Insights of the Preventive Project Dunkelfeld (PPD):Setup, Approach, Treatment Change and(Potential) CP Offenders as Speci...
Overview   • Background and Aims   • Project Design and Procedure   • Treatment   • Preliminary Results   • (Potential) CP...
BACKGROUND AND AIMSUNIVERSITÄTSMEDIZIN BERLIN   3
Background  Clinical experience suggests that there are / is      • Little psychotherapeutic treatment offers for        p...
Background  Relatively little is known about CP and/or CSA offenders who are not formally  involved with the criminal just...
Pedophilia/Hebephilia ≠Child SexualAbuse (CSA)   Sexual Preference Disorder                Sexual behavioral disorder   (P...
Pedophilia/Hebephilia ≠Consuming Child Abusive Images (child pornography offenses)      Sexual Preference Disorder        ...
Aims  • Closing gap of treatment offers  • Closing gap of knowledge(accompanying research )  • (Primary) Prevention of Chi...
PROJECT DESIGN ANDPROCEDUREUNIVERSITÄTSMEDIZIN BERLIN   9
Target Groups of PPD                                                Organic brain dysfunction, a                          ...
Media Campaign      How can target groups be reached?      How can public be sensitized for the problem      (society and ...
Media CampaignCommunication Aims I:         Pedophilic / Hebephilic persons have to perceived as clients with special need...
Media CampaignCommunication Aims II:                            Message pedophilic / hebephilic persons:                  ...
Media Campaign    UNIVERSITÄTSMEDIZIN BERLIN   14
Media Campaign Outdoor Advertising: 2.000 sites in and around Berlin for a period of 4 – 8                      weeks.    ...
Media Campaign – Poster and Spot    UNIVERSITÄTSMEDIZIN BERLIN     16
Intake Assessment  Self-reported Domains         Sexual Age and Gender Preference         Criminal History         Soci...
Intake Assessment  Sexual age preference  Sexual (body) age preference according to DMS-IV-TR (APA,  2000) was coded in th...
Intake Assessment   Criminal history  Detection status                   • Clinical Interview  CSA                        ...
Intake Assessment   Measures of DRF  Problematic                • Offense-supportive attitudes (BMS; Bumby, 1996)  (offens...
Sample Description  Sample Size “Prevention Project Dunkelfeld” (PPD) between 2005 and 2012                               ...
Sample Description         Clinical diagnosis                   14,5                                        Sexuelle Anspr...
Sample Description   •    First problem awareness:    age: 22 yrs.   •    Mean age:                   39 yrs. (range: 17-6...
Sample Description                                   82,5Criminal history    %       50                                   ...
TREATMENTUNIVERSITÄTSMEDIZIN BERLIN   25
Treatment                                  Setting 2005-2011  • Guided group therapy (6-10 participants), closed groups.  ...
Treatment                        Changes in PPD-treatment in 2012   From closed groups to semi-open groups   Implementin...
Treatment                  Revision of guided treatment (in progress)  • Implementing a preparatory /psychoeducational and...
PPD: Treatment    Treatment targets I    DRF                             Intervention    Problematic cognitions          I...
PPD: Treatment    Treatment targets II    DRF                             Intervention    Emotional deficits              ...
Protective/Relapse                 Motivation                     Prevention                       Plans                  ...
Sexual                                                 interest in                                   High sexual    childr...
Session Opening         Continuous evaluation of level of functioning                                                     ...
PRELIMINARY RESULTSUNIVERSITÄTSMEDIZIN BERLIN   34
PPD: Evaluation    Treatment Eligibility (n = 373)                                                   Treatment Completers ...
PPD: Evaulation    Statistical analyses: Within groups      T0                               TRetest        Tint          ...
PPD first results: Comparability on descriptive data      Criminal history by group: LT offenses                   Treatme...
PPD first results: Improvement on measures of DRF    DRF-Improvement within TG                                            ...
