Understanding Kids With Problematic Sexual Behaviors, with Geoff Sidoli, MSW, LCSW
Geoff Sidoli joins us from NCA’s Institute for Better Mental Health Outcomes to talk about some of the least understood and most underserved client populations: kids with sexual behavior problems. Myths abound: about why these kids act out, how treatable they are, and what treatment settings and methods may be most helpful. So often, communities, schools, and even child abuse professionals simply throw up their hands and hope that somehow these kids are going to get better on their own, or that someone will know what to do. But what we know from research, when we set aside all the misinformation, is that these kids are treatable and respond very well to evidence-based care.
So how do we set these kids on a better life trajectory and improve safety at home and in the community? How can we encourage kids and families struggling with this issue to come forward and get help? And most importantly, what are the actions we can take to ensure that these kids have access to the treatments they need to get healthy and thrive? Please take a listen.
Topics in this episode:
Origin story (1:43)
Are there more PSBs or are we just more aware? (2:49)
Risk factors for PSBs? (4:15)
A range of behaviors (9:09)
Myths, misperceptions, and blind spots (12:18)
Effective treatments (22:31)
Research gaps (30:13)
For more information (40:20)
PSBs are problematic sexual behaviors
“20-year prospective follow-up study of specialized treatment for adolescents who offended sexually,” J. R. Worling, A. Litteljohn, A., & D. Bookalam (2010); Behavioral Sciences and the Law, 28, 46-57
“An Empirically-Based Approach for Prosecuting Juvenile Sex Crimes,” Paul Stern, JD, Child Abuse Prosecution Project
“Impressions of child advocacy center leaders: How problematic sexual behavior in children and adolescents is perceived by community professionals,” K. Theimer, M. Miller, K. Owen, E. Taylor, J. Silovsky, Child Abuse & Neglect, Volume 146, 2023, 106456, DOI: 10.1016/j.chiabu.2023.106456
Listen to our Season 3 interview with Dr. Silovsky, “Sexual Behavior in Youth: What’s Normal? What’s Not? And What Can We Do About It?”
“Quantifying the Decline in Juvenile Sexual Recidivism Rates,” Michael F. Caldwell, PsyD, Psychology, Public Policy, and Law, 22 DOI: 10.1037/law0000094
To learn more about problematic sexual behavior in children or for more information about National Children’s Alliance and the work of Children’s Advocacy Centers, visit our website at NationalChildrensAlliance.org. And join us on Facebook at One in Ten podcast.
Season 5, Episode 21
“Understanding Kids With Problematic Sexual Behaviors,” with Geoff Sidoli, MSW, LCSW
[Intro music begins]
[00:09] Teresa Huizar:
Hi, I’m Teresa Huizar, your host of One in Ten. In today’s episode, “Understanding Kids With Problematic Sexual Behaviors,” I speak with Geoff Sidoli, our coordinator for NCA’s Institute for Better Mental Health Outcomes.
Now, some of the least understood and most underserved client populations are kids with sexual behavior problems. Myths abound: about why they act out, how treatable they are, and what treatment settings and methods may be most helpful. So often, communities, schools, and even child abuse professionals simply throw up their hands and hope that somehow these kids are going to get better on their own, or that someone will know what to do. But what we know from research, when we set aside all the misinformation, is that these kids are treatable and respond very well—perhaps even surprisingly well—to evidence-based care.
So how do we set these kids on a better life trajectory and improve safety at home and in the community? As child abuse professionals, how can we encourage kids and families struggling with this issue to come forward and get help? And most importantly, what are the actions we can take to ensure that these kids have access to the treatments they need to get healthy and thrive?
I know you’ll find this conversation as helpful as I did. Please take a listen.
[Intro music begins to fade out]
[01:43] Teresa Huizar:
Hi, Geoff. Welcome to One in Ten.
Thanks for having me, Teresa.
[01:48] Teresa Huizar:
So let’s start at the beginning. How did you come to work with kids and families that are dealing with problematic sexual behaviors [PSB] in youth?
Back in, I guess, 1989, in the Stone Age maybe, I was fresh out of graduate school and working at a residential facility and was hungry to learn more. And one day one of the psychologists said, “Hey, do you want to come and sit on a group?” And I, you know, I said yes to that, any opportunity. And it was for children, adolescents and about five minutes into that group, I realized this was a different treatment group than I’ve ever experienced before.
And about five minutes later, I was hooked. I was fascinated by these kids, what they’ve been through and their thinking processes and really trying to understand what they did. So right away, I was kind of hooked. And really, that took on a 34-year journey. Anytime I’ve moved away from it, I came back to it, and I love the population and the kids and the type of treatment and the progress they make in treatment. Because these kids do really well in treatment.
