Section 1905.10  Purpose and Scope

 

Effective January 1, 2004, the Sex Offender Management Board Act [20 ILCS 4026] and various other statutes provide for the evaluation and/or treatment of convicted sex offenders, in conformance with standards adopted by the Sex Offender Management Board.  It establishes standards for conducting evaluations of, and providing treatment to, adult sex offenders in all circumstances in which conformance with Board standards is required.

 

Section 1905.20  Definitions

 

In this Part, the terms "Board", "sex offender", "sex offense", "management", and "sexually motivated" have the meanings ascribed to them in Section 10 of the Act.  In addition, the following definitions apply:

 

"Act": Sex Offender Management Board Act [20 ILCS 4026].

 

"Case management": The coordination and implementation of the cluster of activities directed toward supervising, treating and managing the behavior of individual sex offenders.

 

"Evaluation": The systematic collection and analysis of psychological, behavioral and social information; the process by which information is gathered, analyzed and documented.

 

"Informed assent": Compliance; a declaration of willingness to do something in compliance with a request; acquiescence; agreement.  The use of the term "assent" rather than "consent" in this Part recognizes that sex offenders are not voluntary clients and that their choices are therefore more limited.  "Informed" means that a person's assent is based on a full disclosure of the facts needed to make the decision intelligently; e.g., knowledge of risks involved, alternatives.

 

"Informed consent": "Consent" means voluntary agreement or approval to do something in compliance with a request.  "Informed" means that a person's consent is based on a full disclosure of the facts needed to make the decision intelligently; e.g., knowledge of risks involved, alternatives.

 

"Parole": Parole or mandatory supervised release.

 

"Polygraph": The employment of instrumentation, as defined by the Illinois Detection of Deception Examiners Act [225 ILCS 430], used for the purpose of detecting deception or verifying truth of statements of a person under criminal justice supervision and/or treatment for the commission of sex offenses.  A clinical polygraph examination is specifically intended to assist in the treatment and supervision of convicted sex offenders.  Clinical polygraphs include specific-issue, disclosure and periodic or maintenance examinations.  Clinical polygraphs may also be referred to as post-conviction polygraphs.

 

"Professional license": A license issued by a State governmental body to practice a particular health or mental health profession.

 

"Sex offense specific": Relating to the problem of sexual offense behavior.

 

"Supervising officer": The probation officer, parole agent or conditional release staff responsible for the behavioral monitoring of sex offenders.  In addition, any person employed by the Department of Human Services (DHS) or by an entity that contracted with DHS to supervise sexually violent persons on conditional release.

 

"Treatment": Sexual abuser-specific treatment is designed to assist clients with effectively managing thoughts, fantasies, feelings, attitudes and behaviors associated with their potential to sexually abuse or their risk for sexual re-offense and to develop a prosocial lifestyle that is inconsistent with offending.

 

Section 1905.30  Provider Qualifications

 

Only individuals licensed as Sex Offender Therapists, Sex Offender Evaluators or Associate Providers by the Illinois Department of Professional and Financial Regulation (DFPR) are approved to conduct the evaluation and treatment services described in the following Sections.

 

Section 1905.40  Assessments

 

a)         Licensed evaluators conduct sexual abuser-specific assessments to promote informed decision making among stakeholders who share responsibility for treatment, risk management and other domains of intervention.  Empirically informed and reliable sexual abuser-specific assessments can be used, for example, to inform:

 

1)         Sentencing and other legal decisions;

 

2)         Treatment planning and progress;

 

3)         Release decision making;

 

4)         Transition and reentry planning; and

 

5)         Supervision and other case management planning.

 

b)         Sexual abuser-specific assessments are most reliable and beneficial when evaluators adhere to ethical practice, incorporate multiple sources of information, use research-supported methodologies, and strive to engage clients in the assessment process.  Furthermore, these assessments are most effective for guiding decision making, maximizing public safety, and promoting successful client outcomes when conducted within the evidence-based risk, need and responsivity framework.

 

c)         Because risk, needs and other circumstances change over time, assessments of sexual abusers are ongoing processes, not a single event.  Research-informed tools that include dynamic risk factors specific to adult sexual abusers are important for obtaining a more accurate understanding of the current risk and intervention needs of a given individual and for informing adjustments to interventions accordingly.

 

Section 1905.50  Assessment Guidelines

 

a)         Licensed evaluators shall conduct objective, impartial and reliable sexual abuser-specific assessments that support well-informed decision making and maintain the credibility and integrity of the profession.

 

1)         Evaluators conduct sexual abuser-specific assessments in accordance with any additional ethical standards, codes, laws or other expectations for the respective profession or discipline of practice.  This includes ethical standards pertaining to, but not limited to, the following:

 

A)        Informed consent;

 

B)        Specialized training, knowledge, expertise and scope of practice;

 

C)        Documentation and retention of records;

 

D)        Currency of research;

 

E)        Confidentiality;

 

F)         Professional relationships; and

 

G)        Conduct.

 

2)         Evaluators:

 

A)        explore and disclose any conflicts of interest or other issues that may interfere with their ability to provide an objective, fair and impartial assessment; and

 

B)        refer the potential client to another clinician or agency if the assessment process and findings will be compromised by those factors.

 

3)         Evaluators conducting sexual abuser-specific assessments:

 

A)        acknowledge and attempt to address any personal biases or assumptions they may have based on age, race, gender identity, sexual orientation, faith practices, cultural differences, socioeconomic differences, education, language, level of intellectual functioning, and mental or physical disability; and

 

B)        refer the potential client to another clinician or agency if the assessment process and findings will be compromised by those factors.

 

4)         Evaluators take into account the client's current legal status (e.g., no legal status; preadjudication, pretrial psychiatric hold; presentencing, civil commitment referral; parole hearing; revocation) and the ways in which that status may influence the nature of scope of the sexual abuser-specific assessment.

 

5)         Evaluators take reasonable steps to:

 

A)        afford the client who is the subject of the assessment (and/or legal guardian) the opportunity to make an informed decision about participating in the assessment process; and

 

B)        document those efforts in the report.  These steps include, but are not limited to the following:

 

i)          Explaining the nature and purposes of the assessment;

 

ii)          Outlining potential benefits, risks and limitations of the assessment procedures that will be used;

 

iii)          Highlighting the potential benefits and impact of participating or declining to participate;

 

iv)         Specifying limits on confidentiality, such as persons or entities to whom the findings will be provided and the circumstances under which information may otherwise be released; and

 

v)         Responding to questions posed by the client regarding the assessment process.

 

6)         Evaluators:

 

A)        inform clients of the evaluator's responsibilities vis-á-vis the client and the request for the evaluation; and

 

B)        ensure that clients understand that the evaluation may still proceed without their consent.

 

7)         Evaluators recognize the potential for disclosures of previously undetected sexually abusive behaviors, work closely with other system stakeholders to establish protocols for the fair, ethical and responsible handling of the disclosures, and ensure the client understands the evaluator's duty to disclose as required by law.

 

8)         Evaluators take reasonable steps to ensure that assessments of sexual abusers are current when that information will be used to inform case management decisions, such as sentencing, civil commitment, release, treatment and supervision.

 

9)         Evaluators take reasonable steps to clearly articulate the specific rationale for all conclusions and recommendations provided in a given assessment, using language that is readily understandable to the consumers of the assessment, including the client.

 

10)        Evaluators consider community safety and the degree to which the client is capable of and willing to manage his or her sexual behavior when making recommendations in the assessments.

 

b)         Evaluators shall clarify with the requestor and subject the specific purposes for which an assessment is being conducted and shall document accordingly.

 

1)         Evaluators conduct sexual abuser-specific assessments primarily for the following purposes:

 

A)        Understanding the nature and extent of a client's sexually abusive behavior;

 

B)        Exploring criminogenic and other needs that should be the focus of treatment and other interventions;

 

C)        Estimating short- and long-term recidivism risk, both sexual and nonsexual;

 

D)        Identifying specific responsivity factors; and/or

 

E)        Obtaining baseline information about a client against which progress and other changes can be gauged.

 

2)         Evaluators recognize that sexual abuser-specific assessments are not designed or reliable for, and should not be conducted for, the following purposes:

 

A)        Substantiating or refuting allegations that are the focus of a criminal, civil, child custody or other investigation;

 

B)        Exploring the veracity or motivations of an alleged victim's statements;

 

C)        Guiding law enforcement, prosecutorial or charging determinations;

 

D)        Suggesting the existence of a predetermined profile of a sexual abuser against which an individual can be compared to determine fact; or

 

E)        Addressing or alluding to a client's potential guilt or innocence, or otherwise speaking to issues that are within the purview of a trier-of-fact.

 

3)         Evaluators collaborate with other stakeholders involved in risk reduction, risk management and prevention efforts to promote the appropriate and effective use of assessment data to inform case management decisions with sexual abusers.

 

4)         Evaluators take steps to educate other stakeholders, including the public, regarding the appropriate purposes, potential misuses, strengths and limitations pertaining to the assessment of sexual abusers.

 

c)         Evaluators shall utilize assessment measures, instruments and procedures that are appropriate for addressing the specific goals of the assessment, for the purposes for which the tools were designed, and for the client being assessed.

 

1)         Evaluators shall be familiar with the psychometric properties of the assessment measures to be used, including reliability and validity, and favor well-accepted instruments that are supported by empirical research.

 

2)         Evaluators shall use instruments and methods for which they are appropriately trained, follow recommended administration protocols for all assessment measures utilized, and offer statements of findings that are limited to the capabilities of these methodologies.

 

3)         Evaluators recognize that assessment instruments developed for and used with adult sexual abusers may not be appropriately normed, valid or reliable for use with other subpopulations of sexually abusive clients.

 

4)         Evaluators shall select the most reliable, valid and appropriate assessment instruments and procedures given the client's age, gender, culture, language, developmental and intellectual functioning, and other unique characteristics.

 

5)         Evaluators who are unable to communicate fluently with a client shall refer the client to another qualified professional who is able to communicate fluently with that client.  A professional interpreter may be used with the client's permission, provided that confidentiality agreements are in place.  Evaluators shall note within their assessments if an interpreter is utilized.

 

6)         Evaluators who conduct assessments on special subpopulations of sexually abusive clients possess specialized knowledge, obtained through focused training, regarding these subpopulations.

 

7)         Evaluators assess/screen clients for acute mental or behavioral health needs that may require intervention prior to initiating assessments or interventions specific to sexually abusive behavior and, if necessary, refer clients to other professionals who are qualified to provide these services.  The impact of those mental health or behavioral needs on the assessment procedures or findings should be noted in the evaluator's report.

