(a) These standards delineate research-based practices for developmentally delayed clients. Licensees shall subscribe and adhere to the following tenets for developmentally delayed clients:
  (1) the assessment and treatment of developmentally delayed clients shall be conducted in the context of the family and support system;
  (2) managing the risk, behavioral interventions, and the imposition of appropriate external controls shall be a priority for clients with disabilities;
  (3) licensees should guard against justifying sexually deviant behavior by indicating that the developmental disability for any client has any relation to his or her victim typology; and
  (4) developmentally delayed clients shall be given the opportunity to exercise their right to make a voluntary and informed decision to participate in treatment. While clients may refuse to participate in or attend treatment, the client shall be informed of the consequences of such a decision. A client shall be fully informed of the nature of the treatment, the benefits, and the available options. Written consent to proceed with treatment shall be obtained by an interdisciplinary review and the parent or legal guardian.
(b) Assessment Standards for the Developmentally Delayed Client.
  (1) licensees shall adhere to the provisions of §810.63 of this title (relating to General Assessment Standards for Adult Sex Offenders and Juveniles Who Commit Sexual Offenses);
  (2) a comprehensive assessment as cited in this section shall be completed within 60 days of a client's being accepted into treatment program;
  (3) the assessment shall be developmentally and age appropriate;
  (4) the assessment shall be sensitive to any cultural, language, ethnic, developmental, sexual orientation, gender, medical, and/or educational issues;
  (5) The assessment shall determine the client's level of functioning, appropriate treatment interventions, and facilitate the development of an individualized treatment plan. Assessments shall be individualized and efforts shall be made to acquire the following information:
    (A) current level of functioning:
      (i) intellectual, neurological, cognitive, and behavior functioning;
      (ii) level of planning the crime of conviction;
      (iii) expressive and receptive language;
      (iv) social judgment, adaptive skills, and moral reasoning;
      (v) sex education and sexual history;
      (vi) adaptive behavior;
      (vii) criminal history;
      (viii) attention deficit;
      (ix) ability to function in groups;
      (x) support systems (Department of Aging and Disabilities and/or Department of State Health Services-Behavioral and Community Mental Health agency involvement, family involvement, social involvement);
      (xi) environmental or contextual factors that contribute to or maintain the behavior; and
      (xii) history of physical, emotional and/or sexual victimization.
    (B) official documents concerning the instant sexual offense report/offense description:
      (i) age and relation to the victim(s);
      (ii) details of the offense;
      (iii) past criminal behavior and/or sexually inappropriate behavior;
      (iv) sexual history and deviant sexual interest; and
      (v) the extent of denial and cognitive distortions.
    (C) pertinent history:
      (i) developmental history;
      (ii) family, marital, relationship, and personal background;
      (iii) past criminal behavior and/or sexually inappropriate behavior;
      (iv) sexual history and deviant sexual interest; and
      (v) the extent of denial and cognitive distortions.
    (D) medical, psychological and/or psychiatric/hospitalization history;
      (i) educational history;
      (ii) occupational history;
      (iii) substance use or abuse;
      (iv) self-destructive behaviors, self-mutilation, and suicide attempts; and
      (v) history of truancy, fire-setting, abuse of animals, and running away.
  (6) If a plethysmograph is conducted with this population, caution shall be used regarding interpretation and validity.
  (7) If visual reaction time measures are utilized, the measures shall only be used with clients who have an IQ score sufficiently high to achieve valid and reliable test results.
  (8) If polygraphs are utilized, prior to administering polygraph examinations a licensed sex offender treatment provider shall collaborate with the polygraph examiner and the supervision officer to assess the client's ability to understand the concepts of truthfulness, deception, or lying and the capacity to anticipate negative consequences based on deceptive responses. Licensed sex offender treatment providers shall:
    (A) recognize that it is primarily the licensed sex offender treatment provider's responsibility to prepare the client for any polygraph;
    (B) obtain the official offense report prior to administering the instant offense polygraph (Occupations Code, Chapter 109, §109.054);
    (C) include all aspects of a client's sexual behaviors and a victim's list for sexual history polygraphs;
    (D) ensure that the polygraph is administered on a voluntary basis and with informed consent unless court ordered; and
    (E) recognize that the polygraph examiner is the authority in determining if a polygraph examination is appropriate.
(c) Treatment Standards for the Developmentally Delayed Client.
