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Practice Profile

Juvenile Sex Offender Treatment

Evidence Ratings for Outcomes:

Promising - More than one Meta-Analysis Crime & Delinquency - Multiple crime/offense types
Promising - 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 variety of interventions are widely used for juvenile sex offender management. Overall, interventions that target juvenile sex offenders aim to reduce the sexual, violent, and nonviolent recidivism of juveniles through a variety of treatment modalities (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 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 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
Juvenile sex offender interventions are aimed at juveniles 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 juvenile sex offender treatment interventions or modalities, such as 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).

Treatment settings are different for interventions (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, individual and family therapy, or a combination. Intervention activities and lengths can vary by program type 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
Losel and Schmucker (2005) found that, across seven studies, participation in juvenile sex offender treatment had a significant positive effect on general recidivism (OR=2.35). Hanson and colleagues (2009) also reported that, across three studies examining adolescent sex offenders, participation in sex offender treatment had a significant positive effect on general recidivism (OR=0.24). This means that in both meta-analyses juvenile offenders who participated in sex offender treatment were significantly less likely to recidivate than juvenile offenders in the comparison group who did not receive treatment.
Promising - More than one Meta-Analysis Crime & Delinquency - Sex-related offenses
There were mixed results when examining the impact of juvenile sex offender treatments on sexual recidivism. Looking across four studies, Reitzel and Carbonell (2006) reported that juvenile offenders who participated in sex offender treatment were significantly less likely to sexually recidivate than juvenile offenders in the comparison group (OR=0.43). Juvenile offenders receiving sexual offender treatment had sexual recidivism rates of 7.4 percent, whereas those receiving no treatment had a sexual recidivism rate of 18.9 percent. Conversely, when examining outcomes from four studies, Hanson and colleagues (2009) found no significant difference between juvenile sex offenders in the treatment and comparison groups with regard to sexual recidivism (OR=0.38).
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) (OR=0.24) between juvenile offenders who participated in sex offender treatment and juvenile 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 - 200170
Meta-Analysis 21990 - 200192986
Meta-Analysis 31990 - 20094284

Meta-Analysis 1

Losel and Schmucker (2005) conducted a meta-analysis of sex offender treatment programs. Studies were included if they met the following criteria: 1) participants in each study had to be convicted of a sex offense or had committed acts of illegal sexual behavior that would result in a conviction if prosecuted; 2) intervention programs had to be aimed at reducing recidivism and not be purely punitive, but include therapeutic measures; 3) recidivism had to be included as a dependent variable; 4) each study had to report the same recidivism outcomes for the comparison group who was not receiving the same treatment; 5) the studies had to have a sample size of at least 10 with a minimum of 5 sex offenders placed in each group; 6) data had to be reported that allowed for the calculation of effect sizes; 7) studies had to be in English, German, French, Dutch, or Swedish; and, 8) all studies included up until the year 2003.

This method resulted in a final sample of 66 reports meeting the authors’ criteria. Several of the reports contained more than one eligible study, so the authors used each eligible study as a separate unit of analysis. Other studies presented results of subgroups, such as type of offense. To allow for maximum differentiation while adhering to the principle of independency between effect sizes, the authors used those subgroups as individual units of analysis. This resulted in 80 eligible comparisons from a total of 69 studies. An adapted version of the Maryland Scale of Scientific Rigor was used to evaluate overall methodological quality of the 69 individual studies. Only studies that received a rating of 2 or higher on the scale were included in the analysis.

A large majority of the studies included in the meta-analysis came from North America, and were relatively recent. About one-third came from unpublished sources. Participants in the studies were mostly adults (56.3 percent adult sex offenders versus 17.5 percent juvenile sex offenders), and participation in the treatment program was usually voluntary (46.3 percent). Sample size varied from 15 to 2,557, with about one third of the comparisons comprising less than 50 offenders. Child molestation (73.7 percent), rape (55 percent), and incest offenses (47.5 percent) were the most common offense types.

A subsample of seven studies, which focused on juvenile sex offender comparisons, was used for this review (17.5 percent of the total meta-analysis sample). Of the seven studies focused only on juvenile sex offenders, five were published in peer-reviewed journals and two were unpublished doctoral dissertations. The studies were published between 1990 and 2001. Sample size and other characteristics about the juvenile-only studies were not provided.

The meta-analysis used odds ratios (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).
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There is no cost information available for this practice.
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Other Information

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A few meta-analyses included additional tests—called moderator analyses—to see if any factors strengthened the likelihood that juvenile sex offender treatment programs improved outcomes. Losel and Schmucker (2005) 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. They 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

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

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.

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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.)

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.

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.

National Institute of Mental Health. “Psychotherapies.” Accessed December 1, 2014.

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.

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 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

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