Adequate program evaluation involves at least two primary approaches. First, implementation research is conducted to ensure that the components necessary for effective treatment exist and are implemented. Second, outcome research is necessary to determine whether the interventions have been effective. In spite of the important functions that program evaluation serves, evaluations of sex offender treatment programs have been few, and those that have been conducted often have had inadequate designs (Camp and Thyer, 1993). The literature provides some examples and ideas for future endeavors.
Most outcome studies have used recidivism rates to assess treatment effectiveness. Yet generally low rates of recidivism, short followup periods, variability in outcome measures (e.g., arrest or adjudication), and other methodological problems limit the usefulness of this approach. Other approaches to assessing treatment effectiveness are required.
Two studies have used self-report measures to evaluate the effectiveness of treatment programs. Hains, Herman, Baker, and Graber (as cited in Camp and Thyer, 1993) conducted pretreatment and posttreatment tests with adolescents in a residential sex offender program and with those on a waiting list. The researchers found significant improvements in social competency following treatment. In addition to examining recidivism data and parole violations, Miner, Siekert, and Ackland (1997) conducted pretreatment and posttreatment assessments with psychological measures such as the Jesness Behavioral Checklist and the Multiphasic Sex Inventory-Juvenile Revised (MSI-JR). As Kraemer, Spielman, and Salisbury (1995) noted, such self-report and objective measures provide a norm-based reference group that can be useful in assessing treatment progress.
Laben, Dodd, and Sneed (1991) used goal attainment theory to develop measurable outcomes in an inpatient juvenile sex offender treatment program. This approach required treatment providers and clients to establish mutual goals through a process of bargaining, negotiating, identifying commonalties, and defining measurable outcomes. Because initial group assessment indicated that treatment group members were very concrete in their thinking and had significant difficulties with verbal reasoning, researchers used visual aids to facilitate the goal attainment and treatment process. When a juvenile successfully completed each identified goal, a staff member would check it off on a written list. When all the goals were met, the juvenile's inpatient treatment was completed.
Goal attainment scaling (GAS) also was used in a study of hospitalized adult sex offenders (Lang, Lloyd, and Fiqia, 1985). In this study, patients and therapists developed individualized scaled descriptions of goals, which were measured to assess treatment outcome. Goals and treatment outcomes were measured on a scale ranging from minus 2 (least favorable outcome) to +2 (most favorable outcome), with 0 representing the expected treatment outcome. At followup, 38 patients had exceeded the "expected" success level, whereas 8 patients were found to have made minimal progress. The authors collapsed 176 of the 180 treatment goals into 4 primary content areas: sexual deviation (30 goals), anger and emotional expression (64 goals), self-concept (31 goals), and poor interpersonal relations (51 goals). The authors concluded: "As an adjunct to therapy, GAS can provide data on desired change over time on each patient's interpersonal, social, and psychosexual adjustment" (p. 536). They also noted that program quality assurance may be enhanced through retrospective reviews of goal attainment profiles and program improvements that result from the reviews.
The importance of program evaluation cannot be overemphasized. Also, as this literature review suggests, effective and humane interventions for juveniles with sexual behavior problems should be individualized, be empirically based whenever possible, facilitate family involvement, and, when program participation is indicated, promote program completion. As Rasmussen (1999) suggested, "Administrators in the juvenile justice system would do well to provide support for those treatment programs that involve families, have specific goals and objectives, and carefully monitor successful completion of treatment" (p. 82).