domestic violence intervention treatment in washington

Amie Roberts, LMHC, CPMDomestic Violence Intervention Treatment Program Manager

Domestic Violence Intervention Treatment in Washington stateAn overview of WAC 110-60A

Who’s here?How does domestic violence treatment

affect your job?

Amie Roberts• Los Angeles to Utah

• Domestic Violence/Sexual Assault Victim Services

• BA in Spanish Literature

• MA in Counseling

• Certified Public Manager

• Licensed Mental Health Counselor

• Experience in Substance Use Disorder, Mental Health and Domestic Violence Intervention Treatment

• Washington state since 2011

• DBHR Mental Health Program Administrator

• Domestic Violence Intervention Treatment Program Manager

(WAC Revision, Advisory Committee, Reviews, Investigations, Conferences and HB 1163 Workgroup)

Motto (and battle cry): “We’re changing the world!”

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www.dshs.wa.gov/ca/domestic-violence/certification-process

85 Certified Domestic Violence Prevention Treatment Programs

Levels of treatment Behavioral assessment

Treatment plans Treatment requirements

Personnel Quality management

Acronyms in these slides… • WAC = Washington Administrative Code• IPV = Intimate Partner Violence• DVIT = Domestic Violence Intervention Treatment• Tx = Treatment• Bx = Behavior• CD or SU = Chemical Dependency or Substance Use• MH = Mental Health• TBI = Traumatic Brain Injury

Quick reference listWAC Section Standards

110-60A-00 Administrative(Definitions, purpose, advisory committee, program records and department records)

110-60A-0100 Certification and application requirements (Certification requirements, application process, documentation for certification and recertification, policies and procedures, facility requirements and quality management)

110-60A-0200 Direct treatment staff requirements(Personnel records, minimum staff requirements, staff disclosures, trainee, staff, and supervisor requirements, supervisor responsibilities, continuing education and adding direct treatment staff)

110-60A-0300 Program and participant standards(Referral screening, non-discrimination, treatment focus, group treatment, treatment practices, participant requirements, co-occurring treatment, participant rights and confidentiality, releases of information and participant contracts)

110-60A-0400 Treatment requirements(Behavioral assessment and interview criteria, treatment planning, placement criteria, required cognitive and behavioral changes, minimum treatment periods and requirements, re-offenses and non-compliance, completion criteria, core competencies and discharging participants)

110-60A-0500 Department reviews and actions(On-site reviews and plans of correction, complaint investigations and program or staff status changes)

• One-size-fits-all

• Assessments and treatment

• Efficacy and trust

Statewide perceptions

Purpose of draft WAC 110-60A

Increase accountability and competency –a pathway to achieve the following:

1. To responsibly and as accurately as possible, assess the risks, needs and responsivity for perpetrators of IPV.

2. To increase victim safety.3. Use evidence-based and promising practices to hold participants accountable for

achieving core competencies, including:I. Documentation of their cognitive and behavioral changes.II. Documentation of their personal accountability.

WAC 110-60A-0025

Levels of treatment

Treatment: One size does NOT fit allTypologies: Battering, Intimate terrorism, Coercive controlling, Situational, Mutual

The assessment, third-party and collateral contacts will help us answer:

• How deeply engrained are current thought and behavior patterns?• Reinforcements: What can we work with? Is there cognitive dissonance?

• Levels 1-3 the core material stays the same – Individualization and how long will it take to establish new patterns and break the abusive pattern? … Levels of care.

• High-risk (critical factors) and criminogenic needs must be included in the treatment plan and addressed in group or individual sessions.

WAC 110-60A-0100-0410

Four levels of treatment(Placement criteria for weekly treatment)

No DVIT

• Not a fit• Not IPV or• Victim Svcs.

Level 1

Low Risk/Need• IPV Bx• Low risk

and lethality

• Early inter-vention

Level 2

Med Risk/Need• Hx and

pattern of IPV Bx

• Little or no crim. needs

Level 3

High Risk/Need• Critical

factor• Anti-social

traits• Crim. needs

Level 4

High Risk/Need• Med-to-

high level of psycho-pathy

6 month min. 9 month min. 12 month min. 18 month min.

WAC 110-60A-0410

Behavioral assessment

Gather informationInterview

Behavioral assessmentProbation

Background checks911 tapes

CPS informationGuardian Ad Litem

Victim Cognitive & behavioral indicators

Family membersOther treatment

Police or incident reportTesting

AssesRisk

LethalityNeeds

MotivationsStrengths

Degree of patterns

WAC 110-60A-0100-0410

Levels of treatmentGeneral responsivitySpecific responsivityIndividualized goals

Individualized interventions

Behavioral assessment and interview

Substance Use(S)

Mental Health(S/A)

Belief System

(A)

TBI(S)

Environ-ment

(A)

Testing

(A/S)

High Risk Factors

(A)

1

2

3

45

6

7

Assessment vs. screening

More robust AND costly

WAC 110-60A-0400

Behavioral assessment and interview

Collateral and third-party information

Ongoing

Assessment layout• Basic demographics• General information• Seven domains• Summary

• Social and legal history• Degree of cognitive and behavioral

patterns• Behaviors to target in treatment• Level of accountability • Motivations and readiness to change• Results of testing• Level of treatment, rationale and

referrals

WAC 110-60A-0400

Victim contactInitial call at assessment and within 14 days of enrollment

• Who you are and the purpose of the assessment• Inform them of victim service programs in their area• Participant is accepted into or rejected from program• Primary objective of DVIT: To help increase safety of the

victim and children and hold participant accountable• Core competencies and minimum treatment completion

criteria• They (victims) are not expected to participate. • Limitations of treatment• Program’s mandated reporting and duty to warn

It’s okay to ask: “Is there anything you

would like us to know?”

