The CARE - Sexual Behavior Problems (CARE-SBP)– Revised 7/31/05
By Kathryn Seifert, Ph.D., Heath Bunting,
The CARE – SBP is an addition to the CARE that can be used to assess a youth’s need for treatment specific to sexual behavior problems. The higher the score, the more likely that a youth will need specialized treatment provided by someone trained in this area. The CARE will continue to provide guidance for the youth’s treatment or intervention plan. It is only to be used for youth between the ages of 13 and 19.
The Items
Items include:
- Has a past sexual behavior problem
Has the youth ever have a sexual behavior problem in the past? This includes touch and non-touch problems involving children more than 4 years younger, developmentally delayed youth, non-consenting youth and those not likely to be able to give informed consent. Behaviors may include peeping, exhibitionism, sexual touching, intercourse, child pornography, phone sex or phone harassment, rape and attempted rape, fellatio, and cunnilingus.
- Delinquency
Any form of past delinquency is to be counted, including drug use and sales, theft, shoplifting, assault, robbery, and murder.
- Fire setting
Has the youth ever set non-functional fires in the past?
- Has history of assaultive behaviors
Has the youth ever assaulted another person, not in self-defense? The assault is sufficiently serious to cause or intend to cause pain, suffering or injury.
- Below average IQ/learning problems
If there has been no IQ testing, this can be assumed if the child receives special education services, has consistently failing grades, or has failed a grade in school.
- Has history of moderate to severe behavior problems
Moderate to severe behavior problems include sexually and physically assaultive behaviors, delinquencies that have come to the attention of the Juvenile Services Department, domestic violence, drug abuse, alcohol problems, or suspensions from school.
These are all historical items and cannot be used to measure progress in treatment. The CARE can be used to measure progress in treatment. However, all of these items can be targets for treatment.
The Sample
There were 479 youth in the sample. The sample of youth were followed for the time they were in treatment in an outpatient clinic (1-5 years). The occurrence of sexual behavior Problems were counted before and after the CARE - SBP was administered. Youth with and without sexual behavior problems were assessed. Sixty-eight percent of the sample were male (331), while 30% were female (147), and 5 were missing this data. Fifty-eight percent (279) were Caucasian, 34% (166) were African American, 3% (14) were Hispanic, 1% (4) were Asian, and 3% (13) were other ethnicity.
One hundred twenty-seven (26%) youth had reported a sexual behavior problem before the administration of the CARE- SBP. Only 13 (3%) had a reported sexual behavior problem in the follow-up period (1-5 years). This is a recidivism rate of 10%. This rate is similar to that found in the literature (7-14%).
Twenty-two percent had below average IQ, 69% had average IQ, and 6% had above average intelligence. Four percent were missing this data. Sixty-eight percent (329) of the sample were living in the community, thirty-one percent were in residential care (149), and 1% (5) were missing this data. Of the full sample, 61% (292) had histories of physically assaultive behaviors, while 39% (190) did not have such histories. Only 86 (18%) youth in the sample had no or mild behavior problems, while 397 (82%) had histories of moderate to severe behavior problems.
Retrospective and Prospective Analyses
All youth were greater than age 12. There were 479 youth in the retrospective analysis. There was a significant relationship between the CARE Sexual Behavior Problems Subscale and a history of past sexual behavior problems (F = 64.76, Eta = .67, p = .00, ROC = .89). Of course this was to be expected, since past sexual behavior problems was one of the items. When the past sexual behavior problems is removed from the analysis, there is still a significant relationship between the Subscale score and past history of sexual behavior problems (Eta = .38, p = .00, ROC = .41). Next, a group of 85 youth were followed for 1- 5 years. The subscale score was analyzed to see if there was a significant relationship to any new incidents of sexual behavior problems. The association was again significant (Eta = .78, p = .00, ROC = .96). The relationship between past and future sexual behavior problems was also significant (Eta = .83, p = .00, ROC = .94). The reason for using additional items is related to the fact that these youth often have more than one problem that needs to be addressed and this is a treatment and risk management oriented tool. Therefore reducing any of the risk factors has the potential to reduce future risk of sexual acting out behaviors.