Oxbow Academy – Unintended Consequences

By Stephen C. Schultz

(Editors Note: This post started as an email I sent to a couple of Educational Consultants. It was the culmination of several conversations. I think there is some genuinely good information here that the general public, clinicians and allied health professionals could benefit from.)

As helping professionals, we often find ourselves in teaching opportunities. We consult with clients, students, families and even others in our profession. The phrase, “Strength in the Struggle” is prominent at Discovery Ranch (A sister treatment program to Oxbow Academy). Clinton Dorny, the Executive Director, mentioned to me the other day that they often tell parents, “If your child isn't struggling here at Discovery Ranch, then we're not doing our job.”

Much of what we do as treatment programs and the value you provide as a therapist, counselor, coach and educational consultant is to assist families in managing “Unintended Consequences”. There isn't a parent out there who has held their newborn and thought to themselves;

“You know, I can hardly wait until you are 14 yrs old, staying out all night and creating chaos in our family so we can spend thousands of dollars for you to attend a residential treatment program.”

Please allow me to share some thoughts and insights I've had over the last couple of months pertaining to Oxbow Academy. I hope to differentiate between the services and language used at Oxbow Academy and what the norm has been over the last 30 years.

There are really three areas of conversation I would like to have. One is the issue of language used when discussing sexual concerns and teens. The second is the area of testing and evaluation of teen sexual concerns. The third is how we as professionals discuss these issues with parents in a helpful and competent manner avoiding fearful language and labels.

The Language

Here is a thought provoking scenario;

A young 5 year old is inappropriately touched by a cousin at a family reunion. This child demonstrates some minor “sexually reactive” behaviors throughout the latency stages of development, but nothing parents and professionals think the child won’t grow out of. When this child turns 11, the parents get cell phones with a family plan. This 11 year old struggled to manage the use in an age appropriate manner over the next few years. By the age of 15, this teen now spends a lot of time on Facebook and even gets involved in a few “Sexting” situations with the phone. The parents are very concerned about a pattern of sneaking the phone and computer use whenever the parents implement any “structure” to minimize the manipulation. The Parents find themselves in a constant battle of “cops & robbers”. Parents finally perform a search of the family computer history and find some porn sites that were regularly visited. When confronted, the teen breaks into tears and expresses sorrow saying it was just curiosity. Some friends at school had mentioned the sites. It would never happen again.

Six months later, there is a family gathering at this particular family’s house. There are cousins running around the house as all of the parents are finishing up dinner and fully engaged in some friendly family banter. The parents we mentioned earlier notice that two of the younger cousins aren't around, nor is their 15 yr old. So, mom goes upstairs and opens one of the bedroom doors to find her teen inappropriately touching them self with the two younger cousins having also participated.

When this scenario is read as a female, how does our society generally interpret the situation? The immediate thought is that it is a treatment issue concerning trauma, sexual reactivity and victimization. When the scenario is presented as a boy, the immediate interpretation is that of a crime…the crime of a sexually aggressive predator, offender or perpetrator.

“Sex Specific Treatment” for teenagers started to blossom soon after mandatory reporting laws were enacted in 1974. Because of mandatory reporting, sexual treatment has always been primarily for adjudicated youth. And, the emphasis has overwhelmingly been on boys. ATSA, NAPN and NOJOS as well as other associations sprung up to support State Sponsored treatment providers and also provide research on adjudicated “Sex Offenders”.

It was natural for these adjudicated treatment programs to adopt the language of the court system. Psycho-sexual testing soon followed. Most of this language from the court system is language that transferred over time to the juvenile system from the adult system. Consequently, labels such as "Predator", “Sex Offender” and “Perpetrator” come from the adult adjudicated system.

The term “Juvenile Sex Offender” is a legal category masquerading as clinical terminology and language.

