Treatment

Overview

Treatment has been a consistent feature of adult and juvenile sex offender management efforts for decades. However, the underlying structure, delivery, and philosophies of sex offender treatment in the field have been much less consistent. Early treatment methods varied widely, based on theories and techniques that ranged from psychodynamic to strict behaviorism (see Laws & Marshall, 2003 for a review). Programming then became grounded within a cognitive–behavioral framework, and eventually incorporated an emphasis on relapse prevention (see Marshall & Laws, 2003). Even today, sex offender treatment continues to evolve. Indeed, the relapse prevention model, which had been standard practice for many years, has become less influential in favor of more contemporary models of treatment that take into account multiple “pathways” to offending for adults and juveniles (see, e.g., Hunter, 2006; Hunter, Figueredo, Malamuth, & Becker, 2003, 2004; Ward & Hudson, 1998, 2000; Ward & Siegert, 2002; Ward, Polaschek, & Beech, 2006).

Despite these ongoing transformations within the sex offender treatment field, one feature has remained constant—the desire and expectation that through intervention, problem sexual behaviors will be reduced and community safety will be enhanced. And current research suggests that, depending upon the underlying theoretical model and the specific techniques used, some forms of treatment come closer to meeting that goal than others (Aos, Miller, & Drake, 2006; Hanson et al., 2002; Reitzel & Carbonell, 2006; Walker, McGovern, Poey, & Otis, 2004). Therefore, as stakeholders begin to critically consider the ways in which treatment is approached within their jurisdictions, the following should be taken into account:

Availability, Capacity, and Accessibility

Because adult and juvenile sex offenders are diverse populations with varied levels of risk and needs, jurisdictions should have a continuum of treatment services available, ranging from an array of options in the community, to services in group homes and moderate care facilities, and ultimately including treatment in secure correctional or residential facilities (see, e.g., Bengis, 1997; Berenson & Underwood, 2000; Hunter, Gilbertson, Vedros, & Morton, 2004; Marshall et al., 2006a; Schwartz, 2003). Keeping in mind that interventions are more likely to reduce recidivism when matched to the level of risk posed by individuals, community–based sex offender treatment is more likely to be effective for low risk offenders; more intensive treatment within correctional or juvenile justice facilities is best reserved for those who pose a higher risk for recidivism (see, e.g., Berenson & Underwood, 2000; Friendship, Mann, & Beech, 2003; Gordon & Nicholaichuk, 1996; Mailloux et al., 2003; Nicholaichuk, 1996).

A continuum of care is particularly important when considering treatment and placement options for juvenile sex offenders (Bengis, 1986, 1997; Hunter, 2006; Hunter et al., 2004). Juvenile facilities tend to be over–relied upon for treating juvenile sex offenders, even when youth pose a low risk, often because of a lack of dedicated treatment capacity in communities (Hunter et al., 2004). Yet research indicates that when delinquent youth are placed together for intervention purposes, recidivism may potentially increase because of the impact of negative peer influences (see Dodge, Dishion, & Lansford, 2006). Moreover, no evidence suggests that this level of care is more effective than other settings in reducing recidivism. On the other hand, family– and community–based interventions with juvenile sex offenders have very positive outcomes (see, e.g., Borduin & Schaeffer, 2002; Hunter et al., 2004; Saldana, Swenson, & Letourneau, 2006).

A continuum of care is particularly important when considering treatment and placement options for juvenile sex offenders.

Ideally, when making decisions about levels of care, the courts and other justice professionals will have the benefit of pre–sentence investigations and comprehensive psychosexual evaluations that specifically address risk and needs in a valid and reliable manner. (For additional information about the use of assessments to inform decisionmaking, see the Assessment section of this protocol.) Following the initial placement, should circumstances warrant (e.g., significant increases or decreases in risk), policies and procedures should be in place that afford correctional and juvenile justice agencies the latitude to make informed adjustments to the level of care accordingly. To the extent possible, treatment settings for juveniles should also take into account the least restrictive alternative, proximity to the home and community, and family strengths and needs.

