Transcript Youth with Sexual Behavior Problems

Youth with Sexual
Behavior Problems:
Crisis Center of Tampa Bay
Efficacy of Treatment
Definition…child on child sexual abuse beyond the abused child’s
normal age appropriate developmental state and unwelcome…
 Treatment Methodology
Risk Factor; Prediction of re-offending?
Psychosexual Evaluation Recommendations?
Legal issues – case already reported?
Alleged victim also in the home?
History of victimization?
Safety implications for:
Child/Family
School
Community
Effects of Adam Walsh Act
7/27/2006
 Registration Risks
 Decrease social bonds
 Inhibit productive
member of society
 Stigmatization
 Ties broken with
society
 Will not seek treatment
since forced to register
 Restrictions on school
placement, team
activities
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Will not seek treatment
since forced to register
Restrictions on school
placement, team
activities
Causation of sexual behavior
problems? Fredrich, D. (2003)
Child Vulnerabilities
Developmental or language delay; impulse control problems
Family Adversity
Lack of guidance;
Supervision
Stress and trauma
Parental depression;
Substance abuse
Modeling of Sexuality
Abuse, nudity
Exposure to porn
Modeling of coercion
Abuse; DV; Peer or
Community Violence
Dangers of conventional wisdom…
 Faulty assumptions
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Juvenile sex offending at epidemic proportions
Youth with sexual behavior problems more in
common with adult offenders than their peers
Increased risk of sexual re-offense
Youth treatment should mirror adult treatment
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Phallometry
Polygraphy
Arousal conditioning
Psychosexual Evaluation / Sexual
History Assessment
 Safety …home, school
and/or community
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Prior history of sex
offending
Public versus private
sex act
# of victims higher
correlation with reoffense
Age of victim
No prior relationship
with the victim
 Commonality
 Exposure to violence
within the family
 Hx of Abuse or neglect
 Moderate level of
psychopathology
 Assess sexual
recidivism versus
general recidivism
Assessment for child on child
 ERASOR (Worley)
 Parent Stress Index
(short form)
 Pathways or Roadmaps
 Adolescent substance
abuse measure
 Treatment goal
expectations
 Professionals commit to
providing services
within their area of
competence in terms of
assessment, treatment
or consulting on clinical
 Evaluations: measure of
risk to re-offend
Treatment Implications
 Existing
methodology
 Relapse
prevention
 Sexual abuse
cycle
 Anger issues
 Cognitive
restructuring
 Journaling
 Sex education
 Holistic/ integrated
treatment
 Cognitive
behavior therapy
 Address growth
and development
 Social ecology
 Emphasis on
health/social skills
 Resilience
Family challenges:
Victim in the home
 Safety Plan: YSBP
& victim
 Assess family and
social support?
 Program treats
victim, youth and
families?
 Model behavior?
 Relapse question
Self regulation
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Thoughts/ feelings/
behavior
Cognitive
restructuring
Empathy
Interpersonal Skills
Training
Emotional
Management
Measuring history of victimization
 Parent Stress
ERASOR (Worley)
Estimated risk of adolescent
sexually acting out behavior
Child Behavior
Checklist
DIPPA for ages 6 &
<
Homework in
Pathways or
Roadmaps
Inventory
 In-depth family
history and request
family participation
to ensure successful
treatment
 (Child) Functional
Assessment Rating
Discern the ‘right’ treatment
 Program styles
 Outpatient /
Residential
 Level of caregiver
involvement
 Short term 3-6 months
 Average LOS 18
months outpatient
 Caution: Adult offender
treatment ….arousal or
teaching arousal
reconditioning not for
children
 Skills attained
 Privacy rules
 Abuse prevention skills
 Identification of
feelings
 Increase decision
making skills
 Increase impulse
control
 Social skills
 Empathy
Snapshot of ‘it takes a village’
 System input
 Educators
 Clinicians
 CPI/
CPS
 Psychological
testing
 Psychiatric
testing
 Who is the village for
each client we see?
Supportive and Protective Factors
Healthy
Boundaries
Modeled &
Supported
Adaptive
Coping
mechanisms
Protect from
Harm, stress
trauma
Protective
Factors
Open
Communication
With an
Adult
Parental
Guidance &
Supervision
Opportunities
For Positive
Activities &
Friendships
Variables – Pilot Study
 Independent Variables
 Parent or Youth
 Siblings in the family
 Also treat victims
 Gender
 Age/ Developmental
Age
 Length of treatment
 Who are the
Significant Caregivers
 Dependent Variables
 ERASOR (pre/6mo)
 PSI (pre/6mo)
 Treatment protocols
 Goals and Objectives
 CBT?
Treatment Methodology?
 Build in consistency
 Most effective
techniques?
 Client typology?
 When techniques are
used (i.e., multifamily
group and how often)
 Measure social
influence/ persuasion?
 Use of Pathways/
Roadmaps workbooks
Factors to consider?
 Traits of youth
acting out
 Biological
predisposition
 Environmental
exposures
 Learned behavior
based on life
experiences
 Parental
involvement
indicative of
success?
