Estelle Sex Offender Treatment Institutional Division Texas Department of Criminal Justice Process Evaluation. Review Team

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1 Estelle Sex Offender Treatment Institutional Division Texas Department of Criminal Justice Review Team Michele Moczygemba, Director of Research,, Lead Reviewer Fred Collisson, Program Administrator, TDCJ Institutional Division Mike Eisenberg, Planner III, Criminal Justice Policy Council Alice Fisher, Director of Governmental Affairs, Windham School District Larry Johnson, Field Service Specialist, TDCJ Community Justice Assistance Division Dimitria D. Pope, Director, Juan Rodriguez, West Texas Community Supervision and Corrections Department Janice Willett, Program Administrator, TDCJ Programs and Services Division The TDCJ Review Team appreciates the effort of Fred Figueroa, Warden Estelle Unit, Lindberg Arnold, Jr., Assistant Warden, and Judy Johnson, Clinical Director, Sex Offender Treatment Program and all staff in accommodating the Review Team=s activities, including providing work space, allocating staff time and exercising flexibility in meeting the schedule of the Process Review Team. Published by Texas Department of Criminal Justice Research, Evaluation and Development Unit January 1998

2 Introduction The Texas Department of Criminal Justice (TDCJ) has actively sought to implement programs and services to address offender needs. Despite these efforts, the recidivism rate for offenders released from Texas= penal institutions have increased over time: 35% return to prison in 1984 to 48% in Additionally, the performance of these programs has never been formally evaluated. In response to these issues, policy makers sought to create strategies that would increase TDCJ=s accountability of programs/services delivery and performance. In September 1996, the Senate Committee on Criminal Justice directed TDCJ to develop a rehabilitation tier of programs designed to impact recidivism. Six programs were established under this concept. Three of which have been targeted for a program evaluation: Leblanc Pre-release Substance Abuse Program, Beto Pre-release Therapeutic Community and the Estelle Sex Offender Treatment Program. The performance of the Rehabilitation Tier programs will be measured through process and outcome evaluations. The Research, Evaluation and Development (RED) Unit is responsible for the process evaluation. The Criminal Justice Policy Council (CJPC) will conduct the outcome evaluation. This report provides the results of the process evaluation conducted on the Beto Pre-release Therapeutic Community (PRTC). The purpose of a process evaluation is to assess the delivery of programs. The three major questions addressed are: 1) what is the program intended to be; 2) what is delivered in reality; and 3) why or what gaps exist between program plans and program delivery. During process evaluations, the efficiency of the programs is also investigated. This will help determine if resources are being used efficiently to maximize services, if the services are producing immediate results, and if the immediate results have the potential to produce desired long-term outcomes. A process evaluation of the Phase II Therapeutic Community component of the Estelle Sex Offender Treatment Program (SOTP) was conducted December 15-19, The Estelle SOTP has three phases. Phase I, Evaluation and Treatment Orientation, is located at the Ramsey II Unit and lasts up to two years. This phase places an emphasis on self-reflection, breaking through offense denial and accepting responsibility for deviant behavior. Phase II, the Therapeutic Community, is located in the Estelle Unit and lasts up to one and one-half years. This phase is highly structured and focuses on restructuring the offender=s deviant behavior and thought patterns. Phase III, Relapse Prevention, is located at the Central Unit and lasts up to six months. This phase is designed to prepare the offender for release back into the community. The Phase II Therapeutic Community of the SOTP has been in operation since January 1996 and is a 126 bed program for male offenders. The program is physically located in Huntsville, Texas in the Estelle Unit. The Estelle Unit houses 3,276 TDCJ-ID offenders. In addition to general population offenders, the unit houses special need substance abusers, high security administrative segregation offenders, geriatric offenders, and contains the Regional Medical Facility. 2

