STANDARDS OF PRACTICE FOR
SEX OFFENDER TREATMENT
PROGRAMS IN NEW HAMPSHIRE
I. SEX OFFENSE SPECIFIC TREATMENT
A. A provider who treats sex offenders under the jurisdiction of the criminal justice system must use sex offense specific treatment.
B. A provider shall develop a written treatment contract
based on the needs and risks identified in current and past
assessments/evaluations of the offender.
C. A provider shall maintain clients’ files in accordance
with the professional standards of their individual disciplines and with New
Hampshire state law on health care records.
Client files shall:
1.
Document the goals of
treatment, the methods used, the client’s observed progress, or lack thereof,
toward reaching the goals in treatment records. Specific achievements, failed assignments, and rule violations
should be recorded.
2.
Accurately reflect the
client’s treatment progress, sessions attended, and changes in treatment.
D. The Treatment Plan shall:
1.
Provide for the
protection of victims and potential victims and the community. It shall not cause the victims to have
unsafe and/or unwanted contact with the offender; and it shall
2.
Be individualized to
meet the unique needs of the offender;
3.
Identify the issues to
be addressed, including multi-generational issues if indicated, the planned
intervention strategies, and the goals of treatment;
4.
Define expectations of
the offender, his/her family (when possible), and support systems;
5.
Address the issue of
on-going victim input when in the best interests of the victim.
E. A provider shall employ treatment methods that are
supported by current professional
research and practice:
1. Group therapy is the preferred method of sex offense-specific treatment. At a minimum, any method of psychological treatment used must conform to the standards for content of treatment (see F) and must contribute to behavioral monitoring of sex offenders. The sole use of individual therapy is not generally recommended with sex offenders, and shall be avoided except when clinically indicated.
2. Additional clinical intervention may include treatment for drug/alcohol abuse, marital therapy, and individual crisis intervention. However, sex offense specific group treatment should remain the primary modality utilized with sex offenders.
(June 2001)
3. If available, the use of male and female co-therapists in group therapy is highly recommended.
4. The optimum size for a clinical group is eight (8), however group size shall not exceed ten (10). Groups specific to the cognitively impaired shall not exceed six (6). It is understood that a particular treatment program may be structured in such a way that specific didactic modules of psycho-educational information are presented to larger groups of sex offenders at one time. Such psycho-educational information is a component of, but not a substitute for sex offense specific treatment.
5.
New Hampshire ATSA
believes that the treatment of sex offenders is sufficiently complex and the
likelihood of re-offense sufficiently high that the client/therapist ratio and
group size should be fairly small.
6.
The provider shall
employ treatment methods and decisions that give priority to the safety of the
offender’s victims and the safety of potential victims and the community.
7.
The provider shall
employ treatment methods that are based on recognition of the need for
long-term comprehensive, offense-specific treatment for sex offenders. Self-help or time limited treatments shall
be used only as adjuncts to long-term, comprehensive sex offender specific
treatment.
F. The content of offense specific treatment for sex
offenders shall be designed to:
1.
Reduce offenders’ denial
and defensiveness;
2.
Decrease and/or manage
offenders’ deviant sexual urges and recurrent deviant fantasies;
3.
Identify and treat the
offenders’ thoughts, beliefs, emotions, and behaviors that sustain sexual
re-offenses or other victimizing or assaultive behaviors;
4.
Identify and address
offenders cognitive distortions;
5.
Identify and treat
offenders personality traits and deficits that are related to their potential
for re-offending;
6.
Identify and treat the
effects of trauma and past victimization on offenders as are related to their
potential for re-offending. (It is
essential that offenders be prevented from assuming a victim stance in order to
diminish responsibility for their actions);
7.
Identify and treat
issues of anger, power and control;
8.
Educate offenders about
the potential for re-offending and an offender’s specific risk factors;
9.
