1. Sex Offender Treatment US Probation Central California Presented by Helene Creager, LCSW Supervisor & Mental Health Coordinator US Probation Central District of California

2. 10/16/08 2 Helene Creager, LCSW, U.S. Probation Central District of California Sex Offender Treatment Containment Approach Containment Approach: A model approach for the management of adult sex offenders (English, et al.,1996). A containment approach seeks to hold sex offenders accountable through the combined use of both the offenders’ internal controls and external criminal justice control measures, and the use of the polygraph to monitor internal controls and compliance with external controls. A containment approach seeks to hold sex offenders accountable through the combined use of both the offenders’ internal controls and external criminal justice control measures, and the use of the polygraph to monitor internal controls and compliance with external controls.

3. 10/16/08 3 Helene Creager, LCSW, U.S. Probation Central District of California Containment Approach Three Central Elements Internal Control Internal Control Sex Offenders are taught to achieve personal control of their inappropriate sexual impulses, feelings and behaviors through offense-specific treatment Sex Offenders are taught to achieve personal control of their inappropriate sexual impulses, feelings and behaviors through offense-specific treatment External Control External Control The criminal justice system provides the external pressure, through the use of sanctions, to ensure that the offender complies with mandated supervision conditions The criminal justice system provides the external pressure, through the use of sanctions, to ensure that the offender complies with mandated supervision conditions Polygraph Examinations Polygraph Examinations One method of combating the offender’s reluctance to disclose information necessary for effective treatment and monitoring One method of combating the offender’s reluctance to disclose information necessary for effective treatment and monitoring

4. 10/16/08 4 Helene Creager, LCSW, U.S. Probation Central District of California Sex Offender Treatment Containment Model Offender Treatment Provider Probation Polygrapher

5. 10/16/08 5 Helene Creager, LCSW, U.S. Probation Central District of California Sex Offender Treatment Research has shown that the most effective offense specific treatment: Research has shown that the most effective offense specific treatment: Holds offenders accountable Holds offenders accountable Is victim/community centered Is victim/community centered Is limited in its confidentiality Is limited in its confidentiality Client well-being may be secondary to public safety Client well-being may be secondary to public safety

6. 10/16/08 6 Helene Creager, LCSW, U.S. Probation Central District of California Sex Offender Treatment Effective Sex Offender Treatment [Per Practice Standards and Guidelines for Members of the Association for the Treatment of Sexual Abusers (ATSA)] Effective Sex Offender Treatment [Per Practice Standards and Guidelines for Members of the Association for the Treatment of Sexual Abusers (ATSA)] Targets individual risk factors, needs and strengths identified in the sex offender specific evaluation Targets individual risk factors, needs and strengths identified in the sex offender specific evaluation Uses cognitive behavioral techniques that target clinical needs that are associated with the risk to re-offend Uses cognitive behavioral techniques that target clinical needs that are associated with the risk to re-offend May include other adjunct treatment such as medication May include other adjunct treatment such as medication

7. 10/16/08 7 Helene Creager, LCSW, U.S. Probation Central District of California Sex Offender Treatment Targets criminogenic needs such as: Targets criminogenic needs such as: Antisocial attitudes and beliefs Antisocial attitudes and beliefs Criminal peer associations Criminal peer associations Deviant sexual arousal Deviant sexual arousal Lack of community supports Lack of community supports Poor educational or vocational involvement Poor educational or vocational involvement Substance use Substance use

8. 10/16/08 8 Helene Creager, LCSW, U.S. Probation Central District of California Sex Offense Specific Evaluation Comprehensive evaluations are critical in order to: Comprehensive evaluations are critical in order to: Assess an offender’s risk to re-offend Assess an offender’s risk to re-offend Develop appropriate treatment and supervision plans Develop appropriate treatment and supervision plans Provide useful guidance to the Courts Provide useful guidance to the Courts

9. 10/16/08 9 Helene Creager, LCSW, U.S. Probation Central District of California Sex Offense Specific Evaluation Sex Offense Specific Evaluations focus on: Sex Offense Specific Evaluations focus on: Risk factors Risk factors Clinical needs Clinical needs Strengths Strengths Risk Management Strategies Risk Management Strategies Offender’s abusive and nonabusive sexual behavior Offender’s abusive and nonabusive sexual behavior

10. 10/16/08 10 Helene Creager, LCSW, U.S. Probation Central District of California Sex Offense Specific Evaluation Components Clinical Interviews Clinical Interviews Psychometric tests: assess for cognitive distortions, mental illness, personality disorders, psychopathology, static and dynamic risk of sexual offending Psychometric tests: assess for cognitive distortions, mental illness, personality disorders, psychopathology, static and dynamic risk of sexual offending Psychophysiological assessment Psychophysiological assessment Review of official documents Review of official documents

11. 10/16/08 11 Helene Creager, LCSW, U.S. Probation Central District of California Sex Offense Specific Evaluation Risk Assessment Includes actuarial assessment tools to measure static factors found to be associated with recidivism and is intended to be a measure of long-term risk potential. Includes tools to measure dynamic risk factors, which have the capacity to change over time. These risk factors become the target for treatment. Includes tools to measure dynamic risk factors, which have the capacity to change over time. These risk factors become the target for treatment.

