Sexually Abusive Children and Youth - Illinoi DCFS Research in Action

This Issue:
Sexually Abusive Children and Youth **Unapproved DRAFT June 30, 2000**

See also these newsletter issues for coverage of related topics:
Sexual Abuse (general topics)
Sexual Abuse Treatment (treatment services to sexual abuse victims and nonoffending parents).

THE DCFS PERSPECTIVE
DCFS Article (Pending)
LITERATURE SUMMARIES
Background: 1. Limited Research About Youth Sex Offending; 2. Sibling Abuse is Common But Dismissed; 3. Should Youth be Treated Like Adult Offenders?; 4. Ethical Issues in Working With Youth
Assessment: 5. Assessing Adolescents; 6. Assessing Sibling Abuse
Treatment: 7. Youth Treatment Should Promote Development; 8. Multisystemic Therapy Shows Promise; 9. Treating Children Who Molest; 10. Relapse Prevention Therapy Helps; 11. The SAFE-T Program; 12. The Stop and Think Program; 13. Therapy for Sibling Incest; 14. DCFS-Related Research is in Progress
Risk and Reunification: 15. Managing Risk in Caring For Youth; 16. Research on Reoffending is Not Yet Clear; 17. Youth Using Force May Be More Dangerous; 18. Recommendations About Risk; 19. Reunifying in Sibling Incest
WEB RESOURCES

DCFS Article top
by - DCFS Division
Article pending...

1. There is Limited Research About Youth Sexual Offending top

Bischof, Gary H. and Karen H. Rosen (1997). "An Ecological Perspective on Adolescent Sexual Offending." Journal of Offender Rehabilitation v26 n1/2 p67-88.

Becker, Judith and John A. Hunter (1997). "Understanding and Treating Child and Adolescent Sexual Offenders." Advances in Clinical Child Psychology, v19 p177-197.

Becker, Judith V. (1998). "What We Know About the Characteristics and Treatment of Adolescents Who Have Committed Sexual Offenses." Child Maltreatment v3 n4 p317-331.

Brown, Elissa and David Kolko (1998). "Treatment Efficacy and Program Evaluation With Juvenile Sexual Abusers: A Critique With Directions for Service Delivery and Research." Child Maltreatment v3 n4 p362-365.

Center for Sex Offender Management (CSOM) (1999). Understanding Juvenile Sexual Offending Behavior: Emerging Research, Treatment Approaches and Management Practices. Policy and Practice Brief.

There are few clear messages in the area of sexually abusive youth, except that we are lacking empirical studies and consistent research results based on reliable methods.

Adolescents Commit 30-50% of Child Sexual Abuse
Until the 1980's adolescent sexual offenses were often dismissed as normal experimentation or developmental curiosity. However, we now know that youth sexual offenses are both prevalent and serious. About 30% to 50% of child sexual abuse and 20% of rapes are committed by adolescents. Youths commit the same types of offenses as adult males including fondling, rape, exhibitionism, and noncontact offenses.

Characteristics of Adolescent Offenders
Researchers have reported these characteristics of adolescent offenders in the samples they studied:

Over 90% are boys, the average age is 15.
Most victims are girls.
Offenders are more likely to have experienced abuse than nonoffenders.
Many offenders have learning disabilities and school problems.
Many offenders have a diagnosable psychiatric disorder such as substance abuse and conduct disorders.
Offenders often have delinquent behavior, depression, lack of social skills, or lack of impulse control.

Are There Subgroups of Offenders?
The population of youth sex offenders is heterogeneous. Although some characteristics of offenders seem consistent across the group, other characteristics vary. For example, differences are found in youth sex offenders in these areas:

Some commit other crimes or delinquent behavior as well as sexual offenses and others do not.
Some act alone while others use accomplices. Some use weapons or force, or alcohol and other drugs during their offenses while others do not.
Some are isolated from peers or lacking in social skills and interest in normal girlfriends while others are not.
Some have poor school and job performance while others perform well.

Suggested Subtypes
Researchers have attempted to explain these differences by dividing offenders into subtypes. One categorization is between those who abuse children and those who abuse peers or adults:

Those abusing children - defined as children 5 or more years younger than themselves - usually abuse females, but about half of these offenders have at least one male victim. About 40% of their victims are siblings or relatives which they involve using guile and tricks. They commonly have poor self-esteem, poor social competence, and depression. Some with severe personality disturbances may be violent.
Those abusing adults usually abuse females, mostly strangers or acquaintances. Their offenses are often part of another criminal activity committed in a public area. They are likely to have a history of general offenses and delinquency, and have a conduct disorder. They are more likely to use violence, use weapons, and injure their victims.

Articles #9, #10 and #17 also discuss subgroups of offenders.

Female Offenses Can Be Serious
Although there are not many studies on female sex offenders a few report that girls victimize both males and females with the same range of offenses as boys, including rape and penetration. They commit repeat offenses, and also like boys, fantasize before offending. A majority of the female offenders have post traumatic stress syndrome, mood disorders, and have been sexually and/or physically abused. They have experienced more extensive and severe maltreatment beginning at a younger age from more perpetrators than many male offenders.

One study reported three sub-types of female sex offenders:

girls motivated by curiosity to commit only a few offenses of a less severe nature often while babysitting, they and their families have few problems
girls who have been victims themselves, and begin offending shortly after being abused using a type of abuse similar to what they experienced
girls with moderate to severe individual and family psychopathology who have experienced severe abuse and neglect such as incest at young age, who are depressed, anxious or have posttraumatic stress syndrome.

The Causes of Sexual Offending Are Not Clear
There is no generally accepted theory about the cause of sexual offending in youth. Researchers have investigated these areas as factors that may contribute to offending:

Experiencing Abuse -

Psychological Problems - Studies testing youth sex offenders with various standard instruments have found conduct disorder, depression, and other problems.

Family Dynamics - Although most researchers believe that family dynamics contribute to offending, the specific family problems or characteristics that are important and the way they affect the adolescent are not clear. For example, some studies show offenders often live in single-parent and blended families while others show they live in intact families. Other family variables connected with offending by some researchers include:

poor father-son relationships
number of family crises
criminal and sex offense history of family members
family religiosity and repression of sexuality
authoritarian leadership
poor communication
marital discord
emotional distance.

Poor Sex Education - Studies have consistently shown that adolescent offenders are very misinformed about sexuality. Their families avoid discussing it, or give unclear or mixed messages about sexuality, and the sex education provided by their schools is also inadequate.

Substance Abuse - Studies show a range of 3.4% to 72% of youth sex offenders use substances during offenses.

Exposure to Pornography - One study suggests that 42% of youth sex offenders were exposed to pornography compared to 29% of general delinquents.

Controlled Research on Treatment is Lacking
Although there are over 800 adolescent sex offender treatment programs in the US, they have not been evaluated. Only two studies have used controlled comparisons between types of treatment and they had small sample sizes, no follow-up and did not use comparable methods.

2. Sibling Abuse is Common But Dismissed top

Alpert, Judith L. (1997) "Sibling Child Sexual Abuse: Research Review and Clinical Implications." Pages 263-273 in Violence and Sexual Abuse at Home: Current Issues in Spousal Battering and Child Maltreatment. New York: Haworth Press.

