Program description, resources, and treatment approach
The Children’s Centers Adolescent Sexual Abuser Program (A.S.A.P.) services children and adolescents ages 5-18 in Wayne County who have demonstrated some form of sexual deviancy. The A.S.A.P. is the largest specialized program for sexual offenders in Wayne County, and one of the largest specialized outpatient programs in the State of Michigan. From March 3, 1998 through March 3, 1999, the A.S.A.P. serviced nearly 200 Wayne County youth. Adolescent sexual offender programs are currently viewed as a vital component in the fight to reduce sexual abuse and sexual assault. Data from crime reports and victim surveys demonstrate that adolescents perpetrate at minimum 20% of all rapes and between 30-50% of all sexual offenses against children (Brown, Flanagan, & McLeod, 1984; Finkelhor, 1996). Finally, a recent polling indicates that the number of child sexual abuse cases may be as many as 19 per 1,000 per year in the United States, (American Humane Association, 1996). These statistics further demonstrate the need for adolescent sexual abuser programs.

Personnel and treatment interventions
The A.S.A.P. personnel consists of highly trained specialists in the area of sexual abuse and sexual deviancy. There are currently 4 full-time clinicians on staff, two contractual clinicians, a specialized case-manager, and a program coordinator. All staff receive annual trainings on new treatment modalities, research, assessments, offender dynamics, sex offender group therapy, and managing sexual offenders. The full-time senior clinician was formally trained to work with sexual offenders under a chief psychologist in the Michigan Department of Corrections, and continues to train new staff in the areas of sexual deviancy.

The A.S.A.P. utilizes a client/family centered cognitive behavioral approach in the treatment of sexual offenders. We currently offer 2 open-ended sex offender specific groups; one for younger and intellectually deficient clients, the other for older and unimpaired clients. Both groups are intended to build leadership skills, reduce shame and depression, build self esteem, increase social skills, improve impulse control skills, work through denial, teach the concepts of relapse prevention, increase the offenders empathy for victims, and increase knowledge of appropriate sexual behaviors and sexual education. Each client receives individual therapy and a complete psychosexual assessment (approximately 4-8 weeks), and family therapy on at least a monthly basis. We also utilize the methods of covert desensitization and aversive conditioning to help decrease the deviant sexual arousal levels. All A.S.A.P. clinicians have access to full psychiatric and psychological services, including examinations, consultation, psychotropic needs assessment, and intellectual functioning assessment. Moreover, the Children’s Center has over 25 specialized programs that can be accessed for secondary conditions following or in conjunction with sex offender treatment.

Resources
There are numerous treatment and training tools available to all A.S.A.P. staff and clients. We have over 30 treatment videos aimed at increasing awareness of sexual abuse, increasing victim empathy, and the awareness of many of the consequences (familial, social, legal). We also have a variety of training videos on sex offender assessment, risk assessment, behavioral deconditioning, and other treatment dynamics. We have approximately 12 different sex offender treatment workbooks at our disposal, and various assessment measures aimed at detecting sexual deviancy. There is also a wide variety of journals, studies, and authoritative books on sexual deviancy. The A.S.A.P. is one of the only specialized outpatient programs with this capacity, training, and resource base in the State of Michigan.

Introduction
In February of 1999, the A.S.A.P. conducted a demographic and descriptive analysis of 43 current clients. The information that this analysis yielded is not only interesting, but also assists the therapists and program coordinator in program design, development, and addressing the needs of our clients. Much of the data obtained from this analysis is consistent with other research findings from both outpatient and inpatient programs.

Three full-time therapists were asked to complete a brief and simple form for each client on his/her caseload. The total number of clients for the analysis was 43 adolescents. The average age of the A.S.A.P. client was 14.3 years old, with a range between 8 and 17 years. There was only one female client in the program during this analysis, thus 97% of the sample were males. The A.S.A.P. personnel are trained and equipped to treat females; however, there are comparatively very few females who enter our program. It is more common for males to behave in sexually deviant ways, but females are and have been capable of behaving in a similar fashion. Moreover, societal perception of and reaction to female sexual abuse is quite different than male sexual abuse, and should be viewed with caution.

