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Bagarozy v Harris Final Report and Recommendations Nj Civil Commitment Facilities 2009

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Attorney/Client Communication

Ian S. Marx
Direct Dial: (973) 360-7951
Direct Fax: (973) 295-1307

January 6.2009


Mr. Jeremiah Simons
Mr. BUchard Bagarozy
Mr. Walter Harrell
Mr. Gilbert Davis
P.O. Box 905
Avenel. NJ 0700 I

Mr. Rodney Roberts
Mr. Joseph Arruano
P.O. Box 699
Kearny. NJ 07032




Bagarozy v. Harris
Civil Action No. 04-CV-3066 (JAP)








Enclosed is a copy of the final report that we have received from Dr. Becker. a copy of
which has also been provided to Judge Falk. You will see that with respect to each of the 12
numbered issues as to which she reached a conclusion (there is no number 8). she has found
•that the program is not minimally adequate/or satisfactory (and thus non-compliant with
clinical standards). Dr. Becker also identifies 24 overall recommendations for the program.
Under the protocol. the Court will now supervise settlement discussions based upon the
report. in which we must participate. We should set up time to speak after you review the
report to discuss your thoughts. Once again. please do not distribute this outside of the

NEW Jl~Sl'




Very truly yours.





Greenberg Traung. LLP I Attorneys dt Ld'.\ I 200 Park A\enue I PO Box 677
Tel 971360.7900 I Fax 973.3018410

IF!orham Park. NJ 07932-0677
W·... w.gtlawccm

Judith V. Becker, PhD
430 N. Tucson Blvd
Tucson, AZ 85716
(52.0) 2.40 -3 8 75

December 29,2008
Dear Mr. DaCosta, Mr. Ahzmey, Mr. Furlong, Mr. Marx 1:
Re: Alves/McGarrrylBagarozy, et al. v. Ferguson, et a1. (consolidated)
U.S. District Court, District of New Jersey, Docket No. 01-0789
The following report is based on information I gleaned from the following activities: tours
of the Kearny and Annex facilities; review of the treatment program and related
documentation, including 23 resident charts, prior consultation reports, other documents
that I had requested and were provided, and interviews anellor communication with the
following: clinical staff members, including the Clinical Director, the Director of
Psychology, the Director of Psychiatry, the Director of Rehabilitation, the Director of
Social Work, and relevant DOC administrators. I also interviewed a representative sample
of 40 residents including those nominated by the Plaintiffs' attorney, as well as telephonic
interviews with 10 residents on conditional release, one of whom did not want any of the
information he provided to be summarized for the report. It should be noted that I was
allowed access to everything I had requested and all mental health and correctional staff
were extremely cooperative and welcoming. I also received and continued to receive
numerous materials sent by mail or handed to me by residents. As per an agreement
between counsel and the State, I have not read any of those materials and will not until the
Court rules as to whether I should include that information in my report.
It should also be noted that because there does not currently exist a universal set of
professional standards for institutions that provide for the care and treatment of civilly
committed sexual offenders, this evaluator was unable to rely on such during the
evaluation. There are, however, universal standards for the care of criminal offenders, such
as the American Correctional Association's Standards for Adult Detention Facilities,
though this evaluator found that such standards were not applicable to many of the
questions asked. In addition, this evaluator inquired as to what the licensing standards were
for this facility, since different states have different licensing procedures, and was informed
by Mr. DaCosta of the following: "While there is no 'licensing' of the facility or program
per se, the DOC does check to see that medical and MH professionals have their
professional licenses before they are approved to be in the facility. Moreover, there are
general codes for fire, basic construction, etc., which would be found in New Jersey
Administrative Code section lOA, but different parts fall under different departments.

I hope I have not omitted anyone else who shOUld have received this.

Finally, with respect to the policies and procedures under which the STU is operated, the
DOC and DHS jointly adopted regulations on October 20, 2008 that may be found at NJAC
10:36A-1.1, et seq, which I have attached for your review." In preparing this final report,
this evaluator relied in part upon standards established in the following resources: Civil
Commitment of Sexually Violent Offenders, Association for the Treatment of Sexual
Abusers, http://www.atsa.comlppcivilcimmit.html;Dr.AnitaSchlank.Guidelines for the
Development of New Programs, The Sexual Predator: Law, Policy, Evaluation, and
Treatment (Kingston, NJ: Civil Research Institute), 1999; Dr. Janice K. Marques,
Professional Standards for Civil Commitmeltt Programs, The Sexual Predator: Law,
Policy, Evaluation and Treatment (Kingston, NJ: Civil Research Institute), 1999; Dr.
Rebecca Jackson, et al. 's Annual Survey of Sex Offender Civil Commitment Programs
(SOCCPN; http://www . soccpn. org/research. html), 2008, in which the State of New
Jersey was included; Practice Standards and Guidelines for Members of the Association for
the Treatment of Sexual Abusers (ATSA), 2001; as well as numerous books and
professional articles pertaining to the assessment and treatment of sexual offenders,
including Roxanne Lieb's After Hendricks: Defining Constitutional Treatment for
Washington State's Civil Commitment Program, Annals of the New York State Academy
of Science (pp. 474-488), 2003, which this evaluator believes to be particularly relevant to
the present litigation. In addition, I have relied on more than 30 years of professional
experience as a clinician and clinical researcher, evaluating and treating sexual offenders,
as well as having served as the clinical consultant to a civil commitment center for sexual
offenders, and having been involved in the evaluation of two other SVP programs.
I had initially submitted a draft report, dated September 8, 2008, to which both the State
and Plaintiffs attorneys had the opportunity to respond. I have taken those responses into
consideration in authoring the final report and I have opted to address issues raised by the
State and the Plaintiffs as follows and made alterations to what was the draft report when
such suggestions were in line with my clinical opinion.
Response to the State's Comments
Regarding queries as to the professional standards I relied upon in determining the State's
compliance in each of the areas of evaluation, please see the above list of resources.
Regarding my suggestion in terms of using dynamic risk assessment instruments, while not
all of the information can be obtained in a secure environment, clearly some of the
information can be, such as general self-regulation, sexual regulation, substance abuse and
negative mood state. Therefore, it is appropriate to use applicable parts of dynamic risk
assessment instruments. Moreover, it should be noted that 54.6% of civil commitment
programs which responded to the SOCCPN annual survey used a dynamic risk assessment
instrument, specifically the STABLE 2007.
Also, I do want to acknowledge that PCL-R documentation was provided in the more
recent material I received in November. Regarding assessment, the Division might also
find useful an article that my colleague and I recently published in The Journal of
Psychiatric Practice entitled, "Assessing Sexual Deviance: A Comparison of
Physiological, Historical, and Self-Report Measures" (Stinson & Becker, 2008). The
sample that was used in that study consisted of civilly committed sexually violent persons.


You inquired as to whether or not this evaluator would agree that if the Division were to
implement all of the recommendations set forth in the "Clinical Assessments, Evaluations,
and Treatment Team Reports" section, then it would be minimally adequate/satisfactory in
this respect. The answer is yes.
In response to your inquiry, this evaluator does believe that the rate at which a resident

progresses through the program phases is idiosyncratic, and it is in fact, an interaction
between amenability to treatment and a resident's risk level, needs, and responsivity. In
regard to your question as to how long it takes for a person to move through the phases of
treatment, in reviewing the Annual Survey of Sex Offender Civil Commitment Programs,
data regarding that information was absent. However, I have contacted several SVP
programs and have made that inquiry. To date, one program has responded. That particular
program uses seven phases, and indicated that people take from three to seven years to
complete the program. I am awaiting responses from other programs and will forward that
information as part of an addendum.
In regard to orientation and rapport-building, I agree that it is important that when residents

are entering a new institution or beginning a new program, they need to be oriented to the
policies and procedures of the new facility. I also agree that it is necessary to build rapport
as part of the therapeutic alliance. I am unaware of any literature that would indicate that it
takes a year to orient people to an institutional setting. I acknowledge that counsel may
advise residents not to discuss their criminal history prior to having their commitment
hearing. Rapport, however, can be established during that waiting period. For example, if
vocational skills and substance abuse issues are assessed, staff can begin to establish a
relationship around those issues. As Dr. Marques notes in her article, "goals should address
not just sexual deviance, but the resident's functioning in other life domains as well. These
include health issues, substance abuse, family relationships, educational, vocational and
recreational needs, and resident strengths. Although such areas may be considered ancillary
to the treatment of sexual deviance, you must consider factors that are predictive of the
individual's success on release" (p. 2-9 - 2-10). It is possible to focus treatment on these
areas without requiring criminal history infonnation.
Regarding individual therapy, I would like to note that every resident is unique and his
treatment needs are unique. Some residents function well in group, others, because of
anxiety or other issues, find this more difficult. Consequently, I believe that a decision
about whether or not an individual is in need of individual therapy should be based on his
unique combination of personal characteristics and mental health needs. With respect to
special programming for residents with special needs, this evaluator would like to note that
of those programs that responded to the SOCCPN 2008 survey, 80% had a Special Needs
treatment track and 60% had a Psychopathy treatment track. My professional opinion is
that residents who have learning disabilities, cognitive impainnents, English-language
deficiencies or serious mental health issues should be provided with equivalent services
and mainstreamed whenever possible.