PPD first results: Improvement on measures of DRF    DRF-Improvement within TG offender groups    • No changes in non-offe...
See other presentationUNIVERSITÄTSMEDIZIN BERLIN   40
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Gerold Scherner: Insights of the Preventive Project Dunkelfeld

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Presentation in Sexpo's international seminar "Sex Offending: Preventive Interventions and Recidivism" 2013

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Gerold Scherner: Insights of the Preventive Project Dunkelfeld

  1. 1. Insights of the Preventive Project Dunkelfeld (PPD):Setup, Approach, Treatment Change and(Potential) CP Offenders as Special Target Group Gerold Scherner & Laura Kuhle U N I IV E R S I ITTÄ TTS M E D I IZZI IN B E R LLI IN UN VERS Ä SMED N BER N 1
  2. 2. Overview • Background and Aims • Project Design and Procedure • Treatment • Preliminary Results • (Potential) CP Offenders as special target group • Prevention Network “Kein Täter werden” UNIVERSITÄTSMEDIZIN BERLIN 2
  3. 3. BACKGROUND AND AIMSUNIVERSITÄTSMEDIZIN BERLIN 3
  4. 4. Background Clinical experience suggests that there are / is • Little psychotherapeutic treatment offers for pedophilic / hebephilic persons • Need for therapy for those who never committed a respective offense • Need for therapy for those who are not known to legal system or not under supervision / probation UNIVERSITÄTSMEDIZIN BERLIN 4
  5. 5. Background Relatively little is known about CP and/or CSA offenders who are not formally involved with the criminal justice system. Mandatory reporting laws create an environment in which at-risk individuals are unlikely to ever be seen voluntarily and which makes prevention efforts and research more difficult. Risk factors associated with reoffending in forensic or correctional samples may not be generalized to undetected offenders. Clinicians would have incomplete and inaccurate information upon which to make recommendations with regard to risk management and treatment targets. UNIVERSITÄTSMEDIZIN BERLIN 5
  6. 6. Pedophilia/Hebephilia ≠Child SexualAbuse (CSA) Sexual Preference Disorder Sexual behavioral disorder (Pedophilia/Hebephilia) (CSA) Dunkelfeld („dark field“) Pedophilia/Hebephilia pedohebephilic Non-pedohebephilic (potential offenders) offenders offenders Hellfeld („brightfield“ = cases known legal system) UNIVERSITÄTSMEDIZIN BERLIN 6
  7. 7. Pedophilia/Hebephilia ≠Consuming Child Abusive Images (child pornography offenses) Sexual Preference Disorder Sexual behavioral disorder (Pedophilia/Hebephilia) (consuming Child abusive images) Dunkelfeld („dark field“) pedohebephilic Non-Pedophilia/Hebephilia offenders pedohebephilic(potential offenders) offenders Hellfeld UNIVERSITÄTSMEDIZIN BERLIN 7
  8. 8. Aims • Closing gap of treatment offers • Closing gap of knowledge(accompanying research ) • (Primary) Prevention of ChildSexualAbuse (CSA) • Prevention of ChildPornography (CP) offenses UNIVERSITÄTSMEDIZIN BERLIN 8
  9. 9. PROJECT DESIGN ANDPROCEDUREUNIVERSITÄTSMEDIZIN BERLIN 9
  10. 10. Target Groups of PPD Organic brain dysfunction, a psychotic condition and/or a problem with drug or alcohol undetected abuse that is not stabilized Non- preferential detected EXCLUDED ExcludedOffenders Currently detected Previously detected Target Group C Pedophiles Hebephiles Never detected Target Group B No offenses Target Group APotentialoffenders UNIVERSITÄTSMEDIZIN BERLIN 10
