Updates in JSO Treatment Presentation to at the OJACC conference

1. Updates in JSO TreatmentPresentation to at the OJACC conference Dr. TyffaniMonford Dent October 16, 2014

2. Before we start…

3. And…I talk in acronyms • JSO-Juvenile Sexual Offender • ASO-Adolescent Sexual Offender • YSBP-Youth with Sexual Behavior Problems • AOD-Alcohol and Other Drugs • GLM-Good Lives Model • CBT-Cognitive Behavioral Therapy • RP-Relapse Prevention

4. Objectives • Identify reasons for Juvenile sexual offending • Gain of current beliefs about JSOs and JSO treatment • Identify emerging treatment areas/models in JSO work

5. Called many things • Adolescent sex offenders • Sexually aggressive adolescents • Juveniles with sexual aggression • Juveniles with sexually aggressive behaviors • Adolescents who have acted out sexually • Juveniles with sexually inappropriate behaviors • Juvenile sexual offenders

7. Most of what we hear about JSOs are untrue because…. Media does a good job of sensationalizing Sexual offending brings out emotional responses vs. rational ones We often hear about the “worst of the worse”---anecdotal Times change and so do kids---info has hard time keeping up with the truth

8. Question Why do they do it?

9. JSOs • Explanations for sexual offending • General delinquency • Sexually abused sexual abuser • Poor childhood attachment • Social problems • Sexual development • Atypical Sexual Interest • Psychopathology • Cognitive Abilities

10. General Delinquency • Many have also committed non-sexual offenses • Our most-quoted meta-analyses (Reitzel & Carbonell (2006); Caldwell, M. F. (2010) indicate they are most likely to recidivate in a nonsexual way • Risk factors associated with recidivism in non-JSOs also cited as in JSOs • Antisocial beliefs • Association with delinquent peers • (Prentky, Pimental, & Cavanagh 2006 as cited in Seto & Lalumeire, 2010)

11. Sexually Abused Themselves • Male children who are sexually abused more likely to engage in abusive behavior later in life • Link of own abuse to later abuse • Modeling of perpetrator • Sexual stimulation=sexual abuse • Adoption of permissive attitudes Re: child/adult sex • Burton, D. L. (2003). Male adolescents: Sexual victimization and subsequent sexual abuse. Child and Adolescent Social Work Journal, 20,277–296

12. Poor Childhood Attachment • Vulnerable boys more likely to seek relationships with other adults than their parents • Try to fulfill attachment need in inappropriate ways • Reduce empathic ability, increase emotional dysregulation, and be more coercive Smallbone, S. W. (2006). Social and psychological factors in the development of delinquency and sexual deviance. In H. E. Barbaree & W. L. Marshall (Eds.), The juvenile sex offender (2nd ed., pp. 105–127). New York: Guilford Press.

13. Social Problems Lack appropriate social skills to engage in relationships with same-age peers Worling, J. R. (2001). Personality-based typology of adolescent male sexual offenders: Differences in recidivism rates, victim selection characteristics, and personal victimization histories. Sexual Abuse: A Journal of Research and Treatment, 13, 149–166.

14. Sexual Development • Earlier onset of masturbatorY behavior • Sex to cope with stress • Marshall, W. L., & Marshall, L. E. (2000). The origins of sexual offending. Trauma, Violence, and Abuse: A Review Journal, 1, 250–263. • More frequent and earlier exposure to sex (observing others or porn use) • Beauregard, E., Lussier, P., & Proulx, J. (2004). An exploration of developmental factors related to deviant sexual preferences among adult rapists. Sexual Abuse: A Journal of Research and Treatment, 16, 151– 161. • Seto, M. C., Maric, A., & Barbaree, H. E. (2001). The role of pornography in the etiology of sexual aggression. Aggression and Violent Behavior, 6, 35–53.

15. Atypical Sexual Interest • Self-reported sexual interest in children associated with sexual recidivism • Worling, J. R., & Curwen, T. (2000). Adolescent sexual offender recidivism. Success of specialized treatment and implications for risk prediction. Child Abuse & Neglect: The International Journal, 24, 965–982.