[02:49] Teresa Huizar:
Back in 1989, my guess is there wasn’t a lot in the public discourse about this population or about the issue at all. And yet now, thankfully, we’re hearing more about it. And I think that often that raises the question among the general public and among professionals about: Was that there’s actually an increase in PSB, or are we just more aware of it—or both?
Yeah. So, you know, obviously all these things come into play and, right, there’s always multiple variables that kind of go into it. I do think yes, we do understand it more. I do think that we talk about it more. And I do think, because we’re so inundated with media, right?, and information, we definitely know more. I think you can go back to the ’90s and I could count the studies on two hands that were out there. And now there are, you know, over 100—well over 100. So we definitely are more informed. So I think that helps with the information.
Again, if you look at the research, it’ll say, Patrick Lussier out of Canada to recent, and he said, really, since the ’70s it has been steadily declining. So, though we hear about it more, we see it more, we treat it more, it’s not occurring more. Again, I think the thankful part is we’re treating it more.
[04:05] Teresa Huizar:
Well, you know, any area within child sexual abuse in which you see a decline—I mean, thrilled—
—we’d like the number to go straight down to zero.
So that’s good. We’ll take a win.
[04:15] Teresa Huizar:
I’m just wondering, you know, not every child abuse professional has the background as you have had over three decades learning about this. And I think the most common question, probably, from folks is: How do these situations arise to begin with? Like, not all kids act out sexually in this way. So why do some kids?
Yeah, in the classic answer, Jim Worling out of Canada—he’s a brilliant researcher and assessor—he’ll look you right in the face and will say, “Well, it depends.”
And really, that’s what it comes at. This is a very heterogeneous population. We tend to think, you know, I’m a mental health practitioner, and we like labels and we tend to we gravitate toward those. My favorite saying I always say is, “If you met one kid with PSB, you’ve met one kid with PSB.” And they’re all very different.
I mean, I always—I use the example of, like, depression. If I said to you, “Look, we’re going to treat everybody with depression with 10 milligrams of Zoloft. That’s all, that’s the only treatment modality,” you’d just laugh at me like—because there are, you know, probably hundreds of modalities because everyone’s depression is different.
And so for these kids, it is, you know, depending when the onset happened. So I always use what I call a contextual and developmental model. That is, understanding that child’s development through the context of their life experiences. And that tends to explain a lot.
So what, what cards these kids were dealt with biologically and through genetics. And then what were the experiences they had? Because I’ll get a kid, and they’ll say, “Well, this kid has no empathy. He doesn’t care.” And then I’ll meet the family and I’ll realize, well, he really didn’t experience empathy. So yes, he doesn’t care. And then I have other kids where, you know, they have no empathetic responses, and I meet their family, and they’re, you know, kind, caring.
They’re all very different. And so really, when I train always take: Be individual in your approach every single time. And that starts from the upfront comprehensive evaluation to really understand: What is this kid’s issues? What are their risks? What are their needs? And what resources that they need?
Rarely do I get two kids who look the same.
[06:16] Teresa Huizar:
I think it’s an important thing that you’re saying, that we should, you know, think carefully, especially in treatment, about the kid in front of us. But we do know there are some risk factors for PSB. Can you talk a little bit about those?
Because I think that, you know, ideally we would prevent these situations from arising in the first place. Right? We want kids to grow up happy and healthy and not having issues that are going to take them into therapy in this way. So when you think about those risk factors, you know, and knowing them myself I know how broad they are, but can you talk a little bit about them? Because I think the other thing is that people often think, “Well, these kids must have been sexually abused themselves.”
And we know that’s not true. So talk a little bit about what some of the risk factors are, if you would.
Right. And as you mentioned, some of the evolution of understanding the risk factors was having to weed out the mythology of what these kids were. You know, they were budding sociopaths or pedophiles. And then we said, “Well, if they’re sexually abusing other kids, then clearly they must have experienced that.” But as we began to talk to these kids and learn by them, listening to them, we found out that most of these kids have not been sexually abused.
Have they experienced some type of trauma or even adverse experience? Yes. A high percentage of them. Common things we see is kids who come from homes where there’s domestic violence. We’re seeing really unhealthy relationships and attachments going back, you know, very young ages. So those are issues. Kids who have been exposed to material that would proliferate like negative or harmful sexual behaviors or—I try not to use the term “deviant” because I really don’t know what deviant is anymore, but, you know, harmful or violent behaviors. Those are things that promote violent relationships. So we want to look at those things.
