2009
Annual Report on the Implementation
of Mental Hygiene Law Article 10
Sex Offender Management and Treatment Act of 2007
February 2010

New York State
Office of Mental Health
O
Michael F. Hogan, PhD
Commissioner

2009 Annual Report on the Implementation of MHL Article 10

Executive Summary
This is the third annual report to the Governor and Legislature on the implementation of the Mental Hygiene Law
(MHL) Article 10: The Sex Offender Management and Treatment Act (SOMTA). Specifically, MHL § 10.10(i) requires
the Commissioner for the NYS Office of Mental Health (OMH) to submit to the Governor and Legislature a report
on the implementation of this article and that:
“Such report shall include, but not be limited to, the census of each existing treatment facility, the
number of persons reviewed by the case review teams for proceedings under this article, the num­
ber of persons committed pursuant to this article, their crimes of conviction, and projected future
capacity needs.”
This report provides an overview of SOMTA and presents data on related assessment, litigation and treatment is­
sues. During the 12-month reporting period from November 1, 2008 through October 31, 2009, OMH reviewed
1,722 sex offenders with SOMTA-qualifying offenses and recommended 63 for civil management.
OMH operates two secure treatment facilities—a 150-bed secure treatment facility located within the Central New
York Psychiatric Center and an 80 bed secure treatment facility located in the grounds of St. Lawrence Psychiatric
Center. These two facilities, along with a temporary secure treatment unit within the Manhattan Psychiatric Cen­
ter located on Ward’s Island in New York City, have the capacity to provide secure treatment to 250 sex offend­
ers. As of October 31, 2009, 200 offenders were designated to a secure treatment facility. In addition, 46 were in
the community under a Strict and Intensive Supervision and Treatment (SIST) order and another 13 were incar­
cerated awaiting disposition of an alleged SIST or parole violation.
Rates of rearrest among referrals that were not recommended for civil management remain low. Overall, roughly
1.6% of those offenders were re-arrested for a sexual offense within a year of their release to the community, while
2.9% were re-arrested at the two-year mark.
OMH continues to develop and enhance treatment services at its secure treatment programs. During this reporting
period, OMH expanded its use of the penile plethysmograph (PPG) assessment process and developed and im­
plemented protocols for the use of selective serotonin reuptake inhibitors (SSRI) and anti-androgen therapy (AAT).
Between November 1, 2008 and October 31, 2009, OMH completed 57 annual reviews of civilly confined indi­
viduals in secure treatment. In one case, OMH determined that the individual was no longer a dangerous sex of­
fender requiring secure treatment and, upon OMH’s recommendation, the court released him to the community
under a SIST order. The court also released two other residents despite OMH’s finding that they continued to be
dangerous sex offenders in need of confinement. Both were released to the community under SIST orders.

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2009 Annual Report on the Implementation of MHL Article 10

Introduction
This report is submitted to Governor Paterson and the Legislature by the Commissioner of OMH pursuant to Ar­
ticle 10 of the MHL. Specifically, MHL § 10.10(i) requires the Commissioner to submit to the Governor and the Leg­
islature a report on the implementation of this article and that,
“Such report shall include, but not be limited to, the census of each existing treatment facility, the num­
ber of persons reviewed by the case review teams for proceedings under this article, the number of per­
sons committed pursuant to this article, their crimes of conviction, and projected future capacity needs.”
The following pages serve to review the history and implementation of MHL Article 10, which was enacted as part
of SOMTA. Part I of this report provides an overview of the legislative intent of SOMTA and the purpose of civil
management. Part II describes the assessment of sex offenders by OMH upon their admission to prison. Part III
of the report summarizes the assessment process employed by OMH to identify sex offenders in need of civil man­
agement. Part IV reviews the adjudication of Article 10 cases, while Part V presents information on the treatment
of individuals involved in civil management.

Part I: The Sex Offender Management and Treatment Act
SOMTA was enacted as Chapter 7 of the Laws of 2007, and became effective April 13, 2007. The legislation
amended sections of New York State’s Correction, County, Criminal Procedure, Executive, Judiciary, Penal, and
Mental Hygiene Laws, and the Family Court Act, and created an elaborate process for the civil management of
certain sex offenders upon completion of their prison terms. SOMTA also requires a risk assessment of sex of­
fenders by qualified staff upon their admission to prison, as well as prison-based sex offender treatment, to be
provided by DOCS, including residential treatment.
The assumptions underlying SOMTA were delineated in a series of Legislative Findings set forth in the MHL §10.01.
Specifically, the Legislature found that:
◆	 Recidivistic sex offenders who pose a danger to society should be addressed through comprehensive and in­
tegrated programs of treatment and management. {§ 10.01(a)}
◆	 Some offenders with mental abnormalities are predisposed to engage in repeated sex offenses. These offend­
ers may require long-term specialized treatment modalities to address their risk of re-offense. That treatment
should continue following incarceration. In extreme cases, confinement will need to be extended by civil
process in order to ensure treatment and protect the public. {§10.01(b)}
◆	 For other sex offenders, it can be effective and appropriate to provide treatment in a regimen of strict and in­
tensive outpatient supervision. Civil commitment should be only one element in a range of responses.
{§ 10.01(c)}
◆	 The system for responding to recidivistic sex offenders with civil measures must be designed for treatment and
protection. It should be based on the most accurate scientific understanding available, including the use of cur­
rent, validated risk assessment instruments. {§10.01(e)}
◆	 The system should offer meaningful forms of treatment to sex offenders in all phases of criminal and civil su­
pervision. {§ 10.01(f)}
◆	 Sex offenders in need of civil commitment comprise a different population with different needs from traditional
mental health patients. The civil commitment of sex offenders should be implemented in ways that do not en­
danger, stigmatize, or divert needed treatment resources away from traditional mental health patients. {§ 10.01(g)}
While the U.S. Supreme Court has determined that civil commitment for the purpose of incapacitation and treat­
ment (rather than punishment) is constitutional, it has placed limitations on government’s authority to civilly com­
mit sex offenders. Government does not have the authority to civilly commit a sex offender simply because he or
she is dangerous and has committed multiple offenses. Rather, civil commitment is authorized only in very limited
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2009 Annual Report on the Implementation of MHL Article 10

circumstances in which the sexual offending stems from a mental abnormality which results in serious difficulty in
controlling behavior.1 To the extent that other dangerous, repetitive sex offenders require long-term incapacitation,
it is incumbent upon the criminal justice system to insure that outcome through appropriate terms of incarceration.
SOMTA, through the creation of Article 10, established an elaborate process to review certain sex offenders in the
custody of “Agencies with Jurisdiction” for purposes of civil management.2 Article 10 requires OMH to evaluate
and recommend individuals for civil management and provide treatment to individuals found by the court to be
in need of civil management. More specifically, the statute provides for the Commissioner of Mental Health to em­
ploy multidisciplinary staff, case review teams, and psychiatric examiners to identify persons suffering from a
mental abnormality that predisposes them to sexual recidivism and may require civil management.3 It also requires
OMH to develop treatment plans for persons released to the community under “Strict and Intensive Supervision
and Treatment” (SIST) and to establish secure treatment facilities for persons deemed in need of confinement.

Part II: Assessment of Offenders at Intake to DOCS Custody
Under Correction Law Section 622, as enacted by SOMTA, sex offenders committed to the custody of the NYS De­
partment of Correctional Services (DOCS) are to be initially assessed by OMH staff knowledgeable regarding the
diagnosis, treatment, assessment or evaluation of sex offenders. The assessment includes, but is not limited to, a
determination of the offender’s risk of sexual recidivism and his or her need for sex offender treatment while in
prison. The assessment results are shared with DOCS for appropriate treatment program placement. In order to com­
ply with these requirements, an evaluation unit was established in 2007 at the Downstate Correctional Facility,
which accounts for approximately 50% of all sex offenders committed to the custody of DOCS. The OMH Sex Of­
fender Evaluation Unit (SOEU) at Downstate Correctional Facility is currently evaluating all inmates with sexual of­
fenses or sexually motivated felonies that are committed through that facility. More recently, OMH evaluations were
extended to cover admissions from Elmira Reception Center. Evaluations of admissions through Elmira are com­
pleted by OMH staff in the Bureau of Sex Offender Evaluation and Treatment (BSOET) at OMH Central Office.

