501 (c) 3 non-profit agency

1. 501 (c) 3 non-profit agency • Intensive Active Treatment Provider (IAT) with Senior Disabilities Services (SDS) through the Intellectual and Developmental Disability (IDD) Home and Community Based Waiver • Sex Offender Treatment Provider (SOTP) with the Department of Corrections (DOC) • Substance Abuse provider through a (SOTP) DOC contract

2. MISSION  The mission of the Center for Psychosocial Development is to provide specialized services for children and adults with disabilities and their families across the State of Alaska. Services are designed to enable people to remain in their homes and communities. Services include education, consultation, evaluation, case management and specialized treatment.  • MISSION STATEMENT  Making communities safer by empowering people with intellectual disabilities to develop healthy relationship skills. • CPD SLOGAN Safe Relationships, Safe Communities

3. CPD addresses the problematic sexual challenges & behaviors experienced within the Mental Health systems, Intellectual and Developmental Disability (IDD) community, & Fetal Alcohol Spectrum Disorder (FASD) populations, across the State of Alaska. Treatment recommendations are individualized in treatment plans for each client.

4. CPD’s Philosophical Framework Prevention of Sexual Abuse Interventions are provided in the least restrictive environments e.g., home, work and community Responsibility to safeguard the community Problematic sexual behaviors can be successfully managed for individual and community safety Community supports facilitate the personal growth of the client with identified problematic sexual behaviors Treatment, monitoring, and support must be individualized Regardless of the problematic sexual behavior, the client is treated with dignity

5. CPD Services • Group Therapy • Individual Therapy • Risk Assessments • Environmental Assessments • Clinical Case Management • Community-Based Observation Training Sessions/Home Visits • Case Conferences • Substance Abuse Treatment (DOC)

6. Group Therapy Services Women’s Program (Wednesday) • 2 – groups Men’s Program (Mon, Tues, Thurs & Friday) • 15 – groups • 9 – DOC groups • 6 – IAT groups

7. SDS & IAT • Medicaid Service (Intensive Active Treatment) • Care Coordinators include our budget and treatment plans in the waiver renewal process. • Coordination with other service providers, e.g., guardians, the host agency staff, housing providers, day rehabilitation staff, employment staff, families and friends are part of the treatment team • Treatment team meetings can get large (lengthy) • Approximately 45 individuals with the IDD waiver served annually at the clinic. • Each year the IAT services are reviewed and require ‘justifications’ for continued services

8. Referrals to CPDfor Intensive Active Treatment • Intake criteria • Clients need to have the IDD Waiver in place, in order for CPD to serve them through Intensive Active Treatment. • IDD application process with SDS and the Intellectual & Developmental Disabilities (IDD) Unit visit the (State of Alaska website) • Anyone can make referrals, however, the Care Coordinator will have to navigate the process of including IAT into the Waiver.

9. Sex Offender Treatment (SOTx )& Substance Abuse Treatment • Intake Criteria for Sex Offender Treatment • Adjudicated sexual offense with Conditions of Mandatory Probation/Parole • A history of cognitive & learning challenges, FASD, or any other mental health issues • Intake Criteria for Sex Offender Tx & Substance Abuse Treatment • History of substance abuse (often included in the index crime) • A condition of Probation/Parole • Assessment confirming substance abuse issue

10. Referrals to CPD for SOTx and/or Substance Abuse Tx • Criminal Justice Planner • Probation Officers and IDP + (Mental Health Clinicians) • SOTP Risk Assessment identifying individual requiring CPD’s specialized treatment program

12. Sexual Abuse • Sexual Abuse is a broad term that includes any sexual or sexually motivated behavior resulting in someone being forced, coerced, or manipulated into witnessing or experiencing sexual harassment, exploitation, or an activity which they did not, or could not consent. • Sexually abusive behaviors include, but are not limited to, forcing someone into sexual activity through threats, coercion or manipulation.

