A HOLISTIC & INTEGRATED MULTIDIMENSIONAL APPROACH TO
RESIDENTIAL TREATMENT FOR YOUTH
WHO HAVE
CAUSED SEXUAL HARM
New York ATSA, Turning Stone 2011
Howard B. Adler, LCSW
Harmony Ayers-Friedlander, LMHC
Hillside Family of Agencies
(www.Hillside.com)
Specialized Care Services
Mission
To provide exceptional services based upon
best practice and evidence-based research
dedicated to:
Stopping sexually harmful behavior
Healing and strengthening the lives of
children and families
Creating safer communities for everyone
Specialized Services Strategic Intent
To be the leader in translating research
into effective practice solutions for
youth who have caused sexual harm.
Whom do we serve?
 12 – 18 year old boys and their families
 History of sexually harmful behavior
 Youth non-adjudicated or adjudicated
 IQ of 65 and higher
Hillside Children’s Center, Varick Campus,
Specialized Program, Romulus, NY – 32 Beds
Snell Farm Children’s Center, Bath, NY - 28 Beds
Youth & Family Challenges
 Trauma history
 Self-regulation difficulties
 Co-morbid diagnoses
 Learning disabilities
 Impairments with school and social
functioning
 Poverty
The rapid advances in the study of sexually abusive
youth, although well meaning and praiseworthy, has
often narrowed our focus to elusive sexual aspects at
the expense of a full accounting of the youth's
development and ecology. While there is much in
youthful development to distract us from a clear
understanding of potential re-offense processes, we
can no longer allow adult programming to be the sole
source of assessing and treating young people.
Robert Longo & David Prescott
(Current Perspectives, 2006)
Youth Outcomes Include:
 Eliminate or significantly reduce risk of harmful sexual
behaviors
 Increase protective factors
 Reduce trauma symptoms
 Eliminate or significantly reduce aggressive behaviors
 Increase life skills
 Achieve service plan goals and objectives
 Connect to three significant people to support ongoing
development
 Improve academic performance
 Increase knowledge of sexual health
 Discharged to lower level of care
Family Outcomes Include:
 Develop and achieve service plan goals
 Commitment to proactive safety plan
 Gain access to community resources
 Increase coping skills and affect regulation
 Increase protective factors
 Restore relationships and hierarchy of roles
 Increase knowledge of sexual health
In summary, moving the Adolescent Sex Offender treatment
field in the direction of Evidenced Based Practice may require
rethinking several aspects of business as usual. First, it should
involve an honest appraisal of the level of evidence we have for
the effectiveness of our established and routine clinical
practices. It should involve coming to terms with the fact that,
currently, the best supported practice model is radically
different in its assumptions, theory and approach from our
established and routine clinical practices.
Mark Chaffin (Current Perspectives, 2006)
Program Foundation:
Empirically Based Best Practices
 Eight Elements That Influence Optimum
Child Development (The National Research Council
and Institute of Medicine (2002) Physical and psychological
safety)
 Best Practices of Youth Violence
Prevention (The United States Department of Health and
Human Services, Center For Disease Control, 2002)
 Four Factors That Influence Successful
Outcomes In Psychotherapy (Miller, Hubble &
Duncan, 1999)
 Attributes Of Resiliency
(Mary Pipher, 2002)
Empirically Based Interventions
 Positive Behavioral Interventions and Supports
[PBIS] (Sugai et al)
 Trauma Focused – Cognitive Behavior Therapy [TFCBT] (Cohen, Mannarino, & Deblinger)
 Aggression Replacement Training [ART] (Goldstein)
 Motivational Interviewing (Miller & Rollnick)
 Dialectical Behavioral Therapy [DBT] (Linehan)
A Collaborative Approach for
Treatment
•
•
•
•
•
Retributive: vs. Restorative:
Authoritarian
• Facilitative
Rigid protocol
• Self-determined pace
Imposed
• Collaborative
“Break denial”
• Empower strengths
Deficit focused
• Celebrate milestones
The New Milieu
 Physical & Psychological Safety
 High warmth, low criticism
 Trauma sensitive environment
 Highly collaborative
 Welcoming to families
 Mentoring
 Learning Environment
 Humor, joy and fun
Applied Behavior Analysis
Positive Behavior Intervention and
Supports
 Creating positive school and living
environments
 Using abundant praise and positive
reinforcement for useful skills and socially
appropriate behaviors.
