Assessment, Treatment, and
Supervision of Youth who have
caused sexual harm by:
Tom Hall LISW
Bryce Pittenger, LPCC
Overview of field: Old Paradigm
• Those—especially males--who have been
sexually abused are going to become offenders.
• “Once an offender, always an offender.”
• Offenders—including children and adolescents-do not respond positively to treatment.
• Only solution is to “lock them up and throw away
the key.” Only other solution is castration.
• If male and acts out with same sex, must be
Old Paradigm
• Must come from highly dysfunctional
• There is no specific family profile. No
unique family pattern has been identified
The characteristics of are diverse and may
or may not be considered dysfunctional.
Old Paradigm
• Were sexually molested as children.
– Many were not sexually victimized as children.
• Will become adult sexual offenders.
– Current research shows that the sexual re-offense
rate for those who receive treatment is low in most US
settings. Studies suggest that the rates of sexual reoffense (5 – 14%) are substantially lower than the
rates for other delinquent behavior (8 – 58%).
Research proves…
• In fact, the risk of child or juvenile reoffending
once they have had treatment is lower than the
risk of sexual harm by children or juveniles who
have not acted out.
• They are just as likely to become victims as they
are to reoffend.
• In one study, seven percent of those adjudicated
for sexual offenses reoffended and six percent of
those not adjudicated committed sex offenses.
Research proves…
• Another study showed that 85% of all
future sex offenses will be committed by
children & adolescents not identified as
sex offenders.
• Another misconception involves the
concept of specialness, meaning that this
population is so difficult to deal with that
only those certified to work with sex
offenders should do so.
Old Paradigm
• These youth are similar in most ways to
adult sex offenders.
– They are different from adult sex offenders in
that they have lower recidivism rates, engage
in fewer abusive behaviors over shorter
periods of time, and have less aggressive
sexual behavior.
Research proves…
• Juveniles are also, obviously,
developmentally different than adults.
– They are different from adult sex offenders in
that they have lower recidivism rates, engage
in fewer abusive behaviors over shorter
periods of time, and have less aggressive
sexual behavior.
– Brains are still developing. It is thought that
the male brain is fully developed by the age of
Research proves…
• The vast majority of individuals who have
been abused DO NOT go on to cause
sexual harm.
• The vast majority of youth do respond to
treatment and do not go on to cause more
sexual harm.
• Interestingly, these youth are at high risk
to commit conduct-type offenses.
Current research…
• The home is the most violent place in America.
• Trauma—including physical, sexual, and
emotional abuse, and neglect has profound
immediate and long term effects upon a child’s
development, including attachment difficulties,
self-esteem, academic problems, poor peer
relationships, anger, developmental delays, and
increased dependency.
Current research…
• Abuse definitely effects whether or not a
person sexually offends. But to what
degree, we do not know.
• The children who are both abused and
witness abuse—particularly domestic
violence--generally have the biggest
Current research…
• Certain research has revealed that:
– Witnessing domestic violence and
experiencing significant physical abuse
combined with neglect may put an individual
at higher risk to sexually offend.
– Domestic violence is showing to be one of the
key factors in sexual offending behavior.
Current research…
• Empirically Supported Risk Factors—
Deviant sexual interest;
prior criminal sanctions for sexual offending;
sexual offending against more than one victim;
sexual offending against a stranger;
social isolation;
uncompleted sex offense specific tx.
Current research…
• Promising Risk Factors—
• Problematic parent-adolescent
• Attitudes supportive of sexual offending.
Current research…
Possible Risk Factors:
High stress family environment;
Antisocial interpersonal orientation;
Interpersonal aggression;
Negative peer associations;
Current research…
Sexual preoccupation;
Sexual offending against a male victim
Sexual offending against a child;
Threats, violence, or weapons in sexual
• Environment supporting reoffending.
Assessment domains
• A comprehensive psycho-social assessment
AND psycho-sexual elements including:
• Development of sexuality-roles (e.g., normal,
problematic, age-appropriate knowledge)
• Development of healthy sexuality
• Inappropriately sexualized environment, (e.g.,
pornography, extreme/unusual family norms,
boundaries, or values)
Assessment elements: offense
Youth’s version
Victim’s version
Family version or level of belief
Other witness(s)’ version(s)
Age and gender of victim, and relationship of victim to youth
Evidence of a planned approach to offending behavior
Use of coercion, threats
Use of force
Attitudes and beliefs about gender roles, children, sexuality, etc
Denial, minimization, rationalization, etc
Empathy for and understanding of the impact on victim
Purposeful behavior to circumvent monitoring and supervision
Extent of obsessive thoughts and behaviors regarding sexuality
Level of supervision at the time of the event
Consequences to the youth following the event
Assessment elements: Static
(historical) risk factors
Heritable characteristics
Fetal insults/infections/conditions
Condition at birth
Permanent disability
Family of origin / culture
Developmental differences
Early experiences with caregivers / caregiver instability
History of criminal charges.
Prior allegations of sexual harm
Sexual or physical abuse or exploitation
Exposure to domestic violence
• Exposure to pornography or adult sexual activity
Assessment Elements: Stable risk
factors (lifespan, less changeable)
Conscience: moral development
Ability to empathize
Intellectual potential
Communication ability
Physical attributes
Heritable neurological characteristics
Traumatic Brain Injury
Assessment elements: Dynamic
risk factors (changeable)
Level of supervision across situations
Communication and social skills
Problem solving skills
Stability of youth’s living environment/family
Nature of sexual thoughts and how thoughts are
Thoughts, feelings, and behavior
Self perceptions
Impact of traumatic experiences (PTSD)
Sexualized environment
Witness to domestic violence/marital dischord
What is normal?
