Optimal Treatment

1. 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

2. 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

3. 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

4. Continuum of CareMatching 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

5. Principles of Risk, Need, and Responsivity(Andrews & Bonta, 2003)

6. Risk Principle: “Who” Should Receive What Level of Services? • Identify the offender’s risk level • Match the level of services to this risk level

7. Continuum of Care to Match Risk Level of Juvenile Offenders Low risk Moderate risk High risk Residential treatment centers, structured group homes, therapeutic foster care Secure correctional, secure residential, inpatient psychiatric facilities Community-based options, day treatment, outpatient services

8. 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

9. Individualized Assessment DJJ Risk Assessment DJJ Sex Offender Risk Checklist Psychosexual Evaluation J-SOAP CANS-SD Case Management Protocols 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: Virginia Department of Juvenile Justice

10. Example of Risk/Need Matching: Missouri Division of Youth Services Intake assessment with youth/family Risk assessment Needs assessment Moderate risk/need High risk/need sanction Low risk/need • Residential services continuum • High secure • Moderate secure • Group homes • Special needs/SED dorms and cottages • Young offender (13 and under) • Serious/certified offenders (up to 21) • Gender specific-programs Community-based services Day treatment/public school Outpatient sex offender groups Family therapy Case manager/p.o. Tracker/mentor Graduated sanctions sanction Community aftercare Day treatment/public school Outpatient sex offender groups Family therapy Case manager/p.o. Tracker/mentor Graduated sanctions

11. 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

12. Responsivity Issues • Motivation • Intelligence • Learning style • Gender • Culture • Ethnicity • Personality characteristics

13. Process-Related Considerations • Strength-based approaches • Balanced models • Accountability • Rehabilitation • Community Safety • Therapeutic engagement, invitational (vs. shame-based)

14. 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)

15. 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

16. Residential/Institutional Programs • Ideally facilitate victim protection and community safety • Provide increased structure • Increased opportunity for immersion in treatment • Cost

17. Residential/Institutional Programs • Important issues to consider: • 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

18. 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/at-risk 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

19. 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

20. 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)

21. 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. shame-based)

22. 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 self-efficacy increases Motivates desire to repair damage, make changes Shame vs. Guilt

23. 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

24. 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!!!!!

25. Cognitive Distortion Content • Minimization • Justification • Rationalization • Externalization

26. 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

27. Victim Empathy • State vs. trait • General vs. victim-specific • Empathy as a staged process • Emotional recognition • Perspective taking • Emotional replication • Responsivity • Selective empathic inhibition

28. General Social Skills • Communication/assertiveness • Problem solving • Conflict resolution • Interpersonal boundaries • Social anxiety • Self-consciousness

29. Sexual-Social Skills • Dating skills • Initiating the relationship • Maintaining the relationship • Initiating physical and sexual intimacy • Safe sexual practices

30. Juvenile Female Sex Offenders

31. 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

32. 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

33. 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”

34. 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)

35. 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)

36. 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)

37. Preliminary Juvenile Female Typologies • Little evidence of prior maltreatment, family dysfunction, or psychopathology; limited offense behaviors; appeared motivated more by experimentation or curiosity • Abuse reactive; offenses paralleled victimization; mild to moderate levels of family dysfunction and psychopathology • Marked psychological and family disturbance; more chronic maltreatment and severe sexual victimization; development of disordered arousal in some cases (Mathews et al.,1997)

38. 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)

39. 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 Risk Factors for Juvenile Female Offenders (Brown & Gilligan, 1992; Chesney-Lind & Sheldon, 1998; Taylor, Gilligan & Sullivan, 1995)

40. 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 Protective/Resiliency Factors (Brown & Gilligan, 1992; Chesney-Lind, 1995, 2001; Maniglia, 1998)

41. 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