Although sibling incest (most of it between older brother and younger sister) is far more common than father-daughter incest, it is researched far less frequently, perhaps because sibling sexual activity is dismissed as normal experimentation. In addition to this lack of interest in the problem, the research is difficult to do and the existing studies have many technical limitations.

It is Difficult to Define Sexually Abusive Contacts
There is still no unversally accepted criteria for distinguishing abusive from non-abusive sexual activity between siblings, and these activities seem to fall on a continuum. But a significant number of sexual contacts are exploitative, and this is due to use of force, or the coercion that is implied when children are of different ages. It is difficult to tell if children consent to sexual activity out of fear, lack of understanding or other factors.

It is Difficult to Estimate the Scope of the Problem
Researchers have reported a variety of estimates of the amount of sexual abuse between siblings, and all of them should be considered under-estimates. Taken all together the research suggests:

about 67% of general abuse between siblings is sexual abuse
about 3% of the population has been sexually abused by a sibling
about 12% of reported incest is sibling incest
more sexual abuse occurs between cousins than between siblings.

Sibling Sexual Abuse Has Negative Effects
Most of the research on the effects of sibling sexual abuse is on its long-term effects on adult sexuality. Most studies suggest that sibling sexual experiences involving coercion (force or age difference) are related to:

adult sexual dysfunction - avoidance or promiscuity
lower sexual self esteem
more frequent adult re-victimization
difficulty in maintaining close relationships - one study found that 47% of sibling incest victims did not marry.

Your Clients May be Victims of Sibling Sexual Abuse
Practitioners should remember that their clients may have experienced abusive sexual contacts with siblings and try to learn about their experiences. Detailed questioning may be needed to find out how much coercion was involved and how distressing the experiences were.

3. Should Youth Be Treated Like Adult Offenders? top

Chaffin, Mark and Barbara Bonner (1998). "'Don't Shoot, We're Your Children': Have We Gone too Far in Our Response to Adolescent Sexual Abusers and Children with Sexual Behavior Problems?" Child Maltreatment v3 n4 p314-317.

An editorial introducing a special journal edition on adolescent sexual abusers.

Fifteen years ago, we were missing solid information about all these topics related to adolescent sex offenders:

treatment models
effectiveness of interventions
risk factors and risk assessment
types of offenders
if offending continues in adulthood.

Fifteen years later, there is still only tentative information in some of these areas, and treatment is still based on models used with adult pedophiles in prison. Since we lack real information, the field has been using 'conventional wisdom' based on work with adult offenders and clinical impressions.

For example, these commonly held beliefs do not have clear research support:

sex offender-specific treatment is best
all sexually abusive children and youth must be treated
most offenders are abuse victims and this causes their abusive behavior
denial must be broken
good therapy must be confrontational
treatment must be long-term and in restrictive conditions
families of abusers are dysfunctional
abusive behavior always follows an offense cycle
abusers must accept that they have an incurable disorder
abusers are so dangerous they must be registered.

While some of the above beliefs apply to some adolescent and child sexual abusers, taken as a whole, they may be punitive and harmful. Instead of a treatment response, they may represent the current political climate of the 'war' on juvenile crime and sex offenders in general. Some of our responses to children and youth should be questioned, for example:

children age 10-12 being registered as offenders
a child of 10 interrogated without parents or attorney and locked up with abusive older inmates
parents of a 7 year old being told he could never return home after two incidents of fondling
preschoolers labeled as offenders based on a family history that might lead to offending
13-15 year olds required to recite daily "I am a pedophile... I can never be trusted... I can never be cured..."
boys admitting to offenses or fantasies they did not commit in order to be released from treatment.

Fifteen years ago our challenge was to get the system to take sexual abuses from youth and children seriously, but we may have been too successful. Treatment models for children and youth should be examined critically, with an understanding that there is little research support for treating them as adult offenders.

4. Ethical Issues Make Working With Youth Challenging top

Center for Sex Offender Management (CSOM) (1999). Understanding Juvenile Sexual Offending Behavior: Emerging Research, Treatment Approaches and Management Practices. Policy and Practice Brief. Available on the Web at: http://www.csom.org/pubs/pubs.html(scroll down the page to find this paper listed)

Hunter, John and Lenard Lexier (1998). "Ethical and Legal Issues in the Assessment and Treatment of Juvenile Sex Offenders." Child Maltreatment v3 n4 p339-350.

In the past ten years, the American public has become more fearful of juvenile crime, more interested in punishment than rehabilitation, and more in favor of trying violent juveniles as adults. This changing climate, plus the lack of research evidence about juvenile sex offenders, creates ethical challenges for practitioners working with the youth.

Problems of Reduced Confidentiality
Sex offenders do not enjoy the complete confidentiality with their therapists that other clients do. Anything the juvenile says may become part of the public record. Therapists may be required to report any child abuse they learn about from the youth, or provide treatment progress to case managers.

The therapist must make sure the youth understands the limits of confidentiality in treatment. His choices are:

to make a full disclosure and cooperate with treatment and face unknown legal consequences
not to cooperate and risk being rejected from treatment and going to prison.

It is hard for a practitioner to know if a youth denies his offenses because of the severe consequences to admitting or because he is not open to treatment.

The Role of Therapy is Compromised
The traditional goal for therapy is to create a trusting relationship that allows clients to be vulnerable, to provide a supportive and protective environment where the therapist is most concerned about the needs and rights of the client. However, in work with offenders, both therapists and the public are unclear about whom they serve - the client's needs or community safety. Some do not believe that offenders deserve therapy. Can effective therapy happen in this climate?

Juveniles Can Now Be Registered
In the 1990s more than 90% of the states created legislation or regulations making juveniles more accountable in the criminal justice system. All states now have laws specifying when juveniles can or must be tried as adults. Three federal laws of 1994 and 1996 mandated that states create registries of sex offenders using violence or offending against minors. "Federal guidelines specifically require the registering of juveniles when they have been convicted of rape, nonconsensual sexual perpetration or sodomy, or incest with a victim at least 2 years young then themselves," and so far 22 states have laws that apply to juveniles.

Supervision Should be a Team Effort
Close cooperation between the courts and treatment providers is needed to make sure that youth comply with treatment. If the court agrees to suspend a youth's sentence if he finishes his treatment, this is a good motivator.

Parole and probation officers need to work closely with treatment providers in a supervision team that also includes case workers, school staff, therapists, and pastors.

Adult Courts Do Not Focus on Rehabilitation
In the past, youth were likely to be offered mental health treatment and rehabilitation. Now the courts are shifting toward trying juveniles as adults, and in adult courts youths are more likely to be ordered into involuntary treatment. Some youth may not meet the legal criteria for involuntary treatment which is based on imminence of danger to the community. Also, a youth may not be competent to understand his case, work with his attorneys and make decisions about his defense.

Assess After Adjudication and Before Sentencing
Some youth are referred for assessment before they are seen by the court to help the court address their cases. However, at assessment, a youth may be asked to give information that can be used against him without protection from the 5th Amendment. Assessments should be made only after the youth is adjudicated and before he is sentenced. An assessor should explain her role and the limits of confidentiality to the family and its attorneys, and get informed consent to the assessment with appropriate signed consent forms, releases and waivers.

