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Sexual Behavior Problems Treatment (Adolescents)

Scientific Ratings in this Topic
  • 1 Well-Supported by Research Evidence
  • 2 Supported by Research Evidence
  • 3 Promising Research Evidence
  • 4 Evidence Fails to Demonstrate Effect
  • 5 Concerning Practice
  • NR Not able to be Rated

Topic Areas

Topic Areas

Definition

Sexual Behavior Problems Treatment (Adolescents) is defined by the CEBC as the treatment of sexual behavior problems in adolescents regardless of the adolescents' involvement in the legal system or the presence of specific case characteristics (e.g., violence/aggression). Many labels have been used to capture some youth in this population, including "adolescent sex offenders," "sexually aggressive youth," and "juvenile sex offenders" to name a few of the most common labels. These labels were considered too narrow for this topic area. For example, not all youth who engage in sexually aggressive behaviors are "offenders" in the legal sense and not all juvenile sexual offenders have engaged in aggressive or nonconsensual sexual behaviors (e.g., many are so-called status offenders who engaged in consensual sexual activities with peers). Moreover, these labels have the unfortunate and unnecessary effect of labeling the youth, rather than the behavior. Adolescents with sexual behavior problems comprise a heterogeneous group of youth, none of whom should be characterized primarily by his or her sexual acts.

For the purposes of this topic area on the CEBC website, sexual behavior problems will be defined as any of the following:

  • Sexual acts committed with another person of any age that were against the victim's will; were without assent/consent; or involved aggression, exploitation, or threats.
  • Sexual acts committed with another person who was unable to provide assent, including children less than 12 years of age and 5 or more years younger than the older youth, or peers or adults with cognitive, intellectual, or other disabilities.
  • Sexual acts without another person but involving child pornography in which the images depicted sexual targets under 12 years of age and assumingly five or more years younger than the adolescent (as distinguished from images that depict peers assumingly the same age of the viewer); solicitation of younger children via the Internet or other technology, with or without the intention of ever meeting to engage in sexual behaviors; or non-contact sexual offenses (e.g., exhibitionism, voyeurism) and self-directed sexual behaviors (e.g., masturbation) that occur in public or semi-public places and that persist even after intervention (as distinguished from behaviors that resolved with initial correction).

National crime data suggest that juvenile perpetrators account for between 17% and 20% of all reported sexual crime, and approximately one in three sex crimes involving victims under the age of 18 years. Particularly considering the vast societal toll of sexual victimization, these statistics situate the problem of juvenile-perpetrated sexual violence as a significant concern for policymakers, the juvenile justice system, and our communities.

  • Target population: Adolescents ages 12 to 18 years who have engaged in one or more instances of inappropriate (including, but not limited to, illegal) sexual behaviors
  • Services/types that fit: Outpatient, day treatment, and residential services in individual or group formats
  • Delivered by: Mental health professionals
  • In order to be included: Program must specifically target sexual behavior problems as a goal
  • In order to be rated: There must be research evidence (as specified by the Scientific Rating Scale) that examines outcomes related to sexual behavior for the youth, such as recidivism or changes in youth behavior, symptom levels, and/or functioning

Definition

Sexual Behavior Problems Treatment (Adolescents) is defined by the CEBC as the treatment of sexual behavior problems in adolescents regardless of the adolescents' involvement in the legal system or the presence of specific case characteristics (e.g., violence/aggression). Many labels have been used to capture some youth in this population, including "adolescent sex offenders," "sexually aggressive youth," and "juvenile sex offenders" to name a few of the most common labels. These labels were considered too narrow for this topic area. For example, not all youth who engage in sexually aggressive behaviors are "offenders" in the legal sense and not all juvenile sexual offenders have engaged in aggressive or nonconsensual sexual behaviors (e.g., many are so-called status offenders who engaged in consensual sexual activities with peers). Moreover, these labels have the unfortunate and unnecessary effect of labeling the youth, rather than the behavior. Adolescents with sexual behavior problems comprise a heterogeneous group of youth, none of whom should be characterized primarily by his or her sexual acts.

For the purposes of this topic area on the CEBC website, sexual behavior problems will be defined as any of the following:

  • Sexual acts committed with another person of any age that were against the victim's will; were without assent/consent; or involved aggression, exploitation, or threats.
  • Sexual acts committed with another person who was unable to provide assent, including children less than 12 years of age and 5 or more years younger than the older youth, or peers or adults with cognitive, intellectual, or other disabilities.
  • Sexual acts without another person but involving child pornography in which the images depicted sexual targets under 12 years of age and assumingly five or more years younger than the adolescent (as distinguished from images that depict peers assumingly the same age of the viewer); solicitation of younger children via the Internet or other technology, with or without the intention of ever meeting to engage in sexual behaviors; or non-contact sexual offenses (e.g., exhibitionism, voyeurism) and self-directed sexual behaviors (e.g., masturbation) that occur in public or semi-public places and that persist even after intervention (as distinguished from behaviors that resolved with initial correction).

