RISK VS RIGHTS: SAFELY SUPPORTING CONSUMERS WITH SEXUAL TRAUMA HISTORIES DAVID K. ATTRYDE, MS LPC

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1 RISK VS RIGHTS: SAFELY SUPPORTING CONSUMERS WITH SEXUAL TRAUMA HISTORIES DAVID K. ATTRYDE, MS LPC

2 PRESENTING CHALLENGE Balancing best practices in supporting IDD and MH consumers with dignity and respect, with responsibility to protect the community from sexual assault Societal values and priorities in recent decades: Increased respect for rights and welfare of IDD and MH consumers (deinstitutionalization, ADA and other federal legislation, person centered approaches, Everyday Lives) Increased restrictions for sexual offenders: (Megan s Law community notification, restrictions on residence, employment, travel. Civil commitment) trail them, nail them and jail them

3 EVERYDAY LIVES DEPUTY SECRETARY S MESSAGE John McKnight, an emeritus professor of education and social policy at Northwestern University, had a message in the first Everyday Lives publication in 1991 that is even more relevant today: Our goal should be clear. We are seeking nothing less than a life surrounded by the richness and diversity of community. A collective life. A common life. An everyday life. A powerful life that gains its joy from the creativity and connectedness that comes when we join in association as citizens to create an inclusive world. Everyday Lives affirms our dedication to making it possible for everyone to live a life of meaning and joy. NANCY THALER, Deputy Secretary, Office of Developmental Programs Everyday Lives: Values in Action, Pennsylvania Department of Human Services, Office of

4 ASSESSMENT & TREATMENT Risk Assessment Self-Regulation Model (SRM) Good Lives Model (GLM)

5 REOFFENSE RISK- 3 DOMAINS Static Risk- factors that are fixed & unchangeable. Regardless of treatment or other individual changes (+,-) or immediate circumstances Dynamic Risk- factors that are changeable via treatment, supervision and other changing circumstances Acute Risk- factors that are immediate and high risk, producing a need for immediate intervention

6 ASSESSMENT TOOLS Static Risk- Static 99/2002 Dynamic Risk- Stable 2007 Acute Risk- Acute 2007

7 STATIC 99/2002 Age at Release Relationship Stability (lived w/ lover 2 years?) Prior convictions, arrests, sentencing Unrelated victims? Stranger victims? Male victims? reminder: these are static, unresponsive to tx,

8 STABLE 2007 Poor problem solving skills Significant social influences Capacity for relationship stability Emotional ID with children Hostility toward women General social rejection Lack of concern for others Negative emotionality Sex drive Sexual preoccupation Sex as coping Deviant sexual practice Cooperation with supervision Impulsivity

9 ACUTE 2007 Victim Access Hostility Sexual Pre-occupation Rejection of Supervision Emotional Collapse Collapse of Social Supports Substance Abuse

10 THE SELF- REGULATION MODEL Offenders do not all offend for the same reasons there are different cognitive processes and maladaptive coping methods that lead to offense These cognitive behavioral pathways to re-offense have to do with how offenders self-regulate their behavior (Ward, Hudson, & Keenan, 1998) First distinction: avoidant (tries to avoid offending) vs. approach (offending is pursued goal) Model has evolved to include four sub-types of offenders, defined by their offense regulation type.

11 WHAT ARE THE FOUR SUBTYPES OF OFFENDERS DEFINED BY THE SELF- REGULATION MODEL? Avoidant passive (under-regulated) want to avoid offending, but lack coping mechanisms Avoidant active (mis-regulated) choose coping methods that work poorly or short term Approach automatic (under-regulated) on autopilot, move towards high-risk situations and offend opportunistically Approach explicit (intact regulation) coping methods support offending, move with planning and intent

12 AVOIDANT PASSIVE Under-regulated want to avoid offending, but lack coping mechanisms Thinking errors rationalize offending behavior Want immediate gratification, particularly when feeling bad; sad, powerless, humiliated Low sense of self-worth and personal abilities Feel shame after offending (vs healthy guilt)

13 AVOIDANT PASSIVE: EFFECTIVE TREATMENT development of an understanding of the offense process, increasing emotional regulatory skills, problem-solving skills, and social skills identifying and restructuring offense-supportive beliefs.

