Most sex offenders appear to desist from sexual and other violent offending; however, research on this population has historically focused more on the characteristics of individuals who persist offending versus those who desist from offending. The present study examined change patterns of 563 child sexual abusers’ scores on the Sex Offender Treatment Intervention and Progress Scale, a dynamic risk measure, at three points of time over 2 years. Individuals who did versus did not commit a new serious offense, defined as a new sexual or other violent offense, at 5-year follow-up were contrasted. Desisters demonstrated most changes during their first year in treatment, whereas change among persisters more often occurred during their second year in treatment. All classes of offenders made gains in addressing dynamic risk related to sexually specific needs, whereas desisters made significantly greater gains in social stability needs. Findings are discussed in light of treatment dose allocation and community reentry needs.

The goal of this study was to derive a clinical prediction rule for transient ischemic attack (TIA) and non-disabling stroke to predict a treatment change based on echocardiogram. Methods: We conducted a cohort sub-study for TIA and non-disabling stroke patients collected over five years from 8 Emergency Departments. We compiled a list of 27 potential predictors to look for treatment change based on echocardiogram findings. We used a univariate, logistic regression and recursive partitioning analysis to develop the final prediction model. Results: The frequency of treatment change was seen in 87 (3.1%) of 2804 cases. The final model contains six predictors: age less than 50 years old, coronary artery disease history, history of heart failure, any language deficit, posterior circulation infarct and middle cerebral artery infarct on neuroimaging. Conclusions: We have developed a highly sensitive clinic prediction rule to guide in the use of echocardiogram in TIA and non-disabling stroke.

The sexual abuse of children is an issue that society must address with urgency and commitment, given the profoundly damaging effects and widespread occurrence of this kind of crime. Providing psychological treatment to identified offenders is an important endeavour of the criminal justice system, with the aim of reducing recidivism and thereby preventing future victims. This dissertation explores a number of areas relevant to the treatment of sexual offenders on a sample of 223 adult males who completed a prison-based programme for child sexual offenders in New Zealand. Specifically, the assessment of treatment outcome and its relationship with recidivism, risk assessment, and the influence of specific offender factors on estimates of treatment outcome and risk were investigated. Study 1 (N = 218) is an independent validation of the validity of the Violence Risk Scale: Sexual Offender Version (VRS:SO; Olver, Wong, Nicholaichuk, & Gordon, 2007), a recently developed risk assessment instrument for sexual offenders that incorporates both static and dynamic risk factors and contains protocols for the assessment of change as a result of treatment. Results indicate support for the inter-rater reliability, concurrent validity, and predictive validity of the VRS:SO with regard to sexual recidivism, with pre-treatment and post-treatment scores showing superior predictive validity relative to a widely used measure of static risk (Static-99; Hanson & Thornton, 1999) and a measure of "Deviance" based on a 4-factor battery of relevant psychometric tests (Allan, Grace, Rutherford, & Hudson, 2007). In Study 2 (N = 218), three separate methods of assessing proximal treatment outcome (representative of three categories of treatment outcome measures that have previously been applied in the literature) are applied and compared in terms of their predictive validity with regard to sexual recidivism, and the relative advantages and disadvantages of their use. These measures are: change on a battery of relevant psychometric tests administered prior to and following treatment; change across treatment on the VRS:SO; and post-treatment ratings of the attainment of treatment goals as measured by a modified version of Hogue’s (1994) Standard Goal Attainment Scaling for Sexual Offenders (SGAS). Results indicate that positive treatment outcomes as measured by all of these methods are associated with reduced sexual recidivism. SGAS scores are identified as being relatively simple and efficient to obtain, however the VRS:SO and the psychometric battery are both able to provide useful pre-treatment clinical information regarding potential treatment targets for a particular offender. Study 3 (N = 223) and Study 4 (N = 216) are explorations of the influence of particular offender characteristics on response to treatment and risk of recidivism. Of particular interest was the personality construct of psychopathy (measured using the Psychopathy Checklist-Revised, PCL-R; Hare, 1991), and both studies are attempted replications and extensions of previously reported interaction effects involving this construct (Heilbrun, 1979; Seto & Barbaree, 1999). The results of Study 3 indicate that there is no interaction effect between PCL-R scores and treatment outcome (as measured by the SGAS) on sexual recidivism, in contrast to an influential study by Seto and Barbaree (1999). Study 4 reports an interaction effect between PCL-R scores and intelligence on recidivism, such that higher than average IQ scores appear to moderate the well-known association between psychopathy and risk. Overall, the findings reported in this dissertation suggest the importance of considering dynamic factors as well as static factors in sex offender risk assessments, and support the premise that dynamic factors are changeable, with change being associated with changes in recidivism. The potential for certain offender characteristics to influence treatment response and risk of recidivism is highlighted, and several areas for further exploration are identified.

