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Sexual Offender Risk Assessment

What do you do when you have a client who has been accused of a sexual offense?

Accurate risk assessment is crucial to proper diagnosis and treatment of sex offenders. 

Special care is required for these cases because of the serious consequences sexual offenses can have on the victims. Most sexual offenders have a strong potential to recidivate, or commit another offense. Sex offenders are just as likely to recidivate with a non-sexual offense as with a sexual offense, but the predictors of these two should be evaluated separately.

Research has also indicated that offenders who received and completed treatment were less likely to recidivate than those who did not, which has major implications for the importance of treatment.

Future incidents of sexual behavior cannot be predicted with complete certainty, but growing research suggests that sexual offense recidivism can be predicted with at least moderate accuracy. The concepts that should be included in a good risk assessment are enduring potentials to reoffend and factors that indicate the onset of new offenses.

Static risk factors, such as previous offenses and childhood abuse can predict patterns that lead to sexual offending. But many factors that change with time can also cause a person’s potential to engage in deviant sexual behavior to fluctuate, so these must also be considered.

A psychologist evaluates the level of violence used in the past, age and gender of victims, use of drugs or alcohol, sexual fantasies, urges, and behavior, history of sexual abuse, age-appropriate sexual relationships, and age of onset of deviant interests. The strongest predictors of sexual offense recidivism are found to be factors related to sexual deviance. These include deviant sexual interests, onset of sexual offenses at an early age, and targeting victims who are boys, strangers, or unrelated to them. Next are general criminological factors, such as prior offenses, age and antisocial personality disorder. These are good predictors of any kinds of crimes and not specific to sexual offenses.

Dynamic factors, or factors that can change frequently, are also important in assessing risk of sexual offense recidivism. Among these are intimacy deficits, attitudes that are tolerant of sexual assault, negative peer influences, emotional and sexual self-regulation, and general self-regulation. Sex offenders can range from low to moderate to high levels on any of these variables; high levels are associated with higher risk of recidivism.

Usually risk of recidivism is determined by a combination of relevant risk factors and not just one, so there are three methods psychologists use to evaluate a range of risk factors. They may use a clinical evaluation based on empirical evidence, pure actuarial predictions, or clinically adjusted actuarial predictions. The clinical evaluation starts with the overall recidivism base rate and adjusts the risk level by considering other factors associated with risk of recidivism.

Actuarial risk assessments attach specific statistical weighting to different variables which assess the risk. They are based on the idea that if accuracy of prediction is the most important factor, it is best to find out how members of a comparable group of individuals conducted themselves over time. There is a specific procedure to translate each variable into a risk level, which requires minimal judgment by the evaluator. Actuarial assessments are predicted to be more accurate than clinical evaluations, but as of now both are considered reliable methods of risk assessment.

Actuarial Assessment of Recidivism in Sex Offenders

Rapid Risk Assessment of Sexual Recidivism (RRASOR): The RRASOR is a brief instrument used to screen for risk of sexual recidivism among males who have been convicted of at least one sexual offense. It relies on information obtained in files and has been tested on many populations.
Sex Offender Risk Appraisal Guide (SORAG): The SORAG is a modification of the VRAG (Violence Risk Appraisal Guide) used to assess the risk of violent and sexual recidivism of previously convicted sex offenders within a specific period of release.
Minnesota Sex Offender Screening Tool Revised (MnSOST-R): This measure incorporates historical and institutional information, such as participation in treatment. Scores are divided into four categories, with estimated recidivism rates ranging from 16-88% over 6 years.

Sexual Violence Risk-20 (SVR-20): The SVR-20 is used to characterize an individual’s risk of committing sexual violence and for planning to manage that risk. It has three major sections: Psychosocial Adjustment, Sexual Offenses and Future Plans.

Multiphasic Sex Inventory-II (MSI-II): The MSI-II measures the sexual characteristics of people who have admitted to or been charged with committing sexual offenses. It can be used both as an evaluation of sexual deviance and to measure treatment progress.

It should be noted that an evaluator cannot determine if someone committed an offense in the past, only their likelihood of committing an offense in the future. Therefore, if you have a client who has been accused of a sexual offense, a risk assessment can look at the likelihood that the individual would commit such an offense. If your client has admitted to committing an offense, or there is strong evidence to suggest the crime has occurred, an evaluation can determine the likelihood of re-offense.

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Dealing with Divorce: 10 Tips to Protect Your Kids

When a family finds itself in the middle of a separation or divorce, one of the first worries is “what about the children?” Divorce has been associated with multiple problems for children and teenagers including: poorer peer relations, low self-esteem, diminished academic performance, health problems, aggression, conduct problems, noncompliance, and depression. However, research has shown that while divorce can be hard on children, it’s often the fighting of the parents that most directly affects the children, and the impact depends on how well the parents are able to isolate the children from these disruptions.

The following are 10 tips to keep in mind to help buffer your children from the problems they may encounter during parental divorce or marital conflict:

How do I help my preschooler or school-age child cope?

