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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.

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Treating and Managing the Sexually Violent Predator

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  1. Treating and Managing the Sexually Violent Predator FMHAC March 16, 2006 Kenneth Carabello, LCSW Liberty Healthcare

  2. Presentation Overview • Overview of SVP Law • Overview of Liberty Healthcare SVP CONREP • Housing • Treatment Issues • Supervision Issues • Wrap-up/Questions

  3. SVP LawA 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, 1996Civil commitment for persons who meet SVP criteria.

  4. 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).

  5. 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.

  6. 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).

  7. SVP Commitment As of 3/1/06 • Referred to DMH 6,368 • Pass DMH record review 3,406 • Positive evaluation for SVP 1,307 • Total committed 539

  8. 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.

  9. So How Do They Get Out?

  10. WIC 6608Petition 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

  11. 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

  12. The primary mission of CONREP is the protection of the public through the reduction or prevention of patient reoffenseProductive, healthy patients, leading a crime-free life

  13. 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

  14. 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

  15. 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.

  16. 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

  17. Regional Coordinator Case Management Duties • 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.

  18. Scheduling and coordinating of professional services listed in section B. • Vocational service referrals. • Quarterly reports to the court.

  19. Community Safety Teams • Regional Coordinators • Treatment Providers • Polygraphers • Victim Advocates • Law Enforcement

  20. Law Enforcement Coordination • 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 high-risk behavior.

  21. Housing

  22. What housing has been found so far? • Monterey County • Marin County • Santa Clara County • Contra Costa County • Solano County • San Diego County

  23. Recent Legislation: County of DomicileNotification

  24. 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

  25. What if we can’t find housing • Locked up Conditional Release • Cond. Rel. Unconditional Release

  26. Treatment Issues • 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

  27. Supervision Issues • Intensive work load • Distances • GPS • Less autonomy than traditional probation/parole - increased role of team

  28. 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

  29. 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

  30. Categories of crimes too broad, imposing restrictions on those with no known risk to children in covered locationsFamilies of offenders also restricted. Children pulled from schools, spouses loosing jobs and community connectionsPhysically and mentally disabled offenders prohibited from living with supportsAffordable housing and transportation scarce in available areasNo time limitNo accommodation for those on parole or probation

  31. 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.

  32. Ken Carabello (310) 348-7200 kcarabello@libertyhealth.com

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