Transcript Doreen Stanzione, Ed.D. STU Lead Psychologist [email protected] Court Decisions: Political Context: US and Individual States Public Opinions/ Government/ Agencies STU: Residents, Treatment, Assessment , DOC NJ SVP Community Provisions: Parole -PSL/CSL, GPS.

Doreen Stanzione, Ed.D.
STU Lead Psychologist
[email protected]
Court
Decisions:
Political
Context:
US and
Individual
States
Public Opinions/
Government/
Agencies
STU:
Residents,
Treatment,
Assessment
, DOC
NJ
SVP
Community
Provisions:
Parole -PSL/CSL,
GPS. Community
Providers, Public
Assistance and
Resources (housing,,
work)
Evolution
of Field:
Best
Practices
NJ STU
Trial Court:
3 Judges, 3
DAGS, PD’s
 Kansas
v Hendricks:
Decided: June 1997

“Finally, the Act is not necessarily punitive if it
fails to offer treatment where treatment for a
condition is not possible, or if treatment,
though possible, is merely an ancillary, rather
than an overriding, state concern.”
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In the end it is decided that act is constitutional given that states have
needs to protect their citizens and confine them if they are a danger,
similar to psychiatric civil commitment laws. One concern though is
what to do when there is no treatment or cure for the problem – in end –
if danger is considered to be posed, then it is supported.
Court expressed some concerns that treatment was not provided from
start. Though, it was court’s belief that treatment was coming up on line.
However, even if the illness could not be treated (though brief
suggested otherwise) there could be reason to contain based on
dangerousness.
Also established is that Kansas SVP act is aimed at containment.
Treatment is thereafter provided given abridgement of civil liberties, but
treatment is not the purpose of the act.
 Turay
v. Seling:
 Federal court re Washington state SVP program.
Decided 2000

“The Fourteenth Amendment Due Process Clause of
the United States Constitution requires state officials to
provide civilly-committed persons, such as these
plaintiffs, with access to mental health treatment that
gives them a realistic opportunity to be cured or to
improve the mental condition for which they were
confined.”
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Central issue: “whether the defendants are providing constitutionally
adequate mental health treatment to the plaintiff SCC residents as
required by due process and the Supreme Court decisions cited above.”
“Accordingly, these plaintiffs, and others involuntarily confined through
civil proceedings, cannot simply be warehoused and put out of sight; they
must be afforded adequate treatment. Although confined, they are not
prisoners. They are entitled by law to "more considerate treatment and
conditions of confinement than criminals whose conditions of
confinement are designed to punish." Youngberg, 457 U.S. at 322, 102
S.Ct. 2452. Recognizing these requirements, the Washington statute
provides that "[a]ny person committed pursuant to this chapter has the
right to adequate care and individualized treatment." RCW 71.09.080(2).”
…”Without Least Restrictive Alternatives (LRA’s), the constitutional
requirement of treatment leading, if successful, to cure and release,
cannot be fully met.”
 Strutton
v. Meade:
 Federal court re Missouri SVP program Decided 2009.

“…there is no fundamental right under the Fourteenth
Amendment to such treatment – at least as a matter of current
binding authority – and as such, the adequacy of treatment at the
MSOTC only violates the Fourteenth Amendment if it shocks the
conscience. The Court concludes that although the available
treatment was not ideal, and in certain instances likely fell below
any reasonable professional standard, it has been and continues to
be constitutionally adequate..”
 Strutton

v. Meade testimony:
“…a sexually violent program facility without restrictions ‘would
become predatory, to an untenable degree. Treatment, of course,
wouldn’t matter at that point without offering relative safety for
the residents by some of the behavioral controls. No treatment
would matter, because when an individual can’t be reasonably
assured of safety, there’s no absolute safety but be reasonably
assured of safety and stability, then all of the talk of therapy won’t
really add anything’.”
 Karsjens
v. Jesson:
 Federal court re Minnesota SVP program Decided 2015