We do want to pay attention to if they are sexual abuse victims because we know that for some kids—going back to Jim’s statement—it depends. It can be something that promotes or is a risk factor for that. Obviously kids who adapt those beliefs and have pro-violent behaviors or pro-, like, sexual harmful behaviors. You know, they believe that they’re supposed to use force or they believe they’re supposed to have, you know, interactions with younger children. We want to pay attention to that.
And then also, you know, peer groups, right? So these kids, if they’re in delinquent peer groups where they don’t value those relationships and harming others become culturally normed, then it’s not a big step for them to then harm somebody and using it in a sexual manner.
You know, those are the big ones. Again, over the years, it’s kind of evolved. Again, I keep quoting Jim Worling, but he did a study where he looked at risk factors over a 20-year period, and we had about 10 studies, and half the studies contradicted the other half. So we were like, okay, half of them say it’s a risk factor, half say it’s not.
So back to, again, Jim’s quote, it depends, depending on that kid. But those ones I mentioned tend to be the consistent ones that we see.
[09:09] Teresa Huizar:
Well, one of the things I was thinking about, Geoff, as you were talking is the sort of continuum of behavior, too, that we’re talking about. There’s not one thing that is PSB.
We’re really talking about a range of behavior and what might be a cause for kids who are engaged and sort of curiosity gotten way out of hand is a very different thing from someone who’s using physical force or coercion as well.
And so, you know, I wonder, how do you advise professionals to sort of approach that wide spectrum, any part of which might walk in one’s door?
Right. Yeah, no, excellent point. Because then, you know, we look at it as a continuum. Everything from what we consider developmentally normative, and that’s even challenging these days, given what kids are exposed to now through the internet and through pornography, all the way through to physically harmful, you know, where they’re using weapons or harming them physically.
It’s fluid. I’ve had kids who were having consensually normative, healthy relationships with a girlfriend, but they were also then sexually abusing their brother on the side. And so it, they could be both happening at the same time.
So again, going back to what I was talking about, that this kind of developmental, contextual approach of looking at kids and saying: Where was their life experiences developmentally? What were they exposed to? What do they understand? And what then do they do? Because I’ll have two kids who come up in the same home, have, you know, genetically the same makeup, basically, the same environmental influences. And one kid will go and, you know, be an A student and, you know, volunteer, do wonderful. And the other child is out using weapons and potentially sexually assaulting a lot of kids. So really understanding the kid within the context of their experience.
Often I’ll be asked is when do we categorize a kid as really being by an offender and a kid who’s not an offender. And really, again, taking that upfront kind of approach to understanding the kid and taking that comprehensive evaluation, we really break it down to what’s going on with that kid.
And really talking to these kids. Most of what I’ve learned was sitting down and talking to them and them explaining to me the decision process they made. Because again, we’ve had lots of kids who are sexually abused, and if all of them went on to sexually abuse, we’d have a pandemic beyond control, right? And so, you know, very few of them really go on to do that.
So understanding within the context of that child, what were those variables that influenced them? Was it domestic violence? Was it really kind of harmful sexual pornography that was, you know, misogynist and violent? So again, individualizing your approach and sitting down with that kid and trying to understand.
And, you know, sometimes it’s an event that occurs or you can see where a kid doing really, really well and then all of a sudden a life event happens, and all of a sudden they take a turn for the worst. So it can be as that drastic or it can be more of a, you know, frog in the frying pan, right? It gradually happens over one time and then all of a sudden we see the behavior, but then we talk to the kid and we learn that this has been brewing for years. It just happened we caught it at this time.
[12:18] Teresa Huizar:
That’s so interesting. I’m just wondering, you know, as you’re talking, particularly given the individuality of these circumstances. I think in the public’s mind there’s many myths about these kids. You know, we’ve talked about one or two. But what do you think among professionals is the most common misperception about these kids?
Yeah, there’s probably a top three list there. And I would say one going back to your, “They’ve been sexually abused.” I think that is a very common one.
That I think we still kind of sometimes look at these kids with a substance abuse approach. That this is a lifelong problem, right? That this will be something they have to manage, their exposure to inappropriate sexual behaviors, having access and opportunity to potential victims. So that kind of, this is a lifelong issue and needs to go on forever.
Those two are the ones I probably see the most. Probably the one after that is that these kids recidivate at really high rates, right? Like 80, 90, 100%. That’s also a really common one, too, that—it’s amazing. We have tons of data on recidivism now but yet that probably still lingers on.
[13:26] Teresa Huizar:
Well, I think the last two that you mentioned, it seems to me what people are getting confused about is the difference between kids and adults.
