Transcript Treating and Managing the Sexually Violent Predator

Treating and Managing the
Sexually Violent Predator
FMHAC
March 16, 2006
Kenneth Carabello, LCSW
Liberty Healthcare
Presentation Overview
• Overview of SVP Law
• Overview of Liberty Healthcare SVP
CONREP
• Housing
• Treatment Issues
• Supervision Issues
• Wrap-up/Questions
SVP Law
A result of concerns regarding the risk to public
safety that results when sex offenders are released
from prison.
Welfare and Institutions Code (WIC) Section 6600 et
al. went into effect on January 1, 1996
Civil commitment for persons who meet SVP
criteria.
In establishing the SVP Act, the California Legislature
declared that there is a small group of dangerous individuals
who have diagnosable mental disorders and can be readily
identified while incarcerated. It further declared that the
needs of this population are very long term and the treatment
modalities that are appropriate for this population are
substantially different from those persons currently civilly
committed under the Lanterman-Petris-Short Act
(commencing with Section 5000) and, accordingly, a new
civil commitment needed to be established to address the
treatment needs of this population. The legislation directed
that such Sexually Violent Predators (SVP’s) be confined
and treated until they no longer present a threat to society.
The aim of this law is to treat and confine these individuals
only as long as their disorders continue to present a danger to
the health and safety of others, and not for any punitive
purposes. The Legislature determined that these “persons
shall be treated, not as criminals, but as sick persons.” (WIC
6250).
6600. As used in this article, the following terms have the
following meanings: (a) (1) "Sexually violent predator"
means a person who has been convicted of a sexually violent
offense against two or more victims and who has a diagnosed
mental disorder that makes the person a danger to the health
and safety of others in that it is likely that he or she will
engage in sexually violent criminal behavior.
Commitment Criteria:
WIC 6600 establishes three major criteria to define a Sexually Violent
Predator:
* He/She has been convicted of a sexually violent offense (penal code
offenses are listed in statute; offenses usually include either child
molestation or rape).
* He/She has had two or more victims as a result of these sex offense
convictions.
* The person has a diagnosed mental disorder that makes him/her likely to
engage in future sexually violent predatory behavior (predatory is defined
as a crime against a stranger, a person of casual acquaintance, or a person
whose relationship is established for the purpose of sexually offending).
SVP Commitment
As of 3/1/06
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Referred to DMH 6,368
Pass DMH record review 3,406
Positive evaluation for SVP 1,307
Total committed 539
Inpatient Treatment
• Men currently at Atascadero State Hosp.
(ASH) and Coalinga State Hospital. The
SVP woman is at Patton State Hospital.
• ASH has four phase treatment program.
So How Do They Get Out?
WIC 6608
Petition for outpatient treatment can be
initiated by patient (WIC 6608) or DMH
(WIC 6607)
Court hearing determines if ordered out.
If ordered out, must be placed in county of
domicile
CONREP
• Administered by CA DMH
• Instituted in 1986
• Provides mandated core services to
judicially committed patients
• Existing CONREPs opted not to treat SVPs
• Liberty Healthcare contracted in February
2003
The primary mission of CONREP is the
protection of the public through the
reduction or prevention of patient
reoffense
Productive, healthy patients, leading a
crime-free life
Containment Model
• Community-based monitoring and
management of sex offenders
• Patient accountability
• Offense-specific treatment, polygraph
assessments and intensive specialized
surveillance
• Victim-centered approach
• Collaboration and communication
Hospital Liaison Duties
• Initial interviews with all newly committed SVPs
• Clinical interviews every six months with each
committed SVP in phase II or higher and his
designated treatment team.
• Monthly meetings with all SVP’s in the final
phases of treatment at the facility (IV and V).
• Development of individualized terms and
conditions
• Phase IV and V staffings
Outpatient Clinical Services
• Sex offender-specific treatment providers
• Sex offender-specific trained polygraphers
• Psychiatrists for pharmacological treatment for arousal
reduction and mental illness
• Professionals who provide plethysmographic assessment
of deviant arousal
• Professionals who provide Abel assessment of deviant
sexual interest
• Psychologists
• Medical physicians.
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Regional Coordinator
Supervision Duties
Unannounced face-to-face visits at and away from home.
Collateral contacts with significant people in SVP’s life
Covert surveillance as indicated
GPS monitoring
Random urine screens for illegal substances
Random phone checks
Unannounced residence, vehicle and personal searches.
Receipt and expenditure reviews; reviews of account
statements if applicable
• Approval of schedules, locations of outings and routes of
travel for all time outside of residence
Regional Coordinator Case
Management Duties
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Prerelease search and investigation of potential housing.
Development of a support and release plan.