Teach offenders
self-management methods to avoid a sexual re-offense;
10. Educate offenders about non-abusive, adaptive, legal
and pro-social sexual functioning;
11. Educate offenders about the impact of sexual offending
upon victims, their families, and the community;
12. Provide offenders with an environment that encourages
the development of empathic skills needed to achieve sensitivity and empathy
for victims.
13. Provide offenders with the guidance to prepare a
written clarification for the victim(s) that meets the goals of: establishing
full perpetrator responsibility, empowering the victim, and promoting emotional
restitution for the victim(s);
14. Identify and address offenders’ deficits in social and
relationship skills, where applicable;
15. Require offenders to develop a written relapse
prevention plan for preventing a re-offense; the plan should identify antecedent
thoughts, feelings, circumstances, and behaviors associated with sexual
offenses;
16. Provide treatment referrals, as indicated, for
offenders with co-existing medical, pharmacological, mental, substance abuse
and/or domestic violence or other issues;
17. Maintain open and honest communication with other
significant persons in offenders’ support systems when indicated, and to the
extent possible, to assist in meeting treatment goals;
18. Evaluate cultural, language, developmental
disabilities, sexual orientation and/or gender factors that may require special
treatment arrangements, and address appropriately.
G. The provision of educational and support services to
the families of sex offenders enhances the possibility of meeting treatment, supervision
and community safety goals.
A. A treatment provider shall obtain signed waivers of
confidentiality based on the informed consent of the offender. The waiver of confidentiality should extend
to the victim’s therapist, all supervising officers and members of the
treatment team. If applicable it should
include the Department of Human Services and other individuals responsible for
the supervision of the offender.
B. When indicated and consistent with the informed
consent of an offender, a provider shall; obtain a waiver of confidentiality in
order to communicate with the victim’s therapist, guardian ad litem, custodial
parent, guardian, caseworker or other professional; involved in making
decisions regarding reunification of the family or an offender’s contact with
past or potential child victims.
C. A provider shall obtain specific releases of
information for communication with other parties in addition to those described
in this standard.
A. Prior to entering a contractual agreement for
treatment, the offender shall participate in an assessment/evaluation. At a
minimum, this should include a clinical interview, which consists of:
1.
A complete history
including social, sexual, criminal, medical, and substance abuse;
2.
The dynamics of the
sexual offending behavior;
3. Identification of problem areas and treatment goals.
A. A provider shall develop and utilize a written
contract with each sex offender (see Appendix A). The contract shall define the specific responsibilities of both
the provider and the offender. Prior to entering into a contractual agreement
for treatment, the offender shall have an assessment or evaluation.
B. The contract shall explain the responsibility of a PROVIDER to:
1.
Define and provide
timely statements of the costs of treatment including all medical and
psychological tests and consultations;
2.
Describe the waivers of
confidentiality that will be required for a provider to treat the offender for
his/her sexual offending behavior. Describe
the various parties with whom treatment information will be shared during the
treatment. Describe the time limits on the waivers of confidentiality and
describe the procedures necessary for the offender to revoke the waiver (see
Appendix B);
3.
Describe the right of
the offender to refuse treatment and/or refuse to waive confidentiality and
describe the risks and potential outcomes of that decision;
4.
Describe the type,
frequency, and requirements of the treatment and outline how termination of
treatment program will be determined;
5.
Describe mandatory
reporting law, RSA 169-C (see Appendix C);
6.
The provider must ensure
that the provider/offender contract is not in conflict with rules and contracts
of the Department of Corrections. (See Appendix D). These rules supercede the
provider/offender contract. It is the
responsibility of the provider to maintain an open dialogue with the parole
officer handling the case, which includes a written monthly report.
C. The contract shall explain any responsibility of an OFFENDER to:
1.
Pay for the cost of
assessment and treatment for him or herself, and his/her family, if applicable;
2.
Pay for the cost of
assessment and treatment for the victims and their families, when ordered by
the court, including all medical and psychological tests, psychological testing
and consultation.
3.
