Multisystemic Treatment of Juvenile Sexual Offenders

Abstract

Multisystemic therapy (MST)is an ecologically-based treatment model that has proven effective with violent and chronic juvenile offenders and that holds promise with juvenile sexual offenders. This article describes the empirical underpinnings, theoretical foundation, and clinical features of MST and provides a brief review of MST outcome studies with juvenile sexual offenders. The theoretical foundation and clinical features of MST draw upon empirical findings regarding the multidetermined nature of serious antisocial behavior as well as upon social-ecological models of behavior in which the youth and family's school, work, peers, and neighborhood are viewed as interconnected systems with dynamic and reciprocal influences on the behavior of family members. In two randomized trials with juvenile sexual offenders, MST has had positive effects on key social-ecological factors (e.g., family affective relations, peer relations, school performance) associated with sexual offending and has demonstrated long-term reductions in criminal activity and incarceration. The success of MST can be attributed primarily to (a) the match between MST intervention foci and empirically identified correlates/causes of sexual offending in youths and (b) the flexible use of well-validated intervention strategies in the natural environment.     

Male Child Sexual Abuse: A Phenomenology of Betrayal

Being deeply understood relies on the ability of the social work clinician to have authentic and genuine empathy for their client. This phenomenological study sought to understand the lived experience of men sexually abused as boys in their childhood, and what life is like for them as sexual abuse survivors in adulthood. Analyses of fourteen male survivors’ narratives into the abuse they experienced as children, and the meaning they make of that experience today, offer insights for therapists. Findings suggest that therapists have a responsibility to ask male clients about sexual victimization, even when this is not the presenting problem but they exhibit sexual abuse related problems; an obligation to educate one’s self on responding therapeutically to disclosure; a duty to receive training to counsel sexually victimized males; a responsibility to advocate for the development of men’s services; and taking an active role in shifting attitudes towards men’s vulnerabilities.

Sexual Offending in Adolescence: A Comparison of Sibling Offenders and Nonsibling Offenders across Domains of Risk and Treatment Need

Sibling sexual offending has received limited empirical attention, despite estimates that approximately half of all adolescent-perpetrated sexual offenses involve a sibling victim. The present study addresses this gap by examining male adolescent sibling (n = 100) and nonsibling offenders (n = 66) with regard to maltreatment histories and scores on two adolescent risk/need assessment instruments, the ERASOR and YLS/CMI. Adolescents who sexually abused a sibling, versus a nonsibling, were more likely to have histories of sexual abuse and been exposed to domestic violence and pornography. There were no group differences on ERASOR and YLS/CMI scales. This study adds to the limited discourse on sibling sexual offending and the larger literature on the heterogeneity of adolescents who have sexually offended.     

Obstacles to Help-Seeking for Sexual Offenders: Implications for Prevention of Sexual Abuse

ABSTRACT

Persons with potentially harmful sexual interests such as attraction to minors are unlikely to seek or receive treatment before a sexual offense has been committed. The current study explored barriers to help-seeking in a sample of 372 individuals in treatment for sexual offending. Results revealed that the shame and secrecy resulting from stigma associated with pedophilic interests often prevented our respondents from seeking professional counseling, and only about 20% tried to talk to anyone about their sexual interests prior to their arrest. Barriers to seeking and receiving psychological services included concerns about confidentiality, fears of social and legal consequences, personal shame or confusion about the problem, affordability, and challenges finding competent therapists who were adequately equipped to help them. Understanding and ultimately reducing obstacles to help-seeking can improve the quality of life for people with harmful sexual interests and potentially prevent sexual abuse of children or other vulnerable individuals.     

Psychologists' Attitudes Toward Adult Male Survivors of Sexual Abuse

ABSTRACT

Psychologists' attitudes toward adult male sexual abuse survivors were explored. Psychologists (n = 154) read vignettes describing the sexual abuse of a male victim, then completed the Male Role Norm Scale, the Jackson Incest Blame Scale, a vignette response sheet, and a personal data sheet. Stepwise regression was used to analyze the data. Variables included characteristics of the psychologists, the perpetrator, and the victim. The psychologists' attitudes toward men, rather than the sex of the psychologists, predicted blaming attitudes. Victim responses, sexual abuse treatment experience, and the severity of abuse were also predictors. Practical suggestions for treatment are noted.     

Heterogeneity of Individuals with a History of Child Sexual Abuse: An Examination of Children Presenting to Treatment

The current study examined children and families who presented for treatment through Project SAFE (Sexual Abuse Family Education) following childhood sexual abuse. Pretreatment assessment data were used to develop clusters of participants with significantly differing presentation of symptom outcome following abuse. Four clusters were discovered: (a) a Highly Distressed group, whose members had clinically elevated scores on all self- and parent-report measures; (b) a Problem Behaviors group, whose members had scores within the normal range for self-report measures and elevated scores on all parent-report measures; (c) a Subclinical group, whose participants had scores below the mean and below cutoff scores for all self- and parent-report measures; and (d) a Self-reported Distress group, whose members had elevated scores on self-report measures and scores below clinical cutoffs for all parent-report measures.     

Group Treatment of Latency-Age Male Victims of Sexual Abuse

Researchers and clinicians across the country have documented increases in reports of sexual victimization of males. Awareness of the immediate and long-term needs of young male victims has highlighted the need for specialized, multi-modal treatment programs for these youngsters. Group therapy can be an important adjunct to individual and family unit therapy with this population. This article provides concrete suggestions for developing, implementing and evaluating a group therapy program for young male victims of sexual abuse. Specific areas addressed include: selection and preparation of group members; structure, phases, and salient tasks of the group; therapeutic group activities; co-leadership issues; managing transference and countertransference in the context of group; and, methods for evaluating the group's effectiveness.     

Personality Profiles of Adult Males Sexually Molested by Their Maternal Caregivers

Sexual abuse of males by female maternal caregivers is an underreported and little studied phenomenon. The present study examined two seemingly diverse groups of adult males who had been sexually abused as children by their female maternal caregiver: those in treatment at a clinic which specialized in working with sexual abuse survivors and those in treatment at a clinic which specialized in working with sexual offenders. This study suggests that the MMPI profiles of these two groups of adult males show greater psychological disruption than do the MMPI profiles of adult males who as children had not been vitimized by females or had been victimized by older males. Thus, treatment strategies may need to be formulated on the basis of the gender of the victimzer as well as on the gender of the victim.     

The Diagnostic Utility of the Child Sexual Behavior Inventory for Sexual Abuse: A Systematic Review

Children with alleged child sexual abuse (CSA) need to be assessed systematically. The use of validated instruments during the assessment, like the Child Sexual Behavior Inventory (CSBI), could add diagnostic value. We aim to assess the diagnostic utility of the CSBI to differentiate between sexually abused and non-abused children. We conducted a systematic review. We searched the electronic databases MEDLINE and PsychInfo for studies comparing CSBI scores in sexually abused children and non-abused children (2–12 years old). Two independent reviewers extracted data and assessed the methodological quality. We included 7 (out of 1048) articles. The CSBI total scores were significantly higher in CSA-victims compared with non-abused children (in case–control settings). However, in children with suspected CSA, the results were ambiguous. One study reported significant differences. Another study reported weak diagnostic ability for the CSBI-3 in children with suspected CSA (a sensitivity and specificity of 0.50, with a positive predictive value of 0.28, and a negative predictive value of 0.72). Research on the diagnostic utility of the CSBI for suspected CSA is limited and shows disappointing results. Until more research is done, the CSBI should not be used on its own to differentiate between sexually abused and non-abused children.     

Educator Sexual Abuse: Two Case Reports

Sexual abuse by educators has become an increasingly noted type of sexual abuse, especially among adolescents, for two reasons. First, there is a potential for these cases to be silent and prolonged and second, when disclosed, the forensic implications usually include both criminal and/or civil sanctions. For forensic case evaluations, developmental traumatology, or the intersection of the traumatic event(s) at a particular age of the student, is often the evaluating framework. We report on two forensic cases of a female student and a male student to emphasize the dynamics of adolescent sexual victimization, its impact on adolescent development, and evidence-based practice for symptom identification and treatment.     

Childhood Sexual Abuse and Brain Development: A Discussion of Associated Structural Changes and Negative Psychological Outcomes

The effects of traumatic exposure have been researched for many years and studies have shown that the parts of the brain affected by sexually traumatic experiences in childhood are also linked to many physical and psychological problems, such as depression, posttraumatic stress disorder, somatic complaints and suicide. Neuroimaging studies have provided a breadth of evidence that childhood sexual abuse is related to structural changes in the brain. Taken together, childhood sexual abuse affects brain development, leading to differences in brain anatomy and functioning that have lifelong consequences for mental health. Several limitations of neuroimaging research on childhood sexual abuse are discussed, including a lack of refined and sensitive neuroimaging measures and problems interpreting results of structural imaged subjects with associated psychiatric conditions. Future, large‐scale studies are warranted to examine the type and severity of the sexual abuse and how each of the levels of childhood sexual abuse contributes to structural and functional changes. Furthermore, future studies are needed to control for comorbid psychiatric conditions in order to disentangle the effects of childhood sexual abuse from psychiatric conditions that damage brain development. © 2018 John Wiley & Sons, Ltd.

‘Childhood sexual abuse affects brain development, leading to differences in brain anatomy and functioning that have lifelong consequences for mental health’

Key Practitioner Messages

• Childhood sexual abuse is linked to observable structural changes in the brain.
• These structural changes in the brain are associated with a myriad number of negative psychological effects.
• Research is limited in elucidating the role of childhood sexual abuse on brain development, as the bulk of the research has focused only broadly on child maltreatment.

     

Knowledge and Skills of Sexual Abuse Prevention: A Study on School-Aged Children in Beijing,China

To examine the level of child sexual abuse prevention knowledge and skills in a sample of school-aged children, a total of 559 children from first to fifth grade were recruited from one primary school in Beijing, China. Participants were asked to finish a questionnaire surveying their knowledge and skills of child sexual abuse prevention. Results showed that accurate rate of knowledge on child sexual abuse prevention were between 44.0% and 80.0%. Percentage of participants having applied the self-protection skills of “saying ‘no,’” “going away,” and “telling adults” properly in hypothetical situations was 57.4%, 28.3%, and 48.3%, respectively. Third-to-fifth graders had a better performance than first-to-second graders, and girls performed better than boys. Findings suggest that Chinese school-aged children are in need of knowledge and skills related to child sexual abuse prevention, and education programs should be developed as soon as possible.     

The Professionalization of Police in Child Sexual Abuse Cases

No abstract available for this article.     

The Prevalence of Child Sexual Abuse among Slovak Late Adolescents

ABSTRACT

The present study aimed to assess the prevalence and characteristics of child sexual abuse (CSA) in a large-scale sample of Slovak late adolescents. Randomized cluster sampling was used to sample 2186 students in their final school year of secondary school with mean age of 18.6 years (SD = .7 years). The study employed the Child Sexual Abuse Questionnaire consisting of multiple behavior-specific questions. The prevalence of CSA was analyzed separately for three clusters of CSA and gender. The prevalence of non-contact forms of CSA was 40.6% among girls and 17.7% among boys. CSA with physical contact without penetration was reported by 30.2% girls and 11.6% boys. The prevalence of CSA with penetration was 5.6% among girls and 1.3% among boys. More than half of CSA occurred between 16 and 18 years of age. The severity of abuse was positively associated with acquaintance to the perpetrator. Roughly 43–56% disclosed the abuse to another person. The majority of disclosed CSA was revealed to peers and partners. A negligible proportion of CSA instances were reported to the police. Prevention activities should consider a broad spectrum of CSA in order to counteract tendencies to associate CSA only with unwanted sexual intercourse.     

Estimating Age: College Males Versus Convicted Male Child Sex Offenders

Two samples, male college students and convicted male child sex offenders, are compared on their abilities to accurately estimate the age group of a series of photographs of a sole female ranging in age from 11 to 29. Both samples tend to overestimate the age group of the subject photos, and no significant difference was found between college students and convicted child sex offenders in their ability to estimate the age of females. Both groups are compared demographically, and only limited differences were found. The implications are discussed in regard to theory and prevention of child sexual abuse.     

Teacher Sexual Misconduct: Grooming Patterns and Female Offenders

Educator sexual misconduct has received increasing attention over the past decade. The attention has exposed a number of concerning issues, including a lack of formal research in the area and difficulties in recognizing and prosecuting cases. Public responses to high profile cases of sexual misconduct involving female teachers suggest that gender-biased views on sex offenders remain prominent in society. This article will review the literature on female teacher sexual misconduct in addition to what is known about grooming patterns and warning signs. Finally, current dilemmas in resolving cases of educator sexual misconduct will be discussed, and basic prevention strategies will be recommended.     

The Relationship between Knowledge and Child and Caregiver Distress during the Medical Examination for Child Sexual Abuse

When child sexual abuse is suspected, a child sexual abuse–related medical examination is recommended to ensure the child's well-being. While the extant research has sought to identify factors influencing child distress during this examination, only recently have studies began examining variables that may be directly associated with the child or with the medical setting. Knowledge of the child sexual abuse–related medical examination is one medical-related variable that has been implicated in child and caregiver distress during the examination. The current study contributes to the existing literature by investigating associations among examination knowledge in relation to caregiver and child anxiety at the time of a child sexual abuse–related medical examination, taking into account ethnicity, past child abuse, injury to child as result of abuse, and caregiver response to disclosure. Sixty-eight children and their nonoffending caregiver were assessed. Results indicated that understanding of the examination and caregiver response to disclosure were significantly associated with caregiver and child anxiety.     

The Frequency of False Allegations of Child Sexual Abuse: A Critical Review

The rate of false allegations has been a topic of research spanning back to as early as the 1970s. Studies have often relied on data gathered by Child Protective Services workers and court administrators. Some researchers have also used hypothetical scenarios to estimate rates. However, given the plethora of sampling methods, there is a large variation in estimated rates of false allegations of sexual abuse depending on the data source and context of the allegation. Additionally, methodological problems such as unclear or invalid criteria used to judge truth or falsity of an allegation, unrepresentative samples, and ignoring important contextual variables such as the stage at which an allegation is made, currently all render the determination of actual rates of false child sexual abuse allegations to be unknown. This examination of literature is intended to gain a firmer understanding of the frequency at which allegations are false and during which stage of prosecution they occur, thus assisting with the legal practice of distinguishing between a false versus positive allegation. Research reviewed supports two general conclusions: (a) the vast majority of allegations are true but (b) false allegations do occur at some non-negligible rate. Suggestions for future research, as well as cautions about claims about specific rates of false allegations in the courtroom, are provided.     

Evaluating Allegations of Child Sexual Abuse Within Complex Child Custody Cases

SUMMARY

This article provides a framework for identifying and assembling the interdependent elements of a child custody evaluation with allegations of child sexual abuse. The identification of several myths regarding child sexual abuse (CSA) introduces the subject matter of this article. A forensic evaluation model (Heilbrun, 2001) is then used to organize the custody evaluator's tasks into the following sequential classifications: (a) preparation; (b) data collection; (c) data interpretation; and (d) communication of results. Through this model, the entwined tasks of evaluating the child's needs and the parents' capacities to meet the child's needs, while simultaneously examining the question of child sexual abuse, are addressed.