Psycho Sexual Evaluation Risk Assessment of Sexual Offenders - 2014

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PSYCHOSEXUAL EVALUATION/
RISK ASSESSMENT OF SEXUAL
OFFENDERS-2014
Donna Moore, Ph.D.
Psychologist
Sexual Offenses
coercive or nonconsensual sexual acts
can be hands on or hands off offenses
not only motivated by sexual gratification
most are planned – they are rarely impulsive
are committed for a number of reasons
committed by persons who use exploitive, assaultive
ways to meet sexual and emotional needs
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Psychosexual Evaluation / Risk Assessment_2014
Sexual Offenses
Lack of CONSENT
Due to youth
Cognitive limitations
Intoxicated or drugged state
Under threat of violence
ASSENT
Not sufficient due to above factors
3
Sexual Offenders
Deviant sexuality
Attracted to children
Intimacy deficits
Objectification
preoccupation
Cognitive distortions
Minimize, rationalize, objectify, shift
Lack of empathy
Denial
4
Risk Assessment
Risk assessment the use of tools based on
evidence to estimate offender’s potential for
reoffending or causing harm to others and
potential causes or sources of that risk.
Sexual Violence
Actual or attempted sexual contact with a
person who is non-consenting or unable to
give consent.
5
Risk Assessment
Purpose to assist in making decisions
Legal- sentencing/ placement
Length of sentence/ type/ intensity
Clinical-
Identify level of risk
Identify treatment needs
Recommend placement (IP or OP)
Recommend restrictions and conditions
Contact with children, computer use, etc
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Risk Assessment
Legal Standards
39-13-702. Intent.
a) … comprehensive evaluation, identification, treatment, and
continued monitoring of sex offenders … necessary in order to
work toward the elimination of recidivism by such offenders.
(b) …program which standardizes the evaluation,
identification, treatment, and continued monitoring of sex
offenders …so that such offenders will curtail recidivistic
behavior, and the protection of victims and potential victims
will be enhanced.
(c ) does not imply that all sex offenders can be successful in
treatment.
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Risk assessment
An evaluation is a snapshot of the offender at
any point in time.
It is based on the data available at hand
It is influenced by
Facts available at the time- where to get?
Self report- not likely to be forthcoming
particularly in pre-adjudication
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Risk assessment treatment
Goal of reducing recidivism
Identification of risk factors associated with sexual
recidivism
Integration of those factors into structured
assessment instruments
Refine interventions aimed at reducing reoffense
rates
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Base Rates
Recidivism 5 years
All SO 14%
Rapists 14%
CM girl 9%
CM boy 23%
extra-familial child
molesters rates from
39-52% are
supported over time.
Recidivism 15 years
All SO 24%
Rapists 24%
CM girl 16%
CM boy 35%
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Errors in clinical judgment
Ignoring base rates
Assigning incorrect weight (high profile but
irrelevant factors)
Illusory correlations between predictor variables
and criterion
Natural bias toward “conservative” judgments to
find someone not dangerous
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What is an Actuarial Assessment?
Making predictions in an objective, consistent,
valid, and reliable manner. Using variables
statistically linked with particular outcome of
interest (increased risk of sexual reoffending).
More accurate than unstructured professional
judgment
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Reluctance to use actuarial assessments
Predicting dangerousness for individuals in general
is the least reliable of psychologists' abilities or
skills.
Problems can occur when clinicians value clinical
experience more than empirical research (Meehl,
1997).
At times, they are overconfident and do not realize
that they are drawing incorrect inferences from
their experiences. It is difficult to learn from
experience because feedback is often unavailable,
and when it is available it can be biased. (Garb,
1998)
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Why actuarial rather than clinical
Clinical judgment has never been superior to actuarial
methods (opposite is true)
Clinicians’ ratings of clients inverse w/recidivism
Clinical opinion (.11) poor predictor of general
recidivism (actuarial assessment .39) despite both
methods having access to the same factors
Best use for clinical judgment is inside the actuarial
instrument
To use the least efficient procedure is not only
unscientific but unethical
Best practice methodology considers all
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If dealing with long term risk: actuarial is the most
valid means of assessing risk
Probability of offending: use actuarial
BUT Actuarial measures do not answer
has risk been mitigated by interventions
timeframe of offense
impact of treatment and supervision
Under what circumstances is person likely to offend
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adjustment of actuarials…
David Thornton, Ph.D., Sand Ridge Secure Treatment Facility
The error of personal or clinical judgment. The
temptation to hide behind professional credentials
while expressing biases based on emotion, values,
limited experience, and empirically irrelevant beliefs.
One method is to make unstructured clinical
assessments, not grounded in the research literature.
This is likely to reduce predictive accuracy as it has
relatively lower accuracy than actuarial assessment.
The other method is to make adjustments in a
structured way that is grounded in empirical research.
This can improve predictive accuracy above that
obtained by STATIC-99R alone.
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Psychosexual Evaluation/ Risk Assessment
Traditional Evaluator
Client is client
Confidentiality is critical
Competency in therapy
Psychotherapy context
Self report as truth
Little control
Collaborative relationship
Goal: Benefit client
Harmed by confrontation
Specialist Evaluator
Community is client
Confidentiality is limited
Competency in evaluation
Psycholegal context
Collateral sources
Highly structured
Adversarial relationship
Benefit society
Not harmed confrontation
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Recognize your role in RA
Conflict - legal vs. ethical
Discuss limits of confidentiality.
Recognize that there is a need for the
offender to mislead.
In most cases, the offender knows his sexual
interests and sexual behavior.
Offender will likely exploit the trust of the
examiner.
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4
Diagnostic Issues
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Risk Assessment of Sexual Offenders
DSM 5 Paraphilic Disorder (A and B)
Paraphilia that is currently causing stress or impairment
to the individual or the
Paraphilia whose satisfaction has entailed personal
harm or risk of harm to others
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Paraphilic Disorder
A -Over a period of 6 months recurrent, intense sexual
urges, fantasies or behaviors involving 1- non-human
objects, 2- the suffering or humiliation of oneself or
one’s partner, or 3- children or other non-consenting
persons
B -Individual has acted on these urges or urges or
fantasies caused marked distress or interpersonal
difficulty
Paraphilic Disorder meet criterion A and B
Paraphilia meet criterion A
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Voyeuristic Disorder
Exhibitionistic Disorder
Frotteuristic Disorder
Sexual Masochism Disorder
Sexual Sadism Disorder
Pedophilic Disorder
Other Specified Paraphilic Disorder
Unspecified Paraphilic Disorder
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Pedophilic Disorder
Period of at least 6 mos, recurrent intense sexually
arousing fantasies , urges or behaviors/ sexual
activity with 13 child
Acted on the urges or urges cause distress or
interpersonal difficulty
At least 16 years of age and 5 yrs older
Exclusive vs nonexclusive
Admit not necessary but objective data (images)
Absence of guilt and no action- pedophilic sexual
orientation
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Pedophilic Disorder
Exclusive attracted only to children
Nonexclusive attracted to adults as well
– Most are nonexclusive (7% identify themselves as exclusive)
Usually attracted to particular age range and/or
gender
– Homosexual pedophiles rates from 9-40%
– Adult homosexuality is about 2-4%
– Larger percentage of pedophiles are homosexual or
bisexual in orientation to children
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Treating child sexual offenders
Generally the more deviant the sexual practices of
the offender
– Child is younger
– More personality disordered traits displayed
– Greater treatment noncompliance
– Greater # paraphilic interests
– Higher likelihood of reoffense
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Pedophilia
50% - 60% pedophiles also have substance abuse
problems
Attraction to children is present in sober and
intoxicated state
Course of pedophilia is long term
44% (N=168) pedophiles were 40-70 years old
Pedophiles offend at later years and greater rate
than sexual sadists and rapists (60% pedophiles)
26
Treating child sexual offenders
Loneliness
Feelings of inferiority
Emotional immaturity
Low self esteem
Difficulty with age appropriate relationships
– Passive aggressive
– Increased anger and hostility
…Yet 50% marry
27
Sexual Addiction
Not widely recognized as disorder (DSM)
Consumer driven not empirically based
Programs occur without government regulation or
accrediting groups
Programs are short term- treatment of the problem
/ core beliefs takes time
Lack of data demonstrating build up of tolerance
over time or withdrawal if deprived of sex (two
characteristics of “dependence”)
28
Avoid constructs between online criminality and
other constructs
Avoid “cybersex addiction” and “internet addiction”,
terms to describe behavior related to these offenses as
they do not capture the psychological and behavioral
complexities of child pornography offending
29
child selection
Vulnerable children
– Divorced home
– Unhappy/ emotionally needy
Children receptive to advances
– Even if not in preferred target group
30

