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Working with children and young people who display harmful sexual behaviour Stuart Allardyce CYCJ/ Barnardo’s Lorraine Johnstone CYCJ / F-CAMHS.

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Presentation on theme: "Working with children and young people who display harmful sexual behaviour Stuart Allardyce CYCJ/ Barnardo’s Lorraine Johnstone CYCJ / F-CAMHS."— Presentation transcript:

1 Working with children and young people who display harmful sexual behaviour
Stuart Allardyce CYCJ/ Barnardo’s Lorraine Johnstone CYCJ / F-CAMHS

2 Aims and Objective To signpost you to key concepts and resources in relation to identification, assessment, intervention and management of children and young people who present harmful sexual behaviours To share information about the CYCJ’s High Risk Mental Health Youth Project

3 Barnardo’s Core Presentation Slide No. 3
Thursday, 06 April 2017

4 Adolescent Harmful Sexual Behaviour – An Epidemic?

5 This never used to happen in the past, did it?

6 Barnardo’s Core Presentation Slide No. 6
Thursday, 06 April 2017

7 3 basic errors to avoid (Letourneau and Miner, 2005)
Barnardo’s Core Presentation Slide No. 7 Thursday, 06 April 2017 3 basic errors to avoid (Letourneau and Miner, 2005) Three falsely held beliefs that influence the length and severity of legal and clinical interventions are: There is an epidemic of juvenile offending, including juvenile sex offending Juvenile sex offenders have more in common with adult sex offenders than with other juvenile delinquents In the absence of sex-offender-specific treatment, juvenile sex offenders and at exceptionally high risk of re-offending

8 PREVALENCE

9 Between 1/5 and 1/3 of all cases of sexual abuse in the UK involve children or young people as perpetrators (Hackett, 2004)

10 Sources Criminal Justice statistics
Child protection research (Glasgow et al 1994) Victimisation studies (Radford et al 2012)

11 Number of recorded crimes in Scotland 2012-2013 (all ages) (Police Performance Framework, Nov 2013)
H

12 Number of recorded crimes 2012-2013 (8-17)
11.7%

13 Glasgow et al 2004

14 Radford et al. (2012) Looked at prevalence of child maltreatment via computer assisted interviews with 2,160 parents or guardians of children and young people under 11 years of age, 2,275 young people between the ages of 11 and 17 (with additional information provided by their parents or guardians) and 1,761 young adults between the ages of 18 and 24.

15 Amongst 11-17 year olds 2. 6% of males and 7
Amongst year olds 2.6% of males and 7.0% of females reported contact sexual abuse (as defined in criminal law) (4.8% overall). Overall figure rises to 16.5% if non-contact sexual abuse incuded 65.9% of the contact sexual abuse experienced by 0-17 year olds was committed by children or young people

16 HETEROGENEITY

17 Sexually harmful behaviour does not describe a single form of offending behaviour, but rather heterogeneity of different kinds of behaviours exhibited by different kinds of children in many varied contexts. This is one of the reasons why a range of terms are used in the literature (‘sexually problematic behaviour’, ‘harmful sexual behaviour’, ‘sexual offending behaviour’ etc.)

18 Joel is 14 and has had sexual intercourse with his 8 year old sister on 6 occasions

19 Amy, age 5 asks her classmates if they want to have sex with her

20 Kobe, age 16 is pressurised into sending a picture of his penis to his classmates' mobile phones

21 Simon, age 11 exposes his genitals in the local park with the intention of being seen by passers-by

22 Key Questions Is the presenting behaviour consensual for all children or young people involved? Is the behaviour reflective of natural curiosity or experimentation? Does the behaviour involve children or young people of a similar age or developmental ability? Is the behaviour occurring in a public or private space? Is this a cause for concern? Are other children or young people showing signs of alarm or distress as a result of the behaviour What child protection issues are raised by the behaviour?

23 Definition – Harmful Sexual Behaviour
Young people who display harmful sexual behaviours are ‘young people who engage in any form of sexual activity with another individual, that they have powers over by virtue of age, emotional maturity, gender, physical strength, intellect and where the victim in this relationship has suffered a sexual exploitation’(Calder, 1999)

24 Understanding heterogeneity
Victim characteristics (Peer vs child molesters; intra familial vs extra familial) Offence characteristics (specialists vs generalists; contact vs non contact e.g. internet offenders) Personality characteristics (abused vs non-abused) Pathways models (early vs late onset) Gender (girls vs boys)

25 Useful resources Brook Traffic Light system
AIM guidance (for teachers, foster carers etc) CYCJ Matrix (available from CYCJ – see upcoming briefing paper) Allardyce & Yates (2013) Assessing Risk of Victim Crossover with Children and Young People who display Harmful Sexual Behaviours. Child Abuse Review (on using typologies as part of a formulation based approach)

26 CHARACTERISTICS

27 Significant recent studies
Caldwell, M. F. (2007). “Sexual offense adjudication and sexual recidivism among juvenile offenders”. Sexual Abuse, 19, Finkelhor, Omrod and Chaffin (2009) ‘Juveniles who Commit Sex Offences against Minors’ Hackett, S., Phillips, J., Masson, H. & Balfe, M. (2013). Individual, Family and Abuse Characteristics of 700 British Child and Adolescent Sexual Abusers. Child Abuse Review 22(4): 232–245. Seto, M. and Lalumiere,, M. (2010) What Is So Special About Male Adolescent Sexual Offending? A Review and Test of Explanations Through Meta-Analysis Psychological Bulletin Vol. 136, No. 4, 526–575 Worling, J. R., Litteljohn, A. and Bookalam, D. (2010), 20-year prospective follow-up study of specialized treatment for adolescents who offended sexually. Behavioral Sciences & the Law, 28: 46–57.