	Most importantly, try to maintain consistency. Children going through separation and divorce need a lot of stability to anchor them during the stressful times of the early stages. Change as little as possible, especially at first.
	Do not alter the way you discipline and reward your child. Keep the routines the same (bedtimes, meals). Children feel safest when things are familiar.
	Be more affectionate. A few extra hugs go a long way during times like these. Don’t overdo this, but a little more affection can make a big difference to children who are feeling scared or lonely.

How do I help my school-age or middle schooler cope?

	Help your children to stay connected. You should support your children’s friendships and activities.
	Attention should be paid to enhancing or maintaining the quality of the parent-child relationship as a way to modify children’s long-term reactions to marital disruptions.

How do I help my adolescent cope?

	For adolescents in particular, the significance of the frequency of contact with parents fades and it is the quality of the relationship that grow more central. The family, especially the parent-child relationship, has been viewed as the main source of support for the adolescent, acting as a buffer to help ameliorate some of the stress encountered during divorce.
	Do not use your teenager as an emotional confidant. Sharing the facts and feelings a child needs to know to be able to accept the divorce is not the same thing as discussing everything related to the divorce about which you may have a need to talk. Don’t make your children bear this burden. They have enough to deal with already.
	Adolescents are more likely to have financial worries than are younger children. Adolescents are more aware than younger children about the limitations imposed by money. They suspect the divorce may have direct financial ramifications for them, and they’re usually right.

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Acknowledgement: Telling Children of the Decision to Divorce

1. If possible, plan to tell the children together, so that the messages you are giving about the decision to divorce are uniform. Do not include specific information about the reasons for the divorce, but rather explain in more general terms, and do not speak poorly about your spouse. It is also generally never a good decision to discuss adult issues, such as infidelity, financial issues, difficulty with in-laws, etc. For one, with regard to self-image, on an internal level children see themselves as “half mom” and “half dad.” Thus when parties tear one another down, it in turn tears down the child’s own internal sense of self. Second, the child is left to try to understand adult issues through a child’s or teenager’s mind, which can lead to a lot of confusion and exacerbate difficulty in their adjustment to the divorce.

2. Messages that project the reality of the situation yet protect the child’s emotions are:

• • Mom and Dad are going to get a divorce. (For younger children: That means that we aren’t going to be married anymore, and that we won’t live together.) This decision doesn’t change the fact that we are still your parents, and it is in no way at all your fault. Being married isn’t good for us anymore, but one good thing about it was that we had you, and we are so happy to have you.

• • While some things will change, like where we each live, one thing that will never change is how much we both love you, and how important you are to us.

• We know that you might be sad or angry or upset about this, and we want you to talk to us about what you think and how you feel, so we can try to help you through this.

3. Prepare and practice ahead of time what you will say. Planning makes any communication go better. Be sure to also prepare for various reactions and how you will deal with them in the moment. For example, children may cry, beg you not to divorce, be angry, yell at you, slam doors, refuse to speak to you, or try to get you to change your mind. Conversely, some children who have been aware of conflict between you may say that they are not surprised. Children are concrete thinkers and may have many practical questions they ask, such as where everyone will live, when they will see each parent, what they will do on holidays and birthdays, or if they will have to move.

New Beginnings: Transitioning a Family into Two Households

1. Keep as much routine and consistency as possible, while allowing for some flexibility to make the process flow smoothly. Similar routines, especially around getting off to school in the mornings, doing homework, and bedtime (even on weekends), make it easier for a child to go between households. Also, create a comfortable space for children in both households, to include a room of their own and toys, clothes, favorite foods, etc., that they don’t have to carry back and forth.

2. While children do best with consistency, expecting rigidity in parenting can lead to unnecessary conflict. Allow your ex-spouse to be their own parent, and respect your different parenting styles. Divorce is a time of changing roles and responsibilities with regard to parenting; pre-divorce roles and responsibilities were divided based on two parents in one household, thus post-divorce is often a time of each parent learning how to do some of the things that used to be the “job” or “area” of the other parent. Avoid the thinking trap of, “It’s always been this way.” and instead try to support one another, for the good of the child, in your respective development and strengthening of skills.

3. Time with your child used to occur by happenstance to some extent. Time now takes more planning. Both parents want quality parenting time with their child, and a healthy relationship with each parent is in the best interests of the child. Maintaining contact between each parent and child is essential. This can be a difficult topic for parents to navigate, as they are driven by love for their child and an underlying fear of losing a close bond and relationship with the child due to divisions in time. Some helpful hints:

(1) Think in terms of quality time versus exactly equal time.

(2) Keep in mind that your children used to know that mom and dad lived at home with them, and even if mom and/or dad were busy some days, there was the underlying comfort of their presence. Make efforts during the transition phase for as much contact between each parent and child as is feasible to help them adjust.

(3) Time and contact are not only in-person. Be creative about other ways to maintain contact, such as a goodnight call between parent and child being part of the daily bedtime routine. And/or quick phone or email messages of “I love you,” “I’m thinking about you,” or “How did your test go?” Keeping contact around the little things that happen in your child’s day is a great way to stay connected. And remember that keeping contact is an adult responsibility – whether the child is age 6 or 16, it is the responsibility of the parent to take the lead in staying connected.

