ATTACHMENT F

Special Commitment Center

(SCC)

Sex Offender Treatment Professional Practice

Standards Manual

2018 Inspection of Care

Manual Revised in 2014 - 2015

Purpose of this Manual

This manual is intended to fulfill SCC’s obligation under 388-881-020WAC to establish “Professional Practice Standards” applicable to DSHS treatment programs for civilly committed adult sex offenders. This manual also serves to support the DSHS obligation under 388-881-025WAC to conduct an annual inspection of care (IOC). The sections and items listed in this manual provide direction to the staff on how to carry out the programming components of the Special Commitment Center’s clinical treatment, residential and medical programs.

SECTION - 1 Sex Offender Specific TREATMENT PROGRAM

STANDARD 1-ASCC Clinical Department appropriately prepares for the arrival and the admission of new residents.

To include:

  • Appropriate program preparation occurs for a new admission.
  • A New Admission Profile (NAP) is created using discovery material and probable cause documentation that synthesizes material including past psychiatric issues, criminal history and previous institutional behavior to provide adequate forewarning to residential and clinical staff of needed preparations and potential risks.
  • SCC conducts a coordinated, comprehensive intake process on the day of admission which meets the immediate needs of the resident and ensures a safe integration into a new living environment.

Clinical Department Staff:

  • Read the resident his/her rights.
  • Provide and complete the designated admissions paperworkand review the resident handbook with the resident.
  • Conduct intake interview and assessment which includes:
  • Risk of suicide / self-harm
  • Compliance with directives
  • Completion of necessary paperwork
  • Explanation of behavior expectations
  • Explanation of the roles of RRC, SG and Clinical staff
  • Point out (and explain if necessary) the basic rules of residential living as addressed in the resident handbook
  • Answer the resident’s questions
  • Alert medical / psychiatry of issues that appear urgent
  • Over the initial 45 days of a resident’s stay, SCC completes an intake/admission process intended to meet the longer-term needs of the resident and start the treatment process.

Initial Treatment Plan

  • An initial treatment plan will be issued within 45 days of the resident’s arrival at SCC; the treatment plan will comply with the standards set in 388-880-040WAC.

STANDARD 1 - B:The treatment program consists of appropriatecomponents.

To Include:

  • The SCC clinical treatment program structure draws on several contemporary treatment models including: risk/needs/responsivity, stages of change, self-regulation, with additional philosophical influences from strengths-based approaches.
  • Treatment is delivered using a cognitive behavioral approach and is delivered in a manner that considers the residents’ level of motivation, learning style, cognitive ability, personality characteristics and other factors that may hinder or enhance treatment response. Treatment components reflect concepts and standards generally accepted by the Association for the Treatment of Sexual Abusers (ATSA) and are consistent with evidence based practices.
  • Structured group treatment activities and components are contained in written clinical materials.
  • The clinical program supports an engagement model for those residents unwilling to participate in the primary core sex offender treatment process and includes groups (i.e., specialty groups, and educational workshops) offered that do not require sex offense-specific disclosures.
  • Non-participating residents (designated as Phase 1) desiring to engage in treatment may sign a treatment consent form at any time and begin receiving specialized case management as directed by the Clinical Director.
  • Phase 1 Residents who desire to enter treatment may also make a written request to be placed on the waiting list for the orientation to treatment group (Awareness and Preparation).
  • When a Phase 1 Regular Track Resident with a history participating in treatment requests to re-enter treatment the Resident’s Treatment Team will provide a written recommendation to the Clinical Director with regards to Treatment Phase, and starting group (Awareness and Preparation, Core Sex Offense Treatment Group and/or Specialty Group). The Clinical Director or designee will schedule the Resident for Review by the Senior Clinical Team who will review the Treatment Team’s recommendation and make a final determination regarding Treatment Phase, Treatment Group and starting treatment assignments from the Blue Book.
  • There are four in-patient phases in the treatment program that represent a progression and are clearly designated in a written document which identifies the activities and accomplishment requirements progressing from Phase 1 to community transition (Completion of Phase 4).
  • Residents are provided a written explanation of the program phases, how to enter treatment, and the criteria for moving from one phase to the next.
  • The philosophy of progression toward the least restrictive environment necessary for management and community transition is a goal of the overall treatment program. Planning and readiness assessment for community transition is appropriate to the resident’s phase of treatment.

