Qualitative Analysis of Administrator, Provider, and Stakeholder Views on the Costs and Benefits of a Treatment for Problematic Sexual Behavior of Youth

Abstract

Evidence-based treatment for youth with problematic sexual behavior (PSB) has the potential for a broad range of costs and benefits, raising the importance of querying its public health impact. This qualitative study examined the impact of treatment for youth with PSB through content analysis of interviews (N = 57) with service agency administrators, treatment providers, and professional stakeholders in communities where recent implementation of interventions for youth with PSB had occurred. Interviewees emphasized multi-level impacts of the program on families (e.g., knowledge, well-being), communities (e.g., public safety, education), and public agencies (e.g., caseloads, stress). Implications for comprehensively evaluating the impact of PSB interventions are discussed.

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Notes

  1. 1.

    Interviewee demographic information excludes the two administrator interviews that were un-transcribable, as detailed in the Procedure section.

References

  1. Aarons, G. A., Hurlburt, M., & Horwitz, S. M. (2011). Advancing a conceptual model of evidence-based practice implementation in public service sectors. Administration and Policy in Mental Health,38(1), 4–23. https://doi.org/10.1007/s10488-010-0327-7.

    Article  PubMed  Google Scholar 

  2. Bayefsky, R. (2014). Dignity as a value in agency cost-benefit analysis. The Yale Law Journal,123(6), 1626–2133.

    Google Scholar 

  3. Bazeley, P. (2013). Qualitative data analysis: Practical strategies. Thousand Oaks, CA: Sage.

    Google Scholar 

  4. Beatty, A. (2009). Strengthening benefit-cost analysis for early childhood interventions. Washington, DC: The National Academies Press.

    Google Scholar 

  5. Berliner, L., & Rawlings, L. (1991). A treatment manual: Children with sexual behavior problems. Seattle, WA: Harborview Sexual Assault Center.

    Google Scholar 

  6. Bond, G. R., Drake, R. E., McHugo, G. J., Peterson, A. E., Jones, A. M., & Williams, J. (2014). Long-term sustainability of evidence-based practices in community mental health agencies. Administration and Policy in Mental Health and Mental Health Services Research,41(2), 228–236. https://doi.org/10.1007/s10488-012-0461-5.

    Article  PubMed  Google Scholar 

  7. Bonner, B. L., Chaffin, M. C., Pierce, K., Swisher, L., Schmidt, S., & Walker, C. E. (2009). Treatment manual for adolescent sexual offenders. Unpublished manuscript. Department of Pediatrics, University of Oklahoma Health Sciences Center.

  8. Bonner, B. L., Walker, C. E., & Berliner, L. (1999). Treatment manual for cognitive behavioral group therapy for children with sexual behavior problems (Grant No. 90-CA-1469). Washington, DC: Administration of Children, Youth, and Families, DHHS.

  9. Borduin, C. M., & Dopp, A. R. (2015). Economic impact of multisystemic therapy with juvenile sexual offenders. Journal of Family Psychology,29(5), 687–696. https://doi.org/10.1037/fam0000113.

    Article  PubMed  Google Scholar 

  10. California Evidence-Based Clearinghouse for Child Welfare. (2011a). Problematic Sexual Behavior—Cognitive-Behavioral Therapy for Preschool Children. Retrieved September 20, 2019, from https://www.cebc4cw.org/program/problematic-sexual-behavior-cognitive-behavioral-therapy-for-preschool-children/.

  11. California Evidence-Based Clearinghouse for Child Welfare. (2011b). Children with Problematic Sexual Behavior Cognitive-Behavioral Treatment Program: School-age Program. Retrieved September 20, 2019, from https://www.cebc4cw.org/program/children-with-sexual-behavior-problems-cognitive-behavioral-treatment-program-school-age-group-2/.

  12. Carpentier, M., Silovsky, J. F., & Chaffin, M. C. (2006). Randomized trial of treatment for children with sexual behavior problems: Ten-year follow-up. Journal of Consulting and Clinical Psychology,74(3), 482–488. https://doi.org/10.1037/022-006X.74.3.482.

    Article  PubMed  Google Scholar 

  13. Chaffin, M. C. (2008). Our minds are made up—Don’t confuse us with the facts: Commentary on policies concerning children with sexual behavior problems and juvenile sex offenders. Child Maltreatment,13(2), 110–121. https://doi.org/10.1177/1077559508314510.