  11. 11. Media Campaign How can target groups be reached? How can public be sensitized for the problem (society and responsibility)? How can contribution to differentiated public consideration concerning perception of pedophilia / hebephilia be achieved ? Homepage Pro-active Public Media Campaign „kein täter werden“ Relation Billboards, Spots „don´toffend“ (journalists, political decision (possible only by pro bono www.kein-taeter-werden.de makers etc.) support of scholz&friends) www.dont-offend.org UNIVERSITÄTSMEDIZIN BERLIN 11
  12. 12. Media CampaignCommunication Aims I: Pedophilic / Hebephilic persons have to perceived as clients with special needs flächendeckende Behandlungsangebote geschaffen werden Pedophilie / Hebephilia is not equal to CSA / CP offenses - Destigmatization Treatment is possible Area-wide treatment offers have to be established Preventive treatment is primary preventive child protection UNIVERSITÄTSMEDIZIN BERLIN 12
  13. 13. Media CampaignCommunication Aims II: Message pedophilic / hebephilic persons: „ You are not guilty for your sexual preference but you are responsible for your sexual behavior“ Raise awareness and acknowledge personal strain Offer low threshold contact options Providing confidentiality UNIVERSITÄTSMEDIZIN BERLIN 13
  14. 14. Media Campaign UNIVERSITÄTSMEDIZIN BERLIN 14
  15. 15. Media Campaign Outdoor Advertising: 2.000 sites in and around Berlin for a period of 4 – 8 weeks. UNIVERSITÄTSMEDIZIN BERLIN 15
  16. 16. Media Campaign – Poster and Spot UNIVERSITÄTSMEDIZIN BERLIN 16
  17. 17. Intake Assessment Self-reported Domains  Sexual Age and Gender Preference  Criminal History  Sociodemographics & mental disorders  Dynamic Risk Factors (DRF) UNIVERSITÄTSMEDIZIN BERLIN 17
  18. 18. Intake Assessment Sexual age preference Sexual (body) age preference according to DMS-IV-TR (APA, 2000) was coded in the presence of recurrent, intense sexually arousing fantasies involving sexual activity with… … a prepubescent child: 302.2 Pedophilia … a pubescent child: 302.9 NOS (Hebephilia) A history of sexual contacts with prepubescent and/or pubescent children was not considered to be sufficient for the diagnosis of paraphilia. UNIVERSITÄTSMEDIZIN BERLIN 18
  19. 19. Intake Assessment Criminal history Detection status • Clinical Interview CSA • Clinical interview • Sexual behavior involving minors scale (SBIMS; Neutze et al., 2011) • Questionnaire of Sexual Experience & Behavior (Q-SEB, Ahlers et al., 2008) CP • Clinical Interview • Questionnaire of Sexually Explicit and Non- explicit Images of Children and Adults (Q-SENICA; Neutze et al., 2011) UNIVERSITÄTSMEDIZIN BERLIN 19
  20. 20. Intake Assessment Measures of DRF Problematic • Offense-supportive attitudes (BMS; Bumby, 1996) (offense-supportive) • Emotional & cognitive victim empathy deficits (ECS; Feelgood cognitions & Schaefer, 2005) Emotional deficits • Self-esteem deficits (RSE; Rosenberg, 1965) • Loneliness (UCLA LS-R; Russell et al., 1980) • Hostility towards women (HTW; Check et al., 1984) • Emotion-oriented coping (CISS; Endler & Parker, 1999) • Child identification (CIS-R; Wilson, 1999) Sexual self- • Coping self-efficacy deficits (SESM-C; Neutze et al., 2011) regulation deficits • Sexualized coping (CUSI; Cortoni & Marshall, 2001) • Sexual preoccupation (SBIMS; Neutze et al., 2011) UNIVERSITÄTSMEDIZIN BERLIN 20
