1. Treatment of Youth Sexual Offenders: Past, Present, and Future Michael H. Miner, Ph.D. Program in Human Sexuality Department of Family Medicine and Community Health

2. Goals for this Presentation Describe the history of youthful sexual offender treatment Describe current trends in treatment of youthful sexual offenders Ideas of where to go from here

3. Driving Factors Data from retrospective studies of adult offenders. Perceived increase in juvenile crime. Feminist perspective

4. In the beginning ….. Clinicians moved from working with adult sexual offenders to working with adolescents (e.g., Judith Becker, Rob Longo) Move from “Boys will be boys” to identification of behaviors that were abusive, damaging, and inappropriate. Clinical practice proceeded research.

5. National Task Force on Juvenile Sexual Offending (1993) Addressed a number of areas including –Community Protection –System Response –Legal Response Mandatory Reporting Prosecution Role and Responsibility of Defense Counsel Court Process –Assessment –Treatment

6. Assumptions Sexually abusive youth require a specialized, offense-specific treatment approach. Offense-specific treatment should be structured Treatment of sexual abusive youth requires nontraditional techniques and may run counter to original professional training Adequate treatment takes 12-24 months Family involvement may have a primary and significant impact on treatment process and management of aftercare plans. Labeling of sexually abusive behaviors is necessary to prevent minimization and denial.

7. Issues to be addressed (Task Force Report, 1993) 1.Acceptance of responsibility 2.Identification of pattern or cycle 3.Interruption of cycle and control of behavior 4.Resolution of victimization 5.Development of victim awareness/empathy 6.Development of sense of mastery and control 7.Understanding role of sexual arousal, reduction of deviant sexual arousal, definition of non-abusive sexual fantasy 8.Development of positive sexual identity 9.Understanding consequences of offending behavior 10.Identification of family issues or dysfunction 11.Identification of cognitive distortions. 12.Identification and expression of feelings 13.Development of pro-social relationship skills 14.Development of realistic levels of trust in adults 15.Management of addictive/compulsive qualities 16.Remediation of developmental delays, development of competent psychological health skills 17.Indications of substance abuse/gang involvement 18.Reconciliation of cross cultural issues 19.Manage psychiatric disorders 20.Remediation of skills deficits 21.Develop relapse prevention plan 22.Restitution/reparation to victims

8. Treatment models: Adolescent and Adult Programs: 1996 Survey Treatment Models Adolescent (n-532) Adult (n=521) Cognitive Behavioral/Relapse Prevention 73.373.1 Relapse Prevention8.19.2 Cognitive Behavioral5.16.1 Psychotherapeutic3.64.0 Family Systems2.82.3 Developmental contextual2.41.7

9. And the research said … Weinrott, 1996 Center for Study and Prevention of Violence, Univ. of Colorado Only one controlled evaluation of treatment All other studies were single group follow-up Two clear conclusions: –Most boys who sexually abuse younger children do not reoffend sexually –Fair likelihood that JSOs will subsequently come to the attention of police for non sex-offenses.

10. Anti-social vs. Sexual Deviant (Butler & Seto, 2002) Two types of adolescent sexual offenders. 1.A type that is persistently antisocial with a history of conduct problems resembling other juvenile delinquents. 40-50% of adolescent sex offenders could be classified as conduct disordered (France & Hudson, 1993; Oliver, Nagayma-Hall & Neuhaus, 1993). 2.A type that does not demonstrate these antisocial traits or conduct problems and appear more similar to non-offenders with the exception of more deviant sexual interests.

11. Age of Victim Offenders with child victims differ systematically from those with peer/adult victims (Hendriks & Bijleveld, 2004; Hunter, et al., 2000; Hunter et al., 2003) Offenders with peer/adult victims more likely to have conduct disorder and other delinquent behaviors than offenders with child victims (Seto & Lalumière, 2005). Stronger support for dividing ASOs into child vs. peer offenders than single vs. group offenders (Kjellgren, et al, 2006)

12. The Deadly Assumption Juvenile sexual offenders are a special class of delinquent. Implications –JSOs have more in common with adult sex offenders than they do with other juvenile delinquents. –JSOs are more dangerous than other delinquent youth. –Cannot expect the “aging out” of criminal behavior found in most delinquent populations.

13. Butler & Seto (2002) Sample: 32 sex offenders, 48 criminally versatile offenders, 34 nonaggressive offenders Design: Cross-sectional comparison Findings: –Sex offenders similar to non-sex offenders on most measures –Sex only offenders had fewer conduct problems, better current adjustment, more prosocial attitudes, and lower risk for future delinquency –Those with sex and other offenses resembled criminally versatile offenders.

14. Van Wijk et al. (2005) Sample: 986 boys ages from the middle and oldest samples of Pittsburgh youth study (ages 10 – 25) Design: Compared sex offenders (n=39); Index violence (n=139); Reported violence (n=291); Moderate offenders (n=215); Minor delinquency/nonoffender (n=302) Findings: –Prevalence: 0.04 for sex offenses; 0.14 for index violence; 0.44 for violence –Sex offenders differed from violent non-sex offenders on only two of variables tested. Sex offenders had more housing problems Sex offenders were older at screening –Trends for sex offenders to differ from violent non-sex offenders on: Higher academic achievement More running away Had younger mothers with less education –Combined group of sex and violent offenders differed from nonviolent offenders on most of the variables tested.

