NADD Bulletin Volume IV Number 6 Article 3

Complete listing

Agency-based Residential Treatment of Developmentally Disabled Adults Who are Sex Offenders or Who Exhibit Problematic Sexual Behaviors

Carolyn Kesterson, M.A., L.P.C., Shari Swinton, B.S.

Historically, state agencies providing services to developmentally disabled individuals have hesitated to address sexually problematic or offending behavioral issues, typically referring persons who need treatment to community-based programs. Such persons have been referred, or ignored, because agencies have lacked the funding, support, and expertise to initiate and maintain adequate services to this at-risk population. One Community Centered Board in the state of Colorado determined to initiate its own program, coordinating with various governing agencies, in order to provide a containment model for residential and day program services for individuals who were evaluated as at-risk to offend.

Initiating such a comprehensive program began when the agency recognized the individuals within their catchment area who posed a threat. Identification occurred either through a review of the person’s historical records, his current behaviors, or court referrals. The burden of the responsibility then fell on the agency, not only to identify persons who posed risk, but also to determine the degree of risk and ultimately to determine if, and how, the agency would provide adequate services to those persons.

Once the individuals were identified as posing a risk to the community, the agency determined, along with its board of directors, to develop its own program rather than to refer the identified individuals. At that point, the agency visited private agencies that already were providing containment services in the state. Modeling their emerging philosophy of treatment and administrative goals on the expertise of existing private programs, the agency administrators began the process of hiring experts in treatment and management of offenders and determining what the practical aspects of implementing a similar program within the agency.

Program Philosophy

The philosophical base of the program was rooted in the belief that the agency had a responsibility to the community to keep it as safe as possible. Secondly, the agency was committed to providing quality services to all of its consumers, including those who were at risk to offend. From that point, the administrative team established its own set of foundational principles which included the need to protect the community and the need to provide humane care of the identified at-risk persons. Subsequently, the following mission statement was developed:

The CHOICES Program is a therapeutic treatment program for persons with developmental disabilities who are sex offenders or who exhibit problematic sexual behaviors.

The program:

1.Acknowledges the ability and right of persons with developmental disabilities to make choices regarding their own sexuality

2.Recognizes that some persons with developmental disabilities may make sexual choices that are inappropriate or illegal and the resulting behaviors must be addressed

3.Offers treatment options for the training or retraining of developmentally disabled persons regarding their sexuality

4.Affirms program participants’ respectful and non-harming sexual behaviors

5.Keeps the program participants and the community safe

The resulting stated purpose for providing a therapeutic treatment setting was: “to provide program participants with an environment in which they are encouraged to adopt new behavior patterns that are non-harmful to themselves and others.” (The CHOICE Program manual, 2001)

Administrative Goals

Program administrators recognized in the program’s early stages that program development would necessarily be a cooperative effort between the agency and other state entities. The administrators worked closely with agency resource coordinators and Arc advocacy coordinators to define the goals and direction of the program. The goals of this cooperative team were to:

1.Provide a quality program and services consistent with the rules and regulations established by the State of Colorado Department of Developmental Disabilities Services

2.Adhere to the standards and guidelines established by the legislatively mandated Colorado’s Sex Offender Management Board, in every case where the standards and guidelines were not in conflict with the rules and regulations of the Department of Developmental Disabilities

3.Focus on providing a therapeutic environment in which the program’s participants were challenged in a humane manner to change their offense-related thinking and behavior patterns

4.Establish a gradual level system approach for treatment so that the program’s participants would progress toward fewer restrictions and greater quality of life

5.Provide a residential setting with: no more than five participants per house, twenty-four hour a day trained staff, and environmental monitoring (alarms, mirrors)

6. Establish and maintain a holistic approach to treatment

7. Maintain a program that was fiscally sound

Now in its third year of operation, The CHOICES Program operates with these same goals.

Legal Considerations

Once the program philosophy and goals had been established, the agency looked toward implementing those foundational principles so that they would be in compliance with state statutes for the treatment of persons with disabilities who were also sexual offenders or persons with problematic sexual behaviors. At times, however, compliance with the statutes could not be clearly defined. Such a dilemma appeared when the rules and regulations of the Department of Development Disabilities Services required that the residence of its consumers be kept confidential while the state also required its convicted offenders to register their place of residence, and the registry then becomes public record. Secondarily, per city ordinance, only one registered offender would be allowed to live at any given address.

