1. Youth with Sexual Behavior Problems: Crisis Center of Tampa Bay
Efficacy of Treatment

2. Treatment Methodology
Definition…child on child sexual abuse beyond the abused child’s normal age appropriate developmental state and unwelcome…
Treatment Methodology
Risk Factor; Prediction of re-offending?
Psychosexual Evaluation Recommendations?
Legal issues – case already reported?
Alleged victim also in the home?
History of victimization?
Safety implications for:
Child/Family
School
Community
Discuss the dilemma when a case has; or has not been reported

3. Effects of Adam Walsh Act 7/27/2006
Registration Risks
Decrease social bonds
Inhibit productive member of society
Stigmatization
Ties broken with society
Will not seek treatment since forced to register
Restrictions on school placement, team activities
Will not seek treatment since forced to register
Restrictions on school placement, team activities
Know your state rules

4. Causation of sexual behavior problems? Fredrich, D. (2003)
Child Vulnerablities
Developmental or language delay, impulse control problems

5. Dangers of conventional wisdom…
Faulty assumptions
Juvenile sex offending at epidemic proportions
Youth with sexual behavior problems more in common with adult offenders than their peers
Increased risk of sexual re-offense
Youth treatment should mirror adult treatment
Phallometry
Polygraphy
Arousal conditioning

6. Psychosexual Evaluation / Sexual History Assessment
Safety …home, school and/or community
Prior history of sex offending
Public versus private sex act
# of victims higher correlation with re-offense
Age of victim
No prior relationship with the victim
Commonality
Exposure to violence within the family
Hx of Abuse or neglect
Moderate level of psychopathology
Assess sexual recidivism versus general recidivism

7. Assessment for child on child
ERASOR (Worley)
Parent Stress Index (short form)
Pathways or Roadmaps
Adolescent substance abuse measure
Treatment goal expectations
Professionals commit to providing services within their area of competence in terms of assessment, treatment or consulting on clinical
Evaluations: measure of risk to re-offend

8. Treatment Implications
Existing methodology
Relapse prevention
Sexual abuse cycle
Anger issues
Cognitive restructuring
Journaling
Sex education
Holistic/ integrated treatment
Cognitive behavior therapy
Address growth and development
Social ecology
Emphasis on health/social skills
Resilience

9. Family challenges: Victim in the home
Safety Plan: YSBP & victim
Assess family and social support?
Program treats victim, youth and families?
Model behavior?
Relapse question
Self regulation
Thoughts/ feelings/ behavior
Cognitive restructuring
Empathy
Interpersonal Skills Training
Emotional Management

10. Measuring history of victimization
ERASOR (Worley) Estimated risk of adolescent sexually acting out behavior
Child Behavior Checklist
DIPPA for ages 6 & <
Homework in Pathways or Roadmaps
Parent Stress Inventory
In-depth family history and request family participation to ensure successful treatment
(Child) Functional Assessment Rating

11. Discern the ‘right’ treatment
Program styles
Outpatient / Residential
Level of caregiver involvement
Short term 3-6 months
Average LOS 18 months outpatient
Caution: Adult offender treatment ….arousal or teaching arousal reconditioning not for children
Skills attained
Privacy rules
Abuse prevention skills
Identification of feelings
Increase decision making skills
Increase impulse control
Social skills
Empathy

12. Snapshot of ‘it takes a village’
System input
Educators
Clinicians
CPI/ CPS
Psychological testing
Psychiatric testing
Who is the village for each client we see?

13. Supportive and Protective Factors

14. Variables – Pilot Study
Independent Variables
Parent or Youth
Siblings in the family
Also treat victims
Gender
Age/ Developmental Age
Length of treatment
Who are the Significant Caregivers
Dependent Variables
ERASOR (pre/6mo)
PSI (pre/6mo)
Treatment protocols
Goals and Objectives
CBT?

15. Treatment Methodology?
Build in consistency
Most effective techniques?
Client typology?
When techniques are used (i.e., multifamily group and how often)
Measure social influence/ persuasion?
Use of Pathways/ Roadmaps workbooks

16. Factors to consider? Traits of youth acting out
Biological predisposition
Environmental exposures
Learned behavior based on life experiences
Parental involvement indicative of success?
Probation involvement
How to measure effectiveness?

17. How to approach the ‘why’ question
Curiosity
Impulsivity/ Immaturity
Deliquency/ Aggression
Psychological issues
Exposure to sexual abuse or materials
Fears
Will youth become adult offender?
Family make-up?
Type of boy/ girl?
The same as adult offenders?

