Publications

Women Who Sexually Offend:
A Protocol for Assessment & Treatment

1.  Definition

A woman who offends sexually is defined as anyone under federal jurisdiction who has:

a.  been convicted of a sexual offence; and/or

b.  been convicted of a non-sexual offence that has sexual motivation (such as a murder that included sexual assault or common assault that was plea bargained from sexual assault); and/or

c.  admitted to a sexual offence for which they have not been convicted.

*Prostitution related offences are not considered sexual offences for the purpose of this protocol.

 

2.  Identification

•  Subsequent to intake assessment using the standardised Offender Intake Assessment (OIA), any woman who meets the above noted definitions will be identified to National Headquarters, Offender Programs and Reintegration as a sex offender under 1 (a), 1 (b) or 1 c).

•  The institutional Psychologist in co-operation with a designated intake assessment staff member will carry out a Specialised Sex Offender Assessment both to confirm identification and determine treatment targets.

•  The national expert in the field of women who sexually offend will be consulted for review of the case elements.

•  If there is consensus that the woman meets the definition as a woman who sexually offends, the following should occur:

 

3.  Assessment

•  Assessment is the cornerstone of any intervention and must occur within six weeks after meeting the definition for sexual offending and prior to formulation of a correctional plan.

•  Assessment takes place at admission, pre-treatment, in-treatment, post-treatment, follow-up, pre-release and post-release.

At admission and following appropriate identification of each woman who sexually offended, information will be gathered including but not limited to:

•  File reviews;

•  Collateral contacts;

•  Clinical interviews;

•  Psychological/psychometric testing;

•  Behavioural assessment: including observation and role plays;

•  Specialised sex offender assessment.

File reviews include, but are not limited to:

•  Pre-sentence/pre-disposition reports;

•  Police reports;

•  Victim impact reports;

•  Psychological and psychiatric reports and;

•  The Judge's reasons for sentence;

•  Community Assessment (CA);

•  Previous assessment and/or treatment reports.

The caseworker (Parole Officer or Primary Worker) in consultation with the psychologist will examine the file review, specifically the Community Assessment, and will determine the need to include further contact with collateral sources, if required:

Collateral contacts include interviews and/or documentation/reports from other collateral contacts with:

•  Spouses and/or significant others;

•  Criminal justice personnel;

•  Community Parole Officer;

•  Mental health professionals and;

•  Any other person who can provide a further perspective on the individual case.

Clinical interviews with the psychologist involve face-to-face interaction with the offender and should be semi-structured (see Appendix A for semi-structured interview).

Psychological tests may be used to provide information on:

•  Mental ability (e.g. learning disabilities, reading level and or level of cognitive functioning);

•  Personality;

•  Neuro-psychological functioning (carried out by a qualified specialist);

•  Attitudes and cognitive distortions;

•  Treatment targets.

Behavioural assessments based on clinical observations from psychologist and staff members and the offender's self-monitoring reports. Structured role-play scenarios may be used to provide information on sexual fantasies/thoughts, social functioning and communication skills.

The Specialised Sex Offender Assessment would focus on the following:

•  Family history;

•  History and development of sexual behaviour (with special focus on early role models, physical, emotional and sexual abuse history, sexual development and sexual relationships);

•  Attitudes and cognitive distortions;

•  Social competence;

•  Medical history (including psychiatric);

•  Criminal History;

•  Prior sexual offences;

•  Prior violent (non sexual) offences;

•  Current sexual offence (gender and ages of victims and relationship to victim(s));

•  Involvement with a co-perpetrator and the nature of the relationship;

•  Was the co-perpetrator charged and if so, the disposition;

•  Use of alcohol and/or drugs as part of the criminal offence;

•  Prior assessment and treatment results and compliance with post-treatment recommendations;

•  Current relationships with partner/children especially if the child was a victim;

•  Emotional expressiveness;

•  Emotional self-regulation;

•  Presence of deviant sexual fantasies/thoughts and their intensity and frequency.

•  Some of these data can be obtained from file review, structured interviews and self-report. Structured assessments such as the LSI (Level of Supervision Inventory-Revised) may be used to structure the interview although they should not be subjected to risk analysis since there is inadequate data on women offenders in general and women who sexually offend in particular. The PCL-R (Psychopathy Checklist Revised), the VRAG (Violence Risk Assessment Guide), the Sex Offender Risk Ax Guide (SORAG) and other actuarial measures are not validated with samples of women, therefore they are not appropriate risk assessment instruments for this group.

