Research and Outcomes

The original group treatment program for children with PSB protocol was developed by Barbara Bonner, C. Eugene Walker, and Lucy Berliner. This school-age group treatment program was evaluated rigorously by comparing it to a group play therapy approach. Initial outcomes demonstrated improvements with reduced PSB and other nonsexual behavior problems (Bonner, Walker & Berliner, 1999). These youth were then followed up in administrative databases for state law enforcement, juvenile services, and child welfare. In this 10-year follow-up study, children who were randomized to the PSB-CBT group treatment were found to be no different from a clinical comparison group (i.e., children referred due to disruptive behavior problems but had no known PSB), both with very low rates of future sexual offenses detected by child welfare, juveniles services, or law enforcement (both around 2% to 3% respectively). The children randomized to the play therapy group had significantly higher rates of future problematic sexual behavior (11%) (Carpentier, Silovsky & Chaffin, 2006). In addition to this research, a small but reasonably rigorous body of PSB treatment effectiveness research has emerged, sufficient to guide recommendations (Bonner et al., 1999; Cohen & Mannarino, 1996, 1997; Pithers, Gray, Busconi & Houchens, 1998; Silovsky, Niec, Bard & Hecht, 2005; St. Amand, Bard & Silovsky, 2008). For research effectiveness and outcomes of the preschool and school-age models, visit the California Evidence Based Clearing House or the Office of Juvenile Justice and Delinquency Prevention Model Programs Guide (MPG).

  • Barry, S. & Harris, E. (2019). The Children's Programme: A Description of a Group and Family Intervention for Children Engaging in Problematic and Harmful Sexual Behavior and Their Parents/Carers. Journal of Sexual Aggression, 25(2), 193-206. https://doi.org/10.1080/13552600.2019.1589002
    • Abstract: Children under 10 are increasingly being referred to services for concerning problematic or harmful sexual behaviour, but information about interventions to support these children and their families is limited. A 3-year pilot of a group cognitive–behavioural intervention for children and their parents/carers is described. Forty-nine children were referred to the programme with 27 completing the programme in this period. This is the first intervention of its kind to be delivered with a UK population and demographic information is provided about the children who have been assessed, including information about age, gender, family composition and abuse history. Outcome data from the Trauma Symptom Checklist for Children, Child Sexual Behaviour Inventory, Strengths and Difficulties Questionnaire and the Parental Stress and Social Support Scale is reported. The available outcome data indicates the group has been largely beneficial in reducing problematic sexual behaviour. Key learning and implications for practice are discussed.
  • Carpentier, M. Y., Silovsky, J. F., & Chaffin, M. (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/10.1037/0022-006X.74.3.482
    • Abstract: This study prospectively follows 135 children 5-12 years of age with sexual behavior problems from a randomized trial comparing a 12-session group cognitive-behavioral therapy (CBT) with group play therapy and follows 156 general clinic children with nonsexual behavior problems. Ten-year follow-up data on future juvenile and adult arrests and child welfare perpetration reports were collected. The CBT group had significantly fewer future sex offenses than the play therapy group (2% vs. 10%) and did not differ from the general clinic comparison (3%), supporting the use of short-term CBT. There were no group differences in nonsexual offenses (21%). The findings do not support assumptions about persistent or difficult to modify risk and raise questions about policies and practices founded on this assumption.
  • Dopp, A., Mundey, P., Silovsky, J. F., Hunter, M., & Slemaker, A. (2020). 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
    • Abstract: Background: Problematic sexual behavior in youth represents a significant public health problem in need of evidence-based treatments. Unfortunately, such treatments are not available in most communities. Objective: This study used a mixed quantitative-qualitative approach to investigate the economics of the implementation of Problematic Sexual Behavior – Cognitive-Behavioral Therapy (PSB-CBT), an evidence-based treatment for problem sexual behaviors in youth. Participants and setting: Youth (N = 413) participated in PSB-CBT at six program sites in youth service agencies across the United States. Method: We used cost-effectiveness ratios (CERs) to compare the direct and indirect costs of PSB-CBT to self- and caregiver-reported youth clinical outcomes (i.e., problem sexual behavior as well as secondary behavioral health problems). CERs represented the cost of achieving one standard unit of change on a measure (i.e., d = 1.0). The design and interpretation of those quantitative analyses were informed by qualitative themes about program costs and benefits that were derived from interviews with 59 therapists, administrators, and stakeholders. Results: CERs (i.e., $ per SD) were $1,772 per youth for problem sexual behavior and ranged from $2,867 to $4,899 per youth for secondary outcomes. These quantitative results, considered alongside the qualitative perspectives of interviewees, suggested that the implementation of PSB-CBT was cost-effective. The results were robust to uncertainty in key parameters under most, but not all, conditions. Conclusions: The results have important implications for decisions made by administrators, policymakers, and therapists regarding use of community-based approaches to address problematic sexual behavior of youth.