3 Organizational Structure The chart depicted below details the organizational structure for program staff working at the Estelle SOTP. The program administrator is an employee with the Programs and Services Division, and therefore reports directly to that division. There is coordination between Estelle Sex Offender Treatment Program Regional Director Warden TDCJ Administrative Oversight Assistant Warden for Treatment ID PSD PD Major WSD Principal Correctional Officers Support Activities Institutional Officers Program Director B11 (1) Clerical Support (2) Program Admin. III (2) Vocational Teachers (8) Academic Teachers (7) Counselor (1) Phase I-Psych-Ed. Ramsey Unit Phase II-TC Estelle Unit Phase III-Relaspe Prevention Central Unit Librarian (1) Clerk III A6 (2) Administrative Technician I A13 Associate Clinical Psychologist IV (2) Computer Aide (1) Associate Clinical Psychologist III B9 (3) Clinical Social Worker III B7 (3) Clinical Social Worker II B5 (3) the program staff and the Estelle Institutional Division staff, but it is a loosely defined association. Mission The mission of the program is to enhance public safety through the provision of effective and efficient sex offender treatment and supervision (TDCJ-Sex Offender Treatment Program SOTP 01.01). Objectives The following are the program objectives as indicated in TDCJ-Sex Offender Treatment Program SOTP 01.01: To reduce the potential for further deviant behavior; To offer a comprehensive treatment program that addresses motivation, psycho-social education, psychological evaluation, sex offender treatment and relapse prevention training for the volunteer population of sex offenders residing in TDCJ; To provide a highly structured but individually focused treatment plan for each volunteer in the SOTP at each stage of treatment; 3

4 To identify and target for change the cognitive and behavioral patterns which have resulted in sexual offending; To require each participant to accept responsibility for all his deviant offenses and demonstrate empathy for all persons who have been hurt by these offenses; To carefully monitor and record the progress of each individual through the various phases of the program; To provide for a continuum of care that reaches across all phases of the SOTP and continues out in the community after the inmate is released from TDCJ; and To establish a clear and comprehensive record system so that valid program evaluations can be conducted according to the guidelines set by the Research, Evaluation and Development Unit and the Criminal Justice Policy Council. Objectives Review objectives were established prior to the review. The review objectives are based on information presented in the Texas Department of Criminal Justice (TDCJ)- Research, Evaluation and Development (RED) Unit publication Putting the Pieces Together: Program Performance Review Proposal. The objectives were refined using information obtained from a self-report process evaluation questionnaire and standard procedures for conducting process evaluations. The objectives define the scope of this review and focus on the following areas: 1) procedures for program placement; 2) programs provided; 3) verification of required programming and services; 4) post-discharge placement and services; and 5) staff and volunteer training. Methodology This section details the overall methods that were used to conduct the process evaluation. To identify procedures that guide the program, program policies and procedures were reviewed and additional program information was obtained using a self-report questionnaire. The program director was asked to complete the questionnaire and return it to the RED Unit prior to the site visit. Information contained in the questionnaire was verified during the site visit by reviewing offender case files and interviewing management, program staff and participants, and observing program operations. It should be noted that the mainframe computer was only used upon the specific recommendation of program staff when reported documentation could not be located in the file. This procedure is followed since the integrity of mainframe data varies. Table 1 details the number of program staff employed at the time of the review and the number interviewed. In addition to the program staff, the Warden, Assistant Warden, Major and specially trained correctional officers were interviewed. Observations of program activities were documented and record searches conducted. Comments from the interviews are summarized throughout this report. At the time of the site visit there were 95 offenders participating in the program. Approximately ten percent (9) were randomly chosen to be interviewed. Three offenders from each level were chosen (e.g., Level III, II and I). Case files were reviewed for a random sample of offenders currently in 4

5 the program as well as case files for offenders who had discharged from the program during December 1997 (n=16 as of 12/15/97). Table 1:Program staff positions and number interviewed Staff Position Number Employed Number Interviewed Sex Offender Treatment Program Clinical Director Program Specialist Associate Psychologist Clinical Social Worker Administrative Technician Clerk Subtotal Correctional Officers (Specially Trained) Total 27 7 Program Information This section provides general information about the program. Detailed are the funding, operational and staffing stability of the program over the past two years. Methodology: The process evaluation questionnaire, TDCJ budget information, summary statistics prepared by TDCJ Executive Services, policies and procedures manual and interviews with facility staff were used to compile this information. Measures: The measures are grouped into three areas: funding stability, operational stability, and staffing stability. Funding Stability The TDCJ-Financial Services Division compiled historical cost and budget information for the program. The expenses reflects salaries for program staff and normal operating costs. Costs related to confining offenders (e.g., security, food, housing) were excluded. Information about total number served was not available, therefore, the average cost per participant could not be computed. Operational Stability Since this is a new program, the traditional measure, significant program changes that have occurred during the last two years, is not applicable. Of particular note is the utilization rate of the program by phase. Staffing Stability The average length of employment is calculated for program staff. Results: Following are the results for the subcategories of the measures. 5

