Elliott, H

Hocken, K

Lievesley, R

Norman, C

Winder, B

Nottingham Trent Institutional Repository (IRep)

The Utility of Qualitative Methods in the Evaluation of Pharmacological Treatment for Convicted Male Sexual OffendersHelen Elliott Rebecca Lievesley Belinda Winder Christine NormanEloise ManbyNottingham Trent University (SOCAMRU)Nottinghamshire Offender HealthcareHMP WhattonBackground• Interventions with sex offenders in UK prisons are primarily psychological in nature, adopting a CBT approach• High levels of sexual preoccupation and hypersexuality in high risk offenders appears to interfere with engagement on psychological treatments, potentially resulting in poor outcome on programmes• Evidence suggests the potential for use of medical treatment in aiding the management and treatment of risk factors such as sexual preoccupation• This is important since sexual preoccupation (both in the offence chain and generally) is the most  frequently occurring ‘strongly present’ risk factor in sex offenders (Hocken, Winder & Grayson, in prep).ContextHer Majesty’s Prison Whatton• 840 adult males convicted of a sexual offence• Medication commenced in November 2009• 99 referralso Approximately 90% of these receive medication• Medications used:o SSRI (Fluoxetine & Paroxetine) o Anti-androgen (Cyproterone acetate / Androcur)o GnRH agonist (Triptorelin)The EvaluationMixed method evaluation• Quantitative components to assess effects of medication on clinical measures of sexual preoccupation and hypersexuality and on psychometric measures of sexual  deviance, sexual compulsivity, personality, anxiety & depression• Qualitative component to explore in depth experiences of the medicationQualitative researchService usersTherapistsOffender SupervisorsKey Findings Key features Key findingsService user studiesAim: To explore the use of anti-libidinals to reduce sexual preoccupation and/or hypersexuality in convicted sexual offendersParticipants: 19 adult male sex offendersMedication: Anti-androgens, SSRIs or combinedAnalysis: Thematic analysis• Reduced sexual preoccupation & arousal• Improved impulse & emotional control• Some noncompliance • No prior knowledge of medication• Concerns about effects & long term useTherapist studyAim: To explore the experiences of individuals involved in the referral of pharmacological treatment and those who work with sexual offenders receiving pharmacological treatmentParticipants: 8 intervention staffAnalysis: Thematic analysis• Offenders’ concerns & insight• Lack of feedback• Lack of awareness about treatment & lack of support• Concerns about throughcareOffender supervisor studyAim: To explore the perspectives and experiences of offender supervisors in relation to the pharmacological treatmentParticipants: 6 offender supervisors Analysis: Thematic analysis• Offenders’ reluctance to engage• Lack of feedback • Lack of awareness• Excluded from treatment process• Importance of throughcareImplicationsTraining / educationImprove information available on medicationTraining for staffIncrease awareness for offendersLack of awareness among those outside psychologyPerceived lack of support for those outside psychology Service users’ concerns about effects and long term useService users’ lack of insightService users had no prior knowledge of medicationi i  / iCollaborationTraining collaborativelyImprove feedback loopCollaboration for throughcareLack of feedback post referralConcerns about throughcareLack of communication between departmentsll iResearchx2 Offender manager community studiesService user follow up studyGP community studyCorroborated findingsReduced sexual preoccupationConcerns about effects and long term useSome non complianceImportance of throughcareConclusions• Qualitative research helps us to understand the context of a treatment service and the experiences of the individuals who participate in the service • Adds an additional dimension to quantitative elements of an evaluation through providing an understanding into the effectiveness of interventions more generally and at a deeper level• This can reveal the need for change, in this instance: o The need for further education/awareness for prison staff and offenders regarding the medicationo A change in the referrals process such that a feedback loop is set up for all referralso A focus on collaboration between departments and the communityo Further research exploring the transition and sustainability in the community 

The utility of qualitative methods in the evaluation of pharmacological treatment for convicted male sexual offenders

http://irep.ntu.ac.uk/id/eprint/32556/1/10038_Winder.pdf

The utility of qualitative methods in the evaluation of pharmacological treatment for convicted male sexual offenders

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