28 Barnardo’s Core Presentation Slide No. 28
Thursday, 06 April 2017 For young people with harmful sexual behaviour, what proportions have been abused? Not known Suffered abuse Suspected of suffering abuse Data on 492 children and young people referred to services in Scotland in relation to HSB, 2004 – 2008

29 Types of abuse experienced
Barnardo’s Core Presentation Slide No. 29 Thursday, 06 April 2017 Types of abuse experienced 36% of young people with harmful sexual behaviour had experienced actual or suspected sexual abuse 34% had been physically abused 40% had witnessed domestic violence 47% had been emotionally abused 41% had experienced neglect

30 Barnardo’s Core Presentation Slide No. 30
Thursday, 06 April 2017 Girls How many are boys? Boys N= 492

31 How many have a learning disability?
Barnardo’s Core Presentation Slide No. 31 Thursday, 06 April 2017 How many have a learning disability? Between a third and a half of adolescents who display harmful sexual behaviour are identified as being intellectually disabled or having significant educational problems (O’Callaghan, 2004) 42% in Scottish study

32 Barnardo’s Core Presentation Slide No. 32
Thursday, 06 April 2017 Behaviour: Manipulation in 70% cases, physical force in 46%, threats in 34%. Victims: 41% had more than one victim. Related victims made up 37% . Strangers 15%. More likely to be female (70%) than male (61%). 32% abused boys and girls Hutton, Whyte 2006

33 52% took part only in contact sexual behaviour such as genital touching, oral-genital contact or attempted/actual penetrative sex (10% actual or attempted penetrative sex) 15% took part only in non-contact sexual behaviour, such as exposure, use of pornography or sexually abusive language 31% took part in both contact and non-contact behaviour 31% had been involved in only one incident

34 Age of onset

35 Key Messages 1. Many children and young people who present with harmful sexual behaviours have histories characterised by multiple abuse and disadvantage. Such children have often come to the attention of child welfare professionals many years before their sexually problematic behaviours start to emerge. Younger children presenting with problematic sexual behaviours are often extremely vulnerable and have may have been extensively sexually abused themselves. In such cases, the child’s problematic behaviours may be a direct consequence of their own experience of being sexualised through abuse. Given this, the best response to these children is similar to that offered to child victims of abuse. Early adolescence, particularly, the onset of puberty appears to be a peak time for the development of harmful sexual behaviours. Most adolescents who develop these behaviours are male, although knowledge is growing about a small number of young women whose sexual behaviours are harmful. Young people with learning disabilities who have sexually abused with harmful sexual behaviour are a particularly vulnerable and neglected group and may need specialist support.

36 ASSESSMENT

37 Models for Assessment with Adults don’t work with young people:
Barnardo’s Core Presentation Slide No. 37 Thursday, 06 April 2017 Models for Assessment with Adults don’t work with young people: Families have a more pro-active role and they should be included in the assessment Young people are subjected to greater influence by supportive networks e.g. parents, carers, teachers, peers Young people are unlikely to have established a fixed pattern of sexual thoughts and behaviour We need to consider the influence of resilience and protective factors. There is little research to quantify this influence and we need to rely on professional judgement. Talk through, take any questions. Families are important because of the messages they give to young people which can have a positive or negative influence on their behaviour Assessments need to be systemic – link with all significant people in their lives. We need to think of a young person’s offending behaviour in a child developmental context. Young people develop and change in all areas of their development e.g. physical, psychological and behavioural. Change can be different for adults [e.g. drug, alcohol abuse, violence] but young people’s behaviour can be more fluid and easier to change especially if patterns have not been established. Research shows that if they receive help the majority of young people will not go on to abuse. There is however a minority of young people who will continue to abuse and having started during their adolescence they can become some of the worst offenders. 4. We cannot accurately predict that young people will re-offend so it does rely on knowledge about the young people and the systems around them. Criminal Justice workers complete Matrix 2000 for adult offenders. This is done during an interview using a form with tick boxes. Risk is assessed according to the outcome. This can be done for adults as there is considerable knowledge and research in this area. This is not the case with young people where research is still in early stages and there are very small samples. It is therefore not reliable. Research is only, at present, able to give us a general picture. We need to look at systems. Show Risk Matrix 2000

38 Some Factors linked to recidivism (Richardson, 2009)
Review of 56 recidivism studies Overall sexual recidivism rate of 12.4%