14 AVOIDANT ACTIVE Mis-regulated choose coping methods that work poorly or short term They give in to deviant thoughts Thinking errors needed to rationalize their offense behavior May experience guilt

15 AVOIDANT ACTIVE: EFFECTIVE TREATMENT Change or improve existing coping skills Improve decision-making skills, Increase emotional regulatory strategies Identify and restructure offense-supportive cognitive distortions

16 APPROACH AUTOMATIC Under-regulated on autopilot, move towards high-risk situations and offend opportunistically It just happened : impulsiveness and poor planning Powerful beliefs that fuel offending = Low awareness of harm May feel good after offending, low guilt Entrenched sexual scripts and unhealthy habits

17 APPROACH AUTOMATIC: EFFECTIVE TREATMENT increasing victim impact awareness, Raising awareness of behavioral chains Restructuring distorted scripts and beliefs Reconditioning deviant arousal where it is present.

18 APPROACH EXPLICIT Intact regulation coping methods support offending, move with planning and intent Strong offense-supportive beliefs and very low levels of harm-awareness Feel good after offending- it meets their needs Typically offend both intra- and extra-familial and victims are often across gender if not exclusively male

19 APPROACH AUTOMATIC: EFFECTIVE TREATMENT They are not amenable to relapse prevention given that behaviors are based on core beliefs that are difficult to change. Useful interventions tend to be related to core views of self, intimacy, and sexuality. High risk: these offenders may require ongoing external supervision and support to safely reside in the community.

20 GOOD LIVES MODEL

21 GOOD LIVES MODEL approach vs avoidance Beyond risk reduction and relapse prevention

22 KEY CONCEPTS Based on a concept of universal human dignity All people value certain states of mind, personal characteristics and experiences People have the ability to select and pursue life goals, make plans and act freely These goals are called Primary Goods Sexual offenses represent the dysfunctional pursuit of universal life goals

23 PRIMARY HUMAN GOODS Life Knowledge Being Good at Work & Play Personal Choice & Independence Peace of Mind Friendship, Relationships Community Spirituality Happiness Creativity

24 LIFE: LIVING AND SURVIVING Positive Approaches: Exercising, Eating well Taking care of physical health Being safe in the world

25 KNOWLEDGE: LEARNING & KNOWING Positive Approaches: Going to school, completing training Learning about myself, e.g. in treatment Mentoring others

26 BEING GOOD AT WORK & PLAY Trying and improving at sports or hobbies Being good at a job Getting education or training to improve at work

27 PERSONAL CHOICE & INDEPENDENCE Positive Approaches: Valuing personal choice in most situations Making plans to meet a goal Being assertive

28 PEACE OF MIND Positive Approaches: Reducing emotional distress or stress Exercise, meditate Be less angry, impulsive

29 RELATIONSHIPS & FRIENDSHIPS Positive Approaches: Time with family Time with friends Seeking intimate relationships Supporting our family, friends, partner

30 COMMUNITY: BEING PART OF A GROUP Positive Approaches: Belonging to group e.g. military, sports team, Volunteer work Neighborhood involvement

31 SPIRITUALITY: HAVING MEANING IN LIFE Positive Approaches: Participation in religious/spiritual acivities Meditation, yoga, prayer Reading, studying your faith, philosphy, self-help Environmental causes,

32 HAPPINESS Positive Approaches: Activities that satisfy or fulfill Seeking pleasure, e.g. sex Activities with purpose & meaning (family time, hobbies, work) Participation in treatment, self-improvement

33 PRACTICAL IMPLICATIONS 1. Determine the primary human goods that are important to the individual. 2. Support the consumer to find realistic, safe ways to meet those goods 3. Help the consumer to overcome barriers to obtaining the goods. 4. Every employee plays a vital role in treatment per GLM principles 5. SO treatment is more than identifying and reducing reoffense risk

34 IMPLICATIONS Enriching and enhancing consumer s lives IS sex offender treatment; IF it is balanced with community safety Safety planning Healthy Boundaries

35 SAFETY PLANNING Fostering community interactions, relationships, employment Learning experience for consumer re: managing risk External vs internal (self-) regulation Initially very specific, later more general (safety plan to approve going to Applebees on Main Street, vs a safety plan for all restaurants) Example of safety plan

36 RESOURCES Practical Treatment Strategies for Persons with Intellectual Disabilities, Blasingame, Gerry Developmentally Disabled Persons with Sexual Behavior Problems, Blasingame, Gerry Intellectual Disability and Problems in Sexual Behavior, Wilson, Robin J., Burns, Michele Association for Treatment of Sexual Abusers (ATSA), safersociety.org

37 CONTACT INFO David K Attryde, MS, LPC. Corporate Clinical Director david.attryde@rhd.org