TITLE: Sotp Program Components
Program components for the SOTP shall include assessment, group therapy and individual counseling in accordance with the Iowa Sex Offender Treatment Program Standards.
- Assessment reports prepared by the contracted provider, shall be completed in accordance with the following guidelines from the Iowa Sex Offender Treatment Program Standards:
- A thorough assessment is needed to identify specific behavior excesses and deficits that predisposed each offender's sexual aggression. Assessment is also required to determine if the offender may be treated effectively within the Department's SOTP.
- There are significant differences between the assessment of offenders typically seen in mental health settings and coerced offenders such as Criminal offenders. Such offenders may adopt an adversarial stance and fail to cooperate fully with the purpose of the assessment, limiting the evaluator's access to sensitive material. The assessment shall attempt to determine the risk the offender poses to the community. The evaluator shall not advocate for the Department, Criminal justice systems nor for the offender.
- For adjudicated offenders, a complete assessment at the presentence level is optimal. The goal of the assessment is to identify factors related to risk for the repeat of sexual offending, to identify treatment issues, and to determine treatment amenability to the SOTP. The assessment shall include a thorough review of all pertinent information available at the time of the offense (before seeing the offender). The clinical assessment of offenders participating in the Creston area SOTP shall be included in the presentence investigation.
- The Polk County area office has determined that it is appropriate to complete the clinical assessment including psycho-sexual testing and polygraph post-sentencing, however, the SOTP Correctional Officer will complete the social/sexual history, record review and offender interview as a component of the presentence investigation.
- Assessments will be completed on all offenders Court ordered to the SOTP and shall address the following:
- Sexual Arousal/History - Inclusion of a sexual history at the presentence level is requisite. Assessment of sexual arousal in a laboratory is optimal. Collateral interview of a significant other is highly recommended. The clinician should attempt to determine whether the offender has adequate social skills and sex education to engage in appropriate consensual activity. This information may be obtained by taking a detailed sexual history.
- Social Competence - An analysis of social skills should assess the offender's success in employment, adult relationships, and social responsibilities. Factors such as I.Q., reading ability, and other learning traits are important variables. A history of aggression and violence are also potent predictors for future behavior.
- Personality Assessment - The assessment of mental illnesses, thought or delusional disorders and personality disorders is important in understanding how they contribute to the aberrant behavior. Appropriate referrals should be made for follow-up to address psychotropic medications and/or psychiatric factor in recidivism.
- Substance Use - Chemical dependence does not cause deviant sexual interests. It may contribute to the etiology of the offense and certainly does complicate treatment. Where there is evidence of substance abuse or dependence, referral for appropriate treatment should be made, concurrent with sex offender treatment.
- Physiological Evaluation - Based on the potential unreliability of self-reporting among sexual abusers, the use of phallometry and polygraph has become widespread in the identification, treatment and management of sexual abusers. Several studies have linked the history of sexually deviant behavior and deviant sexual arousal to risk and recidivism. Therefore, instruments that promote the collection of data in these areas are deemed to have significant clinical value. However, with any psychophysiological instrument, care must be taken to avoid misuse or over reliance on the instrument, procedure or the resulting data. Clinicians using polygraph or phallometry must be aware of the limitations of the instruments and current methodology. Clinicians should also be knowledgeable about the current research regarding interpretation and validity.
- Polygraph - The goal of the polygraph examination is to obtain information necessary for the risk management and treatment, and to reduce the sex offender' denial mechanisms. The examiner should evaluate answers to carefully developed questions as truthful, deceptive or inconclusive. Deceptive results flag areas of concern that the treatment provider and supervising officer need to investigate further. Every effort should be made to assist the offender in obtaining a positive evaluation so that treatment can be informed and relevant. To this end, polygraph data should be used in conjunction with other information when making decisions about case management of sex offenders. All polygraph examiners must: 1)Meet the "Guidelines for Sex Offender Testing" established by the Iowa Polygraph Association and; 2)Successfully complete 40-hours of specialized sex offender examination training recognized and approved by the Iowa Polygraph Association.
- Plethysmography - The purpose of the phallometric assessment of sexual arousal is to provide objective data regarding sexual preferences. It can be used to identify the need to reduce and control deviant sexual arousal. It may also promote self-disclosure and reduce minimization and denial of sexual offenses. Additionally, it can assist in monitoring changes in sexual arousal patterns which have been modified by treatment.
- " Phallometric assessment data should not be used as a sole measure to predict risk of engaging in deviant sexual behavior.