6 Funding Stability: The program receives funding from the TDCJ-Programs and Services Division. Table 2 details the funding information. Other expenses includes normal operating costs such as consumables, travel, rent and equipment. Table 2: Level and source of funding amounts Funding Source Fiscal Year 1997 Expenditures Fiscal Year 1998 Budgeted Salary Expenses Other Expenses Total $296,257 $16,765 $313,022 $434,316 $57,007 $491,323 Operational Stability: In June, 1995, TDCJ-Programs and Services assumed responsibility for the SOTP. In August 1996 the program was developed into the current three phase program. The Phase II Therapeutic Community component was established at the Estelle Unit in October In October 1997, the SOTP policies and procedure were reviewed and are continuing to be revised and augmented due to program reorganization. Figure 1 details each of the phase utilization rates during fiscal years 1997 and partial Phase III of the program is the most underutilized, while Phase I is generally at capacity. The utilization of the Phase II at the Estelle unit has experienced notable fluctuations over time. 6

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8 Staffing Stability: The average length of employment for all program staff is 10 months. The median and mode are 1 year and 2 months. Most of the program staff (n=8 ) have been with the program since it began a little over a year ago. Other Observations: Institutional administration understood that the purpose of the program is to rehabilitate sex offenders. They did not articulate specific awareness of the treatment modality used. Program management staff provided very specific knowledge of the program=s intent and consistently described the program as directed towards teaching offenders skills for pro-social living, specifically addressing criminal thinking errors. Most of the offenders stated that the purpose of the program was to prepare them for release and reduce their chances of reoffending. References to victim empathy and cognitive thinking errors were also reported. 8

9 Objective 1 Verify the procedures for placing offenders into the program. Methodology: The process evaluation questionnaire, program policies and procedure manual and offender case files were reviewed to compile this information. The mainframe computer was only used upon the specific recommendation of program staff when reported documentation could not be located in the file. At the time of the review 95 offenders were in the program. A random sample of case files were examined. Measures: State statute and/or program policy require specific eligibility criteria for program placement, documentation of program activities, and processes for intake. Documentation of these items must be present in each offender case file(s) upon intake or shortly after intake into the program. The measures fall into three areas: Eligibility Criteria, Screening and Intake, and Document Review. Eligibility Criteria: Offenders participating in Phase II of the SOTP are typically transferred from Phase I at Ramsey II where program eligibility is checked. Exceptions are those cases transferred or placed directly into Phase II without having gone through Phase I -- Evaluation and Treatment Orientation. For purposes of this review, eligibility criteria was not checked. However, review team members noted placement exceptions. Screening and Intake Processes: Intake processes are integrated into required documentation. All offenders are advised of the program components and requirements during orientation. Document Review: Documentation of an offender needs assessment, program participation and progress is kept in two separate folders: the SOTP Treatment file that is kept with program administration officials, and the medical file that is kept in the general medical records section of the unit. Following is a detailed summary of the documentation items verified. Progress Summaries A Progress Summary is initiated upon completion of an SOTP Phase and is forwarded to the next unit or Phase. The progress summary contains a variety of counselor assessments. Examples of counselor assessments may include such items as offender=s progress to date, criminal thinking errors, current level of denial and identified grooming patterns. The presence of this summary was verified. Develop Individualized Treatment Plan The Estelle SOTP treatment team must meet with the offender to develop an Individualized Treatment Plan and begin the orientation process. The presence of the treatment plan was verified. Primary Care Therapist A primary care therapist and a peer group must be assigned to the offender. The name of the primary care therapist was identified. Assigned to a Service Crew Offenders in Level III are assigned to a service crew within the Therapeutic Community. This was verified from service crew assignment logs. 9

10 Volunteer to Participate Offenders must volunteer to participate in the program. This was verified by the review of the Statement of Disclosure and Consent and the Consent to Videotape forms. Complete Psychological Assessments Psychological assessments are required on all offenders. The SOTP treatment file contained the actual assessment instruments. The analysis of the instruments were located in the medical file. The presence of the Multiphasic Sex Inventory Profile, Rotter Incomplete Sentence Blank, and the Minnesota Multiphasic Personality Inventory were reviewed. Minimum Custody of L2 program. Offenders must have a minimum classification status to participate in the SOTP Checklist The SOTP checklist must be in the file. The SOTP raw data file contains notes and forms which are not approved for inclusion in the medical file. This includes: SOTP screening forms, testing material, SOTP worksheets, participant schedules, family contacts, written communications between offender and SOTP staff, and other sensitive information as deemed appropriate. Orientation All offenders are to participate in the program and Phase II orientation. A chrono entry in the medical file was used to verify this information. Progress Notes Progress notes are summarized and entered in Section 2 of the medical record on a weekly basis by the primary therapist. Clinical Notes All clinical notes must be proceeded by ΑSOTP NOTE and include the following: clinical impressions, behavioral information, assessment and evaluation of progress and plan, and reference charting Policy of Medical Records. 10