18. Efficacy of Safety Plan
Level of supervision
Sharing bedrooms
Privacy rules and expectations
Personal self-care in private
Adult to be in charge
No sexually explicit media
Caregivers exhibit modesty in presence of child/youth

19. Legal System Investigation Charges filed Court decision
Typically not open to treatment at this juncture due to legal implications
Charges filed
Juvenile/ adult court
Court decision
Probation/ placement
Treatment mandated
Juvenile court – rehabilitate
Adult court – punishment

20. Family Role Listen – use time out for yourself
Pay attention to the story – when to stop
Repeat back; reflective listening
Ask questions – be ready to talk when you least expect it
Listen nonjudgmentally
Communicate in specifics
Discuss behavior - not personalities
Specifics – not generalities

21. How to develop home and community rules…..
Private part rules
Bathing suit rules
Sexual behavior rules
Use redirection, reminders and distraction
Respecting space rules
Imagine the center of a hula hoop
Risky Situations
Sleepovers
Team sports
Holidays
Camping/Recess
Cell-phones
Development of parental supports
Pull from your village of adults in youth’s life

22. Therapist qualifications….
Child development expertise
Sexual development expertise
Familiarity with multiple diagnosis
Impact of society, sexting, bullying on sexual behavior
Knowledge of current research and effective approaches of treatment
Knowledge and acknowledgment of cultural variations in parenting and child sexual behavior
“The world in which you were born is just one model of reality. Other cultures are not failed attempts at being you: they are unique manifestations of the human spirit.”
Wade Davis

23. Questions

24. Example of Safety Plan for Younger Children
Safety Plan for Young Sexually Acting Out Children:
Check each item that applies:
_____ Sexually acting out child should be within hearing and sight of an adult when interacting with other children.
_____ Sexually acting out child will not supervise other children (no babysitting).
_____ Sexually acting out child will not be left alone with any younger or more vulnerable children.
_____ Sexually acting out child should not share a bedroom with younger or more vulnerable children.
_____ A door alarm will be placed on the sexually acting out child’s bedroom door so that at night the caregiver(s) will be aware of the child being out of their room.
_____ Only one child in the bathroom at a time. Children should not be bathed together.
_____ Family members will not change clothing in front of each other and will be appropriately dressed when in the presences of others.
_____ A good rule is to make each child’s bedroom their private place and no other children (unless they share the room) are allowed to go in.
_____ If a door is closed family members must knock before entering. If someone is in the room wait until they leave the room (if it’s the bathroom or bedroom) or if it’s another room wait until they say you can come in.
_____ Sexually acting out child should not spend the night with other children for sleepovers.
_____ Caregivers (babysitters, relatives) of the sexually acting out child should be aware of the sexually acting out behaviors prior to the child being cared by them so that they to can follow the Safety Plan.
_____ No pornographic materials in any media. Cell phone, computer, and game systems must have child locks and be monitored.
We the undersigned agree to follow this safety plan.
________________________ ________
Child’s Signature Date
Guardian’s Signature Date
________________________ ________ _____________________ ______
Therapist’s Signature Date Supervisor’s Signature Date
______________________________________________________ ________________
Client Name Client Number

25. Example of Safety Plan for Older Children
Program for Juveniles Who Sexually Offend
SAFETY PLAN
This safety plan is a contract in which the persons named below agree to support as he/she works to resolve his/her sexual behavior problem. The purpose of this contract is to protect his/her Family and potential victims. We, the undersigned, understand that we must continue to work on this plan during the program. In the event of plan break down, we agree to share honestly and to problem solve together. I agree to the following: 
I will ■ have no contact with my victim.
(in the event that I am allowed contact with my victims I agree to safeguard his/her emotional/mental/physical safety by
■ not use alcohol or drugs.
■ not commit physically or sexually violent acts.
■ not use pornographic materials.
■ use the support of identified others to sexual offending behavior
Some people I can trust to help me prevent my sexual offending behavior are: Some people I can’t trust to help me prevent my sexual offending behavior are:  I agree to handle untrustworthy people by:  Some dangerous situations that could lead to my sexual offending behaviors are:   I agree to deal with these situations by:  When I am feeling I am at risk to re-offend. When I am feeling these feelings, I am telling myself  When I have these feelings and thoughts I agree to:  Parent(s): I/ Weagree to:  ■ Provide supervision for my child in the following ways:
■ To support my child to prevent re-offending behaviors by:
We agree to be available to support the family as they work on the sexual offending problem.
__________________________ ____________________________
Client Therapist Caretaker/Parent
_________________________
Therapist