You know, that so many of the myths that exist about youth with problematic sexual behaviors are really because of our propensity to think about adult sex offenders and everything we’ve ever seen or heard from cases that involved adult offenders.
You know, if you were working with teams, if you were working with CACs [Children’s Advocacy Centers], as you do through the Institute, what is your advice about how to approach and separate out the issues that involve kids versus those which teams do deal with every day that, you know, involve adults who are in a very different place, I think?
Yeah, one of the things I emphasize when I’m—especially clinicians when I’m training working with them—is being aware of your own blind spots.
Look, there’s no such thing as objectivity. That’s just this illusion we create to make us feel better. We’re all subjective and we all bring our baggage. What am I bringing to the table? So when I come in and see that kid—and ultimately, you know, that’s going to color the lens that we look at these kids through. So being aware that if you come in with a pre-existing belief that these are just young versions of adult offenders, yeah, to your point, we really want to pay attention to that.
And so I really talk about, what are you coming into? I think I told you this quote some time ago, but I always talk about being wrong. I ask people what it must feel like to be wrong, and they’ll tell me everything, and I’ll say, “No, that’s what it is to know you are wrong.”
The issue with being wrong is, until you know you’re wrong, being wrong feels exactly like being right. And we have to be able to be willing to cross over and say, “I don’t know, and/or what I do know may be incorrect.” And so being open to making that change philosophically. And then, “How does it apply to the youth that I’m working with?”
I’ve had people who will call me and say, “This kid has really deviant sexual behaviors.” And they’ll tell me he’s masturbating once a month in his bathroom with the door shut in privacy. And I’m like, “That’s deviant?”
You’re like, “That is not deviant, my friend.” [Laughter]
Right? Now I know more about the therapist’s sexual beliefs than I do the kid’s.
And that’s not what I want to know.
So we really, again—how do we perceive these kids? And you mentioned the adults and even in the world, we look at adult offenders, we go, “They must have high recidivism rates.”
But the reality is their recidivism rates are, you know, depending on the study you see, is anywhere from 10 to 20%.
[16:01] Teresa Huizar:
I’ve got to say, though, one in five ain’t great, you know? [Laughter]
No. No. Better than 80 and 90%.
Yeah, yeah. It’s a fair point. The thing is just, overall, what we’re exposed to in the media are the worst of the worst cases and the worst of the worst outcomes. And that really shapes all our thinking. Not just the general public, but professionals as well.
I’m just wondering, you know, I think with clinicians, it’s one thing because they see these kids. They come into their office, and after all, they’re kids. They talk like kids, they act like kids. And so they may say some things that could be upsetting or disturbing, depending on what they’re saying. But at the end of the day, they’re still kids.
I wonder for many other professionals who may not have the, you know, the job in which they’re going to spend lots of time with them in that way over the course of treatment as a clinician would. How do you think about how to humanize these kids and still keep them as kids in one’s mind? Because it seems to me, that’s also at the heart of making sure that we’re treating these kids and youth appropriately.
Yeah. And I love your statement, because I use the same one, Teresa. I’m like, “They’re kids”. I start with, “That’s where they are.” And so, you know, depending on the discipline, I kind of take a different approach. I mean, CAC staff tend to have this advocacy built into us. That’s what we do, right? Making the argument with them is usually not much of an argument. It’s pretty much, you know, maybe new information.
But generally I think when I have to work in the, either the court system or the investigative pieces, whether it’s CPS [child protective services] or law enforcement, that’s where I’m a little bit more—you know, I play to my audience and what they are. And so, often I will use law enforcement folks that I’ve gained an alliance with and they’ve come to understand that they were kids. And then a lot of these kids have experienced some really adverse or traumatic experiences and that, of course, they’re acting on it. I, I knew when I was in an MDT [multidisciplinary team] one day, one of the law enforcement guys leaned over to me and said, “I wonder what that kid’s ACE [adverse childhood experiences] score was?”
I had this moment of wanting to cry out loud.
I bet you did! [Laughter]
Like, “I got to one!” Right? And that, that officer, I used that to the max, and I had him talk to every officer I could.
So he would explain to them that they’re not monsters, that they’re kids. And that if—you know, when they’re like, “Well, they’re not being responsible.” And I would say, “Well, have they experienced responsibility? Because if they haven’t experienced it, how do they know how to?”
And they can understand that to some extent.
And then, you know, with prosecutors, same thing. There’s a great document out there by Paul Stern on evidence-based approaches to prosecution in juvenile, they call juvenile sex crimes. And I use that because, you know, you’re more apt to listen to someone of your own discipline. So I try to utilize those folks when I’m educating that.
