Prison Sex Offender Treatment: Recommendations for Program Implementation July 2007 Prepared on behalf of the California Department of Corrections and Rehabilitation Sacramento, California 0RISON3EX/FFENDER4REATMENT 2ECOMMENDATIONSFOR0ROGRAM)MPLEMENTATION "Y 0EGGY(EILAND+IM%NGLISH *ULY 0REPAREDONBEHALFOFTHE #ALIFORNIA$EPARTMENTOF#ORRECTIONSAND2EHABILITATION 3ACRAMENTO #ALIFORNIA Prison sex offender treatment: Recommendations for program implementation ii Prepared on behalf of the California Department of Corrections and Rehabilitation Table of contents Page 01 Section one: The larger context of treatment and organizational change 01 Preface 01 Introduction 04 Summary of U.S. prison-based sex offender treatment programs 06 Snapshots of prison programs 12 Program description and evaluation findings: Colorado Department of Corrections Sex Offender Treatment and Monitoring Program 18 Atascadero: Program efficacy study 19 Evidence-based correctional practices 23 Implementing organizational change 24 References for therapeutic community discussion 27 Section two: The containment approach 27 Introduction: Containment approach in California 27 The containment approach 38 The post-conviction polygraph examination of sex offenders 42 Effectiveness of the containment model 44 Selected references 47 Section three: Building a CDCR sex offender treatment program 47 Introduction 47 Designing the program for effectiveness 52 Target population 61 Program structure 65 Description of treatment stages 71 Treatment location (facility selection) 77 Community containment 83 Quality control and program evaluation 85 Program staffing 95 Section four: Cost implications 95 Introduction 95 Program costs: Level One and Level Two 96 Cost benefit assumptions 99 Section five: At a glance – next steps for CDCR officials Table of contents continued next page. iii Prison sex offender treatment: Recommendations for program implementation Page 101 Appendices 101 –– Table of contents of appendices 103 A1 Research summary: Limiting visitation with children 115 A2 Sex crimes are under-reported: Three research summary tables 119 A3-A Administrative regulation that established restricted privileges in Colorado 131 A3-B Colorado restricted privileges statute 133 A4-A Treatment recommendations flowchart 135 A4-B Therapist instructions for screening inmates for treatment 145 A4-C Participation criteria for inmate 147 A5 Sample forms: Informed consent sample form, confidentiality waiver, limited immunity, release of information 153 A6 Treatment contract: Two examples 179 A7 Treatment termination document 183 A8-A Individual treatment plan: Example 199 A8-B Personal change contract: Example 205 A9 Support system notification 209 A10-A Alaska Department of Corrections: Safety Net Offender Manual 287 A10-B Alaska Department of Corrections: Safety Net Manual for Therapists & Supervising Officers 367 A11 Recommendations for equipment and program space. 369 A12 Contact with children: Colorado Sex Offender Management Board Standards 391 A13 Sample training program for new staff 393 A14 Supervision: Surveillance, caseload size, contact standards 439 A15 Quality assurance 441 A16 Interview questions for therapist and therapist supervisor 445 A17 Co-therapy: Group processing form and instructions 449 A18-A Polygraph examiner requirements: American Polygraph Association, California Association of Polygraph Examiners, Colorado Sex Offender Management Board requirements for PCSOT examiners 459 A18-B California Coalition on Sex Offenders position paper on PSCOT 467 A19 Sexual history disclosure form 493 A20-A Draft chapter on job impact: Individuals 509 A20-B Draft chapter on job impact: Teams 527 A21 Program description of Colorado DOC’s SOTMP (Sex Offender Treatment and Management Program) 531 A22 Procedure for approving community treatment providers: Colorado DOC 557 A23 Polygraph sanctions grid iv Section one: The larger context of treatment and organizational change Section one: Introduction The larger context PURPOSE OF THIS REPORT of treatment and The California Department of Corrections and Rehabilitation (CDCR) requested a document that organizational change describes an empirically based prison sex offender treat- ment program and provides recommendations for the Preface development and implementation of such a program in the California prison system. Program recommendations Sexual offenses cause tremendous harm to the lives of are drawn from research and clinical experience. Where victims, the victims’ families and our communities. We possible, materials from other programs are included in recommend that the California Department of Corrections appendices to facilitate implementation. and Rehabilitation implement the “containment approach” for managing sex offenders