Chapter 3: Sex Offense-Specific Assessment, Treatment, and Physiological Testing (Probation and Supervised Release Conditions)

A. Statutory Authority

1. Under 18 U.S.C. § 3563(b)(9), the court may provide that the defendant “undergo available medical, psychiatric, or psychological treatment.”
2. Under 18 U.S.C. § 3563(b)(22), the court may provide that the defendant “satisfy such other conditions as the court may impose.”

B. Sample Condition Language

You must participate in a sex offense-specific assessment. [[You must pay the costs of the assessment.] [You must pay [$___ per ___ (e.g., visit, week, month)] or [___ % of the costs of the assessment.]]

You must participate in a sex offense-specific treatment program and follow the rules and regulations of that program. The probation officer will supervise your participation in the program (provider, location, modality, duration, intensity, etc.). [[You must pay the costs of the program.] [You must pay [$___ per ___ (e.g., visit, week, month)] or [___ % of the costs of the program.]]

You must participate in plethysmograph testing as part of the required participation in a sex offense-specific assessment and/or treatment.

You must participate in visual response testing as part of the required participation in a sex offense-specific assessment and/or treatment.

C. Purpose

1. This condition serves the statutory sentencing purposes of public protection and rehabilitation. 18 U.S.C. § 3553(a)(2)(C)-(D).
2. This condition enables the probation officer to satisfy the statutory requirements to keep informed as to the conduct and condition of the defendant; report the defendant’s conduct and condition to the sentencing court; and aid the defendant and bring about improvements in his or her conduct and condition. 18 U.S.C. §§ 3603(2)-(3).
3. The purposes of sex offense-specific assessments are to assess a defendant’s risk for reoffending and current amenability for treatment; guide and direct specific recommendations for the defendant’s conditions of treatment and supervision; provide information that will help to identify the optimal setting, intensity of intervention, and level of supervision; and assess the potential dangerousness of the defendant.
4. The purposes of sex offense-specific treatment are to help those who have committed sex offenses accept responsibility for sexually deviant thoughts and behavior; develop an increased level of recognition and focus on details of actual sexual behavior; and recognize the arousal patterns, fantasies, planning, and rationalizations of their sexually deviant thoughts and behavior.
5. Physiological testing including plethysmograph testing and visual reaction testing may be beneficial as an adjunct to sex offense-specific treatment and may allow the probation officer and the treatment provider to ascertain the arousal pattern of the defendant and to assess defendant progress in treatment.
6. Social science research suggests that correctional interventions that follow the principles of evidence-based practices (e.g., the risk principle, the need principle, and the responsivity principle) promote positive change in the defendant and reduce the probability of recidivism. Under the need principle, correctional interventions should be rooted in empirical knowledge about the sources of criminal conduct and should target known predictors of crime and recidivism that can be changed (also known as “dynamic risk factors” or “criminogenic needs”). They are human deficits directly related to the propensity to commit crime that can be changed. Research has shown that criminogenic needs include antisocial thoughts and attitudes, which can be addressed through cognitive-behavioral treatment. Cognitive-behaviorism assumes that cognitions affect behavior, people can monitor and alter their cognitive activity, and changes in cognitions will lead to changes in behavior (see: Chapter 1, Section III; Chapter 3, Section X).