Procedures at Downstate Reception Center:
Each day, Downstate Correctional Facility receives a “draft” of incoming inmates from county jails in the eastern
half of the State. To accomplish risk screens on all incoming inmates, every morning the SOEU reviews each in­
mate in the draft to identify those with SOMTA-qualifying offenses or designated felonies that appear to be sex­
ually motivated. This review identifies an average of two to three inmates per day with qualifying offenses. SOEU
staff generates rap sheets from the e-Justice and the National Crime Information Center (NCIC) systems, obtains
the pre-sentence investigation report (PSR) for the instant offense from DOCS, and gathers additional data on the
identified cases via searches of the DOCS and OMH databases. If needed, staff also contacts the Office of the Dis­
trict Attorney involved in the case to clarify risk-relevant aspects of the crime (e.g., relationship to victim), gath­
ers prior disciplinary tickets for sexual behavior in prison, and orders records from prior DOCS sex offender
treatment, if applicable. Each afternoon, the above-delineated information is disbursed to SOEU licensed psy­
chologists who complete an actuarial assessment of risk and, if indicated, conduct additional testing and prepare
a comprehensive report outlining dynamic risk factors, treatment needs and recommendations.
1	 Kansas v. Crane, 534 U.S. 407 (2002).
2	 MHL § 10.01(a) defines an Agency with Jurisdiction as “the agency responsible for supervising or releasing such person (sex offender) and can include the Department
of Correctional Services, the Office of Mental Health, the Office of Mental Retardation and Developmental Disabilities and the Division of Parole.”
3	 The definition of mental abnormality under New York’s statute is virtually identical to that of other states with SVP statutes. MHL Article 10 defines mental abnormality
as a “congenital or acquired condition, disease or disorder that affects the emotional, cognitive, or volitional capacity of a person in a manner that predisposes him or
her to the commission of conduct constituting a sex offense and that results in that person having serious difficulty in controlling such conduct.” Persons referred for
assessment for civil management include (1) sex offenders with qualifying offenses in the custody of DOCS who are approaching release, (2) persons under supervision
of the NYS Division of Parole who are approaching the end of their terms of supervision, (3) persons found not responsible for criminal conduct due to mental disease
or defect and who are due to be released, (4) persons found incompetent to stand trial and who are about to be released, and (5) persons convicted of sexual offenses who
are in a hospital operated by OMH and were admitted per the Executive Directive (Harkavy cases).
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Procedures at Elmira Reception Center:
Sex offenders adjudicated in the western part of the State are processed through the Elmira Correctional Facility.
To accomplish risk screens on all incoming sex offenders entered through Elmira, a clerk from Elmira Correctional
Facility’s admissions office identifies offenders with SOMTA qualifying offenses or designated felonies that appear
to be sexually motivated and sends a daily list to OMH BSOET located at OMH Central Office in Albany. On av­
erage, one to two inmates per day are referred to OMH.
For each offender identified with a SOMTA-qualifying offense, BSOET staff generates a rap sheet from e-Justice
and NCIC, requests a PSR for the instant offense from DOCS, and requests records regarding the instant offense
from the Office of the District Attorney who prosecuted the case. As with SOEU staff, BSOET staff also may seek
prior PSRs from DOCS if the offender has served a prior prison term for a sexual offense as well as prior incar­
ceration disciplinary tickets for sexual offenses, and prior DOCS sex offender treatment records. These cases are
then assigned to clinicians in the Risk Assessment and Record Review (RARR) unit within OMH BSOET who com­
plete an actuarial risk assessment, results of which are shared with the DOCS Counseling and Guidance unit on
a weekly basis. If indicated, RARR clinicians also prepare a written report outlining dynamic risk factors and treat­
ment needs and recommendations.
Of the cases screened during the reporting period of November 1, 2008 to October 31, 2009, 42% involved an en­
hanced evaluation that included a detailed examination of dynamic risk factors and treatment needs.

Part III: Assessment of Sex Offenders for Civil Management
OHM has established a Risk Assessment and Record Review (RARR) unit to evaluate all offenders convicted of
qualifying offenses who are referred for assessment under Article 10 (see Table A-1 in appendix for a list of all
qualifying offenses). Each assessment involves the review of multiple records including, but not limited to, police
reports, victim statements, court transcripts, pre-sentence reports, and correctional and mental health records. The
goal of the assessment process is to identify and refer sex offenders who suffer from a mental abnormality and
pose a high risk for sexual recidivism as defined in the statute.
The first step in the review process is to ensure that the referred individual has been convicted of a qualifying of­
fense. Once a qualifying offense has been confirmed, the next step is to determine whether or not the referred
individual has a sexual offense history that involves more than one victim. While the absence of multiple victims
does not preclude a case from moving forward for civil management, single-victim cases are only moved forward
when the case involves indications of murder, torture, sexual sadism, or statements of intent to re-offend.4 The
presence of multiple victims is relevant to establishing volitional impairment resulting in the individual having se­
rious difficulty controlling his or her behavior.5

Actuarial Assessments
Once it has been determined that the qualifying offense and multiple victim criteria have been met, decisions re­
garding further review are guided, though not exclusively determined, by the individual’s score on an actuarial
risk assessment known as the Static-99. This highly researched and validated actuarial risk assessment tool is de­
signed to assist in the prediction of sexual recidivism (defined as a new criminal charge or conviction) among male
sex offenders. The instrument includes measurements of criminal history, age at the time of scheduled release,
prior cohabitation with intimate partner(s), victim gender, and victim-offender relationship. Based on research

4	 A single victim case is defined as a case where there is evidence of only one sexual offense victim in the record. If any record reveals multiple victims of contact and/or
non-contact sexual offenses, the case is identified as having more than one victim. In addition, if a case involves an individual who sexually offended against a single
victim and then after being sanctioned for that offense, committed another sexual offense against the same victim, the case is viewed as having more than one victim.
5	 While single-victim cases involving murder, torture, or sexual sadism can be forwarded for CRT review, the purpose of doing so is to closely review the individual’s his­
tory to identify factors that suggest a pattern of behavior, i.e., multiple victims or intent to reoffend.
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2009 Annual Report on the Implementation of MHL Article 10

within and outside the U.S., the Static-99 classifies sex offenders into one of 10 levels of risk based on their his­
tory. Each Static-99 risk level has a particular expected rate of sexual recidivism. OMH staff has been trained in
the use of this actuarial instrument by certified trainers to ensure proper implementation.
In April 2009, the RARR unit implemented a second risk assessment instrument known as the Screening Scale for
Pedophilic Interests (SSPI).6 The SSPI provides OMH staff a standardized way to measure the extent of sexual in­
terest an offender may have toward children. It is used for any male sex offender who has at least one child vic­
tim age 13 or younger. The presence of pedophilic interest is a significant research-based risk factor for sexual
recidivism. That is, research studies have shown the SSPI score to be positively correlated with sexual recidivism.7
Moreover, results of the SSPI have been shown to correlate with those of other measures of pedophilic interest
such as the penile plethysmograph (PPG).8

Multidisciplinary Review Team and Case Review Team Assessments
Two separate clinical teams are utilized in the civil management review process. The Multidisciplinary Review
(MDR) team, comprised of three randomly selected clinicians with extensive training and expertise in sex of­
fender assessment, completes initial reviews of cases by examining risk and protective factors, diagnosis, treatment,
and/or management of sex offenders. Through this initial assessment, the MDR team determines whether or not
the case should be referred to the Case Review Team (CRT) for a more comprehensive and in-depth evaluation.
Sex offenders who meet the risk thresholds established for the MDR team enter a second level of review conducted
by the CRT. Like the MDR team, the CRT also is comprised of three staff (two of whom were not part of the MDR
team) with expertise in the assessment of sex offenders. The CRT undertakes an in-depth review of the causes
and patterns of the individual’s sexual offending, his or her criminal, mental health, and substance abuse history,
and related problem behaviors while incarcerated and during periods of supervision. If the initial CRT review in­
dicates that civil management may be warranted, the CRT requests that a psychiatric examiner evaluate the re­
spondent for the presence of a mental abnormality, as defined by statute.
When the CRT requests a psychiatric examination a licensed psychologist conducts a detailed psychological ex­
amination to assess for mental abnormality, using methods approved by clinical and professional practice groups.9
The findings from this evaluation are incorporated into a report which is presented to the CRT for final determi­
nation as to whether or not the individual is in need of civil management. Based upon information obtained from
the psychiatric evaluation, as well as the comprehensive record review, the CRT makes a determination whether
or not to refer the individual to the New York State Office of the Attorney General (OAG) to seek civil manage­
ment. OMH then issues a Notice of Determination to the relevant parties (e.g., referring agency, OAG, referred
individual) noting its finding on the issues of mental abnormality, likelihood to re-offend, and the need for civil
management. The decision to refer for civil management must be unanimous among CRT members. The CRT does
not make recommendations as to whether the individual is a dangerous sex offender in need of civil confinement
or a sex offender in need of SIST. The dangerousness determination is made by the court, subsequent to the find­
ing of mental abnormality based upon the report and the testimony of the psychiatric examiner. The psychiatric
examiner may speak to the risk levels warranting confinement or a SIST determination.10