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Child selection
Children targeted
– Lower education
– Higher rated of absenteeism from home
– Mothers more likely single parents and were less
educated
– Fathers absent for three years prior to child’s age of
16
– Fathers lower SES and less educated
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Risk Assessment of Sexual Offenders Female
Offenders
Predisposed
Similar to the pedophile/ Sexually
deviant fantasies when angry, hurt,
or lonely
History of addictive behaviors
Severe emotional problems
Angry and abusive to children
Abuse of position/role
Views herself in romantic
relationship
Denies abusive nature of
relationship
Sees victim as equally responsible
Male Coerced /
Accompanied
Highly dependent
Lower intellectual functioning
Abusive relationships with
male partners
Marginal social functioning
Eventually molest children on
their own
Chemically dependent
-Matthews, 1998
32
Denial
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Child Molester: DISTORTIONS
Children enjoy sex with adults
Having sex with a child is best way to
teach about sex
Sex with an adult doesn’t harm
When a child says Ok, then its Ok
Children who flirt want sex
Children lie
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Rapists: DISTORTIONS
Women who act like sluts need to be raped.
Arrogant women need to be shown.
If a woman wants to resist, she can.
Hitchhikers are asking for it.
She was a crack whore anyways…
“No” means “Yes”
Women shouldn’t let you touch them if they don’t
want more. She lead me on. She set me up.
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Sex offenders
will not like limits
will not see themselves as perpetrators
will hide how out of control they are from themselves
and you
will blame others for their problems
will deny negative or vulnerable feelings
Try to change the environment (i.e. spouse, coworkers,
provider, PO) rather than themselves
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Types of Denial
Denial of Sexual Gratification
Denial of Types of Grooming
Denial of Risk Management Activities
Denial of the Need for Help
Denial of the Difficulty of Change
Denial of Relapse Potential
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Types of Denial
Denial of the Crime
Denial of Responsibility for the Crime
Denial of Intent/Premeditation
Denial of Deviant Arousal and Fantasies
Denial of Frequency
Denial of Intrusiveness
Denial of Injury to Victims
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denial
Not a risk factor- a treatment factor
Not predictive of recidivism for sexual offending
May reflect hostility, pathological lying and
manipulation
May limit opportunity to receive treatment and if
treatment is offered, limits the benefits of treatment
Loses relevance in higher risk offenders
39
Denial
It is typical that persons presenting for
psychosexual or other forensic evaluation have
levels of denial and often an inability to
accurately self appraise. Their true presentation
if often absent in their self awareness.
40
Denial
Denial predictive of reoffense in low risk offenders
Barriers removed within family that believes offender
Not so as nonfamilial offenders do not need to
regain trust and can move on to another victim
Deniers less forthcoming about risk related aspects
of offending
Deniers (eval) fail instant offense polygraph
more often have VOPs (MPS)
41
Denial
Denial and treatment progress-inversely related
admitting a sex crime is a necessary condition for
progress and engagement in treatment (Levenson
and McGowan 2004)
it is impossible to successfully engage in treatment
for a problem one does not admit
Standard of practice that admitted sex crime is
necessary for progress and engagement in
treatment
42