11 Results: Following are the results of the required documentation for offenders participating in the program. Table 3: Results from documentation of program intake procedures Process Measure Applicable Number Number Observed Compliance Rate Progress Summaries Develop Individualized Treatment Plan Primary Care Therapist Assigned to a Service Crew Volunteer to Participate Complete Psychological Assessments Minimum Custody of L2 SOTP Checklist Orientation Progress Notes Clinical Notes SOTP Checklist % 92% 100% 96% 100% 97% 100% 100% 97% 100% 100% 100% Comments: Program staff are required to maintain documentation of an offender=s program participation in two separate files. The SOTP Treatment file contains raw data and assignments completed by the offender. The review team located both progress and clinical notes in most of the files; however, the frequency in reporting information in the file was not consistent with procedures outlined in the policy and procedure manual. Documentation also varied by treatment staff. Other Observations: By TDCJ Policy, participation in the SOTP program is voluntary. All of the offenders interviewed indicated they volunteered for the program. Based on information provided by Programs and Services, an average of five offenders per month were identified as sex offenders but refused to participate. Program staff are required to maintain documentation of an offender=s program participation in two separate files. The SOTP Treatment file contains raw data and assignments completed by the offender. Progress notes and clinical notes are kept in one section of the offender=s medical record. Staff are to be commended on their efforts to keep documentation updated in two separate folders. The overall quality of case file documentation was good. Staff were advised of potential areas of improvement in documentation: 1. Consolidate the two offender files: SOTP treatment files and medical files. Reviewers recognize the potential legal ramifications of said consolidation; however, this is an area that should be explored further. 2. Ensure that documentation specifically details required program activities and that offender participation is recorded. If both progress notes and clinical notes are needed, they should be more clearly distinguished. 3. Training on collection, documentation of required information and interpretation of required fields is needed. 11

12 Objective 2 Describe the types of programs provided in the facility. Methodology: The process evaluation questionnaire, policies and procedures manual, staff and offender interviews, program observations, and specific data on the mainframe computer were used to compile this information. Measure: No measures are applicable for the first part of this objective. This area is intended to establish the baseline of required program participation and describe the programs. Results: Figure 2 contains a time line that details all of the program components provided in the SOTP. Each program component is also briefly described. Figure 2 18 Months Time Line of Program Activities Level III ΑNew Boot Level II Level I The length of each level varies. The levels are awarded to offenders based on behaviors, participation and growth. Required Orientation Group Counseling Individual Counseling Cognitive Training Relapse Prevention Need Based Family Counseling Optional AA/NA Sessions Education Program Alcohol/Drug Education Chaplaincy Program Required Group Counseling Individual Counseling Cognitive Training Relapse Prevention Need Based Family Counseling Optional AA/NA Sessions Education Program Alcohol/Drug Education Chaplaincy Program The SOTP is a modified therapeutic community. The program approach to treatment is rigorous and highly structured. The program consists of three levels with level placement awarded to offenders based on behaviors, diligent participation, and growth, or lack thereof (SOTP 4.03). The time spent 12

13 in each level depends on each individual offenders= progress. As offenders progress through the levels, their privileges increase (e.g., phone calls, commissary allowances). Level III is assigned when offenders first arrive on the Estelle Unit. To advance, offenders must complete two weeks of orientation, complete a Committing Offense Synopsis, and receive membership into the therapeutic peer group. After completing Level III, an offender progresses to Level II. The time spent in this level is determined by the offenders willingness to engage in the program. To complete Level II the offender must complete all three Offense Cycle Worksheets and the Offense Cycle Summary to the satisfaction of the treatment team and his peer group. The offender must also demonstrate diligent participation in the functions of the therapeutic community and positive interaction with peers. After all criteria are met in Level II, the offender graduates to Level I. By the time offender=s reach this level, they should be demonstrating consistent peer leader qualities. To progress through Level I the offender must complete victim empathy work, three traumatic experiences worksheets, forty persons harmed worksheet, a victim empathy letter, victim losses worksheet, and transition to the relapse prevention phase. The program design has offenders transition from Phase I (At Ramsey II) to Phase II ( at Estelle) to Phase III (at Central). For offenders that completed Phase II at the Estelle Unit between December 1-15 (n=14) 36% were transferred to Phase III at the Central Unit. From the random sample of case files reviewed for offenders currently in Phase II (Estelle) (n=) 26% had not gone through the Phase I at the Ramsey II Unit. Program staff reported that pressures to fill the program affected the initial program design. Too, transition of offenders between phases upon phase completion is further impacted by offender release dates. Required Programs The following program components are required for all offenders who participate in the therapeutic community at Estelle. Orientation Offenders are required to complete orientation as a behavioral objective during Level III of the program. Staff interviews indicated that offender orientation generally takes anywhere from two to six weeks for each offender. There are two program therapists assigned the responsibility for instructing all offenders concerning orientation material contained in the SOTP Therapeutic Community Orientation Booklet, Estelle Unit. Offenders are also required to attend community orientation provided by peer leaders in the therapeutic community. Orientation material consists of program definition, philosophy and principles of Sexual Offender Treatment Programming. Group Counseling The primary treatment modality or tool of the Therapeutic Community is ΑCognitive-Behavioral Group Counseling. All offenders are expected to attend therapy groups immediately upon assignment to the program. Therapy groups consisted of three to ten offenders per group at the time of the review. All major behavioral objectives, or therapy assignments for successfully completing a treatment level, are presented in the therapy groups. Some of these assignments are the committing offense synopsis, offense cycle worksheets, offense cycle summary, etc. Peer group members are expected to abide by the ten group rules which provide structure and 13

