This Special Report aims to outline the development process of the first National Clinical and Policy guidelines on Intimate Partner Violence and Sexual Violence in Trinidad and Tobago and to support the implementation of quality standards for survivors. The study used an implementation science approach to identify key evidence-based practice recommendations from guidance documents on health care for women who are subjected to violence and from relevant national legislation, policy, and practices. The process engaged stakeholders in discussions on the appropriateness, implementation, and use of these recommendations in the context of local health care delivery. Multidisciplinary teams of frontline health workers were consulted in groups in each of the five Regional Health Authorities. Interviews were held with senior government stakeholders responsible for health policy and with representatives of four civil society agencies. Participants provided recommendations to integrate quality standards into routine practice. These were incorporated into the guidelines, which include human rights principles and pathways of care for identifying violence, providing psychosocial and clinical care, safety planning, referrals, care during emergencies, and prevention of intimate partner violence and sexual violence. The guidelines were approved by the Ministry of Health of Trinidad and Tobago on 15 August 2022. Training of trainers has been undertaken to support implementation.
El objetivo de este informe especial es describir el proceso de elaboración de las primeras directrices políticas y clínicas nacionales sobre violencia de pareja y violencia sexual en Trinidad y Tabago, así como brindar apoyo para la aplicación de normas de calidad dirigidas a las personas supervivientes. El estudio utilizó un enfoque de ciencia de implementación para hallar recomendaciones prácticas clave basadas en la evidencia a partir de documentos de orientación sobre atención de salud para mujeres víctimas de violencia, así como de las leyes, políticas y prácticas nacionales pertinentes. El proceso involucró a las partes interesadas en las deliberaciones sobre la idoneidad, la puesta en práctica y el uso de estas recomendaciones en el contexto de la prestación de servicios de salud locales. Se realizaron consultas grupales a equipos multidisciplinarios de trabajadores de salud de primera línea de cada una de las cinco autoridades regionales de salud. Se mantuvieron entrevistas con funcionarios gubernamentales con cargos de responsabilidad en materia de políticas de salud y con representantes de cuatro organizaciones de la sociedad civil. Los participantes proporcionaron recomendaciones para integrar las normas de calidad en la práctica habitual. Estas recomendaciones se incorporaron a las directrices, que incluyen principios de derechos humanos y protocolos asistenciales para detectar la violencia, prestación de atención psicosocial y clínica, diseño de planes de seguridad, derivación de los casos, atención durante emergencias y prevención de la violencia de pareja y la violencia sexual. Las directrices fueron aprobadas por el Ministerio de Salud de Trinidad y Tabago el 15 de agosto del 2022. Se ha llevado a cabo la capacitación de formadores a fin de brindar apoyo para su puesta en práctica.
O objetivo deste relatório especial é resumir o processo de elaboração das primeiras diretrizes clínicas e orientações sobre políticas de âmbito nacional para violência por parceiro íntimo e violência sexual de Trinidad e Tobago, bem como apoiar a implementação de padrões de qualidade para sobreviventes. O estudo utilizou uma abordagem científica de implementação para identificar as principais recomendações de práticas baseadas em evidências, derivadas de documentos de orientação sobre atenção à saúde para mulheres vítimas de violência e de leis, políticas e práticas nacionais pertinentes. O processo envolveu as partes interessadas em discussões sobre adequação, implementação e uso dessas recomendações no contexto da prestação de serviços de saúde em nível local. Em cada uma das cinco autoridades regionais de saúde, equipes multidisciplinares de profissionais de saúde na linha de frente foram consultadas em grupo. Foram entrevistadas partes interessadas da alta administração do governo que eram responsáveis pela política de saúde e representantes de quatro organizações da sociedade civil. Os participantes fizeram recomendações para integrar padrões de qualidade à prática de rotina. Tais recomendações foram incorporadas às diretrizes, que incluem princípios de direitos humanos e percursos assistenciais para identificação de violência, oferta de atenção psicossocial e clínica, planejamento da segurança, encaminhamentos, cuidados durante emergências e prevenção de violência por parceiro íntimo e violência sexual. As diretrizes foram aprovadas pelo Ministério da Saúde de Trinidad e Tobago em 15 de agosto de 2022. Realizou-se capacitação de instrutores para apoiar a implementação.

The main objective of this research is to study the relationships of offense-supportive cognitions and sexual fantasies with sex crime. The research involved 48 men: 26 convicted of sexual offenses against minors and 22 convicted of sexual offenses against adults from different prisons in the Community of Madrid, Spain. We used the RAPE Scale and the Sex With Children Scale to evaluate offense-supportive cognitions and an ad hoc adaptation of the Multidimensional Developmental, Sex and Aggression Inventory to evaluate sexual fantasies with minors and sadomasochistic fantasies. The results show that both groups present similar offense-supportive cognitions, while each group had significantly more sexual fantasies related to their specific crime. Participants who had sexual fantasies about minors presented significantly more offense-supportive cognitions justifying child sexual abuse than those who did not present these fantasies, while participants with sadomasochistic fantasies did not present more offense-supportive cognitions about rape. After collecting this information, we ran four mediation models to assess potential relationships between fantasies, offense-supportive cognitions, and specific sexual crime. The mediation models showed that both sexual fantasies with minors and sadomasochistic fantasies had direct relationships with sex crimes. Upon further confirmation with studies with larger sample sizes, our findings support the importance of dealing with sexual fantasies in treatment of people convicted of sexual offenses and imply a need for differentiated treatment, since the content of sexual fantasies was different in each group.

