WED, Oct 6 \ 11.30-13.30 \ Juveniles, I v

001
HOW TO ESTABLISH AND MAINTAIN SECURITY IN TREATMENT OF SEXUAL OFFENDERS

Friedemann Pfäfflin
President of IATSO
Professor of Forensic Psychotherapy, University of Ulm, Ulm, Germany
pfaeff@sip.medizin.uni-ulm.de

The prevailing slogan of sexual offender treatment presently is "control, no cure", indicating that public security is considered to be the utmost aim of sexual offender treatment. In the last decade, measures of security, e.g. more and longer prison sentences, indeterminate psychiatric institutionalization etc., were established in many countries. Thus, external control was enhanced. At the same time, treatment programs were improved, focusing on establishing and enhancing internal control. Programs focusing on criminogenic factors have proved to be very effective in reducing recidivism on a large scale. Yet there are offender groups, mainly with an antisocial personality disorder as a comorbidity, that do not respond as favorably as others. Educational programs are of great use, longlasting effects can, however, be improved when factors of cure identified in general psychotherapy research are additionally implemented in the treatment programs. Discouraging sexual abusive behavior while at the same time encouraging prosocial behavior, empathy and self-esteem of the offender and using his resources will contribute much to establishing and maintaining security.

002
THE INTEGRATION OF ETIOLOGY AND RISK IN SEXUAL OFFENDERS: A THEORETICAL FRAMEWORK

Leam Craig, England

In this paper we attempt to incorporate static and dynamic risk factors into an etiological framework. The major purpose in constructing the model is to link two related clinical domains in order to further both risk assessment and theory directed research. The literature on risk assessment is first outlined and problems in the way risk is measured and conceptualized noted. Next, four major etiological theories of sexual abuse are described in order to demonstrate the correspondence between risk domains and postulated causal mechanisms. Finally, the integrated model of risk and etiological elements, and its clinical and research utility is discussed. In this model the interaction between significant learning events, psychological vulnerabilities (as evidenced by historical and stable dynamic risk factors), contextual or triggering factors, and their convergence in offense related psychological states (i.e., acute dynamic factors) is clearly depicted.

003
ASSESSING RISK OF DANGEROUSNESS IN CHILDREN & ADOLESCENTS

Robert Alan Prentky, Ph.D.
Research Department, Justice Resource Institute, Bridgewater, USA
rprentky@jri.org

There has been relatively little attention to the problems of assessing risk among abuse-reactive, sexually coercive youth. Indeed, to the best of my knowledge, the only empirically validated scales that assess risk posed by sexually abusive youth are those of Jim Worling (ERASOR: Estimate of Risk of Adolescent Sexual Offender Recidivism) and Robert Prentky & Sue Righthand (J-SOAP-II: Juvenile-Sex Offender Assessment Protocol).
Developing valid risk assessment procedures with sexually abusive youth requires overcoming many challenging methodological problems, including, perhaps most importantly, the very low known base rate for sexual recidivism in adolescence which has made it impossible to examine the predictive validity of risk assessment scales such as the J-SOAP. In this talk, I will discuss some of the problems encountered by research in this new area of risk assessment, as well as updating recent progress on the J-SOAP-II by presenting the results from an ongoing research project that has been studying hundreds of sexually abusive children and adolescents. I will report findings from our most recent analyses on 600 children and juveniles. The early findings from this research suggests that existing knowledge about risk assessment with adolescent boys may offer significant insights into those factors that may work for adolescents girls and for pre-adolescents. Most importantly, behaviors that correlated with risk for both boys and girls included traditional outcome markers, such as the total number of victims of sexual abuse, the total number of incidents of sexual abuse, and the degree of violence as reflected by the Sexual Aggression scale. Overall, these findings have been very encouraging.

004
THE USE OF MULTISYSTEMIC THERAPY (MST) WITH JUVENILE SEX OFFENDERS

Elizabeth Jane Letourneau
Medical University of South Carolina, USA
Letourej@musc.edu

Two randomized clinical trials have been conducted comparing MST with usual services provided to adolescent sex offenders (Borduin et al., 1990; Borduin et al., 2001; Borduin & Schaeffer, in press). In the first study, 16 adolescents and their families were randomly assigned to home-based MST services or to outpatient individual therapy. Sexual recidivism (at 3-years post-treatment) for the MST group was 12.5% and for the individual therapy group was 75%. Recidivism for nonsexual offenses was 25% for MST and 50% for adolescents in the individual therapy condition. Borduin and his colleagues recently completed a larger study with a longer follow-up (Borduin et al., 2001; Borduin & Schaeffer, in press). Forty-eight juvenile sex offenders were randomly assigned to MST or “usual services” (e.g., individual or group therapy at local agencies, alternative schooling, curfew). At 8-year follow-up adolescents in the MST condition were less likely than their usual services counterparts to be arrested for sexual (12.5% vs. 41.7%) or nonsexual (29.2% vs. 62.5%) crimes and spent one third as many days incarcerated as adults.
Currently, a larger randomized clinical trial is being conducted that will examine the “real world” effectiveness of MST with juvenile sex offenders as compared to community-based sex offender treatment and other services normally provided to these youths. A description of this current study will be provided, along with adaptations to MST for use with juvenile sex offenders.

005
MAPPING THE INFLUENCE OF TRAUMA ON JUVENILE SEXUAL AGGRESSION

Joann Schladale M.S., L.M.F.T.
Resources for Resolving Violence, USA
schladale@aol.com

Research on juvenile sexual offending indicates both static and dynamic risk factors. Therapeutic exploration of these factors illuminates how family problems, violence, abuse, and developmental challenges influence harmful coping strategies. This presentation will focus on identifying traumatic experiences that influence sexually aggressive behavior and interventions to stop it.
Creating a model for mapping the trauma outcome process helps children make sense of painful life experiences and learn self-intervention techniques for harm reduction. This approach acknowledges ambivalence these youth have about getting into trouble versus staying out of trouble. Issues of power, control, connection and secrecy all play a part in mapping the influence of previous trauma on sexual aggression.
Research indicates that assessment of these children as heartless is incorrect (Groves, 2003). Knowledge of vulnerabilities arising from traumatic experience can inform intervention and streamline progress. A narrative approach that utilizes a life course perspective based upon theories of human and family ecology is applied to treatment for sexual aggression. This model takes into consideration factors influencing successful treatment outcomes in psychotherapy (Miller, Hubble, & Duncan) and integrates them into a holistic approach for healing from traumatic experiences. Children and adolescents learn to face painful experiences in ways that no longer cause harm.
References:
Burton. J., Rasmussen, L. et.al. (1998). Treating Children With Sexual Behavior Problems.
Groves, B. (2002). Children Who See Too Much.
Hubble, M., Duncan, B. & Miller, S. (1999). The Heart and Soul of Change: What Works in Therapy.
Jenkins, A. (1990). Invitations to Responsibility: The Therapeutic Engagement of Men
Who Are Violent And Abusive.
Schladale, J. (2002). The T.O.P.* Workbook for Taming Violence and Sexual Aggression.