BY KATE M. BURBACH KATE BURBACH CALIFORNIA STATE UNIVERSITY, LONG BEACH MAY 2012 A SYSTEMATIC REVIEW OF TREATMENTS USED WITH ADOLESCENTS WHO SEXUALLY OFFEND

INTRODUCTION Target Population: Adolescents who sexually offend will be defined as those aged 13-17, and preadolescents as those aged 9-12 who have committed any act on the sexual offending continuum. The definition of a sexual offense varies greatly depending on the study and is quite broad. For the purposes of this review, the term sexual offense will refer to rape, voyeurism, exhibitionism, sodomy, sexual assault with an object, and lewd acts such as unwanted fondling under or over clothing (California penal code, Title 9: Chapter 5). Prevalence : Juveniles (age 17 and younger) made up 15% of arrests for forcible rape and18% of arrests for all other sexual offenses. That is to say, 2,033 adolescents were arrested for forcible rape while 9,139 adolescents were arrested for other sexual offenses, nationwide, in one year (FBI, 2010). The U.S. Department of Justice (USDJ, 2004) reported that juveniles made up 24% of sexual offenses against victims aged 12-17, 34% of sexual offenses against victims aged 7-11 and 40% of offenses against victims aged 6 years old and younger. Demographics: The Office of Juvenile Justice and Delinquency Prevention (OJJDP), reported the ages of the offenders varied, but the majority were 12 years or older. It was reported that 5% were younger than 9, 16% were younger than 12, 38% were between 12 and 14, and 46% of the offenders were between 15 and 17 (Finkelhor, Ormrod, Chaffin, 2009). OJJDP also reported that females accounted for a mere 7% of adolescents who had sexually offended (Finkelhor, Ormrod, Chaffin, 2009). The Federal Bureau of Investigation (FBI, 2010) concluded that the racial distribution of adolescents who were arrested for a sexual offense consisted of 65% Caucasians, 31% African- Americans, 1% Native Americans, and 1% Asian or Pacific Islander (FBI, 2010). Purpose of Study: A review of the literature is necessary as the efficacies of the many different treatment programs available are unknown. Systematically reviewing all studies addressing treatment outcomes will allow for an understanding of what works with the adolescent sexually offending population.

METHOD For a comprehensive understanding on the topic, databases from several different disciplines, including criminology, sociology, psychology, and social work, were used to acquire the current research pertaining to adolescents who sexually offend. The specific databases utilized were: Academic search complete, socINDEX, Sociological Abstracts, Social Services Abstracts, psychINFO, Criminal Justice Abstracts, and Public Administration. Dissertations contributing to the knowledge base were also searched. Meta-analyses pertaining to adolescent sex offender treatment effectiveness were utilized in tracking studies for recruitment for this review. In addition to database searches, general internet searches were performed which focused on national and state recognized organizations and governmental reports. Manual searches were performed as reference lists from all related articles and books were closely scrutinized. The articles, reports, and books referenced were then retrieved and read for inspection of eligibility. Unpublished data sets from private agencies were also sought after. The following search terms were used, either singularly or in combination, in the afore mentioned searches: “juvenile, adolescent, youth, sex, sexually, offenders, cognitive-behavioral, multisystemic, family, family, offense specific, treatment, therapy, sexually-reactive, recidivism, effective and intervention.” In order to provide current relevant work with this population the search included empirical research studies published between 2000 and Research Questions: What was the demographic make-up of the participants? What types of treatment were used with this population? In what type of setting were the treatments provided? What modality was used for implementation of these treatments? What were the goals of these interventions? What are the outcomes of these interventions? What are the limitations to the research? Inclusion Criteria: Criterions for this review were established as 1) the study was based on first-hand empirical research, 2) a comparison or control group was included in the study, 3) the study included a minimum of 30 participants, 4) the study was current and published between the years , 5) the study must specify the treatment implemented, 6) outcomes of treatment such as recidivism, social competency, or changes in mood and/or behavior must have been evaluated, and 7) the participants must have been adjudicated for a sexual offense as an adolescent (aged 17 or younger). These criterions were established to ensure the integrity of the results. Studies must have included a comparison group or control group to address program effectiveness. Studies also needed to include at least 30 participants to allow for a decent representation from the population for statistical power to evaluate if the treatment outcomes were indeed in response to the treatment rather than happenchance or external factors. It was necessary for the treatment type and goals to be explicitly stated to understand the implemented program in conjunction with the reported outcomes.

AuthorsSampleSetting/Modality/ Treatment GoalsMeasurementOutcomesLimitations Erickson (2008)N= % Male 2% Female TG: 73% Caucasian 13% Asain/Pacific Islander 8% Latino 5% African America 3% Native American CG: 84% Caucasian 0% Asain/Pacific Islander 3% Latino 13% African American 0% Native American Participants from both groups had recently completed a residential program. TG: received Family Functional Therapy(FFT) on the family domain for an average of 3 months. CG: received community based and home based cognitive behavioral/psychoeducational therapy on individual and group domains for an average of. TG: explore motivation, change behaviors, create supportive family environment, connect to community, relapse prevention. CG: Accept responsibility, cultivate empathy, sex education, family support education, develop social skills, anger management, relapse prevention, past trauma/abuse counseling, appropriate arousal. Outcome Questionnaire-45, Youth Outcome Questionnaire, criminal records Sexual Recidivism 0% TG 0% CG Nonsexual recidivism: 40% TG 21% CG No statistically significant differences in change of symptomology between groups. The length of treatment for the CG lasted the majority of the (relatively short)follow up period while the treatment group received therapy for approximately 3-4 months. It is difficult to know whether the recidivism was a result of treatment outcomes or the matter of continued supervision.

