Sex Offender Treatment Provider Parameters
The information below outlines treatment parameters for outpatient treatment providers. The Utah Department of Corrections, pursuant to State statute, maintains a list of Approved Sex Offender Treatment Providers. The following parameters are used to determine eligibility for outpatient sex offender treatment providers and their programs.
• Current Utah licensure in a mental health profession (i.e. psychiatry, psychology, licensed professional counselor, social work or marriage and family therapy);
• Within the two-year period immediately preceding application or re-application for approval as a provider, the individual must have at least 1,000 documented hours of direct clinical experience in sex offender treatment (direct clinical experience means face-to-face contact with patients/clients, direct supervision, training, case coordination and research). Of the 1,000 hours, at least 180 hours must include sex offender assessment experience (sex behavior risk assessments, psychosexual evaluations, interpretation of PPG(Penile Plethysmograph) results and sexual interest measures, intake, clinical interviewing, case supervision, quarterly reports, etc.);
• Within the two-year period immediately preceding application, the individual must have received at least 26 hours of formal training through documented conferences, symposia, seminars or course work related to the evaluation and treatment of sexual offenders. Said training may include behavioral/cognitive therapy methods, reconditioning and relapse prevention, use of plethysmograph examinations, use of polygraph examinations, group therapy, sexual dysfunction, victimology, couples and family therapy, risk assessment, sexual addiction, sexual deviancy and ethics and professional standards. Of these hours, 19 hours must be sex offender specific. It is recommended that affiliate and approved providers focus at least some of these 19 hours on areas that research has determined to be risk-relevant for sexual offending, in order to help better inform assessment and treatment. Up to 10 hours may be obtained through independent, self-study of research or other professional literature;
• Licensed professionals and professionals in graduate training and/or post-graduate residency who do not meet the experience and training requirements may apply for "affiliate approval." Affiliate providers are required to arrange for ongoing supervision with an approved provider meeting the above criteria. Trainees may provide service if their work is part of a degree program and/or leading to licensure and their clinical work is supervised by a licensed professional meeting the above requirements (supervision means one hour of supervision for every 40 hours of direct client contact with a minimum of one hour supervision per month). To re-certify as an affiliate, the provider must comply with the 40-hour training requirement.
• Those who have maintained approved providership for a minimum of 10 consecutive years may apply for the status of “emeritus approved provider.” Such individuals are not held to the same standard with regard to maintaining the standard number of hours of practice (assessment or therapy) but are held to the same standard with regard to maintaining hours of continuing education as approved providers. An emeritus approved provider is expected to submit reapplication every two years, documenting what work has been completed (assessment and/or therapy) and providing verification of adequate continuing education credit hours. Emeritus approved providers may also provide supervision to affiliate providers, under the same terms and expectations as approved providers.
• Approved providers must have as a basic philosophy that accountability and responsibility for sexual offending is a basic requirement for successful completion of therapy.
• Providers must adhere to the reporting requirements as required by the Utah State Department of Corrections and the laws of the State of Utah. See Mental Health Professional Practices Acts 58-60-114 which identifies reporting under Titles 62A, Chapter 3, Part 3; 62A, Chapter 4A, Part 4; 78B, Chapter 3, Part 5; and Section 26-6-6.
• Approved providers and affiliate providers must re-apply to the Department of Corrections, via the Sex Offender Task Force, every two years to renew their approved status. Re-application shall consist of documentation demonstrating ongoing professional training, current licensure with the State of Utah, hours of therapy and assessment provided per year. Any changes in the modality of treatment will be reported to the sex offender task force. Failure to reapply before their approved date expires will result in the provider/affiliate being removed from the provider list.
• Approved providers may supervise a maximum of three (3) affiliate providers. Please note that this entails co-signing on documents, individual & group notes, reports, etc. This should be completed for the first 2000 hours of sex offender treatment and assessment experience. This also includes monitoring the skill and level of competency of the supervisee. After adequate training and supervision, the provider may decrease the level of contact to the minimum of 1 hour per 40 hours of face to face contact. This is similar to the expectations of supervising clinicians as outlined in DOPL, APA, ATSA, etc.
• Providers who change from one program to another must update their application in order to continue providing services.