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Insight alone does not indicate a person is applying
the necessary skills
Group treatment provide peer support and social
skills practice
Supportive challenges and self disclosure
Higher risk offenders are less cooperative
Higher risk offenders may be more likely to be
terminated or quit treatment
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Physiological Measures
less vulnerable to symptom
misrepresentation
phallometry
polygraphy
Neuroimaging
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Viewing Time (Abel Screen)
AASI - based on the relative amount of time an
individual spends looking at visual stimuli. The
objective task is viewing slides and completing a
questionnaire on interest behavior. The key
dependent measure is the relative amount of time
spent looking.
vulnerable to faking as viewing time is not a
physiological variable
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Viewing time
viewing time is not to be used as the sole criterion for
determining deviant sexual interests, estimating a
client’s risk for engaging in sexually abusive behavior,
recommendations to release clients to the community,
or decisions that clients have completed treatment
program.
AASI (and other VRT tools) are best used as clinical
interview aids and treatment tools (rather than risk
assessment and diagnostic tools) and as a way to
gather and organize large amounts of self-report
questionnaire data.
46
Polygraphs
Polygraphs help enable clinicians to obtain more
reliable sexual history and more accurate offense
behavior descriptions overcome denial and
improve assessment of treatment need and risk of
reoffending
Reported less use of grooming potential victims,
obtaining pornography and substance use
Improve quality as well as quantity of information
reported such as masturbating to deviant fantasies,
unsupervised contact with victims
47
Polygraphs
Those motivated not to offend see the polygraph as
a tool of accountability to assist in relapse
prevention
Those not motivated will try to avoid it
48

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DATA
49
Michael Bourke and Andres Hernandez, Psy.D. 2009
At sentencing, 40 (26%) had known histories of
contact offenses causing 75 victims N= 155
85% eventually disclosed offending histories
More dangerous than previously thought
Not innocent “sexually curious” men who are entangled
in the WWW
2% were “just pictures” cases yet admitted in tx
they were at risk
Few offenders would admit true extent of sexual
history if not in intensive tx program
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Study (Seto, M. ,2006) shows support via
plethysmography for sexual preference for children
in pornography offenders vs. contact offenders
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Moore, D.L.
Unpublished program stats 2010
Contact offense history 75% (N= 28) had contact victims
Pre polygraph 8 of 28 or 29% had known victims 3
had prior state charges and federal sex offense was
additional convicted sex offense (11% reoffense)
Post polygraph 13 of 28 or 46% admitted they had
victims previously unknown to authorities
Majority had 10 victims 7 of 28 (25%) were able to pass
polygraphs verifying that they had no known prior
identifiable victims
Did NOT count fantasy/grooming/planning
Of these to date, 2 of 28 (7%) reoffended post treatment
/expulsion
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53 Risk Assessment
What are the important risk factors for
offenders?
Risk Assessment
Child sex abuse .09
MMPI 2 – 2 .09
Anxiety .07
Minimizing .06
Low self-esteem .04
Loneliness .03
Denial .02
Severe psych problems - .03
Low motivation for tx - .08
Lack of victim empathy - .08
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Risk Assessment
Non compliance w Supervision .62
Probation Violation .50
MMPI-2 Scale 4 .43
MMPI-2 Scale 5 .42
Emotional identification w child .42
Sex preoccupation .39
Self regulation problems .37
Any Personality D/O .36
Prior criminal history .32
Childhood behavior probs .30
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Static and dynamic factors
Static variables have long range predictive value
Easily accessible through official records
Little subjective judgment
Assessment of dynamic factors remains largely
depend on practitioner judgment supported by
effective training and protocols
Public has zero tolerance for errors
56
Consider the 2 major categories of risk:
Presence of sexual
deviancy
Sexual interest in
children
Other paraphilia
(voyeurism,
exhibitionism)
Sexual preoccupation
Antisocial lifestyle and
orientation
Rule violations,
poor employment
history,
Reckless, impulsive
behavior (also
predictive of general
recidivism)
57
Dynamic variables
stable may change over time but not subject to short
term fluctuation
Cognitions, treatment compliance, attitudes, insight
acute factors may change over more limited period
of time as short as hours but can be days or weeks
Cooperation with supervision
Sexual Preoccupation
Anger / hostility
Victim access
58
Stable dynamic risk factors
Recidivist sexual offenders hold attitudes, beliefs,
and actions that facilitate sexual offending
Intimacy deficits
Negative social influences
Attitudes tolerant of sexual offending
Sexual self regulation
General self regulation
59
Intimacy deficits
Lack trust in healthy relationships
Little satisfaction in intimate relationships
Lack empathy toward women
Pursue sex in uncommitted relationships
Never married and courtship disordered are likely to
reoffend
Grave difficulties in establishing a meaningful
relationship with adult female is significant predictor
60

