Services

A full clinical evaluation is a comprehensive psychiatric evaluation that will assess for the presence of neuropsychiatric disorders, major mental illnesses, personality disorders, and behavioral disorders which contribute to the presentation of problematic sexual behavior. The evaluation may include the following:

• Review of collateral records (e.g. police report, witness statements, and treatment records)
• Consultation with collateral contacts (e.g. probation, family members, treatment providers)
• Psychiatric interview
• Psychological testing
• Physiologic testing
• Medical testing
• A final report with diagnostic impressions and recommendations
• A case conference with the individuals involved in the patient’s treatment. The goal of the conference is to review the recommendations and develop an effective treatment and supervision plan.

Risk assessment for future problematic sexual behavior and/or sexual recidivism includes assessment of static (historical) and dynamic (current and changing) risk factors. Static factors are used to determine those risk factors, which are stagnant while dynamic factors, determine the amount of risk, treatment needs, and current ability to manage risk. Risk assessments facilitate decisions about treatment needs, dispositional planning, and community supervision.

An interim evaluation is used to evaluate treatment progress and risk management needs. This assessment often includes a clinical review, treatment plan update, updated risk assessment, and consultation with collateral contacts.

Clinicians at the Institution for Sexual Wellness are skilled in the forensic evaluation of individuals charged with sex offenses. The following types of evaluations are available at the Institute:

• Not Guilty By Reason of Insanity
• Aid in Sentencing
• Civil Commitment of Sexually Dangerous Persons
• Violence risk assessment
• Sex offender classification appeal
• Medication evaluation for chemical castration

Case Consultation and Staff Training

ISW values collaboration with other individuals involved in each patient’s care. Treatment effectiveness can increase by working together on cases. Therefore, ISW provides case consultation to residential treatment staff, law enforcement, and others working with the patient. Case consultation includes clinical conceptualizations, discussion of recommendations, education on risk and protective factors, and working with others to develop and execute realistic, effective supervision and treatment plans.

Professional Workshops

The experts at ISW offer a wide range of professional development workshops. The following list provides examples of ISW workshops and seminars (please contact ISW if you would like a more comprehensive list):

Professional Training

Paraphilic interests are fairly common in men and include a wide variety of behaviors typically seen in clinical populations seeking evaluation and treatment for paraphilias.^[1] Those who most frequently seek psychiatric treatment for sex offenses are those accused of or involved in child molestation, voyeurism, exhibitionism, fetishism, frottage, and public masturbation.

Many psychiatrists are unfamiliar with the fundamentals of the assessment and treatment of individuals who sexually offend. The advent of laws for the civil commitment of persons who sexually offend has resulted in the need for psychiatrists trained in paraphilias. As a result of sexual offences legislature, the treatment and release decisions regarding individuals who sexually offend has become a focus of attention for psychiatry. Forensic psychiatrists or psychologists must render an opinion as to whether the person who has sexually offended has a diagnosed mental disorder and, as such, represents a risk to public safety if released from custody into the community. In order to render opinions regarding individuals who have sexually offended, forensic psychiatrists should be educated about the evidence based approach to the treatment and evaluation of this population.

The Institution for Sexual Wellness offers professional training clerkships for clinicians interested in learning more about the treatment and evaluation of persons who sexually offend. Individuals interested in participating in the clerkship should submit a letter of interest to Dr. Sorrentino.

Training Curriculum

The training consists of a two-week curriculum which includes the following:

WEEK ONE:

Tutorial in Risk Assessment Instruments: Trainees will be educated about the various risk assessment instruments used in sexual offence evaluations. More specifically, trainees will be educated about the research methodology and principles involved in the penile plethysmograph, ABEL screening test, and actuarials.

Conducting the Risk Assessment for Individuals who have Sexually Offended: Trainees will observe an evaluation conducted for a person who has sexually offended. The trainee will be educated about the specific questions asked in an evaluation for a person who has sexually offended..

Report Writing: Trainees will be asked to prepare a report of an individual who has sexually offended for the court. The report will not be submitted to the court, but will be used as a training exercise. Dr. Sorrentino will supervise the report.

WEEK TWO:

Testifying in Court: Trainees will observe courtroom testimony in sexual offense cases.

Clinical Treatment of Persons who have Sexually Offended: Trainees will sit in on group therapy with individuals who have sexually offended. In addition, trainees may observe individual therapy sessions including behavioral treatments such as aversive conditioning.

Trainees will participate in the weekly hormonal/antiandrogen clinic. This is a clinic devoted to the treatment of persons who have sexually offended  with testosterone lowering agents.

