The Kia Marama Special Treatment Unit Child Sexual Offending Treatment Programme

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Summary

A residential treatment programme for men in a medium secure unit who have committed sexual offences against children.

Type of intervention

Group work, individual work, prison

Target groups, level of prevention and subgroups

  • (Potential) Offenders | Tertiary prevention | Adults (21+ years) |Men aged 18-20 can be considered on a case-by-case basis | Males | Group work, individual work, prison | English

Target population

The Kia Marama Special Treatment Unit houses adult males who have been convicted of sexual offences against children.  

Kia Marama was established in 1989 as New Zealand's first specialist prison treatment programme for men convicted of sexually motivated offences against children.  The programme was based on the Rockwood Psychological Services programme in Canada, and was designed with the input of Dr William Marshall.

Delivery organisation

Department of Corrections (Statutory Body), New Zealand.

Mode and context of delivery

The Kia Marama Special Treatment Unit consists of two 60-bed units and specialises in the treatment of men who have been convicted of child sex offences.  The Unit operates as a therapeutic “community of change” environment.  

The Child Sexual Offending Treatment Programme that is delivered at Kia Marama is a high-intensity psychological group programme that was designed based on international best practice principles in the treatment of men convicted of sexual offences against children. 

Level/nature of staff expertise required

Kia Marama is staffed by psychologists, reintegration co-ordinators, and custodial staff.  Psychologists are responsible for assessing a man's suitability for the programme, delivering treatment, and monitoring an individual's therapeutic progress. Reintegration coordinators work with participants to identify a reintegration pathway, address potential barriers to transitioning into the community, and preparing for release.  Custodial staff support the unit to operate in accordance with the principles of a therapeutic community.  Kia Marama staff have access to a cultural supervisor who provides guidance in bicultural clinical practices and cultural processes.

Intensity/extent of engagement with target group(s)

Kia Marama is a closed programme that runs for approximately 36 weeks.  Group session are 3 hours in duration and and are held three to four times per week.  Each programme contains up to 10 men.  

In addition to treatment-related activities, residents are expected to engage in meaningful communal tasks, participate in community meetings, and take responsibility for the unit.  Some men may also engage in work within the unit or within the prison grounds (e.g., in the kitchen or garden). 

Description of intervention

The Child Sexual Offending Treatment Programme is a highly structured intensive treatment programme that aims to support men to develop the knowledge, tools, and resources necessary to manage their risk of future sexual offending.   During the programme men learn that their offending is the outcome of  linked steps of thoughts and behaviour.  It offers skills  and strategies for breaking these links, and provides opportunities for men to begin making positive life and behavioural changes throughout the end-to-end pathway of the programme.

The programme views sexual offending through a relapse prevention framework based on cognitive and behavioural principles. It is considered that this treatment framework provides a robust approach to treating men who are at higher risk of sexual reoffending by:

Providing a personalised framework for understanding his high risk emotions, thoughts, situations, relationships, and environments and the actions that will help to manage his risk of sexual offending over the long term.  

Assessment:

The programme consists of a four week assessment period that includes clinical interview and the administration of psychometrics designed to assess an individual's cognitive, emotional, and personality functioning; sexual functioning and characteristics; treatment and relevant clinical needs; and risk of sexual reoffending.  The individual's sexual offending risk factors and most likely offending pathways are formulated in order to ensure that treatment is relevant to their needs. 

Treatment:

The programme is based on a best practice approach for group treatment for men who have sexually offended.  The modules involve the application of cognitive behavioural interventions designed to target specific factors and adhere to the principles of effective correctional intervention (i.e., the Risk, Needs, and Responsivity model; Andrews and Bonta, 2017).  
 
The first phase of the programme involves the development of insight into offence related patterns of thinking and behaviour that contributed to offending, while the second phase focuses on requisite skill development in order to manage future risk of re-offending.  The eight modules are summarised below.
 
Module One: Norm Building
 
The primary focus for this module is to normalise group process for the participants and for them to get to know and build trust with one-and-another and to promote a culture of group safety.  The key objectives of this module are to:
· Increase understanding of the principles and philosophy of a therapeutic community and how it relates to treatment.
· Develop group kawa or norms that are conducive to productive group work and therapeutic change.
· Increase group cohesion and trust in the group process.
· Build motivation to engage in therapy and enhance understanding of the aims of the programme.
· Encourage self reflection on behaviour patterns that contribute to offending.
 
