A Guide for Treating Adolescent Sexual Abusers in Residential Settings: Forty-Five Days at a Time: a Collaborative Effort

By Jimmy D. McCamey Jr. Ph.D.

Treating adolescent sexual abusers in the context of the community is not a new phenomenon, but research suggests as states revise their way of providing residential treatment services to adolescents with sexual abusive behaviors, there is a need to better understand how and when to treat this difficult population with a community treatment model that ensures best practice approaches that provides tested and proven treatment modalities for adolescent sexual abusers who are provided community-based residential treatment services.

This guide for treating adolescent sexual abusers addresses that question and explains the role of community-based residential treatment programs to ensure quality-tested and proven clinical interventions and the safety of others in the community. All the case studies that I have included in this guide for residential treatment with children and adolescents who sexually abuse have come from my twenty-year experience, research, and personal conversations with adolescent sexual abusers. In consideration of the privacy of those individuals, given names and identifying circumstances have been changed, thus such names used in the case studies does not represent an actual client I worked with during the past twenty years.

• Language: English
• Publisher: Xlibris US
• Release date: Oct 26, 2016
• ISBN: 9781524545871

Jimmy D. McCamey Jr. Ph.D.

Dr. Jimmy D. McCamey Jr. has over twenty years of experience in higher education, clinical social work practice, mental health counseling, education consultation, assessment, and treatment of children, adolescents, adults, and families. Dr. McCamey has over two decades of leadership and management experience in residential treatment, psychiatric and community-based treatment facilities, and higher education. In addition to providing mental health counseling and supervision for master-level clinicians, Dr. McCamey has taught undergraduate and graduate social work, psychology, and mental health counseling for over fifteen years. Dr. McCamey is a former faculty member at the University of North Carolina at Wilmington (UNCW) and is currently a tenured associate professor of social work and mental health counseling at Fort Valley State University (FVSU). Dr. McCamey has published extensively in the area of mental health, poverty, social welfare, academic achievement, and African-American men and women, to name a few. Dr. McCamey is a licensed clinical social worker (LCSW), licensed professional counselor (LPC), and a diplomate in clinical social work (DCSW)—all by examination. He is also state certified (GA) as a DUI clinical evaluator, DUI treatment provider, and DUI and driver improvement school director/owner/instructor. He is certified for PRIME for Life (PRI-Version 9), PRIME Solutions (Version 1.0-ASAM Substance Abuse Treatment) and Driving Educators of Georgia (DEOG). Dr. McCamey is a long-standing member of the National Association of Social Work (NAWS).

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A Guide for Treating Adolescent Sexual Abusers in Residential settings

45 DAYS AT A TIME ‘A COLLABORATIVE EFFORT’

Jimmy D. McCamey, Jr., Ph.D.

Copyright © 2016 by Jimmy D. McCamey, Jr., Ph.D.

ISBN:      Softcover        978-1-5245-4588-8

                eBook             978-1-5245-4587-1

All rights reserved. No part of this book may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without permission in writing from the copyright owner.

Any people depicted in stock imagery provided by Thinkstock are models, and such images are being used for illustrative purposes only.

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Rev. date: 10/12/2016

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Contents

Author’s Notes

Acknowledgment

Introduction

1.   What Is Residential Group Care?

2.   Characteristics of Child and Adolescent Sexual Abusers

3.   Type of Treatment Strategies

4.   The Assessment and Admission Process

5.   Sample Diagnostic and Mental Health Assessments

6.   Sample Individual Resiliency Plan

7.   Case Management Approaches for Juvenile Sexual Abusers

8.   The Role of the Family and Placing Agency

9.   The First Forty-Five Days of Placement

10.   The Second Forty-Five Days of Residential Treatment

11.   The Third Forty-Five Days Residential Treatment

12.   The Fourth Forty-Five Days of Residential Treatment

13.   The Fifth Forty-Five Days of Residential Treatment

14.   The Sixth Forty-Five Days of Residential Treatment

15.   The Seventh Forty-Five Days of Residential Treatment

16.   The Eight Forty-Five Days after Residential Treatment

17.   Community Reintegration

18.   Conclusion

19.   Selected Bibliography

Author’s Notes

Treating adolescent sexual abusers in the context of the community is not a new phenomenon, but research suggests, as States revise their way of providing residential treatment services to adolescents with sexual abusive behaviors, there is a need to better understand how and when to treat this difficult population with a community treatment model that ensures best practice approaches that provides tested and proven treatment modalities for adolescent sexual abusers who are provided community-based residential treatment services.

