HOPE for Youth Who Engage in Harmful Sexual Behavior: Explaining the Treatment

The onset of sexual development is a major milestone in the life of any child. Not only does the child’s body begin to change, but they also develop an interest in the bodies of others, and they begin discovering ways to express their newfound sexuality.

Unfortunately, not all of the ways they may choose to express this sexuality are healthy or constructive. In a previous blog post, we explained how children and teens can sometimes learn sexual behaviors that are harmful to themselves or others. Once an individual has learned these behaviors, they may repeat them without much conscious thought and without realizing they are unhealthy.

However, youth can learn to identify and change these harmful behaviors with help from caring adults. This is exactly what our new service program, called “Healing for Optimal living through Protective factors and Education” (or HOPE), is designed to do. Through a combination of individual therapy, family therapy, skills training, sexual education, and other services, our HOPE program can help youth express their needs and desires in constructive, age-appropriate ways.

These interventions not only protect a young person from potential legal problems and relationship issues, but they can also help set them on a path toward healthy, safe living.

For Part Two of our series on our new HOPE program, we once again spoke with Ashlee Prewitt, our Director of Specialty Programs. In this post, Ashlee explains what the treatment entails and what you could expect if you were to enter your child into services.

Ashlee Prewitt, LMHC, CSAYC, Director of Specialty Programs at Cummins Behavioral Health

Getting Started in Services

All services at Cummins Behavioral Health begin with a simple assessment called an “intake assessment.” This occurs during an initial appointment with an Intake Specialist, and it is designed to determine what kinds of services your child may require.

Ashlee explains, “We’ll do an initial intake where we are assessing for mental health and behavioral health, including sexual maladaptive behaviors and trauma, and from that we’re going to get service recommendations. We’ll communicate with the family whether we are aware of any sexual maladaptive needs based on that initial appointment.”

For some consumers, an additional psychosexual assessment may also be conducted at this time. “We’ll get a complete psychosexual history and dive into more detailed questions regarding sexual behavior, sexual attitudes, values and beliefs around sex, and those kind of topics,” Ashlee says. “The benefit of this psychosexual assessment is really getting that deep history.”

If these assessments indicate that treatment for harmful sexual behaviors might be appropriate, then the family will be referred to a specialist in their county for further consultation. This specially-trained provider will work with the family to determine if treatment is truly needed.

If it is, then the youth and their family can begin attending therapy and counseling sessions. These sessions will seek to address any and all emotional, behavioral and developmental issues that are contributing to the youth’s harmful sexual behavior. Ashlee explains,

“We will usually start with weekly or biweekly therapy sessions, depending on their risk level, protective factors, and past treatment. We’ll provide case management and skill development to wrap around the family, so not only is the youth learning new skills and treatments to help with building relationships, healthy impulse control and urge management, but we’ll also incorporate that with the whole family. How can the family help? How can the family demonstrate impulse control, set healthy boundaries, promote safe sex practices, and things like that?”

How Treatment Changes Harmful Behaviors

Maladaptive, reactive, or otherwise harmful sexual behaviors are often only symptoms of underlying struggles a youth may be facing. As we have said, the goal of treatment is to discover these route problems and address them.

“We’re going to identify different decisions or skill deficits that have led to this behavior, whether it is a trauma response, poor impulse control, communication difficulties, or anger management issues,” Ashlee says. She continues,

“For example, if impulse control is a problem, then we’re going to help the child be mindful of what they’re feeling, be mindful of what they’re desiring, do some sort of pro/con list or stop-think-go techniques to help them be able to think through decisions and take in all of the different factors that are at play when they’re making this decision. On the other hand, sometimes these behaviors are manifested because the child doesn’t have words to communicate what they’re feeling. We’re going to teach them: how can you communicate that you’re sexually aroused? How can you communicate that you’re feeling unsafe? How can you communicate you have a need that needs met, and how can you meet that need in a healthy way?”

Consider the specific problem behavior of sending sexually explicit photos to peers over the phone or social media. Because this behavior has become somewhat normalized among adults, a child or teen might believe this is an acceptable way to express their sexuality. How might treatment go about correcting this behavior?

In this particular example, one of the first things the treatment team would do is educate the consumer about the legality of this behavior. Child pornography laws often prohibit the sending or receiving of sexually explicit images of a minor, even if they are sent and received consensually. “It’s something that kids and parents can get in legal trouble for, and not many people actually realize that,” Ashlee says.

