1. Assessing Sexual Offenders Inmates for Residential Community-Based Addiction Treatment RC-BAT Peter R. Cohen MD, Medical Director, ADAA April 29, 2010

2. Why Do We Have to Consider Violent Sexual Offenders for RC-BAT? It’s the Law!!! The right to petition for reconsideration of sentence, except for childhood sexual offenders Requesting an 8-505 order for a substance abuse evaluation

3. What are We Assessing? The Risk for Repeating Sexual Offenses? NO What is my clinical opinion of the ability of the offender to benefit from community- based treatment? Is the offender amenability for treatment in a community-based facility? YES

4. What Is Convincing? The Walk, Not the Talk The 4 C’s of Inmate's Behavior A Pattern of… C ooperation C ompliance Following Institutional Rules C ommitment To Treatment C onfluence of Reports What the Police Reported vs. What the Convict Describes

5. Why Does the Inmate Need to Show a Pattern of Following the 4 C’s? Community-based therapeutic residential settings are not prisons The 4 C’s are an essential ingredients for effective therapeutic community treatment ASAM Level III.3 residential treatment is not designed to treat persons with severe behavior disturbances or psychiatric problems.

6. Why Are You Making Me Do So Much Work? 1.The nature of RC-BAT & Safety Other residents, their children, being housed in the same program and are located in near a neighborhood 2.Research and professional consensus says… There is a need for combined treatment for sexually offending behavior and addiction

7. Why Are You Making Me Do So Much Work? 3.But…alcohol and drug use is never a stand-alone explanation for sexually offending behaviors 4.And…there is no Maryland RC-BAT program that also provides expert, specialized sexual offender treatment

8. Why Are You Making Me Do So Much Work? 5.And…Treatment for addiction is not a substitute for sexual offender treatment 6.And…Sexual offender treatment outcomes are disappointing  Significantly more treatment and outcomes research is needed  Current research: the overall reduced rate for reoffense =10 - 17 %

9. Why Are You Making Me Do So Much Work? 7.Finally… TREATMENT FOR ADDICTION IS NOT MEANT TO BE A SPECIALIZED FORM OF INCARCERATION IN THE COMMUNITY Persons must demonstrate a pattern of following the 4 C’s to predict that they will behave appropriately in the program and not inappropriately in the community

10. What Do You Need to Do? Slow Down the Action STEP 1: REVIEW The police report of the inmate's sexual offense, related to the sentence or because probation or parole has now been violated Past discharge summaries of substance abuse and other behavioral treatment episodes : successful or unsuccessful The history of any incarceration-based infractions

11. What Do You Need to Do? STEP 2: DISCUSS with the inmate this history to ascertain the following: The inmate's motivation to control such behaviors The level of self-observation and self-concern The actual history of attempting to make amends or change such past behaviors

12. What Do You Need to Do? STEP 2: ASK 5 Basic Open-Ended Questions 1. What have you learned since your convictions related to ______ (specific offense)? 2. (With regards to sexual offenses) What action have you taken to change your behaviors around females or males? 3. What is your opinion (or what do you think) about what happened during your crime? 4. (With regards to incarceration-based infractions): What is your opinion (or what do you think) about your getting this infraction (or these infractions)? 5. Have you ever had treatment or needed to receive treatment for… (your sexually offending behaviors or your violent behavior)?

13. What Do You Need to Do? STEP 2: DISCUSS and ASK 5.Have you ever had treatment or needed to receive treatment for… (your sexually offending behaviors or your violent behavior)? If yes, then… Did you show up for treatment? Did you complete treatment? What did you learn? If you didn't complete treatment or show up, why not?

14. What Do You Need to Do? STEP 3: FILE this information in the legal notes section of the TAP summary After gathering this additional information and before submitting the 8-505 report to the court …

15. What Do You Need to Do? STEP 5: “STAFF THE CASE” and SUBMIT “Staff the case” with his or her supervisor Submit a draft of the evaluation and cover letter to the ADAA for review.

16. What Do You Need to Do? STEP 6: FINALIZE the case with the ADAA within 24 hours STEP 7: SEND YOUR RECOMMENDATION

17. What Do You Need to Do? STEP 7: SEND YOUR RECOMMENDATION Community-based treatment is or is not recommended If appropriate for addiction treatment, but not for RC-BAT: state just that, but do not recommend any specific treatment or facility or location

18. What Do You Need to Do? STEP 7: SEND YOUR RECOMMENDATION Please note: A judge cannot write an 8-507 order for incarceration-based treatment. It is up to the discretion of the incarcerated setting.