STANDARD 1 - C:Treatment Planning.

To Include:

  • Participants in sex offender specific treatment have planned individualized treatment.
  • Treatment planning is standardized using a standard format which meets the standards for individual treatment as found in 388-880-040 of the Washington Administrative Code (WAC).
  • An individualized treatment plan exists for each resident.
  • which is currentto the residents needs and treatment protocol.
  • is reviewed a minimum of twice annually and modified as necessary.
  • addresses relevant domains associated with comprehensive treatment.
  • includes individual treatment goals determined by the multi-disciplinary team with resident input (or documented refusal).
  • includes recommended interventions for the level of function of the individual resident.
  • Special Treatment Plans are developed upon significant change in condition or behavior that warrants immediate clinical intervention; that is not otherwise addressed by policy or the Residents current Treatment Plan. Special Treatment Plans are considered clinical documents.
  • Current Conditions are developed upon significant change in condition or behavior that requires immediate intervention.
  • Current Conditions may also be developed to ensure that residents with a history of sexual contact/assault or physical assault are kept separated for an indefinite period of time. Current conditions are SCC documents that may be generated by clinical, security or residential staff.
  • Residents must be made aware of Current Conditions immediately upon their implementation.

STANDARD 1 - D:Treatment Assessments

To Include:

  • As determined appropriate by the SCC Clinical Director individual residents may be administered a battery of tests to assist in treatment planning, progress assessment and diagnostic clarification.
  • The program utilizes a range of assessment tools consistent with current practices in the field of sex offender treatment and general psychological assessment.
  • The tests administered to an individual resident will be based on the referral questions and approved by the SCC Assistant Clinical Director.
  • Physiological testing such as polygraph and plethysmography are systematically integrated into the ongoing assessment and phase advancement process.

STANDARD 1 – E:Treatment implementation.

To Include:

  • Treatment is scheduled, contact is appropriate, content is consistent, and therapist style is appropriate to needs of residents.
  • Treatment sessions are held in accordance with the published treatment schedule and cancelled sessions are documented as to when and why.
  • Treatment contact is sufficient to meet treatment goals.
  • Treatment provider staffing levels are adequate and qualifications are appropriate.
  • Treatment notes are entered into the clinical chart in a timely manner and reflect clinically appropriate information.
  • Treatment facilitators conduct sessions in a professional manner.
  • Content of sessions is consistent with the clinical treatment programwritten goals and expectations.
  • All group treatment sessions are co-facilitated unless otherwise authorized by the Clinical Director or Assistant Clinical Director.

STANDARD 1 - F: Treatment Evaluation

To Include:

  • Systematic measures of progress are used and feedback is regularly provided to participants.
  • Program goals for each treatment phase are communicated to all participants.
  • Specific goals and achievement levels are set for each phase within the treatment program.
  • Assessments of treatment progress to goals are evaluated at each review period.
  • Advancement goals and criteria for each phase of treatment are applied uniformly.
  • Based on each resident’s needs and limitations, the treatment team and the senior clinical team formulate individualized, phase-appropriate treatment goals.
  • Progress toward treatment goals is documented and reported to the resident on a semi-annual basis.
  • The senior clinical team will meet with and review each resident participating in primary core sex offender treatment as necessary and directed by the Clinical Director.

STANDARD 1 – G:Clinical employees are provided with consistent direction and supervision.

To Include:

Clinical supervision of treatment staffto ensure they are trained in the components of the clinical program and to the practice standards set forth by the Clinical Director.

All clinical staff individually receives a minimum of once a month documented clinical supervision with their clinical supervisor and weekly group supervision with the Clinical Director and/or Assistant Clinical Director.

SECTION- 2 HEALTH CARE SERVICES

STANDARD 2 – A:SCC appropriately prepares for the arrival and admission of new residents.

