Vera Sex Offender Treatment and Reentry Report 2008
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TREATMENT AND REENTRY PRACTICES FOR SEX OFFENDERS An Overview of States Reagan Daly Vera Institute of Justice September 2008 Suggested citation: Reagan Daly. Treatment and Reentry Practices for Sex Offenders: An Overview of States. New York: Vera Institute of Justice, 2008. This report was prepared by the Vera Institute of Justice under grant 2006-MU-BX-K018 awarded by the Bureau of Justice Assistance. The Bureau of Justice Assistance is a component of the Office of Justice Programs, which also includes the Bureau of Justice Statistics, the National Institute of Justice, the Office of Juvenile Justice and Delinquency Prevention, and the Office for Victims of Crime. Opinions expressed in this document are those of the author and do not necessarily represent the official position or policies of the U.S. Department of Justice or the Vera Institute of Justice. © 2008 Vera Institute of Justice. All rights reserved. Additional copies can be obtained from the communications department of the Vera Institute of Justice, 233 Broadway, 12th floor, New York, New York, 10279, (212) 334-1300. An electronic version of this report is available for download on Vera’s web site, www.vera.org. Requests for additional information about the research described in this report should be directed to contactvera@vera.org. Treatment and Reentry Practices for Sex Offenders Vera Institute of Justice ii Executive Summary the ACUTE, are becoming more prevalent in community supervision. Over the past 15 years, the response of the criminal justice • No reentry initiatives were found that system to people who have been convicted of a sex offense specifically target sex offenders. Although has become increasingly punitive, relying heavily on eligible for general reentry programming in incarceration. Yet, a consequent increase in criminal most states, people convicted of a sexual justice costs has led some states to reconsider their offense have few, if any, options for reentry response to sex offenders. Concerns about public safety programming that addresses their unique needs. and the protection of victims remain the primary focus, but • Correctional institutions and community many states have also invested in treatment and reentry supervision agencies in most states share programs as alternatives to incarceration for some people. information about the case histories and treatment plans of sex offenders who are Although the content and structure of treatment and reentry programs vary considerably from one jurisdiction returning to the community from prison. to another, few if any resources provide criminal justice Research suggests that this type of inter-agency officials and policymakers an overview of these programs communication can help reduce recidivism. or a comparative assessment of their effectiveness. This • In general, community supervision agencies report attempts to address these issues by providing an manage risk and provide services. Research overview and analysis of existing treatment and reentry suggests that this is an effective approach to practices for sex offenders who are involved with the reducing recidivism. criminal justice system. It focuses, specifically, on four • A limited number of states are conducting broad areas of practice: treatment in prison, treatment research on their own treatment, reentry, and under community supervision, reentry programming, and supervision initiatives. Almost no studies have community supervision. Interviews with state officials and examined these programs from a cost-benefit treatment providers from 37 states that responded to our perspective. survey revealed several findings: • In both prison and community settings, the treatment of sex offenders is generally grounded in evidence-based practices, especially cognitive-behavioral therapy. In general, treatment is much more available in the community than in institutional settings. • In most of the participating states, communitybased treatment for sex offenders is supported, at least in part, by collecting fees from those in treatment—a circumstance that may limit access to these programs. • Standardized risk assessment tools such as the STATIC-99 are now widely used nationally in both prison- and community-based treatment programs. Needs assessment tools, especially Treatment and Reentry Practices for Sex Offenders Vera Institute of Justice iii Acknowledgments I would like to thank the following people for their assistance in conducting this study: Robin Campbell, Ashley Cannon, Tina Chiu, Jennifer Fratello, Jordie Hannum, Alisa Klein, Abbi Leman, Scott Matson, Charles Onley, Ruth Parlin, Maggie Peck, Carla Roa, Christine Scott-Hayward, Neil Weiner, Dan Wilhelm, and finally, all interview respondents. Edited by Patrick Kelly. Treatment and Reentry Practices for Sex Offenders Vera Institute of Justice iv Table of Contents Executive Summary ...................................................................................................... iii Acknowledgments......................................................................................................... iv Introduction and Background.......................................................................................... 1 Methodology ................................................................................................................. 2 Research on Treatment, Reentry, and Community Supervision Practices ............................ 3 Prison- and Community-Based Treatment ................................................................ 3 Reentry Programming ............................................................................................ 6 Community Supervision .......................................................................................... 7 Recent Trends in Treatment, Reentry, and Community Supervision Practices...................... 8 Prison-Based Treatment ......................................................................................... 8 Community-Based Treatment................................................................................ 11 Reentry Programming .......................................................................................... 12 Community Supervision ........................................................................................ 13 Conclusions................................................................................................................. 15 Bibliography ................................................................................................................ 16 Appendix A: State Overview Tables of Prison-Based Treatment ....................................... 18 Appendix B: State Overview Tables of Community-Based Treatment................................ 23 Appendix C: State Overview Tables of Reentry Programming .......................................... 26 Appendix D: State Overview Tables of Community Supervision Practices .......................... 28 Appendix E: Individual State Templates......................................................................... 30 Treatment and Reentry Practices for Sex Offenders Vera Institute of Justice v Introduction and Background release information to the public about known convicted sex offenders, and has continued through the passage of The sentencing and management of sex offenders is one Jessica’s Law in 2006, which introduced stricter of the most difficult and controversial issues facing the penalties and restrictions for sex offenders.) Today, the criminal justice system today. This is in large part due to term sex offense can include everything from child the brutal nature of many sex crimes and the fact that molestation to public urination. The increasing reliance on incarceration as a many victims are children and other vulnerable people— a combination that elicits highly emotional responses response to sex offenses, together with expanded from the public. definitions of what constitutes a sex offense, has driven Over the past 15 years, the criminal justice system’s up criminal justice costs. This has led some states to response to people who have been convicted of a sex reconsider their response to sex offenders. While offense has become increasingly punitive. In 2004, more concerns of public safety and the protection of victims than 150,000 people were incarcerated in state prisons remain the primary focus, a number of states—especially for sex offenses, compared with 142,000 in 2002 and those with limited resources—have concluded that 1 110,000 in 1999. In many states, lengthy prison incarceration is simply not a viable long-term solution, at sentences are now the norm: according to one recent least not for all sex offenders. study, people who are incarcerated in connection with a In fact, most people who are convicted of a sex sex offense spend about twice as long in prison as those offense will be placed under community supervision at 2 who serve time for other crimes. Also, an