UM Guidelines
Other Psychiatric Disorders: Residential Care

Behavioral Health (BH)

BCBST last reviewed August 29, 2018*

Added to Clinical Indications:
  • Imminent concerns of sexually abusive behavior by an Adolescent or sexual behavior problems by a child (12 years of age or under) as indicated by ALL of the following [M]:
    • Member has engaged in an act of sexual abuse to another individual as identified by Department of Children's Services (DCS) or law enforcement
    • Member has had a psychosexual risk assessment performed by a licensed mental health practitioner [N] and member’s current behavior/risk is consistent with a need for Residential treatment specifically designed to address sexually abusive/sexual behavior problems
    • There is a DSM-IV or DSM-5 diagnosis appropriate for this level of care
    • Psychiatric symptoms requiring 1 or more of the following:
      • Recent substantial increase in sexually abusive behavior or sexual behavior problems that cannot be adequately managed outside of a secure treatment setting
      • Severe behavioral health disorder-related symptoms or condition are present as indicated by 1 or more of the following:
        • Evidence of diminished ability to assess consequences of own actions (eg, sexual acting out; other personal boundary violations) that therapeutic intervention can remediate
        • Episodes of external (extreme angry outbursts) or internal (extreme sulking and rumination) anger manifestations
        • A high level of family conflict is present
        • Major dysfunction in daily living is present (eg, family, interpersonal, school functioning)


  1. Bengis, S, Brown, A, Freeman-Longo, R, Matsuda, B, Ross, J, Singer, K, Thomas, J. Standard of care for youth in sex offense-specific residential programs. National Offense-Specific Residential Standards Task Force 1999; NEARI Press.
  2. Prescott, DS, Collaborative treatment for sexual behavior problems in an adolescent residential center. Journal of Psychology and Human Sexuality 2001; 13(3/4): 43-58.
  3. Walker, EC, McCormick, D. Current practices in residential treatment for adolescent sex offenders: A survey. Journal of Child sexual Abuse 2004; 13(3/4):245-255.
  4. Treatment/placement philosophy. Retrieved 5/27/14 from http://www.nojos.net/?page_id=19.
  5. Level six: Sex specific residential intensive sex specific teatment. Retrieved 5/30/14 from http://www.nojos.net/?page_id=128.
  6. Worling, JR, Litteljohn, A, Bookalam, D. 20-year prospective follow-up study of specialized treatment for adolescents who offended sexually. Behavioral Sciences and the Law 2010; 28: 46-57.
  7. Adolescents who have engaged in sexually abusive behavior: Effective policies and practices. ATSA Executive Board of Directors October 30, 2012;1-6.  retrieved 5/27/14 from http://www.atsa.com/adolescents-engaged-in-sexually-abusive-behavior.
  8. Best practice standard in treating youth who engage in sexual misconduct. Retrieved 5/27/14 from http://www.nojos.net/?page_id=42. 
  9. Fanniff, AM, Becker, JV (2006). Specialized assessment and treatment of adolescent sex offenders. Aggression and Violent Behavior 2006; 11:265-82.
  10. Rich, P, Evaluation of Juvenile Sexual Offender and the Assessment of Risk, Understanding, Assessing, and Rehabilitation Juvenile Sexual Offenders, John Wiley & Sons, Inc., 2003.
  11. Viljoen, JL, Mordell, S, Beneteau, JL. Prediction of adolescent sexual reoffending: A meta-analysis of the J-SOAP-II, ERASOR, J-SORRAT-II, and Static-99. Law and Human Behavior 02/20/12:;36(5):423-38. DOI:10.1037/h0093938; Source: PubMED.
  12. Risk assessment fact sheet. Association for the Treatment of Sexual Abusers (ATSA). Retrieved on 5/27/14 from http://www.atsa.com/risk-assessment.
  13. Vitacco, MJ, Caldwell, M, Ryba, NL, Malesky, A, Kurus, SJ. Assessing risk in adolescent sexual offenders: Recommendations for clinical practice. Behavioral Sciences and the Law 2003; 27:929-940.
  14. Caldwell, MF. Study characteristics and recidivism base rates in juvenile sex offender recidivism. International Journal of Offender Therapy and Comparative Criminology 2010; 54:197-212.
  15. TDMHSAS Best Practice Guidelines: Adolescents Who Have Engaged In Sexually Abusive Behavior. Retrieved 7/1/15 from http://www.state.tn.us/mental/policy/best_pract/Pages%20from%20CY_BPGs_309-330.pdf.
  16. TDMHSAS Best Practice Guidelines: Children with Sexual Behavior Problems. Retrieved 7/1/15 from http://www.state.tn.us/mental/policy/best_pract/Pages%20from%20CY_BPGs_297-308.pdf.
  17. Tennessee Sex Offender Treatment Board Approved Treatment Provider Qualifications.  Retrieved 7/8/15 from http://www.state.tn.us/correction/tsotb/pdf/ApprovedProviderQualifications2010.pdf.


[M] “Adolescents who sexually abuse vary in their treatment needs. The dominant treatment model combines elements of cognitive-behavioral therapy with relapse prevention and focuses on individual youth-level factors such as responsibility and victim empathy. Treatment is typically provided … to groups of youth and often lasts a year or longer. Yet, the field of adolescent treatment is evolving.  Studies have repeatedly demonstrated the importance of family involvement in the treatment of adolescents with sexual behavior problems. Perhaps as a result more provider agencies now identify as “family-focused” than in prior years, according to national provider surveys. There also are indications that some programs are more closely matching treatment intensity to youth needs and estimated risk levels and de-emphasizing empirically unsupported treatment elements (e.g., requiring youth to journal about sexual thoughts or discuss deviant sexual fantasies during group sessions). Provider surveys also document a reduction in average treatment duration in recent years. These changes likely reflect consideration of rapid youth development and improved treatment outcomes for interventions that involve families and that address dynamic risk, needs and responsivity.” (ATSA, pp. 1-2)

[N] Evaluator should, at a minimum, be a licensed health services provider who has attended the annual Tennessee Sex Offender Treatment Board (TSOTB) Conference, and has also obtained necessary education, training, and supervision that addresses the assessment and treatment needs of children and adolescents with sexual behavior problems.  The provider is only to employ those skills and techniques for which he/she has education, training, and experience.


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