Individualized cognitive behavioral therapy to reduce criminal recidivism risk among young sexual offenders
| ISRCTN | ISRCTN69989000 |
|---|---|
| DOI | https://doi.org/10.1186/ISRCTN69989000 |
| Secondary identifying numbers | STOP1 |
- Submission date
- 18/06/2019
- Registration date
- 20/06/2019
- Last edited
- 03/12/2024
- Recruitment status
- No longer recruiting
- Overall study status
- Completed
- Condition category
- Mental and Behavioural Disorders
Plain English summary of protocol
Background and study aims
Systematic literature reviews find only weak support for the recidivism-reducing effects of current psychological interventions for young people who commit sexual offences (YSOs). Hence, we evaluate a new, sexual abuse-specific, individualized Cognitive Behavioural Therapy (CBT) intervention, STOP, for YSOs to improve treatment effectiveness.
STOP draws on the limited existing evidence and psychological treatment modalities such as Dialectical Behaviour Therapy (DBT), Multi-systemic Therapy (MST), Motivational Interviewing (MI) and the risk, need and responsivity principles (RNR) for effective work with offender populations.
STOP aims to reduce future sexual offending through a) active reduction of those research-based, malleable recidivism risk factors that each individual YSO present and b) design of an individual stop plan against relapse to follow also after treatment termination. A supplementary support plan, c) informs the offender's network on how to strengthen skills, reduce problem behaviour and monitor that the plan is followed.
Who can participate?
13 - 21-year-old males who have been convicted of a sexual offence and are resident in one of the participating youth homes.
What does the study involve?
YSOs participate in the individualized psychological STOP intervention; newly implemented and currently provided as part of standard YSO care within SiS. The study involves no additional intervention but five extra self-report and teacher report questionnaires and an additional assessment of potential treatment-related changes in risk.
What are the possible benefits and risks of participating?
Benefits from study participation (beyond STOP treatment as such) are limited but may include improved treatment quality due to additional study-related therapist supervision and the possibility to systematically contribute opinions to improve young offender treatment. No potential risks have been identified.
Where is the study run from?
Karolinska institutet, Sweden
When is the study starting and how long is it expected to run for?
January 2018 to October 2022
Who is funding the study?
Statens institutionsstyrelse (Swedish National Board of Institutional Care R&D)
Who is the main contact?
1. Miss Mia Jörgensen (public), Mia.helena.jorgensen@gmail.com
2. Dr Dan Wetterborg (public), dan.wetterborg@ki.se
3. Dr Niklas Långström (scientific). niklas.langstrom@ki.se
Contact information
Public
Division of Psychology
Department of Clinical Neuroscience
Karolinska Institutet
Stockholm
17177
Sweden
| Mia.helena.jorgensen@gmail.com |
Public
Division of Psychology
Department of Clinical Neuroscience
Karolinska institutet
Stockholm
171 77
Sweden
| Phone | +46 (0)76 915 44 29 |
|---|---|
| dan.wetterborg@ki.se |
Scientific
Center for Psychiatry Research
Department of Clinical Neuroscience
Karolinska Institutet
Norra Stationsgatan 69, 7 tr
Stockholm
11364
Sweden
| Phone | +46 (0)70 162 4028 |
|---|---|
| niklas.langstrom@ki.se |
Study information
| Study design | Interventional multi-centre study with pre-post comparison |
|---|---|
| Primary study design | Interventional |
| Secondary study design | Non randomised study |
| Study setting(s) | Other |
| Study type | Treatment |
| Participant information sheet | Not available in web format, please use contact details to request participant information/informed consent sheets (in Swedish) |
| Scientific title | An individualized, emotion dysregulation-oriented, recidivism risk-reducing CBT intervention for institutionalized young sexual offenders: Multi-center feasibility study with pre-postdesign |
| Study acronym | STOP |
| Study objectives | The STOP intervention reduces sexual recidivism risk in YSOs by lowering intermediate dynamic risk factors. STOP participants have reduced criminal recidivism 3 years post-treatment compared to comparison YSOs that did not receive STOP. |
| Ethics approval(s) | 08/05/2019, Etikprövningsmyndigheten (Swedish Ethical Review Authority, Ethics Examination Authority Box 2110, 750 02, Uppsala, Sweden; +46(0)10-4750800; registrator@etikprovning.se), ref: 2019-02375 |
| Health condition(s) or problem(s) studied | Sexually abusive or offending behavior committed by adolescents |
| Intervention | STOP is a new, sexual abuse-specific, individualized Cognitive Behavioral Therapy (CBT) intervention aimed to reduce recidivism in adolescent sexual offenders. STOP draws on the limited existing evidence for this offender population and modern theory and practice of established psychological treatments. These include Dialectical Behaviour Therapy (DBT), Multi-systemic Therapy (MST), and Motivational Interviewing (MI). STOP also follows the risk, need and responsivity principles (RNR, according to Andrews & Bonta) found to improve the outcome of treatment with antisocial individuals; adolescents and sexual offenders. Central to STOP theory is that poor emotional regulation skills contribute substantially to several of the dynamic risk factors implicated in (young) sexual offender recidivism (and assessed with risk evaluation instruments like ERASOR). STOP aims to reduce future sexual offending through a) active reduction of those research-based, malleable recidivism risk factors that each individual YSO present and b) design of an individual stop plan against relapse to follow also after treatment termination. A supplementary support plan, c) informs the offender's network