12. 10/16/08 12 Helene Creager, LCSW, U.S. Probation Central District of California Sex Offense Specific Evaluation Psychophysiolgical Testing According to ATSA: According to ATSA: “Members should use phallometric testing to corroborate the self-report of male clients regarding their sexual arousal patterns and sexual interests; polygraphy to corroborate client self-report regarding their sex offenses, sexual histories and compliance with treatment and supervision requirements; and viewing time measures to corroborate client self-report regarding their sexual interests in children when phallometric testing is unavailable.”

13. 10/16/08 13 Helene Creager, LCSW, U.S. Probation Central District of California Sex Offense Specific Evaluation Plythesmograph (PPG) Phallometric Testing – Plythesmograph (PPG) Involves direct measurement of penile responses to audio/visual stimuli presentations depicting sexual activity with males and females of different ages. Involves direct measurement of penile responses to audio/visual stimuli presentations depicting sexual activity with males and females of different ages. The purpose is to determine gender and age preferences as well as sexual arousal to deviant and non deviant themes. The purpose is to determine gender and age preferences as well as sexual arousal to deviant and non deviant themes. It is seen as an extremely valuable objective measure of sexual arousal. It is seen as an extremely valuable objective measure of sexual arousal.

14. 10/16/08 14 Helene Creager, LCSW, U.S. Probation Central District of California Sex Offense Specific Evaluation Plethysmograph (PPG) The PPG is used to promote self-disclosure, reduce minimization and denial of sexual offenses, and monitor changes in sexual arousal patterns modified by treatment. The PPG is used to promote self-disclosure, reduce minimization and denial of sexual offenses, and monitor changes in sexual arousal patterns modified by treatment.

15. 10/16/08 15 Helene Creager, LCSW, U.S. Probation Central District of California Sex Offense Specific Evaluation Clinical Polygraph The clinical polygraph is a clinical tool used to motivate offenders to truthfully engage in treatment and is used to monitor compliance with treatment and supervision conditions. The clinical polygraph is a clinical tool used to motivate offenders to truthfully engage in treatment and is used to monitor compliance with treatment and supervision conditions.

16. 10/16/08 16 Helene Creager, LCSW, U.S. Probation Central District of California Sex Offense Specific Evaluation Clinical Polygraph Three types: Three types: Full Disclosure/Sexual History Clinical Examination (Used to encourage full disclosure of sexual behavior used to assist in determining risk and developing treatment plans) Full Disclosure/Sexual History Clinical Examination (Used to encourage full disclosure of sexual behavior used to assist in determining risk and developing treatment plans) Maintenance Examinations (Periodic, usually every six months to verify that the offender is being truthful when he denies engaging in any behavior that is not in compliance with treatment, supervision conditions or the law since being placed on supervision or since his last polygraph) Maintenance Examinations (Periodic, usually every six months to verify that the offender is being truthful when he denies engaging in any behavior that is not in compliance with treatment, supervision conditions or the law since being placed on supervision or since his last polygraph) Specific Issue (Typically used for offenders who continue to deny their guilt for a crime for which they were convicted.) Specific Issue (Typically used for offenders who continue to deny their guilt for a crime for which they were convicted.)

17. 10/16/08 17 Helene Creager, LCSW, U.S. Probation Central District of California Sex Offense Specific Evaluation Able Assessment Viewing Time Measures – Able Screen Viewing Time Measures – Able Screen Measures interest and sexual arousal utilizing a slide presentation depicting clothed males and females of different ages involved in various activities Measures interest and sexual arousal utilizing a slide presentation depicting clothed males and females of different ages involved in various activities

18. 10/16/08 18 Helene Creager, LCSW, U.S. Probation Central District of California References/Resources DSM IV TR DSM IV TR Managing Adult Sex Offenders, A Containment Approach (Kim English, 1996) Managing Adult Sex Offenders, A Containment Approach (Kim English, 1996) Practice Standards and Guidelines for Members of the Association for the Treatment of Sexual Abusers (ATSA) Practice Standards and Guidelines for Members of the Association for the Treatment of Sexual Abusers (ATSA) California Coalition on Sexual Offending Website (CCOSO.org) California Coalition on Sexual Offending Website (CCOSO.org) ATSA website (ATSA.com) ATSA website (ATSA.com) Center for Sex Offender Management (CSOM.org) Center for Sex Offender Management (CSOM.org)