  • Jenkins, C. J., Grimm, J. R., Shier, E. K., van Dooren, S., Ciesar, E. R., & Reid-Quiñones, K. (2020). Preliminary Findings of Problematic Sexual Behavior-Cognitive Behavioral Therapy for Adolescents in an Outpatient Treatment Setting. Child Abuse and Neglect, 105. https://doi.org/:10.1016/j.chiabu.2020.104428
    • Abstract: Background- The lack of empirical support for interventions commonly used to treat adolescents with problematic sexual behaviors (PSB) has led to restrictive policies and interventions largely based on perceptions of these youth as younger versions of adult sex offenders, without consideration for developmental and etiological differences between populations. Objective: This study’s aim is to evaluate a low-intensity outpatient treatment regarding the reduction of internalizing symptoms and externalizing behaviors to include, PSB. Participants & Setting: The study examined outcomes for 31 adolescents who completed Problematic Sexual Behavior – Cognitive Behavioral Therapy for Adolescents (PSB-CBT-A) at a Children’s Advocacy Center between 2013 and 2016. Methods: Evaluation of PSB and other symptomology was conducted through pre- and posttreatment administration of standardized instruments. Results: Adolescent PSB-CBT-A treatment completers demonstrated a trend towards statistical significance in reduction of PSB on the YSBPI from 5.33 (SD=6.86) at pre-treatment to 0.17 (SD=0.41) at completion. Additionally, significant reductions in caregiver-reported youth internalizing and externalizing problems were associated outcomes of completing PSB-CBT-A (t(13) = 5.00, p<.001 and t(13) = 2.34, p = .036, respectively). Conclusions: The promising results achieved in this study support further exploration of lowintensity outpatient treatment interventions for adolescents with PSB.
  • Mundey, P., Slemaker, A., Dopp, A. R., Beasley, L. O., & Silovsky, J. F. (2020). Qualitative analysis of administrator, provider, and stakeholder views on the costs and benefits of a treatment for problematic sexual behavior of youth. Administration and Policy in Mental Health and Mental Health Services Research, 47(1), 126-137. https://doi.org/10.1007/s10488-019-00978-3
    • 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.
  • Shawler, P. M., Bard, M .E., Taylor, E. K., Wilsie, C., Funderburk, B., & Silovsky, J. F. (2018). Parent-Child Interaction Therapy and young children with Problematic Sexual Behavior: A conceptual overview and treatment considerations. Children and Youth Services Review, 84, 206-214. https://doi.org/10.1016/j.childyouth.2017.12.006
    • Abstract: Problematic Sexual Behavior (PSB) can be conceptualized as a distinct subset of externalizing behavior pro- blems. Preschool children with PSB commonly have co-occurring nonsexual behavior problems, including dis- ruptive behavior disorders (DBD). Behavioral parent training is the core component of effective treatments for DBD (Kaminski, Valle, Filene, & Boyle, 2008) and for PSB (St. Amand, Bard, & Silovsky, 2008). Parent-Child Interaction Therapy (PCIT) is an empirically supported evidence-based behavioral parent treatment program for young children ages 2 to 7 with disruptive behavior problems (California Evidence-Based Clearinghouse, 2017; Eyberg & Funderburk, 2011; Funderburk & Eyberg, 2011). However, due to the taboo nature of the topic and the potential impact and harm to other children, unique clinical issues can arise when behaviors are classified as “sexual.” Adaptations to PCIT are recommended to address safety, physical boundaries, commonly held myths about the population, and other related issues. Conceptual background of PSB and the fit of behavioral parent training as a core intervention is provided, followed by details regarding augmentations to embed approaches to address PSB within PCIT.