39 Most robustly associated risk factors
Barnardo’s Core Presentation Slide No. 39 Thursday, 06 April 2017 Most robustly associated risk factors Previous sexual offences Kahn and Chambers, 1991 Langstrom, 2002 Langstrom and Grann, 2000 Schram et al., 1991 Worling and Curwen, 2000 Nisbet et al., 2004 Epperson et al., 2005 Rombouts, 2005 Poole et al., 2000 Morton 2003 Santman 1998 Multiple victims Rasmussen, 1999 Worling, 2002 Christodoulides et al., 2005 Stranger victims Ageton, 1983 Smith and Monastersky, 1986 Langstrom, 2002 Lee, Cottle and Heilburn, 2003 Heilbrun, Lee and Cottle, 2005 Rombouts (2005) Poole et al., 2000 Morton, 2003 Previous non-sexual offences Kahn and Chambers, 1991 Boyd, 1994 Nisbet et al., 2004 Epperson et al., 2005 Rombouts, 2005 Morton 2003 Santman 1998 Talk through the risk factors above with reference to David and Gordon as appropriate. This will need to be brief and much of this material will already have been covered whilst discussing the case studies earlier.

40 Younger-aged perpetrator Male victim
Sexual preference for children (male and female) self-report; therapist rating; PPG Worling and Curwen, 2000 Kenny et al., 2001 Schram et al., 1991 Khan and Chambers, 1991 Clift, Gretton and Rajlic, 2007 Rombouts, 2005 Hunter and Figueredo 1999 Morton 2003 Redlak (2003) Younger-aged perpetrator Heilbrun et al., 2005 Lee, Cottle and Heilbrun, 2003 Santman (1998) Nisbet et al. (2004) Male victim Langstrom and Grann, 2000 Langstrom, Grann and Lindblad, 2000 Smith and Monastersky, 1986 Poole et al., 2000 Morton, 2003 Victim of sexual abuse Rubenstein et al., 1993 Khan and Chambers, 1991 Epperson et al., 2005 Rasmussen (1999) Redlak (2003)

41 Impaired social functioning
Knight and Prentky, 1993 Worling, 2001 Langstrom and Grann, 2000 Kenny et al., 2001 Christodoulides et al., 2005 No or uncompleted offence specific treatment Borduin et al., 1990 Worling and Curwen, 2000 Heilbrun et al., 2005 Epperson et al., 2005 Lee, Cottle and Heilburn, 2003 Not strongly associated Denial Grooming Use of threats Intrafamily violence History of delinquency History of sexual violence ADHD Conduct disorders Age difference between victim and perpetrator Psychopathy scores Cognitive distortions

42 A Good Assessment Should Answer the Following Questions:
Barnardo’s Core Presentation Slide No. 42 Thursday, 06 April 2017 A Good Assessment Should Answer the Following Questions: Why did the young person behave/offend in this way? How likely is it that the behaviour/offending will continue? What circumstances could trigger the behaviour and who would the likely victims be? How can risk (to both young person and victim) be managed now? How can risk (to both young person and victim) be managed in the future?

43 A Good Assessment will include…
A thorough analysis of the problematic sexual behaviours including their onset, motivating factors, types of behaviour exhibited, changes in the behaviours over time and the child’s responses to attempts by caregivers to correct such behaviours A detailed social history of both the child and the family, with specific attention given to significant family losses or other traumatic events, child moves and episodes in substitute care A detailed exploration of the child’s prior experiences of victimisation: this should not be limited to the question of whether a child has been abused, but should include as much information as can be gathered about the dynamics of any abuse and, especially if the abuse was sexual in nature, the abusive behaviours that the child was involved in, as these can cast light upon the child’s subsequent sexualised behaviours

44 An analysis of the child’s wider social functioning, relationships and interactions, including both strengths and competencies, as well as risks and deficits Other behavioural issues which may be related to the problematic sexual behaviours, such as conduct problems, ADHD, or post-traumatic responses exhibited by the child The family environment, including how sex and sexuality is viewed and expressed in the home, family disciplinary practices and parenting styles, the level of supervision afforded to children and the carers’ previous attempts to manage and respond to the child’s sexual behaviours

45 Assessment tools Commonly used in UK AIM2 J-SOAP II ERASOR SHARP
Less Commonly used MEGA J-RAT J-SORRAT J-RAS AR-RSBP

46 Deviant Sexual Interest Obsessive Sexual Interests
Attitudes Supportive of Sexual Offending Unwillingness to alter deviant sexual interests/attitudes Ever sexually assaulted 2 or more victims Ever sexually assaulted the same victim 2 or more times Prior adult sanctions for sexual assault(s) Threats of, or use of, excessive violence/weapons Ever sexually assaulted a child Ever sexually assaulted a stranger Deviant Sexual Interest Obsessive Sexual Interests Attitudes Supportive of Sexual Offending Unwillingness to alter deviant sexual interests/attitudes Ever sexually assaulted 2 or more victims Ever sexually assaulted the same victim 2 or more times Prior adult sanctions for sexual assault(s) Threats of, or use of, excessive violence/weapons Ever sexually assaulted a child Ever sexually assaulted a stranger Indiscriminate choice of victims Ever sexually assaulted a male victim Diverse sexual-assault behaviors Antisocial interpersonal orientation Lack of intimate peer relationships/Social isolation Negative peer associations and influences Interpersonal aggression Recent escalation in anger or negative affect Poor self-regulation of affect and behavior (Impulsivity) High-stress family environment Problematic parent-offender relationships/Parental rejection Parent(s) not supporting sexual-offense-specific assessment/treatment Environment supporting opportunities to reoffend sexually No development or practice of realistic prevention plans/strategies Incomplete sexual-offense-specific treatment