13. Alaska • KTOO Public Media-Juneau & KYUK-Bethel (11/17/2017) • 54% of Alaska’s sexual assault victims are Alaskan Native, even though Alaskan Native people compromise only 20% of the state’s population • 47% of the suspected attackers are Alaskan Native as well • Alaskan women are more likely to be attacked than anyone else, nationwide • Most common victim of sex crimes are 14-year-old girls, who are almost always attacked by someone she knows

14. Alaska • The rate of rape across Alaska is 2.5 times the national average. • The rate of child sexual assault across Alaska is almost six times the national average, girl or boy. • Close to 75% of Alaskans have been personally impacted by domestic violence and sexual assault. • 37% of women in Alaska have experienced sexual violence, 50% of Anchorage female residence have been sexually assaulted. • Native Alaskans make up 61% of rape victims in the state, making Alaska Native women 9.7 times more likely than other Alaskans to be victims.  • According to the Crime in Alaska Felony Level Sex Offenses 2017 report, released by the Alaska Department of Public Safety, the rate of reported felony sex offenses in the Western region of Alaska was more than double the statewide rate in 2017. • Western Alaska (which includes Kodiak Island Borough) has had the highest reported rate of felony level sex offenses in the state over the past three years. • In 2017, there were 400 felony sex offenses per 100,000 people compared to the statewide rate of 200 offenses per 100,000 people. A 106 percent higher rate. • The felony sex offense rates decreased overall, according to the report, but the number of victims increased.

15. Why? What do you think is the reason • Kodiak Women’s Resource Center employee states, “It’s due to numerous things. The drug, opiate, heroin, meth epidemic that’s going on; a lot of people are stuck couch surfing. That puts them in a very vulnerable state” • Alcohol has been reported as the main cause • Alaska leads the country in drug consumption

16. MYTH All patients at CPD are sex offenders or sexual abusers (slightly over 50% have adjudicated offenses). FACT: Patients served by CPD have a spectrum of sexuality-related challenges, e.g., media viewing, masturbation issues, socio-sexual behaviors (sexual comments & exposure), sexting and so on.

17. FASD • Fetal Alcohol Spectrum Disorder (FASD) is the most common and most underdiagnosed neurodevelopmental disability. A recent study from four U.S. areas suggested an incidence rate between 2-5%. • Between 10 and 32 million Americans most likely have FASD. • Individuals with FASD are over-represented in the justice system not only in perpetrators, but in victims and witnesses. Youth with FASD are 19 times more likely to be incarcerated in a given year, compared to your w/o FASD. • FASD is a whole- body disorder • CPD clientele • 36% diagnosed • 36% suspected

18. FASD & Inappropriate Sexual Behavior (ISB) • As victim, witness or perpetrator • Occurs in • 45-52% of adults w/ FASD • 39% children 6-11 • 42% in adolescent (11-20) • 65% adult males • 55% of individuals with FAS have experienced sexual violence • Brain based processes associated w/ sexual behavior • Executive functioning • Comprehension • Adaptive behavior • Social skills • Linking consequences to actions • Impulsivity • Response to inhibition

20. Factors Influencing Sexuality & Risk Socio-sexual knowledge/expectations/attitudes Availability of appropriate partners Societal myths regarding sexuality and intellectual developmental disabilities (stigma) Restrictiveness or oppression of sexuality Past sexual abuse experiences Privacy (lack)

21. What do most people with IDD know about Sex? Most will have some knowledge They may have incorrect information There will be less knowledge about complex issues

22. Common Perceptions As a group, parents tend to be more conservative. They are most concerned about their children having children and exploitation. Professionals tend to have liberal attitudes, but have concerns because of parent’s attitudes. In general, members of society have conservative attitudes about IDD clients engaging in relationships or sexual activities.

23. Issues • Do individuals who have a history of sexual misconduct need to disclose their history to a potential partner before engaging in a sexual relationship? • Adults with cognitive challenges and problematic sexual behavior experiences can have access to internet pornography? • Do clients get to choose who is an appropriate sexual partner for the themselves? Any roadblocks? • People with cognitive challenges and problematic sexual behaviors require supervision in the community? • Pedophiles need 24/7 supervision? • Any client with a sexual misconduct violation requires 24/7 supervision?

25. Where Do We Learn About Sex? Schools Religious Affiliates Media Parents Peers Internet!

26. ‘Sex Ed by porn?’ • Sexual interest & exploration is normal • Central media pornography hubs are the most prominent (form) sex educator for many young people • “The genie is out of the bottle.” Larry Flynt 2010.

27. Deviant Sexual Arousal Occurs when sexual gratification/arousal is caused by fantasies or activities that are: atypical, illegal, and/or involve non-consenting beings. Includes sexual arousal to: • children • incapacitated adults • animals • or involves an atypical activity such as flashing or viewing certain types of pornography. Deviant arousal is characterized by distress or impaired functioning in the individual and/or actual or potential harm to others.

28. What is non-deviant sexuality? Sexual arousal that develops over time when a connection is made between arousal/orgasm and a consentinghuman being, fantasy, or activity.