This guide for treating adolescent sexual abusers addresses that question and explains the role of community-based residential treatment programs to ensure quality-tested and proven clinical interventions and safety of others in the community. All the case studies that I have included in this guide for residential treatment with children and adolescents who sexually abuse have come from my twenty-year experience, research, and personal conversations with adolescent sexual abusers. In consideration of the privacy of those individuals, given names and identifying circumstances have been changed; thus, such names used in the case studies do not represent an actual client I worked with during the past twenty years.

Acknowledgment

Writing a book can never be something that just happens. It takes time, dedication, and persistence to complete such a huge task. Being a full-time employee, business owner, father, uncle, mentor, friend, and so many other things to many, it would have been impossible to complete this task without the support of my family, friends, colleagues, and employees at the residential treatment programs I have been afforded the opportunity to work with during the past twenty years. Each of you have continued to inspire my writings and my study of children and adolescent sexual abusers.

Introduction

Residential treatment for adolescent sexual abusers have often been regarded as a last resort due to the belief in beginning treatment in the least restrictive environment (Frensch and Cameron 2002; McCamey and Murty 2014). This belief stems from the goal of deinstitutionalization (Frensch and Cameron 2002). Adolescents in residential treatment often equate with feelings of familial failure (Frensch and Cameron 2002). Determining whether residential treatment is appropriate is difficult due to the lack of consistent guidelines in formal treatment strategies (Frensch and Cameron 2002). For example, though there may be some basic consensus, oftentimes determining treatment placement is decided by various clinicians—each with their own perspective, clinical orientation, and diagnostic impression.

It is believed that children in residential treatment are not often different from children placed in less intensive settings (Frensch and Cameron 2002; McCamey and Murty 2014; McCamey and Brenner 2015). The lives of children in residential treatment programs are often characterized by difficulties with family relationships (Frensch and Cameron 2002). Youth also tend to have a history of substance abuse, family violence, mental illness, and criminal activity (Frensch and Cameron 2002). These adolescents are also less likely to have supportive networks, thus increasing the likelihood to engage in socially unacceptable and sometimes counterproductive behaviors (Frensch and Cameron 2002).

What Is Residential Group Care?

Residential treatment programs are twenty-four-hour facilities designed to address psychiatric, social, psychological, and psychosocial issues with the guidance of multidisciplinary teams (McCamey and Murty 2014; McCamey and Brenner 2015; Hair 2005). There have been questions and concerns regarding the benefits of residential treatment, especially as it relates to treatment efficiency outcomes and treatment gains by children and adolescents (Hair 2005). It is important and necessary to determine the outcomes of residential programs following discharge in an effort to balance cost and safety of the community (Hair 2005). The information on treatment effectiveness and treatment outcomes will guide clinicians and policies on whether residential treatment is truly beneficial as well as inform practice on this unique population (Hair 2005).

Residential programs are thought to significantly improve the overall mental health of children and adolescents due to the durability of treatment (McCamey 2010; McCamey and Murty 2014; McCamey and Brenner 2015). Many effects of treatment are lasting beyond the discharge date up to six months (Hair 2005). However, more long-lasting effects are needed to make serious life changes for children and adolescents who struggle with sexual aggression. Though the goal of deinstitutionalization is to use the least restrictive setting first, there are times when community mental health cannot meet the needs of the client who suffer from sexual aggression and deviant sexual behaviors (Hair 2005; McCamey 2014; McCamey and Murty 2014). Therefore, there remains to be a need for more intensive levels of treatment to manage the aforementioned population (Hair 2005).