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Negative social influences
Promoting antisocial attitudes
Poor behavioral controls
Substance abuse
Dysfunctional coping strategies
Support denial of offenders
Facilitate offenders’ victim access
61
Attitudes supportive of sexual
offending
Sexualize children
Attribute more developmental characteristics to
them
Attribute adult motives for normal childhood
behavior
Child may seek attention, distorted as sexual
interest in adult
Use adult language to describe children,
“negligee”, “flirt”
62
Self Regulation - Sexual
Sex is overvalued
Feel entitled to act out their urges
Feel it helps stress
Negative mood does not cause reoffending but
deviant fantasy to regulate emotions does
Increases risk if
Feel deprived or frustrated if unable to satisfy
sexual urges
negative affect
63
Self regulation - general
Smoke, Drink , Use drugs
Drive fast
Quit school
Have multiple short term relationships
Lifestyle instability
64
Significant Acute factors
access to victims
emotional collapse
collapse of social supports
Hostility
substance abuse
sexual preoccupation
rejection of supervision
Other important for a specific offender (e.g., homelessness,
compliance with psychiatric medication)
65
Factors unrelated to sexual recidivism
Victim empathy
Denial / minimization of offense
A treatment factor
Lack of motivation for treatment
Internalizing psychological problems
Depression, anxiety, low self esteem
Sexually abused as a child
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67 Risk Assessment
Conducting the evaluation
Misconceptions about offending:
Current trends in assessing and treating:
Offending is always triggered by negative
emotions
all offenders want to avoid offending;
offending is a result of skills deficits;
and that there is a focus on avoidance rather than
approach goals.
68
Standards for treating sexual offenders
teach offenders about offense cycle:
life events (including fantasy and personality traits)
that set the stage to offend;
triggers on the path to do so (lots of steps in making
it happen);
motive (sexual deviance) and getting needs met
(emotional and sexual);
willingness (distortions that made it ok);
opportunities to the offender (set up) and then
cover up and pretending it was ok.
69
Evaluation Components
Insight into offense precursors and risk,
Level of cognitive functioning and other responsivity
factors,
Relevant personality traits such as, but not limited to,
suspiciousness, hostility, risk-taking, impulsivity,
grandiosity, arrogance, and psychopathy,
70
Purpose of psychosexual evaluation / referral question
Mental status examination
Sources of information
Background information/ history
Sexual history/ Deviant Sexual Interests
Sexual offense history and conduct
General Psychological Characteristics
Personality/ cognitive how they may interfere with tx
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Psychosexual Evaluation / Risk Assessment_2014 Psychosexual Evaluation / Risk Assessment_2014
thorough sexual history
sexual fantasies, urges, and behavior, early sexual
experiences;
number and duration of sexual relationships;
masturbation and intercourse frequency; sexual functioning;
and unusual sexual interests or behavior that are not sexually
deviant or illegal, such as cross-gender dressing;
Substance use; and Use of sexually arousing materials (e.g.,
magazines, computer pornography, books, videos, Internet
sites, telephone sex services).
72

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Psychosexual Evaluation
Sources of information
Review the following:
Information of searches, investigations
Prior Criminal History – charges and disposition
Chat content/ summary of images
Home search
Interview with offender
Job approval/ interview with employers
Random drug tests/ monitoring / logs
Self report -insufficient to monitor and evaluate
change (need to supplement).
73
Evaluation Components
-findings
Risk Assessment
Results of psychological testing
General Psychological Characteristics/ Amenability
Mental health
Personality disorder
Cognitive abilities
Diagnostic Impression
Placement
Strategies for management
74
ATSA Practice Guidelines-
Psychosexual Evaluation should provide
client’s dynamic risk factors
risk for reoffending
specific treatment needs
Strengths /amenability to treatment
Recommendations
intensity and type of intervention
risk management strategies
Responsivity
do not offer conclusions whether an individual has or has
not committed a specific act of sexual abuse
75
Results of psychological testing
Case Formulation (paraphilia, criminal, interaction)
Diagnostic Impression including personality/character structure
Assessment of Risk
Risk contingent recommendations for treatment and monitoring
Amenability for Treatment
76
Effective evaluations require a comprehensive
review of the offender’s lifestyle patterns,
psychological dimensions, sexual history, and
deviancy.
- The evaluator should be aware that an
offender’s self-report is likely the least reliable
source of information during the evaluation.
Note Accordingly.
77
Review the following:
Information of searches, investigations
Criminal History – charges and disposition
Chat content/ summary of images
Home search
Interview family members ?
Random drug tests/ monitoring / logs
78

