1. The Effective Management of Juvenile Sex Offenders in the Community Section 4: Treatment

2. Section 42 Key Topics for the Treatment Section Part I: Program Availability and Settings Part II: Rehabilitative Trends Part III: Goals, Frameworks, and Modalities Part IV: Common Treatment Targets Part V: Challenges and Controversies Part VI: Treatment Outcomes

3. Section 43 Availability of Juvenile Sex Offender Treatment Programs Nationwide (Adapted from McGrath, Cumming, & Burchard, 2003)

4. Section 44 Program Settings for Juveniles: Community vs. Residential (Adapted from McGrath, Cumming, & Burchard, 2003)

5. Section 45 Continuum of Treatment Settings Range of treatment needs Psychosexual disturbance Environmental instability Risk for recidivism Community- Based Treatment Residential or Institutional Treatment

6. Section 46 Benefits of Community-Based Treatment Intervene in natural environment Support productive involvement Family Peers School/employment Generally cost-effective

7. Section 47 Benefits of Residential Treatment Increased structure and security Victim and community safety Immersion in treatment

8. Section 48 “Getting Tough” on Juvenile Crime Lowered minimum age for waiver Eliminated many confidentiality restrictions Harsher punishments and mandatory sentences Reduced judicial discretion (see, e.g., Fagan, Kupchick, & Liberman, 2003; Fagan & Zimring, 2000; Torbet & Szymanski, 1998)

9. Section 49 Impact of Adult Dispositions on Youthful Offenders Recidivism increases More serious types of recidivism Reduced access to rehabilitative services Increased victimization and suicide rates within institutions Lowered self-expectancies about remaining crime free (see, e.g., Fagan & Zimring, 2000; Mendel, 2000; Redding, 2003)

10. Section 410 Examples of Evidence-Based Interventions Wraparound Services Functional Family Therapy Multisystemic Therapy

11. Section 411 Common Treatment Goals Accept responsibility for behaviors Identify contributing factors Explore, utilize effective coping strategies Develop prosocial skills and competencies Establish positive peer relationships Promote healthy family functioning

12. Section 412 These Youth Aren’t “Specialists” 55% had a prior non-sex offense 61% were convicted of non-sex offenses as adults Only 5% convicted of sex offenses as adults Of sexual recidivists, 72% were also convicted for non-sex offenses as adults. (Nisbet, Wilson, & Smallbone, 2004)

13. Section 413 (Adapted from McGrath, Cumming, & Burchard, 2003) Most Common Theoretical Frameworks Reported Nationwide

14. Section 414 Multiple Modes are Important Group time constraints Sensitive issues and dynamics Responsivity factors Deviancy training concerns

15. Section 415 (Adapted from McGrath, Cumming, & Burchard, 2003) Use of Various Modalities Nationwide

16. Section 416 Common Treatment Targets Responsibility-taking Cognitive distortions or thinking errors Victim empathy Intrapersonal and interpersonal skills Sex education Relationship skills Healthy masculinity Arousal control Trauma resolution Family functioning

17. Section 417 Treatment Targets in Programs Nationwide (Adapted from McGrath, Cumming, & Burchard, 2003)

18. Section 418 Process-Related and Contextual Variables Therapist characteristics Treatment climate “Approach” goals (Fernandez, 2006; Marshall, 2005; Mann et al., 2004; Thakker et al., 2006)

19. Section 419 Juvenile Sex Offender Programs for Females (Adapted from McGrath, Cumming, & Burchard, 2003)

20. Section 420 Treatment Targets for Females vs. Males in Programs Nationwide (Adapted from McGrath, Cumming, & Burchard, 2003)

21. Section 421 Future Directions for Juvenile Female Sex Offender Treatment Identify unique risk and protective factors Clinical characteristics, modus operandi Gender-responsive programs Treatment outcome research

22. Section 422 (Adapted from McGrath, Cumming, & Burchard, 2003) Treatment Programs for Children with Sexual Behavior Problems

23. Section 423 Psychiatric Disorders and Juvenile Sex Offenders Common presence necessitates screening Can interfere with treatment engagement and response Pharmacological interventions may be warranted

24. Section 424 Potential Pharmacological Interventions and Cautions SSRIs may be beneficial for co-occurring disorders Side effects may include reduced preoccupations and sex drive FDA Warning Antiandrogens not recommended as first-line intervention for youth

25. Section 425 Juvenile Programs Using the Polygraph Nationwide (McGrath, Cumming, & Burchard, 2003)

26. Section 426 (Waite et al., 2005) Recidivism Trends for Treated Youth Released from Facilities

27. Section 427 Treated vs. Non-Treated Youth in a Community- Based Program (Worling & Curwen, 2000)

28. Section 428 MST vs. Alternative Treatment (see Borduin & Schaeffer, 2002)

29. Section 429 Summary of Key Points New and evolving field Consider “what works” Holistic, integrated, and comprehensive Challenges and controversies exist Treatment has promise