Abstract
The issue of effective treatments for individuals with a history of sexual offending has legal, social, economic, political, and clinical impacts. Studies conducted on the topic of evaluating treatment outcomes for sex offenders have examined both biological and psychological interventions. The etiology of the phenomenon appears to be multifactorial, as the sexual harasser learns from the social and family context the norms that will constitute our framework of rules, in addition to the characteristics of temperament, character, and personality. Therefore, there is a need for a definite social–health policy at the government level to be able to address the legal-judicial, socio-political, and health problem of Italian sex offenders to reeducate and reintegrate them into society by drastically reducing or nullifying the risk of recidivism. This study proposes the “Trident State Program” (TSP), which could reduce or solve the problem of recidivism of Italian sexual offenders and promote a better process of re-education and reintegration of these individuals. The operational protocol of the program is being drafted.
2. Methods, Aims, and Objectives
2.1. Methods
A narrative literature review of peer-reviewed articles on PubMed from January 1980 to December 2024, using the keyword “sex offender,” was conducted to identify and critically analyze research on correctional interventions in the sex offender population. A total of 788 articles were identified. The methodology of this review conformed to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines (Figure 1). The population of interest included adults over the age of 18 who were in prison or placed in detention in facilities suitable for rehabilitation and rehabilitation. Examples of interventions included psychological, clinical–pharmacological, educational, and legal–punitive therapies, provided by the facilities through the intervention of health care professionals and technicians. Only studies that had the greatest argumentative adherence to programmatic projects, whether structured or in the form of simple protocols, were selected, totaling 56 articles. This narrative review included research articles such as systematic reviews and meta-analyses, randomized clinical trials (RCTs), quasi-experimental studies (i.e., non-RCTs), observational studies, and pre-/post-intervention studies, totaling 81 articles. These articles described the importance of using a programmatic model in theory and the usefulness of implementing the protocol in practice to prevent or rehabilitate sex offenders from the risk of committing the crime or reoffending. Only publications in English with a high scientific impact were selected.
Figure 1.
PRISMA flow diagram template for systematic reviews (Liberati et al., 2009).
2.2. Aim and Objectives
The present editorial article aims to propose a new effective treatment program for sexual offenders (TSP: Trident State Program) through the dissemination of the theoretical model, which will be later structured into a protocol to be administered to a population sample for the pilot study. The primary objective is to investigate the topic of effective treatment for sexual offenders (with the acronym SOTP) in the literature, summarizing the general content of the topic and trying to identify strengths and weaknesses of the current most shared approach, while the secondary objective is to build a theoretical model that is potentially able to respond to the needs of innovation, adaptability, and applicability in reference to the Italian legal–economic context.
3. Singular and Multidisciplinary Approaches: Lights and Shadows in Comparison
In order to understand the etiology, process, treatment, and/or management of persons convicted of a sex offense, it is necessary to depart from the use of a single interpretive point of view, thus favoring a multidisciplinary approach that may be able to analyze all aspects of interest, starting from the analysis of the individuals involved to the assessment of the social–environmental context and individual and collective behaviors (Bartels et al., 2019), with the intention of recovering, re-educating, and reintegrating the offender, essentially fostering a process of new psychophysical balance for the victim of the crime as well (Kemshall, 2017).
Such a holistic view would favor prevention as much as intervention, and would help subjective and collective integrative processes, provided that at the policy level there can be resources and projects intended for implementation in practice (Thomas, 2016).
In the literature, it is not possible at present to favor a specific approach, albeit a multidisciplinary one, because existing approaches offer methodological challenges in many innovative interventions and community integration projects at the global level, but they are often organized for a small population sample and have a limited impact (Pycroft & Gough, 2019), in contrast to larger studies on treatment and risk assessment, where programs and working bodies are based on similar theoretical constructs (McCartan & Richards, 2021).
From this it can be inferred that methodologically, large-scale, randomized, controlled trials may not be the most effective method for understanding individual change and effective risk management, while the best designs may be a combination of quantitative and qualitative research to provide a comprehensive view (Wakeling & Saloo, 2018).