The sexual abuse of children is an issue that society must address with urgency and commitment, given the profoundly damaging effects and widespread occurrence of this kind of crime. Providing psychological treatment to identified offenders is an important endeavour of the criminal justice system, with the aim of reducing recidivism and thereby preventing future victims. This dissertation explores a number of areas relevant to the treatment of sexual offenders on a sample of 223 adult males who completed a prison-based programme for child sexual offenders in New Zealand. Specifically, the assessment of treatment outcome and its relationship with recidivism, risk assessment, and the influence of specific offender factors on estimates of treatment outcome and risk were investigated. Study 1 (N = 218) is an independent validation of the validity of the Violence Risk Scale: Sexual Offender Version (VRS:SO; Olver, Wong, Nicholaichuk, & Gordon, 2007), a recently developed risk assessment instrument for sexual offenders that incorporates both static and dynamic risk factors and contains protocols for the assessment of change as a result of treatment. Results indicate support for the inter-rater reliability, concurrent validity, and predictive validity of the VRS:SO with regard to sexual recidivism, with pre-treatment and post-treatment scores showing superior predictive validity relative to a widely used measure of static risk (Static-99; Hanson & Thornton, 1999) and a measure of "Deviance" based on a 4-factor battery of relevant psychometric tests (Allan, Grace, Rutherford, & Hudson, 2007). In Study 2 (N = 218), three separate methods of assessing proximal treatment outcome (representative of three categories of treatment outcome measures that have previously been applied in the literature) are applied and compared in terms of their predictive validity with regard to sexual recidivism, and the relative advantages and disadvantages of their use. These measures are: change on a battery of relevant psychometric tests administered prior to and following treatment; change across treatment on the VRS:SO; and post-treatment ratings of the attainment of treatment goals as measured by a modified version of Hogue’s (1994) Standard Goal Attainment Scaling for Sexual Offenders (SGAS). Results indicate that positive treatment outcomes as measured by all of these methods are associated with reduced sexual recidivism. SGAS scores are identified as being relatively simple and efficient to obtain, however the VRS:SO and the psychometric battery are both able to provide useful pre-treatment clinical information regarding potential treatment targets for a particular offender. Study 3 (N = 223) and Study 4 (N = 216) are explorations of the influence of particular offender characteristics on response to treatment and risk of recidivism. Of particular interest was the personality construct of psychopathy (measured using the Psychopathy Checklist-Revised, PCL-R; Hare, 1991), and both studies are attempted replications and extensions of previously reported interaction effects involving this construct (Heilbrun, 1979; Seto & Barbaree, 1999). The results of Study 3 indicate that there is no interaction effect between PCL-R scores and treatment outcome (as measured by the SGAS) on sexual recidivism, in contrast to an influential study by Seto and Barbaree (1999). Study 4 reports an interaction effect between PCL-R scores and intelligence on recidivism, such that higher than average IQ scores appear to moderate the well-known association between psychopathy and risk. Overall, the findings reported in this dissertation suggest the importance of considering dynamic factors as well as static factors in sex offender risk assessments, and support the premise that dynamic factors are changeable, with change being associated with changes in recidivism. The potential for certain offender characteristics to influence treatment response and risk of recidivism is highlighted, and several areas for further exploration are identified.