Co-Parenting Effectively: Developing a Positive Shared-Parenting Relationship

1. From the moment of separation you and your spouse begin functioning as co-parents, and how you manage this is vitally important to the well-being of your child. Research has shown that it is not the divorce per se but rather the amount of conflict associated with the divorce that has the most negative effects on children. If there is conflict between you and your ex-spouse, your child will be left to deal with an on-going stressful situation at an age when coping skills around stress are still in development and children are often not able to process such negativity between parents. Some hints to lessen your child’s exposure to conflict:

(1) Minimize the child’s exposure to fighting. Have your disagreements well out of earshot, and remember that kids are experts at listening in.
(2) Don’t use your children as messengers or quiz them about your ex-spouse. The less the children feel a part of their parents’ battle, the better.
(3) Your children may be tempted to act as your confidant and caretaker. Resist the temptation to let them. Let your peers, adult family members, mental health professionals, etc., be your counselors. Let your children be children.

2. Regardless of the actual split of time spent with the child, co-parenting itself is an on-going situation. Thus the time to start lessening the conflict, and build a healthy co-parenting unit is now. Try to move beyond past hurt to forge an amicable co-parenting team for the benefit of your child (and for yourself as well). Components of a positive shared-parenting relationship: focus on effective and respectful communication, navigate differences in parenting styles and agree upon difficult topics, engage in low-conflict joint decision-making, compromise, and be a united front to the child.

3. Remember that you are your child’s role model, and the message your behavior sends to your child is: This is the way people should act in this situation. Co-parenting is an opportunity to teach your child valuable lessons about how to get along with someone even when you disagree with them, how to compromise, and how to maintain positive and healthy relationships even in difficult circumstances. In building and maintaining your co-parenting relationship, think about the messages you are sending your child.

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TIERED APPROACH TO PARENTING PLAN
CONSULTS AND CUSTODY EVALUATIONS

Our unique, tiered approach meets the information and cost needs of every family.

PARENTING PLAN CONSULTS

CUSTODY EVALUATIONS

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Before the fairly recent advent of “collaborative divorce” by family law attorneys, many couples had designed their own collaborative process by using psychologists, ministers, or other neutral parties to mediate the divorce process to reach a fair settlement in an amicable manner. Couples often came to these people saying that they wanted to avoid conflict as much as possible, and keep costs down by avoiding high attorney’s fees. Now, finally, the law profession has taken notice of people’s desire to move through separation and divorce in a low-conflict manner, and has developed what they call collaborative divorce. This has been a wonderful and long-awaited alternative to the traditional divorce model.

How the Collaborative Model Differs from Traditional Divorce

Collaborative divorce is a process of cooperation, not confrontation. The role of attorneys who use this model is the same as the role of mediators has always been: to help you find and focus on common interests, understand each other’s concerns, explore a wide range of possible choices, and reach mutually-acceptable solutions. They also support, encourage and guide you in treating each other with respect, listening to each other’s concerns, exploring all possible choices, and concentrating on amicable solutions. Your collaborative attorneys will adhere to a process of cooperation, not confrontation, while still advising you of the law and representing your interests, working hard with you to help both parties reach an agreement.

Traditional divorce is an adversarial process with the focus on positioning and the use of legal maneuvers, which can end in a trial to decide issues. The collaborative model empowers you to reach your own solutions to sometimes difficult issues, and parties agree not to go to trial. Typically, the collaborative process is less costly and time-consuming than litigation. A collaborative dispute will end up costing less than a typical contested dispute since none of the attorneys’ time is spent on depositions, motions or court hearings. Also, the process allows the parties to be more creative than the court in fashioning settlement terms.

Money Matters

• To most people, whether you are wealthy, middle of the road, or struggle financially, money matters. That is, we all like to feel our money was spent usefully. Consider the costs of a high conflict divorce that ends in litigation: on-line divorce calculators put the cost of litigation at between a low of $26,000 to $130,000 or more PER SPOUSE. Do you really want that much money to be spent on this conflict? Imagine all that you could do with that money: investments, vacations, children’s college funds, new home, etc. You could spend considerably less using the collaborative process.

Self-Determination Matters

• Judicial discretion. That is what litigation ends in. You pay tens of thousands or over a hundred thousand dollars… and you don’t even have the final say. Nor does your spouse. Nor do the attorneys you’ve been working so closely with. The irony is that the judge may come up with conditions that neither you nor your spouse is happy with. Using the collaborative process, at least you have a direct say in the negotiation of the final settlement that you and your spouse agree upon. Though it may require some compromise, you ultimately maintain shared control of the negotiation process and self-determination of the outcome.

Addressing the Concerns of High Conflict Couples

To many people going through a divorce, using the collaborative process seems an obvious choice: it costs less and is less stressful. However, couples in high conflict who cannot imagine at this moment agreeing with their estranged spouse on big issues such as children or finances wonder if this model is a good fit for them. Here’s why it is:

Conflict and Children

• Research has shown that it is not the divorce per se but rather the amount of conflict associated with the divorce that has the most negative effects on children. This is likely because of self-image issues, disruption in attachments, and coping skills around stress. With regard to self-image, on an internal level children see themselves as “half mom” and “half dad.” In a high conflict divorce, parties often tear one another down, which in turn tears down the child’s own internal sense of self. Related to that, the conflict disrupts the attachment between the child and one or both parents, either on an emotional level as they try to figure out who is “right” or who is the “bad” person in the divorce, and/or on a practical level as positive/quality time with one or both parents is interrupted with either overt conflict between the parties or an undercurrent of anger and hostility. The child is left to deal with an on-going stressful situation at an age when coping skills around stress are still in development, and the child is often not able to process such negativity between parents when it goes on over time with no end in sight. Thus the time to start lessening the conflict is during the separation and divorce.