Other Questionable Practices

Phallometric assessment, which involves measuring penile changes during exposure to suggestive material, may not be valid with youth and is ethically questionable.
Very little research has been done on the validity of polygraph tests with youth, and they are not recommended for youth under age 14.
Research gives inconsistent results about the effectiveness of arousal conditioning treatments. There are certainly ethical concerns about using them with youth because they involve masturbation and may cause emotional or physical pain.
Anti-androgens and hormone drug therapies used with youth have been little studied. They may suppress growth, and must not be used with youth under age 18.

Risk Assessments Have Little Research Support
Courts often ask clinicians do risk assessments to help them decide if a youth should be registered and how he should be managed. Risk assessments for any violent offending are not an exact science and none of the assessments often used for adult sexual offending have been validated for youth.

Fortunately, there is a new instrument, the Juvenile Sex Offender Assessment Protocol, which is currently being evaluated. Initial results studying the protocol used with 96 youths indicate it is reliable and valid. The study is now in press.

Other Research in Progress
More research on juvenile sexual offending is certainly needed. The National Center for Child Abuse and Neglect is currently funding two demonstration projects focusing on treatment outcomes for prepubescent children with sexual behavior problems. The Office of Juvenile Justice and Delinquency Prevention is also funding research on the sub-types of juvenile sexual offenders and their particular treatment needs.

5. Assessing Adolescents top

Bonner, Barbara, Brian Marx, Michelle Thompson and Patricia Michaelson (1998). "Assessment of Adolescent Sexual Offenders." Child Maltreatment v3 n4 p374-376.

Smith, Gillan and Lane Fischer (1999). "Assessment of Juvenile Sexual Offenders; Reliability and Validity of the Abel Assessment for Interest in Paraphilias." Sexual Abuse: A Journal of Research and Treatment v11 n3 p207-216.

Use a Variety of Information Sources
It is essential to assess adolescent sexual offenders in order to plan treatment for them and their families. The assessment should include:

interviews with the youth and family members
information from police records, victim statements, and school reports
psychological assessments
previous testing or treatment records.

Investigate All Areas of Life
These specific areas are investigated:

school performance, intelligence and learning ability
history of any abuse or neglect
history of nonsexual delinquent or antisocial behavior
substance use
mental health problems
detailed sexual behavior history
family and peer relationships
empathy, anger and stress management
social skills.

Complete Information About Sexuality Is Needed
Usually the youth and his family are reluctant to discuss his sexual history, so information about this is gradually revealed over the course of treatment. Complete information is needed about the youth's:

'normal' sexual activities
deviant fantasies, behaviors and offenses
coercion or force used
effect of substance use on sexual behavior
ability to control sexual behavior
general knowledge about sexuality.

Use Available Instruments With Caution
A variety of instruments can be used in an assessment, however, the validity and reliability of the tests, or their usefulness in giving information about adolescent sex abusers may be limited. The instruments available to assess sexual behavior should be used especially cautiously because they are not adequately valid and reliable. For example, the Abel Assessment for Sexual Interest has been found "useless" with adolescents.

6. Assessing Sibling Abuse top

Caffaro, John V. and Allison Conn-Caffaro (1998). "Assessment of Sibling Abuse." Pages 111-144 and 263-272 in Sibling Abuse Trauma: Assessment and Intervention Strategies for Children, Families, and Adults. New York: Haworth Press.

Sibling Abuse Interview Protocol
The authors have developed a Sibling Abuse Interview for helping the practitioner assess the distresses and strengths found in families where emotional, physical or sexual sibling abuse may be occurring. The questions included in the Interview are designed to gather information about the family in the areas discussed below.

Interviewing the Victim
Questions for the victim gather information about her level of fear of the offender, her assertiveness or ability to protect herself or report abuse, the degree of difference in power between siblings, how much she takes responsibility for the abuse, and it there is evidence of psychological maltreatment.

Interviewing the Abuser
Questions for the abuser gather information about how much he acknowledges his abusive behavior, his level of coercion, his capacity for empathy, and any history he has of being an abuse victim.

Interviewing Other Siblings
Other siblings in the family may be traumatized by knowing about or witnessing abuse and feel a variety of painful feelings about it. Interview questions are included for gathering information about their experiences.

Interviewing the Sibling Subsystem
Ask questions of the family's children, although it may not be appropriate to meet together with a victim and an abuser to learn about the good features of their relationships, their conflict resolution and communication skills, and how they view their parents.

Interviewing Parents Individually
Each parent should be interviewed separately to gather information about their marital and sexual relationship, including extramarital affairs and how extensively their sexual activity is revealed to the children, substance use, how much they believe that sibling abuse has happened and their feelings about it, how they see the children's family roles, and any history of abuse in their childhoods.

Interviewing Parents Together
Seeing parents together allows the practitioner to watch their interactions and gather information about family stresses, how supportive the relationship is to each partner, how involved parents are with the children, how they discipline and resolve conflicts, and the nature of the sexual climate in the home.

Interviewing the Family
The family interview can help correct and verify the information that has been gathered from the previous interviews, and give the practitioner a chance to observe family interactions. The questions help communicate that every member of the family is important. They help the family determine its goals and see that they can work as a team toward their goals.

7. Youth Treatment Should Promote Development top

Ryan, Gail (1999). "Treatment of Sexually Abusive Youth: The Evolving Consensus." Journal of Interpersonal Violence v14 n4 p422-436.

Treating youth is more complex than treating adults because youth are involved with so many agencies and organizations, such as child welfare, child protection, probation, school, foster family and family of origin. Some of these groups may dismiss the seriousness of youth offenses and not support treatment.

Youth Treatment Should Promote Development
Also, youth are still developing and must be treated as a whole, not focusing only on their offending. Abusive behavior is evidence of deviant learning or developmental deficits. Youth need nurturing to return them to a more normal developmental path. Only some youth will continue to offend as adults. Some will stop on their own and others will stop with treatment. Unfortunately, we do not know how to predict which path youth will follow.

Most Treatment is Based on the Sexual Abuse Cycle
Treatment programs have generally followed models for treating adults using the concept of the sexual abuse cycle. Youth are taught to understand their own pattern of triggers that lead to offending and how to interrupt it.

Sympathy Training is Not the Same as Empathy
Treatment programs usually include training to increase empathy for victims which is taught by encouraging youth to imagine how they would feel in the victim's place. However, this is sympathy rather than empathy. Sympathy is based on assuming that others feel as you do. Many offenders imagine that they and their victims are sharing the same feeling. Empathy, however, is based on assuming that all people are unique in their experiences and feelings and actively looking for cues about their feelings.

Kempe Center Trains Parents and Teachers
The Kempe Center Perpetration Prevention Program trains teachers and parents to evaluate children's sexual behavior. It assumes that children need adults to correct their sexual learning, foster the development of empathy and hold children accountable for their behavior. The program teaches a continuum of four levels of response to inappropriate sexual behavior:

First teach children empathy, that their behavior distresses others.
When empathy does not change the behavior give children a rule that prohibits it.
When neither empathy nor rules work, refer the child for an intervention such as a special group.
When group participation in ineffective, the child is referred to a treatment program.

8. MultiSystemic Therapy Shows Promise top

Swenson, Cynthia, Scott Henggeler and Sonja Schoenwald (1998). "Changing the Social Ecologies of Adolescent Sexual Offenders: Implications of the Success of Multisystemic Therapy in Treating Serious Antisocial Behavior in Adolescents." Child Maltreatment v3 n4 p330-340.