  • Shawler, P., Silvis, V. G., Taylor, E. K., Shields, J., Beasley, L., & Silovsky, J. F. (2020). Early Identification of Youth with Problematic Sexual Behavior: A Qualitative Study. Child Abuse and Neglect. https://doi.org/10.1016/j.chiabu.2019.104317
    • Abstract:Background: Early intervention efforts designed for youth with problematic sexual behavior (PSB) have strong promise. Prompt identification of youth with PSB is critical to ensuring early intervention and effective response. Objective: The current study explored the complexities of how PSB of youth is identified in the community. Setting: A qualitative semi-structured interview approach was utilized to explore the perceptions and experiences of community members involved in cases of youth with PSB. Participants: Participants included 100 community members from eight geographically diverse locations in the United States. Method: Themes involving identification of PSB were classified by qualitative analyses, beginning with thematic analysis followed by focused coding. Results: Results indicated multiple pathways for the identification of youth with PSB involving a variety of professionals and agencies. Victim disclosure and witnessing the PSB were the most common identification pathways, with caregivers and school personnel the most common initial identifiers. Once identified, cases were reported to child welfare, law enforcement, and/or behavioral health agencies. Complications due to unclear response pathways and fears held by caregivers were notable. Conclusions: Developmentally appropriate, evidence-informed policies and procedures for the identification of and response to PSB in youth within and across professions would facilitate a public health response for prevention and early responses to PSB of youth.
  • Shields, J. D., Coser, A., Beasley, L. O., & Silovsky, J. F. (2020). A qualitative examination of factors impacting family engagement in treatment for youth with problematic sexual behavior. Children and Youth Services Review, 108, 104597. https://doi.org/10.1016/j.childyouth.2019.104597
    • Abstract: Widespread implementation of evidence-based responses for youth with problematic sexual behavior (PSB) have strong promise for preventing child sexual abuse and keeping children safe in our communities. Success of any evidence-based program for youth is limited by the ability to actively engage families in the services. Engaging families in treatment for PSB is particularly complex due to a variety of factors at the individual (e.g., taboo topic), family (e.g., cultural factors), system (e.g., multiple agency involvement), and policy levels (e.g., payment for services limited to adjudicated youth). The present study utilized a qualitative methods approach to examine facilitators and barriers to engagement of families in an EBP for youth with PSB amongst a multistate sample. Results revealed that caregiver intent to aid and support youth, as well as perseverance to overcome multiple system barriers, resulted in increased engagement. Family engagement was attainable despite barriers such as stress, lack of support, frequency of youth PSB, severity of child behavior problems, and other difficulties if overcome by caregiver motivation. Recommendations and policy implications for enhancing the engagement of families in treatment for youth with PSB are discussed.
  • Shields, J. D., Klinkebiel, C., Taylor, E. K., Espeleta, H. C., Beasley, L., & Silovsky, J. F. (2018). A Qualitative Analysis of Family Perspective on Treatment Services for Youth with Problematic Sexual Behavior: Enhancing Engagement. Victims and Offenders, 13(7), 955-973. https://doi.org/10.1080/15564886.2018.1506853
    • Abstract: The key to efficacious intervention for youths with problematic sexual behavior (PSB) is direct caregiver involvement. Engaging families in treatment for youths PSB has unique complexities beyond known challenges with behavioral health treatment overall. Qualitative research with youths and caregivers in treatment for PSB complements clinical outcome research by examining consumer perception of impact, supports, and barriers. The authors sought to understand consumer impressions of treatment for PSB to identify factors that impact family participation. Following the completion of PSB–cognitive behavior therapy, 149 caregivers and 144 youths completed a program exit survey. Qualitative interviews were also conducted with 30 caregivers to gain further insight into their experiences. Results revealed that caregivers and youths communicated targets of improvements in their knowledge and skills, family communication, youth behavior, and social support. Recommendations from participants were to expand service availability and address logistical issues, approaches, and content of the program. Findings have implications for strategies to enhance engaging families in treatment programs for youths with PSB.