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With respect to process groups and modules, in reviewing the SOCCPN survey, the report
indicates that in the 14 SVP centers which responded, hours in sex offender specific
treatment ranged from 3 to 20 hours per week. It is clear from the data that this evaluator
collected that the Division's current program is at the low end of that range. With respect to
how clinical services should be broken down, I recommend the following: a daily one hour
process group; one and a half hour long therapeutic modules every other day; one hour
daily groups for such things as life skills and therapeutic recreational activities; and
individual therapy, as needed. At the current time, how clinical services are broken down at
other sex offender civil commitment facilities are not known to me. If this information
becomes available, I will revise my recommendations accordingly.
While I understand and am sensitive to the severe budget constraints under which the State
is currently operating, and the fact that the provision of the level of services I am
recommending would require the hiring of additional staff, I would like to quote what
Judge William L. Dwyer said in Turay v. Weston, 1999: "Nothing compels a state to adopt
a statute of this nature in the first place, and many states have not done so, but a state that
chooses to have such a program must make adequate mental health treatment available to
those committed." I am of the opinion that the New Jersey legislature needs to appropriate
adequate funding to the Division for this purpose.
With respect to employment for residents, the SOCCPN survey did not report on number of
hours that residents in other civil commitment centers are employed. One program that
responded to my inquiry noted that residents in this state's facility work on average, three
to five hours per week, which is commensurate with the Division's current practice.
The Division respectfully submitted that the overall recommendations I made in the draft
report exceeded the scope of my retention. I agree that some of the recommendations I
made, particularly those to the New Jersey legislature, exceeded the scope. I have deleted
those recommendations.
Responses to other suggestions regarding the draft report have been incorporated into the
appropriate sections.

Response to the Plaintiffs' Comments
Although I am sympathetic to concerns raised in the Plaintiffs' comments and appreciate
the need for specific recommendations as outlined in the Plaintiffs' comments, doing such
would be beyond the scope of the Contract that this evaluator agreed to. I have responded
to some of the comments and perhaps have overstepped my bounds in terms of what the
Contract dictated.
I. Overall Therapeutic and Rehabilitative Milieu
As the Department of Human Services, Division of Mental Health Services (the Division)
notes, the contract states .....a Joint Expert to conduct an evaluation of the sex offender
treatment program at the Special Treatment Unit in Kearny, New Jersey and the Annex in


Avenel, New Jersey." The Division notes that they have no control over the facility issues
that I had addressed in the draft report. Consequently, it would appear that it is beyond the
scope of the contract and inappropriate for me to provide infonnation or recommendations
regarding room size, food quality, number of showers and urinals, etc. I do, however,
strongly suggest that envirorunent and conditions of confinement matter, both for residents
and for staff who work in facilities that appear to be less than therapeutically adequate.
Also, as the State notes in the 10/20108 letter, the Contract indicated I am to opine as to
whether the present program is minimally adequate or not, and not to reconstruct the
State's treatment program from the ground up or make findings that must be implemented.
Consequently, I must confine myself to the scope of the issues to be addressed in the
Contract and I cannot provide the degree of specificity as to recommendations the Plaintiffs
want me to make although I acknowledge the importance of them. Below are some specific
responses, and the remainder comments are addressed in the body of the report and in the
Overall Conclusions section, when this evaluator felt they were applicable.
a. Treatment Space and Confidentiality
I have added a recommendation to the overall opinion and recommendation section of
the final report that follows.
b. Living Conditions and Resident Health and Safety
As noted above, issues related specifically to the facilities, which are run by the
Department of Corrections, were not to be included in my evaluation, as noted by the
State. Consequently, although I feel such factors as room size, resident safety, and
resident hygiene, can all contribute to a therapeutic environment, my contract with the
State does not provide for me to comment specifically on these factors.
c. Resident-Staff Interactions
i. Strip Searches: While some residents may pose a risk to other residents and to
staff, I am of the opinion that a screening procedure other than strip searches be
employed. I am aware that at many United States airports devices are being used, such
as body scans, to ensure that passengers are not carrying any illegal weapons or drugs
that would place other people at risk. I would recommend that such procedures be
utilized, but not a "one-size-fits-all" approach, specifically, only those residents who
have a history of having difficulty within institutional settings, of following the policies
or procedures of the institution should be subjected to such screening. While I do not
have data available on the use of strip searches, I am aware of at least one civil
commitment program where strip searches are not conducted on residents on a routine
ii. The grievance process was mentioned as an issue by some residents I
interviewed. Those few residents who brought it up complained about the length of
time the process took. Moreover, the grievance process appears to be less than
adequate, in that residents reported that over 90% of their grievances are not


2. Clinical Assessments, Evaluations, and Treatment Team Reports
a. I would like to note that the ATSA Practice Standards and Guidelines for Members
of the Association provided a list of assessment instruments which have been used in
assessing sexual offenders. Also, a 2006 article entitled Assessing Treatment Progress
in Civilly Committed Sex Offenders, coauthored by Drs. Ferguson, Main, and
Schneider, outlined measures of treatment progress and linking treatment progress to
treatment completion. The authors also identified a number of assessments and
measures of treatment progress. Some of those measures could be used in the program.
Assessments should be conducted by licensed staff members who have had supervised
training in utilizing such instruments. It is recommended that once residents have been
oriented and consented to the treatment program, assessment should begin. The sooner
a comprehensive assessment is completed, the sooner therapy can begin. As noted in
my report, there should be pre and post testing for each module so that one can attempt
to assess a resident's progress over the course of his treatment. Evaluation of progress
should be based not only on a resident's self-report, but also on psychometric
evaluations and observations made by staff and therapists. The final report as well as
the draft report outlined the type of comprehensive assessment that should be
I wholeheartedly agree with your concern about the need for detailed recommendations
to residents about the content of their assessments, phase placements, and the
requirements to move to the next phase of treatment. It was not my charge to design or
redesign the treatment program, however, each resident should have a clear
understanding of the reasons for his phase placement and specifically what goals he
must attain to move to the next phase. It is recommended that residents be updated
regularly (i.e., monthly) on their current phase status and goals for promotion to the
next phase. It should be the responsibility of the resident's primary therapist to provide
an update in writing to the resident each month.
b. There are methods by which to assess if progress is being made within a specific
phase of treatment. One could utilize a Treatment Progress Scale, the Goal Attainment
Scale, unit staff and therapist observations, and paper and pencil testing. What was
striking in my interviews with residents was that they were at a loss to describe what
actions they needed to take to advance in phase and ultimately be conditionally
released. In my interviews with residents on conditional release, they were also at a
loss to describe what needed to occur in order for the conditions of release to be
decreased or for them ultimately to be unconditionally discharged from the program.
Regarding the suggestion that more detailed recommendations be made regarding the
appropriate content of treatment plans and content requirements being reflected in
relevant treatment protocols, I must observe that I agree completely. I have added the
recommended list of issues to my final report.


Below is my final assessment of each of the areas of evaluation indicated in the Contract.

FINAL REPORT: Areas of Evaluation
1. Overall Therapeutic and Rehabilitative Milieu

In terms of evaluating a therapeutic and rehabilitative milieu it is important to look
at the environment and conditions that the residents inhabit, in addition to the treatment and
clinical office spaces.
Living Conditions
Annex Facility. The living areas at the Annex facility consisted of donns, which
appeared extremely overcrowded. The men had a lot of personal property in the incredibly
small space in which each resident was housed. Many of the men also had coolers in which
they stored food brought to them by their visitors because they reported that the food
served at the facility wasn't very good. In one dorm housing 68 men, there were only 6
shower stalls, 2 urinals, and 4 toilets. Residents reported that they frequently had to wait in
line to use a toilet or to shower. This waiting put men at risk of being late to either their
work assignments or therapy groups. Moreover, this is particularly problematic for
individuals whose work assignments are in the kitchen because they must observe hygienic
regulations prior to reporting to their food service work. Although there is a regulation
against smoking within the facility, it was reported by residents that some individuals do
smoke in the bathroom; as such, secondhand smoke then reaches the men in the dorms.
This is problematic for those men who have respiratory problems. As I was walking
through one of the dorms, a resident pointed out that the conditions under which they were
living could represent a fire hazard given the large number of people in the small space and
the amount of property that the residents had.

