Clinical Model

Description of Clinical Program

Sexual behavior of children and youth can become harmful to themselves and to other children as well as illegal.  Problematic sexual behaviors (PSB) do not represent a medical/psychological syndrome or a specific diagnosable disorder, but rather a set of behaviors that fall well outside acceptable societal limits (Chaffin et al., 2006).  We have defined children with PSB as children who initiate behaviors involving sexual body parts (i.e., genitals, anus, buttocks, or breasts) that are developmentally inappropriate or potentially harmful to themselves or others (Silovsky & Bonner, 2003).  Problematic sexual behaviors of adolescents are more often also considered illegal.  As a result juvenile justice is often involved with the family.

PSB-CBT is a group treatment model originally designed to treat youth ages 7 to 12 who present with PSB. The PSB-CBT treatment approach uses concurrent groups for youth and their caregivers with combined multi-family group sessions about once a month. Active participation of a caregiver is required, with the caregiver defined as the person who provides primary care of the child in the home (e.g., mother, father, step-parent, grandparent, foster parent). PSB-CBT shares the common theory base and core components of evidence-based programs (EBP) for PSB. The underlying approach is strengths-based, focusing on the youth as children first with capacity to learn and implement appropriate behavior, make safe decisions, and develop healthy relationships. Using cognitive-behavioral approaches, the youth are taught rules about sexual behavior and specific skills of coping, self-control, and decision making. Core treatment components with caregivers address managing child behavior, supporting healthy development, sex education, abuse prevention, and rules about sexual behavior. The PSB-CBT treatment manual provides structure and guidelines to the sessions, but it is not a “cookbook” that is rigidly implemented. Rather, the therapists implement the core component with adaptations to fit the families being served. The group modality includes sessions with the children and caregivers together concurrently.  These sessions are about once a month.  For the family modality, sessions vary in terms of setup: Caregiver alone, child alone, and the family together.   

Based on the research on PSB-CBT, the program was given a “strong” rating by the Collaborative Outcome Data Committee (CODC; Hanson, Bourgon, Helmus, & Hodgson, 2009) and is ranked as “Effective” in the OJJDP Program Model Guide. A ten-year follow-up with preteen youth randomized to PSB-CBT found recidivism rates comparable to youth with behavior problems but no previous history of PSB (2-3%), and significantly lower than youth randomized to the play therapy treatment group condition (10%; Carpentier et al., 2006). 

Model Training and Fidelity Requirements

Providers seeking to become certified to implement PSB-CBT must meet the following training and consultation requirements for the school-age model.  Through this process, providers implementing the group modality will need to complete requirements for both youth and caregiver groups.  Completion of these requirements and fidelity in the school-age group or family modality is determined by the PSB-CBT Master Trainers, or Approved Trainer.  Training, including fidelity modality requirements include:

  1. Completion of the full exploration of PSB fit-to-agency process as demonstrated by completion of the OUHSC PSB-CBT Program Organizational Assessment and Agency Application after the community has self-evaluated readiness. 
  2. Completion of all required readings and pre-work assignments resulting from review of the exploration phase materials.
  3. Attendance and active participation in a PSB-CBT intensive clinical training approved by the OU PSB-CBT T/TA Program.
  4. Completion of at least one-year (12-months) of experience conducting PSB-CBT treatment with a minimum of four families (e.g., caregiver and youth) in group modality, or six-months with a minimum of two families in the family modality through completion.
  5. Implementation of the PSB-CBT model per the treatment curriculum and with appropriate conceptualization of youth with PSB.
  6. Active participation in consultation calls, at minimum 80% attendance, facilitated by an OU PSB-CBT Approved Trainer until fidelity to the model has been met.  "Actively participated" means, at a minimum, directly involved in consultation discussion, regularly sending recorded sessions to a Master Trainer for fidelity monitoring, and evidence of application of feedback from consultation by a PSB-CBT Approved Trainer.
  7. Regularly submit recordings of PSB-CBT sessions for fidelity monitoring by a Master Trainer or Approved Trainer.  Clinicians are encouraged to review own recordings using the OU PSB-CBT fidelity monitoring forms to evaluate their own performance.
  8. Demonstrate competence in assessing PSB families' progress in treatment using clinical judgement and the CSBI (and other standardized measures) to make appropriate decisions about completion of PSB-CBT treatment services.
  9. Upon successful completion, clinician must agree to continue to implement the OU-PSB-CBT model(s) with fidelity and adhere to administrative decisions from OU PSB-CBT T/TA Program regarding the OU PSB-CBT model.  Meeting the above requirements is the first step to becoming a Within-Agency Trainer


Characteristics of Providers Successfully Trained in PSB-CBT

Successful and sustainable implementation of the model requires attention to particular factors, or "drivers" that support model fidelity and improved client outcomes.  Agencies that have successfully implemented PSB-CBT with fidelity note selection of clinicians to participate in training and implementation of PSB-CBT as a key driver to success.

Through the selection process, agencies have determined that the following characteristics are representative of clinicians effective in their uptake and delivering of PSB-CBT:

  • Cognitive-behavioral and family systems orientations.
  • Comfortable discussing sexual development and sexual content with children and caregivers.
  • Able to effectively engage caregivers, family members, and youth.
  • Comfortable with directive approaches in clinical treatment.
  • New providers who have a mature approach to families or seasoned provider who have an approach and conceptual understanding similar to PSB-CBT.
  • Strong organizational skills (e.g., ability to coordinate, community outreach, and managing referrals).
  • Good communication skills with families and referral sources.
  • Prepared to actively and directly collaborate with partnering agencies and community stakeholders, such as probation and child welfare.
  • Able to apply and teach parents behavioral management and relationship building skills.
  • Experienced with group treatment modality (caregiver and child).
  • Comfortable managing child/youth behavior in a group or family therapy setting.
  • Strong presentation and facilitation skills for group training and education sessions.
  • Invested in sustaining the PSB-CBT program within agency.

young AA boy - swing

young caucasian girl - swing