Program Overview

The Sex Offender Treatment Program is an intensive outpatient community based treatment program offered through in person office based or live online. This program is designed and individualized for the treatment of both the Adult and Juvenile population.

This program is designed for the offender who recognizes and takes responsibility for their own behavior and is willing and able to live within the limits placed upon them by this treatment program, the judicial system, and society. Examples of offending behaviors include child molestation; voyeurism; exhibitionism; frotteurism; public masturbation or lewd acts; rape and sexual assault; child pornography; obscene phone calls/letters; violations of professional boundaries; sexual harassment.

Our program follows a cognitive-behavioral approach that will provide the foundation for the most effective treatment with the population and will be based upon the Sex Offender Containment Model, a comprehensive approach to sex offender management, drawing on the expertise and special knowledge of all the agencies, partners and individuals working with individuals to manage properly.

Program Goals

◦ Active involvement in the treatment process
◦ Accept responsibility for behaviors
◦ Develop awareness and understanding of consequences related to sex offending
behaviors
◦ Be able to demonstrate empathy and compassion
◦ Develop healthy relationships and social support network
◦ Develop relapse prevention strategies Treatment is composed of education and
therapy through group process, individual therapy, and couples/family therapy as
appropriate.

The duration of treatment is based upon the person’s needs, motivation level or timeline established by the court order.

Cost

Individual Counseling Sessions: $100

Group Therapy Sessions: $75

Section Divider

Sex Offender Treatment Program Application

Please answer the following questions to the best of your abilities. These questions are to help the therapist with the therapy process. This information is held to the same standards of confidentiality as our therapy

Section I

Name *

First

Last

Email *

Date of Birth *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Phone *

Sex *

Male
Female

Charges: (Statue and Description) *

Court Jurisdiction

Are You a Registered Sex Offender *

County of Registration

Section II

Attorney Information

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Name *

First

Last

Phone *

Email *

Section III

If Previously Incarcerated – Complete Section III

Facility / Prison Psychologist

Phone

Parole Officer

Name

First

Last

Phone

Address

Address Line 1

Address Line 2

City

State

Zip Code

Incarceration Status

Incarcerated
Post Release

Psychosexual Evaluation / Risk Assessment

Documents

Click or drag files to this area to upload. You can upload up to 6 files.

Upon admission to the Sex Offender Treatment Program, each individual will be required to complete and sign: Treatment Contract; document that outlines expectations of the treatment program, detailing requirements and consequences if the contract is broken. Safety Plan; a document that outlines the structure and required boundaries that must be met inorder to participate in the program.

By completing this form does not intended to create and does not constitute a therapeutic relationship nor does constitute acceptance in the Sex Offender Treatment Program offered By Bevill and Associates LLC. After review of said information by the clinical team of Bevill and Associates LLC applicant will be notified of acceptance in program.

Signature *

Date

TREATMENT AGREEMENT

Counseling for deviant sexual behavioral is a highly specialized treatment program. It is a privilege for those who take treatment of their sexual problems seriously and want to change their behavior.

Below are the requirements that must be agreed upon in order to participate in this treatment program.

I will be open and honest about my past and present sexual thoughts, fantasies and behavior with my counselor.

I am committed to changing my unhealthy and deviant sexual behaviors as evidenced by the following behaviors:

a. No pornography

b. No deviant or unhealthy sexual behavior.

Sexual contact and fantasies will be within the confines of an equal, honest, committed, consensual and appropriate relationship.

I will not use any illegal drugs or alcohol while in treatment. I understand and agree to random drug testing at the discretion of my counselor while participating in the program. I also understand I am responsible for any cost associates with said test,

I will participate in individual counseling as recommended by counselor (biweekly).

I will participate in group therapy as recommended by counselor (biweekly).

If I have access to or use cell phones or devices that has the ability to send or receive photos or pictures I will agree to have monitoring software installed on the device.

I will NOT use any computer or computer-related devices without monitoring software being placed on devices. I will agree within 48 hours of my first appointment, I will place one of the following internet filters listed below on ALL electronic devices (phones, tablets, laptops and desktop computers) that I have access to.

I will list my therapist as one of my accountability partners (abevill@bevillandassociates.com) or (kculp@bevillandassociatesllc.com)

Recommended:

Accountable 2 You
https://www.accountable2you.com/?code=4450365

Use of any other software requires the approval of my therapist.

I will agree to any assessments which include risk assessment and / or psychological assessments recommended by my therapist. I understand there may be additional cost that I will be responsible for paying the assessments.

I will not access social networking sites.

By signing below I am agreeing to the treatment plan and understand the importance of it towards me attaining recovery with my issues. I also understand that if I do not adhere to any of the conditions listed in the treatment plan listed above that my therapist can terminate me from the Treatment Program. *

Signature *

Date *

Payment Information

Credit Card Information

Credit Card Authorization ( All clients must maintain a current credit card on file).

I, authorize the maintenance of valid credit card information to guarantee my chosen payment option. Charges will appear on your credit card statement as “Bevill and Associates LLC.”

Cardholder Name *

First

Last

Type of Card *

Visa
Master Card
Amex
Discover

Credit Card Number *

Expiration Date *

3 Digit CVV Code *

Billing Zip Code *

Payment Guarantee

I understand that I am individually responsible for all incurred charges, even if I direct you to bill another person. If I direct charges to be billed to another person, I represent that I am authorized to give you such direction. If I have directed you to bill charges to another person who fails to make payment promptly when due, I will promptly pay on demand. I understand that if I commit to joining a weekly therapy group, In the event that I dispute a credit card charge without first trying to resolve my concern directly with Bevill and Associates LLC I agree to reimburse Bevill and Associates LLC. $25 per disputed transaction to compensate Bevill and Associates LLC for the costs incurred in trying to recover disputed funds. I understand there is a 24-hour cancellation policy and that I will be charged without providing 24 hours advance notice to cancel a session.I have read, understand and agree to the information, authorization and guarantee stated above.

Signature *

Date *

Complete This Section If You Have Blue Cross Insurance

Blue Cross Insurance Information

Bevill and Associates LLC only accepts Blue Cross Blue Shield plans. Please note some Blue Cross plans provide mental health coverage through a secondary insurance carrier in which Bevill and Associates LLC may not be in-network.

Policy Holder Name

First

Last

Contract Number

Group Number

Date of Birth 00/00/0000

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