The literature on juvenile sex offend ers focuses on gen - eral treatment strategies. For a more complete understanding and, thus, successful intervention in the development of paraphilias and antisocial sexual disorders, program strategies must be evaluated in terms of their effect on the client post-treatment. This report looks at the long-term results of a residential correctional program for juvenile sex offenders. The results for sexual reoffense are heartening; 94% of the program's released clients have not been convicted of a subsequent sexual offense. The underlying agent of change, according to the released clients themselves, is the way the program operates. Although we clearly need to address specific issues of content and treat individual disorders (eg, depression), the findings here reaffirm the critical nature of the therapeutic relationship.
From life history accounts and interviews of adult sex offenders (and victims of sexual abuse) we have learned that most adult offenders committed their first offense during early adolescence. Groth, Longo, and Mc Fa din1 report that 60% to 80% of adult sex offenders begin their offending pattern during adolescence. In Minnesota, a survey of adults incarcerated for sexual offenses found that 80% to 90%. committed their first sexual offense between 13 and 15 years of age (M. O'Brien, personal communication, 1981). Studies of these adult sex offenders report an average of over 380 victims.1-2 Two studies of child victims of sex crimes3,4 report that over 50% of male victims and 20% of female victims suffer at the hands of adolescents. Symptoms of these developing paraphuias and related disorders are typically identified only when a youth has harmed another person and comes to the attention of the courts or social service agencies. Given the potential pool of adult sex offenders these juveniles represent, it is a social imperative to intervene.
Placement of these youth in residential and community-based sex offender specific programs enables mental health professionals to intervene at an early stage with these developing paraphilias. Specialized programs offer a unique opportunity to observe the initial stages with paraphilias and related disorders. They also provide an environment to implement methods of treatment designed to redirect their aberrant sexual behavior.
The number of youth exhibiting aberrant sexual behavior is notable. Nationally there are currently over 200 residential and almost 500 community-based programs specifically for juvenile sexual offenders.5 These programs account for most youth who have been identified as committing a sexual offense. The residential programs contain the more serious juvenile sex offenders: those who have already committed more than one offense, those who could not be successfully treated in a community setting, and those whose offense defines them as a substantial public safety risk. The proliferation of residential programs (from nine to more than 200 in less than a decade) requires an examination of the effectiveness of such programs. This examination must go beyond short-term sexual recidivism rates, investigating the long-term impact of sex offender programs on the individual.
Only a few studies are available on the success of community-based adolescent sex offender programs, Smith and Monastersky6 found 14.3% of their 112 subjects reoffended within a period of 17 to 49 months. Knopp5 reports on two other community-based recidivism studies: one of program completers with a 6% recidivism rate (M. O'Brien, personal communication, 1990), and one with 9.2% recidivism of 69 cases 12 to 30 months postrelease.7 The only available report on recidivism postrelease from a residential program was cited by Knopp.8 Of 80 cases from one facility, 5% committed a subsequent sexual offense.
The paucity of data on this population is notable. Given the willingness of our society to respond to the problem of early aberrant and abusive sexual behavior, as witnessed by the enormous growth of programs, an equal effort must be directed at defining and refining effective interventions. The approach taken in this follow-up study is twofold. It investigates the traditional rate of recidivism. The unique and salient aspect of this follow-up addresses self-reported sexual reoffending and the impact of the program on the youth's lifestyle post-treatment. Since denial and secrecy are critical dynamics for youth engaging in aberrant sexual practices,4 recidivism (conviction post- treatment) alone cannot be prima facie evidence of success. Self-reported reoffense rates have not been investigated, as it is assumed that they would be notably less accurate due to underreporting. However, we must begin to assess the validity of self-report in this field, The study presented here gathered self-report reoffense and program impact data through direct contact with the study population.
SETTING OF THE PROJECT
The Juvenile Sex Offender Program (JSOP) at the Hennepin County Home School is an intensive program designed to intervene with the serious juvenile sex offender. The program was developed over a decade ago and is active in setting guidelines for programming nationally and internationally.10 The general format and content of the JSOP follow the guidelines set by the National Task Force on Juvenile Sexual Offending.'1 The preliminary report published by this group is based on consensus of 40 experienced professionals in the field, including representation from the Home School program itself. The primary therapeutic modality is group work. Family involvement on an ongoing basis throughout the program is essential. Confidentiality between groups (within a living unit) and other therapeutic sessions (family, individual, etc.) is waived. This nontraditional approach is necessary to overcome the denial and secrecy with which aberrant sexual behavior patterns develop.
Five content areas are addressed with all residents of the program.'1 These five areas are categorized as follows: personal accountability, life history, personal victimization, sexual assault cycle, and victim empathy. They are approached in the progra m in the order d escribed here. It must be noted, however, that issues related to any of these content areas may arise or be revisited at any point in the program. Where and how these areas are addressed depends on the needs of the individual rather than a set of "program steps."
These youth arc deficient in their sense of personal accountability. Thcy must learn to take responsibility for their actions. This is achieved by getting the youth to take responsibility for the commitment offense (behavior for which they were adjudicated and referred). Ty pical Jy, each youth moves through a process of denial to minimization and justification prior to understanding the choice he made to commit a sexual offense.
There is a strong defense against their own life experience. In order to accurately assess individual needs, develop a reality-based relationship, and provide the youth with a framework for understanding his aberrant sexual behavior, staff have each youth work through a detailed life history. The life history focuses on sexual development and aggression, It is necessary to distinguish tor the youth those experiences that are typical versus those that are atypical. It is also necessary to clarify those experiences in which the youth was the initiator versus the recipient.
With the serious juvenile sex offender, a history of acute and/or chronic trauma is evident. This may be a part of the case record or it may emerge during the life history-taking. Unresolved childhood trauma blocks the youth from developing a healthy attachment to adults and from developing an internalized sense of personal accountability The trauma is not necessari Jy related linearìy to the youth's own aberrant behavior, therefore care must be taken not to underrate the reporting of the youth. Resolving these traumatic experiences enables the youth to move through them and redirect himself toward a normative developmental pathway.
Resolution of trauma is not sufficient to change a preferential behavior pattern. Due to the inherently pleasurable aspect of sexuality and the durability of paraphilias, cognitive-behavioral intervention is a significant aid to developing a nonabusive sexual lifestyle. Each youth can define a sexual assault cycle with concrete interventions for each step in the cycle. The sexual assault cycle is a generalized cycle deveioped from similarities across the youth's aberrant behavior events. The sexual assault cycle includes the feelings, thoughts, and behaviors before, during, and after offenses. Interventions for the cycle are practiced within the treatment setting.
Presentation of the victim's perspective promotes the development of empathy. When it can be achieved, victim reconciliation is recommended. This must always be arranged according to the mandate of the victim. Victim-sensitive therapy is a cogent reminder that work with the offender is always done in the first instance to make reparation to the victim. This essential orientation to the other rather than self underlies all work with the offender.
The process with which the program achieves its goal is a twofold one of safety and security. The program's dual function is to: 1) provide public safety by isolating the youth from the community until he can gain behavioral control, and 2) provide security for the youth to take therapeutic risks. This environment allows the development of a meaningful, prosocial child-adult attachment. It is only through both these functions that functional socialization occurs. Providing only public safety overemphasizes dependency and, thus, a maladaptive attachment. Providing only personal security overemphasizes independence and, thus, a maladaptive attachment.
The Hennepin County Home School's Juvenile Sex Offender Program consists of two 24-hed cottages on the grounds of a sevencottage, 168-bed institution. All youth accepted into the JSOP are adjudicated delinquent. Residents come from all over the country, with half the beds reserved for local county referrals. Because laws vary widely from jurisdiction to jurisdiction, a decision to define categories of offender was based on previous categorizations in the literature.12 Three categories were defined: child molesters (victim younger than 13 years), sexual aggressors (victim older than 13 years), and non-touch offenders (offenses involving window-peeping, indecent exposure, etc.). All youth are committed by juvenile courts, therefore distributions of race and socioeconomic status are not expected to reflect those of the population at large. Each resident entering the iSOP has an individualized treatment plan. In addition, all followthe sex offender specific treatment components described above.
All residents of the program released from its inception until January 1991 were identified. The first official release from the JSOP was in April 1982. There were 285 residents released between these dates. Criminal record checks (Bureau of Criminal Apprehension records, Hennepin County Juvenile Family Tracking System, and Subjects in Process System) and descriptive variables were collected for the entire population. Data were collected on a direct contact protocol designed in the form of a questionnaire that was either completed by the phone interviewer or by the subject himself by mail. These data were compared to the records check information for the contact population.
Five descriptive variables were collected from the JSOP files. These included: length of stay (LOS), intake age, offense category, length at risk (LAR; time since release) and race. Two variables collected on the direct contact protocol are reported here: self-report of sexual reorfending and positive program elements.
Intake Age Distribution
Residential Stay Length
Time from Release to Follow-up
The subjects were 285 youths released between April 1982 and January 1991. Characteristics of the subjects can be seen in Tables 1 and 2. The majority of youth entered the program at ?4 to 1 6 years of age (64.4%). A significant minority were 17 years old at intake. Overall, the majority of youth in the JSOP are white (70.5%). A significant number are black (22.4ffi ). Other minorities represent only 5.7% of the tota! released population. Of the 285 youths released, 71% (201) were child molesters, 27% (76) were sexual aggressors, and 2% (8) were non-touch offenders.
Of the released subjects, 92%. had been adjudicated on a sexual offense, with the specific definition dependent on the local jurisdiction (court of origin). The 8% who had been adjudicated on non-sexrelated charges had sexual offenses on record. The length of stay in the ]SOP ranged from less than 30 days to 30 months (Table 3). The majority of the subjects were in the program between 7 and 12 months (55.9%). The length at risk of the subjects ranged from leys than six months to 102 months (Table 4). Fifty-two percent had been released between two and six years.
Of the 285 subjects available, 193 (70%) were located for the sample population. A comparison of the sample to the subject pool indicates that the sample accurately represents the entire group of released residents (Table 5).
Recidivism and Reoffense Rates
Based on sexual offense convictions, a 6% recidivism rate was found for the sample. The selfreport sexual reoffense rate was 11%, which is notably higher than the recidivism rate. Table 6 summarizes the sexually abusive behavior post-treatment. Due to the low numbers, no statistical comparisons can be made between these two subgroups and the nonsexually abusive post-treatment group.
There were 15 total different cases of sexually abusive behavior post-treatment. This indicates that only three of lhe self-report incidents were not also convictions. Three of the reoffenses were committed by youths who spent less than six months in the program. This is 11% of the total number of the sample who had been in the program less than six months. Two reoffenses involved youths who spent seven to nine months in the program. This is 4.49!, of the total number for this length of stay. Six reoffenses were committed by youth who spent 10 to 1 2 months in the program. For this group, that is 10% of the total. The remaining four reoffenses were committed by youths who spent 13 to 15 months in the program. Again, that is 10% of the sample. There are no reofteuses for youth spending more than 15 months in the program.
There is no pattern for rcof fending and length at risk. All sexual abuse post-treatment cases were in that portion of the sampie released for less than 5 ½ years. However, 83',?. of this subgroup was contacted compared to only 52% of the subgroup at risk over 5 ½ years.
Comparison of all Related Residents (N) to Subjects Found (n)
Sexually Abusive Behavior Post-Treatment (n = 193)
Program Impact Survey Response
One question on the survey asked youth about positive program elements. The question was posed as follows: "What elements of the program have been particularly helpful to you?" The majority stated that experiencing a caring relationship and /or identifying and expressing their inner emotional states is what enabled them to change. Below are some examples of the responses.
* 25% learning the meaning oí or how to have a relationship:
Staff genuinely cared about residents.
Some relationships with residents have turned into longstanding relationships.
Staff care and understand what's going on, putting in effort to help people.
The care that was involved . . . staff actually took time to talk with you.
When a person had problems, staff sought them out and talked it through. Several other placements never did that.
The one part of the program I feJt was very helpful was learning about relationships . . . learning to distinguish between sexual and nonsexual relationships.
(The program) helped me get along with peers . . . sharing information and feelings could help self and others.
* 24% learning to identify or express feelings appropriately:
Learning to deal with my feelings in a proper way.
Taught me to understand other peoples' feelings and how I affect these feelings.
Lots of ways to deal with emotions . . . (there were) no restraints on what I was allowed to say.
1 learned a sense of security . . . (the) ability to express feelings and identify with victims' feelings.
Being able to be open about sharing feelings . . . now I let people know my feelings and I don't let them build up.
Learning how to deal with anger.
Recidivism and Reoffense Rates
The recidivism rate of 6% verifies the efficacy of intervention with juveniles and confirms the low rates for recidivism found in other ¿i VtJ liable reports.1' Our Jow rate of recidivism is notable because of the serious nature of the subject population. It is significant also because this sample includes all released residents rather than only looking at recidivism for program cornpie ters. Juvenile sex offender specific treatment is in a developmental stage with no adequate research available validating effective program components. In order to develop programs that contain enough but not too much, we must first investigate the results of all attempts at intervention, including those we consider a failure. Given the information on adult sex offenders beginning their aberrant patterns in adolescence1 (M. O'Brien, personal communication, ?981) and the significant number of victims who identify adolescents as their assailants,3·4 the low recidivism rate for our serious juvenile sex offenders is reducing the potential pool of adult sex offenders.
The results of this follow-up study indicate that the confidential collection of data on sexually abusive behavior has validity. Contrary to prediction, the self-report reoffense rate was higher than the recidivism rate. The youth contacted were not informed that legal records were being accessed, yet they chose not to report false negatives. Including self-report measures for follow-up studies allows us to look more accurately for characteristics of those who become habitual offenders.
Length of Stay and Length at Risk
Further investigation is needed on the relationship between program length of stay and recidivism. The variation in length of stay may primarily be due to changing court dispositions over the past 10 years. it is essential that sexual offender treatment programs assess the optimal length of stay in order to work with the court system. Since the legal hold is often the primary motivator for the juvenile sex offender, a working relationship between the court system and the residential treatment network is essential for success. The variation in length of stay and recidivism found here may also be related to as yet unidentified characteristics of the recidivist group itself. It is apparent that, due to low rates of recidivism, programs must network to form joint data pools to arrive at statistically valid conclusions.
The result for "length at risk prior to recidivating" suggests that relapse (reoffending) is related to specific stressful events in an individual's life that are unpredictable. Although the specific events may not be identified, we do, as mental health professionals, know a lot about the types of events that create high stress over the lifespan. It may be necessary to incorporate, as a part of transitional support programming, an educational component that identifies these Stressors for this at-risk population. Confirmation of this result would be a key element in the development of long-term support systems for juvenile sexual offenders. Ts it a question of long-term continuous support or the long-term availability of a support system that can be accessed readily when high-stress life events occur? Both these suggestions run counter to the current disjuncture between services for minors and services for adults, especially within the judicial system.
Given the low rate of recidivism, the salient concern may relate to initial assessment and measures of treatment progress. It raises the question of whether we can better identify the 5% to 10% of the group who need long-term care and monitoring. From the literature,s there appears to be a 5% to 10% error rate at intake for juvenile sex offender programs across the continuum-ofcare. Continuum-of-care is used to describe the range of services necessary to intervene with this population, from the least restrictive setting to the most restrictive setting; eg, at home with outpatient counseling to a 100% facility secure placement.) This may be related to the fact that risk assessment tools are not standardized and that programs operate without validated studies of client characteristics compared to program components.
Although it is clinically understood that not all programs (even across one level of the continuumof-care) meet the needs of all juvenile sex offenders, most assessments are biased toward the philosophy of a particular program rather than an objective assessment of the youth's psychological status. Within the "serious offenders" subgroup of juvenile sex offenders, the JSOP admits youths with wideranging needs. This range includes a significant subgroup with bipolar disorder or chronic depression, as well as youths with no affective disorder symptoms but with many indications of a developing character disorder. Although the sexual abuse issues can be addressed in a similar manner with such a divergent population, those with the most severe individual pathology may not get the individual attention necessary within the group work model. This same concept can be applied throughout the continuum-of-care.
Program Impact Survey Response
The sample's responses to an open-ended question about helpful program elements is enlightening. This type of information allows us to begin to understand success and failure rather than simply report recidivism. Because we know little about effective interventions, an indepth open-ended personal followup is essential. If we had simply used a checklist of program components to define "effective intervention," we would have a list of content areas remembered by these youth, but would have missed what the clients took away as key elements of the change process.
Although we must continue to include sex offender specific treatment components to assure public safety, the responses received here remind us of the importance of the nature of the therapeutic relationship. What these young men are certainly saying is that the key to their maintenance of a nonabusive lifestyle is the way they are treated in the program, not the content in and of itself. One may have all the subject areas4 included in programming without developing the necessary relationship between staff and residents.
What are the elements of process in the JSOP that develop these sincere and adaptive attachments between staff and residents? They are contained within the provision of safety and security for the residents. There is a consistent approach to limit-setting, where the residents can learn to count on staff for teaching personal accountability. Limits and consequences may vary depending on the resident's individual needs and current role in the program; however, these differences are clearly explained to the group so that the residents can join with the staff in supporting them.
Certain behavioral guidelines apply to all residents, such as no physical assaultiveness and no sexual contact, which maintain the safety of the group and to which the same consequences are given. Some residents need more guidance in order to meet these standards, and it is expected that peers as well as staff identify warning signs until these residents gain more personal control. Adaptive attachments can only form within the context of a community that sets clear boundaries, maintains them, and is willing to define negotiable areas relevant to any given current population.
When community boundaries operate in this manner, it provides the staff with the time and energy to provide a "whole atmosphere of caring" (former resident's comment.) Program staff are all equally involved in the day-to-day life of these young men. Regardless of the specific job duties, each staff member feels able to contribute with their personal style to the growth and development of the residents. Staff can do more than say they care about these youth - they can act that way. If they get angry with a youth's behavior, this is appropriately expressed. If they are pleased with a resident's actions, they can express that pleasure.
Because these young men have experienced maladaptive attachments in the past, or even appear to lack any significant relationship in their lives (especially with an adult), individual staff develop attachments with those residents with whom they can relate as persons. There is an acceptance of our human need for affectional touch. Residents are encouraged to develop ways of expressing nonsexual affection with each other and with staff. Staff and residents alike always have the right to "check out" the meaning of a gesture. The process of relationship development is not consigned to group or family sessions, but goes on in the program at al! times.
The issue of follow-up with this population must be addressed. Prior indications were that this population is very difficult to track and disinclined to respond to requests for follow-up information. The results of our study show that there is a method by which this can be achieved successfully. The 70% contact rate is significantly higher than any prior report.
A key element in our success may be that the program with which these youth were involved did the follow-up study, and did it by direct contact. This is a timeconsuming and expensive method; however, it is worthwhile. The data resulting from such a study are complicated. Attributional analyses would provide a much better understanding of open-ended responses. Support for more qualitative studies at this stage in the sex offender treatment field may prove more efficient in the long run, as well as aiding in the effort to prevent sexual victimization,
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3. Rogers CM, Terry T. Clinical intervention with boy victims of sexual abuse. In: Stuart IR, Creer JG, eds. Victim* of Sexual Aggression: Men, Women ami Children. New York, NY: N'ostrand Reinhold; 1984.
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11. Bremer JF Addressing the serious juvenile sex offender: components of residential treatment. In: Dargis A, ed. State of Corrections: Proceedings of ACA Annuii! Conferences. Laurel, Md; American Correctional Association; 1989.
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Intake Age Distribution
Residential Stay Length
Time from Release to Follow-up
Comparison of all Related Residents (N) to Subjects Found (n)
Sexually Abusive Behavior Post-Treatment (n = 193)