1. The Prevention of Childhood Sexual Abuse: Intervention with Men at Risk of Perpetration Skye Stephens, Ph.D Candidate February 3 rd 2016 PGR148950 Skye Stephens, Ph.D Candidate February 3 rd 2016 PGR148950

2. Luke Malone: Story of “Adam”  Realized sexual interest in boys at age 11  Viewed child pornography as a teenager  Online support groups  Formal mental health contacts  Realized sexual interest in boys at age 11  Viewed child pornography as a teenager  Online support groups  Formal mental health contacts

3. Learning Objectives 1.Increase understanding of what puts men at risk for sexual offending 2.Explore a public health approach to CSA through secondary prevention programming 3.Explore the inherent ethical dilemma in working with this population 1.Increase understanding of what puts men at risk for sexual offending 2.Explore a public health approach to CSA through secondary prevention programming 3.Explore the inherent ethical dilemma in working with this population

4. Can we effectively and ethically intervene with this population?

5. Operational Definitions

6. What is Childhood Sexual Abuse (CSA)? “Involvement of a child in a sexual activity that he or she does not fully comprehend, is unable to give informed consent to, or for which the child is not developmentally prepared or else that violate the laws or social taboos of society” (World Health Organization, 2006 p. 10)

7. What is Pedohebephilia? Pedophilia Hebephilia

8. Sexual Interest Versus Behaviour Offences against children Pedohebephilia

9. Etiology of Pedohebephilia Psychological/ Learning Psychological/ Learning  Conditioning (e.g., Laws & Marshall, 1990)  Abused-Abuser hypothesis (Lee et al., 2000)  CSA Neurodevelopmental Perturbations  Something goes awry in utero  Structural differences  White matter differences (Cantor et al., 2008)

10. Effects of Detection Status  Disentangling the effects of offending (Kager et al., 2015):  Impulsivity  Decreased connectivity between amygdala and orbitofrontal cortex  Effects due to CSA as opposed to pedophilia  Disentangling the effects of offending (Kager et al., 2015):  Impulsivity  Decreased connectivity between amygdala and orbitofrontal cortex  Effects due to CSA as opposed to pedophilia

11. Can it be Treated?  Argued to be permanent (e.g., Seto, 2012)  Age of onset  Romantic and sexual behaviour  Stability over time  Possible to manage sexual interest  Argued to be permanent (e.g., Seto, 2012)  Age of onset  Romantic and sexual behaviour  Stability over time  Possible to manage sexual interest

12. A Public Health Approach to Prevention of CSA Prevention Programming

13. A Public Health Approach  What is a public health response?  Smallbone, Marshall, & Wortley (2008)  Prevention programming:  Primary – target wider population  Secondary – target at-risk population  Tertiary – target those already impacted  What is a public health response?  Smallbone, Marshall, & Wortley (2008)  Prevention programming:  Primary – target wider population  Secondary – target at-risk population  Tertiary – target those already impacted

14. Prevention Project Dunkelfeld  Launched in 2004 in Germany  Self-identified men  Large scale media campaign  “No one is to blame for their sexual preferences, but everyone is responsible for their behaviour”  Launched in 2004 in Germany  Self-identified men  Large scale media campaign  “No one is to blame for their sexual preferences, but everyone is responsible for their behaviour”

15. Dunkelfeld Assessment (Beier et al., 2009)  Stage 1: Anonymous contact  Over 38 months, 808 people  Stage 2: In-person assessment  45% assessed  75% prior offence  86% previous disclosure  Stage 3: Offer treatment*  Stage 1: Anonymous contact  Over 38 months, 808 people  Stage 2: In-person assessment  45% assessed  75% prior offence  86% previous disclosure  Stage 3: Offer treatment*

16. Dunkelfeld Program Format  Group therapy program (5-10 clients) for 12 months  Multidimensional approach  Cognitive behavioural therapy  Sexological (e.g., relationship counselling)  Pharmacological – antiandrogens (e.g., Lurpon)  Group therapy program (5-10 clients) for 12 months  Multidimensional approach  Cognitive behavioural therapy  Sexological (e.g., relationship counselling)  Pharmacological – antiandrogens (e.g., Lurpon)

17. Pilot Dunkelfeld Results (Beier et al., 2015)  Non-randomized waiting list control design  Pre-post assessment of questionnaire  Treatment group exhibited changes on:  Emotion-oriented coping & coping self-efficacy  Offence supportive attitudes  Sexual preoccupation  Self-esteem  Hostility towards women  Non-randomized waiting list control design  Pre-post assessment of questionnaire  Treatment group exhibited changes on:  Emotion-oriented coping & coping self-efficacy  Offence supportive attitudes  Sexual preoccupation  Self-esteem  Hostility towards women

18. Pilot Dunkelfeld Results (Beier et al., 2015)  Those engaged in prior abuse:  80% did not persist in CSA  9% did not persist in CPO  Those who did not engage in prior abuse:  No one started to engage in CSA  23% started to use CPO  Those engaged in prior abuse:  80% did not persist in CSA  9% did not persist in CPO  Those who did not engage in prior abuse:  No one started to engage in CSA  23% started to use CPO

19. LimitationsLimitations  Research design  Small sample sizes  Demands of group intervention  Raises ethical questions  Research design  Small sample sizes  Demands of group intervention  Raises ethical questions

20. Prevention Programming in North America Is it possible to develop prevention programs within Canada?

21. Ethical Issues with Prevention Programs  North America has mandatory reporting  Child Family and Services Act (S. 72)  Regulated Health Professions Act (S. 2)  Can be sued by survivors for not disclosing abuse  Expansion of mandatory reporting laws  North America has mandatory reporting  Child Family and Services Act (S. 72)  Regulated Health Professions Act (S. 2)  Can be sued by survivors for not disclosing abuse  Expansion of mandatory reporting laws

22. Can we effectively and ethically intervene with this population?

23. New Program: Help Wanted  Development of a treatment program for adolescents  Project launched in September, 2015  First phase of study  www.jhsph.edu/helpwantedstudy www.jhsph.edu/helpwantedstudy  MooreCenter.JHSPH@gmail.com  Development of a treatment program for adolescents  Project launched in September, 2015  First phase of study  www.jhsph.edu/helpwantedstudy www.jhsph.edu/helpwantedstudy  MooreCenter.JHSPH@gmail.com

24. Luke Malone: Story of “Adam”  Referred to a new therapist  Developed an online support group for teens  Reached out to journalist Luke Malone  Put in contact with researchers  Referred to a new therapist  Developed an online support group for teens  Reached out to journalist Luke Malone  Put in contact with researchers

25. SummarySummary  You are not responsible for your interests, but are responsible for your behaviour  Secondary prevention programming has promise  Need for rigorous research on programming  Ethical intervention is possible with this population  You are not responsible for your interests, but are responsible for your behaviour  Secondary prevention programming has promise  Need for rigorous research on programming  Ethical intervention is possible with this population

26. Thank you for your attention! Questions? PGR148950