Multisystemic therapy (MST) has been proven effective in treating chronic nonsexual offenders. It has these features:

Many factors - MST attempts to address the many factors - individual, family, peer and school - that may contribute to offending.
Natural settings - MST is offered in natural settings such homes and schools. Delivering service in the community overcomes barriers to accessing treatment, makes it easier for clients to transfer their therapy gains to real life, and results in lower drop out rates.
Tailored - Interventions are tailored for the unique strengths and deficits of the youth and family.
Intensive - The treatment is very intensive and may take only 4-6 months.
Empowers caregivers - MST focuses on empowering the caregivers to be the change agents for their children. For example, if relaxation techniques are used, the caregiver is taught the technique and then given the opportunity to teach and practice the technique with the youth.
Community support - MST involves any individuals related to the youth who can provide support, monitoring, role reinforcement or any other assistance.

In contrast, other treatments may target only individual factors, be unmodified for unique needs, and offered only in restricted settings.

The MST Model For Sexual Offenders
Preliminary research suggests MST shows promise for treating sexual offending. Work was done in 1997 on adapting MST to address the specific issues of sexually abusive youth. Its main points are listed below, although be aware that the adapted model is not yet validated by research.

Grooming - The initial goal of MST is to evaluate the offender's grooming process, including types of offenses, distorted attitudes and thoughts, fantasies, victim empathy, and the offense cycle. The assessment should use the Adolescent Modus Operandi Questionnaire. This information is used to find family members who may contribute to the offending, and to involve other people who can help monitor the offender's behavior.

Clarification - This process helps the youth and family admit the offense, hold the youth responsible, make psychological restitution to the victim, and prepare a safety plan.

Family Reunification - The manual gives details for reunification in six gradual stages.

Treatment for Sexual Victimization - Some youth and caregivers may be victims of sexual abuse and are offered trauma-specific treatment.

Peer Relations - Interventions may be offered for youth or families who are isolated or have poor social skills.

9. Treating Children Who Molest top

Johnson, Toni Cavanagh (1998). "Children Who Molest." Pages 337-352 in Sourcebook of Treatment Programs for Sexual Offenders. New York: Plenum Press.

The author has many years' experience working with children who molest. She sees three levels of sexual behavior problems in children:

Level 1 - Sexually reactive children

Level 2 - Children who engage in extensive, mutual sexual behaviors are again coping with painful feelings due to experiencing abuse by finding similarly lonely children who will engage sexually with them. This provides a sense of connection. No coercion is involved.

Level 3 - Children who molest show frequent and pervasive sexual behaviors. Sexuality and aggression are closely linked in their thinking and their behaviors are impulsive, compulsive and/or aggressive. They use bribery, trickery, manipulation or emotional or physical coercion and select victims with special vulnerabilities. They generally have problems in all areas of their lives.

Assessing Sexual Behavior Problems
Since the 1980s when sexual behavior problems were first recognized, most children with these problems have been diagnosed as "molesters". This over-represents the size of the problem and hurts the children whose problems are in level 1 and 2 by distressing them with unnecessarily restrictive treatment.

Use Group Therapy for Children
Children's treatment must directly address the problem behavior, nondirective play therapy is not adequate. Also, group therapy for the children is highly recommended because it allows children to participate actively in healthy ways with other children. Individual therapy should be reserved for issues that cannot be addressed by the group. Children should also be assessed for hyperactivity, learning problems, and other special education needs.

Children Have Different Needs Than Older Offenders
Materials used with children must be age appropriate. Do not use materials from adult and adolescent offender treatments without modifying them. These differences between children and older offenders are important:

children's offending is more due to modeling than sexual desire
children's fantasies are less well developed
children are less able to understand abstract concepts
children are less sophisticated emotionally
children's values, attitudes and feelings are primarily shaped by their families and they cannot see the family as separate from them.

Parents Must Participate in Treatment
It is essential that parents of molesting children also participate in therapy, especially when children are young and must continue to live with their parents. A court mandate for treatment is usually needed to motivate parents to participate. Family therapy is essential because the factors that sustain sexually aggressive behaviors are often found in relationships among nuclear and extended family members. Finally, parents must make safety plans for their children with school staff and other groups in the community, especially for bathroom and playground supervision of their children.

Fewer Children Are Referred for Treatment Than Expected
Both outpatient and inpatient treatment programs have received fewer referrals than they initially expected, and they have received children who are not "Level 3" molesters. There are fewer molesting children than initially thought. Unfortunately, children who molest victims outside their homes are unlikely to receive treatment because both police and child protection agencies are unlikely to respond to these cases.

Residential Treatment Issues
Residential centers may have inadequate funding or training to meet the needs of their children. They may house together children of all levels of sexual behavior problems, including victims, or house children with adolescents. Also, in an effort to protect children, all physical contact between children as well as staff is sometimes prohibited. Instead:

Children who molest should be given separate housing and treatment with others of the same age, in small units to allow individual attention.
When offender and nonoffender children and adolescents must be housed together, develop good safety plans that involve all the children and encourage self-respect.
Children should have opportunities to learn healthy physical contact and develop appropriate attachment.

Treatment is Difficult for Providers
While working with children who molest has its rewards, it is also emotionally draining, physically exhausting and can affect the way caregivers see the world. Training and support for line staff must be very extensive to prevent burnout and harsh treatment of the children.

10. Relapse Prevention Therapy Helps top

Pithers, William, Alison Gray, Aida Busconi and Paul Houchens (1998). "Children With Sexual Behavior Problems: Identification of Five Distinct Child types and Related Treatment Considerations." Child Maltreatment v3 n4 p384-404.

The authors studied 127 children with sexual behavior problems aged 6-12, including 83 boys and 44 girls. The children and their caregivers were evaluated with a variety of instruments. More than half of the children had experienced both sexual and physical abuse and 60% of these had been in therapy before they started acting out.

Expressive Therapy and Relapse Prevention Therapy
Children and their families were randomly assigned to two treatments with the treatment evaluated after 16 weeks. One of the therapies offered was Expressive therapy which uses metaphors, symbols, rituals and activities in a spontaneous way. Skills are learned indirectly by experience. Relapse prevention therapy, modified for children, was also offered. It is based on understanding the cycle of triggers that lead to acting out and has these features:

It is structured and predictable.
It teaches children self-soothing behaviors that can lessen their distress.
It directly teaches ways to regulate emotions and behaviors.
It helps parents learn appropriate responses to children's distress.
It encourages families to develop supportive networks to help prevent future acting out.

Five Child Types
The children were categorized in five groups based on their personal and family characteristics.

Sexually Aggressive Children:

were mostly boys
had the lowest level of anxiety
used aggression with victims
had the highest rate of conduct disorder and penetrative behaviors
in the past were abused by the fewest number of perpetrators
their extended families had few perpetrators
were not helped by either treatment - equal numbers of children showed improvement and worsening of symptoms.

Abuse Reactive Children:

were mostly boys and likely to be younger
had experienced a high level of maltreatment and were abused by more perpetrators
had more psychiatric diagnoses, usually oppositional defiant disorder and attention deficit hyperactivity disorder
had the second highest rate of penetrative behaviors
had a higher number of victims
started acting out soon after being abused
were helped by modified relapse prevention therapy.

