# Enhancing Rehabilitation Practices: Over- and Undertreatment in a German Outpatient Sexual Offender Program: Monitoring Degrees of Treatment Based on Standardized Risk Levels

## TL;DR

A German outpatient program for sexual offenders found that most patients are undertreated, highlighting the need for better individualized treatment strategies to improve rehabilitation and public safety.

## Contribution

The study introduces a method to monitor treatment adequacy using standardized risk levels, revealing significant undertreatment and the role of sociotherapeutic facilities in rehabilitation.

## Key findings

- 56% of sexual offenders in the program were undertreated, 14% overtreated, and 30% adequately treated.
- Sociotherapeutic facilities significantly influence treatment adequacy and help reduce undertreatment.
- High-risk offenders often withdraw early, suggesting a need for combined imprisonment and specialized treatment programs.

## Abstract

Effective reintegration into the community requires tailored treatment programs that address criminogenic needs. Ultimately, these efforts are essential to maintaining public safety.

This study aimed to evaluate whether our outpatient program met the criminogenic needs of participants.

Between 2008 and 2023, treatment needs of a sample of 955 male sexual offenders were assessed using the Static-99 tool and standardized risk levels.

A significant 63.5% of the offenders exhibited treatment needs. Among the total population, 56% were undertreated, 14% overtreated, and 30% adequately treated. Therapy in sociotherapeutic facilities had a significant influence on over- and undertreatment.

The degrees of treatment based on standardized risk levels are proving to be very valuable in forensic outpatient care, underscoring an urgent requirement for more individualized treatment strategies. Sociotherapeutic interventions play a key role in reducing undertreatment.

Quality problems in treatment mainly include over- and undertreatment. Undertreatment happens when patients do not receive the necessary treatment, while overtreatment involves giving excessive or unnecessary treatment, which can be harmful and represents an unnecessary consumption of limited resources. The essential goal is adequate treatment, which should be timely and beneficial. Our study uses standardized risk levels to provide insights into recidivism risk and recommend adequate treatment duration based on treatment needs. Our main goal was to ensure the correct amount of treatment for sexual offenders.

A German outpatient sexual offender program monitored treatment degrees based on standardized risk levels to prevent over- and undertreatment, enhancing rehabilitation practices.

Data from the past 15 years was perused, focusing on sexual offenders attending our programme. Regrettably, a majority were found to be undertreated. Special attention was given to patients undergoing treatment in sociotherapeutic facilities (STFs), which are specialized departments within prisons where psychotherapeutic interventions take place. These facilities often significantly extend treatment times, which has a positive impact on the need for treatment.

This observation highlights the alarming trend that high-risk patients often withdraw from treatment early. A promising answer lies in combining imprisonment with STF to ensure completion of the program, a cornerstone of the rehabilitation journey. This urges the need for full support and specialized programs.

Degrees of treatment help tailor sexual offender programs, focusing on recidivism risk to balance treatment intensity.Over 50% of patients in our outpatient program are receiving less care than required for their risk levels.Utilizing standardized risk levels to guide treatment planning ensures adequate treatment for all offenders, enhancing rehabilitation outcomes and minimizing inefficiencies.The unmet treatment needs of high-risk inmates, resulting from undertreatment in prison-based sociotherapeutic facilities, place a burden on the limited resources of outpatient programs.

Degrees of treatment help tailor sexual offender programs, focusing on recidivism risk to balance treatment intensity.

Over 50% of patients in our outpatient program are receiving less care than required for their risk levels.

Utilizing standardized risk levels to guide treatment planning ensures adequate treatment for all offenders, enhancing rehabilitation outcomes and minimizing inefficiencies.

The unmet treatment needs of high-risk inmates, resulting from undertreatment in prison-based sociotherapeutic facilities, place a burden on the limited resources of outpatient programs.