And you know, there’s a nomenclature to every profession, right? And when I’m talking to a judge, I don’t talk in clinical terms. But I do talk in terms that they’ll be receptive and that I know they’ll go, “Okay. I understand that piece. That makes sense to use a diversion program with this kid if we can get better outcomes.”
So, really, it’s playing to my audience and paying attention to who my audience is. So I will change my approach up depending that it is. But, you know, you almost feel like you’re a chameleon because you have to change a lot.
But, you know, MDTs, the ones I’ve seen where you have all those people on board, boy, when they manage these cases, they manage them so efficiently and effectively and the outcomes are amazing.
[19:30] Teresa Huizar:
In a lot of ways, there’s no real alternative in terms of, you know, CACs have a role in helping these kids. Because who else has expertise around child sexual abuse? Who else has all the MDT partners at the table? Who else can influence the outcome as well as they can? Who has trained clinicians? You know, it’s just to me, it is the logical and natural place in most communities for services to wrap around these kids. And I’ve just been so delighted to see so many CACs take this on so much.
But to your point about needing to bring professionals along with us, I know, you know, we’ve seen recent research that, you know, the directors themselves talking about the fact that there’s questions in their own mind about how much their MDTs may believe in the work they’re doing or fully understand and embrace the work that they’re doing with this population.
So, I think that that tells me that we still have a little more persuasion, maybe, to do with our partners.
We do. And I work with the folks at OU [Oklahoma University] and Jane Silovsky. We have these conversations a lot where it’s like, even when we tell people, like, it’s not against our accreditation standards, is these are kids, we’re not considering them perpetrators, really.
And I’ve had some folks say, “Look, I don’t care if the Standards say it’s okay, I’m not going to bring those kids into my CAC.” And so there’s still plenty of work to be done. And, you know, when I take that approach, I try not to hit them with like, “This works.” I go, “How did you get to that decision?” I try to figure out how they got there. Going back to your point of when people, you know, make a decision about something, I want to understand the process they went about making that decision. And then I address it that way. If I try to start with, “Look, you’re wrong,” and throw a bunch of statistics at them, they’re just going to, you know, walk away from me even more entrenched in what I’m trying to get them out of.
So really kind of listening. Offering information when they’re willing to take it. But talking about the process, I’ve had some success in getting folks to say, okay, let’s—you know, I say, “Take a small test to change work with one or two kids, just see how it goes and then make a decision, evaluate, and then move from there.”
[21:37] Teresa Huizar:
I think the other thing for folks to think about in terms of the question that you’re asking in terms of how they feel about it is we also have people who come to this work with their own trauma histories. And I think we all have to own that and be aware of the way that that may be influencing the decision making as leaders, as MDT members, as child abuse professionals.
As you say, it’s not about trying to pretend we can always be objective but it is about sort of acknowledging our biases and also making sure that that isn’t the thing that’s driving our decision making. Certainly there may be some communities where there is another resource and it would be perfectly reasonable for that resource to serve these kids.
But I think, and most, most of the time in the U.S. we’re really consigning these kids to no treatment at all if they’re not going to be seen or treated in the CAC setting, unfortunately.
[22:31] Teresa Huizar:
Can you talk a little bit, Geoff, about the effectiveness of treatment and what treatments do exist with this population?
Yeah, great question, because that’s probably one of the biggest ones talking to CACs around the country about. The great news, I would say, is: Treatment works.
When we look at kids who recidivate, who have received treatment, a Michael Caldwell study—it’s getting a little dated, but it’s still 2016, it’s still relevant. Dr. Caldwell’s study shows about 2.75% of kids will recidivate. Which, you know, if you look at CDC standards, that’s a cure rate. That’s really, really good.
And actually what he has shown is actually in the last 15, 20 years, we’ve brought that down. We’ve gotten better. So that means our therapy approaches are improving. We’re looking at these kids as kids. We are now infusing our treatment or our main thrust of treatment is around trauma. And that we’re really focusing on those issues with kids. That we are paying attention to what I call the big three: trauma, attachment, and the neuroscience around it.
Those are the, those are the three legs of the stool that I like to preach about that. Those are the things we focus on in treatment. You know, obviously for the trauma piece, we know that the attachment piece is that this is about relationships. And if they’re having harmful relationships, it’s probably entrenched in some attachment issues.
And then obviously the neuroscience, I don’t need to talk to this population about how that plays into brain development and emotional development and all those things. So when we’re looking at treatment and—look, we have a broad range, even though, you know, we’re talking usually 3- or 4-year-olds up to 17-year-olds. That’s a lot of developmental change or spectrum there.
