NOJOS Treatment Levels: Treatment, Duration, and Discharge

Current NOJOS materials reviewed August 2026

NOJOS organizes treatment into eight levels. These levels form a continuum—from short-term education provided at home to treatment in a secure facility.

A higher number generally means greater treatment intensity, supervision, or restriction. It should not be interpreted as a moral ranking of children or as a simple measure of how serious an allegation sounds.

The appropriate level should be determined through a qualified sex-specific assessment that considers the child’s risk, needs, strengths, developmental abilities, mental health, family circumstances, available supervision, and living environment.

Level One: Short-term psychosexual education

Level One is the least intensive NOJOS intervention. It is intended for children assessed as presenting a low risk and a relatively limited need for intervention.

NOJOS describes Level One as short-term psychosexual education, provided individually or in a group. The child’s family should also be included.

The current NOJOS standard says that Level One intervention should:

Occur approximately weekly.
Last approximately two to three months.
Use an individualized psychosexual-education curriculum.
Address the child’s particular developmental and educational needs.
Include family participation.
This is not therapy – this is education

Possible subjects include healthy sexuality, consent, boundaries, social skills, decision-making, family communication, and rules about appropriate behavior.

NOJOS expressly states that Level One is not traditional individual psychotherapy. It also says that Level Two outpatient sex-specific psychotherapy is not recommended at this level.

If hands-on problematic sexual behavior involving an identified victim is alleged, NOJOS permits additional victim-empathy work. The guidelines nevertheless contemplate a limited, educational intervention rather than an open-ended course of traditional sex-specific therapy.

Level Two: Outpatient sex-specific therapy

Level Two is intended for children assessed as presenting low to moderate needs that require more than brief psychoeducation.

Treatment remains in the home and community but may include:

Individual sex-specific therapy.
Family therapy.
Group therapy when appropriate.
Psychoeducation.
Safety planning and supervision.
Treatment of related emotional, behavioral, developmental, or family concerns.

Unlike Level One, Level Two is psychotherapy. Treatment is generally provided at least weekly, but the frequency and duration are individualized according to the assessment and the child’s progress.

Level Two treatment may involve more extensive work concerning the alleged conduct, accountability, empathy, patterns of behavior, coping skills, family functioning, and plans for preventing future harmful behavior.

Level Three: Intensive in-home, family-based, school-based, or day treatment

Level Three adds intensive services while attempting to keep the child in the home and community.

A child at this level may have significant family, environmental, behavioral, mental-health, school, or supervision needs that cannot be adequately addressed through ordinary outpatient therapy alone.

Services may include:

Intensive family-based treatment in the home.
Individual, family, or group sex-specific therapy.
Parent education and coaching.
Behavioral-management services.
Wraparound support.
Increased school supervision.
School-based services or day treatment.
More detailed safety and supervision planning.

Level Three is not necessarily based on greater sexual risk alone. A child might be placed at this level because the family or school environment lacks the stability, structure, or resources needed to manage the child safely at a lower level.

Once the intensive environmental or family services are no longer necessary, NOJOS says that stepping down to a lower level should be considered.

Level Four: Family-based out-of-home treatment

Level Four involves removing the child from the current home while continuing treatment in a family-based setting.

Possible placements include:

Kinship care.
Foster care.
A proctor home.
Another structured family-based placement.
Transitional living for an older adolescent.

This level may be considered when the child’s assessed risk cannot be managed in the existing home or when the available caregivers cannot or will not provide the necessary supervision and treatment support.

Level Four is intended to be less restrictive and less institutional than a group home or residential-treatment center. Family involvement and eventual reunification or transition to a lower level should remain important parts of planning when appropriate.

Levels Five and above: Group-home, residential, and secure treatment

Beginning at Level Five, NOJOS treatment moves beyond outpatient, school-based, and family-based services into congregate living arrangements. Depending upon the level, the child may live in a therapeutic group home, residential-treatment center, psychiatric facility, or secure-care setting.

These programs generally involve progressively greater structure and closer supervision. Depending upon the child’s assessed needs and placement, restrictions may include:

Step-down planning before the child returns home or enters a less restrictive placement.

Twenty-four-hour staff supervision.
Sex-specific treatment provided several times each week.
Individual, group, and family therapy.
Behavioral monitoring throughout the day.
Formal safety and supervision plans.
Restrictions on contact, privacy, movement, or community access.
Schooling provided within the program rather than at a community school.
Structured rules governing interactions with peers.
Psychiatric treatment and medication management when needed.
Court, juvenile-justice, or child-welfare oversight.

The level is not determined by the allegation alone

Two children accused of similar conduct could receive different recommendations. An assessment may consider:

The child’s age and development.
The nature, frequency, and duration of the behavior.
Whether force, coercion, threats, or planning were involved.
The child’s understanding of consent and boundaries.
Mental-health or developmental conditions.
Prior interventions and the child’s response to them.
Protective factors and personal strengths.
Family stability and caregiver capacity.
Whether the home includes an alleged victim or other vulnerable children.
Whether reasonable supervision can be provided in the community.

Conversely, placement outside the home does not necessarily mean that the child was assessed as presenting a high sexual risk. A lower-risk child might require a different living arrangement because of family conflict, the needs of an alleged victim, or the absence of an appropriate caregiver.

the assigned level, parents can request a written explanation, updated assessment, treatment-plan review, or independent clinical opinion.

How long is treatment expected to last?

Level One: approximately two to three months
Level Two: Up to 12 months
Level Three: Up to 12 months, although the intensive services may end sooner if the child and family no longer require that degree of support.
Level Four and above: Duration is more open-ended and depends on treatment progress, assessed risk, placement needs, caregiver capacity, and readiness to move to a less restrictive setting.

Sources

Important disclaimer

NOJOS Help is an independent website written by a parent. It is not affiliated with, operated by, sponsored by, or endorsed by NOJOS, the NOJOS organization, or any NOJOS-approved provider.

NOJOS Help is not a law firm. This site provides general educational information and does not provide legal or clinical advice or create an attorney-client or therapist-client relationship. Laws, policies, and treatment guidelines can change, and the appropriate response depends on each family’s circumstances. Families facing an investigation, juvenile proceeding, assessment, or treatment decision should consult qualified independent professionals.