Some adolescents who have committed a sexual crime are placed by the courts in secure residential settings. Given the heterogeneity of this client group, it is important for clinicians in these settings to complete comprehensive assessments to determine the course and content of specialized treatment, if necessary. With a focus on residential care, suggestions are provided for the assessment of strengths, risks, and needs. Particular attention is paid to issues related to informed consent, interviewing, and risk assessment. Also reviewed are various treatment issues with implications in secure settings, including the delivery of therapeutic services, use of manuals, therapeutic relationships and context, and self-care for providers. The growing evidence base for cognitive-behavioral treatment for adolescents who have sexually offended is outlined, and common treatment goals for youth who have offended sexually are critically examined. With an emphasis on treatment tailored to the unique needs of each adolescent, suggestions are offered regarding goals such as increasing accountability, recovery from posttraumatic distress, developing offense-prevention strategies, and enhancing awareness of victim impact, prosocial sexual attitudes, and healthy sexual interests. Additional issues that are considered with implications for clinicians working in secure settings include sibling sexual abuse and offenses involving child abuse imagery.
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