  (1) treatment shall be developmentally and age appropriate;
  (2) treatment components for developmentally delayed clients should be based on those used in treating non-developmentally delayed clients but tailored to address the learning limitations and special issues confronting these clients;
  (3) treatment programs shall address the barriers encountered by the client;
  (4) cognitive behavioral therapeutic approaches shall be paired with the cognitive strengths and weaknesses of the client;
  (5) treatment should include concrete skill building related to social interaction, social skills, sexual behavior, and sex education;
  (6) clients with disabilities shall be offered treatment that is appropriate to their developmental capacity, their level of comprehension, and the ability to integrate treatment components;
  (7) progress in treatment and ability shall be determined by the client integration of the components of treatment;
  (8) group treatment shall be based on the client's level of functioning in a group setting;
  (9) licensees shall use more individually oriented behavioral interventions coupled with empirically supported approaches for clients whose level of functioning is determined to be inappropriate for group treatment;
  (10) licensees should be provided a reasonable alternative toward identifying risk situations or behaviors and appropriate interventions for clients unable to conceptualize the components of treatment;
  (11) if treatment groups are utilized for developmentally delayed clients, groups shall not be less than 60 minutes in length with no more than 8 clients per group;
  (12) treating developmentally delayed clients shall be based on a multidisciplinary approach and empirically supported approaches that includes, but is not limited to, the client, treatment provider, supervision officer, and if applicable the following: the family, guardian, custodian, school officials, law enforcement, child protective services, and the victim's therapist;
  (13) a written initial individualized treatment plan shall identify the issues, intervention strategies, and goals of treatment and shall be prepared for each client within 60 days of beginning treatment. Treatment plans should be updated at least annually;
  (14) progress, or lack of progress needs to be based on clearly specified objective criteria, refusal or failure to attend or participate in treatment, failing to abide by the client's treatment plans and/or contracts, or any disclosures regarding violations of supervision shall be clearly documented in treatment records. This information shall be provided and communicated to the appropriate supervising officer in the justice system according to the referring agency policy or pursuant to the court order;
Cont'd...
(15) monthly treatment progress reports shall be distributed to the supervision officer, referring agency, and/or court. Discharge reports shall be issued according to the referring agency policy or pursuant to the court order;
  (16) when a client has attained the goals outlined in the individualized treatment plan, there should be a gradual and commensurate adjustment of interventions;
  (17) some degree of denial shall not preclude a client from entering treatment, although the degree of denial shall be a factor in identifying the most appropriate form and location of treatment;
  (18) clients who remain in significant denial and/or are extremely resistant to treatment after a period of time determined by the treatment provider and supervision team should be reassessed for appropriate placement in alterative treatment and/or interventions;
  (19) modifications in treatment and in expectations for treatment outcomes may be required in instances of persistent denial;
  (20) when treating developmentally delayed clients who have committed a sexual offense, a licensee shall recognize their vulnerabilities and their risk of victimization by non-delayed clients;
  (21) licensees shall communicate and exchange information with the Department of Family Protective Services-Child Protective Services, Child Care Licensing, and with appropriate agencies regarding the safety of a child or children in the primary residence in which a sex offender resides;
  (22) the safety of the children takes precedence and the highest priority shall be given to the rights, well-being, and safety of children when making decisions about contact between the client and children. If the client has a history of deviant sexual arousal and/or deviant sexual interest to or reported fantasies of sexual contact with children, client should be restricted from having access to children. Supervised visits may be considered if:
    (A) it is determined that sufficient safeguards exist to protect the child(ren);
    (B) the sex offender has demonstrated control over deviant arousal;
    (C) it does not impede the sex offender's progress in treatment; and
    (D) if it is compliant with the court mandated or Texas Board of Pardons and Paroles ordered conditions.
  (23) the licensee shall make every effort to collaborate with the victim's therapist in making decisions regarding communication, visits and reunification. Contact shall be arranged in a manner that ensures the child/victim safety first;
  (24) if reunification is deemed appropriate by the victim's therapist, the process shall be closely supervised. There shall be provisions for monitoring behavior and reporting rule violations. A victim's comfort and safety shall be assessed on a continuing basis; and
  (25) licensees shall be familiar with and adhere to §810.64(d) of this title (relating to Assessment and Treatment Standards for Adult Sex Offenders) and §810.65(g) of this title (relating to Assessment and Treatment Standards for Juveniles Who Commit Sexual Offenses).

Source Note: The provisions of this §810.67 adopted to be effective October 22, 2006, 31 TexReg 8520; amended to be effective April 24, 2011, 36 TexReg 2396; amended to be effective October 1, 2015, 40 TexReg 6748