  21. 21. Sample Description Sample Size “Prevention Project Dunkelfeld” (PPD) between 2005 and 2012 Respondends of Media Campaign 2000 1740 Baseline Assessments 1800 Individuals fullfilling inclusion criteria 1600 1400 1200 1000 800 719 600 373 400 Treatment 200 eligibility 0 UNIVERSITÄTSMEDIZIN BERLIN 21
  22. 22. Sample Description Clinical diagnosis 14,5 Sexuelle Ansprechbarkeit für Pedophilia präpubertäre Kinder (Pädophilie) Hebephilia Sexuelle Ansprechbarkeit für 52,1 peripubertäre Kinder (Hebephilie) 33,4 Sexuelle Ansprechbarkeit für Teleiophilia Erwachsene (Teleiophilie) n = 683 UNIVERSITÄTSMEDIZIN BERLIN 22
  23. 23. Sample Description • First problem awareness: age: 22 yrs. • Mean age: 39 yrs. (range: 17-67) • Already seeking therapy: 54,7% • Formal education: 38,8 % > 10 Jahre 62,2 % <=10 Jahre • Living alone: 64,3 % Source: Telephone-Screening UNIVERSITÄTSMEDIZIN BERLIN 23
  24. 24. Sample Description 82,5Criminal history % 50 44,8 45 no offenses 40 37,7 35 30 CP only 25 20 13,5 Mixed offender 15 10 5 3,9 CSA only 0 UNIVERSITÄTSMEDIZIN BERLIN 24
  25. 25. TREATMENTUNIVERSITÄTSMEDIZIN BERLIN 25
  26. 26. Treatment Setting 2005-2011 • Guided group therapy (6-10 participants), closed groups.  45 sessions à 3 h, two therapists per group  cognitive behavioral approach, good lives model • Individual therapy  45 sessions à 50 min. • Sexual and couple therapy; medical treatment on demand; After care groups UNIVERSITÄTSMEDIZIN BERLIN 26
  27. 27. Treatment Changes in PPD-treatment in 2012  From closed groups to semi-open groups  Implementing psychoeducational / motivational sessions  additional interview with one of the future therapists of reference  Revision of „guided Treatment Manual“  Implementing prevention network for area-wide treatment offer UNIVERSITÄTSMEDIZIN BERLIN 27
  28. 28. Treatment Revision of guided treatment (in progress) • Implementing a preparatory /psychoeducational and motivational module • Change of Treatment Manual to a more flexible and „guided Treatment Manual“, emphasizing discursivity and interrelatedness of addressing treatment targets in sessions Psychoeducation / Emotions Perceptions Motivation Motivation Empathy & Perspective Biography & Schemata Taking Sexual Fantasies & Social Relationships Intimacy & Trust Behaviors Coping & Problem Solving Planning the Future Protective Measures UNIVERSITÄTSMEDIZIN BERLIN 28
  29. 29. PPD: Treatment Treatment targets I DRF Intervention Problematic cognitions Identification and decrease of deficits in… Perception and interpretation Offense-supportive attitudes Cognitive and emotional victim empathy deficits Emotional deficits Identification und decrease of problematic attitudes regarding emotions Skills: communication of emotions / needs Skills: regulation of stress and other emotions UNIVERSITÄTSMEDIZIN BERLIN 29
  30. 30. PPD: Treatment Treatment targets II DRF Intervention Emotional deficits Intimacy towards adults Sexual satisfaction in relationships Establishing social support Developing future plan Sexual self-regulation Skills: Perception of Self- and others Skills: Awareness of moods, emotions and needs Decrease of sexual preoccupation: medical treatment acceptance of sexual fantasies UNIVERSITÄTSMEDIZIN BERLIN 30
  31. 31. Protective/Relapse Motivation Prevention Plans Medication no Attachment penalizing Future-Me Emotional Skills Plan Sexual (Relapse) Acceptance Prevention Experience in Fantasy / Intimacy Self-Control & Behavior Emotional Empathy Good life Skills Child Pornography Social Relation- cognitive ships Self-efficacy distortions Problem Solving Victim Empathy Learning HistoryUNIVERSITÄTSMEDIZIN BERLIN 31
  32. 32. Sexual interest in High sexual children Low self- desire esteem General Poor social antisocial relationship cognitions quality Narrow Dissexual possibilities behaviors CSA to create supportive positive Pedo-hebephilic cognition mood states preoccupation Poor Fear of dissexual problem behaviors Social solving isolation abilities Emotion- Opportunity regulation deficits Negative Sexual self- social regulation influences deficitsUNIVERSITÄTSMEDIZIN BERLIN 32
  33. 33. Session Opening Continuous evaluation of level of functioning Repetition and consolidation of contents Modul e2 Modul Modul e 12 e3 Modul Modul e 11 e4 Problematic behaviors Modul Risk situations Modul e 10 Risk factors e5 Modul Modul e9 e6 Modul Modul e8 e7 Session EndingUNIVERSITÄTSMEDIZIN BERLIN 33
  34. 34. PRELIMINARY RESULTSUNIVERSITÄTSMEDIZIN BERLIN 34
  35. 35. PPD: Evaluation Treatment Eligibility (n = 373) Treatment Completers 80 In Treatment Waiting list 29 Drop-out 203 12 Treatment denier 49 *August 2012 UNIVERSITÄTSMEDIZIN BERLIN 35
  36. 36. PPD: Evaulation Statistical analyses: Within groups T0 TRetest Tint T1 T2 Baseline Pre- In-treatment Post- Follow-up Treatment Treatment TG WG Group comparisons of on DRF within treatment / waitingtime to evaluate changes dependent conditions: Wilcoxon signed-rank test, set at .05 level of significance; One-way repeated measure analyses UNIVERSITÄTSMEDIZIN BERLIN 36
  37. 37. PPD first results: Comparability on descriptive data Criminal history by group: LT offenses Treatment group (TG; n = 53) Waitinglist Group (WG; n = 22) 100 90 n = 26 non-CSA offenders n = 27 CSA offenders 80 % 70 60 50 45,5 40 31,8 34 30 22, 6 18,2 26,4 20 9 10 4,5 0 no offenses CP only offenses Mixed offenses CSA only offenses (n = 12; n = 4) (n = 14; n = 7) (n = 18; n = 10) (n = 9; n = 1) TG and WG comparable on LT offense history UNIVERSITÄTSMEDIZIN BERLIN 37
  38. 38. PPD first results: Improvement on measures of DRF DRF-Improvement within TG **Z = -2.72 + Problematic • Emotional victim • Offense-supportive cognitions empathy* attitudes** • Cognitive victim empathy (Perspective taking) Self-esteem** Emotional • Hostility towards women deficits • Emotional loneliness** • Emotion oriented coping* • Sexual coping self- • Masturbation frequency efficacy* Sexual related to CSA* self-regulation - up Changes on DRF within TG are stable at one-year follow *Z = -2.16; *Z = -2.49; No changes on DRF within WG = -2.62; *Z = -2.27; *Z = -2.44 **Z = -4.47; **Z UNIVERSITÄTSMEDIZIN BERLIN 38
  39. 39. PPD first results: Improvement on measures of DRF DRF-Improvement within TG offender groups • No changes in non-offenders • CP only offenders showed less offense-supportive attitudes • CSA only offenders showed less offense-supportive attitudes, but more emotional victim empathy deficits • Mixed offenders improved most: less… – loneliness & hostility towards women – emotional victim empathy deficits & offense supportive attitudes – coping self-efficacy deficits & sexual preoccupation *Z = -2.55 *Z = -2.38; *Z = -1.96 *Z = -2.16; *Z = -2.37; **Z = -3.68; *Z = -2.12; *Z = -2.51; *Z = -2.11 UNIVERSITÄTSMEDIZIN BERLIN 39
  40. 40. See other presentationUNIVERSITÄTSMEDIZIN BERLIN 40

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