Assessing Efficacy of Sex Offender
Treatment Programs: Why This is
Anthony Beech
Assessing Efficacy of Sex Offender Treatment
Programs: Why This is Important
Decisions about public policy should be informed by the best
available research evidence
Practitioners and decision-makers should be encouraged to
make use of the latest research and information about best
practice, and to ensure that decisions are demonstrably
rooted in this knowledge
 Given the limited resources to run programs, all work clearly has to be
 We also need to know what works best for whom
Such work can give us a better idea of how to improve
programs once they are in operation
Systematic reviews 2009
Aims of the talk
Give a background to how research-based
treatment evolved
 Examination of meta-analyses that have
attempted to demonstrate what treatment
 And further, what type of treatment
 Describe how the What Works approach has
grown out of this work, that addresses:
◦ Risk
◦ Need
◦ Responsivity in treatment
The issue of offender rehabilitation has been a
controversial and contested one
The flashpoints include debate over the effectiveness of
rehabilitation and claims that even if treatment does
reduce reoffending offenders do not deserve the
opportunity to learn new skills and ultimately a chance
at better lives (Ward, Collie & Bourke, 2009)
Instead, the argument goes, they should be humanely
contained and the focus of sentencing on retribution
rather than treatment (Ward, Collie & Bourke, 2009)
What Works
Background 2
However, what is increasingly clear is that it is possible
to reduce reoffending rates by treating or rehabilitating
offenders as opposed to simply incarcerating them
(Andrews & Bonta, 2007)
Furthermore, treatment can be cost-effective as well as
harm reducing
Most recent comprehensive reviews of what works in
the correctional domain agree that some types of
rehabilitation programmes are extremely effective in
reducing reoffending rates (e.g., Andrews & Dowden,
2005, 2006).
What Works
Background 3
For example, Lipsey’s (1992) examination of
almost 400 studies of juvenile delinquency
treatment programmes led to the conclusion
that cognitive behavioural interventions that
were delivered in a rigorous and appropriate
manner resulted in considerable reductions in
reoffending (i.e., by at least 10%)
 Thus active attempts to change the
characteristics of offenders associated with
crime can reduce future risk
What Works
What does not work
On the other hand, deterrence based approaches and
diversion do not appear to provide any kind of significant
treatment effect
 The evidence suggests that deterrent type approaches which
includes intensive supervision programming, boot camps,
scared straight, drug testing, electronic monitoring, and
increased prison sentences are ineffective in reducing
recidivism (e.g., Gendreau, Goggin, Cullen, & Andrews, 2000;
MacKenzie, Wilson & Kider, 2001)
 In fact, a review of RCTs of scared straight programmes,
Petrosino, Turpin-Petrosino and Fincknaeuer (2000)
concluded that most actually increased recidivism (by up to
What Works
Effective treatment delivery in the UK
In June 1998 the UK Home Office started what is known as
the ‘What Works’ Initiative
While earlier Dr. David Thornton had done the same thing in
UK prisons
This has led to the development and implementation
of a demonstrably ‘effective core set of programs of
supervision for offenders’ which:
Are research-based (typically from large meta-analytic studies)
Are based on a cognitive-behavioral treatment (CBT) approach
Run to a clear model that is used in for all groups
Provide supervised treatment to ensure program integrity
Meta-analytic approaches
Meta-analysis is becoming increasingly recognized as a useful
tool as it is the process by which a number of study results
are combined in order to yield an overall weighted average
statistic (Egger et al., 2005)
 In the sex offender field, Kenworthy, Adams, Bilby, BrooksGordon, and Fenton (2004), conducted a meta-analysis of nine
identified RCTs, with over 500 offenders. Their results ranged
from one study demonstrating no benefit of psychodynamic
treatmen ; to another indicating that a cognitive-behavioral
treatment (CBT) approach resulted in reduced re-offending
 Using the same nine studies, by Brooks-Gordon, Bilby and
Wells (2006), concluded that CBT reduced re-offense at one
year but increased re-arrest at 10 years
 Hence, merely relying on RCTs suggests somewhat
inconclusive evidence for treatment
 Therefore, it would seem necessary to look for the
effectiveness of treatment using other treatment designs
Meta-analytic studies of sex offender treatment
using a wider range of designs than just RCTs
Hanson et al. (2002) (N = 9,534) sexual recidivism rate for the
treated groups was lower than that of the comparison groups
(12.3% versus 16.8% respectively;)
Lösel & Schmucker, 2005 (N = 22,181) treated offenders
showed 37% less sexual recidivism that untreated controls
Beech, Robertson and Freemantle (in preparation) (N =
14694) A positive effect of treatment in sexual reconviction
reduction (9.39% in the treated group versus 15.61% in
untreated controls)
The Beech et al. study has an odds ratio of 0.54, CI 0.43 - 0.69,
p < 0.0001) indicating that the likelihood of individuals being
reconvicted after treatment was around half that of those who
had not undertaken treatment
Treatment designs
Meta-analytic evidence base for CBT
Kenworthy et al. (2004) (N = 500+)
CBT and behavioural treatment
 psychodynamic
↓ sexual recidivism
Alexander (1999) recidivism rates (N = ????)
