Abstract
The process of transitioning from prison to the community poses unique challenges for those who have been convicted of sexually based offenses. Due to the realities associated with the unique challenges facing these individuals, the community supervision process fluctuates along the correctional continuum which polarizes rehabilitative and control. The current study examines how this fluctuation relates to both the supervision process and correctional outcomes. Furthermore, the literature suggests five specific checkpoints along this continuum which are measured both qualitatively and quantitatively. The five checkpoints are Social Reintegration, Community Reentry, Status Maintenance, Statutory Compliance, and Risk Management. Overall, all five checkpoints are included in some way in the community supervision process; and analyses show significant links between the checkpoints and correctional outcomes.
Keywords
Introduction
Contemporary research on community realities for sex offenders has highlighted the existence of a continuum which polarizes rehabilitation and risk management (Barton-Bellessa & Hanser, 2012; Farkas & Stichman, 2002; Levenson & Cotter, 2005a, 2005b; Levenson, D’Amora, & Hern, 2007; Levenson & Hern, 2007; Terry, 2006; Tewksbury, 2005; Tewksbury & Lees, 2006). Despite misconceptions about the rigidity of this polarization, research suggests that criminal justice practitioners, particularly community corrections officers (CCOs), fluctuate between crime control and rehabilitation (Lutze, 2014). Ultimately, the continuum of care is known only by its polar opposites and is commonly referenced as the pendulum swinging as correctional emphasis changes. The current study provides checkpoints along that continuum in an effort to provide a theoretical understanding of the space between crime control and rehabilitation as guiding philosophy of correctional discourse. Figure 1 illustrates these checkpoints along this philosophical continuum. Moving from the rehabilitate to the control end of the continuum, these checkpoints are as follows: social reintegration, community reentry, status maintenance, statutory compliance, and risk management. While a comprehensive review of the literature provides a theoretical foundation for these checkpoints, important empirical gaps remain.

Checkpoints along the correctional continuum.
The first gap in the literature is the lack of empirical support for the existence of these checkpoints in the practice of sex offender community supervision. While the parameters of each checkpoint have been defined through a synthesis of contemporary literature, the existence of these checkpoints has not been empirically tested. The second gap is a lack of empirical measurement of how these checkpoints along the continuum are prioritized by CCOs. Being that these checkpoints are newly developed, their use and acceptance among professionals has not been studied. Finally, the third gap is a lack of an empirical demonstration of the link between the checkpoints and correctional outcomes (e.g., new convictions, technical violations).
The current study examines how focusing on these checkpoints impacts correctional outcomes. Within the context of the current study, recidivism as a correctional outcome is defined as any new conviction. Focusing on correctional outcomes eliminates the ambiguity associated with the term recidivism. While all nonsuccessful correctional outcomes could be classified as recidivism, the term fails to differentiate between new criminality and technical violation. The current study operationalizes recidivism as any new conviction post incarceration which includes both felonies and misdemeanors. It is important to note that technical violations are subject to classification, meaning that there are different types of technical violations. For the current study, technical violations are bifurcated between violations of department of corrections (DOC) imposed conditions of supervision and violations of statutorily imposed requirements (i.e., failure to register).
Method
The current study examines three research questions which have been derived from the gaps in the current literature. The first research question, which will be examined through a qualitative method, asks, Is there empirical evidence of the five checkpoints within the process of community supervision with sex offenders? The second and third research questions, which are examined quantitatively, ask, Which of the checkpoints do community corrections officers prioritize while working with sex offenders; and how does focus on specific checkpoints relate to correctional outcomes?
Research Design
The current study utilizes a longitudinal research design by examining the chronological field notes (chrono/chronos) composed by CCOs for offenders whose community supervision occurred between August 1, 2008 and December 31, 2011. The chronos provide a series of entries that record the CCOs’ efforts and the offenders’ progress during supervision. The chronos are used to identify the checkpoints, which are measured qualitatively as themes and quantitatively as frequencies and proportions. Follow-up or recidivism data regarding the offenders’ continuous criminal behavior are used to link the checkpoints to correctional outcomes. The use of a longitudinal research design strengthens the theoretically understood checkpoints by demonstrating the predictive utility of this perspective with regard to correctional outcomes, especially new convictions. While this approach lacks the robustness of an experimental design, the analysis presented provides strong support for the conclusions drawn.
Along with the information maintained in the Offender Management Network Information (OMNI) system which maintains record data for the Washington State Department of Corrections (WA-DOC), the current study utilizes record data maintained by the Washington State Administrative Office of the Court (AOC) to track offender recidivism post incarceration. While technical violations of both DOC and statutorily imposed conditions are recorded in the DOC record data, arrest, charge, and convictional data are maintained by the AOC. To link the measures of the checkpoints with new convictions, the current study uses unique identifies to track new conviction records of sampled cases throughout the follow-up period.
Providing an adequate follow-up period is crucial to any recidivism study. To provide an adequate, postincarceration follow-up period, the current study examines a sample of cases from those offenders who were supervised in the community between 2008 and 2011. 1 New conviction data from AOC ranged from January 1, 2008, to February 1, 2015; therefore, the specific follow-up period is based on when the offender in the sampled case was released from prison. The follow-up period ending February 1, 2015, provides sufficient exposure or opportunity to failure.
Data acquisition
The data for the current study have been acquired from the WA-DOC and the Washington AOC. Data from the DOC include the chronological field notes composed by CCOs and the legal face sheets which outline the offender-specific supervision condition for each case. The risk and needs data for each offender also have been acquired. 2 The WA-DOC uses specific instruments to assess risks and needs of sex offenders—the Static 99 and the Washington State Sex Offender Risk Classification for risk and the WA-DOC Offender Needs Assessment for needs. Data from these assessments are maintained by the WA-DOC and were made available along with other OMNI data. Data from the AOC consist of conviction data for the offenders identified in the cases included in the final sample. The chronos are made available through a secure server file exchange, per WA-DOC protocol. Research staff at DOC compiled the record data (chronos and legal face sheets) for the offenders who meet the sampling frame discussed below. Recidivism, or correctional outcome data, has been made available through data requests protocols outlined by Washington AOC and/or the Washington State Institute for Public Policy (WSIPP).
