Mark W. Benner, M.S.W.
Agencies that provide support to individuals with developmental disabilities are being increasingly challenged to support sexual offenders who present at various levels of risk. There are limited financial resources, supports, and therapists available to address the long- term needs of an offender with a developmental disability. The closure and phasing down of the large institutions, the lack of specialized residential treatment programs and the increasing discharge of formerly institutionalized sex offenders places demands on communities and clinicians who support persons with developmental disabilities. Community based services are, at times, unprepared and ill-equipped to effectively support the offender with a developmental disability. This challenge represents a demand for creativity and the development of existing resources while maintaining the delicate balance between effective risk management and advocacy.
Responses to the Offences of Individuals with a Developmental Disability
A number of individuals with developmental disabilities exist who have demonstrated a range of sexual offending behaviour and who continue to present this risk on an on-going basis. Individuals with developmental disabilities who sexually offend are identified by various service providers and at various points. Identification occurs in a variety of ways: parents and support persons are concerned about the individual who was found masturbating his eight year old brother; an institution is discharging a developmentally disabled offender who has had no freedom outside the institution for the past 15 years; a ward of a Childrens Aid Society turns eighteen and despite his participation in an intensive residential treatment program for offenders, has no supports, including financial, to support him in the community past his eighteenth birthday; a repeat offender with a developmental disability requires extensive supervision and is admitted to a psychiatric hospital; and a young man with a developmental disability offends and is found not criminally responsible for his sexual offense and is required to attend hearings to ascertain that hes still developmentally disabled.
A confirmed label of developmental disability or even a perceived developmental disability seems to influence prevalence rates, the responses to the offense, and the assessment of risk, as well as, whether treatment is available and how that treatment is provided. True prevalence rates of the numbers of offenders who are developmentally disabled as well as how many individuals with a developmental disability who offend are difficult to ascertain. There is controversy about the possible differential arrest and convictions rates between disabled and non-disabled sex offenders (Day 1997). Confounding this issue is the concept of Counterfeit Deviance as suggested by Hingsburger, Griffiths, and Quinsey (1991a), who identified Counterfeit Deviance as behaviour which topographically is deviant, but which upon investigation is a result of some other unidentified factors. This issue further complicates the identification and subsequent treatment of the sex offender with a developmental disability.
The individuals developmental disability also may affect the manner in which risk is assessed. Assessment of risk by professionals who evaluate offenders may result in either under-estimation or over-estimation due to the evidence of a developmental disability. The criminal justice systems response is often a bimodal approach of either dismissal of the behaviour or an overly punitive response (Mikkelsen & Stelk, 1997). The criminal justice system seems generally perplexed as to what to do with the offender with a developmental disability.
Treatment and the necessary long-term support of offenders with a developmental disability is often difficult and at times seemingly impossible. Therapists specializing in offender assessment and treatment are often reluctant to support an offender with a developmental disability. Integrating developmentally disabled offenders into groups of non-developmentally disabled ...often creates frustration for the groups leaders, non-disabled participants, and most importantly fails to teach the disabled offender how to recognize and interrupt the cognitive chain of events which leads to relapse (Demetral, 1994).
Many agencies who support individuals with developmental disabilities are finding that they are required to learn as you go concerning the offender aspects of support. Finding that you are suddenly needing to support a newly identified offender tests even the most seasoned front-line worker. There is no Introduction to Relapse Prevention 101 offered at community colleges. Agencies may find their philosophies challenged to the core and their budgets strained.
The seemingly few existing specialized offender treatment programs are often unable to move graduates back into communities with adequate supports and resources, and supporting offenders in community settings can be costly. With limited financial resources to adequately meet offenders needs, community agencies are being challenged to develop safe and effective methods of supporting offenders. What can develop in spite of the limits are creative and innovative methods of support using a coordinated team effort. There are many examples of agencies who support individuals with a developmental disability who have forged collaborative relationships in order to meet the needs of offenders while conserving community safety and maintaining client advocacy.