A further concern involves physical safety of the men. A correctional officer is
stationed in each dorm 24 hours per day; however, given the crowding and the physical
layout of the dorm, I question an officer's ability to have full visual access to all residents,
particularly those men who occupy the lower bunks.
Kearny Facility. This facility had previously operated as the Hudson County Jail; it
is a very old facility. Men are in single cells/rooms, within which there is a bed, a toilet and
a sink. As in the Annex, the men appeared to have significant amounts of personal property
in their cells. The facility did not appear clean, and there were no pictures on the walls or
other decorations that would bespeak the rehabilitative nature of the facility, unlike what I
saw in the Annex. During my tour of the facility, a resident expressed concern about
resident safety in the event of an emergency or fire. His concern was that the cell locking
system has reportedly malfunctioned, and consequently each cell has had to be manually
Overall Assessment. In my professional career, I have had the opportunity to visit a
number of secure mental health and correctional facilities around the United States. The


living conditions that I witnessed at both the Annex and Kearney facilities are among the
worst that I have ever seen. Such conditions of confinement have served to lead many of
the residents to believe that they are simply being warehoused and punished within
deplorable conditions. This belief can lead to a sense of hopelessness and is ultimately
counter-therapeutic. If ultimately a goal for the residents is to be discharged back to the
community, then one would hope that the environment within an institutional setting would
be such that they could acquire the living skills necessary to succeed in the community
outside of the facility. Moreover, the design of living spaces at the Annex and the
assignment of men to those spaces are not clinically driven. For example, developmentally
disabled residents might be better served by having their own wing, so that they are not
preyed upon by more sophisticated or psychopathic residents. Ideally individuals should be
housed based on what phase of the program they are in. The currently overcrowded
conditions put men at risk for infection, lead to safety issues, and are detrimental to mentalhealth well being. Moreover, the environment is experienced as punitive by the residents,
which only serves to increase malaise and hopelessness, which are ultimately countertherapeutic. As noted by Dr. Marques, in Professional Standards for Civil Commitment
Programs, "the program [should be] housed in a treatment oriented (not punitive)
environment, adequate space is provided for living, treatment, other activities, and for
separation among resident groups" (p. 2-11 - 2-12). This is clearly not the case at the STU.
Treatment Environment
Annex. There appeared to be an adequate number of therapy rooms and within them
were pictures and decorations which bespoke the therapeutic and rehabilitative atmosphere.
Treatment rooms were large, adequately furnished, and generally appropriate for
conducting group treatment.
Kearny. The majority of groups occur in a trailer, some in small rooms, and some in
a large room separated by a divider. A correctional officer sits in a booth in the middle of
the trailer where he/she can observe the groups. It was apparent that this booth is not
soundproof; as during my visit an officer was able to interrupt an ongoing group by
shouting from the booth to a resident that he had a visitor. The resident got up and left the
group. In addition. it was also possible to hear what was going on in another group
occurring at the same time in an adjacent room. This set-up is questionable with regard to
maintaining confidentiality of treatment group proceedings.
Overall. The treatment space at Kearny did not appear to be adequate for
conducting group therapy. Group therapy rooms should be designed so that there are no
extraneous noises and so that residents feel that they can participate without fear of being
overheard. Moreover, there are no rooms available for individual therapy.

Clinical Staff

It is my opinion that the office space and general work conditions for staff are
wholly inadequate. Clinical staff share offices, and these spaces are crowded, poorly lit,
and not well furnished. Clinical records are not available online and computer equipment is
dated, making it more difficult for staff to do their jobs. These inadequate work conditions
may also affect staff morale.

At the Annex facility, staff are officed in trailers with no restroom. In order to use
the restroom, staff must exit the trailer and walk to the main building to use restroom
facilities that were inadequate with respect to general cleanliness and upkeep.
Overall Opinion and Recommendations
Based on my tour of the facilities, interviews with residents and communications from
staff, my opinion is that the overall therapeutic and rehabilitative milieu is II0t
minimally adequate/unsatisfactory. Overall, the conditions are in no way facilitative of
positive resident or staff morale. Due to this environment, staff and residents are
demoralized, and residents have a sense of utter hopelessness.
Residents and staff should be inhabiting a facility that is truly therapeutic and safe.
Such a facility needs to provide adequate space for residents. Each resident should have his
own room and adequate personal hygiene amenities. Such a facility should look like a
therapeutic environment. Wall surfaces should include artwork and preferably art produced
by residents. Such a facility should have adequately sized and comfortably furnished
dayrooms. There should be sources of recreational materials for the men, and both indoor
and outdoor recreation spaces. Such a facility should have different wings or tiers, and the
placement of residents should be clinically driven based on treatment needs, cognitive
abilities, and phase in the program. Such a facility should have adequate programming
spaces for individual treatment sessions, group treatment sessions, educational classrooms,
staff training, and therapeutic community meetings. Such a facility should also provide
adequate office space for staff including rooms for training and staff meetings, with clean
restrooms located nearby. Also, staff should have access to state-of-the-art computer
technology so that residents' charts can be easily accessed and updated for best therapeutic
2. Clinical Assessments, Evaluations, and Treatment Team Reports
In reviewing residents' charts, I found the following: charts for the most part
contain confidential forensic psychiatric and psychological evaluations, informed consent,
a checklist for orientation of new residents, an admission note, next of kin emergency
contacts, an individualized treatment plan, annual review checklists, psychosocial
assessments, treatment plan status reviews, a resident input form, multidisciplinary reports
for the TPRC, TPRC reports, process group notes, rehabilitation notes, educational
assessments, vocational and recreational notes, and substance abuse assessments.
Documents in the charts also contained MAP notes, if a resident was on MAP status, notes
if a resident was a treatment refuser, and educational module or process notes.

For the most part, the confidential forensic evaluations were detailed. Two actuarial
risk assessment instruments were being utilized to assess risk. Psychopathy Checklist
Revised (PCL-R) scores were included when residents entered Phase 3 of treatment. There
was, however, no specific dynamic risk assessment instrument being utilized. Both the
psychosocial assessment and the substance abuse assessment appeared to be
comprehensive. There were also forms when an educational assessment had been
completed, and there were also rehabilitation and vocational notes. On rare occasion,
charts were incomplete and had items missing. One item that was frequently missing from
the charts was the resident's autobiography. This evaluator asked a clinical staff member
about this omission, and was informed that staff are sometimes told to keep these items in
charts and at other times are told to keep them in a separate file. This contradictory
instruction appears to result from disparity among supervisors.
The pre-treatment assessment is, in this evaluator's OpinIOn, not very
comprehensive. Other than the assessments mentioned above, residents are assessed with a
personality inventory (MMPI-2) and the Bumby Cognition Scale, the Wide Range
Achievement Test and an intelligence test. None of the test protocols were in the charts
reviewed. After the submission of the draft report, I did receive two boxes of resident
clinical files. Apparently, a third box was sent but not received by this evaluator. While
there were some additional assessment materials included, the assessment still did not
appear to be comprehensive.
Also at some point in treatment, individuals are assessed with polygraphy.
Plethysmography, however, is not being used. I was informed, however, that after repeated
requests the STU has just been given permission and funding to obtain a plethysmograph.
A concern is the lack of pre-and post-module testing. Pre-post testing is imperative in
order to assess each resident's strengths and weaknesses prior to beginning treatment so as
to best develop an individualized treatment plan tailored to each resident's needs, as well as
to provide an objective measure of changes that occurred as a result of treatment. There is
a post-test for arousal reconditioning, but this is a paper and pencil test. While such tests
and the current practices of assessing the resident's sexual acting out, possession of
pornography, and polygraph testing of current arousal patterns are informative, none are
direct and objective measures of sexual arousal, such as the penile plethysmograph.
Without pre-and post-testing and without an objective assessment of sexual arousal,
decisions about progress apparently then are made on a subjective basis. It is critical that
other than subjective means be used to evaluate residents' treatment progress or lack
thereof. It is critically important that dynamic risk factors be the targets of any
intervention. The static risk factors are risk factors that are not changeable. Intervention
needs to focus on assessed, stable, and acute risk factors. Dr. Schneider, a staff member at
the STU, has written a chapter for a book in which she reviews the literature to date on
dynamic risk assessment instruments and describes the development of a dynamic
treatment monitoring scale. There are, as she notes in her chapter, a number of scales that
are currently in use nationally, and which this evaluator believes potentially could be used
at the STU. These include: the standardized goal attainment scale, the sex offender
treatment rating scale, and the stable and acute 2007. The scale which she and her
colleague have developed looks very promising. It consists of 17 variables which each

resident should be rated on. Dr. Schneider reports that she plans to have staff utilize this
scale in assessing treatment progress among the population of civilly committed sex
offenders. This evaluator looks forward to the development of psychometric properties on
this scale.
The yearly TPRC evaluations are based on reviews of collateral material, input
from the multidisciplinary team, and a brief interview with the resident.
multidisciplinary team subjectively evaluates the resident on performance in eleven areas.
It is on the basis of these evaluations and interviews with the resident that the TPRC makes
their determination of a resident's phase level.
The group process notes and educational module notes are minimally documented
on checklists. These notes are relied upon by the multidisciplinary team to make
assessments about a resident's progress or lack thereof. However, the form of the checklist
is too generalized to allow for an evaluation of a resident's progress. The checklists are not
sensitive enough to capture and report the small changes in a resident's attitude or selfcomprehension. It \Yould be more useful to both residents and clinical staff if progress
notes and observations were written in a narrative form.
Overall Opinion and Recommendations
This evaluator finds it difficult to give an overall rating on clinical assessment,
evaluation, and treatment team plans. The reason for this difficulty is that some of the
forms of assessment appear adequate while other methods of evaluation are not minimally
adequate. As mentioned, there has been no objective measure of sexual arousal patterns.
Yet, the recidivism literature informs us that deviant sexual arousal is highly predictive of
recidivism. Furthermore, as noted above, there are not pre and post test measures for the
modules to date, and there are no dynamic risk assessment instruments utilized, although
such an instrument has been developed by a staff member, and there are plans to utilize it
in the future. Residents, following their orientation and signing a consent to be assessed,
should receive a comprehensive assessment. Since many residents had previously received
treatment, they should be evaluated on what they gleaned from that treatment, and assigned
to modules or treatment phase based on the results of that assessment. Residents should be
informed as to why they are being placed in a specific phase and what specifically needs to
be done to complete to a phase and advance to the next one. Both residents within the
facility and those on conditional release informed this evaluator that they were unaware as
to what specifically was required to advance in phases, to advance to conditional release,
and to be unconditionally released. Residents also commented on how repetitive the
treatment was, some being assigned to the same module three times, and having to take
many modules over and over again. Each resident's primary therapist should meet with a
resident at least monthly to provide feedback on their progress.
Based on my review of records, my finding is that some parts of the clinical
assessment, evaluation, and treatment team plans are lIot 1IIi1,imally
adequate/UllSatisfactory while other parts are millimally adequate/satisfactory. Each
resident upon entering the facility should receive a comprehensive psychological