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Simply interviewing an alleged perpetrator cannot
be relied upon without looking at collateral data.
This does not mean that interviewing the alleged
perpetrator (or testing) is not important.
The main point is to be comprehensive in the data
collected so that all types of input are considered in
the assessment, before any conclusions are reached.
Self report will ultimately be insufficient to monitor
and evaluate change. Supplement it with
performance-based measures.
79
Treatment issues
80
treatment
Few seek treatment on their own
No treatment is effective unless the pedophile is
wiling to engage in treatment
Manage pedophilic urges (urges can be managed-but
attraction does not change)
Group based with individual
Address distortions and denial, relapse prevention,
sexual impulse control training, perspective taking
81
Drop outs
Attrition is high in offender based residential and
community based treatment programs 30-50%
Drop outs have higher recidivism (3x )
Married drop out less
Incest drop out less than pedophiles
Less willing to take responsibility to behavior or to
effectively engage
82
Lack of Treatment engagement
Responsibility factor that accounts for treatment
attrition
Lack of motivation
Denial
Refusal to accept responsibility for one’s actions
Poor attitude toward treatment
Work to address
83
Treatment drop outs
Generally noncompliant to rules and regulations
Act aggressively in treatment
Have histories of misconduct
Have longer offense histories
Disruptive to treatment program
84

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Self Presentation
85
Sexual History- verified by polygraph
early sexual experiences and sexual conditioning
experience of sexual abuse
Sometimes fabricated for sympathy
no. and duration of sexual relationships
gender identity and sexual orientation
frequency of masturbation and interpersonal
sexual activity
sexual functioning
86
Sexual History- verified by polygraph
sexual repertoire, including range of sexual
practices and unusual sexual interests
use of sexually arousing material (magazines,
phone sex)
frequency and content of sexual fantasies
types and severity of paraphilic behaviors and
interests
Duration of offending
87
Risk Assessment of Sexual Offenders Sexual
Offense Conduct
circumstances of abuse (location, likelihood of
detection)
location of offense (open vs restricted space)
intrusiveness of offenses (in victim’s home,
duration and type of behaviors )
number of assaults
intent (shock and run, terrorize and retaliate;
contact)
Look at Set up and distortions
88
Sexual Offense Conduct Contact Offenses
Contact
Type of contact
Extent
Duration
Attempted and completed acts
Method of making initial contact
Grooming methods
Eliciting compliance
Fantasy
89
Sexual Offense Conduct Non contact
Cybersex / Travelers
Content of chat
Method of initial contact
Screen name
Modus operandi (tools)
Chat rooms
90

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Risk Assessment of Sexual Offenders Sexual
Offense Conduct
Child Pornographers
Offense conduct (possession and receipt;
trafficking, distribution and selling, producing and
manufacturing)
Content of images (age of victims depicted, types
of individuals , type of sexual activity, type of
coercion, type of violence)
Duration of offense conduct
Quantity of images - collections/classification
91
Exposure to nonviolent pornography
Increased callousness toward women
Trivialization of rape
Distorted perceptions of sexuality
Devaluation of monogamy
Decreased satisfaction with partner’s sexual
performance, affections and physical appearance
Decreased sexual intimacy
Viewing nonmonogamous relationships as normal
92
Psychopathy
Grandiose, dominant, manipulative person; who
shows shallow and insincere emotions; who
displays weak and short-lived interpersonal
bonding; who is lacking in empathy and genuine
guilt; and who are impulsive, sensation-seeking,
and readily violate social norms.
The higher a person’s psychopathy score, the less
amenable to treatment. Treatment of this
population makes them worse!
93
Psychopathy
For all types of offending, (violent, sexual, general)
offenders scoring PCL-R (³ 26) were significantly
more often reconvicted
sexual deviance score significant predictor of
sexual reconviction
term applied loosely to criminals and sex offenders
94
95 Actuarial Measures
http://www.STATIC-99.org
Which Actuarial Assessment Should I
Use?
You want to assess sexual deviancy and
antisocial/violent tendencies.
Sexual Deviancy- STATIC:
STATIC-99, STATIC-99R, STATIC 2002
Sexual Deviancy- DYNAMIC:
STABLE 2007 and ACUTE 2007
Violence:
PCL-R
STATIC-99R
VRAG/SORAG
96

17
Risk Assessment Instruments
Static 99R .30
Static 2002R .30
Static 99 .28
SACJ-Min .24
Risk Matrix 2000 .28
SORAG .22
SVR-20 .14
RRASOR .22
97
STATIC – 99R
A 10 item risk assessment instrument.
Actuarially based.
Designed to estimate the probability of sexual
and violent reconviction for adult males.
Each factor is reliably associated with recidivism.
Only static factors (others possible).
Not a comprehensive assessment tool
98
STATIC – 99R
Who can you use it on?
Adult males, charged with or convicted of at least
one sex offense against child or non-consenting
adult.
Can be used with first time offenders.
It is not recommended for adolescents.
Not recommended for Statutory Rape cases where the
“ages of the perpetrator and the victim are close and the
sexual activity was consensual.”
99
Deciding “close in age and consensual…”
a) The “alleged victim” states the sexual interaction
was consensual and has never claimed otherwise;
AND
b) The offender had no pre-existing power
relationship over the “alleged victim” (e.g., swim
instructor) AND
c) The age difference is no greater than 3 years (it
can be up to 5 years if the offender is of lesser
cognitive developmental capacity than the victim).
100
STATIC – 99R
Not recommended for females.
Not recommended for prostitution related offenses,
pimping, consenting public sex, or possession of
pornography and indecent materials.
Not recommended for people who have never committed
a sex crime, or for determining guilt from innocence.
Can be used with offenders who sexually abuse animals.
Can be used with DD offenders.
101
Psychosexual Evaluation / Risk 102 Assessment_2014