To include:

  • Appropriate preparation occurs for a new admission and activities on the day of admission are appropriate.

A.Psychiatry

  • Reviews psychological / psychiatric commitment evaluation to alert SCC to known psychiatric issues and determine the probable level of service need.
  • In conjunction with residential management, determines most suitable initial housing placement in advance of arrival.
  • Assess with security management movement restriction likely to be required during the first 72 – hours following arrival.

B.Medical

  • Reviews the correctional health records to alert SCC to known health issues.
  • Internal processes necessary to address serious health issues such as insulin dependent diabetes, essential medications, special dietary restrictions and dangerous food allergies are prepared for the new admission’s arrival.
  • Upon arrival perform an in-person medical intake assessment of immediate and basic health needs and completion of intake forms including the DSHS privacy fact sheet.
  • Obtain past medical history.
  • At the assessment an appointment is made with the Medical Provider for an intake physical.
  • Order essential medication and medical dietif indicated by medical condition.

STANDARD 2 - B:Completing the admissions process.

To Include:

  • Over the initial 45 days of a resident’s stay, SCC completes an intake/admission process intended to meet the longer-termmedical and psychiatric needs of the resident and start the treatment process.
  1. Vulnerable Adult Status Review
  • Within 3 working days of a resident’s arrival as a new admission, the resident is screened by qualified individuals to determine if he/she meets the criteria for vulnerable adult status protection under conditions set down in the Washington State Court of Appeals Decision (Ricky Calhoun v. SCC).
  1. Psychiatric Assessment
  • A psychiatric assessment is conducted within 3 working days (normally performed on day of arrival) for any resident identified as arriving to SCC from jail or prison with psychiatric medications, or who was identified during the pre-arrival psychiatric screening as requiring psychiatric attention upon arrival.
  • For all other new admissions, a psychiatric assessment is conducted within 10 working days of the resident’s arrival.
  1. Medical Intake Assessment
  • A New Resident Medical Assessment and Physical will occur within 10 working days of the resident’s arrival as a new admission.

STANDARD 2 - C:Health care services are appropriate to meet the routine and emergency medical needs.

To Include:
Health care services meet preventative, routine and emergency care consistent with Washington Apple Health, a managed care plan.
  • Health services are provided or available 24 hours each day.
  • Certified and licensed health care professionals meet resident health care needs within their scope of practice which includes assessment and direct care in:
  • Preventative care, routine care & emergent care.
  • Participate in the development and review and update of medical treatment plans and care plans to accommodate follow-up and continuing care.
  • Provide consultation to program area staff regarding medical issues.
  • Monitoring and implementation of the management of the self medication program including policies procedures and educational programs for residents.
  • Dental care including preventative, routine, and emergent dental care is provided to residents by appropriately credentialed dentist, dental assistant and/or dental hygienist.
  • Arrangements and processes for resident hospitalization and treatment with community providers exist to support a continuity of care.
  • The institution has adequate policies and procedures to manage a resident with a serious health condition.

STANDARD 2 - D:Communicable disease, infection control, infectious disease monitoring and education for staff and residents.

To Include:

  • Communicable disease, infection control and infectious disease monitoring of staff and residents is adequate.
  • Policies, procedures and practices adequately address an infection control program that includes:
  • Infectious disease/blood borne pathogen control plans.
  • Prevention and control measures and investigation procedures.
  • Provision of a sanitary environment.
  • Staff training to meet OSHA and DSHS standards.
  • Resident training in cleaning and sanitization of surfaces and in handling soiled or possibly contaminated waste associated with resident jobs.
  • Policies, procedures and practices provide for availability of medical examination of any resident suspected of a communicable disease.
  • Policies, procedures and practices address the management of serious infectious diseases.
  • Staff and residents receive immunizations and education appropriate to an institutional environment.
  • Immunizations offered to staff and residents include, but are not limited to:
  • Flu.
  • Hepatitis A and/or B.
  • Other agents in accordance with Center for Disease Control recommendations.
  • Residents receive Pneumovax as well.
  • Staff and Resident education includes:
  • Blood and Body Fluids Precautions.
  • Blood-borne pathogens.
  • Resident education includes:
  • Medication education specific to each resident includes dosage, side effects, and drug interactions.
  • Infectious disease surveillance among staff and monitoring of residents includes:
  • TB screening.
  • Hepatitis screening.
  • Other agents in accordance with Washington State Department of Health (DOH) regulations.
  • SCC mandatory reporting.
  • Health care providers receive supervision and oversight in the provision of services.
  • Contracted ARNP services are reviewed by the Medical Director

STANDARD 2 - E:Health care facilities are properly equipped and maintained, in a manner to support the provision of health care services.