6	 Seto, Michael C., & Lalumiere, Martin L. (2001) A Brief Screening Scale to Identify Pedophilic Interests Among Child Molesters. Sexual Abuse: A Journal of Research and
Treatment, 13(1), 15-25.
7	 Seto, M. C., Harris, G. T., Rice, M. E., & Barbaree, H. E. (Oct. 2004) The Screening Scale for Pedophilic Interests Predicts Recidivism Among Adult Sex Offenders With Child
Victims. Archives of Sexual Behavior, 33(5), 455-466.
8	 Ibid.
9	 Clinicians follow protocols and practices recommended by the American Psychological Association and the Association for the Treatment of Sexual Abusers.
10 Sex offenders requiring civil management include “dangerous sex offenders requiring confinement” and those appropriate for “strict and intensive supervision and treat­
ment” (SIST). A “dangerous sex offender requiring confinement” means a person who is a detained sex offender suffering from a mental abnormality involving such
a strong predisposition to commit sex offenses, and such an inability to control behavior, that the person is likely to be a danger to others and to commit sex offenses if
not confined to a secure treatment facility. A sex offender requiring SIST means a detained sex offender who suffers from a mental abnormality, but is not a dangerous
sex offender requiring confinement.
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The Static-99 score is the initial determiner of the path the case will take through the review process. Prior to 2009,
OMH targeted those scoring “6” or higher to by-pass screening by the MDR team and move directly to a more in­
tensive review by the CRT. A threshold of “6” was selected based on the research with the belief that individuals
at that level of risk had an expected rate of sexual recidivism of approximately 40% over a 10-year follow-up pe­
riod. In late 2008, however, the developers of the Static-99 revised the expected rates of sexual recidivism based
upon more recent studies of sexual recidivism across all risk levels. The more recent studies indicated that the ex­
pected rates of recidivism for today’s offenders are lower (at each level of the Static-99) than what occurred 10
years ago when the Static-99 was first developed and normed (the original norms were based on groups of of­
fenders released from prison during the 1970s and early 1980s). In fact, the 40% 10-year recidivism rate was found
to be more akin to today’s Static-99 level 7. Based upon this finding and in consultation with Dr. R. Karl Hanson,
developer of the Static-99, the guidepost for immediate, intensive screening by the CRT was adjusted in early
2009 from a level “6” to a level “7.”
Offenders scoring a “7” or higher on the Static-99 would by-pass screening by the MDR team and move immedi­
ately to the CRT screening unless: 1) the offender had at least one year of parole supervision remaining on his
term and had not, in the past, exhibited improper sexual behavior while under probation or parole supervision,
or; 2) the offender’s records indicate nothing more serious than a low-level felony offense (e.g., “persistant sex­
ual abuse”) involving repeated misdemeanor level “forcible touching” or repeated misdemeanor level “sexual
contact.” In such cases, these offenders would be first screened by the MDR team and a determination about
whether or not to refer the case to the CRT for further review would be made.
The updated recidivism estimates by the developer of the Static 99 and the increased weight OMH review proto­
cols placed on the protective factor of parole supervision did alter the probability that cases with these charac­
teristics would result in a civil management recommendation. In fact, the adjustments to the risk assessment
process that were made in early 2009 resulted in a decline in referrals for civil management to OAG from 2008.
This decline has occurred largely among cases with significant parole time left on their sentences. Upon comple­
tion of that supervision, these offenders can be re-referred to OMH by Parole for consideration for referral to
OAG for civil management, in effect providing the opportunity for a second assessment as to the need for civil
management.
The OMH RARR process is summarized on the following page in Figure 1.

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2009 Annual Report on the Implementation of MHL Article 10


Figure 1

Risk Assessment and Record Review (RARR) Civil Management Review Process

No Further
Review

Does the offender have a qualifying offense?

RARR clinician staff complete the Static·99 unless contraindicated by Static·99
(see 2003 Coding Manual)

No Further
Review

Is there evidence of more than one victim in the record? - Does the offense involve Sadism, Murder or
Torture? Are there statements of intent to re·offend?

If Static-99 Score of 3 or less - Does the offense involve Sadism, Murder or Torture?
Are there statements of intent to re-offend? Is a combination of psychopathy and sexual deviance present? , . _...~

No Further
Review

Is there at least 1year of
supervision upon release and
the offender has no history of
t---.,sexual offending andlor sexual
acting-out behaviors while on
supervision?

No Further
Review

Using Research Based
Considerations, MDR Team
Determines whether Individual
Needs Further Review by the
CRT

No Further
Review

• RARR clinicians maintain the ability to refer offenders
who have a Static-99 score of4 or higher directly to
CRT, ifsufficient research-based factors are present.

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2009 Annual Report on the Implementation of MHL Article 10

Results of civil management screening by OMH
From November 1, 2008 to October 31, 2009, 1,798 cases were reviewed by OMH for possible civil management.
Of those, 76 referrals (4.2%) were deemed not to have committed a SOMTA-qualifying offense.11 Of the 1,722 re­
ferrals qualifying for review, 1,598 (92.8%) were referred from the Department of Correctional Services (DOCS), 119
(6.9%) were referred from the Division of Parole, and 5 (0.3%) were referred from the Office of Mental Health (OMH)
or the Office of Mental Retardation and Developmental Disabilities (OMRDD). The 1,722 referrals involved 1,686
unique offenders, as some offenders were referred and reviewed more than once during the reporting time period.
Of the 1,686 offenders qualifying for review, 194 (11.5%) were referred for further review by the CRT, of which
63 (3.7%) were recommended for civil management. Characteristics of the offenders’ criminal histories, SOMTAqualifying offenses, and sexual recidivism risk scores are displayed in Tables 1 and 2. As shown, those offenders
referred to the OAG for pursuit of civil management have more extensive sexual offense histories, more frequent
incarcerations, higher risk scores, and were less likely to have parole time remaining on their sentences than those
not referred for civil management. As noted in Table 2, sex offenders referred to the OAG for civil management
averaged 5.8 years in DOCS custody prior to their first release on the sentence underlying their Article 10 refer­
ral. Of respondents referred to the OAG during the reporting period, 24% did not have a record of participating
in DOCS sex offender treatment, while the remaining 76% averaged 6.9 months in DOCS sex offender treatment
prior to their release.
From April 13, 2007 to October 31, 2009, 185 decisions regarding civil management have been handed down by
the courts. Mental abnormality was found in 171 (92.4%) of the trials, 99 of which resulted in a finding that the
respondent is a dangerous sex offender requiring confinement and 72 resulted in SIST determinations.12
The current rate of referral for civil management (3.7%) is similar to those of other states with similar referral
processes. For example, in California and Florida, the two largest states with similar review processes (whereby
all prison releases are screened for civil management) 2.3% (California) and 1% (Florida) of all referrals result in
confinement. Likewise, in Washington and Minnesota (other states with a similar referral and review processes),
the commitment rates are 1.3% and 1.5%, respectively.

11 Between November 1, 2008 and October 31, 2009, the RARR unit reviewed 1,686 offenders for civil management consideration. The RARR unit, however, completed 1,798
reviews (i.e., some offenders had multiple reviews) during this same time period.
12 Probable cause was not found in two of the 185 cases. Additionally, the court found in favor of the respondent in 12 of the cases.
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Table 1

Characteristics of Offenders Reviewed Under SOMTA
Characteristics of Referrals 1

No CRT
(n = 1450)

CRT, No CM
(n = 131)

CM
(n = 63)

74.9%
22.2%
2.7%
0.1%
3.0 (2.0)

10.0%
31.3%
54.2%
4.6%
6.0 (2.0)

1.6%

19.1%
54.0%
25.4%
7.0 (1.0)

72.9%
16.6%

97.7%
51.1%

98.4%
66.7%

13.9%
73.1%

27.5%
58.9%

46.0%
63.5%

(n = 135)

(n = 32)

(n = 39)

2.7 (1.4)

3.4 (1.6)

4.6 (0.8)

Characteristics of Instant Offense

(n = 1492)

(n = 131)

(n = 63)

Percent PL 130 Offense
Rape
Sexual Abuse
Criminal Sexual Act (Sodomy)
Other PL 130
Percent other sexual offense
Percent designated felony 5

88.0%
38.8%
26.2%
18.4%
4.6%
0.9%
11.1%

84.7%
38.9%
28.2%
14.5%
3.1%
0.8%
14.5%

85.7%
23.8%
31.7%
30.2%
0.0%
1.6%
12.7%

(n = 1485)

(n = 131)

(n = 63)

Percent New York City
Percent suburban New York City
Percent upstate new York

28.0%
10.6%
61.4%

33.1%
7.7%
59.2%

31.8%
7.9%
60.3%

Parole Time Remaining on Sentence

(n = 1492)

(n = 131)

(n = 63)

55.3%

51.5%

38.1%

Static 99 Risk Score

Percent 0-3
Percent 4-5
Percent 6-7
Percent 8 or higher
Average score (Standard Deviation - SD)

Victim/Offender Relationship 2
Percent unrelated
Percent stranger

Characteristics of Victims in History
Percent male victim
Percent with "child victim" charge in criminal history 3

SSPI Score 4
Average score (SD)

Region of Last Conviction Prior to SOMTA Review 6

Percent with at least 1 year
Notes: No CRT = Case was not referred to CRT review; CRT, No
CM = Case was reviewed by CRT, but not recommended for
Civil Management; CM = Case was recommended for Civil
Management.
1 42 Offenders were not scored with the Static-99; 14 were Adoles­
cent at the time of offense, 22 were Female offenders, and 6 had
the Presence of Only a Category B Offense. Also, an additional 36
offenders were referred to OMH for SOMTA review, but were
deemed to not have committed a SOMTA-qualifying offense.