increasing some point—either on probation immediately following number of local and state laws impose strict registration sentencing or on parole after having served a jail or and residency requirements on people who have been prison term. A 1997 study by the Bureau of Justice convicted of a sex offense, even after they have served a Statistics reports that of the approximately 234,000 adult prison sentence. There are now more than 636,000 sex offenders who are under the custody or control of registered sex offenders in the United States—one in 500 correctional agencies on any given day in the United 3 Americans. This number has doubled in the last 4 decade. The punitive response of the past 15 years is not limited to sentencing laws and stricter registration States, almost 60 percent are under some form of community supervision.5 Although there has been no follow-up study in recent years, this number has likely grown. requirements: the definition of what constitutes a sex To cope with the large number of sex offenders under offense has also been greatly expanded. (The beginning community supervision, a growing number of states are of this expansion coincided with the 1993 passage of investing in treatment programs. Increasingly, these Megan’s Law, a federal regulation that directed states to programs are also functioning as alternatives to incarceration. However, the content and structure of treatment and 1 W.J. Sabol, H. Couture, and P.M. Harrison, Prisoners in 2006 (Washington, DC: Bureau of Justice Statistics, 2006); P. M. Harrison and A. J. Beck, Prisoners in 2004 (Washington, DC: Bureau of Justice Statistics, 2004); A. J. Beck and P. M. Harrison, Prisoners in 2000 (Washington, DC: Bureau of Justice Statistics, 2000). 2 Lawrence A. Greenfield, Sex Offenses and Offenders: An Analysis of Data on Rape and Sexual Assault (Washington, DC: Bureau of Justice Statistics, 1997, NCJ 163392). 3 National Center for Missing & Exploited Children, Registered Sex Offenders in the United States per 100,000 Population (map), March 25, 2008. 4 Devon B. Adams, Summary of State Sex Offender Registries (Washington, DC: Bureau of Justice Statistics (Fact Sheet): March 2002, NCJ 192265). Treatment and Reentry Practices for Sex Offenders reentry programs vary considerably from one jurisdiction to another, and there are few resources for criminal justice officials and policymakers who would like an overview of these programs nationwide. Both the Center for Sex Offender Management and the Association for the Treatment of Sexual Abusers, an international non-profit 5 Ibid. Vera Institute of Justice 1 organization, have produced publications on the treatment community supervision. We end with a discussion of and management of sex offenders, but policymakers overarching themes and conclusions. seeking to optimize their use of resources would profit from a survey of the programs that are currently in place across the United States. Similarly, their policy decisions Methodology would benefit from a comparative assessment of the effectiveness of current practices. Vera researchers relied on qualitative methods to collect This report attempts to address these issues by and analyze data for this report. Data was collected over providing an overview and analysis of existing treatment a six-month study period through phone interviews with and reentry practices for sex offenders involved with the state officials and other policymakers who manage sex criminal justice system (as opposed to those who are offenders. 6 civilly committed). Drawing on information that was For each of the four substantive areas mentioned collected by Vera researchers from policymakers and earlier (prison-based treatment, community-based treatment providers in the 50 states and Washington, DC, treatment, reentry, and community supervision), Vera it emphasizes the structure, content, and availability of researchers developed detailed interview questionnaires those programs and, when applicable, compares current and identified at least one potential respondent from each practices to research findings. Specifically, it focuses on state (for a minimum total of four contacts per state). four broad areas of practice: treatment in prison, Most respondents either worked in the Department of treatment under community supervision, reentry Corrections or another state agency or were treatment 7 programming, and community supervision. providers. Interview questions were open ended. The overall response rate for all four substantive Note that this report does not provide an exhaustive catalog of what each state is doing in terms of treatment, areas categories across all 51 jurisdictions was 65 reentry, and community supervision, nor does it provide percent.9 For each state, Vera researchers entered a comprehensive overview of the legal context in which information into an answer template that covered all four 8 these services are being delivered. Rather, it aims to substantive areas. Once this answer template was identify and analyze nationwide trends in treatment and completed, it was sent back to the respondents to reentry practices. confirm that it was consistent with the information they After a brief description of our methodology, we had provided. The completed state templates are begin with a review of the latest research on treatment, included as appendices in this report. They provide reentry, and community supervision practices for sex detailed information on both the treatment and reentry offenders. Then, we present and analyze our findings practices themselves as well as the context in which they from each of the four broad areas of practice, beginning were developed. To identify larger patterns, Vera researchers with prison-based treatment and followed by community-based treatment, reentry programming, and conducted a qualitative data analysis. This qualitative analysis consisted in reviewing each state template and 6 Civil commitment is the court-ordered confinement and treatment of sex offenders who are deemed to represent a significant threat to public safety. 7 Sex offenders in the community also receive treatment under civil commitment. However, this study focuses exclusively on treatment in the criminal justice context. 8 To gain a better understanding of state legislation governing sex offender definitions, registration requirements, and sentencing practices, the Vera Institute has also issued a companion report, The Pursuit of Safety: Sex Offender Policy in the United States, that gives a national overview of these issues. Treatment and Reentry Practices for Sex Offenders categorizing treatment and reentry practices according to topics of general interest, such as whether statewide standards exist or the number of treatment providers in a given state. These state overviews are also included in 9 In social science research, a response rate above 50 percent is considered adequate for analysis and publishing (see Babbie 2005 for more information). Vera Institute of Justice 2 the appendices. Categorizing treatment and reentry makes it difficult to assess the financial impact of these practices in this manner provided researchers with a programs. broad overview of the subjects. There are, however, a number of methodological This study has two methodological limitations. First, issues associated with research on sex offenders that as is true of any study that relies on interview responses, limit the applicability of these findings. For one, it is some of those we contacted chose not to participate, with often difficult to find a control group with which to the result that there are gaps in our data. Our discussion compare program participants—a necessary step if one is of national trends and patterns here reflects only those to know for certain a program’s effect. Also, low states that responded to requests for phone interviews. baseline rates of sexual offense arrests and significant Second, the trends identified in this report are based on under-reporting of sexual offenses make it difficult for information reported by state contacts. While Vera researchers to demonstrate statistically significant researchers made every effort to ensure that the reductions in sexual offending as a result of treatment information is accurate, this is a complex subject, and the and reentry programs.10 open-ended nature of our interview questions left room for interpretation and (possibly) error. In the remainder of this section, we discuss in more detail research as it relates to each of the four broad areas of practice identified earlier: treatment in prison, Research on Treatment, Reentry, and Community Supervision Practices community-based treatment, reentry programming, and community supervision. PRISON- AND COMMUNITY-BASED TREATMENT Treatment programs generally have three aims: First, they In this section, we present an overview of recent research aim to help offenders take responsibility for their actions. on treatment (both in prison and in the community), Second, they aim to prevent relapse. Third, they aim to reentry, and community