Next, the providers will work with the youth to determine why they are engaging in this behavior. “What needs are they trying to meet, or what is the goal there? And what are the healthy ways that they can now meet those needs or have that desired outcome?” Ashlee explains. “If it’s because they want to be in a relationship with someone, then we’ll talk about how we can build a healthy relationship. If their motivation for doing this is to be funny, or for shock value, then we’ll discuss how we can do this in a way that’s not going to run the risk of getting them into legal trouble.”

Once the providers understand what need the behavior is meant to fulfill, they will work with the youth to help them meet that need in a more constructive manner. Ashlee explains,

“If we’re working on, for example, building healthier relationships, that’s going to take time. We’re going to dive into: what examples of relationships have they seen that are good, or positive and healthy? What have they seen that’s not positive and healthy? What did they like about each? Then we’ll move forward and start to apply. We’re going to practice how we build those relationships. We’re going to roleplay communication. We’re going to roleplay interacting in ways that are appropriate and healthy. And we’re going to help them achieve that desired outcome in a healthy, prosocial manner.”

Working with the Whole Family

Although our HOPE services are focused on youth-facing interventions, that doesn’t mean the rest of the family is left out of the process. On the contrary, as a child or teen progresses through treatment, their parents or caregivers will be involved at every step along the way.

Ashlee explains, “We have family therapy sessions with the whole family together, and parents or caregivers also have their own sessions with the therapist who’s providing services. That way the parents have a place that is safe where they can walk through and process what’s going on, and they can work with the therapist so that the treatment team truly is aligned with everyone.”

It can be difficult for parents to watch their child struggle with a behavioral health issue, so we also try to provide emotional support for parents as needed. “It is very tough, and there are not a lot of resources and support for parents who go through this with their children. That is one of the big reasons why we set up our treatment pathway the way we have,” Ashlee says.

Additionally, different families may hold different beliefs regarding what constitutes “appropriate” expression of sexuality. The treatment team will work with parents or guardians to ensure that everything they communicate with the youth is in alignment with family beliefs about sex. Ashlee explains,

“We are absolutely going to be culturally sensitive and take into account the family’s beliefs, whether they are religious or personal. We are always going to partner with parents and make sure they are on the same page with us so that we are never in contradiction of their beliefs. That is how we’re going to meet them where they are and communicate those beliefs that are healthy and appropriate.”

Meet Our Treatment Team!

Our HOPE services are now available in Marion, Hendricks, Putnam and Montgomery counties. We hope to extend services to Boone County in the future, but for now, consumers in Boone county may be connected with a provider in Marion County or Montgomery County.

Depending on the county you receive services in, one of the providers below will act as your primary clinician.

Stacey Bostian-Miller, MS, LMHC, NCC, CSA (Hendricks County)

Stacey has had the enjoyment of being in the helping field for almost 25 years. While most of her work in the helping field thus far has been in the dental field working with people of all ages, she switched careers in 2017 and went into the mental health field. She earned a Bachelor of Arts degree in Psychology with a concentration in childhood and adolescent development and a Master of Science degree in Mental Health Counseling and has been employed with Cummins Behavioral Health Systems Inc. since October of 2017, where her role is a school-based therapist for kindergarten through 4th grade. She has also had the opportunity of working with adolescents, teens, families, couples, adults, and domestic violence survivors. Prior to her time as a mental health counselor, she volunteered as a CASA in Boone County and volunteered with Mental Health America of Hendricks County, where she went to elementary schools and presented puppet shows focusing on mental health and social topics. She is always excited to engage in trainings to further her knowledge, improve her skills, and keep up with the latest evidence-based interventions. She truly enjoys trauma work and play therapy techniques and is working toward a Certificate in Trauma Studies as well as focusing on becoming a Registered Play Therapist. Her most recent venture is beginning to work with adolescents who have engaged in sexually harmful and/or reactive behaviors.

Jeremy Haire, LMHC (Montgomery County)

Jeremy started his career working with youth and families in 2005 after volunteering in an after-school program. He has served in several roles as a volunteer, case manager, community-based therapist, home-based therapist, school-based therapist, group therapist and a supervisor. He loves having the opportunity to make an impact in the lives of children and their families. It is important to him that youth feel respected and they learn there is hope in recovery. During his career, he has been given the opportunity to receive training to strengthen and improve his clinical skills. Some examples are: Motivational Interviewing, Cognitive Behavioral Therapy, Family therapy techniques, Play Therapy techniques, Theraplay techniques, and Trauma Focused-CBT. He has used these skills to provide a variety of services that include intake evaluations, risk assessments, individual and family therapy, group therapy, skills training, and case management.

