Mandated or Voluntary Treatment of Men Who Committed Child Sexual Abuse: Is There a Difference?

Child sexual abuse is associated with multiple and often severe consequences for people who are affected by it. From the perspective of indicative prevention, the treatment of people who have sexually abused children represents one important strategy, with the assumption that there is often a risk for sexual recidivism. However, there is still very limited knowledge about how men who have not been convicted of child sexual abuse but participate in voluntary treatment (here called non-forensic clients) differ from those who have been convicted and undergo mandated treatment (here called forensic clients). This study compared 22 forensic and 22 non-forensic clients regarding pedophilic interests, static and dynamic risk factors, responsivity features, and treatment progress during an individualized treatment based on the principles of risk, need, and responsivity. We found neither differences in the rates in the DSM-5 diagnosis of pedophilic disorder, nor in risk and responsivity associated scores at the beginning of treatment. In both groups, a low to moderate risk for sexual re-offending was estimated. Both groups improved their functioning on dynamic risk and responsivity factors under treatment, while age at the beginning of therapy also had a positive effect on all outcomes. Non-forensic clients had a higher amount of responsivity associated resources than forensic clients during treatment. The limitations of these results and their implications for further research and prevention approaches are discussed.

Experienced usability of wearable biosensors for monitoring and coaching is associated with an intended long-term use in forensic psychiatry: Questionnaire study (Preprint)

BACKGROUND The use of ambulatory biosensor devices for monitoring and coaching in forensic psychiatric settings yields high expectations for improved self-regulation of emotions and behaviour in clients and staff members. More so, if clients have mild intellectual disabilities, they might benefit from these biosensors as they are easy to use in every-day life, which ensures that clients can practice with the devices in multiple stress and arousal inducing situations. However, research on the use of biosensors in forensic psychiatry for clients with mild intellectual disabilities and their caretakers has been scarce. Besides that, although wearable biosensors show promise for healthcare, recent research showed that the acceptance and continuous use of wearable devices in consumers is not as was anticipated, probably due to low expectations. OBJECTIVE The main goal of the current study was to investigate the associations between and determinants of, the expectation of usability, the actually experienced usability and the intention for continuous use of biosensors. METHODS A total of 77 participants (N = 31 forensic clients with mild intellectual disabilities; N = 46 forensic staff members) participated in a one-week trial. Preceding the study, we selected four devices that were thought to benefit the participants in domains of self-regulation, physical health or sleep. Both qualitative and quantitative questionnaires were used that explored the determinants of usability, acceptance and continuous use of biosensors. Questionnaires consisted of the System Usability Scale (SUS), the Technology Acceptance Model (TAM)- questionnaire, and the Extended Expectation Confirmation Model (EECM)- questionnaire. RESULTS Only the experienced usability of the devices was associated with intended continuous use. Interestingly, the forensic clients scored higher on acceptance and intention for continuous use than staff members. In addition, moderate associations were found between usability with acceptance and continuous use. The qualitative questionnaires in general indicated that the devices were easy to use and gave clear information. CONCLUSIONS Contrary to expectations it was the actual perceived usability of wearing a biosensor that was associated with continuous use, and to a much lesser extend the expectancy of usability. Clients scored higher on acceptance and intention for continuous use. It must be further investigated whether this is a true effect or due to a social desirability bias in the client group. However, it is interesting that clients scored higher on acceptance and continuous use as they might benefit from the ease of use of these devices and their continuing monitoring and coaching applications. For clients with mild intellectual disabilities it is especially important to develop easy to use biosensors, with a minimum requirement on cognitive capacity to increase usability, acceptance and continuous use.

Individual, Service, and Neighborhood Predictors of Aggression Among Persons With Mental Disorders

We examined the predictive validity of individual, service, and neighborhood factors for aggression by 1,491 forensic clients found Not Criminally Responsible on account of Mental Disorder (NCRMD), under the jurisdiction of a Review Board, and thus subject to supervision conditions. Younger patient age and personality disorder diagnosis were associated with both clinically documented aggression and recidivism. Medication adherence was related to clinically documented aggression, but not criminal recidivism. Number of reports from an institution (possibly reflecting assessor or institutional experience with NCRMD assessments) did not predict clinically documented aggression, but more comprehensive risk reports were associated with fewer such clinical incidents. More community mental health resources within a 45-min drive of an individual’s residence were associated with less recidivism, but not less clinically documented aggression. We conclude that extra-individual factors are related to aggression, the neighborhood to which forensic clients return matters, and effects can differ for criminal recidivism versus clinically documented aggression.

Policy, practice and regulatory issues in mobile technology treatment for forensic clients

This article examines developments in mobile technologies that target the treatment and support needs of offenders in the community, and sets out three challenges that must be addressed if these interventions are to become part of the correctional programs environment. These are: how to identify good quality mobile applications that will yield genuine benefits for practitioners and service users; how to adapt forensic treatment approaches to work effectively in a mobile application environment, and how to make mobile applications available to forensic clients and motivate people to use them. Until these challenges are addressed the potential value of mobile technologies in providing greater access to forensic treatment will not be realised.

The importance of the therapeutic alliance when working with men who have committed a sexual offence

Purpose While there is general agreement in the literature regarding the importance of the therapeutic alliance (TA) in psychological interventions with people, the forensic context raises some unique challenges. The purpose of this paper is to discuss how these challenges are managed within a therapeutic context. Design/methodology/approach This paper consists of a literature review examining the following: the significance of the TA in interventions with forensic clients, especially men who have committed a sexual offence and the impact on treatment efficacy and change; therapist characteristics as well as some of the obstacles and challenges present in a correctional setting, which can impact on the TA and; the role of transference and countertransference in relation to these forensic clients. Findings Through the literature review, there is a discussion regarding how some of the common obstacles within correctional settings can be overcome, and how certain therapist qualities should be interpreted. Originality/value This paper will discuss some of the practical applications of certain recommended therapeutic factors within a correctional setting, challenging some of the common misconceptions and limitations. Furthermore, transference and countertransference, topics which are seldom discussed, will be considered in this paper.