 

8)         Evaluators strive to meet the special needs of clients with developmental, learning or physical impairments during assessments (e.g., using taped versions of questionnaires, modifying terminology/language on self-report instruments).  Reasons and the rationale for using alternative testing methods should be documented in the report, and it should be noted that these special accommodations may have an impact on the reliability and validity of instruments that are typically self-administered.

 

9)         Evaluators should note in the report any limitations or biases related to using instruments or procedures that were not developed to take into account a client's age, race, gender identity, sexual orientation, faith practice, cultural background, socioeconomic status, education, language or level of intellectual functioning.

 

d)         Evaluators shall recognize that conducting psychosexual evaluations provides a critical opportunity to gain comprehensive understanding of the client's circumstances, risk, intervention needs and responsivity factors; engage the client in the assessment and overall intervention process; and offer reliable data to inform decision making.

 

1)         Evaluators rely on multiple sources of information when conducting a psychosexual evaluation, preferably to include the following:

 

A)        Client interviews;

 

B)        Interviews with collateral informants, as applicable (e.g., family, intimate partner/spouse);

 

C)        Thorough review of official documents (e.g., police reports, victim impact statements, criminal justice records, previous assessment and treatment records, presentence or social services investigations);

 

D)        Empirically grounded general psychometric testing (e.g., intellectual, diagnostic);

 

E)        Empirically grounded strategies to estimate risk of sexual and/or nonsexual recidivism; and

 

F)         When professional judgement dictates:

 

i)          Empirically grounded instruments designed to measure broad sexual, as well as offense-related, attitudes and interests;

 

ii)         Empirically grounded, objective psychophysiological measures of sexual arousal, interests and/or preferences.

 

2)         Evaluators identify, document and explain the implications of specific responsivity factors, which include, but are not limited to, the following:

 

A)        Age;

 

B)        Culture;

 

C)        Psychosocial and emotional development;

 

D)        Level of adaptive functioning;

 

E)        Neuropsychological, cognitive and learning impairments;

 

F)         Language or communication barriers;

 

G)        Acute psychiatric symptoms;

 

H)        Denial; and

 

I)         Level of motivation.

 

3)         Evaluators interact with clients in ways that are designed to promote engagement, decrease resistance, and foster internal motivation throughout the assessment process.

 

4)         Evaluators explore and incorporate the client's own perspectives, interests and goals when interviewing and assessing the client.

 

5)         Evaluators take reasonable steps to employ communication methods that take into account specific responsivity factors such as culture, developmental level, and intellectual functioning.

 

6)         Evaluators recognize that the varying reasons for which a client presents for a psychosexual evaluation may impact the client's demeanor during the interview.

 

7)         Evaluators seek to obtain a range of general background information about the client, including, but not limited to, the following:

 

A)        Developmental history (e.g., family dynamics, exposure to violence, maltreatment);

 

B)        Nature and quality of past and current relationships (e.g., family, peers, intimate partners);

 

C)        Medical and mental health history (i.e., client and family);

 

D)        Intelligence, cognitive functioning and level of maturity;

 

E)        Education and employment history;

 

F)         Antisocial orientation (e.g., antisocial attitudes and values, psychopathy, antecedents of juvenile delinquency, adult criminal history, violence or aggression); and

 

G)        History of substance use and abuse.

 

8)         Evaluators collect information regarding sexual history information that includes, but is not limited to, the following:

 

A)        Psychosexual development, early sexual experience, and history of age-appropriate, consensual sexual relationships;

 

B)        Nature and frequency of sexual practices (e.g., masturbation, nonabusive and nondeviant sexual behaviors, unconventional or risky sexual activities);

 

C)        Paraphilic interests, fantasies and behaviors that may not be sexually abusive (e.g., fetishes, masochism);

 

D)        Use of sexually oriented services or outlets (e.g., magazines, internet access, telephone sex lines, adult establishments);

 

E)        Abusive or offense-related sexual arousal, interests and preferences;

 

F)         History of sexually abusive behaviors, both officially documented and unreported (if identified through credible records or sources);

 

G)        Information about current and/or previous victims (e.g., age, gender, relationship to client);

 

H)        Contextual elements of sexually abusive behaviors (e.g., dynamics, motivators, patterns, circumstances); and

 

I)         Level of insight, self-disclosure and denial (e.g., of the behaviors, motivations or intent, level of violence and coercion) relative to various aspects of the sexually abusive behavior.

 

9)         Evaluators explore and document a client's strengths, assets and protective factors, which may include, but are not limited to, the following areas:

 

A)        Prosocial community supports and influences, and others involved in care and treatment;

 

B)        Structure and support that promote maintaining success (e.g., limited access to potential victims);

 

C)        Healthy, age-appropriate, normative, long-term intimate and sexual relationships;

 

D)        Motivation to change;

 

E)        Insight, understanding and management of risk factors;

 

F)         Appropriate problem-solving and emotional management skills; and

 

G)        Employment, financial and residential stability.

 

e)         Potential Involvement of Adult Victims in the Evaluation Process

 

1)         If a victim expresses an interest in having his or her perspectives represented by actively participating in the evaluation process of the sexual abuser, the evaluator shall adhere to certain parameters.

 

A)        The evaluator should never initiate contact with a victim.  The victim should be the first to initiate any type of contact.

 

B)        The evaluator shall inform the victim of the process through which the victim may provide either a written or oral statement regarding the offense.  The victim should be made aware that he or she may have someone with him or her, such as a victim's advocate, to provide support.

 

C)        With expressed consent of the victim, the evaluator may consult with victim advocates, when involved, and consider alternate methods of incorporating the perspectives of the victims (e.g., written victim impact statements).

 

D)        The evaluator shall exercise caution if interviewing victims because of potential risk of unintended impact on the victims.

 

E)        The evaluator shall interview victims only when possessing the requisite knowledge, experience, skills and training to work with sexual abuse victims.

 

F)         The victim may opt to provide a statement at any time.

 

f)         The Written Report

 

1)         In the psychosexual evaluation report, evaluators outline the full range of information sources used to conduct the psychosexual evaluation, note any relevant information sources that were unavailable at the time of the evaluation, and highlight the potential implications of any data limitations on the conclusions and recommendations contained in the report.

 

2)         Evaluators provide an addendum to the psychosexual evaluation report when additional key information is received about the client that significantly impacts the initial findings, conclusions and recommendations.

 

3)         Evaluators document areas of convergence and/or divergence among the client's self-report, collateral information, and other sources of assessment data, including objective behavioral or psychophysiological assessment measures.

 

4)         Evaluators clearly articulate conclusions and recommendations based on supporting evidence documented in the body of the report, and that generally address the following (as relevant to the purpose of the assessment):

 

A)        Recidivism risk (sexual and nonsexual);

 

B)        General and offense-related criminogenic needs;

 

C)        Responsivity factors;

 

D)        Other intervention needs;

 

E)        Current stressors;

 

F)         Client-identified goals and interests;

 

G)        Implications of the client's strengths and assets;

 

H)        Potential risk management strategies that may be important for other stakeholders to consider (e.g., potential targets for community supervision); and

 

I)         Recommended interventions that support the application of the risk, need and responsivity principles for the client and that sufficiently take into account victim and community safety.

 

5)         Evaluators note in the psychosexual evaluation report any recommended interventions or services that are unavailable due to limitations of existing resources, while recognizing that the absence of existing resources does not lessen the evaluator's responsibility for providing assessment-driven recommendations.

 

6)         Evaluators recognize that communicating the results to the subject of the evaluation may be beneficial (e.g., for clarity, to facilitate client engagement, to gauge the subject's response to feedback) and take reasonable steps, using language at a level that is accessible to the individual being assessed, to:

 

A)        inform the subject of the conclusions and recommendations contained in the evaluation report and the basis for those conclusions and recommendations; and

 

B)        provide clarification when warranted, practical and appropriate.

 

Section 1905.60  Risk Assessment

 

Evaluators shall appreciate the potential weight of general and sexual abuser-specific risk assessments across various criminal justice-related and civil contests and the associated implications (not only for community safety, but also for the potential impact on the client's civil liberties) and the critical need to ensure reliable and valid findings.

 

a)         Evaluators clarify the specific purpose for conducting a risk assessment on a given client and the way in which that information will be used, and articulate this in communications regarding the findings.

 

b)         Evaluators conducting risk assessments on sexual abusers are well versed in the contemporary research regarding static and dynamic factors linked to recidivism among sexual abusers.  These variables fall into the following categories:

 

1)         Criminal history (e.g., prior arrests, convictions);

 

2)         Victim-related variables (e.g., age, gender, relationship);

 

3)         Sexual deviancy (e.g., offense-related sexual arousal, interests and/or preferences; sexual preoccupation);

 

4)         Antisocial orientation (e.g., criminal attitudes, values and behaviors; lifestyle instability);

 

5)         Intimacy and relationship deficits (e.g., problems with intimacy, unstable relationships, conflictual intimate relationships, deficits in social support and interaction); and

 

6)         Self-regulation difficulties (e.g., hostility, substance abuse, impulsivity, access to victims).

 

c)         Evaluators conducting risk assessments of sexual abusers use empirically supported instruments and methods (i.e., validated actuarial risk assessment tools and structured, empirically guided risk assessment protocols) over unstructured clinical judgment.

 

d)         Evaluators conducting risk assessments of sexual abusers are appropriately trained in scoring, interpreting effectively and accurately reporting, and applying the findings of the risk assessment instruments/protocols employed.

 

e)         Evaluators recognize the potential for both sexual and nonsexual recidivism among sexual abusers and clarify the type of recidivism risk assessed in the report or other statements of findings.

 

f)         Evaluators are aware of the relative strengths and limitations of the risk assessment measures/methods employed, reference these issues when communicating risk assessment findings, and ensure that statements about the findings remain within the scope/capability of these measures (e.g., refraining from making absolute judgements about whether a given sexual abuser will or will not recidivate).

 

g)         Evaluators ensure that any communications about a given client's recidivism risk are based on current and reliable assessment data about that person.

 

h)         Evaluators appreciate that recidivism risk is not static and may change as a result of interventions, client actions or other circumstances and, therefore, evaluators conducting risk assessments employ research-supported methods of assessing dynamic risk factors as warranted over time.

 

Section 1905.70  Psychophysiological Assessments

 

Evaluators shall recognize that psychophysiological assessment methods such as phallometry, viewing time and polygraphy may have particular utility to obtain objective behavioral data about the client that may not be readily established through other assessment means; explore the reliability of client self-reporting; and explore potential changes, progress and/or compliance relative to treatment and other case management goals and objectives, not determine guilt or innocence.  Each assessment method is further explained in Section 1905.140.

