Sex Offense Treatment Provider Parameters

Sex Offense 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 Offense Specific Treatment Providers. The following parameters are used to determine eligibility for outpatient sex offense specific treatment providers and their programs.

Professional Qualifications

• Current Utah licensure in a mental health profession (i.e. psychiatry, psychology, mental health 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 offense specific 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 offense specific assessment experience (sex behavior risk assessments, psychosexual evaluations, interpretation of PPG (Penile Plethysmograph)/Abel results, intake, clinical interviewing, case supervision, quarterly reports, etc.);

• Within the two-year period immediately preceding application, the individual must have received at least 24 hours of formal training through documented conferences, symposia, seminars or coursework related to the evaluation and treatment of persons who sexually offend. Examples of places to obtain such training include ATSA, quarterly Sex Offense Task Force Training, Global Institute of Forensic Research, NOJOS sponsored trainings, International Trauma Training Institute, etc. Training must be directly related to interventions involving persons who sexually offend including behavioral/cognitive therapy methods, reconditioning and relapse prevention, use of sexual interest measures, use of polygraph examinations, group therapy with different subsets of persons who sexually offend (i.e. child sexual exploitation materials, low risk, women, etc.), victimology, suicide prevention respective to persons who sexually offend, couples and family therapy related to reunification, sex offense specific risk assessment, sexual deviancy and ethics and professional standards, particularly within the forensic realm. 

• 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.” As a first-time applicant, an affiliate does not need to meet the required hours of training, but upon renewal of an affiliate status, the expectation is they obtained the ongoing training required to work not only in the field, but specifically with persons who sexually offend as outlined in the application. 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 graduate program and/or leading to licensure and their clinical work is supervised by a licensed professional meeting the above requirements; it must be documented on the application that they are an active student and a copy of their transcripts are required. Supervision parameters include 1 hour of supervision per every 40 client hours with a minimum of 1 hour of supervision per month. 

• 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 and thoughts/behaviors contributing to their choice to sexually offend is a basic requirement for successful completion of therapy. Responsibility includes acknowledgement and recognition of all elements of convicted offense(s). Accountability entails an understanding of the complex dynamics involved in the commission of, or approximation to, sexual offenses.  If a client does not take accountability for sexual offenses and related behaviors, then the provider must carefully consider the client’s progress in the program. The client must be able to demonstrate reduced risk to sexually offend in spite of their challenges with accountability and/or responsibility. Approaches should include the client’s development of protective factors while mitigating risk factors accordingly.

• Providers must adhere to the reporting requirements as prescribed 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 Offense Task Force, every two years to renew their approved status.  The sex offense task force reserves the right to verify all CEU hours. 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 Offense Task Force. Failure to reapply before their approved date expires will result in the provider/affiliate being removed from the provider list.  If approval has expired the provider will be removed from the quarterly training mail list and will not receive training updates. If approval status has been suspended after a site review, the provider will remain on the mailing list but will be removed from the website until they are back in good standing with the Task Force. 

• Approved Providers wishing to provide supervision must adhere to the following tiered system for supervision: 
• Approved Provider must be 2 years post licensure and have equal or greater than 2,000 hours of direct sex offense treatment experience and can supervise 3 Affiliates (3:1). 
• Senior fully licensed supervisors (5 or more consecutive years on approved SOTF provider list) can supervise 6:1. 
• Emeritus fully licensed Supervisors (10 or more consecutive years on approved SOTF provider list) can supervise 6:1

• Please note Supervision entails co-signing documents, individual & group notes, reports, etc.  This should be completed for the first 2000 hours of sex offense 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 persons who sexually offend 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.).

Program Parameters

Outpatient treatment programs for persons who sexually offend (PSO’s) must have the following components:

Intake into an outpatient sex offense specific treatment program shall consist of and include:

• Intake assessment: includes the results of one validated static and dynamic risk assessment instrument, mental status assessment, behavioral observations, strengths and protective factors, assessment of childhood abuse including being sexually abused as a minor, substance use/abuse, 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 person’s current treatment, and an evaluation of the person’s current amenability to sex offense specific treatment.

