Assessment, Treatment, and Supervision of Youth who have caused sexual harm by: Tom Hall LISW Bryce Pittenger, LPCC

1. Assessment, Treatment, and Supervision of Youth who have caused sexual harm by: Tom Hall LISW Bryce Pittenger, LPCC

2. Overview of field: Old Paradigm • Those—especially males--who have been sexually abused are going to become offenders. • “Once an offender, always an offender.” • Offenders—including children and adolescents-- do not respond positively to treatment. • Only solution is to “lock them up and throw away the key.” Only other solution is castration. • If male and acts out with same sex, must be homosexual.

3. Old Paradigm • Must come from highly dysfunctional families. • There is no specific family profile. No unique family pattern has been identified The characteristics of are diverse and may or may not be considered dysfunctional.

4. Old Paradigm • Were sexually molested as children. • Many were not sexually victimized as children. • Will become adult sexual offenders. • Current research shows that the sexual re-offense rate for those who receive treatment is low in most US settings. Studies suggest that the rates of sexual re-offense (5 – 14%) are substantially lower than the rates for other delinquent behavior (8 – 58%).

5. Research proves… • In fact, the risk of child or juvenile reoffending once they have had treatment is lower than the risk of sexual harm by children or juveniles who have not acted out. • They are just as likely to become victims as they are to reoffend. • In one study, seven percent of those adjudicated for sexual offenses reoffended and six percent of those not adjudicated committed sex offenses.

6. Research proves… • Another study showed that 85% of all future sex offenses will be committed by children & adolescents not identified as sex offenders. • Another misconception involves the concept of specialness, meaning that this population is so difficult to deal with that only those certified to work with sex offenders should do so.

7. Old Paradigm • These youth are similar in most ways to adult sex offenders. • They are different from adult sex offenders in that they have lower recidivism rates, engage in fewer abusive behaviors over shorter periods of time, and have less aggressive sexual behavior.

8. Research proves… • Juveniles are also, obviously, developmentally different than adults. • They are different from adult sex offenders in that they have lower recidivism rates, engage in fewer abusive behaviors over shorter periods of time, and have less aggressive sexual behavior. • Brains are still developing. It is thought that the male brain is fully developed by the age of 26.

9. Research proves… • The vast majority of individuals who have been abused DO NOT go on to cause sexual harm. • The vast majority of youth do respond to treatment and do not go on to cause more sexual harm. • Interestingly, these youth are at high risk to commit conduct-type offenses.

10. Current research… • The home is the most violent place in America. • Trauma—including physical, sexual, and emotional abuse, and neglect has profound immediate and long term effects upon a child’s development, including attachment difficulties, self-esteem, academic problems, poor peer relationships, anger, developmental delays, and increased dependency.

11. Current research… • Abuse definitely effects whether or not a person sexually offends. But to what degree, we do not know. • The children who are both abused and witness abuse—particularly domestic violence--generally have the biggest problems.

12. Current research… • Certain research has revealed that: • Witnessing domestic violence and experiencing significant physical abuse combined with neglect may put an individual at higher risk to sexually offend. • Domestic violence is showing to be one of the key factors in sexual offending behavior.

13. Current research… • Empirically Supported Risk Factors— • Deviant sexual interest; • prior criminal sanctions for sexual offending; • sexual offending against more than one victim; • sexual offending against a stranger; • social isolation; • uncompleted sex offense specific tx.

14. Current research… • Promising Risk Factors— • Problematic parent-adolescent relationship; • Attitudes supportive of sexual offending.

15. Current research… • Possible Risk Factors: • High stress family environment; • Impulsivity; • Antisocial interpersonal orientation; • Interpersonal aggression; • Negative peer associations;

16. Current research… • Sexual preoccupation; • Sexual offending against a male victim • Sexual offending against a child; • Threats, violence, or weapons in sexual offense; • Environment supporting reoffending.