- " Failure to develop significant responses to deviant sexual themes cannot be used to demonstrate innocence of specific allegations of sexually deviant behavior.
- " Development of significant arousal to deviant themes cannot be used to demonstrate guilt of a specific allegation of sexually deviant behavior.
- " It is inappropriate to use erection responses to determine or make statements about whether or not someone has engaged in a specific behavior or whether someone fits the "profile of a sexual abuser".
- " Extreme caution should be used in interpreting erection responses to non-standardized sets of stimuli.
All agencies utilizing plethysmography must follow the standards for plethysmograph examination established by the Association for the Treatment of Sexual Abusers (ATSA) as identified in their Ethical Standards and Principals for the Management of Sexual Abusers, Section 15 and Appendix B.
- Biological Factors - A screen for biological factors, in particular the endocrine system abnormalities and neuropsychological impairments, is desirable as they can play a significant role in the commission of sexual offenses. Biological factors must be assessed for offenders being considered for hormonal intervention therapy. The most prominent factors are endocrine functioning as examined by sex hormones and routine blood work (liver functioning and glucose).
- Assessment of Offenders
- SOTP staff shall determine if the offender has a current assessment with recommendations for treatment. If not, the case shall be discussed with a supervisor/manager and/or the contracted provider to determine if an assessment is needed and shall be required of the offender.
- Possible reasons for excusing the assessment requirement may include a short supervision period of six (6) months or less, mental or emotional instability of the offender, other assessment or counseling services already provided to the offender through another agency, or other such special circumstances.
- Note: If deemed appropriate by SOTP staff and/or the Contracted Provider, an assessment for an offender may be limited to polygraphy if no other risk factors, except sexual arousal and history, have previously been addressed through other assessments or evaluation.
- Dependent on the county of jurisdiction within the District, the offender will be referred for assessment to the appropriate Contracted Provider either at the PSI stage (Creston Area SOTP) or following intake (Des Moines Area SOTP).
- The first assessment appointment for the offender shall be arranged by SOTP staff by telephone with the date, time and place of the appointment provided to the offender. Travel permits will be given to the offender if necessary. Prompt notice shall be made to the Provider doing the assessment should it be necessary to change the appointment or the offender is unable to attend.
- The referral process shall be completed by sending the following information to the evaluation agency: 1)known social and criminal history of the offender; 2)trial information; 3)minutes of testimony; 4)victim statement of the current offense; 5)any other pertinent material.
- Individual counseling and/or group therapy sessions conducted by Contracted Providers, shall in accordance with the following guidelines from the Iowa Sex Offender Treatment Program Standards:
- Treatment of the sex offender is frequently coerced, therefore, it is not necessary for the offender to enjoy treatment, to like his/her treatment provider, or the SOTP requirements. Treatment requires that the offender give up some of his/her most pleasurable and stimulating activities. The purpose of treatment is to gain control over deviant arousal, maintain healthy functional relationships, develop self-confidence in one's abilities to interact in the world, and behave in a responsible and safe manner, thereby lessening the risk of re-offense to the community.
- The goal of treatment is to eliminate recurring sexual assault. Treatment of the offender in prison or the community will reduce the risk posed to society by some offenders.
- Post-treatment management using relapse procedures should include long-term follow-up. Just as evaluation procedures cannot be based on a single assessment technique or instrument, treatment programs must be multifaceted. Information on sexual arousal patterns, social competence, and cognitive distortions may eventually allow predictions to be made about the likelihood of recidivism in the future.
- All individual and group therapy shall include the following:
- Cognitive Factors - Cognitive distortions refer to self-statements made by offenders that allow them to deny, minimize, justify, and rationalize their behavior. Other factors include attitudes supportive of sexual assault and lifelong patterns of distorted thinking by individuals who engage in criminal behavior. The clinical approach which has the most potential for changing cognition is cognitive behavioral therapy adapted to sex offenders. It is not just the actual cognitive restructuring techniques which may produce the desired changes in attitudes. Every aspect of treatment is likely to change typical patterns of thinking.
- Relationship Skills - Empathy for victims represents a critical source of motivation for the offender's treatment and maintenance. Victim empathy should be developed prior to the introduction of Relapse Prevention. Relapse Prevention concepts are highly cognitive strategies. They can heighten an offender's intellectualized defenses recognizing the harm inflicted upon victims. This may result in offenders viewing Relapse Prevention as an interesting intellectual exercise.
