Children with PSB should be viewed first as children.6 Sexual development in children is a normal part of the development process. Sexual behaviors in children range from normative to cautionary, to problematic and harmful. PSB of children is often misunderstood. The process of growing up and forming healthy, intimate relationships starts in early childhood, continuing throughout adolescence into adulthood.

A good foundation in understanding typical sexual development is essential for accurately deciding where a sexual behavior falls on the continuum from typical to concerning to problematic or harmful.

Typical sexual behavior occurs among children who are around the same age, size, and development. It is curiosity-driven, spontaneous, and infrequent. Problematic sexual behavior is a set of behaviors that are developmentally inappropriate, potentially harmful to self or others, and potentially illegal.

For more information on typical and problematic sexual behaviors, see page 28 in the Restoring the Sacred Circle Toolkit. 

Much of what is known about PSB in the general population comes from published research and clinical practice. There is no specific body of research on PSB in American Indian or Alaska Native communities. Below are a few examples of general population facts: 

• - PSB is not related to race or ethnicity.  

• - There is no research to indicate that American Indian youth have higher rates of PSB than non-American Indian youth.  

• - Youth in the general population commit more than 26% of all sex offenses and more than 36% of sex offenses are against youth victims.  

• - Youth who exhibit inappropriate sexual behavior and receive early intervention services are less likely to have future incidents.  

• - Treatment services for youth with PSB should also directly involve parents and/or guardians. A child’s ability to recover is influenced by the support he or she receives from caregivers. Caregiver support is critical for recovery. 

For more information on what we know about youth and PSB, see page 31 in the Restoring the Sacred Circle Toolkit. 

Community Challenges & Solutions  

• Challenge:  Youth with PSB is a concern of community members, yet agencies often have no clear guidelines for response.  

• Solution:  Frequent community outreach to educate community members and dispel misunderstandings about sexual development and PSB of youth. Strengthen partnerships with local schools and engage parents. Advocate for quality screening, assessment and interventions for PSB in community. 

Capacity Challenges & Solutions  

• Challenge:  Tribes may not be equipped to handle PSB cases due to jurisdictional issues, lack of expertise and other necessary resources. Mental health services, children’s advocacy centers, or forensic interviews are not available in many tribal communities.  

• Solution:  Utilize existing training models, map processes for referral and treatment, collaborate with programs, and connect families to healers and traditional rites of passage that support healing. Consider building on the systems of care model or other strengths, resources and leaders in the community. For examples of systems of care, click this link. 

Gaps and Protocol Challenges & Solutions  

• Challenge:  Gaps in protocols exist across the country, recognizing that in tribal communities these gaps are often magnified because of unclear jurisdictional issues. Determining jurisdiction can be difficult, especially in cases of concurrent jurisdiction involving tribal, state and federal law enforcement.  

• Solution:  Consider changing laws and agency/interagency policies, protocols and procedures to be developmentally appropriate and support prevention, identification, and response and treatment strategies for families of youth with PSB and child victims. Develop a taskforce or workgroup focused on community change to address PSB of youth with agency/system leadership representatives to outline protocols.  

Access to Evidence-Based Treatment Challenges & Solutions: 

• Challenge:  Treatment that honors, respects, and integrates Tribal and community practices is needed for youth with PSB, child victims, caregivers, and other family members affected. Many tribal communities do not have access to treatment due to funding, limited number of qualified clinicians and rural locations 

• Solution:  Increase the number of providers trained to recognize and treat youth with PSB, child victims and families. Utilize existing treatment resources, CACs and traditional healers. The impact of trauma needs to be integrated into the treatment approach and should include family members 

For more information regarding overcoming challenges in tribal communities, see page 50 in the Restoring the Sacred Circle Toolkit. 

Problematic Sexual Behavior-Cognitive Behavior Therapy (PSBCBT) has demonstrated long-term positive results for youth with PSB. Trauma-focused CBT (TF-CBT) is also effective when youth with PSB have significant trauma history and symptoms. Other options to consider are: 

Honoring Children, Respectful Ways Teaching from Indian Country 

• Tribes can use the Honoring Children, Respectful Ways curriculum. This is the tribal enhancement of the Problematic Sexual Behavior– Cognitive Behavior Treatment (PSB-CBT) for American Indian and Alaska Native children. PSB-CBT is a treatment program for children between the ages of 3 and 12 with PSB, with the underlying philosophy that children have the capacity to make safe decisions and develop healthy relationships with the support of their caregivers. View the Honoring Children, Respectful Ways factsheet, here. 

Good Lives Model Teaching from Indian Country 

• The Good Lives Model (GLM) is a strength based appropriate and responsive model used in Indian Country and beyond with the treatment of youth with PSB. It is based on the concept of Human Goods and has been used for more than 20 years with youth who have engaged in sexually abusive behaviors and is based on the underlying assumption that all individuals have similar basic needs and aspirations that they strive for in their lives. The GLM involves combining ways to live more fulfilling lives with understanding and managing individual risks.  

For more information on how treatment services and practices for the sacred circle, view the Implementation Guide for Mental Health Providers. Additionally, see page 40 in the Restoring the Sacred Circle Toolkit. 

The National Symposium on the Sexual Behavior of Youth hosted a Youth Partnership Board Youth Panel question and answer panel session. In this session, tribal experts discussed the traditional teachings and perspectives to prevent PSB and restore the Sacred Circle.

We want to keep things sacred in the lives of our children and families. It is important to know what to say and when to say it.

#1 Keep eyes away from others’ private parts
#2 Keep private parts covered
#3 Keep hands away from private parts
 

We acknowledge the NCSBY Caregiver Partnership Board for their words and wisdom. Understanding sexual behaviors: Children and youth exhibit a range of sexual behavior from typical to concerning to problematic to illegal. Typical sexual behavior tends to be exploratory, occurs spontaneously between similar aged peers who are functioning at the same level, responds to intervention, and is not associated with strong emotions. When sexual behaviors are problematic (children are of different ages and abilities, strong negative emotional reactions, frequent or includes threats, force, or aggression), the behaviors may require specialized intervention.

When youth receive evidence-based interventions, their risk of future illegal sexual behavior is extremely low, with recidivism rates around 3-5%.

Professionals working in law enforcement can help mend the Circle by understanding their roles in the response to youth with PSB. To learn more, view our fact sheet here

The juvenile justice system addresses youth who have failed to follow required laws and policies. Often, child protective services (CPS) work with juvenile justice to provide services for youth with PSB and their victims. Juvenile justice and courts can help mend the Circle by understanding the needs of youth and their families.

To learn more, view our fact sheet here

Traditional practices and ceremonies can facilitate resilience and protective factors in families. Health providers in tribal communities play important roles in identifying and providing culturally congruent effective treatment for youth with PSB, child victims and their families. 

Addressing trauma, abuse, and neglect in tribal communities is necessary for understanding PSB. Trauma-informed principles can help us support all youth. 

To learn more, view our fact sheet here