    Article  PubMed  Google Scholar 

  14. Chaffin, M. C., Berliner, L., Block, R., Johnson, T. C., Friedrich, W., Louis, D., et al. (2008). Report of the ATSA Task Force on children with sexual behavior problems. Child Maltreatment,13(2), 199–218. https://doi.org/10.1177/1077559507306718.

    Article  PubMed  Google Scholar 

  15. Chaffin, M. C., Letourneau, E. J., & Silovsky, J. F. (2002). Adults, adolescents, and children who sexually abuse children: A developmental perspective. In J. E. B. Myers, L. Berliner, J. Briere, C. T. Hendrix, C. Jenny, & T. A. Reid (Eds.), The APSAC handbook on child maltreatment (pp. 205–232). Thousand Oaks, CA: Sage Publications Inc.

    Google Scholar 

  16. Chamberlain, P., Snowden, L. R., Padgett, C., Saldana, L., Roles, J., Holmes, L., et al. (2011). A strategy for assessing costs of implementing new practices in the child welfare system: Adapting the English cost calculator in the United States. Administration and Policy In Mental Health,38(1), 24–31. https://doi.org/10.1007/s10488-010-0318-8.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Charmaz, K. (2014). Constructing grounded theory (2nd ed.). Thousand Oaks: Sage.

    Google Scholar 

  18. Crouch, E. (2012). Policy evaluation using cost-benefit analysis: Empirical ramifications for two policy issues (Doctoral dissertation). Retrieved from Tiger Prints, Clemson University. (Paper 1060).

  19. Dopp, A. R., Borduin, C. M., & Brown, C. E. (2015). Evidence-based treatments for juvenile sexual offenders: Review and recommendations. Journal of Aggression, Conflict and Peace Research,7(4), 223–236. https://doi.org/10.1108/JACPR-01-2015-0155.

    Article  Google Scholar 

  20. Dopp, A. R., Borduin, C. M., Rothman, D. B., & Letourneau, E. J. (2017). Evidence-based treatments for youths who engage in illegal sexual behaviors. Journal of Child & Adolescent Psychology,46(5), 631–645. https://doi.org/10.1080/15374416.2016.1261714.

    Article  Google Scholar 

  21. Dopp, A. R., Mundey, P., Silovsky, J. F., Hunter, M., & Slemaker, A. (2019). Economic value of community-based services for problematic sexual behaviors in youth: A mixed-method cost-effectiveness analysis. Child Abuse & Neglect. https://doi.org/10.1016/j.chiabu.2019.104043.

  22. Finkelhor, D., Ormrod, R., & Chaffin, M. C. (2009). Juveniles who commit sex offenses against minors (NCJ 227763). Washington, DC: U.S. Department of Justice, Office of Juvenile Justice and Delinquency Prevention.

    Google Scholar 

  23. Freyd, J. J., Putnam, F. W., Lyon, T. D., Becker-Blease, K. A., Cheit, R. E., Siegel, N. B., et al. (2005). The science of child sexual abuse. Science,308, 501. https://doi.org/10.1126/science.1108066.

    CAS  Article  PubMed  Google Scholar 

  24. Greenwood, P. W. (2008). Prevention and intervention programs for juvenile offenders. The Future of Children,18(2), 185–210. https://doi.org/10.1080/15564880903227438.

    Article  PubMed  Google Scholar 

  25. Hackett, S., Holmes, D., & Branigan, P. (2016). Operational framework for children and young people displaying harmful sexual behavior. London: NSPCC.

    Google Scholar 

  26. Hackett, S., Masson, M., Balfe, M., & Phillips, J. (2015). Community reactions to young people who have sexually abused and their families: A shotgun blast, not a rifle shot. Children and Society,29, 243–254. https://doi.org/10.1111/chso.12030.

    Article  Google Scholar 

  27. Hanson, R., Bourgon, G., Helmus, L., & Hodgson, S. (2009). The principles of effective correctional treatment also apply to sexual offenders: A meta-analysis. Criminal Justice and Behavior,36(9), 865–891. https://doi.org/10.1177/0093854809338545.

    Article  Google Scholar 

  28. Henggeler, S. W., Letourneau, E. J., Chapman, J. E., Borduin, C. M., Schewe, P. A., & McCart, M. R. (2009). Mediators of change for multisystemic therapy with juvenile sexual offenders. Journal of Consulting and Clinical Psychology,77(3), 451–462. https://doi.org/10.1037/a0013971.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Hyde, J. K., Mackie, T. I., Palinkas, L. A., Niemi, E., & Leslie, L. K. (2015). Evidence use in mental health policy making for children in foster care. Administration and Policy in Mental Health,43(1), 52–66. https://doi.org/10.1007/s10488-015-0633-1.