OFFENSE SPECIFIC MODELS

DISCUSSION Results: Available research addressing treatment effectiveness is extremely limited. Several studies had to be excluded because they did not meet the basic criterion established for this review. The most commonly found limitation in these studies was a weak study design. Countless numbers of studies did not include the fundamental comparison/control group. It was not uncommon to find a study was based on a case example or sample sizes as small as 6. Another impediment to obtaining more studies for inclusion was inconsistency in participant definition. This was manifested as treatment groups were comprised of both the adolescent sexual offender and their family members, or included adolescents suspected of engaging in inappropriate sexual behaviors (or were assessed to be at risk of doing so) in addition to adjudicated adolescent sex offenders. Some studies were based on treatment providers’ opinions and perspectives of the implemented program instead of assessing outcomes of the recipients of the treatment. Finally, it was noted that three studies, published in separate journals, were actually reporting on the same dataset. Ultimately 7 studies were identified for inclusion in this review. Findings: Some of the common goals in the offense specific treatments were obtaining social skills, developing victim empathy, increasing self-esteem, and accepting offender responsibility (Eastman, 2004; Erickson, 2008; Waite, Keller, McGarvey, Wieckowski, Pinkerton, & Brown, 2005; Worling, & Curwen, 2000 ). Because the offense specific treatments included increasing empathic response it would appear, that at least one, of the offense specific treatment goals addresses the theory of attachment and the subsequent lack of empathy in adolescent sexual offenders. Shared goals among the ecological approaches were to increase positive peer relationships, increase grades, and strengthen familial support (Borduin, Schaeffer, & Heiblum, 2009; Letourneau, Henggeler, Borduin, Schewe, McCart, Chapman, & Saldana, 2009). Ecological approaches target the many facets of a sexually offending adolescent’s life, such as other delinquent behaviors and familial relationships. These goals would address the concepts identified in the learning theory. The adventure based program focused on developing appropriate sexual thoughts and behaviors, accepting responsibility for one’s behaviors, developing relationships of equality, and managing stress and anger (Gillis, & Gass, 2010). The treatments showed to be effective in achieving their specific program goals. Implications: In general, adolescents who sexually offend are not likely to sexually recidivate after an intervention has taken place. They are, however, very likely to recidivate in other criminal charges and delinquent behavior. Therefore, it would appear that a successful treatment for these adolescents would target other problematic areas of the adolescent’s life that contribute to general delinquent behavior. One example of a problematic area to address is an adolescent’s academic success as made manifest in reduced truancy, increased grades, increased positive peer relationships and improved behaviors in the classroom. Another example area is that of strengthening familial relationships. Registries can lead to an adolescent’s isolation and removal from society. The label of a sexual offender will hamper or impair the adolescent’s ability to enroll in school or obtain employment (Leversee & Pearson, 2001). These negative outcomes only increase the likelihood that an adolescent will continue to engage in deviant behavior (Chaffin, 2008). Conversely, this review has shown that MST, which focuses on keeping the youth in their environment and intervening on academic, peer, and familial levels, holds promise in meeting the needs of the adolescent. The implications of requiring adolescents to enlist in state registries, to be labeled for years to come as a sex offender, should be called into question as the research has shown that treatment can be effective in reducing both sexual and criminal recidivism.

REFERENCES Borduin, C., Schaeffer, C., & Heiblum, N. (2009). A randomized clinical trial of multisystemic therapy with juvenile sexual offenders: effects on youth social ecology and criminal activity. Journal of Consulting and Clinical Psychology, 77 (1), California Penal code. Title 9: Crimes against the person involving sexual offenses Eastman, B. (2004). Assessing the efficacy of treatment for adolescent sex offender: a cross over longitudinal study. The Prison Journal, 84 (4), Erickson, C. (2008). The effectiveness of functional family therapy in the treatment of juvenile sexual offenders. Indiana University, Department of Philosophy in the Counceling and Educational Psychology, School of Education. Federal Bureau of Investigation, Uniform Crime Reports. (2010). Age specific arrest rates and race specific arrest rates for selected offenses. Retrieved from Finkelhor, D., Ormrod, R., & Chaffin, M. (2009). Juveniles who commit sex offenses against minors. Office of Juvenile Justice and Delinquency Prevention. Gillis, H., & Gass, M. (2010). Treating juveniles in a sex offender program using adventure-based programming: a matched group design. Journal of Child Sexual Abuse, 19, Letourneau, E., Henggeler, S., Borduin, C., Schewe, P., McCart, M., Chapman, J., Saldana, L. (2009). Multisystemic therapy for juvenile sexual offenders: 1-year from a randomized effectiveness trial. Journal of Family Psychology. 23, (1), Leversee, T., & Pearson, C., (2001). Eliminating the pendulum effect: A balanced approach to the assessment, treatment, and management of sexually abusive youth. Journal of the center for families, Children, and the Courts, 3, Waite, D., Keller, A., McGarvey, E., Wieckowski, E., Pinkerton, R., & Brown, G. (2005). Juvenile sex offender re-arrest rates for sexual, violent nonsexual and property crimes: a 10-year follow-up. Sexual Abuse: A Journal of Research and Treatment, 17, 313. Worling, J., & Curwen, T. (2000). Adolescent sexual offender recidivism: success of specialized treatment and implications for risk prediction. Journal of Child Abuse and Neglect. 14, (7),