•  A report summarising both OIA and specialised sex offender assessments should be completed within six weeks of admission by the institutional psychologist.

•  Once assessment has been completed, the assigned Intake Assessment staff member and the institutional Psychologist will develop a correctional plan to meet the offender's individual case needs and will discuss this plan with the national expert in the field of women who sexually offend. Issues such as sentence length, duration and frequency of sex offender therapy for women who sexually offend should be addressed at this time. If there is more than one woman who has sexually offended in a facility at any one time, group therapy should be the preferred option.

•  Special care should be given to identify only those areas that are relevant to need and risk, as program over-prescription has tended to occur in the past.

 

4.  Roles & Responsibilities

The institutional psychologist is responsible for assessing women who sexually offend.

The professional delivering the sex offender therapy for women who sexually offend will have completed the 5-day training and will provide a post program report.

The caseworker ( parole officer or primary worker ) manages the case and provides follow up and updates at critical moments in the sentence.

The national expert in the field of women who sexually offend provides expert advice and feedback to case management teams and psychologists, and facilitates information sharing at regional, local and inter jurisdictional levels across the country.

If psychiatric or health care issues emerge, a psychiatrist or nurse may be consulted as an adjunct member of the case management team.

In the case of Aboriginal women who sexually offend, the native liaison officer will be permanent member of the case management team.

Program deliverers will be included in the case management team when the offender takes part in recommended correctional programs.

The offender is expected to participate in the assessment and treatment process to the full extent of her abilities.

 

•  Correctional Planning & Supervision

•  If the sentence is short (less than four years), treatment requirements will have to be met in the most efficient manner possible while insuring the needs are met and the care is of quality. In the instance of shorter sentences, it would be reasonable to offer sex offender therapy for women who sexually offend at the same time as other correctional programs.

•  If the sentence is over four years, the general strategy for program planning will apply but care must be taken that sex offender therapy for women who sexually offend evolve into maintenance therapy and decline to biweekly and eventually monthly/bimonthly sessions. Provisions must be made to terminate/discontinue maintenance when there is no longer a clinical need to continue.

•  In the case of long term offenders, maintenance should be offered following treatment for a defined period of time to taper off and then be re-established closer to release date. This would insure support for transition into the community.

Elaboration of the correctional plan (the frequency and duration of sex offender therapy for women who sexually offend, the recommended programs, and the sequencing of treatment) will involve at a minimum the caseworker, the institutional psychologist and the national expert in the field of women who sexually offend . Any changes made to the correctional plan will similarly involve these three professionals.

 

Phase 1

Women who sexually offend will receive sex offender therapy that focuses on sex offending at the beginning of their sentence. Frequency and duration of the sex offender therapy for women who sexually offend will be determined on a case -by -case basis and will be done in consultation with the national expert in the field of women who sexually offend. Frequency and duration will be influenced by the careful assessment of idiosyncratic case details. Frequency could be increased or reduced based on clinical analysis.

Sex offender therapy for women who sexually offend is comprised of a number of modules, which will be provided according to specific offender needs. These are described below.

The following components have been identified as meeting criminogenic needs in women who sexually offend. Involvement should be driven primarily by need, as risk variables have yet to be identified for this group.

Sex Offender Therapy for Women who sexually offend

It is recommended that the therapy be structured to focus on need and be goal directed to address particular issues for each case.

 

•  Self-management

Self-management is the core intervention in sex offender treatment. It is during this component of therapy that offenders develop an understanding of their offending behaviour and patterns and the life and personal circumstances contributing to sexual offending. During this component of therapy, offenders will examine life circumstances via an autobiography exercise, will analyse sexual offending behaviour through an offence analysis or crime cycle, and will formulate plans to manage cognition, emotion, and environment to prevent reoffending and to manage their behaviour in the community. Self-management begins with the development of rapport and mutual goals and is often referred to as the "therapeutic alliance" - an essential element in any therapeutic intervention. The self-management module will lead to the development of a release plan. The professional delivering sex offender therapy and the caseworker will actively encourage the offender to develop a feasible plan for release as critical moments in the sentence approach (e.g., private family visits, transfers, and release, including temporary absences and work release). Self-management is a continuous module which all other elements of sex offender therapy (i.e., cognitive processes, deviant fantasy and arousal, emotional self-regulation, etc.), are incorporated into a self-management plan.

