Assessment and treatment of adolescents with harmful sexual behaviours. / by Sydney Forensic Clinic

Although the term “harmful sexual behaviour” refers to a broad spectrum of sexual behavioural problems, including those that are considered non-criminal, this article will focus on adolescents who have engaged in sexual behaviour that has led to adjudication by the youth justice system.

Any contact with adolescents with harmful sexual behaviour should consider the reluctance they are likely to feel about disclosing the behaviour to others and the social, personal and legal consequences they are likely to experience as a result of disclosure. Establishing a therapeutic alliance through respect, credibility and transparency, minimising embarrassment and shame and instilling hope throughout the process is a key challenge of working with this group. 

The assessment of adolescents who have sexually offended can have different purposes at different stages of the legal process. A pre-sentence assessment, for instance, may focus on risk of reoffending, treatment targets and prognosis, whereas a pre-release assessment may focus on community safety, and long-term treatment needs. Psychological assessment of adolescents who have sexually offended should include information from multiple sources, including official documentation, interviews with the adolescent and collateral sources such as family, school and other mental health professionals, and relevant psychometric measures, and aim to establish the functions of the harmful sexual behaviours and how these have occurred in the context of the adolescent’s family and other systems.

Structured professional judgement (SPJ) tools can be used to inform assessment of adolescents’ risk of sexual reoffending. SPJ tools allow for risk assessments to be conducted in a systematic manner with consideration of empirically-validated static (historical and unchangeable) and dynamic (changeable through intervention or treatment) risk factors, while remaining flexible to consider the unique needs and strengths of the individual. Some of the dynamic risk factors relevant to adolescents’ risk of sexual reoffending include sexual preoccupation and obsessive sexual interests, poor interpersonal functioning, poor self-regulation, high-stress or unstable family environments, internal motivation for change and insight into one’s own risk factors.

It is important to note that SPJ tools should not be used to address long-term risk of adolescents’ sexual re-offending, and that scores from SPJ tools should not be used in isolation when assessing risk. Adolescence is a time of rapid neurological, social, sexual, physical and moral development, which any formulation of adolescent risk should consider.

Treatment targets are generated by the assessment process and are tailored to the individual. Research indicates that treatment outcomes for adolescents who have sexually offended are influenced by the therapeutic relationship between the therapist and the client and the willingness of the adolescent and their caregivers to engage in treatment. Wherever possible, the therapist sees the adolescent together with their caregivers to ensure that any interventions initiated in session are reinforced and modelled in other settings. Given the prevalence of victimisation and trauma among adolescents who have sexually offended, a trauma-focused approach to treatment is supported by research. Multisystemic Therapy for youths with problem sexual behaviours, the current best-practice intervention for this population, aims to identify individual and family strengths, promote responsible behaviour and teaches behavioural skills in the context where the young person and their caregivers will eventually practise the behaviour. Other approaches may address treatment targets including the development of healthy sexual interests, increasing accountability and responsibility for past offending, and developing sexual offence prevention plans, which includes the adolescent’s unique needs, strengths and risk factors. Professionals working with adolescents with harmful sexual behaviour should ensure they receive adequate support such as clinical and peer supervision to maintain their ability to work empathically and effectively with this population. 

 ©Sydney Forensic Clinic 2019

Useful links

http://www.atsa.com/juvenilepractice

https://www.mstpsb.com/