“The Fourteenth Amendment does not allow the state, DHS, or
the MSOP to impose a life sentence, or confinement of indefinite
duration, on individuals who have committed sexual offenses
once they no longer pose a danger to society. The Court must
emphasize that politics or political pressures cannot trump the
fundamental rights of Class Members who, pursuant to state law,
have been civilly committed to receive treatment. The
Constitution protects individual rights even when they are
unpopular.”
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Unconstitutional as Applied:
“(1) Defendants do not conduct periodic, independent risk
assessments or otherwise evaluate whether an individual continues to
meet the initial commitment criteria or the discharge criteria if an
individual does not file a petition;
(2) those risk assessments that have been performed have not
all been performed in a constitutional manner;
(3) individuals have remained confined at the MSOP even
though they have completed treatment or sufficiently reduced their
risk;
(4) discharge procedures are not working properly at the
MSOP;
(5) although section 253D expressly allows the referral of
committed individuals to less restrictive alternatives, this is not
occurring in practice because there are insufficient less restrictive
alternatives available for transfer and no less restrictive alternatives
available for initial commitment; and
(6) although treatment has been made available, the treatment
program’s structure has been an institutional failure and there is no
meaningful relationship between the treatment program and an end
to indefinite detention.”
“By failing to provide the necessary process,
Defendants have failed to maintain the [sex
offender treatment] program in such a way as to
ensure that all Class Members are not
unconstitutionally deprived of their right to
liberty.”
Remedies Phase Hearings Begin: August 2015

Van Ordern v. Schafer
- Federal Court regarding Missouri Program:
Decided September 2015
Plaintiffs Claim:
1. particular modalities of treatment at SORTS are inadequate due to
staff and funding shortages.
2. entire SORTS treatment program is a sham because, in its 16 years
of operation, SORTS has neither established the risk assessment and release
procedures contemplated by the SVP Act, nor successfully treated and
released, following such treatment, any residents back into the community.
While treatment program appears to have
improved substantially since 2009, there continue
to be challenges in lack of procedure and support
for procedure from numerous entities supporting
discharge following completion of program.
Thus far, despite numerous residents getting to
highest phases, none have been discharged
through treatment.
Felt concerns met the “shocks-the-conscience” standard.
“SVP Act is unconstitutional as applied to SORTS for the following reasons:
(1) Defendants have not performed annual reviews in accordance
with the SVP Act, as interpreted by the Missouri Supreme Court, and as
required by the Due Process Clause;
(2) Defendants have not properly implemented any program to
ensure the least restrictive environment, and have not implemented—or
even designed—the community reintegration phase of the SORTS treatment
programs; and
(3) Defendants have not implemented release procedures, including
director authorization for releases, in the manner required by the SVP Act and
the Due Process Clause. As nearly every witness who testified in this case
agreed, these systemic failures have created a pervasive sense of hopelessness
at SORTS that is undermining what little improvement the SORTS treatment
programs have made.”
Will return to court on 09/29/15 to address schedules and procedures for
remedies phase.
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Texas SVP – Currently Occuring
The implementation of the outpatient civil commitment program in Texas
is the first innovative type of civil commitment in the United States.” –
2010 Texas state website
“In an effort to make the program more constitutionally sound, the state
is officially moving to an "in-patient" model in which offenders will be
placed in one facility and eventually work their way to freedom.” –
Houston Chronicle, June 14, 2015
1.
2002 – NJ Appellate Court
Essentially supported the Judge in
considering Discharge Options.
2.
2005 – NJ Supreme Court
Essentially, to be returned to the STU, your
problematic behavior needs to be related to risk of
sexual reoffending.

Clarification of Disorder meeting criteria:
Disorder that leads to sexual acting out is
supported as meeting criteria of Mental
Abnormality in Statute. In this case it was
Antisocial Personality Disorder (ASPD) given that
W.Z. was committed without Paraphilia Dx.