So, again, really looking at what treatment is for developmentally and contextually with those kids. Because the type of treatment you’re going to do with a 4- or 5-year-old is not going to be the same treatment you do with a 15-year-old. But I’ll go back to—and this is kind of like beating this over and over again, but how we individualize our approaches.
I will have kids who are 8 years old, and they’re using weapons in their sexually harmful behavior, and I have 16-year-olds who just watched a lot of bad porn or got bad sexual messages or unhealthy sexual messages and then are peeping toms or doing things that are not hands-off contact. So it really kind of varies.
We don’t have a ton of what evidence-based therapies that we love to promote. We do know the University of Oklahoma has been doing some great work. They have a couple models. Their school-aged, which is 7 to 12, has a good deal of research behind it, is considered evidence based, and one that working with them we promote a lot because it shows to be really effective.
Brian Allen up in Pennsylvania also has a phase-based model that he has gotten a couple clinical trials that looks really good as well too. So we’re really excited about his work being more prevalent out in the community.
In the adolescent world, we’re a little less options. So really, when we look at evidence-based models, if you look at like SAMHSA or the California Clearinghouse, multisystemic therapy is the one that we know of in the adolescent world. But it does have a tendency to look at kids who have more what we call criminogenic aspects. We know that MST was developed for kids with conduct disorder. So we know there’s a legal aspect to that. So that tends to work better with those kids.
But we also know a lot of kids who are exhibiting problematic sexual behavior aren’t really like criminals. They’re not, and they’re not specialists where they’re just working on sexual harm. Often a typical kid is a kid who, kind of socially awkward, goes through puberty, sees a lot of bad pornography, wants to act out their sexual desires and beliefs, but doesn’t feel comfortable with a girl her own age. But, “Hey, my cousin who comes over on the weekends, who’s 5 and likes to play Candyland with me, will do whatever I tell her to do.” And that’s not an uncommon scenario to see something like that.
So. It really—I know I’m kind of all over the place with what I’m explaining, but I guess my point back to that is that are we taking, again, individual approaches? And that not only addresses the kind of the main thrust, but a lot of populations that get left out, like BIPOC and our LBGTQI population.
I’ve been working with some trans kids for the past couple years, and I’ll tell you, I learned a tremendous amount from work—again from the kids. But these populations, we still have not enough information to understand how we can approach it. Again, so, by individualizing that approach, that can really help overcome some of that issues.
Especially when we were trying to, we want a DEI approach. Because if I work with a kid on the Eastern Band of the Cherokee, that kid’s going to look different than the kid who’s on the Navajo reservation in Arizona, right? I’m not, “Oh, well, they’re Native Americans. I’ll take this.” No, you’re going to take an individualized approach based upon their community and what they’ve been exposed to and where they come from. So really trying to understand. And the research will say one of the most evidence-based things we can is to individualize our approaches to meet the individual needs of the kid in front of you.
[27:38] Teresa Huizar:
So it seems like in the CAC world, probably the most common trauma-based intervention we have is TF-CBT [Trauma-Focused Cognitive Behavioral Therapy]. We have almost universal adoption of that. And I’m aware that there are, I don’t know if you would call it an application [or adaptation] or whatever, but there is one around PSB. Can you talk a little bit about that?
Yeah, yeah. So TF-CBT PSB initially actually was developed for younger school-aged kids where we knew trauma was a significant or predominant issue in the treatment. And so, we’ve been getting kids trained in that probably, gosh, it’s at least three or four years, probably more than that. I’m probably not, I got that correct.
But that application has really again, yes, addressing these kind of needs—we talked about the attachment, the trauma, the neuroscience. Because that’s kind of built into TF-CBT. We know that. And so when we’re applying it to PSB, you know, it’s subtle things. Like in TF-CBT, we have cognitive distortions that we deal with with kids. And that’s usually around why it happened to them. The twist we’ll do that with PSB is, the cognitive distortion of “why I did this to someone else.” So, you know, the core is there and that application really works. And just recently, actually, there’s been a good amount of work around TF-CBT with adolescents.
Melissa Grady, she’s a great researcher, but also very experienced in TF-CBT, but is now adapting the model to look at the older adolescents because, again, they’ve had some trauma experience and it seems that it can be applicable.
I know at my CAC prior to coming to NCA, TF-CBT was one of our main models that we used, and we adapted it for PSB. I was lucky because Ashley Fiore, our national trainer [here at NCA], was my trainer there, and she was very astute in being able to provide that. But again, it, that seems like a really good direction that I’m hoping more CACs will begin adopting down the road.