evaluation including the following elements: intellectual, psychological, neurological
(when indicated), psychiatric, psychosocial, vocational, education level, as well as medical.
An experienced clinical staff member should take a thorough sexual history that covers all
of the paraphiJias as well as the sexual dysfunctions. Given that many of the residents are
diagnosed with antisocial personality disorders, there is much that can be gleaned from the
core principles that have been helpful in intervention with antisocial populations (Andrews
& Bonta, 2003; Cullen and Gendreau, 2000). Specifically, the principles of risk, need, and
responsivity would apply to the residents. As mentioned above, it is critical that pre and
post module testing be done. Instruments such as the Multi-Phasic Sex Inventory (MSI-II)
and the Psychopathy Checklist Revised (PCL-R) should be utilized for each and every
resident. Plethysmography should be utilized with every resident who is willing to undergo
such assessment. There are instruments available to assess sex education, empathy,
cognitive distortions, dynamic risk factors, vocational skills, educational ability, and
readiness to enact change. It would appear, based on all material and information
reviewed, that frequently, decisions about advancement to a phase are based on subjective
assessment as opposed to having established clear goals for an individual and assessing
other than subjectively their progress in having obtained those goals. In making these
recommendations, I referred to ATSA's Practice Standards and Guidelines for Members of
ATSA, which outlines requirements for sex offender evaluation, including types and sources
of information, psychophysiologic testing, and an extensive list of psychological
instruments commonly used in the evaluation of sexual abusers. While the ATSA standards
do not specifically require assessment prior to treatment, good clinical practice dictates that
baseline measures be obtained prior to beginning treatment. This appears to be particularly
relevant for individuals have been in treatment elsewhere for a period of time, to assess
what they have learned and what has yet to be learned. Furthermore, as noted by Dr. Janice
Marques in her chapter, Professional Standardsfor Civil Commitment Programs,
.....adequate treatment begins with an evaluation of the client and the development
of a comprehensive treatment plan. This is an industry-wide standard, of course, but
individualized treatment planning is even more important in civil commitment
programs than in some other treatment settings be individualized, treatment
plans must assess the special needs of each resident. .. Psychiatric evaluation and
psychological/neurological testing are often needed before the team can detennine
how a resident's treatment should proceed" (p. 2-9).
3. Program Phases
The written plan and resident handbook outline five phases of treatment. Phase 1:
Entry; Phase 2: Rapport Building; Phase 3: Core/Intensive; Phase 4: AdvancedIHonor; and
Phase 5: Transition. The phases seem appropriate based on their descriptions in these
documents with respect to goals for each phase. Upon entry into the facilities, all residents
are placed in Phase 1, where they are expected to orient to the STU and demonstrate a basic
understanding of the commitment program, the treatment plan, and the journaling process.
The written plan indicates that it is anticipated that residents move through Phase 1 in one
year. In Phase 2, residents are expected to gain an understanding of core sex offender
specific treatment concepts and to fully participate in treatment. Residents are anticipated
to progress through Phase 2 in one year. For Phase 3, while criteria are stated, including

such things as: presenting a sex offense history, understanding motives underlying sexual
assault, completing an autobiography, accepting responsibility for sex offenses, and
completing a relapse prevention plan, residents must remain in this phase until their selfreports are consistent with polygraph testing. For Phase 4, the resident is expected to apply
and "live" the principles learned in Phase 3, as well as sustain all significant treatment
gains over a "significant period of time". It should be noted that "significant period of
time" is not defined. Phase 5 is a transition phase, and residents must demonstrate
consistency in meeting earlier goals and expectations. They will have been given increased
privileges and responsibilities, both on and off the grounds of the facility. In order to
progress out of Phase 5, residents must also pass a polygraph examination in addition to
meeting all the other criteria for the phase. Successful completion of all phases suggests
that the resident is a viable candidate for release to the community.
In my examination of the amount of time that all residents have been at the facilities
and their current phase in the program, I found that residents do not appear to be
progressing through the program along the timeline suggested in the written plan. On
average, residents have been in the program for 69 months (5 years, 9 months), but the
average phase in the program was 2.2 (the modal phase was 2). Of the residents I
interviewed, their average length of stay at the facilities was 57 months (4 years, 9 months)
and their average phase was 2.3 (the modal phase was 2). Given that the written plan
indicates approximate completion times for Phases 1 and 2 of one year each, it is
perplexing that many of the residents appear to be spending significantly more than 2 years
in these phases. Moreover, it is questionable why it takes a year each for orienting and
rapport building, especially since half of the men committed to STU came from the Adult
Diagnostic and Treatment Center where they were receiving sex offender specific
I have several issues with respect to progress through the treatment phases. First,
there appears to be no objective measure of treatment progress. Although each phase has
specific criteria that must be met, there is no infonnation as to how these criteria are
assessed. It appears that there is no pre-post testing conducted to assess progress other than
the polygraph, which can only provide information regarding physiological changes that
occur as a resident answers specific questions. Second, when the residents were asked what
they needed to do to move through the phases, many were stymied and unable to articulate
the criteria, others said, "I don't know, things keep changing." Third, it i~ unclear why all
residents are automatically placed into Phase I upon commitment, particularly if they have
had extensive sex offender treatment in the past. Moreover, I am concerned with the length
of time that is required to progress through the first two phases, given that the criteria listed
seem to require significantly less time than one year per phase.
It is important for the residents and the treatment staff of a therapeutic treatment
center to be able to assess, prior to any component of treatment, exactly what the resident's
strengths or deficits are in any area, to have clear criteria as to how to make changes, then
to be able to reassess any progress that has been made so that the resident is informed of
what further is expected and so that changes can be made to an individualized treatment


Overall Opinion and Recommendations
While it is clear that there are discrete phases of treatment, and the phases as written
seem appropriate, it is of extreme concern that residents are not progressing through the
phases. It is understandable why a sense of hopelessness exists among the residents.
Without clear criteria and without residents seeing that people are being discharged from
the program, a sense of hopelessness will persist. It is clear that the residents are not
receiving sufficient therapeutic intervention based on a review of the number of therapeutic
contacts they are having on a weekly basis. This evaluator questions how residents can be
expected to progress through the phases of the program when they are not provided the
amount of therapy necessary to gain the skills required for progress. Moreover, clear
criteria need to be communicated to residents as to treatment objectives and goals.
It is also problematic that residents are not provided with individual therapy. It
appears that a one-size-fits-all approach is being utilized in that all treatment occurs in a
group setting. It may not be the case that all residents require individual treatment,
however, it is likely that many would benefit from it. This of course, should be assessed
when men first enter the program. There also needs to be specialized programming for the
cognitively impaired and for those individuals for whom Spanish is their primary language.

It is recommended that at the Kearny facility, group and individual therapy rooms
are needed. As noted above, the trailers did not appear soundproof, and this evaluator was
able to overhear a therapy session in the next room. This obviously compromises a
resident's right to confidentiality.
Overall, based on my tour of the facilities, interviews with residents and staff, and reviews
of collateral materials, my finding is that the phases of treatment as outlined in the
written plan are minimally adequate/satisfactory. However, I have also determined that
resident progress through the phases and the means by which progress is e,'aluated
are together 1I0t minimally adequate/ullsatisfactory.