January 2010

2 Victim/Offender Relationship was defined as outlined in the
Static-99 coding manual.
3 OMH had the data for all cases
4 SSPI data was available starting April 2009.
5 See Table A-1 for a listing of designated felonies.
6 OMH did not have the Region of Last Conviction for 7 offenders
who did not go onto CRT.

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Table 2

Criminal Histories of Offenders Reviewed Under SOMTA
Criminal History of Referrals

No CRT
(n = 1486) 1

CRT, No CM
(n = 130) 1

CM
(n = 63) 1

4.6 (4.9)
75.7%

7.2 (5.7)
91.5%

6.4 (4.7)
93.7%

2.7 (2.4)
59.6%

4.0 (3.3)
80.8%

3.6 (2.2)
85.7%

4.0 (4.2)
70.5%

6.3 (5.2)
86.9%

5.5 (4.3)
90.5%

1.8 (1.3)
44.9%

2.5(2.0)
64.6%

2.4 (1.4)
76.2%

1.2 (0.6)
19.7%

2.0 (1.4)
59.2%

2.5 (1.5)
74.6%

1.2 (0.6)
17.4%

1.9 (1.4)
55.4%

2.4 (1.4)
76.2%

1.6 (0.9)
26.4%

1.8 (1.7)
42.3%

1.9 (1.1)
63.5%

0.6 (0.8)
10.6%

0.8 (1.0)
21.5%

0.6 (0.7)
11.1%

4.9 (4.5)
52.5%

6.1 (5.8)
57.8%

5.8 (6.5)
57.1%

Arrests Prior to SOMTA Review
Average number (SD)
Percent 2 or more
Felony Arrests Prior to SOMTA Review
Average number (SD)
Percent 2 or more

Convictions Prior to SOMTA Review
Average number (SD)
Percent 2 or more

Felony Convictions Prior to SOMTA Review
Average number (SD)
Percent 2 or more

Sexual Arrests Prior to SOMTA Review
Average number (SD)
Percent 2 or more

Sexual Convictions Prior to SOMTA Review
Average number (SD)
Percent 2 or more

Prison Sentences Prior to SOMTA Review
Average number (SD)
Percent 2 or more

Probation Sentences Prior to SOMTA Review
Average number (SD)
Percent 2 or more

Time Spent in DOCS on SOMTA Offense (excl. jail) 2
Average number of years (SD)
Percent 3 years or more
Notes: No CRT = Case was not referred to CRT review; CRT, No
CM = Case was reviewed by CRT, but not recommended for
Civil Management; CM = Case was recommended for Civil
Management.
1 OMH did not have the criminal history of 6 offenders that did
not go onto CRT and 1 offender who the CRT ruled no CM. An

January 2010

additional 36 offenders were referred to OMH for SOMTA re­
view, but were deemed to not have committed a SOMTA-quali­
fying offense.
2 Data were available only for Respondents who were consid­
ered a New Commitment by DOCS.

10

New York State Office of Mental Health

2009 Annual Report on the Implementation of MHL Article 10

Timeliness of Civil Management Determinations
OMH strives to complete the review process for civil management referrals through issuance of a Notice of De­
termination at least ten business days prior to an offender’s release date. As can be seen in Table 3, on average,
OMH makes these determinations 27 business days prior to an offender’s release. This represents an increase of
over two weeks (16 days) compared to the previous year.
Table 3

Number of Business Days between Respondent Release Date
and the Notice of Determination
Average Number of Business Days
Between Offender Release Date
and the Notice of Determination

Month

November 2008 ............................................................................................................................................10

December 2008 ..........................................................................................................................................20

January 2009................................................................................................................................................23

February 2009 ..............................................................................................................................................24

March 2009 ..................................................................................................................................................25

April 2009 ....................................................................................................................................................24

May 2009......................................................................................................................................................38

June 2009 ....................................................................................................................................................40

July 2009 ......................................................................................................................................................42

August 2009 ................................................................................................................................................36

September 2009 ..........................................................................................................................................15

October 2009 ................................................................................................................................................24

Average for the Annual Review Reporting Period ......................................................................................27


Post release arrests of individuals not referred for civil management
Re-arrest data were available on 2,722 offenders evaluated under SOMTA since its inception, deemed not to be
in need of civil management, and released from DOCS. An analysis was conducted to determine the rates of re­
arrest for these offenders, both any re-arrest and sexual re-arrest, during their time in the community (i.e., post
civil management review). Because these individuals varied in terms of their “time at risk” in the community, a
statistical technique termed “survival analysis” was employed to measure the extent of recidivism. Survival analy­
sis essentially develops a “best estimate” of recidivism over time for an entire sample given the patterns of re­
cidivism occurring among sub-samples “at risk” for various amounts of time.
Figure 2 provides a “best estimate” of re-arrest (for any offense) for those individuals who were released from
DOCS custody subsequent to an OMH decision to not pursue civil management. The blue line represents persons
categorized as low risk by the Static-99 (score “0-1”), the yellow line represents those offenders categorized as
medium-low risk by the Static-99 (score “2-3”), the black line represents those offenders categorized as mediumhigh risk by the Static-99 (score “4-5”), and the red line represents persons with a Static-99 score of “6” or higher
(high risk). Across all four groups of offenders, approximately 17% were re-arrested within their first year of release,
while 28% were re-arrested within their first 2 years of release. The re-arrest rate was highest at the 1-year mark for
those offenders scoring “4” or “5” on the Static-99 (re-arrest rate of 25%) and highest at the 2-year mark for those
offenders scoring a “6” or higher on the Static-99 (42%). It should be noted that the group of offenders scoring “6”
or higher is relatively small and, thus, provides less stable estimates toward the end of the analytic period.

January 2010

11

New York State Office of Mental Health

2009 Annual Report on the Implementation of MHL Article 10

Figure 2

Survival Analysis of Re-Arrest for Any Offense Post Release from DOCS
100%

90%

80%

Percent Re-arrested

70%

60%
50%

High

40%

Med-high

30%

Med-low

20%
10%

Low

0%
0

60

120

180

240

300
360
420
480
Days since DOCS release

540

600

660

720

Figure 3 shows the trend in re-arrest for a sexual offense for the entire group of releases. This analysis is not pro­
vided by risk level because the rates of re-arrest were so low that estimates for subgroups lacked stability. Over­
all, roughly 1.6% of the offenders were re-arrested for a sexual offense at the one-year mark, while approximately
2.9% were re-arrested for a sexual offense at the two-year mark. Over 80% of the rearrests involved misdemeanor
or low-level (Class E) felony charges. Thus, approximately one half of one percent were rearrested for higher-level
felony sex offense. Forcible touching was the most common type of charge. More “time at risk” and larger sam­
ple sizes are needed, however, to reliably discern differences in patterns of sexual recidivism across risk groups.