Residential treatment can provide a consistent, nurturing environment along with predictable and consistent expectations that help the youth learn healthy ways of managing feelings and emotions, especially sexual aggression. These things help shape and guide more desirable behaviors that can lead to better outcome and resiliency (Hair 2005). It can be difficult to measure the effectiveness in residential treatment due to the complexity of the settings and lack of research on treatment outcomes and longitude studies for this population. McCamey (2010) and Brenner and McCamey (2015) concluded that residential treatment shows promising results, especially when linkages to community-based services are added following discharge. Variables that can affect treatment outcomes include the staff, philosophy, the relationship between the client and therapist, and individual characteristics (Hair 2005; McCamey 2010; McCamey and Murty 2014; McCamey and Brenner 2015). Residential treatment can be a valuable intervention but must be followed with some sort of aftercare and safety support networks (Hair 2005; McCamey and Brenner 2015).

Outcome studies of residential treatment programs have provided mixed results with minimal success; however, there continues to be a gap in the research which examines this important issue (Frensch and Cameron 2002; McCamey 2010). Demographic information has not been predictive of post-discharge success, which further complicates the research data (Frensch and Cameron 2002). Treatment factors, individual characteristics, and family involvement have been indicated in better outcome results, but more attention is needed on such studies. Overall, this particular study found positive results for residential treatment programs. Better adaptation was related to perceived support from others after discharge (Frensch and Cameron 2002). McCamey (2010) stressed the importance of continuity of care to community-based services following residential treatment. Researchers stressed the importance of actively involving adolescents in their treatment planning and goals (Frensch and Cameron 2002; McCamey 2010).

Based on the research conducted by Frensch and Cameron (2002), it can be difficult to maintain changes made in a residential program, especially when supportive environments are not established prior to discharge and maintained when the youth return to their family of origin or a less controlled environment. It is also important to note that protective and relapse prevention services must be established as part of the discharge safety plan. Changes can dissipate over time (Frensch and Cameron 2002). Overall improvement in treatment is not always an indicator of continued performance in the community (McCamey 2010). Therefore, providing linkages to community services may aid in maintaining the initial changes made in treatment, which is thought to reinforce positive coping skills, relapse prevention, and cognitive restructuring (McCamey and Brenner 2015).

Characteristics of Child and Adolescent Sexual Abusers

Juvenile sexual abusers may experience more social isolation from both their peers and their relationship with their family (Vizard, Monck, and Misch 1995, 737). Young sexual abusers may be shy, timid, or experience withdrawal compared to juvenile delinquents (Vizard, Monck, and Misch 1995, 737). Child molesters may have less intimate relationships and fewer friends, especially with females (Vizard, Monck, and Misch 1995, 737). Adolescent sexual abusers may have social-skill deficits, are isolated sexually and socially, and may have family dysfunction that includes violence (Vizard, Monck, and Misch 1995, 737). However, data has been difficult to interpret. For example, there may be no difference in family functioning of adolescents who sexually offend and juvenile delinquents (Vizard, Monck, and Misch 1995, 737). Learning difficulties, poor school achievements, communication problems, low self-esteem, or affective mood disorders may be other characteristics of juvenile sexual abusers (Vizard, Monck, and Misch 1995, 738). A consideration to take note is whether childhood victimization leads to adult offending (Vizard, Monck, and Misch 1995, 738). Physical violence in childhood may be an indicator of future adolescent sex offending (Vizard, Monck, and Misch 1995, 738). Future research should focus on better understanding the implications of being abused as a child and the development of abusive characteristics once an adolescent or adult.

Adolescent sexual abusers may have a wide range of psychiatric disorders ranging from conduct disorder, depression, ADHD, or adjustment disorder (Vizard, Monck, and Misch 1995, 739). More research needs to