RE: Best Practices with Youth

["Silovsky, Jane F. (HSC)" <Jane-Silovsky@xxxxxxxxx>]

For young children who have a sexual abuse history and sexual behavior problems, I'd encourage you to look at the work of Judith Cohen and Tony Mannarino, whose randomized control trial of cognitive-behavior therapy and non-directive therapy found significant (statistical and clinical) reductions in sexual behavior problems with the use of cognitive-behavior therapy which was maintained at follow up.  Both treatments individual, rather than group.  The children and parents were involved in the treatment. 

Cohen, J. A., & Mannarino, A. P.  (1996a).  A treatment outcome study for sexually abused preschool children: Initial findings.  Journal of the American Academy of Child and Adolescent Psychiatry, 35, 42-50.

Cohen, J. A., & Mannarino, A. P.  (1997).  A treatment study for sexually abused preschool children: Outcome during a one-year follow-up.  Journal of the American Academy of Child and Adolescent Psychiatry, 36, 1228-1235. 

-----Original Message-----
From: owner-CHILD-MALTREATMENT-RESEARCH-L@cornell.edu
[mailto:owner-CHILD-MALTREATMENT-RESEARCH-L@cornell.edu]On Behalf Of
Chaffin, Mark J. (HSC)
Sent: Friday, October 03, 2003 10:01 AM
To: Child Maltreatment Researchers
Subject: Best Practices with Youth


Rob,

Although there is considerable clinical lore and opinion that some sort
of "sex-offender specific" treatment is absolutely a must for these
youngsters, the findings from the two randomized trials done to date
suggest that the more targeted CBT sexual behavior oriented approaches
did no better than unstructured unfocused models.  Of course, all of the
treatments in both trials had parent involvement, which may be the key.
It may not matter what you do with the kids, so long as you have the
parents involved and providing some level of supervision and support.
All the kids got better, recurrence rates were low and most recurrences
were for less serious non-victimizing types of sexual behaviors. 

We are currently working up 10-year follow-up data on a couple of
hundred under 12 y/o kids from the Oklahoma project, and thusfar it
looks like recurrence of reports for sexually abusive behavior are so
low that its impossible to make treatment type comparisions.  For
example, our initial database match with child welfare report and police
report data found only two kids out of 200 who had a CPS sexual abuse
perpetration report across their adolescence and early adulthood, and
virtually none who had police reports for an alleged sex offense.  This
might suggest that best practice for these kids should be determined
more by what other (i.e., non-sexual) problems they have, rather than
being intensively sex sex sex sex sex oriented.  We know these kids have
multiple comorbidities (ODD, CD, PTSD) and perhaps any best practice
approach should consider these more general problems as a major part of
treatment.  There are evidence-based best-practice treatments for these
problems.

Mark Chaffin