National crime data suggest that juvenile perpetrators account for between 17% and 20% of all reported sexual crime, and approximately one in three sex crimes involving victims under the age of 18 years. Particularly considering the vast societal toll of sexual victimization, these statistics situate the problem of juvenile-perpetrated sexual violence as a significant concern for policymakers, the juvenile justice system, and our communities.

  • Target population: Adolescents ages 12 to 18 years who have engaged in one or more instances of inappropriate (including, but not limited to, illegal) sexual behaviors
  • Services/types that fit: Outpatient, day treatment, and residential services in individual or group formats
  • Delivered by: Mental health professionals
  • In order to be included: Program must specifically target sexual behavior problems as a goal
  • In order to be rated: There must be research evidence (as specified by the Scientific Rating Scale) that examines outcomes related to sexual behavior for the youth, such as recidivism or changes in youth behavior, symptom levels, and/or functioning

Why was this topic chosen by the Advisory Committee?

The Sexual Behavior Problems Treatment (Adolescents) topic area is relevant to child welfare because many children in the child welfare system who have been victims of sexual molest often become sexual predators or exhibit other sexually inappropriate behaviors as they reach adolescence. These children usually experience multiple placement moves and it becomes increasingly difficult to find a foster family or relative family placement since their behaviors put other children at risk, thus requiring a residential treatment or group home for placement. As a result, these children grow up in foster care without a permanent, loving home. Without treatment, these children face the risk of committing a sexual offense that will result in their entry in either the juvenile or adult justice system.

Danna Fabella, MSW
Linkages Project Director
Child and Family Policy Institute of California
Sacramento, CA

Why was this topic chosen by the Advisory Committee?

The Sexual Behavior Problems Treatment (Adolescents) topic area is relevant to child welfare because many children in the child welfare system who have been victims of sexual molest often become sexual predators or exhibit other sexually inappropriate behaviors as they reach adolescence. These children usually experience multiple placement moves and it becomes increasingly difficult to find a foster family or relative family placement since their behaviors put other children at risk, thus requiring a residential treatment or group home for placement. As a result, these children grow up in foster care without a permanent, loving home. Without treatment, these children face the risk of committing a sexual offense that will result in their entry in either the juvenile or adult justice system.

Danna Fabella, MSW
Linkages Project Director
Child and Family Policy Institute of California
Sacramento, CA

Topic Expert

The Sexual Behavior Problems Treatment (Adolescents) topic area was added in 2011. Elizabeth J. Letourneau, PhD was the topic expert and was involved in identifying and rating any of the programs with an original load date in 2011 (as found on the bottom of the program's page on the CEBC) or others loaded earlier and added to this topic area when it launched. The topic area has grown over the years and any programs added since 2011 were identified by CEBC staff, the Scientific Panel, and/or the Advisory Committee. For these programs, Dr. Letourneau was not involved in identifying or rating them.

Topic Expert

The Sexual Behavior Problems Treatment (Adolescents) topic area was added in 2011. Elizabeth J. Letourneau, PhD was the topic expert and was involved in identifying and rating any of the programs with an original load date in 2011 (as found on the bottom of the program's page on the CEBC) or others loaded earlier and added to this topic area when it launched. The topic area has grown over the years and any programs added since 2011 were identified by CEBC staff, the Scientific Panel, and/or the Advisory Committee. For these programs, Dr. Letourneau was not involved in identifying or rating them.

Programs

Multisystemic Therapy for Youth with Problem Sexual Behaviors

Multisystemic Therapy for Youth with Problem Sexual Behaviors (MST-PSB) is a clinical adaptation of Multisystemic Therapy (MST) that has been specifically designed and developed to treat youth (and their families) for problematic sexual behavior. Building upon the research and dissemination foundation of standard MST, the MST-PSB model represents a practice uniquely developed to address the multiple determinants underlying problematic juvenile sexual behavior.

MST-PSB is delivered in the community, occurs with a high level of intensity and frequency, incorporates treatment interventions from MST, and places a high premium on approaching each client and family as unique entities. Treatment incorporates intensive family therapy, parent training, cognitive-behavioral therapy, skills building, school and other community system interventions, and clarification work. Ensuring client, victim, and community safety is a paramount mission of the model.

Each youth/family has uniquely and collaboratively designed individual treatment plans, and each treatment site is encouraged to conjointly develop locally defined outcomes that suit community needs.

Scientific Rating 1

HOPE Program

The HOPE Program works with adolescent clients in individual and group settings. The program specializes in forensic and cognitive behavioral therapy, as well as general psychotherapy for individuals, couples, and families coping with emotional, behavioral, and psychological challenges. The HOPE Program also offers treatment approaches for family reunification and safety planning.

Scientific Rating NR

Pathways Fifth Edition

Pathways Fifth Edition is a structured, guided workbook for use with adolescents of all genders with sexual behavior problems, including but not limited to sexual offending. Pathways Fifth Edition focuses extensively on helping clients develop healthy and responsible patterns of thinking and behavior, and also provides concrete guidance about how to control sexual feelings in healthy and responsible ways, including guidelines for successful friendships and dating relationships. Relapse prevention techniques are reinforced, as is a new focus on helping clients develop healthy and responsible lifestyles by creating a Healthy Living Project to follow. Pathways Fifth Edition includes new skill and knowledge-based exercises that aim to help clients identify feelings, manage anger, understand consent, develop healthy relationships, and become more sensitive to others. Pathways Fifth Edition also provides concrete tools for completing the victim clarification (apology) process and the family reunification process. This workbook is a treatment tool that hopefully leads the client towards a lifestyle of honesty, responsibility, sensitivity, and integrity.

