Description of Clinical Program
Sexual behavior of children and youth can become harmful to themselves and to other children as well as illegal. Problematic sexual behaviors (PSB) do not represent a medical/psychological syndrome or a specific diagnosable disorder, but rather a set of behaviors that fall well outside acceptable societal limits (Chaffin et al., 2006). We have defined children with PSB as children who initiate behaviors involving sexual body parts (i.e., genitals, anus, buttocks, or breasts) that are developmentally inappropriate or potentially harmful to themselves or others (Silovsky & Bonner, 2003). Problematic sexual behaviors of adolescents are more often also considered illegal. As a result juvenile justice is often involved with the family.
PSB-CBT™ is a group treatment model originally designed to treat youth ages 7 to 12 who present with PSB. The PSB-CBT™ treatment approach uses concurrent groups for youth and their caregivers with combined multi-family group sessions about once a month. Active participation of a caregiver is required, with the caregiver defined as the person who provides primary care of the child in the home (e.g., mother, father, step-parent, grandparent, foster parent). PSB-CBT™ shares the common theory base and core components of evidence-based programs (EBP) for PSB. The underlying approach is strengths-based, focusing on the youth as children first with capacity to learn and implement appropriate behavior, make safe decisions, and develop healthy relationships. Using cognitive-behavioral approaches, the youth are taught rules about sexual behavior and specific skills of coping, self-control, and decision making. Core treatment components with caregivers address managing child behavior, supporting healthy development, sex education, abuse prevention, and rules about sexual behavior. The PSB-CBT™ treatment manual provides structure and guidelines to the sessions, but it is not a “cookbook” that is rigidly implemented. Rather, the therapists implement the core component with adaptations to fit the families being served. The group modality includes sessions with the children and caregivers together concurrently. These sessions are about once a month. For the family modality, sessions vary in terms of setup: Caregiver alone, child alone, and the family together.
Based on the research on PSB-CBT™, the program was given a “strong” rating by the Collaborative Outcome Data Committee (CODC; Hanson, Bourgon, Helmus, & Hodgson, 2009) and is ranked as “Effective” in the OJJDP Program Model Guide. A ten-year follow-up with preteen youth randomized to PSB-CBT™ found recidivism rates comparable to youth with behavior problems but no previous history of PSB (2-3%), and significantly lower than youth randomized to the play therapy treatment group condition (10%; Carpentier et al., 2006).