Guiding Frameworks and Goals

To facilitate consistency, integrity, and effectiveness, sex offender treatment programs must have a clearly articulated model of change or theoretical approach that outlines both the underlying philosophy and method of intervention. At present, the cognitive–behavioral approach is the most widely employed model of treatment for both adult and juvenile sex offenders (see McGrath et al., 2003). Cognitive–behavioral treatment addresses the inter–relatedness of thoughts, emotions, and behaviors—specifically as they relate to sex offending and other problem behaviors. Through skill building, reinforcement, and practice, interventions center around replacing maladaptive thoughts and unhealthy coping methods with positive strategies. This approach is designed to assist clients with meeting several goals, including the following (see, e.g., ATSA, 2005; Longo & Prescott, 2006; Marshall et al., 2006a, 2006b):

Research demonstrates that cognitive–behavioral approaches designed for sex offenders result in significant reductions in recidivism with both adults and juveniles (Hanson et al., 2002; Lösel & Schmucker, 2005; MacKenzie, 2006; Reitzel & Carbonell, 2006; Walker et al., 2004).

Treatment programs must have a clearly articulated model of change or theoretical approach that outlines both the underlying philosophy and method of intervention.

Another treatment model that appears promising for juvenile sex offenders is Multisystemic Therapy (MST) (Borduin & Schaeffer, 2002; Henggeler, Schoenwald, Borduin, Rowland, & Cunningham, 1998; Letourneau, Borduin, & Schaeffer, in press; Saldana et al., 2006). MST is a community–based model that targets multiple key influences (e.g., individual, family, peer, school) with the goals of improving family functioning, enhancing parenting skills, increasing positive peer involvement, improving school performance, and building upon community supports (Henggeler et al., 1998). An extensive body of research demonstrates its efficacy with justice–involved youth, not only with respect to reducing recidivism, but also in terms of increasing other positive outcomes for youth and their families (see Henggeler et al., 1998). Research suggests that using MST as the framework for intervention with juvenile sex offenders can yield similarly positive outcomes (see, e.g., Borduin, Henggeler, Blaske, & Stein, 1990; Borduin & Schaeffer, 2002; Gallagher, Wilson, Hirschfield, Coggeshall, & MacKenzie, 1999; Letourneau et al., in press; Reitzel & Carbonell, 2006).

Given the current available research, jurisdictions that are invested in implementing research–supported models of treatment are well–advised to use a cognitive–behavioral approach with adult sex offenders. And with juveniles, the contemporary literature indicates that employing either Multisystemic Therapy or cognitive–behavioral treatment is a logical choice (see, e.g., Reitzel & Carbonell, 2006; Walker et al., 2004).

Modes, Methods, and Targets

Most treatment programs for adult and juvenile sex offenders deliver interventions within a group setting (McGrath et al., 2003). Group treatment is advantageous for several reasons, not the least of which are resource and time efficiency. It also provides the opportunity for participants to embark on the change process with other individuals who can relate to them, increases their receptiveness to feedback because it comes from peers, allows for modeling and practicing positive skills with peers, and instills hope and self–efficacy through observing the progress and success of others (ATSA, 2005; Berenson & Underwood, 2000; Jennings & Sawyer, 2003; Marshall, Anderson, & Fernandez, 1999, Marshall et al., 2006b; NAPN, 1993; Sawyer, 2002; Schwartz, 1995). The following are key issues related to modes and methods of treatment.

While commonly used, group therapy also presents disadvantages. For example, even when groups are limited to an ideal size of 8–10 members, they offer only a limited amount of time for participants to address multiple needs and issues during each treatment encounter. Groups may also be suboptimal for participants with specific responsivity considerations such as cognitive impairments, varied learning styles, low motivation, or denial. The group setting is also not conducive to discussing sensitive issues or addressing family or marital difficulties. Finally, with juvenile sex offenders specifically, treatment providers must remain cognizant of the research on aggregating juveniles for intervention (see, e.g., Chaffin, 2006; Dodge et al., 2006; Hunter, 2006; Hunter et al., 2004b). In some instances, the strong negative peer influences that exist when juveniles are treated in group settings may mitigate or even nullify the potential benefits of intervention (Dodge et al., 2006).

Although most empirical examinations that demonstrate treatment effectiveness include programs with group therapy as a primary mode of treatment, the research does not suggest that group treatment alone is superior to other modes of specialized treatment for sex offenders (Lösel & Schmucker, 2005; Reitzel & Carbonell, 2006). Indeed, the success of MST and other family– and community–based interventions with juvenile sex offenders clearly indicates that the use of group therapy is not the only means of achieving positive outcomes.

For these and other reasons, treatment for adult and juvenile sex offenders should not be limited to a group modality. Rather, depending upon the needs and circumstances of each client, programs should also employ the following treatment modalities:

Indeed, in sex offender treatment programs throughout the country, the overwhelming majority of programs report using individual, couples, and family therapy (McGrath et al., 2003).