Another issue which had legal implications for the program surrounded the process of evaluation of those persons who might be eligible for the program. Generally, for a person to receive services from a service agency functioning under the supervision of a Community Centered Board, the person would be required to have a Full Scale IQ score no higher than 70. Among those persons who qualified for services per their IQ scores, those who were offenders most commonly had not been convicted of crimes because of their disabilities. The onus of evaluation and subsequent labeling of the individuals fell on the agency. As a result, the agency determined only those individuals who were convicted or who received an Imposition of Legal Disability from the court to receive services from the agency would qualify for The CHOICES Program.

In order for the court and the agency to have clear understanding of the potential dangerousness of the individual when considering an imposition, the agency established an agency review process per Administrative Review. In such a review, historical data, collaborative information, and professional evaluations are considered by a team of administrators, resource coordinators, and treatment providers. Consequently, an individual was determined appropriate—or not—for the program based on the outcome of the review and a subsequent recommendation from the individual’s interdisciplinary team. Of concern was the matter of placing a stigmatizing label on an individual without the benefit of a legal conviction. The agency, in recognizing extreme caution must be used, determined that a psychiatric diagnosis pertaining to sexual behavior combined with a professional psychosexual evaluation that supported the diagnosis jointly would be considered by the reviewing team before it would consider placing a label of “sex offender” or “person with problematic sexual behavior” on a non-convicted person who posed risk. The results of the administrative review concluded in a written Rationale for Placement, which could then be presented as justification to the court, the Department of Developmental Disabilities Services, family members, and the individual stating the reason for placement of a non-convicted individual in The CHOICES Program.

Placement Considerations

Once the evaluation and review processes were completed, the individual’s interdisciplinary team considered various placement options for the individual, being certain The CHOICES Program was the least restrictive environment in which the person could live while maintaining community safety. The interdisciplinary team was made up of the individual’s resource coordinator, authorized representative (typically an Arc advocacy coordinator), day and/or residential program representatives, and any adjunct professionals (therapists, nurses, psychiatrist, etc.). If the options of the person’s living on his/her own, with the family of origin, in a host home, or an agency group home or personal care alternative were ruled out as the safest and least restrictive environment, the individual was referred by the team to The CHOICES Program Director for consideration as being eligible for the program.

Maintaining the Program

Once the decision was made to establish the program, agency administrators determined the operations and therapeutic component of the program would be overseen and implemented by a treatment team which was composed of a program manager and a clinical director. Direct care staff would maintain the therapeutic milieu, so that daily activities continually would focus on the aspects of change and responsible behavior among the consumers.

Regular interdisciplinary (IDT) and yearly individualized plan (IP) team meetings would ensure the consumers were being treated humanely and therapeutically. Weekly core team meetings with representatives from administration, resource coordination, the Arc, the treatment team, and medical staff would review current programmatic and individual concerns. Quarterly supervision team meetings would review the direction and progress of the program. The team approach assured that the concerns of each entity could be heard, discussed from a variety of perspectives, and implemented. Operationally, the Health Department and Department of Developmental Disabilities Services audits standardized optimal operational functioning.

Community Safety/Consumer Progress

Keeping the community safe while enhancing the safety and progress of the program’s participants have shown to be mutually proactive goals. For instance, the fences that surround the backyards of the residences prevent the consumers from leaving the residence or from viewing potential victims. The fences, then, serve both to keep neighbors safe from offense and to keep the consumers safe from victimizing and potential litigation. Similarly, each facet of the program serves to protect individuals both within and outside the program while encouraging responsible decision making among the program’s participants.

Realistically, considering most individuals in the program will need assistance with ongoing supports through a lifetime, agencies providing services to those persons who offend or who exhibit problematic sexual behaviors have an unmatched opportunity to protect the community. Through an Imposition of Legal Disability, the agency is mandated by the court to provide services to the individual, a process that is reviewed every six months. At that time, the individual’s needs and progress are presented to the court giving the community ongoing access to supervision of the program’s participants. Furthermore, the therapeutic residential concept keeps the program participants continually aware of their issues and need for personal responsibility. Third, ongoing team review insures the humane treatment and accountability of the consumers.

Given the structure of the system within which persons with disabilities are served combined with the involvement of the court, residential treatment, and team review, the potential for long-term monitoring of persons at risk to offend is well in place. Supported by such an involved network of professionals and peers, those persons at risk to offend—and agencies dedicated to serving them—who are motivated to succeed have every chance to do so.

For further information:

Carolyn Kesterson, M.A., L.P.C.
North Metro Community Services
1001 W. 124th Avenue
Westminster, CO 80234