Youth with Sexual Behavior Problems: Crisis Center of Tampa Bay

1. Youth with Sexual Behavior Problems:Crisis Center of Tampa Bay Efficacy of Treatment

2. 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

3. 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 Will not seek treatment since forced to register Restrictions on school placement, team activities Effects of Adam Walsh Act 7/27/2006

4. Causation of sexual behavior problems? Fredrich, D. (2003)

5. Dangers of conventional wisdom… • Faulty assumptions • 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 • Phallometry • Polygraphy • Arousal conditioning

6. Safety …home, school and/or community Prior history of sex offending Public versus private sex act # of victims higher correlation with re-offense 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 Psychosexual Evaluation / Sexual History Assessment

7. 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 Assessment for child on child

8. 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 Treatment Implications

9. Safety Plan: YSBP & victim Assess family and social support? Program treats victim, youth and families? Model behavior? Relapse question Self regulation Thoughts/ feelings/ behavior Cognitive restructuring Empathy Interpersonal Skills Training Emotional Management Family challenges: Victim in the home

10. Measuring history of victimization • ERASOR (Worley) Estimated risk of adolescent sexually acting out behavior • Child Behavior Checklist • DIPPA for ages 6 & < • Homework in Pathways or Roadmaps • Parent Stress Inventory • In-depth family history and request family participation to ensure successful treatment • (Child) Functional Assessment Rating

11. 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 Discern the ‘right’ treatment

12. System input Educators Clinicians CPI/ CPS Psychological testing Psychiatric testing Who is the village for each client we see? Snapshot of ‘it takes a village’

13. Supportive and Protective Factors

14. 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? Variables – Pilot Study

15. 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

16. 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? Factors to consider?

17. 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? How to approach the ‘why’ question

18. Level of supervision Sharing bedrooms Privacy rules and expectations Personal self-care in private Adult to be in charge No sexually explicit media Caregivers exhibit modesty in presence of child/youth Efficacy of Safety Plan

19. 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 Legal System

20. 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

21. 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 Pull from your village of adults in youth’s life How to develop home and community rules…..

22. Child development expertise Sexual development expertise Familiarity with multiple diagnosis Impact of society, sexting, bullying on sexual behavior Knowledge of current research and effective approaches of treatment Knowledge and 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 Therapist qualifications….

23. Questions

24. Example of Safety Plan for Younger Children • Safety Plan for Young Sexually Acting Out Children: • Check each item that applies: • _____ Sexually acting out child should be within hearing and sight of an adult when interacting with other children. • _____ Sexually acting out child will not supervise other children (no babysitting). • _____ Sexually acting out child will not be left alone with any younger or more vulnerable children. • _____ Sexually acting out child should not share a bedroom with younger or more vulnerable children. • _____ 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. • _____ Only one child in the bathroom at a time. Children should not be bathed together. • _____ Family members will not change clothing in front of each other and will be appropriately dressed when in the presences of others. • _____ 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. • _____ 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. • _____ Sexually acting out child should not spend the night with other children for sleepovers. • _____ 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. • _____ 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. • ________________________ ________ • Child’s Signature Date • ________________________ ________ • Guardian’s Signature Date • ________________________ ________ _____________________ ______ • Therapist’s Signature Date Supervisor’s Signature Date • ______________________________________________________ ________________ • Client Name Client Number

25. Example of Safety Plan for Older Children • Program for Juveniles Who SexuallyOffend • 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. • __________________________ ____________________________ • Client Therapist Caretaker/Parent • _________________________ • Therapist