  Research has also shown that children are healthiest and happiest when they have a positive attachment to both parents. The collaborative process can help you to develop a positive cooperative co-parenting relationship even through your anger. With the exception of the rare cases in which one parent meets criteria for “unfit” as a parent, regardless of the final custody arrangement, you will both have some joint role in parenting, just by the fact that you are both parents. Using the collaborative process, with the focus on amicable and mutually-agreed upon solutions, is a good place to start. Versus the traditional adversarial model, the collaborative model improves the chances for long-term goodwill.

Conflict and You
Intense sadness, intense anger, hopelessness, frustration, fear, confusion, a sense of betrayal… the list goes on of painful feelings experienced throughout the process of divorce. It is not surprising that people experiencing painful emotions engage in conflict. Ultimately though, people have more of a sense of contentment and well-being in their lives when they are not in constant conflict. The collaborative process can help you move through the conflict, lessen it, and enjoy more peace of mind and hope for the future. Using the collaborative process, with the focus on amicable and mutually-agreed upon solutions, is a good place to start. Versus the traditional adversarial model, the collaborative model improves the chances for long-term sense of satisfaction.

Using the Collaborative Divorce Model

There are two primary ways to utilize collaborative divorce:

(1) You can still use a mediator (psychologist, clergy, etc.) as a neutral party to mediate the divorce process to reach a fair settlement in an amicable manner. You would get legal advice from your respective attorneys who agree to use the collaborative process, that is, agree to represent you while also encouraging the peaceful resolution of issues that you are working toward with your mediator. Once an agreement has been reached, both lawyers would assist both parties to obtain any necessary court approval. This option tends to be less expensive than option 2 below; however, it is best to use a mediator who has experience mediating separation and divorce. For example, at Lepage Associates we developed Separating with Civility & Divorcing with Dignity as a facilitation and mediation process to meet the needs of people going through divorce.

(2) You can use attorneys trained in collaborative divorce for the entire process: legal advice, mediating the settlement agreement, and obtaining court approval.

(3) A final point to make is that in both 1 and 2 above, experts are brought into the collaborative process as needed. For example, a Certified Public Accountant with expertise in divorce financial planning may join the team as a neutral, to assist you in making financial decisions for the settlement. If you are not already using a psychologist as a mediator, a Psychologist may join the team as a neutral, to help you prepare for legal meetings, assist you in developing and deciding upon a parenting plan, provide coaching for cooperative co-parenting, or help you get past stuck points in the negotiations.

If you or someone you know is going to separate and divorce, consider using the collaborative approach. The professionals involved are committed to helping parties get through this difficult time in life with as little conflict as possible under the circumstances. The collaborative divorce model promotes fair agreements and healthy peace of mind.

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The issues in divorce can be many for people with children. The role of the child specialist is to help the parents with the vast array of child-centered issues, and to help the children to be heard in a healthy way.

Helping the Parents with Their Child Questions and Issues

Including the Children’s Voices in a Healthy Way

THE VOICE OF THE CHILDREN

Scenario/Problem: Dad was staying in the family home and mom had moved to an apartment. The 14-year-old daughter regularly asked to skip her time with mom and go back to dad. Mom was very angry about this, worrying that dad was sabotaging her, and that the daughter was siding with dad and growing closer to him, thus she was feeling disconnected from her daughter and angry at her spouse. Time with the child specialist revealed… that the teenager got bored easily at mom’s apartment since mom was very social and went out regularly, and mom’s new apartment was not in her old neighborhood so she couldn’t walk to friends’ homes. The daughter, like the mom, was very social and wanted to go out too whenever mom wasn’t home. Mom could completely identify with this since she was so social herself, and now instead of feeling estranged from her daughter she felt closer to her upon realizing they were the same in this personality trait. Also, mom now had real information on which to make decisions: she could simply let the daughter stay at dad’s more, or she could stay in with the daughter or find shared outside interests, or when her lease was up she could move into the old neighborhood. After the meeting with the child specialist, the mom learned that her daughter’s motivations were socially motivated, and she was no longer angry with her spouse or upset over the situation.

