Presenting Problem
I will begin with a problem related to sexual abuse and the ensuing family problems and legal issues following it. I am currently working in my field placement at Lifespan Family Services, (LFS), with a 16-year-old boy who was discharged from a residential treatment facility to a foster home from this agency. The boy we will call Brian, was referred by the Jefferson County Probation Department with the goal of transitioning him back to the home of his maternal grandparents who currently take care of one of his older brothers. Brian and his two older brothers share the same biological father who perpetrated sexually on all three boys. During the first several years of Brian's life he lived in the home where the incidents took place. After it was discovered that the father was abusing the boys, Children and Youth Services, (CYS), of Jefferson County removed all three boys from the home pending charges against the biological father. The father of the three boys was eventually convicted of a multitude of charges related to his perpetrating on the boys and was given a lengthy prison sentence. Brian's mother was involved with a multitude of paramours’ in short term relationships one of which resulted in the birth of a girl.
Brian's mother eventually remarried and maintained custody of the three boys and their younger sister. The stepfather had very little interest in fathering the three boys and would have almost no positive interaction with them. The union between Brian's mother and their stepfather lasted six years and Brian stated that he was hard to live with. He would often punish the boys for minor incidents by taking their toys and isolating them from each other. After six years, the relationship deteriorated to the point where the man moved out of the home. Brian and his brothers were not adequately supervised in their home due to the inattentiveness of Brian’s mother. At or about the age of 12, Brian and his older brothers began to perpetrate sexually on the young girl. After it was discovered that all three boys were engaging in sexual abuse with the young girl, the county agency CYS, intervened and eventually removed the boys from the home. At this point, the boys were aged 12 through 14. The maternal grandparents were then granted temporary custody of the boys pending legal action.
All three boys were eventually placed in a residential treatment facility in Bradford, Pennsylvania. This particular RTF maintains a strong emphasis on sexual abuse and victims of sexual abuse. The residential treatment facility, Beacon Light, was home to all three boys at various times in their teenage years. While in placement, Brian benefitted from the increased structure, nurturing and educated oversight. After spending a year at Beacon light, Brian was allowed to live with his grandparents for 6 months. While participating in an aftercare program, Brian was caught stealing money from a woman’s purse at the local YMCA. This resulted in his being placed at another residential facility, Pathways in Oil City, Pennsylvania. Brian’s brothers also had numerous incidences in their history of stealing and destroying property in the community. In a study that compared sexually victimized and non-sexually victimized adolescent males the results indicate that the sexually victimized sexual abusers have more severe developmental antecedents (trauma, family characteristics, early exposure to pornography and personality) (Burton Duty and Leibowitz 2011). Brian’s case history is replete with many examples of the boys being exposed to pornography and other inappropriate events when living with their stepfather. The history of childhood sexual victimization may be only one of a plethora of events creating these differences. The two brothers were also eventually transferred to the same RTF, Pathways after their time at Beacon Light. One of Brian’s brothers is currently living with their grandparents. Brian’s oldest brother is still currently placed at Pathways.
Bio-psychosocial Assessment
Brian is a 16 year old male of European descent. His parents are multi-generational Americans and as such English is their sole language spoken in the home. In fact, no specific ethnicity is discussed or reported, so whatever it is, obviously has a weak attachment with Brian. Brian has 3 other siblings’ two older brothers and one sister. Brian’s two brothers are one year apart in age; Brian is the youngest of the three boys. Brian’s younger sister is a half-sister, with a father from his mother's previous relationship after her separation from Brian’s biological father.
Biological
Brian currently has no major health concerns; he is prescribed glasses for minor nearsightedness and chooses to avoid wearing them, even though he admits they help in reading the white board in class. Brian was a full term birth with no identified complications. His mother indicated that there were no delays in his motor or communication functioning, as he achieved all normal milestones.
Psychological
Brian is most often very quiet and shy in his presentation. When speaking with him, he often looks down and talks softly. Due to his Axis I disorders, he is often clearly inattentive, distracted and maintains a short attention span. Brian is currently seeing a psychiatrist for medication oversight. Brian is prescribed several medications for his disorders. He is currently taking Depakote and vyvanese. Brian has borderline intellectual functioning, he does not have a mental retardation diagnosis however, and he has done well in supported learning classes at his home school. Brian Still receives therapy from point of light an agency located in Shippenville Pa. for sexual abuse victims and abusers. He has the following axial diagnoses as contained within the current edition of the Diagnostic and Statistical Manual of the American Psychiatric Association, (DSM IV TR, 2000).
Axis I: 314.01 Attention Deficit Hyperactivity Disorder, (ADHD)-Combined type, V61.21 Sexual Abuse of Child
Axis II: V62.89 Borderline Intellectual Functioning
Axis III: None
Axis IV: Problems with primary support group Out of home placement
Axis V: 53
Environmental Influences
Brian and his brothers were eventually placed in a residential treatment facility in Bradford, Pennsylvania. This particular RTF maintains a strong emphasis on sexual abuse and victims of sexual abuse. The residential treatment facility, Beacon Light, was home to all three boys at various times in their teenage years. After spending a year at Beacon light, Brian was allowed to live with his grandparents for 6 months. While participating in an aftercare program, Brian was caught stealing money from a woman’s purse at the local YMCA. This resulted in his being placed at another residential facility, Pathways in Oil City, Pennsylvania. Brian’s brothers also had numerous incidences in their history of stealing and destroying property in the community.
The two brothers were also eventually transferred to the same RTF, Pathways after their time at Beacon Light. The three boys were also court-ordered to not have any contact with their sister. The two younger boys, Brian and his brothers, have expressed interest in living with their maternal grandparents. Brian's brother currently lives with his maternal grandparents. Brian is currently in foster placement living with a family just 3 miles from his grandparents’ home, and doing well. Brian was very young when his biological father lived with him and he has stated he doesn’t remember a lot about him. Brian does however remember his stepfather who lived with him for six years. During this time he suffered emotional abuse in the form of overly punitive consequences for minor behaviors. His older brothers were also victims of the stepfather who apparently never attempted to properly bond with the boys. It is well known that physical and sexual abuse is a risk factor for sexual aggression perpetration and victimization, but the literature also supports the associations between child maltreatment in the form of emotional abuse as well as sexual and physical revictimization. A study that looked at childhood emotional abuse as a predictor found that, emotional abuse is an important predictor of later problems, at least as important as other types of abuse (such as childhood physical or sexual abuse) that are often considered more serious (Zurbriggen, E., L,. Gobin, R., L., and Freyd, A., J., 2010). I talked extensively with Brian’s maternal grandparents and they related many stories of the emotional abuse that these boys were subjected to during the 6 years that they were exposed to their stepfather. At one point they stated that they allowed their daughter, the boys’ mother and her then husband, to occupy a mobile home on their property. They stated that on several occasions the boys were told to stay in the trailer and not allowed to leave and play outside as a result of punishment for some minor infraction. The grandparent’s confirmed that the stepfather frequently would withhold the boy’s toys and not allow them to play with them as a consequence of a behavior. According to the grandparent’s report the stepfather would taunt the boys by playing with the toys himself and not allowing them to have them. The man would apparently take the consequences to another level in a sadistic and cruel demonstration of his power over them.
Intervention