Rule-Breaking Children:

were likely to be girls
had the highest rate (71%) of extended families that included sexual abusers
had the longest time period between first being victimized and acting out
used aggression with victims
had the highest Child Behavior Checklist total score, more externalizing rather than internalizing
had problems with nonsexual acting out as well
were helped equally by modified relapse prevention therapy and expressive therapy.

Highly Traumatized Children:

were equally male and female
had the highest number of psychiatric diagoses
had the highest rate of posttraumatic stress disorder
had extensive histories of being maltreated and abused by more people
had a higher number of victims
were likely to be younger
started acting out shortly after being victimized
had parents who felt less attached to them than any other type
were helped by modified relapse prevention therapy.

Nonsymptomatic Children:

were within the normal range on most tests
had the fewest number of victims
had the lowest rating on aggression
were least likely to have a psychiatric disorder
had sexual abusers in 52% of their extended families
were helped by modified relapse prevention therapy.

Parental Attachment is a Critical Factor
Attachment between parents and children was profoundly insecure in all five types and most insecure with the highly traumatized children. Lack of attachment correlated with the number of victims abused by the child. The children in this study made most improvement in therapy when their parents were more attached to them.

Insecure attachment may be the link between child maltreatment and delinquency or offending in youth and adults. Previous research suggests that when attachment is broken, children fail to identify with parental and societal values and to learn to control their behavior. Not identifying with values creates social alienation and makes children more vulnerable to antisocial peer influences. Also, parents who are not attached are little involved with their children and do not provide good supervision or monitoring.

Relapse Prevention Therapy Helps Parental Involvement
Clearly, enhancing parental attachment should be a major goal of treatment. The modified relapse prevention therapy, by teaching parents how to respond appropriately to their children's distress with both care-giving and discipline, enhances their involvement with their children. Greater involvement is linked to greater attachment and closer monitoring. This structured therapy helped parents improve their skills more quickly than the expressive therapy.

Relapse Prevention Therapy Helps Traumatized Children
Also, relapse prevention therapy may be more helpful for the traumatized child because it gives a needed feeling of order. It helps children learn self management skills more quickly than in expressive therapy.

11. The SAFE-T Program top

Worling, James R. (1998) "Adolescent Sexual Offender Treatment at the SAFE-T Program." Pages 353-365 in Sourcebook of Treatment Programs for Sexual Offenders. New York: Plenum Press.

The Sexual Abuse: Family Education and Treatment (SAFE-T) Program of Toronto provides holistic, comprehensive treatment for incest victims and adolescent sexual offenders.

Most Offenders are Males Aged 12-19
The adolescent offenders in the SAFE-T program have the following characteristics:

93% are male, ages 12-19
34% of their victims are siblings, 51% are outside the family
62% of their victims are female 62% and 17% are male
43% were sexually abused as children; 75% of those abusing boys were sexually abused as children; 25% of those abusing girls were sexually abused as children.

Only Youth in Placement are Accepted
SAFE-T does not work with cases if the offender is still living in the same home as his victim. This places SAFE-T in the role of child protection if their assessments indicate that the youth should be removed.

No Phallometric Assessment is Used
Although it is legal in Canada to use pornography for research purposes such as phallometric testing, the children that appear in pornography are exploited victims.

It is not justifiable to expose youths to deviant images during the test when the images may have adverse affects on their development. Phallometric testing has not been proved reliable with youth and there is no normative data from nonoffenders to use for comparison. With adult offenders, risk factors for future offending are reliably correlated with deviant arousal patterns, but this is not true for youth. Finally, the SAFE-T program has a holistic focus and is more concerned with other aspects of youth.

Holistic Treatment Approach
Prevention of future offenses is the top treatment priority at SAFE-T. Individual treatment goals are prepared and reviewed every four months. The strengths perspective, cognitive behavioral therapy, family systems therapy, insight oriented therapy and play and art therapy are all used to address these issues:

relapse prevention
denial and accountability
arousal
sexual attitudes
victim empathy
other issues as indicated, such as social skills, self esteem, body image.

SAFE-T has been successful modifying methods taken from adult treatment programs for youth by using simpler language, more concrete activities, games and repetition.

'What Do I Lose' is a Motivator
The capacity for victim empathy is less well developed in youth than adults and may be especially thwarted in youth who have been abused. The SAFE-T program gets better results using the natural egocentricity of youth and focusing on what they will lose by reoffending. Youth are particularly anxious to avoid losing their freedom or contact with family and friends.

Youth do Well With Group Therapy
Adolescents do well with the group therapy format. They need to relate to their peers and peer pressure helps in confronting denial. Youth also want to rebel against adults and so readily take on ownership of group activities.

Meetings Enhance Collaboration
To enhance collaboration among the many agencies involved with each youth, SAFE-T brings together parents, probation officers, child protection workers, group home staff and so on for meetings. Each case is also attended by a multidisciplinary team of therapists: the family therapist, the offender's therapist, the youth group leader, the victim's therapist, and the parent group leader.

Discounting is the Most Difficult Issue
The greatest difficultly faced by SAFE-T is the pervasive minimizing of the importance of youth sexual offending by police and other agencies who consider offending normal sexual experimentation.

Families Make Youth Work More Difficult
A major difference between working with adult versus youth offenders is that youth work must involve the family of origin. Youth are at the developmental stage of separating from their parents, and they struggle with this at the same time that parents must be monitoring them closely.

Family environments are often unstable and negative and contribute to the offending; these factors must be addressed. Incest families in particular have excessive discord, physical discipline, verbal aggression, and rejection of the abuser. It is very difficult for parents in sibling incest families to support both the victim and abuser. The children who are not victimized must deal with loyalty issues and all family members are concerned about the abuser's removal and return. Families arrive for treatment feeling ashamed, guilty and embarrassed so they are offered a caring and nonjudmental relationship.

Families must also be involved in the relapse prevention program designed for each offender. After family members and the youth are well prepared, the youth presents them with information about his offenses, triggers, and coping strategies and enlists their help. Parents often have difficulty hearing about the offenses in detail and learning that they have been planned.

Treatment Outcomes are Positive
The SAFE-T program shows positive results. Only 5% of the youth completing at least one year of treatment received additional criminal charges during the following 2-10 years. For a comparison group of youth who did not completing treatment, the rate is 18%.

12. The Stop and Think Program top

Butler, Linda and Colin Elliott (1999). "Stop and Think: Changing Sexually Aggressive Behaviour in Young Children." Pages 183-203 in Children and Young People Who Sexually Abuse Others: Challenges and Responses. London: Routledge.

The authors are with the Wrexham Child and Adolescent Mental health Service in the UK. They have developed the Stop and Think program which is based on the cognitive behavioral approach but adapted for the developmental level of children. The Stop and Think approach is a problem solving technique to help children manage their impulsivity. The program is intensive and long term, perhaps 2 years.

Repetition, Fun and Involvement of Caregivers
Lots of repetition is needed to teach the approach and games, quizzes, cartoons, mnemonics, situation cards and role playing are used to keep children engaged. Children's caregivers must also be actively involved so that the skills can be practiced at home.

The Four Steps of Stop and Think
The Stop and Think approach is based on four steps that children learn to apply to their everyday problems as well as to sexually abusive behavior.

