Policy discussions regarding the legal and treatment dispositions of adolescents arrested for sexual offenses have been contentious, with some policy makers and treatment professionals arguing for lifelong placement on sexual offender registries and extended residential treatment (e.g., J. Ring, quoted in Michels, 8/16/2007
), and others emphasizing the generally low recidivism rates of such youth and their need for strength-focused, community-based services (e.g., Chaffin, 2008
). Regardless of these different perspectives, however, virtually all stakeholders agree that the scope of sexual offending by juveniles is substantial and warrants the development of effective interventions.
Regarding the scope and consequences of adolescent sexual offending, official records indicate that minors account for about 20% of all serious sexual crimes (Pastore & Maguire, 2007
), and victim reports indicate that the proportion of juvenile (vs. adult) offenders increases as the age of victims decreases (Snyder & Sickmund, 2006
). Importantly, sexual assault victims are at relatively high risk for numerous negative sequelae (see Chapman, Dube, & Anda, 2007
; Letourneau, Resnick, Kilpatrick, Saunders, & Best, 1996
), and estimates of the annual U.S. cost for sexual assault place the sum in the billions
of dollars (e.g., Post, Mezey, Maxwell, & Wibert, 2002
). Moreover, though engendering little public sympathy, significant social and fiscal costs also are borne by juvenile sexual offenders. Many are removed from their families for years and are required to register publicly for life, processes that likely limit the development of their social, academic, and vocational competencies (Chaffin, 2008
; Letourneau & Miner, 2005
). In consideration of these circumstances, the validation of effective interventions could reduce the significant social and fiscal costs to victims, offenders, and society by reducing future sexual victimizations and increasing the likelihood that juvenile sexual offenders become law-abiding and productive citizens.
In developing effective treatments for juvenile sexual offenders, it seems reasonable to draw on the knowledge base regarding the risk factors for sexual offending by adolescents as well as the literature on the types of interventions that have been effective in treating other types of serious antisocial behavior in adolescents such as criminal activity and substance abuse. Interestingly, research shows that the risk factors for adolescent sexual offending are very similar to those observed for these other types of serious antisocial behavior. For example, in a longitudinal study examining 66 correlates of juvenile sexual and violent offending, van Wijk et al. (2005)
found that violent sexual offenders were similar to violent nonsexual offenders with respect to nearly all family (e.g., poor supervision and communication) and peer (e.g., involvement with delinquent and substance-abusing peers) risk factors. Similarly, Ronis and Borduin (2007)
found that juvenile sexual offenders, like other serious juvenile offenders, had lower bonding to family and school and higher involvement with deviant peers than did nondelinquent youth.
Regarding interventions that have been identified as effective in treating other types of antisocial behavior in adolescents, the Surgeon General’s report on youth violence (U.S. Public Health Service, 2001
) identified three treatments for juvenile criminal behavior with established effectiveness (i.e., functional family therapy, multidimensional treatment foster care, multisystemic therapy). Significantly, these interventions share a family-based focus as well as the capacity to address a comprehensive array of risk factors in the youth and family’s natural environment. Likewise, based on Waldron and Turner’s (2008)
recent review of the adolescent substance abuse treatment literature, several relatively comprehensive family-based interventions (e.g., brief strategic family therapy, functional family therapy, multidimensional family therapy, multisystemic therapy) have shown considerable promise or success in attenuating this type of antisocial behavior. Together, these findings suggest that a family-based approach with the capacity to address a comprehensive array of risk factors might provide an effective treatment for adolescent sexual offenders. Indeed, the small efficacy research literature on juvenile sexual offenders supports this possibility.
Recent reviews of the juvenile sexual offender outcome literature (Hanson et al., 2002
; Reitzel & Carbonell, 2006
) have noted that two efficacy trials of multisystemic therapy (MST; Henggeler, Schoenwald, Borduin, Rowland, & Cunningham, 1998
) are the only randomized trials conducted in this area of research; both produced promising results. As suggested previously, the comprehensive nature and family- and community-based emphases of MST are consistent with the types of interventions that have been successful in treating other types of antisocial behavior in adolescents. In the first small efficacy trial with juvenile sexual offenders (n
= 16), Borduin and colleagues (Borduin, Henggeler, Blaske, & Stein, 1990
) reported that significantly fewer youth in the MST condition (12.5%) than in the outpatient “usual services” condition (75%) were rearrested for sexual crimes over a 3-year follow-up. A second, larger efficacy study (Borduin, Schaeffer, & Heiblum, in press) included 48 juvenile sexual offenders randomized to MST or usual services (a combination of cognitive-behavioral group and individual treatment administered in a juvenile court setting) conditions. At 8.9 years post-treatment, MST participants were significantly less likely than their usual services counterparts to be rearrested for sexual (8% vs. 46%) and nonsexual (29% vs. 58%) offenses. Thus, the results from these two relatively small-scale efficacy studies support the potential of MST as an effective community-based treatment for juvenile sexual offenders.
The purpose of the present study was to provide a rigorous effectiveness
trial of MST with juvenile sexual offenders that included a comparison condition that is generally typical of the community based services provided to such offenders in the U.S. Although a precise definition of an effectiveness does not exist, as the efficacy-effectiveness distinction can vary on many dimensions (e.g., characteristics of the intervention, practitioners, clients, service delivery, provider organization and service sytem; Schoenwald & Hoagwood, 2001
), the general distinction between efficacy and effectiveness trials is important for the emerging field of implementation science (Fixsen, Naoom, Blase, Friedman, & Wallace; 2005
). Weisz and his colleagues (e.g., Weisz, Donenberg, Han, & Weiss, 1995
) have shown that the average effect size in child mental health efficacy studies (i.e., often university based, using graduate students as therapists) is considerably greater than the average effect size of effectiveness trials conducted in community practice settings using real world practitioners. A recent meta-analysis of MST randomized trials (Curtis, Ronan, & Borduin, 2004
) drew a similar conclusion, with MST efficacy trials having larger effect sizes than MST effectiveness trials. Pertaining to MST with juvenile sexual offenders, the two aforementioned trials conducted by Borduin and his colleagues were primarily efficacy studies. Although participants had a wide variety of co-occurring problems, the therapists were clinical psychology doctoral students, and the principle investigator provided the clinical training and supervision. In contrast, in the present study, community-based MST services were provided by an existing private provider agency. Thus, the present study represents an important step in bridging the gap between science and practice (National Institute of Mental Health, 1999
) for this clinical population.
In conducting this effectiveness trial, a primary goal was to include a comparison intervention that represented the types of services typically provided for juvenile sexual offenders. Treatment as usual for juvenile sexual offenders (TAU-JSO) includes interventions that have a cognitive-behavioral orientation, focus on individual (youth-level) behavioral drivers, and are delivered in weekly group treatment sessions for a year or longer (Letourneau, 2004
; Letourneau & Borduin, 2008
; McGrath, Cumming, & Burchard; 2003
; Walker, McGovern, Poey, & Otis, 2004
). The individual treatment focus and the group-oriented delivery of TAU-JSO contrast well with the family-based and ecological emphases of MST.
In sum, within the context of community-based treatment programs, the relative effectiveness of a promising family-based approach (i.e., MST) was contrasted with a set of interventions that generally reflect treatment as usual for juvenile sexual offenders. As described subsequently, 1-year post-recruitment outcomes were examined for deviant sexual interest/risk behaviors, delinquency, substance use, mental health symptoms, and out-of-home placements.