 Probation
involvement
 How to measure
effectiveness?
How to approach the ‘why’ question
 Curiosity
 Impulsivity/
Immaturity
 Deliquency/
Aggression
 Psychological
issues
 Exposure to sexual
abuse or materials
 Fears
Will youth
become adult
offender?
 Family make-up?
 Type of boy/ girl?
 The same as
adult offenders?
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Efficacy of Safety Plan
 Level of supervision
 Personal self-care in
 Sharing bedrooms
private
 Adult to be in charge
 No sexually explicit
media
 Caregivers exhibit
modesty in presence of
child/youth
 Privacy rules and
expectations
Legal System
 Investigation
 Typically not open to
treatment at this
juncture due to legal
implications
 Charges filed
 Juvenile/ adult court
 Court decision
 Probation/ placement
 Treatment mandated
 Juvenile court –
rehabilitate
 Adult court –
punishment
Family Role
Listen – use time out for yourself
Pay attention to the story – when to stop
Repeat back; reflective listening
Ask questions – be ready to talk when you
least expect it
 Listen nonjudgmentally
 Communicate in specifics
 Discuss behavior - not personalities
 Specifics – not generalities
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How to develop home
and community rules…..
 Private part rules
 Bathing suit rules
 Sexual behavior rules
 Use redirection,
reminders and
distraction
 Respecting space rules
 Imagine the center of a
hula hoop
 Risky Situations
 Sleepovers
 Team sports
 Holidays
 Camping/Recess
 Cell-phones
 Development of
parental supports
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Pull from your village
of adults in youth’s life
Therapist qualifications….
 Child development expertise
 Sexual development
 Knowledge and
expertise
 Familiarity with multiple
diagnosis
 Impact of society, sexting,
bullying on sexual behavior
 Knowledge of current
research and effective
approaches of treatment
acknowledgment of cultural
variations in parenting and
child sexual behavior
 “The world in which you
were born is just one model
of reality. Other cultures are
not failed attempts at being
you: they are unique
manifestations of the human
spirit.”
 Wade Davis
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Questions
Youth
Significant caregivers
School
Community
Example of Safety Plan for Younger
Children
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Safety Plan for Young Sexually Acting Out Children:
Check each item that applies:
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Sexually acting out child should be within hearing and sight of an adult when interacting with other children.
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Sexually acting out child will not supervise other children (no babysitting).
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Sexually acting out child will not be left alone with any younger or more vulnerable children.
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Sexually acting out child should not share a bedroom with younger or more vulnerable children.
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A door alarm will be placed on the sexually acting out child’s bedroom door so that at night the caregiver(s) will be aware of the child
being out of their room.
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Only one child in the bathroom at a time. Children should not be bathed together.
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Family members will not change clothing in front of each other and will be appropriately dressed when in the presences of others.
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A good rule is to make each child’s bedroom their private place and no other children (unless they share the room) are allowed to go
in.
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If a door is closed family members must knock before entering. If someone is in the room wait until they leave the room (if it’s the
bathroom or bedroom) or if it’s another room wait until they say you can come in.
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Sexually acting out child should not spend the night with other children for sleepovers.
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Caregivers (babysitters, relatives) of the sexually acting out child should be aware of the sexually acting out behaviors prior to the
child being cared by them so that they to can follow the Safety Plan.
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No pornographic materials in any media. Cell phone, computer, and game systems must have child locks and be monitored.
We the undersigned agree to follow this safety plan.
________________________
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Child’s Signature
Date
________________________
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Guardian’s Signature
Date
________________________
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_____________________
Therapist’s Signature
Date
Supervisor’s Signature
______________________________________________________
________________
Client Name
Client Number
______
Date
Example of Safety Plan for Older
Children
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Program for Juveniles Who Sexually Offend
SAFETY PLAN
This safety plan is a contract in which the persons named below agree to support as he/she works to resolve his/her sexual
behavior problem. The purpose of this contract is to protect his/her Family and potential victims. We, the undersigned,
understand that we must continue to work on this plan during the program. In the event of plan break down, we agree to share
honestly and to problem solve together. I agree to the following:
I will
■ have no contact with my victim.
(in the event that I am allowed contact with my victims I agree to safeguard his/her
emotional/mental/physical safety by
■ not use alcohol or drugs.
■ not commit physically or sexually violent acts.
■ not use pornographic materials.
■ use the support of identified others to sexual offending behavior
Some people I can trust to help me prevent my sexual offending behavior are: Some people I can’t trust to help me prevent my
sexual offending behavior are: I agree to handle untrustworthy people by: Some dangerous situations that could lead to my
sexual offending behaviors are: I agree to deal with these situations by: When I am feeling I am at risk to re-offend. When I am
feeling these feelings, I am telling myself When I have these feelings and thoughts I agree to: Parent(s): I/ Weagree to:
■ Provide supervision for my child in the following ways:
■ To support my child to prevent re-offending behaviors by:
We agree to be available to support the family as they work on the sexual offending problem.
__________________________
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Client
Therapist
Caretaker/Parent
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Therapist