14 orderly discussion of all treatment issues raised by members of the group. All therapeutic confrontations and process are facilitated by two co-therapists assigned to each group with each offender receiving 4.5 hours of group per week. Group counseling is offered three times (i.e., Tuesdays - Thursday) a week by 10 full-time staff. Offenders receive 1 2 hours of group each of the days. In addition to this structured group work, offenders spend 6 2 hours participating in therapeutic community activities (e.g., AM and PM meetings, confrontation groups) and four hours completing homework assignments. This amounts to a total of 15 hours. Individual Counseling Individual counseling is a required program component. Program policy dictates that at least once a month, the primary therapist has a counseling session with each offender on their caseload. All offenders are to receive an individualized treatment plan within thirty days of entering the program. These sessions provide the offender with an opportunity to discuss current or new problems and therapists with an opportunity for direct feedback to the offender on behavior in group. Cognitive Training This program component consists of the Psycho-Educational Modules offered to offenders in the program. The modules consist of Cognitive Restructuring and Aggression Control. Cognitive Restructuring focuses on errors in thinking which predispose and precipitate the sex offender to initiate deviant sexual activity. Offenders learn to identify thoughts and feelings, to recognize and correct criminal thinking errors, and to eliminate treatment obstruction tactics. Aggression Control teaches offenders methods and techniques for evaluating patterns of aggressive behavior. The offender learns the predisposing and precipitating factors of aggressive behavior and skills for self control. At the time of review, forty-one offenders were enrolled in Cognitive Restructuring classes and sixty-seven in Aggression Control. The original program design had this module being provided during Phase I -- Ramsey II location. Relapse Prevention Although the primary emphasis is within Phase III -- Central Unit, relapse prevention is a concept which is taught throughout the SOTP Phase II -- Estelle program. Offenders are taught a process model for the maintenance of abstinence from deviant sexual activity. The process uses many of the principles incorporated in the analysis of sexually deviant behavior individualized for the offender. Offenders must complete the relapse prevention worksheet. The worksheet is presented to the offender=s group for approval. Additional factors which increase the risk of relapse are incorporated into subsequent worksheets. Need Based The following programs are provided to offenders based on their need. Family Counseling Family counseling provides offenders an opportunity to involve the family in the treatment process prior to the offender=s release. This builds a support system which is viewed as crucial to post-release adjustment. The primary therapist addresses family counseling with the offender during orientation. If a consent form is signed by the offender, the family is notified by letter, that the offender is in the program and invited to contact the offender or therapist regarding 14