[1] Crepault C, Coulture M: Men’s erotic fantasies. Arch Sex Behav. 1980, 9:565-580.

ISW is frequently asked to offer attorney consultation in addition to being retained as experts for those involved in the legal system. Attorney consultation is available to assist with a multitude of issues, including the following topics:  dangerousness, insanity defenses, mitigation reports, competency to stand trial, recommendations for administering objective testing and psychological assessment, appropriateness for chemical castration and to evaluate treatment progress.

Evaluation of Physicians in the #MeToo Era

Too many physicians and health care administrators labor under the illusion that the medical profession is immune to sex- and gender-based bullying, harassment, discrimination, and abuse.  Even though the #MeToo Movement hasn’t yet fully penetrated the medical profession, the same problems of human behavior occur in the health care environment as occur in all other settings, despite high educational level, high intelligence, rigorous training, supervision by regulatory agencies, and training for mandated reporters to recognize abusive behaviors.

One need look no farther than the case of Dr. Larry Nassar to realize that abusive physicians can evade detection for years even while repeatedly abusing patients in front of others, with catastrophic results for their patients and employers.  In 2016, the Atlanta Journal-Constitution published the most extensive investigation ever conducted on physician sexual misconduct in the United States (Teegardin et al., 2016).  The series, entitled “Doctors & Sex Abuse,” uncovered more than 3,500 cases of sexual misconduct by physicians across the nation since 1999.  The authors suggest that these cases of sexual misconduct epitomize the medical culture that ignores, enables, and excuses sexual misconduct by physicians across the nation.

Renewed attention to the issue of sexual harassment presents an opportunity to address problematic sexual behaviors in physicians.  Such behaviors include gender biases, inappropriate sexual language, unwelcome touching, sexual harassment, unwanted sexual advances, coercive advances, and sexually abusive behaviors.  Acknowledging the problem of sexual misconduct by physicians is the first step toward prevention.  Addressing the problem starts with understanding the behavior, the investigative and preventive measures available, the risk for future behaviors, and the potential for rehabilitation.

One of the tools available is to refer physicians whose behavior has caused concern for a psychosexual evaluation by a clinician with specialized expertise.  A psychosexual evaluation is a clinical evaluation that provides an evidence-based assessment of the subject’s risk of engaging in future problematic sexual behaviors, identifies treatment needs, and recommends any necessary training, supervision, or monitoring for both that physician and other professionals in the same environment.  The psychosexual evaluation also informs whether the physician with problematic sexual behaviors is able to safely and competently practice medicine, also referred to as a Fitness for Duty Evaluation.

Physicians who engage in the following behaviors should be referred for a Fitness for Duty Evaluation that includes a psychosexual evaluation:

• Gender-biased behavior, e.g., referring to women as “girls” or locker room talk that does not respond to disciplinary action
• Sexual behavior inappropriate to the health care setting, e.g., showing pornography to others, taking unnecessary photos, or lewd comments during physical exams
• Sexually harassing behavior, e.g., insisting on social contact outside work or unwanted comments about appearance
• Behavior that is not well understood, e.g., a vague complaint from patients or co-workers that a physician is making others feel uncomfortable
• Any coercive or abusive sexual behavior, e.g., demands for sexual contact, rubbing or touching someone without consent, or rape

The #MeToo Movement is about medicine.  The national discourse on gender bias in the workplace includes healthcare institutions.  It is our responsibility as physicians to promote physician wellness by confronting the problem.  To assist in this mission, PD&A offers the following consultative services:

• Fitness for Duty Evaluations
• Referral to treatment programs for impaired physicians
• Consultation to healthcare institutions about high risk behaviors and risk reduction strategies

Reference:

Teegardin, C., Robbins, D., Ernsthausen, J., Hart, A. (2016, July 6).  License to Betray.  Atlanta Journal-Constitution.  Retrieved from http://doctors.ajc.com/doctors_sex_abuse/?ecmp=doctorssexabuse_microsite_nav

ISW has expanded our services. We now offer comprehensive evaluations and treatment of adults who deliberately set fires. We offer individualized treatment recommendations, and guidance for the supervision and management for individuals who engage in firesetting behavior or are at risk to do so. Our services are consistent with the current recommended best practices in this area, including use of the Multi-trajectory Theory of Firesetting (M-TTAF) model. Limited yet growing research exists pertaining to treatment and risk assessment of adults who have exhibited firesetting behaviors. ISW evaluators have been trained by the leading experts in this field. For further information, please contact info@instituteforsexualwellness.com.