Highly Likely: Statute language:
To discharge – a court must find that “the person will not be
likely to engage in acts of sexual violence because the person is
amenable to and highly likely to comply with a plan to facilitate the
person’s adjustment and reintegration into the community…” NJSA
30:4-27.32c(1)(emphasis added)…..”We regard that language as the
other side of this coin. It supports our understanding of the Act’s
requirements, namely that commitment is appropriate for an
individual who is ‘highly likely’ not to control his or her sexually
violent behavior.”
Provides Symmetry between commitment and discharge
process at STU which is concern of recent findings of
unconstitutionality of SVP Acts as applied.
1 - 2002/2003 – NJ Superior Court
Relates to Gradual De-Escalation of Restraints with
creation and implementation of Comprehensive Discharge
Plan (CDP) and furloughs.
2 – 2005 – NJ Appellate Division
Supported Written Plan for Provision of Care and
supported timeframe estimates. We now utilize these
with the Settlement.
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Essentially supports that Court can review
treatment.
The focus of the Annual Court review is to
examine whether individual continues to meet
criteria for SVP commitment. When Resident
wants to bring up a treatment issue there needs
to be appropriate notice given as this is not
focus of these hearings.
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Modified Activities Program (MAP) provides
due process. Grievances are part of that
process.
Cited Youngberg v. Romeo supporting
treatment exercised by qualified professionals
and the necessity of needing to restrict
movement/behaviors at times for the safety of
others.
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MAP process “designed to enhance behavioral stability
and pro-social functioning. Those residents whose
internal behavior controls deteriorate such that they
pose a threat or danger to themselves, other residents
and/or STU staff are subject to increased external
controls and reduction of privileges. The MAP policy
in particular is well within the ambit of delegated
authority of those responsible for the treatment of the
sexually violent predators. Thus, MAP is not a
punishment to those involuntarily committed, but a
necessary part of the entire treatment regimen to
rehabilitate those committed to a return to the
community.”

CB committed to STU in 2003, placed on
Conditional Discharge (CD) in 2004. Had
various difficulties in community after 3.5
years was in arrears with his placement. Had
previously had SSD, had been later denied.
Various types of assistance were sought from
different agencies, Temporary Rental
Assistance, smaller copay for tx. Judge ordered
STU to pay for CB’s placement and treatment
until he received SSD.

Trial Judge’s argument was that he viewed
CB’s case as consistent with Conditional
Extension Pending Placement (CEPP) that
would fall under General Civil Commitment
(GCC). Within GCC there are provisions for
assistance. It was overturned by appellate
court due to lack of provision within the SVPA
to explicitly fund placements and the efforts
already made by various agencies to assist CB.
Also felt that his time in community
distinguished him from GCC.
Had 9 total offenses involving bondage of teenage
boys, but most did not result in sexual offense
charges. Had been charged on one occasion, but
pled to other charges and technical sexual offense
charge was dropped.
He admitted at ADTC that he found bondage
sexually arousing.
Held: Court may consider the circumstances that
led to the qualifying prior conviction. When that
conduct is substantially equivalent to the sexually
violent conduct encompassed by the offenses in
N.J.S.A. 30:4-27.26(a), then that prior conviction
may provide the predicate for a civil commitment
application under subsection (b). That
determination may be made by the committing
court, on application of the Attorney General.
Essentially, nonsexual convictions can count.