Mixed/blended methods
The current study utilizes a mixed or blended methodological approach, combining quantitative analyses of manifest-coded variables. Manifest or deductive coding (Bradley, Leslie, & Devers, 2007) procedures identify the existence of the checkpoints that have been defined through the literature review and operationalized in the variable measurement discussion below. This blended approach provides a thorough examination of the chrono narratives and a rigorous measuring of the frequencies of each checkpoint as well as the documentation of technical violation. Along with the quantified narrative data, the current study uses quantitative count-based data to fully measure all possible correctional outcomes including both technical violations and new convictions. This mixed approach uses a distinctive combination of inductive and deductive logic allowing for the examination of the theoretical components of the correctional care continuum, while simultaneously exploring the lived experiences documented in the chrono narratives, which can inform future theoretical developments. The measurement specifications and variable operationalization are discussed in the measurement section of this study.
Sampling
The current study is concerned with unique challenges facing CCOs who are tasked with supervising sex offenders as they transition from incarceration back into the community. The transition from incarceration to the community poses unique challenges for sex offenders which are rooted in the tremendous amount of social stigma faced by those who carry the sex offender label (Hattery & Smith, 2010; Neuilly & Zgoba, 2006; Pryor, 1996; Sample & Brary, 2006). While stigma is a barrier for all who are labeled as criminal, the sex offender label has been shown to be more troubling than the stigma associated with nonsexually based crimes (Goode & Ben-Yehuda, 2009; Jenkins, 1998). The realities of these stigma-drive challenges and societal barriers to reentry and reintegration have led many jurisdictions, including Washington State to create specialized caseloads for the CCOS who supervise these offenders in the community (Lutze, 2014). To fully capture and accurately measure all five of the checkpoints associated with the supervision of this transition, the following sampling procedures must be used.
Target population and sampling frame
The units of analysis for the current study are individual cases of sex offender supervision. Although the study examines how the supervision practices (i.e., checkpoint prioritization) of CCOs relate to correctional outcomes, the CCOs themselves are not specifically analyzed. Furthermore, while each case is represented by an offender, only the offender’s recidivistic behaviors are analyzed. Consequently, the target population for the current study is comprised of sex offender cases, postincarceration community supervision in Washington State. According to the WA-DOC, roughly 20% of Washington’s prison population is made up of sex offenders, 95% of which will return to the community (doc.wa.gov/community/sexoffenders/communitytreatment.asp, 2014).
Due to the extensive number of cases within the target population, only the cases that met the sample frame were included in the pool from which the final sample was drawn. Cases that met the following criteria were included in the sampling pool. The offenders in the case were convicted of a sexually based offense in adult court. While there are many different types of sexually based offenses, research suggests that the stigma-driven challenges associated with the sex offender label are not offense specific (Sample & Brary, 2006). Therefore, it can be argued that all five checkpoints are applicable to all sex offense cases, regardless of crime specification. Only cases in which the offender was incarcerated were included in the sampling pool. The requirement of incarceration is critical to the proposed study as it focuses on the challenges of the transition to the community associated with community supervision (i.e., establishing social viability, acquiring housing, maintaining employment). Also, offenders were under the institutional and community supervision of the WA-DOC. The correctional discourse requirements outlined by the various policy directives of the WA-DOC suggest that each checkpoint should be addressed in each supervision case. The final requirement of the sampling frame is that only those cases in which the offender completed DOC community supervision in the 2011 were included. There are two specific reasons for the completion year of 2011 inclusion criterion: (a) it allows of an adequately sized follow up period for recidivism, and (b) it eliminates an important threat to internal validity of the study–historical effects. In June 2012, the WA-DOC implemented a new policy that has the potential to impact the validity of technical violations as an outcome measure.
Sampling procedure
The WA-DOC identified 287 cases which met the sampling frame outlined above. The final sample size of 200 was determined by using the formula 50 + 8(K) + k suggested by Green (1991). When attempting to establish the significance of individual predicators, as is the case in the proposed study, Green (1991) suggests that one case be added for each predictor, thus making the minimum sample size required for the proposed study 95 cases. The minimum number of cases was doubled to 190 and rounded up to 200 to provide enough power for further analyses. 3 The findings from Green’s (1991) equations was cross-referenced with Cohen’s (1992) power printer, which suggested that a sample of 93 would be sufficient, ensuring that the final sample size of 200 provides adequate statistical power.
To eliminate the impact of systematic bias, the current study utilizes simple random sampling to identify the 200 cases to be included in the analysis. Research staff at the WA-DOC used computer generated random sampling identification to isolate the sample from the sampling pool. The practice of random sampling ensures that cases are not excluded based on offender risk or classification level, offender sex, victim status, or any other systematic characteristics. Such sampling practices allow for the unique impacts of the predictor variables to be measured.
Measures
Contemporary research provides a strong foundation for the operationalization of the variables being measured in the current study. Each of the five checkpoints has unique attributes that can be identified in the chrono narratives. Using the operational definitions discussed below coupled with manifest coding procedures; each checkpoints is identified throughout the narratives. The frequency at which each of the checkpoints is identified in the narratives has been recorded and used in quantitative analyses.
The appendix provides the manifest coding scheme for the qualitative analysis. The unique attributes of each checkpoints listed guides the quantitative content analysis, which identifies the existence and frequency of each checkpoints. Consistent with the manifest coding procedures discussed by Kraska and Neuman (2012), the variable attributes list represents the “list of words, phrases, or symbols” to be located in the data narrative (p. 213). Therefore, any of the chronos entry that discusses relationships, social networking, social engagement, stress or anxiety, shame or stigma, or social isolation are coded as a Social Reintegration entry. Although Social Reintegration and Community Reentry are often colloquially equated, for the purposes of the current study, the terms have been bifurcated and unique attributes have been assigned to each. Consequently, chronos entries that address issues regarding housing security and stability (not related to zone restrictions), employment, or personal safety are coded as Community Reentry entries. As a checkpoint, Status Maintenance is somewhat dynamic, as the supervision conditions imposed upon an offender are generally offender specific. To identify Status Maintenance chrono entries, a combination of the attributes outlined in the appendix and the offender-specific condition defined by the offenders legal face sheets—a list of offender-specific attributes, condition, and legal requirements, are used. In contrast to the highly specific Status Maintenance variables attributes, Statutory Compliance attributes are more universally applied to all sex offender cases, making identification less arduous. Any entries that address registration, notification, or residency restrictions are coded as Statutory Compliance chrono entries. Finally, any chronos entry which addresses containment appointments, office check-in frequencies, home visits, actuarially risk assessment, or GPS/electronic monitoring are coded as a Risk Management entry.
