Evaluating the Preliminary Effectiveness of Continuum of Care Program in Youth with Problematic Sexual Behaviors: One-Group Pre-Posttest Design

Background and Significance: Sexual offense post treatment is the most often researched indicator related to treatment outcomes. Research has consistently documented very low sex offense rates post treatment. However, the youth we serve are much more than any single behavior and our measurement of outcomes should reflect the whole youth. Youth with problematic sexual behavior (PSB) often present with co-occurring symptoms of anxiety, depression, and significant histories of trauma. In this context, using the Trauma Symptom Checklist for Children (TSCC), we preliminarily evaluate the Continuum of Care Program for youth with PSB in Alabama.

Methods: From 21 counties in Alabama, 334 youth and caregivers were initially recruited to participate in the program evaluation. Among them, 204 consented to their data being collected during treatment for program evaluation purposes. Of the 204, 68 youth had completed both the pre/post-treatment TSCC. Prior power analysis based on literature showed at least 62 participants per test being required to detect 80% power at α=.05 (Cohen’s d=.31). The TSCC was administered by the clinician as part of normal procedures. The TSCC is a self-report instrument comprised of 54 items related to trauma, including anxiety, depression, anger, posttraumatic stress, dissociation, overt dissociation, fantasy dissociation, sexual concerns, sexual preoccupation, and sexual distress. Each item was rated on a 4-point Likert scale: 0=never, 1=sometimes, 2=lots of times, 3=almost all of the time. A paired samples t-test was used to determine whether an adolescent’s symptoms changed from pretest to posttest.

Results: Trauma symptoms were significantly reduced with a moderate effect size. The results indicate that posttest scores were significantly lower on all six general trauma symptom scales from pretest, and on three of the four subscales. These included the following: Anxiety at pretest (M=51.07) and posttest (M=46.85), t(67)=3.29, p< .001; depression at pretest (M=51.51) and posttest (M=46.72), t(67)=3.22, p<.001; anger at pretest (M=45.04) and posttest (M=42.15), t(67)=2.89, p<.01; post-traumatic stress at pretest (M=49.99) and posttest (M=45.65), t(67)=3.31, p<.001; dissociation at pretest (M=50.62) and posttest (M=47.31), t(67)=2.55, p<.001; overt dissociation at pretest (M=52.06) and posttest (M=48.22), t(67)=2.83, p<.01; sexual concerns at pretest (M=49.62) and posttest (M=45.15), t(67)=3.23, p<.001; sexual preoccupation at pretest (M=47.47) and posttest (M=44.21), t(67)=3.09, p<.001; and sexual distress at pretest (M=56.73) and posttest (M=49.94), t(67)=2.90, p<.01. Effect sizes of each outcome ranged from .31 to .40, indicating there was adequate statistical power.

Conclusion and Implications: Posttest scores are statistically significantly lower on all six scales from pretest, and on three of four subscales. Our results indicate initial support for decrease of symptoms during the course of treatment for PSB. Despite the preliminary effectiveness of our intervention, the degree to which reductions were maintained long-term are unknown. In Alabama, treatment for PSB is not covered by insurance or Medicaid, limiting access for many people, as the only other option for community-based treatment is to pay out of pocket for private providers, of which there are few in this region. Showing evidence of secondary mental health benefits could support a shift in policy.