Under the guidance and
supervision of the therapist, the offender shall inform the offender’s relevant
family, and support system of details of past offenses which are essential to
ensuring help and protection for past and potential victims and to the relapse
prevention plan. Clinical judgement, in
conjunction with parental discussion, should be exercised in determining what
information is provided to children.
4.
Notify the treatment
provider of any changes or events in the lives of the offender and members of
his family or support system.
5.
If indicated,
participate in polygraph, unless there is a significant mental impairment or
medical condition.
6.
Participate in
plethysmograph testing as required by the treatment provider.
7.
Identify and provide a
minimum of one appropriate chaperone who will participate in chaperone
training. (See Section IX).
8.
Comply with conditions
of probation, parole or community corrections.
D. This contract shall also, (as applicable):
1.
Provide instructions and
describe limitations regarding the client’s contact with victims, secondary
victims and children.
2.
Describe limitations and
prohibitions on viewing of sexually explicit or violent material.
3.
Describe the
responsibility of the offender to protect community safety, by avoiding high
risk situations or aggressive or re-offending behavior and by reporting any
such behavior to the provider and the supervising officer as soon as possible.
4.
Describe limitations or
prohibitions on the use of alcohol or drugs not specifically prescribed by
medical staff
5.
Describe limitations or
prohibitions on employment, recreation and living arrangements.
A. The ultimate goal of sex offender treatment is to
protect the community from criminal sexual behavior and to protect the victims
and potential victims by reducing the client’s risk of re-offense.
B. The program must provide activities and procedures
that are designed to assist clients to achieve the following goals:
1. The client must acknowledge the criminal sexual behavior and admit or develop an increased sense of personal culpability and responsibility for the behavior.
2. Reduce their denial or minimization of their criminal sexual behavior and any blame placed on circumstantial factors; disclose their history of sexually abusive and criminal sexual behavior and of sexual arousal;
3. Identify and reduce deviant arousal patterns and develop appropriate sexual outlets.
4. Develop an understanding of offending cycle, high risk factors and intervention strategies.
5. Learn and understand the effects of sexual abuse upon victims and their families, the community, and the client and the client’s family; and develop and implement options for restitution and reparation to their victims and the community, in a direct or indirect manner, as appropriate.
A. Completion of treatment should be understood as not
being the end of offenders’ rehabilitative needs or the elimination of risk to
the community. If risk increases,
treatment may be reinstated.
B. A sex offender treatment provider shall consult with
all involved parties about the completion of treatment. This decision shall come after a review of
treatment progress. It is generally
accepted that community based treatment cannot be accomplished in less than two
years.
C. In order to complete treatment, an offender needs to demonstrate the following:
1.
Accepts full responsibility
for all offending behaviors. This
includes disclosure of the complete history of criminal, abusive and deviant
sexual behaviors and arousal patterns.
2.
Demonstrates an increase
in victim empathy.
3.
Completes Relapse
Prevention Plan and demonstrates effective implementation of this plan.
D. To determine the timing of recommendation for the discontinuation of treatment, the provider
shall:
1.
Assess and document how
the goals of the treatment plan have been met, when actual changes in a
client’s re-offense potential have been accomplished, and when risk factors
remain, particularly those affecting the emotional and physical safety of the
victims;
2. Seek input form others who are aware of a client’s progress as part of the decision about whether to terminate treatment;
3. Report to the supervising officer regarding a client’s compliance with treatment and recommend any modifications in conditions of community supervision and/or termination of treatment;
4. Inform the client, at the end of the reassessment process, regarding the aftercare plan that includes ongoing behavioral monitoring, such as periodic polygraph examinations. Such monitoring is intended to motivate the offender to avoid high-risk behaviors that might be related to increased risk of re-offense.
SPECIALIZED TREATMENT STANDARDS
VII. WORKING WITH SEX OFFENDERS WITH DEVELOPMENTAL DISABILITIES
A.