Prison–Based Sex Offender Treatment

The majority of states offer some form of prison–based sex offender treatment in one or more of their facilities (West, Hromas, & Wenger, 2000). In some jurisdictions, correctional agencies are legislatively or otherwise mandated to maintain treatment programs and, in some instances, legislation requires sex offenders to participate in these programs in order to be considered for conditional release or parole. Regardless, although prison–based sex offender treatment programs are generally available, their actual capacity may be quite limited (see, e.g., Gordon & Hover, 1998; West et al., 2000). These capacity concerns, coupled with the ever–increasing numbers of convicted sex offenders entering prisons (Harrison & Beck, 2006), mean that it will be a greater challenge to ensure that all of the sex offenders who can benefit from prison–based treatment will be able to access it.

To increase availability, capacity, and accessibility, program administrators and staff have begun to develop a range of prison–based sex offender–specific interventions that vary in nature and intensity (see, e.g., Gordon & Hover, 1998; Marshall et al., 2006b; Schwartz, 2003). This may include services such as psychoeducational classes, “outpatient” or “call out” groups, or intensive treatment programs such as therapeutic communities (see, e.g., Gordon & Hover, 1998; Marshall et al., 2006b; Schwartz, 2003; West et al., 2000). When a range of services exists, sex offenders should be channeled into those services based on their assessed level of risk. This increases the potential impact of interventions while maximizing limited resources (see, e.g., Gordon & Hover, 1998; Mailloux et al., 2003; Marshall et al., 2006b; Nicholaichuk, 1996; Schwartz, 2003).

As jurisdictions attempt to expand the reach of prison–based sex offender treatment, policies should be established that:

Facility–Based Treatment for Juveniles

Within the juvenile justice system, well over one–third of publicly operated institutions and facilities are over capacity (Snyder & Sickmund, 2006). Indeed, during the past several years, state–operated facilities experienced a 20% increase in the placement of juvenile sex offenders and privately–operated facilities saw an increase of 68% (Snyder & Sickmund, 2006). This surge in the placements of juvenile sex offenders is noteworthy given the decrease in facility placements for other justice–involved youth (Snyder & Sickmund, 2006). It is not known whether the increase is a function of reduced availability and/or capacity of juvenile sex offender–specific programming within state–operated facilities, a greater capacity for such programming within the privately–operated placements, or both. Nonetheless, the substantial increase in juvenile sex offenders entering both public and private juvenile facilities will likely pose challenges with respect to treatment capacity.

For those agencies and facilities who receive juveniles in need of residential or other facility–based sex offender treatment, several factors should be considered as a means of balancing the treatment needs of these youth with the limited specialized treatment capacity (see, e.g., Bengis, 1997; Bengis et al., 1999; Berenson & Underwood, 2000; Wieckowski, Waite, Pinkerton, McGarvey, & Brown, 2004). For example, clear policies, procedures, or guidelines should be developed in order to:

Community–Based Programs for Adult and Juvenile Sex Offenders

Throughout the country, community–based sex offender treatment programs for adults and juveniles far outnumber prison–based and other residential treatment programs (McGrath, Cumming, & Burchard, 2003). This apparent increase in availability and capacity is a positive trend, especially because some research suggests that community-based treatment has a greater impact than institutional treatment with adults, and because family– and community–based interventions are among the most promising interventions for juvenile sex offenders (see, e.g., Aos, Phipps, Barnoski, & Lieb, 2001; Aos et al., 2006; Lösel & Schmucker, 2005; Reitzel & Carbonell, 2006; Worling & Curwen, 2000).

While increased availability and capacity is desirable, larger numbers of programs and providers may pose challenges related to the assurance of quality, integrity, consistency, and effectiveness of community–based treatment services. To address this concern, jurisdictions may wish to establish formal mechanisms to ensure that minimum expectations or standards for treatment are met and maintained. Some states have developed statewide standards or formal certification processes (e.g., Colorado, Illinois, Tennessee, Texas, Utah), and professional membership organizations and other interested entities have also proposed guidelines for treatment (see, e.g., AACAP, 1999; ATSA, 2005; NAPN, 1993). Another strategy to promote quality and consistency can be implemented when criminal and juvenile justice agencies contract with community–based treatment providers. In these instances, specific requirements can be outlined in the request for proposals, including minimum provider qualifications, the program model to be used, expectations for quality assurance, and requirements for tracking outcomes.

The following factors may also be helpful as stakeholders critically examine the community–based sex offender treatment programs that exist in their jurisdictions:

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