4. Process Groups and Modules
Of the 40 men interviewed, when asked what groups they were presently in, the
majority reported being in a process group which meets two times per week for an hour and
a half each time. Two men were in a MAP group which meets once a week. The total
number of weekly therapeutic hours that these 40 men reported being involved in was on
average 3 hours per resident per week. At the time of my visit, no core modules were being
run at the Annex. They apparently had completed on June 23 rd and reportedly were to be
restarted in August. Of the men interviewed, 85% were currently engaging in treatment.
Apparently a number of self-help groups (run by residents) are in existence at the
facility. These groups include Arousal Reconditioning, Relapse Prevention 1-3, Anger
Management, Alcoholics Anonymous, Adult Children of Alcoholics, Sex and Love Addicts


Anonymous, Open Floor, Health, Music, Spiritual Development, and Meditation. I have
been informed that staff are not present in these self-help groups, but the groups are
audiotaped and listened to by staff and staff can provide guidance to the residents based on
the tapes. Given the number of self-help groups it certainly appears that many of the
residents are motivated to engage in therapy. This was corroborated by information
obtained during resident interviews. While it is to the credit of the program that it offers
both modules and process groups, unfortunately, there are not sufficient modules offered,
and space in offered modules is limited. Consequently, a number of men are waiting to get
into modules.
Based on my interviews with the residents, it appeared that they are receiving
minimal clinical contact time. Since clinical staff schedules are not available, it is difficult
to quantify exactly how much time clinical staff are actually spending with the residents,
but based on resident report and records, it does not appear that they are receiving
sufficient therapeutic contact hours. Moreover, it is worrisome that developmentally
delayed residents and predominantly Spanish-speaking residents are placed in the same
treatment groups, as there should be specific tracks for individuals with developmental
disabilities, other forms of cognitive deficits, and the seriously mentally ill, and they should
be mainstreamed when possible.
I had the opportunity to review the findings of a 2007 resident survey conducted by
Jennifer Schneider, PhD, who is employed by the STU. Of the 360 residents available to
survey, only 195 elected to participate in the survey; a 54% participation rate. Residents
were surveyed as to numerous aspects of the treatment program. Twenty-three percent felt
that the process groups should meet more frequently than twice per week. Thirty-nine
percent felt that the module meetings should occur more frequently than once a week.
When asked to rate their overall experience of the groups, 85% ranked their experience as
positive in nature. When surveyed as to what issues they would have liked to spend more
time on during treatment, 40% reported wanting to spend more time on victim empathy,
44.8% reported wanting to spend more time on relapse prevention, and 42.8% reported
wanting to spend more time on distorted thinking. When asked about the least helpful
components of treatment, 35% cited the size of treatment groups. When questioned as what
should be improved, 44.6% reported that the content of group session and 40.5% reported
increase in the amount of therapy offered.
Overall, the mission of the program, the use of psycho-educational and process
groups, and the types of treatment modules denoted in the handbook are most appropriate.
Unfortunately, what appears in the manual does not appear to be fully carried out in
practice. This is a particularly critical point, given that the liberty of these men is at stake. It
is impossible for residents to progress through the phases of treatment if core groups are
not available to them, or do not meet with sufficient frequency to allow for therapeutic
Overall Opinion and Recommendations


This evaluator really struggled in tenns of reaching an overall opinion in this area.
While the use of psycho-educational groups and process groups is a good model for
treatment, there are clearly not enough groups offered. Moreover, there are other types of
groups that I would recommend including in the program including groups relevant to
motivational interviewing, managing behavior and affect, and healthy relationships.
Based on the model described in the manual, my finding is that the process groups
and modules are m;,,;mally adequate/satisfactory:. However, based on resident interviews,
and review of materials, my finding is that the availability and intensity of the process
groups and modules are not minimally adequate/ullsatisfactory.
It is my
recommendation that the clinical staff be required to provide a minimum of 15 to 20 hours
in direct clinical service to each resident. This can be accomplished by providing
individual therapy and by increasing the number of psycho-educational modules and
having daily process groups.
Individual therapy can motivate residents working on their individualized treatment
plans and assist them in working on trauma and other psychologically relevant issues.

s. Vocational, Recreational, and Educational Therapy
The vocational program aspires to deliver programming that will provide skills to
prepare residents for life outside of the institution, which include writing resumes, filling
out job applications, and preparing for job interviews. This is an important goal of overall
programming and a critical life skill for survival in the community. Of those residents who
were questioned about vocational training, none mentioned that they received training in
these skills, (perhaps this is a result of the majority of residents still being in Phase 2).
Residents did indicate that there is a culinary program, a computer class, a sewing class,
and a past program on electronics, though some of the residents were unaware of the
existence of these programs.
Residents are employed within the institutional setting at jobs such as cleaning,
cooking, laundry, and general maintenance as long as they are not treatment refusers. The
number of hours they work depends on the treatment phase they are in. For example,
residents in Phase 1 work 5 hours per week, while residents in Phase 3 work 15 hours per
week. During my tours of the facilities there appeared to be many residents in their rooms
or living spaces during daytime hours, with little or nothing to do.
With respect to recreation activities, a schedule provided to me indicated that there
are arts and crafts, music relaxation, games socialization, and bingo. Of the men who were
asked about recreational activities, although games and bingo were mentioned, none
mentioned arts and crafts or music, though I did see one man working on an art project at
the Annex. It seems that limited recreational opportunities are available. The men at the
Annex have a relatively large yard outside, but the outdoor space at Kearny was small.
Moreover, there appeared to be minimal indoor recreational space. The amount of time that
men can spend in recreation yards is limited, and there is limited recreational equipment.


With respect to exercise equipment, there were two elliptical machines, and I was told
additional equipment was ordered, but is on hold. Overall, the amount of exercise
equipment and recreational space and equipment is woefully inadequate for the number of
men housed at these facilities. There appear to be occasional social gatherings planned for
residents; a barbecue was being held during my visit, and I was infornled that parties are
held for Thanksgiving and Christmas.
With respect to education, opportunities are limited. However, basic educational
skill training is available, and residents are able to receive help in working towards a OED.
A staff member pointed out to me that while in the past, men might have been able to
access correspondence courses, the majority of such courses have gone online and it is
difficult for men to take them, given that they are not allowed access to the Internet and
there are a limited number of computers.
There is a law library available at both sites. Residents have access to LexislNexus,
however one of the more knowledgeable residents informed this evaluator that there are
certain law treatises that are required but were not available. (It should be noted that this
evaluator does not claim expertise in evaluating what a state-of-the-art law library should
contain). It should be noted that I was informed that less than 10% of residents participate
in any type of educational program. It is unclear why this is the case, however, and may be
due to lack of interest, lack of course variety or availability, or other factors.
Overall Opinion and Recommendations
Based on my tour of the facility, resident and staff interviews, and review of
materials, my finding is that the vocational, rehabilitative, and educational
programming is not minimally adequate/IlIIsatisfactory. Overall, opportunities for
residents are extremely limited in these areas.
First, there is limited staff in these areas, and efforts should be made to hire
additional staff as soon as possible. The Director of Rehabilitation indicated that she is
attempting to develop relationships with outside companies to allow for contract work in
the facility. Second, comprehensive vocational evaluations should be conducted on every
resident. Vocational modules should be based on the needs of the residents. For example,
how many residents aspire to go into the culinary arts profession or to go into sewing? It
would appear based on information from residents that courses in auto mechanics,
electronics, or other skills that would lead to jobs on the outside should be offered. Third,
residents need to learn the basic skills for employment. There is some discrepancy between
what residents report as being available and what staff report, but regardless, greater effort
should be made to incorporate basic job preparation skills and inform residents of their
availability. Current job options are adequate and teach skills that are valuable for life in
the community, however, it is my opinion that residents should be allowed to work a
greater number of hours at their jobs.
With respect to recreation, it is clear that more opportunities for residents are
needed. Perhaps residents could be surveyed to assess the types of activities most desirable,


and an effort made to include the most popular activities in the recreational programming.
They also need a gym, with up-to-date fitness equipment in appropriate numbers for the
resident population. In addition, regularly scheduled team sport activities such as basketball
and volleyball games and exercise classes are recommended. Such activities would
increase both physical and mental well-being among the residents, as well as provide them
with skills for when they leave the facility, such as social skills, cooperation and team
building, and help them learn to manage leisure time when outside of the institution. In
addition, there needs to be an increase in time allowed for recreation and supervised
recreational activities should be available seven days a week.
With respect to education, there needs to be more extensive educational
programming, including preparation for GED, courses in health education including basic
hygiene, smoking cessation, infectious disease prevention, diabetes and blood pressure
management. It is recommended that outreach be made to local junior colleges and colleges
to see if facuity might volunteer to come in and teach courses, or if graduate students could
somehow get course credit for teaching courses at the facility. Outreach should also be
made to retired persons organizations to see if retired teachers or individuals with specific
skills might volunteer to teach at the facility. The state and the institution could then
provide certificates of appreciation to honor such volunteerism. Overall, education needs to
include a greater variety of courses, needs to be better tailored to the educational needs of
residents, and needs to increase vastly in tenns of frequency of course offerings. While this
important for all residents, it is particularly important for those who are not participating in
treatment. As Dr. Marques noted:
"There is general agreement that programs need to provide structure and activities
for those [not in treatment] and must not ignore or warehouse them ... It means that
they should have treatment plans to address their individual needs. to describe
possible therapeutic engagement strategies. and to identify goals such as those
related to fitness. health. education. vocational skills. hobbies. or family and social
relationships. This in turn requires the program to have sufficient staff and
resources to provide educational. vocational. recreational. and family/social
programs as well as resident job assignments." (p. 2-13)