 Using clear objective data to inform goal
development and progress.
 A scientific approach to understanding
behavior and how it is affected by the
environment
TREATMENT PHILOSOPHY
Healing occurs within the context of relationships.
All services are intended to Instill Hope and are:
Clinical Evaluations
Bio-Psycho-Sexual Eval (Specialized Care
Services Evaluation)
 Values, Beliefs& Attitudes about Sexuality
 Adolescent Sexual Behavior Inventories (Self & Parent)
 JSOAP-II
Psychological Assessment
 Millon Adolescent Clinical Inventory; Resiliency Scales for
Adolescents; Trauma Symptom Checklist for Children; etc.
Psychiatric Assessment
Treatment Approach
Clinical programming includes:
Individual therapy
Trauma Outcome Process (T.O.P.
*Workbook)
Family therapy
Group modalities: sexual health, life
skills, affect regulation, A.R.T.
Multi sensory modalities: art, pet, music,
movement, drama, and recreation therapy
Treatment Process
Adapted from Resources for Resolving Violence, Inc. (Joann Schladale)
Making Connections
It’s about welcoming, orienting, joining, & evaluating youth & family
The following is excerpts from a letter of Support demonstrating the
power of warm and empathic beginning.
To whom it may concern:
I am writing to you in reference to Snell Farm and how
my family feels about this agency……... I wanted a place that
could help my son. The staff there didn’t know me from Adam,
all they knew was the needs of my family and what I was looking
for. They listened and took time with me before being paid to
help. The compassion and kindness that was bestowed to me as
a stranger I couldn’t express correctly in words.
…….. This time in our lives is a struggle and a battle for my
family to get through but for the first time in a long time, I
don’t feel like we are going through it alone. I feel like Snell
Farm is there with us………..
Family Driven Practice
Family Group Decision Making (American Humane
Association):
 Engaging and calling together a family group
 Including family that may not be currently
connected and/or has been marginalized.
 Empower families to make decisions and plan for
youth to create safer communities
Another example is Child and Family Teams (CFT)
FAMILY FINDING
(Kevin Campbell)
A six-step model that establishes a
lifetime network for disconnected youth:
Youth have 40 family members identified.
Functional family members come together,
take responsibility, and develop realistic
plans for the youth’s safety and wellbeing.
Youth are placed permanently with family,
whenever possible.
Learning their family story mends youth’s
sense of disconnectedness.
Youth have a high likelihood of permanency
and wellbeing now and into adulthood.
Recognizing the Need for Help
It’s about taking responsibility through strength and courage.
T.O.P. Workbook* Chapter 1
helps kids begin to think about
how getting into trouble is
negatively impacting their lives,
dreams, and goals. Questions
help kids consider the need for
changing their current
behaviors through recognizing
things are not working well now
but through attention and
practice this can change.
Perhaps more importantly, this research can lead us
to viewing our clients' trauma histories and
attachment relationships as essential elements in
treating abusive behavior and developing pro-active,
preventive interventions that focus on addressing
trauma experiences and attachment disruptions in
young children.
Kevin Creeden (Current Perspectives, 2006)
Working Through Difficult Things that Happen in Life
It’s about honestly facing trauma that helps stop harmful behavior.
Working Through Difficult Things that Happen in Life
It’s about honestly facing trauma that helps stop harmful behavior.
Working Through Difficult Things that Happen in Life
It’s about honestly facing trauma that helps stop harmful behavior.
Trauma Focused – Cognitive
Behavioral Therapy
I.
II.
III.
IV.
V.
VI.
VII.
Psycho-education
Relaxation skills
Feelings Identification
Cognitive Restructuring
In vivo Desensitization
Parenting Skills
Safety Planning
Stopping Harmful Behavior
It’s learning that events, thoughts, feelings and beliefs effect behavior.
Context:
What situations trigger thoughts of violence and abuse? What do I think about myself & others at these
times? How do I start to think about causing harm in these situations? What can I do to tame thoughts
about destructive behavior in these situations?