supervision practices for sex rehabilitate people who have been convicted of a sex offenders. The aim is to provide a context for the offense.11 Different programs pursue these goals in a assessment of current state practices described in variety of ways, ranging from CBT to chemical castration subsequent sections of this report. (the use of a hormonal medication such as Depo-Provera to Broadly, the research on treatment methods has temporarily reduce testosterone levels) to education. The consistently found that cognitive-behavioral therapy appropriateness of any particular approach often depends (CBT), a treatment that relies on changing thought on the nature of a person’s offending behavior: a treatment processes to help people understand and accept that is geared toward pedophiles, for example, may not be responsibility for their offenses, is the most effective appropriate for an adult rapist who exhibits more general approach to reducing sexual and overall recidivism. criminal tendencies. (This result applies to programs that provide CBT in prison as well as those that provide it in other settings.) Treatment across settings. A 2002 meta-analysis of 43 In addition, the research on reentry and supervision studies on the psychological treatment of sex offenders practices has uncovered two salient findings: social found that the average rate of sexual recidivism for support is key to making a successful transition back to people in treatment (12.3 percent) was statistically society, and supervision is most effective when combined with specialized sex offender treatment services. Unfortunately, there has been little cost-benefit analysis of treatment and reentry programming, which Treatment and Reentry Practices for Sex Offenders 10 It becomes increasingly difficult to establish statistically significant differences as the number of outcome events decreases. 11 Kurt Bumby, Understanding Treatment for Adults and Juveniles Who Have Committed Sex Offenses (Silver Spring, MD: Center for Sex Offender Management, 2006). Vera Institute of Justice 3 significantly lower than for those who did not receive 12 differences in risk assessment scores between those who treatment (16.8 percent). The average rate of overall completed the program and those who did not, it is recidivism for those in treatment was also lower (27.9 impossible to know for certain whether factors other than percent, compared with 39.2 percent for people who treatment affected the observed outcomes.16 were not in treatment).13 Finally, the analysis found that In contrast, there are several studies which have CBT, which has become standard practice in almost examined specific treatment programs and concluded every state, is much more effective than the treatments that they do not have a significant effect on recidivism that were used before 1980. More recently, a review of rates.17 Among these is a study in which prisoners who 69 controlled outcome evaluations of sex offender had volunteered to participate in California’s Sex treatment confirmed many documented earlier findings. Offender Treatment and Evaluation Project (SOTEP) It also found that treatment reduces sexual recidivism by were randomly assigned to either SOTEP (which an average of 37 percent and that hormonal therapy and employed CBT and relapse prevention, a treatment that CBT work best—although it was difficult to separate the uses cognitive and behavioral techniques to help 14 effect of these treatments from other factors. The report offenders identify and change negative behavioral concluded that more rigorous studies were needed to patterns) or a control group.18 Likewise, researchers from determine the effectiveness of different treatments for the Washington State Institute for Public Policy different types of offenders. (WSIPP), which is well-known for both its metaanalyses and its research on treatment for sex offenders, Prison-based treatment. The research literature on the found that a sex offender treatment program for inmates effectiveness of treatment programs for incarcerated had little effect on recidivism rates for sexual and violent offenders is fairly inconclusive. A 2003 study of 195 sex offenses—despite the fact that those who participated in offenders who took part in a prison-based CBT program the program did so voluntarily and were thus likely to be in Vermont found that people who completed the amenable to treatment.19 program were significantly less likely (5.4 percent) than In spite of these inconclusive results regarding those who dropped out (30.6 percent) or refused to prison-based treatment in general, there is some evidence participate (30.0 percent) to be charged with a sexual that CBT in particular is effective for lowering 15 offense in a six-year follow-up period. It also found recidivism rates. In addition to the Vermont study that continuing with treatment after release from prison was significantly associated with lower recidivism of sexual offenses. However, this study did not use randomly assigned treatment or control groups, so despite the fact that researchers found no significant 12 Because meta-analyses incorporate numerous studies that measure recidivism differently, it is not possible to define recidivism more specifically. 13 R.K. Hanson, A. Gordon, A.J.R. Harris, J.K. Marques, W. Murphy, V.L. Quinsey, and M.C. Seto, “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 (2002): 169-194. 14 F. Lösel and M. Schmucker, “The Effectiveness of Treatment for Sexual Offenders: A Comprehensive Meta-Analysis,” Journal of Experimental Criminology 1(2005): 117-146. 15 R.J. McGrath, G. Cumming, J.A. Livingston, and S. Hoke, “Outcome of a Treatment Program for Adult Sex Offenders: From Prison to Community,” Journal of Interpersonal Violence 18, no 1 (2003): 3-17. Treatment and Reentry Practices for Sex Offenders 16 The use of comparison groups allows researchers to assess whether or not changes in outcomes following treatment would have occurred in the absence of treatment as well. Random assignment to treatment or comparison groups provides the strongest evidence of a treatment effect because it creates two groups that are comparable except for the treatment intervention. 17 A. Mander, M. Atrops, A. Barnes, and R. Munafo, Sex Offender Treatment Program: Initial Recidivism Study (Anchorage, AK: Alaska Department of Corrections, 1996); and V.L.E. Quinsey, G.T. Harris, M.E. Rice, and C.A. Cormier, Violent Offenders: Appraising and Managing Risk (Washington, DC: APA, 1998). 18 J.K. Marques, M. Wiederanders, D.M. Day, C. Nelson, and A. Van Ommeren, “Effects of a Relapse Prevention Program on Sexual Recidivism: Final Results from California’s Sex Offender Treatment and Evaluation Project (SOTEP). Sexual Abuse: A Journal of Research and Treatment 17 (2005): 79-107. Note that because random assignment fully controls for competing influences on recidivism, the absence of a significant difference between the two groups in this study can be interpreted as strong evidence that there was in fact no difference between them. 19 L. Song, and Roxanne Lieb, Washington State Sex Offenders: Overview of Recidivism Studies (Olympia, WA: Washington State Institute for Public Policy, 1995). Vera Institute of Justice 4 mentioned above, a 2000 study of high-risk sex $3,258 per participant. In contrast, treatment delivered to offenders who volunteered for Canada’s Clearwater Sex juveniles in an institutional setting saved an average of Offender Treatment Program, which used both CBT and $7,829 per participant.23 This was the only cost-benefit a relapse prevention component, found that program analysis we uncovered in our review. participants had significantly lower reconviction rates than those in a comparison group.20 Moreover, the Community-based treatment. The research on difference in conviction rates was much larger for sexual community-based treatment programs for sex offenders reconvictions than for nonsexual reconvictions. suggests, fairly consistently, that these programs are Similarly, in a comprehensive meta-analysis, WSIPP effective in reducing recidivism. In one study of 1,400 researchers found that prison-based CBT reduced sex offenders who were sentenced to probation in 21 recidivism by an average of 14.9 percent. Therapeutic community programs, which emphasize Minnesota, researchers found that re-arrest rates for sexual offenses for those who completed treatment (5 group support in facilitating behavior change, have also percent) were lower than for those who began but did not been shown to exert a beneficial effect on sex offender complete treatment (11 percent) and those who never recidivism. In 2003, the Colorado Division of Criminal entered treatment (11 percent).24 The Minnesota study Justice found that sex offenders who participated in their also found that offenders who completed treatment were prison-based therapeutic community program were less likely to be re-arrested for any new offense (13 significantly less likely than sex offenders who did not percent versus 45 percent for those who began but did participate