The importance of assessing psychopathic traits in juveniles who have committed sexual offenses has been established in individuals who demonstrate a particularly severe and violent pattern of behavior. Additionally, the assessment of these traits in other juveniles might be relevant considering that higher levels of these traits represent an increased probability of the juvenile committing offenses. This study is a systematic review of the literature about the presence of callous-unemotional (CU) traits in juveniles who have committed sexual and non-sexual offenses, in order to ascertain eventual differences between these groups regarding the presence of CU traits. Studies were obtained from multiple databases, with predefined exclusion and inclusion criteria, according to PRISMA-P guidelines. A total of 18 studies were reviewed and included in the final analysis. The 18 studies used measures of CU traits and reported descriptive categories of CU traits in juveniles who have committed general offenses or juveniles who have committed sexual offenses. Meta-analytic procedures such as pooled means, pooled variances, and pooled standard deviations are presented in this study. The main conclusion obtained is that juveniles who have committed general offenses present higher levels of CU traits compared to juveniles who have committed sexual offenses. Although the review highlights limitations in the literature, the identification of these characteristics in different types of juveniles who have committed offenses is important to shed light on the phenomenon and develop interventions better suited to their characteristics. Recommendations for future research are also presented.

Partly due to a lack of release options for individuals who committed sexual offenses, forensic follow-up treatment has been strengthened latest since 2007. The current study investigates whether the foundation of a professionalized follow-up-treatment has actually improved release options for individuals who committed sexual offenses. Thus, the aim of the present study was to assess the difference in criminogenic needs and recidivism relevant characteristics (e.g., index offense, criminal history, psychiatric diagnoses and risk assessment) between three groups who had been released from forensic psychiatry at different times or under different outpatient follow-up modalities: (1) individuals released prior the foundation of professionalized follow-up-treatment, (2) individuals released after the foundation and received treatment, and (3) individuals released after the foundation but not receiving this special treatment. It was found that with the availability of professionalized forensic followup treatment, persons with higher scores in common risk assessment tools and a longer duration of implacement had been released. Indeed, this indicates an increased risk tolerance among decision makers. However, it was not those who were released after the foundation of the professionalized forensic follow-up treatment but without this specific treatment who showed the lowest initial risk, but those who were released prior to the foundation. Results are discussed in terms of possible explanations and methodological issues.

This study examined the relationship between the actual level of physical violence in sexual offenses and dark triad, empathic and impulsive personality traits of their perpetrators. Sixty-four male perpetrators of sexual offenses without any serious mental illness were included. A 5-point Likert-type coding system based on Violence Profile for Current Offense was applied to assess the severity of physical violence of each sexual offense. Personality traits of dark triad (psychopathy, Machiavellianism, narcissism), trait empathy and impulsiveness were also evaluated. Multivariate analyses indicated that non-stranger victim, secondary psychopathy, narcissism and empathy could significantly predict greater involvement of physical violence in a sexual offense. In addition, empathy was negatively correlated with all dark triad traits. Sexual violence should be conceptualized in the form of a continuum, and, considering such an approach, offenders with high secondary psychopathy and narcissism may show preference for sexual assaults that are more violent in nature.

The field of legal anthropology has widely debated Indigenous Peoples\' justice practices. However, Indigenous Peoples\' legal perspective on sexual offenses remains understudied. In this respect, this article approaches the spiritual and political dimensions of the Arhuaco People\'s justice system to examine its procedures and sanctions. We want to understand how the Arhuaco People administer justice in cases where male community members are allegedly responsible for committing sexual crimes against women. During fieldwork in the Arhuaco territory, the authors employ methodologies drawn from the procedural paradigm-legal conscience studies as an interpretive framework to understand how Arhuaco women conceive legal phenomena.

Community management policies for individuals convicted of sexual offenses (ICSO) are controversial, mainly because the effectiveness of these policies in reducing recidivism is limited and appear to have some collateral effects. Despite this, the current meta-analysis found the public highly support these policies. Studies examining public perceptions regarding community management policies for ICSO to understand levels of support, misconceptions about the policies, and factors affecting the views of the public were reviewed. After searching 7 electronic databases, 43 studies, both quantitative and qualitative, were included in the systematic review and 31 in the meta-analysis. Studies could be longitudinal or cross-sectional, needed to include public attitudes, opinions, and perceptions about ICSO community management policies and could include standardized or non-standardized measures, indirect assessments of attitudes, along with interviews and focus groups. Results suggest that overall, policies were supported by 76% of the public, 61% believed in their effectiveness, and 63% felt safer because of the policies. However, only 36% accessed the registry, 38% took preventive actions, and 40% were aware/concerned about the collateral consequences. All analyses yielded high levels of heterogeneity. Misconceptions about policies and ICSO were moderate. Finally, 36 studies explored factors that affected the public\'s attitudes and perceptions of policies with a variety of significant associations and predictors. The findings provide comprehensive evidence that while these policies are supported by the public, the public have less belief in the effectiveness of them in protecting children and reducing recidivism. Implications for public policy and future research are discussed.