2008 – Judge Perretti ruled that while RF’s predicate
met criteria for statute and a Personality Disorder, state
had not met threshold of highly likely. Age at offense
as well as cognition weighed in. Felt he was protected
by PSL and would be afforded Comprehensive
Discharge Plan (CDP) by STU which would also keep
him below threshold of “highly likely.”
2009 – Appellate Court overturned and committed RF
expressing concern over judge’s discount of state
witnesses and view of RF as “calculating and
predatory.”
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2014 NJ Supreme Court upholds trial court decision.
HELD: The trial court’s findings in a civil
commitment hearing under the Sexually Violent
Predator Act, N.J.S.A. 30:4-27.24 to -27.38, are entitled
to deference, and a reviewing court may not overturn
the commitment court’s ruling based upon its
determination that it would have come to a different
conclusion had it sat as the trier of fact.
...The
Settlement…
Alves et al. v. Main et al.
Federal Case 2:01-cv-00789-DMC-MF
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Class: all persons involuntarily confined to the
STU under the NJ SVPA
Defendants: STU Clinical Director,
Commissioner and Assistant Commissioners of
NJ DMHAS, Attorney General of NJ
Originally included DOC but they were
dropped from the suit when STU moved out of
Kearny facility.
More than a decade of negotiations!
Primary:
Defendants have failed to provide the class
with adequate mental health treatment, thus
depriving the residents of the opportunity to
“show that they have been cured of their mental
abnormality and deserve a conditional discharge.”
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More specific:
Residents are offered a max. of two 90—minute
PGs/week (& they are often overcrowded or
shortened in length).
Residents are prevented from taking
psychoeducational modules because they are
offered infrequently or not at all.
Some residents are arbitrarily restricted from
moving outside their housing unit, rendering
some programming unavailable to them (South
Unit).
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STU improperly withholds therapy as
punishment for rule infractions.
The STU fails to give residents timely and
concrete information regarding evaluative
criteria, treatment progress and goals, and the
estimated time to discharge.
The STU fails to assist with discharge planning.
Treatment is not adequately tailored to the
specific needs of each resident.
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The deficiencies are caused, in part by the
STU’s failure to adequately staff the facility.
As a result of the deficiencies, too few residents
have been discharged or are close enough to
expect discharge in the foreseeable future.
There is no mechanism for addressing
complaints regarding the treatment program.
Settlement Agreement
12/4/12
Staffing:
 Employ sufficient Treatment Staff to comply
with all material terms of this Settlement
Agreement
 8 Therapists (not including psychiatrists) for
every 50 Residents who are actively
participating in tx
 Each Therapist (clinical) maintain minimum of
16 hrs/wk direct contact
 Social workers: 10 hrs therapy, 6 hrs case mgt.
General:
 Provide individually tailored treatment that
adequately meets the needs of each Resident.
 Any final report, recommendation, or
determination for tx, tx status, phase
designation, phase progression, disciplinary
action shall be communicated orally & in
writing to Resident within 15 days of action.
 Adopt objectively measurable pre- and postmodule testing
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Test results provided to Resident within 15
days of completion of post testing & discussed
in PG within 30 days of module completion.
Staff utilizing PCL-R and PPG are properly
trained.
New Resident admission: orientation to occur
by 5pm on following business day, provide
and review Resident Guide (including
Ombudsman, potential post-discharge
placement info)
Treatment:
 Offer each Resident (not TR or MAP) a min. of
20 sixty-minute hrs/wk of professionally led
therapeutic programming (incl. professionally
monitored self-help groups).
 At least 87% scheduled PG meetings actually
meet during the calendar year.
 Provide minimum of 1 to 2 modules in every 16
week cycle (except for TR or MAP Status).
 Residents may enroll in up to 3 modules
during any cycle, including self-study.
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Maintain master record of Residents’ current
phase, to document & evaluate trends
Maintain master record of recommended
psycho-educational modules, compiled from tx
plans & TPRC reports, in an effort to schedule
module offerings consistent w/ tx needs.
MAP group meets at least 2x/wk
Residents on Program MAP status should be
able to attend PGs & modules unless
contraindicated (& informed in writing)
Treatment Planning:
 Initial treatment plan will include and
incorporate past tx progress and evaluations
(unless they are unavailable due to no fault of
DMHAS)
 Make specific and individualized
recommendations re: tx goals, objective criteria
necessary to meet goals, & anticipated time
frames for completion of both.
 Include assessment of Resident’s need for 1:1
therapy (issues other than s.o. specific issues) &
recommend a phase designation
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Conduct a review of initial comprehensive
treatment plan every 6 months, to be followed
within 15 days by a meeting w/ Resident to
review tx plan.
Specifies a list of things that must be included
on the tx plan (e.g., curricular
recommendations, d/c info, MAP, privileges,
etc.)
Assessment:
 Review process shall include evaluation of
current tx plan, tx progress notes, & any pre- or
post-module testing results.
 Shall include interview with Resident & team.
 CARP shall make a final decision about Phase
designation within 60 days of recommendation
date & decision shall be communicated to
Resident in writing within 15 days of decision.
 When providing written report to Resident, tx
staff will explain the report (includes a list of
specific things that must be discussed).
Vocational Training:
 Conduct individualized voc. assessment within
45 days of final commitment. Update as needed
& when Resident enters Phase 4.
 Offer voc. training that provides basic “job
skills,” “life skills” & Residents’ general
interests (contingent upon staffing & plant
space)
 Make available avg of 10 hrs/wk of voc.
activities, including institutional job
 Permit Residents in P5 to pursue voc. skills
training outside of STU, where appropriate
 Arrange for outside vendors to provide onsite
voc. offerings paid for by residents
Education:
 Continue to employ a minimum of 1 certified
teacher at each facility (building)
 Residents may pursue an educational
curriculum for at least 10 hrs/wk, including
formal instruction, homework time, self-help.
 Interested Residents provided remedial
education training or GED course offerings
w/in 6 mo. of request
 Permit, but not pay for, Residents to pursue
post-secondary education w/in facility.
Recreation:
 Offer professionally facilitated rec. activities 6
days/wk
 Conduct annual surveys re: desired rec.
activities & try to offer popular activities.
 Conduct annual surveys re: topics of interest in
the area of general health education & offer
related modules.
Treatment Ombudsperson:
 Responsible for establishing & implementing
procedures for eliciting, receiving, processing,
responding to, & resolving complaints from
Residents, family members, & other interested
citizens concerning tx conditions at STU.
Social Work:
 Social workers shall use info in potential postd/c placement file to develop d/c plan for each
Resident when court-ordered, recommended
by TPRC, or Resident reaches P4. Social
workers help Resident find housing & support.
Independent Experts/Trainers
 Subject to the availability of qualified, willing
candidates, DMHAS will retain Independent
Experts in the field of sex offender treatment
and assessment. A “qualified” candidate shall
have expertise and experience in the area of sex
offender management and treatment. (4/yr)