Scheduling and coordinating Community Safety Team
Collateral contacts with providers, state liaison, law
enforcement, employers, family, etc.
• Individualized supervision plan.
• Transportation if needed.
• Assistance with basic life support (clothing, food,
medicine) as needed.
• Scheduling and coordinating of professional services listed
in section B.
• Vocational service referrals.
• Quarterly reports to the court.
CA
Dept. of Mental Health
LIBERTY
VICE PRESIDENT,
BEHAVIORAL HEALTH
DMH Consulting
Psychologist
State Hospitals:
Atascadero
Coalinga
Patton
Clinical Liaison
Executive Director
of LIBERTY CA CONREP
(COMMUNITY PROGRAM
DIRECTOR )
Administrative
Assistant
Regional Coordinators
Victim Advocates,
Local Law
Enforcement,
DMH, Others
“Containment”
Community
Safety Team
Community
Polygraphers
Community
Providers
Community Safety Teams
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Regional Coordinators
Treatment Providers
Polygraphers
Victim Advocates
• Law Enforcement
Law Enforcement Coordination
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Improved coordination of containment activities.
Enhanced communication through familiarity.
Insurance of Sex Offender Registration Requirements.
Support from law enforcement in community notification
activities.
Facilitation of apprehension of the SVP upon absconding,
committing a new criminal offense, or violating the
conditions of release.
Provision of consultation and/or training specific to sex
offender management to law enforcement officers.
Facilitation of responses to Global Positioning Satellite
alerts.
Acquire assistance in handling potentially violent or highrisk behavior.
Housing
What housing has been found so
far?
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Monterey County
Marin County
Santa Clara County
Contra Costa County
Solano County
San Diego County
Recent Legislation:
County of Domicile
Notification
Residence Considerations
• Proximity to potential victims
• Offense pattern
• Parks/Schools/Daycare/places where
children congregate (perception)
• Proximity to services
• Public transportation
• Property owner fully informed
What if we can’t find housing
• Locked up
• Cond. Rel.
Conditional Release
Unconditional Release
Ark.pdf
Treatment Issues
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Patient fully versed in relapse prevention
Continuity of treatment
Stress of high profile placement
Early restrictions
Development of social supports
Behavioral stability under tight supervision
SVP MINIMUM PERFORMANCE STANDARDS
FOR COMMUNITY OUTPATIENT TREATMENT*
SERVICE FUNCTION TYPE
----------------------------LEVELS-------------------------Intensive
Supportive
Transitional
Yearly
(1 per Year)
Annual Review
Individual Contact
Weekly
(4 per Month)
Group Contact
Minimum Monthly
(1 per Month)
Weekly
Bi-weekly
(Once every
2 Weeks)
Minimum
Monthly
Home Visits
Weekly
Collateral Contact
Weekly
Monthly
Substance Abuse Screening
Weekly
Minimum Monthly
Quarterly
(1 every 3 Months)
Assessment (Dynamic Risk)
Polygraphic Assessments:
Quarterly
Twice per Year
2. Sexual History
Once
None
Abel Screen/PPG
Assessment
Twice per Year
Yearly
GPS Data Review
Daily
(Once per Day)
1. Monitoring/Maintenance
Patients on Anti-Androgen/
Post Orchiectomy:
1. Testosterone & Blood
Levels
2. Bone Density Testing
Weekly
Monthly
At Admission and Randomly every 6 Months Thereafter
At Admission and Yearly Thereafter
*All treatment will follow Relapse Prevention Model
Supervision Issues
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Intensive work load
Distances
GPS
Less autonomy than traditional
probation/parole - increased role of team
Current Policy Issues
Longer sentencing
Civil commitment - how long will
there be patients?
Treatment - does it help?
GPS - use it for all sex offenders?
Notification
Registration - classification
Sex Offender Residency
Restrictions
Iowa County Attorneys Assoc., Jan 2006
• No known correlation between residency restriction
and reduction of sex offenses
•Children not attacked by strangers at covered locations
•Stranger attacks rare.
•Law enforcement notes restrictions cause homelessness,
failure to report residence changes, and false address
registrations (Des Moines Register reported twice as
many unknown location of sex offenders 1/06)
•No demonstrated protective effect of residency
requirement
Categories of crimes too broad, imposing restrictions on those
with no known risk to children in covered locations
Families of offenders also restricted. Children pulled from
schools, spouses loosing jobs and community connections
Physically and mentally disabled offenders prohibited from
living with supports
Affordable housing and transportation scarce in available
areas
No time limit
No accommodation for those on parole or probation
Numerous negative consequences of the lifetime residency
restriction has caused a reduction in the number of
confessions made by offenders.
Counterproductive to well established principles of treatment
and rehabilitation.
Ken Carabello
(310) 348-7200
[email protected]