47 Indiscriminate choice of victims Ever sexually assaulted a male victim
Diverse sexual-assault behaviors Antisocial interpersonal orientation Lack of intimate peer relationships/Social isolation Negative peer associations and influences Interpersonal aggression Recent escalation in anger or negative affect Poor self-regulation of affect and behavior (Impulsivity) High-stress family environment Problematic parent-offender relationships/Parental rejection Parent(s) not supporting sexual-offense-specific assessment/treatment Environment supporting opportunities to reoffend sexually No development or practice of realistic prevention plans/strategies Incomplete sexual-offense-specific treatment   Deviant Sexual Interest Obsessive Sexual Interests Attitudes Supportive of Sexual Offending Unwillingness to alter deviant sexual interests/attitudes Ever sexually assaulted 2 or more victims Ever sexually assaulted the same victim 2 or more times Prior adult sanctions for sexual assault(s) Threats of, or use of, excessive violence/weapons Ever sexually assaulted a child Ever sexually assaulted a stranger Indiscriminate choice of victims Ever sexually assaulted a male victim Diverse sexual-assault behaviors Antisocial interpersonal orientation Lack of intimate peer relationships/Social isolation Negative peer associations and influences Interpersonal aggression Recent escalation in anger or negative affect Poor self-regulation of affect and behavior (Impulsivity) High-stress family environment Problematic parent-offender relationships/Parental rejection Parent(s) not supporting sexual-offense-specific assessment/treatment Environment supporting opportunities to reoffend sexually No development or practice of realistic prevention plans/strategies Incomplete sexual-offense-specific treatment

48 Scale 1: Sexual Drive/Preoccupation Scale
Scale 2: Impulsive, Antisocial Behavior Scale Scale 3: Clinical/Treatment Scale Scale 4: Community Stability/Adjustment Scale 1: Sexual Drive/Preoccupation Scale Prior charged sex offence History of predatory behavior Evidence of sexual preoccupation Duration of sex offence history Scale 2: Impulsive, Antisocial Behavior Scale Caregiver Instability Ever arrested before the age of 16 years School Behavior Problems School Suspensions or Expulsions History of Conduct Disorder Multiple types of offences Impulsivity History if alcohol abuse History of parental alcohol abuse Scale 3: Clinical/Treatment Scale Accepts responsibility for sexual offences Internal motivation for change Understands sexual assault cycle Evidence of empathy, remorse, guilt Absence of cognitive distortions Scale 4: Community Stability/Adjustment Scale Evidence of poorly managed anger in the community Stability of current living situation Stability of school Evidence of Support Systems in the Community Quality of Peer Relationships

49 SHARPS Domain 1. Sexually Harmful Behavior Domain 2. Antisocial Behavior Domain 3. Adverse Life Experiences Domain 4. Sexual Development and Adjustment Domain 5. Social Development and Adjustment Domain 6: Emotional Development and Adjustment Domain 7. Personality Development and Adjustment Domain 8. Mental Health Development and Adjustment Domain 9. Cognitive Development and Adjustment Domain 10. General Self-Regulation Domain 11. Environment Risks Domain 12. Motivation and Compliance Victim Characteristics Age Difference between Abuser and Victim Location Where Sexually Harmful Behavior Occurred Severity of Sexually Harmful Behavior Nature of Aggression Used During Sexually Harmful Behavior Onset and Duration of Sexually Harmful Behavior Frequency of Sexually Harmful Behavior Escalating Pattern of Sexually Harmful Behavior Established/Emerging Pattern of Harmful Sexual Behavior Domain 2. Antisocial Behavior History of Violent Behavior/Criminal Convictions History of Delinquency/Criminal Convictions Substance Misuse/Dependency Domain 3. Adverse Life Experiences History of Childhood Sexual Victimization History of Childhood Physical Victimization Exposure to Sexual Abuse/Sexual Violence Peer Victimization Domain 4. Sexual Development and Adjustment Unmet Need for Sexual Contact/Experience with a Peer Motive Underpinning Sexually Harmful Behavior Nature of Reinforcement from Sexually Harmful Behavior Pornography Misuse/Dependency Sexual Learning Experiences Sexual Fantasies Sexual Preferences Sexual Orientation/Relations with Same-Sex peers Cognitive Rules Underpinning Sexually Harmful Behavior Attitudes and Beliefs Underpinning Sexually Harmful Behavior Heterosocial Competency/Relations with Opposite-Sex Peers Heterosexual/Dating Experiences Domain 5. Social Development and Adjustment Social Competency Social Integration Social Immaturity Social Delinquency Domain 6. Emotional Development and Adjustment Emotional Dysregulation General/Victim Empathy Deficits Emotional Immaturity Attachment Difficulties Domain 7. Personality Development and Adjustment Emerging Personality Disorder Psychopathy Rating Domain 8. Mental Health Development and Adjustment Childhood and Adolescent Psychiatric Disorders Childhood and Adolescent Psychiatric Symptoms and Deficits Domain 9. Cognitive Development and Adjustment Intellectual Disability and Cognitive Deficits Social-Cognitive Information Processing Deficits Domain 10. General Self-Regulation and Level of Independence General Self-Regulation and Coping Deficits Level of Independence Domain 11. Environment Risks Family Environment and Opportunities for Sexually Harmful Behavior Neighborhood Environment and Opportunities for Sexually Harmful Behavior School Environment and Opportunities for Sexually Harmful Behavior Domain 12. Motivation and Compliance Family Acceptance/Compliance/Responsivity Young Person’s Manageability/Treatability/Responsivity

