1. Community Treatment for Special Needs Adults Who Have Committed Sex Offenses Dr. H. Mitzi Doane Mr. Brian Peterson

2. Brief History and Background Dr. Doane started working with special needs adults in 1998 at the Institute for Psychological and Sexual Health In 2001, she began her work with this population at the Duluth Psychological Institute Mr. Peterson completed SO Treatment in 2000. In 2001, he became a therapy aid

3. A Word About Labels We teach what you did was monstrous, but that does not make you a monster. Avoid using the term sex offender. They are human beings who committed a grave crime, but they are far more than just criminals. The stigma of being a sex offender is akin to being a leper in ancient times. The penalties for sex offenses are more severe than for other crimes.

4. Clients Total Population Served52 Types of Disabilities FAS4 Intellectually Disabled39 Bipolar7 TBI3 Autism Spectrum11 Some clients have more than one of the above.

5. Demographics cont. Age Range18-75 Median Age34 EthnicityNat. Amer.6 European Amer.45 African-Amer.1 Living Ind.23% Group Home77%

6. Length of Time in Treatment Average is 2.5 years However, one individual has been with group from the beginning and will stay. This individual is intellectually challenged and presents a risk without ongoing treatment. Clients are weaned from treatment. Most return for a period of 3-6 months after completion by returning every two weeks, then once a month.

7. Time cont. Clients are also encouraged to return to group any time they feel the need for support. To date, only three clients have done so. Time in treatment is often dependent on a variety of factors including: severity of offense, type of disability, whether living independently or not, and ability to use the skills they have been taught.

8. Types of Offenses Distinction between pedophile and child molester. Pedophiles only experience sexual satisfaction with children. Child molesters sexually abuse children, but children are not their primary sexual choice. Often crimes of power and/or availability.

9. Offenses Pedophiles5 Child Molesters29 Incest3 Rape18 Exhibitionism3 Voyeurism1 Frotteurism1 Some clients are found in more than I category

10. Crimes cont. Median age of crime 27 The majority of crimes committed prior to age 18 53 % tried for the crime and came to group on probation 47 % had never been charged and came to group via family or group home Not uncommon for adolescents to have a stay of adjudication

11. Recidivism Since 2001, only 6 of the 52 clients have violated probation. Only 1 client actually engaged in inappropriate sexual behavior. Of the 5, two were sent to jail and four were sent to prison. Contrary to belief, these crimes have a low rate of recidivism: 3.3% child molestation, 2.5 rape (US Dept. of Justice, 2013)

12. Clients Sexual History About two thirds of clients had been victimized themselves. The perpetrators are often older children in the neighborhood, family members or friends and babysitters (who are often female). One client was victimized for 5 years by a middle school teacher. This contrasts with 13% of those non-disabled who have committed sex offenses. (Sorrentino, R., 2010)

13. Rape Is a broad term and the crime occurs on a continuum from penetration to inappropriate touching. We use the term rape to emphasize the lack of consent. None of our clients would be considered “power rapists”. Victims are most likely to not be chosen at random and often are considered vulnerable.

14. Child Victims As is true for rape, child molestation runs the gamut from penetration to inappropriate touching. Some of the clients charged with possession of child pornography but they also had engaged in actual molestation as well.

15. Treatment Protocol Primary treatment consists of psych educational group therapy as well as adjunctive individual therapy. Group meets weekly for 90 minutes. If a client is living in a group home, a staff member must accompany them. This insures that there is carry through at home. Staff must be mature enough to handle the material covered in group.

16. Treatment cont. All clients are initially assessed for their readiness for group. Clients must demonstrate that they understand what they did and why it was wrong. However, many clients still come to group with some denial and minimization.

17. Treatment cont. Clients are required to contact fellow group members at least twice a week by phone, where possible. This insures a support system is present outside of group. However, on three occasions this had led to inappropriate sexual talk. However, this ultimately came out in group.

18. Cardinal Rule You are only safe from relapse unless you are honest. Group is a place to be honest. Even if I have to report to probation officer a violation of probation, honesty is taken as a sign of recovery.

19. Treatment Rules Masturbation is okay. However the following rules must be followed: No more than once a day. Done in private and only in bedroom. Use of pornography (if allowed) must be a single magazine that has been screened for any material that is violent, illegal, or degrading. No video or computer pornography is allowed.

20. Rules cont. Must police their fantasies and learn to not bring themselves to orgasm if thinking is inappropriate, i.e. it might lead to action that would result in relapse. This is critical as many have never had a healthy sexual experience with another and they must resist replaying those memories.

21. Rules cont. Confidentiality is imperative. They must not repeat what they have heard in group and they are only to acknowledge other group members outside of group, if they have been given permission. Staff members are told that only information that applies to their client can be shared with group home. I must report violation to probation officer. All clients must be willing to sign a release.

22. Rules cont. All sexual behavior, including fantasies, are to be shared in group. If sexual behavior is with another, then safe sex must be practiced and partner must be over 18 and not more disabled than client. Dating is encouraged where possible. However, collecting data and forming friendships are emphasized over sexual behavior. If possible, I ask to meet the dating partner.

23. Rules cont. Under no circumstances is one to engage in sexual fantasy or behavior with a group member while still in treatment. Under no circumstances is one allowed to ‘date’ someone living in the same group home. Both of the above are considered incest.

24. Treatment Paradigm Cognitive behavioral approach to treatment is used. Primary focus twofold: Keeping society safe by preventing further victims Keeping client safe, especially for those who already have a conviction. This makes them particularly vulnerable to unfounded accusations. They need to know how to keep themselves safe.

25. Paradigm cont. Each client must accept responsibility for what they did without excuses Sex abuse results from a series of decisions Need to learn to identify the triggers that led to making the decisions to abuse Can learn to monitor and control behavior and thoughts which can led to sex abuse.

26. Basic Curriculum Modeled after the treatment program developed by the Center for Sex Offender Management of the U.S. Dept. of Justice and Vermont Sex Offender Treatment. The content is similar but it has been simplified in order to deal with special needs populations. Most of the work is done orally, rather than in written format.

27. Paradigm Emphasizes the following: Thinking Errors Core Values and Beliefs Empathy and Awareness of Perspective of others Healthy Sex Behavior Education Healthy Relationships Identifying Triggers Relapse Prevention Planning

28. Paradigm cont. Every attempt is made to accommodate the specific needs of the clients. Material is taught, retaught and practiced. Group is empowered to both confront and affirm each other where appropriate. Group is empowered to make decisions about whether a client is allowed to stay in group after an infraction such as using pornography inappropriately, using the internet or videos, violating terms of probation, etc.

29. Paradigm Clients also participate in decision about a client’s readiness for graduation. Specific rules may be designed for individuals, e.g. not having pictures of children in their rooms, no unsupervised use of the internet, 24/7 supervision.

30. Mr. Peterson’s Story One Man’s Journey

31. Dr. H. Mitzi Doane Duluth Psychological Clinic 205 W 2 nd St Duluth, MN 55802 218-722-2005 mdoane@d.umn.edu

32. Mr. Brian Peterson 218-481-7128 jjohn40082@hotmail.com