Dependent variables/correctional outcomes
Four correctional outcomes have measured as dependent variables in the current study. Due to the sampling frame specifications, the possibility exists that the offenders could have earned multiple technical violations or have been reconvicted multiple times. Therefore, all technical violations and all new convictions are measured in specific ways. Technical violations data which were obtained through the DOC record data allow for them to be classified as either violation of DOC imposed condition or statutorily imposed requirements. New conviction data have been obtained from record data obtained from the AOC. Raw count data for the technical violations are used in bivariate and multivariate analyses, while due to data limitations, recidivism has been dichotomized based on new convictions.
Analysis
The current study utilizes both qualitative and quantitative analyses. Each research questions requires a different type of analysis. Both qualitative and quantitative content analyses are used in the early analytical phases, while a series of statistical analyses are used to measure relations between variables and cases. Collectively, the analyses below provide empirical answers to the important research questions that have been raised and the knowledge gaps which were identified.
As alluded to earlier, the qualitative analysis uses a manifest coding approach to identify aspects of the five checkpoints in the narratives. The manifest coding process was guided by the coding structure provided in the appendix. During qualitative analysis, words and phrases, or their equivalent within the narratives were coded as the appropriate corresponding checkpoint. These manifestations are organized and presented thematically based on the checkpoints in the following section.
The unique qualitative approached used here is an adaptation of traditional thematic analysis. While traditional thematic analysis uses an inductive logic to identify conceptual themes within a narrative, the deductive analysis here aligns more closely with the positivist theoretical perspective while maintaining important aspects of the interpretative approach (see Lanier & Briggs, 2014). Given that each CCO uses his or her own terminology when composing a chrono narrative, the qualitative analysis required a degree of interpretation to ensure that the narrative text was appropriately coded as the proper checkpoint. Furthermore, while traditional qualitative analysis seeks to examine the construction of meaning (Kraska & Neuman, 2012), the current approach seeks to highlight the existence of those aspects of sex offender community supervisions suggested by contemporary literature.
Findings
A total of 200 cases were randomly selected for analysis from a total population of 287 cases that met the parameters of the sampling frame. The qualitative examination of the supervision narratives found in the chronos revealed that 30 of the offenders in the randomly selected cases were deported to their home country, while another four offenders were transferred out of state for supervision. Consequently, the total number of cases included in the final analyses is 166 cases, all of which represented offenders who were supervised by the WA-DOC following release from incarceration. Table 1 provides the descriptive statistics.
Descriptive Statistics (n = 166).
Note. Valid Percentages Reported.
Washington State Sex Offender Risk Classification.
The majority of the offenders in study are males (96.4%), White (77.7%), with an average age of 40 years. The majority of the offenses in the sampled cases included some degree of assault-based victimization of children (76.5%) while adult victimization occurred in fewer than 10% (9%) of the sampled cases. Nonassault sexual offenses such as failure to register, selling or possessing child pornography, or exposure crimes accounted for just over 14% (14.5%) of the cases. Over half (55.7%) of the offenders were classified as level one or low risk based on their crimes, while sex offense–specific actuarial-based risk assessments classified the majority of the offenders as low to moderate risk. Furthermore, with regard to general risk of recidivating, nonsex offense–specific assessments classify nearly half (48.8%) of the offenders as low risk. Actuarial-based needs assessments show that the offenders in the sampled cases, on average, score high in the areas of employment (
The qualitative analysis provides strong support for the existence of the five checkpoints in the community supervision process. Not only are each of the five checkpoints represented throughout the supervision narratives (chrono), but each aspect of each of the checkpoint were identified as well. Overwhelmingly, the qualitative analysis and discussion provided a definitive answer to the first research question.
Social Reintegration
The dominant thematic aspects of the Social Reintegration checkpoint those related to repairing or establishing supportive, prosocial relationships such as familial or spousal. When these aspects of Social Reintegration emerged, the CCOs noted substantial problems. Findings show that the harm caused by the offenders and the stigma those crimes carry impacted the offender’s Social Reintegration. The following case illustrates this reality: [ex-wife] stated that her entire family has been devastated by [offender’s] actions and does not want him to be anywhere in their vicinity”[offender] is emotional about wanting to see his father {sick in hospital} but the rest of the family wanting nothing to do with him and not wanting this contact [. . .] “distraught, his father has been given 2 months to a year to live and he can’t see him”
When family relationships are strained or nonexistent, offenders seek out relationships in the community. However, due to the stigma associated with the sex offender label, establishing supportive, prosocial relationships is difficult. Consequently, offenders seek out relationships with other offenders or members of their counseling groups.
[offender presented a safety plan to attend a group member’s home for a BBQ/potluck for group members . . . [offender] will be giving a ride to one of his group members
The CCOs of the offenders who participated in this community sex offender treatment program group gathering showed support of such prosocial engagements. However, in some cases the reality of offender–peer relationships can be problematic, particularly when offenders have supervision conditions restricting them from associating with convicted felons. The following case illustrates this challenge: I [CCO] would speak to [Offender] today regarding his GF, informed [Offender] that he can no longer have contact with her as she is a convicted felon
The complex challenges associated with sex offender community reintegration impact the supervision process and demands that the CCOs who are working with these offenders be proactive in addressing them.
Many of the CCOs in the study utilized proactive approaches to aiding the offender with the challenge of Social Reintegration, particularly with regard to social networking and engagement. Nearly all of the CCOs in the current study encouraged structured community involvement including community resources such as churches, centers, or organizations.
Advised [Offender] to seek a support group/social club through community outreach agency [CCO] spoke with [Offender’s] wife this date. She requested information on how [Offender] could begin attending Church with her. Told her [. . .] he needs to be with an approved chaperone [Offender] tells me he joined the senior center we had encouraged
Along with requiring offenders to disclose their crimes and supervision conditions to church leaders, outreach facilitators, or organizations, CCOs utilize a chaperone system which allows offenders to engage within the community and attempt to build prosocial support networks. Chaperones are generally close friends or family members who routinely provide support for the offender—church pastors, parents, and siblings being the most common.
[Pastor] requested that he, his wife, and his son be allowed to be chaperones [Offender] brought his fiancé in to meet me [. . .] brought in chaperone paper work as he thought we could fill it out while he was here
While the chaperone system is beneficial for those offenders who are working toward establishing prosocial support networks, it is predicated upon the offenders having or being able to establish relationships. Throughout the supervision narratives, CCOs routinely note offenders’ existing, developing, and problematic relationships. Most frequently, such relationships are noted at times of face-to-face encounters.