Scientific Rating NR

Sexual Abuse Counseling and Prevention Program

SACPP is a counseling and treatment service that works holistically with families affected by child sexual abuse. It is designed to engage with the broader system around the child/young person – including schools, health services, out-of-home care providers (such as foster care and residential care), and other services providers. Young people who have engaged in sexually abusive behaviors require the ongoing support of their family and community to ensure their risk of re-offending is minimized. Therefore, an ecological approach to working with adolescents is essential.

Scientific Rating NR

Trauma Outcome Process Assessment Model

The TOPA program is designed to help sexually abused and sexually abusive children/youths: (a) recognize how self-destructive and/or sexually abusive behaviors connect to past sexual abuse and other traumatic experiences (e.g., physical abuse, exposure to domestic violence); (b) take responsibility for maladaptive behaviors; and (c) make adaptive choices when current stressors trigger feelings or memories related to past traumas. Therapists take a directive role by creating a safe therapeutic environment, then implementing cognitive-behavioral interventions through experiential methods (art therapy, play therapy, sand tray, bibliotherapy, role play, drama, relaxation). Therapist also works with parents or caregivers to ensure that the home environment supports and maintains the child's treatment gains.

Scientific Rating NR

Programs

Multisystemic Therapy for Youth with Problem Sexual Behaviors

Multisystemic Therapy for Youth with Problem Sexual Behaviors (MST-PSB) is a clinical adaptation of Multisystemic Therapy (MST) that has been specifically designed and developed to treat youth (and their families) for problematic sexual behavior. Building upon the research and dissemination foundation of standard MST, the MST-PSB model represents a practice uniquely developed to address the multiple determinants underlying problematic juvenile sexual behavior.

MST-PSB is delivered in the community, occurs with a high level of intensity and frequency, incorporates treatment interventions from MST, and places a high premium on approaching each client and family as unique entities. Treatment incorporates intensive family therapy, parent training, cognitive-behavioral therapy, skills building, school and other community system interventions, and clarification work. Ensuring client, victim, and community safety is a paramount mission of the model.

Each youth/family has uniquely and collaboratively designed individual treatment plans, and each treatment site is encouraged to conjointly develop locally defined outcomes that suit community needs.

Scientific Rating 1

HOPE Program

The HOPE Program works with adolescent clients in individual and group settings. The program specializes in forensic and cognitive behavioral therapy, as well as general psychotherapy for individuals, couples, and families coping with emotional, behavioral, and psychological challenges. The HOPE Program also offers treatment approaches for family reunification and safety planning.

Scientific Rating NR

Pathways Fifth Edition

Pathways Fifth Edition is a structured, guided workbook for use with adolescents of all genders with sexual behavior problems, including but not limited to sexual offending. Pathways Fifth Edition focuses extensively on helping clients develop healthy and responsible patterns of thinking and behavior, and also provides concrete guidance about how to control sexual feelings in healthy and responsible ways, including guidelines for successful friendships and dating relationships. Relapse prevention techniques are reinforced, as is a new focus on helping clients develop healthy and responsible lifestyles by creating a Healthy Living Project to follow. Pathways Fifth Edition includes new skill and knowledge-based exercises that aim to help clients identify feelings, manage anger, understand consent, develop healthy relationships, and become more sensitive to others. Pathways Fifth Edition also provides concrete tools for completing the victim clarification (apology) process and the family reunification process. This workbook is a treatment tool that hopefully leads the client towards a lifestyle of honesty, responsibility, sensitivity, and integrity.

Scientific Rating NR

Sexual Abuse Counseling and Prevention Program

SACPP is a counseling and treatment service that works holistically with families affected by child sexual abuse. It is designed to engage with the broader system around the child/young person – including schools, health services, out-of-home care providers (such as foster care and residential care), and other services providers. Young people who have engaged in sexually abusive behaviors require the ongoing support of their family and community to ensure their risk of re-offending is minimized. Therefore, an ecological approach to working with adolescents is essential.

Scientific Rating NR

Trauma Outcome Process Assessment Model

The TOPA program is designed to help sexually abused and sexually abusive children/youths: (a) recognize how self-destructive and/or sexually abusive behaviors connect to past sexual abuse and other traumatic experiences (e.g., physical abuse, exposure to domestic violence); (b) take responsibility for maladaptive behaviors; and (c) make adaptive choices when current stressors trigger feelings or memories related to past traumas. Therapists take a directive role by creating a safe therapeutic environment, then implementing cognitive-behavioral interventions through experiential methods (art therapy, play therapy, sand tray, bibliotherapy, role play, drama, relaxation). Therapist also works with parents or caregivers to ensure that the home environment supports and maintains the child's treatment gains.

Scientific Rating NR