[29:35] Teresa Huizar:
Yeah, absolutely. And we’ve already seen, I think, a lot of interest in that, in part because, you know, there’s a workforce that’s very, you know, conversant with TF-CBT in general. And so adding this on may seem less daunting than sort of starting from a place of learning an all new intervention and trying to get that into place.
So I think, you know, what we hope is that professionals, wherever they are, will take baby steps in this direction if they haven’t already. And if they’ve already taken baby steps, you know, we’ll take the next step because certainly this is a population that, you know, can so greatly benefit, I think, from an MDT approach and from a really effective, you know, place of help and support.
I’m wondering, you’ve been talking about the research, and certainly it’s grown over those years since 1989, but unquestionably, there are still research gaps. When you think about what you’d like to know more about and don’t know now, in working with this population, what is it? What are the areas where you go, “Gosh, we just don’t know enough about that right now”?
Yeah. Great, great question. So I would probably break it down to assessment and treatment.
Assessment, I still think we have room to grow on understanding risk and how we evaluate risk. I think the field has moved away from using things like “moderate,” “low,” and “high risk” to apply to kids. Because again, it kind of scared people, and we love labels. And again, understanding what the risk factors are and clearing that up a little bit more because we want to make sure we manage those risk factors.
And hand in hand with that, we are getting better but we still need more research around protective factors. Because yes, risk factors are really important that we understand what the risk is, but protective factors is going to get us out of this. And that’s, you know, the priority we want.
It used to be treatment was get them to stop doing bad things. And I was like, “Well, okay, can we get them to do good things?” Because if they’re doing the right thing, most likely is they’re not doing the wrong thing. So that’s what I want to promote, right?
So these protective factors really, there’s research there. Kevin Powell out of Colorado is a buddy of mine. And Kevin has the resiliency and protective factor scale and he’s working on the psychometric properties of it right now, but it looks really, really good. And it’s an excellent instrument to use. And he offers it for free, which is really wonderful.
So more and more information, I guess, around protective factors and how they, how we can utilize them, evaluating it in assessment and then applying it in treatment.
Going back to treatment, some of the populations I addressed before. How models we can address with BIPOC populations because those are the kids when, especially when they get into the court system, they’re the most likely they’re going to get sent off.
One of the things I did at my CAC is I created a diversion program, and I was really happy because we reduced how many kids were going into the system. But then when I looked at it, we were diverting one in three white kids, but we were diverting only one in 10 brown and Black kids. And I’m like, this is not good, right?
So we need to get better at providing services to that population as well as the LBGTQIA, especially when—again, I mentioned trans youth, because we have no instruments to help us with that. We have some risk instruments that we can use, but we don’t have anything in that area. And those kids I feel like are just kind of hanging out there, like we don’t know what to do with them. And some, some point we are. But how do we handle the gender diversity of these kids? And we’re not good at that right now.
So that’s definitely one area to focus on. It would be nice to have some more evidence-based practice therapies but I think the challenge we’re going to have is, (1) development is fluid. And a kid at the first month in treatment is going to look a lot different than the sixth month in treatment, especially if they’re going through puberty that they’re going to change dramatically.
And that, you know, how we, again, treat these kids individually and not use box treatment. Like everybody gets the same thing—that just doesn’t work very well. And lots of these kids—even things like like … we did a lot of sexual health with kids. We want them to, you know, have healthy sexual behaviors. But I have one kid who, you know, he’s afraid to hold his girlfriend’s hand because he masturbates, and he’s afraid he’ll get her pregnant if he holds her hand. I have another kid who thinks that strangulation is part of foreplay. Both those kids need sexual health, right? But do I want to put them in a group together and merge them? Right. No, I do not want to merge them.
So when I say “individualize,” I will split hairs to some degree that we really need to look at these kids. They’re so unique that if we box treatment or create a checkbox mentality—we know research tells us bad treatment is worse than no treatment. And so we’ve got to get it right. So having better treatment models is definitely an area of research that I would love to see some further progress.
[34:19] Teresa Huizar:
Well, I am hoping the CDC or SAMHSA or someone will fund that, because it would be great to see. And there certainly hasn’t been enough of it.
And I think, you know, the difficulty is in some of the populations that you’re talking about, too, you don’t want to add stigma. So, I think this is just yet another factor is, yes, we need to know more about these populations. Yet, there are so many myths that already attend to these populations that, you know, how do we explore those things and do so responsibly in a way that doesn’t seem to imply that particular groups have somehow more of an aptitude for PSB or something else? Which unfortunately is a part of the sort of harmful myths and messaging that we’ve seen sometimes in the broader discourse.
