The Rules Committee met at 10:00 a.m. on July 27, 2002, at La Mansion del Rio Hotel, 112 College Street San Antonio, Texas. I. Call to order, Chairperson, Maria Molett. Meeting called to order at 10:15 a.m. on July 27, 2002. II. Introduction of Members, Guests, and Staff. Committee Members Present: Maria Molett Dr. Walter Meyer Richard Mack Estella Guillen Dr. Glen Kercher Grace Davis Jennifer Coyle Committee Members Not Present: Kristy Carr Judy Johnson Michael Maples Pat Logterman Paul Jordan TDH Staff present: Janet Latham David Richards Lupe Ruedas Public Present: Vivian Lewis Heine Diana Garza Louis III. Approval of the October 1, 2001 meeting minutes. Dr. Meyer motioned for approval of minutes. Richard Mack seconded and all were in favor. IV. Discussion regarding establishing an inactive RSOTP status. David Richards will bring Rules from other programs to the next meeting for review and possible discussion regarding establishing an inactive status for RSOTPs. No action taken at this time. V. Discussion regarding ASOTP supervision prior to becoming a RSOTP. Suggestions were made regarding possibly establishing an intern status for those therapists that do not have the initial 250 clinical hours to become an ASOTP. The item was tabled and no action was taken. VI. Public Comment. Vivian Lewis Heine, RSOTP informed the committee that there was some concern that the proposed rules were not easily accessible to registrants. Ms. Heine suggested that the Rules be re-posted to allow others to submit their comments. Maria Molett advised to have comments in writing and hand in to any council member or to give to Janet Latham. VII. Discussion and Possible Action regarding comments on the proposed rule changes to 22 T.A.C Chapter 810, published in the Texas Register, pages 42-50 dated May 10, 2002. Comments were reviewed and the possible responses were discussed. Comment: 810.62(b)(13) … cognitive process and arousal patterns…. This statement should read sexual arousal patterns or sexual interest patterns or sexual preference patterns. Response: The committee concurs; all were in favor with further modification from the committee and the change will be recommended to the council. Comment: 810.62(b)(22) … methods such as polygraph, phallometric and other research based sexual arousal/sexual preference assessments….it appears that "other research based sexual arousal/sexual preference assessments" is likely referring to Visual Reaction Time measures, probably the most well known at this time being the Abel Assessment of Sexual Interest. I make this assumption because Visual Reaction Time Measures is currently the only other research based sexual interest assessment technique available besides phallometric measure. If it is this technique that this rule is referring to, I suggest it mimic ATSA and read…"methods such as polygraph, phallometric and visual reaction time measure." Response: The committee agrees in part and will revise the wording to remain consistent throughout the rules. Comment: It is my assumption that the reference to VRT is being termed "sexual arousal/preference assessment" in the proposed rules. If this is correct, we suggest that VRT, a well-known descriptor for the technology, be substituted for the descriptor found in the proposed rules. Response: The committee agrees with the commenter and will revise the proposed rules accordingly. Comment: 810.62(b)(23) Physiological measures and sexual arousal/sexual preference assessment…. Same comment here as in 810.62(b)(22) above. Are you attempting to refer to visual reaction time measures? If so it should read as such: Proposed amendment: Psychophysiological measures should not replace…. Or Phallometric or visual reaction time measures should not replace… Response: Committee agrees in part and will determine the appropriate terminology at the next Rules Committee meeting and will consistently use it throughout the rules. Comment: 810.62(b)(25) Physiological or sexual arousal/sexual preference assessment…. Since the old rules used the term Phallometric methods where you have now placed "physiological", I assume this refers to that technique. Again refer back to 810.62(b)(22) above; if sexual arousal/sexual preference refers to visual reaction time, this language implies that visual reaction time is not a physiological measure, which is inaccurate. Proposed language: Psychophysiological assessment cannot….or Phallometric or visual reaction time measures or polygraph cannot… Response: The committee agrees in part and will determine which terminology would be used and it will be listed consistently throughout the rules. Comment: 810.62(b)(27) when using phallometric assessment or aversion techniques with persons under 15…This age should be 17, medical and or psychological intervention cannot ethically be performed on minor children without guardian's knowledgeable consent. Response: This is no change to the current rules. It should be noted that the rules are indicating that not only consent should be sought, but if phallometric measures or adverse techniques are used with persons 15 years of age or younger that a consent among a multidisciplinary team should be the approach. The ATSA guidelines do not indicate that it is inappropriate to use phallometric measures with adolescents. The guidelines suggest that the user should use caution when using this type of measure with adolescents. The ATSA guidelines suggest that the user should weigh the potential risk against the potential benefits when using such measures. It should also be noted that it is not unethical to use phallometric measures or aversion techniques with minors as the comment above suggests. Additionally, there are some phallometric measures, which use stimuli appropriate to adolescents. The committee suggested that the language might need to be tightened up and possibly include the language "post pubescent minors" in this section. Comment: 810.64(b)(1) ……to document changes in arousal control, physiological measurement is essential. I basically support this statement however, for reasons stated above, the language is inaccurate. Proposed language: To document changes in sexual arousal control, psychophysiological measurement is essential… Response: When measuring sexual arousal as measured