6. Release Preparation and Programming
The following data were provided to me regarding how many individuals have been
discharged from the program: 110 residents have been discharged since the inception of the
program. Of those, 69 were discharged at the initial 20-day hearing, 23 via court order, 5
via treatment recommendation, and 13 died. A document provided to me after my visit to
the STU, dated October 30, 2008, indicates that 16 men are on conditional release (one,
however, was incarcerated at the Essex County Jail).
In interviewing ten of the residents who were on conditional release and gave
pennission to share their comments anonymously, the following is a summary of their
comments: "treatment was good, but I had to do the same thing over and over again," "it's
repetitious and gets hopeless," "I am not a group man," "everything was good, I have no
recommendations," "some therapists are there just for a job, others are there to help you,"


"therapists are afraid of DOC," "I'd be lying if I didn't say I benefited," "treatment was
very inadequate, staff are arbitrary," "it's run like a prison," "some staff/officers are
emotionally abusive," "the crowding is a nightmare," "inadequate recreation and medical
care," "transition inadequate," "we're not prepared for a return to the community," "a lot of
staff are not qualified," "no one is given a plan to come off conditional release." While a
several men felt that the treatment was helpful, the majority of comments related to the
repetitiveness of the treatment and the lack of preparation for transitioning to the
community, suggesting that overall, treatment and release planning are inadequate.
There is no independent living program for men getting ready for discharge. The
institution however, does have a furlough program. Social work staff reported that efforts
are made "to assist those men who have been approved for conditional release in finding
housing and obtaining needed support, though some of the residents who were interviewed
and on conditional release reported otherwise.
I had the opportunity to review the findings of a 2007 resident survey conducted by
Jennifer Schneider, PhD, who is employed by the STU. Of the 360 residents available to
survey, only 195 elected to participate in the survey; a 54% participation rate. Residents
were surveyed as to numerous aspects of the treatment program. When surveyed as to
resources required for discharge planning during transition and upon release, roughly a
third felt that they needed skills training in each of the following areas: money
management, resume writing, interviewing skills, employment counseling, and
relationship/social skills.
Overall Opinion and Recommendations
Overall, based on my interviews with staff, current residents, and residents on
conditional release, it is my opinion that release preparation and programming are
barely minimally adequate/satisfactory. Although a number of men are on conditional
release, a majority of them felt that they had to find housing and jobs on their own.
Furthermore, several men were concerned about what would happen to them if they no
longer had the finances to pay for their outpatient treatment, which is a condition of their
release. Also at issue is the difficulty of having to register as a sexual offender and inform
potential employers, landlords, and neighbors of their sex offender status.
7. Therapist Training and Supervision
I was informed that the STU provides one hour of group clinical supervision at each
site per week and one to one and one-half hours of grand rounds per month for all staff.
Regarding external training opportunities, few staff members attend external training on a
regular basis due to the fact that paperwork required for the approval of external training is
a cumbersome process that must be completed 40 days in advance and requests to attend
external training are frequently denied for budgetary reasons. Attendance at out-of-state
training, such as ATSA and MASA conferences has been denied for several years. Staff
who attended such conferences must pay their own travel expenses and had in the past been
required to utilize vacation time.


Some staff expressed concern about the quality of the clinical supervision received,
which is critically important when working with such a diverse and at-risk population as
those being served at the STU. It also appeared that some clinical staff were overseen by
program coordinators with less education and experience than the people that they were
When staff schedules were requested, I was informed that therapists are not
required to turn in weekly schedules of activities. This is of concern particularly given that
I was also informed that some staff members reportedly spend time on other jobs, were not
being truthful on their timesheets, and utilized work time for inappropriate personal
activities on the Internet. It should be noted that more than one staff member made these
DOC Staff Training
I met with the Director of DOC and had requested to meet with a number of other
DOC officers, but only one officer and a DOC supervisor agreed to meet with me.
However, another correctional officer did contact me and provided information. This
evaluator would like to note that all members of the DOC staff with whom she had contact
were professional and courteous. It was clear that the correctional staff have not received
what this evaluator would consider to be sufficient and on-going training in working with
this specialized population. It was reported that more correctional staff are needed, and on
one shift there are only 12 officers and 2 supervisors for 227 residents. Actually, it is quite
amazing that there have not been more incidents given the low staff to resident ratio.
There is a daily meeting between correctional and mental health staff. In general,
the officers interviewed felt that corrections and mental health staff worked well together
and all officers were aware of the mission of the facility.
One of the DOC officers who contacted this evaluator raised questions as to why
modules were not offered more frequently; why the program was not designed and
implemented to allow residents to exit into the community; why the program was designed
so that residents could not easily advance through phases of treatment; why residents
appeared to be warehoused; and why there weren't more work furloughs, halfway houses
or group homes within the facility.
It is recommended that DOC officers receive, at a mInImUm, yearly ongoing
training by mental health staff as to issues in working with this specialized population. I
would also recommend that more officers be hired given the current low staff to resident
ratio. I offer the opinion that more officers are needed given that the special treatment
program is jointly run by DOC and the Division. I would like to note, however, that there
are other models for such programs. But given the existing program, it appears

Overall Opinion and Recommendations


Based on my staff interviews and correspondence, and review of materials, my
finding is that the therapist training and supervision is II0t millimally
adequate/unsatisfactory. Clinical staff working with this population need to receive at
least one-hour of individual supervision weekly as well as weekly or bi-weekly group
supervision by an individual who has had prior experience in conducting both individual
and group therapy with the population being served. Those providing supervision should be
documenting what was discussed in the supervision meetings as well as ensuring that their
supervisees are providing clinical services to the residents, preparing materials for clinical
work, taking part in training, or updating clinical records during work hours. Furthennore,
clinical staff needs to be afforded the opportunity to attend ongoing trainings at either
ATSA or any other state or professional national organization where the most up-to-date
clinical and research findings are provided.

Note: 110 lIumher 8 was listed ill tile COli tract

9. Therapeutic Community
The written plan for the provision of resident care indicates that the STU strives to
maintain an environment where residents work on appropriate treatment goals as close to
24 hours a day, 7 days a week as possible. According to the written plan, the STU has
designed a structured therapeutic community program for residents who are sufficiently
motivated to benefit from a more intensive treatment regimen. The written plan indicates
that community meetings occur that include elements of "peer assistance, constructive
criticism for potentially dysfunctional behaviors, praise for pro-social behaviors, and
behavioral interventions to diminish unwanted behaviors." A major goal is to promote
prosocial values. At the present time, there are 37 men in the therapeutic community,
housed in one wing of the Annex. The living conditions for those in the therapeutic
community were as poor as those of the rest of the residents. Unfortunately, the community
meeting for the day of my visit had been cancelled, so I was unable to see what occurs in
that meeting.
In a conversation with staff regarding the therapeutic community, it was reported
that it began approximately two years ago. That initially the therapeutic community
consisted of the entire dorm (69 men), but in the words of a staff member "that wasn't
working how we hoped with that large a number," so in June 2008, the TC was virtually
cut in half. The therapeutic community is located in Dorm C at the Annex. Currently, men
in Phases 2-5 comprise the TC. It was learned that one can become part of the TC either by
recommendation by the clinical team or self-referral. If a person is self-referred, he
undergoes an interview, meets with a treatment team, and is assessed based on his
engagement in treatment as well as his "willingness to fully engage in TC functions and
buy into tenets." The TC team holds a weekly meeting. The TC operates under a "pull-up"
system where residents learn to take responsibility for their behavior. and gain

assertiveness and comfort with the supervisory process. TC residents reportedly have the
same number of treatment groups, but have more committee functions. Staff report that
TC residents "live the therapy" for a greater proportion of their time. The TC also has a
number of self-help groups, run by TC members. There are reportedly also a number of
committees that TC residents are appointed or volunteer into. Staff are not members, but
act as consultants. Most committees meet at least weekly, according to staff. Committees
are as follows: Remedy Committee; Advisory Committee; Media Committee; Socialization
Committee; Transition Committee; and Mediation Committee.
Several of the residents I had interviewed had been in TC but were no longer
members. When asked about the treatment in general, few spoke of the therapeutic
community, and those that did simply stated that they had been in TC but no longer were.
While it is important to have a therapeutic community so that individuals are "living the
program" and can receive greater privileges based on their performance in treatment and
the living milieu, and although efforts are being made to have such a TC, it appears that
due to staff shortages and the design of the facilities, the current TC is not reaching its
potential. Furthermore, only approximately 10% of all residents at STU are in TC, and
those that are in TC do not seem to be experiencing a therapeutic community of sufficient
intensity with respect to number and frequency of TC activities. While there are no
universally accepted standards as to what percentage of residents should be in a therapeutic
community, ten percent appears to be a very low number and this evaluator would like to
see at least one third of the residents in the therapeutic community.
Overall Opinion and Recommendations
Based on my tour of the facility, resident and staff interviews, and review of
materials, my finding is that the therapeutic community is not minimally
adequate/unsatisfactory. In my opinion, a greater percentage of the STU population
should comprise a therapeutic community, such a community should have a living space
that is commensurate with a physical community so that residents are not sharing living
spaces with non-TC residents, and it should offer more advantages in terms of the physical
plant, treatment, and community activities, so that other residents should aspire to be part
of the therapeutic community. In my interviews with residents, not one of them volunteered
that they desired to be part of the TC. Given that this is designed to be a therapeutic
community, it is necessary that therapeutic activities playa significantly larger role than
they currently do.