in prison and on parole. The containment approach is a comprehensive strategy that VALUE OF TREATMENT prioritizes victim protection and community safety. As states face the cost of burgeoning prison populations, along with the public’s fear of sexual offenders, the use of Prison treatment for sex offenders can be an effective sex offender treatment as a primary management and con- component of the containment approach. Intense prison tainment tool has become commonplace in jurisdictions treatment can reduce recidivism and enhance community across the United States. safety. It can also reduce the substantial costs (emotional and financial) associated with recidivism. Miller, Cohen Fortunately, a plethora of research studies over the past 1 and Wiersema (1996) estimated that child sexual abuse 20 years is guiding most programming, and there is a crimes costs victims and society $99,000 per victimization, general consensus among sex offender management profes- and estimated $87,000 per rape/sexual assault victim- sionals about “best practices” for this population. When ization. These costs are estimated to be $140,531 and this information is combined with the “what works in cor- $123,497 in 2007 dollars. Ninety-percent of the costs are rections” literature describing evidence-based practices that associated with significant reduction in the quality of life reduce recidivism, a solid framework is available for devel- 2 for victims of these crimes. oping and implementing a state-of-the-art prison treatment program. However, prison treatment will be more effective Quantifying the costs of sexual victimization seems to if it is followed by community-based containment services, trivialize it nonetheless. As Miller et al. (1996:14) state, including supervision, treatment, and polygraph testing. “pain, suffering, and reduced quality of life do not have a market price and cannot be bought and sold.” Certainly victims would pay dearly to avoid them, as would their RECIDIVISM REDUCTION families and members of the community. While the efficacy of sex offender treatment remains a debated topic, many studies show that treatment participa- The following report details a prison sex offender treatment tion is correlated with lower officially recorded recidivism program plan that is designed to reduce recidivism and rates.3 Studies of programs using cognitive-behavioral avoid the costs and immeasurable harm of sex crime victim- ization. It provides evidence-based sex offender treatment and management recommendations to increase community 3 Hanson, K. R., Gordon, A., Harris, A. J. R. , Marques, J. K., Murphy, W., Quinsey, V. L. and Seto, M. C. (2002). First Report of the Collaborative safety and decrease new sex crimes by known offenders. Outcome Data Project on the Effectiveness of Psychological Treatment for Sex Offenders. Sexual Abuse: A Journal of Research and Treatment, Vol.14, No. 2, 169-194. This meta-analytic review examined the effective- 1 See Miller, T.R., Cohen, M.A. and Wiersema, B. (1996). Victim Costs ness of psychological treatment for sex offenders by summarizing data and Consequences: A New Look. A final summary report presented from 43 studies (combined n = 9,454). Averaged across all studies, the to the National Institute of Justice, U.S. Department of Justice. sexual offense recidivism rate was lower for the treatment groups (12.3%) Washington, D.C. NCJ155282. than the comparison groups (16.8%, 38 studies) and the same was found with general recidividism (treatment 27.9%, comparison 39.2%, 30 2 The complex estimates include tangible and intangible losses to the studies). Current treatments (cognitive–behavioral, k = 13; systemic, k = victim, plus costs associated with the criminal justice system, victim 2) were associated with reductions in both sexual recidivism (from 17.4 to services, incarceration of the offender, and “second generation costs” 9.9%) and general recidivism (from 51 to 32%). Older forms of treatment associated with future victims of crimes associated with earlier victims. (operating prior to 1980) appeared to have little effect. 1 Prison sex offender treatment: Recommendations for program implementation treatment techniques have found recidivism reductions of activities. The unique knowledge generated about the 30-50 percent. This reduction translates into victimiza- CDOC program from its internal research operation pro- tions prevented, criminal justice expenditures avoided, vides additional empirical guidance for implementation of and crime-free living on the part of many offenders. a similar program at CDCR.6 It also reflects the necessity Clearly, sex offender treatment can be an effective offender of such research to the treatment model so that service management tool and crime prevention