At issue, therefore, is not the analysis of the critical issues of the current models used (which have already been widely demonstrated to be effective) but rather the need to integrate them into a more systematic action framework that can promote multi-layered intervention (from the political to the social and clinical world), taking into custody the individual who has a criminal record for sexual crimes from the moment in which he is convicted to the moment in which he needs re-education and reintegration into society.
4. Individual and Collective Profile Management: The Principal Models Compared—A Methodological Discussion of the Introduction of a New Program
All active practitioners in the field, from therapists to social correctional policy officials to health care providers, are under increasing pressure to provide and foster the use of interventions that are effective, efficient, and cost-effective, according to an organizational rationale; therefore, it is essential to understand what the most durable and performance-based technical characteristics of individual interventions are according to a theoretical–practical model scheme (Lösel et al., 2020).
The main evaluation factors relate to the program orientation and method of delivery, its content, its adaptability to the specific case, and the treatment setting. Meta-analyses in the literature are mainly oriented toward social–environmental approaches (such as criminological models) (Deaton & Cartwright, 2017; Bonta & Andrews, 2016; Andrews et al., 1990) and clinical approaches (cognitive–behavioral, group therapy, strategic-integrated, and psychodynamic) (Mpofu et al., 2018; Lösel & Schmucker, 2005) and recombined with each other (Olver et al., 2020; Marshall et al., 2011).
Since 2010, the Risk–Need–Responsivity model (RNR) has become the main model for penitentiary interventions at an international level. It has proven to be effective for various categories of offenders—women (Blanchette & Brown, 2006), people with mental disorders, people who are either extremely poor or have no financial problems (Andrews et al., 2001), young people (Dowden & Andrews, 1999), and sexual offenders (Hanson & Bourgon, 2007). The RNR model is the one that best responds to the principles of individualized and reintegrative intervention, and it seems possible to apply it to the Italian penal context (Zara, 2016).
In Table 1, the main approaches that are most used in clinical practice (in terms of psychiatric rehabilitation and re-education) are compared.
Table 1.
Comparison of the descriptions of the principal approaches used to plan rehabilitative interventions for sex offenders.
The most suggested models in the literature are based on the strengths of the treatment and rehabilitation of individuals with a prosocial purpose, according to the “Good Lives” Model (which represents the evolution of the “Risk-Need-Responsivity Model”), as rehabilitation is considered more of a process than an outcome by virtue of the cognitive–behavioral structure of the therapeutic intervention in which most programs/interventions for people convicted of sexual offenses are rooted (Gannon et al., 2019; Mpofu et al., 2018).
Central to the critical analysis of the intervention are the offender’s cognitive and behavioral profile, and thus his mental health, but also his relationships with family and peers, occupation, education, lifestyle, and social–demographic factors (Farrington, 2019; Sanders, 2017); the model that tries to integrate all these elements is represented by epidemiological criminology (“EpiCrim”) (Lainer, 2014; Waltermaurer & Akers, 2013), which seeks to respond to crime at the population level using public health approaches that work at the individual, interpersonal, community, and societal levels through all four stages of prevention (primary, secondary, tertiary, and quaternary) (McCartan & Kemshall, 2020). This model emphasizes the importance of the individual, his or her relationships, and the broader social context, so that we can better understand his or her pathways to crime and develop rehabilitation programs that are fit for the intended purpose, reinforcing the thesis that sexual abuse is first and foremost a community problem, as well as an individual problem, and therefore requires an integrated, multidimensional response (Knack et al., 2019).
In Table 2, the main models that are the most effective are compared.
Table 2.
Comparison of the strengths and weaknesses of the principal models used to plan rehabilitative interventions for sex offenders.
The following models, which are most widely used in clinical practice, reflect the State Health System’s attempt to curb the pathological phenomenon and remedy it through a structured, clinically based intervention.
However, despite this specialized effort, the deep-seated reasons for the failure of the full recovery of these are multifactorial, and depend on the degree of impairment of the patient’s clinical profile, the social–environmental context of reference and how it reinforces or does not reinforce the subjective psychopathological tendency, the work context and the subject’s ability to reintegrate into society and regain economic independence, and the support during follow-up by public and private agencies, organizations, and facilities dedicated to patients with this clinical problem.