Figure 3

Survival Analysis of Re-Arrest for a Sexual Offense Post Release from DOCS
50%
45%
40%
Percent re-arrested

35%
30%
25%
20%
15%
10%
5%
0%
0

January 2010

60

120

180

240

300
360
420
480
Days since DOCS release

12

540

600

660

720

New York State Office of Mental Health

2009 Annual Report on the Implementation of MHL Article 10

Part IV: The Adjudication of Article 10 Referrals

Between the effective date of Article 10 (April 13, 2007) and October 31, 2009, OMH has referred 356 sex offenders
to the OAG for civil management adjudication, 63 of whom were referred during the reporting period November
1, 2008 thru October 31, 2009.13
Article 10 provides that within 30 days of the filing of the sex offender civil management petition, the Court shall
conduct a hearing to determine whether or not there is probable cause to believe the Respondent is a sex offender
with a mental abnormality, as defined by statute. From November 1, 2008 to October 31, 2009, 84 probable cause
determinations have occurred. Since inception of SOMTA, all but two hearings resulted in an affirmative finding
of probable cause.
The litigation in civil management cases is often protracted, requiring multiple court proceedings and appearances
by OMH psychiatric examiners. Figure 4, below, shows the percent of cases reaching disposition by the number
of days since probable cause determination. As can be seen, fewer than 60% of the cases were disposed within
one year of the probable cause determination.
Figure 4

Survival Analysis of Time to Disposition in Article 10 Cases
100%
90%
80%

Percent disposed

70%
60%
50%
40%
30%
20%
10%
0%
0

60

120

180

240
300
360
420
480
Days since probable cause determination

540

600

660

720

13 Sixty of the cases referred prior to November 1, 2008 were “Harkavy cases” that were re-evaluated under Article 10.
January 2010

13

New York State Office of Mental Health

2009 Annual Report on the Implementation of MHL Article 10

Article 10 trial process
Article 10 respondents have the right to a trial by jury. The jury, or court if a jury trial is waived by the respon­
dent, must determine (by unanimous vote) whether a respondent is a “detained sex offender who suffers from a
mental abnormality.” The burden of proof, placed upon the OAG, is one of “clear and convincing evidence.” If
the jury, or court if a jury trial is waived, finds that the respondent suffers from a mental abnormality, the trial judge
must determine whether the respondent is a dangerous sex offender requiring confinement or a sex offender re­
quiring strict and intensive supervision and treatment (SIST). As with the earlier phase of trial, the standard of proof
for the dangerousness determination is one of “clear and convincing evidence.”
As of October 31, 2009, 185 decisions regarding civil management have been handed down by the court since
SOMTA’s enactment in 2007. Mental abnormality was found in 171 of the cases (92.4%), 99 of which resulted in
a finding that the respondent is a dangerous sex offender requiring confinement and 72 of which resulted in SIST
determinations.
Sex offenders involved in the civil management process receive treatment within an OMH secure treatment facil­
ity if they are placed there pending trial or have been adjudicated as a dangerous sex offender requiring con­
finement. Those adjudicated as sex offenders requiring civil management, but not adjudicated as dangerous sex
offenders, are released to the community under a SIST order. As of October 31, 2009, 100 respondents were in
secure treatment pre-trial awaiting adjudication, 100 were in secure treatment as dangerous sex offenders requir­
ing confinement, and 46 were under active SIST orders. Three-fifths of those adjudicated as a dangerous sex of­
fender consented to confinement rather than proceeding to trial.
Table 4 shows the criminal histories and Static-99 scores of those respondents who, based on the initial court de­
cision, were placed on SIST or civilly confined in an OMH facility. The SIST placements are grouped by whether
OMH recommended the placement. As shown, over one-third of the SIST placements were not recommended by
OMH. Moreover, the SIST placements who were not recommended by OMH had more extensive criminal histo­
ries than the SIST placements that had been supported by OMH. For example, SIST placements not recommended
by OMH averaged 3.3 sexual offense arrests prior to SOMTA review, while those recommended for SIST averaged
2.1 such arrests.

January 2010

14

New York State Office of Mental Health

2009 Annual Report on the Implementation of MHL Article 10

Table 4

Offenders Reviewed Under SOMTA and Placed on SIST or Civilly Confined
Original Decision of SIST or Confinement

Court Order to SIST

Court Order
to Confinement

SIST
Recommended
by OMH (n = 45)

SIST
Not Recommended
by OMH (n = 27)

Inpatient
(n = 99)

(n = 44) 1

(n = 27)

(n = 96) 1

5.8 (4.4)
88.6%

9.0 (10.2)
96.3%

7.1 (7.7)
94.8%

3.3 (2.1)
81.8%

4.0 (2.7)
88.9%

3.5 (2.7)
79.2%

5.1 (4.2)
84.1%

7.9 (10.1)
96.3%

6.2 (6.8)
90.6%

2.1 (1.0)
63.6%

2.5 (1.5)
70.4%

2.3 (1.4)
67.7%

2.1 (1.2)
61.4%

3.3 (5.6)
74.1%

2.7 (1.8)
75.0%

1.9 (1.0)
59.1%

3.1 (5.9)
63.0%

2.5 (1.9)
70.8%

1.6 (1.0)
45.5%

1.6 (0.7)
51.9%

1.7 (1.0)
47.9%

Average number (SD)
Percent 2 or more

0.6 (0.9)
13.6%

0.7 (0.9)
22.2%

0.8 (0.9)
17.7%

Characteristics of Referrals

(n = 45)

(n = 27)

(n = 99)

Static 99 Risk Score
Percent 0-3
Percent 4-5
Percent 6-7
Percent 8 or higher
Average score (SD)

15.6%
28.8%
44.5%
11.1%
6.0 (2.0)

3.7%
29.7%
51.8%
14.8%
6.0 (1.0)

8.1%
25.3%
53.5%
13.1%
6.0 (2.0)

80.0%
37.8%

81.5%
40.7%

79.5%
36.4%

20.0%

33.3%

38.6%

Criminal History of Referrals
Arrests Prior to SOMTA Review
Average number (SD)
Percent 2 or more

Felony Arrests Prior to SOMTA Review
Average number (SD)
Percent 2 or more

Convictions Prior to SOMTA Review
Average number (SD)
Percent 2 or more

Felony Convictions Prior to SOMTA Review
Average number (SD)
Percent 2 or more

Sexual Arrests Prior to SOMTA Review
Average number (SD)
Percent 2 or more

Sexual Convictions Prior to SOMTA Review
Average number (SD)
Percent 2 or more

Prison Sentences Prior to SOMTA Review
Average number (SD)
Percent 2 or more

Probation Sentences Prior to SOMTA Review

Victim/Offender Relationship 2
Percent unrelated
Percent stranger

Characteristics of Victims in History 2
Percent male victim
Notes: SIST Recommended = SIST Team Recommended SIST and
the Respondent was released onto SIST. SIST Not Recommended = SIST team did not recommended SIST and the Respondent was released onto SIST. Inpatient = Respondent is
confined and has never been on SIST.

January 2010

1 OMH did not have the criminal history of 1 Respondent that the
SIST team recommended SIST and 3 Respondents who were in
inpatient treatment.
2 Victim/Offender Relationship was defined as outlined in the
Static-99 coding manual.

15

New York State Office of Mental Health

2009 Annual Report on the Implementation of MHL Article 10

Part V: Treatment Within Civil Management
Strict and Intensive Supervision and Treatment
Article 10 provides for either confinement in secure treatment or management into the community under a SIST
order, depending on the Court’s dangerousness determination. New York and Texas are the only states that statu­
torily authorize the placement of civilly managed sex offenders directly into the community. The Texas statute pro­
vides for only community-based civil management of sex offenders, although, in practice, Texas often utilizes
local jails and other correctional facilities as community residences for the purpose of civil management.
In New York, the primary goal of SIST is to successfully manage, in the community, sex offenders who are deter­
mined to suffer from mental abnormalities that predispose them to commit sexual offenses, but who are not deemed
to be dangerous enough to require civil confinement. SIST provides increased public protection through manda­
tory treatment and intensive supervision, while avoiding the high costs associated with confinement in a secure treat­
ment facility. Since the inception of SOMTA through October 31, 2009, 77 individuals have been subject to a SIST
order, 38 of whom were ordered onto SIST between the reporting period of November 1, 2008 and October 31,
2009. Approximately half of the SIST individuals were simultaneously serving a parole term. Of the 77 individuals
who have been subject to SIST, nine have subsequently been civilly confined in an OMH secure treatment facility
for SIST violations, 13 are in local custody and pending further proceedings for violating their SIST conditions, six
are in the custody of DOCS, 14 three are waiting to be released into the community, and 46 remain in the commu­
nity under active SIST orders (see Table 5).
Table 5

Respondents Placed on SIST as of October 31, 2009
SIST Activity

Number

Total SIST Orders..........................................................................................................................................................77

Active SIST Orders ......................................................................................................................................................68

Respondents on Parole and SIST (active orders) ........................................................................................................35

Respondents on SIST Alone (active orders) ................................................................................................................33

Respondents in Community..........................................................................................................................................46

Respondents with a SIST Order – Release Pending ......................................................................................................3