Primary Treatment Targets

Within the context of the principles of effective correctional intervention, the need principle states that recidivism is most likely to be reduced when interventions primarily target crime–producing or criminogenic needs (see, e.g., Andrews & Bonta, 2007). In order to maximize the likelihood that interventions will be effective for adult and juvenile sex offenders, therefore, treatment providers should focus their efforts on the changeable factors that are known to be associated with sexual recidivism (i.e., criminogenic needs). These dynamic factors are often identified through extensive research designed to identify the characteristics and factors that differentiate sexual recidivists from non–recidivists. This provides clinicians with insight into the kinds of factors that, if targeted in treatment, will significantly reduce reoffense potential. It also allows treatment providers to be aware of the types of factors that may not require a considerable investment of time and energy during the course of treatment, as they may not yield significant dividends in the long term.

Treatment providers should focus their efforts on the changeable factors that are known to be associated with sexual recidivism.

Current research indicates that the following clusters of dynamic risk factors are linked to sexual recidivism, and, therefore, are important targets of treatment for sex offenders (see, e.g., Hanson & Bussiere, 1998; Hanson & Harris, 2000, 2001; Hanson & Morton–Bourgon, 2005; Worling & Langstrom, 2006):

It should be noted that although these broader categories of dynamic risk factors are associated with sexual recidivism, not all of the individual variables that are or can be included in these categories are independently correlated with recidivism.

Other Common Targets of Treatment

Even though some dynamic factors do not predict long term recidivism, they may predispose an individual to begin sex offending (persistence factors versus initiation factors). Understandably then, many treatment programs address those variables. In addition, treatment programs focus on elements that can equip adult and juvenile sex offenders with the skills and competencies that will allow them to lead “good lives” (Mann, Webster, Schofield, & Marshall, 2004; Thakker, Ward, & Tidmarsh, 2006; Ward & Fischer, 2006; Ward & Stewart, 2003). These factors may not be directly linked to recidivism but will lead to improved quality of life, which is arguably an important goal of treatment.

Put simply, the emphasis on criminogenic needs provides the major thrust of intervention for sex offender treatment, but many current treatment programs also target non–criminogenic needs, including the following (Marshall et al., 2006b; McGrath et al., 2003; Rich, 2003; Worling, 2004):

Providers must keep in mind the research on the need principle, which reveals that when non–criminogenic needs outweigh criminogenic needs in treatment, the overall impact of the interventions is undermined significantly (Andrews & Bonta, 2007; Dowden & Andrews, 2000).

Special Considerations with Juvenile Sex Offenders

Treatment approaches and other management strategies designed for adults cannot simply be applied to juvenile sex offenders.

When treatment programs for juvenile sex offenders rapidly developed approximately two decades ago, they mirrored programs for adult sex offenders. This occurred primarily because the differences between adult and juvenile sex offenders were not fully understood and the assumption was made that adults and juveniles were alike in most ways (see, e.g., Bumby & Talbot, 2007; Chaffin, Letourneau, & Silovsky, 2002; Longo & Prescott, 2006). But because the period of adolescence is characterized by cognitive, emotional, social, moral, and biological processes that are qualitatively different from those in adulthood, the treatment approaches and other management strategies designed for adults cannot simply be applied to juvenile sex offenders (see, e.g., ATSA, 2000; Chaffin, et al., 2002; Fanniff & Becker, 2006; Letourneau & Miner, 2005). Over the past several years, researchers have begun to further illuminate characteristics and features that differentiate juvenile from adult sex offenders (Barbaree & Marshall, 2006; Caldwell, 2002; Fanniff & Becker, 2006; Hunter et al., 2003, 2004a; Knight, 2004; Miranda & Corcoran, 2000; Worling & Langstrom, 2006). More specifically, this research suggests that juveniles:

Moreover, the available evidence indicates that juvenile sex offenders may be more similar to other justice–involved juveniles than to adult  sex offenders, which means that treatment for juvenile sex offenders should take into account the broader juvenile delinquency research (Fanniff & Becker, 2006; Letourneau & Miner, 2005; Nisbet, Wilson, & Smallbone, 2004; Seto & Lalumiere, 2006; Smallbone, 2006). This has resulted in greater emphasis on and sensitivity to socio–ecological theories that recognize the multiple determinants of delinquent behavior (e.g., individual, family, peer, school, community) when approaching treatment for juvenile sex offenders (see, e.g., Borduin & Schaeffer, 2002; Longo & Prescott, 2006; Hunter et al., 2004b; Letourneau & Miner, 2005; Saldana et al., 2006).

To some extent, however, intervention targets addressed in “traditional” juvenile sex offender treatment programs will likely still resemble targets for adult sex offenders, because some of the risk factors believed to be associated with initiation and persistence for juveniles are similar to those for adult sex offenders (see, e.g., Bumby & Talbot, 2007; Prescott, 2006; Worling & Langstrom, 2006). The following are common targets of treatment currently employed in juvenile sex offender treatment programs throughout the country (McGrath et al., 2003):

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