Transcript CSOM Trot Sept 2005 Treatment

Optimal Treatment
Flexible and comprehensive
Emphasis on accountability, rehabilitation, and
community safety
Incorporated across settings (home, school,
neighborhood)
Collaborative in nature
Based on risk-needs-responsivity principles
– Offered on a continuum
Matched to level of risk
Least restrictive placement philosophy
– Individualized and developmentally appropriate
Based on identified criminogenic and other needs
Delivered in a manner that will facilitate understanding and
internalization
Youth who were sexually victimized
and went on to perpetrate...
were younger at time of victimization
were victimized more frequently
waited a longer period of time to disclose
perceived their families as having been
less supportive of them
Hunter & Figueredo, 2000
– suggests attachment and environmental
issues may be etiologically significant
Sex Offender Treatment vs. “Traditional”
Mental Health Treatment
Non-voluntary by nature
Level of stigma due to the behaviors involved
Confidentiality waivers/limitations due to
required collaborative efforts
Individual, group, and family therapies
Interventions tend to be long-term
Harder to find qualified professionals
Not fully recognized by managed care systems
Impact of treatment failure is profound
Consider “management” vs. “treatment”
– Includes legal and supervisory dimensions
Continuum of Care
Matching Level of Risk
Emphasis on the least-restrictive alternative that
ensures victim/community safety
Community-based options for those who are
less seriously disturbed and pose less risk
Residential programs for those having more
severe psychosexual, psychiatric, and
dangerousness issues
Correctional settings for those less amenable to
treatment
Aftercare, transitional, and reentry services for
youth whose risk level allows for return to
community
Principles of Risk, Need,
and Responsivity
(Andrews & Bonta, 2003)
Risk Principle: “Who” Should
Receive What Level of Services?
Identify the offender’s risk level
Match the level of services to this risk
level
Continuum of Care to Match Risk
Level of Juvenile Offenders
Low risk
Community-based
options, day treatment,
outpatient services
Moderate risk
Residential treatment
centers, structured
group homes,
therapeutic foster care
High risk
Secure correctional,
secure residential,
inpatient psychiatric
facilities
Need Principle: “What” Problems
Should be Targeted?
Identify those changeable risk factors
that are directly linked to the offender’s
offending behavior
Target these risk factors, referred to
“criminogenic” needs, in treatment and
supervision
Example of Risk/Need Matching: Virginia
Department of Juvenile Justice
Case Management
Protocols
Individualized Assessment
DJJ Risk Assessment
DJJ Sex Offender Risk Checklist
Psychosexual Evaluation
J-SOAP
CANS-SD
Community or residential
placement
Type and intensity of
supervision and other
interventions
Readiness for
stepdown/termination of
treatment and supervision
services
Example of Risk/Need Matching:
Missouri Division of Youth Services
Moderate risk/need
Intake assessment with youth/family
Risk assessment
Needs assessment
High risk/need
sanction
Low risk/need
Residential services continuum
High secure
Moderate secure
Group homes
Community-based services
Day treatment/public school
Outpatient sex offender groups
Family therapy
Case manager/p.o.
Tracker/mentor
Graduated sanctions
•Special needs/SED dorms and cottages
•Young offender (13 and under)
•Serious/certified offenders (up to 21)
•Gender specific-programs
Community aftercare
Day treatment/public school
Outpatient sex offender groups
Family therapy
Case manager/p.o.
Tracker/mentor
Graduated sanctions
sanction
Responsivity Principle: “How”
Should Services be Delivered?
Assess factors that will influence how
the offender will respond to services
Match “general” and “specific” services
to offender’s responsivity factors
Responsivity Issues
Motivation
Intelligence
Learning style
Gender
Culture
Ethnicity
Personality characteristics
Process-Related Considerations
Strength-based approaches
Balanced models
– Accountability
– Rehabilitation
– Community Safety
Therapeutic engagement, invitational
(vs. shame-based)
Therapeutic Engagement and
Invitational Approaches
Allows youth to identify their own motivations for
change, change their own capacity for relating to
others, and focus on establishing their own goals and
motivations to achieve them
Treatment occurs in a collaborative, respectful, and
dignified context, rather than in a punitive and
controlling manner
Emphasizes the concept of choice, highlights the
ability to change behaviors, offers hope, and
facilitates self-efficacy
(Bumby, Marshall, and Langton, 1999; Jenkins, 1998)
Community-Based Treatment
Allows for greater family involvement
Allows for continued involvement in
potentially productive roles
Facilitates use of external supervision agents
(e.g., juvenile/probation officer) and other
collaboration team members
Potentially more cost effective
May be less intense
Victim access issues
Residential/Institutional
Programs
Ideally facilitate victim protection and
community safety
Provide increased structure
Increased opportunity for immersion
in treatment
Cost
Residential/Institutional
Programs
Important issues to consider:
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Offenders grouped together or mixed?