15 the program. If the family member agrees to participate, an appointment is established for the family, offender, and primary therapist to meet. Family members are asked to meet for at least two session prior to the offender=s release. According to interviews with program staff, counseling with offenders and family members are rare. Since the program began in January 1996, approximately five offenders and their families have participated in counseling sessions. Sometimes when the offender gives consent, the family refuses to participate. Also, family members may be unable to come to the prison due lack of transportation or other problems. Phone contact is a much more common form of counseling with the offender=s family and occurs with at least 75% of the SOTP population according to a lead counselor. Optional Program Activities The following program components are optional and available to any offender located at Estelle, if applicable. An offender=s primary counselor is responsible for determining if the following programs may be attended. AA/NA Sessions and Alcohol and Drug Education Offenders in the SOTP have access to these programs. Participation is optional and at the discretion of the offender and his primary counselor. Education Program If an offender does not have a GED or High School Diploma, he is eligible to apply for services provided by the Windham School District. Windham has 23 educational and vocational slots available for all offenders in the Estelle Unit Complex. If an offender in the SOTP is approved for education programming, he is not assigned to a prison job. Classes are provided Monday through Friday for three hours each day. Interviews with program staff indicated that there is a lack of communication/coordination concerning time and availability of the SOTP offenders for programming. If greater attention to distribution of offenders to caseloads was provided, offenders could attend programming provided by both Windham and the SOTP staff. Vocational Program Offenders who meet the program eligibility criteria may participate in the program. The program is capable of providing services to 23 offenders and lasts nine to twelve months. Progress through the therapeutic community is the priority participation requirement; therefore access to vocational programming is limited and left to the discretion of the primary counselor. Chaplaincy Program Offenders have access to the Estelle Unit Chaplain. At the time of the review, plans were underway to introduce a twenty week program. This program is scheduled to be offered one hour per week. Participation is voluntary. Measures: This objective is intended to establish the baseline of required program components and document the extent of time offenders spend in various activity areas. Activities are divided into five categories. They are further divided into activities that occur in each phase of the program. 15

16 Treatment included. Group counseling, individual counseling and, if applicable, cognitive training are Functional Orientation was included for Level III and household duties were included in all Levels. Household duties consist of ten hours of work within the therapeutic community. Most offenders are also required to perform twenty hours of work detail within the prison. Only offenders assigned to special programming do not perform other work within the prison. Productive Reentry For the program need group, education programming is included. For the program need group, vocational training is included. Interpersonal Unstructured time in which offenders have opportunity to select and participate in optional program activities and other free time (excluding sleep) was included. Results: Table 4 presents the average percent of time offenders are involved in each program activity area. The raw data is presented in Appendix A. Table 4: Activity Areas Percentage of time residents spend in each program activity area No Special Programs Assigned Prison Work Program Need Group No Prison Work Treatment Functional Productive Reentry Interpersonal 13% 27% 0% 0% 60% 13 or 31% 9% 0 or 18% 0 or 13% 60% Comments: Regardless of program assignment, offenders spend the majority of their time in interpersonal activities. Offenders who are not receiving special programs are assigned prison work duties. Other Observations: During the interviews with offenders, almost all indicated they were receiving the services they needed. When asked what they would like more of, group and individual counseling were the most common responses. Most of the offenders liked the peer group structure of the program the best. Very few consistent responses were received on what should be changed. Responses included, more staff, mixed groups, their own unit, etc. During interviews with program staff, most indicated that the offenders were not receiving the program/services they needed. Staff mainly wanted offenders to stay in the program longer (e.g., up to five years). Staff also indicated that there were certain groups of offenders who were excluded (e.g., females, mentally and physically impaired, Spanish speakers). Most program staff thought the 16

17 peer group sessions were the best part of the program. Other than length, some staff wanted to provide more psycho-educational sessions and provide services in a separate facility. Review team members that observed the group sessions were impressed with the techniques employed by the SOTP counselors. The sessions are provided in very confined spaces in the unit and are generally very confrontational. The peer groups mentioned above were very dynamic and involved considerable offender participation. 17

18 Objective 3 Verify that offenders are receiving required programming. Methodology: The process evaluation questionnaire, staff and resident interviews, and offender case files were used to collect information for this objective. A review of discharges during December 1997 was used to verify required programming and completion criteria. Specific methods are detailed for the various measures. Required Programming Measures: Program policy requires that the following program components be provided to all offenders who are participating in the program. This information is documented in the SOTP Treatment files. Since the offenders had been discharged, medical files for some offenders were not available. Length of Stay This was verified by computing the difference between the offenders= intake date into Estelle and the date they leave the program. Offender case files were used to obtain this information. Based on the programs design, offenders are intended to be in the program 12 to 18 months. Documentation in case files to calculate this measure conflicted. The most consistent source was the date of transfer from one unit to Estelle and from Estelle to a new unit. Group Counseling Group counseling is required for all offenders at least three times per week. Medical files were reviewed for this documentation. Individual Counseling Offenders are to receive at least one session per month. Medical files were reviewed for this documentation. Psychological Education Offenders who did not receive anger management and cognitive restructuring at Ramsey II are required to obtain it at Estelle. To verify that offenders had received this programming, the check list in the SOTP Treatment file was reviewed to see if they were scheduled to receive the programming. If the program was marked yes, pre and post tests for the courses should be in the case file. Family All offenders are to obtain family counseling. Family members are only contacted if the offender signs a release form permitting the counselor to contact the family member. The presence of this form was verified. Relapse Prevention This is provided during group sessions, but offenders are also required to complete two relapse prevention work sheets. The presence of these worksheets was verified in the SOTP Treatment file. Required Programming Results: In general, the documentation of the frequency of sessions does not occur in a consistent manner. Treatment plans document offender need areas, course of treatment and projected time table for completion. However, in some instances completion dates indicating that a particular need area had been addressed are not documented and there is no supporting documentation in the progress notes to indicate satisfactory completion. This made these 18

