The treatment programs at Sand Ridge Secure Treatment Center (SRSTC) make Wisconsin a safer place by reducing the level of sexual violence in society. SRSTC is considered a national center of excellence in the evaluation and treatment of sexual violence.
Staff believe that individuals can make positive changes in their lives and behavior, including the elimination of sexually violent acts. Staff use open and assertive communication when working patients. Services are provided in a trauma-sensitive environment. Knowledge, based on research, guides all activities.
Risk, Need, Responsivity
Research shows that treatment services for sex offenders are more effective when the principles of risk, need, and responsivity are carefully implemented
The risk principle requires concentrating more intense treatment on higher risk offenders. This principle is easy for SRSTC to follow since individuals deemed to be low risk would not be committed under Chapter 980 to SRSTC.
The need principle requires that treatment be focused on social and psychological factors that predisposed to offending. SRSTC identifies these factors through the treatment process using a research-based framework.
The responsivity principle requires using treatment methods to which offenders are generally responsive and tailoring treatment to the learning style of the individual. SRSTC seeks to tailor treatment to the learning style of the individual through the use of four treatment tracks and individualization within track based on detailed assessment. The methods used include cognitive behavioral therapy and motivational interviewing.
Three Phases of Treatment
The population at SRSTC is quite diverse, varying greatly in the degree to which psychopathic traits are present and in level of cognitive functioning. This diversity can make it challenging to deliver effective treatment services. Staff seeks to respond to these challenges in several ways.
- Treatment services always begin with a very comprehensive assessment.
- Treatment services are divided into four tracks, according to degree of cognitive functioning and level of psychopathic traits.
- Treatment services are further individualized based on the patient's profile.
Each treatment track at SRSTC has three phases. Patients advance to the next phase if and when they demonstrate satisfactory progress in the earlier phase.
Phase 1 programming works with patients in meaningfully engaging in the treatment program. It focuses on assisting patients in building the attitudes, skills, and motivation that are necessary for effective treatment participation. Phase 1 helps patients learn to better regulate their impulses and emotions.
Phase 2 programming works with patients to develop a shared understanding of their specific treatment needs, including an understanding of the factors that contributed to their past offending. During this phase patients work on seeing in a more objective way how these factors have affected them in the past and how they continue to affect them now. Achieving this requires attending specifically to the thoughts, attitudes, emotions, behaviors, and sexual arousal linked to their sexual offending and learning to recognize when these thoughts, emotions, behaviors, or sexual arousal occur. As patients become aware of the impact of these factors therapists assist them in discovering and developing the determined motivation required to overcome these problems.
Phase 3 programming works with patients to assist them in effectively managing their personal risk factors and developing healthier ways of functioning in order to transition to the community. Within each of these defined phases patients advance if and when they demonstrate satisfactory progress in the earlier phases.
Four Treatment Tracks
The treatment program at SRSTC has four primary treatment tracks.
The Conventional Treatment Track is designed to treat patients without significant cognitive deficits and with no more than moderate levels of psychopathic traits. This does not mean that patients in the track are homogeneous. IQs can range from the lower end of the average range to those who have superior intelligence. Patients in this track range from individuals in which psychopathic traits are largely absent to those in which moderate levels of these traits are present. This requires that treatment services be significantly individualized within the track.
Although patients in this track tend to be less impaired than those in the other tracks this does not mean that the psychological risk factors underlying their offending are necessarily less marked. Treatment in this track is more similar to treatment that would be provided in high intensity Department of Corrections programs.
- Phase 1 focuses on self-management and learning how to participate in treatment.
- Phase 2 focuses on patients learning to understand themselves through life history review and analysis of past offenses.
- Phase 3 focuses on living in a healthier way and community preparedness.
Corrective Thinking Program
The Corrective Thinking (CT) Treatment Track is designed specifically for offenders with marked psychopathic traits and normal levels of cognitive functioning. Individuals who display psychopathic traits are difficult to treat but are treatable. These individuals require a treatment approach that can initially address the personality disorder traits that interfere with the conventional treatment process and simultaneously monitor and address these traits during the conventional aspect of sex offender treatment.
- Phase 1 focuses on psychopathic features, personality disorder traits, and general criminality and helping the patient manage the behaviors associated with these characteristics.
- Phase 2 focuses on the patient learning to identify the individual psychological factors that contributed specifically to their past offending and demonstrating motivation to work on them.
- Phase 3 focuses on the patient working to manage their identified sexual offense risk factors and developing healthier functioning.
Choices and Opportunities for Meaningful Personal Achievement (COMPASS)
COMPASS is designed specifically for cognitively impaired patients and others who have difficulty functioning in various life areas but who do not show marked levels of psychopathic traits. Patients generally have below average IQs and/or show deficits in processing speed, executive functioning, or memory scores. They may also be placed in the track because of a severe learning disorder or because severe and persistent mental illness suppresses working memory or executive functioning. The COMPASS population is a heterogeneous mix of those with intellectual disabilities, learning disabilities, mental disabilities, and other disabilities.
COMPASS is tailored for those who have difficulty learning through traditional methods, in an effort to address their sexual offending and related factors, and prepare them to live offense-free in the community. As a result, the material is presented in various ways to best meet the individual needs of patients. Visual illustrations are used extensively, as are methods such as role-plays and collages. Games are sometimes used to review material, as retention and memory are issues for COMPASS patients. Groups generally need to be shorter, to fit attention spans, and may be held more frequently than in other tracks. Examples across various life areas may need to be given in order to help patients generalize the material.
- Phase 1 focuses on self-management, as well as addressing factors which may interfere with making progress in treatment. Basic concepts of COMPASS are taught (e.g., old me or the negative part of oneself which is selfish and hurts others versus new me which is pro-social).
- Phase 2 focuses on the identification of risk factors which led or may lead to offending, as well as development of positive coping skills.
- Phase 3 focuses on building one’s new identity to ensure living safely and productively in the community.
Achieving Capability [to] Thrive (ACT)
ACT is designed to address specific identified needs of a unique and specialized population. This population generally has treatment needs in five primary areas.
- Deviant sexual interests and behaviors
- Elevated levels of psychopathy and strong antisocial orientation as evidenced by elevated Hare Psychopathy Checklist-Revised (PCL-R) scores
- Cognitive deficits including intellectual disabilities, learning disabilities, severe mental illness, traumatic brain injury, or other deficits
- Significant trauma history and trauma symptoms
- Significant substance use history.
The presence and the interaction of these five areas create unique challenges and approaches in providing treatment for these patients. Often these patients’ needs are so unique and divergent from others within their own treatment track, they require “tracks within the track,” that is, their own unique treatment approach within ACT. Additional examples of ACT treatment’s unique approaches include greater use of individual treatment, using a slower pace, applying multiple modality presentations, using less abstract concepts and language, using repetition, role-play, mentoring, and greater use of affirmations, encouragement, and support.
- Phase 1 focuses on “treatment engagement,” where the goal is for patients to develop a therapeutic alliance with facilitators, learn the skills necessary to engage meaningfully in the treatment process, and obtain stabilization of functioning.
- Phase 2 focuses on “strengths and problem identification,” where the goal is for patients to identify their strengths, individualized treatment needs, self-defeating life patterns, and psychological risk factors, and learn healthy general and sexual self-management strategies and skills to function effectively.
- Phase 3 focuses on “healthy lifestyle,” where the goal is for patients to practice consistent recognition and management of their psychological risk factors, healthy self-management, healthy social relationships , and preparation for reintegrating into the community.