Frequency/intensity
Safety/security
Living/sleeping areas
Staff training and other staff issues
Length of stay
Transition to aftercare
Potential iatrogenic effects
Iatrogenic Effects
Even with the best of intents, certain
interventions and approaches may actually
cause harm, rather than help
Increasing body of research on detrimental
impact of interventions with high-risk/atrisk juveniles, particularly in residential or
institutional settings
Based on longstanding recognition that negative
peer influences undermine healthy development
Almost 1/3 of the controlled intervention studies
show negative effects
Likely an underestimate
Dishion, McCord, & Poulin, 1999
Iatrogenic Effects
Aggregating delinquent peers, in some
circumstances, may increase short and long
term negative impact
Positive reactions and other reinforcing
behaviors (i.e., “deviancy training”) result in
increased maladjustment
– substance abuse, delinquency, violence, relationship
difficulties
Peer reinforcement in residential or
institutional programs can be so intense that it
undermines adult prosocial influences
Significant implications for system
philosophies, policies, and practices
Dishion, McCord, & Poulin, 1999
Treatment Targets and
Approaches
Identify and address static and
dynamic risk factors
Reflect areas of need identified
through the assessment process
Criminogenic
Non-criminogenic
Delivered in a manner that will
promote understanding and
internalization (responsivity)
Treatment:
Style and Substance
Developmentally appropriate
Address special populations
Severe behavioral health
MRDD
Female offenders
Strength-based approaches
Balanced models
Accountability
Community safety
Rehabilitation
Therapeutic engagement, invitational (vs. shamebased)
Shame vs. Guilt
Shame
– Focus is on “bad self”
– Perceive self as
unchangeable
– Self-focus reduces
empathic ability
– Feel exposed and
scrutinized
– Defensive
externalization
– Hostility, low esteem,
and hopelessness
– Cripples coping
responses
Guilt
– Focus is on “bad
behaviors”
– Recognize behaviors as
changeable
– Fosters sense of
responsibility
– Discomfort over
recognizing impact of
behavior
– Optimism and selfefficacy increases
– Motivates desire to repair
damage, make changes
Common Treatment Targets
Denial
Accountability and responsibility-taking
Cognitive distortions
Empathy/victim impact
Social competency
Esteem enhancement
Recognizing and interrupting cycles of
behavior/relapse prevention
Common Treatment Targets
Emotional expression/anger management
Sexual education
Healthy sexuality
Healthy masculinity
Trauma resolution
Impulsivity and immediate gratification
Arousal reconditioning
– Verbal satiation, covert sensitization
Family education and involvement!!!!!
Cognitive Distortion Content
Minimization
Justification
Rationalization
Externalization
Cognitive Distortion Process
Mitigates/suspends awareness of
wrongfulness and culpability
Suspends awareness of victim harm
Decreases personal discomfort
Allows for positive experience/
gratification
Protects esteem
Victim Empathy
State vs. trait
General vs. victim-specific
Empathy as a staged process
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Emotional recognition
Perspective taking
Emotional replication
Responsivity
Selective empathic inhibition
General Social Skills
Communication/assertiveness
Problem solving
Conflict resolution
Interpersonal boundaries
Social anxiety
Self-consciousness
Sexual-Social Skills
Dating skills
Initiating the relationship
Maintaining the relationship
Initiating physical and sexual intimacy
Safe sexual practices
Juvenile Female Sex
Offenders
Responses to Juvenile
Females’ Sexual Behaviors
Boys’ sexual experiences and practices are monitored
less and implicitly/explicitly condoned
Girls’ sexual behaviors are more closely scrutinized
and frowned upon by parents/authority figures
– Females are almost exclusively presented to juvenile
authorities for certain types of sexual behaviors (e.g., early
sexual activity, promiscuity)
– Sexual activity is often perceived as incorrigibility by
parents/guardians
Ironically, sexually offending behaviors perpetrated
by juvenile females have either escaped detection
or have been largely ignored
Why Are Juvenile Female
Offenders Overlooked?