19 items difficult to verify. Results relating to each measure are discussed separately. Additionally, only ten of the fourteen discharged offenders= medical files were still available at the time of the review. Length of Stay Based on cases where the best information was available (n=9), offenders stay in the program averaged twelve months. The mode and median are 13 months. This was computed by using the transfer/orientation date and the discharge date located in the Progress Notes or the date of transfer out of Estelle. Group Counseling Documentation in the case files support that group counseling occurs. All of the medical files reviewed had general information relating to offenders attending group sessions. Specific information detailing the frequency and subject matter of the sessions was not consistently documented. Individual Counseling Offenders receive an average of six individual sessions during their stay. With an average stay of twelve months the compliance rate is 50%. Psychological Education A total of twelve offenders were noted to have received anger management and cognitive restructuring. Of that number, one anger management pre and post test was present and five cognitive restructuring pre and post tests were present in the SOTP Treatment file. The compliance rates are 8% for anger management and 42% for cognitive restructuring. Family Of the fourteen discharge files reviewed, 57% (n=8) consented to have their family members contacted. There was no consistent documentation as to whether these contacts actually occurred. Relapse Prevention Of the fourteen discharge files reviewed, 57% (n=8) had the first worksheet present and 64% (n=9) had the second worksheet present. Five offenders were missing both worksheets and one offender was missing the second worksheet. Discharge Criteria Measures: Local procedure requires that the items listed below must be complete for the offender to be discharged from the program. Level III to Level II The following criteria are required for an offender to go from Level III to Level II status. These items were verified utilizing case files for all offenders listed as Level II during the review (n=24). Complete Orientation Offenders are required to complete two weeks of orientation. This was verified by the date indicated on the SOTP Services Checklist and initial chronological recording in the medical files. The length of time offenders spent in orientation was not verifiable. Complete Committing Offense Synopsis Offenders must complete this summary to the satisfaction of the treatment team and the offenders= peer group. The presence of this homework assignment was verified in the SOTP Treatment file. Membership Letter All offenders must achieve membership into the therapeutic peer group. This is done by drafting a membership letter and presenting it to the group for approval. The presence of this letter was verified in the SOTP Treatment file. 19

20 Level II to Level I The following criteria are required for an offender to go from Level II to Level I status. These items were verified utilizing case files for all offenders listed as Level I during the review (n=9). Complete Offense Cycle Worksheets Offenders must complete these three worksheets to the satisfaction of the treatment team and the offenders= peer group. The presence of these homework assignments was verified in the SOTP Treatment file. Complete Offense Cycle Summary Offenders must complete this summary to the satisfaction of the treatment team and the offenders= peer group. The presence of this homework assignment was verified in the SOTP Treatment file. Demonstrate Diligent Participation Offenders must be participating in the functions of the therapeutic community and have positive interactions with peers. This item was not specifically verifiable. The peer groups acceptance of the offenders paperwork is an indicator of participation. Level I to Exit The following criteria are required for an offender to go from Level I to Exit status. Offenders may exit from Phase II by being transferred to Central for Phase III; by being released on mandatory supervision; or by being released from supervision. These items were verified utilizing case files for offenders discharged during December 1997 (n=14). Information was obtained for 13 of the offenders. One of the case files was unavailable. Complete Victim Empathy Work This consists of the Victim Empathy Letter and the Victim Losses Worksheet. The empathy letter is written based on how the offender perceives the victim feels about being harmed. The losses worksheet details the losses the victim has had as a result of the crime. The presence of these homework assignments was verified. Three Traumatic Experiences Worksheets Three offender traumatic experiences are detailed by the offender. They describe how the offender felt then and how the offender feels now with regards to the offense. The presence of these homework assignments was verified. Forty Persons Harmed Worksheet This worksheet details at least forty people the offender has harmed by the offense, their relationship to the offender and how the victim reacted/felt. The presence of this homework assignment was verified. Transition from Estelle to Central The percentage of offenders who transitioned from Estelle to Central was documented. Exit the SOTP Phase II The following criteria are required for an offender to exit Phase II of the SOTP. These items were verified utilizing case files for offenders discharged during December 1997 (n=14). Information was obtained for 13 of the offenders. One of the case files was unavailable. 20