10. Confidentiality
Confidentiality within therapy groups varies across facilities. At the Annex, groups
occurred in relatively large rooms, and there did not appear to be any issue regarding the
confidentiality of information conveyed in groups at that setting. At Kearny, the set-up of
treatment groups within the treatment 'trailer allows for others (including correctional
officers) to easily overhear group proceedings (please see the section on Treatment
Environment above), which, in my opinion, greatly compromises confidentiality of

therapy. In addition, during my visit a correctional officer escorted me to a treatment group
at the Kearny facility and proceeded to sit in on the group, while the therapist leading the
group did not request that he leave. When I asked the Clinical Director if correctional
officers generally sit in on groups, he reported that they do not, but opined that the
correctional officer probably thought that it was his responsibility to escort me and
accompany me throughout the group session. It concerns me greatly that correctional
officers can potentially hear group therapy sessions, and greater attention needs to be paid
to ensuring confidentiality between resident treatment and correctional staff.
While there is an inherent double bind for civilly committed sex offenders, it
appears that there are few protections in place at these facilities to mitigate the
consequences of such. For example, all residents should be infonned that any statements
that they make in group or individual contacts with therapists potentially could possibly be
used against them in a court of law, but can also be used in detennining whether and when
they will be advanced in phase and released from the facility. This should be clearly stated
in the resident handbook and a statement to this effect included in the resident's consent
Overall Opinion and Recommendations
Based on my tour of the facility, presence in treatment groups, interviews with
residents, and review of materials, pending issuance of my final report, my preliminary
finding is that the level of confidentiality is "ot mi"imally adequate/ullsatisfactory. It
appears that there is limited confidentiality of group therapy sessions at the Annex facility
and there is minimal separation between treatment and the DOC with respect to punitive
DOC repercussions for violations of treatment rules and policies. I recommend that greater
efforts be made to ensure that treatment sessions remain confidential from correctional
officers and other residents not participating in the treatment group.

11. Gradual De-Escalation of Restraints
It appears that de-escalation of restraints comes in two fonns. In one fonn, as
individuals pass through the different phases in treatment and continue to work at their
therapy, they are granted increased work hours. In the other fonn, as Phase 5 of the
treatment program is achieved, residents are granted furloughs to the community. It is my
opinion that while the program does provide de-escalation, it does not occur at the quantity
or rate that one would hope to see in a therapeutic program.
Although this evaluator is unable to cite any scholarly literature, I am aware of a
2000 court order in the State of Washington which detennined that a separate, "step-down"
facility was necessary. In this order, Judge Dwyer states "mental health treatment, if it is to
be anything other than a sham, must give the confined person the hope that if he gets well
enough to be safely released, then he will be transferred to some less restrictive alternative"
(p. 11).


Overall Opinion and Recommendations
Based on resident and staff interviews and review of materials, my finding is that
gradual de-escalation of restraints is II0t lIIi"illlally adequate/Ullsatisfactory. Perhaps
due to limitations in staff and opportunities for other activities, current de-escalation is
limited; however, I am of the opinion that greater thought needs to be given to increasing
the de-escalation of restraints. The program has been creative in developing a furlough
program, in which some men can go out into the community accompanied by a staff
member, however. It is this evaluator's opinion that a greater number of men should have
the opportunity to have supervised furloughs into the community. Specifically, if a resident
is participating in therapy and evidencing general self-regulation skills, then he should be
afforded the opportunity, under supervision, to have brief forays into the community. For
those men who have cognitive limitations and significant substance abuse histories, it is
recommended that a group home or similar type of facility be created to allow them to have
greater freedom whi Ie at the same time providing the level of care that they require. Other
areas to include in a de-escalation system would be increased visitation or recreation
schedules, changes in living arrangements or placement, more freedom of movement,
among other privileges.

12. Increased Visitation
Residents are allowed two hours of visitation, three days per week. In speaking with
the residents, they felt that visitation is not long enough or frequent enough, and they also
expressed concern about the rooms in which visitation occurs, as visitation rooms at both
facilities are rather stark. Residents have also voiced concern about how their families are
treated by corrections officers. One resident reported that his partner stopped coming
because of things that were said to her by correctional staff. It should be noted however,
that while some of the residents complained about how visitors were treated, others felt that
their visitors were "treated good."

Overall Opinion and Recommendations
Based on my tour of the facility, and resident interviews, my finding is that
visitation is millimally adequate/satisfactor)'. It is recommended, however, that the rooms
used for visitation be made more "user-friendly." Also, correctional officers should be
trained in relating more appropriately to visitors and instructed not to engage in any
conversation that is demeaning to residents or their visitors. Visitation is important given
that the residents need to be able to maintain contact with family members and friends in
the event that they are released. Such visits enable residents to establish a social support
network that will prove beneficial for their successful reintegration into the community.
Perhaps increased visitation could be used as a privilege for those residents who are in the
therapeutic community and in later phases of the program. Family support groups should
be held regularly and DOC staff should be educated in how to be respectful towards family
members during their visits.


13. Availability of Psychiatric Consultation
At present there is only one psychiatrist for both the Annex and the Kearny facility.
There had been six other consulting psychiatrists, but for one reason or another, they all left
over the past year. The present psychiatrist not only is responsible for providing psychiatric
care to those residents who are in need, but he also conducts some of the commitment
evaluations. I have some concern that this potentially places the psychiatrist in a dual role.
The psychiatrist has done due diligence in making sure that none of the individuals that he
is presently treating are individuals who are assessed for commitment. It is clear that the
current psychiatrist is well trained, well respected and is doing the best job that he can
given how staffing shortages at the facility.
Overall Opinion and Recommendations
Based on the services this psychiatrist provides, my finding is that the availability
of psychiatric consultation is not minimall)' adequate/unsatisfactory. This rating is based
exclusively on the lack of psychiatrists, not on the performance of the present psychiatrist.
It is imperative that positions be posted so that the positions that were vacated can be filled
immediately. The October 30,2008 SOCCPN report indicates that the average ratio for
residents to Psychiatrist is 122:1

Overall Recommendations
The joint expert opines that the mission of the STU would be better served if the
following were to occur:

It is recommended that the State of New Jersey model their Civil Commitment

Center on a therapeutic environment and not on a jailor prison-like
environment. Adequate living space needs to be provided for residents and
adequate office space and treatment rooms need to be available for staff. In such
a facility, a fully-equipped infirmary should also be established. Recreational
space and classrooms for educational and vocational training should also be
abundant. Such a facility should also provide adequate and "friendly" visitation

It is abundantly clear that more clinical and custody staff are needed at the
It is also recommended that treatment providers receive more training and
individualized supervision. Information obtained from residents and
professional staff (this evaluator interviewed a number of staff members and
also obtained information from staff telephonically) indicates that residents and
some staff see the milieu as one of punishment. Some staff members expressed
concern about administrators not being on-site as frequently as they should, not








being involved with clinical staff as much as staff would like, and also exhibit a
pattern of favoritism. Concern was also raised regarding case supervision and
the clinical experience of an individual providing supervision who may not have
had any direct experience in treating this specialized population.
Weekly therapist schedules should be made available to the Clinical Director.
All files should be computerized so that clinical staff can access medical
records, assessments, treatment notes, homework assignments and other
information pertinent to a resident's course of treatment.
Assessments should begin as soon as possible after a resident's orientation to
the facility, and consent has been signed.
Assessments should be comprehensive and include those areas outlined in
Section 2 above. A detennination based on the comprehensive assessment
should be made as to whether the resident would benefit from group, individual
or group, or individual treatment. Also, an assessment should be made as to
which phase of treatment a resident should be assigned upon arrival.
Specifically, some residents may have had prior treatment while incarcerated in
prison, and it is possible that they will not require all the modules in a particular
phase of treatment.
Specific short and long-tenn treatment goals should be part of the treatment
plan. Requirements to move to the next treatment phase should also be part of
the treatment plan.
Pre- and post-testing should be conducted for every module.
Requirements for discharge should be given to each resident upon entering the
Residents should receive monthly feedback from their primary therapist on their
Process groups should occur daily.
Specialty modules should occur at least twice per week, for an hour and a half
each time.
Both group and individualized supervision should be provided to treatment
Funds should be made available for staff to attend either regional or national
conferences related to sex offender assessment and treatment.
Professional staff who do risk assessments should keep up with research in the
risk assessment area, and resident risk levels should be modified based on recent
A comprehensive treatment plan should be made available and explained to
each resident within one month of his comprehensive assessment.
Special needs tracks should be made available.
Men should be housed based on special needs and phase level.
Vocational, educational, and life skills services should be increased.
Individuals on MAP status should receive more in the way of therapeutic
contact time.
The treatment rooms should be such that material being discussed is
confidential and rooms are soundproof.



It is recommended that an external advisory board be appointed, and that part of
their charge be to conduct a yearly external review of the program. It is also

recommended that an Ombudsman be appointed.
It is recommended that there be a resident council that can meet monthly with
the Clinical Director.