18
STATIC – 99R: Scoring
The STATIC-99R is scored by adding the
scores for each of the ten items. This is the
total risk score.
The total risk score is translated to a
Global Risk Level.
Look at the Recidivism Percentage by Risk
Level (STATIC-99R worksheet)
103
STATIC – 99R
Young
Lived w intimate
partner 2 yrs
Index nonsexual
violence
Prior nonsexual
violence
Prior sex offense
Prior sentencing dates
Any conviction non
contact sex offenses
Unrelated victims
Stranger victims
Male victims
104
Combine static and dynamic
STATIC 99R plus
STABLE 2007
SOTIPS
105
Dynamic factors (outside STATIC)
Sexual Deviance/ self regulation
Prior so against 2 or
under 12/ 1 unrelated
Offense as juv and
adult
Dropping out or no tx
Masturbation 1/daily
Lifestyle instability/ criminality
Childhood
maladjustment, hx
grade failure, psy tx,
group home placement,
run away criteria for
CD
PCL- R of 30
Psychosexu
al
Evaluation
/ Risk
Assessment
_2014
106
Dynamic factors (outside STATIC)
Sexual Deviance/ self regulation Lifestyle instability/ criminality
Prostitutes, strip clubs,
phone sex
Internet sex / cruising
Sexual talk
30 partners
Violation of
conditional release or
new offense while on
supervision
Unemployed 50%
Negative emot/ -prob
solv
107
SOTIPS
Sexuality and Risk Responsibility
Sexual offense responsibility
Sexual behavior / attitudes/ interests
Sexual Risk Management
Criminality
Criminal and rule breaking behavior/ attitude
Treatment and Supervision Cooperation
Stage of change
Cooperation w treatment / community supervision
Self Management
Emotion mgt, problem solving, impulsivity
Social Stability and supports
Psychosexual Evaluation / Risk Assessment_2014 Psychosexual Evaluation / Risk 108 Assessment_2014
Employment, residence, social influences

19
(STABLE 2007)
Sign Soc Influences Score
Capacity or Relatio Stab
Emotional ID w children
Hostility toward women
General Self-regulation
Lack of concern/others
Impulsive
Poor problem solving
Neg Emotion
Sex Drive/Sex Preoccupat
Sex as Coping
Deviant Sex Pref/ Dev Int
Psychosexual Evaluation / Risk 109 Assessment_2014
Cooperation w supervision
Restrictions
110
Risk Contingent Recommendations
Contact with victim
Contact with minors
Offender specific risk factors
alcohol, access, driving, pornography/erotica
Offender specific behavioral restrictions
employment, pets, social, cable, internet, mail boxes,
storage, binoculars, cameras, videogames
Communication- social networking- NONE
Treatment (IP/OP; modality; structure)
111
Employment
internet, telephone use
supervised, unstructured, management potential
Social and Spiritual
positions of trust, access to potential victims
Recreational -- proximity to victims
Housing access to victims and other risk factors- pool, picnic
areas,
112
Psychosexual evaluations provide treatment and
management strategies, they do not, however, make
definitive statements as to any examinee's guilt or
innocence. Mr. H has not been convicted of a sexual
offense and denies sexual motivation for which to
seek treatment. Typically, persons who engage in
sexual misconduct can benefit from some type of
therapeutic intervention. For any intervention to be
effective, however, there is a condition of problem
acceptance and acknowledgement.
113
Do not minimize recommendations because…
- The offender may go to prison or that
prison may increase risk, etc.
- The offender won’t be able to feed their
family if out of the home, etc.
- The offender cannot afford the treatment.
- You believe you know the offender better than
others
114

20
Assumptions: Risk Assessment of Sexual
Offenders
Risk cannot always be defined by the nature of the
crime.
Risk is not a static variable, although it resides within a
historical context.
Risk is created by the offender.
Risk cannot be assumed to be lessened by time.
The offender has great motivation to not tell you
everything and has much reason to tell you what you
want to hear.
115
Assumptions: Risk Assessment of Sexual
Offenders
Re-offenses rarely come to our attention.
Treatment may help, but it is never an absolute bar
against reoffense.
Dynamic factors that may lessen risk, e.g., benefit of
treatment, are in their infancy stage of study.
Personal contact with an offender may lessen our ability
to predict objectively.
Victim preferences vary according to situation. Modus
operandi changes.
Actuarial measures are generally better than clinical
judgment.
116
- Offenses are rarely spontaneous. They are
planned and premeditated.
- Offending is a choice.
- Assume fantasy
- Assume no empathy for victim.
- Assume sexually objectification of the victim.
- Assume grooming of victim and others.
117
- Assume more than one offense.
- Assume a negative lifestyle or significant
dysfunction in select areas
- Assume the offender may have violated
males and females.
- Assume distortions, minimizations, etc.
- Assume dishonesty towards accountability
at some level.
118
-Assume offenders will tell you what they
think you want to hear.
-Assume offenders knew the abuse was
illegal and wrong
- Assume offenders will try to believe what
they want, and get others to believe the
same.
- Assume long term risk and need for sex
offender specific therapy
119
- Assume you have never asked enough
questions.
-Assume the offender would deny all of the
above assumptions.
-Never minimize behavior that involves the
violation of the personal boundary of
another person or behavior that contributes
to a maladaptive lifestyle.
- All offending behavior requires treatment.
120

