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Treating Youth with Sexual Aggression: Stopping Predators? Or Meeting Needs?

For the last three decades, the Juvenile Starting Over (JSO) program at Westchester Jewish Community Services (WJCS) has been treating Youth with Sexual Aggression (YwSA). It is the only community-based program in the area specially designed to help these young people cease their problematic sexual behaviors and lead more functional lives. Over these thirty years, international researchers and clinicians have slowly gained a better understanding of YwSA and the best ways to help them. In doing so, they have learned that many older ideas about these issues were incorrect. Unfortunately, many of these errors linger in the popular consciousness and even the thinking of mental health professionals. These misconceptions need to be corrected and the JSO program at WJCS in concert with the Subcommittee on Youth with Problematic Sexual Behavior of the Westchester County Coordinated Children’s Services Committee, is helping to lead the way.

In the early 1990s, many adult sex offenders told mental health professionals that their inappropriate sexual interests and behaviors, such as attraction to and molesting of young children, began in adolescence. Consensus rapidly spread that the best way to prevent the development of adult sex offenders is to aggressively treat young people with sexual behavior problems. This view cast YwSA as “sexual predators in the making” and a group warranting fear by society and professionals. It is illogical to conclude that because some adult sex offenders had problems as youth that all youth with sexual behavior problems are destined to become adult sex predators. Nonetheless, this view dominated thinking in the field for some time.

During this period, treatment of YwSA looked very similar to the treatment of adult sex offenders. Due to fear the problems would worsen, treatment was applied aggressively and often in highly restrictive residential settings. The programs made much use of confrontation to reduce the manipulation and dishonesty common among adult sexual predators. Treatment often assumed that youth had deviant sexual interests and sexual thinking that reflected an incurable addiction. Even if the youth had one past offense, treatment focused on interrupting the “cycle” of sexual misbehavior and the prevention of “relapse” back into that cycle.

In recent years, research has made clear that YwSA rarely show the features of adult sexual predators, they look a lot more like youth with nonsexual behavior problems, and they are unlikely to continue offending in adolescence, let alone adulthood. For example:

  • Unlike adult sexual predators, YwSA rarely have multiple offense victims and rarely demonstrate engrained patterns of deviant sexual interests.
  • When compared to youth who have nonsexual conduct problems, YwSA tend to have similar vulnerabilities (e.g., family disconnection) and problems (e.g., school difficulties), and they show similar social skills, attitudes toward sex, and history of sexual experiences. The two groups overlap in that many YwSA also have nonsexual behavior problems, and some youth with nonsexual behavior problems will later engage in sexual aggression. Some experts, in fact, have argued that YwSA are not a specialized group at all and should be understood in the same ways we understand youth with general conduct problems.
  • Relatively few YwSA continue to engage in sexual aggression after their misbehavior is detected. For example, 85-95% of juvenile sexual offenders will not commit another sexual offense across five to ten years.

Treatment for YwSA has evolved greatly based on these findings. Still, there is no single Evidence-Based Program for treating YwSA. This is because, when looked at more closely, YwSA are a diverse group and are not all alike. They vary in the types of offenses they commit; the social circumstances they come from; their sexual knowledge and experiences; their cognitive and mental health problems, etc. Some of these youth are engaging in a broad array of misbehavior. Others show focused weaknesses in judgment, social skills, interpersonal boundaries, and sexual knowledge such that they naively stumbled into sexual misbehavior. And a few do have focused deviant sexual interests and may be on a path to chronic sexual misbehavior.

Effective treatment of YwSA must be individualized and matched to what is needed in each case. This is consistent with what is known about treating youth with general behavior problems. There is no single treatment manual or protocol that is effective with every youth. But there is a model for conceptualizing and guiding treatment interventions that is very effective: the Risk-Needs-Responsivity model (See Vincent, G., Guy, L., & Grisso, T. (2012). Risk assessment in juvenile justice. A guidebook for implementation. MacArthur Foundation).