17. Assessment domains • A comprehensive psycho-social assessment AND psycho-sexual elements including: • Development of sexuality-roles (e.g., normal, problematic, age-appropriate knowledge) • Development of healthy sexuality • Inappropriately sexualized environment, (e.g., pornography, extreme/unusual family norms, boundaries, or values)

18. Assessment elements: offense specific • Youth’s version • Victim’s version • Family version or level of belief • Other witness(s)’ version(s) • Age and gender of victim, and relationship of victim to youth • Evidence of a planned approach to offending behavior • Use of coercion, threats • Use of force • Attitudes and beliefs about gender roles, children, sexuality, etc • Denial, minimization, rationalization, etc • Empathy for and understanding of the impact on victim • Purposeful behavior to circumvent monitoring and supervision • Extent of obsessive thoughts and behaviors regarding sexuality • Level of supervision at the time of the event • Consequences to the youth following the event

19. Assessment elements: Static (historical) risk factors • Heritable characteristics • Fetal insults/infections/conditions • Condition at birth • Permanent disability • Family of origin / culture • Developmental differences • Early experiences with caregivers / caregiver instability • History of criminal charges. • Prior allegations of sexual harm • Sexual or physical abuse or exploitation • Exposure to domestic violence • Exposure to pornography or adult sexual activity

20. Assessment Elements: Stable risk factors (lifespan, less changeable) • Temperament • Conscience: moral development • Ability to empathize • Intellectual potential • Communication ability • Physical attributes • Heritable neurological characteristics • Traumatic Brain Injury

21. Assessment elements: Dynamic risk factors (changeable) • Level of supervision across situations • Communication and social skills • Problem solving skills • Stability of youth’s living environment/family • Nature of sexual thoughts and how thoughts are manifested • Thoughts, feelings, and behavior • Self perceptions • Impact of traumatic experiences (PTSD) • Sexualized environment • Witness to domestic violence/marital dischord

22. What is normal? • Development sexuality • Age appropriate knowledge and understanding • Of sexual touch, gender roles, and biology • Ecological pond: what are our kids exposed too>

23. Ecological Pond • Onset of puberty* Socio-economic maturity** • 1900 -- 15 ? 14 - 15 • 1925 -- 15 16 • 1960 -- 13 18 • 1980 -- 12 20 ??? • 2000 -- 10 - 11 20 +++ • * Female menses; ** Skills to be successful ‘adult’

24. Neurobiology Yeah, we know about sexual development and hormones, But what’s going on in the brain ? Second onslaught of Rapid growth and pruning New cells and neural pathway…….... Period of less stability and more impulsivity……… Moody, unpredictable, ……..mistakes are made ! Reconstruction designed to accomplish what it is being used for (for better or worse)……...

25. Evaluating behavior Is it a Problem? If so . . . . . What Kind of Problem?

26. Sexual behavior might be a problem for many reasons… • It might be a problem for the person who is doing it… because it puts the person at risk in some way: (health, reproduction, exploitation, stigma, illegal,lowers self image or efficacy) • It might be a problem for others… because it makes them uncomfortable; violates norms, standards, or values; breaks rules or regulations. • OR, it might be a problem because it is abusive and/or illegal… • These are very different problems ! • ….but knowing the kind of problem helps identify reasonable interventions.

27. Defining Abusive Behavior 1. Consent vs. Cooperation - Compliance 2. Equality: Power - Control - Authority 3. Coercion: Pressure -- Threat -- Force

28. Universal goals… • Communication: Express thoughts, feelings and needs • Empathy: Identify, interpret & validate emotions and needs of self and others • Accountability: Accurate attributions of responsibility • Emotion Regulation: ‘handle’ emotional states without engaging in harmful behaviors to self or others • Increase Protective factors: Skill building where deficits, family functional strengths, individual functional strengths, environmental functional strengths