Upon receipt of a SIST order, OMH SIST staff, located within BSOET, begins to facilitate reintegration of SIST respondents through community reintegration conference calls among SIST team members (OMH, community based
treatment providers, secure treatment facility clinicians, and the Division of Parole). The purpose of the reinte­
gration conference call is to coordinate and share information critical to effective management in the community.
When a sex offender is placed on SIST, s/he agrees to abide by specific court-issued conditions, which are typi­
cally based upon the recommendations of Parole in consultation with OMH and the designated community based
treatment provider(s). These conditions are extensive and mirror specialized conditions imposed on sex offend­
ers subject to traditional parole supervision and often involve global positioning satellite (GPS) tracking, polygraph
monitoring, specification of residence, prohibiting contact with identified past or potential victims, type and fre­
quency of treatment sessions, and other related treatment and supervision requirements. Further specifications gen­
erally include abiding by curfews and abstaining from drinking alcohol, using illicit drugs, possessing pornography,
and using the internet.
Parole is responsible for monitoring individuals on SIST, implementing the supervision plan, and assuring com­
pliance with court-ordered conditions. Sex offenders placed on SIST often participate in multiple treatment pro­

14 Two of these six are in DOCS custody for a new charge.
January 2010

16

New York State Office of Mental Health

2009 Annual Report on the Implementation of MHL Article 10

grams in the community (see Table 6), and OMH and community based treatment providers work closely with
Parole to ensure compliance with all SIST conditions. Supervision/treatment team members participate in monthly
interagency case management meetings to review the progress of the individual and ensure that any necessary
revisions in the supervision/treatment plan are identified and implemented in a timely manner.
As of October 31, 2009, all SIST participants were referred for sex offender treatment, while 53% were referred
for substance abuse treatment, and 30% were referred for mental health treatment (see Table 6).
Table 6

Treatment Services Utilized by Respondents on SIST Orders
Treatment Services

% Referred and Utilized

Sex Offender Treatment..........................................................................................................................................100%

Substance Abuse Treatment ....................................................................................................................................53%

Mental Health Treatment..........................................................................................................................................30%

Case Management Services ......................................................................................................................................8%

iIle'X offender treatment under SIST
SHiT is
iill hased.
cmmitive-hehavioral model.
inCOT'JXll'3tecl aa relanse
oreAll sex
based unon
upon a cognitive-behavioral
model, and incorporates
relapse prevention component. The treatment team seeks to assist the offender in gaining and maintaining control over crim­
inal sexual behaviors, deviant conditions and arousal patterns, and other life issues that may contribute to
re-offending. Reviews of current sex offender research literature indicates that sexual offense specific treatment,
coupled with intensive community supervision and regular use of polygraphs (commonly known as the contain­
ment model) is an effective method to manage high-risk sex offenders in the community. The containment model
has been found to significantly reduce sexual offense recidivism and, where appropriate, can significantly reduce
the cost of civil management relative to placement in secure treatment.

Housing and treatment availability remain significant challenges in the SIST plan development process. A large
portion of counties and municipalities throughout the State have residency restrictions for sex offenders.15 As
shown in Table 8, nearly half of SIST participants who are at liberty in the community reside in hotel/motels, shel­
ters or are undomiciled, while a little over one-quarter reside in housing programs. Moreover, many communities
throughout New York State have no sexual offense specific treatment services to offer SIST respondents, and
other communities with existing services are reluctant to accept SIST cases, especially sex offenders from other
counties without qualified sex offender services of their own. The problem is particularly acute in rural areas
where the distance between residences and treatment services is often significant and public transportation is un­
available. In many such cases, OMH has to pay for transportation to and from treatment in addition to paying for
the sex offender treatment itself.
Table 7

Type of Residence Utilized by Active Respondents on SIST orders as of October 31, 2009
SIST Housing Type

Frequency

Percent

DSS/Undomiciled

8

17.4

Family/Friends

9

19.6

Hotel/Motel

8

17.4

13

28.3

Own House/Apartment

2

4.3

OMRDD

1

2.2

Shelter

5

10.8

46

100

Housing Program

Total

15 At least 19 counties have countywide residency restrictions. In addition, many cities, towns, and villages in counties without countywide residency restrictions have en­
acted local restrictions.
January 2010

17

New York State Office of Mental Health

2009 Annual Report on the Implementation of MHL Article 10

SIST Violation Process
If a SIST respondent seriously or repeatedly violates the conditions of the SIST order, s/he is taken into custody
and a psychiatric evaluation is ordered. As stipulated in SOMTA, once a serious SIST violation has occurred, the
psychiatric evaluation must be conducted within five days of the individual being taken into custody (usually in
county jail), or the respondent must be released. Per SOMTA, failure to file a petition within the five day timeframe does not affect the validity of the petition or any subsequent action. Therefore, a psychiatric examination
may still be conducted after the five day period. The purpose of the psychiatric evaluation is to determine whether
modifications are needed to the SIST conditions, or whether the individual is a dangerous sex offender in need
of confinement.
Since the inception of Article 10, of the 77 individuals subject to a SIST order, 30 individuals have been charged
with violating either the SIST order of conditions or the conditions of parole supervision (the latter can occur when
individuals are simultaneously serving a parole term and under a SIST order). Eight of the 30 violations involved
inappropriate sexual behavior, two of which resulted in a new criminal charge. Both offenses involved frotteuristic
(sexual touching) behavior. These two individuals were returned to DOCS custody on parole violations, the re­
maining were not charged with a new crime, but modifications were made to their supervision conditions and
treatment plans. Six SIST violators were civilly confined, and the remaining 16 violators were pending adjudica­
tion at the end of the reporting period.

Treatment in OMH Secure Facilities
Sex offenders under civil management receive treatment within an OMH secure treatment facility if they are placed
there pending trial or have been adjudicated as a dangerous sex offender requiring confinement. As of October
31, 2009, 100 respondents were placed in secure treatment facilities pre-trial and awaited adjudication, and 100
were confined by court order in secure treatment facilities as dangerous sex offenders. Three-fifths of those ad­
judicated as a dangerous sex offender in need of confinement consented to confinement rather than proceeding
to trial. Pre-adjudicated placements in secure treatment present unique challenges because they often refuse to
participate in treatment. Given the costliness of secure treatment (estimated to be $175,000 per year), considera­
tion should be given to developing less expensive alternatives to secure treatment in OMH facilities for pre-adju­
dicated Article 10 respondents.

Treatment in OMH Secure Facilities
Section 10.10(a) of the MHL authorizes OMH to accept custody and confine respondents in secure treatment fa­
cilities for the purposes of providing care, treatment, and control, following a finding that the respondent is a dan­
gerous sex offender requiring confinement. The law states that secure treatment facilities are separate and distinct
facilities from psychiatric hospitals [§7.18(b)], and that its residents must be kept separate from other persons in
the care, custody, or control of the Commissioner of OMH (§10.10(e)). Currently, OMH operates Sex Offender
Treatment Programs (SOTPs) within the secure treatment facilities located on the grounds of Central New York
Psychiatric Center (CNYPC) and St. Lawrence Psychiatric Center (SLPC). The CNYPC program has a capacity of
150 residents, while SLPC currently can accommodate up to 80 residents. In addition, the Manhattan Psychiatric
Center (MPC) has a 20-bed ward for respondents attending court proceedings in the New York City area. As of
October 31, 2009, 143 respondents were designated to CNYPC and 57 were designated to SLPC (see Table 8).

January 2010

18

New York State Office of Mental Health

2009 Annual Report on the Implementation of MHL Article 10

Table 8

Bed Census as of October 31, 2009
CNYPC

SOTP
SLPC

Total

79

21

100

30
34
64

11
25
36

41
59
100

143

57

200

Pre-Trial
Post-Confinement
Trial
Consent
Total Confined

Total
Secure Treatment SOTP Model

The secure treatment facilities operate Sex Offender Treatment Programs (SOTPs) within the overarching frame­
work of the Risk-Need-Responsivity Model (RNR). RNR emphasizes matching the residents’ risk to the level of serv­
ices provided, targeting the residents’ criminogenic needs in treatment, and maximizing the residents’ ability to
benefit from treatment by tailoring treatment to their learning style, motivation, abilities, and strengths. Cognitive
behavioral therapy and relapse prevention strategies are utilized in the treatment interventions. All interventions are
designed to promote growth in key areas such as treatment engagement, general self-regulation, sexual deviancy
management, and development of pro-social attitudes and behavior, with the intended outcome of reducing resi­
dents’ risk of sexual recidivism. The final treatment goal is the residents’ safe re-integration into the community.

