Notes from the ATSA Conference

FAC was fortunate to have two members of our Board attend the annual ATSA conference. We were equally fortunate that they returned with detailed notes on the different sessions, so that we have an idea of what’s being talked about among treatment professionals and what new issues and ideas are being exchanged.

Below are summaries from each session:

 

Summary One
Pre-Conference seminar “A Strengths-Based Treatment Program for Sexual Offenders”
Presenters: Liam E Marshall PhD
Research and Academics and Provincial Forensics
Waypoint Centre for Mental Health Care & Rockwood Psychological Services

W. L Marshall, OC, FRSC, PhD C. Psychology
Rockwood Psychological Services

•    Note Dr. W. L. Marshall, fondly referred to by all the key speakers and ATSA officers as “Bill” was honored with a special presentation. He is a long time contributor and very highly regarded by his colleagues.
Summary of the Model:
A Strengths-Based Approach is regarded as a balanced approach. Since sex offender clients are typically coerced into treatment both legally and psychologically, issues of dignity, respect, self-determination, humane treatment, which would include a focus on strengths, is lacking but needed.
Rationale for a Strengths-Based Approach is a focus on improving well-being and life satisfaction, which at least does no harm, an impact that has been found to occur with some more coerced types of treatment programs. Interestingly, according to the presenters, the Strengths-Based Approach is more enjoyable and less stressful for therapists as well.
Negatives with ‘Problem-Focused’ Treatment include examinations of problems in order to try and explain behaviors, and most importantly, leads to labeling.  At this point,  Dr.W.  Marshall referenced Relapse Prevention Plans that excessively include what NOT to do!”
A Strengths-Based Approach is not to be considered as soft on clients nor does it take away responsibility.  It costs no more than other approaches and is not considered to be a ‘cure,” as there actually is no such thing!
The presentation flowed into a Risk-Needs- Responsivity section (commonly referred to as R-N-R.)
This session was an in-depth presentation.  One take away that impressed me was that during a participant discussion about polygraphs, the senior Dr. Marshall stated, and I quote: “There is no evidence to suggest polygraphs are useful!  There is no shred of evidence to support polygraphy!”  At this point he referenced the U.S. National Research Council.
Another discussion point made was that the ‘containment model” (this is the one most used by our experiences with treatment providers) is Non-empirically Based as it draws on the assumption that ALL sex offenders are high risk.”
I attended a separate session that allowed for more in-depth discussion on polygraphy.  A separate summary will be provided.

Summary Two
Afternoon Session Pre-Conference Seminar Wed. Oct 14 “Internet –Based Child Exploitation “Case Formulation and Intervention Planning
Prersenters: Derek Perkins
NHS West London Mental
This presentation was heavy with data and trends.  Some interesting points:
According to the Royal Canadian Mounted Police Data (2012):
There are 14 million pornography websites (did not specify how many were child pornography)
1 million child abuse images
23 thousand to 40 thousand sites defending adult-child sites (Data from the U.S, Dept. of Justice (2013)
15-30 years imprisonment for 1st offense
Up to life if sadistic, violent, a child was sexually abused or with prior convictions for child sexual exploitation
UK and Europol data also provided similar results.
The UK Prime Minister declared a crackdown on online pornography in July 2013.  Implementation of pornography filters to reduce children’s access to sexually explicit material, criminalized access to ‘extreme pornography” and limit the proliferation of CSEM (Child Sex Exploitation Material) on the internet
Web site reference for further information: www.don’t-offend.org
Characteristics of CSEM users:
Sexual interest in children, high levels of anti-sociality, access to children, few psychological barriers of acting on their urges
This I found interesting: Data on reoffending of CSEM users:
Seto: 3.4 CSEM and 2% contact sex offense
Faust (2014) 3 % contact sex offense; 1.6% CSEM
The latter portion of this session dealt with “Pathways to Online Sexual Offending
The model presented was very complex, at least to me. And the conclusion slide stated this does not inform probabilistic reoffending risk but can be used to complement existing risk measures. The CPORT model, which is from the work of Seto and Eke which is increasingly being referenced in multiple works regarding risk, is provided below:
CPORT Model
Included are 7 risk predictor items:
•    Age above 35 years (49%)
•    No prior criminal history (41%)
•    Any contact Sex offense (18%)
•    Any failure on conditional release (15%)
•    Pedophilic or hebephiliac interest (40%)
•    More boy than girl content in illegal images material (15%)
•    More boy that girl content in nudity (fully or partially dressed, no sexual activity) and other child content (e.g. website images, catalogs, children in public spaces, (16%)
(My comment: We need to be familiar with this model.  It was derived from a partnership with one of the Canadian provinces law enforcement records and is well vetted among the research field.  Note: that possession of CP only is NOT included at all in these 7 items.  This is not intended to indicate that this is not to be considered but the cause for concern does not emerge or factor in with this study.)
As with many presentations and studies, more work in this field is recommended.