Group/ behavioural
25.8% (119/461)
18.3% (96/254)
13.6% (127/931)
8.1% (18/221
Lösel and Schmucker (2005) (N = 22,181 )
 CBT and behavioural treatment
 Insight oriented, therapeutic community,
other psychosocial
↓ sexual recidivism
Robertson, Beech, & Freemantle (in preparation) (N = 14,694 )
 CBT and behavioural treatment
↓ sexual recidivism
 psychodynamic
The What Works (RNR) Principles
(Andrews & Bonta, 2003;
Harkins & Beech 2007b for a review)
 RISK: Providing
the treatment intensity
proportional to risk level
 NEED: Targeting problematic behaviours or
criminogenic need (dynamic risk factors)
 RESPONSIVITY: tailoring treatment in such a
way that the individual will gain the most
benefit from it
Targeting risk
Overall risk management approach to treatment
 Key assumption that criminal behaviour is explained
by an individual’s profile of risk factors which are
acquired and maintained through conditioning,
observational learning, and personality dispositions
(Andrews & Bonta, 2006; Ward, Polaschek, & Beech, 2006)
Treatment then needs to target an individual’s specific
risk factors to reduce the likelihood of future
offending (Andrews & Bonta, 2006)
Why target high risk individuals?
When risk cases reported separately in studies
then larger effects found for higher risk cases
(Andrews et al., 1990)
Might be expected as these are the people who
untreated are much more likely to recidivate
 It makes sense to target resources at those most
likely to reoffend
Why target criminogenic need?
 Targeting ‘more
promising targets’ reduced recidivism
more than ‘less promising targets’ (Dowden, 1998)
 ‘More promising’
Changing antisocial attitudes/ feelings
Reducing antisocial peer associations
Promoting identification/ association with anticriminal role models
Increasing self-control, self- management, and problems solving skills
‘Less promising’
◦ Increasing self-esteem without simultaneous reductions in anti-social thinking,
feeling and peer associations
◦ Focusing on vague emotional complaints that have not been linked with criminal
◦ Attempting to turn the client into a better person when standards of being a
better person do not link with recidivism
Why address ‘Responsivity’?
Offender characteristics such as
Learning style
Cognitive maturity
By identifying personality and cognitive styles,
treatment can be better matched to the
Evidence supporting treatment that
adheres to RNR principles
(Andrews & Bonta, 2003)
If no treatment is offered or if none of the principles
are followed, an effect size (r) of -.02 was observed in Andrews and
Bonta’s study, demonstrating an increase in criminal recidivism
 However, if treatment is delivered in a manner that adheres to:
– only one of the above principles an effect size (r) of .02 is observed
– two of the principles effect size (r) is 0.18
– all three principles an effect size (r) .26 is observed
Therefore treatment programs that adhere to all three principles of
RNR show greatest reductions in sexual recidivism (Hanson et
al., 2009)
Evidence supporting RNR sex offender
(Hanson, Bourgon, Helmus, & Hodgson (2009) )
• Hanson, Bourgon, Helmus and Hodgson (2009) report the most
recent examination of effects of treatment examining 23 studies
(n=6746) that met the basic criteria for quality of design
• All studies were rated on the extent to which they adhered to
the risk, need, and responsivity (RNR) principles of the ‘What
Works’ approach
• Hanson et al. found that the sexual recidivism rate in untreated
samples was 19%, compared to 11% in treated samples
• Studies that adhered to all three RNR principles were found to
produce recidivism rates that were less than half of the recidivism
rates of comparison groups
• While studies that followed none of the RNR principles had little
effect in reducing recidivism levels.
Overview of treatment process
The RNR approach (a type of ‘What works’ approach) tells
◦ who should be allocated to which programmes (e.g., higher RISK
individuals should be allocated to highest intensity and lowest risk
to lowest intensity or no treatment)
◦ what should be targeted in treatment (i.e., NEED principle says
criminogenic need should be targeted in treatment- usually these
need areas are deviant sexual interest, offense-supportive attitudes,
socio-affective functioning, and self-management in sex offenders)
◦ and how treatment should be delivered (i.e., the RESPONSIVITY
factor says treatment should be offered in a way so that the
individual will gain the most benefit)
Then a specific model to guide the treatment of sex
offenders is used
Critique of the ‘What Works’ approach
Premier correctional rehabilitative theory
Provides a clear direction for treatment
Strong empirical base
But it does not focus on the overall well-being of the individual
Avoidance-goals (e.g., avoiding reoffending) are much less
motivating than approach- goals (e.g., pursuing a better life that
is not compatible with offending; Mann, Webster, Schofield, & Marshall,
There are problems with too much reliance on meta-analyses
◦ Are only as good as what you put in
◦ Can be like comparing ‘apples and oranges’
◦ File drawer effect
Some key references
Andrews, D. A., & Bonta, J. ( 2007). The psychology of criminal conduct, 4th
edition. Cincinnati, OH: Anderson.
Andrews, D.A., Zinger, I., Hoge, R.D., Bonta, J., Gendreau, P., & Cullen, F.T.
(1990). Does correctional treatment work? A clinically relevant and
psychologically informed meta-analysis. Criminology, 28, 369-404.
Beech, A.R., Robertson, C., & Freemantle, N. (submitted). A meta-analysis
of treatment outcome studies: Comparisons of treatment designs and
treatment delivery.
Hanson, R.K., Gordon, A., Harris, A.J.R., Marques, J.K., Murphy, W., Quinsey,
V.L., & Seto, M.C. (2002). First report of the collaborative outcome data
project on the effectiveness of psychological treatment for sex offenders.
Sexual Abuse: A Journal of Research and Treatment, 14, 169-194.
Harkins, L., & Beech, A.R. (2007a). Measurement of the effectiveness of sex
offender treatment. Aggression and Violent Behavior, 12, 36-44.
Harkins, L., & Beech, A.R. (2007b). A review of the factors that can
influence the effectiveness of sexual offender treatment: Risk, need,
responsivity, and process issues. Aggression and Violent Behavior, 12, 615-627.
Lösel, F., & Schmucker, M. (2005). The effectiveness of treatment for sexual
offenders: A comprehensive meta-analysis. Journal of Experimental
Criminology, 1, 117-146.