Cove PREP Frequently Asked Questions (FAQ's)Q: Why do people commit sexual offenses?
A: There is no simple answer to this question because a variety of biological, social, psychological and environmental factors appear to contribute to sexually abusive behavior. However, a number of researchers and practitioners who have worked with this population have identified categories that describe common types of offenders:
1) Career Criminal Offender - These individuals view others only as objects, rather than as human beings with worth and value. Their offending occurs out of the drive to achieve immediate gratification with no regard to the long-term consequences either to themselves or their victims.
2) The Angry Offender - This type of sexual offender shows little to no learned ability to manage emotions and direct anger in a productive manner. Instead the individual looks to inflict the same pain, discomfort, and humiliation he feels onto those with whom he comes into contact.
3) The Mentally Ill Offender - Most mentally ill individuals do not commit sexual offenses. However, many sexual offenders do have one or more mental health diagnoses ranging from mood disorders to serious personality disorders. These disorders, particularly when untreated, result in extreme emotional instability and socially awkward behaviors. Inability to form appropriate relationships and rejection by peers can result in sexual offending.
4) The Maturationally Limited Offender - This type of offender does not function in a manner that would be considered "normal" or "age-appropriate" for someone of his age. This may be due to mental retardation or due to profound deficits in social skills. These individuals typically look for acceptance from people who are functioning at a similar social or emotional level, e.g. young children or other perceived weaker individuals, who may then become targets of their sexual behavior.
5) The Paraphilic Offender - This type of sexual offender may have numerous fetishes (objects or rituals which they associate with or use for sexual gratification). Examples might include: feet/shoes; undergarments; hair or urine, etc). Another category of paraphilic interest is pedophilia. This is characterized by recurrent, intense sexual fantasy, urges, or behaviors with a prepubescent child in whom there is at least a 5-year age difference.
Another variation of sexual offending appears to result from exposure to an overly sexualized environment and/or inappropriate exposure to sexual behavior or materials at an early age. For these individuals, sexual boundaries within the home were lacking or unclear. At one extreme are households where sexual contact among multiple family members was the norm. In other cases, unclear ideas about appropriate and inappropriate sexual behaviors result from subtle blurring of physical, sexual or emotional boundaries. In either case, both the individual and the family, require extensive education on how to establish and maintain appropriate boundaries to eliminate the cycle of sexualized behavior in the home.
Q: Will my child be safe in your facility?
A: Cove PREP is highly committed to providing a safe environment for both residents and staff. Each resident has a single bedroom. Bathroom use and showers also occur singly. Cove PREP provides 24-hour awake staffing coverage. Direct Staff to resident ratio during resident waking hours is 1:4 and 1:8 during hours of sleep. Average Direct Service Staff to resident ratio during resident waking hours is 1:4 or lower on weekdays and 1:4 on weekends. All sleeping rooms are connected to an alarm system that sounds anytime a door is opened. Staff maintains line of sight observation of all residents during all waking hours and conduct visual bed checks every 15 minutes throughout the night.
Clinical Staffing Qualifications:
* Act 33/34 Clearances refer to Child Abuse & Pennsylvania State Police Criminal Background Checks. FBI checks are conducted on any prospective employee who has resided in Pennsylvania less than two (2) years.
Q: What is the difference between normal experimentation and a "real" problem?
A: Looking at "who", "what", "how often"; "where" and "why" will give you clues to the difference.
Experimentation can be generally defined as trying something new out of curiosity or lack of knowledge, without malicious intent and without have a specific goal to achieve gratification. Once a youth knows what to expect (physical sensation) and continues to repeatedly seek that with the same or multiple children, that's a "red flag" that there may be a problem.
"Who" - with whom did the "experimentation" occur? age difference? male or female? The greater the age difference, the greater the concern warranted. Involvement with more than one individual and/or both genders should raise the concern level.
"What" was the behavior? Is it something that would seem to fit with normal curiosity of a child that age, or does it seem to suggest an unusually advanced knowledge of sexual behaviors?
"How often" - have there been a number of instances of the behavior or does there appear to be a pattern? Does there appear to be a degree of compulsivity or preoccupation?
