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CAMH Stories Centre for Addiction
and Mental Health

Assessing sexual re-offence risk: CAMH educates community workers

Jake began dating Jane two months ago and recently moved into her place. Jane has an 11-year-old son, Jimmy. Neighbors discovered that Jake is on the sex offender registry, with two prior convictions for molesting young boys. The neighbors reported their concern to the police and Child Protective Services (CPS). CPS is investigating to determine whether Jake poses a risk of sexual abuse to Jimmy.

Toronto, September 22, 2016 - Professionals in health and corrections often work with people, like Jake, who have been convicted of sexual offences or who may be at risk to commit an offence.

CAMH’s Sexual Behaviors Clinic (SBC) – part of the hospital’s Complex Mental Illness Forensic Program -- is a key resource, one of only two publicly-funded clinics of its kind in Ontario.

In September, SBC hosted an education forum for more than 100 parole and probation officers, child protection and community workers. The forum provided an overview of assessment tools and related services as part of a continuing education series hosted by CAMH.

Robert McGrath Robert McGrath provided an overview of the ROSAC tool, used to assess the Risk of Sexual Abuse of Children.

At the September sessions, keynote speaker and psychological services consultant Robert McGrath gave an overview of the ROSAC tool, used to assess the risk of sexual abuse of children.

“Among men with a history of sexual offending, some should never have contact with certain children, some may safely have contact with certain children if adequate supervision plans are in place, and some may not pose any clear present risk to children,” Robert said. Compared to other tools that assess the risk of sexual re-offence, the 30-item ROSAC tool takes extra steps to assess:

1)    the risk of adult males -- who have sexually abused -- to sexually abuse a specific child

2)    under what circumstances, if any, the abuser might safely be allowed contact with the child.

Some factors – such as an abuser’s failure to complete treatment, or substance abuse -- will tip the balance towards the risk of harm, says Robert. Other factors – such as full cooperation with investigation and interventions, having employment and a support network -- will weigh against the risk of harm.

Ultimately, ROSAC can help a professional make a determination of whether there is:

  • Significant risk --  prohibit all contact
  • Some risk – restrict contact and develop safety plan
  • No clear present risk – monitor, no current intervention.

Understanding needs of the child and family

Robert also discussed the importance of understanding what the person who has been directly victimized – and their family members – want. “Child protection interventions must take into account each child’s needs for stability as well as safety.” Risk of harm of sexual abuse must be balanced with the risk of harm of separation from adults to whom the child is attached, Robert said. “A supportive and nurturing family, a sense of connectedness, and a permanent home are central to a child’s healthy development.”

The second keynote speaker at the September CAMH session was Dr. Andrew Harris, a consulting clinical forensic psychologist in private practice. He looked at how dynamic prediction tools such as the STABLE-2007 and the ACUTE-2007 can extend the predictive validity of risk assessments.

“Our agency works with probation officers and the justice system, so having an awareness and understanding of these tools is really helpful,” said participant Melonie Sampson-Laidlin, a Program Supervisor at treatment and transitional homes operated by Vita Community Services in Weston, Ontario. “The idea of structured professional judgement -- based on assessments – helps us look at how best to work with people with intellectual disabilities. Many of our clients are sex offenders and we use a number of tools to determine risk and manageability in a treatment and community setting.”

“For me personally, the big take away was not viewing -- or treating -- all sex offenders with the same lens – for example that restrictions can vary significantly based on a professional assessment.”

Black Creek Probation and Parole Officer Chantal Huard said the second session focusing on prediction tools “was very relevant to my position -- we do these assessments on all sex offenders that come on probation. It was a great refresher as I completed the training about two years ago. It was also nice to share views at the CAMH session with other partners in the justice system on how they do these assessments.”

Participants learned more about CAMH’s Sexual Behaviors Clinic (SBC), where many clients are referred as a condition of parole or probation related to a sexual offence. The clinic also treats clients who are distressed by sexual interests or behaviours – they are typically referred by a family physician for conditions such as sex addiction, porn addiction, or attraction to minors (without ever having acted on it).

CAMH provides treatment, best practices

“Every day, our clinic staff partner with the community to provide assessment, treatment and best practice recommendations,” says CAMH Social Worker Erin Stirr. “We also host these professional development sessions to highlight new strategies and resources.”

Previous such sessions have featured expert speakers from CAMH, police sex crimes units, the Ontario Crown Attorneys’ Office, Children’s Aid and the research field, she noted.

CAMH’s SBC clinic provides sexological assessment, recommendations as well as treatment, which may include group and individual therapy, and medication to reduce sex drive. Family counselling is also provided, since stigma from a sexual offence can impact the family’s friendships, home and immigration status.

Some clients have cognitive, mental illness or substance abuse issues. The clinic’s inter-professional team including psychiatrists, psychologists, sexology and social workers, provides care based on a detailed assessment of each client.

“The education series is a big part of our program,” said Erin. “We want to continue to share knowledge with community workers, to listen and learn from their experiences, and to let them know that our clinic is always here for them and their clients.”

Erin Stirr 
CAMH Social Worker Erin Stirr


Forum participantsThe CAMH SBC 6th Annual Education Event was hosted by CAMH at the Toronto Police College in September. From left: Taya Jones, CAMH SBC Manager; Stephanie Brown, CAMH SBC Social Worker; Erin Stirr, CAMH SBC Social Worker; Dr. Alasdair Goodwill, Psychologist, Supervised Practice; Robert McGrath, Presenter; Dr. Ainslie Heasman, CAMH SBC Psychologist; Dr. John Arrowood CAMH SBC Psychologist; Leah Hartman, CAMH SBC Psychology Resident.



Conclusion to the case study

Participants took on several case studies, including the case of Jake, outlined in the introduction to this article.

Jake’s ROSAC assessment showed several key factors – such as his exclusive sexual interest in young boys – that indicated he is at significant risk to reoffend. Participants concluded that Jake presents a significant risk of sexual abuse to Jimmy, and recommended that CPS prohibit him from having contact with the young boy.

For more information:

Please contact the CAMH Sexual Behaviours Clinic: 416-535-8501 ext. 34886

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