Section 4: Treatment
2 Hours

Lecture Topic TOPIC: TREATMENT

Part VI: Follow–Up Studies and Treatment Outcome Research

For people who work in the field of juvenile sex offender management, the question “Does treatment work?” is inevitably posed. This is a difficult question to answer, in part because there have been only a limited number of well–designed treatment outcome studies.

In an ideal research design, large groups of similar juvenile sex offenders would be randomly assigned to “no–treatment” and “treatment” conditions—and maybe even multiple treatment conditions. So, some youth would receive no treatment at all, other youth would receive intervention X, another group would receive intervention Y, and another group would receive intervention Z. Then all youth would be followed for several years to identify reoffense rates both for new sex offenses and non–sex offenses. Any differences in the groups would be easier to attribute to the type of intervention provided, and it may be possible to identify the more superior intervention.

Unfortunately, these types of research designs have been almost non–existent with juvenile sex offenders thus far.

Follow–up Studies Without Comparison Groups

Most common are studies that simply follow juvenile sex offenders for a few years after receiving treatment to see how many of the youth reoffend. As a result, we are not necessarily able to determine the impact of treatment per se, because the treated youth are not being compared to another group of “untreated” juvenile sex offenders.

Nonetheless, something that has been helpful about these follow–up studies is that we have consistently seen very low sexual recidivism rates for juveniles who receive juvenile sex offender treatment. For example, in a recently published study, researchers followed 250 youth who received sex offender treatment within one state’s juvenile justice facilities and were subsequently released to the community.73 Recidivism was assessed in terms of re-arrests for new sex offenses, non-sexual crimes against persons, and property offenses. The average follow–up period was approximately five years.

Use SlideUse Slide #26: Recidivism Trends for Treated Youth Released from Facilities

The sexual recidivism rate for youth in this study was only about five percent. These low sexual recidivism rates are very consistent with other follow-up studies of juvenile sex offenders.74 Notice that the non-sexual recidivism rates—particularly non-sexual crimes against persons—were markedly higher than the sexual recidivism rates. This, too, is quite consistent with other research.75

Taken together, these research findings seem to indicate that youth who have received treatment recidivate sexually at very low rates, and that they appear to be much more likely to recidivate with a non–sex offense than with another sex offense. Remember, however, that because this particular study did not use a “no treatment” comparison group, we cannot be certain that the low recidivism rates are definitely and only because of the treatment. In fact, it could simply be the case that juvenile sex offenders—even without treatment—have low rates of sexual recidivism.

Follow–up Studies with Default Comparison Groups

Other researchers have included comparison groups so that we can better answer the “treatment impact” question. In most of the follow–up studies that have used “treatment” and “no–treatment” comparison groups, however, the youth were not randomly assigned. Rather, the comparison groups were pre–existing, or became comparison groups by default. For example, common comparison groups include youth who never entered treatment for some reason, dropped out of treatment before completing, or were terminated from treatment before completing.

This is not an ideal approach to developing comparison groups, but it is probably better than having no comparison group at all, because we can infer that at least part of any observed differences in outcomes may be related to the provision of treatment. I’d like to draw your attention to one such study.

Worling and Curwen (2000) attempted to examine the impact of community–based, cognitive–behavioral and relapse prevention treatment that also included individual and family interventions.76 To do so, they compared treated versus untreated juvenile sex offenders, with an average follow–up period of over six years.

A unique feature of this study was that the researchers compared the two groups of juvenile sex offenders not only on sexual recidivism rates, but also in terms of recidivism with violent, non–sex offenses and non–sexual, nonviolent offenses. Recidivism was defined as a new charge.

Use SlideUse Slide #27: Treated Versus Non–Treated Youth in a Community–Based Program

As you can see, the findings were quite promising. Specifically, the treated youth recidivated at lower rates than the untreated youth across all categories—for sexual, non–sexual violent, and non–sexual, non–violent offenses. And notice the very low sexual recidivism rate for these youth—only 5 percent. The sexual recidivism rate for the untreated group was nearly four times higher—18 percent. Of course, one cannot help but notice that the recidivism rates for other types of behaviors were quite a bit higher. Again, this parallels the growing body of research demonstrating that sexual recidivism rates are low, and that if juvenile sex offenders do reoffend, it is more likely to be with non-sex offenses.

Remember, because the youth in this study were not randomly assigned to the “treatment” or “no–treatment” conditions, we cannot conclude with absolute certainty that juvenile sex offender treatment was the only reason that recidivism rates were lower. But given the consistency in findings like this across a number of similar studies, we do have reason to believe that treatment for these youth does have a positive impact.

