual . Static factors involve variables that are stable over time whereas dynamic variables are subject
to change. While numerous studies have evaluatedstatic risk factors, the literature is practically voidof studies devoted to the evaluation of dynamic factors (Hanson, 1998) . Hanson and Harris (2000)
addressed this issue by providing evidence thatdynamic factors can be broken down further into
stable dynamic risk factors (those expected toremain unchanged for a substantial period of time)and acute dynamic risk factors (factors that changerapidly) . In their study of 208 sexual offense recidivists and 201 non-recidivist sex offenders, theauthors concluded that stable dynamic risk factors
showed the greatest potential in differentiating theIn recent years, a variety of evaluative instruments
have been developed in order to assess the risk ofsex offender recidivism . Some of these instruments
include the Sex Offender Risk Appraisal Guide(SORAG), Rapid Risk Assessment of Sexual
Offense Recidivism (RRASOR), Static-99 and theMinnesota Sex Offender Screening Tool-Revised(MnSOSTR) . General recidivism tools such as theViolence Risk Appraisal Guide (VRAG) and thePsychopathy Checklist-Revised (PCL-R) have also

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offenders in order to determine its predictive accuracy in assessing sexual recidivism . The results support use of the VRAG in predicting violence among
high-risk offenders, and it performed well uponcross-validation and follow-up when the two samples were combined . The authors claim that from apractical standpoint, the focus should be placed
upon predictions of future violence, not necessarily
a differentiation between sexual and nonsexual violence . Nunes et al . (2002) compared the predictive
accuracy of the SORAG to the revised Static-99 .
When the instruments were evaluated independently of one another, evidence suggests that they did
not provide any unique contributions and may be
redundant . However, when phallometric scores werecomputed in conjunction with Static-99 scores, accuracy increased . The authors propose that this effectwas not observed in the use of the SORAG because
it targets only general deviant arousal .

shown promise in determining sex offender recidivism. Barbaree et al . (2001) concluded that whenthese instruments were cross-validated on a sample
of 215 sex offenders, the VRAG, SORAG, RRASOR and Static-99 were capable of predicting general, violent and sexual recidivism . MNSOST-R
scores and guided clinical interviews were able toindicate general recidivism, but showed little sensitivity in discerning between serious or sexual reoffending . Out of all of these measures, the PCL-R,
when used alone, was sensitive in predicting generaland serious recidivism but was unable to predict
sexual recidivism.
According to Abel et al . (1994), screening tests forpedophilia have existed in various forms for a number of years . These screening tools have included
interviews, questionnaires, home visits and police
reports. Institutional policies have also been developed in the hopes of managing child molestation(education/training, elimination of individual staffchild interactions), yet all of these methods sufferfrom various limitations . The Abel Screening Tool(1994) entails a questionnaire and slides depicting
children, adolescents and adults . The individual
then rates these images based upon on how sexuallyarousing they are . A psychophysiological handmonitor then records physiological responses . The
efficacy of the instrument was established by comparing the responses of a self-selecting sample of"normal" participants to that of pedophiles that
had molested pubescent males and prepubescentmales/females . The Abel Screen displays high specificity (77%-98%), sensitivity (76%-91%) and efficiency (77.5%-96 .9%) when applied in a settingthat assumes a 5% prevalence rate of child molestation . The volumetric phallometer (sensitivity
86.7% ; specificity 95% ; and efficiency 94 .6%) andcircumferential plethysmograph (sensitivity 47 .5% ;specificity 100% ; efficiency 97 .4%) also display
respectable sensitivity, specificity and efficiency, butevidence suggests that these instruments are much
more intrusive, expensive and problematic than theAbel Screen .

Static-99, one of the most recent and promising risk
assessment instruments, consists of only static risk
factors taken from the RRASOR and the Structured
Anchored Clinical Judgment (SACJ) . Hanson andThornton (2000) combined the two scales in orderto determine whether or not a hybrid would display
greater predictive accuracy than the individual
scales . These instruments were applied across four
data sets, and it was concluded that while the RRASOR and the SACJ were nearly equivalent in theirpredictive accuracy of sexual recidivism, Static-99
showed the greatest accuracy. However, Sjoestedt
and Langstrom (2001) provide evidence illustratingthat the RRASOR and Static-99 should not be usedas the only determinants of risk . Cross-validation ofthese two instruments on a sample of 1,400
Swedish sex offenders illustrated that both instruments displayed moderate predictive accuracy
regarding short-term sexual recidivism . However,
Static-99 was found to have greater predictive accuracy when it came to assessing violent recidivism,
not sexual recidivism .
Social scientists have undertaken the task of developing a risk assessment instrument to screen for thepresence of ephebophiles within the clergy . Musser
et al . (1995) found that the Millon Clinical
Multiaxial Inventory (MCMI-II) was incapable ofdifferentiating cleric sex offenders from mentally ill

The Violence Risk Appraisal Guide (VRAG) andthe Sex Offender Risk Appraisal Guide (SORAG)
are very similar in their content . Rice and Harris(1997) utilized the VRAG on a sample of 159 sex

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the MCMI-II items. However, the combined scale
failed to identify many of the ephebophiles in thesample . The individual scales were capable of differentiating sexually abusive clerics from mentally
ill clerics, but the authors urge that a multidimensional approach be utilized when evaluating sex
offenders .

clerics . Cimbolic et al . (1999) attempted to create
an ephebophile scale by combining 11 items fromthe MCMI-II with 16 items from the MMPI-2 .
When tested on a sample of 165 Catholic priests
undergoing treatment, the authors concluded that a
combination of the two scales displayed greater
accuracy and increased the internal consistency of1 84