    Article  Google Scholar 

  30. Jefferson, T., Austen, S., Sharp, R., Ong, R., Lewin, G., & Adams, V. (2014). Mixed-methods research: What’s in it for economists? The Economic and Labour Relations Review,25(2), 290–305. https://doi.org/10.1177/1035304614530819.

    Article  Google Scholar 

  31. Kelley, A., Shawler, P., Shields, J. D., & Silovsky, J. F. (2019). A qualitative investigation of policy for youth with problematic sexual behavior. Journal of Community Psychology,47(6), 1347–1363. https://doi.org/10.1002/jcop.22187.

    Article  PubMed  Google Scholar 

  32. Kettrey, H. H., & Lipsey, M. W. (2018). The effects of specialized treatment on the recidivism of juvenile sex offenders: A systematic review and meta-analysis. Journal of Experimental Criminology,14(3), 361–387. https://doi.org/10.1007/s11292-018-9329-3.

    Article  Google Scholar 

  33. Letourneau, E. J., Eaton, W. W., Bass, J., Berlin, F., & Moore, S. G. (2014). The need for a comprehensive public health approach to preventing child sexual abuse. Public Health Reports,129(3), 222–228. https://doi.org/10.1177/003335491412900303.

    Article  PubMed  PubMed Central  Google Scholar 

  34. MacDonald, G. (2001). Effective interventions for child abuse and neglect: An evidence-based approach to planning and evaluating interventions. New York: Wiley.

    Google Scholar 

  35. Masson, H., & Hackett, S. (2004). The extent and nature of work with adolescents who have sexual behavior problems: Findings from a survey of youth offending teams in England and Wales. Youth Justice,4(3), 160–177. https://doi.org/10.1177/147322540400400302.

    Article  Google Scholar 

  36. McGrady, M. E. (Ed). (2018). Building the economic evidence base for pediatric psychology services [Special issue]. Clinical Practice in Pediatric Psychology, 6(2).

  37. Mundey, P., Kelley, A., Shawler, P., Shields, J., Silvis, V., & Silovsky, J. F. (2019). Community response to youth with problematic sexual behavior: A qualitative analysis of eight communities (Manuscript in preparation).

  38. National Institute of Justice. (2015). OJJDP model programs guide. Program profile: Children with problematic sexual behavior-cognitive behavioral therapy (PSB-CBT). Retrieved September 20, 2019, from https://www.crimesolutions.gov/ProgramDetails.aspx?ID=380.

  39. Panzano, P. C., & Roth, D. (2006). The decision to adopt evidence-based and other innovative mental health practices: Risky business? Psychiatric Services,57(8), 1153–1161. https://doi.org/10.1176/ps.2006.57.8.1153.

    Article  PubMed  Google Scholar 

  40. Petersen, A. C., Joseph, J., & Feit, M. (Eds.). (2014). New directions in child abuse and neglect research. Washington, DC: National Academies Press.

    Google Scholar 

  41. Petrosino, A., Turpin-Petrosino, C., & Guckenburg, S. (2010). Formal system processing of juveniles: Effects on delinquency. Campbell Systematic Reviews,1, 1–88. https://doi.org/10.4073/csr.2010.1.

    Article  Google Scholar 

  42. Pittman, N., & Parker, A. (2013). Raised on the registry: The irreparable harm of placing children on the sex offender registry in the US. Washington, DC: Human Rights Watch.

    Google Scholar 

  43. Roundfield, K. D., & Lang, J. M. (2017). Costs to community mental health agencies to sustain an evidence-based practice. Psychiatry Services,68(9), 876–882. https://doi.org/10.1176/appi.ps.201600193.

    Article  Google Scholar 

  44. Shawler, P., Silvis, V., Taylor, E. K., Shields, J. D., Beasley, L., & Silovsky, J. F. (2019). Early identification of youth with problematic sexual behavior: Impact on prevention of child sexual abuse (Manuscript in preparation).

  45. Shields, J. D., Klienkenbiel, C. M., Taylor, E. K., Espeleta, H. C., Beasley, L. O., & Silovsky, J. F. (2018). A qualitative analysis of family perspective on treatment services for youth with problematic sexual behavior. Victims & Offenders,13(7), 955–973. https://doi.org/10.1080/15564886.2018.1506853.