Four Phase Treatment Program
Treatment offered in the SOTPs is delivered through a four-phase model. The model is designed so that the res­
idents’ progress through treatment in an incremental manner, acquiring skills and knowledge that are built upon
in subsequent treatment phases. The pace of residents’ advancement through the four-phase model is dependent
upon their completion of treatment goals of each phase. Phase progression occurs at each resident’s treatment
pace, rather than a pre-determined time frame.
Treatment Readiness is Phase I of the treatment program. It focuses on developing the skills necessary to suc­
cessfully participate in treatment. During this phase of treatment, residents are not expected to discuss details of
their sexual offending histories.16 They are expected, however, to admit to having committed a sexual offense, de­
velop familiarity with group processes and their treatment plan, acknowledge a desire to change, and commit to
participating in treatment. At the end of Phase I, residents are expected to sign a contract stating that they are will­
ing to participate in psychological testing, including the penile plethysmograph (PPG), if appropriate.
Phase II, Skills Acquisition and Practice, is the phase in which residents begin to explore their sexual offense his­
tory, personal values, sexuality issues, arousal patterns, risk factors, and strategies to live an offense-free life. Dur­
ing this phase, residents are required to participate in the group process, acknowledge their sexual offense history,
accept personal responsibility for their offenses, identify issues related to deviant arousal patterns and cognitive dis­
tortions, and identify their strengths, treatment needs and goals. Moreover, residents in Phase II are required to:
◆ write and present an offense history and autobiography;
◆ identify and journal thinking errors;

16 Confined sex offenders are afforded the same confidentiality protections that apply to all other civilly commitment persons when discussing prior offenses during thera­
peutic sessions.
January 2010

19

New York State Office of Mental Health

2009 Annual Report on the Implementation of MHL Article 10

◆ demonstrate positive community membership by following the SOTP Code of Conduct;
◆ examine personal values and how they can affect success in the community;
◆ engage in behaviors that are pro-social, and refrain from secretive, deceptive and manipulative behaviors;
◆ express emotions appropriately;
◆ identify healthy and disordered arousal patterns;
◆	 identify and refrain from engaging in grooming behaviors (behaviors aimed at gaining another individuals con­
fidence in order to assume a position of power);
◆ show motivation to change disordered arousal pattern; and
◆ demonstrate an understanding of how to apply a relapse prevention strategy to one’s particular offense pattern.
Phase III, Skills Application, is the phase in which residents are expected to internalize and demonstrate pro-so­
cial behaviors. In this phase, the residents are required to demonstrate an ability to challenge and replace think­
ing errors in a variety of situations, interrupt offense-related behavioral patterns, use pro-social coping skills when
faced with difficulties, consistently demonstrate appropriate assertiveness skills when interacting with others, and
ask for guidance and assistance from others when having difficulties. Additionally, during Phase III of treatment,
residents are expected to commit to maintaining healthy relationships.
Phase IV, Community Re-Entry Plan Development, is the phase in which residents develop community re-entry
plans. In order to complete this phase of treatment, residents must identify appropriate treatment and community
supports, demonstrate realistic short-term and long-term goals, and identify and make contact with a community
support system including community service providers and, if appropriate, family and other community members
who may assist in the transition process.
At the end of the reporting period (October 31, 2009), over half of the 200 individuals involved in some level of
treatment in the secure facilities had progressed to phase II or beyond. Those post adjudication were more likely
to be further advanced in treatment. As of October 31, 2009, no residents had progressed to Phase IV of the treat­
ment program (see Table 9).
Table 9

Phase Data for those Designated to SOTP
Facility

Phase I
Phase II
Phase III
Total

CNYPC

SLPC

Total

Post-Pc/Pre-Trial

Post-Trial
(Confinement)

Post-Pc/Pre-Trial

Post-Trial
(Confinement)

49
20
3
72

17	
35	
11	
63

17
3
0
20

6
24
5
35

	

89
82
19
190

Before a resident can be advanced to Phase IV, the SOTP Director or Chief of Service submits a clinical summary
with a recommendation for promotion to the OMH BSOET Treatment Review Committee. Members of the Treat­
ment Review Committee include the Division of Forensic Services’ Medical Director, the BSOET Director, the
BSOET Chief Psychiatric Examiner/Secure Treatment Services Unit (STSU) Director, and the STSU Assistant Director.
The BSOET Treatment Review Committee reviews the case information and makes a determination about whether
or not the resident is appropriate for advancement to Phase IV. If the resident is determined not to be appropri­
ate for advancement, the Treatment Review Committee outlines specific treatment goals for the resident to ac­
complish before she/he can be reconsidered for advancement. Residents will only transition to Phase IV with the
approval of both the SOTP and the BSOET Treatment Review Committee.
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2009 Annual Report on the Implementation of MHL Article 10

For residents considered by the SOTP to be approaching completion of Phase IV, the SOTP Director or Chief sub­
mits a clinical summary with discharge recommendations to the OMH BSOET Treatment Review Committee. Upon
conclusion of its review, the BSOET Treatment Review Committee shares its findings with the Commissioner about
whether the resident remains a dangerous sex offender in need of confinement or may be appropriate for courtordered release under a SIST order.

Core Program Services
A. Assessment:
A rigorous assessment protocol is utilized in the secure treatment facilities in order to determine the residents’ risk,
sexual and criminogenic treatment needs, as well as any special considerations that impact service provision (e.g.,
cognitive limitations, mental illness, psychopathy). The assessment evaluates sexual interest and attitudes, per­
sonality type, mental health, cognitive limitations, substance abuse, psychopathy, treatment progress (if the resi­
dent previously participated in community or prison-based treatment programs), reading comprehension, and
treatment readiness.

B. Education/Vocational Training:
The secure treatment facilities provide a wide array of educational and vocational programs that help residents
develop the skills necessary for a successful transition to the community. Program targets include academic skills
development, pro-social skill development, problem solving, stress and time management, employment readiness,
and job skills.

C. Psycho-educational Interventions:
The secure treatment facilities provide psycho-educational groups throughout all phases of treatment. Psychoeducational groups teach residents about their disorders and risk factors, while also providing them with infor­
mation on coping skills. Although psycho-educational groups are offered throughout all phases of treatment, they
are most often used in Phase I. Groups in later phases of treatment tend to utilize cognitive-behavioral treatment
modalities to alter thought processes and behaviors rather than merely increasing knowledge.

D. Pro-social Development:
The secure treatment facilities provide a variety of interventions, opportunities, and planned activities specifically
aimed at improving the residents’ sense of community and pro-social attitudes and behaviors both within the fa­
cility and post-discharge. Residents who are able to develop strong pro-social skills will be better prepared for a
successful transition to the community and a safe, healthy, and productive life.

E. Process-oriented Treatment:
Once residents have advanced to Phase II, they will have the opportunity to participate in process-oriented group
treatment including, but are not limited to, Cognitive-behavioral therapy, principles of the Good Lives Model, anger
management, criminal and addictive thinking, recovery/relapse prevention, sexual deviance, arousal recondition­
ing, and dialectical behavioral therapy. Process groups focus on helping the residents to examine personal issues
as they relate to their specific phase of treatment, dynamic risk factors, and individualized treatment goals.

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Specialized Treatment Tracks
In keeping with RNR principles, treatment at SOTPs has been tailored to address the specialized needs of several
populations of sex offenders. Two specialized treatment tracks have been developed for sex offenders with (1)
cognitive impairment/serious and persistent mental illness, and (2) psychopathy.
Sex offenders with these deficits have treatment needs that differ from those without such problems. The follow­
ing examples demonstrate some of the ways in which treatment is customized for these populations.
◆	 Sex offenders with cognitive impairment may require interventions that are less reliant upon reading and writ­
ing, or reading material that is adapted to their functioning level.
◆	 Sex offenders with serious and persistent mental illness may need a period of medication stabilization before
they can effectively benefit from group therapies, in addition to customized treatment groups that address their
mental illness.
◆	 Sex offenders with psychopathic traits pose a risk to more vulnerable sex offenders within the residential set­
ting. Thus, psychopathic sex offenders are treated in a separate treatment track that is designed to meet their
specific needs, some of which include high degrees of impulsivity, poor behavioral controls, and a strong
propensity to manipulate people (staff and residents) in their environment.
Currently, 34 residents are receiving treatment in the combined cognitively impaired/serious and persistent men­
tal illness (SPMI) treatment track at SLPC. Of the 34 residents in the combined track, all are diagnosed with at least
one serious and persistent mental illness and 27 are assessed with cognitive impairment. The psychopathy track
is currently in the final stage of development at CNYPC. Residents are being assessed for their appropriateness
for this track. Of those residents who have been assessed, 18 have been deemed as appropriate for the psy­
chopathy treatment track, and approximately 23 additional residents are under consideration and are awaiting com­
pletion of the assessment process. Residents not placed in a specialized treatment track receive treatment in a
conventional treatment track.

