AGENDA

1. WASHINGTON STATECOMMUNITY PROTECTIONPROGRAM (CPP)WASPC ConferenceOctober 8, 2014Moderator: Chris ColemanPanelists: Marci Arthur Lori Gianetto Bare Sara Straus-King

2. AGENDA • History of the program • Myths • Who are individuals with Community Protection support needs? • Definitions • Developmental Disabilities Administration (DDA) Policies • Statistics • Why it works • Treatment Strategies

3. HISTORY A fire was set intentionally by a client enrolled with DDA in 1996 resulting in the deaths of two women The Legislature ordered DDA to identify clients living in Adult Family Homes with histories of dangerous behavior Efforts were expanded in 1997 to clients living in supported living

4. HISTORY • Task Force created in 1998 • Policies and Procedures written • Training Curriculum developed • Community Protection (CP) Providers • RFQ (Request for Qualifications) for CP Residential Providers

5. HISTORY • CP Waiver Implemented 2004 • First in nation • Participation is voluntary • Chapter 71A.12.200-280 RCW written by Legislature in 2006 • Chapter 388-831 WAC completed in October 2008

6. MYTHS • You are considered for the CP Program if you stole a pack of cigarettes • Once you are in, you never get out! • It’s just like prison • People who live in it are terrible

7. Who are individuals with CP support needs? One of the following criteria must be met (Chapter 388-831-0030 WAC): You have been charged with or convicted of a crime of sexual violence as defined in Chapters 9A.44 RCW or 71.09 RCW ;You have been charged with or convicted of a crime involving sexual acts directed towards strangers or individuals with whom a relationship has been established or promoted for the primary purpose of victimization, or persons of casual acquaintance with whom no substantial personal relationship exists;You have been charged with or convicted of one or more violent crimes as defined in Chapter 9.94A.030(45) RCW; You have not been charged with or convicted of a crime identified above, but you have a history of violent, stalking, sexually violent, predatory and/or opportunistic behavior which a qualified professional has determined demonstrates a likelihood to commit a violent, sexually violent and/or predatory act; andYou constitute a current risk to others as determined by a qualified professional.Charges or crimes that result in acquittal are excluded.

8. Who are individuals with CP support needs? – simplified An enrolled participant with DDA and 18 years old or older and Has a history of sexual or violent crime and Has been determined by risk assessment to be a moderate to high risk to reoffend

9. Identification File review Individuals with CP Issues form competed Regional CP committee review Meeting with participant Risk assessment Referral to program

10. COMMUNITY PROTECTION PROGRAM DEFINED • Services to support people with CP support needs • Voluntary • Opportunity for people to live successfully in community & stay out of jail, prison, hospital • Security Precautions • Alarms on Doors/Windows • Supervision while in community

11. DEFINITION - continued • Specialized Environment • Safe, structured environment • Rules & Restrictions • Expectations for personal responsibility • Positive Behavior Support Plans • Cross System Crisis Plans

12. DEFINITION - continued • Treatment Team • Group responsible for development, implementation and monitoring of participant’s supports and services • Participant, Case/Resource Manager (CRM), therapist, residential provider, employment provider, mental health representative, DOC rep., legal rep or family member

13. DDA POLICIES 15.01 - CP Identification 15.02 - CP Program Services 15.03 - CP Employment Program 15.04 - CP Residential Services 15.05 - CP Exit Criteria Policy Manual

14. CP Policy 15.01 – Identification and Eligibility • Establishes guidelines for CRMs to follow when identifying an individual as a person with CP issues • Procedures • Complete Individual w/ CP Issues Form 10-258 • Send to CP Coordinator with additional documentation as necessary

15. CP Policy 15.02 – Program Services • Guidelines for CRMs to follow when offering and authorizing services for people with CP issues. • Services Offered: • Community Protection Residential Program (including therapy, employment, etc.) • MPC (with full disclosure)

16. CP Policy 15.03 – Employment Services • Agency Support Structure • Security • Integration • Collaboration • Administrative requirements, i.e. insurance, policies • Staff training • Staff must be trained in supporting persons with community protection support needs prior to working alone with participants

17. CP Policy 15.04 – Residential Services • Expectations • Safeguards • Integration • Collaboration • Staffing • Household composition – mixing of households subject to approval • Administrative requirements, i.e. certification, insurance, policies • Staff training • Staff must be trained in supporting persons with community protection support needs prior to working alone with participants • Site Approvals

18. CP Policy 15.05 – Exit Criteria • Four ways to leave CP • Phase Out (Graduate) • Be terminated (non-compliance) • Voluntarily leave • Be found not eligible for enrollment with DDA through an Eligibility Review