This date at [Offender’s] residence and met with [Offender] and his mother [Offender’s] brother and his friend were also in the residence [Offender’s] wife, father, and pastor came into the office
Collectively, the qualitative data suggest that the relationships, social networking, and social engagement aspects of the Social Reintegration checkpoint are indeed part of the community supervision process. 5 While the checkpoint of Social Reintegration only accounts for roughly 10% of chrono entries, the degree of their impacts need to be examined further.
Although less frequently addressed in the supervision narratives, abstract social realities experienced by the offenders such as social anxiety, shame/stigma, and isolationism, compared to more concrete challenges (i.e., marriage). The social anxiety that is most often noted is related to an offender’s fear of vigilante-violence—being targeted due to their status as sex offenders.
[Offender] called this a.m. very upset stating that he wants to go back to prison. He said he is tired of being a victim in the community “[Offender] called this date to report harassment by his ex-wife [. . .] told by police that there is nothing he can do to keep his ex-wife from harassing him He informed me that housemate was making death threats to him [. . .] waving a butcher knife around
Along with experiencing harassment and threats of violence, CCOs note that offenders experience isolation and shame which in some cases were linked with suicidal thoughts.
[Offender] is apparently not wanting any contact with anyone [. . .] was very emotional today, crying and stating that he just realized he has nobody in the world [Offender] was having thoughts of suicide and hurting himself [Offender] called from hospital last night, psych-ward with assistance from attendant. Said he was taken into the hospital after suicidal thoughts
While these challenges to Social Reintegration are not as thematically dominant, the impacts of these challenges are important as they suggest instability that may lead to supervision failure.
Community Reentry
A thorough examination of the supervision narratives found that reentry issues are routinely addressed by CCOs. Reentry concerns encompass more concrete elements related to establishing life in community such as housing, employment, safety, and where an offender can live. The housing and employment aspects of the Community Reentry checkpoint emerged as dominant themes. CCOs routinely note concrete observations such as unemployment or homelessness. Consequently, when such challenges were brought to the attention of CCOs, she or he thoroughly noted them.
Qualitative findings support the assertion that sex offenders face daunting barriers to housing stability, while many experience extended periods of homelessness.
Said he slept under a railroad bridge last night in down town, doesn’t know where he will sleep tonight [Offender] needs a light jacket, his tent is leaking from light rain [Offender] reported that he is homeless and spending nights on the street [. . .] directed him to stay at a shelter this evening, provided addresses of other shelters if not availability
The dominance of the homelessness theme among the chronos can be attributed to poverty, which is exacerbated by the offenders’ inability to secure employment, and housing rejections.
The offenders’ inabilities to secure or maintain employment is noted throughout the supervision narratives. In general, CCOs report that when offenders experience issues with employment, they are either denied jobs or fired from existing jobs due to their sex offender status. All sex offenders are required to disclose their offense to current or potential employers; however, this practice seems to be impeding offenders’ ability to secure employment.
[Offender] shared that he did not get the job he applied for due to his offense [Offender] applied for work through express and was basically told that they do not hire felons [. . .] he said he did not pass an employment screening”
In some cases, offenders were not required to disclose their offenses prior to being hired; however, once their offenses were made known, they lost their jobs. In cases where employers do not perform background checks or offenders are not able to disclose before being hired, the eventual disclosure results in termination, while others report that coworks or community members disclose to employers once they are made aware.
[Offender] is working temp construction at the mall, using break room for employees and disclosed to employer today [. . .] said he was terminated from his new job at the end of shift reports being fired from his job that I assisted him in obtaining [. . .] a lady recognized him from the sex offender website and reported it to the plant manager
The immediate consequences of employment instability among the offenders in the cases sampled range from continued job searching to homelessness. Although many offenders in the sampled cases are dependent upon their jobs to pay rent, poverty is not the only threat to housing stability.
Although offenders might be able to afford housing, or in some cases be able to secure long-term placements in homeless shelters, their status as sex offenders threatens their longevity and housing stability. CCOs reported that offenders under their supervision experience housing instability due to three primary reasons: housing denial due to sex offender status, evictions, and being forced to relocate due to threats of violence or harassment. It is important to note that these housing denials are based on considerations other than zoning restrictions imposed by statutes which are addressed in Checkpoint 4.
Called [Offender] to let him know that I was notified that housing was denied due to the apartment manager not wanting a registered sex offender at the address and [Offender] was not allowed to lease [Offender] has been looking for a new place for them to live, said most landlords don’t have a problem with the sex crime, it’s the kidnap 1 that they have issues with
Other barriers to housing stability stem from social or community reactions to sex offenders residing in specific locations. While some social and community resistance to sex offender housing is manifested through systemic pathways (i.e., filing complaints or evictions), other responses are intimidation-oriented and threating.
[landlord] of the place they are living came over to the residence and gave [Offender’s] wife a very bad time about [Offender’s] offense and said they are not welcome in the [park] gave them eviction paperwork [Offender] provided his new address. He moved because of threats to his former trailer park manager and himself [Offender] states he’s not showering at the shelter as three men approached him last time he was there and told him they would beat him up if they saw him there again.
Consequently, an offender’s inability to maintain stable housing impacts various aspects of the community corrections process (i.e., home visits, community engagement). The realities of homelessness or housing instability coupled with threats to the personal safety of the offenders create a complex supervision process which demands the attention of the CCOs involved. However, based on the average percentage (12.4%) of chrono entries addressing Community Reentry, it does not seem as though such issues are prioritized in the supervision of sex offenders in the community.
Status Maintenance
The Status Maintenance checkpoint emphasizes whether offenders are avoiding contact with minors or victims, accurately disclosing their offenses when necessary, and adhering to all DOC imposed condition of community supervision. Findings suggest that sex offender specific supervision conditions are intended to disrupt behavioral patterns that are linked to sexual misconduct (i.e., pornography restrictions, phallometric testing, or relationship restrictions). Qualitative findings show that CCOs make thorough records of the steps they take to impose the DOC conditions of supervision. This was found to be particularly true when imposing conditions could lead to further actions (i.e., negotiated sanctions or stipulated agreements). Consequently, CCOs make multiple entries related to scheduling, administering, and reviewing of polygraph and plethysmograph testing. Furthermore, as housing is a major issue for sex offenders, CCO notes suggest that living arrangement approvals consume a lot of their time.