 

•  Deviant thoughts/fantasies

Deviant thoughts/ fantasies may not be relevant to all women who sexually offend. However, they should be evaluated in each case, as presence of deviant thoughts/fantasies may emerge as a risk factor. There are no physiological assessment tools which are sufficiently unintrusive, economically feasible or sufficiently valid for this population, to justify investment in the relevant technology. As a result, each offender should be asked to relate her thoughts and/or fantasies (whether she experienced any sexual thoughts or fantasies) prior to the offence, whether she was sexually aroused prior to, during or after the offence and to describe any current sexual thoughts or fantasies related to the offence.

If she does describe current sexual thoughts/fantasies related to the offence, the professional delivering the sex offender therapy can discuss the nature of arousal and the impact of arousal on future offending. The professional delivering the sex offender therapy can also discuss how the offender can learn to recognize the triggers and control the thoughts and behaviours that result. Self-monitoring should occur for at least two weeks documenting frequency, intensity and content of both deviant and appropriate thoughts/fantasies. Techniques for controlling deviant thoughts and fantasies can be discussed with the national expert in the field of women who sexually offend who can help the service provider to design an appropriate treatment strategy.

 

•  Sexuality, intimacy and relationships

Many women who sexually offend have experienced profoundly dysfunctional family relationships and were often exposed to physical, sexual and emotional abuse. As a result, many have been involved in problematic relationships. Women who sexually offend may also have been involved in their crimes as a result of their relationships with coercive and violent partners (either male or female). This issue will be explored in some depth. Examining past relationships and determining the deficits and assets of past relationships can help the woman to consider different methods of seeking out caring relationships. Sexuality is considered within the context of loneliness and intimacy deficits.

 

•  Empathy/Victim Awareness

This issue may not be relevant to each offender and requires discussion, file review, observation within the session and on the Unit, to determine whether deficits exist. A behavioural test such as the Behavioural Empathy Test (Williams and Khanna, 1990) and/or a psychometric test such as Hogan's Empathy Test (I960) can provide some information on the presence and extent of this deficit. If empathy is absent, a four-stage model can be presented. This focuses on perception, cognition, emotion and enactment skills. Victim awareness generally involves brainstorming the impact of sexual assault on victims, watching films depicting victim experiences, writing a hypothetical letter of apology to the victim, writing a hypothetical letter from the victim's perspective and role-playing. Empathy can interfere with cognitive distortions and should reduce both deviant fantasies and sexually assaultive behaviour.

 

•  Cognitive distortions

Not all women who sexually offend endorse cognitive distortions about their victims. The dynamics of offending are quite different from those found in men and assumptions about the presence, frequency and intensity of cognitive distortions should be evaluated prior to intervention. Gentle questioning, provision of evidence (e.g., through discussion, bibliotherapy and film) together with examination of alternate perspectives can induce change in the way victims are conceptualised.

 

Phase 2

Relationship between sex offender therapy for women who sexually offend and other programs

Offenders should remain in sex offender therapy for women who sexually offend even when other programs are underway as a method of encouraging the offender to relate each of the other modules to the overarching risk management strategy described in the self-management module. During this phase, sex offender therapy for women who sexually offend should decrease in frequency and intensity.

Based on the literature available on women who sexually offend, a number of correctional programs meet common needs of this population. However, correctional planning should include only those programs which meet the needs as determined during OIA and relevant to the case and should only occur when the group dynamics support her integration into specific groups.

Interventions offered to Aboriginal women who sexually offend may also incorporate Aboriginal healing approaches.

As a result of the identification of individual needs (OIA), the offender, through the correctional plan, will be encouraged to take part in relevant programs. The following have been identified as potentially useful programs which target criminogenic needs or responsivity factors. As noted above, the intervention strategy will be developed by the caseworker, institutional psychologist and the national expert in the field of women who sexually offend, and will meet the criminogenic needs of the individual.

 

•  Cognitive skills

The criteria for inclusion in this program may include impulsivity, problems with logical planning and poor decision-making skills. It seems reasonable, in terms of sequencing to present this as the second module. During this phase, the caseworker and psychologist should meet for a case conference with the Cognitive Skills Program Delivery Officer as defined by the program standards.