A provider who treats
sex offenders who have developmental disabilities must provide treatment in a
fashion that enhances the individuals ability to gain the optimum benefit of
treatment.
B.
The provider should be
able to:
1.
Have a knowledge of the
complexities and manifestations of developmental disabilities.
2.
Possess the capacity to
understand individual learning styles and adapt treatment
approaches to compliment these styles.
3.
Engage in a
multidisciplinary team approach to ensure a full understanding of the
individuals support system.
4.
Utilize modifications
and adaptations to evaluations and assessment tools to ensure comprehension of
the material being presented while not compromising the validity of the test
results.
5.
Conduct collateral
interviews and attain record reviews to assist with thorough
evaluation results.
6.
Have a good
understanding of human behavior and willingness to teach skills in order to
facilitate learning in treatment.
7.
Know how to communicate
in a way that ensures the individual understands.
8.
Possess an understanding
of the service delivery system that sustains the individual.
9.
Match the individual
with others who have approximately the same developmental level, severity of
offense and ability to comprehend importance of treatment.
10.
Assess and treat dual
diagnosis (mental illness and developmental disability).
11.
Recognize the need to
assist the individual to accept ongoing supervision and/or supportive services
as deemed appropriate in the relapse prevention plan.
12.
Make recommendations for
the least restrictive environment in the continuum of care that will ensure
community safety as well as keep the individual safe.
13.
Teach the individual to assist
in their supervision.
14.
Participate in continued
professional development that specifically addresses sex offender treatment for
individuals with developmental disabilities.
15.
Seek consultation and/or
supervision as needed specific to this sub-population.
IX. STANDARDS
FOR THE PSYCHOPHYSIOLOGICAL DETECTOR OF DECEPTION (POLYGRAPH)
A. Polygraph or PDD examinations have been used effectively as a treatment tool with sex offenders since the early 1980’s. Since that time the procedures and equipment have improved significantly and currently there are at least 35-40 states using polygraph exams for maintenance and monitoring. Polygraph examiners are viewed as significant members of the “multi-disciplinary team” or community containment model, which also include treatment providers and probation/parole officers.
B. The polygraph must be administered in a controlled
setting and in conjunction with sex offender treatment staff. The procedures must be in accordance with
the current standards and practices of the American Polygraph Association and
the current ethical standards and principles for the use of physiological
measurements and polygraph examinations of the Association for the Treatment of
Sexual Abusers (ATSA).
C. Any agency or sex offender program that uses the
polygraph must develop standards and procedures that address the following:
1.
Purpose and rationale
for the use of the polygraph
2.
Qualifications of the
staff who administer the examinations
3.
Process to obtain
informed consent
4.
Establish polygraph
examination recording guidelines
5.
Recommended frequency
and types of polygraph exams
6.
Decision making matrix
and procedures for failed polygraphs
7.
Conditions and
safeguards for data collection and quality assurance
IX.
PHYSIOLOGICAL RECORDER
OR PENILE PLETHYSMOGRAPH (PPG) STANDARDS
A. Karl Hanson (1996) examined 30,000 sex offenders and
concluded, “the largest single predictor of sexual offender recidivism was a
sexual preference for children as measured by phallometric methods.” This is the only objective measurement of
sexual arousal and can provide valuable information regarding treatment
efficacy and the need for behavioral treatment. It should not be used to determine whether someone has offended,
but can provide valuable information regarding patterns of sexual arousal.
B. Phallometric assessments need to be administered in a
controlled setting and in accordance with the ethical standards and principles
for the use of physiological measurements and plethysmograph examinations of
ATSA. Results must be interpreted
within the context of a comprehensive assessment and treatment process and may
not be used as the only source of clinical decision-making and risk assessment.
C. The assessment needs to be administered by a qualified
examiner. Programs interested in these
assessments need to contract with a qualified consultant who uses the
appropriate technology and meets the approved standards.