1. What's the problem?

2. What can I do? Brainstorming possible solutions.

3. What might happen? Thinking about the future. He must be able to understand several complex issues including how social interaction works, how to take other peoples' perspectives, reciprocity in relationships and cause and effect.

4. Decide and Do Choosing an action, carrying it out, and evaluating what happens.

The THINK-FEEL-DO Triangle
Children must have background skills in order to carry out the four Stop and Think steps. Teaching these skills using the Think-Feel-Do Triangle is a major focus of the program. Each point of the triangle represents thinking, feeling, and doing.

Feelings

Thoughts - Children also work on identifying the thoughts that go with their feelings. One of the activities used is to add cartoon-like 'thought bubbles' to their body maps of feelings.

Linking feelings, thoughts and behaviors - Finally, children learn to understand how feelings, thoughts and behaviors are all connected by using the Think-Feel-Do Triangle. They first draw triangles representing everyday incidents that include their thoughts, feelings, and behaviors about the incidents at the three triangle points. Then they use the triangles for past sexually abusive behavior.

Children and Adults Get Information About Triggers
This investigation of feelings and thoughts about a child's sexually abusive behavior brings out information about the triggers that lead the child into abusive incidents. The child needs to recognize and think about these triggers. Adults also need this information to understand the situations that are high risk for the child so they can choose safe environments for the child. Triggers may be thoughts, emotions, images, situations or sensations, such as:

the thought, "no one cares about me"
the image of being hurt
the emotion of being lonely or sad
the situation of being alone with child like a previous victim
the sensation of a smell or touch that seems erotic to the child.

Introducing Stop and Think
After children have worked with the Triangle, the four Stop and Think steps are introduced. Children first practice them to solve everyday problems. Then they apply the steps to past incidents of sexually abusive behavior. Finally, they prepare for future situations that might trigger abusive behavior, by role playing or imagining situations in therapy.

Empathy is Difficult for Children
To develop empathy, children need to be developmentally ready to take another person's perspective. It may also be difficult for children who have been abused to focus on the feelings and needs of another child, when their own needs are not met. When children are not ready for empathy, just focus on how an incident of sexually abusive behavior affects the abuser with consequences that he will not want to experience.

13. Therapy in Sibling Incest top

Hackett, Simon, Bobbie Print and Carol Dey (1998). "Brother Nature: Therapeutic Intervention with Young Men Who Sexually Abuse Their Siblings." Pages 152-179 in From Hearing to Healing: Working with the Aftermath of Child Sexual Abuse, 2^nd Ed. Chichester, West Sussex, England: John Wiley & Sons, Ltd.

The authors are with G-MAP, a British agency serving sexually disturbed youth.

Myths About Sibling Sexual Abuse
Many myths about sibling sexual abuse are believed by both the public and professionals, including:

Sexual abuse rarely takes place between siblings due to the taboo on incest.
Sexual contact between siblings is usually experimental, consensual, and just a one-time, unplanned event.
Sexual abuse between siblings will go away if left alone.
Young men who seek victims outside of the home are more dangerous and have more problems than those who abuse siblings.

Abusers of Siblings are Disturbed and Commit More Serious Offenses
Although there is little research on sibling sexual abuse, the existing studies suggest that male youth who abuse their siblings are significantly disturbed and commit serious offenses. In general, they commit more acts of abuse over a longer time period, and more serious offenses than youth who only abuse children outside the home. Researchers have also found that the families of youth who abuse their siblings have significant problems.

Treatment is Victim-Centered
The first responsibility of a program for treating sibling sexual abusers is to their victims and the primary goal of therapy is to prevent further victimization. Involving the child protection agency and ensuring the safety of victims or children who could become victims must be the first tasks, before the abuser is offered any services. The abuser must not stay in the same house as his victim, or be placed in a situation that allows future abuse. Healing begins with the victim and then moves to the abuser, the parents and the family.

The Abuser Needs Healing
There are no models specifically for work with youth who have abused siblings. The G-MAP program model is based on the following assumptions:

Abusive behavior is self-reinforcing.
Abusive behavior is accompanied by a distinct pattern of thought and feelings.
Abusive behavior is controlled rather than cured.
Treatment includes identifying an abuser's unique pattern of offending and developing a relapse prevention strategy.

The G-MAP model assumes that an abuser is damaged by the experience of abusing and treatment must help him heal his self-perception and sexuality. Practitioners who use anger or aggression to work with abusers reinforce the dynamics that lead to the abuse. The challenge to practitioners is to nurture the child in the abuser with support and understanding while still requiring acceptance of responsibility, and accountable and respectful behavior.

The G-MAP Treatment Components
Group or individual therapy is used to address the following tasks and issues:

sex education
accountability
cognitive distortions
deviant arousal patterns
assertiveness and anger management
social skills
self-esteem
the abuse cycle and relapse prevention skills
victim empathy
victim apology and restitution
family therapy
dealing with being a victim of abuse.

Healing the Family is Crucial
Offender treatment programs may be weak in offering treatment to families, perhaps because it seems to shift some responsibility from the offender to the family. Also, it can be more difficult to work with the family, especially when there is no hope of reunification. But family work is still crucial. Parents often feel they have failed and blame themselves. They may have to grieve over having to choose between living with the abuser or living with the victim. They will want reassurance that the future will be better, but they must receive honest information about the prospects for relapse.

Preparing for Contact Between the Victim and Abuser
Late in therapy, the abuser may have contact with his victim when it is her voluntary choice and in her best interest. Careful preparation of both victim and abuser is needed, and the contact is always supervised.

The abuser must demonstrate that he has accepted full responsibility for the abuse and no longer displays distorted thinking, self-pity and inappropriate attitudes. He must demonstrate true empathy for the victim, which means he wants to help the victim heal, not to meet his own goals of reducing his guilt or returning to the family. He can rehearse for the contact by writing letters of apology addressed to the victim but not sent.

Requirements Before Considering Reunification
Practitioners may be very motivated to try to reunify the family, partly because it is hard to find a placement for the abuser. But it is not necessary for the parties to forgive each other or feel that an ongoing relationship of any kind is appropriate.

Before considering reunification, the following minimum requirements must be met:

The victim:

The abuser: must accept full responsibility for the abuse, demonstrate empathy for the victim and awareness of the impact of his behavior on other family members, show remorse, is willing to talk to the victim and family about the abuse at their request, is willing to make appropriate apologies, understands his motivation for the abuse, is able to admit his ongoing risk factors and can ask for help to prevent relapse.

Parents: are able to put victim's needs for protection first, have confronted the abuser and expressed their feelings about the abuse to him, are able to discuss the impact of the abuse on themselves, hold the abuser responsible and do not blame the victim, and have the parenting skills needed to manage risk and ensure openness in the family.

The family members: have made an informed choice for reunification, have been successful with their therapy, demonstrate open family dynamics with appropriate boundaries and healthy interactions, and the family has a working protection plan with external supports.

Spaccarellli, Steve (2000). Summary of Proposed Research: SACY Longitudinal Study. Chicago, IL: Child Abuse Unit for Studies, Education and Resources (C.A.U.S.E.S).

The Chicago group, Child Abuse Unit for Studies, Education and Resources, is planning a longitudinal study to gather data and answer questions about juvenile offenders. The study will follow 450 sexually aggressive DCFS wards over a period of 5 years.