29. Counterfeit Deviance/Problematic Behaviors Occur when: • There is a lack of human sexuality education, and boundaries • Lack of social skills and opportunities to develop healthy intimate relationships • Little understanding of legal issues combined with developmental age of child of young adolescent

30. Common Themes Social Anxiety Loneliness Problematic Internet Use

32. Internet communication • Little is known, about the platforms where adults meet and interact with children for sexual purposes, with the potential to develop into arrangements for a physical meeting. • Most research conducted into the areas of Internet sexual offending has been around the possession, distribution, or production of child pornography

33. Problematic Internet Use (PIU) • Inability to regulate one’s Internet use, causing distress and functional impairment and has been used synonymously with Internet addiction and pathological Internet use. • Empirically, PIU has been associated with severe psychological, social, and professional repercussions. • About 30% of all internet traffic is porn-related • With a click of the button, vast arrays of free pornographic imagery is available.

34. XXX Social Media XXX • Readily available and aggressively marketed online, pornography has become the default sex educator for many young people. Its influence is shaping sexual expectations and norms, with serious implications for young people’s capacity to understand and negotiate free and full consent, for mutual respect, and for gender equality. • There is a growing concern internationally that porn’s influence is contributing to cultural conditions that cultivate sexual assault.

35. What is pornography? ‘Sexually explicit media that is primarily intended to sexually arouse the viewer’

36. Sexuality and Aggression • Acts of aggression are commonplace in best selling pornography • 88% physical • 48% verbal • Aggression is overwhelmingly directed towards women. • Pornography is associated with aggressive attitudes & behaviors • Increase in hostile sexiest attitudes • Sexually coercive behaviors • Higher tolerance of unwanted sexual

37. Pornography Although everyone has an opinion on pornography, and very few acknowledge watching it; the viewing of “tube” sites like PornHub and YouPorn provide clear evidence to the contrary (Psychology Today piece on pornography viewing).

38. Pornography • All too often at the front lines of practice, pornography is an inconvenient elephant in the room that invites morality-laden, rather than empirically informed responses. • The concern is that people’s moral beliefs can cloud their judgment about clients in their care, raising questions about who gets to make the decisions about their own life and, under what condition?

39. The mainstreaming of pornography More than 90% of boys have seen online porn More than 60% of girls have seen online porn

40. What is mainstream pornography • Widely available on the internet • Easily accessible via other mediums such as DVDs • Mainly targeted at a male heterosexual consumer • Gay male pornography is also a significant genre • Diversity and commonality • Commonality relates both to the sorts of sex acts that are commonplace and to the ways that sex and gender are portrayed

41. World’s biggest porn site • 24.7 billion searches in 2017 • 81 million visitors each day • Pornhub is the 23rd most popular website in the world • 75% of all traffic is from a mobile phone

43. O’ philias • Pedophilia – sexual desire in an adult for a child • Hebephilia – sexual preference for children on the cusp of puberty ages@ 11-14 • Ephebophilia – primary sexual interest in mid-late adolescents generally ages 15- 19 • Teleiophilias– primary sexual interest in 17 year olds and older • Gerontophilia – primary sexual interest in the elderly • Infantophilia– primary sexual interest to children below 6 years of age

45. Desistance • A criminal history is a valid indicator of the propensity for rule violation, and such records are highly used in applied decision making both within and outside of the criminal justice systems (e.g., employment screening). • A criminal conviction, however, is a time dependent risk factor. • Studies find that after about 10 years offense-free (5 years for juveniles), the risk presented by most individuals with a criminal record is not meaningfully different from that of the general population.

46. Desistance Given that desistance is almost inevitable, record retention and access policies need to carefully consider the consequences of decisions being based on old records with little information value.

47. A Cogent Rationale for Clinical Strategies Knowledge of relevant research…and the organization provided by theoretical conceptualizations…

49. Transference • Refers to redirection of a patient’s feelings for a significant person to the therapist. • Sometimes sexual, however, can be rage, hatred, mistrust, parentification, dependence or god-like. • Often manifests itself as resistance and needs to be explored in the psychodynamic psychotherapy sessions. • If it is not attended to, it will become the greatest threat to the treatment.

50. Countertransference • Result of the patient’s influence on the provider’s unconscious feelings. • The patient represents for the provider an object of the past on to whom past feelings and wishes are projected. • Early paradigms were focused on the psychotherapy connection between the professional and the patient.