40-WEEK CORE FOUNDATION PROGRAM

Specializing in the Treatment of Children and Youth with Sexual Behavior Problems

Stetson's 40-Week Core Foundation Program and the Continuum of Care

The goal of the 40-week Core Foundation Program focuses upon the completion of concrete elements of treatment, each of which serve as the building blocks for treatment to be continued beyond the foundation period in the least restrictive and most appropriate treatment setting along the Continuum. In addition, the foundation program provides a structured psychoeducational and cognitive-behavioral program that teaches students and provides them with important ideas, insights, and behaviors related to the development and elimination of sexually abusive and sexually troubled behavior.

The core of the 40-week foundation treatment program includes:

• The teaching and acquisition of ideas that specifically pertain to the development of and engagement in sexually abusive and sexually troubled behavior.
• The completion of an interlocking series of short-term treatment groups.
• The containment and stabilization of behavioral difficulties and the development of behavioral and emotional self-regulation.
• The resolution of psychiatric difficulties that can be diagnosed and treated within this time frame.
• Family psychoeducation that pertains to both sexually abusive behavior and a more complete understanding of the child in treatment.
• Identification of and treatment to alter problematic patterns of family interaction and support healthy, supportive, and effective family interactions.
• The identification of factors that are relevant to risk for sexual re-offense or continued sexually troubled behavior.
• A focus on understanding the impact of adverse childhood experiences upon psychosocial functioning. 
• The development of a safe behavior/relapse prevention plan to help reduce risk for continued sexually abusive or sexually troubled behavior.

Discharge, Aftercare and Continuing Treatment Recommendations

As discharge is planned, Stetson School, along with the referral source and guardians will identify treatment elements that require continued care and focus as targets of aftercare treatment, and make recommendations regarding continued treatment and safety needs.  Such recommendations are intended to guide involved parties in formulating an aftercare plan for each student that will help them to retain and practice ideas and information learned in treatment.

At the completion of the 40-week Core Foundation Program most students will continue treatment often in a less intensive treatment setting.   In other cases, the referral source may decide that the student and his treatment will be best served by remaining at Stetson School.  For those students continuing in treatment at Stetson School, length of stay will be individualized to fit the goals of the referral source, guardian and the needs of the student. Treatment will continue to build upon the progress shown during the foundation period, and will strengthen, deepen, and consolidate treatment gains in critical areas.

Core Clinical Treatment Groups

All students are engaged in psychotherapeutic process groups, which focus on the interactional, expressive, and social skills of students, and psychoeducational or cognitive-behavioral groups, which focus on teaching and exploring content-based information and ideas.

Cognitive-behavioral group are curriculum driven, although vary by Stetson School treatment unit, based on the age, developmental level, and cognitive capacity of students. Core psychoeducational groups include "Tools and Concepts," focusing on cognitive-behavioral concepts specifically related to sexually abusive and sexually troubled behavior; "Healthy Sexuality" (adolescent) or "Healthy Relationships" (pre-adolescent), "Victim Awareness and Empathy," and "Safe Behavior/Relapse Prevention and Discharge Planning."

The 40-Week Core Foundation Program Treatment Targets
Treatment is aimed primarily at targets in seven concrete and measurable domains.

Domain 1. Treatment Progress
(1) Attainment of Treatment Goals, (2) Emotional Stability and Self-Regulation, (3) Behavioral Stability and Self-Regulation, (4) Retention and Transfer of Skills, (5) Demonstration of Prosocial Behavior, (6) Honesty, (7) Impulse Deferment, and (8) Remission of Psychiatric Comorbidity.

Domain 2. Treatment Participation
(1) Motivation for Treatment, (2) Participation in Individual Treatment, (3) Participation in Group Therapy, (4) Participation in Family Therapy, (5) Acceptance of Responsibility, and (6) Completion of Treatment Tasks.

Domain 3. Treatment Knowledge and Application:
(1) Knowledge of Treatment Concepts, (2) Ability to Recognize and Correct Thinking Errors, (3) Ability to Recognize and Interrupt Behavioral Cycle, (4) Ability to Develop and Use Appropriate Coping Skills, (5) Communication Skills, (6) Judgment and Decision Making Skills, and (7) Safe Behavior/Relapse Prevention Planning and Use.