Researchers expect to gather complete descriptions of the youths' offenses, attitudes, personality traits, and case histories. They hope to learn which types of placement and treatment are best for certain types of offenders; for example, if outpatient treatment is best for sexual deviance problems and inpatient or residential treatment is best for psychopathological problems.

15. Managing Risk in Caring For Youth top

Epps, Kevin (1999). "Looking After Young Sexual Abusers: Child Protection, Risk Management and Risk Reduction." Pages 67-85 in Children and Young People Who Sexually Abuse Others: Challenges and Responses. London: Routledge.

The risk that a young sex abuser presents to others is always changing as both he and his circumstances change. Managing this changing risk requires planning, monitoring and evaluations based on good quality information about the youth.

First, Admit Risk and Protect Victims
When sexual abuse is revealed, the first requirement is to admit that there is always a risk of abuse happening again, and both professionals and caregivers may find this hard to accept.

Then, the immediate response must be to protect other children. Often the first response of parents or caregivers is to get the youth into therapy, but therapy is a longer-term issue. Instead, assess how much contact the abuser may have with the victim and other children. This may lead directly to removing the abuser from his home and/or from his normal school.

Assess Risk to Children at Home and School
If the abuser's victim is a sibling, how much contact with his family is appropriate? The abuser should be removed from his home to prevent any victim contact if abuser makes threats to the victim, blames the victim, or tries to convince the family the victim is lying. Even subtle eye contact and body posture can continue to damage the victim. Telephone contact may also need to be restricted because so much intimidation and influence can be communicated by telephone.

The abuser may also present a risk to children at school if he has abused children there, or has abused children of a similar age and gender. He may need to be removed from school and placed in a special school or schooled at home. Most schools do not have the resources to provide enough supervision for determined abusers.

Second, Plan for Management at Home or in Placement
The mid-range plan for managing risk is based on adults taking charge of the abuser and his environment. This plan must be based on gathering information about three areas: the abuser, his abusive behavior, and the adult-managed environment where he will be managed.

Gather information about the abuser -

impulsive, overactive or volatile temperament
preoccupied with sexuality
long established pattern of abuse
entrenched beliefs supporting abuse
disorders such as ADHD or substance abuse
learning or thinking disabilities
emotional problems such as an inability to relate to peers or trust adults.

Gather information about the abuse behavior - Find out about his victims, the grooming and coercion he used and the situations in which abuse occurred. Past behavior predicts future behavior, so this information will help his adult managers understand his high risk situations.

Gather information about the adult-managed environment - Whether the youth is at home, in foster care or in residential care, he will need adults who actively create a safe environment with close supervision and establishing and enforcing behavioral boundaries. Abusers usually have experienced little limit setting in the past. The best environments promote assertive and open communication and thus the development of healthy boundaries.

In family care environments the ability of the family to provide this close supervision must be carefully examined. A family's ability may be compromised by illness, work obligations and the needs of other children for attention. If parents were victims of childhood abuse themselves, they may overlook signs of abuse or feel powerless to stop it. Both male and female caregivers should be involved in providing supervision, women should not be held solely responsible.

In residential environments the other child residents are especially vulnerable to abuse. Especially consider if the children are similar to abuser's past victims. The residential environment also needs physical security resources, but also the dynamic security provided by adequate and well trained staff.

Adults Need to Monitor Interactions
Adults managing abusive youth need to understand and be aware of the interactions between children in their care and the types of interactions that may indicate potential problems. They must predict and prevent future abuse. They must establish clear policies about physical contact between children.

Youth Can Abuse While Seeming to Follow the Rules
Persistent abusers may use allowed or innocent looking types of physical contact to obtain sexual arousal. Particular problem areas for supervision are any unstructured time, such as when children are in bedrooms, and when children are close together such as at meals when an abuser may abuse a victim under the table. Abusers can also gradually press boundaries to their advantage. For example, an increase in rough and tumble play or other trends may be used by the abuser, but done gradually enough that the trend is not be noticed by staff.

Placement Changes Increase Risk
Any changes in placement may give the abuser a chance to take advantage of the situation, and may change the risk he represents. New caregivers need the fullest possible detailed information about the youth and his abuse history in order to supervise him effectively.

Caregivers Have Difficulties Interacting With Abusers
Adults working with abusers may experience the following difficulties, which can be eased with training:

feeling awkward responding to sexualized behavior
finding it hard to listen to the youth describing how he abused his victims
feeling afraid of being accused of abuse
feeling overwhelmed by the youth's needs
dealing with feelings of having been abuse victims themselves
dealing with the unpredictability and uncertainty of the case, which may have new disclosures any time.

Long-Term Management Goal is Treatment to Help the Abuser Stop
The long-term goal for reducing risk is to help the abuser stop. Adults cannot control and his environment indefinitely. Unfortunately, research can not yet help us determine which youth will continue abusing as adults and which will stop on their own. In order to gain more information that might allow us to predict a youth's behavior and manage his needs, we need to know about his inner world of thoughts and feelings through a therapy program. Most programs use structured group work with a cognitive behavioral approach. For best results, there must be collaboration between those providing therapy and those providing care.

Caregivers Need Information From Therapy
Unfortunately, treatment providers have varying policies about confidentiality, and some may not share from therapy sessions that caregivers need to know in order to manage risk. For example, if the therapist learns that the youth has a preoccupation with a certain child or type of victim, caregivers could use this information to protect potential victims.

Caregivers also need information about how the youth responds to treatment in order to monitor risk. He may show progress, or he may not motivated to change and his supervision may need to be increased. If he is not motivated to participate in therapy, caregivers can encourage him with a behavior modification program that gives rewards for going to therapy sessions.

Monitor Clinically Relevant Behaviors to Tell if Risk is Reduced
After management and treatment, how can we tell if risk has been reduced? To answer this question, the assessment and treatment program must identify the 'clinically relevant behaviors,' including internal behaviors such as thoughts and feelings, that seem to be the most important contributors to his offending. Data should be gathered about these behaviors before treatment and after treatment. If the contributing behaviors have been reduced significantly, this may be evidence of a reduction in risk. For example, a youth's offending may be linked to his lack of ability to make friends and be assertive with peers. If he shows no improvement in these skills, he may still be a risk to other children.

16. Research on Reoffending Is Not Yet Clear top

Rasmussen, Lucinda A. (1999). "Factors Related to Recidivism Among Juvenile Sexual Offenders." Sexual Abuse: A Journal of Research and Treatment v11 n1 p69-85.

Research has not yet given clear answers about what factors are linked to recidivism for juvenile sex offenders. Past studies have reported that these characteristics were associated with reoffending in their samples:

having mostly male victims
having a history of sexual or physical abuse
having a history of family divorce or separation.

For this study, the author reviewed five-year retrospective data on 170 convicted, first-time sexual offenders aged 7-18. Most of the youth were in community outpatient treatment. 58.8% of the sample were convicted for a new nonsexual offense, and 14.1% committed a new sexual offense.

Nonsexual Offenses
The factors most associated with nonsexual reoffending were:

prior nonsexual offenses
failure to complete treatment
offending against an older victim
parents divorced or separated.

These results are consistent with earlier studies that suggest that some juvenile sex offenders have conduct disorder and a delinquent behavior profile.