Scenario/Problem: Four-year old child was becoming increasingly resistant to going to spend time with his father, whether for a day or an overnight. He would cry and beg not to go. Dad was feeling frustrated and saddened by his son’s outbursts and seeming diminished interest in spending time with him. Mom thought the father-son bond was important, yet she was uncertain as to whether the son should have to go given his level of distress around the visits. The son would never tell them why he didn’t want to go, other than that he didn’t like his time with his dad. The parents had talked to specialists and guesses were that perhaps the overnight schedule needed to be adjusted, or that the child was angry at the father for moving out. No specialist had talked to the child. Time with the child specialist revealed… that the father took a lot of work calls on his cell phone, and that was upsetting the child. The child was very frustrated that in the middle of an activity they would have to stop while the father took a call; at the age of four he was unable to easily shift to a solitary new activity and wait for his father’s return. The boy was also angry and sad that the father would put work before him, given that they now had less time together than when they lived in the same house. After the meeting with the child specialist, the father decided to turn off his cell phone when he had his son. Each time he picked him up he showed him he was turning it off, to the delight of the son who was now excited for their time together. The father reported back that months later, his son started giving him “permission” at times to use his cell phone, for example at times telling him, “Dad, I’m going to be coloring for a while if you want to turn your cell phone on.” A side note: This father deciding to turn off his cell was but one solution. Had he truly needed it on for work, another solution could have been to help the son understand why his father had to take some calls during their time together, and help the child develop strategies to deal with those times.

Scenario/Problem: Two sisters, ages six and eight, were asking to live with their mother and to see their father for occasional visits. It seemed odd that they were requesting such little time with him as they were also very excited to spend time with him, and cried when they left. The father was very angry at the mother, believing she must be influencing them. The mother was very angry with the father, believing he must have said or done something to make them want such little time with him. Both parents agreed that prior to the recent separation they had each enjoyed close attachments with both girls. Time with the child specialist revealed… that the girls believed that mom had no friends, only was happy when with them, and would be sad and lonely whenever they left to spend time with dad. They based this belief on two things: mom went to work and to church and church-related activities but didn’t socialize otherwise, and whenever they would leave her, even pre-divorce such as to spend a weekend with grandparents, she would kiss them and tell them that she would miss them “every second” they were gone. They contrasted this to dad, who was very social and engaged in a variety of non work and non church activities, and who said his goodbyes with, “love you, love you, love you.” In their estimation then, dad was just fine away from them, but their mother was sad without them. Interestingly the children’s perception was skewed in an important way – while “work” and “church” were non-fun in their minds, their mother had friends in both places, lunched daily with friends, and thoroughly enjoyed her Bible study, women’s group evenings, etc. She in fact was social and happy with friends, but they didn’t know it. After the meeting with the child specialist, the mother started talking with the girls about her lunches with her friends at work, sharing fun times she was having with her church friends, and telling them things she was looking forward to doing while they were with their father. This took the pressure off them that they had been feeling in terms of worrying about their mom, and they could relax and enjoy their time with their dad.

… But a few examples of how using a child specialist to listen to the voice of the children can benefit everyone …

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Ways Psychologists Can Help with Separation & Divorce

Communication Consultant  –  Child Specialist  –  Co-Parenting Consultant
Parenting Plan Expert  –  Support Person/Therapist

The issues in separation and divorce are complex, and men and women separating and divorcing have been seeking the help of psychologists during this process for some time, often at the suggestion of their attorneys.

When preparing for legal meetings and when identifying needs/interests …

Communication Consultant: Our psychologists are experts in communication skills and the divorce process, and we know that distressing emotions often emerge during legal meetings between spouses, which then cause people to act in ways that can make reaching resolution much more difficult. We help people identify their possible triggers, and prepare for emotional reactions and how to deal with them in the moment. Our expertise in handling one’s own emotions and the emotional reactions of others provides a highly useful addition to the preparation that attorneys provide their clients. In addition, we are trained to ask the right questions to help people understand their own underlying needs/interests, and to help them do this even when they first need to get past difficult emotions to achieve that clarity.This skill in targeted interviewing done in an empathetic manner by someone expert in helping people in times of high emotion make us an invaluable asset in helping parties identify their interests in a timely manner so that they can move on to discussing options.

When preparing to tell the children about the decision to divorce…

Child Specialist: Parents often worry about how they will tell their child of the decision to divorce. Our child specialists can work with parents to prepare for this important conversation. Based on our expertise in child development, we assist parents in making decisions about timing, messages that project the reality of the situation yet protect the child’s emotions, and how to handle reactions and questions.

When working to develop an amicable co-parenting relationship…

Co-Parenting Consultant: People who are newly divorced are also learning to co-parent anew, with a transition to two households and changing roles and responsibilities with regard to parenting. These practical changes combined with difficult emotions from the divorce can make co-parenting challenging at times. With our expertise in parenting, families, divorce, and conflict resolution, we help people develop a positive, cooperative, low-conflict shared parenting relationship.

When children need help to have a voice in the process…

Child Specialist: Our child specialists can provide the child a voice in the divorce process by assessing the child’s needs and concerns. Children are often hesitant to be open with parents during separation and divorce, and child psychologists are trained in talking with children and teenagers during difficult times, thus we may be able to elicit more information than parents regarding the child’s true thoughts and feelings. In this manner we can be used to give the child a true, safe means of expression in the process. We also assist the parents in recognizing and meeting the child’s needs during this difficult time and transition. The child specialist may work with the parents to develop and implement a parenting plan that reinforces a healthy, close relationship with both parents while instituting boundaries for the child’s behavior.

