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How big a difference can new evidence-based treatment methods make in the cases of juvenile offenders with mental health problems?

In Cook County, Illinois, juvenile court leaders decided to find out. Specifically, they agreed to participate in a randomized controlled experiment to test the impact of Multisystemic Therapy (MST) – a prominent new treatment methodology – against the court’s usual services for youth accused or adjudicated for juvenile sex offenses.

The study, published in 2009, involved 127 youth accused of sex offenses and ordered by the court to attend sex offender treatment. Sixty-seven were assigned to MST, and 60 were assigned to Cook County probation department’s existing juvenile sex offender unit and required to take part in weekly sex offender treatment groups.

The offenders’ mean age was 14.6 years (range 11 to 18 years). Most youth (98 percent) were male, 54 percent Black, 44 percent White, with 31 percent reporting Hispanic ethnicity. Their offenses included aggravated criminal sexual assault (31 percent), criminal sexual abuse (24 percent), criminal sexual assault (18 percent), and aggravated criminal sexual abuse (15 percent). Evaluators found no differences between youth in the MST and comparison groups in terms of their sexual offense records or demographics.

Youth assigned to MST received treatment at home and in community settings such as school, scheduled for the family’s convenience. Caregivers as well as the juvenile offender were included in the treatment, which was delivered by clinicians specifically trained on the MST model. MST focuses on giving parents the skills and resources they need to deal with difficulties commonly experienced while raising adolescents, and giving the juveniles the skills and resources to deal with problems both inside and outside the family. For the sex offender group, the MST model was tailored to address youth and caregiver denial of the offense, minimize the youths’ access to potential victims, and promote normative, age-appropriate sexual experiences with peers.

The Treatment as Usual (TAU) group received services primarily from personnel from the juvenile sexual offender unit of Cook County’s juvenile probation department. They attended weekly sex offender treatment groups of 8 to 10, for 60-minute sessions led by probation officers who had completed a certification course for treating juvenile sexual offenders. The sessions addressed issues such as victim empathy, deviant arousal, and cognitive distortions, with the goals of helping youth accept responsibility for their offenses, break the sexual offense cycle, and devise strategies to reduce the risks for recidivism.

Researchers collected data on problem sexual behavior, delinquency, substance use, mental health symptoms, and out of home placement (e.g., foster care, detention, residential treatment) at baseline (within 72 hours of recruitment into the study) and at 6 and 12 months after recruitment. Sexual reoffending was not examined as an outcome because it is too rare to support statistical analysis—in fact only one incident of sexual recidivism was recorded for the entire study group during the 12-month period.

The study found that youth in the MST group proved far and away more successful than those receiving usual treatment. Juveniles in MST experienced significant reduction in problem sexual behavior (e.g., having unprotected sex, pressuring others into having sex), relative to the TAU group, as well as a significant reduction in delinquent behavior and substance use relative to the TAU group over the 12-month period. For instance, involvement in delinquent behavior declined from 75 percent to 30 percent for MST youth, versus a much smaller decline for youth in the TAU group (52 percent to 42 percent). Finally, MST youth proved far less likely than TAU youth to be removed from home in the year after treatment: 7 percent versus 18 percent.

“The findings suggest that family- and community-based interventions, especially those with an established evidence-base in treating adolescent antisocial behavior, hold considerable promise in meeting the clinical needs of juvenile sexual offenders,” the study concluded. “In addition, current results supporting MST bring into question the public health/safety effects of the increasingly severe legal consequences (e.g., lifetime public registration, prolonged residential treatment) placed on juveniles who sexually offend.”

Sarah Boslaugh is a staff writer for the Juvenile Justice Information Exchange.

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