Risk: The number, type, and severity of Risk factors are issues proven to be associated with continued sexual misbehavior. The number, type, and severity of these factors helps identify a youth’s risk level and informs the intensity of services needed to successfully manage the youth. This way, lower-risk youth do not suffer the potential negative effects of over-involvement in services and precious resources are most efficiently assigned. Notice that treatment intensity is not based on the severity of past sexual misbehavior or on the breadth of mental health concerns alone.

Needs: Criminogenic needs are dynamic and changeable factors that are directly linked to the individual’s sexual misbehavior and provide the primary targets of successful treatment. The goal here is effective treatment focus. Hours spent addressing deviant sexual interests is wasted time, for example, with a teen who has none. And a child whose sexual aggression was mainly due to poor social skills may require only social skills training to prevent reoffending.

Responsivity: Responsivity factors are not, in and of themselves, linked to the sexual misbehavior but they may interfere with successful treatment and need to be addressed. For example, a youth whose resistance to treatment receives no attention will not be successful no matter how well-focused the treatment is. Likewise, a youth who is struggling with posttraumatic anxiety may not benefit from treatment if that underlying issues is not addressed. Responsivity also means delivering treatment in ways that match the developmental, cognitive, and emotional abilities of the youth.

The Juvenile Starting Over (JSO) program at WJCS is a community-based program dedicated to serving the needs of Youth with Sexual Aggression in Westchester County using a Risk-Needs-Responsivity model. Referrals to the program come from the local juvenile probation department, social services, other agencies serving the social and clinical needs of troubled youth, and families of these children. Treatment begins with a detailed Psychosexual Risk Assessment geared to identifying the youth’s risk level, needs factors, and issues related to treatment responsivity. Clearer information about risk has allowed for many more Westchester youth to be treated in the community and for residential placement to be used with only the few highest risk youth.

For Westchester youth provided treatment in the community through the JSO program, a critical first step is developing a Safety Plan that specifies the youth’s supervision needs in the community. A critical goal is limiting the youth’s access to their victim(s), to other potential victims, and to sexually activating experiences, such as viewing pornography. When youth in treatment are on probation, probation officers work in concert with the JSO therapists to develop and monitor these plans.

Once safety is established, the Psychosexual Risk Assessment is used to develop an individualized treatment plan addressing each youth’s needs and responsivity factors. More commonly targeted needs include the following: Poor Sexual Knowledge, Poor Social Skills, Poor Impulse Control, Poor Affect Regulation, Family Dysfunction, Antisocial Associations, Lack of a Plan for Managing Risk, Low Appreciation of Victim Experiences, Cognitions and Attitudes that Support General and Sexual Misbehavior.

Treatment within each area utilizes workbooks, videos, and other materials developed by the nations’ experts in treating YwSA. Whenever possible, Evidence Based Treatments are used, such as using Aggression Replacement Training methods to target impulsivity or using Dialectical Behavior Therapy principles to address emotion dysregulation. JSO clinicians also use Evidence Based Treatments to address responsivity factors, such as Motivational Interviewing for treatment resistance or Trauma Focused – Cognitive Behavior Therapy for posttraumatic anxiety. Treatment can be provided in various modalities, including individual, group, and family counseling sessions. When changes to environmental circumstances are critical, training can be provided to parents/caregivers or consultation offered to staff at residential treatment facilities. Treatment progress is tracked in collaboration with each client using a standardized instrument with the goal of discharge once all treatment needs have been met. When the youth victimized individuals within their own family, treatment sessions are used as a context for apologies and reunification of the family.

Most Youth with Sexual Aggression are not the sexual predators they were once believed to be. Many can be effectively treated while residing in the community. Still, many of them have gaps in their knowledge, deficits in their skills, and limited insight into their behavior and its consequences that requires focused treatment. The JSO program at WJCS is constantly evolving in its efforts to provide the most effective and evidence-based treatment interventions to help these children and teens, along with their families, right their course.

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