The 2017 ATSA Adolescent Practice Guidelines

The ATSA Adolescent Practice Guidelines (APG) has finally been published!  The APG addresses the expected areas of best practices, but also offers progressive perspectives on many related issues.  To obtain a copy of the 85-page 2017 APG, please see the end of this blog.  

Sexual offending by teenagers, as a class, is materially different from adults.  The APG boldly addresses these differences, proficiently noting distinctions of adolescence, understanding youthful etiologies of sexual violations, and offering cogent recommendations for sound assessments and appropriate treatment.  Such discernments are essential for systemic integrity in managing responsible interventions and successful recovery for teenagers and their families. 

Tom Leversee and Jacque Page co-chaired the committee that developed the APG.  Because Tom was invited to co-author this blog and it would be unseemly for him to gush about the excellent product that was crafted by the APG team, Tom’s comments are deliberately separated from the discussion by SAJRT blogger, Jon Brandt.  Tom writes…

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In addition to Tom and Jacque, the Adolescent Practice Guidelines were primarily authored by a committee that included Kevin Creeden, Elizabeth Letourneau, Sue Righthand, and Daniel Rothman. The revision and final approval process involved the ATSA Board and a response period for ATSA membership.  Maia Christopher provided her unwavering support, persistence, and guidance. 

The APG integrates a historical context, unique features of the adolescent population, empirical underpinnings, and foundational concerns.  The APG addresses interventions including Assessment, Treatment, Special Populations, and Policy considerations. 

A historical review of the treatment and supervision of those who have sexually offended reveals how policies and practices for adults gradually migrated into the juvenile system.  A survey of policies and practices in various jurisdictions, agencies, and individual practitioners would surely find that vestiges of adult models continue to impact the adolescent field.  The inclusion of a Policy section notes that the application of adult policies to adolescents is not only ineffective at reducing the low base rate for sexual recidivism, but comes with unintended consequences that can produce more harm than good. 

The APG seeks to further reverse this historical trend by offering an empirically grounded, caregiver-involved, developmentally appropriate approach for addressing abusive sexual behavior with adolescents.  This includes an emphasis on the social ecology in which adolescents reside and on the importance of therapeutic relationships.  Effective practices and policies reflect the heterogeneity that has been found in the research and the need for comprehensive assessments and individualized treatment plans.  Four fundamental aspects of effective public policy for adolescents are offered.

The enthusiastic response to the workshop on the APG that Jacque and I presented at the 2016 ATSA conference in Orlando suggests an excitement that goes beyond individual practitioners and programs.  Workshop participants spoke of a desire to utilize the APG to educate important participants, including probation and parole officers, human services caseworkers, attorneys, and judges.  Many have expressed the hope that the APG will not only be utilized to inform significant change in clinical practice and policy, but to inform legislation.  Meaningful change will require effective collaboration between a broad range of interdisciplinary stakeholders.

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The APG sensibly expects assessments to be empirically informed, and logically expects treatment to be “assessment informed.”  The APG points to the Risk-Need-Responsivity model as the gold-standard for guiding assessments and treatment.   With a 3% base-rate for sexual recidivism, as a practical matter, nearly all juvenile offenders are at low risk for sexually reoffending.  Therefore, exploring Needs and Responsivity may be vastly more beneficial than diligently trying to micromanage Risk.  The APG correctly notes that general delinquency correlates with sexual offending and therefore certain dynamic risk factors may be valid targets for treatment.

With the backdrop of sexual safety, personal accountability, and social justice, the APG supports the principles of Good Lives, positive psychology, and building on protective factors.  It encourages a pro-social, holistic reconciliation of individual needs, aspirations, human agency, family involvement, and community support – a synergistic milieu within which young clients can recover and prosper.

The APG confidently weighs-in on many competing concerns and perplexing controversies. It also acknowledges that some complex issues cannot be resolved by science alone.  Therein lies the intersecting domains of clinical judgement and professional ethics.  Being mindful of the involuntary nature of clients, and the value of well-informed assessments, the APG discusses many concerns that are ethically tinged, including: being part of a team intervention, managing unprivileged communication, determining when an assessment or treatment are (not) indicated, acknowledging the limitations of forensic psychology, challenging unwarranted legal interventions or sanctions, avoiding unnecessary conditions or undue burdens on clients, promoting least-restrictive placements, and supporting least-intrusive methods.  The APG, with participation from the ATSA Board, recommends against the use of the polygraph and PPG for clients under 18.*

With an eye on standards for practitioners, the APG expects clinicians to be qualified and technically skilled.  But it also wants clinicians to recognize that the therapeutic relationship is not only central to inspiring motivation and hope for recovery, but that it might be a therapist’s greatest asset.  The APG bravely comments on how unwarranted social controls and misguided policies may interfere with rehabilitation efforts.  The final section suggests that engaged practitioners can help to inform colleagues, mediate public policies, and perhaps intercede on behalf of clients.  Public safety is a systemic concern, and many stakeholders participate in reducing recidivism, but the clinician may be uniquely positioned to not only guide clients through recovery but to advocate for their well-being.

Journal articles and text books are vital conveyances of knowledge that help to build a sound framework for practicing in our field, but best practices depend on the skilled, ethical applications of knowledge, experience, and the ‘professional self,’ uniquely applied to each client.  The 2017 Adolescent Practice Guidelines is a compendium of wisdom.  Potentially, it will help good practitioners become great clinicians, and interventions with adolescents will be more empirically rich and ethically sound.

Jon Brandt, MSW, LICSW

Tom Leversee, LCSW

*Note: these and other controversial areas of juvenile practices are topics for future SAJRT blogs.

The Adolescent Practice Guidelines is available free to ATSA members by logging into the Member’s Page.  When the APG is available for purchase by non-members, information will be posted here.