• Psychosexual evaluation: when clinically indicated (completed by a licensed psychologist who is an approved provider or approved evaluator) for purposes such as re-offense, multiple prior unsuccessful episodes of sex offense specific treatment, or agent/therapist/evaluator concern is sufficient to warrant this level of assessment. The evaluation shall include the results of actuarial risk assessment instruments (measuring static and dynamic variables) with acceptable research validation, records reviewed, tests administered, tests reviewed, reason for referral, behavioral observations, biopsychosocial history relevant to the present referral question (family, social, medical, academic, employment, marital, mental health, substance use, trauma history, legal history), supervision history, sexual development history, sexual offending history, current testing results (including personality, academic, cognitive, trauma, neuropsych, etc.), sexual interest, protective factors, diagnostic impressions, summary and recommendation(s). Of note, the PPG (using audio stimuli only, no visual stimuli), Abel Assessment, or other sexual interest and/or arousal evaluation for PSO’s helps to establish a baseline for future treatment and provides a more thorough assessment of the PSO’s treatment needs and risk to reoffend. Evaluators shall include testing instruments recognized in the sex offense evaluation community as valid tools prior to the initiation of treatment.

Subsequently, a written report must be submitted to the person’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:

• 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. 
• Documentation will be retained for a 10-year period effective May 1, 2021    

Outpatient treatment program shall be defined as:

• It is expected outpatient treatment requires at least 12 months of weekly individual and group treatment followed by continued care lasting 12 months which may be longer or shorter as clinically indicated and supported by a dynamic risk assessment (i.e. SOTIPS).
• 
  At least one weekly individual session lasting at least 50 minutes, conducted by an approved provider or affiliate provider.

• At least one weekly sex offense specific group therapy session lasting at least 80 minutes, conducted by an approved, provider or affiliate provider; until the client moves into the transition phase of treatment.

• A sexual history polygraph examination for both male and female PSO’s 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 risk relevant factors.

• Additional polygraphs may be completed periodically during treatment to ensure the PSO is not violating any court orders, treatment rules and regulations or violating any of the terms and conditions of his/her probation and/or parole.  Additional polygraph examinations may be administered to any PSO when deemed appropriate by the provider and/or Adult Probation and Parole.

• 50 hours of psychoeducational classes which may include: relapse prevention, assault cycle, thinking errors, relationship skills, financial literacy and healthy human sexuality, and 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 a PSO to repeat some or all of these classes if clinically indicated.

• A maintenance polygraph examination will be completed by all PSO’s prior to the completion of treatment to determine compliance with treatment program rules, court orders, and supervision requirements.

• Additional sexual interest and/or arousal evaluations may be completed based upon clinical need.  If a valid sexual interest/arousal evaluation has been completed in the last two years, then a follow up sexual interest/arousal evaluation may not be necessary, depending on results.

• A minimum of one progress report shall be submitted to the PSO’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 PSO’s supervising agent. The summary may also be shared with the PSO at the clinician’s discretion through a feedback session but cannot be released to the PSO unless through the GRAMA process (see UDC website for more information).

Intensive outpatient treatment program services:

An intensive outpatient treatment program will include the same treatment regimen as the outpatient treatment program as well as an additional weekly sex offense specific 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:

Continued care treatment program services are those designed for PSO’s who have, 1) completed sex offense specific treatment while incarcerated and prior to being granted parole, 2) have been paroled to a community correctional center and completed the treatment program at the community correctional center, or 3) completed an outpatient treatment program in the community. It is recommended continued care will last approximately 12 months. The duration may be longer or shorter as clinically indicated and supported by a combined risk assessment utilizing a static and dynamic risk tool (i.e. VASOR-2/SOTIPS) and will be defined as:

Individual and group sessions must be conducted by an approved or affiliate provider. Initially, the PSO will be seen weekly for individual and group sessions. Dosage will be reduced as clinically recommended and in collaboration with the supervising agent.

• If the client completed the Sex Offense Treatment Program while in prison, then a sexual history polygraph (SHE) will be completed by the PSO during Continued Care regardless of whether the PSO plans on engaging in reunification. The results of the SHE will help determine clinical appropriateness of contact with minors or reunification in the community.

