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SEX OFFENDER TREATMENT EVALUATION – MALES
OFFENDER NAME (Last, First, MI)
DOC #
SID #
DOB
FACILITY
| CHECK ONE |
| |_| INITIAL REPORT |
|_| RE-EVALUATION REPORT
REPORT DATE
AGENT #
MR / PMR / ES DATE
DISCHARGE DATE
PART I: CRIMINOGENIC NEEDS (Recommended)
| COMPAS: Assessment Date: |
| |_| Not Available |
Risk Level: |_| Low |_| Moderate |_| High
Summary of Needs:
DEPARTMENT OF CORRECTIONS WISCONSIN
Division of Adult Institutions Division of Community Corrections DOC-3776 (Rev. 7/2018)
DISTRIBUTION: Original (DAI) – PSU Record, SOT/Ch. 980 Section; Official Record – DCC Offender Case File; Copy - BOCM Original (DCC) – DCC Offender Case File, Confidential; Copy – Community Provider
PART II: SEXUAL OFFENDING HISTORY
List convictions, with dates of offenses, in chronological order (include court case number if available): This list contains the following type of offenses:
|_|Juvenile; |_| Adult:
Details of sexual offenses - Describe for each offense, in the order listed above: (a) sex and DOB or age of victim(s), (b) victim relationship to offender and any specific vulnerability factors, (c) brief description of assault(s) including location, any weapons used, threats and injuries, any sadistic behavior, and any other pertinent history.
Offender’s account - of offenses (detected and undetected) and amenability for sex offender treatment:
Prior Sex Offender Treatment History: |_|None; |_| Participated; |_| Completed Specify:
PART III: RECIDIVISM RISK (STATIC 99-R) – (required)
| 1. Age at Release |
| |_| |
| 18-34.9 (1 point) |
| |_| |
| 35-39.9 (0 points) |
| |_| |
| 40-59.9 (-1 point) |
| |_| |
| 60+ (-3 points) |
| 2. Ever lived with a lover for at least 2 years? |
| |_| |
| Yes (0 points) |
| |_| |
| No (1 point) |
| 3. Index non-sexual violence. Any convictions? |
| |_| |
| Yes (1 point) |
| |_| |
| No (0 points) |
| 4. Prior non-sexual violence. Any convictions? |
| |_| |
| Yes (1 point) |
| |_| |
| No (0 points) |
| 5. Prior sex offenses. Charges/Convictions |
| |_| |
| 6+/4+ (3 points) |
| |_| |
| 3-5/2-3 (2 points) |
| |_| |
| 1-2/1 (1 point) |
| |_| |
| 0/0 (0 points) |
| 6. Prior sentencing dates |
| |_| |
| 4 or more (1 point) |
| |_| |
| 3 or less (0 points) |
| 7. Any convictions for non-contact sex offenses |
| |_| |
| Yes (1 point) |
| |_| |
| No (0 points) |
| 8. Any Unrelated Victims |
| |_| |
| Yes (1 point) |
| |_| |
| No (0 points) |
| 9. Any Stranger Victims |
| |_| |
| Yes (1 point) |
| |_| |
| No (0 points) |
| 10. Any Male Victims |
| |_| |
| Yes (1 point) |
| |_| |
| No (0 points) |
TOTAL STATIC 99-R SCORE:
| CATEGORY: |
| |_|I Very Low (-3,-2) |
| |_| II Below Average (-1,0) |
| |_| III Average (1-3) |
| |_| IVa Above Average (4,5) |
| |_| IVb Well Above Average (6+) |
Rationale for Rating(s):
PART IV: TREATMENT NEED (STABLE – 2007) – (recommended)
| Problems |
| Unable to Score |
| None |
(0 points) Some (1 point) Definite (2 points) Rationale / Comments
| Significant Social Influences |
| |_| |
| |_| |
| |_| |
| |_| |
| Capacity for Relationship Stability |
| |_| |
| |_| |
| |_| |
| |_| |
| Emotional Identification with Children |
| |_| |
| |_| |
| |_| |
| |_| |
| Hostility Toward Women |
| |_| |
| |_| |
| |_| |
| |_| |
| General Social Rejection / Loneliness |
| |_| |
| |_| |
| |_| |
| |_| |
| Lack of Concern for Others |
| |_| |
| |_| |
| |_| |
| |_| |
| Impulsive Acts |
| |_| |
| |_| |
| |_| |
| |_| |
| Poor Cognitive Problem Solving |
| |_| |
| |_| |
| |_| |
| |_| |
| Negative Emotionality / Hostility |
| |_| |
| |_| |
| |_| |
| |_| |
| Sexual Preoccupation/ Sex Drive |
| |_| |
| |_| |
| |_| |
| |_| |
| Use of Sexual Activity for Coping |
| |_| |
| |_| |
| |_| |
| |_| |
| Deviant Sexual Interests |
| |_| |
| |_| |
| |_| |
| |_| |
| Cooperation with Supervision |
| |_| |
| |_| |
| |_| |
| |_| |
TOTAL STABLE SCORE: CATEGORY: |_| Low (0 – 3) |_| Moderate (4-11) |_| High (12 or more)
Rationale for Ratings /Offender interview notes:
COMBINED STATIC/STABLE CATEGORY: |_| I Very Low |_| II Below Average |_| III Average |_| IVa Above Average |_| IVb Well Above Average
PART V: PROTECTIVE FACTORS (SAPROF) – (optional)
The presence of any of the factors listed below may support or assist desistance from sexual offending.
