FORMAL ASSESSMENTS-TESTING

Although formal assessments of persons involved in the issue of sexual offenses against a child could occur at any point during an investigation, assessments of alleged offenders are of greatest clarity and usefulness after the accused individual has admitted to the offense, and prior to the disposition of the case in court (or by other authorities). Motivation to be open and honest is usually reduced if an alleged offender is still in complete denial he/she has committed an offense.

Ethical concerns should also be monitored regardin6g the issue of informed consent, especially if an individual who has committed an offense agrees to a formal evaluation with hopes of being able to "prove" his/her innocence (through denial) in order to avoid the consequences likely to follow. Usually, validity and utility are increased when these formal evaluations are conducted with an individual who is willing to acknowledge the basic facts of the case.

In the following sections, formal assessments of alleged offenders, victims and non-offending guardians are discussed. The goals of assessments can be for "clinical" (treatment) purposes, "forensic" related to prosecution, or for issues of "protection". In dealing with cases, these goals are sometimes difficult to completely divide into separate steps. However, it is preferable for professionals involved in formal assessments to keep these distinctions clearly in mind to understand the role they are playing at any given time.

First, this article will address formal evaluations of persons who have allegedly committed one or more inappropriate sexual acts with an unwilling partner or a person of greater vulnerability. For simplicity, this individual is referred to as an "offender", although in reality this could even include a child who has involved a playmate in sexual contact that the playmate was not expecting or was talked into. For ease of reading, offenders are referred to by male pronouns. In reality, both male and female offenders exist, although the research still supports a much lower rate of sexual offending by females.

PSYCHOSEXUAL EVALUTATIONS

What is a psychosexual evaluation?

• It is an evaluation conducted by a mental health professional that focuses on the client's psychological and sexual functioning. This evaluation also examines the client's sexual interests, attitudes and behaviors to see if the client has a sexual deviancy problem. These evaluations also assess the client's risk for re-offending or acting out sexually in the future. This part of the evaluation is called a risk assessment.

Who is qualified to conduct a psychosexual evaluation?

• A mental health professional, usually with a master's or doctoral degree in counseling, social work, psychology or some other mental health discipline is qualified to conduct an evaluation. The professional should have received specialized training in how to assess and treat sexual deviancy. This is a specialty area in which most mental health professionals have not received training.
• The mental health professional should have training and/or experience in evaluating individuals in the specified age range. For example, if the evaluator is conducting a psychosexual evaluation of an adult, then he or she should have training in evaluating sexual deviancy in adults. Or, if the client is a sexually aggressive child, then the evaluator should be trained in assessing sexual issues in children.
• The Association for the Treatment of Sexual Abusers (ATSA) is an organization of professionals who are trained to evaluate and treat sexual abusers. According to ATSA's "Principles for the Management of Sexual Abusers," a mental health professional who works with sex offenders should have "demonstrated competence in providing a minimum of 2000 hours of face-to-face contact with clients who have perpetrated sexual abuse." (Cited from "Principles for the Management of Sexual Abusers," page 9, ATSA booklet)

What does a psychosexual evaluation involve?

• A psychosexual evaluation can include general psychological testing, IQ testing and questionnaires that assess one's sexual interests, attitudes and behaviors. For adolescents and adults, this evaluation might also include a test that measures one's sexual arousal pattern by measuring the client's changes in penile circumference while he is presented with sexual stimuli on audiotape and/or videotape. This test is called the penile plethysmograph test. There is also a test that measures one's sexual interest in different types of sexual stimuli. This test is called the Abel Assessment.
• The types of testing and procedures used in psychosexual evaluations vary with the age of the client being evaluated. Thus, the testing for children is different from the testing administered to adolescents and adults.

When is a psychosexual evaluation needed?

• It is needed when someone is known to have committed a sex offense. A psychosexual evaluation can assess the individual's treatment needs and risk for re-offending. This is described on ATSA's web site (http://www.atsa.com/pprsattaiwa.html)

Treatment is not intended to replace other possible responses through the criminal justice system, but is intended for use in conjunction with other options for the reduction of overall rates of sexual offending in a community.