15. Miner et al. (2010) Sample: 278 boys ages 13 – 28 recruited from treatment programs, juvenile probations and juvenile detention facilities. Design: Compared sex offenders with child victims (n=107); sex offenders with peer/adult victims (n=49); non-sex delinquents (n=122) Findings: –Logistic regression indicated sex offenders with child victims when compared to non-sex delinquents showed less cynicism, more anxiety with women, more hypersexuality, and more sexual preoccupation. –Sex offenders with peer/adult victims not substantially different from non-sex delinquents. –Sex offenders with child victims differed from those with peer/adult victims in a similar manner as they differed from non- sex delinquents.

16. Conclusions In general, juvenile sexual offenders do not differ from non-sex delinquents However: –Sex offenders with child victims differ from both sex offenders with pubescent victims and non-sex delinquents on variables related to social skills, social isolation, and sex drive. –Some evidence of more family instability in sex offenders. –Sex offenders with no history of delinquency may show fewer problems and more prosocial attitudes and achievements than other delinquents.

21. Treatment models: Adolescent and Adult Community Programs – U.S.: 2009 Survey Treatment Models Adolescent (n=268) Adult (n=324) Cognitive Behavioral63.865.1 Relapse Prevention9.714.8 Family Systems2.82.3 Risk-needs-responsivity3.03.1 Multisystemic6.03.1 Good Lives3.75.2

22. Treatment Targets: Adolescent and Adult Community Programs – U.S.: 2009 Survey TargetsAdolescent (n=268) Adult (n=324) Arousal control57.568.5 Emotional regulation65.865.7 Family support networks94.077.2 Intimacy/relationship skills86.891.2 Offense responsibility88.291.8 Offense supportive attitudes51.854.4 Problem solving86.079.9 Self-monitoring54.056.2 Social skills training94.187.5 Victim awareness and empathy92.692.7

23. Treatment modality: Adolescent and Adult Community Programs – U.S.: 2009 Survey Treatment Models Adolescent (n=271) Adult (n=326) Group69.488.0 Individual94.884.6 Family or couples84.665.3

24. Conclusions Theoretic orientations similar for adult and adolescent sex offender programs Targets similar for adult and adolescent sex offender programs Less reliance on group therapy and more use of family therapy in adolescent programs. Data similar across residential and community and U.S. and Canadian programs.

25. Need for paradigm shift In general, youths who have committed sex crimes are unlikely to go on to commit sex crimes as adults Accumulated data support the heterogeneity of youth who commit sex crimes Accumulated data do not support the assumption that youth who commit sex crimes are systematically different from youth who commit non-sex crimes. When different, appears to be in areas of social isolation, social skills, lack of misanthropic views Not clear how youth who commit sex crimes are similar/different from youth with psychological problems other than delinquency.

26. IATSO Standards of Care (Miner et al., 2006) 1.Juveniles are best understood within the context of their families and social environments 2.Assessment and treatment of juveniles should be based on a developmental perspective, should be sensitive to developmental change, and should be an on- going process. 3.Assessment and treatment should include a focus on the youth’s strengths. 4.The development of sexual interest and orientation is dynamic. The sexual interests of youth can change over the course of adolescence and this is the period when sexual orientation immerges. 5.Youth who have committed sexual offenses are a diverse population. They should not be treated with a “one size fits all” approach. 6.Treatment should be broad-based and comprehensive. 7.Labels can be more iatrogenic in children and adolescents than in adults. The juvenile and his/her family/primary care-giving system should be treated with respect and dignity. 8.Sexual offender registries and community notification, should not be applied to juveniles. 9.Effective interventions result from research guided by specialized clinical experience, and not from popular beliefs, or unusual cases in the media.

27. And the research says …. Meta-analysis (Reitzel & Carbonell, 2006) found a significant effect for treatment, but just one additional random allocation study since Weinrott (1996). –Searched studies conducted from 1990-2001 –Only 9 studies (4 published) met inclusion criteria The only intervention that has been rigorously tested in sexual offending youth is Multi-Systemic Therapy (Borduin et al., 1990; Borduin & Schaeffer; 2001; Borduin et al., 2009).

28. Future Directions

29. New Assumptions Youth who commit sex crimes are not a special class of delinquent. Most will not go on to commit sex crimes as adults. To understand a youth’s behavior, you have to place it within the social and environmental context in which he/she resides. When there are differences between youth who commit sex crimes and those who commit other crimes, they are in the areas of social involvement and interpersonal relationships.

30. Future treatment interventions Move away from offense-specific focus Include a broad-based approach that focuses on the youth’s strengths and needs, and on the supports and barriers in his/her environment. Foster social involvement rather than limit social involvement. Focus on providing opportunities for growth more than limiting opportunities to offend.

31. Moving forward Further develop empirical base. More rigorous treatment efficacy trials –Currently MST most promising intervention because it focuses broadly, but also because it is the only intervention subjected to rigorous study.

32. Contact Information Program in Human Sexuality 1300 So. Second Street, Suite 180 Minneapolis, MN. 55454 miner001@umn.edu