Module Two: Distress Tolerance and Blocks and Walls
 
Many participants will not have developed appropriate affect regulation skills during their lifetime.  Therefore, it is important to provide psycho-education and develop some basic affect regulation prior to beginning work on their offence process.  The key objectives of this module are to:
· To increase understanding of potential blocks and walls to the treatment process.
· Increase insight into how blocks and walls negatively impact treatment.
· Provision of some fundamental affect regulation skills to assist participants to manage their emotional responses appropriately.
· Prepare participants for potential challenges that they are likely to face during treatment.
· Provide psycho-education on cognitive/behavioural mechanisms associated with emotional distress.
 
Module Three: Understanding offence Process
 
Facilitating the participants’ understanding of their behaviour leading up to their sexual offence will increase their ability to actually change their behaviours.  Ultimately, the aim is to assist participants develop a coherent narrative of their offence process so that they understand the pattern of thoughts, feelings, and behaviours that eventually culminated in offending.  The key objectives of this module are to:
· Increase self-responsibility for offending.
· Assist in the development of understanding into the difference between predisposing and precipitating factors.
· Facilitate understanding of offence process by facilitating an understanding of factors in life that motivated and maintained offending.
· Assist and increase in understanding of any ameliorating factors or strengths.
· Facilitate change in thinking patterns that serve to maintain the offence process by promotion of appropriate attitudes and beliefs.
· Assist identification of the necessary treatment goals that relate to each of the components of their offence process.
 
Module Four: Interpersonal Learning 
 
Research has indicated that treatment interventions designed to reduce aggression and violence (including sexual violence), such as emotional self management, problems solving, and interpersonal skills, predominantly results in positive outcomes.  Implicit in all of these approaches is that the target intervention is designed to address factors that will also result in participants who engage in violent acts developing an increased capacity to take another’s perspective and understand the impact of their actions on others more realistically.  The key objectives of this module are to:
· Facilitate the development of emotional recognition in self and others and what might trigger such an emotional reaction.
· Facilitate the development of insight into blocks to perspective taking, including offence supportive core beliefs, unrealistic interpretations of others’ facial expressions or behaviour etc.
· Increase insight into emotional triggers.
· Understand the process associated with shame versus guilt.
· Understand what is required to perspective take.
· Increase appreciation and understanding of the perspective of others.
Module Five: Sexual Self Management
 
Treatment issues associated with sexuality education, including the development of a secure sense of one’s sexual identity and addressing sexual dysfunction, have been identified by Hudson, Wales, and Ward (1999).  The key objectives of this module are to:
· Explain human sexuality and physiological changes driving sexual excitement.
· Development of a more accurate and complete knowledge of adult sexuality and mutually fulfilling adult sexual encounters.
· Assist participants with deviant sexual arousal to reduce and/or eliminate the sexually arousing effects of deviant (child and/or violent) sexual fantasies and increase sexual interest toward adult partners.
· Assist participants to develop an understanding about the concepts relating to mutually satisfying sexual relationships.
· Assist participant to disrupt and diminish the attractiveness of deviant fantasy by providing a realist description of consequences.
· Support the participant to develop a sense of self efficacy in being able to manage potentially high risk situations in a safe manner.
· Aid participants in the development of techniques that enable this disruption and diminishing of deviant sexual urges.
 
Module Six: Self Regulation
 
A participant’s capacity to self-regulate is an important factor in behavioural change.  In particular, participants with deficits in this area are unlikely to follow through with stated intentions, are likely to fail to avoid high risk situations, and may become overwhelmed by negative life events.  The key objectives of this module are to:
· Assist in the development of skills to recognise a range of emotions, especially anger anxiety/stress and sadness/depression.
· Assist participants to identify particular emotions that have been difficult to manage in the past, particularly those associated with their offending.
· Facilitate the understanding, identification, and management of environmental, cognitive, and physiological components of emotions, and the triggers for each of these emotions.
· Provide the skills necessary to develop cognitive, physiological, and behaviour techniques to adaptively respond to these emotions, and where possible facilitate practice opportunities within sessions.
· Support the development of an ability to accurately monitor moods in order to appropriately manage these better.
· Assist participants to identify any ameliorating factors or strengths.
 