Racial make-up, place of residence, and referral source for sample
Out of the sample, 74% (n=32) clients are African American, 12% (n=5) are Caucasian, 9% (n=4) bi-racial, and 5% (n=2) are Hispanic. The percentage of African American clients run slightly higher than an earlier study (1997) conducted by the A.S.A.P. with a greater sample size. In the earlier study, 59% of A.S.A.P clients were African American. There is a significant difference between the percentages of Caucasian clients from the earlier study—40% of A.S.A.P. clientele in the earlier study were Caucasian. The percentages for Hispanics were almost identical. Some general inferences can be made with regard to the increase in percentage of African American clients, and the decrease in Caucasian, however, this would be better suited for future empirical investigation.

For the entire sample of 43 clients, 44% (n=19) resided in a single parented (maternal) home, 21% (n=9) in a general residential setting, 14% (n=6) with foster parents, 7% (n=3) in a single parented (paternal) home, 7% (n=3) with both mother and father in the home, and 7% (n=3) resided with grandparents.

Nearly 42% of the entire sample was referred by the Wayne County Probate Court, with the remaining clients being referred from other agencies, Family Independence Agency, or self-referrals.

Victimology and other paraphilias
The average (mean) number of victims per offender for the 43 clients used in this analysis was 1.7, with the range being between 1-7 victims. Roughly 39% of the entire sample had more than one victim. There was an average of 7.5 (mean) separate offenses for each client, with the range being between 1-50 offenses. Forty-four percent of the entire sample had more than one sexual offense. It must be noted, however, that the more a client progresses in treatment, the more they are likely to admit otherwise unknown offenses.

Forty-six percent of the clients in the sample were related to their victims, either as siblings, cousins, or other relatives. The percentage for this sample is congruent with other findings (Fehrenback et al., 1986; Schram et al., 1991). Furthermore, all of the remaining offenders were acquainted with their victims; there were no offenses on strangers in the sample. For victims not related to the offender, the most common situation in which the offense occurred was babysitting.

There was 18% of the entire sample who either utilized force, or threatened to utilize force during the offense. One out of the eight clients in a general residential setting used or allegedly used force during the commission of their sexual crimes. Moreover, 55% of those in residential had more than one offense (compared with the 44% for the overall sample). The remaining clients used other methods to obtain compliance or even cooperation from their victim. Some of the common techniques involve bribery, trickery, disguising the abuse or the intent, and taking advantage of power/authority they have over the victim.

Two clients had what is commonly called “hands off” offenses. One of these clients was diagnosed with fetishism (intense sexual attraction to non-living objects) and one was charged with indecent exposure (flashing, exposing). Moreover, there was one 17 year old client in the current analysis who was waived to adult court during the treatment process.

Abuse dynamics
It is quite common for sexual offenders to have been sexually victimized themselves at some point in there life, most notably in childhood. Consistent with this dynamic is the 30% (n=13) of clients in this analysis who report being sexually abused themselves. This number may, in fact, be lower than the actual percentage due to the fact that many clients, especially males who have been sexually abused by other males, choose not to disclose this information. Many times throughout the treatment process clients will disclose their own sexual victimization, however, they are more apt to disclose their offense before they disclose their victimization.

Twenty-five percent (n=11) of the sample admitted to being physically abused at some point in their life, and 32% (n=14) have used or abused substances and/or alcohol. Very few, however, of the clients were under the influence of a substance or alcohol during the commission of their sex crime.

Out of the 13 sexually abused clients in the sample, 32% had more than one sexual offense. Moreover, out of the 14 clients who use/abuse substances and/or alcohol, 32% had more than one sexual offense.

Clients in denial
Out of the entire sample of 43 clients, 18% were in complete denial (n=8) with regard to their deviant sexual behavior. There has been an extensive amount of research on denial in relation to the field of sexual deviancy, with the main focus on establishing predictable patterns of behaviors. This discovery could, in theory, assist therapists in identifying those clients who are in denial as opposed to the very few who were falsely accused, as well as those who are a moderate to high risk for a future sexual offense. For instance, research has suggested that lower levels of denial at intake predict successful program compliance (Hunter & Figueredo, 1999).

Out of the eight deniers in the analysis, 6 were referred from the Wayne County Juvenile Court. Therefore, approximately 75% of those in denial were referred from the court.

Sixty-two percent of the deniers used, or allegedly used force during the commission of their sexual offense, or after the offense as a means of silencing the victim. Seventy-five percent (6/8) reside in a single parented home (maternal), compared with the %% for the general sample. Only 13% of deniers were related to their alleged victims (46% for entire sample).