X = unable to score 0 = not present, 1 = present to some extent, 2 = clearly present
| Internal factors |
| X |
| 0 |
| 1 |
| 2 |
| Rationale / Comments |
| Key |
| Goal |
| 1. Intelligence |
| |_| |
| |_| |
| |_| |
| |_| |
| |_| |
| 2. Secure attachment in childhood |
| |_| |
| |_| |
| |_| |
| |_| |
| |_| |
| 3. Empathy |
| |_| |
| |_| |
| |_| |
| |_| |
| |_| |
| |_| |
| 4. Coping |
| |_| |
| |_| |
| |_| |
| |_| |
| |_| |
| |_| |
| 5. Self-control |
| |_| |
| |_| |
| |_| |
| |_| |
| |_| |
| |_| |
| Motivational factors |
| X |
| 0 |
| 1 |
| 2 |
| Rationale / Comments |
| Key |
| Goal |
| 6. Work |
| |_| |
| |_| |
| |_| |
| |_| |
| |_| |
| |_| |
| 7. Leisure activities |
| |_| |
| |_| |
| |_| |
| |_| |
| |_| |
| |_| |
| 8. Financial management |
| |_| |
| |_| |
| |_| |
| |_| |
| |_| |
| |_| |
| 9. Motivation for treatment |
| |_| |
| |_| |
| |_| |
| |_| |
| |_| |
| |_| |
| 10. Attitudes toward authority |
| |_| |
| |_| |
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| |_| |
| |_| |
| |_| |
| 11. Life goals |
| |_| |
| |_| |
| |_| |
| |_| |
| |_| |
| |_| |
| 12. Medication |
| |_| |
| |_| |
| |_| |
| |_| |
| |_| |
| |_| |
| External factors |
| X |
| 0 |
| 1 |
| 2 |
| Rationale / Comments |
| Key |
| Goal |
| 13. Social network |
| |_| |
| |_| |
| |_| |
| |_| |
| |_| |
| |_| |
| 14. Intimate relationship |
| |_| |
| |_| |
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| 15. Professional care |
| |_| |
| |_| |
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| |_| |
| 16. Living circumstances |
| |_| |
| |_| |
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| |_| |
| |_| |
| |_| |
| 17. External control |
| |_| |
| |_| |
| |_| |
| |_| |
| |_| |
| |_| |
TOTAL: /34
Rationale for SAPROF Rating(s):
FINAL JUDGMENT ABOUT STRENGTH OF SAPROF PROTECTIVE FACTORS
| |_| Low |
| |_| Low-Moderate |
| |_| Moderate |
| |_| Moderate High |
| |_| High |
PART VI: RESPONSIVITY FACTORS
| |_| Reading comprehension may be below 6th grade level |
| |_| Language barrier: |
| |_| IQ may be below 80 |
| |_| Hearing impaired |
| |_| Unstable psychological status (refer) |
| |_| Evidence of serious social skills impairment due to developmental or psychological concerns. |
Other ADA condition that may affect treatment responsivity (describe):
PART VII: SUMMARY AND RECOMMENDATIONS
Summary:
Review of Parts I - VI, the recommendation for sex offender services is (check ONLY ONE box):
| · available information from criminogenic needs |
| · risk to sexually reoffend |
| · treatment needs, |
| · protective factors |
| · responsivity factors |
| |_| |
| No SOT |
| |_| |
| SOT-2 Short-term |
| |_| |
| SOT-4 Long Term-Intensive Residential |
| |_| |
| SOT-1 Education |
| |_| |
| SOT-2 Short-term Adaptive |
| |_| |
| SOT-4 Long Term-Intensive Residential Adaptive |
| |_| |
| Aftercare Institution |
| |_| |
| SOT-2 Short-term Ltd. English Proficiency (LEP) |
| |_| |
| SOT-4 Long Term-Intensive Residential LEP |
| |_| |
| Aftercare Community |
| |_| |
| SOT-2 Short-term Alternative to Revocation |
| |_| |
| SOT-4 Long Term Alternative to Revocation |
| |_| |
| Treatment recommendations deferred to: |
Comments / Rationale:
DAI ONLY: FOR A RE-EVALUATION, DURING A SINGLE PERIOD OF INCARCERATION, CHECK ONE BOX BELOW
| |_| |
| Different treatment recommendation: previous evaluator consulted and agreement reached regarding new recommendation on (date): |
| |_| |
| Different treatment recommendation: consultation with previous evaluator was not available |
| |_| |
| Different treatment recommendation: change being made by SOTE evaluator as part of a Differing Opinions Resolution Process (DORP) |
CLINICIAN NAME (type or print legibly)
CLINICIAN SIGNATURE
DATE
SUPERVISOR NAME – IF NECESSRY (type or print legibly)
SUPERVISOR SIGNATURE
DATE