by physiological changes is the key word here. Therefore, documenting any changes would require a physiological measurement. At this time, the committee needs to determine if there is documentation that visual reaction can be used to measure the change as a result of behavioral work. Suggested change of language: ..whatever instrument is used initially identify sexual arousal or sexual preference be used to follow up on changes made from treatment. Research regarding whether the VRT is able to show change over time will be sought and considered when revising this language. Comment: 819.64(b)(11) …the use of polygraphs and phallometric or sexual arousal/sexual preference assessments…Proposed language: the use of polygraphs and phallometric or visual reaction time assessments… Response: Committee agrees in part; and will determined the appropriate terminology at the next rules committee meeting and will consistently use it throughout the rules. Comment: 810.122 (12) Sexual arousal/preference assessments – The self report measure of sexual preference. If you refer to visual reaction time, it is an accepted objective psychophysiological measure while has research support and has been acknowledged as a valid OBJECTIVE measure of sexual interests by the American Psychiatric Association and by the Association for the Treatment of Sex Abusers (ATSA). Visual reaction time and/or the Abel Assessment IS NOT A SELF-REPORT. Proposed language: Visual reaction time- Measures based on the relative amount of time spent looking at visual stimuli. (See ATSA guidelines pg.70). Second Comment on the same rule: In Subchapter E. 810.122 (12) the authors' descriptor referenced the VRT as a self-report measures, VRT is an objective measure for deviant sexual interest based on viewing time, not self-report. Numerous articles have been published and/or presented on VRT that well document this fact. The way the proposed rule is worded is misleading and incorrect. Response: Committee agrees in part; terminology will be determined by the committee and used consistently throughout the rules. Comment: 810.153 The council shall contract….tracking services, polygraph services, medication, penile plethysmographs,…Recent independent and ATSA sponsored research have demonstrated that visual reaction time measures (specifically the Abel assessment of sexual interest) have shown reliability and validity comparable to the penile plethysmograph in identifying sexual interest patterns. ATSA has acknowledged the acceptability of this methodology. In Texas, the use of visual reaction time out numbers penile plethysmography 3 to 1. There is no research available, which would support visual reaction time being excluded from use in this instance. Proposed language: The council shall contract…tracking services, polygraph services, medication, psychophysiological assessment of sexual interest services,… Response: This language is specifically from the Health and Safety Code, Article 4, Title 11, Chapter 841. The council has no authority to change the language without an amendment to the current statute. Comment; 810.153(7) Plethysmograph- Physiological measure of sexual arousal. Penile plethysmograph assessments shall consist of concurrent monitoring of erectile response, GSR, and respiration while the client is attending to sexual stimuli presented in an audio-visual format. First plethysmograph is a medical instrument, which measures blood flow to a variety of body parts. Technically you are referring to a PENILE plethysmograph and the word PENILE should be added to the beginning of this rule. NOT that I support this rule in any form. Second, there are numerous penile plethysmograph assessment instruments on the market. I support the use of phallometric measures in our field because I believe the research supports it's use. What is described here is a specific phallometric instrument, produced by a specific manufacturer. There is absolutely no support from any professional organization or by the research that this particular instrument is any more reliable or valid than the other types of penile plethysmographs that do not use GSR or respiration or audio-visual format. In fact GSR and respiration have not been shown or even proposed as valid measures sexual interest or arousal patterns. Those measures are suggested as indicators of possible client control and the research is still limited and sparse on that premise. There are no support guidelines that would suggest audio-visual format is any more accurate than audiotapes and visual slides presented separately. Response: The committee agrees in part. Possible changes to language: Plethysmograph .... shall consist of concurrent monitoring of erectile response, GSR, and respiration while the client is attending to sexual stimuli presented in an audiovisual format. Suggested change to: ...sexual stimuli presented in an audio-visual or audio, or visual format. The Committee agrees, all references to plethysmograph should be replaced with Penile Plethysmograph. If the description of the Plethysmograph describes only one brand of plethysmograph, then the council should consider changing it as not to exclude other types of Plethysmographs. If it does describe other Plethysmographs, then the committee will need to decide if it is too narrow of a description that it excludes other acceptable Plethysmographs. VIII. Discussion and Possible Action regarding final adoption of the proposed rules to 22 T.A.C Chapter 810, published in the Texas Register, pages 42-50 dated May 10, 2002. Rick Mack motioned to extend the proposed rules comment period for an additional 30 days. Estella Guillen seconded the motion. All were in favor. Janet Latham will send a letter with the proposed rules to all registrants to ensure all registrants have the opportunity to comment on the proposed rules during the extended thirty (30) day comment period. IX. Presentation of Future Agenda Items. Consideration of an inactive RSOTP Status and an intern status prior to becoming an ASOTP was suggested agenda items. X. Discussion of Future Meeting dates. The Rules Committee meeting will be held September 27, 2002. XI. Adjournment. Maria Molett motioned for adjournment Dr. Meyer seconded. All were in favor. The meeting adjourned at 12:07 p.m.