 

a)         Evaluators obtain specific informed consent from clients prior to using psychophysiological measures.

 

b)         Evaluators are familiar with the strengths and limitations of psychophysiological instruments and note these issues when interpreting and communicating the findings from these instruments.

 

c)         Evaluators take reasonable steps to obtain assurances that examiners utilizing psychophysiological assessment instruments are appropriately trained in the use of those instruments, use accepted methods, and adhere to applicable professional/discipline-specific standards or guidelines.

 

d)         Evaluators recognize that the findings from psychophysiological measures are to be used in conjunction with other sources of assessment information, not as the single source of data for any assessment.

 

e)         Evaluators recognize that the results of psychophysiological measures are not to be used as the sole criterion for any clinical decision regarding offending, including, but not limited to, the following:

 

1)         Estimating level of risk for recidivism;

 

2)         Making recommendations for release to the community from a correctional, institutional or other noncommunity placement;

 

3)         Determining treatment completion; or

 

4)         Drawing conclusions regarding compliance with or violations of conditions of release or community placement.

 

f)         Evaluators appropriately limit the use of phallometric measures to the following purposes:

 

1)         Assessing the client's relative sexual arousal and preferences regarding age and gender;

 

2)         Evaluating the client's arousal response to various levels of sexually intrusive or aggressive/coercive behaviors;

 

3)         Exploring the potential role of offense-related sexual arousal in the client's sexually abusive or at-risk behavior and developing accompanying treatment goals; and

 

4)         Monitoring the effectiveness of interventions involving the modification, management and expression of both health and offense-related sexual arousal.

 

g)         Evaluators appropriately limit the use of viewing time measures to the following purposes:

 

1)         Assessing the client's sexual interests with respect to age and gender;

 

2)         Evaluating the client's arousal response to various levels of sexually intrusive or aggressive/coercive behaviors;

 

3)         Exploring the potential role of offense-related sexual arousal in the client's sexually abusive or at-risk behavior and developing accompanying treatment goals; and

 

4)         Monitoring the effectiveness of interventions involving the modification, management and expression of both health and offense-related sexual arousal.

 

h)         Evaluators appropriately limit the use of polygraph measures to the following purposes:

 

1)         Facilitating a client's disclosure of sexual history information, which may include sexually abusive or offense-related behaviors;

 

2)         Eliciting from the client clarifying information regarding the instant/index offense;

 

3)         Exploring potential changes, progress and/or compliance relative to treatment and other case management goals and objectives; and/or

 

4)         Making collaborative case management decisions about a client with other partners and stakeholders.

 

Section 1905.80  Treatment Interventions

 

a)         Sexual abuser-specific treatment is designed to assist clients with effectively managing thoughts, fantasies, feelings, attitudes and behaviors associated with their potential to sexually abuse or their risk for sexual re-offense and to develop a prosocial lifestyle that is inconsistent with offending.  Sexual abusers are a heterogeneous population, with risk levels and treatment needs that can differ markedly.  Therefore, sexual abuser-specific treatment services are best offered and provided along a continuum of care (from correctional, institutional, inpatient or residential facilities to community settings) and are matched to the assessed recidivism risk and treatment needs of a given client.

 

b)         Research indicates that treatment for criminal justice-involved populations, including adult sexual abusers, is most effective when it is delivered in accordance with the evidence-based principles of correctional intervention (risk, need and responsivity).  As applied to treatment interventions for sexual abusers, this translates into the following:

 

1)         Risk:  Sexual abusers presenting a higher risk of reoffending receive a greater intensity and dosage of treatment services, while lower risk sexual abusers receive less.  Providing an inappropriate intensity of services may negatively affect treatment effectiveness and recidivism risk.

 

2)         Need:  Treatment primarily targets research-supported dynamic risk factors that are linked to recidivism (i.e., criminogenic needs) over targets of intervention that are not empirically linked to recidivism.

 

3)         Responsivity:  To address general responsivity factors, evidence-based intervention models are broadly structured, cognitive-behavioral, and skills-oriented.  Unstructured, insight-oriented models typically are less effective in reducing sexual recidivism and do not constitute primary interventions in the treatment of sexual abusers.  To address specific responsivity factors, services are delivered in a manner that accommodates client characteristics, such as level of intellectual functioning, learning style, personality characteristics, culture, mental and physical disabilities, and motivation level. Services also build upon client strengths, which may include motivation, ability to read and write, lifestyle stability, prosocial support systems, and willingness to comply with supervision requirements.

 

c)         Treatment effectiveness for sexual abusers is also enhanced when providers engage clients in the treatment process and interact with clients in a respectful, directive and empathic manner.  For some adult sexual abusers, complementary interventions, such as psychiatric or mental health care, couples or family therapy, educational, housing or employment services, and risk management strategies such as community supervision, may contribute to public safety efforts and promote the overall stability and success of clients.  Treatment providers often collaborate with other professionals who have various roles and responsibilities, agents, victim advocates, and other treatment providers, as well as positive community resources and supports.  Treatment providers should remain abreast of current research and align practices accordingly.  Recommended methods include structured, cognitive-behavioral, and skills-oriented treatment approaches that target dynamic risk factors.  These methods have the greatest potential for reducing rates of sexual and other types of criminal reoffending in the male adult sexual abuser.

 

Section 1905.90  Treatment Guidelines

 

a)         Licensed treatment providers shall utilize sexual abuser-specific treatment that is guided by ethical principles and current empirical research in order to maximize treatment effectiveness, promote public safety, facilitate prosocial goals for clients, and maintain the integrity of the profession.

 

1)         Treatment providers utilize sexual abuser-specific treatment in accordance with any additional ethical standards, codes, laws or other expectations for the respective profession or discipline of practice.  This includes ethical standards pertaining to, but not limited to, the following:

 

A)        Informed consent;

 

B)        Specialized training, knowledge, expertise and scope of practice;

 

C)        Documentation and retention of records;

 

D)        Currency of research;

 

E)        Confidentiality;

 

F)         Professional relationships; and

 

G)        Conduct.

 

2)         Treatment providers appreciate that treatment for individuals who have sexually abused or are at risk for sexually abusing others is an evolving science.

 

3)         Treatment providers remain apprised of contemporary research and engage in professional development activities to ground their provision of research-supported and evidence-based interventions for sexual abusers accordingly.

 

4)         Treatment providers encourage, support and, whenever possible, participate in ongoing empirical research efforts designed to identify and refine effective interventions for sexual abusers and those at risk to sexually abuse others.

 

5)         Treatment providers working with sexual abusers collaborate with other professionals who are involved in the management of clients, including judges, probation/parole officers, correctional and other facility staff, child welfare workers, and victim therapists in order to facilitate information sharing and further the goals of treatment.  This collaboration/cooperation is consistent with and limited to activities and behavior appropriate to treatment providers' professional roles.

 

6)         Treatment providers recognize that correctional staff and community supervision practitioners who are well-trained and skilled in using evidence-based behavioral techniques and interventions (e.g., prosocial modeling, skill practice, rehearsal of strategies, redirection, positive reinforcement) can complement treatment activities in correctional and other facilities and post-release.

 

b)         Assessment-Driven Treatment

Treatment providers shall recognize the importance of individualized, assessment-driven treatment services and deliver treatment accordingly.

 

1)         Treatment providers ensure that, prior to initiating treatment services for individuals who have sexually abused or are at risk of sexually abusing others, a psychosexual evaluation of a client's recidivism risk and intervention needs has been conducted, is current and is comprehensive.

 

2)         Treatment providers rely on research-supported assessment methods that are designed to identify dynamic risk factors present for a given client.

 

3)         Treatment providers develop and implement an individualized, written treatment plan for each client, outlining clear and specific treatment goals and objectives that are consistent with the results of a current psychosexual evaluation.

 

4)         Treatment providers routinely review and update treatment plans based on multiple methods of assessment.

 

5)         Treatment providers offer treatment that is appropriate for a client's assessed level of risk and intervention needs.

 

6)         Treatment providers offer treatment only when they have the resources necessary to provide an adequate and appropriate level of intervention for a client's risk and needs.

 

7)         Treatment providers refer a potential client to other treatment providers or agencies when they cannot provide an adequate and appropriate level of intervention. This may involve a full transfer or sharing of clinical responsibility.

 

8)         Treatment providers recognize the importance of primary and secondary prevention by making treatment services available to, or making appropriate referrals for, individuals who may be at risk for engaging in sexually abusive behaviors and are seeking nonmandated assistance.

 

9)         Treatment providers recognize that some individuals may present for sexual abuser treatment in the absence of legal or other mandates and that appropriate services should be made accessible to those individuals.

 

Section 1905.100  Treatment Methods

 

a)         Treatment providers working with sexual abusers shall utilize empirically supported methods of intervention.  Recommended methods include structured, cognitive-behavioral, and skills-oriented treatment approaches that target dynamic risk factors.

 

1)         Treatment providers deliver services to clients using a variety of modalities, including individual, family and group therapy, that are matched to each client's individual intervention needs and responsivity factors.

 

2)         Treatment providers assist clients with identifying and analyzing the individual's factors (e.g., environmental, cognitive, affective and relational) that increase the individual's vulnerability to engage in sexually abusive behaviors.

 

3)         Treatment providers use cognitive-behavioral techniques, at the earliest opportunity, to help clients develop and rehearse strategies (i.e., avoid or escape high risk situations, use adequate coping skills) to effectively manage situations that may increase their risk of sexually abusing or otherwise reoffending.

 

4)         Treatment providers use behavioral methods, such as education, prosocial modeling, skill practice, rehearsal of strategies, redirection and positive reinforcement, to teach or enhance skills that will help clients achieve prosocial goals.

 

5)         Treatment providers encourage clients to practice the skills they learned in treatment and ensure that these skills generalize to clients' environments.

 

6)         Treatment providers assist clients in developing individualized strategies and plans for effectively managing their risk of sexual abuse or other harmful or illegal behaviors.  These plans include specific strategies for avoiding or limiting access to potential victims, recognizing and coping with risk factors, and building social support systems.

 

7)         Treatment providers assist clients with identifying and enhancing prosocial interests, skills and behaviors that the clients themselves seek to enhance or attain (i.e., approach goals that are oriented toward a nonoffending lifestyle), as opposed to strictly focusing on managing inappropriate thoughts, interests, behaviors and risky situations (i.e., avoidance goals).