    Article  Google Scholar 

  46. Silovsky, J. F., Hunter, M. D., & Taylor, E. K. (2018a). Impact of early intervention for youth with problematic sexual behaviors and their caregivers. Journal of Sexual Aggression,25(1), 4–15. https://doi.org/10.1080/13552600.2018.1507487.

    Article  Google Scholar 

  47. Silovsky, J. F., Shawler, P., Taylor, E. K., Shields, J. D., & Beasley, L. O. (2018b). Impact of systems change on the implementation of evidence-based practice: Case study (Manuscript in preparation).

  48. Smith, C., Allardyce, S., Hackett, S., Bradbury-Jones, C., Lazenbatt, A., & Taylor, J. (2014). Practice and policy in the UK with children and young people who display harmful sexual behaviours: An analysis and critical review. Journal of Sexual Aggression,20(3), 267–280. https://doi.org/10.1080/13552600.2014.927010.

    Article  Google Scholar 

  49. St. Amand, A., Bard, D. E., & Silovsky, J. F. (2008). Meta-analysis of treatment for child sexual behavior problems: Practice, elements, and outcomes. Child Maltreatment,13(2), 145–166. https://doi.org/10.1177/1077559508315353.

    Article  PubMed  Google Scholar 

  50. Starr, M. A. (2014). Qualitative and mixed-methods research in economics: Surprising growth, promising future. Economic Systems,28(2), 238–264. https://doi.org/10.1111/joes.12004.

    Article  Google Scholar 

  51. Swisher, L. M., Silovsky, J. F., Stuart, R. F., & Pierce, K. (2008). Children with sexual behavior problems. Juvenile and Family Court Journal,59(4), 49–69. https://doi.org/10.1111/j.1755-6988.2008.00021.x.

    Article  Google Scholar 

  52. Washington State Institute for Public Policy [WSIPP]. (2018a). Updated inventory of evidence-based, research-based, and promising practices: For prevention and intervention services for children and juveniles in the child welfare, juvenile justice, and mental health systems. Seattle, WA: University of Washington. Retrieved September 20, 2019, from http://www.wsipp.wa.gov/ReportFile/1699/Wsipp_Updated-Inventory-of-Evidence-Based-Research-Based-and-Promising-Practices-For-Prevention-and-Intervention-Services-for-Children-and-Juveniles-in-the-Child-Welfare-Juvenile-Justice-and-Mental-Health-Systems_Inventory.pdf.

  53. Washington State Institute for Public Policy [WSIPP]. (2018b). Benefit-cost results. Seattle, WA: University of Washington. Retrieved September 20, 2019, from https://www.wsipp.wa.gov/BenefitCost.

  54. Ziller, A., & Phibbs, P. (2003). Integrating social impacts into cost-benefit analysis: A participative method: case study: The NSW area assistance scheme. Impact Assessment and Project Appraisal,21(2), 141–146. https://doi.org/10.3152/147154603781766365.

    Article  Google Scholar 

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Acknowledgement

We are grateful for the interviewees who made time to express their thoughts and views on PSB of youth, as well as the broader efforts of personnel at each of sites described in this study. We are also thankful to the Office of Juvenile Justice and Delinquency Prevention for funding this research. The manuscript also benefited from the comments of two anonymous reviewers.

Funding

This project was supported by Grant 2010-WP-BX-K062 and 2013-MU-MU-K102 awarded by the Office of Juvenile Justice and Delinquency Prevention, Office of Justice Programs, U.S. Department of Justice. The opinions, findings, and conclusions or recommendations expressed in this publication/program/exhibition are those of the author(s) and do not necessarily reflect those of the Department of Justice.

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Correspondence to Jane F. Silovsky.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. All study procedures were approved by the University of Oklahoma Health Sciences Center IRB office (IRB # 4041).

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Mundey, P., Slemaker, A., Dopp, A.R. et al. Qualitative Analysis of Administrator, Provider, and Stakeholder Views on the Costs and Benefits of a Treatment for Problematic Sexual Behavior of Youth. Adm Policy Ment Health 47, 126–137 (2020). https://doi.org/10.1007/s10488-019-00978-3

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Keywords

  • Evidence-based treatment
  • Problematic sexual behavior
  • Qualitative research
  • Implementation
  • Public health impact