Oxbow Academy – Unintended Consequences

By Stephen C. Schultz

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 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, or 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 years 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 has been the norm over the last 30 years.

There are three main areas of conversation I’d like to address:

1. The language used when discussing sexual concerns in teens.
2. The process of testing and evaluation for teen sexual concerns.
3. How we, as professionals, discuss these issues with parents in a helpful and competent manner—avoiding fearful language and labels.

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The Language

“Sex-specific treatment” for teenagers began to emerge soon after mandatory reporting laws were enacted in 1974. Due to these laws, sexual treatment has traditionally taken place within the adjudicated system for youth, with a heavy emphasis on boys. Organizations such as ATSA, NAPN, and NOJOS, among others, were established to support state-sponsored treatment providers and conduct research on adjudicated “sex offenders.”

It was natural for these adjudicated treatment programs to adopt the language of the court system. Soon after, psycho-sexual testing followed. Much of the language used in juvenile treatment was transferred from the adult legal system, leading to terms such as “predator,” “sex offender,” and “perpetrator.”

The term “juvenile sex offender” is a legal category masquerading as clinical terminology. These labels mean different things to different people and elicit strong emotions based on individual beliefs and experiences. Consequently, we continually work to ensure the teens we serve do not internalize or identify with these harmful labels.

In 2007, Oxbow Academy became the first free-standing residential program to recognize the need for treatment of these issues outside the court system. Oxbow began offering specialized treatment to families seeking private intervention. This allowed parents to intervene early and enabled Oxbow Academy to expand therapeutic offerings while moving away from the language and stigma of the adjudicated system.

Over the last couple of months, I have spoken with three different educational consultants about Oxbow. The last conversation, during a recent tour, began in a friendly and casual manner. The consultant said,
"So, I've heard a lot of good things about Oxbow. Now… you work with the more aggressive sex offenders, right?"

I suspect we have created some unintended consequences from past conference workshops. The clinical information we know about a student at admission is generally just the “tip of the iceberg.” However, some have mistakenly come away from the workshops with the idea that Oxbow Academy primarily serves “perpetrators” and “sex offenders.” I don’t mention this out of frustration—rather, it highlights the need for more appropriate language and just how engrained the negative language is in society as a whole.

Oxbow Academy specializes in working with teen boys and their families who are struggling with Problematic Sexual Behavior (PSB). These concerns may include sexual trauma, sexual abuse, and compulsive sexual behavior. More often than not, co-occurring issues also require clinical attention, such as anxiety, depression, ADHD, ASD, NLD, PDD, eating disorders, and self-harm.

Our student profile consists of clinically complex, “emotionally acting-in” students, further complicated by sexual concerns. Early on, we refined the residential component to provide separate campuses for students on the autism spectrum or with other developmental difficulties. While neurotypical and non-neurotypical students have different residential and clinical needs, they come together daily for school and activities to foster a more normative experience.

To reiterate, there is a need to focus on language when discussing sexual concerns in students who have no legal involvement. The terminology widely used today is rooted in the court system and does not serve this population appropriately.

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The Testing

Another important conversation is the issue of testing. For years, the standard approach to addressing sexual concerns has been psycho-sexual testing. This typically includes standard psychological assessments supplemented with sex-specific inventories and interviews. Many testing centers and outpatient clinics providing these services were originally designed for adjudicated youth referred by case managers or probation officers.

To understand the limitations of this approach, it’s helpful to consider the history of psycho-sexual testing.

When “mandatory reporting” laws took effect in the 1970s, treatment for adolescents with sexual offenses primarily existed within the adjudicated system. These treatment providers needed a way to assess risk prior to a youth’s release back into the community. Research on recidivism (relapse into previous behavior) became the focus, and testing tools were developed to measure the likelihood of reoffending.

The primary standardized tests used in psycho-sexual evaluations today include:

• 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)

These tools measure recidivism risk—that is, the likelihood of repeating an offense. However, they have been normed on adjudicated populations and do not account for any potential clinical differences in non-adjudicated youth.

This is not to say these tests lack value—they are useful when applied in the proper context. However, the key takeaway is that contextual interpretation is crucial. It is also of great value to have functional assessment measures and data provided to the testing professional which allows for a more comprehensive evaluation.

It is impossible to measure the risk of a behavior that has not yet been fully disclosed. Many students keep secrets, and only in a safe, therapeutic environment do they gradually open up. Without a complete and validated sexual disclosure and data informed functional assessment, the psycho-sexual testing can yield unreliable results—leaving parents with tenuous hope and less than accurate assessments.

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The Family

We all understand that parents struggle with the decision to place their child in a residential setting. It is an emotional and often traumatic process. However, as professionals, we recognize that it is often the best course of action for the child and family.

In recent calls with educational consultants, I’ve encountered families hesitant to place their son at Oxbow due to concerns about being in a program with “those kinds of boys.” Some ultimately chose traditional placements, only for their child to later act out sexually—sometimes leading to legal consequences.

Oxbow Academy is committed to admitting only clinically appropriate students. When a family or consultant considers Oxbow, there is a strong likelihood that the known concerns meet the criteria for admission. The real question is not whether a student is "bad enough" for Oxbow, but rather:

"Is Oxbow Academy the most clinically sophisticated and effective option for identifying sexual concerns and facilitating healing?"

Delaying treatment due to fear only prolongs a family’s distress. The earlier these concerns are properly addressed, the better the outcome.

I hope this information is helpful and provides clarity. These are complicated clinical situations, and we are here to support families in navigating them.

For more information, please visit our website. www.OxbowAcademy.net