Section 4: Treatment
You may be surprised to learn that juvenile sex offender treatment is—relatively speaking—a new area of focus within juvenile justice. In fact, as we mentioned earlier during the training, it was not all that long ago that some behaviors which we would now consider to be sexually abusive were chalked up to being “just a phase” or were excused with a “boys will be boys” way of thinking.
And because these youth were not receiving much attention in the field, only a handful of specialized treatment programs existed for them. In fact, it has been reported that in the early 1980s, there were only 20 identified programs for treating juvenile sex offenders.1 That’s pretty amazing, isn’t it?
Once professionals’ attention to juvenile sex offenders began to increase, however, the number of treatment programs for these youth increased dramatically.
So when the Safer Society Foundation began to formally survey programs across the nation a few years later—in 1986—there were nearly 350 juvenile sex offender treatment programs.2 And over the past several years, the number of programs providing treatment for juvenile sex offenders has continued to grow. The most recent survey indicates that there are now well over 900 juvenile sex offender programs across the country!3
As you can see, most of these treatment programs for youth are community–based, although there are a sizable number of residential or institutional treatment programs as well. Together, these programs provided treatment to nearly 20,000 sexually abusive youth during the year that they were surveyed.4 It is interesting to note, however, that although residential settings accounted for only about one–fourth of all of the juvenile sex offender treatment programs, nearly half of those 20,000 youth were treated in those residential programs!
Certainly, we know that not all juvenile sex offenders need to be sent to a residential or institutional setting to receive treatment, but we also know that not all youth can be safely treated in the community. But how do we determine which youth should be treated in a residential program, and which can be allowed to remain in the community?
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That’s right—many factors must be considered when making that determination. Remember, juveniles who commit sex offenses are a diverse and heterogeneous population. Some youth pose a greater risk than others, some youth have more treatment needs than others, some youth are more amenable to treatment than others, and some youth may have families that are more supportive and stable than others.
This highlights, once again, that because juvenile sex offenders are not all alike, assessments are very important for making informed decisions. And in this particular context, it is important that the individual risks and needs of each youth are assessed in order to make the most appropriate decision about the type of treatment setting that the youth needs and that will allow for victim and community safety. Remember, one size does not fit all!
To illustrate, a youth who evidences considerable behavioral disturbances or aggression, demonstrates longstanding or chronic patterns of sexual deviance, resides in a chaotic home environment, and has considerable treatment needs may be best served in a residential program. And if the youth suffers from significant mental health symptoms that cause him to be a danger to himself or others, an inpatient psychiatric setting may be warranted.
Conversely, a juvenile who seems to be more stable overall, has a supportive and structured home environment, has demonstrated a limited number of sexual behavior problems, and is motivated to change will probably be considered appropriate for treatment in the community.
What this means is that treatment services for juvenile sex offenders should be available along a continuum, with community–based services on one end, and residential or even institutional or correctional treatment programs on the other end. Where any individual youth receives treatment—and the kinds of interventions that are used—should be based on the level of risk and needs of that youth. In addition, a youth’s placement along that continuum of care may change over time, as his or her circumstances change, either for the better or for the worse.
For example, if a youth is placed in the community, but continues to have difficulty managing his behaviors and community safety is compromised considerably, then he may require a more restrictive or structured setting. On the other hand, when a youth who is initially placed in a residential program progresses in treatment, and the family needs are addressed sufficiently, it may be appropriate to allow him to return home to continue in treatment in the community.
As always, there are pros and cons for these alternatives. What are some advantages of providing sex offender treatment in a community–based program?
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Yes, community–based treatment has a number of benefits. It allows a youth to remain with or close to home and family, continue attending school locally, develop or maintain prosocial peer relationships, and practice skills and competencies in his or her natural environment. And it is oftentimes less costly to provide community–based services.
But, there may be some “down sides” to community–based treatment as well. For example, in community settings, treatment may only be offered once or twice per week—so it tends to be less intensive. In addition, some youth who remain in the community may still have access to victims, or may be more vulnerable to high risk situations, and therefore cannot be safely managed within a community treatment context.
And in some instances, certain stakeholders’ expectations for accountability, punishment, and community protection may not be fully met when the youth remains in the community and is not receiving intensive interventions.
Residential or Institutional Treatment
Some of the concerns with community–based treatment can be addressed through the availability of residential or institutional programming for juvenile sex offenders.
Residential programs can provide a unique opportunity for youth to be “immersed” in more intensive treatment services and to be exposed to a therapeutic milieu around the clock. In addition, for youth who pose a danger to themselves or others, the structured—and sometimes secure—environment provides for victim and community safety, and ensures that the youth is accountable at all times.
And for youth who have demonstrated an unwillingness to comply with treatment and supervision expectations in the community, placement in a residential or institutional setting can send a strong message to them and to others about the seriousness of the behavior, while still offering them the opportunity to address treatment needs that can ultimately allow them to return to the community.
What are some of the “down sides” of institutional or residential treatment?
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Yes, just as there are pros, there are also cons. On the negative side, residential and institutional programs are generally costly than community–based services. And removing a youth from the community can be very disruptive, particularly when the youth is separated from potential positive community influences and roles within the family and school. In addition, there is a significant potential for these youth to be exposed to more deviant peers, which may impact their own development, progress, and adjustment, and which may actually undermine some of the benefits of residential treatment.5
Indeed, there is research indicating that in some circumstances, when youth are placed with other delinquent peers for the purposes of intervention, outcomes may be poorer and they may be more prone to recidivism.6 This is a result of what has been termed “deviancy training,” which can be so strong that it negates the potential positive impact of the treatment interventions. Overall, these findings may not be particularly surprising, given the broader body of research showing that youth who associate with negative or delinquent peers tend to continue getting into trouble over time.7
The potential for deviancy training in residential or institutional programs is a current concern in the field of juvenile justice overall—and in the juvenile sex offender management field specifically—which has led some professionals to question the common use of these types of placements for some youthful offenders.8 In fact, because of the potential negative impact of aggregating youth for the purposes of intervention, some professionals may even have reservations about the usual practice of providing sex offender treatment to juveniles in a group context—regardless of whether it is in a residential or community setting. On the other hand, much of the research, albeit not well controlled research, that demonstrates positive outcomes from juvenile sex offender treatment has typically included programs that used a group modality.9
Presently, there is no “answer” to this controversy, and only further research will help provide more guidance for practitioners. Suffice it to say that the potential for deviancy training should be considered when implementing treatment programs and reviewing placement options for youth.
One could speculate that deviancy training and the associated negative outcomes may be more likely to occur when there is no rehabilitative focus within the juvenile justice setting. In other words, simply “locking up” these youth with other delinquent or violent youth may be especially problematic. And we have concrete evidence that more punitive approaches—particularly absent any rehabilitative efforts—are not likely to lead to the desired results with youth in the juvenile or criminal justice system.10
This is a perfect lead into our next topic—the shifting philosophies within the juvenile justice arena that have occurred over time.