The risk of failure and thus relapse is a problem that needs to be analyzed from a multifactorial perspective and needs to be addressed through a more in-depth analysis than just the clinical profile, which also and especially considers government intervention at the political and social levels.
There is an urgent need to find a specific program of intervention that can offer an organized, structured, and functional solution to the problem, one that starts from individual subjective needs but generally protects the fundamental rights of the community of the social context of reference.
5. The Complexity of the Current Corrective Action System and the Proposal of the “Trident Statal Program” (TSP) in the Field of Sex Crimes: Theoretical Framework and Structural Model
5.1. Foreword
Criminal justice policies, in all the world’s legal systems, are marked by a logic of the rationalization of resources, designed with respect to the costs and challenges of project implementation.
Public action must conform to criteria of efficiency, effectiveness, and the cost-effectiveness of intervention, and thus the results must be achieved with the least effort, to the maximum satisfaction expected prior to the intervention, and with the least financial outlay. This view, however, makes it difficult to apply interventions in all contexts in which the criminological–legal model must adapt to the needs of pedagogical–educational models and biopsychosocial models with re-educational purposes, as is the case in the hypothesis of individuals who commit sex crimes (Cellini, 2019).
In such cases, government coverage of the service is provided by a public network through health facilities and contracted institutions, and a secondary care network of a private type, managed by nonprofit organizations and associations and private personal care services, which take charge of the subject, follows him from the early stages of rehabilitation to those of reintegration into society. This “binary” model of care has, over time, demonstrated various criticalities, fostering the dysfunctional dynamics noted in the literature, such as the risk of recidivism, partial or absent health care in the medium and long term after the prison sentence, and a social stigma of the criminal that persists even after re-education.
The proposed “Trident Statal Program” (TSP) aims to smooth out these shortcomings by fostering a system that can be functional in every concrete scenario related to sex offenders.
Table 3 contains a theoretical framework and model, structured into three specific interventions (or pillars).
Table 3.
“Trident Statal Program” (TSP): the technical details of the model.
5.2. “Primary Intervention”: The Preventive System and the Pedagogical–Educational Model
The first pillar structuring the program is devoted to the pedagogical–educational model of the preventive system, inspired by the German preventive intervention of the “Dunkelfeld Prevention Project” (Mokros & Banse, 2019) and to the American model that established the figure of the consultant and mental health professional (school counselor and educational psychology) in a school context (McAndrew et al., 2019).
This intervention is based on the preventive principle of educational action and is dedicated to both the person who has not committed a sexual offense and the person who might commit it because he or she has a criminal inclination (both with a formative–educational function).
Specifically, this pillar involves the following actions:
- (1)
- Organization at the ministerial level of a specific educational policy (not modified) that provides for compulsory thematic meetings in middle–secondary schools to train the teaching staff and students about sexual offenses and defense tools.
- (2)
- Initiation of a psychological service desk in all school levels, regardless of grade, with the inclusion of at least one psychologist figure, framed by a national labor contract, with a permanent status, and with a managerial and organizational role, also supporting teaching and administration.
- (3)
- Centralized government management of policies to support the sex offender through participation in public calls for proposals with stringent legal requirements and making winning private organizations equal to public law entities, as supervised by the Ministry of Health.
5.3. “Secondary Intervention”: The Repressive System and the Criminological–Legal–Political Framework
The second pillar structuring the program is devoted to the criminological–legal model of the repressive system.
This intervention is based on the repressive principle of legal action and is dedicated to both the subject who has committed a sexual offense (with a punitive function) and the subject who might commit it because he or she is criminally inclined (with an anticipatory function).
Concretely, this pillar provides for the following actions:
- (1)
- Establishment of an inter-ministerial office dedicated to sex crimes, interfacing the Ministries of Education, Justice, and Public Security.
- (2)
- Tightening of the punishment regime for sex crimes, with repressive purposes and exclusion of rewards and sentence discounts.
5.4. “Tertiary Intervention”: The Clinical (Rehabilitation) System and the Biopsychosocial Model
The third pillar structuring the program is devoted to the biopsychosocial model of the rehabilitation system.
This intervention is based on the rehabilitative principle of psychosocial action and is entirely dedicated to the sex offender (with a reintegrative function).