• Development sexuality
• Age appropriate knowledge and
• Of sexual touch, gender roles, and biology
• Ecological pond: what are our kids
exposed too>
Ecological Pond
Onset of puberty*
1900 --
15 ?
14 - 15
1925 --
1960 --
1980 --
20 ???
2000 --
10 - 11
20 +++
* Female menses;
Socio-economic maturity**
** Skills to be successful ‘adult’
Yeah, we know about sexual development and hormones,
But what’s going on in the brain ?
Second onslaught of Rapid growth and pruning
New cells and neural pathway……....
Period of less stability and more impulsivity………
Moody, unpredictable, ……..mistakes are made !
Reconstruction designed to accomplish what it is being used for
(for better or worse)……...
Evaluating behavior
Is it a Problem?
If so . . . . .
What Kind of Problem?
Sexual behavior might be a
problem for many reasons…
It might be a problem for the person who is doing it…
because it puts the person at risk in some way:
(health, reproduction, exploitation, stigma, illegal,lowers self image or
It might be a problem for others…
because it makes them uncomfortable; violates norms,
standards, or values; breaks rules or regulations.
OR, it might be a problem because it is
abusive and/or illegal…
These are very different problems !
….but knowing the kind of problem helps identify reasonable
Defining Abusive Behavior
Consent vs. Cooperation - Compliance
Power - Control - Authority
Pressure -- Threat --
Universal goals…
• Communication: Express thoughts, feelings and needs
• Empathy: Identify, interpret & validate
emotions and needs of self and others
• Accountability: Accurate attributions of responsibility
• Emotion Regulation: ‘handle’ emotional states without
engaging in harmful behaviors to self or others
• Increase Protective factors: Skill building where
deficits, family functional strengths, individual functional
strengths, environmental functional strengths
Sexual abuse by youth…
56 – 57% of Sexual Abuse of Boys
15 – 25% of Sexual Abuse of Girls
of Male Population
5 – 7% of Female Population
Normal sexual behavior 14 to 18
Explicit Conversation with Peers
Obscenities / Jokes
Innuendo / Flirting
Erotic Interest / Masturbation
Courtship / Hugging / Kissing
6. * Foreplay (petting)
7. * Mutual Masturbation
8. ** Monogamist Intercourse (Stable or Serial **)
Needs intervention…
1. Preoccupation / Anxiety re Sexuality
Pornographic Interest
Polygamist Behavior ***
Sexually Aggressive Themes / Obscenities
Graffiti (Chronic / Targeting individuals)
6. Embarrassing others
7. Violating Body Space / Boundaries
8. Single Occurrences: Peeping, Exposing, Frottage with
Known Age-mates
9. Mooning / Obscene Gestures ****
Needs intervention…
1. Compulsive Masturbation
2. Degradation / Humiliation
3. Attempting to Expose Others
4. Sexually Aggressive Pornography
5. Sexual Conversation / Contact with
Significantly Younger
6. Grabbing, Goosing
7. Explicit Sexual Threats
Illegal behaviors…
1. Sexual Abuse, Molest, Harrassment
2. Obscene Calls
3. Voyeurism
4. Exhibitionism
5. Frottage
6. Child Sexual Abuse
7. Rape
8. Bestiality
Core elements of Specialized
treatment approach
Research informs practice. These treatment
principles are based on the current research in
the field.
Treatment needs to reflect the individualized
needs of the youth and family including any cooccurring mental, behavioral, or substance
abuse disorders.
Sound core treatment components are
reflective of a comprehensive assessment.
Treatment elements are tailored to a youth’s
cognitive ability, experience, and
developmental stage
Treatment elements
• Psycho-education of youth and families
including but not limited to: laws governing
sexual behavior in New Mexico, identification of
sexually inappropriate or abusive behaviors,
elements of consensual sexual behavior, neurobiological effects of trauma and attachment
disruptions, components of healthy relationships
(sexual and non-sexual), considerations with
regard to pornography, and human sexuality
Treatment elements
• Building of Core Competencies through skills and
strengths identification and practice. To increase
overall mental, emotional, relational, spiritual,
cognitive, and sexual health.
• Multi-sensorial and experiential exercises.
• Management of static or stable risks.
• Individualized target goals for dynamic risks and
skill deficits.
Safety Planning
There are three different functions of
safety plans:
1) To address the safety and well-being of
the youth in relation to self harm;
2) To address the safety and well-being of
the youth in relation to harm by others;
3) To address the safety and well-being of
others in relation to the youth.
What is a sexually abusive
• Defining sexually abusive behavior:
– Lack of Consent
– Lack of Equality
– Coercion
• The age of consent is 14 in NM.
Therefore, anyone under the age of 14
cannot legally give consent.
Risk factors for recidivism
• Factors that indicate risk for recidivism by youth:
– History of multiple offenses, especially after adequate
– History of repeated non-sexual offenses.
– Clear and persistent sexual interest in children.
– Failure to comply with sex offense specific tx.
– Self-evident disturbances of arousal and
– Verbal threats of intent to reoffend.
– Parental/guardian resistance to adequate supervision.
Use of Polygraph
The use of polygraph raises
ethically sensitive questions and
concerns-especially when this practice is
used with minors
Treatment providers and juvenile justice authorities
can and should collaborate on cases but providers need
to remain mindful that it is never their role to
investigate, catch, prosecute, judge, or punish.
Treatment providers need to continually remind
themselves of what their treatment goals are.
“It is less than responsible when a field embraces
unusual, coercive, and intrusive practices with minors
without simultaneously undertaking the rigorous testing
needed to judge whether intended benefits actually
How do we teach responsible, caring, non-coercive
behaviors if we cannot model that ourselves?
Specialized Probation
Specialized Probation agreement
Collaborative team effort
Safety planning

Tom Hall LISW and Bryce Pittenger, LPCC