In fact, some meta–analyses—again, studies that evaluate a number of studies collectively to identify overall treatment effects—have suggested that cognitive-behavioral approaches to juvenile sex offender treatment are associated with significant reductions in sexual and non–sexual recidivism.77 Most studies in the meta-analyses do not have the ideal methodology—random assignment—and therefore we are somewhat limited in terms of the conclusions that can be drawn.

Follow–up Studies with Randomly–Assigned Comparison Groups

You’ll recall that earlier we discussed some interventions for juveniles that have been found to “work” in reducing further delinquency among youth. We highlighted Wraparound Services, Functional Family Therapy, and Multisystemic Therapy. And you may also remember that I noted that there have been a couple of very promising treatment outcome studies involving Multisystemic Therapy with juvenile sex offenders specifically.78 They are very good examples of well–controlled treatment outcome studies, because the researchers randomly assigned youth to the MST and comparison groups.

Use SlideUse Slide #28: MST vs. Alternative Treatment

As you can see in this slide, the researchers found that juvenile sex offenders who received MST interventions reoffended at significantly lower rates than youth in the comparison groups, both in terms of sexual and non–sexual crimes. And because of the strong research design, it is easier to attribute the differences in outcomes to the specific interventions provided.

However, the sample sizes for these studies that used MST have been relatively small, so it will be important to look at MST with larger samples of juvenile sex offenders to see if similar results are found in the future. Nonetheless, MST does appear to be associated with very promising treatment outcomes with juvenile sex offenders. And since we have talked about how important it is to provide treatment that is comprehensive, holistic, and integrated—not just focusing on the youth’s sex offending behaviors or the youth by himself—these positive treatment outcomes for MST with juvenile sex offenders make a lot of sense, don’t they?

So, the question “Does treatment work?” has not been fully answered. In fact, it is pretty clear that we still have a long way to go before we fully understand the impact of treatment for juvenile sex offenders. It may be that there are different types of interventions that lead to reductions in recidivism, or different approaches that are better for different kinds of juvenile sex offenders.

At the same time, the current available evidence does seem to suggest that cognitive–behavioral approaches that include individual and family interventions, as well as the MST approach, are associated with positive outcomes with these youth.79

Summary

We’ve covered quite a bit of information in this section, haven’t we? So let’s take a moment to summarize.

Use SlideUse Slide #29: Summary of Key Points

First of all, it is important for us to recognize that the field of juvenile sex offender treatment is relatively new, and it is still developing. It wasn’t all that long ago that there were only a handful of programs for juveniles! And now, there are hundreds and hundreds of juvenile sex offender treatment programs across the country.

Second, we were reminded that in our desires to respond quickly to reduce juvenile crime, we must avoid the tendency to react punitively and to try to “treat youth more like adults.” Rather, we must rely on the available literature that tells us “what works” in juvenile justice. And we highlighted a few examples of interventions—Wraparound Services, Functional Family Therapy, and Multisystemic Therapy—that have a great deal of promise for reducing recidivism among juveniles.

Third, we reviewed the common goals of treatment for juvenile sex offenders, and highlighted the most common frameworks and targets for treatment programs. We discussed just how important it is to keep in mind that these youth are not simply “sex offenders” and that we should strive to develop interventions that are holistic, comprehensive, and developmentally appropriate.

This led to the fourth major area that we discussed—current challenges and controversies. Once again, we emphasized that juvenile sex offenders are not the same as adult offenders, and that even within the juvenile sex offender population, there is considerable diversity. As such, the uncritical application of adult models and approaches, and the use of “one size fits all” programs are not appropriate for all youthful offenders, and tailored interventions must be used for special populations. We also talked about developmental considerations and controversies, specifically surrounding certain pharmacological interventions and the use of the polygraph.

And finally, we were again reminded that there is a long way to go with respect to evaluating the impact of juvenile sex offender treatment. We reviewed some of the evidence that seems to suggest that cognitive–behavioral approaches—as well as MST—are promising interventions for juvenile sex offenders. And we discussed the growing body of research that indicates that sexual recidivism rates for juvenile sex offenders is quite low, and that these youth do not appear to specialize in sex offenses. In fact, it is becoming evident that juvenile sex offenses are not nearly as likely to commit additional sex offenses as they are to engage in other non–sexual, delinquent conduct.

A detailed list of references is included in your participant materials. Because this training is designed to provide an overview of the key issues, we strongly encourage those of you who are interested to explore these and other resources, keeping in mind that to provide treatment to juvenile sex offenders, specialized training and experience are critical prerequisites.

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