Specifically, this pillar provides for the following actions:
- (1)
- Establishment of a personalized educational–training and clinical–psychological pathway, which is aimed at the re-education and reintegration of the sex offender already during the period of detention and throughout the subject’s life, with a follow-up function. The course must be educational in nature to enable the subject to find an independent personal and work placement in society, and it must be clinical in nature to offer him or her continuous personal support during and after the state of imprisonment and social reintegration.
- (2)
- Placement of the subject in the “Protection and Guardianship Program”, which gives a new personal identity to the sex offender and removes him or her from the social context of reference, to be reintegrated into a new neutral social–environmental context without, however, losing contact with close family members.
6. Methodological and Applicative Discussions
6.1. The Choice of the Model (Trident Statal Model, TSM)
The Trident model, in this area, represents a novelty in the legal–political and judicial–criminological landscape, as the prevalence is mono-interventionist or otherwise uncoordinated in multiple areas, as demonstrated in the literature during this review.
The pillars on which the entire program is built guide action on all sides involved in the model under analysis, which, due to its specific peculiarities, requires coordination between the legal, political–criminal, and clinical fields.
In fact, the failure of intervention for an individual is attributable to several variables. Subjective variables include age, gender, family background, personal history, subjective perception of one’s condition, and the severity of paraphilic symptoms, measured in terms of intensity and frequency. Objective variables include the economic and organizational conditions and the deviant–criminal outbursts of the social context, as well as working conditions, support from authorities and institutions during the sentence, rehabilitation, and social reintegration.
This new proposed model adapts to the multifactorial nature of the phenomenon, which intends to overcome this analysis asking too many questions, preferring instead a holistic approach to the problem by placing the sexual criminal at the center of the re-educational and rehabilitative process.
6.2. Model Description
To meet the needs of the program, the model is structured in three different pillars, which must coordinate to foster the result oriented precisely to the reduction or absence of recidivism of the crime and individual psychophysical well-being in relation to one’s clinical condition.
The pedagogical–educational model embodies the first pillar that performs preventive function with respect to the crime, with a formative–educational purpose, working on the process of subjective awareness.
In concrete terms, this pillar includes both actions at the government–ministerial level (such as the organization of a specific and non-modifiable educational policy at the local level, which includes mandatory thematic meetings in middle and high schools to train teaching staff and students on the topic of sexual crimes and on legal defense methods) and at the organizational–local level (such as the activation of a psychological help desk in all schools, regardless of the school year, with the inclusion of at least one psychologist with a management and organizational role who is also in support of the teaching and administration staff).
The aim is to extend the proposal to a transversal level, to ensure greater transparency and control by the bodies with decision-making power (such as the choice to ensure centralized management by the State in policies to support sexual crimes, through participation in public tenders, with stringent legal requirements and the equivalence of private entities awarded contracts to public law entities, and under the supervision of the Ministry of Health and/or Justice).
The centrality of decision-making power is essential to ensure decentralization, subject, however, to conditions of strict capillary control.
The criminological–legal model embodies the second pillar, which performs a repressive function with respect to the crime that has already taken place, either with an anticipatory purpose (in the sense of intimidating the potential subject about his or her intent via fear of punishment) or with a repressive–punitive purpose (in the sense of punishing the criminal and giving a strong and resistant signal to the community).
Specifically, this pillar includes actions at the government–state level, which are substantiated by the establishment of an inter-ministerial office dedicated to sexual offenses, which interfaces with the Ministries of Education, Justice, and Public Security, also by tightening the punitive regime for sexual offenses and excluding rewards and sentence discounts in cases of good behavior (the failure of which, during the time the sentence is served, will lead to specific aggravations of the sentence already imposed by the magistrate).
The importance of these interventions lies in the fact that repressing sexual misconduct at the punitive level is a deterrent to those who wish to commit such offenses, and thus a stricter regime could discourage such individuals to satisfy their illicit impulses.
The biopsychosocial model embodies the third pillar that performs a rehabilitative function with respect to the crime that has already taken place, with rehabilitative and reintegrative purposes in the sense of fostering both the re-education of the subject who is under the sanction regime and their reintegration into society in order to re-integrate him or her and allow him or her to return to live an adequate and dignified life, under conditions of respect and safety of his or her social community of reference.