WAC 110-60A-0325 to 0330

Treatment plans

Treatment plans

Measurablebehavior changes

Update when there are:

• Significant changes• Factors with victim safety• A change in risks, needs, goals or objectives• Moving to a different level of treatment

WAC 110-60A-0405

Treatment requirements

From “Topics” to cognitive and behavioral changesHow does that change our treatment approach

or delivery style?

∆ Unique Forensic Counseling Skillset

WAC 110-60A-0415

Cognitive and behavioral changes and documentation

WAC 110-60A-0415

The goal is to affect cognitive and behavioral change, which must be shared by the participant in group and documented in the participant’s individual record.

Cognitive and behavioral changes(Levels 1-3)

WAC 110-60A-0415

Forms of abuse Belief systems Respectful relationships

Impact on children Financial and legal obligations

Cultural and family dynamics

Accountability Empathy Defense mechanisms

Healthy support system Indicators/red flags Cognitive distortions

Motivations for abuseAutobiographical relationship history

MOTIVATIONS FOR ABUSIVE BEHAVIORS

A Sense Of Entitlement

A Belief That I Should Have The Power & Control Over My Partner &

Children

Learned Experience –Abuse Gets Me What I

Want

The Need To Be Right Or Win At All

Costs

Insecurity And Fear

WAC 110-60A-0415

Areas of focus NOT found in WAC 110-60A

WAC is the minimum standard. Add topics, discussions, lessons, exercises or assignments that meet the individual treatment needs of the participant.

Stacking

What is Mind-Body Bridging?

S c a n n i n gWAC 110-60A-0415

Completion criteriaFor levels 1-3

Contract Requirements

Goals and Objectives in

Treatment Plan

(Bx Changes)

Minimum Treatment

Period

Required Co-occurring

Treatments or Classes

Required Assignments, Exercises, and

Cognitive / Behavioral Changes

WAC 110-60A-0430

Core competenciesFor levels 1-3

• Takes accountability• In compliance with

accountability plan

Documented

• Change in beliefs and no violence or threats (min. six months)

Documented

• Knows personal primary motivations for abuse & alt ways to meet needs

Documented

WAC 110-60A-0430

Treatment deliveryExceptions for participants to attend via live video need to be requested by the program on the participant’s behalf.• More than 45 miles• Physical disability• Other good cause• Confidential and HIPAA compliant live

video attendance program

Keep level 4 treatment groups separate. Otherwise, the program is tailored to the participant’s needs and program’s abilities.

WAC 110-60A-0345

Personnel

DOH Cred.:UDA

RCW 18.130

Staff levelsTrainee SupervisorStaff

• Bachelor’s degree in counseling, psychology, social work or similar social service field

• 30 hours victim advocacy training

• 30 hours DVIT training

Trainee requirements plus:• 50 hours supervised

DVIT treatment experience (min. of 6 groups)

• 50 hours of experience working with victims of domestic violence

Staff requirements plus:• Master’s degree in

counseling, psychology, social work or similar social service field

• 2 years and 250 hours of direct DVIT experience

• 100 hours of experience working with victims of domestic violence

Background Check

WAC 110-60A-0200 to 0250

Quality management

Treatment outcomesfor participants

• Demographics• Quantitative and qualitative questions• Core competencies• Program feedback

WAC 110-60A-0125

Quality management

How the program providesevidence-based or promising practices:

1. Cognitive-behavioral approaches

2. Motivational interviewing or similar

client-centered approaches

3. Trauma-informed behavioral interventions

4. Strength-based strategies

5. Positive behavioral reinforcement strategies

WAC 110-60A-0125

Quality management

How the program provides:• Guide for facilitators• Coordination with local victim services• Collaboration with another domestic violence intervention treatment

Program• Services to those who need sign language or interpretation• Regular participation in the local task force, workgroup or committee• Policies and procedures for complaints and grievances

WAC 110-60A-0125

Quality management

WAC 110-60A-0125

Every three monthsSend in evaluations of treatment outcomes

data.

Every six monthsDocument observation and monitor compliance

with WAC 110-60A (assessments, groups and participant records).

AnnuallyReview and improve cultural competency.

On-site reviews and investigations

WAC 110-60A-0500

What we covered today…• Levels of care (no more one size fits all)

• Required evidence-based and promising practices

• A change in how and when survivors are contacted

• A robust behavioral assessment to determine treatment placement

• Measurable, behavioral goals in a treatment plan before starting treatment

• An option for confidential video attendance

• Areas of treatment focus

• Required cognitive and behavioral changes

• Required completion criteria and core competencies

• New quality management (data)

Questions?

(360) 790-1483AMIE.ROBERTS@DSHS.WA.GOV