Domain 4. Social Relationships and Skills:
(1) Empathy, Awareness, and Concern for Others, (2) Remorse and Restitution, (3) Ability to Form and Maintain Prosocial Peer Relationships, (4) Cooperative and Respectful Adult Relationships, (5) Engagement in Social/Recreational Activities, (6) Ability to Manage Conflict, (7) Appropriate Boundaries in Relationships, (8) Capacity for Platonic/Non-Sexual Relationships, and (9) Self-Care Skills.

Domain 5. Treatment of Sexually Abusive/Troubled Behavior:
(1) Disclosure of Sexually Abusive/Troubled Behavior, (2) Capacity to Discuss Sexually Abusive/Troubled Behavior, (3) Self-Awareness of Sexual Behavior Problems, (4) Understands Sexual Motivation and Cause, (5) Containment of Sexual Urges and Sexualized Behaviors, (6) Expression and Demonstration of Prosocial Sexual Attitude, (7) Victim Awareness and Empathy,    (8) Victim Clarification, and (9) Resolution of Sexual Deviance/Preoccupation.

Domain 6. Primary Care Giver/Family Environment
(1) Care Giver/Family Supportive of Treatment, (2) Care Giver/Family Involvement and Cooperation in Treatment, (3) Care Giver/Family Participation: Family Psychoeducation, (4) Care Giver/Family Participation: Family Therapy, (5) Care Giver/Family Responsiveness & Availability to Student, and (6) Care Giver/Family Functioning and Stability.

Domain 7. Risk Status
(1) Sexual Recidivism: Risk for Sexual Re-Offense/Sexually Troubled Behavior.

Individualized Length of Treatment at Stetson School and the Core Foundation Program

Stetson School specializes in the treatment of sexually abusive and troubled behavior, treating both the problematic sexual behavior and other treatment concerns and needs relevant to the each individual student. Nevertheless, treatment and healing does not proceed in a linear fashion, and varies from individual to individual. Consequently, the length of treatment at Stetson School is individualized, based upon both the needs and goals of the placing agency or legal guardian and the individualized needs of each youth admitted to the program.

Stetson School strives to return youths in treatment to a less contained setting as soon as they are able to manage this safely and effectively with the goal of maintaining the behavioral, emotional, and social changes gained while at Stetson School.  To this end, progress in treatment is reviewed through quarterly Individual Service Plan (ISP) meetings, and more frequently as needed. Length of time in treatment therefore varies for different Stetson students, and to a great degree is based upon the goals of treatment presented by the placing agency upon referral to Stetson School and recognized at the time of admission.

Stetson School: A Culture of Recovery

Stetson School offers a treatment and rehabilitation program that specializes in the treatment of sexually reactive, sexually abusive, and sexually troubled behavior in pre-adolescent and adolescent boys with IQ's 55 and above. Treatment at Stetson School is informed by well-accepted theories and practices of sex offender specific treatment, ideas and principles of attachment theory, and recognition of the shaping impact of childhood adverse experiences, maltreatment, and trauma. The culture of recovery at Stetson School reflects a treatment environment in which our students are enabled to "recover" from the effects of earlier damaging life experiences.

Our treatment model is very much client-centered, and recognizes and treats each student as a whole person whose sexually troubled behaviors are one part of a much larger complex of emotional, cognitive, behavioral, and social problems.  We understand and believe that every youth in treatment at Stetson School are the outgrowth of earlier adverse childhood experiences, which in some cases have been developmentally traumatic.  In turn, these childhood experiences have significantly shaped and defined current emotional, cognitive, and behavioral responses, social attachment and relatedness, and the development of critical social skills.  As such, treatment for sexual acting out behaviors at Stetson School is embedded within a treatment program that is largely rehabilitative in nature.

All of Stetson's staff are trained in an attachment-informed model of treatment and a model of treatment that recognizes and responds to the power of early adverse childhood experiences in each child.

Underlying Treatment Philosophy and Approach: The ACORN Treatment and Rehabilitation^©

ACORN

Attachment and socially connected relationships
Competency and social skill development
Overcoming adversity and trauma
Regulation and self-control of behavior and emotion
New self: New ideas, new attitudes, new understanding.