16. Question • What are we supposed to do?

17. Provide holistic treatment that stops sexually harmful behavior

18. A Comprehensive Approach Can Effectively Manage Sexually Abusive Youth In Their Community • Managing sexually abusive youth in the community is complex. • A single strategy doesn’t have maximum impact. • One service system by itself cannot address all issues effectively. • Multiple systems working together result in more effective management of these youth and better outcomes

19. Treatment

20. Treatment Works Recidivism (charges) • 10 year follow-up 20 year follow-up, present Treatment Comparison Treatment Comparison Any 35% (20/58) 54% (49/90) 38% (22/58) 57% (51/90) NonVi 21% (12/58) 50% (45/90) 28% (16/58) 52% (47/90) Vinonsex19% (11/58) 32% (29/90) 22% (13/58) 39% (35/90) Sexual 5% (3/58) 18% (16/90) 9% (5/58) 21% (19/90) Worling, Littlejohn & Bookalam (2010) 20-Year Prospective Follow-Up Study of Specialized Treatment for Adolescents Who Offended Sexually Behav. Sci. Law 28: 46–57

21. Treating Juveniles vs. Adults • Question? • Are children/adolescents different from adults? • If so, how so?

22. If juveniles are fundamentally different from adults, why use adult interventions (or consequences) on them?

23. Differences between juveniles and adults with sexual aggression Patterns of sexual interest and arousal Perpetration behaviors are less consistent and sophisticated Situational and opportunity factors Adolescent sexual abusers who have themselves been the victims of sexual abuse are far closer in time to their own abuse

24. Adolescents have less developed sexual knowledge. Adolescents live in a world with different values, beliefs and expectations. The role of the family is more critical Adolescents experience and expect a greater degree of external control over their behaviors/interactions. More open and used to education and the acquisition of new skills. Less research on juvenile offenders

25. Myths we have dispelledWorling, J. (2013) What were we thinking? Five erroneous assumptions that have fueled specialized interventions for adolescents who have sexually offended. International Journal of Behavioral Consultation and Therapy 8 (3-4), 80-86 • They are all sexually deviant-relapse prevention/decrease deviant arousal/thought-stopping • They are all just delinquents-too focused on criminal • They all have psychiatric problems-mental issues made them do it • They are all just deficit-ridden-we only looked at problem-reduction • They are all deceitful-so we were confrontational

26. Sex Offender Treatment Today Need for sex-abuse-specific programming has become accepted, Interventions more complex Developmentally-appropriate work Recognition of general juvenile delinquency Renewed focus on trauma and its impact Importance of therapeutic relationship

27. A Collaborative Approach for Treatment Restorative: • Facilitative • Self-determined pace • Collaborative • Empower strengths • Celebrate milestones Retributive: Authoritarian Rigid protocol Imposed “Break denial” Deficit focused

28. How are we achieving this? • New/modified treatment models • Change in how we provide treatment • Change in view of sexuality

30. Emerging Models/Concepts • Developmental Perspective • Trauma-focused • Healthy Sexuality • Motivational Interviewing • Risk-Needs-Responsivity • Good Lives Model • Treatment Curricula (examples)

31. Developmental Perspective • Assess for developmental competence and support maturation in • Physical • Cognitive • Social • Emotional • Communication • Morality • Functional Assessment • Linear View

32. Trauma Focus • Research suggests that early childhood trauma common in lives of sex offenders • History of trauma is a set of experience that influence the identity of the individual (Creeden, 2009. How trauma and attachment can impact neurodevelopment: Informing our understanding and treatment of sexual behaviour problems. The Journal of Sexual Aggression, 15, 261-273)

33. Early trauma paves the way for maladaptive coping and interpersonal deficits • ACE-Adverse Childhood Experiences • Article by Levinson indicates that adult criminals experience significant ACE • Higher rate of early trauma in adult SOs than general population

34. Treatment needs to incorporate how trauma shapes beliefs and behaviors • Healthy communication • Explore how trauma influences assumptions about the world • Maladaptive skills=survival skills at one point that now interfere with healthy relationships/boundaries • Defensiveness=helplessness & inadequacy

35. Incorporate as components of other treatment • GLM, CBT, RP, etc. Levenson, J. (2013). Incorporating trauma-informed care into evidence-based sex offender treatment. Jnl of Sexual Aggression, 1-12.

