National Center on the Sexual Behavior of Youth

UNDERSTANDING TREATMENT

Treatment Providers

Treatment for illegal sexual behavior is most typically provided by professionals from mental health disciplines, such as social work, psychology, and psychiatry. It is recommended that providers 

• be licensed mental health professionals or work under the supervision of a licensed professional; 
• have previous general experience working with adolescents and their families; 
• be familiar with the current literature regarding adolescents with illegal sexual behavior;
• participate in training and continuing education for treating youth with illegal sexual behavior
• be members of relevant professional organizations such as the Association for Treatment of Sexual Abusers (ATSA), American Professional Society on the Abuse of Children (APSAC), American Psychological Association (APA),and  National Association of Social Workers (NASW)

In some areas, treatment is provided by juvenile justice personnel, who are typically probation officers. These treatment providers work under the supervision of the juvenile justice system. They have received training in treating adolescents with illegal sexual behavior. The recommendations we suggest above for mental health professionals, such as specialized training and knowledge of the literature, also apply to juvenile justice personnel. 

Some states have special certification requirements for individuals who treat adolescents with illegal sexual behavior. 

Approaches to Treatment

Several treatment approaches are currently being used to treat adolescents with illegal sexual behavior. The judge or probation officer may recommend, or order, an adolescent to be part of a specific program or the parents may have a choice of providers. The availability of treatment programs may impact the decision made.  In some cases, the legal/juvenile justice system may pay for the treatment. In other cases, it will be the parents’ responsibility. These are decisions that need to be discussed with your child’s attorney or a representative of the court/juvenile justice system. 

When families have a choice of treatment providers, caregivers need to have information about the various approaches of treatment to decide what would be best for their teenager and family. Questions for parents to consider, as they weigh this decision, are the following: 

• Is the provider licensed to provide mental health services in the state, or is the provider working in an agency under supervisors who are licensed?
• Does the provider have adequate knowledge about youth with illegal sexual behavior? Does the provider know the types of information provided on this website?
• Is the provider familiar with the research and literature about adolescents who have engaged in problematic or illegal sexual behavior?
• Does the provider attend annual trainings for this population and have membership in professional organizations? 
• Does the provider know which approaches to treatment are the most effective? 

A good treatment program would be one with experienced, licensed therapists, who have a productive working relationship with the court, probation staff, and CPS, and with a reputation for providing effective services to these adolescents. 

A questionable program is one that utilizes therapists with limited knowledge and experience with adolescents who demonstrate illegal sexual behaviors, professionals without a license, providers who perceive all adolescents with illegal sexual behavior as high risk for reoffending, and uses treatment designed for adults and are not developmentally appropriate for adolescents.  Parents should evaluate how well their program works. Ideally, a program would offer information about the percentages of teens that re-offended after completing their treatment program. Parents should be able to expect that the program provides assessments of the adolescent’s treatment needs before, during and at the end of treatment. 

Several approaches have been used to treat adolescents with illegal sexual behavior. Depending on the particular case, one or more of the interventions described below will typically be used. 

Multisystemic Therapy – Problematic Sexual Behavior (MST-PSB) 

Multisystemic Therapy (see mstservices.com) is an approach to treatment that has the strongest research support in decreasing general delinquent behavior, substance abuse, and illegal sexual behavior by adolescents. The treatment provider is available 24 hours a day, 7 days a week and works closely with the youth and his parents. MST does not include going to a clinic for therapy for an hour a week. In this approach, the therapist has only a few clients and spends a lot of time with the teen, his parents, other family members, and peers. The therapist primarily works with the parents and youth in the home to target problematic behaviors. They often also work with the caregiver and teen in community settings to improve the teen’s behavior, school achievement, and social activities. Treatment with MST-PSB takes about six to nine months, is performed in the community, and directly involves the caregivers. It is important to note that MST-PSB is not available in all areas and that there are conditions that need to be met in order for a youth to qualify for treatment. However, if MST-PSB is available in your community, it may be very helpful for your adolescent and family. 

Cognitive Behavioral Group Therapy

Cognitive Behavioral Group Therapy is a psychoeducational approach to treatment that is conducted in groups of six to eight adolescents. This approach addresses issues such as taking responsibility for the illegal behavior; learning legal, appropriate sexual behavior; increasing involvement in prosocial activities and with non-delinquent peers; and preventing future illegal sexual and nonsexual behavior. Adolescents attend weekly 1 to 1.5 hour group sessions in the community for 8 to 24 months, depending on the program’s requirements. Parents are encouraged or required to attend and participate in a weekly educational support group. The parent group is recommended because caregiver participation has found to significantly improve treatment outcomes. This treatment approach is widely accepted and used for adolescents. Limited research is available, however, that compares this approach to other types of interventions to see if it is the best approach to use. 