In 2007, Oxbow Academy was the first free standing residential program to recognize the need for residential treatment of these issues outside the realm of the court system. Oxbow began offering exclusive treatment services to families that wished to privately fund treatment without a mixed population of adjudicated students. This allowed parents the choice to privately intervene early and it allowed Oxbow Academy to expand the therapeutic offerings and move away from the “adjudicated” population, language and labels.

These “labels” mean many different things to different people and elicit very strong emotions based on an individual’s beliefs and experience. Thus, it has been a constant effort to assist the teens we work with to avoid self identification with this language.

You may be asking why I even bring this up. Over the last couple of months, I have spoken with three different educational consultants about Oxbow; the last one being a few weeks ago on a tour. The conversations started in a friendly and innocent manner with the Educational Consultant saying,

“So, I've heard a lot of good things about Oxbow. Now…you work with the more aggressive sex offenders, right?”

Obviously we, and if I'm being honest, it’s me…haven't done a very good job of defining the population of students we work with, or in creating much needed language around these very clinically complicated and emotionally charged issues.

I suspect we have created some “unintended consequences” from a family video we have been showing at some of the regional NATSAP Conferences as well as the 90 day evaluation we have been sending to consultants that lists the full sexual disclosure of the student. What we know about on admission is generally just the "Tip of the Iceberg" for these students. 

With the video, our hope was to educate clinicians, consultants and programs on the clinical necessity of a full and complete sexual disclosure by each student in treatment and the importance of an emotionally safe treatment culture that facilitates that effort. Also, because we view ourselves in a “Trusting Treatment Partnership” with the family and the educational consultant or other referring professional, sharing the 90 day evaluation is a natural part of the treatment process. While we thought that we were demonstrating the thorough therapeutic work that was being done, we failed to realize that educational consultants and other allied professionals were viewing the video and the 90 day evaluation out of context. Many of whom have very little experience in these matters. Consequently, we spend a great deal of time in communication with the family, and relatively little time with the consultant and other supporting professionals.

For those who have not seen the video, it is a case study of a family and the struggles they had with their son who was abused at a young age by a female cousin. It shows how there was some sexual reactivity over the years for this young boy. He then eventually began to instigate some inappropriate touching with cousins and neighbors. It also points out how the family had asked for help from professionals on many occasions and when the sexual concerns were discussed, the professionals minimized the behaviors as simply “kids being kids” and said it was not of “primary” concern. The parents also discuss in the video some of the struggles they endured from the myriad drug regimens their son was placed on and the horrible side effects that ensued. 

However, it appears the takeaway for some who have viewed the video or received a copy of a 90 day evaluation, is that Oxbow Academy works with “Perpetrators” and “Sex Offenders”.  I don’t mention this in a frustrated manner; it simply demonstrates the need for more appropriate language.

So…Oxbow Academy specializes in working with teen boys and their families who are struggling with sexual concerns. These concerns may include sexual trauma, sexual abuse and compulsive sexual behavior. More times than not, there are co-morbid concerns that need clinical attention as well. These include therapeutic interventions and therapeutic support in the treatment of Anxiety, Depression, ADHD, ASD, NLD, PDD as well as Eating Disorders and Self Harm.

The student profile for Oxbow Academy is the clinically complicated “emotionally acting in” student you would see at Discovery Ranch, only complicated further with sexual concerns. Over a year ago, we refined the residential component of treatment. We now offer a separate residential campus for those students who are on the “spectrum” or struggle with other developmental difficulties. There is a residential campus for Neuro-Typical students and a residential campus for non-Neuro-Typical students. While they have very different residential and clinical needs, the students do come together each day for school and other daily activities to provide a more normative experience.

To reiterate, there is no language for students demonstrating sexual concerns who have no legal involvement. The current language being used is terminology and definitions set forth by the court system.