21
GENERAL PARAMETERS FOR SO ASSESSMENT
- Know your own personal boundaries, biases, and minimizations
regarding offenders and victims.
- Decide what you determine to be an offender, a victim, and
a sex crime.
- Recognize your role as an assessor and not a trier of fact.
- Develop a means of establishing rapport yet with objectivity.
- Be sure to understand the legal and ethical issues pertaining to
assessment of an offender, e.g., signed consent, signed releases
of information.
- Recognize that the offender will likely exploit the trust of the
examiner.
121
GENERAL PARAMETERS FOR SO ASSESSMENT
- Recognize that there is a need to confront the offender at times
during the assessment in order to obtain information and
challenge distortions, which may be contrary to previous
training.
- Have a good understanding of the basic theories and
typologies of offenders and victim. Our knowledge base tends
to lead our clinical assessment.
- Always monitor for collusive engagement.
- Realize the common insecurities we all have in working with this
population that speak to the need for regular supervision and
consultation.
- Assessment and evaluation is an ongoing, continuous process
throughout treatment with an offender
122
Recommendations of concern
Mr. X does not fit the profile of a
pedophile/predator/sex offender
Mr. X’s behavior was not consciously planned
Mr. X is safe around male / teen/ etc children
Mr. X needs counseling to deal with interpersonal
skills, maturity concerns, and self-esteem
123
Recommendations of concern
Mr. X has now gained control of his impulses and it
is not expected to be a risk to children.
Mr. X should be reunited with his children.
Mr. X’s abuse of children was caused by his early
abuse.
Mr. X is a fine, upstanding citizen; having much to
offer the community, and should be given probation.
124
Avoid
Extensive dynamic interpretations
Advocating quick reunification or contact with children
without supervision
No concerns for risk relevant behaviors and
management of those
Extensive statements about personal qualities that have
limited relationship to risk (church attendance,
employed, married)
Lack of appreciation for time involved for true change
125
126 Cases

22
Mr. L
The STATIC-99R is an actuarial risk assessment
measure that considers static factors that are
correlated with sexual reoffense. As this
assessment tool focuses on unchangeable factors, it
does not address all relevant factors for sexual
recidivism, including those that may be targets for
change. This score on this measure should be seen
as a baseline of risk.
127
Mr. L
Sexual recidivism is predicted by static and dynamic
sexual risk factors as well and criminal factors. Mr. L
presented with the following dynamic factors that
are correlated with risk. The following are self
regulation issues. He demonstrated childhood
maladjustment by receiving psychiatric treatment
and placement in state custody for his repeated
misconduct.
128
Mr. L
He demonstrated a high sexual drive and deviant
sexual preoccupation through his use of pornography
including deviant pornography (urophilia and
voyeurism). He has used the services of prostitutes
and accessed sexually oriented materials through the
internet by swapping personal images and accessing
materials through membership in sexually deviant
sites.
129
Mr. L
His lack of concern for others regarding sexual
contacts and lack of intimacy with adult partners
suggests intimacy deficits that also speak to
increased risk.
Mr. L’s highest area of risk comes from poor
self regulation of his sexual behavior as
indicated by the following.
130
Mr. L
He had an extensive pornography collection that
included numerous images of child erotica and
pornography. Mr. L has a history of multiple sexual
partners (200). His attitudes about sexuality were
cavalier, hostile, and demeaning toward females in
a manner that justified his actions and are
supportive of continued sexual exploitation of
females. Substance abuse is a disinhibitor as well
and as such will limit good decision making.
131
Mr. L
Considering all factors that are empirically related
to reoffense, his risk for sexual recidivism should be
considered to be high
132

