Best Practice Standard in Treating Youth Who Engage in Sexual Misconduct

Best-PracticesThe definition of best practice in treating sexually abusive youth is still in question (Chaffin & Bonner, 1998; Developmental Services Group, 2000, Hunter & Longo, 2004).  While the field is not new, conceptualization of what constitutes effective treatment for this population is still evolving (Chaffin, Chapter 28; Hunter and Longo, 2004).  However, over the last few years, research and juvenile sex-specific treatment techniques have changed substantially, highlighting the past misapplication of adult sex offender treatment models and the importance of modifying juvenile sex-specific treatment practices.


“As late as 2002, the majority of juvenile treatment programs have continued to adhere to a traditional adult sex offender treatment model” (Burton and Smith-Darden, 2007).  National experts indicate adult approaches are misdirected with adolescents.  “We can no longer allow adult programming to be the sole source of assessing and treatment young people” (Prescott and Longo, Current Perspectives: Working with Sexually Aggressive Youth & Youth With Sexual Behavior Problems, Longo, Robert E and Prescott, David S., Editors, NEARI Press, 2006).  It is vital that mental health professionals are willing to explore and accept that many of the practices of the past may not be the most effective way of treating these youth.


All too often, clinical approaches have overlooked developmental and contextual issues.  Many programs have focused treatment on areas that may not be relevant for the juvenile sex offender population, such as deviant sexual arousal (Freeman-Longo, 2002; Hunter, 1999; Hunter & Becker, 1994).  Techniques and modalities used in treating adult sexual offenders have been directly applied to youth, or modified only slightly to make materials more easily understood, without taking into consideration learning styles, developmental issues, and intelligence variations of these clients (Gardner, 1983).  However, youth are, by definition, different.  They exist in a different context and at different developmental stages than adults. They often have unresolved histories of trauma, both physical and physiological.  High levels of confrontation are still used in many programs.  When used with traumatized youth, these techniques may serve to re-traumatize them instead of promoting healing, forgiveness, and respect for self and others. Even the recent research with adult sex offenders demonstrates that warm, empathic, rewarding, and directive therapeutic styles can produce better treatment outcomes than harsh and confrontational methods (Marshall, Fernandez, Serran, Mulloy, Thornton, Mann & Anderson, 2003).  The best practitioners are warm and empathic, addressing all aspects of the youth’s  functioning, while maintaining a focus on those areas demonstrated to be associated with risk. Interventions that do not take the youth’s family circumstances into consideration may well do harm in the long run.


Based on current research and professional opinion, “best treatment practices” with youth must be focused on developing an approach that meets the individual and developmental needs of youth and is reflective of the youth’s individualized pathway to offending.  Specifically, the sex- specific treatment approach must be sensitive to the youth’s developmental trajectory and how experience, development, environment, society, and culture impact this trajectory and create dynamics, issues, and problems that placed the youth on a pathway to sexually offend.


“We do not know exactly what variables need to be present, in what combinations, in what relationships to each other, at what critical points of development, with what intensities, and in what context, in order for sexual abuse to occur and be maintained” (Thomas 2006).  However, what is clear is that sexual acting out is a result of multiple, interacting factors (etiological and maintenance factors) that converge at a particular point in time in a given context. These factors “have a cumulative effect” on the youth (Prescott 2006) diverting their normative path of development. It is about the convergence and melding of these factors that creates a synergistic reaction (Ward, Polaschek, and Beech, 2006).  Etiological and maintenance factors include: disruption and deficits in development, inconsistent and unhealthy environments, deficits in executive functioning and problems with self regulation, cognitive distortions and underdeveloped values and morality, problems in emotional identification, expression and regulation, problems and deficits in self concept, self esteem and self identity, social competency and social relatedness problems, childhood trauma and maltreatment, awareness deficits and other co-morbid mental health issues and learning disabilities.


Sex-specific assessment should help identify which factors, in what proportion, and at what point in development youth were directed onto the pathway to offending.  Additionally, treatment should assist the youth to increase competency and skills necessary to ensure their ability to control or eliminate the etiological and maintenance factors that influenced their pathway to offend, to reestablish a healthy developmental trajectory (in all developmental stages), to obtain their needs and human goods in a healthy way and to place themselves back on a healthy pathway towards becoming a functional, healthy and happy adult (Ward, T., Polaschek, D. and Beech, A. Theories of Sexual Offending, John Wiley & Sons, Ltd. 2006).


National literature endorses the use of a holistic, integrated approach to treating youthful sexual abusers (Longo, 2001; Hunter & Longo, 2004).  This approach blends traditional aspects of sexual-abuser treatment into a holistic, humanistic and developmentally-consistent model for working with youth (Morrison, Chapter 13).  While cognitive-behavioral treatment methods appear promising, treatment must go beyond the sexual problems and address “growth and development, social ecology, increasing health, social skills, resiliency, and incorporate treatment for the offender’s own victimization and co-occurring disorders” (Developmental Services Group, 2000).  If successful risk reduction involves changing thoughts and behaviors, then a holistic, integrated model prepares the youth to make these changes while respecting his/her long-term development (Prescott, David S., and Longo, Robert E., Current Perspectives: Working with Young People Who Sexually Abuse, Current Perspectives: Working with Sexually Aggressive Youth & Youth With Sexual Behavior Problems, Longo, Robert E and Prescott, David S., Editors, NEARI Press, 2006, page 54-56).


Holistic Developmental Approach


The primary aim in juvenile sex-specific treatment is to instill in the youth the knowledge, skills and competencies necessary to develop and implement a positive identity revolving around personally meaningful ways of meeting their human needs and pursuing their interests. Thus, treatment is less focused on “deviant sexual arousal” and/or “sexual assault cycle” and more focused on factors related to the youth’s  developmental trajectory—the causal and maintenance factors that diverted the youth to a pathway to offend.


Treatment interventions need to help the youth to successfully re-enter a healthy developmental trajectory and build the competency, resiliency, and protective factors necessary to resolve and/or eliminate etiological and maintenance factors that led them to offend. According to the “Good Lives Model,” treatment should help the youth acquire (in a healthy way) the skills and primary human goods (healthy living, knowledge, excellence in play and work, excellence in self agency, freedom from emotional turmoil and stress, friendship, community, purpose in life, happiness and creativity) required to be happy and healthy and live a good life (Ward, T.; Polaschek, D. and Beech, A. Theories of Sexual Offending, John Wiley & Sons, Ltd. 2006, page 297-313).


Nevertheless, as part of a holistic approach, treatment should integrate standard sex-offense- specific treatment components, such as development of full accountability for all offense behaviors, insight into offense dynamics and choice to offend, building realistic and effective self-regulation (relapse-prevention) strategies and skills, develop a family safety plan, develop healthy sexual attitudes, boundaries, sexual identity, and develop and sustain victim empathy and general empathy.  Treatment should also include sex education and healthy sexuality interventions. A psychosexual education emphasis is needed to provide the youth with information regarding maturation, human development, healthy sexual functioning, the current laws regarding sexual conduct and a healthy sexual identity.  Many of these youth also need opportunities to resolve their own childhood victimization with sensory interventions  separate from focus on their sexual misconduct to assist them to resolve trauma, enhance emotional coping skills and develop a healthy sexual identity. Overall, treatment is about aiding these youth to understand themselves, their sexuality and sexual development, as well as own responsibility for their sexuality (thoughts, feelings, and behavior), further identifying that there are consequences for their choices, and develop competencies and skills to enter or reenter a normative developmental pathway for their sexuality and life.

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