So you’re talking to child abuse professionals, so folks just like you care about this work, care about these kids, and are doing it every day. If you can wave your magic wand and say, “Here are the things that I would just love to see changed, you know, right now. I would love to see them.” What would they be for you when you’re thinking about this?
Wow, you’re going to use the magic wand. You must be listening—
The magic wand, it’s a toughie.
—listening to my therapy sessions because I love the magic wand.
So I guess, some points we’ve talked about so far, but I would like the CAC world and child welfare to really embrace these kids. For so long, they were a ship with no harbor. It just wasn’t a place for them. And that adds to the stigma too, right? Because social isolation is part of why they do what they do. And so when the system creates a social isolation, we’re becoming part of the problem. And we may take something from adverse to trauma, you know, by accident.
So I would want us to really create a system. I’ve been advocating for a long time in the CAC world that we need to be the landing place for these kids. One, we’re safe. We understand child sexual abuse, as you said multiple times, and I totally agree. And we understand how to keep kids safe. And we can treat this population, keep kids safe, and get good treatment outcomes.
And we know how to focus on the positives. We know how to focus on those risk factors. We know how to be strengths-based. We know all those things, and we, if we know something, we know about dysregulated kids, right, and we know how to work with them. And on top of that, we’re good with families and these kids. You know, I always tell families when they come in, I’m like, “Look, you didn’t cause this problem, but you are the medicine that will cure this problem.”
And so you’ve got to be part of that. So how we bring them on board. So I would hope that we could kind of let go some of our fear and anxiety. I hope we could let go of some of the labels that we use. Try to be objective where we can and really try to understand these kids and what’s going on.
And it really just starts with having an open mind and listening, right? Be—just be quiet and listen to these guys. I told you many times already today, I’ve learned so much by just shutting up and listening to the kids I work with. Ninety percent of what I know is from them. And when you, you know, from that first moment in 1989, where I sat down and listened to those kids, I went, “Wow, they are teaching me to help them.” And anytime I can get that situation, I want to take advantage of it.
And so I think it also then lends to the kids who are being harmed by adults, because I think we’ll understand them better, too. And I think we need to. I’m not saying that we are not a society without consequences. The big thing for me, I always say is, “Please don’t ever talk about holding people accountable.” I hate that term with a passion. [Laughter] But our job is not to hold people accountable. Because, one I do all the work and they don’t learn anything. What we need to do is create accountability within our clients, within ourselves.
How do we entice, how do we encourage, how do we invite people to be accountable? Because that’s where change happens. Because if I’m just holding them accountable, as soon as I leave, it’s gone. So that mind frame in the CAC of: How do we create accountability? And most of the ways we do it is we model it. Because that’s at our core. What we do is be accountable.
So I think my waving my wand, I probably put about 10 things in there. So sorry, Teresa.
But the bottom line is I want CACs to be the world that these kids experience. That’s the world I think that can make the biggest difference in them and in our larger communities.
[38:52] Teresa Huizar:
You’ve talked about listening to these kids, and I think that’s critically important. I also think it’s important to hold empathy for these kids. If you feel empathy toward these kids and what these families are struggling with, it’s like anything else in the CAC world. You can better serve them because you can feel, you know, you can imagine what it would be like to have these struggles. And we all have some. So I just appreciate you bringing both empathy and a listening ear to these kids and families.
Is there anything I should have asked you and didn’t, Geoff?
That’s tough because I can talk about these kids all day long. It is my passion and love for so long. But I appreciate you brought up empathy. I think that’s the big one. But going back to your statement earlier about: These are kids. And what would you want for your kids? None of us would ever want to imagine this would happen in our family, your child, your nephew, your cousin who it is.
But remember, these are kids, and every kid deserves a chance to have a life where they can not only survive but thrive. Dan Siegel talks all the time about: Empathy isn’t connecting with someone you identify with. Broaden your scope and ability of empathy, and I think that will make a huge difference.
[Outro music begins]
[40:06] Teresa Huizar:
Well, thank you so much, Geoff. We really appreciate you coming on One in Ten and appreciate all your work for the Institute as well.
Well, thank you for the opportunity, Teresa. I’ve always appreciated listening to One in Ten, and this is a great opportunity for me. So, thanks.
[40:20] Teresa Huizar:
Thanks for listening to One in Ten. If you liked this episode, please subscribe. We’ll be back in January with a new season of the best minds tackling the world’s toughest problem: child abuse. For more information about this episode, or any of our others, please visit our podcast website at OneInTenPodcast.org.
And we wish you and yours a happy holiday season from all of us at One in Ten.