Final Comments:
The clinical staff I communicated with appeared to be a very dedicated group of
individuals who cared deeply about the residents in their care. This evaluator would like to
thank the administrators, residents, clinical staff, and correctional staff for their openness
and the courtesy they extended her. Residents and staff are both in a difficult situation
given the environment they are in and the lack of resources allotted to the facilities.
I respectfully submit this final report.

Judith V. Becker, Ph.D.

List of Documents

1. Division of Mental Health Services, Administrative Bulletin Transmittal Memo,
6/6/2002 (pp. 1-8)
2. Raymond Alves et at. complaint, dated 10/28/2004 (pp. 9-26)
3. Richard Bagarozy complaint, dated 6/28/2004 (pp. 27-40)
4. William Moore complaint, dated 4/21/2005 (pp. 41-75)
5. Expert reports ofPrentky (3/20/05), App (3/4/05), and Schlank (5/29/04) (pp. 76116)
6. Plaintiff summary of resident phase status data (pp. 117-150)
7. Parties' settlement correspondence, including letter from Plaintiffs (5/18/06) and
letters from the AG (12/1/06) (pp. 151-174)
8. Special Treatment Unit, Written Plan for the Provision of Care, (3/30/06) (pp. 175395)
9. Residents Guide to the STU, March 12,2004 revision (pp. 396-436)
10. Residents Guide to the STU, June 2001 revision (pp. 437-466)
11. Residents Guide to the STU, unknown date (pp. 467-518)
12. DMHS TPRC Review Committee, revised 6/8/03 (pp. 519-526)
13. STU Policies and Procedures, effective 12/16/04 (pp. 527-536)
14. Ann Klein Forensic Center Special Treatment Unit Sex Offender Disclosure
Questionnaire (pp. 537-554)
15. Education Modules Curriculum (pp. 555-989)
16. Plaintiff Summary of STU Job Descriptions (pp. 990-1469)
17. Sex Offender Treatment Skills for Corrections Professionals Participant Manual,
written by the DOJ, Nat'! Institute of Corrections, (pp. 1470-1949)
18. Workshop materials and relevant chapters (pp. 1950-2821)
19. Guidelines for the Development of New Programs by Anita Schlank
20. ATSA Civil Commitment of Sexually Violent Offenders
21. Professional Standards for Civil Commitment Programs by Janice K. Marques
22. Book Chapter entitled Assessing Treatment Progress in Civilly Committed Sex
Offenders- The New Jersey Approach
23. Article entitled Assessing Inpatient Treatment Progress: The Development ofthe
Dynamic Treatment Monitoring Scale authored by S. Katz Schivone and J.
24. Letter from Mr. DaCosta, dated 10/15/08
25. Letter from Mr. Marx, et al., dated 10/15/08
26. Letter from Mr. DaCosta, dated 10/20/08
27. Letter from Mr. Marx, et al., dated 10/29/08

Materials requested and provided following my visit to the STU facilities:
28. Resident Charts
29. Findings from 2007 Resident Survey Conducted by Jennifer Schneider, PhD
30. STU Treatment Plan, dated 07/21/08
31. STU Morning Meeting Agenda, dated 07/28/2008


32. Resident Module Assignment, dated July 2008
33. STU Program Schedule, effective 07/14/2008
34. ANNEX MAP Roster, dated 07/21/2008
35. Email Communications regarding the Number of Residents Discharged, dated
36. STU ANNEX and Kearny Group Schedules 2007 and 2008
37. STU Staff Schedules, various dates in 2008
38. Therapeutic Schedule entitled New Beginnings, OS/2008
39. Document entitled Residence by Admission Date: Sending Institution and
Discharge Status
40. Document Entitled STU Polygraphs
41. Document entitled Transitional Planning, Conditional Discharges, Potential
Conditional Discharges
42. Several Documents Entitled Comprehensive Discharge Plan
43. Several Annex Clinical Supervision Notes
44. Arousal Reconditioning Final Exam
45. Recreation Schedules (March 2003)
46. Law Library Hours
47. Sex Education Module Syllabus
48. Residents Currently in MAP Group as 0[07/10/2008
49. Two boxes of resident clinical files (though I was told an additional box was lost in
the mail)

Interview Schedule
Tuesday, 7/22

7/23 (Annex)

Thursday 7/24

Friday 7/25

Meeting with
Plaintiff residents at
Kearny facility

Meeting with
Plaintiffs at
Annex facility

Meeting with a
DOC lieutenant

Meeting with
Substance Abuse

Tour facilities at
Kearny and
meeting with all
residents at Kearny

Tour facilities at
Annex and
meeting with all
residents at

Meeting with
Clinical Director,
Merrill Main

Sit in on a
process group

Meeting with
Natalie Barone,
Director of

Sit on a
process group

Lunch with
psychiatrist Dean
Michael De Crisce

Lunch with a
staff therapist

Meeting with
Quality Assurance
Specialist (Natasha


Meeting with
Director of
Rehabilitation (Terri
Meeting with Social
Work Supervisor
(Heather Burnett)

Meeting with a
DOC officer*


Lunch with a staff
Meet with Brian
(psychologist that

Meeting with DOC
administrator for
both facilities
(Goodwin and

Monday 7/28

Met with Jennifer
Schneider, head of
Quality Assurance
and Research

Resident Interviews


Lunch with a staff


Lunch with
Director and
Director of



Record review

Record Review

* I had requested to meet with officers, only one volunteered to be Interviewed. However, while at
one of the facilities, another officer approached me. He did not wish to be identified but did share
with me his views and suggestions.
** A total of 40 men had been interviewed. This included the residents who were randomly selected
and the residents who were nominated to be interviewed by the Plaintiffs' attorney. One man who
had been randomly selected chose not to be interviewed, consequently a person who had
committed his offenses as a juvenile but was then civilly committed was selected to be interviewed.



Resident Interviews
Summary of the people who were interviewed (randomly selected to be representative
sample based on commitment date, facility (Annex or Kearny) and phase in Program:
• Commitments ranged from 1999 to 2008.
o Average time since commitment: 57 months
• Phase in program (based on resident report):
o Range Phase 1-4
o Mode: Phase 2
• Phase 1: 3 residents
• Phase 2: 18 residents
• Phase 3: 10 residents
• Phase 4: 2
• Treatment Refusers: 6 residents
• Unknown: 1 resident (did not know his phase)

List of Questions Asked
Date admitted:
Sex offender treatment history:
In prison:
Arrest history:
Sex offenses:
Non-sex offenses:
Phase in Program:
Time spent in each phase of program:
What have you been told you need to do to be released?
Currently employed?
How much individual therapy?
Name of primary therapist:
How many groups currently in?
Group names:
Meeting frequency:
Treatment goals: .
Have they been attained?
In your view, how is progress measured?
What has been most helpful to you?
Perceived strengths of the program?
What needs to be changed?
Opinion of professional mental health staff:

Overall Rating:
1 (Poor) 2 (Less than adequate)
Opinion of corrections staff:
Overall Rating:
1 (Poor) 2 (Less than adequate)
Opinion of living conditions:
Overall Rating:
1 (Poor) 2 (Less than adequate)
Overall rating of STU/Annex:
1 (Poor) 2 (Less than adequate)

3 (Adequate) 4 (Good)

5 (Excellent)

3 (Adequate) 4 (Good)

5 (Excellent)

3 (Adequate) 4 (Good)

5 (Excellent)

3 (Adequate) 4 (Good)

5 (Excellent)

Summary of Ratings by Resident Interviewees:




Opinion of professional mental health staff
oRange: 1-5 (ratings of 0 not included)
o Mean: 1.97
o Mode: 1
Opinion of corrections staff
oRange: 1-5 (ratings oro not included)
o Mean: 1.93
o Mode: 1
Opinion ofliving conditions:
oRange: 1-4 (ratings of 0 not included)
o Mean: 1.24
o Mode: 1
OveraIJ rating of STU/Annex:
oRange: 1-5 (ratings of 0 not included)
o Mean: 1.5
o Mode: 1



R ecommen d ed Stan d ard s ~or C"I
IVI C omml men tP roerams *
Marques, ATSA,

Trainin~ and Supervision
Staff adequately trained
Clinical direction by qualified
Gender balance of staff
All staff understand model
Treatment planning and clinical
decisions consistent
Staff rotate assi.lOUllents
Treatment staff do not take role in
initial commitment
Treatment Components and
Measures ofProgress
Complete background information
Use of polygraph
Individualized, comprehensive
treatment plans
State-of-the-art components
Ongoing monitoring
Systematic measures and regular
Identifiable phases, including
community release
Vocational and educational
Treatment Environment
Treatment-oriented environment
Adequate space and separation of
resident groups
Staff behavior
Consistently enforced rules
Respectful treatment and
grievance procedures
Program for residents who refuse
Program Review and Oversight
Internal review procedure
External review procedure

































Questionable··· •







·Adapted from Prentky report (3/20/05)
··Should be more focused on individual trauma issues.
...Apparently, an advisory board is in the process of being formed. ... •• ·Per residents' reports.