in the program to recidivate across a number not complete treatment, and 42 percent for those who 22 of measures. Moreover, the Colorado study found that longer periods of treatment in the therapeutic community never entered treatment). In addition, there is evidence that treatment designed led to lower recidivism rates upon release. Again, to address deviant feelings and behaviors specifically though, this evaluation did not use randomly assigned related to sexual offending has an effect on both sexual treatment and control groups, nor did it match people in and nonsexual recidivism rates above and beyond the the two groups on the basis of characteristics that may effects of general treatment, which addresses more have influenced their decision to enroll in treatment. As general mental health and behavioral issues. For a result, it is not possible to attribute the observed example, a 1998 study found that probation supervision outcomes to the program with any certainty. combined with specialized sex offender treatment, as With regard to the cost of prison-based treatment compared with probation supervision combined with programs, a cost-benefit analysis by the WSIPP found only general mental health treatment, significantly that these programs, when combined with aftercare, reduced overall re-arrests (for both sexual and nonsexual actually increase costs to taxpayers by an average of offenses) among a group of sex offenders in rural Vermont.25 However, neither the Minnesota nor the 20 J. Looman, J. Abracen, and T. Nicholaichuk, “Recidivism among treated sexual offenders and matched controls,” Journal of Interpersonal Violence 15, no. 3 (2000): 279-290; Polly Phipps, Kim Korinek, Steve Aos, and Roxanne Lieb, Research Findings on Adult Corrections Programs: A Review (Olympia, WA: Washington State Institute for Public Policy, 1999). Throughout this section, “significance” means statistical significance. 21 Steve Aos, Marna Miller, and Elizabeth Drake, Evidence-Based Public Policy Options to Reduce Future Prison Construction, Criminal Justice Costs, and Crime Rates (Olympia, WA: Washington State Institute for Public Policy, 2006). 22 Kerry Lowden, Nicole Hetz, Linda Harrison, Diane Patrick, Kim English, and Diane Pasini-Hill, Evaluation of Colorado’s Therapeutic Community for Sex Offenders: A Report of Findings (Office of Research and Statistics, Division of Criminal Justice, 2003). Treatment and Reentry Practices for Sex Offenders Vermont study used random assignment, so it is not possible to conclude with any certainty that the 23 Aos, Miller, and Drake, Evidence-Based Public Policy Options to Reduce Future Prison Construction, Criminal Justice Costs, and Crime Rates, 2006. 24 Sex Offender Supervision: 2000 Report to the Legislature (St. Paul, MN: Minnesota Department of Corrections, 2000). 25 R.J. McGrath, S.E. Hoke, and J.E. Vojtisek, “Cognitive-Behavioral Treatment of Sex Offenders: A Treatment Comparison and LongTerm Follow-Up Study,” Criminal Justice and Behavior 25 (1998): 203-225. Vera Institute of Justice 5 reductions in re-arrests were due to treatment rather than studies that addresses the subject directly began by other factors. examining the general literature on successful reentry With regard to specific treatments, there is strategies for people convicted of a wide range of considerable evidence, grounded in methodologically offenses. Then, arguing that these reentry strategies can sound research, that community-based CBT is effective be applied to sex offenders so long as one takes the in reducing overall recidivism. However, it remains unique needs of sex offenders into account, it identified unclear whether community-based CBT is effective in several key factors in the successful reentry of sex reducing sexual recidivism. In a systematic meta- offenders: analysis of sex offender programming that examined only those evaluations that used a well-matched comparison group, WSIPP researchers found that CBT significantly reduces recidivism (by an average of 31.2 percent across studies) among low-risk sex offenders on 26 probation. The WSIPP study did not, however, examine the impact of CBT on sexual recidivism. It is difficult to assess the impact of medical treatments on sexual offending. This is primarily due to 1. Institutional and community case managers collaborate to maintain a consistent approach. 2. Manage sex offenders in prison in a way that prepares them for release. 3. Consider the benefits of discretionary release policies. 4. Have case managers actively involved in facilitating the transition. ethical restrictions that prevent researchers from 5. Recognize victims as important stakeholders. randomly assigning people to procedures or treatments 6. Develop a community supervision approach for that are either potentially harmful or invasive. sex offenders that promotes successful outcomes Nonetheless, there have been a handful of studies in this in addition to risk management.29 area. One of these, a study based on a sample of mostly pedophiles, found that people who volunteered for and The Center for Sex Offender Management endorsed were surgically castrated were significantly less likely to these strategies in a 2007 report. engage in recidivism of sexual offenses than volunteers 27 A handful of studies have examined the impact of who were not castrated. In addition, a meta-analysis specific reentry models on sex offenders leaving prison. found that hormonal therapy was, on average, more A 2005 study, for example, examined Circles of Support effective in reducing sexual recidivism than psychosocial and Accountability (COSA), a program that originated in interventions—although other aspects of these programs Canada and is becoming more prevalent in the United 28 may account for this effect. States. COSA encourages high-risk offenders to develop support networks in the community, consisting mostly of REENTRY PROGRAMMING volunteers from faith-based organizations who visit them Reentry programming aims to help sex offenders make on a regular basis, following their release from prison. the transition back into the community after they are The researchers found that sex offenders who released from prison. Although reentry in general is a participated in COSA recidivated at a rate that was 31.6 major topic in the field of corrections, there has been percent lower than people in a matched group who did relatively little research that focuses on the specific not participate.30 Another study of COSA, this one from needs of sex offenders leaving prison. One of the few 26 Steve Aos, Marna Miller, and Elizabeth Drake, Evidence-Based Adult Corrections Programs: What Works and What Does Not (Olympia, WA: Washington State Institute for Public Policy, 2006). 27 Ibid. 28 Lösel and Schmucker, 2005. Treatment and Reentry Practices for Sex Offenders 29 K.M. Bumby, T.B. Talbot, and M.M. Carter, “Sex Offender Reentry: Facilitating Public Safety through Successful Transition and Community Reintegration,” Criminal Justice and Behavior (in press). 30 R.J. Wilson and J.E. Picheca, “Circles of Support and Accountability: Engaging the Community in Sexual Offender Management” in B.K. Schwartz (Ed.), The Sex Offender: Issues in Assessment, Treatment, and Supervision of Adult and Juvenile Vera Institute of Justice 6 2007, concluded that the program led to a 70 percent ensure victim safety, and make reparation to reduction in re-arrests for sexual offenses and a 57 victims. 31 percent reduction in re-arrests for violent offenses. 2. Sex offender management should rely on interagency coordination, interdisciplinary Finally, a number of studies suggest that many sex offenders leaving prison need community support to find partnership, and job specialization to provide a a place to live, as strict residency requirements often unified approach. 32 3. Offenders should be held accountable through make it difficult for them to find affordable housing. individualized case management plans that use COMMUNITY SUPERVISION informal controls (which are learned and Community supervision refers to those forms of reinforced through treatment) as well as external correctional supervision that do not involve controls (in particular the active involvement of incarceration, such as probation, parole, and community family and law enforcement). Polygraphs should corrections. (Community corrections involves also be used to monitor these internal and monitoring offenders independently of probation and external controls. 4. State and local criminal justice agencies and parole. In general, community corrections agencies supervise offenders who have been diverted from prison policymakers should work together to develop but who represent a higher risk than people on informed public policies. 