Treatment Aids
Some sex offenders experience intense sexual preoccupation and sexually deviant urges, which do not respond
sufficiently to cognitive-behavioral interventions alone. For this population, pharmacological agents can assist by
diminishing sexual preoccupation and urges, thereby increasing the offender’s ability to benefit from cognitivebehavioral and arousal reconditioning strategies. Consequently, in 2009, OMH developed the capacity to provide
pharmacologic interventions involving selective serotonin reuptake inhibitors (SSRI) and antiandrogen therapy
(AAT), to augment cognitive-behavioral therapies. Pharmacologic interventions are only undertaken at the request
of the resident in consultation with MHLS.
This year, OMH also has expanded the use of PPG in treatment Phases II through IV in order to measure deviant
sexual arousal. This measurement informs arousal reconditioning treatment plans, and helps the treatment team
to identify individuals who might benefit from SSRI and AAT treatment. In addition, if a respondent is participat­
ing in pharmacological interventions, the PPG is used to assess its effectiveness. It is not used to assess for risk of
sexual recidivism. If a resident consents to participate in the PPG (a separate consent form is required), the as­
sessment occurs within a laboratory setting in complete privacy. For residents assessed with sexual deviancy by
the PPG or other assessment tools, arousal reconditioning interventions may be appropriate. OMH is in the process
of developing an arousal reconditioning protocol. Numerous behavioral conditioning methods have demonstrated
varying levels of effectiveness over the years in managing/reducing sexual deviance and increasing healthy sex­
ual conduct. When these methods are paired with treatments that address other areas of need, they can be help­
ful in further reducing some offenders’ risk for sexual recidivism.

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2009 Annual Report on the Implementation of MHL Article 10

Annual Reviews
Pursuant to MHL §10.09, the Commissioner of OMH must provide an annual review of each SOTP resident’s men­
tal condition in order to determine whether or not the resident remains “a dangerous sex offender requiring con­
finement.” OMH has developed a multi-step annual review process that begins with a notification to the resident
of his/her right to petition for discharge, as well as a psychiatric evaluation.
Unless the resident refuses to participate in an annual review, an OMH psychiatric examiner conducts a psychiatric eval­
uation, typically by video-teleconferencing (VTC), a widely accepted practice in the field of psychiatric evaluation, and
submits his or her written report to the BSOET Treatment Review Committee. Upon conclusion of its review and after
consultation with the treating facility, the BSOET Treatment Review Committee shares its findings with the Commissioner,
or his designee, regarding whether or not the resident remains a dangerous sex offender in need of confinement. The
Commissioner, or his designee, reviews all available reports and, if necessary, conferences with the SOTP and the
BSOET Treatment Review Committee in order to make a final determination about whether or not a petition for dis­
charge should be filed. The Commissioner (or his designee) notifies the court, in writing, whether or not the resident
is currently a dangerous sex offender requiring confinement. After an evidentiary hearing and by clear and convincing
evidence, the court makes the final determination regarding whether or not the resident requires continued confine­
ment or can be discharged to the community. It is anticipated that courts will issue SIST orders at the time of discharge.
Between November 1, 2008 and October 31, 2009, OMH completed 57 annual reviews for persons scheduled for
review during that time period. In one of the 57 cases, the individual was originally placed on SIST, but had vio­
lated the conditions and thus had been admitted into secure treatment. In his annual review, OMH found that the
individual was no longer a dangerous sex offender requiring continued confinement. The court concurred and
released the offender to the community under a SIST order. In four other cases, OMH recommended continued
confinement but the court ordered the individuals to be discharged under SIST orders.

Conclusion
Article 10 provides for the civil confinement of sex offenders in “extreme” cases (MHL section 10.03(b)) in which
such confinement is necessary to ensure treatment and protect the public. While approximately half of the sex of­
fenders in secure treatment facilities are still awaiting adjudication, the population of these facilities was stable until
the last month of this reporting period. Several factors contributed to the leveling off of the secure facility census
including reduced rates of admission following refinement of the assessment process, increased dispositions and
increased reliance by the courts on SIST as a mode of treatment and supervision. However, the census began to
climb again in October 2009 and, while outside the period of this report, it should be noted that it has continued
to climb through December 2009. The end-of-year census for 2009 stands at 214.
The management of SIST continues to present significant challenges due largely to the absence of adequate hous­
ing and, in some areas of the state, the lack of access to treatment services. While allegations of SIST violations
are relatively common, few have involved sexual reoffending and, in those rare instances, the recidivist offenses
were frotteurism. Moreover, few violations have resulted in the admission of sex offenders into secure treatment.
It is anticipated, however, that more such admissions may occur as the SIST population continues to grow.
Treatment in OMH secure treatment facilities has advanced over the last 12 months, in part through broader use
of PPG and the introduction of pharmacologic interventions. The broader interventions have provided important
treatment aids to individuals for whom cognitive behavioral interventions are insufficient. Residents continue to
progress through the four phases of treatment and to generally respond positively to treatment interventions.
In the coming year, OMH will continue to work in close collaboration with all of its partners to further ensure the
effective implementation of Article 10. Likewise, communities across the State will need to expand access to treat­
ment and housing for this population to help ensure their effective management under SIST orders.

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2009 Annual Report on the Implementation of MHL Article 10

APPENDIX

Table 1-A
SOMTA Qualifying Offenses
Article 10 Sexual Offenses (Includes Felony Attempt and Conspiracy to Commit)

January 2010

PL SECTION
130.25
130.30
130.35
130.40
130.45
130.50
130.53
130.65

Crime
RAPE 3RD DEGREE
RAPE-2ND
RAPE-1ST
CRIMINAL SEXUAL ACT-3RD (AKA Sodomy)
CRIMINAL SEXUAL ACT-2ND (AKA Sodomy)
CRIMINAL SEXUAL ACT-1ST (AKA Sodomy)
PERSISTENT SEXUAL ABUSE
SEXUAL ABUSE-1ST

130.65-A
130.66
130.67
130.70
130.75
130.80
130.85
130.90
230.06
255.26
255.27

AGGRAVATED SEXUAL ABUSE 4TH
AGGRAVATED SEXUAL ABUSE -3RD
AGGRAVATED SEXUAL ABUSE 2ND
AGGRAVATED SEXUAL ABUSE-1ST
COURSE SEX CONDUCT-CHILD 1ST
COURSE SEX CONDUCT-CHILD 2ND
FEMALE GENITAL MUTILATION
FACILIT SEX OFF/CONTROL SUBST
PATRONIZE PROSTITUTE-1ST
INCEST 2ND
INCEST 1ST

25

Class
E Felony
D Felony
B Felony
E Felony
D Felony
B Felony
E Felony
D Felony
E Felony
D Felony
C Felony
B Felony
B Felony
D Felony
E Felony
D Felony
D Felony
D Felony
B Felony

New York State Office of Mental Health

2009 Annual Report on the Implementation of MHL Article 10

Table 1-B
SOMTA Qualifying Offenses
Article 10 Designated Felonies if Sexually Motivated
(Includes Felony Attempt and Conspiracy to Commit)
PL SECTION
120.05
120.06
120.07
120.10
120.60
125.15
125.20
125.25
125.26
125.27
135.20
135.25
140.20
140.25
140.30
150.15
150.20
160.05
160.10
160.15
230.30
230.32
230.33
235.22
263.05
263.10
263.15

January 2010

Crime
ASSAULT -2ND
GANG ASSAULT 2ND DEGREE
GANG ASSAULT 1ST DEGREE
ASSAULT 1ST DEGREE
STALKING 1ST DEGREE
MANSLAUGHTER-2ND
MANSLAUGHTER -1ST
MURDER-2ND DEG
AGGRAVATED MURDER
MURDER-1ST DEGREE
KIDNAPPING 2ND
KIDNAPPING-1ST
BURGLARY-3RD
BURGLARY-2ND
BURGLARY-1ST
ARSON-2ND:INTENT PERSON PRESNT
ARSON-1ST:CAUSE INJ/FOR PROFIT
ROBBERY-3RD
ROBBERY-2ND
ROBBERY-1ST
PROMOTING PROSTITUTION-2ND
PROMOTE PROSTITUTION-1ST
COMPELLING PROSTITUTION
DISSEM INDECENT MAT MINOR 1ST
USE CHILD <17- SEX PERFORMANCE
PROM OBSCENE SEX PERF-CHILD<17
PROM SEX PERFORMANCE-CHILD <17

26

Class
D Felony
C Felony
B Felony
B Felony
D Felony
C Felony
B Felony
A-1 Felony
A-1 Felony
A-1 Felony
B Felony
A-1 Felony
D Felony
C Felony
B Felony
B Felony
A-1 Felony
D Felony
C Felony
B Felony
C Felony
B Felony
B Felony
D Felony
C Felony
D Felony
D Felony

New York State Office of Mental Health