 

Summary Three
Thursday, Oct. 15, 2015
Plenary Session: “From Sweeping Controversies towards a Differentiated View on the Effects of Sexual Offender Trearment” Presented by Dr. Friedrich Losel, Institute of Criminology, Cambridge University, United Kingdom.  (Presented to all in attendance as a general session)
The speaker, with the utmost credentials in the field internationally, began with addressing the emotionality of the topic of sex offenders.  He provided a history dating back to the 19th century.
Key points include:
1)    Many political discussions are marginally based on research
2)    When research supports a political aim, there are windows of opportunity for impact
3)    Controversies exist on sex offender treatment between experts
4)    Data is often selected/selective
5)    Samples are often small and the quality of methodology is low
6)    Where treatment is considered, group sessions often result in a closing down of the communication resulting in low impact/effect
7)    Many recent evaluations yield very low recidivism rates
Concluding statement: We need to improve our agreement with the facts! (i.e. what works, with whom, in what contexts, under what conditions, regard to outcomes, and the overarching question of WHY?

Summary Four

Thursday Oct. 15, 2015
Pornography: Defining the clinical response: History, Societal Impact, the future, and your First Five Sessions” led by Andres J.R. Harris, Ph.D., Psych.
Current beliefs; Pornography is now part of the social fabric. A multi-faceted approach is needed to deal with it on a societal level.  These include legal controls, enforcement, early education for both children and parents, and ways to remove the money!  As a point of interest, Denmark teaches about pornography in its schools
A history was provided from Freud, Bandura (social learning theory) Skinner (behaviorist).
A process of four sessions to address further understanding of the evolution of pornography was presented as follows:
First session: Consent to counseling for the extent in which one engages in pornography.
Second session: A signified historical view is how pornography was used as a political influence (who could access etc.) and today’s evolution of revenge porn, and various Internet accessed sites.
Third session: Pornography has driven technological changes.  Historical views were of catalogs and even cave dwelling art and museums. Printing presses influenced heavily prior to technology.
Fourth session: attempts to define pornography.  (Playboy, stag films, etc.)
As far as the dangers noted in fully addressing this issue, research problems exist because a lot of self-report data is used, and research is dated but can have a long shelf life. Risk factors are multiple depending on exposure and personality make up.  Several researchers were referenced.
Fifth session: Thought Stopping techniques which include distractions, tools such as journaling, recognition there is a problem, frequency of use.
Future trends include the use of meta-data to target porn consumers; wearable tech in the form of tattoos and eventually watches and glasses that can transmit porn images.

Summary Five
Publishing PROTECT-Journey to Evidence –Based
It was about a highly funded program in Ohio that is defined as a community-based adolescent treatment program for sexual behaviors issues. Funding includes reimbursement from Medicaid. A total of 40 evaluators are hired to oversee a program with 124 clients in a given year. This is a VERY high ratio. A couple of’ take a ways’ could be that it is very costly to do preventive work in this field. The program includes a workbook series that can be purchased.  This program could however serve as a resource for the Family Foundation for Internet Awareness (FFIA), not to duplicate but to reference.
Summary Six
Management of Non-Contact Sexual Offenders; “Bridging the Gap: A Collaborative Evidence-based Model between Law Enforcement and Treatment Providers for Non-Hands on sex Crimes  “
Facilitated by Chris Kishiyama, Retired Captain and Candice Christensen, CMHC, CSAT-S Founder Namaste Center for Healing
(Note: Chris worked as special Ops in the Utah state Prison, Idaho Correctional Center, Special Sargent Drug Offender Reform, and Executive Government Relations Consultant, and Franklin Covey Leadership 2015 to present)
Candice: Clinical Director Sex Offender Outpatients Program in Utah, Private Practioners, Certified ABEL Assessor etc.
Concern: Treatment pf group members that include non-hands on offenders and hands-on offenders was ineffective because they were grouped with high risk, making it ineffective for low risk offenders.
1)    One size fits all treatment does not apply to sex crimes
2)    Social disgust impacts is important to how many treatments are provided
3)    Many clinical assessments and recommendations are not taken into account
Extensive discussion on trauma of having been abused and sexual addiction behaviors.
This session was actually rather clinical but it did provide food for thought.
Summary Seven
Friday, October 16, 2015
Plenary Session: Development and prevention of Physical Aggression:  The Long Term Gene Environment Perspective presenter: Richard E Tremblay Ph. D. Professor, School of Public Health U. College Dublin, Ireland
Session was very academic regarding an increasing number of longitudinal studies of singleton and twins initiated at birth or during first years of life show that physical aggression is more frequent in early childhood than at any other time during the life span. Therefore preventive interventions during this period are much more likely to be effective and substantially could decrease the costs of criminal behavior during adolescence and early adulthood.
Summary Eight
“Use of Polygraph in Supervision and Trearment Effective? Essential? Ethical?” presenters: Robin Wilson, PH, D. ABPP
David S. Prescott, LICSW
Objective is this session were to critically review:
1)    current use of polygraph in sexual violence prevention
2)    literature underscoring the use of polygraphs with clients who have sexually offended, as well as emerging research highlighting the therapeutic alliance
3)    implications of engaging in practices that have limited or no empirical basis.
Positions made by presenter were:
1) Field has a long history of false assumptions
2) We’ve fallen prey to these as well!
3) Solid research is needed
4) Human lives are in the balance
The need to do what works involves consideration of all angles and to be data-driven.