Two particularly unique sex offender specific conditions are the requirement to participate in polygraph and plethysmograph testing. Findings suggest that each of these tests serve specific functions. Throughout the supervision narratives, polygraph testing was used to determine whether offenders were adhering to the other conditions of supervision (i.e., no contact with minors, not consuming alcohol, or viewing pornography).
[Offender] completed a polygraph exam submitted by examiner and result: deceptive on alcohol question Received polygraph report from examiner this date. Poly shows no deception when asked about contact with minor females
Along with illustrating how the polygraph testing was used as a supervision tool, the narratives suggest that polygraph testing is a major part of the process. A single polygraph test could account for multiple chrono entries—outlining notification timelines, testing locations, results discussions, and in some cases negotiated sanctions when needed.
Phallometric testing or plethysmograph testing is a sexual preference and arousal assessment. 6 As a condition of supervision, these tests were discussed less frequently throughout the supervision narratives. Such tests were used primarily with offenders who had sexually victimized children.
[Offender] did complete a plethysmograph recently, showed arousal to children
While such testing appeared in fewer cases than did polygraph testing, the procedure regarding multiple chrono entries is consistent, particularly with regard to scheduling.
The approval of living arrangements and sexual partnerships are both aspects of the Status Maintenance checkpoint that routinely appears in the supervision narratives. Such conditions are intended to ensure that offenders are not putting themselves at risk by living with or around criminogenic triggers and to ensure that the sexual relationships in which they engage are legal and consensual. These conditions are enforced in two ways: CCOs inspection of living arrangements and face-to-face disclosure meetings with the offender, their intended sexual partner, and the CCO.
Reminded [Offender] that [CCO] would need to have access so he should consider locations that allow him access and not be near locations likely to put him in contact with minors [Offender] said there are no drugs, alcohol, or firearms in the house and (name omitted) is the only other person living in the house. [. . .] I told him I would approve of the place and I would be coming by [Offender] has requested a discloser meeting with his friend (name omitted). He wants to be in a romantic relationship with her [CCO] reviewed [Offender’s] conditions and it only says he can’t have a relationship with a woman who has minor children without permission [. . .] [CCO] would work with provider to determine when he and (name omitted) can have sexual relations
While enforcing the conditions of approved housing and relationships does not account for as many chrono entries as a single polygraph and plethysmograph examination, these aspects of the Status Maintenance checkpoint do account for a substantial amount of time.
The remaining aspects of the Status Maintenance checkpoint such as firearm or adult entertainment restrictions, legal financial obligations (LFOs), and travel permit requirements are also present throughout the supervision narratives, but they do not account for as many chrono entries or take up as much of the CCO’s time. Many of the offenders sampled struggle with substance or pornography addiction, while nearly all of the offenders struggled to meet their LFOs while on supervision. Consequently, CCOs appear to use every opportunity to address these issues with offenders and note such concerns in the chronos.
Statutory Compliance
Statutory Compliance includes offender registration, notification, and residency restrictions. When these state and federal mandatory requirements do emerge, registration requirements are noted most regularly. On average, Statutory Compliance is only mentioned by CCOs in 2% of chrono entries; however, when it is noted it seems to be noted with other concerns. Qualitatively, thematic trends in the chrono narrative suggest that the address requirement part of registration is important as many offenders in the sampled cases experienced homelessness.
[CCO] reminded [Offender] to register at the sheriff’s office once he has secured an apartment
Furthermore, when offenders are homeless, they are required to register on a weekly basis. CCOs make sure to note when they remind offender to do so.
[Offender] is heading to county to register which will be weekly as long as he is homeless
Consequently, the majority of chrono entries addressing the issue of sex offender registration are found in the cases in which the offender experiences long periods of homelessness.
The second aspect of the Statutory Compliance checkpoint is community notification. The data suggest that notification requirements are noted by CCOs in three specific ways: CCOs attending notification meetings to inform the public of the offender’s conditions and restrictions, assisting county law enforcement with posting flier notifications where necessary, and working with the offender to address the collateral consequences and community responses evoked by the notifications.
[CCO] left message with Det. requesting contact regarding [Offender’s] SO registration fliers that were placed in the neighborhood mailboxes last week [CCO] Attended the community notification meeting at (town omitted) school district administration building. [CCO] told [Offender] that DOC and the Court do not prevent him from defending himself. However, he is unable to defend himself with a deadly weapon. That right has been taken away. He said he just wanted to know because he was concerned that he would be attacked after the fliers went out
Along with ensuring that offenders are in compliance with, and adjusting to registration and notification requirements, CCOs must confirm that offenders are obtaining housing outside of restricted zones. Restricted zones are those areas in the community that are within a specific distance from parks, schools, playgrounds, and daycare centers. The supervision narratives illustrate how these zoning restrictions exacerbate the problematic task of securing stable housing, as CCOs will be required to reject or approve an offender’s proposed address due to its location.
[Offender] would have been living in a community protection zone if [Offender] moved in the house. I called [Offender] back to let him know that could not live at the proposed address. (case 100) [CCO] did initial internet search found address to be too close to a daycare. Called back spoke with sister, assisted her in getting a couple more RV park addresses that were not too close to schools, parks, or daycares.
As a checkpoint for community supervision with sex offenders, Statutory Compliance does not appear in the supervision narratives as frequently as the others. However, the rigidity of the statutes allows for no flexibility. While CCOs may be able to grant leniency if an offender violates a DOC imposed condition of supervision (i.e., consumes alcohol, views pornography), CCOs have no ability to practice discretion with regard to statutorily imposed conditions.
Risk Management
The fifth and final checkpoint along the continuum of care is Risk Management, which encompasses those aspects of community supervision that aim specifically to inhibit the offender’s ability to engage in subsequent criminality. The dominant themes with regard to Risk Management are surveillance and incapacitation. CCOs routinely note surveillance practices as multiple contacts and schedule reporting, while narratives suggest that varying degrees of incapacitation occurs through GPS or home visits. Chrono entries addressing surveillance and incapacitation practices dominated the Risk Management entries, while risk assessment or other instrumentation received less attention.