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Preinspection
Potential Noncompliance Issues
Objections
Federal Monitor Inspection
Report
Objections
Proof - Further argument – More proof
Final report
Cures
The Benefits of the Settlement for the STU:
 Experts
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Evaluation
Training
Exposure/reinforcement/encouragement
Accountability
Improve processes
 QA
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Staffing
Treatment staff
 Staff dedicated to Settlement & program
development
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Moving Forward:
 RNR
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GLM
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Focus on Responsivity
Gradual paradigm shift
Curriculum
Documentation
Dynamic Risk
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More formally addressed within documentation
STABLE 2007
 Adaptations for inpatient pop. as per Andrew Harris
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Research
Christine Zavalis, Psy.D.
Special Treatment Unit
Treatment Progress Review Committee
[email protected]
In August of 1998, the New Jersey State Legislature
passed Senate Bill Number 895 entitled the “New
Jersey Sexually Violent Predator Act” revising the
Title 30 Statute. The law indicates that “because of the
nature of the mental conditions from which sexually violent
predators suffer, and the danger they present, it is necessary
to house involuntarily committed sexually violent predators
in an environment separate from persons committed under
(C: 30:4-27.1 et seq.) or otherwise confined.”
The, “The Department of Corrections shall be
responsible for the operation of any facility
designated for the custody, care and treatment of
sexually violent predators, and shall provide or
arrange for custodial care of persons committed
pursuant to this act.” (Title 30:4-27-11a)
“The Division of Mental Health Services in the
Department of Human Services shall provide
or arrange for treatment for a person
committed pursuant to this act.”
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Arizona
California
Florida
Illinois
Iowa
Kansas
Massachusetts
Minnesota
Missouri
New Hampshire
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New Jersey
New York
North Dakota
Pennsylvania
South Carolina
Texas
Virginia
Washington
Wisconsin
Federal
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August of 1999: STU opens in Kearny
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“temporary facility”
May of 2001: Annex opens in Avenel
May of 2009: Appellate Division says must move out of
Kearny
May of 2010: STU moves all residents to Avenel.
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Aggravated Sexual Assault
Aggravated Criminal Sexual Contact
Sexual Assault
Criminal Sexual Contact
Felony Murder where the underlying crime is
Sexual Assault
Kidnapping where offense is found to be
sexually motivated
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ADTC
46%
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Other prisons42%
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DHS, DDD, JUVY, Street 12%
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Some prisons do SVP evaluations
Deputy Attorney General’s office
Clinical Certificates (2 doctors)
20 day initial evaluations (usually waive)
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Psychiatrist and Psychologist (TPRC)
Initial Hearing
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Discovery files
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Legal documents
Past psychiatric/psychological reports
Institutional documents
Interview with resident
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Static
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Dynamic
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Changing
What we attempt to modify through treatment
Stable
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Historical, unchanging
Attitudes, coping styles, relationship stability…
Acute
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Immediate concerns
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STATIC-99R
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Young
Ever Lived With
Index Non-sexual Violence – any convictions
Prior Non-sexual Violence – any convictions
Prior Sex Offenses
Prior Sentencing Dates (excluding index offense)
Any Convictions for Non-contact Sex Offenses
Any Unrelated Victims
Any Stranger Victims
Any Male Victims
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Long history of incorporating stable risk factors in
evaluations at the STU
Recently incorporated Stable 2007 into evaluations for:
 Initial evaluations
 Phase 3B and above
 Outpatient evaluations
Received trainings through NYATSA, NJATSA, STU
Grand Rounds, STU in-house trainings
Adjusted for inpatient populations
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STABLE-2007
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Significant Social Influences
Capacity for Relationship Stability
Emotion Identification with Children (only scored for offenders with child
victims)
Hostility Toward Women
General Social Rejection
Lack of Concern for Others
Impulsive
Poor Problem Solving Skills
Negative Emotionality
Sex Drive/Sex Preoccupation
Sex as Coping
Deviant Sexual Preference
Co-operation with Supervision
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ACUTE 2007 (for outpatient evaluations)
Victim Access
 Hostility
 Sexual Pre-Occupation
 Rejection of Supervision
 Emotional Collapse
 Collapse of Social Supports
 Substance Abuse
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Offending dynamics
 Incest vs stranger
 Modus Operandi
 Opportunistic/impulsive vs planning
 Victim profile range
 Duration of offending history
 Onset of offending behavior
 Escalation of offending behavior
 Sadism
 Breadth of deviant arousal
 Use of a weapon
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Permissive/Dysfunctional Attitudes
High Risk/Criminal Lifestyle
Victim impact
Multiple failed treatment episodes
Personality Disorders
Mental Health issues
Institutional history
Ability to be managed in the community
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Glib/Superficial Charm
Grandiose Sense of Self-Worth
Need for Stimulation/Proneness to Boredom
Pathological Lying
Conning/Manipulative
Lack of Remorse or Guilt
Shallow Affect
Callous/Lack of Empathy
Parasitic Lifestyle
Poor Behavioral Controls
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Promiscuous Sexual Behavior
Early Behavioral Problems
Lack of Realistic Long Term Goals
Impulsivity
Irresponsibility
Failure to Accept Responsibility for One’s Own Actions
Short-term Marital Relationships
Juvenile Delinquency
Revocation of Conditional Release
Criminal Versatility
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Age
Medical Issues
Treatment Exposure and Benefit
Parole Supervision for Life
Compliance with Supervision
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Initial Hearing
 Is the resident highly likely to reoffend
 Can they be managed in the community
Annual Hearing (is the resident still highly likely to reoffend)
 Yearly evaluations
 Accelerated reviews
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Deputy Attorney General
Public Advocate
Expert Psychologist/Expert Psychiatrist
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The judge makes the ultimate decision (3 judges in house)
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Consultation with treatment team
Chart review
Resident interview
Risk assessment
Assess treatment progress
Consider medical mitigation of risk
Treatment recommendations
Phase recommendation
Recommendation for discharge
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PHASE 1 – Entry, orientation, and dealing with the
trauma of commitment
 and Treatment Refusers
PHASE 2 - Rapport building and initial engagement in
treatment
PHASE 3 – Core/Intensive
 3a – Early Core Work
 3b – Advanced Core/TC
PHASE 4 – Advanced/Honor/Maintenance
PHASE 5 – Transition/Furloughs
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