A. A chaperone training program is designed to keep society safer by providing the chaperone with an understanding of sexual offender behavior, traits and cycles. The chaperone will be required to sign a contract at the conclusion of the training and may have their rights to be a chaperone revoked if unable or unwilling to perform their responsibilities (Appendix E).
B. The chaperone training program should include the
following components:
1.
What treatment is and
how it works.
2.
Motivation for deviant
behavior-power and control issues
3.
A supportive
environment, encouraging chaperones to discuss the impact of perpetrators
behavior on themselves, family and community
4.
Participation by a
volunteer perpetrator to disclose his layout, outlets, cycle, high risks,
coping strategies and what treatment is to him and to answer questions from
chaperones.
C. In order to fully understand the individual offender, the chaperone must understand:
1.
The exact nature of the
perpetrator’s crime.
2.
“Homework” assignments
for the chaperone to discuss and document with the perpetrator, including layout,
outlets, high risks and coping strategies.
3.
Rules for any contact
between perpetrator and children or victim, which would include:
a.
Never being alone with
children.
b.
Never initiating
physical contact.
c.
No discussions about
sexuality between perpetrator and children.
d.
No secret keeping.
e.
If a perpetrator is
going to live in a household with children there should be specific
arrangements concerning a wide variety of issues, including locks on bathrooms
and bedrooms, and not being alone with children.
4.
Chaperones should
contact the treating therapist to facilitate open communication.
5.
Chaperones should sign a
contract which indicates they are aware of the expectations and rules that are
inherent to being a chaperone, including the willingness to call the police ,
parole officer, therapist, if there is any behavior that jeopardizes the safety
of the community.
A. One of the expectations of these standards is the need
to provide victim-sensitive programs.
Therefore it is considered good practice to form a networking
partnership with their local victim services agency. There are 13 victim service agencies that are members of the New
Hampshire Coalition Against Domestic and Sexual Violence. Providers can contact the Coalition (603)
224-8893 for more information or refer for a list of member programs (Appendix
F).
B. Among the important reasons for connecting with victim
services is to acknowledge and solicit their expertise in advocating for victim
protection and safety. Providers and
the families they serve will benefit from victim services agency input into and
involvement in treatment programs.
C. Treatment providers shall make themselves available,
whenever possible, for the following joint ventures by offering:
1.
Educational
presentations on your work for victim services agency staff/volunteers
2.
Informational groups for
survivors, on treatment programs, through the victim services agencies.
3.
Collaboration on joint presentations
with the victim services agencies for school groups, community groups, etc.
4.
Time for a presentation
by the victim services agency during one of your group sessions.
5.
Active participation on
a committee consisting of treatment team members and some community members in
your area. The purpose of this committee would be to educate the community on
the issues of sexual assault, treatment programs and community safety issues
and to engage the community in working on the problem in a constructive way.
a)
Formation of such a
group should be a joint venture between the victim services agency and the
treatment provider.
b)
Members may include, in
addition to the treatment provider and the victim services agency,
representatives from Probation and Parole, the faith community, education and
appropriate community agencies and/or leaders.
6.
The victim services
agency may not be in a position to accept any of these offers or may not be
interested in the options, but keep open and available if situations should
change.
1.
Open your protocols for
review by the victim services agency, specifically your safety procedures and
your protocols for victim contacts.
1.
Establish a process for
resolving complaints or grievances by victims and on issue-related concerns by
the victim services agency.
1.
Providers should seek
victim-oriented education.
2.
Victim services’
agencies offer volunteer training, which they may make available for providers,
or they may be willing to do a presentation for treatment staff.
3.
Attending the state
DV/SA conference annually is another way to access information on victims’
issues and is recommended. Every effort
should be made to ensure on-going education and training on the latest thoughts/research
on victim issues.
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Appendix A: |
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Appendix B: |
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Appendix C: |
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Appendix D: |
“Sample Parole Conditions
for Sex Offenders” and “Parole Conditions and Restrictions” |
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Appendix E: |
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Appendix F: |