D. Method of Implementation

1. The physical and psychological harm caused by sex offenses is particularly traumatic, and probation and pretrial services officers should give priority to minimizing the impact on victims and to preventing new sex crimes from occurring. Not all persons charged with or convicted of sex offenses are alike. Rather, they present a spectrum of criminogenic risk and therapeutic need. Officers’ investigation and supervision techniques should vary accordingly.
2. Traditional mental health treatment should not be used in place of sex offense-specific treatment. However, a defendant with a mental health disorder may require mental health-specific treatment interventions in conjunction with sex offense-specific treatment (see: Chapter 3, Section II).
3. The probation officer should meet with the defendant and the clinician to develop an individualized treatment plan that clearly outlines the goals and objectives of treatment and the methods that will be used to achieve those goals. The probation officer should use this meeting to address any concerns the defendant has, discuss how compliance will be monitored, and explain the consequences of noncompliance. The probation officer should clearly state his or her role in monitoring the treatment plan.
4. There are various types of sex offense-specific treatments. Group treatment is the preferred treatment modality, but individual sessions may be used as an adjunct to group treatment to address specific issues that arise.
5. Cognitive-behavioral and medication-assisted treatment are the most widely accepted treatment modalities for sex offense-specific services. The pharmacological options include three categories of drugs: (1) anti-androgens used to lower testosterone (e.g., Depo Provera); (2) anti-androgens used to lower testosterone to castrate levels (e.g., Lupron and Zoladex); and (3) antidepressants (called selective serotonin reuptake inhibitors–SSRIs) used to treat depression and obsessive-compulsive symptoms (e.g., Prozac and Paxil). Medication is not appropriate for all defendants with a history of sex offenses and is not an isolated treatment (i.e., it is administered in conjunction with psychotherapy).
6. Effective supervision of defendants with a history of sex offenses requires close collaboration between treatment providers and probation officers. It is the responsibility of the probation officer to coordinate this communication with the therapist and include the defendant in this process. The defendant must be aware that the therapist and probation officer maintain regular communication throughout the course of treatment. The probation officer should have at least monthly contact (in person or by telephone) with the treatment provider. The amount of contact may need to be higher based on the level of risk and the needs of the defendant. The probation officer should reduce the contact based on the defendant’s progress in treatment and reassessment of the defendant’s risk and needs.
7. The condition should be worded to allow for a co-payment amount for sex offense-specific treatment if the defendant is financially able. Having the defendant pay for services promotes the defendant’s personal investment in his or her treatment.
8. Sex offense-specific evaluations or treatment may include physiological testing such as the plethysmograph, visual reaction testing, or the clinical polygraph.  
9. The plethysmograph assesses sexual arousal patterns in males. Deviant sexual arousal is revealed by physiological responses to audio or visual sexual stimuli. Deviant sexual arousal patterns provide the framework to develop an individualized treatment plan tailored to arrive at a more comprehensive understanding of the defendant’s sexual interests. Results can help identify defendants at higher risk for sexual re-offending. Plethysmograph results should not be used as the sole criterion for estimating risk of engaging in sexually abusive behavior. The results should be considered in conjunction with other evaluative measures. The results of the plethysmograph should not be used to initiate any revocation proceedings.
10. Visual reaction time is a sexual interest assessment used to assess both normal and deviant sexual attraction. It requires interpretation and scoring by the private company that developed the tests. Sexual attraction is measured by recording the length of time an image is viewed. Multiple images are presented to the person being tested. The person rates the attractiveness of the images while the viewing time for each photograph is measured. The person also completes questionnaires related to social desirability and cognitive distortions. The results should not be used as the sole criterion for estimating risk of engaging in sexually abusive behavior. The results should be considered in conjunction with other evaluative measures.
11. In some cases (e.g., when there is a clear and documented history of sexual attraction to children), physiological testing mechanisms such as the plethysmograph or visual reaction time may not be necessary.
12. In some cases, probation officers may not determine that physiological testing mechanisms such as the plethysmograph or visual reaction time are necessary until after sentencing and release from imprisonment. Probation officers continually evaluate supervision and treatment plans throughout the course of supervision. If a clinical assessment after release from imprisonment reveals that  physiological testing mechanisms such as the plethysmograph or visual reaction time are necessary, the probation officer may recommend that the court modify the conditions of supervision, and there is no requirement that the modification be predicated upon a violation of an existing condition or a change in the defendant’s circumstances (see: Chapter 1, Sections II(A)(3) and II(B)(3)).