Juvenile females traditionally seen as having
“internalizing” behavioral health concerns, less
outwardly aggressive
Perceived as less dangerous than juvenile
males, for whom emphasis is placed on
disorders of conduct and crimes against persons
Largely over-represented in private psychiatric
facilities rather than in the juvenile courts and
justice agencies
Policies, court processing, programming efforts,
and resources largely directed toward managing
male offenders
Why Are Juvenile Female
Offenders Overlooked?
Professional bias that sexual offenses committed by
females are less serious or harmful
Stereotyped views of female sexuality may serve to
inhibit the tendency of potential reporters to report
potential abuse
Underreporting by victims
“Legitimate” contact that accompanies certain
caregiving activities may blur the ability to recognize
or define the contact as inappropriate
Historic perception that sexual offending is a “male
only crime”
Similarities and
Differences: Offense
Patterns
Both groups engage in multiple acts against
multiple victims
Both groups target male and female victims
Both groups target relatives or acquaintances
Female offenders tend to victimize children
in the context of babysitting activities
Female offenders less likely to use force
(though a significant number of females do
use force)
(Bumby & Bumby, 1997; Mathews et al., 1997)
Characteristics of Juvenile
Female Offenders
Significant social maladjustment
Psychological disturbance
Academic performance deficits
Substance abuse
Delinquency
Previous maltreatment
Family dysfunction
Sexual victimization
(Bumby & Bumby, 1997; Mathews et al., 1997)
Sexual Victimization Experiences:
Juvenile Female vs. Male Offenders
78% of the females experienced sexual
victimization, compared to 34% of the
males
Females experienced more extensive
victimization
– abuse began at an earlier age
– targeted by more than one abuser
– abused by both a male and female
perpetrator
– subjected to use of force or aggression
(Mathews et al., 1997)
Preliminary Juvenile Female
Typologies
1. Little evidence of prior maltreatment, family
dysfunction, or psychopathology; limited
offense behaviors; appeared motivated more
by experimentation or curiosity
2. Abuse reactive; offenses paralleled
victimization; mild to moderate levels of
family dysfunction and psychopathology
3. Marked psychological and family
disturbance; more chronic maltreatment and
severe sexual victimization; development of
disordered arousal in some cases
(Mathews et
al.,1997)
Gender-Specific Programs for
Juvenile Female Sex Offenders
Unique needs of girls
Adolescent female development
Societal and cultural messages
Unique risk factors
Unique protective and resiliency
factors
(Bumby & Bumby, in press; Chesney-Lind, 2001;
Maniglia, 1996; Mathews et al. ,1997; Poe-Yamagata &
Butts, 1996)
Risk Factors for Juvenile
Female Offenders
Academic failure
Unmet health and
behavioral health
needs
Pregnancy
Family dysfunction
and fragmentation
Societal influences
such as sexism and
racism
Body image concerns,
eating disorders
Substance abuse
Exposure to domestic
violence within the
home and in their own
relationships
Sexual victimization
(Brown & Gilligan, 1992; ChesneyLind & Sheldon, 1998; Taylor,
Gilligan & Sullivan, 1995)
Protective/Resiliency Factors
Gender identity
development
Individualism
Confidence,
assertiveness, strong
sense of self
Healthy relationships
with effective
boundaries
Need for
belongingness
Physical safety and
physical development
Safety to explore
sexuality at her own
pace for healthy sexual
development
Identification and
utilization of positive
female role models and
mentors
(Brown & Gilligan, 1992;
Chesney-Lind, 1995, 2001;
Maniglia, 1998)
Other Special Considerations
Special populations
MRDD offenders
Children with sexual behavior problems
17-21 year olds
Family involvement
Family therapy
Siblings
Supportive and psychoeducational groups
Transition and reentry
Registration/notification
Risk assessment
Treatment outcomes