5. Criminal justice agencies should develop quality probation.) The research on community supervision is similar to that on reentry in that it stresses the control mechanisms to monitor the importance of social bonds and community support in implementation of these strategies and to assess reducing recidivism and rehabilitating offenders. their effectiveness over time. One of the most promising models of community supervision—and perhaps the most widely known in the Each of these principles is grounded in the clinical sex offender management community—is the treatment literature, and research on the containment containment model, an evidence-based model developed model provides support for its effectiveness in reducing by the Colorado Division of Criminal Justice in the recidivism. Some of this research overlaps with the 1980s. The containment model is grounded in five key treatment literature discussed earlier—for example, the principles, all of which support the notion that sexual re- Colorado therapeutic community program that was offending can be minimized through internal and found to reduce recidivism was grounded in the 33 external controls: containment approach. In addition, a 2001 Oregon study found that people on probation and parole who took part 1. The primary objectives of sex offender management are to enhance public safety, in a program that combined treatment, polygraph monitoring, and specialized supervision were 40 percent less likely to be convicted of a new felony than people on probation and parole in a neighboring county who did Populations (pp 13.1-13.21) (Kingston, NJ: Civic Research Institute, 2005). 31 R.J. Wilson, J.E. Picheca, and M. Prinzo, “Evaluating the Effectiveness of Professionally Facilitated Volunteerism in the Community-Based Management of High-Risk Sexual Offenders: Part Two—A Comparison of Recidivism Rates, The Howard Journal, 46, no. 4 (2007): 327-337. 32 Joan Petersilia, When Prisoners Come Home: Parole and Prisoner Reentry (New York, NY: New York Open Society Institute, 2003). 33 K. English, S. Pullen, and L. Jones, Managing Adult Sex Offenders in the Community: A Containment Approach (Washington, DC: National Institute of Justice, Research in Brief, 1997). Treatment and Reentry Practices for Sex Offenders not receive the same combination of services.34 Other state-specific analyses have found that sex offenders who are supervised under the containment model have low 34 K.A. England, S. Olsen, T. Zakrajsek, P. Murray, and R. Ireson, “Cognitive/Behavioral Treatment for Sexual Offenders: An Examination of Recidivism,” Sexual Abuse: A Journal of Treatment and Practice 13, no. 4 (2001): 223-231. Vera Institute of Justice 7 felony re-arrest rates (6 percent in one study). However, differences between the two groups with respect to the none of these state-specific studies used comparison number of people charged with sexual offenses; the groups, so it is difficult to attribute this outcome with number of people charged with sexual or violent 35 any certainty to the containment model. offenses; or the number of people charged with criminal offenses in general.39 Other research suggests that strong social support can play a crucial role in preventing recidivism. For example, a 2004 study of sex offenders sentenced to probation for child molestation found that people who had strong support from family and friends were less likely to have their probation status revoked for either a Recent Trends in Treatment, Reentry, and Community Supervision Practices technical violation or a new arrest and that people with strong support whose status was revoked generally lasted 36 This section summarizes recent trends in each of the four longer on probation than people without such support. substantive areas outlined earlier—prison-based The study also found that people who were employed treatment, community-based treatment, reentry, and 37 were less likely to violate the terms of probation. These community supervision—as revealed by our survey. findings are consistent with a body of research that When applicable, we assess these trends in light of highlights the shortcomings associated with a straight extant research. A detailed, state-by-state overview of risk management approach (that is, an approach that current practices for each substantive area can be found emphasizes monitoring offenders without attempting to in the appendices. address their needs). According to some studies, risk management strategies have a negligible impact on PRISON-BASED TREATMENT recidivism rates among the general offender population Our analysis of prison-based treatment indicates that when they are used in isolation; additional research while few states are able to provide treatment to all suggests that this is true of sex offenders as well.38 imprisoned sex offenders who are eligible, the treatment On a different note, a recent study in Vermont services that are currently in place are grounded in examined the impact of polygraph techniques on evidence-based approaches such as CBT and relapse recidivism rates among 208 adult male sex offenders prevention. There is less emphasis on drug therapy and who were both receiving treatment and under community polygraph monitoring, which have not yet been supervision. Half of the people in this sample group were adequately evaluated by researchers. Our qualitative subject to polygraph monitoring. Researchers found that analysis of survey data identified four trends: the limited although significantly fewer people in the group that was availability of prison-based treatment; the widespread subject to polygraph monitoring were charged with non- use of evidence-based treatment; the growing use of sexual violent offenses, there were no significant treatment standards; and the widespread use of risk (but not needs) assessments. 35 Division of Probation Services, Special Analysis (Denver, CO: State Court Administrators Office, Judicial Branch, 2007); M. Walsh, “Overview of the IPSO Program—Intensive Parole for Sex Offenders – in Framingham Massachusetts, Presentation by the parole board chair to the National Governors Association policy meeting on sexual offenders. November 15, 2005. San Francisco, CA. 36 This includes revocations for technical violations and new arrests. 37 John R. Hepburn, and Marie L. Griffin, “The Effect of Social Bonds on Successful Adjustment to Probation: An Event History Analysis,” Criminal Justice Review, 29, no. 1 (2004). 38 Kurt Bumy, Tom Talbot, and Madeline Carter, Managing the Challenges of Sex Offender Reentry (Silver Spring, MD: Center for Sex Offender Management, 2007). Treatment and Reentry Practices for Sex Offenders Limited availability. Prison-based treatment for sex offenders is available in most states. In general, though, the treatment capacity of prisons and jails is quite 39 R.J. McGrath, G.E. Cumming, S.E. Hoke, and M.O. Bonn-Miller, “Outcomes in a Community Sex Offender Treatment Program: A Comparison Between Polygraphed and Matched Non-polygraphed Offenders,” Sex Abuse 19 (2007): 381-393. Vera Institute of Justice 8 limited, especially when compared with community- Very few states employ drug therapy as part of based programs. Across the 37 states that responded to prison-based treatment on anything other than a case-by- our survey of prison-based treatment, we found that the case basis. Among those states that do administer drugs, percentage of imprisoned sex offenders in treatment at most use anti-depressants such as selective serotonin any given time ranged from 1 to 33 percent. Interviews reuptake inhibitors (SSRIs), as opposed to chemical with policymakers and treatment providers suggest that castration or other types of hormonal therapy—the types limited institutional capacity was the primary reason of drug therapy that are generally associated with these figures were so low. Only one state (Pennsylvania) medical treatment of sex offenders in the research reported that treatment is available in all facilities; in literature. Because very few studies have examined the contrast, 13 states reported that treatment was either role of anti-depressants in prison-based treatment for sex unavailable altogether or available in only one facility. offenders, it is difficult to draw conclusions about the Our findings also suggest that it is especially difficult for impact of current drug therapy practices. female sex offenders to access treatment. Fewer than half While polygraphs are more prevalent than drug of the participating states reported that treatment is therapy in the context of prison-based treatment, they are available in at least one women’s prison. (We did not, hardly widespread. Fewer than half of the states that however, directly ask about the availability of treatment responded to our survey reported using polygraphs in in women’s prisons, so the actual number may be some capacity in prison-based treatment programs. higher.) Unfortunately, as noted earlier, there is very little In light of the limited availability of prison-based research (as of spring 2008 we were unable to find a treatment programs, it is not surprising that very few single study) that examines the impact of polygraph states require all incarcerated sex offenders to undergo monitoring on sexual recidivism. treatment. Indiana, Iowa, Missouri, and New Jersey were A few states reported assigning people to different the only states that