Female Victims or Male Victims?
The factors most associated with sexual reoffending were:

greater number of female victims
greater total number of victims
parents divorced or separated
failure to complete treatment
a slight tendency toward reoffending if also a victim of physical or sexual abuse.

These results conflict with earlier studies suggesting that molesting more male victims is associated with reoffending.

17. Youth Using Force May Be More Dangerous top

Butz, Catherine and Steve Spaccarelli (1999). "Use of Physical Force as an Offense Characteristic in Subtyping Juvenile Sexual Offenders." Sexual Abuse: Journal of Research and Treatment v11 n3 p217-232.

A sample of 101 juvenile sexual offenders in residential treatment were evaluated with the Multiphasic Sex Inventory and the Jesness Inventory.

Force Means a More Serious Offender
The results suggest that youth who use force should be considered more serious and deviant offenders. Those who used force were:

more likely to fantasize about assault
showed a greater level of deviant sexual interest, including greater interest in young children
more likely to have multiple victims
more likely to commit penetration.

Subtypes Based on Force
This study also suggests that two subtypes of juvenile offenders are not rapists (those using force) versus those who molest mostly younger children. Based on use of force, the two subtypes are:

those who have not yet used force, and who offend less frequently and with less invasive acts
those whose deviant interest in younger children tends to escalate over time and comes to include the use of force or threats to obtain compliance.

This study did not find that the youth who used force were more likely to be victims of sexual abuse, or that they were more delinquent than those who did not use force.

18. Recommendations About Risk top

Becker, Judith and John A. Hunter (1997). "Understanding and Treating Child and Adolescent Sexual Offenders (1997)." Advances in Clinical Child Psychology, v19 p177-197.

Unfortuantely, we do not have any risk assessment guidelines that are validated by research. However, the authors use this list to help determine which youth present a higher risk and need to have residential treatment:

greater number of arrests
greater number of victims
greater level of psychopathy
greater number and intensity of thought distortions
offenses are premeditated, using force, or with penetration
greater degree of compulsitivy and arousal.

19. Reunifying in Sibling Incest top

Hargett, Harl (1998). "Reconciling the Victim and Perpetrator in Sibling Incest." Sexual Addiction and Compulsivity v5 n2 p93-106.

The author is from the Lost and Found program of Morrison, Colorado, and suggests a model for reunifying families in cases of sibling incest.

Requirements for Considering Reunification
Consider reunification if the offending youth has been removed from the home, and all family members have received their appropriate therapy. It is unlikely that reunification will be successful when caretakers have in some way participated in the incest because caretakers must be able to provide supervision, security and safety. The following conditions should be met:

Disclosure

Safety Contract - A safety contract should be used during out-of-home therapy. Teachers, probation officers, pastors, mentors or other approved adults are also involved in the safety contract. The behavior of everyone in the family while under the safety contract reveals if they can maintain safe and appropriate sexual boundaries. There should have been no violations during the therapy period.

Vigilance - Each adult member of the family must acknowledge that sexual offending could happen again and be alert to cues or possible problems.

Perpetrator Accountability - The offender must demonstrate remorse and show that he has learned about his offense cycle and how to break it by following safe boundaries.

Victim - The victim must be able to express her desire for reunification, and show her own ability to maintain safe boundaries. In some cases, the victim may have contributed to the offenses, and this must be addressed in therapy. She may feel guilt, shame, and grief at losing a relationship with the offender.

Model for Reunification
If the conditions above have been met, reunification may be attempted by using the three Reconciliation Sessions discussed below:

First Reconciliation Session
The offender will first write a statement, probably with many revisions, and present it to the victim in person. Caretakers stand behind the victim who faces the offender across some kind of barrier. The victim is allowed to interrupt and question the offender but caretakers may not speak until the end. The offender must answer the victim honestly and courteously. The offender may not apologize or ask for forgiveness at this first session. The therapist will end the session immediately if the offender makes any attempt at verbal aggression or seduction or at the request of the victim or the guardians.

The offender must discuss the following points in a way that is appropriate for the victim's level of development:

a description of the abuse incidents
a statement of full responsibility for the abuse including the type of coercion used, the victim was not responsible, and it was immoral
a declaration that he is willing to accept any consequences for his behavior, make full restitution and will never sexually hurt anyone else again
a list of his offense triggers, skills he has learned to help avoid reoffending, vows he has taken to avoid reoffending, and adults to whom he will be accountable
his understanding of why he offended, the penalties he has paid and the lessons he has learned, without excuses or self-pity.

A recording of the session is reviewed by an independent party. If the victim or guardians feel that the offender demonstrated acceptable empathy and accountability, the next session is held.

Second Reconciliation Session
For this session, the offender presents the same material as the first session, but without a script, while on his knees and addressed to the family. In addition to the material of the first session, the offender may ask for forgiveness. The rest of the family understand in advance that they are not required to forgive, and that each person will forgive individually. The

family may express regret for failing to provide safety and security to both victim and offender.

A recording of the session is again reviewed by an independent party to see if all participants express appropriate attitudes.

Final Restitution Session
At the final session, contract of restitution is established that meets the needs of the victim and perhaps also the family. One victim requested a missionary trip to China as restitution for her inability to worship or engage in church activities with "a pure heart" during the abuse. The trip was funded by the offender and the family, who believed they were partially at fault. The contract should be as creative and individualized as needed, notarized, and prepared as a legal document.

Accountability After Reunification
After the offender has been returned to the home, the following aftercare must be provided:

therapy, such as weekly family counseling
suitable home rules and discipline to prevent further abuse
a continuing accountability plan for offender and victim with an approved adult outside the family
at 30 days and at 120 days, an assessment to see if abuse has re-occurred.

Web Resources top

Factsheet on Juvenile Sex Offenders
The Center for the Study and Prevention of Violence offers a factsheet available at:
http://www.colorado.edu/cspv/factsheets/factsheet2.html

Research Paper
Understanding Juvenile Sex offenders: Research Findings and Guidelines for Effective Management and Treatment offered by the University of Virginia Insitute of Law, Psychiatry and Public Policy. 1999.
http://ness.sys.virginia.edu/juv/SexOffenders.html

Legal Issues
A position paper, "The Effective Legal Management of Juvenile Sexual Offenders" is offered by the Association for the Treatment of Sexual Abusers at:
http://www.atsa.com/pages/policy/position.html

Illinois Treatment Program for Juvenile Offenders
The Alternative Behavior Treatment Centers in Lake County, Illinois, provides residential and outpatient treatment and is licensed by DCFS. Click "ABTC Referrals" to use their on-line pre-screening application.
http://www.abtc-centers.org

Training About Sexually Abusive Children
The Kempe Children's Center offers training to professionals and caregivers about how to prevent sexually abusive behavior in children and youth, as well as treatment for sexually abusive children. The program is described at:
http://www.kempecenter.org/about.htm#PERPETRATION

Publications, Referrals and Training
http://www.safersociety.org

The Safer Society Foundation specializes in publishing materials on prevention and treatment of sexual abuse. They also offer training/consultation, a research service through their reference library, and treatment referrals based on their database of nationwide assessment and treatment programs.

Some of their publications on sexually abusive children and youth include:

Guided Workbooks for Juvenile Sex Abusers
Adolescent Sexual Offender Assessment Packet
The Brother/Sister Hurt
Working With Young People Who Sexually Abuse
Stop! Just for Kids (with sexual touching problems)

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