6800 Appendix 6 SOT Evaluation Adaptive — Males (DOC-3776D).doc

DOC document 233 KB Posted May 1, 2019

Attached to: Non-residential, Community, Sex Offender Treatment Services for Division of Community Corrections Correctional Clients Statewide
Contract number: 410036-M19-CJO6800-RFB-00
Issued by: Wisconsin

About this file

Written by GovTribe AI · Aug 7, 2025

This document is a standardized evaluation form (DOC-3776D) used by the Wisconsin Department of Corrections, Division of Community Corrections for assessing male sex offenders in their treatment program. The form is designed to evaluate inmates and individuals under community supervision to determine appropriate sex offender treatment (SOT) placement and services within Wisconsin's correctional system.

The document outlines a comprehensive assessment framework that evaluates criminogenic needs using COMPAS assessment tools, sexual offending history, recidivism risk through the Static 99-R instrument, and treatment needs via the ARMIDILO-S assessment for individuals with developmental and intellectual limitations. The evaluation determines placement in various treatment levels ranging from basic SOT-1 Education to intensive SOT-4 Long Term-Intensive Residential programs, including adaptive versions for special populations and alternative-to-revocation options. The form requires completion by qualified clinicians with supervisory approval and includes sections for protective factors, responsivity considerations, and specific recommendations for treatment services, with distribution to the Department of Community Corrections case files and community treatment providers.

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DEPARTMENT OF CORRECTIONS

Division of Community Corrections

DOC-3776D (Rev.10/2017) DRAFT

WISCONSIN

SEX OFFENDER TREATMENT EVALUATION ADAPTIVE — MALES

DOC NUMBER

OFFENDER NAME (Last, First, MI)

SID NUMBER

DATE OF BIRTH

FACILITY/LOCATION

Check One: Initial Report

REPORT DATE

AGENT #

MR / PMR / ES DATE

DISCHARGE DATE

Re-evaluation Report

PART I: CRIMINOGENIC NEEDS(Recommended)

COMPAS Assessment Date:

Attach the Criminogenic needs finding from COMPAS FORMCHECKBOX Attached; FORMCHECKBOX Not Available: explain: .

Risk Level: FORMCHECKBOX Low FORMCHECKBOX Moderate FORMCHECKBOX High

Summary of Needs:

PART II: SEXUAL OFFENDING HISTORY (Required)

List convictions, with dates of offenses, in chronological order (include court case number if available):

This list contains the following type of offenses: FORMCHECKBOX Juvenile; FORMCHECKBOX 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: FORMCHECKBOX None; FORMCHECKBOX Participated; FORMCHECKBOX Completed; Specify: ;

PART III: RECIDIVISM RISK (STATIC 99-R) (Required)

1. Age at Release

FORMCHECKBOX

18-34.9 (1 point)

FORMCHECKBOX

35-39.9 (0 points)

FORMCHECKBOX

40-59.9 (-1 point)

FORMCHECKBOX

60+ (-3 points)

2. Ever lived with a lover for at least 2 years?

FORMCHECKBOX

Yes (0 points)

FORMCHECKBOX

No (1 point)

3. Index non-sexual violence. Any convictions?

FORMCHECKBOX

Yes (1 point)

FORMCHECKBOX

No (0 points)

4. Prior non-sexual violence. Any convictions?

FORMCHECKBOX

Yes (1 point)

FORMCHECKBOX

No (0 points)

5. Prior sex offenses. Charges/Convictions

FORMCHECKBOX

6+/4+ (3 points)

FORMCHECKBOX

3-5/2-3 (2 points)

FORMCHECKBOX

1-2/1 (1 point)

FORMCHECKBOX

0/0 (0 points)

6. Prior sentencing dates

FORMCHECKBOX

4 or more (1 point)

FORMCHECKBOX

3 or less (0 points)

7. Any convictions for non-contact sex offenses

FORMCHECKBOX

Yes (1 point)

FORMCHECKBOX

No (0 points)

8. Any Unrelated Victims

FORMCHECKBOX

Yes (1 point)

FORMCHECKBOX

No (0 points)

9. Any Stranger Victims

FORMCHECKBOX

Yes (1 point)

FORMCHECKBOX

No (0 points)

10. Any Male Victims

FORMCHECKBOX

Yes (1 point)

FORMCHECKBOX

No (0 points)

TOTAL STATIC 99-R SCORE: Risk: FORMCHECKBOX Level I (-3, -2) Very Low Risk FORMCHECKBOX Level II (-1, 0) Below Average Risk

FORMCHECKBOX

Level III (1-3) Average Risk FORMCHECKBOX Level IVa (4,5) Above Average Risk

FORMCHECKBOX

Level IVb (6+) Well Above Average risk

Rationale for Ratings

Comments:

PART IV: TREATMENT NEED (ARMIDILO-S; required)

Assessment of Risk and Manageability for Individuals with Developmental and Intellectual Limitations Who Offend Sexually. Use scoring definitions from ARMIDILO-S scoring manual

RISK FACTOR RATING

X = Insufficient information to score the item

Y = Item is definitely present

S = item is somewhat present

N = Item is not present

STABLE CLIENT FACTORS (rationale)

Critical Item

1. Supervision Compliance

FORMCHECKBOX

2. Treatment Compliance

FORMCHECKBOX

3. Sexual Deviance

FORMCHECKBOX

4. Sexual Preoccupation/Sexual Drive

FORMCHECKBOX

5. Offense Management

FORMCHECKBOX

6. Emotional Coping Ability

FORMCHECKBOX

7. Relationships

FORMCHECKBOX

8. Impulsivity

FORMCHECKBOX

9. Substance Abuse

FORMCHECKBOX

10. Mental Health

FORMCHECKBOX

11. Unique Considerations (personal and lifestyle)

FORMCHECKBOX

Acute Client Factors (rationale)

1. Changes in Compliance with Supervision or Treatment

FORMCHECKBOX

2. Changes in Sexual Preoccupation/Sexual Drive

FORMCHECKBOX

3. Changes in Victim-Related Behaviors

FORMCHECKBOX

4. Changes in Emotional Coping Ability

FORMCHECKBOX

5. Changes in Use of Coping Strategies

FORMCHECKBOX

ARMIDILO-S Risk/Needs Rating

FORMCHECKBOX

Low FORMCHECKBOX Moderate FORMCHECKBOX High

PART V: PROTECTIVE FACTOR RATING (optional)

X = Insufficient information to score the item

Y = Item is definitely present

S = item is somewhat present

N = Item is not present

STABLE CLIENT FACTORS (rationale)

Critical Item

1. Supervision Compliance

FORMCHECKBOX

2. Treatment Compliance

FORMCHECKBOX

3. Sexual Deviance

FORMCHECKBOX

4. Sexual Preoccupation/Sexual Drive

FORMCHECKBOX

5. Offense Management

FORMCHECKBOX

6. Emotional Coping Ability

FORMCHECKBOX

7. Relationships

FORMCHECKBOX

8. Impulsivity

FORMCHECKBOX

9. Substance Abuse

FORMCHECKBOX

10. Mental Health

FORMCHECKBOX

11. Unique Considerations (personal and lifestyle)

FORMCHECKBOX

Acute Environment Factors (rationale)

1. Changes in Social Relationships

FORMCHECKBOX

2. Changes in Monitoring and Intervention

FORMCHECKBOX

3. Situational Changes

FORMCHECKBOX

4. Changes in Victim Access

FORMCHECKBOX

5. Unique Considerations

FORMCHECKBOX

ARMIDILO-S Protective Rating

FORMCHECKBOX

Low FORMCHECKBOX

Overall Convergent Risk Category: FORMCHECKBOX Low FORMCHECKBOX

Discussion of Overall Risk, Needs, and Protective Factor Rating/Notes from Clinical Interview:

PART VI: RESPONSIVITY FACTORS (required)

Language barrier: Reading comprehension may be below 6th grade level, , Hearing impaired, IQ may be below 80, Evidence of serious social skills impairment due to developmental or psychiatric disorder, Unstable psychiatric status (refer), Other ADA condition that may affect treatment responsivity (describe):

PART VII: SUMMARY AND RECOMMENDATIONS (required)

Comments:

Based on a review of the available information from criminogenic needs, risk to sexually reoffend, treatment needs, protective factors, and responsivity factors, the recommendation for sex offender services is:

No SOT

SOT-1 Education

Aftercare-Institution

Aftercare-Community SOT-2 Short-term

SOT-2 Short-term Adaptive

SOT-2 Short-term Ltd. English Proficiency (LEP)

SOT-2 Short-term Alternative to Revocation SOT-4 Long Term-Intensive Residential

SOT-4 Long Term-Intensive Residential Adaptive

SOT-4 Long Term-Intensive Residential LEP

SOT-4 Long Term Alternative to Revocation

FORMCHECKBOX

Treatment recommendations deferred Rationale:

PRINTED or TYPED CLINICIAN’S NAME

CLINICIAN’S SIGNATURE

DATE

PRINTED or TYPED SUPERVISOR’S NAME (if necessary)

SUPERVISOR’S SIGNATURE (if necessary)

DATE

DISTRIBUTION: DCC Offender Case File, Sec. IV-Confidential Documents; Community Provider

File details come from the government source that posted it. Updated Aug 7, 2025.