When defining a Generalist Perspective, the literature on generalist practice from authors such as Landon (1995) and Johnson (1992) reminds us that generalist practice is frequently described as grounded in general and social systems theory. “This approach often includes some form of problem solving as well as other types of intervention applicable to all levels of client systems”, (Turner, J., 2003).
There has been a lot of attention focused on adult sex offenders but less research on adolescent sex offenders, “adolescent sexual offenders (ASOs) account for 12.5% of all arrests for rape and 14% of all arrests for other sexual offenses” (United States Department of Justice, 2009). In an article that focused on prevention strategies the author highlights the fact that, most sexual abusers are not strangers or pedophiles; many (about a third) are themselves juveniles. Many have relatively low risks for re-offending once caught”, (Finkelhor, 2009). In a study that compared sexually victimized and non-sexually victimized adolescent males the results indicate that the sexually victimized sexual abusers have more severe developmental antecedents (trauma, family characteristics, early exposure to pornography and personality), (Burton Duty and Leibowitz 2011). Brian’s case history is replete with many examples of the boys being exposed to pornography and other inappropriate events when living with their stepfather. The history of childhood sexual victimization may be only one of a plethora of events creating these differences. “Childhood sexual abuse and other forms of childhood victimization are significant antecedents of sexual offending by adolescents, and therefore may need to be addressed in treatment”, (Pullman, L. & Seto, M. 2012). Multi-systemic therapy (MST) is an approach that simultaneously targets multiple domains including family functioning, social skills and problem solving, peer interventions and academic achievement. In (Pullman, L. & Seto, M. 2012), many ASOs are generalist offenders who may be at risk for other forms of delinquency. Brian does have a history of other anti-social behaviors such as stealing which is one of the charges that led to his being placed on probation and eventually placed in an RTF for a 6 month period. Brian currently does receive counseling at Point of Light in Shippenville, Pennsylvania, twice a month and he is currently finishing phase 3 of a 4 phase program.
Brian’s treatment is based partly on the MST plus cognitive-behavioral therapy focusing on sexual self-regulation, this because when Brian was unsupervised he engaged in searching online porn sites and as part of his probation, is not allowed on the internet at his current foster home. Brian was issued a laptop computer at his high school but is not allowed to take it off school grounds. When talking to Brian about some of his experiences in various counseling situations he stated that his counselors often questioned him about the experiences and encouraged him to address his feelings about them. “Addressing past trauma early in treatment may relieve chronic emotional distress and help the youth more readily engage in various components of traditional juvenile sex offender treatment” (Hunter, 2010). Brian stated that his older brothers had more difficulty talking about the past experiences than he did, Brian’s oldest brother is having the most difficult time and may remain in the RTF until the age of 21. Brian on the other hand reports that he was and is open to discussion about his past, he openly talks about past abuse and indeed he was the first of the three boys to complete his treatment at the Beacon Light Facility. Brian has been involved in strengths based interviewing in several of his programs that he was referred to after being removed from his grandparents’ home. In an article that looked at, the strengths perspective in social work, “the strengths-focused social work information-gathering interview is an opportunity to draw on the resources and capabilities of young adults who have experienced Childhood Sexual Abuse, CSA”, (Kelly, and Gates, 2010).
In an article that looked at, “Trauma Outcome Process Assessment” (TOPA), Brian’s treatment mirrors the approaches that utilizes a holistic approach much like TOPA, it delves in to various aspects of the individual’s, “neuropsychological functioning, family dynamics, culture, and community”, (Rasmussen, 2012). Brian seems to have benefitted from this approach that the literature suggests may help sexually abusive youth to decrease maladaptive behavioral responses to traumatic experiences and integrate past traumas with other life events.
Due to Brian’s diagnoses, he currently is prescribed medications as previously listed. Since current models of treating troubled youths are largely pathology based, Brian, as with many troubled youths’ disordered behavior is often seen as an "illness," one most effectively treated through medications. In an article that looked at “Integrating a Strength-Based Approach with a Medical Model however, integration of a strength-based strategy is decisively important. In bridging these two approaches, small modifications will produce large results”, (Foltz, 2006). The article effectively argues that medications may provide some short term management of behavior. Indeed Brian has had some problems sleeping and he reports that his medications have helped with that. The article makes a strong point that, “long-term positive changes come as corrective interpersonal relationships serve to rewire the resilient human brain”, (Foltz, 2006). As clinicians we need to re-examine the assumptions that have been relied on for decades and understand how psychiatric medications and therapeutic interventions can be balanced for the benefit of troubled children.
Overall Brian is receiving a multitude of services that include a mobile therapist, and a case manager that provides independent living skills instruction. Brian also continues to participate in an ongoing four phase sexual abuse counseling program at Point of Light. The combination of these services will offer a broad range of strategies to achieve the goals of healthy development for Brian and improve the societal conditions that will facilitate optimum growth. Social Work has changed over the years and the literature supports an integrative form of applying theories, (Turner, 2003), writes that, “The challenge now is not to be an expert in every theory and thought system but to know the potential of each and how to find a particular theoretical approach and method”. An array of services and approaches are being utilized with Brian and he is on track to be allowed to return to his grandparents pending a court hearing on October 25, 2012.
At the time of this writing, Brian, attended that court hearing and it was determined that he is allowed to return to live with his grandparents. The judge stated that he will review Brian’s case in 3 months and determine if his probation will be terminated.
Strength and Resiliency Theory
As stated earlier Brian’s maternal grandparents will have custody of Brian, one brother currently living with them, and eventually his oldest brother. His grandparents had assumed the duties of caring for the boys during the periods of the mother’s absence prior to their time in placements. Brian’s grandmother is 70 years of age and his grandfather is 74. It could safely be said that they will be assuming custody in an “off time” situation, (Greene, 2007). As written in our text, “older adults who decide to take on the responsibility of parenting their grandchildren are resilient, and possess physical, emotional, and spiritual strengths to survive their challenges” (Greene, 2007). Indeed Brian’s grandparents have a strong religious background and they attend church on a weekly basis. For Many elderly persons, the culture value of religion and spirituality is important, (Greene, 2007), Brian will be expected to join his brothers and grandparents every Sunday for services. Brian’s grandparents have demonstrated strengths based approach while caring for their grandsons. “The nature of a strengths-based perspective supports an assessment of the environment that highlights strengths and supports and deemphasizes deficiencies”, (Fraser, Kirby, and Smokowski), (2004). In one discussion I had with Brian’s grandfather he indicated to me that Brian responded positively to requests made to him in a non-demanding fashion. He also stated that in a previous foster placement the caregivers would make harsh demands on Brian which resulted in Brian resisting them many times. The reports from Brian’s current foster parents corroborate what his grandfather reported.
Brian has demonstrated a desire to meet the goals that were outlined for him by the probation department. Brian is enrolled in the local vocational technical school for ½ of his school day. He attends his regular school for academics in the morning. Brian does well in his schooling; he is studying culinary arts at Jeff-Tech and hopes to eventually work as a cook. He has also improved his hygiene in that he now bathes shampoos and brushes his teeth daily. Previously, he would do so only when the mood struck him. When Brian first arrived at his current foster home he would go days without showering and also displayed a habit of urinating in the bathroom sink. The foster parents discussed with Brian the appropriate ways to keep good hygiene and bath rooming skills and he responded positively and demonstrated a major improvement. Brian also volunteered to help with various chores around the home and was given a small allowance as a reward. Overall, Brian has demonstrated great resiliency in surviving the many obstacles he has endured in his short life.

