National Center on the Sexual Behavior of Youth

What qualifications are needed to work clinically with youth with problematic sexual behavior?

Clinicians should comply with generally accepted standards of practice of their mental health profession and follow the Professional Code of Ethics published by the Association for the Treatment of Sexual Abusers. Clinicians should:

• Have appropriate training, experience, and continuing education.

• Recognize their abilities and limitations.

• Engage in consultation and teamwork.

• Follow relevant professional guidelines and ethical standards.

Practitioners have an ethical obligation to become educated about relevant issues, seek out appropriate consultation, and coordinate care with other professionals involved whenever possible.

Clinicians must not have a conviction or a deferred judgment for any offense involving criminal, sexual or violent behavior or a felony that would bring into question the competence or integrity of the individual to provide sexual abuse specific treatment. 

What are the ethical guidelines for professionals working with youth with problematic sexual behavior? 

• Professionals must be knowledgeable of their own profession’s ethical guidelines and standards of care as they relate to children and families, and specifically youth with problematic sexual behavior and youth involved in the courts. 

• Ethical guidelines require professionals to work within their areas of expertise, seek consultation when needed, and refer out if they are not adequately knowledgeable or proficient in a particular area. Professionals must always practice within the boundaries of their training and profession.

• Some professions may not have ethical guidelines that directly address youth with problematic sexual behavior—in these cases, Association for the Treatment of Sexual Abuser’s guidelines for clinical professionals are a starting point for supporting ethical practices.

 (See the Association for the Treatment of Sexual Abusers Professional Code of Ethics)

[See also profession’s ethical principles and codes for Psychologists, Juvenile Justice, Probation, Child Welfare, Prosecuting Attorneys, Criminal Justice, and Counselors here and here] 

What training, experience and continuing education activities are important for working with youth with problematic sexual behavior? 

• Children and adolescents are not small adults.  Professionals must have education and training in child and adolescent development.  Relevant coursework, supervision and, especially, ongoing continuing education are important.

• Professionals require specific training to develop core knowledge in child and teen problematic sexual behavior.

• Professionals must  understand the heterogeneity among youth, their individual risks, strengths, and needs, and the context of the situation.  

• The nature and extent of this training needs to be commensurate with the type of activities and services provided.  

• Because laws and public policy influence decision making, professionals must be familiar with policies and laws that pertain to youth with problematic sexual behavior. 

• Professionals must recognize trauma and the potential impact on those involved and affected by the problematic sexual behavior. 

• Multidisciplinary teams help facilitate coordination of care and support professional decision making for youth and their families. Professionals must be aware of the roles and responsibilities of the other professionals involved in the response to youth problematic sexual behavior.

What are some specific areas of knowledge and expertise for professionals working with youth with problematic behavior?

Professionals must be able to answer the question, “Is the sexual behavior normative or problematic?” This requires knowledge of the following topics: 

• Range of sexual behavior exhibited by children and teens.

• Relevant local laws.

• Varying cultural attitudes and beliefs. 

• Healthy sexual development in children and teens.

• How to work with youth and their families. 

• How to establish communication and parenting skills that promote healthy development (For further discussion of these topics, see Sexual Behavior: Typical or Problematic?, and Assessment (Coming Soon).

Professionals must be able to determine if the behavior is potentially illegal or problematic and what are options are available. A number of factors impact this determination.

• State and federal laws vary dramatically for youth.

• Relevant laws and public policies are included below.

          • The Federal Child Abuse Prevention and Treatment Act (CAPTA) (PL 111-320) provides federal guidelines for child abuse and neglect and child protection.

          • The Adam Walsh Child Protection and Safety Act of 2006 (PL-109-248) is the federal law that is designed to protect children from sexual exploitation, sexual abuse, and other sex offenses.  

         • This Act strengthen penalties for crimes against children, makes it more difficult to reach children on the internet for sexual acts, requires background checks for adoptive and foster parents, and has expanded the national sex offender registry.  

          • State laws are also relevant to address problematic sexual behavior of youth. These laws include ones pertaining to abused and neglected children, family court proceedings, children’s behavioral health programs, and sexual offender registration and community notification.