reported mandatory treatment in treatment programs based on their level of risk. This prison without any qualifiers. (In other words, all practice is consistent with criminological research, which incarcerated sex offenders in those states are presumably shows that, in the general population of offenders, those required to undergo treatment.) Other states provide who are higher risk achieve better outcomes when they treatment to select groups of sex offenders, or offer receive more intensive programming, and those who are education that does not technically qualify as treatment. lower risk do better in less intensive programming.41 Montana, for example, requires all people convicted of a Finally, a number of states have treatment programs sex offense to participate in a 15-week group educational that employ either multiple treatment components or a program with a sex therapist prior to being screened for progressive series of phases (or both). Most multi-phase further treatment; Ohio mandates treatment for all programs begin with an educational component. The medium- and high-risk sex offenders, as defined by content and purpose of this educational component 40 scores on the STATIC-99 risk instrument. varies from program to program: In Colorado and Montana, for example, the first phase of treatment Evidence-based treatment methods. Our survey involves providing an overview of the program so that indicates that most prison-based treatment programs rely participants know what to expect before they begin. In heavily on CBT, a treatment that, as noted earlier, is Ohio, on the other hand, the first phase consists of a supported by research. “psychoeducation” program that explains to participants 40 The STATIC-99 is an actuarial risk assessment instrument that predicts risk for sexual recidivism among adult males based on 10 factors that are stable over time. 41 D.A. Andrews and J. Bonta, The Psychology of Criminal Conduct. 3rd edition (Cincinnati, OH: Anderson, 2003). Treatment and Reentry Practices for Sex Offenders Vera Institute of Justice 9 the nature of their mental illness to help them prevent STATIC-99. In general, standardized instruments are relapse. more common than customized instruments, though it remains unclear to what extent such standardized Standards for treatment. Most states have standards instruments have been validated for the particular uses that define the parameters of treatment programming, individual states put them to. although only 15 of the 37 states that responded to our Only five states (Colorado, Illinois, Utah, Vermont, survey reported that their standards had been developed and Wisconsin) reported having developed customized by independent bodies outside of the department of risk assessment tools based on statistical data drawn corrections. The existence of treatment standards is from local sex offender populations.43 Two of the most significant because it creates a system of accountability widely recognized customized state tools are the among criminal justice agencies and providers and Minnesota Sex Offender Screening Tool (MnSOST-R) encourages them to use evidence-based techniques. and the Vermont Assessment of Sex Offender Risk Independent standards provide an additional level of (VASOR), both of which are being used in a number of oversight and, thus, encourage criminal justice agencies other states. and treatment providers to adopt responsible and Although the use of risk assessment tools is fairly effective approaches to treatment. Moreover, the fact that widespread, only a few states use actuarial needs independent standards are usually drafted by mental assessments in prison. (The two types of instruments health professionals and other authorities suggests that serve very different purposes in the context of prison- such standards are more likely to be effective than based treatment: risk assessments are primarily used to standards created by correctional officials. Among the predict the likelihood that a sex offender will recidivate; states with standards that were created by independent, needs assessments provide information about “dynamic” legislatively created bodies are Colorado, Connecticut, factors—such as alcoholism and negative moods—that 42 Kentucky, and Texas. Several other states—among change over time. Information about dynamic factors can them Washington, Vermont, and Montana—have then be used to craft individual treatment plans with standards that were created by independent bodies that targeted interventions that can be re-evaluated over were not legislatively created. time.) Only about one-quarter of states reported using a standardized needs assessment instrument in prison Risk and needs assessments. A great majority of settings; Vermont is the only state that has developed its participating states use at least one actuarial risk own needs assessment instrument.44 The Vermont assessment instrument for predicting sexual recidivism instrument is distinct from other needs assessment among people incarcerated for sex offenses. Such tools instruments in that it can be used not only to identify have the advantage of determining risk through statistical possible interventions, but also to assess progress in relationships, rather than through subjective clinical treatment. judgments. The most widely used risk assessment instrument is a standardized instrument known as the 42 Both Delaware and New Mexico recently passed legislation to create sex offender management boards (SOMB) for the purpose of drafting treatment standards. In addition, California and West Virginia are currently developing standards tied to legislative initiatives: California has a SOMB and recently created a treatment committee, which submitted a report to the state legislature in early 2008. In West Virginia, the Department of Health and Human Resources is developing standards to meet requirements of the 2006 Child Protective Act. Treatment and Reentry Practices for Sex Offenders 43 Minnesota has one as well—the MnSOST-R—but did not participate in the study. 44 The MnSOST-R includes some dynamic factors, but in this report, needs assessment instruments have been defined as those that contain ACUTE dynamic factors. Among those that are commonly recognized are the ACUTE, Vermont Treatment Needs and Progress Scale, Multiphasic Sex Inventory (MSI), Psychological Inventory of Criminal Thinking Styles (PICS), Sex Offender Need Assessment Rating (SONAR), and COMPAS. Vera Institute of Justice 10 COMMUNITY-BASED TREATMENT programs than in prison-based programs. Thirty-two out In most states, the treatment that is provided for sex of 36 states that responded reported using polygraphs in offenders under community supervision is, like that some capacity for sex offenders on community which is available for incarcerated sex offenders, supervision. A few states reported using them for grounded in evidence-based approaches such as CBT. multiple purposes, including assessing the offender’s Most states also reported efforts to ensure that consistent ability to admit the full extent of his or her crime; treatment is available for people returning home from assessing the offender’s criminal history; obtaining prison. In general, sex offenders in the community have information about victims; and assessing the extent to greater access to treatment than those in prison, although which an offender is complying with treatment and in many states access to treatment is at least partially supervision requirements (the most common use). As paid for by offender fees. noted earlier, there is little evidence that polygraphs are There are many different community-based treatment programs for sex offenders. At the county effective in reducing recidivism rates, so it is unclear whether or not these practices should be expanded. level, where most probation is administered, there can be considerable variation in the content and structure of Consistency between prison-based and community- these programs. To simplify the process of gathering based treatment programs. In most states, correctional information on community-based treatment, we focused institutions and community supervision agencies share exclusively on programs at the state level, most of which information about the case histories and treatment plans target people on parole. of sex offenders who are returning to the community from prison. By communicating in this manner, these Evidence-based treatment. As was the case for prison- states aim to ensure that treatment is provided based treatment programs, almost all community-based consistently during the transition period—a goal that is treatment programs use CBT to some extent; many also consistent with the unified approach to sex offender use relapse prevention, arousal control (a technique for management emphasized in the containment model. The reducing deviant sexual urges), and victim empathy (a majority of states that took part in our survey reported technique that helps sex offenders become aware of the that even in cases where a person begins treatment in impact of their