"Where" did the behavior occur? Sexual behavior that occurs in public areas such as parks or public pools, etc. are another cause for increased concern.
Was any force or threat of force used? Were any threats or rewards used to try to keep the other individual from telling? Threats, force or use of any type of a weapon requires immediate intervention.
Secrecy - for example: Touching a young child in an inappropriate manner and then denying that they ever did it after they were caught.
Intrusiveness - peeping; flashing; masturbating in the open; stealing items such as underwear.
Q: How does Cove PREP determine what treatment is necessary?
A: Extensive and multidisciplinary assessment is required to determine the level of treatment, plan of care and duration of treatment required.
All residents admitted to the program are initially screened for reading and mathematics level. On the most basic level, its critical that we know how well a new resident can read and comprehend what he reads before he completes other diagnostic testing. Reading comprehension or other learning disorders are frequently identified through this screening.
If a youth has not had Intelligence testing completed within the past two years, or if a question exists about the results of previous testing, standardized intelligence testing will be completed. This information assists the therapist in matching the level of material presented to the youth's ability.
All youth have a Nursing Assessment conducted within 24 hours of admission and a Physical conducted within one week of admission. Arrangements are made for hearing, dental and vision exams if they have not been conducted within the timeframes established by the Pennsylvania Department of Public Welfare licensing requirements. As indicated, lab work or referral for consultation with outside specialists will be arranged.
A Psychosexual history is conducted upon admission in which extensive information regarding the youth's family and social history is gathered. Additionally, information regarding the youth's history of sexual behavior and developed are gathered. This information along with information obtained from any previous treatment form the basis of the initial treatment plan that is utilized until all diagnostic testing and examinations are completed.
All residents are assessed utilizing a variety of assessment tools, which have research-based validation. These assessment tools measure different factors associated with sexually abusive behavior such as: attitudes; cognitive distortions; types and frequency of sexual activities engaged in; history of own victimization, etc. Particular attention is paid to identifying whether the youth has sustained sexual interest in any deviant categories, e.g. young children or the use of violence and force associated with sexual behavior.
All residents admitted to Cove PREP are assessed utilizing the Abel Assessment for Sexual Interest, which includes both self-report and objective measures of deviant sexual interest. The Abel Screen enables more accurate identification of any deviant sexual interest in various age and gender groups, e.g. 2 to 4 year old males or 6 to 10 year old females. While not all youth have patterns of deviant sexual interest as a contributing factor to their offending, the presence of deviant interest has been identified as a significant risk factor for re-offending. Identification of specific patterns of deviant sexual interest enables therapeutic interventions to be tailored to addressing each resident's individual pattern of sexually deviant interest. Specific behavioral programming is offered that targets at reduction of deviant interest and arousal in these high-risk areas. Post-testing utilizing the Abel Screen is also completed near the end of treatment to measure progress.
A variety of other evaluation instruments specific to deviant sexual interest and delinquency are also utilized to obtain as complete and accurate a picture of the nature, scope and intensity of the sexual offending and criminal behavior patterns in residents. Other evaluation instruments utilized include: the Multiphasic Sex Inventory (MSI); Juvenile Sex Offender Assessment Protocol (JSOAP); Estimate of Risk of Adolescent Sexual Offense Recidivism (ERASOR); the Bumby Cognitive Distortions Scale; the Compulsive Masculinity Scale.
Other Psychological Assessments
Additional assessment instruments are used to identify problems in the areas of mood disorders (depression or anxiety); anger management; ability to emotionally connect to other people; and broader criminal or delinquency attitudes or behaviors. Additional evaluation instruments that may be utilized in the diagnostic process include: the Millon Adolescent Clinical Inventory (MACI); Beck Depression Inventory-II; Beck Anxiety Inventory; and the Diagnostic Interview for Borderlines; the State Trait Anger Expression Inventory (STAXI); Jesness Inventory (relative to delinquency patterns); and the BarOn Emotional Quotient Inventory (residents ages 15+) which provides a global assessment of resident capacity for empathy.