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Treating clinicians
Multidisciplinary Treatment Team
 Psychologists, Social Workers, Substance Abuse
Counselors, Program Coordinators
Treatment Progress Review Committee
 Independent assessors but in facility
Psychiatry
 Independent assessors but in facility
Clinical Assessment Review Panel
 Independent assessors in DHS central office

Relapse Prevention


Risk-Needs-Responsivity


Management of risk factors
Level of risk dictates how we treat/supervise
Good Lives Model

Increasing positive aspects of life


Treatment is tailored to the individual
Special Considerations (issues that impact
ability to integrate treatment)



Cognitive Limitations
Psychopathy
Mental Health Issues






Process Group
Individual Sessions (when clinically appropriate)
Modules
 Relapse Prevention, Arousal Reconditioning, Personal
Victimization, Victim Empathy, Sex Education
 Anger Management, Emotion Regulation, Stress Management,
Family of Origin, Relationship Skills, etc.
Self-Help Groups
Written requirements (Autobiography, Sexual History Questionnaire,
Personal Maintenance Contract, Substance Abuse Maintenance
Contract, Victim Impact letters, Covert Script, etc.)
Polygraph Examinations

Substance Abuse Treatment


Process Groups
Modules
 Drug and Alcohol Education, Relapse Prevention,
Anger Management, Criminal and Addictive Thinking,
Step Book Series, Recovery Dynamics, Socialization for
Recovery, Disease of Addiction, etc.