- Relapse Prevention - Sexual offending is not a mental illness. The behavior of sexual offenders is not out of their control. Relapse Prevention trains offenders to reduce exposure to risky situations, to alter their view is a pro-social direction, to develop more acceptable responses to meet their needs, and to provide them with the skills necessary to enact these alternatives. The offender is seen as continuing to be at some risk after treatment which should be followed by some form of continuing contact until legal expiration of sentence.
- Modification of Inappropriate Sexual Arousal - The goal of intervention is elf-control of deviant sexual interests identified in treatment evaluation. Behavioral treatments may be used to assist the offender in controlled deviant arousal. The offender shall be taught and encouraged to use strategies that will promote generalization to everyday life. The Contracted Provider (C.A.S.) currently utilizes ammonia aversion as a treatment option.
- Appropriate Use of Medication - The effective use of anti-androgens with selected offenders can enhance progress in treatment and reduce level of risk to the community. Many psychotropic medications have been used to therapeutic advantage. These include but are not limited to neuroleptics, Lithium, anti-depressant and anti-anxiety drugs in addition to hormonal agents. Pharmacological therapy should be used only as past of a multifaceted treatment program. Medical contra-indications must be respected and informed consent is requisite.
- Individual counseling for offenders:
- When assessment report recommends individual counseling, or an offender receiving group therapy is deemed inappropriate to continue, and/or an offender is determined by SOTP staff to be unable to participate in group therapy, the officer or counselor supervising the offender may refer the offender to a contracted provider, community mental health agency or private practitioner, to obtain individual counseling, if the offender has private insurance, access to public funding, or is otherwise able to pay for the counseling. For offenders who do not have the above payment resources, a referral may be made to the contracted provider for individual counseling and/or for assistance in locating other counseling resources.
- When referred for individual counseling, should the offender not have already done so, the offender shall sign the SOTP Release of Information and contract/supervision agreement. A standard two-party release shall also be signed to request dates of counseling sessions, counseling plans, progress in counseling, and recommendation for monitoring techniques, behavioral restrictions, etc.
- The provider shall be given the following information about the offenders know social and criminal history, trial information, minutes of testimony, victim statements, information from any other evaluation materials and a copy of all supervision conditions.
- The first individual counseling appointment for any offender shall be arranged by SOTP staff by telephone with the time, date, and place of appointment provided to the offender. Prompt notice shall be made to the provider should it be necessary to change the appointment or the offender is unable to attend.
- Group therapy sessions for supervised offenders:
- Group therapy sessions shall cover the following education and treatment topics as outlined idn the Department's Sex Offender Treatment Program Curriculum:
- Social Skills
- Interpersonal Relationships
- Sex Education
- Deviant Cycle
- Relapse Prevention
- Recreations and Leisure
- Program Exit
- Sessions shall be open, allowing offenders, as directed by SOTP staff to enter at the beginning of new topics.
- Every offender entering group sessions shall receive a group or individual orientation to the program that includes an overview, explanation of fees, group rules, etc.
- The time required for an offender to be in treatment shall be determined by SOTP staff in consultation with Contracted Providers, or Department supervisory staff. All offenders entering group shall be required to attend sessions covering all education and treatment topics in the SOTP curriculum. No excused absences shall be allowed, i.e., all sessions must be made-up by completing homework assignments, attending another group session, or attending the missed session when again offered, etc., as directed by SOTP staff.
- When an offender is staffed by the above individuals, a decision may be made for mandatory group attendance to be continued or modified to an aftercare status with required attendance of fewer than weekly sessions per month. (See program completion). As supervision of the offender continues by the Department, the offender may be required, at any time, to again attend group sessions as directed by SOTP staff.
- Aftercare for an offender shall continue until the offender is discharged from supervision. The frequency of aftercare sessions required of an offender shall be the determination of SOTP staff in consultation with Contracted Providers, and the Department supervisory staff.
- Services may include a self-contained, but open to group, to provide group therapy for low-functioning offenders.
- Intra-Familial Programming:
- Offenders whose victim was a family member may be referred to any other Department approved provider of group therapy for intra-familial offenders, if participation is possible and appropriate.
Note: Prior to the referral of an intra-familial offender to any provider, SOTP staff shall have reviewed the referral program in order to determine that it meets applicable Iowa Sex Offender Treatment Program Standards for such treatment.
- Intra-familial treatment for sexual abuse recognizes that a complete treatment program will treat both the offender's predisposition to offend as well as the dynamics within the family. This approach takes into account both the treatment needs of the offender and the family system.