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OXBOW SURVEY
Oxbow Academy is a residential treatment program that specializes in the treatment of boys 13 to 17 years old that are struggling with inappropriate sexual behaviors.  We understand that issues of this nature are extremely confidential.  We also recognize how critical it is for a parent to seek help.
   

This confidential questionnaire is intended to help you identify behaviors that often signal a problem.   We can help you find the hope and healing your family may need. 
Complete the information as accurately as possible.

You may contact us at any time at (435) 436-9460.

 

Parent’s first name and last initial

Email address

Telephone

Your son’s age

 

 Answer the questions using the following scale:

 

1 – Never
2 – Rarely
3 – Sometimes
4 - Frequently

1. Often boys who are struggling with sexual behavioral problems let their personal hygiene deteriorate.  Is your son demonstrating poor personal hygiene?



2. It is common for boys who struggle with sexual issues to also have substance abuse issue as well.  Does your son have a history of using drugs or alcohol? 

3. It is common for adolescent boys with sexual behavioral problems to also struggle with depression, anxiety, self harm, or other mental health issues.  Has your son shown signs of depression, anxiety, or other mental health issues?



4. Often adolescent boys who have sexual behavioral issues will isolate themselves. Frequently they choose to spend time alone in their room or away from family and peers.  Is your son isolating himself and choosing not to be involved in extra curricular activities?


5.  Most boys struggling with sexual issues will demonstrate a decline in their academic performance due to lack of concentration, poor self image, or difficulty interacting with peers.   Is your son struggling in school?


6. Some boys who struggle with sexual issues feel inadequate or uncomfortable around peers their own age and will choose to spend time with younger children. Does your son tend to spend more time interacting with a younger peer group?


7. A boy who is struggling with sexual issues will be very guarded about his personal things for fear his issues will be discovered.  Is your son hyper-sensitive about his personal belongings, space or room?


8. Viewing pornography is a common issue shared by boys with sexual behavioral problems.  Parents will take steps to block access to pornography, only to discover their son is willing to take greater risks to acquire it.  Is your son willing to risk social or legal boundaries to access pornography?


9.  When confronted about issues that are sexual in nature, boys with sexual problems tend to become very defensive and angry with those who confront them.  When questioned about his behavior, does your son become defensive, angry, or shut down?


10. Demonstrating inappropriate sexual behavior in public is considered a high risk factor for future acting out.  Has your son demonstrated inappropriate behavior in a public place?


11.
Most parents feel that their son’s behaviors are far more involved than what he is willing to admit.  Do you feel that your son is hiding inappropriate sexual behavior?


12. 
It is very common for “at home” interventions to fail.  Have you tried to intervene in some way but have been unsuccessful?


13.
When caught engaging in inappropriate behaviors, does your son minimize the affect and the extent of those behaviors?


14.
Do you have suspicions that your sons inappropriate behaviors have extended beyond himself?


15. 
Does your son have any unusual sexual obsessions towards inanimate objects?


16. 
One of the most important indicators there may be a serious problem is when parents feel there’s a problem.  Using the scale below, indicate how concerned you are about your son's behavior.
 
    1.  Slightly Concerned
    2.  Somewhat Concerned
    3.  Fairly Concerned
    4.  Very Concerned



How urgent is your need to get help for your child?


Are you aware of the financial commitment required for treatment?


Do you have access to the resources needed to pay for treatment?


If you chose to place your child in treatment, would you need to borrow funds?


Are there any legal or court related issues that would need to be resolved prior to placement in treatment?



We hope this questionnaire has been helpful to you. This self-evaluation may be the first step toward a healthy, happy life for your child.  If you wish to talk to a licensed therapist, or an admissions officer, please contact Oxbow Academy at (435) 436-9460.

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