References
Burton, D., L., Duty, K., J., and Leibowitz, G. S. (2011). Differences between Sexually Victimized and Nonsexually Victimized Male Adolescent Sexual Abusers: Developmental Antecedents and Behavioral Comparisons. Journal of Child Sexual Abuse, 20:77–93.
Diagnostic and Statistical Manual of Mental Disorders. (2000). Arlington, VA: American Psychiatric Association.
Finkelhor, D., (2009). The Prevention of Childhood Sexual Abuse. The Future of Children. 19, (2), 169-194.
Foltz, R., (2006). Balancing the imbalance: Integrating a Strength-Based Approach with a Medical Model. Reclaiming Children and youth. 15:(2) 92-94.
Fraser, M.W., Kirby, L.D. and Smokowski, P.R. (2004). “Risk and resilience in childhood”. In Risk and resilience in childhood: An ecological perspective, Edited by: Fraser, M.W. 13–66. NASW Press.
Greene, R., R., (2007). Child Welfare, Resilience, and Kinship Care. In Social Work Practice: A Risk and Resilience Perspective. Belmont CA: Thompson Brooks/Cole.
Hunter, J. A. (2010). Prolonged exposure treatment of chronic PTSD in juvenile sex offenders: Promising results from two case studies. Child Youth Care Forum, 39, 367–384.
Kelly, B., L., and Gates, T., G., (2010). Using the Strengths Perspective in the Social Work Interview With Young Adults Who Have Experienced Childhood Sexual Abuse. Social Work in Mental Health. 8, (5), 421-437.
Pullman, L., and Seto, M. (2012). Assessment and treatment of adolescent sexual offenders: Implications of recent research on generalist versus specialist explanations. Child Abuse & Neglect 36, 203– 209.
Rasmussen, L., A., (2012). Trauma Outcome Process Assessment (TOPA) Model: An Ecological Paradigm for Treating Traumatized Sexually Abusive Youth. Journal of Child & Adolescent Trauma. 5:1, 63-80.
Turner, J., C. (2003). Bartlett’s Definition of Social Work Practice: A Generalist Educator’s Perspective. Research on Social Work Practice, 13 (3), 339-348.
United States Department of Justice. (2009). Uniform crime report.
Zurbriggen, E., L,. Gobin, R., L., and Freyd, A., J., (2010). Childhood Emotional Abuse Predicts Late Adolescent Sexual Aggression Perpetration and Victimization. Journal of Aggression, Maltreatment & Trauma, 19:204–223.