21 Release Essay Offenders must complete a release essay. This documents what the offender learned during the program, a summary of his written assignments, and their long and short-term goals. The presence of this assignment was documented. SOTP Ballot A treatment team ballot form is required for all offenders to be discharged from Estelle. The ballot contains the primary therapist=s recommendations, concurring opinions and dissenting opinions. A majority vote is needed to discharge the offender. The presence of this ballot was verified. Discharge Criteria Results: Since fiscal year 1997, 38% of the offenders released from Estelle SOTP had completed the phase, 23% withdrew from the program, 18% were terminated by program staff and 6% were released from the institutional division (e.g., paroled) prior to completion. The remaining summary statistics are presented in Table 5. Table 5: Program Completion Process Measure Applicable Number Number Observed Compliance Rate Orientation Committing Offense Synopsis Membership Letter % 88% 75% Offense Cycle Worksheets Offense Cycle Summary % 67% Victim Empathy Letter Victim Losses Worksheet Traumatic Experiences 40 Persons Harmed Worksheet Transition to Central Release Essay SOTP Team Ballot % 100% 69% 69% 38% 69% 69% Comments: The offenders homework assignments are maintained in the SOTP case file. These assignments are hand written by the offenders. The review team experienced some difficulty differentiating between assignment types. Assignment headers do not always appear on the work product. Additionally, some offenders are advanced to the next level without having presented their assignments to their group. This resulted in less than perfect compliance rates for some of the assignment areas. In other instances, offenders were maintaining their assignments in their cells. Program staff indicated that the offenders chose to keep their assignments. 21

22 Objective 4 Document and verify post-discharge placement and services. Methodology: The process evaluation questionnaire, staff interviews and a review of offender case files were used to collect information for this objective. Prior to release from the SOTP, a treatment team reviews an offender=s program participation to determine the quality of treatment option. The team reports recommendations for continued treatment and supervision requirements to the offender. The primary care therapist prepares a discharge report (Closing Summary) for the next phase of treatment (Phase III -- Central Unit) or mails a copy to the parole representative in charge of the sex offender=s supervision. The presence of a Closing Summary was verified for offenders who discharged during December 1997 (n=14). Once an offender is discharged from the program, staff reported that it takes a few weeks to prepare the closing summary. Therefore, 77% were not in the case files. However logs were reviewed and these summaries were being prepared. Objective 5 Document the extent to which staff and volunteers are appropriately trained. Program Staff The Estelle SOTP staff were in compliance with their training requirements. Staff indicated that the standards developed by the Council on Sex Offender Treatment are too high to be maintained with their current funding levels. Program administration expressed concern about their inability to provide quality Αcutting edge training to the program staff. This was identified as a critical need area. Security Staff SOTP training records for correctional officer staff are not maintained in a centralized location and there are no clear guidelines pertaining to whom is responsible for recording, verifying, tracking, and maintaining SOTP training documentation. This information was verified with SOTP staff, Unit Personnel, the Warden=s office and the Major=s office. It was determined that training logs were signed by correctional officers participating in the training, but these logs could not be located. Two memorandums were observed listing 16 staff who received a two hour training session within the last three months. A conversation with two correctional officers working in the SOTP confirmed that they had received the training. Since 9/96 there have been five training sessions conducted for security staff (including supervisors). Initially, a three day orientation training was conducted for the entire unit to prepare staff for the implementation of the SOTP in the Estelle Unit. More recently, a two hour training session was designed and is conducted sporadically or as requested by security supervisors. 22

23 Appendix A Raw data relating to the amount of time offenders spend in program activity areas

24 Number of hours offenders spend in each program activity area Program Name Program Length Estelle 1 2 years No Special Programs Special Programs Treatment Group Counseling Individual Counseling Family Counseling Anger Management Cognitive Training 0 or 20 AA/NA Sessions Treatment Sum or 35 Functional Orientation 0 0 CSR 0 0 Personal living skills 0 0 Household Duties/Work Functional Sum Productive Education Program 0 0 or 20 Productive Sum 0 0 or 20 Reentry Alcohol and Drug Ed 0 0 Employment Program 0 0 Drill and Ceremony 0 0 Life skills Training 0 0 Parenting Classes 0 0 Relapse Prevention 0 0 Vocation Training 0 0 or 15 Reentry Sum 0 0 or 15 Interpersonal Chaplaincy Program 0 0 Unstructured time Physical Education 0 0 Recreational 0 0 Interpersonal Sum Base Hours

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