Containment utilizes a multiple-contact approach to essentially quasi-incapacitate the offender though indirect control (Edson, Lundell, & Robinson, 2007). By recording every contact between the offender and the CCO, treatment staff, law enforcement, or electronic kiosk, CCOs demonstrate the containment aspect of the Risk Management checkpoint. In many of the sample cases, multiple and consecutive chrono entries are containment, Risk Management oriented.
[Offender] reported as directed [. . .] provided a signed copy from therapist as proof of treatment [. . .] making good progress in IOP TX [. . .] reported as directed [. . .] reported as directed
Subsequent analyses (see Table 2) show that Risk Management is the most frequently utilized and most highly prioritized of the five checkpoints—due considerably to the routine use of containment.
Checkpoint Prioritization: Sample Averages (n = 166).
Note. The checkpoints are listed in order along the correctional care continuum. The raw average is the average number of times the checkpoint appears in the narratives, while the percentage average accounts for the average number of time the checkpoints appears given the total number of chrono entries.
Other incapacitation-oriented aspects of the Risk Management checkpoint are home visits and electronic monitoring (GPS). The supervision narratives suggest that both home visits and GPS monitoring serve the role of restricting the offender’s mobility—both routinely and momentarily. The data suggest that the constant surveillance from the GPS monitoring evokes fear, anxiety, and stress leading offenders to be confused about their approved locations.
[Offender] reported today [. . .] asked for a trip permit to see a family member in the hospital, and said that the GPS was not functioning correctly Met with [Offender] this a.m. and seems anxious upon his arrival. He states that on Thanksgiving his GPS device started flashing all lights green rapidly [. . .] called me and reportedly left a message, followed by a call to 911
The incapacitating effects of home visits recorded in the chronos suggest a momentary restriction on the offender’s mobility. This momentary restriction of the offender’s mobility generally takes one of two forms—the CCO is present in the offender’s home and therefore the offender must engage with them, or the offender being instructed when to be home so that a home visit can be conducted.
[CCO] conducted home visit. [Offender] was there as well as father who didn’t have much to say [. . .] I did not go inside as the home was-is still filthy. [Offender] came to the door but has been ill with serve bronchitis [CCO] Conducted unannounced home visit this date. Met [Offender] and [Offender’s] GF at his residence. Looked inside of the house and checked [Offender’s] room visually. GF was mad at CCOs visit
While the home visit does momentarily and indirectly incapacitate the offender, it also serves as an additional contact between the CCO and the offender which can be understood as part of the containment aspect. Regardless of the degree of incapacitation, immobilization or containment, the intention is to reduce the risk the offender presents to the community.
The final aspect of the Risk Management checkpoint is risk assessment, which allows CCOs to fully gauge an offender’s risk to community safety. There are many different risk assessment instruments being utilized by various Departments of Corrections. 7 The supervision narratives discuss the utilization of specific risk assessment instruments, which are intended to guide the development of supervision modalities. 8 The supervision narratives suggest that risk assessment instrumentation is a routine part of the community supervision process.
No change. Static 99 score1, low; Stable 12 high; Acute 2/4 high/high. Overall DRA supervision priority mod-high [Offender] scored low on combining static 99, stable-2007 and Acute-2007 risk factors Dynamic Risk Assessment completed via file review: Static 99 = 0 (Low Risk); Stable = 9/24 (Moderate Risk) and Acute = 2-Sex/Violence Risk (High Risk) and 4-general Recidivism (High Risk) Combine Scores place [Offender] at a Moderate Priority
The qualitative data demonstrates that the risk assessment, as defined by the checkpoints approach, is a key part of Risk Management.
Collectively, the supervision narratives contained in the chronological field notes composed by CCOs provide support for the existence of the five checkpoints outlined by the current study. Furthermore, the qualitative examination of the chronos has contextualized the various aspects of the checkpoints, illustrating both the presence and purpose of each. Along with providing evidence of the empirical existence of the checkpoint in the supervision process, this qualitative examination has provided a unique opportunity to use a thematic coding approach to identify and contextualize concerns about sex offenders often discussed in the literature without evidence of their importance to CCOs who are responsible for implementing the law, policies, and practices of sex offender community supervision.
Both the qualitative and quantitative analyses performed in the current study show that the checkpoint of Risk Management is focused on most extensively by CCO when working with sex offenders. The supervision narratives sampled for the current study accounted for a total of 4,861 pages of text and produced a total of 73,460 individual mentions of the five checkpoints. As the previous section illustrates, the discussion mentions each of the checkpoints aligned with the various aspects of each individual checkpoint. The individual measure of each checkpoint shows how each concern was prioritized in each case (see the appendix). Table 2 shows how the checkpoints are prioritized at the aggregate level.
Table 2 shows that on average, nearly half (46.3%) of chrono entries discuss or address some aspect of Risk Management. The second most frequently utilized and/or prioritized checkpoint for the sampled cases is Status Maintenance. On average, roughly one third (29.2%) of the chrono discussions focused on issues related to regulating DOC imposed supervision conditions. Issues related to Community Reentry (i.e., housing, employment, or personal safety) are the third most frequently addressed in the sampled cases. On average, just more than 12% (12.4%) of chrono entries focus on Community Reentry. The two least frequently addressed of the five checkpoints are Social Reintegration and Statutory Compliance. On average, roughly one tenth (10.1%) of the chrono entries addressed issues related to Social Reintegration, while only 2% of chrono entries addressed Statutory Compliance. These findings suggest that when working with sex offenders, CCOs prioritize and focus most extensively on the checkpoints that are closest to the control end of the correctional care continuum.
The current study finds that there are both correlational and predictive relationships between the checkpoints and correctional outcomes. Negative binomial regression analyses show that the number of chrono entries discussing certain checkpoints is predictive of increases or decreases in technical violations. Furthermore, a survival analysis shows that the number of chrono entries addressing Status Maintenance is predictive of new convictions.
In an effort to answer this research question, current study uses both negative binomial and Cox regression analyses. Due to the nature of the data and the necessity of accounting for exposure-time (offense opportunity), a negative binomial model is used for technical violations, while an event history or survival analysis is used for recidivism; both analyses account for exposure time or time to failure.
Table 3 provides the negative binomial regression models that demonstrate the predictive relationships between the checkpoints and the three types of technical violations examined in the current study—all technical violations, technical violations of DOC imposed conditions, and technical violations of statutorily imposed conditions. For all three models, the parameter estimates were fixed at one. Estimating the parameter estimates did not significantly improve the model. Therefore, the fixed parameter estimate models were selected as they produced the strongest model fit.