When developing the parenting plan…

Parenting Plan Expert: Psychologists who are experts in child development, family relationships, and custody arrangements can be very helpful to parents as they decide what might be the best parenting plan for their child. Consulting with someone who is an expert in these areas can help parents make a decision that they have confidence in. A consult for parenting plan assistance is not a lengthy, expensive, or adversarial process. Parents describe the child and their family, describe their parenting strengths and limitations as well as practical concerns, explain their initial thoughts about the parenting plan arrangement, and share any uncertainties they are facing in making a decision. We ask several questions to gather additional relevant information and will also meet with the child if the parents wish. We then share our thoughts with the parents regarding what would likely be some good parenting plan arrangements for their child and family unit. We do not make the decision, but rather provide a wealth of information and a professional opinion that parents utilize as they wish in making their final decision. Our unique tiered approach meets the information and cost needs of every family. (Should the parents want a full custody evaluation, we can provide that as well.)

When discussing options moves slowly or gets stuck…

Communication Consultant: Our psychologists are experts in communication skills, and part of our communications expertise is in negotiation and conflict-resolution between people in relationships. As a relationship ends and emotions are high, we are skilled at strategies to help parties talk and listen in a way that they are able to negotiate effectively. We can work with individuals or meet with the parties together to help get them past a stuck point, and we can attend meetings as neutrals to work with the teams to break the impasse and get the process moving forward again.

When someone needs support or therapy…

Support Person/Therapist: The benefits of support/therapy during difficult and stressful times of life have been well documented. We provide supportive therapy for adults to help ease emotional pain, gain insight into the past and/or present, learn skills to prevent similar problems from occurring again, regain happiness, and feel good about and be prepared for the future. With regard to children, our child psychologists are specialists in the emotional and social development of children and teenagers. Parents may notice that their child is showing negative effects of the divorce, such as emotional upset or withdrawal, anger, anxiety, academic difficulties, problems with peers, drug or alcohol use, breaking rules, etc. There are many ways we can be of assistance during separation and divorce. We offer play therapy to children and supportive therapy to teenagers, to help them diminish any emotional pain they may be feeling, and develop coping skills to move through the divorce process with less distress.

Weekday, evening and Saturday appointments available.

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OPPOSITIONAL DISORDER & CONDUCT DISORDER: TREATMENT, PREVENTION AND WHAT PARENTS CAN DO

Many children and teens display many of the symptoms of Oppositional Defiant Disorder (ODD) and CD at times, but there are some ways to tell whether your child suffers from the disorder. (Click here if you need a description of the symptoms of ODD and CD.) If these behaviors disrupt social and/or academic functioning, and are consistent (do not only happen as a result of an “episode” or mood swing), your child could be diagnosed with ODD. As a parent, you may see some signs that you are dealing with a child or teen with ODD, such as the feeling that you must always be on your toes to avoid an outburst, these behaviors are creating problems in the family, or setting boundaries and consequences does not stop the behavior.

There are many causes of ODD, including biological defects, genetics, and environmental influences such as dysfunctional families and a history of substance abuse. Before taking any action, it is important that a psychologist determines whether your child actually has ODD and identifies what types of treatment to use.

Since there are many similarities between the symptoms of ODD and conduct disorder, it is important that a psychologist determine how serious the symptoms are. Both disorders include defiance, difficulty in school, disobedience, anger and resentment, and disrespect for brothers and sisters. However, one thing a psychologist may look at to differentiate between the two is how the child or teen treats animals. If he or she is cruel or physically abusive family pets, conduct disorder may be the more likely diagnosis. Legal trouble is another indicator of the more serious conduct disorder rather than ODD. Multiple instances of criminal behavior like setting fires, breaking and entering and assault are consistent with a diagnosis of conduct disorder.

Although a psychologist should implement the treatment, parents are often the most effective resource in helping their children deal with ODD and conduct disorder. The most important thing for a parent to remember is never to give up on your child or yourself and to realize that sometimes it is necessary to change some of your own behaviors in order to change your child’s. For example, always be supportive and understanding, and praise and reinforce positive behaviors. Your child’s psychologist can help you determine ways you can be most helpful and be part of the solution. A psychologist can teach you additional skills to elicit cooperation, including setting appropriate limits and developing effective intervention plans. Some helpful tips for parents of children with ODD and conduct disorder include:

• Always focus on positive rather than negative behavior; give positive reinforcement when your child exhibits cooperation or obedience
• Set reasonable, age-appropriate boundaries and be consistent when enforcing them. For example, if your child refuses to do his or her chores, punish the behavior in the same way every time.
• Take a time-out or break if you are about to make the conflict with your child worse, not better. This is good modeling for your child.
• Pick your battles. Since the child with ODD has trouble avoiding power struggles, prioritize the things you want your child to do. If you give your child a time-out in his room for misbehavior, don’t add time for arguing. Say “your time will start when you go to your room.”
• Don’t take on the burden of managing your child by yourself; try to get help and support from other adults in the child’s life like your spouse, teachers and coaches. Maintain your other interest so that your child’s ODD doesn’t consume all your time and energy.
• Manage your own stress with exercise and relaxation.
• Make sure your child gets plenty of sleep every night.
• Develop a consistent daily schedule that incorporates your own and your child’s interests, and get into a routine.
• Work with your child to pinpoint the emotions or anxiety that may be maintaining or worsening their symptoms.
• Encourage your child to join extracurricular activities or get exercise to provide an outlet for pent-up energy and stress.

