Sexually Abusive Youth Emili Rambus, Psy.D. Associates in Psychological Services Jackson Tay Bosley, Psy.D. NJ Association for the Treatment of Sexual Abusers

What we know about sexually aggressive youth Overrepresented in population 30-80% report victimization 30-60% educationally classified More amenable to treatment Easier to treat (!!??) Most desist behavior with age and treatment Small number maintain hurtful behaviors into adulthood

Who are they? What is the best way to deal with the issue? Quick answers: 1. Heterogeniety 2. Treatment backed by legal mandate

Heterogeniety Wide variety of behaviors that bring these youth to our attention Wide variety of concomitant problems that these youth have Wide variation in responses to intervention

Wide variety of behavior(s) 9 y/o babysitter 13 y/o sexual harasser 15 y/o babysitter/fondler 16 y/o babysitter/OS 3 victims 17 y/o consensual sex with 13 y/o 17 y/o forced sex with peers 18 y/o many young victims

Wide variety of problems No other issues DD and aggressiveness Long & extensive criminal hx Substance abuse “Unmanageable” in community No parental support All of above (except first)

Variety of responses to disclosure/intervention Denial of event(s) Guardedness Refusal to talk Legalistic responses Admission with explanation Admission without explanation Remorse and guilt for offensive behavior

What they have in common Broke the law & got caught (2C-14.) – Aggravated Sexual Assault – Sexual Assault – Aggravated Criminal Sexual Contact – Criminal Sexual Contact – Other crimes (designated by court) Consequences (Megan’s Law)

Age of consent in NJ In NJ: 16 is the general age of consent, but… 13, 14 and 15 year olds can consent to be sexual with someone up to 4 years older than themselves (to the date).

Assessment A comprehensive assessment is required to establish treatment needs Beyond general assessment of individual functioning, extensive information re: all charged offenses is needed. “Discovery Material”

Issues in assessment Needs assessment – To determine treatment needs – To establish treatment amenability Risk assessment – Likelihood of sexual recidivism – Likelihood of criminal recidivism – Dispositional planning

Needs Assessment Specifics of the inappropriate sexual behavior – Do not use client report exclusively – Collateral data essential Concomitant problems – Criminality – Family issues – DD, substance abuse, others

Risk Assessment Risk – These are the internal characteristics/issues that speak to the predisposition to commit sexual offenses Risk Management – These are the external factors that mitigate this risk Good parental role models Adequate supervision

Risk Assessment (cont.) Unstructured clinical assessments are not accurate Empirically guided clinical assessments are more accurate Best Practice is to use structured assessment tools

Structured Assessment Tools Sexually offensive behavior – Juvenile Sex Offender Assessment Protocol- Second Edition (J SOAP-II) – Estimate of Risk of Adolescent Sexual Offender Recidivism (ERASOR) Aggressive/antisocial behavior – Structured Assessment of Violence Risk in Youth (SAVRY)

Other Tools Registrant Risk Assessment Scale Juvenile Risk Assessment Scale Juvenile Sexual Offense Recidivism Assessment Tool (J-SORRAT-II) Juvenile Risk Assessment Tool (J-RAT)

Risk factors for juveniles (Clinical) Multiple offenses Offending while on supervision Offending in a public place Deviant sexual interests Antisocial orientation/peers Impulsivity Clinical presentation Langstrom, et. al. (2000), Prescott (2001)

Risk factors for juveniles (Actuarial) Psychopathy/antisociality Deviant sexual drive Intellectual deficits Functional deficits Substance Abuse Personal history of victimization Negative treatment outcome Epperson, et.al. (2004)

Offense-specific treatment Legally mandated Tailored to the individual Cognitive-behavioral focus Offense-focused – Denial-common, major treatment issue – Self-awareness – Skill building, arousal, empathy

Offense-specific treatment (cont.) Structured group therapy – Time-limited modules – Address commonly noted issues Individual treatment Family therapy – Enhance supervision – Establish positive role models

Offense-specific treatment (cont.) Tools – Safety plan – Sexual assault cycle – Skills acquisition Philosophy – Relapse prevention – Accountability Necessity of good supervision

Recidivism rates (Juveniles) Sexual recidivism rates for juveniles are generally low, but vary considerably – 1.7% to 19.6% – Varies with definition and follow-up time – Non-sexual recidivism rates for juveniles are much higher, but vary considerably – 17.1% to 90% – Sampling bias

Treatment effects on recidivism One methodologically sound study N=148, 6 year follow-up 72% reduction in recidivism (sexual) 41% reduction in recidivism (non-sexual, violent) 59% reduction in recidivism (non-sexual, non-violent) Treated rate 5%, untreated 18% Worling and Curwen (1999)

Recidivism rates (Adults) Sexual recidivism rates for treated adult sexual offenders % – Incest very low 4 – Pedophiles (F victim) low to mod 15.6 – Pedophiles (M victim) mod to high 19.7 – Rapists mod to high 20.1 – Exhibitionists high 23.4 Alexander, M (1999) SO treatment efficacy revisited. SA-JRT, 11.2

Etiology Multiple individual explanations: – Proximal causes (triggers) – Distal causes (underlying contributors) Empirically: – Deviant sexual arousal – Antisociality

What we know about sexually abusive juveniles Context is important – Family effects (violence, deviance) – Peers (criminality, gangs) Note co-morbid disorders – Substance abuse – ADHD – Conduct/Oppositional Defiant Disorder – Developmental/cognitive limitations – Mood disorders/PTSD

Megan’s Law NJ Statutes do not make a distinction between adults and juveniles adjudicated for sexual crimes. All fall under the mandates of Megan’s Law.

Megan’s Law Registration and community notification provisions are implemented the same for adults and juveniles, with a few exceptions.

Megan’s Law All offenders are assessed for the risk they pose to the community through the use of the Registrant Risk Assessment Scale (for adults) and the soon-to-be-implemented Juvenile Risk Assessment Scale (for juveniles).

Megan’s Law Tier One offenders register only (with the police department) Tier Two offenders register and local organizations are notified Tier Three offenders register and are subject to door-to-door notification

What works: Accountability Invitation to responsibility Corroboration/collaboration – With parents – With probation/parole officers Respectful interactions Empathic understanding and rapport

What doesn’t work Non-offense specific “counseling” Abusive confrontation Strict adherence to a “one-size-fits- all model” Neglecting contextual (family and peers) issues

Impact of work on treatment providers Comfort level with sexuality Supervision, supervision, supervision Parallels impact of sexual abuse Power and control, anger Hypersensitivity to issues Toxicity Vulnerability/helplessness Self-care vs. burnout

Contact Information Emili Rambus, Psy.D. (908) x48 Assn. for the Treatment of Sexual Abusers NJ Chapter of ATSA Center for Sex Offender Management NJ State Police (registry)