• Criminal convictions or licensure actions must be disclosed fully and may result in denial of application approval. No person convicted of a felony within the last 10 years may be an approved or an affiliate provider, nor can they employ approved or affiliate providers to provide services to offenders under the jurisdiction of AP&P. (See ATSA's Ethical Standards & Principles for the Management of Sexual Abusers, Ethical Standards item #6). Any person who has a felony conviction more than 10 years old and is applying to be an affiliate or approved provider would be reviewed on a case-by-case basis. Failure to disclose criminal convictions or licensure actions will result in removal from approved status.
• With reasonable notification, providers must be able to appear in Court or Board of Pardons hearings as needed, regardless of compensation being offered.
• Providers will provide reports as needed by the Court, Board of Pardons and/or the supervising AP&P agent.
• If an applicant does not directly provide all services, the application should detail how these services will be provided (i.e., contracting with another approved provider/affiliate, referral to another agency, etc.).
Outpatient treatment programs for offenders convicted of a sexual offense must have the following components:
Intake into an outpatient sex offender specific treatment program shall consist of and include:
• An intake assessment shall at least include the results of one validated risk assessment instrument, mental status assessment, behavioral observations, strengths and protective factors, assessment of childhood abuse including being sexually abused as a minor, and substance use/abuse, and a complete review of known sexual offending history, review of known nonsexual criminal history, education, employment, medical history, social history, and identification of any other issues relevant to the offender’s current treatment, and an evaluation of the offender’s current amenability to sex offender specific treatment.
• Complete a psychosexual evaluation, when clinically indicated (completed by a licensed psychologist who is an approved provider or approved evaluator) to include sex offender specific testing and assessment of personality and intelligence using testing instruments recognized in the sex offender evaluation community as valid tools prior to the initiation of treatment. This evaluation has been observed as necessary in select cases. An intake assessment by an approved provider will often suffice.
• A psychosexual evaluation (for purposes such as re-offense, multiple prior unsuccessful episodes of sex offender treatment, or agent/therapist/evaluator concern is sufficient to warrant this level of assessment) shall include the results of at least one actuarial risk assessment instrument with acceptable research validation, records reviewed, tests administered, tests reviewed, reason for referral, behavioral observations, developmental history(family, social, medical, academic, employment, marital), mental health, substance abuse, non-sexual abuse, sexual abuse, legal history, supervision history, sexual developmental history, sexual offending history, testing results, risk assessments, summary and recommendation. A PPG (using audio stimuli only, no visual stimuli) or other sexual interest and/or arousal evaluation for male offenders will be completed as part of the psychosexual evaluation to establish a baseline for future treatment and to establish a more thorough assessment of the offender’s treatment needs and risk to reoffend.
Subsequently, a written report must be submitted to the offender's supervising AP&P agent citing the following:
• Summary of test and assessment results, including specifics on the risk for re-offending, based upon the results of at least one risk assessment instrument.
• Suitability and amenability for treatment.
• Proposed treatment recommendations.
Individual and Group Note Format:
- Each face to face contact shall be documented.
- Individual and group notes shall use a standardized format (i.e. SOAP, DAP, SIP).
- Notes should reflect treatment goals and objectives.
- Treatment plans will include: problem areas, goals(i.e. SMART), interventions, signature lines for the client and clinician.
- Treatment plans should be reviewed with the client at least every quarter.
- Each plan will be revised and updated on an on-going basis with the client.
Outpatient treatment program shall be defined as:
• It is expected outpatient treatment requires at least 12 to 18 months of weekly individual and group treatment.
• At least one individual session lasting at least 50 minutes, conducted by an approved provider or affiliate provider at least weekly.
• At least one sex offender group therapy session lasting at least 80 minutes, conducted by an approved, provider or affiliate provider, at least weekly; until offender moves into the transition phase of treatment.
• A disclosure polygraph examination for both male and female offenders to establish a baseline for future treatment and evaluation will be completed during the introductory phase (within the first 180 days of initiating treatment) to assess the level of disclosure that has taken place.
• Additional polygraphs may be completed periodically during treatment to ensure the offender is not violating any court orders, treatment rules and regulations or violating any of the terms and conditions of his probation and/or parole. Additional polygraph examinations may be administered to any offender when deemed appropriate by the provider and/or Adult Probation and Parole.