50 Concerns & Strengths (Static & Dynamic)
Sexually Harmful Behaviour Developmental Family Environmental 1b. Sexually abused a stranger 1a. Evidence of previous contact sexually abusive behaviors Static Concerns 1e. Previously been significantly sanctioned for sexually abusive behavior 1d. Previous non-sexual offences 1c. Used or threatened violence during sexual assault 1g. History of aggressive (non-sexual) behavior 1f. Abused on or more victims on more than 2 occasions 1j. Has sexually abused males 1i. Sexually abused 2 or more victims 1h. History of cruelty to animals 1l. Previous allegations of sexually abusive behaviors (but no conviction or admission) 1k. Abusive behavior included penetration or attempted penetration 2a. Cold, callous attitude towards sexual offending Dynamic Concerns 1m. Offence/s appear based on grievance or revenge 2c. Self-reported sexual interest in children 2b. Sadistic or violent sexual thoughts 2d. Beliefs that minimize or support sexually abusive behaviors DEVELOPMENTAL CONCERNS 2e. Obsessive/preoccupation with sexual thoughts/pornography 3b. Formal diagnosis of Conduct Disorder 3a. Previous drop out from treatment programmes to address abusive behaviors 3e. Early onset (pre 10 years) of severe non-sexual behavioral problems 3d. Witnessed domestic violence 3c. Experienced significant physical, emotional, sexual abuse or neglect 3h. Problematic sexual behaviors commenced pre-puberty and continued into adolescence 3g. Ever had a diagnosis of attention deficit hyperactivity disorder (ADHD) 3f. Ever had a diagnosis of depression or other serious mental health problem 4c. Emotional congruence/identification with young children 4b. Difficulties emotionally regulating 4a. Generally highly impulsive or compulsive 4f. Distorted self-image (extremely negative or narcissistic) 4e. Poor assertiveness skills (overly passive or aggressive style) 4d. Poor general capacity for empathy (not just in relation to victims) 4i. Pervasive anger 4h. Unresolved trauma (PTSD) 4g. General socially isolated (emotionally lonely) 4l. The young person displays non-compliance towards supervision 4k. Young person currently engages in substance misuse 4j. There has been a recent escalation in the young person’s aggression or hostility towards others FAMILY ISSUES 5b. The most significant adults in the young person’s life (e.g. parents, carers_ have a history of not addressing their own traumas/problematic behaviors 5a. Early years or most of life in highly dysfunctional family The most significant adults in the young person’s life deny, minimize or justify the index offence The most significant adults in the young person’s life express anger toward or blame the victim(s) ENVIRONMENTAL 6d. Family members do not support or actively undermine professional intervention 6c. Young person is currently experiencing a life crisis such as family rejection or death of a significant family member 7c. Young Person has abused or attempted to abuse another person in their current living environment 7b. Previously been excluded from school or employment 7a. Pattern of discontinuity of care 8c. Current carers are not support of professional intervention 8b. Local community is hostile towards the young person 8a. Peer group predominantly pro-criminal 8d. Young person currently has little daily structure or pro-social activities in his life Static SEXUALLY AND NON-SEXUALLY HARMFUL BEHAVIOURS STRENGTHS 9c. Abusive behavior ceased when the victim demonstrated non-compliance or distress 9b. Abusive behavior appears to be peer influenced 9a. Referral behavior appears to be experimental 10b. Regrets having sexually offended 10a. Accepts responsibility for the index offence (low level of denial) Dynamic 10c. Willing to address sexual behavior problems DEVELOPMENTAL ISSUES 11b. Above average intelligence 11a. Healthy physical developmental history 12c. Developmentally appropriate level of sexual knowledge 12b. Good negotiation/problem solving skills 12a. Positive talents and/or leisure interests 12e. Good communication skills 12d. Positive realistic goals/plans 13a. Grown up with consistent and positive relationship with at least one adult 14a. The most significant adults in a young person’s life (e.g. parents, foster carers) demonstrate good protective attitudes and behaviors 14d. The most significant adults in young person’s life (e.g. parents carers) are generally health 14c. The most significant adults in young person’s life (e.g., parents, carers) have a positive support network 14b. The most significant adults in young person’s life (e.g. parents, carers) demonstrate positive emotional coping strategies ENVIRONMENTAL ISSUES 15b. Positive evaluation from work/educational staff (e.g. of behavior, attendance, application to activities) 15a. The young person uses at least one emotional confidant 15e. Makes positive use of social support network 15d. Young person feels emotionally and physically safe within their current environment 15c. Positive relationships with professionals 15f. Current carers/living environment can maintain appropriate level of supervision

