Treating and Managing the
Sexually Violent Predator
March 16, 2006
Kenneth Carabello, LCSW
• Overview of SVP Law
• Overview of Liberty Healthcare SVP
• Treatment Issues
• Supervision Issues
A result of concerns regarding the risk to public
safety that results when sex offenders are released
Welfare and Institutions Code (WIC) Section 6600 et
al. went into effect on January 1, 1996
Civil commitment for persons who meet SVP
In establishing the SVP Act, the California Legislature
declared that there is a small group of dangerous individuals
who have diagnosable mental disorders and can be readily
identified while incarcerated. It further declared that the
needs of this population are very long term and the treatment
modalities that are appropriate for this population are
substantially different from those persons currently civilly
committed under the Lanterman-Petris-Short Act
(commencing with Section 5000) and, accordingly, a new
civil commitment needed to be established to address the
treatment needs of this population. The legislation directed
that such Sexually Violent Predators (SVP’s) be confined
and treated until they no longer present a threat to society.
The aim of this law is to treat and confine these individuals
only as long as their disorders continue to present a danger to
the health and safety of others, and not for any punitive
purposes. The Legislature determined that these “persons
shall be treated, not as criminals, but as sick persons.” (WIC
6600. As used in this article, the following terms have the
following meanings: (a) (1) "Sexually violent predator"
means a person who has been convicted of a sexually violent
offense against two or more victims and who has a diagnosed
mental disorder that makes the person a danger to the health
and safety of others in that it is likely that he or she will
engage in sexually violent criminal behavior.
WIC 6600 establishes three major criteria to define a Sexually Violent
* He/She has been convicted of a sexually violent offense (penal code
offenses are listed in statute; offenses usually include either child
molestation or rape).
* He/She has had two or more victims as a result of these sex offense
* The person has a diagnosed mental disorder that makes him/her likely to
engage in future sexually violent predatory behavior (predatory is defined
as a crime against a stranger, a person of casual acquaintance, or a person
whose relationship is established for the purpose of sexually offending).
As of 3/1/06
• Referred to DMH 6,368
• Pass DMH record review 3,406
• Positive evaluation for SVP 1,307
• Total committed 539
• Men currently at Atascadero State Hosp.
(ASH) and Coalinga State Hospital. The
SVP woman is at Patton State Hospital.
• ASH has four phase treatment program.
So How Do They Get Out?
Petition for outpatient treatment can be
initiated by patient (WIC 6608) or DMH
Court hearing determines if ordered out.
If ordered out, must be placed in county of
• Administered by CA DMH
• Instituted in 1986
• Provides mandated core services to
judicially committed patients
• Existing CONREPs opted not to treat SVPs
• Liberty Healthcare contracted in February
The primary mission of CONREP is the
protection of the public through the
reduction or prevention of patient
Productive, healthy patients, leading a
• Community-based monitoring and
management of sex offenders
• Patient accountability
• Offense-specific treatment, polygraph
assessments and intensive specialized
• Victim-centered approach
• Collaboration and communication
Hospital Liaison Duties
• Initial interviews with all newly committed SVPs
• Clinical interviews every six months with each
committed SVP in phase II or higher and his
designated treatment team.
• Monthly meetings with all SVP’s in the final
phases of treatment at the facility (IV and V).
• Development of individualized terms and
• Phase IV and V staffings
Outpatient Clinical Services
• Sex offender-specific treatment providers
• Sex offender-specific trained polygraphers
• Psychiatrists for pharmacological treatment for arousal
reduction and mental illness
• Professionals who provide plethysmographic assessment
of deviant arousal
• Professionals who provide Abel assessment of deviant
• Medical physicians.
• Unannounced face-to-face visits at and away from home.
• Collateral contacts with significant people in SVP’s life
• Covert surveillance as indicated
• GPS monitoring
• Random urine screens for illegal substances
• Random phone checks
• Unannounced residence, vehicle and personal searches.