36. Healthy Sexuality

37. What we were doing • Decreasing understanding that there are relationships not rooted in sex • Not assisting clients in understanding that there is such a thing as healthy sexuality • Becoming worse than our clients • Not permitting normal sexual development • Sexual feelings=shame/guilt

38. Beliefs About Sexuality In Two Models(Steve Brown, ATSA 2009) Traditional Model • Problem sexual behavior mainly about power and control • Emphasis on control of problem sexual behavior • Sexuality regarded with seriousness and gravity • Education about sexuality focused on consequences and danger New Paradigm • Problem sexual behavior mainly about relational needs and attachment • Balance focus on problem sexual behavior and promoting social and sexual competencies • Sexuality associated with seriousness as well as things light and humorous • Education about sexuality balances focus on consequences/dangers and benefits/pleasures

39. Continued Traditional Model • Info about sexuality=permission to engage in sexual behavior • Touch viewed as dangerous-easily sexualized leads to sexual acting-out • Sexuality is dangerous and something to fear New Paradigm • Info about sexuality satisfies curiosity and decreases negative sexual health outcomes • Touch is a critical part of relationships. Touch can be non-sexual • Sexuality is a critical life force in all people that can be used positively or negatively

40. What is Motivational Interviewing A directive, client-centered counseling style for eliciting behavior change by helping clients to explore and resolve ambivalence (Rollnick & Miller, 1995).

41. The Spirit of Motivational Interviewing • Motivation is elicited from the client, not imposed from without. • It is the client’s task, not the therapist's, to articulate and resolve ambivalence. • Persuasion is not effective for resolving ambivalence. • The counseling style is generally a quiet & eliciting one. • The therapist is directive in helping the client to examine and resolve ambivalence. • Readiness to change is not a client trait, but a fluctuating product of interpersonal interaction. • The therapeutic relationship is a partnership.

42. Risk-Needs-Responsivity • Canada, 1980s • Not a “treatment model” but a way of identifying how treatment should occur

43. Risk principle: Match the level of service to the offender's risk to re-offend. • Need principle: Assess criminogenic needs and target them in treatment. • Responsivity principle: Maximize the offender's ability to learn from a rehabilitative intervention by providing cognitive behavioural treatment and tailoring the intervention to the learning style, motivation, abilities and strengths of the offender.

44. Risk • the possibility of harmful consequences occurring • Components • The existence of potentially harmful agents (people, animals, diseases, toxins, situations, etc.) • the possibility that the hazards associated with the agents in question will actually occur

45. How we see it • Likelihood that something bad is gonna happen • Reserve more intensive treatment for those more likely to do it again—based on risk assessment

46. Sooo….look at risk factors(Andrews and Bonta, 1998; Blackburn,2000; Hollin, 1999; McGuire, 2000). Categories (broad) 1) dispositional factors such as psychopathic or antisocial personality characteristics, cognitive variables, and demographic data; (2) historical factors such as adverse developmental history, prior history of crime and violence, prior hospitalization, and poor treatment compliance; (3) contextual antecedents to violence such as criminogenic needs (risk factors of criminal behavior), deviant social networks, and lack of positive social supports; (4) clinical factors such as psychological disorders, poor level of functioning, and substance abuse

47. Divide risk • Static-can’t change • Dynamic-have the ability to change

48. Need • Criminogenic • AOD • Hx of criminal behavior • Antisocial Attitudes/beliefs • Antisocial relationships • Family life/chaotic or problematic • School

49. Responsivity • How an individual interacts with the treatment environment, covering a range of factors and situations. • Motivation • Learning style • Language skills • Maturity (emotional, developmental)

50. Criticism of RNR • Focus was primarily on risk • Need to incorporate/recognize what “good” person may have been attempting to achieve in a “bad” way • Focus on elimination of negative attitudes/behaviors without replacing it with anything Laws & Ward (2011) Desistance from sex offending: alternatives to throwing away the key. Guilford Press: NY Ward, Mann, & Gannon (2007). The good lives model of offender rehabilitation: Clinical implications. Aggression and Violent Behavior, 12, 87-107