51 MEGA Aggregates Neuropsychological Family Antisocial Sexual Incident
Coercion Stratagem Relationship Scales 1.Risk 2.Dynamical 3.Principles 4.Static 5.Protective risk 6.Female Aggregates Neuropsychological considers variables related to gross neuropsychological functioning (e.g. orientation to person, time, and place, level of self-governance, attention, concentration, daydreaming, learning disorders, etc.) Family Lovemap considers elements pertaining to intimacy deficits encountered in overall family history of relationships and how intimacies are (or are not) expressed (e.g. compassion, concern, empathy, kindness, gentleness, etc) Antisocial – variables related to antisocial behaviour that come to the attention of law enforcement and/or are illegal e.g. truancy Sexual Incident – sexual behaviours illegal by statute and cause harm, coarse sexual improprieties Coercion – variables surrounding the use of force and weapons Stratagem – history of planning related to sexually abusive behaviours, luring, stalking, or forcible removing the other person from premises Relationship (Predatory) – variables related to predatory dynamics and sexually abusive behaviour (gender, age and number of victim)  Scales 1.Risk 2.Dynamical 3.Principles 4.Static 5.Protective risk 6.Female Miccio-Fonsexa (2009). MEGA: A New Paradigm in Protocol Assessing Sexually Abusive Children and Adolescents, Journal of Child and Adolescent Trauma, 2:

52 Key Findings Inter-rater reliability Predictive Accuracy
Earl-20B (Enebrink et al., 2006) SAVRY, YLS/CMI & PCL:YV (Catchpole and Gretton, 2003) PCL:YV and YLS/CMI (Marshall et al., 2006)

53 Challenges Developmental Sensitivity Narrow Conceptualisations of SPJ
‘Delinquency Models Risk Specificity Psychometric Properties Utility of the Available Protocols Actuarial Models. Narrow Conceptualizations of the SPJ model. Risk Specificity. Psychometric Properties. Reliance on Delinquency Models. Developmental Sensitivity. Actuarial Models

54 Actuarial Models LSCMI – Roll out across Scotland Criminal and Youth Justice The problems associated with the actuarial and adjusted-actuarial approach have been discussed above and in other papers (see XXX). Suffice to say that it is of serious concern that these models continue to hold such prominence in the field of youth justice. It is incumbent on practitioners, policy-makers and decision makers to review the appropriateness and acceptability of these approaches.

55 Narrow conceptualisation of SPJ
Risk factors rated for presence Numerical coding Cumulative Risk Models Adjusted-Actuarials Ecological Fallacy While many of the youth risk assessments described above claim to be developed according to SPJ guidelines, a review of their user instructions revealed that they offer little (or no) guidance beyond step 2 of the sequence of assessment articulated in the SPJ model. For example, assessors are not told how to interpret their findings to ensure an individualized case-conceptualization (or formulation) – a fundamental step towards understanding and managing risk (Logan & Johnstone, in press; RMA, 2008). Furthermore, anecdotal evidence suggests that where risk factors are rated on a numerical scale, assessors simply cannot resist drawing inferences from the ‘score’. This increases the likelihood of the ecological fallacy – the belief that the gorup average describes the individual - and could lead to false conclusions. Cumulative risk models say nothing about how a particular risk factor operates (Sanson & Prior, 2008). A key challenge for assessors is to move beyond a simple listing of risk factors to a more integrative analysis (and narrative discussion) of what, why and how these particular risk factors might be relevant to a particular time in a particular context in relation to a particular behaivour. Douglas (2009) described this process as ‘achieving idiographic optimization of nomothetic data’.

56 e.g., ERASOR Scoring 5. Ever sexually assaulted 2 or more victims
Present Adolescent has intentionally sexually assaulted 2 or more victims Possibly or partially present Possible or partial evidence that the adolescent has intentionally sexually assaulted 2 or more victims Not Present Adolescent has intentionally sexually assaulted 1 victim Unknown Insufficient information to support a decision regarding this risk factor 5. Ever sexually assaulted 2 or more victims

57 Risk specificity Swearing Shoplifting Serious aggression
Risk Specificity. A third concern is that the available protocols are lacking in terms of risk specificity. A wide range of antisocial conduct – not necessarily violence of a nature or degree that would warrant dangerous offender provisions – is assessed for in these guides. For example, the EARL-20, the protocol was designed “for assessing the potential for antisocial, aggressive or violent conduct” (page xii) which includes a vast range of behaviours from swearing and shoplifting to serious aggression. The specificity of effects and sensitivity of the protocols for serious violence will be difficult (if not impossible) to discern as they currently are. If risk assessment is to have utility, it is important to distinguish between different forms of risk (i.e., the topographical analysis) as well as the relationship between a wide range of different cognitive, affective and behavioral mediators and mechanisms (i.e., risk formulation). Thus, it is unclear how useful the content is for identifying those children who present an ongoing risk of serious harm to the safety of the public at large and who therefore require restrictive legal sanctions as opposed to those who pose a risk of frequent nuisance but low harm behaviors Serious aggression

58 The link might be to poverty rather than crime
Webster et al. (2006) note that the static risk factors usually associated with offending by young people are also prevalent amongst non-offenders The link might be to poverty rather than crime Webster et al. (2006) note that the static risk factors usually associated with offending by young people are also prevalent amongst law-abiding populations. These authors equate so-called risk factors such as truanting, single parenthood, educational low-achievement and disruptive childhoods with poverty rather than criminality: "the narrowing down of risk factors to the family, parenting, truancy and peer-groups, reflects more a process of political expediency… than any genuine attempt to understand the causes of criminality." (Webster et al., 2006: 12). Webster et al. also draw attention to the 'false negatives' of young people who show all the predictive signs of offending but remain law-abiding and suggest that risk assessment may be a reactive process of containment rather than a proactive means of resolving structural constraints for many disadvantaged young people: "Much of what happened in the lives of our informants could not have been predicted from earlier experiences… In isolating individual risk factors from their context in biography, place and social structure, such [risk assessment] devices offer ways of managing offenders rather than addressing the causes and cessation of individual offending." (ibid: 18).

