Social-Therapeutic Custodial Treatment of Individuals Who Committed Sexual Offences: A Comprehensive Controlled and Multicentred Evaluation.

backgroundIn-prison treatment of persons who committed sexual offences often showed nonsignificant, small or sometimes even negative effects, particularly in sexual recidivism. Various reasons for this situation seem to be relatively short and standardised group-based programmes, isolated implementations and insufficient attention to context factors and needs for replication.

aimsThis study contains a controlled evaluation of males who had committed serious sexual offences and received treatment in German social-therapeutic prison units (STUs) versus a control group from regular prisons without treatment. STUs offer a broad range of treatment (including CBT) and rehabilitation measures during about 2 years of incarceration.

methodsValid recidivism data were available for 1245 individuals, of which 710 were treated (TG) and 535 were not treated (CG). In addition to the individuals from STUs, there was also a subsample that received individual or group treatment in normal prisons. The mean follow-up period after release was 9.3 years. As there were expectable differences between treated and untreated persons, a comprehensive propensity score matching (PSM) of relevant variables was applied that led to balanced equivalence of TGs and CGs. In addition to various criteria of recidivism (e.g., general, sexual, violent), we developed a harm index of seriousness. Offender characteristics were assessed by the regular documentation form of the Criminological Service in Bavaria that also contained the Static-99 risk measure. For the assessment of therapeutic context factors, prisoners and staff filled in the EssenCES on the institutional climate in the STUs.

resultsThere were significant treatment effects on general recidivism (TG = 35.9% vs. CG = 41.4%) and nonsignificant tendencies on sexual recidivism (6.0% vs. 8.0%) and other outcomes. In contrast to general recidivism, sexual recidivism did not occur later after release. There were more promising results in a more recent cohort than in a previous cohort, and the sexual harm of treated persons decreased post-treatment (as compared to pretreatment). Men who had committed rape of adult victims showed more violent and less sexual recidivism than individuals who had victimised children. The seven STUs differed substantially in recidivism and dropout rates. These differences were related to the risk level of the inmates, but prison climate was also associated with outcome differences. On average, there were both similarities and differences in the climate ratings by inmates and staff. Most individuals from the STUs got a legal order for relapse prevention in community treatment centres after release. However, this did not lead to a booster effect, whereas persons who were not treated in custody benefitted from therapeutic aftercare.

conclusionsThe results of a comprehensive social-therapeutic treatment of prison inmates who had been sentenced for sexual offences showed multifaceted patterns of results. Offender variables played an important role in the outcomes. Individuals who had victimised children were particularly assigned to STUs, and persons with a not generally assessed paraphilic disorder may be relevant for less promising results in sexual recidivism. There were also hints that the intensive treatment in STUs may not be superior to therapeutic interventions in regular prisons. Based on our findings, differentiated selections of groups, treatment contexts and outcome measures are suggested for further development of successful treatment strategies in custody.