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Appendix I
Culturagram
Brian currently is on probation for sexually abusing his younger sister
Brian currently is on probation for sexually abusing his younger sister
The family has been lifelong residents of the community where they currently reside
The family has been lifelong residents of the community where they currently reside

Brian and his family speak English only
Brian and his family speak English only

Brian and his brothers were placed in RTF’s after perpetrating on their younger sister
Brian and his brothers were placed in RTF’s after perpetrating on their younger sister

Family
Brian Age 16
Brother Age 17
Brother Age 18
Stepsister Age 12
Mother Age 42
Grandfather Age 72
Grandmother Age70
Family
Brian Age 16
Brother Age 17
Brother Age 18
Stepsister Age 12
Mother Age 42
Grandfather Age 72
Grandmother Age70

Health beliefs are traditional and all are encouraged to utilize modern medical treatments as needed
Health beliefs are traditional and all are encouraged to utilize modern medical treatments as needed

The family follows all traditional U.S. holidays
The family follows all traditional U.S. holidays
Brian’s Family has a high level of value for education despite the fact that both grandparents dropped out of high school. They encourage Brian to stay in school
Brian’s Family has a high level of value for education despite the fact that both grandparents dropped out of high school. They encourage Brian to stay in school
Embracement of Christian principles attend services weekly
Embracement of Christian principles attend services weekly
Tenuous family relations, inconsistent discipline & structure
Tenuous family relations, inconsistent discipline & structure
Impact of Brian and his brothers and the associated sexual abuse by their natural father
Impact of Brian and his brothers and the associated sexual abuse by their natural father