• For sexually aggressive children and adolescents, this evaluation can also be helpful in assessing the child's placement needs. For example, a psychosexual evaluation can help determine if the child needs residential treatment to treat his sexually aggressive behaviors.
• When someone has been suspected of having committed a sex offense or acted in an inappropriate sexual manner. A psychosexual evaluation cannot assess guilt or innocence regarding a specific sex offense. However, this type of evaluation can be helpful in assessing if a client has a sexual deviancy problem that requires specialized treatment.

Psychosexual evaluations can be for:

• Children
• Adolescents
• Adults

Psychosexual Evaluations for Children

When does a child need a psychosexual evaluation?

• When a child is showing inappropriate sexual behavior such as:
• Excessive masturbation
• Making inappropriate sexual comments and gestures
• Exposing one's genitals to others
• Sexually touching other children who are 3 or more years younger
• Sexually touching others against their will
• Sexually touching animals
• When a child continues to act out sexually despite having been told to stop.

What does a psychosexual evaluation of a child involve?

• This evaluation usually involves:
• An interview with the child's parent or primary caretaker
• An interview with the child
• Questionnaires that are completed by the child's parent or caretaker
• Questionnaires to assess the child's general emotional and behavioral functioning
• Questionnaires to assess the child's specific sexual behaviors
• General psychological testing that is administered to the child
• To assess emotional functioning, psychopathology and intellectual functioning
• Specific sexual questionnaires or tests that are administered to the child

• These tests are carefully worded to use simple, non-threatening terms such as "private parts"
• The tests vary depending upon the child's age and developmental level

What information is obtained from a psychosexual evaluation?

• n assessment of the extent and severity of a child's sexual problem.
• Recommendations for the type of treatment a child should receive to address his/her sexual problem.
• Recommendations for the type of placement a child needs.
• For example, a child's sexual problem may be too severe for the child to remain in a home with younger children. The child may need to be placed in a home where there are no younger children. Or the child may need more intensive treatment than is available on an outpatient basis. Thus, a specialized residential treatment program for sexually aggressive children may be recommended.
• Recommendations for how a caretaker can implement a safety plan to ensure that a sexually aggressive child does not have the opportunity to molest other children.

Who typically requests a psychosexual evaluation of a child?

• Parents or caretakers who are concerned about their child's sexual behavior.
• DFACS caseworkers who are concerned about children who are acting out sexually.
• Other professionals who suspect that a child may have a sexual problem.
• Funding agencies that are trying to assess if a child needs a specialized residential treatment program to address the child's sexually aggressive behavior.
• Mental health agencies that need to assess a child's specific treatment needs.

Psychosexual Evaluations for Adolescents

When does an adolescent need a psychosexual evaluation?

• When an adolescent is showing inappropriate sexual behavior such as:
• Exposing oneself.
• Peeping into others' windows.
• Inappropriately touching others against their will.
• Engaging in sexual activity with children who are 3 or more years younger.
• Engaging in sexual activity with family members such as siblings.
• Engaging in sexual activity with a non-consenting partner.
• Engaging in sexual activity with someone who is significantly weaker in some way, such as mentally, physically, emotionally, or socially.
• Engaging in sexual activity with animals.
• Engaging in unusual sexual practices such as cross-dressing or stealing women's underwear.
• When an adolescent has been found guilty or has pled guilty to a sex offense of any kind.

What does a psychosexual evaluation of an adolescent involve?