• 50 hours of psychoeducational classes (a minimum of 5 topics from the following: relapse prevention, assault cycle, thinking errors, relationship skills, and sex education, victim empathy) consisting of at least 10 hours per subject. Additional class topics may be addressed based upon individual need, namely: parenting, and stress management, pornography addiction and recovery class. Previously completed classes may be accepted to meet this requirement.
• In addition, the treatment program may require an offender to repeat some or all of these classes if clinically indicated.
• A compliance polygraph examination will be completed by all offenders prior to the completion of treatment to determine compliance with treatment program rules, court orders, and supervision requirements.
• A second or more PPG(s) or other sexual interest and/or arousal evaluations will be completed based upon clinical need. If a valid PPG in the last two years is accounted for, then a follow up PPG may not be necessary, depending on results.
• Outpatient treatment will be followed by continued care, to be determined by the additional needs after the outpatient program is completed.
• A minimum of one progress report shall be submitted to the offender's supervising AP&P agent per quarter.
• Upon termination of the treatment episode, regardless of reason for the termination (successful completion, unsuccessful completion, transferring treatment or maximum benefit), the provider shall complete a discharge summary within 10 working days, which will be shared with the offender’s supervising agent. The summary may also be shared with the offender at the clinician’s discretion.
Intensive outpatient treatment program services:
• An intensive outpatient treatment program will include the same treatment regimen as the outpatient treatment program as well as at least an additional weekly sex offender group session conducted by an approved provider or affiliate provider. Additional sessions or components may be added as clinically indicated.
Note: The above components of intensive treatment will be conducted on a minimum of three different days per week.
Continued care treatment program services are those designed for offenders who have, 1) completed sex offender specific treatment while incarcerated and prior to being granted parole, 2) have been paroled to a community correctional center and completed the residential treatment program at the community correctional center, 3) completed an outpatient treatment program in the community. It is recommended continued care will last 12 months, and may be longer or shorter as clinically indicated and will be defined as:
• A compliance polygraph examination a plethysmograph or other sexual interest and/or sexual arousal assessment will be completed by all offenders prior to the completion of a continued care treatment program to determine compliance with both treatment program rules and with court orders and to ensure there have been no violations of probation/parole rules and regulations. Additional polygraph examinations may be required of any offender when deemed appropriate by the provider and/or Adult Probation and Parole.
• A minimum of one progress report shall be submitted to the offender's supervising AP&P agent per quarter.
As a transition is made from the use of the word AFTERCARE to CONTINUED CARE, treatment providers understand that whether reference is made to AFTERCARE or CONTINUED CARE in the work currently done with court-mandated sex offender clients, we are referring to synonymous descriptors that reference the same stage of treatment. For purposes of treating the sex offender clientele, AFTERCARE and CONTINUED CARE are not two separate, distinct entities or phases of treatment. The vernacular CONTINUED CARE is encouraged over AFTERCARE in order to create consistency among treatment providers, as well as for clients to begin to embrace the notion that, while they have finished the OUTPATIENT or RESIDENTIAL treatment portion of their clinical experience, their clinical work is not complete until they have continued with and have completed the last phase of treatment, which is CONTINUED CARE. Clients will earn the status of ‘treatment completed’ when the client has completed both outpatient OR residential, AND continued care.
Most of the clinical field is moving towards the vernacular of Continuing or Continued Care in preference over Aftercare. In 2014, Drs. Philip Herschman and Steven Proctor discussed the importance of Continued Care versus Aftercare. They defined Continued Care as “the provision of any form of treatment services following the initial phase of treatment, irrespective of duration or level of care.” Continued Care is more RNR (risks, needs, responsivity) driven, and is not time-driven. Continued Care can be as short or as long as needed in order to meet the client's needs. Continued Care is structured yet is less prescriptive in terms of level system or specific assignments/tasks. We recognize that a client who has completed outpatient or residential treatment generally: 1) acknowledged treatment needs for which he/she was referred in sufficient detail for treatment staff to have developed a treatment plan that, if implements properly, could be reasonably expected to reduce risk to reoffend; 2) demonstrated an understanding of the thoughts, attitudes, emotions, behaviors, and sexual interests linked to his/her sexually abusive behavior and can identify these when they occur in his/her present functioning; 3) demonstrated sufficiently sustained changes in managing these thoughts, attitudes, emotions, behaviors and sexual interests and developed / enhanced prosocial attitudes and skills such that it is reasonable to concluded that he/she has reduced his/her risk to reoffend. In Continued Care, there is a gradual reduction to the intensity and/or dosage of those services that were prescribed to the client during outpatient OR residential treatment as the client consistently demonstrates stability and positive gains. In Continued Care, treatment providers prepare the clients for treatment completion, which includes a gradual reduction in frequency of contacts over time as treatment gains are sustained. Booster sessions may be scheduled to reinforce and assess maintenance of treatment gains.