  • Silovsky, J. F., Hunter, M., & Taylor, E. K. (2018). 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
    • Abstract: Targeting broad implementation of early intervention services has a high potential for impact given the prevalence of child sexual abuse committed by youth and the low recidivism rate following effective interventions. This multisite quasi-experimental study examined the outcomes for 320 youth ages 10–14 years and their caregivers who participated in community-based problematic sexual behavior – cognitive behavior therapy (PSB-CBT). Significant reductions in PSB with a large effect size (e.g. t(126) = 11.69, p < .001, d = 2.08) were found. No site differences were found, despite racial and regional diversity. Nonsexual behaviour problems, emotional problems, and trauma symptoms also significantly improved. Positive outcomes extended to caregivers. Recommended next steps include rigorous strategies for examining the impact of widespread implementation of evidence-based early intervention programmes on the prevention of sexual abuse, complemented with thoughtful efforts to develop and implement policies and procedures that improve the safety and well-being of all children in the community.
  • Silovsky, J. F., Niec, L., Bard, D. E., & Hecht, D. B. (2007).  Treatment for Preschool Children With Interpersonal Sexual Behavior Problems: A Pilot Study. Journal of Clinical Child and Adolescent Psychology, 36(3), 378-391. https://doi.org/10.1080/15374410701444330
    • Abstract: This pilot study evaluated a 12-week group treatment program for preschool children with interpersonal sexual behavior problems (SBP; N ¼ 85; 53 completed at least 8 sessions). Many children presented with co-occurring trauma symptoms and disruptive behaviors. In intent-to-treat analysis, a significant linear reduction in SBP due to number of treatment sessions attended was found, an effect that was independent of linear reductions affiliated with elapsed time. Under the assumption that treatment can have an incremental impact, more than one third of the variance was accounted for by treatment effects, with female and older children most favorably impacted. Caregivers reported increase in knowledge, satisfaction, and usefulness of treatment. In addition to replication, future research is needed to examine (a) effects of environment change and time on SBP, (b) stability of treatment effects, and (c) best practices to integrate evidence-based treatments for comorbid conditions.
  • St. Amand, A., Bard, D. E., and 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
    • Abstract: This meta-analysis of 11 treatment outcome studies evaluated 18 specific treatments of sexual behavior problems (SBP) as a primary or secondary target. Specifically, it examines relations among child characteristics, treatment characteristics (including practice elements), and short-term outcome (including sexual and general behavior problems). Utilizing pre- and postintervention results, the overall degree of change over the course of treatment was estimated at a 0.46 and 0.49 standard deviation decline in SBP and general behavior problems, respectively. As hypothesized, the caregiver practice element Parenting/Behavior Management Skills (BPT) predicted the Child Sexual Behavior Inventory (and the Child Behavior Checklist when BPT was combined with caregiver Rules about Sexual Behaviors). In contrast, practice elements that evolved from Adult Sex Offender (ASO) treatments were not significant predictors. BPT and preschool age group provided the best model fit and more strongly predicted outcome than broad treatment type classifications (e.g., Play Therapy or Cognitive Behavior Therapy). Results question current treatments for children with SBP that are based on ASO models of treatment without caregiver involvement.
  • Taylor, E. K., Slemaker, A., and Silovsky, J. F. (2020). Professionals' Perceptions of Electronic and Online Sexual Behaviors of Youth in their Community. Children and Youth Services Review. https://doi.org/10.1016/j.childyouth.2020.104831
    • Abstract: Over the past decade, internet access has become deeply ingrained in the daily lives of individuals across the world, with particularly rapid growth in its use by children and adolescents. In the United States (U.S.), 45% of teens report using the internet "almost constantly" (p. 8; Anderson, M., Jiang, J., & Pew Research Center, 2018). With such increased availability availability of technology, concerns have arisen regarding how easily youth can engage in sexual behaviors online or via electronics, like viewing pornography or "sexting". Despite this increase in concern, many professions responsible for youth (e.g., schools, law enforcement, child welfare) are faced with navigating and guiding youth online behavior. However, limited research to date has examined how professionals who work with youth, specifically those who have engaged in other problematic sexual behavior, perceive and conceptualize electronic and online sexual behavior. We conducted qualitative interviews with 36 professionals from different disciplines across eight sites. Participants were asked about their perceptions of youth use of technology; changes in rates of electronic and online sexual behaviors over time; the severity, frequency, and impact of the behavior; and typical community responses to the behavior. Stakeholders perceived youth's engagement in electronic and online sexual behavior to be frequent, growing, and concerning yet reported that they lacked clear protocols to determine the severity of these behaviors and guide responses. Implications of the results for prevention efforts, future research directions, and policy development are discussed.