Negative Binomial Models: Checkpoints Predicting Technical Violations (n = 166).
Note. Technical Violations (All) χ2 = 88.138 Sig < .0001. Technical Violations Conditions χ2 = 98.579 Sig < .001. Technical Violations Statutes χ2 = 47.287 Sig < .001.
Significant at the .05 Level. **Significant at the .01 Level.
The parameters in Model 1 explain a significant amount of the variance in the number of technical violations committed (χ2 = 88.138 p<.0001). Findings show that the frequency at which CCO note certain checkpoints predicts the number of technical violations an offender receives. Controlling for risks and needs, the frequency with which CCOs address the checkpoints of Community Reentry and Risk Management is found to be significant (χ2 = 3.981, p = .046; χ2 = 5.589, p = .018) in Model 1. For every additional mention of the Community Reentry checkpoint identified in the supervision narrative, there is an expected .006 log count decrease in the number of technical violations an offender commits. For every additional mention of the Community Reentry checkpoint identified in the supervision narrative, there is an expected .008 log count decrease in the number of technical violations an offender commits. For every additional mention of the Risk Management checkpoint identified in the supervision narrative, there is an expected .003 log count increase in the number of technical violations an offender commits. Model 1 suggests that the more CCOs note the checkpoints closest to the control end of the correctional care continuum (Risk Management), there is an increase in the offender’s likelihood of being violated for any technical violations. Furthermore, the analysis suggests that Community Reentry issues, while noted less frequently than Risk Management, are important for successful transitioning.
The parameters in Model 2 explain a significant amount of the variance in the number of condition-based technical violations committed (χ2 = 95.597 p<.001). Controlling for risks and needs scores, the frequency with which CCOs address the issues related to the checkpoints of Community Reentry and Risk Management is found to be significant (χ2 = 5.746, p = .017; χ2 = 6.799, p = .009). For every additional mention of the Community Reentry checkpoint identified in the supervision narrative, there is an expected .008 log count decrease in the number of condition-based technical violations an offender commits. For every additional mention of the Risk Management checkpoint identified in the supervision narrative, there is an expected .003 log count increase in the number of condition-based technical violations an offender commits. Despite the fact that addressing and enforcing DOC imposed conditions is the second most frequently recorded checkpoint, the findings in Model 2 suggest that the more often CCOs address or note Risk, the more likely an offender is to be violated for a condition-based technical violation. Yet noting issues related to Community Reentry is linked to a decreased likelihood in offenders being violated for a condition-based technical violation.
The parameters in Model 3 explain a significant amount of the variance in the number of statute-based technical violations an offender commits (χ2 = 47.287 p < .001). Controlling for risk and needs scores, Model 3 shows that the number of times a CCO notes issues related to Status Maintenance, the more likely offenders are to commit statute-based technical violations (χ2 = 4.55, p = .033). For every additional mention of the Status Maintenance checkpoint identified in the supervision narrative, there is an expected .006 log count increase in the number of statute-based technical violations an offender commits. Model 3 suggests that noting the process of imposing DOC imposed condition is linked to technical violations of statutorily imposed conditions. Status Maintenance chrono entries are usually linked with a face-to-face encounter between the CCO and the offender; the increased contacts appear to provide CCO with opportunities to identify statutory-based violations.
The Cox Regression Model presented in Table 4 illustrates the predictive relationship between the five checkpoints and recidivism. The Cox Regression Model accounts for exposure time or time in the community post incarceration. Accounting for the exposure time is important when studying recidivism as the more exposure an offender has to the community, the more opportunism the offender has to be convicted of new crime.
Cox Regression: Checkpoints Predicting Recidivism (n = 166).
Note. M = Model; N = Null.
Significant at .05 level.
The predictors in the Cox Regression Model presented in Table 4 measuring the influence of the checkpoints on recidivism shows a significant portion of the variance in new convictions (χ2 = 19.649, p = .033). The findings show that number of chrono entries addressing Status Maintenance is related to increased likelihood of recidivism. Controlling for risks and needs scores, and holding all other measures constant, for every additional mention of the Status Maintenance checkpoint, the propensity of an offender being convicted of a new crime increased by .007% (hazard ratio = 1.007, p = .048).
Overall, the analyses in this section illustrate that the relationship between the checkpoints and correctional outcomes is both significant and predictive. 9 Collectively, the two prediction models show that increases in CCOs noting some checkpoints is predictive of technical violations and new convictions. Furthermore, the prediction models show that more frequent chrono entries related to offender control are predictive of negative correctional outcomes. However, the increased frequency of Community Reentry chrono entries is predictive of decreases in negative correctional outcomes—suggesting that a rehabilitative focus is advantageous.
The findings presented in this study provide answers to the research questions concerning the existence and utility of the checkpoints regarding sex offender community supervision. The qualitative analysis shows that the checkpoints as identified by the literature exist within the context of community supervision. The challenges faced by the offenders who are transitioning from prison to the community are part of the overall supervision process. The CCOs who work with sex offenders during this time of transition must be aware of and account for these realities in the supervision process. These findings show that CCOs focus most exclusively on the checkpoints related to offender control and that the degree to which CCOs focus on each of the checkpoints is linked to offenders’ violating the conditions of supervision. Furthermore, the findings show that offense type is also linked to the degree to which CCOs utilize specific checkpoints. In general, the findings show that checkpoint prioritization does matter to the process and the outcomes of community supervision. The findings show that focusing on those checkpoints at the control end of the correctional care continuum predicts technical violations, suggesting that by not prioritizing the rehabilitation checkpoints, CCOs create a discourse with a trajectory toward failure.
Discussion and Implications
The current study produced three critical findings that relate specifically to the dynamics of the correctional discourse between CCOs and sex offenders. Qualitative findings show that there is a considerable disconnect between the offenders’ experiences and the noted priorities of the CCOs. Quantitative findings suggest that CCOs prioritize control and condition enforcement, guiding the process toward technical violations, disrupting the offenders’ strained attempts at reintegration or reentry. The findings of the current study support the social construction-based argument put forth by Goode and Ben-Yehuda (2009) and Jenkins (1998) who maintain that sex offenders are socially constructed as less than human, and therefore, any social responses to them will be punitive and further exacerbate their de-humanization. Unfortunately, it cannot be assumed that the duty-mandates placed upon CCOs will make them immune to the social construction processes inherent to the communities in which they work and live. The findings of the current study suggest that while CCOs may not construct the offenders as monsters or folk devils (see Goode & Ben-Yehuda, 2009), they do construct them as risks that must be managed, which in any context is less than fully human (Schaefer, 2014).