Completion of treatment
Sex offender treatment may be ended in one of the following four ways. Criteria for each are specified below:
• Notification of discharge from treatment at a minimum must be made verbally to AP&P prior to notifying the offender of his or her status. Notification by the provider to the supervising agent must be made within 72 hours of unsuccessful termination; a phone call is sufficient for this. Written notification (e-mail, fax or letter) shall be submitted by the provider to the supervising agent within 10 business days of the offender’s discharge.
• The discharge summary must address reasons for unsuccessful completion, progress to date of the offender, prognosis, risk to the community, and indicate whether or not the offender reached maximum benefit of offered treatment.
Successful completion is defined as completing the goals of the outlined treatment program (see Continued Care above). Upon successful completion, the following are required by the approved or affiliate provider:
• Notification of discharge from treatment at a minimum must be made verbally to AP&P prior to notifying the offender of his or her status. Written notification (e-mail, fax or letter) by the provider to the supervising agent must be made within 10 business days of the recommendation designate therapy as completed.
• The the discharge summary must include description of the issues addressed, compliance of the offender, progress made, prognosis and results of a valid PPG or other sexual interest and/or sexual arousal assessment (either during the current treatment episode or, if valid and showing no concerns, from prior to the current treatment episode), and termination polygraph in the last 90 days.
• Offenders transferring from one program or agency to another should have approval by the offender's supervising AP&P agent.
• Maximum benefit is a condition under which an offender has been clinically determined to have reached the greatest degree of progress likely to be possible, falling short of meeting criteria for successful completion. This status reflects a combination of good effort on the offender's part AND the presence of one or more factors interfering with further progress, such as limited cognitive capacity, dementia, neurological impairment, major mental illness (schizophrenia, bipolar disorder, etc.), or severe personality disorder. This condition also recognizes that it is highly unlikely that any further clinical intervention will provide additional improvement in the offender's functioning and/or decrease in the offender's risk for re-offending.
• In the instance of a maximum benefit termination of treatment, the affiliate or approved provider shall include in the Discharge Summary specific reasons for the maximum benefit termination as well as any appropriate assessment or additional treatment recommendation to address the concerns identified.
Completed Prison SOTP:
• Completed Prison SOTP is defined as successful completion of sex offender specific treatment while incarcerated (referred to in the UDC SOTP program as “Transitioned). As with other forms of completion of treatment, a discharge summary will be completed by the clinician that details an offender's progress; areas that will need to continue to be addressed in treatment; assessed risk for re-offending; and any applicable recommendations regarding structure and supervision.
Note: Individuals who have completed sex offender treatment while incarcerated are expected to go into Continued Care services (as detailed above) when returned to the community. Transition does NOT warrant an offender moving into continued care (again, as noted above) due to remaining issues revolving around recognizing and managing a wide range of new risk issues and situations.
A Discharge Summary shall contain at least the following:
• Date treatment was initiated and terminated
• Reason for treatment being terminated (successful completion, unsuccessful completion, transfer of treatment or maximum benefit)
• Current results of at least one research validated sex offender risk assessment instrument
• Description of progress made during the treatment episode (including any psychoeducational classes completed)
• Remaining sex offender specific issues needing to be addressed
• Remaining non-sex-specific issues needing to be addressed
• Recommendations for further treatment, as appropriate
As required by the Sex Offender Task Force a program may be reviewed/audited for compliance with listed parameters. The audit will consist of,
- site visit
- review of 15% of client files
- general program review
- review of program documentation
- presence of group and individual notes
- review of professional qualifications
- intake and discharge requirements
- review of risk assessment tools
- presence of quarterly reports
- utilization of polygraphs, and sexual interest and/or arousal assessments
(Updated May 23, 2018)