The article presents criteria for identifying children who are sexually abusive and discusses how their treatment needs differ from sexually abused children. Practice models and treatment approaches commonly used to treat sexual abuse victims and juvenile sexual offenders are reviewed. Then the Trauma Outcome Process is presented, with a discussion of how its premises explain the etiology of sexual behavior problems. The article describes the steps involved in using the Trauma Outcome Process to assess children with sexually abusive behavior problems and to formulate a treatment plan. The potential applications of this model with victim and offender populations and with different types of traumatic experiences are noted. Although the Trauma Outcome Process model has yet to be empirically validated, it has stimulated interest and research in the professional community. It was used as part of the theoretical framework for the University of Louisville's Juvenile Sexual Offender Counselor Certification Course (Schladale, 1992). It was translated into Spanish and used as an intervention in a treatment program in Virginia for Hispanic juvenile sexual offenders. It was also used as a treatment model in a residential facility for adolescent sexual offenders in New Mexico. 2 figures and 49 references