Thèse de doctorat présenté en vue de l'obtention du doctorat en psychologie - recherche intervention, option psychologie clinique (Ph.D) / Evaluating treatment programs specialized in treating sexual offenders and reducing recidivism, especially sexual recidivism, is of great importance to the general public and policy makers because of the many physical and psychological consequences these crimes have on the victims and their families. The present study evaluated the changes that occurred in moderate to high risk sexual offenders who followed a specialized community treatment program. In order to accomplish this, gains during treatment and their ability to predict lower recidivism rates was examined using three different methods of measurement: risk assessment, self-reports, and phallometric testing. Change scores were derived from the Stable-2007 and its three dimensions (i.e., antisociality, sexual deviance, and hypersexuality); the Molest and Rape Scale; the Sexual Interest Cardsort Questionnaire; and phallometric testing. Measures were administered pre- and posttreatment in a sample of 105 adult male sexual offenders with adult and child victims. Recidivism data were obtained from official criminal records. The average follow-up period for participants was of 12 years postrelease. Findings were indicative of significant positive changes in dynamic risk factors as measured by the Stable-2007 and its three dimensions; in PSIs as measured by the Sexual Interest Cardsort Questionnaire and phallometric testing; but not in cognitive distortions as measured by the Molest and Rape Scale. The majority of change scores were non significantly associated with reductions in sexual, violent, or general recidivism after controlling for pretreatment and static risk. Comparing the different methods of measurement in their ability to capture changes and predict recidivism was unable to be done due to the lack of significant results. The following study is only the second to examine treatment change on the Stable-2007 and its relationship to recidivism, and the first examining treatment change in its three different dimensions. Although the program seemed to be effective in reducing certain dynamic risk factors, the relationships between treatment change and lower recidivism rates, especially sexual recidivism remains unclear. More studies examining treatment change on specific dynamic risk factors using different measures are needed to establish more comprehensive conclusions about which dynamic risk factors are more susceptible to change and most effective if reducing recidivism rates. / L’évaluation des traitements visant la réduction des taux de récidives, surtout sexuelle, chez les agresseurs sexuels est un sujet de grande importance due aux conséquences physiques et psychologiques que ces crimes ont sur les victimes et leurs familles. Pour ces raisons, la présente étude avait comme objectif principal d’évaluer des changements suivant la participation d’un programme de traitement en communauté spécialisé dans le traitement d’agresseur sexuel à risque et aux besoins modérés à élevés. Pour accomplir ceci, les gains acquis sur différents facteurs de risques dynamiques et leurs capacités de prédire la récidive ont été examinés. Les gains ont été mesurés en utilisant une échelle d’évaluation du risque dynamique de récidive, des questionnaires auto-rapportées et des évaluations phallométriques. La Stable-2007 et ses trois dimensions (c.-à-d. antisocial, déviance sexuelle, et hypersexualité) ont été utilisées pour mesurer plusieurs facteurs de risques dynamiques, le Molest and Rape Scale ont été utilisés pour mesurer les distorsions cognitives, et le Sexual Interest Cardsort Questionnaire et l’évaluation phallométrique ont été utilisés pour mesurer les intérêts sexuels paraphiliques. Toutes les mesures ont été administrées pré et posttraitement à 105 agresseurs sexuels avec des victimes soit adultes et/ou enfants ayant complété le programme de traitement. Les données de récidives ont été obtenues des dossiers criminels officiels avec une période de suivi moyenne de 12 ans. Suite à la complétion du programme de traitement, il y a eu des gains significatifs sur les facteurs de risque dynamiques mesurés par la Stable-2007 et ses trois dimensions, et sur les intérêts sexuels paraphiliques mesurés par le Sexual Interest Cardsort Questionnaire et l’évaluation phallométrique. Cependant, aucune amélioration n’a été trouvée pour les distorsions cognitives. En examinant la relation prédictive entre les gains sur ces mesures et les taux de récidives, la majorité des changements positifs n’étaient pas significativement associés à des réductions de taux de récidive sexuel, violent et général, après avoir contrôlé pour le risque prétraitement et statique. Due aux résultats non-significatives, la capacité des différentes mesures à identifier des changements et prédire la récidive n’a pas pu être comparé. Cette étude est la deuxième étude examinant des changements pré à posttraitement sur la Stable-2007 et la première à examiner ses changements sur les trois dimensions de la Stable-2007. Même si le programme de traitement évalué semble être capable de produire des changements positifs dans certains facteurs de risque dynamiques, la relation entre ces gains et leurs capacités de prédire des taux plus bas de récidives reste contradictoire et incertaine. Plus d’études examinant les gains sur des facteurs risques dynamiques spécifiques en utilisant différentes mesures sont nécessaires avant de pouvoir vraiment établir les facteurs dynamiques les plus susceptibles à changer et prédire des taux de récidive plus bas.