59 Prentky et al., (2000); Epps & Fisher (2003)
As a group, juvenile sex offenders are characterized as high in general delinquency and antisocial behavior and lack of impulse control. It is possible that the literature (and therefore risk assessment guides) are simply picking up on the likelihood of delinquency and not risk of serious sexual harm per se.

60 Psychometric Properties
Lack of studies Typically include white male populations Range of outcome variables – self-reported violence, institutional violence, non-serious violence (Burman, 2007) Relevance to serious harm? A third issue is that the extant literature pertaining to the psychometric properties of the available protocols fails to provide compelling evidence of their psychometric properties. Space does not permit a detailed discussion of each study here but in general terms, it can be concluded that while several studies report statistically significant findings with regard to the reliability and validity of many of the measures across contexts and countries (see McNeil YEAR for a review – YOU HAVE NO REFERENCE FOR MCNEIL) there are some concerns. First, the predictor and outcome variables are diverse across studies and it is not possible to extrapolate from the findings the extent to which they identify risk of serious harm. Second, some protocols such as the SAVRY and YLS/CMI have been  studied far more than the other measures. Third, there are inconsistent and concerning results. For example, Elkovitch et al., (2008) found that raters were not able to identify detected cases of either sexual recidivism or nonsexual violent recidivism above chance when their conclusions were aided by the SAVRY and J-SOAP-II and a high level of rater confidence was not associated with accuracy.

61 Misplaced Confidence Elkovitch et al., (2008) found that raters were not able to identify detected cases of either sexual recidivism or nonsexual violent recidivism above chance when their conclusions were aided by the SAVRY and J-SOAP-II and a high level of rater confidence was not associated with accuracy.

62 Reliance on Delinquency Models
A fourth observation is that the conceptual underpinnings of risk assessment are heavily weighted towards delinquency models where methodologies typically utilize broadly defined criterion variables – often any type of antisocial , violent, aggressive or sexually inappropriate behavior. It is possible – if not likely -- that the over-reliance on delinquency models (e.g., Farrington et al 2006; Loeber-Stouthamer-Loeber, 1999 – YOU HAVE NO REFERNCE FOR THIS)), is likely to limit the utility of these protocols. Very serious crimes perpetrated by children do not always conform to a criminogenic risk needs or delinquency model. Forensic mental health and adolescent psychiatry settings bare testament to this fact. For some young people, major mental illnesses and symptoms associated with other forms of mental disorders (e.g. autistic spectrum disorders, mental retardation, personality problems, trauma and dissociation etc.) can be the critical -- and sometimes the only risk factor. Acquiring a developmentally sound framework for risk assessment is a significant challenge particularly because h.uman development is a metamorphic process which is likely to be at its most energetic during the formative years. As such , the specialism of developmental psychopathology provides a useful framework from which to adjudge the utility of youth violence risk models and procedures. A key objective in this field is to gain ‘a process-level understanding of how, why and in what ways individual differences in normal and abnormal social, emotional, cognitive and behavioral development emerge, interact, and develop across the lifespan’ (Richter, 1997, p.198). Concepts such as heterogeneity versus homogeneity, homotypic versus heterotypic continuity, change and stability, equifinality versus multifinality, and the direction of effects in causal models are all relevant to reaching reliable assessments of risk. Richter (1997) referred to these issues collectively as ‘the developmentalist’s dilemmas’. There relevance to risk assessment is considered below. Henry Jake Jenny

63 “The Hubble hypothesis and the developmentalist’s dilemma” (Richters, 1997)

64 Heterogeneity and Homogeneity
Low intelligence Emotional congruence The principles of Heterogeneity and Homogeneity refer to the fact that because a child (or group of children) might display phenotypically similar behaviors – in this case, violence or sexual violence – it would be erroneous to assume that they constitute a homogenous sample. As explained above, to date, much of the research used to inform the content of the available risk assessment protocols comes from the delinquency and criminogenic literatures and much of the extant literature on antisocial children is derived from methodologies where there is an a priori assumption of homogeneity with respect to both outcome and predictor variables. This is unlikely. The diverse motivations and modus operandis used by individuals seeking sexual or some other form of psychological gratification through offending provides a compelling illustration of this point. An adolescent with low intelligence and paedophilic proclivities driven by a sense of emotional congruence with children is likely to differ from another child who shows a predilection for perpetrating predatory stranger rape characterized by severe physical violence or homicidal fantasies that satisfies some intrinsic need for control and dominance. In turn, both will differ from an 13-year-old reenacting   their own abuse experiences on a 4-year-old sibling. The available risk assessment protocols are limited in their explanation of how to make sense of the different risk factors for different outcomes thus, assessors who lack an in-depth knowledge of violence and sexual harm, normal development, abnormal psychology, and developmental psychopathology as well as mental disorders in children are therefore vulnerable to inadvertently misusing and misinterpreting the significance of their risk ratings. Poor supervision