Family Therapy

Family therapy is used to directly address the illegal sexual behavior or to focus on problems within the family that influence the youth’s progress in treatment. Family therapy usually involves all members of the family and may be particularly useful in cases where the sexual behavior occurred within the family. When a victim is a family member, then the timing of including all members in family session must take into consideration the progress the youth with problematic sexual behaviors and child victim has made in treatment and the wishes of the victims.  Family therapy may be used as the primary approach to treatment or may supplement other therapies such as when the family is involved in the reunification process.

Individual Therapy

Individual therapy may be provided if other forms of treatment, such as MST-PSB or group therapy, are not available or if the adolescent has other psychological problems that need to be addressed. In this approach, a therapist typically meets with the adolescent on a weekly basis for an hour to address issues related to his illegal sexual behavior. If the youth has other psychological problems, such as depression, these would also be addressed in the individual sessions. In these cases, it is recommended that the teen’s caregivers be included in the treatment on a regular basis. The caregiver can provide important information on the boy’s behavior at home, at school, and in the community. The therapist can discuss issues of behavior management, supervision, and progress in treatment during the sessions. 

Residential Treatment

There are times when an adolescent is demonstrating more severe sexual behaviors that have not responded to treatment in the community, or that compromise the safety of those in his home and possibly, the surrounding community. In these situations, the adolescent may also have mental health diagnoses such as Oppositional Defiant Disorder, Conduct Disorder, Depression, Post- Traumatic Stress Disorder and/or drug and alcohol abuse. Residential Treatment Centers are designed to treat adolescents who are in need of a secure living environment, are experiencing multiple difficulties that may include complex family problems, and likely have behaviors that have not responded well to mental health treatment that has been provided in the community. Adolescents stay at the facility, and length of stay can vary tremendously to up to two years.  Approach to services also varies but is often designed to promote positive behavior change and address mental health needs.  During their stay, they attend individual and/or group psychotherapy and are provided with psychiatric medication management. Some Residential Treatment Centers have their own programs to treat problematic sexual behaviors and others refer their clients to programs at outpatient settings in the community. Though often challenging to take place due to distance, family involvement is critical during the adolescent’s stay and caregivers are encouraged to participate in ongoing family therapy as well as other therapy programs that are recommended.
 

Inpatient Psychiatric Treatment

When teens have concerning psychiatric issues that are not responding to community based approaches, they may require psychiatric hospitalization to address their treatment needs. The hospitalization can be short or long-term, depending on whether the purpose is to stabilize the youth or to address more severe psychiatric problems. Some hospitals conduct treatment programs for adolescents with illegal sexual behavior as part of the youths’ overall treatment plan, which may include group cognitive-behavioral treatment. Youth who are hospitalized should be discharged when their mental health disorders have stabilized, they have made progress in treatment, and they are responsive to adult supervision. They may be released to continue treatment in a community-based program and have ongoing monitoring of their mental health disorder.

 Getting the Most Out of Treatment 

Some treatment programs for adolescents require parental attendance and participation while others have limited parental involvement. Direct parental involvement in education on strategies to support the teens’ future decision making and behavior is important for positive outcomes. We recommend that you actively participate in the treatment to the extent that is suggested or required by the program. It will be helpful for you to understand what your teen is learning in the program, and how to provide super-vision and the best support to your adolescent. If the only available treatments do not involve families, we recommend you ask to be included in individual or family sessions with your teen. We also recommend you meet with the treatment providers to learn what the program is focusing on, the progress your teen is making, and how you can help. Questions or concerns you have about the treatment program can be addressed directly with the provider.  

Parents also need to consider obtaining treatment for other children affected by the teens’ behavior, including the child victim. The type of treatment most helpful for the child victim will depend on a variety of factors such as the extent and severity of the problematic sexual behavior and response of the caregivers. An assessment and perhaps a brief intervention may meet the child victim’s needs. In some cases, the child may need a more extended intervention. The adolescent’s treatment provider or a CPS case worker may be able to provide names of therapists with expertise in treating child victims.  

In some cases, an adolescent’s illegal sexual behavior can trigger personal emotional difficulties for one or both parents, particularly if they have been abused in the past. It is quite difficult to deal with a child’s sexual behavior when problems remain from the parents’ past. In these cases, it is important for the parents to seek services to address their own needs so that they can then best help their child.

When the caregivers are involved in their teen’s treatment, many have positive reports at the end of treatment. They report that they communicate better with their adolescent, their family is closer than before the illegal behavior, and their teen has matured and is doing well in school and at home. These are the outcomes that providers hope will happen for all adolescents and their families. 

Length of Treatment 

The length of treatment varies from program to program and depends on 

• the seriousness of the sexual behavior; 
• whether the youth has other delinquent behavior; and
• the youth’s and family’s active participation and progress in treatment. 

Adolescents who are in community-based treatment programs and live in the community are treated in shorter-term, less-intensive programs that usually meet once a week for one to two hours and last from 8 to 24 months. Some adolescents need long-term, intensive treatment in a restricted placement. Programs in these settings typically use a “levels system” by which the youth’s progress is measured and rewarded as he moves through the levels to discharge.  As mentioned earlier, if you have questions or concerns about the program, it is recommended that you discuss these with the program director or your son’s probation officer or attorney.