Fifty percent of all the deniers had some history of substance use or abuse, which was significantly higher than the general sample (32% for entire sample). Thirty-eight percent of deniers stated that they were physically abused at some point in their life, compared with the 25% for the entire sample. Finally, only 13% of the deniers admitted being sexually abused themselves, compared with the 30% of the entire population.

There are four charts in the appendix of this essay. Chart #1 graphically demonstrates the racial make-up of the clients in this analysis. Chart #2 and #3 graphically demonstrate the demographic characteristics between deniers and admitters.

Based on the data from this analysis, there does appear to be a pattern of characteristics that differentiate deniers from admitters; however, since the sample size was low, it must be viewed with caution and some skepticism. Future empirical investigation should focus on these characteristics and obtain reliability and validity measures using a larger sample.

The Children’s Centers Adolescent Sexual Abuser Program provides children and adolescents and their respective families with specialized treatment and services to assist in eliminating sexual deviancy. The results of this analysis clearly demonstrate that sexual offending is a very complex behavior that is not easily compartmentalized or predictable; however, the results have yielded valuable information that can be used for further investigation.

The analysis identified and categorized current client demographic and descriptive data, with the aim of establishing patterned characteristics. The overwhelming majority (74%) of clients in this analysis were African American, which demonstrates the need for cultural diversity training and staffing. A closer examination of the current percentage of African Americans in Wayne County would provide further insight into the prevalence of sexual offenders, and whether the percentage in this study is an accurate reflection of the percentage in the county.

With 44% of the clients in this analysis residing in a single parent home (maternal), an effort could be made to provide greater prevention services to children, and more support to single mothers. Single parents may not be able to provide the supervision, guidance, and education that duel parented households can, and therefore possibly place their children at a higher risk for sexual victimization, sexual offending, and overall delinquency. Moreover, this data reflects the need to develop “parent groups” in order to offer more support and education with regard to sexual behavior, and to teach the concepts of relapse prevention. Relapse prevention, in particular, could enhance the awareness of possible sexual deviancy and act as an external supervisory means for additional support.

With the understanding that nearly 50% of the entire sample had more than one sexual offense, added emphasis should be made in attempting to work through denial with clients, and for therapists to refocus their attention on the underlying and latent dynamics of sexual offending behavior. Moreover, a careful examination of existing sexual abuse victim programs should be undertaken to determine whether there are adequate services in place for victims. Alternative and more creative techniques of working through denial and facilitating full disclosure should be examined to assist the client in therapist in this process. For instance, polygraph maintenance exams are one way of potentially providing the necessary means for determining the honesty of a sex offender throughout treatment.

The implications of this analysis merit further research and treatment efforts with regard to sexual offenders who deny their offense(s). The deniers in this analysis were far more likely to utilize or threaten force, or be accused of utilizing force, than the sample as a whole. Moreover, the deniers were far more likely to assault non-relatives. It may be that deniers were under the assumption that coercive methods for non-familial victim compliance and silence was the most effective means; conversely, it may also imply that adolescents who were accused of utilizing force were much more likely to deny their involvement in the assault altogether. Deniers were nearly twice as likely as the general sample to experiment, use, or abuse drugs and alcohol. Efforts should be made to address the secondary issue of substance abuse and to offer psychoeducational groups dealing with substance abuse and prevention.

American Humane Association. (1996). Fact sheet on child sexual abuse. Denver: Author.

Brown, E. J., Flanagan, T. J., & McLeod, M. (Eds.). (1984). Sourcebook of criminal justice statistics—1983. Washington, DC: Bureau of Justice Statistics.

Fehrenback, P. A., Smith, W., Monastersky, C., & Deisher, R. W. (1986). Adolescent sexual offenders: Offender and offense characteristics. American Journal of Orthopsychiatry, 56, 225-233.

Finkelhor, D. (1996, August). Keynote address. Presented at the International Congress on Child Abuse and Neglect, Dublin, Ireland.

Schram, D. D., Milloy, C. D., & Rowe, W. E. (1991). Juvenile sex offenders: A followup study of reoffense behavior. Unpublished manuscript.

Hunter, J. A., & Figueredo, A. J. (1999). Factors associated with treatment compliance in a population of juvenile sexual offenders. Sexual Abuse: A Journal of Research and Treatment, 11, 49-67.