• Receipt and expenditure reviews; reviews of account
statements if applicable
• Approval of schedules, locations of outings and routes of
travel for all time outside of residence
Regional Coordinator Case
• Prerelease search and investigation of potential housing.
• Development of a support and release plan.
• Scheduling and coordinating Community Safety Team
• Collateral contacts with providers, state liaison, law
enforcement, employers, family, etc.
• Individualized supervision plan.
• Transportation if needed.
• Assistance with basic life support (clothing, food,
medicine) as needed.
• Scheduling and coordinating of professional services listed
in section B.
• Vocational service referrals.
• Quarterly reports to the court.
Dept. of Mental Health
State Hospitals: Executive Director
Atascadero Clinical Liaison of LIBERTY CA CONREP
Coalinga (COMMUNITY PROGRAM
Patton DIRECTOR )
Victim Advocates, Community Community
Local Law Safety Team Providers
Community Safety Teams
• Regional Coordinators
• Treatment Providers
• Victim Advocates
• Law Enforcement
Law Enforcement Coordination
• Improved coordination of containment activities.
• Enhanced communication through familiarity.
• Insurance of Sex Offender Registration Requirements.
• Support from law enforcement in community notification
• Facilitation of apprehension of the SVP upon absconding,
committing a new criminal offense, or violating the
conditions of release.
• Provision of consultation and/or training specific to sex
offender management to law enforcement officers.
• Facilitation of responses to Global Positioning Satellite
• Acquire assistance in handling potentially violent or high-
What housing has been found so
• Monterey County
• Marin County
• Santa Clara County
• Contra Costa County
• Solano County
• San Diego County
County of Domicile
• Proximity to potential victims
• Offense pattern
• Parks/Schools/Daycare/places where
children congregate (perception)
• Proximity to services
• Public transportation
• Property owner fully informed
What if we can’t find housing
• Locked up Conditional Release
• Cond. Rel. Unconditional Release
• Patient fully versed in relapse prevention
• Continuity of treatment
• Stress of high profile placement
• Early restrictions
• Development of social supports
• Behavioral stability under tight supervision
SVP MINIMUM PERFORMANCE STANDARDS
FOR COMMUNITY OUTPATIENT TREATMENT*
SERVICE FUNCTION TYPE
Intensive Supportive Transitional
(1 per Year)
Weekly Minimum Monthly
Individual Contact (4 per Month) (1 per Month)
Group Contact Weekly
Home Visits Weekly (Once every
Collateral Contact Weekly Monthly
Substance Abuse Screening Weekly Minimum Monthly
Assessment (Dynamic Risk)
(1 every 3 Months)
1. Monitoring/Maintenance Quarterly Twice per Year
2. Sexual History Once None
Twice per Year Yearly
GPS Data Review (Once per Day)
Patients on Anti-Androgen/
1. Testosterone & Blood
At Admission and Randomly every 6 Months Thereafter
2. Bone Density Testing At Admission and Yearly Thereafter
*All treatment will follow Relapse Prevention Model
• Intensive work load
• Less autonomy than traditional
probation/parole - increased role of team
Current Policy Issues
Civil commitment - how long will
there be patients?
Treatment - does it help?
GPS - use it for all sex offenders?
Registration - classification
Sex Offender Residency
Iowa County Attorneys Assoc., Jan 2006
• No known correlation between residency restriction
and reduction of sex offenses
•Children not attacked by strangers at covered locations
•Stranger attacks rare.
•Law enforcement notes restrictions cause homelessness,
failure to report residence changes, and false address
registrations (Des Moines Register reported twice as
many unknown location of sex offenders 1/06)
•No demonstrated protective effect of residency
Categories of crimes too broad, imposing restrictions on those
with no known risk to children in covered locations
Families of offenders also restricted. Children pulled from
schools, spouses loosing jobs and community connections
Physically and mentally disabled offenders prohibited from
living with supports
Affordable housing and transportation scarce in available
No time limit
No accommodation for those on parole or probation
Numerous negative consequences of the lifetime residency
restriction has caused a reduction in the number of
confessions made by offenders.
Counterproductive to well established principles of treatment