actions on victims.) Again, the prison but does not continue treatment under community prevalence of CBT is consistent with research that shows supervision, prison officials and community supervision this method is effective in reducing recidivism. officials communicate about the person’s prison-based Community-based treatment programs are also treatment. In Montana, for example, community similar to prison-based treatment programs in their treatment providers generally call prison case managers reluctance to use drug therapy on anything other than a to learn more about a person’s treatment while in prison, case-by-case basis. Although officials in about half of while in Colorado prison-based treatment providers send the states that responded to our survey reported that drug treatment records on to community-based providers as a therapy is sometimes used for sex offenders under part of the standard discharge procedure. community supervision, most also noted that it is not a standard component of treatment. A number of states Greater availability but limited state funding. Our reported using hormonal drug therapy in addition to data also suggest that treatment is more readily available chemical drug therapy—almost always only rarely or on under community supervision than in institutional a case-by-case basis. settings. This is to be expected, given the higher risk of On the other hand, the use of polygraph tests appears to be much more prevalent in community-based Treatment and Reentry Practices for Sex Offenders recidivism among offenders who re-integrate into society. All of the states that participated in our Vera Institute of Justice 11 community treatment interview reported that treatment is limited. Although sex offenders in most states are available in some capacity for sex offenders under eligible for general reentry programs, only about a third community supervision; about two-thirds described the of participating states reported that they have reentry distribution of treatment providers as “statewide.” programming that targets the specific needs of this The number of treatment providers varied greatly population. In addition, the role of faith-based from one state to another, ranging from three (in both organizations in providing reentry programs for sex Arkansas and Washington, DC) to 427 (in Texas). There offenders is not especially prominent. On the other hand, was also a great deal of variation in treatment settings. case managers—people assigned to help sex offenders Most states contract with private providers in some plan and carry out reentry plans—are becoming more capacity; some states contract with a single provider, common in prisons. others work with an assortment of different providers. An example of the former is Connecticut, which Lack of sex-offender specific initiatives. Especially contracts with the Connection Inc.’s Center for the striking was the finding that many states do not have Treatment of Problem Sexual Behavior (CTPSB) to reentry initiatives for sex offenders.45 Most states provide all treatment to people on probation and parole. reported that they provide at least some services for (CTPSB employs a staff of 30). Examples of the latter offenders (including sex offenders) during reentry, but include Washington and Ohio. In Washington, treatment only around half reported having specific reentry is provided by both the Department of Corrections and initiatives to coordinate the delivery of those services. private contractors. In Ohio, there are two types of None reported having a reentry initiative specifically for residential programming for sex offenders in the sex offenders. Both Colorado and Ohio reported that community: halfway houses that provide sex offender- they use the COSA model (discussed earlier in the specific programming (in addition to other types of section on reentry programming), but because COSA programming) for offenders on probation and parole, and focuses on post-release support, it is not, technically community-based correctional facilities, which provide speaking, a reentry initiative. Finally, we found that in diversionary programs for low-risk sex offenders on most states that provide services to sex offenders at some probation. point during reentry, those services are available in all For many community-based treatment programs, prisons throughout the state. funding appears to be a significant concern. Most states reported that at least some funding comes directly from Case managers in prison and community settings. offenders; around one-quarter of states reported that Our review also indicates that case managers—people offender fees are the only source of funding for assigned to help sex offenders plan and carry out community-based treatment. In these states, access to individual reentry plans—are almost as widely available community-based treatment is at least partially in prisons as they are in the community. This is a very dependent on the sex offender’s ability to pay for it. positive development; as mentioned earlier, collaboration between institutional and community case REENTRY PROGRAMMING managers has been identified as one of the key Given that most sex offenders who are sentenced to components of successful reentry. About half of the prison are eventually released into the community, states we interviewed reported that some sort of case reentry programming has recently become a topic of significant interest in the field of sex offender management. Yet, our review has revealed that reentry programming for sex offenders in the United States is Treatment and Reentry Practices for Sex Offenders 45 For the purposes of this report, a reentry initiative is distinct from reentry programming in that it represents a comprehensive effort to provide well-coordinated services to people who are making the transition home from prison. In general, reentry initiatives regulate the provision of services both before and after release. Vera Institute of Justice 12 manager is assigned to offenders while they are still in Washington reported that at least half of all nonprofit prison. Our survey also indicates that this practice is not reentry service providers are faith-based, and in limited to states with a particular reentry initiative in Michigan, faith-based organizations play a role in the place. Montana, for example, does not have a reentry development of reentry policy through county-level initiative; nonetheless, probation officers begin working reentry steering committees. In Delaware, nonprofit with offenders to prepare them for reentry about 90 days organizations generally do not provide services to sex prior to release. In many states, the role of post-release offenders; however, the few that do are faith-based. case manager is filled by probation and/or parole officers, although some states (such as Pennsylvania and COMMUNITY SUPERVISION Utah) employ specialized case managers for that The last of the four substantive areas on which we purpose.46 In Washington State, some service providers surveyed policymakers and treatment providers was the begin working with offenders six to twelve months supervision of sex offenders in the community. As in before release and continue working with them in the previous sections, our discussion here is limited to community. supervision at the state level. In some states, that means both probation and parole. In other states (such as Role of faith-based organizations. Our data suggest Kansas), it also means community corrections agencies that in most jurisdictions, faith-based organizations do separate from probation and parole. In still other states, not play a central role in the provision of post-release where probation is administered at the county-level, it reentry services for the general population of offenders. means parole alone. And in a few states (Pennsylvania is While a number of states have adopted the COSA model, an example), probation and parole are administered at which, as discussed earlier, makes extensive use of both the state and county level. In order to simplify our volunteers from faith-based organizations to support and discussion, we do not distinguish here between parole- monitor sex offenders returning to the community, very based practices and probation-based practices on the few states cited COSA as a reentry initiative. Indeed, the state level. For more information on these issues, please role of faith-based organizations in reentry appears refer to the individual state appendices. difficult to measure. Most interview respondents could Our review indicates that needs assessments are only estimate the involvement of faith-based increasingly being administered to sex offenders under organizations in very general terms (e.g., some, limited), community supervision. In addition, we found that in and Vera researchers were unable to obtain precise data most states, community supervision agencies pursue two about the proportion of service providers that are faith- goals: managing risk and providing services. Research based. That said, respondents from