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Teen Problematic Sexual Behavior (PSB) - A Data Informed Treatment Approach




By Stephen C. Schultz

I recently returned from a visit to California, where the clinical director of Oxbow Academy and I met with a family whose son had recently graduated from Oxbow. This meeting was intended to "check in" with the family, see how things were progressing, and assist in realigning any unmet expectations. One thing that stands out is the remarkable maturity and insight students gain during their time at Oxbow, often surpassing their peers. As we continue working with these families—who are truly pioneers in their persistence and dedication to their sons—we have observed some consistent trends.

Key Trends

  • Previous Treatment: Sixty percent of students have had prior treatment experiences, such as outpatient care, day treatment, partial hospitalization, or placement in a residential treatment center (RTC).
  • Adoption: Similarly, about 60% of students at Oxbow are adopted.

The Challenges of Addressing Sexual Issues

Due to the shame associated with sexual issues, what therapists and families initially uncover is often just the "tip of the iceberg." Many boys are skilled at playing what we call “information poker,” revealing only what is already known while keeping the rest of their “cards” hidden. This dynamic makes adolescents particularly difficult to work with in outpatient settings. General residential care often struggles to address these challenges as well.

By the time families contact us, behaviors have often escalated into a crisis, and financial resources for treatment may be running low. This prompted us to ask a critical question:

"How can we set up a system that encourages and supports early intervention?"

A Structured Approach: The First 90 Days

I’m pleased to share that our first phase of treatment provides an integrated and consolidated evaluation process. This initial phase lasts 90 days and includes the following components:

  1. Integration into Core Areas:
    Students are fully engaged in academics, residential living, and therapy during this period.

  2. Comprehensive Data Collection:
    Data is compiled across academics, residential living, and therapeutic progress using the Residential, Emotional, Social, Behavioral Assessment (RESBA).

  3. Full Sexual Disclosure:
    Each student works closely with their therapist to provide a full sexual disclosure.

  4. Bio-Feedback Exam (Polygraph):
    Students participate in a bio-feedback exam to validate their honesty during disclosure.

  5. Psychosexual Evaluation:
    Summaries of the student’s efforts in academics, residential living, and therapy are combined with the bio-feedback results. This comprehensive data is then sent to a psychologist for a detailed Psychosexual Evaluation.

At the end of this 90-day phase, parents and referring professionals receive an Integrated Functional Assessment, Psychological Testing, and Sexual Risk Assessment. This allows families and professionals to make informed decisions about the next level of care required.

Benefits of This Approach

  • Limited Initial Commitment: Parents commit only to the first 90 days of treatment.
  • Informed Treatment Planning: Data collected during this phase directly informs the student’s treatment plan.
  • Flexibility for Referring Programs: Students can return to referring treatment programs if clinically appropriate.
  • Sophisticated Clinical Support: Allied professionals gain a robust and clinically sophisticated option to discuss with families.
  • Full Engagement: Students are actively involved in academics, residential activities, and therapy throughout the evaluation process.
  • Encouraging Transparency: The clinical use of the polygraph encourages students to “lay all their cards on the table,” ensuring the development of a complete and accurate treatment plan.

NEW HOPE. NEW HELP. NO SECRETS

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