Critical element: Polygraphs are a part of the ‘three legged ‘stool of the containment approach so highly touted by Kim English: (supervision. treatment, and polygraphs!)  The presenter asked “is the polygraph the final answer?
Critical question: How does the polygraph relate to risk assessment findings?
Denial is not directly related to risk.
What actually do we need to know?
Disclosure-is it a process, an event? Can it be encouraged, forces or nudged?
Is disclosure the same as honesty or can it be a case of one-up man-ship?
Point made by presenter: when in an incarceration environment, the only decision one can make is whether to act up or not!
As clinicians and concerned practitioners, the goal is to assist all residents in the development of a BALANCED, SELF-DETERMINED LIFESTYLE. Contemporary research in the field suggests that learning to live a ‘good life’ is inconsistent with antisocial behavior. Reference made to W. Marshall’s work on Strength-Based Approach (see summary one)
It is important to note that it is often ‘over-assumed’ about number of victims disclosed in the interest of safety! (This needs to be further examined as to how this can be addressed/remedied because so many perceptions and treatment decisions, as well as sentences, etc. are affected by this factor!!!)
Chaffin, 2010 procedure to extract confessions seem to hold a particular sensitivity in the health care ethics literature, especially if the procedures are coercive or harsh.
Now may be the time to step back and take a look at how polygraphs and its processes align with best practice.
Research References:
From the British Psychological Society: Most published research on polygraphic deception detection has been concerned with its possible use in criminal investigations.”  (NOTE this does NOT include treatment for someone convicted of a crime requiring Treatment!)
National Research Council (2003)
“Almost a century of research in scientific psychology and physiology provided little basis for the expectation that a polygraph test could have extremely high accuracy!”
Hanson and Bussiere (1998) found no correlation between denial and risk to reoffend. Failing a polygraph evaluation did not predict recidivism (Cook, 2011; McGrath, et. Al 2007) Most studies supporting the use of the polygraph suffer from methodological problems and a lack of sufficient peer review (National Research Council, 2003.)
A LOT depends on the examiner. There is a possibility that findings in the future research will determine differences among polygraphists.
The ‘ethics’ of polygraphs are noted by Cross and Saxe(2001) which noted concerns regarding validity and ethics of coercion.
There may be some false assumptions. Canada does not require polygraphs. They have done the research but we must do the same. Whether or not passing a polygraph determines a critical decision is important.
Critical closing questions:
How did the polygraph become part of the containment model?  Was it a “Don’t just stand there—do something!” approach?
Polygraphy is an area where secrecy is prime!!!Polygraphs can/may be useful in certain circumstances but how do we know what these circumstances are?
Maintenance polygraphs are an issue.
Note: The session had about 150 people attending. Before the start, presenters asked for a show of hands on three areas: 1) Those who were strongly in favor of polygraphs; 2) those who were unsure; and 3) those who were opposed. According to the presenters the numbers were 60%, 20% and 20 % respectively. Interesting!  At the close of the session, the same informal survey was taken and the results remained about the same. This can be indicative of people’s minds made up no matter the facts!!

Summary Nine:
Treatment Considerations for Child Pornography Offenders
This session related to those offenders who have CP-only offenses, not mixed offenders.  A clinical first question is: Who are you dealing with? Labels used are: CPO (Child Porn offenders: CSAIO (Child Sexual Abuse Image offenders); and CSEMO (Child Sexual Exploitation Materials offenders
Question posed by Presenter:  Does it actually matter what we call these offenders because in reality, there is a stigma associated with this offense that requires a balance between public demonization with    evidence –based practices.
Returning to the purpose of session, with CPO, they tend to be male, Caucasian, higher IQ and better educated AND less criminal history than contact sex offenders.  More likely to be pedophiles (I hate to include this but it was in the PPT slide!) yet lower in static and dynamic risk measures, (e.g. PCL-SC, Stable 2000, Risk matrix 2000)
General Typologies:
•    Antisocial, dysregulated, Pedophilic, sex ‘addicts, special needs offenders.
•    Implications for treatment:
•    Mixed offenders (CP and past-current direct victimization) are different than CPO offenders (Smid et.al.2014; Babchishin, 2015; Eke, Seto & Williams, 2011)
•    How are they different? (Lower in anti-sociality—mixed offenders are more likely to be pedophilic (Babchishin (2015)
•    From a treatment perspective, a mixed offender would automatically be directed towards a regular sex offender treatment program as a contact offender who has an identified or known victim.
RISK and CP ONLY Offenders:
Higher risk would include prior police contacts, charges or convictions; multiple computers, young victims under 5
Overall, future contact offenses in the CP only group has been reported to be LOW by several researchers (Endrass, et.al…2009;Goller et.al. 2010; Seto, Hanson, Babchishin, 2011)
Note: The stigma of CP is equal if not greater than contact offenses.  Many struggle with suicidal ideation at the time of their arrest.
TREATMENT presentation went into steps to access CP etc.,