19. Current Statewide Statistics 721 Individuals Identified as Community Protection (3.4% of adult DDA enrolled population) 435 Individuals residing in the Community Protection Residential Program (39.7% of those identified are not supported in the residential program) 136 Additional Individuals Identified as “Tracking Only” 40 graduations

20. Community Protection Identification Response

21. DDA Sex Offender-Kidnapping Registration Rate

22. WHY IT’S WORKING • Supports • Opportunities to succeed • Treatment Team • Collaboration • Training

23. TREATMENT STRATEGIES FOR PERSONS WITH DEVELOPMENTALDISABILITIES Sara Straus-King, M.A., C.S.O.T.P

24. WORKING WITH PERSONS WITH DEVELOPMENTAL AND INTELLECTUAL DISABILITIES BRINGS MANY UNIQUE CHALLENGES Cognitive Impairments Social Delays Self Regulation Skills Deficits

25. RESEARCH AND RESOURCES While some resources exist regarding the treatment of sexual offenders who have disabilities (Blasingame, 2005; Haaven, Little & Petre-Miller, 1990; Hansen & Kahn, 2005; Horton & Frugoli, 2001) there are still a limited amount of interventions to address clients with forensic challenges

26. STRATEGIES THAT WORK One study of individuals with developmental delays, psychiatric orders, and severe behavioral problems has found a strategy that works (Bird, Sperry & Carreiro, 1998)

27. This treatment model includes: • goal setting • case management • social skills teaching • positive reinforcement • crisis intervention • competency based skills training • medication monitoring • data based outcome measurement • community living arrangements

28. CRITICAL COMPONENT OF SEX OFFENDER SPECIFIC TREATMENT WITH DEVELOPMENTALLY DELAYED CLIENTS Communication is highly essential and key in successful treatment Understanding how communication is impacted by disabilities

29. Therapist style, skill level, and understanding of impairments and needs • Effective: active listening, listening with empathy, openness, awareness of- expression, body language, tone, pitch, volume, articulation

30. ADDITIONAL CHALLENGES More concrete styles of thinking Less ability to abstract and reflect Difficulty generalizing concepts Difficulty with analogies More limited vocabulary More limited life experience Short attention spans Superficial compliance Trouble understanding cause and effect Difficulty relating to others Response to abuse

31. CLINICAL ASSESSMENT OF SEXUAL RISK History of sexual behavior Sexual knowledge Individual or solitary sexual behavior Sexual experiences Sexual arousal and interest Personal history of victimization/exploitation Exposure to pornography Witnessed sexual behavior Understanding of appropriate versus inappropriate sexual behavior

32. OTHER RISK FACTORS TO CONSIDER IN ASSESSMENT Family History Criminal History Drug and Alcohol History Mental Health Medical/Physical Health Education/Vocation/Employment History Social Skills Support Systems Current Environment and Living Situation

33. TREATMENT INTERVENTIONS Healthy Sexuality Legal Versus Illegal Sexual Behavior Sexual Arousal and Fantasy Management Boundaries Cycles of Behavior and Patterns Emotion Expression and Regulation Social Skills / Relationship Development Responsibility and Accountability Independent Living Skills Anger Management

34. Healthy Choices / Increase Positive Behavior and Decrease Negative Behavior Consequential Thinking Thinking Errors Relapse Prevention (Avoid / Escape Techniques, High Risk Situations) Problem Solving Responsibility and Accountability

35. Tailoring client treatment to fit their risks, needs, and response to therapy results in success in reaching goals and having a better quality of life

36. OVERCOMING OBSTACLES Sex offenders, including developmentally delayed offenders, who are held accountable for their behavior and receive appropriate intervention are less likely to re-offend. The criminal justice system serves a role in ensuring community safety (identifying sex offenders, holding them accountable, directing them to treatment, and encouraging compliance).

37. OVERCOMING OBSTACLES Therapist’s role is to assist client in reducing risk by tailoring treatment to fit needs (modifications, adaptations, flexibility, support and creating opportunities).

38. RECOMMENDATIONS FOR LAW ENFORCEMENT Special training dealing with: • Recognition of the indicators of developmental delay • Effective communication strategies for dealing with developmentally delayed persons

39. RECOMMENDATIONS FOR LAW ENFORCEMENT Accessibility of community resources that may aid in investigations Informing developmentally delayed suspects of their rights and determining if they understand- a protocol should be developed and followed in the event that an individual does not understand their rights

40. RECOMMENDATIONS FOR LAW ENFORCEMENT Collateral information on the individual’s level of functioning and other pertinent background information from various sources should be available to investigators with consent

41. Contact Information Marci Arthur, marci.arthur@dshs.wa.gov Chris Coleman, ncc22@comcast.net Lori Gianetto Bare, GianeLC@dshs.wa.gov Sara Straus-King, soundcounseling@frontier.com