Presentation on theme: "Youth with Sexual Behavior Problems: Crisis Center of Tampa Bay"— Presentation transcript:
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 MethodologyRisk 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/FamilySchoolCommunityDiscuss the dilemma when a case has; or has not been reported
3 Effects of Adam Walsh Act 7/27/2006 Registration RisksDecrease social bondsInhibit productive member of societyStigmatizationTies broken with societyWill not seek treatment since forced to registerRestrictions on school placement, team activitiesWill not seek treatment since forced to registerRestrictions on school placement, team activitiesKnow your state rules
4 Causation of sexual behavior problems? Fredrich, D. (2003) Child VulnerablitiesDevelopmental or language delay, impulse control problems
5 Dangers of conventional wisdom… Faulty assumptionsJuvenile sex offending at epidemic proportionsYouth with sexual behavior problems more in common with adult offenders than their peersIncreased risk of sexual re-offenseYouth treatment should mirror adult treatmentPhallometryPolygraphyArousal conditioning
6 Psychosexual Evaluation / Sexual History Assessment Safety …home, school and/or communityPrior history of sex offendingPublic versus private sex act# of victims higher correlation with re-offenseAge of victimNo prior relationship with the victimCommonalityExposure to violence within the familyHx of Abuse or neglectModerate level of psychopathologyAssess sexual recidivism versus general recidivism
7 Assessment for child on child ERASOR (Worley)Parent Stress Index (short form)Pathways or RoadmapsAdolescent substance abuse measureTreatment goal expectationsProfessionals commit to providing services within their area of competence in terms of assessment, treatment or consulting on clinicalEvaluations: measure of risk to re-offend
9 Family challenges: Victim in the home Safety Plan: YSBP & victimAssess family and social support?Program treats victim, youth and families?Model behavior?Relapse questionSelf regulationThoughts/ feelings/ behaviorCognitive restructuringEmpathyInterpersonal Skills TrainingEmotional Management
10 Measuring history of victimization ERASOR (Worley) Estimated risk of adolescent sexually acting out behaviorChild Behavior ChecklistDIPPA for ages 6 & <Homework in Pathways or RoadmapsParent Stress InventoryIn-depth family history and request family participation to ensure successful treatment(Child) Functional Assessment Rating
11 Discern the ‘right’ treatment Program stylesOutpatient / ResidentialLevel of caregiver involvementShort term 3-6 monthsAverage LOS 18 months outpatientCaution: Adult offender treatment ….arousal or teaching arousal reconditioning not for childrenSkills attainedPrivacy rulesAbuse prevention skillsIdentification of feelingsIncrease decision making skillsIncrease impulse controlSocial skillsEmpathy
12 Snapshot of ‘it takes a village’ System inputEducatorsCliniciansCPI/ CPSPsychological testingPsychiatric testingWho is the village for each client we see?
14 Variables – Pilot Study Independent VariablesParent or YouthSiblings in the familyAlso treat victimsGenderAge/ Developmental AgeLength of treatmentWho are the Significant CaregiversDependent VariablesERASOR (pre/6mo)PSI (pre/6mo)Treatment protocolsGoals and ObjectivesCBT?
15 Treatment Methodology? Build in consistencyMost 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 predispositionEnvironmental exposuresLearned behavior based on life experiencesParental involvement indicative of success?Probation involvementHow to measure effectiveness?
17 How to approach the ‘why’ question CuriosityImpulsivity/ ImmaturityDeliquency/ AggressionPsychological issuesExposure to sexual abuse or materialsFearsWill youth become adult offender?Family make-up?Type of boy/ girl?The same as adult offenders?
18 Efficacy of Safety Plan Level of supervisionSharing bedroomsPrivacy rules and expectationsPersonal self-care in privateAdult to be in chargeNo sexually explicit mediaCaregivers 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 implicationsCharges filedJuvenile/ adult courtCourt decisionProbation/ placementTreatment mandatedJuvenile court – rehabilitateAdult court – punishment
20 Family Role Listen – use time out for yourself Pay attention to the story – when to stopRepeat back; reflective listeningAsk questions – be ready to talk when you least expect itListen nonjudgmentallyCommunicate in specificsDiscuss behavior - not personalitiesSpecifics – not generalities
21 How to develop home and community rules….. Private part rulesBathing suit rulesSexual behavior rulesUse redirection, reminders and distractionRespecting space rulesImagine the center of a hula hoopRisky SituationsSleepoversTeam sportsHolidaysCamping/RecessCell-phonesDevelopment of parental supportsPull from your village of adults in youth’s life
22 Therapist qualifications…. Child development expertiseSexual development expertiseFamiliarity with multiple diagnosisImpact of society, sexting, bullying on sexual behaviorKnowledge of current research and effective approaches of treatmentKnowledge 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
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 DateGuardian’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 OffendSAFETY PLANThis 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 behaviorSome 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