23
Mr. H’s risk level is such that he could be managed in
an outpatient program within a containment model of
treatment, probation and polygraph if he is able and
willing to attend and participate as directed. The
following are community recommendations if or when
the court feels Mr. H is ready for community
supervision. These clinical recommendations are
provided for consideration of disposition…not
interpreted as indicative of guilt.
133
Mr. H could participate in a truth verification
examination (polygraph) with an examiner
approved by the sex offender treatment board. A
favorable polygraph seems unlikely as Mr. H has
made disclosures of sexual misconduct to others and
a recommendation for a polygraph examination
was not made due to his prior statements. It may be
helpful in the future to motivate him to make
disclosures that will be necessary for treatment
engagement.
134
Bill- low static/ mod dynamic
The following dynamic predictors were known at the
time of that assessment: sexual self regulation:
deviant sexual preoccupation through pornography
use, telephone sex, use of prostitutes in Australia, high
number of sexual partners (30), and accessing
sexually oriented materials on the internet including
engaging in the pedophilic subculture, chatting online
and engaging in other sexual behaviors;
135
Bill, Dynamic factors:
persistent deviant sexual interests (interest in
children as evidenced in a prior contact sexual
offense and instant offense, public sexual acts)
attitudes tolerant of sexual abuse of children
including images of bondage of children and
oral rape of children as young as toddlers.
136
Bill
Although risk estimates are typically lower for older
offenders, his increasing age was not a protective
factor against pedophilia as one does not “age out”
of the chronic, lifelong sexual disorder.
137
Bill post polygraph admissions
use of prostitutes (admitted 5-6 from Malaysia),
number of sexual partners (15 males in anonymous
contacts in adult bookstores),
history of sexual deviance dating back to teenage
years including 15 admitted incidents of voyeurism
against his sister while she bathed;
sexual contact with animals (two calves and one
pony);
sexual contact with same age male peers.
138

24
fantasies of 12-13 year old girls fellating him
150 film clips of children with adults, “barely legal”
images, children with children, and images of nude
children as young as infants.
Admitted anal sex and bondage with his ex wife
when he tied her hands and feet together and
another time he tied her over a chair
Admitted he went to Swingers clubs on six occasions.
139
Bill- post polygraph admissions Bill
Themes
Fellatio by 15 y/o niece
Fellatio with men in bathhouses
Fellatio(attempted) with animals
Fellatio by prostitutes
Fellatio in CP images
toddlers fellating adult males
140
Bill
Struggled to take responsibility for deviant interest
Enabled by girlfriend
Violated probation within two months of completion
Contact w minors in their home
141
Case: “Mike”- evaluation
Traveled to meet 12 year old girl
“like to hump 14” and “mike for jailbait”
Denied contacts
Admitted chatting with underage females
Admitted planning to but not meeting another
underage female
30 year old Married male
142
Case: “Mike”- treatment post
release
Admitted contact offenses beginning at 19
One vic asleep, one he said he was bf
Admitted chatting with 100s of underage girls for
sexual purposes
Admitted stealing women’s panties at public laundry
rooms , hid in ceiling
Pen pals with woman from Philippines – intended to
move there for access to young women/girls
143
Mike
Has had four reports to court for watching erotic
but not illegal images
Has failed two polygraphs (not consecutive) for
viewing images
Delayed scheduling
Continues to objectify females (adult and teen)
144

25
Case: “Rick”- evaluation
58 y/o married Caucasian Male
No prior Criminal hx
No mental health complaints
Contacted “John14KY”
Requested image, discussed sexual interests and
proposed meeting
Sent images and requested it be destroyed after
viewing CONCERNS?
145
Case: “Rick” treatment
60 y/o married Caucasian Male
Returned to treatment upon release from detention
Post polygraph – indicated contact victims
beginning as teen
Voyeurism/ fantasy objectification of boys
throughout lifetime
Former church leader/volunteer/teacher
146
Sexual History Rick
First vic @ 15 / 9 y/o sleeping
16 / 10
26 / 15 (lasted year)
28 married
Continued affairs/ objectifying /fantasizing
Online chat rooms/ S and M / travel to meet men
54 instant offense travel to meet John 14
58 near VOP at convenience store
147
Mr. J
Mr. Js narcissistic personality features, are long
standing. Because of this, true change is difficult.
While his personality does not increase his risk, per
se, it does decrease his chance of accepting the
need for and making positive changes that would
reduce his risk for sexual acting out. Mr. J
acknowledged a significant past use of alcohol. As
this is considered a disinhibitor of sexual behavior,
any personal reservations and internal roadblocks
he might face would be more easily overcome with
alcohol.
148
Mr. J
Actuarial risk assessment measures for sexual
recidivism were not used in this evaluation
because they were developed for offenders
who were convicted of contact sexual offenses.
Although Mr. J does not demonstrate some of
the factors typically associated with increased
risk (e.g., youth, prior criminal history,
psychopathy, etc.) several factors which are
empirically guided suggest he is at low risk for
sexual reoffense.
149
Mr. J
Mr. Js risk is highest for viewing and obtaining child
pornography. He should not be allowed to work in
any type of law enforcement or security as he abused
his titular power when employed as such through
abuse of adult females. If he should gain access to his
or his paramour’s grandchildren, he is likely to act out
through manipulating situations where he can engage
in voyeurism and, possibly, child molestation.
150

26
Richard 2
62 y/o male with CP, former teacher ’69 - ’71
Member of Netnews3
Had images as well as videos of sexual contact and
penetration of girls under 14
349 images of known CP, 2 -5 y/o girls Heather and
Helen who had sexual contact w adult males, 2 girls
identified
7000 images, 3700, 2500 girls in panties, 1300
nude and in sex, 195 b w, desktop, 15 videos
151
Richard 2
Post 2nd polygraph admitted 18 victims
Victims were females ages 6-12
Students in band, neighborhood girls
Brought them to Opryland
Took them on “dates” on one date met Matt
Admitted producing pornography w/ Matt (father
and security guard)
152
QUESTIONS?
Thank you
Donna Moore, Ph.D.
615-595-6412
drdonnamoore@bellsouth.net
drdonnamoore.com
153

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