Psychiatric and Psychological Services
Juveniles who are referred to Cove PREP often have had several prior unsuccessful placements, have histories of significant behavioral problems, have one or more identified psychiatric diagnoses, and/or are on psychotropic medications at the time of referral. All residents receive a psychiatric evaluation and, if indicated, psychological testing as part of a comprehensive evaluation. While psychiatric treatment is not the primary focus of the Cove PREP Sexual Offender Treatment Program; addressing co-morbid psychiatric problems is necessary to enable residents to benefit from the primary treatment programming.
The Treatment Team comprised of the Psychiatrist, Psychologist, Management Team, Therapists, Shift Supervisors, Reintegration Specialist and Lead Teacher utilize the results of these assessment to develop the initial Integrated Service Plan, which is completed within 30 days of admission. All resident cases are reviewed on a weekly basis to monitor progress in sexual offender therapy, milieu behavior and educational performance. These weekly reviews are conducted in Treatment Team meetings. This intensity and frequency of communication allows for rapid modification of therapeutic and behavioral approaches.
An Individualized Service Plan (ISP) review meeting is scheduled within 30 days after admission. The resident, his parents or guardians, the Probation Officer, and other involved professionals, if any are invited to participate in this meeting to review the goals established for the initial phases of care.
Short-term Diagnostic Services
At the request of a number of referral sources, Cove PREP now offers a 4-6 week short-term diagnostic service. This service is appropriate for adolescent male sexual offenders who have been adjudicated delinquent of a sexual offense, but for whom additional assessment is needed to determine the nature and severity of their sexual offending patterns in order to determine appropriate placement and/or disposition. The diagnostic work-up will provide:
Q: What is my role as a parent with a child in treatment?
A: The most effective role that a parent or caregiver can have with a child in treatment is one of a supportive nature. This includes remaining in contact with the therapist on a regular basis to obtain accurate updates on therapeutic process, providing any additional information requested, and being willing to hold your child accountable for his actions and participation in treatment. Parents of youth who have committed sexual offenses often struggle with one of two extremes of behavior. They may deny or minimize the seriousness of their son's sexual offending. They may make excuses for or otherwise "enable" (helping the offender to justify and make excuses for their behaviors) their child to avoid fully taking responsibility for their behavior. Secrecy and manipulation are key components of sexual offending. Parents often have a difficult time seeing or accepting how manipulative their child is with them and others in his attempts to protect and maintain his sexually offending behavior.
At the other extreme are parents who are so angry, embarrassed and ashamed of their child that they have difficulty maintaining any type of positive relationship with their son. Willingness to keep open lines of communication with the Treatment Provider, Probation (if they're involved) and the youth has proven helpful to both families and the youth as they work through these difficult situations. Over time, decisions can be made about where the youth will live post-treatment and whether reunification is a realistic goal.
Q: Can my family ever be reunited?
A: Unless contraindicated due to current or past abuse and/or neglect findings or Court-ordered, Cove PREP actively works to engage residents' parents or legal guardians in the treatment process. Where return to the home is anticipated, therapy staff provide education on sexual offending issues and provide family therapy sessions with the resident and parent(s)/guardian to address the sexual offending cycle, supervision needs, etc. With court approval, residents who have met the requirements, work through a graduated system of off-grounds family visits and home passes to allow for gradual preparation for return home, or transition to group home or independent living programs. If the resident's victims reside in the home, parents are encouraged to obtain services for the victim. We attempt to obtain two-way release of information in order to work cooperatively with the victim's therapist to ensure that the victim's needs, and readiness, remain primary in any planning for reunification. All work with the resident's family occurs while the resident is in placement. We work with Probation or other involved parties to identify appropriate outpatient therapy as part of discharge planning.
Q: What is Cove PREP's success and recidivism rate?
A: Follow-up on successfully discharged residents currently occurs through contact with Probation Officers and through former residents phone or mail contact with the facility. To date, of more than 55 successfully discharged residents, we have identified three (3) youth or less than 5% that any have been arrested for a subsequent sexual offense. Several have had additional legal involvement related to other delinquent acts, e.g. theft, probation violations related to behavior problems in the home, etc. Of those described as having "fair" or "poor" adjustment, anecdotal reports note parental failure to follow-through with recommended psychiatric services and psychotropic medication regimes as a significant contributing factor to adjustment problems.