 

b)         Dynamic Risk Factors

Treatment providers shall focus treatment interventions primarily on research-supported dynamic risk factors that are linked to sexual and nonsexual recidivism (i.e., criminogenic needs) over factors that have not been shown to be associated with recidivism, as outlined in this subsection (b).

 

1)         General Self-regulation

 

A)        Treatment providers assist clients in learning to self-manage emotional states that support or contribute to their potential to sexually abuse.

 

B)        Treatment providers assist clients in learning and practicing problem-solving and impulse control skills.

 

C)        Treatment providers assist clients in obtaining appropriate services for evident problems related to the clients' mental health and substance use patterns.

 

2)         Sexual Self-regulation

 

A)        Treatment providers use cognitive-behavioral, behavioral and/or pharmacological techniques to promote healthier sexual interests and arousal, fantasies and behaviors oriented toward age-appropriate and consensual partners.

 

B)        Treatment providers use cognitive-behavioral, behavioral and/or pharmacological techniques known to be associated with:

 

i)          reductions in sexual preoccupation (paraphilic and nonparaphilic) and deviant sexual interests and arousal; and

 

ii)          improvements in the management and control of sexual impulses.

 

C)        Treatment providers target cognitions that are supportive of age-inappropriate and nonconsensual sexual interest, arousal and behavior in order to assist clients in enhancing their sexual self-regulation.

 

D)        Treatment providers help clients find effective ways to minimize contact with persons or situations that evoke or increase clients' deviant interests and arousal.

 

3)         Attitudes Supportive of Sexual Abuse

 

A)        Treatment providers recognize that client attitudes and beliefs that are tolerant of sexual abuse (e.g., women enjoy being raped, children should be able to make up their own mind about having sex with adults) are important treatment targets.

 

B)        Treatment providers:

 

i)          use established cognitive therapy techniques to strengthen attitudes, beliefs and values that support prosocial sexual behaviors; and

 

ii)         help clients manage or decrease those that support sexually abusive behavior.

 

C)        Treatment providers are aware that, although clients may hold attitudes, beliefs and values that are unconventional but unrelated to their risk for sexually abusive or criminal behaviors, these attitudes, beliefs and values are not deemed appropriate primary treatment targets.

 

4)         Intimate Relationships

 

A)        Treatment providers assist the client in the development of skills that can enable the experience of prosocial intimate relationships with adults.  Treatment providers orient their interventions so that they build on strengths in the client's existing relationships, when appropriate.

 

B)        Treatment providers aim, when possible and appropriate, to include adult romantic partners in treatment in order to maximize treatment gains and enhance prosocial lifestyles.

 

5)         Social and Community Supports

 

A)        Treatment providers encourage and assist clients in identifying appropriate, prosocial individuals who can act as positive support persons.

 

B)        Treatment providers encourage family members and other support persons to actively participate in the treatment process and to help clients achieve and maintain prosocial lifestyles.

 

C)        Treatment providers assist clients who are transitioning to the community or are already in the community to develop and maintain stable prosocial lifestyles, which are characterized by stable and appropriate housing, employment and leisure activities.

 

D)        Treatment providers recognize that developing a support network may be contraindicated with clients who have a history of violence toward support persons and have not been violence-free for a significant amount of time.  Hence, treatment providers encourage clients to make small and gradual changes and closely monitor these changes to ensure clients are receiving or have received interventions to address these issues and reduce the risk for violence.

 

6)         Treatment providers may, as warranted for a given client based on a comprehensive assessment, also include treatment targets that are not clearly established by research to be dynamic risk factors (e.g., denial and minimization, low self-esteem) but that, when addressed, enhance therapeutic alliance, treatment engagement and treatment responsiveness.

 

c)         Treatment Engagement and Goal Setting

 

1)         Treatment providers shall strive to foster clients' engagement and internal motivation at the onset, and throughout the course of, sexual abuser-specific treatment, recognizing that these process-related variables enhance treatment responsiveness and outcomes.

 

2)         Treatment providers recognize that, although many clients present for sexual abuser-specific treatment as direct result of legal or other mandates, external motivators alone are generally insufficient for producing long-term change among clients.

 

3)         Treatment providers provide services in a respectful, directive and humane manner and facilitate a therapeutic climate that is conducive to trust and candor.

 

4)         Treatment providers recognize that client engagement may increase, and resistance may decrease, when the treatment provider and client are in relative agreement about treatment goals and objectives.  To the extent possible, treatment providers involve clients in the development of their treatment plans and in the identification of realistic goals and objectives.

 

5)         Treatment providers clarify, at the onset of sexual abuser-specific treatment, the client's understanding of the problems for which the client referred to treatment and that primary treatment objectives are often specific to modifying deviant sexual attitudes, interests, arousal and behaviors.

 

6)         Treatment providers are aware that clients present with differing levels of internal motivation to change (and varied types and levels of denial and minimization related to sexually abusive behavior, interests, arousal and attitudes and beliefs), but that such characteristics do not preclude access to treatment.

 

7)         Treatment providers recognize that denial and minimization may impact the client's engagement in treatment, but that the influence of denial and minimization on sexual recidivism risk has not yet been clearly established and may vary among client groups.

 

8)         Treatment providers support the client in being honest in discussing the client history and functioning, but acknowledge that it is not the role of treatment providers to attempt to determine or verify a client's legal guilt or innocence or to coerce confessions of unreported or undetected sexually abusive behaviors.

 

9)         Treatment providers are aware that attempting to provide treatment for problems that a client persistently denies having results in limitations in making reliable clinical recommendations about the individual's treatment progress and re-offense risk, and that this has ethical implications.

 

10)        Treatment providers routinely seek and explore the client's perspectives and offer feedback on the client's engagement, motivation and progress in treatment, or lack thereof.

 

Section 1905.110   Treatment Progress and Completion

 

Treatment providers shall recognize and communicate that successful completion of a sexual abuser treatment program/regimen indicates that a client has demonstrated sufficient progress in meeting the specified series of goals and objectives of an individualized treatment plan designed to significantly reduce and reasonably manage the individual's risk to reoffend.  Completion of treatment should be understood as meaning the successful completion of treatment, and not as the cessation of court-ordered, offense-specific treatment or the completion of the sentence imposed by the court or the Prisoner Review Board.  Successful completion of treatment may not end the sex offender's need for ongoing rehabilitation or elimination of risk to the community.

 

a)         Treatment providers develop written treatment contracts/agreements (e.g., treatment consent forms) to ensure clarity and agreement between the provider and clients.  The contracts address, at minimum, the following:

 

1)         The nature, goals and objectives of treatment;

 

2)         The expected frequency and duration of treatment;

 

3)         Rules and expectations of treatment program participants;

 

4)         Rewards and incentives for participation and progress;

 

5)         Consequences of noncompliance with program rules and expectations; and

 

6)         Criteria used for assessing progress and determining program completion.

 

b)         Treatment providers routinely utilize multiple methods in an effort to objectively and reliably gauge treatment progress, particularly with respect to dynamic risk factors.  These methods include:

 

1)         Structured, research-supported tools and inventories;

 

2)         Specialized behavioral/psychophysiological tools;

 

3)         Client self-report; and

 

4)         Collateral reports.

 

c)         Treatment providers routinely review the client's individual treatment plan and clearly document in treatment records the specific and observable changes in factors associated with the client's risk to recidivate, or the lack of changes.

 

d)         Treatment providers recognize that a client who has successfully completed treatment has generally:

 

1)         Acknowledged the problems for which the client was referred in sufficient enough detail for treatment staff to have developed a treatment plan that, if implemented properly, could be reasonably expected to reduce the risk to reoffend;

 

2)         Demonstrated an understanding of the thoughts, attitudes, emotions, behaviors and sexual interests linked to sexually abusive behavior and can identify these when they occur in the client's present functioning; and

 

3)         Demonstrated changes in managing these thoughts, attitudes, emotions, behaviors and sexual interests that are sufficiently sustained to create a reasonable assumption that the client reduced the risk to reoffend.

 

AGENCY NOTE:  Offenders under conditional release, parole or probation may have additional specific indicators to enable the treatment provider to assess treatment completion to include completion of levels of supervision (this may include various components such as compliance with conditions of supervision, lack of sanctions, employment, progress in treatment, etc.), polygraph examinations and/or plethysmographs, etc.  The decision to successfully terminate a supervised offender from treatment should be made by the  multidisciplinary team.

 

e)         Treatment providers evaluate a client's treatment progress within the context of a thorough understanding of the client's individual capacities, abilities, vulnerabilities and limitations.   Associated recommendations should reference these factors and aim to stay within the bounds of what is likely or possible for the individual client.

 

f)         Treatment providers providing community-based treatment recommend:

 

1)         more intensive treatment and/or supervision if a client experiences significant difficulties managing the risk for sexual abuse in a way that jeopardizes community safety; and

 

2)         gradual adjustments to the intensity of services as the client consistently demonstrates stability and positive gains.

 

g)         Treatment providers prepare their clients for treatment completion, which may include a gradual reduction in frequency of contacts over time as treatment gains are made, booster sessions to reinforce and assess maintenance of treatment gains, and consultation to any future service providers.

 

h)         Treatment providers are clear when communicating with clients, other professionals, and the public that some clients may require ongoing management of their risk and treatment needs.

 

i)          Treatment providers utilize the client, support persons and appropriate professionals involved in ongoing case management with written information that includes follow-up recommendations for maintaining treatment gains.

 

j)          Treatment providers immediately notify appropriate authorities if a legally mandated client discontinues treatment or violates a mandated condition of parole, probation or treatment.

 

k)         Treatment providers hold nonmandated clients to the same treatment expectations as mandated clients.

 

Section 1905.120  Responsivity Factors and Special Populations

 

Treatment providers shall acknowledge the diversity among individuals who sexually abuse others and that responsiveness to sexual abuser-specific treatment can vary as a function of client characteristics such as demographics, language, development, capabilities, functioning and motivation to change.

 

a)         Treatment providers recognize that not all treatments have been developed or evaluated with various subpopulations of sexual abusers (e.g., individuals with intellectual and developmental disabilities, clients with serious mental illness, those with varied cultures and other demographics).  The limitations of treatments with these populations should be identified prior to initiating treatment services.

 

b)         Treatment providers appreciate that treatment for sexual abusers is more effective when responsivity factors are addressed and recognize the potential for unintended collateral consequences when services fail to take into account responsivity factors.