To Include:

  • SCC health care facilities are adequately equipped.
  • Available equipment is sufficient to provide:
  • Medical care including emergency care.
  • Dental care.
  • Optometric care.
  • Physical therapy.
  • Limited laboratory procedures including specimen processing.
  • Health Equipment is maintained and the premises are clean and orderly with safe disposal of medical waste material.

STANDARD 2 - F:Pharmaceutical services are adequate to meet the demands of the institution.

To Include:

  • Health clinic properly manages pharmaceuticals and pharmaceutical services are sufficient to meet residents’ routine health care needs.
  • All medications are provided as prescribed or issued.
  • Clinic procedures and practices provide for the proper management of pharmaceuticals and address the following:
  • Medications are prescribed only when clinically indicated.
  • The prescribing provider reevaluates a prescription prior to its renewal.
  • Medicines are prescribed and handled according to state requirements.
  • The administration of medication is properly documented and physically monitored at the time of delivery.
  • Medication Orders are maintained and reconciled on a regular basis.
  • Medication errors are documented on an incident report.
  • Prescriptive and order-writing privileges are consistent with state requirements.
  • Medications, controlled substances, syringes and needles are properly identified and securely stored away from access by unauthorized persons.
  • Regular counts of controlled pharmaceuticals are conducted.
  • Medications are administered by persons properly trained and qualified according to state requirements.
  • Pharmacy services (via vendor agreement) include medication ordering, accounting, and delivery.
  • Self-medication programming exists to enhance resident “ownership” of personal health care in the areas of self-administration, responsibility for follow-up, and responsibility for “refills”.
  • For residents approved to participate in the “May Carry” program the following exists:
  • Medical treatment compliance education and support includes monitoring and feedback to the resident and treatment team.
  • Resident medical treatment compliance is routinely monitored.
  • Regular feedback is provided to the resident and treatment team.
  • Routine medical treatments are available to residents through medical and nursing staff.
  • The presence of expired, excess and unauthorized medications in resident possession is routinely screened by security staff.
  • Misuse of medications associated with the “May Carry” program is documented in an incident report.

STANDARD 2 - G:Resident health care records.

To include:

Resident Health Records are prepared and maintained in a manner that supports the residents’ treatment and respects confidentiality.

  • Records are maintained in an organized manner and stored to prevent loss and maintain confidentiality.
  • Relevant to the individual resident’s health status, the record contains the following information:
  • Completed admissions screening forms.
  • All findings, diagnoses, treatments, dispositions.
  • Prescribed medications and their administration.
  • Laboratory, x-ray, and diagnostic studies.
  • Signature and title of documenter.
  • Consent and refusal forms.
  • Release of information forms.
  • Place, date, and time of health encounters.
  • Health service reports, e.g., dental, mental health, and consultations.
  • Treatment plan, including nursing care plan.
  • Progress reports.
  • Discharge summary of hospitalization and other termination summaries.
  • Advance Health Care Directive, if resident elected to have one.
  • Name of a designated individual(s), such as parents/guardians or others, to be notified in case of serious illness, surgery, injury, or death, if resident elected to provide this information.
  • SCC uses a standardized format for maintaining active health care records.
  • Records are maintained using:
  • a consistent format and structure.
  • The active health record is maintained separate from the clinical record.
  • Medication profile information is updated annually or more often as needed.
  • The health care records on persons who are no longer residents of the program are retained and archived according to department policy and state regulations.

STANDARD 2 - H:Informed Consent for Care.

To include: