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Practice Profile

Therapeutic Treatment for Juvenile Sex Offenders

Evidence Ratings for Outcomes:

Promising - More than one Meta-Analysis Crime & Delinquency - Multiple crime/offense types
No Effects - More than one Meta-Analysis Crime & Delinquency - Sex-related offenses
No Effects - One Meta-Analysis Crime & Delinquency - Violent offenses

Practice Description

Practice Goals
Given the prevalence of sexual offending by juveniles, coupled with the potential link between sexually abusive behavior during adolescence and sexual offending later in life, a wide variety of interventions have been used for juvenile sex offender management. Overall, all interventions that target juvenile sex offenders aim to reduce the sexual, violent, and nonviolent recidivism of juveniles (Reitzel and Carbonell 2006).

Although the treatment of sex offenders has been around for decades, treatment approaches have changed in recent years. For many years, juvenile sex offender treatment was largely based on adult sex offender treatment, as juvenile and adult sex offenders were thought to be similar. However, when research emerged indicating the developmental, motivational, and behavioral differences between juvenile and adult sex offenders, therapeutic treatment interventions for juveniles became more responsive to the diversity of sexually abusive behaviors and the specific offending-related factors found among adolescents and children. For example, juvenile offenders, both sexual and general (nonsexual) offenders, are generally more impulsive and less aware of the consequences of their actions than adults. Therapeutic treatment interventions for juveniles are designed to take these behavioral differences into account as well as the family, peer, and other social correlates that impact general and sexual offending for juveniles (Przybylski 2014).

Target Population
Therapeutic treatment interventions for juvenile sex offenders are aimed at youth who have been referred and adjudicated for a sexual offense or have committed illegal sexual acts that would lead to adjudication, if prosecuted. Offenses can include rape, child molestation, incest, and exhibitionism.

Practice Theory
Juvenile sex offenders have more in common with other juvenile delinquents than they do with adult sexual offenders (Przybylski 2014). As a result, juvenile sex offender treatment can range from interventions specifically tailored for sexual offenders to interventions targeting general offending behaviors.

One theoretical approach to the treatment of juvenile sex offenders is to consider sexual offending a special case of general offending; that is, applying principles of general offending to sexual offending (Hanson et al. 2009). Another approach is human service interventions, which tend to have an impact on general offending behavior and follow the principles of risk, need, and responsivity. In other words, treatments are most likely to have an impact if they treat offenders who are more likely to reoffend (i.e., at greater risk), target characteristics related to reoffending (i.e., criminogenic need), and match the treatment to the offenders’ abilities and learning styles in regard to responsivity (Hanson et al. 2009). An example incorporating the responsivity principle into treatment is a cognitive–behavioral intervention that addresses issues such as denial, accountability, and victim empathy.

Practice Components
There are various types of therapeutic treatment interventions or modalities for juvenile sex offenders, including, but not limited to cognitive–behavioral, cognitive–behavioral/relapse prevention, psychotherapeutic (sexual trauma), and multisystemic therapy.

Cognitive–Behavioral Therapy (CBT)
CBT is usually conducted in a group therapy setting and involves addressing the irrational thoughts and beliefs of offenders that lead them to engage in antisocial behaviors (Aos et al. 2006). CBT programs include elements that seek to help offenders correct their deviant thoughts by practicing opportunities to model and engage in prosocial and problem-thinking skills and behaviors (Aos et al. 2006).

Cognitive-Behavioral Therapy/Relapse Prevention (CBT-RP)
Relapse prevention is based on social–cognitive psychology and incorporates relapse-prevention strategies with cognitive behavioral strategies to prevent or limit relapses. Treatment approaches assess the environmental and emotional characteristics of situations that could lead to relapse. After these situations are identified, a therapist works with the individual’s responses to these situations, while also analyzing the factors that caused them. The therapist then develops strategies to target weaknesses in the individual’s cognitive and behavioral repertoire (Larimer, Palmer, and Marlatt 1999).

Psychotherapeutic (sexual trauma)
Programs that fall into this category involve the use of insight-oriented therapy that can be done either individually or in a group setting (Aos et al. 2006). These programs usually take the form of traditional therapy practices, such as talk therapy, and explore the underlying causes and thoughts related to offending behaviors. Psychotherapeutic interventions for juvenile sex offenders can target the trauma that the juveniles may have experienced in the past, helping them to understand their illness and better manage their symptoms (National Institute of Mental Health 2014; Przybylski 2014).

Multisystemic Therapy (MST)
MST is a community-based intervention that has been used for serious and chronic juvenile offenders. MST for sexual offenders is designed to reduce the occurrence of sexual offenses by targeting the underlying problematic behavior: primarily by addressing a youth’s socialization processes and interpersonal transactions. Treatment is provided within the youth’s natural environment (typically where the youth lives). As a result, the treatment provider works closely with the youth’s family and the community, such as peers, teachers, or probation officers. By working with the youth’s family, MST aims to empower the parents by providing them with the skills and resources needed to raise their adolescent (Borduin, Schaeffer, and Heiblum 2009).

The settings for these interventions vary (depending on whether the juvenile has been adjudicated and sentenced to out-of-home placement or community-based treatment), but could include detention center/youth residential facilities, community-based (outpatient) treatment centers, or a combination of settings. The format for sex offender treatment also varies, but could include individual therapy, group therapy, family therapy, or a combination. Intervention activities and lengths can vary by modality as well, with some interventions including postdischarge, follow-up monitoring services.

Meta-Analysis Outcomes

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Promising - More than one Meta-Analysis Crime & Delinquency - Multiple crime/offense types
The findings across all three meta-analyses that examined general (or non-sexual recidivism) were consistent, indicating that juvenile sex offenders who participated in therapeutic treatment were less likely to recidivate than those offenders in the comparison group who did not receive treatment. Schmucker and Lösel (2017) found that across five studies participation in therapeutic treatment had a statistically significant positive effect on general recidivism (OR = 2.97) for juvenile offenders. Hanson and colleagues (2009) also reported that, across three studies examining adolescent sex offenders, participation in sex offender treatment had a statistically significant positive effect on general recidivism (OR = 0.24). Finally, across six studies, Kettrey and Lipsey (2018) found a statistically significant positive effect on general recidivism (OR = 0.58).
No Effects - More than one Meta-Analysis Crime & Delinquency - Sex-related offenses
The impact of therapeutic treatment of juvenile sex offenders on sexual recidivism was mixed. Across four studies, Reitzel and Carbonell (2006) found that juvenile sex offenders who participated in therapeutic treatment were less likely to sexually recidivate than juvenile sex offenders in the comparison group (OR = 0.43). Conversely, when examining outcomes from four studies, Hanson and colleagues (2009) found no statistically significant difference between juvenile sex offenders in the treatment and comparison groups with regard to sexual recidivism. Furthermore, Kettrey and Lipsey (2018) examined outcomes from eight studies and found no statistically significant difference on measures of sexual recidivism between juveniles who received therapeutic treatment and comparison group juveniles who did not receive treatment.
No Effects - One Meta-Analysis Crime & Delinquency - Violent offenses
Hanson and colleagues (2009) found no significant difference with regard to violent recidivism (including sexual recidivism) between juvenile sex offenders who participated in therapeutic treatment and juvenile sex offenders in the comparison groups who did not receive treatment. However, this result should be interpreted with caution because it is based on outcomes from only two studies.
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Meta-Analysis Methodology

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Meta-Analysis Snapshot
 Literature Coverage DatesNumber of StudiesNumber of Study Participants
Meta-Analysis 11990 - 200950
Meta-Analysis 21990 - 200192986
Meta-Analysis 31990 - 20094284
Meta-Analysis 41990 - 20148802

Meta-Analysis 1
Schmucker and Lösel (2017) conducted a meta-analysis of therapeutic treatment programs for males who had been convicted for a sexual offense or committed acts of illegal sexual behavior that would have led to a conviction if officially prosecuted. This meta-analysis updated a previous meta-analysis conducted by the researchers in 2005. The researchers searched a broad range of literature databases, scanned previous reviews and primary studies on the topic, hand-searched 16 relevant journals, carried out an internet search of pertinent institutions, and personally contacted experts in the field of sex offender treatment. Studies were included if they met the following criteria: 1) used a randomized controlled trial design or quasi-experimental design, which employed matching procedures to statistically control for potential biases; 2) examined intervention programs that included therapeutic measures (i.e., psychosocial or organic treatment approaches); 3) reported official recidivism data as an outcome and provided sufficient information for effect size calculation; and 4) had a sample size of at least 10. There were no restrictions with regard to country of origin or language, and both unpublished and published studies were eligible.

This method resulted in a final sample of 27 studies. Occasionally, a reference contained more than one eligible study, so the authors used the individual study as the unit of analysis. Further, some studies presented results of subgroups. The authors used the subsamples as units of analysis when this would improve equivalence between treated and control groups and the report allowed for a differentiated coding of the individual subsamples. This resulted in 29 eligible comparisons.

This study pool comprised 4,939 treated and 5,448 untreated offenders. Only about one fifth of the comparisons were derived from randomized controlled trials. A quarter of the comparisons (7 comparisons) were retrieved from unpublished sources. Most comparisons appeared in studies published since 2000 (14 comparisons), 11 during the 1990s, and 4 during the 1980s. Eleven of the comparisons were published in studies that took place in Canada, eight in the United States, three in Great Britain, three in Germany, and four in unknown locations. Eighteen were published as journal articles, four as books or chapters in a book, and seven were unpublished. In 21 of the comparison, the mode of treatment was primarily cognitive-behavioral; however, four used a therapeutic community approach, two used an insight-oriented psychotherapeutic approach, and two used multisystemic therapy. No studies on hormonal treatment or organic treatment approaches met the inclusion criteria. Twenty-six of the comparisons examined treatments specific to sex offenders, and three were general. Twelve of the comparisons evaluated treatments delivered in outpatient settings, 10 in prisons, 5 in hospitals, and 2 in mixed settings.

The mean age of the treated offenders across all comparisons was 31.13 years. However, a subsample of five comparisons that focused exclusively on juvenile sex offenders was used for the CrimeSolutions.gov review (17.2 percent of the total meta-analysis sample). The specific characteristics about the juvenile-only studies were not provided.

The meta-analysis used odds ratio (OR) to measure effect sizes. Effect sizes were calculated using a random effects model. For studies that did not report statistics that could be easily transformed into OR, the authors used standard procedures to calculate Cohen’s d and then used these statistics to calculate OR. Whenever possible, participants who dropped out of the treatment program were included in the treatment group (i.e., intent to treat).

Meta-Analysis 2

Reitzel and Carbonell (2006) conducted a meta-analysis of juvenile sex offender treatment effectiveness. The comprehensive search strategy included published and unpublished studies from 1975 through 2003. To be included in the meta-analysis the studies were required to have a sample of juveniles (ages 7 through 20) who were adjudicated for a sex offense, with a portion of the sample participating in sex offender treatment and either a no-treatment control or a comparison treatment group.

A total of nine studies (four published, five unpublished) from 1990 through 2003 were included in the final analysis. The total offender sample size was 2,986 (male, n=2,604; female, n=121) of which 1,331 were in no-treatment control groups, 1,301 were in sex offender treatment groups, and 354 were in comparison treatment groups. Study group assignments were either unknown or unclear (one study), assigned based on need or risk (three studies), assigned incidentally (three studies), or assigned randomly (two studies). The mean age was 14.6 and included 41 percent minority youth.

Effect sizes were calculated using a fixed-effects model due to the small number of included studies. The maximum likelihood estimate (MLE) of odds ratio was calculated for each study. The MLE of odds ratio was then converted into a natural log odds ratio for statistical analysis. Additionally, studies were weighted based on their sample size.



Meta-Analysis 3

Hanson and colleagues (2009) conducted a meta-analysis to examine whether principles associated with effective interventions for general offenders (risk–need–responsivity) would also apply to psychological treatments for sexual offenders. A comprehensive search of databases was conducted. To be included in the meta-analysis, studies had to examine treatment effectiveness by comparing recidivism rates using a sex offender population with  a matching comparison group of sex offenders. The authors defined sex offenders as “offenders with sexually motivated offenses against an identifiable victim” (p. 868). Participants in the control/comparison group could have received an alternate treatment, less treatment, or no treatment. In order for the studies to meet the “need” principle of the RNR model, at least 51 percent of the treatment had to target criminogenic needs, such as antisocial lifestyle, impulsivity, or negative peer associations. Services in the treatment program met the “responsivity” aspect of RNR when the treatment was provided in such a way as to match the needs and learning style of the client.

The number of eligible studies was narrowed down using the Collaborative Outcome Data Committee (CODC) guidelines, which help to determine the extent to which a study’s features indicate possible bias when estimating treatment effect. Only studies categorized as weak, good, and strong were included. This resulted in a total of 23 studies included in the analysis. A majority of offenders included in the studies were adult males (three studies indicated the inclusion of some female offenders in the sample). Fourteen studies were published and nine were unpublished.  The majority of the studies (74 percent) were from North America (Canada and the United States). The sample sizes ranged from 16 to 2,557. In 10 of the studies, the treatment programs were offered in institutions, and in 11 studies they were offered in the community (in two studies the treatment was offered in both settings).

Of these 23 studies, only four were specifically focused on juvenile sex offenders. The four studies were published between 1990 and 2009. Three of the four studies were published in peer-reviewed journals, and one was a master’s thesis. There were a total of 284 juveniles (including treatment and control group members) across all four studies. Other characteristics about the juvenile-only studies, such as gender or race/ethnicity breakdowns, were not provided.

Statistics were calculated using both a fixed effect and random effect models and by calculating odds ratio (OR).

Meta-Analysis 4
Kettrey and Lipsey (2018) conducted a meta-analysis to assess the effectiveness of psychosocial, therapeutically oriented treatments on sexual offending of juvenile sex offenders (JSOs). To identify studies, the researchers searched 62 electronic databases, including a large parent meta-analysis database of studies evaluating the effects of psychosocial, therapeutically oriented interventions or therapies among juveniles who have committed a chargeable offense. To identify unpublished literature, the researchers searched Google Scholar, the webpages and reference pages of authors of eligible or nearly eligible studies, and the reference lists of the previous meta-analyses that evaluated JSO interventions.

To be eligible for inclusion, studies had to examine treatments provided exclusively to JSOs under the age of 21 who committed acts that constituted chargeable sexual offenses. Participants had to reside in the United States or a predominantly English-speaking country. Eligible treatment programs had to be implemented individually with JSOs or in groups composed entirely of JSOs; however, they could not be implemented in mixed groups that included juveniles who had not committed sexual offenses. Studies had to have used random assignment of juveniles to conditions, matched them on one or more recognized risk factors for recidivism (e.g., offense history, rape myth acceptance), or reported baseline measures of group differences on such risk factors. Finally, studies were only eligible if they reported quantitative outcome data for at least one delinquency measure, were published or reported in 1950 or later, and conducted no earlier than 1945. Studies that examined the effects of pharmaceutical or medical treatments, or interventions that did not have a primary therapeutic orientation (e.g., incarceration, probation, deterrent programs) were excluded.

The search resulted in eight studies described in 12 reports that met the eligibility criteria, of which seven were published journal articles, and one was an unpublished thesis. Four studies were conducted in the United States, two in Australia, and two in Canada. One study was a randomized controlled trial, whereas the remaining studies either matched treatment and comparison groups on some set of background characteristics or reported baseline measures of at least one risk factor for recidivism that could be used to assess group equivalence. The study pool comprised 415 treated and 322 untreated subjects. Sample sizes ranged from 16 to 190. Treatment samples were predominately male (90 to 100 percent), and among the four studies that reported race or ethnicity, largely white (53 to 67 percent). The mean age (reported in four studies) ranged from 13.5 to 15.4 years, and three studies included some juveniles younger than age 13. In terms of the main form of treatment, three studies examined group counseling, two examined family counseling, one examined individual counseling, and one examined mixed counseling (a combination of group, family, and individual). The remaining study examined a skills-building program, specifically an adventure-based, behavior management program. All programs were specifically tailored to JSOs. Three of the treatments were provided in residential settings, and the other five were delivered in community settings.

Seven of the eight studies reported sexual recidivism outcomes, while six of the eight reported general recidivism outcomes. Statistics were calculated using both fixed effect and random effect models and by calculating odds ratios.
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Cost

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There is no cost information available for this practice.
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Other Information

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This practice has been updated to reflect findings from a more recent meta-analysis. The original meta-analysis, by Lösel and Schmucker (2005), was reviewed in 2014 and received a Promising rating for reducing general recidivism. When a re-review of Schmucker and Lösel (2017) was conducted in 2019, the Promising rating for reducing general recidivism was maintained. Additionally, also in 2019 a new meta-analysis by Kettrey and Lipsey (2017) was added to the evidence base, The Promising rating for general recidivism continued to be maintained; however, based on the new meta-analysis, the sexual recidivism outcome rating was changed from Promising to No Effects.

Losel and Schmucker (2017) conducted a moderator analysis of offender characteristics and reported that programs targeting juvenile sex offenders had a stronger (although not significant) effect when compared with programs targeting adult sex offenders. Hanson and colleagues (2009) also reported that treatment was more effective for juvenile sex offenders compared with adult sex offenders. Both Losel and Schmucker (2017) and Hanson and colleagues (2009) noted that the difference between the juveniles and adults was primarily due to large effects on general recidivism that came from two studies of multisystemic therapy (MST).
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Evidence-Base (Meta-Analyses Reviewed)

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These sources were used in the development of the practice profile:

Meta-Analysis 1
Schmucker, Martin, and Friedrich Lösel. 2017. “Sexual Offender Treatment for Reducing Recidivism Among Convicted Sex Offenders: A Systematic Review and Meta-Analysis.” Campbell Systematic Reviews 13(1):1-75.

Meta-Analysis 2

Reitzel, Lorraine, R., and Joyce L. Carbonell. 2006. “The Effectiveness of Sexual Offender Treatment for Juveniles as Measured by Recidivism: A Meta-Analysis.” Sexual Abuse: A Journal of Research and Treatment 18:401–21.



Meta-Analysis 3

Hanson, R. Karl, Guy Bourgon, Leslie Helmus, and Shannon Hodgson. 2009. “The Principles of Effective Correctional Treatment Also Apply to Sexual Offenders: A Meta-analysis.” Criminal Justice and Behavior 36(9):865–91.