 

c)         Treatment providers assess and identify responsivity factors, such as comprehension, cognitive capabilities, adaptive functional level, psychiatric stability, and other factors that may impact a client's ability to maximally benefit from sexual abuser-specific treatment.

 

d)         Treatment providers strive to adjust approaches to interventions and match clients to appropriate services based on identified responsivity factors in order to facilitate clients' maximum benefit from services.  This includes, for example, the provision of language interpreters, services for deniers, services for clients with cognitive or developmental limitations, and culturally competent programming.

 

e)         Treatment providers strive to equip themselves with the knowledge and skills necessary to adequately address clients' responsivity factors and/or special needs by participating in professional development activities.

 

f)         Treatment providers recognize their own strengths and limitations with respect to their ability to provide adequately responsive services to clients and refer clients to qualified providers skilled in addressing specific responsivity factors, when necessary.

 

g)         Treatment providers understand that, for some subpopulations of sexual abusers, sexual abuser-specific treatment services are best provided subsequent to or in concert with other psychiatric, behavioral or responsivity-oriented interventions.  Treatment providers offering sexual abuser-specific treatment collaborate with the providers of those services to ensure that sexual abuser-specific services are complementary and not contraindicated.

 

h)         Treatment providers providing sexual abuser-specific treatment work closely with a client's partner, family members and other community support persons who can facilitate successful treatment outcomes because of their abilities to attend to a given client's specific responsivity factors.

 

Section 1905.130  Risk Reduction and Risk Management in the Community

 

a)         Many adult sexual abusers residing in the community are supervised under the jurisdiction of the courts, correctional departments, probation or parole divisions or mental health agencies.  Approaches to reducing and managing risk in the community may involve imposing various supervision conditions, expectations and requirements; monitoring and tracking; linking clients to appropriate programs and services; facilitating successful reentry to and stability in the community following release from correctional or other facility custody; promoting continuity of care within and across facility-based programs and services and community-based services; educating and engaging the public and communities; using and encouraging other system partners to use empirically informed assessment information to guide interventions and strategies; and engaging positive community support networks, which may include trained volunteers.  Some strategies are explicitly designed to reduce the recidivism risk of sexual abusers by assisting them with developing and enhancing prosocial attitudes, skills and behaviors; increasing healthy and appropriate interests; effectively managing risk factors; developing positive and prosocial community supports; and enhancing other protective factors.  Other strategies are primarily designed to promote accountability, deterrence and risk management.

 

b)         Research indicates that focusing supervision activities primarily or exclusively on risk management is not effective in reducing recidivism, whereas using risk-reducing interventions, such as treatment and other skill-building interventions, to complement risk management-based supervision strategies leads to better outcomes. To support a balance of risk reduction and risk management efforts, contemporary trends involving sexual abusers in the community often emphasize multidisciplinary and multi-agency collaborations.  These collaborative efforts are part of contemporary practices in the treatment and supervision of sexual abusers, as supported by the extant literature.  It may include communication and partnerships among professionals, such as sexual abuser-specific treatment providers and other treatment providers (e.g., substance abuse, mental health, marital and family therapists), probation or parole officers, case managers, child welfare professionals, victim advocates, law enforcement officials, polygraph examiners and others.

 

c)         In many jurisdictions, collaboration occurs through multidisciplinary case management teams, the composition of which may vary depending on the risk, needs and circumstances of a given client.  Key elements of effective collaboration include a clear delineation of roles and responsibilities, complementary policies and procedures, ethically sound communication and information-sharing mechanisms, and a shared community safety goal.  Through effective partnerships, early intervention can be exercised to reduce the risk posed by sexual abusers prior to behaviors that are not yet criminal in nature and to facilitate the exchange of information to develop appropriate treatment plans, inform risk management decisions, make recommendations regarding victim contact, and increase the overall stability and success of clients in the community.

 

d)         In cases in which a client will be released from a correctional, inpatient or other institutional setting, the transition to the community is likely to be more successful when collaboration exists among professionals with case management responsibilities in the facility and in the community.  Transition and reentry planning should be initiated well in advance of the client's release in order to identify any current and ongoing intervention needs, promote continuity of care, explore and begin to address potential barriers to reentry in the community (e.g., housing or employment challenges), clarify any post release conditions and expectations, and facilitate access to community resources and services, which may include community-based sexual abuser-specific treatment.

 

e)         Research on correctional populations, including sexual abusers, demonstrates that interventions are most effective when guided by evidence-based principles of correctional intervention (i.e., risk, need and responsivity).  Therefore, community-based risk reduction and risk management strategies involving sexual abusers are ideally matched accordingly and may change over time, based on current and empirically informed assessment information.  Although higher risk/higher need clients may require supervision, monitoring and treatment of greater intensity and dosage, less intensive supervision and other risk management and risk reduction strategies may be more effective and sufficiently adequate for sexual abusers with lower recidivism risk, fewer intervention needs and greater protective factors.

 

f)         Overarching Risk Reduction and Risk Management Considerations

 

1)         Treatment providers recognize that the community management of sexual abusers generally involves a variety of interventions, strategies and mechanisms.

 

2)         Treatment providers appreciate that sex offender-specific public policies and practices have varied goals (e.g., deterrence, retribution, risk management, risk reduction, prevention) and may reflect different interests and priorities for stakeholders.  Some may complement sexual abuser-specific treatment, other risk-reducing interventions and prevention strategies; others may not.

 

3)         Treatment providers recognize that some interventions and strategies used to promote risk management and risk reduction with clients have more empirical support than others.

 

4)         Treatment providers remain apprised of the current research pertaining to the impact and effectiveness of various risk management and risk reduction policies and strategies utilized with clients in the community.

 

5)         Treatment providers are encouraged to work with researchers to assess the impact and effectiveness of community-based risk management and risk reduction strategies utilized with clients.

 

6)         Treatment providers play a role in educating stakeholders regarding the current empirical support for various strategies and encourage the use of research-supported principles and practices to promote effective risk reduction and risk management with clients in the community.

 

7)         Treatment providers appreciate that the application of empirically informed assessments of risk and need can enhance the potential effectiveness of risk management and risk reduction strategies for sexual abusers in the community and support the use of those assessments system-wide.

 

8)         Treatment providers strive to ensure that collaborative partners and other stakeholders have access to current, empirically informed assessments to guide decision making regarding risk management and risk reduction of sexual abusers in the community.

 

g)         Multidisciplinary Collaboration

 

1)         Treatment providers recognize that effectively reducing and managing risk among sexual abusers in the community often involves collaboration across multiple agencies, entities and disciplines.

 

2)         Treatment providers appreciate that their respective roles and responsibilities with clients are part of a broader system of community management.

 

3)         Treatment providers strive to engage stakeholders, such as the judiciary, treatment providers, probation and parole officers, correctional staff, victim advocates, law enforcement agents, employers, landlords and housing officials, civic organizations, mentors, the faith community, and other community supports, in contributing to risk reduction, risk management and prevention activities.

 

4)         Treatment providers recognize that collaborative partnerships are more effective at increasing community safety when the various stakeholders are appropriately trained and knowledgeable about working with sexual abusers.  Therefore, treatment providers promote education and training of the involved professionals and nonprofessionals (e.g., family members, community supports).

 

5)         Treatment providers ensure that information-sharing and collaboration occur within the parameters of confidentiality provisions, informed consent and other ethical standards.

 

h)         Collaborating with Probation/Parole or Other Community Supervision Professionals

 

1)         Treatment providers working with sexual abusers shall collaborate with probation and parole officers, correctional and other facility staff, case managers, and post release aftercare professions to support successful public safety and client outcomes.

 

2)         For clients who are under court-mandated or other formal supervision in the community (e.g., probation, parole, aftercare/step-down from an inpatient treatment facility), treatment providers strive to obtain supervision- and treatment-related information from the appropriate authorities.  This minimally includes copies of:

 

A)        presentence investigations, prerelease evaluations, previous sexual abuser-specific evaluations, treatment summaries, and conditions of probation/parole or post release placement in the community; and

 

B)        when possible, documents regarding the investigation of the offenses.

 

3)         Treatment providers working with sexual abusers review with the probation officers/parole agents and other case managers the specific conditions that are designed for risk reduction and management purposes and discuss the rationale with the clients.  These conditions often include, but are not limited to, the following:

 

A)        Abstaining from alcohol and/or illegal drugs, when substance use is a risk factor;

 

B)        Adhering to treatment expectations (e.g., participation, compliance with program rules and individual treatment plans);

 

C)        Practicing healthy sexual attitudes and behaviors;

 

D)        When appropriate, disclosing offense history, risk factors and effective coping strategies to professionals who are involved with the client and the client's significant others;

 

E)        Making plans for work, social and leisure activities to enhance quality of life and reduce possible exposure to cues or situations associated with the client's risk of reoffending;

 

F)         Complying with other conditions of supervision, such as restricted internet access, employment, volunteering, polygraph examinations and electronic/GPS monitoring; and

 

G)        Complying with restrictions on contact with children or other vulnerable parties (e.g., adults with developmental limitations), as deemed necessary for a given individual.

 

4)         Treatment providers working with sexual abusers establish and clarify the appropriate parameters (e.g., timing, type of content) and mechanisms (e.g., written, verbal, face-to-face) for reciprocal information-sharing with the probation/parole officer or other relevant case management professionals in order to promote well-informed decision making.  This minimally includes the following:

 

A)        Attendance in treatment;

 

B)        Overall participation in treatment;

 

C)        Specific changes in dynamic and protective risk factors;

 

D)        Progress toward specific goals in treatment;

 

E)        Engagement and compliance with supervision;

 

F)         Referrals to and/or participation in additional programs and services; and

 

G)        Adjustments to level of supervision or supervision strategies.

 

5)         Treatment providers report, to the appropriate professionals with the authority and responsibility for supervision, in a timely manner, any violations of their clients' conditions of supervision and significant adverse changes in dynamic risk factors.

 

i)          Treatment providers shall recognize the distinct but potentially complementary roles and responsibilities of treatment providers and supervision officers, clarify these roles and responsibilities to clients and other professionals, and actively strive to maintain these professional boundaries.

 

1)         Treatment providers are aware of the ethical concerns related to dual relationships and adhere to any licensing, discipline-specific, ethical or other credentialing standards and guidelines regarding dual relationships and conflict of interest.

 

2)         While supporting complementary risk reduction and risk management efforts with clients, treatment providers strive to ensure that:

 

A)        Sexual abuser-specific treatment providers limit their role to that of a clinician and do not attempt to assume the roles of supervision officers or law enforcement agents, or represent themselves as such.