• This evaluation usually involves:
• An interview with the adolescent's parent or primary caretaker.
• An interview with the adolescent.
• A review of collateral information such as the victim's statement, police report, or court records.
• It is very important for the evaluator to obtain information about the client's sexual offense from someone other than the alleged perpetrator since alleged perpetrators often deny, distort, or misrepresent their offense.
• ATSA states "any evaluation conducted without collateral information should be interpreted very cautiously." (cited from p.13 of ATSA booklet)
• Questionnairesthat are completed by the adolescent's parent or caretaker.
• Questionnaire to assess the adolescent's general emotional and behavioral functioning.
• General psychological testing that is administered to the adolescent.
• This may include IQ testing and personality testing.
• Specific sexual questionnaires or tests that are administered to the adolescent.
• These tests assess the adolescent's sexual interests, attitudes and behaviors.
• Risk assessment procedure.
• The evaluator assesses the adolescent's risk for re-offending by examining a number of different factors related to the adolescent's attitudes, behaviors, family factors, access to potential victims and current level of supervision.
• There are formal risk assessment procedures that have been developed based on recidivism research.
• Polygraph
• Some evaluators require the client to take a polygraph, or "lie detector", test as part of the evaluation. Other evaluators may recommend that a polygraph be used as part of the client's treatment to facilitate the client being completely honest about his history of offending.
• Penile Plethysmograph Test
• This test assesses a male client's sexual arousal pattern by measuring changes in the circumference of his penis when he is presented with sexual stimuli on audiotape and/or videotape.
• This test can be very helpful in assessing the degree and extent of the client's deviant sexual arousal.
• This test does not assess guilt or innocence regarding a sex offense. Instead, it simply assesses the client's sexual arousal pattern.

The test results can be used to decide which behavioral techniques are needed to help the client reduce his deviant sexual arousal. The effectiveness of the behavioral techniques can then be tested using the penile plethysmograph to measure the client's response to the techniques.

This test is not used by all evaluators when assessing adolescents since this is an intrusive measure and there is concern that individuals under age 18 cannot legally give their consent to such a procedure.

ATSA has recommended that the penile plethysmograph not be used with anyone younger than 14 years of age.

What information is obtained from a psychosexual evaluation?

• An assessment of the extent and severity of an adolescent's sexual problem.
• Recommendations for the type of treatment an adolescent should receive to address his sexual problem.
• Recommendations for the type of placement an adolescent needs.
• For example, an adolescent's sexual problem may be too severe for the adolescent to remain in a home with younger children. The adolescent may need to be placed in a home where there are no younger children, or he may need more intensive treatment than is available on an outpatient basis. Thus, a specialized residential treatment program for adolescent sex offenders may be recommended.

Who typically requests the psychosexual evaluation of an adolescent?

• Judges or probation officers from juvenile court who are working with adolescents who have committed a sex offense.
• Judges often order an adolescent who has been convicted of a sex offense to receive a psychosexual evaluation before the adolescent returns to court for his sentencing or dispositional hearing. The information from the psychosexual evaluation can help guide the judge in his or her sentencing of the adolescent. This can help the adolescent obtain any specialized treatment he may need while minimizing the potential risk to the community.
• DFACS caseworkers who are concerned about adolescents who are acting out sexually.
• Other professionals who suspect that an adolescent may have a sexual problem.
• Funding agencies who are trying to assess if an adolescent needs a specialized residential treatment program that addresses sexual issues.
• Mental health agencies that need to assess an adolescent's specific treatment needs.
• A sex offender treatment program often requires that a client receive a psychosexual evaluation before beginning the treatment program.
• ATSA recommends that a psychosexual evaluation be completed before an offender is accepted into a community-based treatment program.
• Parents or caretakers who are concerned about their adolescent's sexual behavior
• An adolescent's defense attorney may request a psychosexual evaluation of his client.
• Usually, the defense attorney is hoping that the evaluator can recommend probation for his client if the client's risk for re-offending is low enough.
• A defense attorney may also hope to use a psychosexual evaluation to help secure a residential treatment placement for the adolescent rather than incarceration.
• Sometimes, defense attorneys request a psychosexual evaluation in the hope that the evaluator can state that the adolescent did not commit the sex offense in question. However, evaluators can never assess guilt or innocence regarding a sex offense. There is no psychological test that can prove or disprove that a person committed a sex offense.

Psychosexual Evaluations for Adults

When does an adult need a psychosexual evaluation?

• When an adult has been found guilty or pled guilty to a sex offense of any kind.
• When an adult is showing inappropriate sexual behavior such as:
• Exposing oneself.
• Peeping into others' windows.
• Inappropriately touching others against their will.
• Engaging in sexual activity with children.
• Engaging in sexual activity with family members such as his children or step-children.
• Engaging in sexual activity with a non-consenting partner.
• Engaging in sexual activity with animals.
• Engaging in unusual sexual practices such as cross-dressing or stealing women's underwear.