Specifically, this pillar includes actions at both the individual and collective level, such as the establishment of a personalized educational–training and clinical–psychological path aimed at the re-education and reintegration of the sex offender during the period of detention and throughout the subject’s life, with a follow-up function, and the inclusion of the subject in the “Protection and Guardianship Program”, which gives him or her a new personal identity and removes him or her from the social context of reference in order to be reintegrated into a new, neutral social–environmental context without losing contact with close family members.
The purposes are clearly re-education and social reintegration, favoring the protectionist approach of the sex offender in comparison to the social stigma he or she receives for the serious crime committed.
Re-educating them sexually and reintegrating them into a protected and neutral context could foster the process of correcting the offending conduct, reducing the risk of recidivism.
The operating protocol that will be used for the first pilot study, scheduled for 2026, is currently being finalized and evaluated by the Ethics Committee consulted.
7. Limitations of the Model and Future Prospects
The proposed program represents a theoretical model that must be structured in its functional elements, to be administered first in a pilot study and then in a representative population sample of subjects who commit sexual crimes. The model is currently being approved by the Ethics Committee, who have been consulted to proceed with an exploratory investigation through a selection of a pilot population from a prison context. A fundamental limitation concerns the state-run nature of the program. Indeed, the program, in its entirety, must be submitted to a legislative process for finalization in a study sector with a representative population; therefore, the costs of establishment, management, and regulation would be borne by the state budget and, therefore, should be foreseen with specific economic–legal mention. Furthermore, depending on the nation (or the legal system of reference, whether civil law or common law), the model may already partially exist, and therefore it may not be necessary to define it ex novo but rather to remodel it based on the new program. Pending feedback from the Ethics Committee, the current limitations identified in making the protocol practical in the final drafting phase relate to the selection of the prison population sample (for the variables of age, type of crime, type of conviction, psychopathological profile, and pre- and post-crime conduct), to government authorizations to participate in the pilot study, and to the costs of carrying out the study; however, the challenge is stimulating, and the project will continue with the intention of making the model operational through the protocol.
8. Conclusions
Prison system policies toward the sex offender population is the foundation for implementing a structured and functional program that ensures a model inspired by the principles of prevention (in which the education system strengthens the concept of legality), repression (in which sexual offenses are severely punished), and rehabilitation (in which the offender is re-educated and reintegrated into society).
The current system integrates multiple models, depending on the context, but does not guarantee adequate positive coverage in terms of prevention and resolution of possible recidivism by sexual offenders themselves. The Trident State Program (TSP) aims to improve the current political, regulatory, and socio-criminological framework, in Italy and the Western world in general, to strengthen therapeutic intervention and its positive effects and reduce or eliminate the risk of sexual offense recidivism. Clearly, to design a program capable of best addressing and managing a complex and heterogeneous problem such as the management of sex crimes, an implementation phase is needed to test the protocol.
Future research will focus on completing the operational protocol for this model, obtaining government authorization to conduct a pilot study, and then a study with a representative sample of the prison population will be conducted to demonstrate the effectiveness, efficiency, and cost-effectiveness of the proposed new model.
Author Contributions
G.P. conceived, developed, and edited the manuscript and has exclusive authorship of the conception and development of the “Trident Statal Program” (TSP). S.E. and S.G. supported the process of publishing the manuscript, in the verification and revision phase of the manuscript, together with G.D. and I.P., who provided additional technical and scientific input to the drafting phase. All authors have read and agreed to the published version of the manuscript.
Funding
This research received no external funding.
Institutional Review Board Statement
Not applicable.
Informed Consent Statement
Not applicable.
Data Availability Statement
No new data were created or analyzed in this study.
Conflicts of Interest
The authors declare no conflicts of interest.
Abbreviations
Cognitive–Behavioral Therapy (CBT). Multisystemic Therapy (MST). Additional Sex Offender Treatments (ASOTs). Risk–Need–Responsivity (RNR). Good Lives (GLM). Epidemiological Criminology (EpiCrim). Effective Treatment for Sexual Offenders (SOTP). Trident Statal Program (TSP).
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