Prevention is a key aspect of the treatment of disruptive behavior disorders such as ODD and conduct disorder. Parents can be instrumental in preventing the disorder from progressing by using parent management strategies recommended by a clinician. Children and adolescents can benefit from psychoeducational programs that help them deal with conflict and regulate their emotions and behaviors effectively. In children, parent management, social skills training, conflict resolution and anger management have been used as effective prevention methods. For adolescents, psychoeducation programs like cognitive interventions and skills training, vocational training and academic preparations can reduce some of the symptoms associated with ODD and conduct disorder.

When choosing an intervention plan, take into account the recommendations of a psychologist because making the wrong decision could be more detrimental than beneficial. For example, residential programs like boot camp are not the right choice for many children and teens. These programs may be overly restrictive and may not enhance your child’s sense of self-esteem and responsibility. School-based programs have showed promising results as well in reducing bullying, antisocial behavior and negative peer influence.

There are several effective methods of treatment for disruptive behavior disorders such as ODD and conduct disorder. Treatment programs should be designed by a psychologist and specialized to each individual child and family’s needs. It must last at least several months to be effective and can occur either continuously or in periodic sessions. Treatment may include individual therapy, family therapy and/or school-based intervention. Sometimes medication is used as part of a treatment plan, but it is rarely effective without being paired with behavioral therapy.

• Cognitive-behavioral therapy (CBT) is a treatment technique that involves changing a person’s thoughts and beliefs in order to change his or her problematic behaviors. CBT is a general term for several different types of therapies that meet these criteria. Previous research has proven it and effective and cost-efficient method for treating ODD and conduct disorder. It can be administered to individuals or to groups.
• Individual therapy
• Family therapy
• Community-based therapy – focus on the child or adolescent in the context of different environments. These include family, school and community influences.
• Social skills training

Lepage Associates offers an extensive list of services geared toward children and adolescents. We provide unique options for adolescents, including a media room that allows teens to express themselves using movie clips, CDs or other media. Some may prefer to sit outside during therapy or take a walk on the America Tobacco Trail that backs up to the office. Our therapists specialize in many aspects of counseling for teenagers, including self-esteem and self-improvement, building positive relationships with friends and family, regulating and understanding emotions, and adjusting to the pressures of school.

The clinicians at Lepage Associates also believe children respond to different methods of therapy and a variety of environments, depending on their individual needs. “Play and talk” therapy for children help them develop social and problem-solving skills, expressing emotions in positive ways and adjusting to school among others. We provide services for both children and parents directed at dealing with childhood disorders, specifically ODD and how to manage it a home and at school.

Dr. Tina Lepage has many years of experience in child development and families and has worked in outpatient settings where ODD and CD were prominent to include juvenile courts and residential treatment programs for teens. She is well able to assess delinquent behaviors in children and adolescents, and offer a treatment plan for stopping these conditions before they progress into adulthood.

The therapy, coaching and consulting that Lepage Associates’ clinicians provides to parents can be beneficial in educating them about their child or teen’s disorder and empowering them to help their child or teen help themselves. Meeting with one of the psychologists who specializes in parenting children or adolescents with psychological disorders will equip parents of children with ODD and conduct disorder with the skills to manage it. Early and targeted therapeutic intervention with the child or teen can be quite effective in eliminating the behaviors and helping your child or teen be a happy and symptom-free.

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Parents must educate themselves about red flags that may indicate substance use, so that they can respond quickly when a red flag occurs. The American Council for Drug Education website provides the following indicators that have been linked to possible drug use. These indicators should motivate you to explore more and clarify if it is substances causing the symptoms:

1. Sudden decline in school achievement.
2. Cigarette smoking.
3. Marked shift in the child’s friends, especially association with known or suspected drug users.
4. Serious erosion of parental trust in the child.
5. Support by the child for the idea of legalizing marijuana.
6. Marked personality changes. (Such as social withdrawal, a new guardedness in communication with family members, depression, changes in sleep patterns, etc.)
7. Withdrawal from extracurricular activities that were previously important to the child.
8. Cutting classes, tardiness or truancy from school.
9. Deterioration in appearance and personal hygiene, or dramatic image changes.
10. Increased secretiveness, unexplained phone calls, heightened hostility to inquiry, sudden onset of hypersensitivity.
11. Going out every night. (Especially “hanging around” as opposed to scheduled youth activities.)
12. Unexplained disappearance of family funds or family and personal possessions (to buy drugs) and/or appearance of unexplained money or items such as new clothes and CDs (from selling drugs).
13. Aggressive behavior such as recurrent fighting, violent hostility, or other evidence of social alienation from the mainstream.
14. Heavy use of over-the-counter preparations to reduce eye reddening, nasal irritation, or bad breath.

While a red flag does not provide enough indication on its own that your teen is using, each of these red flags should result in some action by the parent to explore what has caused it. Substance use can be ruled out, and early intervention can occur to help fix the problem, whether the problem is substance use or something else.