What does a psychosexual evaluation of an adult involve?

• This evaluation usually involves:
• An interview with the adult client.
• A review of collateral information such as the victim's statement, police report, or court records
• It is very important for the evaluator to obtain information about the client's sexual offense from someone other than the alleged perpetrator since alleged perpetrators often deny, distort, or misrepresent the offense.
• ATSA states "any evaluation conducted without collateral information should be interpreted very cautiously." (cited from p.13 of ATSA booklet)
• General psychological testing that is administered to the adult.
• This may include IQ testing and personality testing.
• Specific sexual questionnaires or tests that are administered to the adult.
• These tests assess the adult's sexual interests, attitudes and behaviors.
• Risk assessment procedure.
• The evaluator assesses the adult's risk for re-offending by assessing certain factors that are known to increase a client's risk for re-offending. There are several formal risk assessment procedures that have been developed based on research that shows which sex offenders are more likely to commit another sex offense.

• Polygraph
• Some evaluators require the client to take a polygraph or lie detector test as part of the evaluation. Other evaluators may recommend that a polygraph be used as part of the client's treatment to facilitate the client being completely honest about his history of offending.
• Polygraphs are generally not accepted as evidence in legal proceedings in the U.S. It is recommended that the polygraph be used solely as a diagnostic and treatment tool in psychosexual evaluations.
• Penile Plethysmograph Test
• This test assesses a client's sexual arousal pattern by measuring changes in the circumference of his penis when he is presented with sexual stimuli on audiotape and/or videotape.
• This test can be very helpful in assessing the degree and extent of the client's deviant sexual arousal.
• The test results can be used to decide which behavioral techniques are needed to help the client reduce his deviant sexual arousal. The effectiveness of the behavioral techniques can then be tested using the penile plethysmograph to measure the client's response to the techniques.
• This test does not assess guilt or innocence regarding a sex offense. Instead, it simply assesses the client's sexual arousal pattern.

What information is obtained from a psychosexual evaluation?

• An assessment of the extent and severity of an adult's sexual problem.
• Recommendations for the type of treatment an adult should receive to address his sexual problem.
• Recommendations for specific behavioral techniques needed to help the client reduce his deviant sexual arousal.

Who typically requests the psychosexual evaluation of an adult?

• Judges may court order that an adult who is found guilty of a sex offense receive a sex offender evaluation or psychosexual evaluation as a condition of his probation, and that the offender follow any treatment recommendations given by the evaluator.
• In many states, offenders are required to receive a psychosexual evaluation after they have been found guilty but before their sentencing hearing. In these cases, the psychosexual evaluator may be asked to assess whether the offender's risk for re-offending is low enough for him to be placed in the community on probation.
• Probation officers may request that an adult sex offender who is on probation take a psychosexual evaluation in order to assess his treatment needs and risk for re-offending.
• DFACS caseworkers may request that an alleged sexual perpetrator receive a psychosexual evaluation as a part of his DFACS case plan.
• For example, a man who has been accused of molesting his daughter may be required by DFACS to receive a psychosexual evaluation to help offer recommendations regarding treatment and placement.
• Other professionals may refer an adult who has a sexual deviancy problem.
• A sex offender treatment program often requires that a client receive a psychosexual evaluation before beginning the treatment program.
• ATSA recommends that a psychosexual evaluation be completed before an offender is accepted into a community-based treatment program.
• A client's defense attorney may request a psychosexual evaluation of his client.
• Usually, the defense attorney is hoping that the evaluator can recommend probation for his client if the client's risk for re-offending is low enough .
• Sometimes, defense attorneys request a psychosexual evaluation in the hopes that the evaluator can state that the client did not commit the sex offense in question. However, evaluators can never assess guilt or innocence regarding a sex offense. There is no psychological test that can prove or disprove that a person committed a sex offense.
• A concerned spouse may refer his or her partner for an evaluation and treatment.
• Adults can request a psychosexual evaluation if they know or suspect that they have a sexual deviancy problem.
• Unfortunately, adults who have a sexual deviancy problem rarely seek evaluation and treatment on their own since they typically have little motivation to change and/or they are afraid of the potential negative consequences of reporting their sex offense to a professional.