 

B)        Probation/parole officers do not represent themselves as specialized sexual abuser-specific treatment providers unless they possess the requisite education, training, supervision, licensure and continuing education;

 

C)        Probation/parole officers who deliver "general" cognitive and/or behavioral interventions to promote skill-building and behavior change among clients are well-trained and appropriately supervised to deliver those interventions with fidelity; and

 

D)        Probation/parole officers do not assume specialized clinical responsibilities within treatment programs for sexual abusers with clients for whom they have supervision responsibility.

 

3)         In order to promote a collaborative treatment approach, treatment providers are encouraged, when clinically appropriate, to allow probation/parole officers to observe clinical treatment sessions in programs for sexual abusers.  However, the following guidelines should be taken into consideration:

 

A)        Treatment providers recognize that these observations can:

 

i)          help educate officers about individuals who sexually abuse and the nature and approach to treatment for sexual abusers; and

 

ii)          help officers obtain information that may enhance their supervision of a given client.

 

B)        Treatment providers recognize that these observations can impact client confidentiality, inhibiting client participation and disclosure; disrupt continuity of the treatment process; and blur clients' perceptions of officers' roles.

 

C)        If allowing these observations, treatment providers:

 

i)          Ensure that officers identify themselves by position and work responsibilities and clarify to session participants their roles and responsibilities as supervision officers;

 

ii)          Review and clarify the purpose and possible impact of having officers present;

 

iii)         Obtain appropriate informed and voluntary consent from clients; and

 

iv)         Ensure that officers are aware of and adhere to professional ethics, including, but not limited to, confidentiality limits and boundaries.

 

j)          Engaging Community Supports

 

1)         Treatment providers shall recognize that an appropriate support person can assist professionals and clients with risk reduction, risk management and other successful outcomes for clients, victims and communities.

 

2)         Treatment providers collaborate with clients and other professionals to identify and engage community support persons in the supervision and treatment processes, when appropriate and feasible.

 

3)         Treatment providers acknowledge that appropriate support persons are able and willing to:

 

A)        Appreciate that clients are responsible for having engaged in sexually abusive behavior;

 

B)        Recognize that recidivism risk can increase and decrease over time;

 

C)        Maintain routine contact with the individual who has engaged in sexually abusive behavior;

 

D)        Understand, recognize,  intervene and report when risk factors are present;

 

E)        Maintain, model and assist clients with practicing prosocial attitudes and behaviors;

 

F)         Support adherence to supervision, treatment and other expectations pertaining to risk reduction and risk management;

 

G)        Participate in the development and implementation of safety plans for victims and other vulnerable persons as applicable; and

 

H)        Communicate routinely and effectively with the professionals responsible for assessing, supervising and providing treatment to sexual abusers.

 

4)         Treatment providers establish and clarify appropriate parameters (e.g., timing, nature, limits, methods) of reciprocal information-sharing with support persons.

 

5)         Treatment providers take appropriate steps to ensure that support persons are equipped with knowledge and skills regarding risk factors for reoffending, strategies for effectively reducing and managing clients' risk for recidivism, and the strengths and limitations of strategies in place.

 

6)         Treatment providers:

 

A)        educate clients and identified support persons regarding the roles, responsibilities, expectations and risks and benefits associated with serving as part of a collaborative support network; and

 

B)        elicit informed consent accordingly.

 

k)         Collaborating with Child Protective/Child Welfare Professionals

This Section pertains to clients whose sexually abusive behaviors, interests, preferences, or arousal involve children and the potential for these clients to have planned or unplanned contact with children (e.g., children in their own families, the children of new romantic partners, friends, coworkers, or neighbors).  It is important to note that contact is not limited to the client's close physical proximity with a child or adolescent, but also includes one-to-one interactions such as telephone calls, emails, written notes and communications through third parties.

 

1)         Treatment providers shall prioritize the rights, well-being and safety of children when making decisions about client contact with minors.

 

2)         Treatment providers take reasonable steps to support a client's adherence to any no contact orders or other restrictions that have been imposed by the courts or other entities statutorily authorized to impose restrictions for that client.

 

3)         When contact with children is at issue under the terms of any legal disposition (e.g., court order, probation/parole order), treatment providers may provide written assessment-driven recommendations regarding an individual client's acceptable level of contact with children that range from no contact to supervised or unsupervised contact.

 

4)         Treatment providers' recommendations regarding contact with minors should be minimally informed by the following:

 

A)        Empirically informed assessments of recidivism risk and protective factors;

 

B)        The client's history of deviant sexual interests, fantasies and behaviors involving children;

 

C)        The nature, extent and duration of the offending behaviors of the client;

 

D)        The client's engagement and progress in sexual abuser treatment, particularly with respect to general and sexual self-regulation, sexual preoccupations and extent of sexual deviance variables; the abuser-victim relationship; and offense-related motivations, grooming patterns, attitudes and offense-specific variables;

 

E)        The presence of positive prosocial supports for the client who can serve as chaperones;

 

F)         The client's engagement and compliance with supervision expectations and conditions;

 

G)        The ability, skills and willingness of nonoffending parents or guardians to provide an environment that is appropriately conducive to maintaining the child's emotional and physical safety;

 

H)        The availability and professional opinions of a qualified child advocate, mental health or child welfare professional to whom the child and family are therapeutically engaged, and the confidence that the child will be able to articulate interests and concerns regarding the potential for contact with the client;

 

I)         The child's reported interests for contact or no contact, or if contact would not be in the best interests of the child; and

 

J)         The extent to which community strategies are currently in place to provide adequate mechanisms and resources to ensure adequate child safety plans for victims and other minors.

 

5)         Treatment providers collaborate with the proper authorities or professionals to support restrictions that prohibit clients from having contact with a child if the child does not want contact or if contact would not be in the best interests of the child or other vulnerable persons.

 

6)         Treatment providers consider the impact that the client's contact with siblings may have on the victim and approve contact that minimizes distress to the victim.

 

7)         Treatment providers work collaboratively with child welfare/child protection agencies, victim advocates and others (e.g., treatment providers, probation/parole officers) to develop safety plans for victims and other vulnerable children.

 

8)         Treatment providers obtain informed consent from a child's nonoffending parent or legal guardian before approving a client's contact with that child, while adhering to the parameters of any legal or other restrictions.

 

9)         Treatment providers may support structured and/or supervised contact with children when the following occur:

 

A)        the client is making acceptable progress in treatment and/or supervision;

 

B)        he/she is effectively managing dynamic risk;

 

C)        appropriate safety precautions are in place; and

 

D)        contact is assessed to be in the best interest of the child by the appropriate/designated professionals working with those responsible for child welfare decisions, taking into account the expressed interests of the child.

 

10)        Within the bounds of confidentiality, treatment providers regularly exchange information in a timely manner with child welfare workers involved in a client's case and with child welfare workers involved in monitoring the safety of children with whom the client is having or considering having contact, unless otherwise specified by law.  Information may include, but is not limited to, the following:

 

A)        Client's treatment progress;

 

B)        Significant changes in dynamic risk factors; and

 

C)        Significant barriers and social services agreements in place with goals and objectives that have to be met by all in order to promote contact or reunification.

 

11)        Treatment providers familiarize themselves with restrictions related to client-victim contact and abide by those restrictions in a therapeutic manner.

 

12)        Treatment providers ensure that, as warranted for a given client, contact with children is addressed as part of a comprehensive community risk management plan and should be linked to the client's re-offense risk, progress in treatment, and/or compliance with supervision, as applicable.

 

13)        Treatment providers document all decisions about a client's contact with children, including whether contact is recommended, the type of contact that is recommended, the preparations made with children and chaperones, and information obtained during the ongoing monitoring process.

 

l)          Addressing Family Reunification and Visitation

 

1)         Treatment providers shall collaborate with child welfare workers to address family reunification efforts when clients have abused children in their own families and wish to have contact with them, or they seek to begin relationships with individuals who have children.

 

2)         Treatment providers recognize that family reunification, in many cases, is not an advisable goal because of the risk and potential for harm that may be unmanageable (e.g., high risk, lack of appropriate caregiver supervision, nature of the victimization, impact on family and victim).  However, family reunification may be one of the many ways that victims and families attempt to resolve issues generated by the offender's abuse and may be beneficial for other reasons in some circumstances.

 

3)         Treatment providers are aware that reunification is a gradual and well-supervised procedure in which a sexual abuser is allowed to reintegrate into the familial network where the victims or potential victims are present.

 

4)         Before providing recommendations regarding family reunification, treatment providers collaborate with professionals from a range of disciplines who have different agency missions and mandates, which may include child welfare professionals, family therapists, victim services providers or advocates, treatment providers, supervision officers, and other community supports.

 

5)         Treatment providers ensure that any child contact decisions within the context of family reunification efforts should be informed by a thorough assessment of the client's risk, the child's safety plan, and consultation with other members of the community risk management team, such as collaborative partners and stakeholders.

 

6)         Treatment providers ensure that, as appropriate and indicated, contact with the client's children, his/her current partner's children, or children of family members are also discussed as part of the reunification process. 

 

7)         Treatment providers do not recommend the involvement of the victims or potential victims in family reunification efforts unless that involvement is likely to benefit the victims or potential victims and unlikely to cause them inordinate levels of distress.

 

8)         Treatment providers, if necessary, recommend that the client be removed from the residence of the victims or potential victims rather than removing the victims or potential victims.

 

9)         Treatment providers consider the wishes of the victims or potential victims with regard to family reunification, taking into account their ability to understand the ramifications of their decisions.

 

10)         Treatment providers ensure that a child has access to a responsible adult chaperone trusted by that child before recommending the client be allowed to have contact with that child.

 

11)         Treatment providers may make recommendations for a client to have contact with interfamilial victims and other family members under 18 (or otherwise vulnerable persons) only when the following are present:

 

A)        A nonoffending parent or another responsible adult who is adequately prepared to supervise the contact;

 

B)        The victim or minor is judged to be ready for the contact by a professional who can monitor the victim's or minor's safety; and

 

C)        The client has made acceptable progress in treatment.

 

12)         Treatment providers ensure that appropriate safety plans are developed and monitored during the family reunification process.  Safety plans should include explicit and nonnegotiable rules and boundaries, as well as the method to address infractions.

 

m)        Engaging Chaperones and Community Supports

 

1)         Treatment providers shall exercise prudence and caution when involved with the selection and education of responsible adult chaperones for contacts between clients and children and other vulnerable parties who may be unable to give consent.