on how to strengthen skills, reduce problem behavior and monitor that the plan is followed. STOP is a multi-modal intervention with four treatment tracks; skills, individual therapy, network and everyday environment. The skills track takes place individually/in groups, and provides YSOs with social learning-theory-based and sexuality-specific information and a selection of skills to practice. The individual treatment track includes chain analysis of the sexual problem behavior of each individual YSO and establishes the stop plan. The network track is directed towards key individuals in the youth’s network; herein the support plan is created and anchored. Within the everyday environment track, an assigned treatment assistant works systematically with motivational efforts and to strengthen and generalize skills from the stop plan. Overall, STOP is carried out during 17-26 weeks and comprises three tracks with 6-10 skills sessions of 90 min each, 10-15 individual sessions of 90 min each, and 6-7.5 h of network work. |
| Intervention type | Behavioural |
| Primary outcome measure | 1. Pre-post changes in expert-completed Estimate of Risk of Adolescent Sexual Offense Recidivism (ERASOR) 2.0-based, pre-specified summary scores of intermediate sexuality-specific and other dynamic risk factors for criminal recidivism, respectively. Assessments are conducted by trained and supervised evaluators (other than the therapist) and cover the past month at baseline and at follow-up the past month immediately before the completion of the intervention. 2. Register-based sexual and (non-sexual) violent criminal recidivism rates (suspicions according to the National Crime Register) for 3 years following completed treatment. |
| Secondary outcome measures | 1a. Pre-midtherapy-post changes in self-reported emotional instability problems according to the Difficulties in Emotion Regulation Scale (DERS-16). 1b. Pre-midtherapy-post changes in teacher-rated impulse control difficulties according to the Swanson, Nolan and Pelham scales (SNAP-IV). 2. Register-based psychiatric diagnoses and psychotropic medication use, 3 years following completed treatment (according to the Swedish National Board of Health and Welfare's a) National patient register, and b) National register of prescribed and dispensed medications, respectively). 3. STOP participants are compared to two comparison groups of male, individually matched (birth year, criminal and psychiatric history) young offenders also convicted to residential treatment within the National Board of Institutional Care I) YSOs for whom, due to logistical reasons (but not treatment refusal), STOP was not provided. II) Young offenders convicted of non-sexual, violent index offences, not eligible for specialized sexual offending-specific treatment. |
| Overall study start date | 15/01/2018 |
| Completion date | 31/10/2022 |
Eligibility
| Participant type(s) | Other |
|---|---|
| Age group | Mixed |
| Sex | Male |
| Target number of participants | 30 |
| Total final enrolment | 28 |
| Key inclusion criteria | 1. 13-21 years of age 2. Male 3. Placed in one of 4 locked institutions held by the Swedish National Board of Institutional Care (Statens institutionsstyrelse, SiS) 4. Suspected or convicted of one or more index sexual offences 5. ERASOR-rated moderate to high risk for sexual recidivism 6. Remaining time in custody four months or more 7. Sufficient understanding of Swedish / English or (in some cases) communication with an interpreter |
| Key exclusion criteria | 1. Intellectual impairment (Total IQ < 70) 2. Any psychiatric disorder currently characterized by marked instability. This includes, but is not limited to, ongoing manic episode, a psychotic condition or a markedly elevated suicide risk. |
| Date of first enrolment | 01/07/2019 |
| Date of final enrolment | 20/12/2021 |
Locations
Countries of recruitment
- Sweden
Study participating centres
Uppsala
755 97
Sweden
Hässleholm
281 51
Sweden
Kalix
952 21
Sweden
Lund
224 21
Sweden
Lindome
437 21
Sweden
Sponsor information
University/education
Department of Medical Epidemiology and Biostatistics
Stockholm
171 77
Sweden
| Phone | 0704254133 |
|---|---|
| niklas.langstrom@ki.se | |
| Website | https://ki.se/en |
"ROR" |
https://ror.org/04hmgwg30 |
Funders
Funder type
Government
No information available
Results and Publications
| Intention to publish date | 31/12/2023 |
|---|---|
| Individual participant data (IPD) Intention to share | Yes |
| IPD sharing plan summary | Available on request |
| Publication and dissemination plan | Two scientific reports in English submitted for publication to peer-reviewed international journals. Implementation and feasability outcomes in 2022 Pre-post intervention results, somewhat later, in the autumn of 2022 A summary lay report in plain Swedish, early 2023 |
| IPD sharing plan | Data cannot be shared publicly due to ethical reasons; public data availability for this small, vulnerable sample of young people who sexually offended would severely increase the risk of compromising their anonymity. Data can be requested from the Department of Clinical Neuroscience, Karolinska institutet (contact via registrator@cns.ki.se) for researchers who meet ethical and legal criteria for access to confidential data. |
Editorial Notes
03/12/2024: Internal review.
25/07/2022: The following changes have been made:
1. The contact details have been updated for two of the contacts.
2. The recruitment end date has been changed from 30/06/2022 to 20/12/2021.
3. The overall trial end date has been changed from 31/12/2024 to 31/10/2022 and the plain English summary updated accordingly.
4. The intention to publish date has been changed from 31/12/2022 to 31/12/2023.
5. The final enrolment number has been added.
6. The IPD sharing statement has been added.
20/06/2019: Trial’s existence confirmed by Etikprövningsmyndigheten (Swedish Ethical Review Authority)