Essential Components of Community-Based Treatment Supports
Components of community based support should include goals to minimize the risk to community while facilitating the offenders control over his sexual impulses and reducing offending behaviours. Components should also address the facilitation of the offenders development of appropriate social skills including sexual expression and reintegration into the community to enjoy a lifestyle that is as independent as is practical given the limits of his developmental disability (Tudiver, Broekstra, Josselyn, & Barbaree, 1997).
Because support is provided within the community, it is necessary that community safety supersedes individual choice and the clients wishes may have to be subordinate to the needs of the system and the demands of the community (Hingsburger, Ormiston Naylor, Nethercott, & Tough, 1991).
1) Ongoing Assessment
Initial and on-going assessment of risk is essential. Assessments completed on-site give a systems perspective, allowing the clinician to evaluate not only the individual but the strengths of the system in supporting him to not re-offend. Interviews with parents and other family members, teachers, support workers and other key persons provides the foundation of team building which will maintain a strong system of support.
Risk assessments of individuals with a developmental disability must be creatively adapted to the abilities of each individual offender. As with all offenders, it always needs to be stressed that any level of risk may increase or decrease dependent on both internal and external changes and developments, and that risk needs to be evaluated on an on-going basis.
2) Treatment that Works!
It may seem unnecessary to qualify that treatment should be treatment that works, but it is worth highlighting that the specific treatment methods for individuals with developmental disabilities needs to be even more practical, efficient, flexible, and individualized. Ideal treatment programs should provide sufficient structure and supervision to protect with as little restriction of liberty as necessary. (Mikkelsen & Stelk, 1997). Cognitive-behavioural programs involving reduction of deviant arousal while increasing appropriate arousal, social skill training, victim empathy, and relapse prevention training are recognized as promising forms of treatment for sex offenders (Grossman, Marits, & Fichtner, 1999). Similar to the assessment of risk of offenders with a developmental disability, treatment strategy adaptation is necessary and requires creativity and perseverance.
A range of treatment needs to be available to the offender, represented by the opportunity for intensive weekly sessions to the more longterm booster sessions or follow-up format of support. Agencies supporting offenders with developmental disabilities may find the use of contracts helpful in clarifying roles and responsibilities (Hingsburger et al., 1991b). By using contracts, both parties become more aware of what goals they working towards and with regular review and re-negotiation, the over- and under-reaction (Mikkelsen & Stelk, 1997) problem is challenged and addressed.
Some individuals living in the community have participated in years of offender treatment, often living under some form of graduated level of supervision while others come to our attention presenting at high risk but no history of assessment or treatment. The support team needs to be in agreement about what is being treated and how it is being treated. If everyone does not agree that the behaviour is really sexually offensive rather than just they dont know any better, treatment will be severely compromised and the support will surely fail.
Follow up needs to be long term and treatment needs to be revised according to the risk presented at that time.
3) Responsive Supervision
Grossman et al. (1999) report the need for a comprehensive program for individuals at high risk of reoffending but make no mention of supervision other than detention and confinement. Often individuals with a developmental disability require some level of adaptive skill support and it is this support system that is often called upon to respond to the offenders actual or perceived risk with appropriate levels of supervision. The rose and thorn concept of being labeled not only developmentally disabled but also an offender represents both an asset and a liability. Being labeled developmentally disabled can provide an individual with the support and services one requires including risk management and supervision. We need to remember that despite risk, there are offenders who dont want the support and determined supervision. A non-labeled offender would likely walk away from the support and supervision but an offender with a disability is less likely to decline or refuse the support and supervision. We can assume the vulnerability of this population at all levels. This may be due to dependence on the system, lack of assertiveness and not being aware of rights and choices or in some cases, care providers assuming they have the prerogative to enforce mandatory supervision. How many non-labeled offenders have access to the degrees of support and supervision afforded to the disabled population? Informed consent, from assessment through treatment and supervision, is required.
