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In spite of the serious and costly problems presented by juvenile sexual offenders, rigorous tests of promising interventions have rarely been conducted. This study presents a community-based effectiveness trial comparing multisystemic therapy (MST) adapted for juvenile sexual offenders with services that are typical of those provided to juvenile sexual offenders in the U.S. Youth were randomized to MST (n = 67) or treatment as usual for juvenile sexual offenders (TAU-JSO; n = 60). Outcomes through 12 months post recruitment were assessed for problem sexual behavior, delinquency, substance use, mental health functioning, and out-of-home placements. Relative to youth who received TAU-JSO, youth in the MST condition evidenced significant reductions in sexual behavior problems, delinquency, substance use, externalizing symptoms, and out-of-home placements. The findings suggest that family-and community-based interventions, especially Correspondence concerning this article should be addressed to Elizabeth J. Letourneau, Family Services Research Center, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, McClennan Banks Building 4 th Floor, 326 Calhoun St. STE MC406, Charleston, South Carolina, 29425. Electronic mail may be sent to letourej@musc.edu. The second author is a board member and stockholder of MST Services, LLC, the Medical University of South Carolina-licensed organization that provides training in MST. The third author is a board member of MST Associates, LLC, the organization that provides training in MST for youth with problem sexual behaviors. Publisher's Disclaimer:The following manuscript is the final accepted manuscript. It has not been subjected to the final copyediting, fact-checking, and proofreading required for formal publication. It is not the definitive, publisher-authenticated version. The American Psychological Association and its Council of Editors disclaim any responsibility or liabilities for errors or omissions of this manuscript version, any version derived from this manuscript by NIH, or other third parties. The published version is available at http://www.apa.org/journals/fam/. Policy discussions regarding the legal and treatment dispositions of adolescents arrested for sexual offenses have been contentious, with some policy makers and treatment professionals arguing for lifelong placement on sexual offender registries and extended residential treatment (e.g., J. Ring, quoted in Michels, 8/16/2007), and others emphasizing the generally low recidivism rates of such youth and their need for strength-focused, community-based services (e.g., Chaffin, 2008). Regardless of these different perspectives, however, virtually all stakeholders agree that the scope of sexual offending by juveniles is substantial and warrants the development of effective interventions. NIH Public AccessRegarding the scope and consequences of adolescent sexual offending, official records indicate that minors account for about 20% of all serious sexual crimes (Pastore & M...

Although the term attachment disorder is ambiguous, attachment therapies are increasingly used with children who are maltreated, particularly those in foster care or adoptive homes. Some children described as having attachment disorders show extreme disturbances. The needs of these children and their caretakers are real. How to meet their needs is less clear. A number of attachment-based treatment and parenting approaches purport to help children described as attachment disordered. Attachment therapy is a young and diverse field, and the benefits and risks of many treatments remain scientifically undetermined. Controversies have arisen about potentially harmful attachment therapy techniques used by a subset of attachment therapists. In this report, the Task Force reviews the controversy and makes recommendations for assessment, treatment, and practices. The report reflects American Professional Society on the Abuse of Children's (APSAC) position and also was endorsed by the American Psychological Association's Division 37 and the Division 37 Section on Child Maltreatment.

This study validated a measure of expert clinical consultation and examined the association between consultation, therapist adherence, and youth outcomes in community-based settings. Consultant adherence to the multisystemic therapy (MST) consultation protocol was assessed through therapist reports, and therapist adherence to MST principles was assessed through caregiver reports in 2 samples of families (N1 = 178, N2 = 274) and therapists (N1 = 87, N2 = 162). Caregiver reports of youth behavior and functioning were obtained in the second sample pre- and posttreatment. Random effects regression models demonstrated associations between consultant behavior, therapist adherence, and posttreatment youth behavior problems and functioning. Instrumental aspects of consultation supported therapist adherence and improved youth outcomes; supportive aspects of consultation were negatively associated with adherence and outcomes. These findings suggest the availability to clinicians of expert consultation can impact clinician fidelity to a treatment model and child outcomes.

The mediators of favorable multisystemic therapy (MST) outcomes achieved at 12 months post recruitment were examined within the context of a randomized effectiveness trial with 127 juvenile sexual offenders and their families. Outcome measures assessed youth delinquency, substance use, externalizing symptoms, and deviant sexual interest/risk behaviors; and hypothesized mediators included measures of parenting and peer relations. Data were collected at pretreatment, 6 months post recruitment, and 12 months post recruitment. Consistent with the MST theory of change and the small extant literature in this area of research, analyses showed that favorable MST effects on youth antisocial behavior and deviant sexual interest/risk behaviors were mediated by increased caregiver follow-through on discipline practices as well as decreased caregiver disapproval of and concern about the youth's bad friends during the follow-up. These findings have important implications for the community-based treatment of juvenile sexual offenders.The primary purpose of this study was to examine the mechanisms by which an evidence-based treatment of juvenile offenders decreased the antisocial behavior and deviant sexual interest and sexual risk behaviors of juvenile sexual offenders participating in a randomized effectiveness trial. Pertinent antisocial behaviors included criminal offending, substance use, and externalizing problems. Deviant sexual interest and sexual risk behaviors were also examined in light of their hypothesized association with sexual reoffending (Worling & The first author is a board member and stockholder of MST Services, LLC, the Medical University of South Carolina-licensed organization that provides training in MST. The fourth author is a board member of MST Associates, LLC, the organization that provides training in MST for youth with problem sexual behaviors.Correspondence Publisher's Disclaimer:The following manuscript is the final accepted manuscript. It has not been subjected to the final copyediting, fact-checking, and proofreading required for formal publication. It is not the definitive, publisher-authenticated version. The American Psychological Association and its Council of Editors disclaim any responsibility or liabilities for errors or omissions of this manuscript version, any version derived from this manuscript by NIH, or other third parties. The published version is available at http://www.apa.org/journals/ccp/ NIH Public Access Author Manuscript J Consult Clin Psychol. Author manuscript; available in PMC 2010 June 1. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript Langstrom, 2006). Importantly, and consistent with the recommendations of Weersing and Weisz (2002) pertaining to studies testing mediational models, this effectiveness study focused on real-world clients treated in community-based contexts.Multisystemic therapy (MST;Henggeler, Schoenwald, Borduin, Rowland, & Cunningham, 1998) was selected as the evidence-based treatment model examined in this study (Let...