Professionals should collaboratively determine what response options fit with the characteristics of the case (e.g., deferred prosecution, types of charges, rehabilitation, and placement). The options that would be considered best in terms of standards of care may not be readily available in the community. Efforts towards systems change may need to be considered.

• Professionals must keep in mind that most laws related to sexual offenses were developed to apply to adult sexual offenders.  Many laws do not consider the differences in adult behaviors and child or youth with problematic or illegal sexual behaviors. 

          • For example, some jurisdictions are considering legislation that would address “youth produced images” (also referred to as, “sexting”) separately from child pornography.

Professionals must also be aware of the rates and risks of problematic sexual behavior including:

• Low frequency of recurrent problematic or illegal sexual behavior overall. 

• Rates of nonsexual behavior problems are more likely than sexual ones.

• Research-based risk and protective factors that may increase or decrease the likelihood of problematic sexual behaviors.

• [Understanding PSB in Youth; Assessment (Coming Soon)]

Professionals must be knowledgeable of evidence-based interventions and characteristics of best practices, including:

• Evidence-based behavior management interventions.  

• Interventions should be family focused and match the interventions to fit the risk, needs, and responsivity of the youth with problematic sexual behavior.

• Be developmentally appropriate for children or teens.  

See the Clinical Decision-Making and Intervention (Coming Soon) sections for more information about best practices and evidence-based practice.

Professionals must be aware of the impact and response to trauma experienced by the youth with problematic sexual behavior, child victims, and families. Professionals must recognize trauma and intervene when appropriate. [www.nctsn.org]

Professionals must be knowledgeable about factors relevant for decision-making when considering placement following problematic sexual behavior including the steps for timely family reunification when out-of-home placement occurs. [See Clinical Decision Making, Levels of Care]

Are there instances when specialized training is required?  

Yes. Atypical sexual interests are rare among youth with problematic sexual behavior.  Professionals working with teens with persistent, atypical sexual interests should stay abreast to the latest research and practices on how to address these concerns in a developmentally appropriate manner (do not utilize strategies solely designed for adults with pedophilia).  The Association for the Treatment of Sexual Abusers lists training opportunities and requirements. 

[See Interventions (Coming Soon)] 

What are the limitations of practice?

Professionals need to be cognizant of their capacity and competence, reaching for supervision and consultation particularly when reaching the boundaries of expertise. However, it can be difficult to know what we do not know.  Continuous education, consultation and support is needed.  In addition to the professional knowledge and skills described above,  consultation and teamwork is important for helping professionals  monitor decision making, the progress of families as they work toward reunification and resolution, the identification of risk and protective factors, and safety planning.  

What are some guiding principles for professionals who work with youth with problematic sexual behavior? 

Realize The Potential Impact And Act Accordingly

•Working with youth with problematic sexual behavior and their families is rewarding, as families resolve their difficulties.  

I've just really seen the changes in these families, not just in the reduction of problematic sexual behaviors but positive outcomes in terms of academic performance, and family functioning."   

—Program Therapist, 2016

In response to the question "What keeps you working with youth who have problematic sexual behaviors?"

Positive outcomes, from this, in particular program I think the group treatment...has a lot to do with...that cohesion and that peer support from the families; I've just really seen the changes in these families, not just in the reduction of problematic sexual behaviors but positive outcomes as well in terms of academic performance, family functioning and, and things like that so I mean we just, we get to see a lot of really neat positive outcomes.”  

• At the same time, work is often also difficult and demanding.  It exposes professionals to hardships and the traumatic experiences of others that affect professionals differently.

• Consultation and peer support help professionals address difficulties should they arise.

Be Mindful Of Professional Roles And Responsibilities  

• Youth problematic sexual behavior is organizationally complex. Multiple professionals are often involved, who may at times have competing interests or philosophies (such as decisions regarding family reunification, victim contact, and community safety).   

               • Professionals may have unrealistic expectations of each other’s roles and
                 expertise.  

               • Probation officers or child welfare workers may be asked to give treatment
                 recommendations beyond the scope of their training and expertise.  