Parents should keep their eyes and minds open; for example, a teen that keeps Febreze or mouthwash in his or her car or room may very well be using these to mask the odor of cigarettes, marijuana, alcohol, etc. Similarly, a new interest in colognes, incense or scented candles can be used to mask odors. The following practical pointers are provided by the students of Summit School, a Chapel Hill high school for students dealing with maintaining sobriety:

1. If you think that your child is using drugs they are.

2. No one “holds onto” drugs for anyone else. If you find drugs among your child’s possessions it is because they belong to your child.

3. If your child’s friends are using drugs it is likely that your child is as well.

4. Cough and cold products are highly addictive and commonly abused. If you find them in your child’s room and you have not purchased them (or if more has been taken than you know to be reasonable) you have very good reason to suspect that your child is abusing them.

5. Do not wait to get help. Seek the assistance of a certified drug and alcohol specialist as soon as you have suspicion.

Parents often say that after noticing a red flag and confronting their child, they are left feeling totally confused as to what exactly the problem is and how serious the problem is. The teen denies use, or fesses up to using ‘just this once,’ or provides reasons for using, such as to lessen academic pressures and anxiety, social pressure to use, depression, frustration with schoolwork, boredom, etc. Very often the teen promises to never use again. The parent is left with little to no clarity on what the scope of the problem entails, and uncertain about whether or not to believe their child’s assertions that they have used only this once (or a few times), and will never use again. Linda Hammock, a Licensed Professional Counselor and Certified Addictions Counselor who specializes in teens and families notes, “In my 20 years of substance abuse counseling, I have found most parents believe that they have a good idea of what their teen does. When I work with the teens who abuse substances, it becomes crystal clear that their highly functioning and loving parents have been frighteningly in the dark.”

Studies have shown that early intervention is key in preventing a deepening of the problem, yet often parents are not yet concerned enough at that early stage to utilize the two main tools for early intervention: seeking professional help and support, and strong consequences for substance use.

Parents are often very reluctant to utilize an outside professional at this early stage, thinking, “my child doesn’t need therapy just because he or she drank once,” or “this problem is still at a level that I can handle.” However, there are some ways in which a professional can be helpful at this early stage:

(1) It sends a clear message to the teen that the parent takes this behavior very seriously and is highly concerned, and
(2) A licensed mental health professional trained in adolescent substance abuse assessment can evaluate the teen and provide the parent with suggestions for successful early intervention.

It is important to be certain the mental health professional you use specializes in adolescent substance abuse assessment. While at first glance it can seem confusing to determine this, knowing a few important questions can help.

You want to know four main things:
does the person specialize in
(1) teens and families,
(2) teen substance use, and
(3) assessment of adolescent substance abuse.
(4) If the person answers yes to all three, a good follow-up question might be to ask what percent of their practice is spent doing adolescent substance abuse assessments.

One helpful certification to notice is that of certified clinical addictions specialist (still ask the above questions though, because some certified addictions specialists work only with adults).

The parent may utilize the professional for only one or a few sessions, not therapy per se, but to assess the depth of the problem, whether there are issues in addition to substance use that the teen is struggling with, and what treatment resources are most appropriate if needed. In this manner the mental health professional provides assessment of the problem and coaches the parent through the problem. Such an assessment also looks at any factors that may have contributed to the choice of the teen to use, such as social problems at school, depression, academic anxiety, family conflict, etc. While teens may be reluctant to talk openly with their parents about these topics, or may even lack insight as to the effect such feelings or situations are having on their decision-making, a professional assessor can often uncover these. Thus early intervention by a professional can help clearly define the problem in its’ entirety, making parental reaction/intervention more targeted and successful. The assessor can also suggest whether intervention beyond parental reaction is likely needed and act as a resource for treatment information if so.

The importance of a strong consequence to the teen cannot be emphasized enough as the most important component of preventing further use. Parents may give a consequence, though often not a strong enough one that sends a message to the teen, and sometimes even just give a “talking to” the teen, telling the teen not to do it again. When you consider the ‘benefits’ the teen gets from use (looking cool in front of their peers, fitting in with peers, trying something new and daring, relief of boredom, ‘feeling good’ from the high, etc.), a “talking to” is not a deterrent. In the cost-benefit analysis the teen does to determine whether or not to use again, the consequences for continued use must be quite high for use to be deterred. Your reaction to your teen’s first time caught using alcohol or drugs will send the message of just how serious you are about alcohol and drug use not being permitted. Your message should be clear: no alcohol or drug use, in any amount, at any time, for any reason. (The article in this series on setting limits and following through on consequences can help you determine and stick with consequences.)

Many families deal with teen substance use at some point, and parents experience a lot of anxiety wondering whether or not they are doing the right things to prevent further use when it happens. Early intervention is key in preventing a deepening of the problem. Clarify the problem when you notice red flags; inaction is worse than overreaction. If it turns out your teen was not using after all, your child still will have gotten the message along the way of how seriously you will react to substance use should it happen. If your child was using, determine the level of the problem, give strong consequences, and if needed, enter your child into treatment.

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