Program Profile: Sexual Abuse: Family Education and Treatment Program (SAFE-T)

This is a community-based program that provides sexual abuse–specific assessment, treatment, consultation, and long-term support to adolescents who were convicted of sexual abuse and to their families. This program is rated Promising. Intervention participants showed a statistically significant lower likelihood of being charged with a sexual reoffense, nonsexual violent reoffense, nonviolent reoffense, or any reoffense, compared with control participants, at the 20-year follow up.

A Promising rating implies that implementing the program may result in the intended outcome(s).

A Promising rating implies that implementing the program may result in the intended outcome(s).

Program Goals/Target Population

The Sexual Abuse: Family Education and Treatment (SAFE–T) Program is a specialized, community-based program that provides sexual abuse–specific assessment, treatment, consultation, and long-term support to 1) child victims of incest and their families (including adults who commit incest), 2) children with sexual behavior problems and their families, and 3) adolescent who are convicted of sexual offenses and their families.

Services Provided

The SAFE–T Program is initiated with a comprehensive clinical and psychometric assessment that assists in the development of individualized treatment plans for adolescents and their families; treatment goals are usually reviewed every 6 months. The course of treatment depends on the clinical needs of the individual, as well as the availability and willingness of family members. They are typically involved in group, individual, and family therapy. SAFE–T is a family-oriented program; thus, treatment providers work collaboratively with adolescents and their family members to address the risk of sexual reoffense and other important clinical needs that may be present (e.g., antisocial attitudes, depression, and social problems) while building on individual and family strengths at the same time.

The program uses a variety of cognitive–behavioral and relapse-prevention strategies and addresses issues related to denial and accountability, deviant sexual arousal, sexual attitudes, and victim empathy. Though the program is individualized, there are common topics that are addressed during treatment, including developing offense-prevention plans, enhancing awareness of victim impact, reducing the impact of traumatic past events, and enhancing family communication and relationships. Related treatment goals include the enhancement of social skills, self-esteem, body image, appropriate anger expression, trust, and intimacy.

Over the past two decades, the program has undergone some changes. For instance, the average length of treatment is now about 16 months (down from 24 months) because the intensity of individualized treatment is more closely matched to the estimated level of an adolescent’s risk of reoffending. In addition, discussions about the details of an adolescent’s past sexual offending and sexual interests are now primarily kept to individual treatment sessions. Group sessions concentrate more on the development of the skills and attitudes necessary for healthy interpersonal and sexual relationships.

Study

Worling, Litteljohn, and Bookalam (2010) conducted a 20-year prospective follow-up study of the Sexual Abuse: Family Education and Treatment (SAFE–T) Program in Toronto, Ontario. The study was a 10-year extension of a previous 10-year follow-up study (Worling and Curwen 2000). Study participants included 148 adolescents (139 males and 9 females) who were convicted of or acknowledged a sexual offense, as defined by the Criminal Code of Canada. The adolescents had been assessed by the SAFE–T Program between October 1987 and October 1995. At the time of the initial assessment, adolescents were between 12 and 19 years old (with an average age of 15). The average age of participants at the time of this follow-up study was 31½ years. The victims they had sexually assaulted were:

• Intrafamilial (28 percent), extrafamilial (55 percent), or both (17 percent)
• Female (61 percent), male (16 percent), or both (23 percent)
• Children (55 percent), peers/adults (35 percent), or both (10 percent)

The SAFE–T treatment group consisted of 58 adolescents (53 males and 5 females) who participated in at least 10 months of specialized treatment. All adolescents in the treatment group received individual therapy, and most of them also participated in group and family therapy. The average length of treatment overall was 24.42 months. Adolescents who dropped out of treatment after 12 months were classified as members of the treatment group. Slightly fewer than one third (18 out of 58) of the treatment group dropped out after 12 months of treatment, but before completing the entire program. The comparison group consisted of 90 adolescents (86 males and 4 females). About half of the comparison group received only an assessment from staff at the SAFE–T Program, but they received treatment elsewhere. The group also included 17 adolescents who refused treatment (treatment refusers) and 28 adolescents who dropped out of treatment before a 12-month period (treatment dropouts). Overall, 67 percent of the comparison group received treatment from outside the SAFE–T Program, but information regarding the nature of the treatment was unavailable. There were no statistically significant differences between the groups with respect to personal characteristics, offense characteristics, or any of the scores that came from numerous psychological tests given to adolescents during the initial assessment.

Data on recidivism (measured as criminal charges) for the 20-year follow-up period (October 1987 to October 2007) was collected from the Canadian Police Information Centre. The follow-up period for this study ranged from a minimum of 12 years to a maximum of 20 years. Recidivism data was classified into three categories: 1) sexual offenses (any Canadian Criminal Code offense of a sexual nature); 2) violent nonsexual offenses (any criminal charges involving actual or threatened violence toward a person such as assault, assault with a weapon, robbery, or uttering death threats); and 3) nonviolent offenses (offenses such as theft, break and enter, weapon possession, trafficking in narcotics, or breach of probation).

The study looked at the number of different charges that recidivists accumulated over the 20-year period and at the number of different reoffense episodes (i.e., discrete days on which a recidivist reoffended). It also examined the number of recidivists who accrued new sexual offense charges as adults (age 18 and older). Kaplan–Meier survival functions were used to compare the 20-year recidivism rates between the treatment and comparison groups. Tests for differences between survival functions are reported as chi-square values based on the log rank statistic. The researchers did not conduct subgroup analyses.

These sources were used in the development of the program profile:

These sources were used in the development of the program profile:

Worling, James R. 1998. “Adolescent Sexual Offender Treatment at the SAFE–T Program.” In William L. Marshall, Yolanda M Fernandez, Stephen M. Hudson, and Tony Ward (eds.). Sourcebook of Treatment Programs for Sexual Offenders. New York, N.Y.: Plenum.

Worling, James R., and Tracey Curwen. 2000. “Adolescent Sexual Abuse Offender Recidivism: Success of Specialized Treatment and Implications for Risk Prediction.” Child Abuse and Neglect 24(7):965–82.

Following are CrimeSolutions-rated programs that are related to this practice:

Therapeutic Treatment for Juveniles Having Committed Sex Offenses

This practice includes a variety of treatment modalities (including cognitive-behavioral therapy, relapse prevention, and multisystemic therapy), which are designed to reduce the risks and harms associated with juveniles at risk of committing sexual offenses. The practice is rated Promising for reducing juveniles’ rates of general recidivism but rated Ineffective for reducing sexual recidivism and violent recidivism.

Evidence Ratings for Outcomes

	Crime & Delinquency - Multiple crime/offense types
	Crime & Delinquency - Sex-related offenses
	Crime & Delinquency - Violent offenses

Why might a practice's outcome ratings differ from the ratings of specific programs encompassed by that practice?