               • Child welfare workers, probation officers or judges may turn to clinicians to
                 make final decisions about whether siblings should have contact, whether a
                 youth may return home, or what school or extra-curricular activities a youth
                 can attend.

               • Clinicians may be asked legal questions, such as whether a youth should be
                 on probation or even a sex offender registry. 

• When professionals are asked to make determinations that are beyond their professional roles, it’s important to maintain appropriate boundaries, seek consultation as needed, and practice accordingly.

• Development of a functional multidisciplinary team can facilitate not only coordination of care but also a better understanding of each professional’s roles, responsibilities, and expertise and improve decision making.  

See Intervention (Coming Soon)

I think that the multidisciplinary team is really important… these cases are always so complex, they are never cut and dry…. having the eyes of other agencies and therapists paints a much broader picture… we are able to meet more of the needs that the families have.”  

—Program Therapist, 2016

Assessment 

What qualifications are necessary for professionals who conduct clinical and risk assessments of youth with problematic sexual behavior?

Qualified professionals (also referred to as evaluators or assessors) may include probation officers, social workers, licensed therapist, licensed counselors, clinical psychologist, and others. Professionals who conduct clinical assessments must be grounded in:

• Research pertaining to child and adolescent development.

• Knowledge about the heterogeneity of these youth.

• Research supported risk and protective factors. 

• Knowledge of the risk, needs, and responsivity principles (RNR Model) with consideration to the individual, family, and community risk and protective factors.

• Behavioral health challenges.

• Knowing what an evaluation can and cannot do. For example, assessments  provide clinical information that may aid decision-making but assessments  cannot determine whether or not a child committed an offense.

• Appropriate assessment practices, including procedures, relevant measures, developmentally appropriate risk assessment tools, and interpretation of assessment findings.

• Relevant evidence-based treatment. 

Quality assessments (Coming Soon) are essential for informing decision-making, identifying appropriate interventions (Coming Soon) and for facilitating positive outcomes. Although the extent or comprehensiveness of the assessment will depend on the purpose of the evaluation, (e.g., to guide treatment planning or legal decisions). See Assessment (Coming Soon), RNR Model 

State professional licensing boards can provide additional guidance regarding requirements within their jurisdiction for professionals who conduct evaluations and assessments.

Some states have practice standards for professionals who work with youth with problematic sexual behavior. (See the Rhode Island Department of Children, Youth, and Families Practice Standards)

For further information regarding these domains click on these links for Assessment, Assessment Measures, Decision-Making, and Intervention.  

Forensic Evaluations, Risk Assessments, and Evaluations in Legal Settings

Professionals may conduct forensic evaluations, risk assessments, and evaluations used in legal settings. Assessment findings may have long-term impacts to youth, families, and the community. Professionals must have:

• Specialized training in forensic evaluation.

• Relevant laws and legal procedures. 

• Risk and needs assessment and cautions.

See Assessment (Coming Soon)

What are the necessary qualifications for professionals delivering services to youth with problematic sexual behavior? 

The professional working with youth with problematic sexual behavior need the training, experience, and continuing education activities as described above [LINK to second question]

Service delivery qualifications will depend upon the profession and role.  

• The role of a juvenile probation officer or a child welfare caseworker differs from that of a clinician.  

• The nature and extent of specialized education or training is to be commensurate with the type of services provided.

• Clinicians must be qualified in their profession and be appropriately trained and able to provide effective interventions or referrals for these youth and their families.

Do all states require the same qualifications for professionals who deliver services to youth with problematic sexual behavior? 

No. State and regional practices vary widely and are not always based on current facts or research. 

• Some states require treatment providers who provide therapy for youth with problematic sexual behavior to be certified as specialists in sex offense specific treatment.  

• Other states have developed guidelines and standards to promote the safe treatment and management of youth with problematic sexual behavior.  

• Because of the diversity of these children and teens, professional certifications may not ensure the youth receives the most efficacious treatment that matches their presenting problems.  

• Training and skills in evidence based family and parent interventions and safety planning may be more relevant than extensive training, certifications, or licensure as a sex offender treatment provider.

See Safety Planning and Intervention (Coming Soon)