Self-Help Groups

Rehabilitation Department
Modules (Art, Music, Social Skills, Money
Management, Stress Management, etc.)
 Open Recreation
 Vocational Programming
 Educational Programming
 Jobs (sensitive areas)


Therapeutic Community


Advanced therapeutic milieu
Focus:
 Developing responsibility for self and the TC
community
 Living treatment



Modified Activities Program (MAP)
 MAP group
MAP levels
 Temporary Closed Custody (TCC)
 Room MAP
 Tier MAP
 Wing MAP
 Program MAP
Treatment Refusal
 Treatment Orientation group


Does resident’s risk fall below the level of
Highly Likely?
Is the resident Highly Likely to comply with
supervision?

Interplay between
Actuarial Risk (Static-99R)
 Treatment
 Psychopathic/Antisocial personality structure
 Deviant Arousal
 Psychiatric History (self-regulation)
 Supervision (availability and amenability)



Treatment Driven
Court Driven

292 Discharges



87+ initial hearing
57 deceased/hospice
129 conditional discharge status
 75 Phase 5

2006
2007
2008
2009
2010
2011
2012
2013
2014
1
1
7
5
9
7
9
12
14

2015
10


















2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
1
5
1
4
3
7
3
5
1
1
2011
2012
2013
2014
2015
9
1
5
7
1








2001
2002
2003
2004
2005
2006
2007
2008
14
17
9
11
8
14
7
20
2009
2010
2011
2012
2013
2014
2015
10
18
20
12
20
32
18




Phase 4 generally lasts 1 year
Active Discharge Planning
 Housing, employment, support network, leisure activities,
etc.
Gradual De-escalation of Restraints
Challenges
 Finding a placement
 Case management






Individually tailored based on the resident’s needs
Plans range from 12 to 24 furlough
 (1 or 2 furloughs in rare cases – nursing home)
Diagnostic (helps identify problems to address before
discharge)
Helps them prepare for discharge
Resident expected to process the furloughs
Polygraph examinations during the process

Gradual de-escalation of restraints



4 hour furloughs (interview with housing placement,
mall, public transportation, area around discharge
placement, restaurant, sex offender treatment
provider, one stop career center, AA/NA
Gradually increase furloughs to 24 hours, 48 hours,
72 hours, 96 hours, 120 hours
Itineraries required





Gradual de-escalation of restraints
Interview with resident
Consultation with outpatient treatment
providers
Consultation with parole officer
Consultation with Community Resource Team
at the STU








Housing/Employment
Outpatient sex offender treatment
AA/NA
Weekly contact with Community Resource Team
Parole supervision
PSL-like conditions (GPS, curfew, random drug screens,
polygraph examinations, restricted computer use)
Maintain contact with TC “keep safe”
Restrictions specific to resident (social networking sites, known
drug areas, schools, parks, bars, clubs, no unsupervised contact
with children, etc)





Unable to form stable relationships
Experienced financial stress
Experienced domestic discord
Had negative social influences
Experienced social disconnection and
loneliness

38 Readmitted

13 “discharged” to prison
3 “discharged” to AKFC
22 violated/arrested

6 Prison/jail










CDS/Alcohol
Smart phone
Social networking
Removed GPS, fugitive status
Curfew violations
Moved without prior approval
Residence issues
Contact with minors



New Sex Crime (4)
Child Pornography (1)
Other Serious Crimes (5)


Burglary, Aggravated Assault, Attempted Homicide,
Manslaughter, Resisting Arrest
Re-evaluate risk to determine if they need to be
re-committed

They were able to:

Create a positive support network
 Strong connection with family and friends
 Involved in social positive activities


Find stable housing
Find stable employment