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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)
