Numerous meta-analyses and reviews have been conducted on the effectiveness of psychological treatment of sexual offenders in reducing recidivism, but no meta-analysis has been done on sexual offenders against children (SOAC) specifically. A moderate treatment effect has been shown in several evaluations of general sexual offenders, while many scholars maintain that the question remains unanswered until an adequate number of effectiveness studies with a strong research design have been carried out. In this meta-analysis, we evaluated 14 studies selected and coded according to Collaborative Outcome Data Committee (CODC) criteria. They included 1,421 adult offenders in psychotherapy and 1,509 nontreated controls, with a minimum average follow-up period of 3 years, published in peer-reviewed journals in 1980 or later. Recidivism was defined as rearrest or reconviction. Study quality was classified into strong, good, weak or rejected. The analysis revealed a treatment effect size of r = .03 for nine studies evaluated as Good or Weak, while all studies yielded an effect size of r = .08, including five studies classified as Rejected. The results show that the available research cannot establish any effect of treatment on SOAC. Despite a large amount of research, only a tiny fraction of studies meet a minimum of scientific standards, and even fewer provide sensible and useful data from which it is possible to draw conclusions.
The Scandinavian countries share a social-democratic and humanistic view in that mentally disturbed offenders should not be punished or sentenced to prison if they are considered unaccountable for their actions. The countries differ, however, for example regarding referrals for medico-legal examinations. This article gives: 1) an overview of the Scandinavian forensic psychiatric practices regarding organization, legislation, resources and use of methods, and 2) a study of forensic psychiatric assessment as they are done in the Scandinavian countries. From each country 20 forensic psychiatric court reports concerning male murderers were examined. Each report was scored in five sections: characteristics of the defendant, setting of the observation, acting professions, methods used and premises for the experts' conclusions. Data were summarized with descriptive measures. Danish and Swedish experts had a more frequent use of tests and instruments than Norwegian experts. Swedish experts used the Global Assessment of Functioning Scale (GAF), and they diagnosed the observant according to DSM-IV. The Scandinavian experts rarely referred to the tests they had applied nor did they refer to any kind of theory or literature as a basis for their conclusion. Only a few reports expressed doubt concerning the validity of the conclusion. Stating all the premises of the forensic psychiatric examination might improve the quality of the reports by doing them more explicit and verifiable. More use of standardized actuarial-based methods and more attention to knowledge about clinical judgmental processes is recommended.
In Norway the prosecuting authorities can request a forensic psychiatric screening report in order to determine whether a full forensic psychiatric report is required. This study explores three research questions. Are such screening reports considered relevant by the prosecution authorities? To what extent are their recommendations followed? What is the concordance of the conclusions of the screening reports and the full reports? This study analysed the screening reports issued on 419 defendants by Oslo Police District's Office for Forensic Psychiatry in 2002 -2005, and the 91 (22%) full reports issued on these defendants. All reports were evaluated using a structured rating form. Of the 118 screening reports that recommended a full report, 50% were followed up by the prosecution authorities. In contrast, non-recommendation of a full report was almost always followed, while 16% of open recommendations resulted in a full report. Instigation of a full report was significantly associated with major crimes, and with positive recommendation compared to open recommendation. The concordance between screening and full reports was 46% regarding psychosis, 78% regarding unconsciousness, and 94% regarding mental retardation. Based on these findings, the value of the system of screening reports seems to lie primarily in negative recommendations. Low concordance between screening and full reports, and the limited follow-up of expert recommendations for full reports, indicate that the system has questionable validity.
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