The new HaSB-IDD trial

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Accessible summary

The public are understandably concerned about men who commit sexual offences. Such men usually receive treatment in prisons, probation and in health services (such as secure units). However, some men with harmful sexual behaviours have learning disabilities or autism and they often do not get offered treatment (unlike non-disabled men).

Nevertheless, there is a cognitive behavioural treatment designed especially for men with learning disabilities and/or autism. It is called SOTSEC-ID and was developed in the early 2000s in the NHS by Dr Neil Sinclair, Prof Glynis Murphy, and colleagues. Early research showed it was effective in improving men’s understanding of the effect of their behaviour on their victims, improving their sexual knowledge (for example, of the need for consent), and improving their attitudes to women and others. Most men (94%) were not convicted of further offences, according to follow-up studies (see the tab https://research.kent.ac.uk/safer-idd/research/sotsec-id/ for research papers).

In this early research there were no comparison groups of men receiving other types of treatment (or no treatment at all), so as to compare them to those treated with SOTSEC-ID. A new research project called the HaSB-IDD trial has now been funded by NIHR and it is using gold standard methods, ensuring that SOTSEC-ID is compared to other treatments (known as Treatment As Usual or TAU).

The HaSB-IDD trial

Health settings working with men with learning disabilities and/or autism who have done harmful sexual behaviour, from various areas of the UK (e.g. South East, East, Midlands and North, and Scotland), will be asked to join the project. The men will get Treatment as Usual (TAU) or the special treatment, called SOTSEC-ID. They will be asked about their sexual knowledge and attitudes, and how they think their victims feel, and we will record whether any harmful sexual behaviour has occurred, at the start of the research, then 6 months later, then one year later, and two years later.

The research will last for 54 months overall (4 and a half years), and if the treatment is successful, this will make the men less risky with fewer harmful sexual behaviours. It will improve public safety, and reduce the number of victims. It will also mean that the cost of care for the men is lower.

Summary for Professionals

Background

Cognitive behavioural treatment for non-disabled men who engage in harmful sexual behaviour is widely available in prisons, probation and in health settings. Such treatment has been well researched and the majority of studies report positive outcomes in terms of reduced re-offending. This kind of treatment is far less widely available for men with intellectual and/or developmental disabilities (IDD) and has been less often researched. The studies that do exist have been reviewed in a number of recent systematic reviews and said to be promising, but none have involved randomised controlled trials.

Aims and objectives

We aim to conduct a single-blind cluster-randomised controlled trial of a well-established group CBT programme known as SOTSEC-ID, across 30 sites in the UK, in secure services and community settings, for men with IDD and harmful sexual behaviour. We will assess cognitive distortions, frequency of harmful sexual behaviour, sexual knowledge, victim empathy, self esteem and locus of control in treated and untreated men with IDD and harmful sexual behaviour. We will also assess quality of life, and costs and cost effectiveness of the treatment.

Methods

Men with IDD and harmful sexual behaviour will be recruited from health settings across the UK. Following assessment for suitability, and consent procedures, they will be recruited and their cognitive distortions, harmful sexual behaviour, sexual knowledge, victim empathy, self-esteem and locus of control will be assessed (Baseline, Time 1). The sites will be randomised to receive either 6 months of SOTSEC-ID treatment (2 sessions per week), with risk management, or to receive TAU, with risk management. At six-months post-baseline (Time 2) all men will be re-assessed, and then again at 12-months post baseline (Time 3), and 24-months post-baseline (Time 4). A modified CSRI will be used to measure costs of treatment/TAU, and the EQ-5D-5L to measure health-related quality of life, so as to allow costs and cost effectiveness of the intervention to be analysed. In addition, qualitative studies will examine the men’s views, their carer’s views, and therapist views of the treatment (including its acceptability) in small purposive samples.

PPI has been considered important and has been built into the project in a number of ways, with consultation with people with learning disabilities and carers throughout the project.

Timelines and impact

The trial will last for 54 months overall, starting October 2021, and it is anticipated that if the treatment proves to be successful, this would significantly reduce the threat of harm posed by individuals who were successfully treated. It would improve public safety, particularly for vulnerable individuals with disabilities (potential victims) and reduce the need for treatment for victims. It will also enhance the confidence of therapists who are providing this treatment and reduce the care costs associated with risk management strategies currently used to manage these individuals with IDD and harmful sexual behaviour.

Progress so far

By August 2023, 11 sites had been recruited (in Kent, Northumberland, Essex, Norfolk, Hertfordshire, Gloucestershire, Surrey, Humber, Lothian). Some had collected baseline data and been randomised, some were still collecting baseline data. A further six sites are interested in taking part and working towards recruitment. We are still seeking a further 20 or so sites.