The number of individuals who sexually offended, and who are continued to be treated with pharmacological agents to reduce sex drive after their release from prison or forensic psychiatry, are not known. Furthermore, figures on the number of those who stop their sexdrive supressing antiandrogen treatment in the outpatient setting are unknown as well. This is of central importance though as it might be associated with an increased risk of recidivism.
To assess prescription patterns as well as adherence to pharmacological treatment in outpatient clinics in Germany for individuals who have sexually offended and were released from prison or forensic psychiatric hospital.
A self-constructed online survey assessing the pharmacological treatment modalities was sent by e-mail to n = 103 forensic outpatient clinics in Germany. Thirty-three (32.0%) completed the questionnaire and reported about 834 patients.
Prevalence of the use of different pharmacological agents in the treatment of individuals convicted for sexual offenses as well as the number of patients who have discontinued testosterone-lowering medication (TLM).
Among all institutions, 22.4% (n = 187) of individuals received pharmacological treatment, with 40.1% receiving gonadotropin-releasing-hormone-agonists, 26.2% antipsychotics, 24.6% selective serotonin reuptake inhibitors, 6.4% cyproterone acetate, and 2.7% a combination of gonadotropin-releasing-hormone-agonists and cyproterone acetate. A significant positive correlation was found between the number of patients released from a forensic-psychiatric hospital and the number of patients treated with TLM. Within 1 year 8.6% (n = 16) stopped their TLM during or at the end of the supervision period, most of them against treatment providers advice.
Substantial regional differences indicate uncertainties regarding the prescription of pharmacological agents for outpatients who have committed sexual offences in Germany. The discontinuiation of TLM within the first year of treatment against treatment providers advise in a substantial proportion of patients could be associated with a serious risk for reoffending.
The present survey captures prevalences of the pharmacotherapy in forensic aftercare facilities for individuals who have offended sexually, and is the first to record the number of discontinuations. This is a cross-sectional survey covering only 1 country, but includes a large number of individuals.
Even though the number of treated individuals has increased in prisons, the majority of pharmacological treatment is still provided by forensic hospitals, which then translates into the outpatient setting. The number of those who stop taking such medication is a highly relevant topic for both forensic treatment providers and legal decision makers.

Although many studies supported the use of actuarial risk assessment instruments (ARAIs) because they outperformed unstructured judgments, it remains an ongoing challenge to seek potentials for improvement of their predictive performance. Machine learning (ML) algorithms, like random forests, are able to detect patterns in data useful for prediction purposes without explicitly programming them (e.g., by considering nonlinear effects between risk factors and the criterion). Therefore, the current study aims to compare conventional logistic regression analyses with the random forest algorithm on a sample of N = 511 adult male individuals convicted of sexual offenses. Data were collected at the Federal Evaluation Center for Violent and Sexual Offenders in Austria within a prospective-longitudinal research design and participants were followed-up for an average of M = 8.2 years. The Static-99, containing static risk factors, and the Stable-2007, containing stable dynamic risk factors, were included as predictors. The results demonstrated no superior predictive performance of the random forest compared with logistic regression; furthermore, methods of interpretable ML did not point to any robust nonlinear effects. Altogether, results supported the statistical use of logistic regression for the development and clinical application of ARAIs.

In offending populations, prevalence rates of mental disorders are much higher than in the general population. Nevertheless, it is unclear whether mental disorders can improve the prediction of recidivism beyond actuarial risk assessment tools.
The present prospective-longitudinal study was conducted between 2001 and 2021 and included 1066 men convicted of sexual offenses in Austria. All participants were evaluated with actuarial risk assessment tools for the prediction of sexual and violent recidivism and the Structured Clinical Interview for Axis I and Axis II disorders. Sexual and violent reconvictions were assessed.
Exhibitionism and an exclusive pedophilia showed the strongest correlations with sexual recidivism in the total sample. In the child related offense subsample additionally a narcissistic personality disorder was correlated with sexual recidivism. The strongest correlation with violent recidivism was found for an antisocial and borderline personality disorder. None of the mental disorders could improve the prediction of recidivism beyond actuarial risk assessment tools.
Common current actuarial risk assessment tools revealed good predictive accuracy in men convicted of sexual offenses. With few exceptions mental disorders were only weakly associated with recidivism, suggesting that there is no direct link between mental disorders and violent and sexual reoffending. Mental disorders should nevertheless be considered in treatment issues.