29. Sexual abuse by youth… 56 – 57% of Sexual Abuse of Boys 15 – 25% of Sexual Abuse of Girls 8% of Male Population 5 – 7% of Female Population

30. Normal sexual behavior 14 to 18 • Explicit Conversation with Peers • Obscenities / Jokes • Innuendo / Flirting • Erotic Interest / Masturbation • Courtship / Hugging / Kissing • * Foreplay (petting) • * Mutual Masturbation • ** Monogamist Intercourse (Stable or Serial **)

31. Needs intervention… • Preoccupation / Anxiety re Sexuality • Pornographic Interest • Polygamist Behavior *** • Sexually Aggressive Themes / Obscenities • Graffiti (Chronic / Targeting individuals) • Embarrassing others • Violating Body Space / Boundaries • Single Occurrences: Peeping, Exposing, Frottage with Known Age-mates • Mooning / Obscene Gestures ****

32. Needs intervention… • Compulsive Masturbation • Degradation / Humiliation • Attempting to Expose Others • Sexually Aggressive Pornography • Sexual Conversation / Contact with Significantly Younger • Grabbing, Goosing • Explicit Sexual Threats

33. Illegal behaviors… • Sexual Abuse, Molest, Harrassment • Obscene Calls • Voyeurism • Exhibitionism • Frottage • Child Sexual Abuse • Rape • Bestiality

34. Core elements of Specialized treatment approach • Research informs practice. These treatment principles are based on the current research in the field. • Treatment needs to reflect the individualized needs of the youth and family including any co-occurring mental, behavioral, or substance abuse disorders. • Sound core treatment components are reflective of a comprehensive assessment. • Treatment elements are tailored to a youth’s cognitive ability, experience, and developmental stage

35. Treatment elements • Psycho-education of youth and families including but not limited to: laws governing sexual behavior in New Mexico, identification of sexually inappropriate or abusive behaviors, elements of consensual sexual behavior, neuro-biological effects of trauma and attachment disruptions, components of healthy relationships (sexual and non-sexual), considerations with regard to pornography, and human sexuality

36. Treatment elements • Building of Core Competencies through skills and strengths identification and practice. To increase overall mental, emotional, relational, spiritual, cognitive, and sexual health. • Multi-sensorial and experiential exercises. • Management of static or stable risks. • Individualized target goals for dynamic risks and skill deficits.

37. Safety Planning There are three different functions of safety plans: 1) To address the safety and well-being of the youth in relation to self harm; 2) To address the safety and well-being of the youth in relation to harm by others; and 3) To address the safety and well-being of others in relation to the youth.

38. What is a sexually abusive behavior? • Defining sexually abusive behavior: • Lack of Consent • Lack of Equality • Coercion • The age of consent is 14 in NM. Therefore, anyone under the age of 14 cannot legally give consent.

39. Risk factors for recidivism • Factors that indicate risk for recidivism by youth: • History of multiple offenses, especially after adequate tx. • History of repeated non-sexual offenses. • Clear and persistent sexual interest in children. • Failure to comply with sex offense specific tx. • Self-evident disturbances of arousal and dysregulation. • Verbal threats of intent to reoffend. • Parental/guardian resistance to adequate supervision.

40. Use of Polygraph The use of polygraph raises ethically sensitive questions and concerns--especially when this practice is used with minors

41. Treatment providers and juvenile justice authorities can and should collaborate on cases but providers need to remain mindful that it is never their role to investigate, catch, prosecute, judge, or punish. • Treatment providers need to continually remind themselves of what their treatment goals are.

42. “It is less than responsible when a field embraces unusual, coercive, and intrusive practices with minors without simultaneously undertaking the rigorous testing needed to judge whether intended benefits actually exist.” • How do we teach responsible, caring, non-coercive behaviors if we cannot model that ourselves?

43. Supervision • Specialized Probation • Specialized Probation agreement • Collaborative team effort • Safety planning