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
Prospectively registered
Protocol
Statistical analysis plan
Results
Individual participant data
Record updated in last year

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

Miss Mia Jörgensen
Public

Division of Psychology
Department of Clinical Neuroscience
Karolinska Institutet
Stockholm
17177
Sweden

Email Mia.helena.jorgensen@gmail.com
Dr Dan Wetterborg
Public

Division of Psychology
Department of Clinical Neuroscience
Karolinska institutet
Stockholm
171 77
Sweden

Phone +46 (0)76 915 44 29
Email dan.wetterborg@ki.se
Dr Niklas Långström
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
Email niklas.langstrom@ki.se

Study information

Study designInterventional multi-centre study with pre-post comparison
Primary study designInterventional
Secondary study designNon randomised study
Study setting(s)Other
Study typeTreatment
Participant information sheet Not available in web format, please use contact details to request participant information/informed consent sheets (in Swedish)
Scientific titleAn individualized, emotion dysregulation-oriented, recidivism risk-reducing CBT intervention for institutionalized young sexual offenders: Multi-center feasibility study with pre-postdesign
Study acronymSTOP
Study objectivesThe 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) studiedSexually abusive or offending behavior committed by adolescents
InterventionSTOP 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 typeBehavioural
Primary outcome measure1. 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 measures1a. 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 date15/01/2018
Completion date31/10/2022

Eligibility

Participant type(s)Other
Age groupMixed
SexMale
Target number of participants30
Total final enrolment28
Key inclusion criteria1. 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 criteria1. 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 enrolment01/07/2019
Date of final enrolment20/12/2021

Locations

Countries of recruitment

  • Sweden

Study participating centres

SiS Bärby ungdomshem (youth home)
Funbo-Broby 53
Uppsala
755 97
Sweden
SiS Hässleholm ungdomshem (youth home)
Norregatan 20
Hässleholm
281 51
Sweden
SiS Johannisberg ungdomshem (youth home)
Johannisbergsvägen 25, Box 20
Kalix
952 21
Sweden
SiS Råby ungdomshem (youth home)
Box 24036
Lund
224 21
Sweden
SiS Fagared ungdomshem (youth home)
Box 4
Lindome
437 21
Sweden

Sponsor information

Karolinska institutet
University/education

Department of Medical Epidemiology and Biostatistics
Stockholm
171 77
Sweden

Phone 0704254133
Email niklas.langstrom@ki.se
Website https://ki.se/en
ROR logo "ROR" https://ror.org/04hmgwg30

Funders

Funder type

Government

Statens institutionsstyrelse (Swedish National Board of Institutional Care R&D)

No information available

Results and Publications

Intention to publish date31/12/2023
Individual participant data (IPD) Intention to shareYes
IPD sharing plan summaryAvailable on request
Publication and dissemination planTwo 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 planData 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)