 

2)         Treatment providers recommend as potential chaperones only adults who:

 

A)        Accept and understand the client's history of sexually abusive behavior;

 

B)        Appreciate that the client is solely responsible for decisions to act in a sexually abusive manner (i.e., chaperones do not place responsibility on victims or external circumstances);

 

C)        Recognize the potential for risk and intervention needs to change over time, either increasing or diminishing;

 

D)        Appreciate the need for the client to have prosocial supports; and

 

E)        Accept the role and responsibilities of being an effective chaperone.

 

3)         Treatment providers ensure that clients educate potential chaperones candidly about the clients' sexually abusive behaviors, antecedent and ongoing risk factors, and treatment and/or supervision conditions.

 

4)         Treatment providers ensure that chaperones fully understand the safety plan for the children and appropriate reporting procedures for violations of the safety plan.

 

5)         Treatment providers monitor authorized contacts between the client and children through interviews with the client, the chaperone and/or the child's therapist/support person, and through other supervision options.

 

n)         Continuity of Care

 

1)         Treatment providers shall recognize that continuity of care is necessary to support effective risk management and risk reduction of sexual abusers in the community.

 

2)         Treatment providers facilitate, in a timely manner, the seamless access to and provision of follow-up services for clients who transition from one program to another.   This may include transition from:

 

A)        Institutional to community-based treatment;

 

B)        Community-based treatment to treatment in a correctional, inpatient or other institutional setting;

 

C)        Programming within a facility/institution or within the community, at a lateral level of transfer; or

 

D)        The current jurisdiction/place of residence to a new jurisdiction of residence, due to relocation or transfer of supervision.

 

3)         Treatment providers seek information, through appropriate release of information when necessary, regarding treatment progress and take this into consideration when initiating treatment services for a client who has been receiving services elsewhere or in another setting in order to prevent duplication of efforts and promote timely, assessment-driven, well-informed treatment planning.

 

4)         Treatment providers, to the greatest degree possible, include the client, institutional caseworker, institutional treatment staff, community supervision staff, community treatment staff, family members, and support persons in release planning meetings.  When this is not possible, electronic alternatives, such as teleconferencing or videoconferencing, may be used.

 

5)         Treatment providers providing services to clients prepare written treatment/discharge summaries for clients who change programs, transition from an institution to the community, or transition from the community to an institution (i.e., lesser level of care or increased level of care/security).  These summaries usually include the following elements:

 

A)        Assessment of risk to sexually harm others, including individualized risk factors and indicators of imminent risk;

 

B)        Assessment of dynamic risk factors and protective factors/client strengths (e.g., prosocial support systems);

 

C)        Description of offending pattern;

 

D)        Description of sexual and nonsexual criminal history;

 

E)        Identification of relevant problems and continuing interventions needs (including medication);

 

F)         Level of participation in programming; and

 

G)        Recommendations for community supervision, treatment and support services to guide post-release case management decisions.

 

6)         When appropriate and within ethical parameters, bounds of confidentiality, and other information-sharing statutes or professional regulations, treatment providers working in correctional facilities or inpatient/other institutional settings provide community-based providers, supervision officers/case managers, aftercare workers, and other appropriate support persons with information that can be used to inform appropriate post release or transitional treatment, supervision and management in the community.

 

Section 1905.140  Pharmacological Interventions

 

Treatment providers shall recognize that the usage of pharmacological interventions may be beneficial to the offender and support effective risk management and risk reduction.

 

a)         For adult sex offenders, when used in combination with other treatment approaches, biological interventions like testosterone-lowering hormonal treatments may be linked to greater reductions in sexual arousal.  Nonhormonal psychotropic medications can also be effective supplements to standard therapeutic interventions for sex offenders.  Pharmacological interventions are not typically used for all sexual offenders, but are often applied to those with paraphilias or offense-specific patterns of sexual arousal that could be altered through the use of these interventions. Further, the interventions should be integrated into a comprehensive treatment program that addresses other static and dynamic risk factors that contribute to sexual offending.

 

b)         Hormonal Agents for Managing Sexually Abusive and Paraphilic Behaviors

A number of hormonal agents have been introduced as pharmacological treatments for reducing testosterone and sexual drive in individuals with paraphilias and/or who have engaged in sexually abusive behaviors.  Primary examples include medroxyprogesterone acetate (MPA – Depo Provera), Leuprolide acetate, cyproterone acetate, and gonadotropin-releasing hormone analog.  These chemical agents, referred to as antiandrogens, act by breaking down and eliminating testosterone and inhibiting the production of leutinizing hormone through the pituitary gland, which in turn inhibits or prevents the production of testosterone.  Because testosterone is associated with sexual arousal, the use of these agents generally results in a reduction of sexual arousal.  This reduction in sexual arousal is assumed to also reduce the motivation for sexual offending in individuals predisposed to those behaviors.

 

c)         Nonhormonal Agents for Managing Sexually Abusive and Paraphilic Behaviors

 

1)         Despite there being no double-blind placebo-controlled treatments of the efficacy of selective serotonin reuptake inhibitors (SSRI) for the treatment of sexual offenders, SSRI have been reported to be the most commonly prescribed agents for sexual offenders, at least in the United States and Canada (i.e., 50.3%  of community and 55.3% of residential programs in the United States, and 47.4% of community and 75% of residential programs in Canada, treating adult male sex offenders prescribe SSRI for clients).

 

2)         As is the case with hormonal agents, the prescriptive use of nonhormonal pharmacological agents to treat sexual offenders will not address all etiologies and risk factors and should therefore be combined with psychotherapy specific to sexual offenders.

 

d)         Pharmacological Treatment of Comorbid Psychiatric Conditions

 

1)         Studies of sexual offenders, men with paraphilias, and those with nonparaphilic expressions of "hypersexuality" suggest that mood disorders (dysthymic disorder, major depression and bipolar spectrum disorders), certain anxiety disorders (especially social anxiety disorder and childhood-onset posttraumatic stress disorder), psychoactive substance abuse disorders (especially alcohol abuse), Attention-Deficit/Hyperactivity Disorder (ADHD), and neuropsychological conditions (e.g., schizophrenia, Asperger's syndrome, head injury) may occur more frequently than expected in sexually impulsive men, including sexual offenders.

 

2)         Empirically established effective pharmacological treatments for mood disorders, ADHD and impulsivity are well documented.  These conditions affect prefrontal/orbital frontal executive functioning and are associated with impulsivity; therefore, amelioration of those conditions could certainly affect, if not markedly ameliorate, the propensity to be sexually impulsive.

 

e)         Practice Guidelines

 

1)         Nonphysician treatment providers do not make specific recommendations about what medications should be prescribed.  It is appropriate for treatment providers to refer clients to physicians who have experience working with individuals who sexually offend as possible candidates for pharmacological therapy.  They can provide information about the role of pharmacological therapy in sexual deviancy treatment to the consulting doctor.  Nonphysician treatment providers could consider referring clients to a physician for possible pharmacological therapy if these clients have relatively high levels of deviant sexual arousal, are considered to be at moderate to high risk for reoffending, or have not been able to achieve control over their deviant sexual arousal using sexual arousal conditioning procedures.  Clients who repeatedly engage in impulsive or compulsive behavior, or who report a persistent inability to control deviant sexual fantasies, arousal or behavior may also be reasonable candidates for pharmacological therapy.  Motivated and informed clients are often the best candidates for pharmacological therapy.

 

2)         A physician prescribes medications only after a comprehensive sexual abuser evaluation has been completed.  It is important to individualize medical treatment for the patient based on the patient's particular need, response, medical history and personal agreement with the treatment offered.  Pharmacological therapy is linked to appropriate treatment and supervision and is medically monitored.  As with any treatment, appropriate informed consent is obtained when pharmacological therapy is implemented.  Informed consent includes a discussion of medication options, targeted symptoms, potential side effects, and the expected course of pharmacological therapy.

 

3)         The use of medication may help clients manage their risk for sexually abusive behavior, but medications do not "cure" deviant sexual interests or fully eliminate the risk of reoffending.

 

f)         Ethical Considerations

Research support for the effectiveness of pharmacological treatments such as testosterone-reducing agents is mixed.  Without clear data regarding the efficacy of pharmacological treatments, providers should be sure to balance the risks of the interventions with potential benefits of treatment.

 

Section 1905.150  Psychophysiological Tools

 

Treatment providers and evaluators shall recognize that the usage of psychophysiological tools may be utilized in the assessment of offenders in relation to treatment progress, compliance with supervision, and support effective risk management and risk reduction.  The following will detail each type of psychophysiological tool.

 

a)         Phallometry

 

1)         Phallometry is a specialized form of assessment used in treatment with individuals who have committed sexual offenses.  Responsible use of phallometry results requires at least a rudimentary understanding of how phallometry works and its advantages and limitations.  As with any instrument or procedure, treatment providers are familiar with current literature and obtain appropriate training before using or interpreting phallometric testing results.  Examiners receive training in phallometric testing in order to become knowledgeable about the technical aspects of the equipment and the appropriate protocols for conducting phallometric testing specific to the equipment being used.  Examiners are also familiar with the research evidence on the reliability and validity of phallometric testing.

 

2)         Phallometric testing using penile plethysmography involves measuring changes in penile circumference or volume in response to sexual and nonsexual stimuli.  Circumferential measures (measuring changes in penile circumference) are much more common than volumetric measures (measuring changes in penile volume), which are used in only a few laboratories worldwide.  However, there is good agreement between circumferential and volumetric measures once a minimal circumference response threshold is reached.  Therefore, circumferential measures are the focus of this subsection (a).

 

3)         Phallometric testing provides objective information about male sexual arousal and is therefore useful for identifying deviant sexual interests during an evaluation, increasing client disclosure, and measuring changes in sexual arousal patterns over the course of treatment.

 

4)         Phallometric test results are not used as the sole criterion for determining deviant sexual interests, estimating risk for engaging in sexually abusive behavior, recommending that clients be released to the community, or deciding that clients have completed treatment programs.  Phallometric test results are interpreted in conjunction with other relevant information (for example, the individual's offending behavior, use of fantasy and pattern of masturbation) to determine risk and treatment needs.  Phallometric test results are not to be used to draw conclusions about whether an individual has committed a specific sexual crime.  As well, there are limited data available regarding the use of plethysmography with clients who have developmental disabilities and clients with an acute major mental illness.  Therefore, treatment providers need to exercise caution in using phallometry with these populations and in interpreting and reporting phallometric results.

 

5)         Prior to testing, examiners screen clients for potentially confounding factors such as medical conditions, prescription and illegal drug use, recent sexual activity, and sexual dysfunction.  Clients with active, communicable diseases, particularly sexually transmittable diseases, are not to be tested until their symptoms are in remission.