• A maintenance polygraph examination will be completed by all PSO’s 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 that have not been reported, discussed and addressed with therapist and supervising agent. Additional polygraph examinations may be required of any PSO when deemed appropriate by the provider and/or Adult Probation and Parole.

• A minimum of one progress report shall be submitted to the PSO’s supervising AP&P agent per quarter. This report is due no later than the 10th day of the month following the end of the quarter.

PLEASE NOTE: Continued Care is RNR (risks, needs, responsivity) driven, 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 implemented 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 conclude 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 offense specific treatment may be discharged in one of the following four ways. Criteria for each are specified below:

Unsuccessful termination:

• Notification of discharge from treatment at a minimum must be made verbally to AP&P prior to notifying the PSO 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 PSO’s discharge.

• The discharge summary must address reasons for unsuccessful completion, progress to date of the PSO, prognosis/treatment amenability, risk to the community, and indicate whether or not the PSO reached maximum benefit of offered treatment.

Successful completion:

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 least verbally) to AP&P prior to notifying the PSO 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 designating therapy as completed.

• The discharge summary must include a description of the issues addressed, compliance of the PSO, progress made, prognosis and results of a 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.

Transferring treatment:

• PSO’s transferring from one program or agency to another must have approval by the PSO’s supervising AP&P agent and must not have any outstanding treatment fees. The current therapist and the new proposed therapist should all be involved and aware of the transfer process to ensure continuity of care and maintenance of professional ethics involved with treating clients. 

Maximum benefit:

• Maximum benefit is a condition under which a PSO 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 PSO’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 PSO’s functioning and/or decrease in the PSO’s risk for re-offending. The treatment provider needs to make an earnest effort to gather collateral data to substantiate the factor that interferes with progress, i.e., doctor’s note, medical diagnostics, diagnosis from psychological assessment, etc.

• 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.

Denier Track:

We do not offer a denier track for persons who sexually offend. If a client is struggling with accountability for their convicted crimes, it is the responsibility of the clinician to properly identify the appropriate treatment targets for that particular client while considering the safety and cohesion of the group they will enter and balancing community safety. If that client is becoming a problematic addition to the group because they are engaging in significant denial to the point where it is compromising the integrity of the group, then the clinician is responsible for mitigating and resolving the issue in a therapeutic fashion. 

Response to Failed Polygraph:

• If a client continues to react to a question in their termination polygraph, has received the prescribed treatment dosage, and their dynamic risk assessment score is low, they could successfully complete treatment.  If they score moderate or higher on their dynamic risk assessment at termination, these cases need to be staffed with the treatment team including the supervising agent prior to determination of treatment status.

Completed Prison SOTP:

• Completed Prison SOTP is defined as successful completion of sex offense specific treatment while incarcerated (referred to in the UDC SOTP program as “Transitioned” – successful completion). As with other forms of completion of treatment, a discharge summary will be completed by the clinician that details a PSO’s progress; areas requiring further intervention; assessed risk for re-offending; and any applicable recommendations regarding structure and supervision.

Note: Individuals who have completed sex offense specific treatment while incarcerated are expected to go into Continued Care services (as detailed above) when returned to the community including a sexual history polygraph. 

Discharge Summary

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 a static and dynamic sex offense specific risk assessment instrument validated through research and accepted within the professional community
• Description of progress made during the treatment episode (including any psychoeducational classes completed)
• Remaining sex offense specific issues needing to be addressed when applicable as well as when transferring to another provider or unsuccessful discharge.
• Remaining non-sex-specific issues needing to be addressed
• Recommendations for further treatment, as appropriate
   

Audit Process

As required by the Sex Offense Task Force, a program may be reviewed/audited for compliance with listed parameters.  The audit will consist of:

• Site visit (may include shadowing of a group session to evaluate program fidelity according to approved program description submitted to the Task Force)
• Review of 15% of client files
• General program review
• Review of program documentation (effective March 1, 2021 document retention is 10 years)
• 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
• Documents pertaining to activity requests, safety plans and approved sponsors

(Updated 3/22/2023)