Meta-Analysis 4
Kettrey, Heather Hensman, and Mark W. Lipsey. 2018. “The Effects of Specialized Treatment on the Recidivism of Juvenile Sex Offenders: A Systematic Review and Meta-Analysis.” Journal of Experimental Criminology 14(3):361–87
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Additional References

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These sources were used in the development of the practice profile:

Aos, Steve, Polly Phipps, Robert Barnoski, and Roxanne Lieb. 2001. The Comparative Costs and Benefits of Programs to Reduce Crime. Version 4.0. Olympia, WA: Washington State Institute for Public Policy. (This study was reviewed but did not meet Crime Solutions' criteria for inclusion in the overall program rating.)


http://www.wsipp.wa.gov/ReportFile/756/Wsipp_The-Comparative-Costs-and-Benefits-of-Programs-to-Reduce-Crime-v-4-0_Full-Report.pdf

Borduin, Charles M., Cindy M. Schaeffer, and Naamith  Heiblum. 2009. “A Randomized Clinical Trial of Multisystemic Therapy with Juvenile Sexual Offenders: Effects on Youth Social Ecology and Criminal Activity.” Journal of Consulting and Clinical Psychology 77(1):26–37.
https://www.semanticscholar.org/paper/A-randomized-clinical-trial-of-multisystemic-with-Borduin-Schaeffer/0edd5901b167829949d5bfe61f37a6af57745c6b

Långström, Niklas, Pia Enebrink, Eva-Marie Laurén, Jonas Lindblom, Sophie Werkö, and R. Karl Hanson. 2013. “Preventing Sexual Abusers of Children from Reoffending: Systematic Review of Medical and Psychological Interventions.” BMJ 347:f4630.

Larimer, Mary E., Rebekka S. Palmer, and G. Alan Marlatt. 1999. “An Overview of Marlatt’s Cognitive-Behavioral Model.” Alcohol Research & Health 23(2):151–60.



Lösel, Friedrich, and Martin Schmucker. 2005. “The Effectiveness of Treatment for Sexual Offenders: A Comprehensive Meta-Analysis.” Journal of Experimental Criminology 1:117–46.

National Institute of Mental Health. “Psychotherapies.” Accessed December 1, 2014.
http://www.nimh.nih.gov/health/topics/psychotherapies/index.shtml

Przybylski, Roger. 2014. “Adult Sex Offender Recidivism.” Sex Offender Management Assessment and Planning Initiative. Washington, D.C.: U.S. Department of Justice, Office of Justice Programs.
http://www.smart.gov/SOMAPI/printerFriendlyPDF/complete-doc.pdf

Walker, Donald F., Shannon K. McGovern, Evelyn L. Poey, and Kathryn E. Otis. 2005. “Treatment Effectiveness for Male Adolescent Sexual Offenders: A Meta-Analysis and Review.” Journal of Child Sexual Abuse 13(3–4):281–93.

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Related Programs

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Following are CrimeSolutions.gov-rated programs that are related to this practice:

Multisystemic Therapy for Youth With Problem Sexual Behaviors (MST–PSB) Promising - One study
This program is an adaptation of Multisystemic Therapy, specifically designed for adolescents who have committed sexual offenses and demonstrated other problem behaviors. The program is rated Promising. Program participants had lower rates of self-reported person and property offenses as well as lower rates of arrests for sexual crimes and other crimes, compared with control group participants. These findings were statistically significant.

Sexual Abuse: Family Education and Treatment Program (SAFE–T) Promising - One study
This is a community-based program that provides sexual abuse–specific assessment, treatment, consultation, and long-term support to adolescents who were perpetrators of sexual abuse and to their families. This program is rated Promising. Intervention participants showed a statistically significant lower likelihood of being charged with a sexual reoffense, nonsexual violent reoffense, nonviolent reoffense, or any reoffense, compared with control participants, at the 20-year follow up.
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Practice Snapshot

Age: 7 - 20

Gender: Both

Race/Ethnicity: Other, White

Targeted Population: Sex Offenders

Settings: Correctional, Inpatient/Outpatient, Other Community Setting, Residential (group home, shelter care, nonsecure)

Practice Type: Aftercare/Reentry, Cognitive Behavioral Treatment, Family Therapy, Group Therapy, Individual Therapy, Violence Prevention

Unit of Analysis: Persons