The need for advocacy at all levels of support to an offender with a developmental disability is highly stressed. Ensuring neither an over- nor an under-reaction to an individuals behaviour becomes a right in itself. For the individual displaying offensive and unacceptable behaviour, their right to treatment needs to be advocated for as well as the over-control and loss of freedom for someone who has earned and proved a degree of change.
Supervision in reality becomes a type of confinement and as Grossman (1999) warns, precautions must be taken to ensure that treatment environments are appropriate for the risk level presented. Supervision should only respond to the particular risk that an individual represents at a particular place and a particular time. Thus community supervision is required to respond to the range of minimal weekly/monthly booster sessions to 24-hour intensive supervision. The Harvey Approach or invisible supervision is an example of a creative and responsive method of providing the middle ground supervision to offenders with a developmental disability (Hingsburger et al., 1991b). Here, community outings are scheduled with unseen supervision. Similar to the treatment contract, supervision levels need to be evaluated and adjusted according to the risk presented, trust gained, and responsibility assumed.
4) Teams of Support
Teams made up of significant participants in a persons life as well as paid professional supports can be an effective method of supporting an offender with a developmental disability. Parents and other family members, friends, church members, probation officers, front-line support workers, and therapists working in collaboration can all assist in the day to day support of an offender with a developmental disability. Training should be available to those providing direct support and information needs to be shared amongst all team members. Examples of this may entail sharing an offence cycle plan with a probation officer so that s/he is aware of specific high risk behaviours if they are reported, or teaching a foster parent the basics of relapse prevention strategies and such concepts as the role of SUD (or Seemingly Unimportant Decisions) or high risk situations.
Goals for non-offending as well as life goals need to be established and known to the team members. Taking time out to celebrate another month, another 6 months or another year without another victim often becomes a team activity. Expecting consistency amongst team members about what defines risk behaviour and the sharing of decisions around changes in supervision help the team members share the load of decision making and ultimate responsibility. If when relapse occurs and there is finger pointing and blame, then the team is not working together and signifies a lack of co-ordination, communication and shared decision-making.
The availability of therapists willing to support offenders with a developmental disability is slowly evolving. Access to consultation and ideally on-sight consultation can be an effective support for communities with limited resources.
Supporting offenders is hard work with limited rewards. It is promising those professional associations and conferences at all levels are becoming more inclusive of the issues facing offenders with a developmental disability. The growing formal and informal networks of clinicians willing to share their successes and failures is helping to develop our ability to support this challenging group.
Day, K. (1997). Clinical features and offense behaviour of mentally retarded sex offenders: A review of research. The NADD Newsletter, 16, 86-90.
Demetral, G. D. (1994). A training methodology for establishing reliable self-monitoring with the sex offender who is developmentally disabled. The Habilitative Mental Healthcare Newsletter, 13, 57-60.
Grossman, L. S., Martis, B., & Fichtner, C. G. (1999). Are sex offenders treatable? A research overview. Psychiatric Services, 50, 349-361 .
Hingsburger, D., Griffiths, D., & Quinsey, V. (1991a). Detecting counterfeit deviance. The Habilitative Mental Healthcare Newsletter, 10, 51-54.
Hingsburger, D., Hillis Ormiston, T., Naylor, D., Nethercott, A., & Tough, S. (1991b?). Community access for sex offenders with developmental disabilities: A process for dealing with trust, risk and responsibility. The Habilitative Mental Healthcare Newsletter. 98-100
Mikkelsen, E. J. & Stelk, W.J. (1997). Assessment of risk in criminal offenders with mental retardation. The NADD Newsletter, 14, 91-95
Tudiver, J., Broekstra, S., Josselyn, S., & Barbaree, H. (1997). Addressing the needs of developmentally delayed sex offenders. Health Canada (Family Violence Prevention Division).
For further information:
Mark Benner, M.S.W.
Regional Support Associates,
Woodstock General Hospital
293 Wellington Street North
Woodstock, Ontario, Canada N4S 6S4