a few states did suggests that this is an effective approach to reducing report that faith-based organizations either play or are recidivism. expected to begin to play a significant role in the provision of reentry services. In Ohio, for example, a law Increasing use of needs assessments. There is a (HB 113) was recently passed that requires the growing use of needs assessment instruments for sex Department of Rehabilitation and Corrections to work offenders under community supervision. One prominent with faith-based organizations to develop prison-based example is the ACUTE, which was adapted from the Sex mentorship reentry programs. Respondents from Offender Need Assessment Rating (another needs assessment tool) and includes seven scales of acute 46 In both Pennsylvania and Utah, sex offenders are assigned to a “transitional coordinator,” a parole agent charged with helping the newly released person re-integrate into the community immediately upon release from state prison. After 90 days, the person’s case is then transferred to a general parole agent. Treatment and Reentry Practices for Sex Offenders Vera Institute of Justice 13 dynamic factors, which change rapidly.47 As mentioned sex offenders under community supervision. Specialized earlier, the use of such tools is a positive development, provisions are supervision conditions—such as as they can track changes in dynamic risk factors over restrictions on an offender’s contact with minors—that time and modify supervision practices according to apply specifically to sex offenders. In general, they aim changes in risk levels. More than half of the states that to enhance community supervision and reduce exposure responded to our survey reported that they use actuarial to cues that are likely to trigger deviant behavior. In needs assessment tools to manage sex offenders under many states, specialized provisions are reserved for community supervision—a figure that is much higher specialized caseloads that include only sex offenders.50 than the proportion of states that use these tools in prison (Probation and parole officers who administer these 48 settings. As previously mentioned, Vermont has caseloads have generally undergone specialized developed a customized instrument that assesses both training.) In addition, more than half of the states that reported needs and treatment progress, and this instrument has recently been adopted in West Virginia as well. In addition to needs assessments, almost all of the back have lifetime supervision (mandatory supervision for the rest of a person’s life). In most cases, this states we surveyed administer at least one type of sanction is only used for high-risk or violent sex actuarial risk assessment to sex offenders under offenders: In Iowa, for example, only people who are community supervision. The STATIC-99 is the most convicted of a Class C felony sex offense or higher are prevalent risk assessment tool: 24 out of the 29 states we eligible for lifetime supervision. Our review does not indicate that specialized interviewed reported using it in some capacity. Only three states reported having developed customized risk provisions, specialized caseloads, and lifetime assessment tools for sex offenders under community supervision have displaced efforts to provide services, supervision, although customized tools are used more however. As noted earlier, most of the states that frequently in the community than in prison. The responded to our survey reported that treatment has customized risk assessment tools that were developed in become an important part of community supervision. Colorado and Vermont, as discussed earlier, are This finding is consistent with research showing that administered both in prison and to those under community supervision that combines surveillance and community supervision. Additionally, the Iowa intensive supervision with treatment and rehabilitation Department of Corrections is in the process of services is more effective at reducing recidivism than developing a customized tool called the ISORA 8 for sex surveillance alone, both among the general offending 49 offenders on both probation and parole. population and among sex offenders.51 50 Focus on treatment and monitoring. Our review also revealed that most states have specialized provisions for 47 ACUTE dynamic factors are distinct from stable dynamic factors, which change over longer periods of time. 48 Again, needs assessment instruments are defined as those that contain ACUTE dynamic factors. These include the ACUTE, Vermont Treatment Needs and Progress Scale, Multiphasic Sex Inventory (MSI), Psychological Inventory of Criminal Thinking Styles (PICS), Sex Offender Need Assessment Rating (SONAR), and COMPAS. 49 Alabama; Kansas; Montana; Washington, DC; and Wyoming also reported having customized risk assessment tools under community supervision, but they described them as general risk assessment instruments, rather than sex offender-specific. Treatment and Reentry Practices for Sex Offenders Some states do not have specialized caseloads for all sex offenders under community supervision, but this is usually because not all jurisdictions have enough sex offenders to warrant specialized caseloads. Additionally, some states require only those sex offenders who meet certain risk or offense criteria to be supervised on specialized caseloads. For example, in Indiana, if an offender on parole is originally convicted of or has a history of at least one of a specific subset of offenses, including, rape, criminal deviant conduct, molestation, or failure to register, he or she is required to be supervised under the Sex Offender Management and Monitoring Program. 51 S. Aos, P. Phipps, R. Barnoski, and R. Lieb, Evidence-Based Adult Corrections Programs: What Works and What Does Not. Document number 06-01-1201. (Olympia, WA: Washington State Institute for Public Policy, 2006); R.J. McGrath, G.F. Cumming, J.A. Livingston, and S.E. Hoke, “Outcome of a Treatment Program for Adult Sex Offenders: From Prison to Community,” Journal of Interpersonal Violence, 18 (2003): 3-17. Vera Institute of Justice 14 Conclusions Research suggests that this type of inter-agency communication can help reduce recidivism. Our findings can be summarized as follows: • • both manage risk and provide services. Research In both institutional (prison-based) and suggests that this is an effective approach to community settings, the treatment of sex offenders is generally grounded in evidencebased practices, especially cognitive-behavioral therapy (CBT). In general, treatment is much more available in the community than in institutional settings. • In a majority of participating states, community- In general, community supervision agencies reducing recidivism. • A limited number of states are conducting research on their own treatment, reentry, and supervision initiatives. There have been almost no studies that examine these programs from a cost-benefit perspective. based treatment for sex offenders is supported, at least in part, by collecting fees from those in treatment—a circumstance that may limit access to these programs. • Standardized risk assessment tools such as the STATIC-99 are now widely used in both prisonbased and community-based treatment programs across the nation. However, a lack of data prevented us from determining the number of states that have validated these tools for their local populations. • Needs assessment tools, especially the ACUTE, are becoming more prevalent in community supervision. • We found no reentry initiatives that specifically target sex offenders. Although sex offenders in most states are eligible for general reentry programming, there are few reentry programs that address the unique needs of this population. One exception is Circles of Support and Accountability (COSA), a program that encourages high-risk offenders to develop The variety in treatment and reentry practices across different states (and even from one jurisdiction to another) makes it impractical to devise blanket recommendations from these findings. However, the need for more rigorous research on treatment and reentry practices for sex offenders is clear. Although the current body of research indicates that cognitive-behavioral therapy and the containment model of supervision are both effective in reducing recidivism, many questions remain unanswered: Many of the practices described in this report, for example, consist of multiple components, but it is unclear how each of the individual components affects recidivism or improves offender outcomes such as reintegration. Furthermore, there is very little research that provides a clear picture of what works for whom. Finally, it bears repeating that there is a noticeable lack of research on the cost-savings associated with treatment and reentry programs. Finding answers to these questions will help policymakers create more informed and more effective policies for the treatment and management of sex offenders. support networks in the community. 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