JUVENILE SEX-OFFENDER TREATMENT
Juvenile sex-offender treatment, by and large, is based upon adult sex-offender treatment (Lambie & Seymour, 2006), despite research indicating juvenile sex offenders may be different from adult sex offenders (Gunby & Woodhams, 2010). As described by a well-known therapist, Robert Longo, in a New York Times Magazine article, treatment for juvenile sex offenders has changed substantially in the past few years:
As part of [adolescent boys' sex offender] treatment, the boys had to keep journals - which Longo read - in which they detailed their sexual fantasies and logged how frequently they masturbated to those fantasies. They created "relapse-prevention plans," based on the idea that sex offending is like an addiction and that teenagers need to be watchful of any "triggers" (pornography, anger) that might initiate their "cycle" of re-offending. And at the beginning of each group session, the boys introduced themselves much as an alcoholic begins an Alcoholics Anonymous meeting: "I'm Brian, and I'm a sex offender. I sexually offended against a 10-year old boy; I made him lick my penis three times." Sex-offender therapy for juveniles was a new field in the 1980s, and Longo, like other therapists was basing his practices on what he knew: the adult sex-offender-treatment models ... As it turns out, he went on to say, "much of it was wrong." There is no proof that ... using adult sex-offender treatments on juveniles is effective. Adult models he noted don't account for adolescent development and how family and environment affect children's behavior.
(Jones, 2007, n.p.)
Treatment for juvenile sex offenders was first developed in 1975; yet it was not until the 1980s when more structured programs were created (Lab, Shields, & Schondel, 1993). In 1980, there were only 20 juvenile sex-offender treatment programs (National Adolescent Perpetrator Network, 1993). Also, at this time, the rate of adjudicated juvenile sex offenders had increased (Reitzel & Carbonell, 2006). Mandatory treatment was urged by the National Adolescent Perpetrator Network (1993). Researchers reported that by 1992, there were 750 outpatient and residential treatment programs for juvenile sex offenders (Burton & Smith-Darden, 2000).
Juvenile sex offenders are treated either in a residential or outpatient center. One study showed that of 20,000 juvenile sex offenders who received sex-offender treatment, half were treated in a residential center (Center for Sex Offender Management, n.d.). Many factors, many of those identified during the assessment phase, will determine whether a juvenile is treated in an inpatient or outpatient center. The following is an explanation provided by the Center for Sex Offender Management (n.d., p. 3) in a training manual regarding such decisions:
To illustrate, a youth who evidences considerable behavioral disturbances or aggression, demonstrates longstanding or chronic patterns of sexual deviance, resides in a chaotic home environment, and has considerable treatment needs may be best served in a residential program. And if the youth suffers from significant mental health symptoms that cause him to be a danger to himself or others, an inpatient psychiatric setting may be warranted.
Conversely, a juvenile who seems to be more stable overall, has a supportive and structured home environment, has demonstrated a limited number of sexual behavior problems, and is motivated to change will probably be considered appropriate for treatment in the community.
When treatment programs for juvenile sex offenders were being developed in the 1980s and later, they lacked a foundation of empirically-based findings to build for effective therapy (Reitzel & Carbonell, 2006). More recently, suggested treatment included wraparound services, functional family therapy, cognitive-behavioral approaches (Walker, McGovern, Poey, & Otis, 2004), and multisystemic therapy (Center for Sex Offender Management, n.d.).
Wraparound services involve assigning a juvenile sex offender a case manager who is responsible for coordinating services within the community. Thus, there is an attempt to manage the juvenile in the community as opposed to providing services in a residential treatment center. Services are provided for not only the youth, but also the family. The case manager takes on many roles, including mentoring, supportive, and supervisory roles. It is also common for wraparound services to include a multidisciplinary team approach. Initial research on wraparound services show promising results, with reduced recidivism rates among those who have received this type of treatment (Aos, Phipps, Barnoski, & Lieb, 2001; Center for Sex Offender Management, n.d.).
Functional family therapy, as the name suggests, focuses on the structure and dynamics of the family. The focus is to provide parents with the skills necessary to provide appropriate boundaries, discipline, and support for the child. This type of therapy has existed for several decades and has been used for families with and without a juvenile sex offender (Aos et al., 2001; Center for Sex Offender Management, n.d.).
Multisystemic therapy focuses on, "improving family functioning, enhancing parenting skills, increasing the youth's associations with prosocial peers, improving school performance, and building upon community supports" (Center for Sex Offender Management, n.d., p. 9). It is similar to functional family therapy in that it involves the whole family and addresses multiple factors associated with antisocial behavior. The family is involved in developing a treatment plan. Initial research studies showed that not only were recidivism rates lower for those who participated in the treatment, but other improvements were also made, such as family functioning, school performance, peer relationships, and prosocial behaviors (Center for Sex Offender Management, n.d.; Saldana, Swenson, & Letourneau, 2006).
Cognitive-behavioral treatment is defined by the National Alliance of the Mentally Ill as a form of treatment that examines the intersection of thoughts, feelings and behaviors. It involves the identification of thinking patterns that are precursors to problem behaviors, such as committing a sex crime. It also involves the client and therapist actively working together and includes the client taking an active role in their own treatment (NAMI, n.d.). Cognitive-behavioral treatment is the most common type of treatment for juvenile sex offenders, and positive results have been obtained (Center for Sex Offender Management, n.d.; Righthand & Welch, 2001).
The effectiveness of treatment for juvenile sex offenders has been assessed through a meta-analysis that included nine studies. This included a total of 2,986 juvenile sex offenders who were followed for an average of 59 months. The results showed that 13% sexually recidivated. Also, 25% recidivated for non-sexual violent crimes, 29% for non-sexual non-violent crimes, and 20% for unspecified non-sexual offenses. It also showed that juveniles who received treatment had significantly lower recidivism rates than those who did not receive treatment. Thus, treatment appears to reduce recidivism among juvenile sex offenders. The type of treatment varied substantially from individual treatment, group therapy, family therapy, cognitive-based treatment, and non-cognitive-based treatment, to combinations of these (Reitzel & Carbonell, 2006).