The Testing

The other conversation I would like to explore is the idea of testing. When there are sexual concerns, the standard for many years has been to have a psychologist do Psycho-Sexual Testing. This is generally standard psych testing with the addition of a series of sex specific assessments, inventories and interviews. There are outpatient clinicians as well as private testing centers that provide these services. Most of the outpatient clinics were established to meet the need of adjudicated youth who were referred by a case manager or probation officer. Please allow me to share a little history of the Psycho-sexual testing process and how it came to be.

As mentioned, the treatment for adolescents with “sex offences” originated in the adjudicated system. For adolescents, sexual issues were rarely addressed in therapy until it became a legal problem. The adjudicated treatment providers had a steady population of students in treatment, but needed a way to asses risk prior to release back to the community.

Collins (1980) defines recidivism as a return to prior behavior. Studies in the past have measured recidivism in terms of reported new offenses, or rearrests, or reconvictions subsequent to release from a program (Roy, 1995). There is a study that was conducted by Benda (1987) of adjudicated delinquents in a State correctional facility that measured recidivism by the number of youth who had police contact following their discharge from treatment.

Often the research is conducted through the use of a survey with case managers and it is usually administered over the phone. (Nelson, 2002)

There are four standard “Tests” that were developed to evaluate risk. While there are other “Inventories” and “Structured Interview Assessments”, these are the main standardized tests used in today’s Psycho-Sexual testing;

·         Juvenile Sex Offender Assessment Protocol (JSOAP-2)

·         Estimated Risk of Adolescent Sex Offense Recidivism (ERASOR)

·         Juvenile Sex Offense Risk Assessment Tool (JSORAT-2)

·         Sexual Behavioral Risk Assessment (SBRA)

What these tests measure is the “Risk” of recidivism, or in other words, the repeating of the “offense” the adolescent was charged with.

As you can see by the instrument names, the current tests have been normed on the adjudicated population and do nothing to address any clinical differences in the non-adjudicated population or the language used. Now, please don't think that this current testing is not valuable, it is! It simply needs to be used in the appropriate context. 

The point I wish to share is that the contextual interpretation is extremely important. There must be other sex specific "Functional Assessment"  measures in place that provide a complete evaluation process.

There is no way to measure “Risk of Recidivism” for a behavior, thought or action that is not known about.

This is a very important concept to remember when you are having a conversation with parents. Students with sexual concerns are very good at keeping secrets. Just about every clinician has been in a situation where they are working with a student and they “know in their gut there is more”, but the student is hanging onto more information for dear life! Often, this is clinically significant information. They may put one or two cards on the table, but hold the rest of them very close to the vest.

It’s only in an emotionally safe environment and culture with skilled therapists that they will slowly start to drop the other cards. It’s only when all of the cards are on the table that the Psycho-sexual process realizes its highest potential.

The reason I mention this is that over the last seven years, we have had numerous students come to Oxbow Academy already having had a Psycho-sexual evaluation performed in a traditional treatment center. There were histories taken from parents, records reviewed and students themselves were interviewed. Then the psychologist performs the testing. However, the teens were still carrying secrets.

Risky behavior continued to plague the student. Treatment professionals found themselves in a constant game of "cops and robbers" with these kids.  Once the students are transitioned to Oxbow, the students start to open up and take an appropriate risk to share everything...to trust. They start developing a relationship with honesty. I recognize this next statement is extremely bold.

It’s not until there has been a fully validated sexual disclosure of inappropriate thoughts, fantasies and behaviors that the Psycho-sexual testing will be effective in measuring the risk of continued inappropriate thoughts, fantasies and behaviors. Until then, parents are spending money on tenuous hope and unreliable results.

The Family

We all know that parents struggle with placing their teens in a residential setting, and rightly so! It’s a traumatic time for families, yet as a professional, you know it is most likely the best thing for the family and the student.

I recently had a couple of unrelated calls from educational consultants wanting to “run a situation” by me. I welcome these types of calls. In each case, the information that was known was significant enough to meet clinical criteria for admission to Oxbow Academy. The families however, struggled with the idea of their son being placed in a program with “those kind of boys”. The students were then sent to a standalone assessment center where they received a “Psycho-Sexual” and it was determined they didn't need Oxbow Academy. ( Again, I have failed to educate other allied professionals on the services Oxbow provides.) They were both placed in traditional settings.