Christina Kerns, MSW, LSW (Montgomery County)

Social work has always been the right profession for Christina because of the overwhelming passion she has for helping individuals meet their mental, physical, social, and spiritual needs. She strives to understand all difficulties by encouraging individuals to challenge themselves to make a change in their own lives. Over the past nine years, she has developed a strong clinical skill set through the combination of education and practical experience. She provides therapeutic services for children, families, and individuals by utilizing an integrated approach tailored to their unique needs. She has also worked with a variety of diverse populations within the community. She understands the benefits of both professional and personal development throughout a lifespan and would consider herself a lifelong learner. She cultivates new opportunities by learning additional skills and techniques to assist all individuals. In addition, she has gained extensive experience in policy and public health research under the guidance of a research team and a fellowship. She encompasses advocacy and prevention surrounding the mental health of Putnam County’s residents, as seen through her work as Co-President for Mental Health America of Putnam County (MHAoPC). She works hard to establish financial stability and sustain community partnerships.

Erica Bostic (Putnam County)

Erica has been a provider supporting children and families since 2020. Her aspiration to help this underserved community has been her passion since she can remember. She started this career path in 2015 at Indiana State University by choosing to study social work. She served as an intern at a nursing home and the Salvation Army, but instantly learned that her passion was working with youth. In 2019, she started her master’s program at IUPUI and chose the school track in hopes of becoming a School Social Worker. She interned at Northwood Elementary school and was amazed at all the opportunities to help children within the community. When COVID-19 hit that school year, it opened her eyes to how desperately the field and community needed the extra supports and services that she could potentially provide. Through her education, she has been given the opportunity to improve her clinical framework by utilizing Cognitive Behavioral Therapy, play therapy, Trauma Focused-CBT, Mindfulness, and Dialectical Behavioral Therapy. Through these techniques and her current position as a School Based Therapist with Cummins Behavioral Health Systems, she can offer a wide range of services and supports to children and families in the community

Kendra Solana, LSW (Putnam County)

Kendra is from a small rural town that suffers from mental health stigma, and it has been her goal to continue challenging that mental health stigma on the micro, mezzo, and macro levels. She graduated from Indiana State University with her Bachelor's in Social Work in 2020, and with her Master's in Social Work in 2021. She has interned with community mental health centers for the last 2.5 years, two being with Cummins, with a focus on working with the addiction population, i.e. IOT, life skills training, and case management. She was then offered a permanent position with Cummins prior to graduating with her masters. She was privileged enough to continue her professional development with those who supported her academic success, as well as found the inspiration through the Cummins team to take on the position she now fulfills. The position includes completion of intake assessments, collaboration with juvenile probation/DCS and their youth/families, focus on the high-risk youth population, and she facilitates the adolescent relapse prevention group. Thank you to our youth, families, affiliates, and team for allowing me to be a part of their processes! Recovery is possible.

Allen Graham, MMFT (Marion County)

Allen is enthusiastic about helping others to heal and to grow. He started working in mental health in 2014 as a life skills specialist at an inpatient setting. He worked primarily with adolescents and children, helping them to build Dialectical Behavior therapy skills. Since completing his Master’s in Marriage, Couples, and Family Therapy, he has worked with a diverse population with a variety of challenges. This has allowed him to further develop his clinical framework, building his understanding in Dialectical Behavior Therapy, Cognitive Behavioral Therapy (CBT), Trauma Focused CBT, Feedback-Informed Treatment, Structural Family Therapy, and Internal Family Systems.

Laura Braun, LMHCA (Marion County)

Laura has enjoyed being a mental health therapist since 2018. Professionally, she has served this field as a community-based therapist and an individual therapist for children, adolescents, and adults. She has been given the opportunity to strengthen her clinical framework by providing Cognitive Behavior Therapy, Play Therapy techniques, Trauma Focused-CBT, Certified Individual Trauma Informed Therapy, and best practice treatment for adolescents that have engaged in sexually harmful and/or reactive behaviors. She has utilized her framework to provide services and support to children and their families including but not limited to individual therapy and family therapy.

Our services for youth who engage in harmful sexual behaviors are available now! If you believe your child or teen might need treatment and you would like to speak with someone, please call us at (888) 714-1927. With the proper help and support, your child and your family can recover from these challenges!