 

•  Abuse and Trauma

Dealing with victimisation, though not necessarily a criminogenic factor, has been described as a responsivity issue and may contribute to problems in developing victim empathy. This group should be presented as either the first or second correctional program depending on the role of abuse in the offender's life. If the woman co-offended and the relationship with the co-accused is perceived as a major factor in the sexual assault (s), it would be more appropriate to present this program early in the sequence. However, if the abuse was limited to early experiences, (and has less of a direct role in the offence pattern) it could be presented later in the program sequence. A majority of women who sexually abuse others have experienced early and prolonged abuse. The professional delivering the sex offender therapy should ensure that the offender with abuse issues can tie her experiences to those of her victim(s).

•  Substance use

The majority of women who sexually offend identify themselves as users of alcohol, drugs or both substances. As such, this issue should be addressed reasonably early in the sequence of programs, since it is likely to have been a precursor to offending. Again, sex offender therapy for women who sexually offend can help to relate this problematic behaviour with abuse issues as well as to the management of risk to re-offend.

 

•  Emotional management

A number of women who sexually abuse have notable problems with expressing emotions in an appropriate manner. In some cases, anger, depressed mood or anxiety can impact on offending. Programs addressing emotion management should then be included in correctional planning if necessary.

 

•  Parenting

For those offenders who have assaulted their children and who may be permitted supervised contact with them, this group would meet obvious needs. Even if the offender has been removed from her family, she may eventually care for other children. This group would be suitable for most women who sexually offend since parenting issues have generally begun in the family of origin and continue to play an ongoing role in their abuse of others.

 

•  Community Integration Programs

Finding accommodation, employment, pro-social leisure activities and a support network are essential elements of adaptation to the community. This group should represent one of the last programs in the sequence as it naturally links with community release. The individual therapist and caseworker will actively work with the offender to have these in place prior to release.

 

•  Education and employment

Although their relationship to offending has not been proven conclusively, it makes intrinsic sense to provide each woman with skills appropriate to the community where she will be released. These issues can be addressed on an ongoing basis throughout the offender's incarceration.

It must be stressed that participation in relevant programs is essential. Each program described above should be carefully evaluated with respect to its relevance to the individual offender. Over-prescription can have a negative impact on offending.

 

Phase 3

•  Maintenance Intervention

Maintenance programming must be available to all treated women who sexually offend in an effort to help them to maintain the gains they have achieved through previous and more intense intervention. Once the correctional plan is complete, sex offender therapy for women who sexually offend will evolve into maintenance intervention and can decrease from every week to once every two weeks to once per month. In the event that a woman is serving a long sentence, maintenance may eventually taper off to be re-established near the release date. This process of gradually decreasing intervention should encourage some independence from the therapeutic relationship. Resolution of dependency issues is as important as the development of the therapeutic alliance.

Maintenance programs primarily focus on reviewing day-to-day issues, gains made in treatment, review of risk factors, coping strategies and release plans. As the offender approaches her release date, the content of the maintenance component will be focussed on the practicality and feasibility of her release plan and the management of relevant risk factors in the community. The initial relapse prevention plan may need to be revised, updated or otherwise altered to meet any new contingencies.

•  Pre-release Planning

The offender will have developed a release plan during sex offender therapy for women who sexually offend. This plan will be discussed with the caseworker, the institutional psychologist as well as the national expert in the field of women who sexually offend. The plan may involve the community caseworker, a representative from the Elizabeth Fry Society, a community psychologist, maintenance groups, a halfway house, employers and family members. In both the self-management component and in meetings with the caseworker every possible effort must be made to make these plans realistic and concrete as applicable to her community.

The community psychologist and the community caseworker will be asked to meet with the offender and the institutional case management team prior to release. The national expert in the field of women who sexually offend will remain involved as a consultant in the supervision of women who sexually offend.

 

Phase 4

•  Community Monitoring

The national expert in the field of women who sexually offend will hold case conferences with the caseworker and the community psychologist every three to six months or whenever risk factors change significantly.

The community caseworker and the community psychologist should receive a very detailed description of the offender's progress in sex offender therapy for women who sexually offend, programs and institutional performance. Since risk is a dynamic factor, a number of factors can impact on risk management.

•  Has the offender completed the sex offender therapy for women who sexually offend?

•  Can she describe her offence progression?

•  Has she developed a concrete relapse prevention plan?

•  Can she identify her high- risk situations?

•  Does she have concrete coping strategies for each?

•  Is she returning to a questionable relationship?

•  Is she involved in the maintenance component of the therapy in the community?

•  Is she compliant with therapy in the community?

•  Is she compliant with community supervision?

Negative responses to these questions suggest issues that must be resolved in an effort to manage risk to re-offend.