Module Seven: Relationships
 
Research suggests that having a prolonged intimate connection to someone may be a protective factor against sexual re-offending (Hanson & Bussiere, 1998).  On the whole, the relative risk of sexual re-offending is lower in men who have been able to form intimate partnerships.  While participants will often reflect on the number of sexual partners they have had, this is in contrast to the nature of their intimate relationships.  Relationship skills deficits are a significant factor for many of the men who sexually offend against children.  The key objectives of this module are to:
· Assist participants to understand the meaning and value of achieving intimacy in adult/adult relationships.
· Support those participants who become aware of, and understand the origins of, fear of intimacy.
· Identification of dysfunctional relationship styles and/or avoidance of intimacy.
· Facilitate the development of skills for enhancing intimacy (including conflict resolution and assertive communication).
· Facilitate the adoption of attitudes appropriate and conducive to respectful, consenting, and mutually rewarding sexual intimacy with an adult partner.
· Aid understanding of behaviour that contributes to mutually fulfilling sexual encounters.
· Assist participants be alert to potential future difficulties if they are considering resuming a relationship after release from prison. 
· Assist participants to identify ameliorating factors or strengths.
 
Module Eight: Release Planning and Future Self Management
 
The work for this module has been socialised throughout the whole programme, with participants being reminded to consider course work in relation to how it fits with their offence process and what is required to develop an adequate safety plan for longer-term risk management.  The key objectives of this module are to: 
· Facilitate participants’ comprehensive understanding of the specific quadrants involved in their offence process and the choices that were made in order to offend.
· Assist participants to understand, and gain competence in using, coping strategies appropriate to address each of the individualised treatment goals.
· Support the participants to be able to clearly articulate their own offence process, and be willing to share this information with significant others (e.g., support people, whānau, and their probation officer).
· Foster the development of a commitment to a lifelong plan to avoid future offending and the adoption of a prosocial identity and good life.

Evaluations

A 2012 study by Lucy Moore examined the criminal history and post-release outcomes for all men who had committed a sexual offence against a child and were released from a New Zealand prison between 1998 and 2010.  The study compared the outcomes for 428 men who had attended Kia Marama and 1,956 men who did not attend Kia Marama or a similar Special Treatment Unit.  Kia Marama attendees were followed up for an average of 6.36 years and individuals in the untreated control cohort were followed up for an average of 6.81 years.

The results showed that 7.2 percent of men who attended Kia Marama  were convicted of new sexual offences during the follow-up period compared to 10.0 percent of men from the untreated group.  This represented a 29.4 percent reduction in sexual re-offending for men who were treated at Kia Marama and was a statistically significant finding.  Results also showed that treatment at Kia Marama significantly reduced the rates of both violent re-offending (from 18.4 percent to 10.3 percent; a 49.3 percent reduction) and general re-offending (from 40.2 percent to 32.7 percent; a 27.6 percent reduction).

References

Andrews, D. & Bonta, J. (2017). The Psychology of Criminal Conduct (6th Ed.). New York: Routledge.

Hanson, R. K. & Bussière, M. T. (1998).  Predicting relapse: a meta-analysis of sexual offender recidivism studies. Journal of Consulting & Clinical Psychology, 66(2), 348-362

Moore, L. (2012).  A comparison of offence history and post-release outcomes for sexual offenders against children who attended or did not attend the Kia Marama Special Treatment Unit.  Unpublished Masters Thesis, University of Canterbury, New Zealand. 

Bakker, L., Hudson, S., Wales, D., & Riley, D. (1998). And there was light: Evaluating the Kia Marama treatment programme for New Zealand sex offenders against children. Psychological Service Report, Department of Corrections. Wellington, New Zealand.

Hudson, S.M., Wales, D.S., & Ward, T. (1998). Kia Marama: A treatment program for child molesters in New Zealand. In W. Marshall, S.M. Hudson, T. Ward, & Y. Fernandez (Eds.), Sourcebook of treatment programs for sexual offenders (pp 17-28). New York: Plenum.

Contact details

Email: alexandra.green@corrections.govt.nz 

RATING: Promising