This environment and our approach is incorporated into the Stetson School "ACORN" model, reflecting our philosophy of and approach to treatment and rehabilitation. In helping our students to create "new" selves, they are enabled to form healthy and secure attachments to others, overcome childhood adversity and traumatic experiences, build social competency and social skills, and develop self-regulation and behavioral control: Attachment and socially connected relationships, Competency and social skill development, Overcoming adversity and trauma, Regulation and self-control of behavior and emotion, New self: new ideas, new attitudes, new understanding.

Assessment at Stetson School

In all cases, treatment follows and builds upon a two-month period of assessment, during which an understanding of the each youth's case is developed and formulated, an evaluation is made of the youth's risk for sexual recidivism or continued sexually troubled behavior, and treatment needs are identified, including psychosocial, psychiatric, behavioral, medical, and educational needs, as well as family therapy needs.

Family Involvement at Stetson School

In addition to working and engaging directly with our students, it is the mission of Stetson School to include and encourage families, to the greatest degree possible, to actively engage and participate in the treatment of their children. Stetson School fosters a treatment environment that is family supportive with respect to building and maintaining strong family contact, as well as oriented to the individual treatment needs of each student. The "family supportive" treatment environment at Stetson School is one in which, while maintaining a structured, predictable, and safe campus, priority is given to encouraging and allowing parents, legal guardians, and other important family members to actively engage and participate in their child's treatment at Stetson School.

Family supportive treatment includes both promoting and providing opportunities for family contact and visitation and fostering active family engagement in the treatment of Stetson School students. We believe that family participation is critical on several levels, including consistent and positive close contact between students and their family members; consistent and positive contact between parents and/or legal guardians and Stetson treatment staff; engagement of parents and other important family members in the treatment process; and the establishment of pathways that strengthen the development of current and future family relationships and promote healing in families where sexually abusive behavior has contributed to stress, and sometimes victimization, within the family.

Individualized Psychotherapeutic Treatment at Stetson School

All youths admitted to Stetson School are assigned a licensed master's or doctoral level clinician. All clinicians are trained and supervised in the treatment of sexually abusive and troubled behavior. They provide individual therapy, group therapy, and family therapy whenever indicated and available, based on family circumstances. Treatment at Stetson School is focused on the "whole" child and is thus individualized to meet the needs of each particular student, and is comprehensive.  Clinicians work closely with the larger treatment team including case managers, direct care staff, teachers, nurses and supervisors for each student in order to identify and meet the complex case needs of each individual student.

Treatment identifies and addresses issues specific to each youth. These include mood and behavioral disorders; social skill deficits and development; significant psychiatric difficulties; issues of attachment, social connection, and trauma related to earlier life experiences; and family functioning.

Case Management Services

In addition to being assigned an individual clinician, each student at Stetson School is assigned a case manager, also trained and supervised in the treatment of sexually abusive and troubled behavior. Case managers actively oversee and coordinate care for each student, serving as a primary liaison between Stetson School and families, custodial and placement agencies and other external parties, courts and legal entities where relevant, as well as members of the Stetson School treatment team.

Residential Treatment

Stetson School utilizes around the clock structure and supervision in a staff secure environment to provide safety for students, as well as to protect the safety of others, and the community at large during the course of treatment. Our staff is specially trained and our environment is designed to prevent further incidents of sexually inappropriate behavior. It is extremely important to interrupt any pattern of sexual activity or sexualized acting out with others while in treatment.

In addition to safety, we also provide our students with a consistent therapeutic milieu that supports the psychotherapeutic clinical work. Direct care staff work with students on behavioral regulation, relationship development, social skills, self-care, affect regulation, recreational abilities, prosocial choices, problem solving, and a variety of other competencies that are important to recognize and treat in eliminating sexually abusive behavior and reducing other forms of sexually troubled behavior. Milieu treatment is provided through daily routines and interactions, staff advocate relationships, skills groups, and therapeutic recreation groups. The effect of this therapeutic support throughout each day enhances the effectiveness of clinical treatment.

Education

In addition to clinical and residential services, all students are educated on-campus in a fully accredited Massachusetts licensed Chapter 766 approved school. Each student is placed in a self-contained classroom based on his academic strengths and needs, in which we provide a highly structured and supportive environment through small classes of approximately ten students.  Each classroom is taught by a licensed teacher and supported by two classroom aides.  All school staff are trained in the treatment of sexually abusive and trouble behavior, and work closely with the treatment team to meet the individual needs of each student.