 

6)         Specific informed consent for the testing procedure and release forms for reporting test results are obtained at the beginning of the initial appointment.  Laboratories have a standard protocol for fitting gauges, presenting stimuli, recording data and scoring.

 

7)         Examiners use the appropriate stimulus set to assess sexual interests that are the subject of clinical concern.  For example, examiners use a stimulus set with depictions of children and adults to test clients who have child victims or who are suspected of having a sexual interest in children.  At a minimum, examiners have at least two examples of each stimulus category.  Stimuli that are more explicit appear to produce better discrimination between individuals who sexually offend and control subjects than less explicit stimuli.  It is important to ensure that the stimuli are good quality and avoid any distracting elements.

 

8)         Treatment providers are aware of the applicable legislation in their jurisdiction regarding the possession of sexually explicit materials.  If permitted to use visual stimuli for testing of sexual interest in children, examiners use a set of pictures depicting males and females at different stages of physical development, ranging from very young, prepubertal children to physically mature adults.  The use of neutral stimuli, such as pictures of landscapes without people present, may increase the validity of the assessment.  The inclusion of the neutral stimuli serves as a validity check because responses to sexual stimuli that are lower than responses to neutral stimuli might indicate faking attempts.  Faking tactics include looking away from or not listening to stimuli.  Audiotaped stimuli may also be used to assess sexual interest in children; if used, these stimuli clearly specify the age and sex of the depicted individuals.

 

9)         For testing of sexual arousal to nonconsenting sex and violence, examiners using audiotapes include stimuli describing consenting sex, rape and sadistic violence.  Stimuli depicting neutral, nonsexual interactions are also included.  Stimuli can depict males or females, children or adults.

 

10)        The phallometric testing report includes a description of the method used for collecting data, the types of stimuli used, an account of the client's cooperation and behavior during the testing, and a summary and description of the client's profile of responses.  Client efforts to fake or other potential problems with the validity of the data or the interpretation of results are also reported.

 

11)        The three most common means of scoring plethysmograph data are standardized scores, percentage of full erection, and millimeter of circumference change.  Those using phallometric assessment are aware of the advantages and disadvantages of each scoring method.  Research has found that standardized scores (e.g., z scores) increase discrimination between groups.  Transforming raw scores to standardized scores for subjects who show little discrimination between stimuli can, however, magnify the size of small differences between stimuli.  Raw scores, millimeter of circumference change, or scores converted to percentage of full erection may be clinically useful in the interpretation of results.

 

12)        Deviance indices can be calculated by subtracting the mean peak response to nondeviant stimuli from the mean peak response to deviant stimuli.  For example, a pedophilic index could be calculated by subtracting the mean peak response to stimuli depicting adults from the mean peak response to stimuli depicting prepubescent children.  Thus, greater scores indicate greater sexual arousal to child stimuli.

 

13)        Because the sensitivity of phallometric testing is lower than its specificity, the presence of deviant sexual arousal is more informative than its absence.  Results indicating no deviant sexual arousal may be a correct assessment or may indicate that a client's deviant sexual interests were not detected during testing.

 

14)         Research indicates that initial phallometric assessment results are linked with recidivism.  Repeated assessments can be helpful to monitor treatment progress and to provide information for risk management purposes.

 

b)         Viewing Time

 

1)         Viewing time is a specialized form of assessment used in the treatment of individuals who have committed sexual offenses.  Responsibly using the results of viewing-time measures requires treatment providers to have at least a rudimentary understanding of how viewing time measures work, as well as their advantages and limitations.  As with any instrument or procedure, treatment providers should be familiar with current literature and obtain appropriate training before using or interpreting viewing time testing results.

 

2)         Unobtrusively measured viewing time is used as a measure of sexual interest.  The relative amount of time clients spend looking at pictures of children (who can be clothed, semiclothed or nude) is compared to the time that the same adult spends looking at pictures of adults.  Research suggests that, as a group, individuals who have offended against children look relatively longer at stimuli depicting children than adults.  Unobtrusively measured viewing time correlates significantly with self-reported sexual interests and congruent patterns of phallometric responding among nonoffending subjects.  Little is known, however, about the value of retesting using viewing time as a measure of treatment progress.

 

3)         As with any test, specific informed consent for the test procedure and release forms for reporting results are obtained prior to beginning testing.  Examiners have a standardized protocol for presenting the stimuli, recording and scoring.  Examiners are familiar with the reliability and validity of the test.  In particular, it is important that examiners know the degree to which the viewing time measure being used has been validated for the client population being assessed.  This technology has primarily been used to identify sexual interest in gender and age.  As well, there is limited information specific to the use of viewing time with clients with developmental disabilities.

 

4)         For testing sexual interest in children, examiners have a set of pictures depicting males and females at different stages of development, ranging from very young children to physically mature adults.  It is important that stimuli are of good quality and avoid any distracting elements.  Treatment providers who use sexually explicit stimuli are aware of applicable legislation in their jurisdiction about possession of these materials.

 

5)         The test report includes a description of the method used for collecting data, the types of stimuli used, an account of the client's cooperation and behavior during testing, and a summary and description of the client's responses.  Client efforts to fake or other potential problems with the validity of the data or the interpretation of results are also included.

 

6)         As noted in this subsection (b), viewing time is not to be used as the sole criterion for determining deviant sexual interests, estimating a client's risk for engaging in sexually abusive behavior, recommending whether a client be released to the community, or deciding whether a client has completed a treatment program.  Viewing time test results are interpreted in conjunction with other relevant information (for example, the individual's offending behavior, use of fantasy, the pattern of masturbation) and are never to be used to make inferences about whether an individual has committed a specific sexual crime.

 

AGENCY NOTE:  Viewing time is a more accepted practice with juveniles and less intrusive than phallometry or polygraphy.

 

c)         Polygraphy

 

1)         Polygraph testing involves a structured interview during which a trained examiner records several of an examinee's physiological processes.  Following this interview, the examiner reviews the charted record and forms opinions about whether the examinee was nondeceptive or attempting deception when answering each of the relevant questions.

 

2)         Post conviction Sex Offender Polygraph Testing is a specialized form of general polygraph testing that has come into widespread use in the United States.  Although all principles applicable to general polygraph testing also apply to post conviction sex offender testing, its unique circumstances generate additional challenges.  Using post conviction sex offender testing responsibly requires treatment providers to have at least a rudimentary understanding of how polygraphy works, its advantages and limitations, and special considerations related to its integration into sex offender work.  This subsection (c)(2) serves as a brief introduction to these issues.  As with any instrument or procedure, treatment providers should be familiar with current literature and obtain appropriate training before using or interpreting polygraph results.

 

3)         Post-conviction sex offender testing is intended to serve two objectives:

 

A)        To generate information beyond what can be obtained from other self-reported measures; and

 

B)        To explore and support compliance and gauge progress with respect to supervision expectations and treatment expectations and goals.

 

4)         Some research indicates that the polygraph exam can lead to clients providing increased information regarding their offending; however, test validity and reliability often vary widely across studies.  Therefore, it is important for providers to become informed about types of tests that produce the most accurate findings.  As well, it is possible that some of the information obtained through post conviction sex offender testing might be fictitious, representing an accommodation to pressure for disclosures.  The second objective of post conviction sex offender testing (enhanced supervision and treatment compliance) has received only limited empirical attention.

 

5)         The American Polygraph Association, the National Association of Polygraph Examiners, and other polygraph associations have developed standards for certifying polygraph examiners who work in sex offender management and treatment, as well as standards for administering sex offender tests.  Some states also regulate post conviction sex offender testing standards and procedures.  Treatment providers are familiar with laws, state regulations, and association guidelines governing post conviction sex offender testing where they practice.  Treatment providers work with examiners who meet certificate requirements and adhere to procedures recommended by a relevant polygraphists' organization.

 

6)         Four types of post conviction polygraph exams are commonly performed with sex offenders:

 

A)        Instant/Index Offense Tests are designed to explore and clarify discrepancies between the offender's and the victim's descriptions of the conviction offenses.

 

B)        Sexual History Disclosure Tests are designed to facilitate a client's disclosure to their treatment providers of sexual history information, which may include sexually abusive or offense-related behaviors.

 

C)        Maintenance/Monitoring Tests are designed to explore potential charges, progress and/or compliance relative to treatment, supervision and other case management goals, objects and expectations.

 

D)        Specific Issue Tests are generally designed to explore a client's potential involvement in a specific prohibited behavior, such as unauthorized contact with a victim at a particular time.

 

7)         Polygraph test accuracy is believed to be greatest when examiners focus on highly specified (i.e., single issue, narrow and concrete) questions.  Treatment providers cooperate with examiners in structuring tests that are responsive to program needs without unnecessarily compromising accuracy considerations.

 

8)         Limits of confidentiality are fully disclosed to clients prior to polygraph testing.  Clients are informed in writing about how the results of polygraph exams will be used and who will receive the results.  Clients are informed about the possible consequences to them as a result of the polygraph exam.

 

9)         There is very limited empirical research on the use of polygraph with clients who have developmental disabilities and clients with low/borderline IQs.  Therefore, additional caution is advised if treatment providers use polygraph in the management and treatment of these clients.

 

10)        Polygraph charts are not the only means of monitoring offenders' behavior and are not to be the sole basis for significant case decisions.  Examiner and examinee characteristics, treatment milieu, instrumentation, procedures, examination type, base rates of attempted deception in the populations being tested, and other idiosyncratic factors can affect accuracy and usefulness.  Likewise, when questions are not highly specific, there is reason for concern regarding the results of polygraph testing for monitoring purposes.

 

11)        Treatment providers' primary purpose for collecting sexual history information is the increased ability to design clinical interventions and other management strategies.  The usefulness of post conviction sex offender polygraph testing as a clinical tool derives from its ability to elicit historical information, allowing psychosexual behavioral patterns to be more fully revealed, better understood and, therefore, more effectively managed and changed.  Client disclosures of potentially incriminating information to mandated reporters can, however, lead to future prosecution.  Treatment providers inform clients, in writing, of this potential dilemma and how it is addressed in their jurisdiction and program.

 

12)        Polygraphy is not used as the sole criterion for determining deviant sexual interests, estimating a client's risk for engaging in sexually abusive behavior, recommending whether a client be released to the community, or deciding whether a client has completed a treatment program.  Polygraph results are interpreted in conjunction with other relevant information to make these decisions.  Polygraph results should be one of the many variables for treatment providers to utilize when changing a client's status in treatment.