Victim Selection:
Who did I think about harming? What did they look like & what other qualities do they have? What did I
imagine them to be like? What were my fantasies about them? What can I do to tame selection of
potential victims?
The Set Up & Harmful Behavior
How many people have I harmed through violence or sexual abuse? What were their names, ages, and
relationship to me? How did I gather information about the people I chose to abuse? How did I begin the
offense? What can I do to stop setting up others as potential victims? What did I think, and say to myself,
as I was-causing harm or abusing? What was the actual sequence of each offense? What were the details
of each separate offense? How was the victim reacting to the offense? What did I think and feel when it
was over? What am I doing to stop myself from behaving destructively?
Self-Intervention & Social Support
What specifically am I doing to stop being abusive? What specifically am I doing to manage pain without
causing harm? What fantasies do I have that are not abusive? Who might I ask for help in resigning from
my abusive lifestyle? How might they be helpful? What situations should I tell them about that are difficult
for me? What changes will they notice that indicate I am eliminating my pattern of abuse?
Stopping Harmful Behavior
It’s learning that events, thoughts, feelings and beliefs effect behavior.
Demon
Picture of the shame and guilt as a demon
holding him captive. This was a cathartic
process as he was able to release his
shame and confront the image.
Letting Go
Created directly following demon
drawing. Center image is of a woman
sharing or receiving a gift of light,
surrounded by images of loving / caring
interactions. Illustrates and confirms
change in understanding and being.
Restoring and Building Relationships
It’s about making amends, improving relationships and planning for safety & success.
The following are excerpts from a letter to child who was harmed by
sexual abuse
Hi Jamie,
This is your meeting and I can leave whenever you need me to if
you don’t like what I’m saying or it’s too hard to hear. I know it’s been a
long time since we’ve seen each other. I’m very glad that this day has
come. Thank you for allowing me this opportunity to talk with you. What
I did to you was not your fault. I take all the blame and responsibility
for what happened because it was my fault. You didn’t do anything wrong.
The reason why our family was separated was because of what I did and
had nothing to do with anything you did……….
……….. I lost your trust by sexually abusing you, and you might not like me
or believe in me anymore and I can understand why you would feel that
way. You might not want to be alone with me anymore either and that’s
ok too. You may not want to be alone with guys because you might be
afraid it would happen again or you might not trust them, and I am sorry
for that. My family might not trust me now either, and I know I have to
regain their trust back and repair what I have done.
Restoring and Building Relationships (Continued)
Creating a sand mandala as
a form of expressive
therapy, brought two
conflicted brothers into a
more healthy relationship
with each other. The
process of being in a circle
gave them permission to
just be together in a natural
way that disregarded old
barriers. It was a highly
intimate in the moment
experience, where they
allowed each other to be.
Living Your Plan
It’s about practicing new ways of responding & living what was learned.
Two players having a
conversation about the
“What Ifs” after treatment.
Player one: asking, “Will I
move on with my life after
treatment. Will I be the
same, will I change?”
Player two: responds, “You
need to move on and not
hold on to anger about
family. Need to let things
go.”
“I am going to promise to
treat family a lot better than
they treated me.”
Planning for Continued Success
It’s about demonstrating what was learned through ritual & ceremony.
Getting ready to leave soon, this youth created a "healthy place" as he saw it,
including another house he joined with his own, where his friends would live. He
also built a "stone garden and path" and "lemonade" sign, the side of the house
includes the images of his family…….
One of this child's strengths were his positive relationships with his same-aged
peers. He also liked the outdoors and as he transitioned home the old friends he
had in his neighborhood/ those relationships were important in grounding him in
health and appropriate socialization……
Aftercare Services
It’s about ending and transitioning back to the community with continued help
and support
Training & Consultation
 Specialized Care Model
 Life skills
 Aggression Replacement Training
 Mentoring
 TF-CBT
 Family therapy
 Family Meetings (Family Driven)
 Family Finding
 Applied Behavior Analysis
 Interactive Supervision
If you treat an individual as he is, he
will stay as he is, but if you treat him as if
he were what he ought to be and could be,
he will become what he
ought to be and could be.
Johann Wolfgang von Goethe