NOTA Individualised Treatment Programme: David Briggs, Stephanie Hill & Roger Kennington
It is with great pleasure the NOTA Individualised Treatment Programme is now completed and ready for launch. The Programme has been developed on behalf of the NOTA Practice and Policy Committee with support from previous and current Chairs and has been peer reviewed by named and anonymous colleagues.
The Programme outlines an individualised approach to work with men (age 18+) who may pose a risk of sexual abuse, who have been convicted of a sexual offence, or those who have not been convicted of an offence but whose sexual behaviour is concerning and potentially harmful. It is responsive to the needs of men who have committed all types of sexual offences including accessing child abuse imagery. It can be used with men who are considered unsuitable for group work programmes, for example because of mental health or personality issues, reduced learning capabilities, or whose circumstances are such that access to group work is limited or non-existent.
As with any intervention the Programme’s central aim is to reduce risk. It is designed to be responsive to the individual needs of clients and has at its heart the development of a collaborative formulation of each client’s difficulties. This formulation is used to determine a treatment pathway to address dynamic risk factors, strengthen desistance, and promote good lives plans and aspirations.
Those who deliver the Programme are expected to be experienced practitioners who have access to professional supervision and are familiar with the practice standards of their professional body.
The Programme is comprised of a manual outlining underlying principles and theory, and a practice manual.
The emphasis is made on responding to individual differences. Hence, for a client with relatively few dynamic risk factors, their journey through the Programme may be relatively brief, accessing a lower dosage response to their needs. Conversely for those clients who exhibit complex problems and a number of risk factors their journey will be longer. The ethos is such that both client and practitioner work together in the early stages of the Programme to determine what interventions are needed and in what order. The authors are sensitive to the dangers of both under and over treating clients, as well as the importance of optimising interventions to prevent the likelihood of drop out.
In order to achieve these aims, the Practice Manual is constructed of a series of modules. A core module is that of the assessment of the client and the building of an understanding of their difficulties – the “Collaborative Formulation Module.” The assessment and management of acute risk factors in the module “Managing Imminent Risk” are addressed early, the goal being to help those clients at imminent or high risk of acting out sexually in the short to medium term to access strategies for containing risk.
Another of the earlier modules of the Programme (“Establishing a Basis for Working Together”) is designed to help the practitioner establish a positive basis and contract for involvement with the client and addressing essential precursors for change. A key factor relates to the client’s motivation to change which may vary at different times and need to be revisited. The whole of the Programme is delivered in a motivational style.
Key risk domains are covered in other modules within the Programme. There are modules for addressing sexual thoughts and arousal, emotional and behavioural regulation, attitudes which may support abuse and factors influencing interaction with others. These are developed in the context of promoting Good Life strategies.
A final module within the Programme helps the client to move forward, promoting desistance and minimising the possibility of relapse.
The Programme will serve the needs of those who wish to work with sexual abusers on a one-to-one basis (rather than in group). Examples include practitioners working in probation, criminal justice, social work, mental health and the independent sector. Interest has already been expressed. Two training courses are agreed (although currently on hold because of Covid 19 restrictions) and a third agency has expressed interest. A workshop was held at NOTA Conference last September (although a formal launch was postponed because of the presenters’ travel arrangements being cancelled). There was due to be a launch at NOTA Scotland but that conference has been cancelled. We are determined to launch the programme when current restrictions abate. This will include courses which NOTA members can sign up to either individually or via agency bookings.
It is expected that experienced practitioners will attend a two-day Familiarisation Training Course providing an overview of the Programme, its content, model of change, methods of working and additional guidance on aspects of the Programme that are likely to be most challenging e.g. progressing a collaborative formulation, working on aspects of sexual self-regulation, and also some aspects of general self-regulation. The Programme is cognitive behaviourally based and also draws on techniques from schema-focused therapy and other behavioural therapies.
In the longer term, it is planned for NOTA’s Training Committee to sponsor modular training. Themes will include: motivational interviewing, skills-based practice, working with attitudes which support abuse, addressing socio-affective functioning deficits, managing sexual self-regulation difficulties, enhancing general self-regulation and schema therapy. These specialist areas will be provided by trainers with particular expertise in the respective areas.
Those attending the training will be provided with a copy of the Programme. If individuals or agencies require further information please contact Roger Kennington at firstname.lastname@example.org.
Roger Kennington, Independent Consultant, Roger Kennington Consulting