By focusing the community supervision process on Risk Management, CCOs create a correctional discourse that is linked to increased chances for the enforcement of technical violations. Furthermore, by emphasizing the Risk Management checkpoint, CCOs fail to significantly reduce the likelihood of recidivism. By demanding that the process of community supervision, with sex offenders or otherwise, identify the community as the client, risk focused policies impede the process from being truly client centered (see Roger, 1957). For the community supervision process to truly aid the offender with the challenges he or she will face during the transition from prison to the community, correctional policies must demand that the offender be fully identified as the client—meaning that the offender is the intended and primary recipient of the correctional discourse (see Blackburn, 2002), or at least an offender-centered approach that is balanced with a community-centered approach (Lutze, 2014). Furthermore, the correction approaches regarding imposed conditions, field work, and violations practices, should add to a correctional discourse that more closely resembles the client-centered approach embracing the conditions outlined by Rogers (1957), especially the notions or empathic engagement and unconditional positive regard. While the primary emphasis of this study is centered on correctional discourse within the context of offender supervision, the finding presented here has important implication for those who work clinically with these individuals. As argued by Polizzi (2014), the development of therapeutic relationships which are built on trust is a difficult task when the client–therapist dynamic is disrupted by the coercive nature of the criminal justice system. Both CCOs and clinicians should work to avoid further stigmatizing these individuals by overemphasizing risk as such practices can lead to further marginalization and a decreased likelihoods desistance (Braitwaite, 1995; Pryor, 1996). Rather, both CCOs and clinical practitioners need to prioritize those checkpoints at the rehabilitative end of the continuum—working toward outcomes related to a sustainable community and social viability for the offender (Rotman, 1990).
Consistent with the overall findings of the current study, the policies and practices that dictate the community supervision of sex offenders are heavily focused at the control end of the correctional continuum. Such policies do not account for previous research findings regarding the realities faced by sex offenders during the transitional time following incarceration. The current Risk–Needs approach to community supervision needs to be expanded to allow for a more comprehensive understanding of the offenders’ lived realities and experiences during this arduous time (Polizzi, 2014). Furthermore, CCOs must understand the limitations to the Risk–Needs approach with regard to implementing and designing supervision modalities that promote the strengths and isolate the limitations.
Offender Programming
Aside from the implications for clinical discourse, the current study can also inform offender programming. First, offender programs, regardless of the clinical philosophy (e.g., psychodynamic, cognitive behavioral), must address the importance of social/community reintegration. Offenders’ inabilities to develop or maintain social support during the transitional period between prison and community impact their efforts toward desistance (Cullen, 1994). Second, programs and those who work with sex offender in the community must recognize how the sex offender label impacts the personal safety of the offenders. The narratives analyzed here documented incidences of threats of physical violence as well as insecure and unstable housing. Third, programs need to emphasis the realities of the supervision process by educating offenders about adhering to supervision condition and statutory requirements in therapeutic rather than disciplinary manner. Finally, programs need to provide a therapeutic space where offenders can “make good” and redefine themselves within a social context that both accounts for and moves beyond their criminality (Maruna, 2002). As started by Schaefer (2014), when working with sex offenders in the community, CCOs, clinicians, and program providers can serve as a social pathway for reintegration by empowering offenders to reconcile their pasts and redefine themselves void of the stigma associated with their past criminality.
Limitations and Future Research
The current study is not without limitations. While the qualitative analysis shows that CCOs address a wide range of issues in the chronos, there remains a high degree of discretion regarding what goes into chrono entries. Within the current correctional paradigm which emphasizes community safety, CCOs may be more likely to note those issues related to risk and offender control. Consequently, the chronos may not fully capture the entirety of the supervision process. Overcoming this limitation will require extensive observational research of CCO-offender engagement. However, the current study provides a foundation for such subsequent research. The sample also represents a limitation as it includes only those cases in which individuals completed supervision. This sampling frame parameter excludes those who failed to complete supervision or those under life-time supervision. Also, the current study lacks a measure of intercoder reliability due to the fact that a single researcher preformed all analyses presented in this study. Given the unique qualitative analysis which was guided by the manifest coding scheme and used a deductive approach, the impact of this limitation should be negligible. Finally, the analysis related to technical violations is subject to the limitation of iatrogenic effects, meaning that the relationship between the chrono entries and the number of technical violation might be the result of the correctional process rather than supervision dynamics. Both the sampling and iatrogenic limitations provide opportunities for future research. By engaging in observational research, scholars will be able to assess the differences in correctional process and supervision dynamics which will allow for a more precise examination of the relationship between supervision dynamics and various correctional outcomes including technical violations.
Footnotes
Appendix
| Checkpoint | Variable attributes: Coding words/phrases |
|---|---|
| 1. Social reintegration | • Relationships ○ Friends, family, community • Social networks ○ Groups, churches, organizations • Social engagement ○ Prosocial community or neighborhood interaction • Stress anxiety ○ Fear of physical or verbal attacks • Stigma/shame ○ Embarrassment • Social isolation ○ Self-imposed social removal, societal rejections or forced exclusion |
| 2. Community reentry | • Housing security and stability ○ Property damage, denial of housing, forced to move (not related to zone restrictions) • Employment ○ Job loss, denial of promotion, denial of employment • Personal safety ○ Vigilantism, personal energy, harassment |
| 3. Status maintenance | • Location/geographical boundary restrictions • Fulfill and maintain statutory compliance • Approval of living arrangement • Treatment • Substance use restrictions • Restricted contact with victim/potential victims • Sexual relationship approval • Collaborative disclosure • Online restrictions • Adult entertainment restrictions • Firearm restrictions • Financial obligations ○ Restitution, child support, court fees, etc. |
| 4. Statutory compliance | • Offender registration • Community notification • Residency restrictions (statutorily imposed, NOT stigma related) |
| 5. Risk management | • Containment appointments ○ Mandatory meetings with required professionals (therapists, social workers) • Office check-ins • Home visits • Risk assessment ○ Risk score–based interactions • Global Positioning System (GPS)/electronic monitoring |
Note. The supervision conditions outlined under Checkpoint 3—Status Maintenance—are Washington Specific.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.