The curriculum, which is aligned with the Massachusetts State Frameworks, is taught during a year-round, 216 day school year. The non-traditional length of the school year allows flexibility with course scheduling, filling academic gaps, and ensuring that there is no academic regression. Stetson works closely with Local Education Agents (LEA) to ensure that students are meeting local academic requirements and provided the services needed and outlined in the Individualized Education Plans (IEP). When students are ready to discharge, Stetson works closely with the LEA to find the most appropriate and least restrictive academic environment for that student.

Stetson School is a Massachusetts approved Chapter 766 residential special education school, providing state of the art residential treatment for children and adolescents who present with sexually harmful, sexually reactive, and sexually inappropriate behavior.

General Profile of Students Referred to Stetson School

• A history of sexually abusive or sexually reactive behaviors, significant conduct problems not amenable to outpatient care
• Psychiatric and/or learning disabilities
• Ages 9 – 18 upon admission
• IQ's of 55 and above, with others reviewed on a case by case basis
• Functionally able to participate in the treatment program, in an unlocked setting
• Display some potential to benefit from therapeutic residential placement
• Either have not yet completed high school and require educational services, or are prepared to participate in some type of continuing education, vocational/technical training, or college preparatory work
• History of acting out behaviors
• Angry, aggressive, and /or sometimes suicidal, with oppositional and defiant behaviors
• History of sexual victimization, abuse, and/or neglect
• May require medication management and review
• May display periods of emotional loss of control, tantrums, or may engage in extreme behaviors requiring physical restraint
• Fire setters and runners may be considered on a case by case basis

Children that require detoxification services, stabilization of an active or untreated mental illness, require a locked detention setting, or can be described as significantly predatory in their sexual abusing history may not appropriate for Stetson School.

Specialized Services
Stetson School offers the following stand alone, on site services to males ages 9 to 22:

• 10-Week Psychosocial/Psychosexual Assessment:
  Serves children and youth who display inappropriate sexual behaviors but undetermined treatment/placement needs. Psychosocial and Psychosexual Assessments are completed to address these issues and recommendations are offered.  An initial treatment plan is developed for students who are recommended for continued placement at Stetson. 
• Juvenile Sexual Abuser Service:
  Serves adolescent males who have a history of sexually abusive behavior. Goals of this treatment service are to prevent further sexual victimization, and to prevent further coercive, aggressive or abusive behaviors.
  In addition, treatment services teach and develop pro-social behaviors and replacement skills. When appropriate, treatment helps resolve personal victimization, trauma or the negative impact of disrupted development.
• Sexually Reactive Latency Service:
  Serves younger boys, ages 9-13, with history of sexual victimization or trauma and subsequent sexually abusive behaviors toward others may be appropriate for this service. Special residential structure addresses the developmental needs of this population including: behavioral incentive plans, specialized groups, and a focus on general behavioral stabilization and trust-building vs. emphasis on disclosure of offending behaviors. Staff receives special training and practice working with attachment issues, and the unique dependency/nurturing needs of this population.
• Healthy Sexuality Service:
  Serves adolescents who are assessed to have a history of problem sexual behaviors such as sexual harassment and impulsive sexualized actions which may not be classified as sexually abusive, however, which may be coupled with a pattern of conduct problems and oppositional behaviors.  Specialized group content focuses on social norms for sexualized behaviors, and aligning behaviors and attitudes with those norms.
• Alternative Learning Program Service:
  Serves adolescents with serious learning problems and below average Full Scale IQs of 55 and up. This component shares the treatment goals of the Juvenile Sexual Abuser Program, however, the residential milieu, educational services, and clinical approaches are geared to the special learning needs and care needs of adolescents who function at a lower developmental level.  ALPS clinicians use a specialized risk assessment tool to evaluate progress.
• Youth Extended Service:
  Serves cognitively impaired young men, ages 17-21, who have mastered the concepts of juvenile sexual abuser treatment and are ready to work on vocational preparedness and community integration activities for a more productive and self-sufficient future.  Participants still require a staff secure environment, but can safely manage more frequent routine contacts with the community for shopping, recreation, and community service. In addition, a Rehabilitation Specialist works with each student to map out functional and adaptive goals such as managing a household, banking, work study program and then provides supervised practice to support mastery of the goals. The YES program is a stand alone program with a separate rate due to the added costs of specialized rehabilitation, student salaries and work preparedness programming.