Oxbow Academy is committed to making sure that any student admitted to Oxbow is clinically appropriate. I think it is safe to say that anytime someone thinks of Oxbow as a solution for a teen, there is significant concern about sexual issues of some kind. The dilemma that consultants and clinicians always seem to have in common with families is this;

 “Are the sexual concerns BAD ENOUGH that the student needs to be at Oxbow?”

To reframe the question;

“Is Oxbow Academy the most clinically sophisticated and efficient option for identifying sexual concerns in their entirety and moving the student and family into the process of healing?”  

Kicking the proverbial “can” down the road due to “fear” only prolongs the emotional pain of the student and family. It also creates a scenario where parents “hope” the alternative course of treatment solves the problem, thus never really alleviating the anxiety that accompanies sexual concerns.  

As options for evaluation are considered, there are some questions that need to be asked;

1)      Will the student be placed in a homogeneous population within the evaluation facility thus maximizing the emotional safety and potential for honest disclosure and catharsis?

2)      Will the student work through a full sexual and non-sexual disclosure while there?

3)      Will the therapist actively work with the student as an advocate throughout the disclosure process, or is the disclosure simply another task to complete in a long list of assignments?

4)      Does the evaluation center have staff and therapists that specialize in sexual concerns with appropriate physical and emotional safety measures in place?

5)      What specific behavior is the Pycho-Sexual Evaluation testing recidivism for if there is not a fully validated disclosure?

6)      If there is not a fully validated disclosure, how can you competently asses further risk?

When families demonstrate a concern for placing their son at Oxbow, it is essentially the verbalization of “the fear of the unknown”. There could be a fear that there is more to come out and social services will descend on their home and take their computers and split up the family. There may be an irrational fear that their son is “incurable”. There could be concern that their son “isn't that bad” and would learn bad things from other students. There may be avoidance on the part of parents due to past trauma in their own life and the fear of having to relive those experiences or battle those demons. There are literally as many reasons to avoid placement at Oxbow as there are families with issues. Here are some thoughts to consider as you speak with families;

1)      We encourage all families to come visit prior to placement.

2)      Our goal is to establish a healthy, trusting relationship with the families.

3)      Families can meet with current students, speak with current parents and get a feel for the types of boys and families we work with.

4)      Avoid the language of adjudication…this isn’t the population we work with.

5)      If a traditional program has a clinician who has worked with “sex offenders” in the past, that does not mean the clinician is specialized in this disorder.

6)      The only way to reliably have a student provide a full disclosure is to have them be in a homogeneous population with a culture of physical and emotional safety.

7)      The only way to consistently and reliably have Psycho-sexual testing be as accurate as possible is to have a fully validated sexual disclosure.

8)      The students we work with don’t want to have these problems any more than their parents do.

9)       We address concerns of Sexual Trauma, Sexual Addiction/Compulsion and Sexual Abuse along with any co-morbid issues.

10)   Our clinicians are experts at navigating any mandatory reporting situations that come up. We have not had any families disrupted by their State of origin because a student discloses in treatment. In fact, in most instances there isn't even a case opened.

11)   If reportable information comes out in a traditional placement, the therapist may or may not have the experience or expertise to handle the situation in a competent manner, thus realizing the very fears the parents were hoping to avoid.

12)   If suspected sexual concerns aren't addressed in full, then it is like identifying lumps through the process of a mammogram but not having a biopsy. There is obviously “Fear” of what the results of a biopsy might be. However, we deal with the cancer concern because there is an undeniable risk of the lumps metastasizing.

I hope this information has been received in the spirit in which it was intended. There is often a lot of confusion, misunderstanding and painful emotions around these very clinically complicated situations.

Please review our website for more information about Oxbow Academy.