65 Heterogeneity and Homogeneity
Homicidal ideation Sexual deviation (sadomasochistic) The principles of Heterogeneity and Homogeneity refer to the fact that because a child (or group of children) might display phenotypically similar behaviors – in this case, violence or sexual violence – it would be erroneous to assume that they constitute a homogenous sample. As explained above, to date, much of the research used to inform the content of the available risk assessment protocols comes from the delinquency and criminogenic literatures and much of the extant literature on antisocial children is derived from methodologies where there is an a priori assumption of homogeneity with respect to both outcome and predictor variables. This is unlikely. The diverse motivations and modus operandis used by individuals seeking sexual or some other form of psychological gratification through offending provides a compelling illustration of this point. An adolescent with low intelligence and paedophilic proclivities driven by a sense of emotional congruence with children is likely to differ from another child who shows a predilection for perpetrating predatory stranger rape characterized by severe physical violence or homicidal fantasies that satisfies some intrinsic need for control and dominance. In turn, both will differ from an 13-year-old reenacting   their own abuse experiences on a 4-year-old sibling. The available risk assessment protocols are limited in their explanation of how to make sense of the different risk factors for different outcomes thus, assessors who lack an in-depth knowledge of violence and sexual harm, normal development, abnormal psychology, and developmental psychopathology as well as mental disorders in children are therefore vulnerable to inadvertently misusing and misinterpreting the significance of their risk ratings. Interpersonally dominant

66 Heterogeneity and Homogeneity
Prior hx of CSA The principles of Heterogeneity and Homogeneity refer to the fact that because a child (or group of children) might display phenotypically similar behaviors – in this case, violence or sexual violence – it would be erroneous to assume that they constitute a homogenous sample. As explained above, to date, much of the research used to inform the content of the available risk assessment protocols comes from the delinquency and criminogenic literatures and much of the extant literature on antisocial children is derived from methodologies where there is an a priori assumption of homogeneity with respect to both outcome and predictor variables. This is unlikely. The diverse motivations and modus operandis used by individuals seeking sexual or some other form of psychological gratification through offending provides a compelling illustration of this point. An adolescent with low intelligence and paedophilic proclivities driven by a sense of emotional congruence with children is likely to differ from another child who shows a predilection for perpetrating predatory stranger rape characterized by severe physical violence or homicidal fantasies that satisfies some intrinsic need for control and dominance. In turn, both will differ from an 13-year-old reenacting   their own abuse experiences on a 4-year-old sibling. The available risk assessment protocols are limited in their explanation of how to make sense of the different risk factors for different outcomes thus, assessors who lack an in-depth knowledge of violence and sexual harm, normal development, abnormal psychology, and developmental psychopathology as well as mental disorders in children are therefore vulnerable to inadvertently misusing and misinterpreting the significance of their risk ratings.

67 Structured Professional Judgement
Risk Assessment Scenarios Formulation Structured Professional Judgement Risk Factors Management Violence risk assessment in forensic mental health settings includes the process of gathering information for use in making clinical/forensic decisions. A detailed assessment can involve many different modalities and methods of information collecting and may include, for example, interviews with the service user, interviews with family members, employers, friends, victims, administration of specialist tests such as personality disorder and intellectual assessments, a review of health, social work, police, prison, education, employer records etc. A violence risk assessment is the process of gathering information in order to: Background: Ensure a detailed and comprehensive knowledge of the person’s background. This ensure that all potential risks (not just the index offence type) are identified and assessed. It also is essential to producing a detailed formulation as it is only through the process of examining the person’s background that factors that help us explain the behaviours can become apparent. Risk Factors: Ensure a thorough analysis of the risk factors shown in the research and clinical literatures as being relevant to the types of risk posed Risk Formulation: Produce a risk formulation (narrative) of the nature of the person’s risk (4Ps model). This is the process whereby the evaluator pulls all the relevant information together to produce a coherent explanation or narrative of the person’s history, their risk factors and how and when these risks function in order to increase the likelihood of the risk. Risk Scenarios: Make a projection about the likelihood of this risk in given circumstances (scenarios) Identify areas in need of intervention and inform the timing and context of these interventions Risk Management: To assist in the selection of other risk management interventions and to determine the level of input required to manage the risk. The content and comprehensiveness of a risk management plan will be dependent on the quality of risk assessment information. In some circumstances the right recommendation will be simply to gather more information. In other circumstances you might be in a position to make recommendations about treatment, monitoring, supervision and victim safety planning. Irrespective of what, the policy should make it clear that all patients should have a risk management plan. Communication. It is futile to spend time completing a detailed risk assessment and risk management if it is not communicated. From a policy perspective, it is also impossible to audit or govern practice if it is not written down. A policy statement should therefore state clearly that a key purpose of violence risk assessment is to communicate and document risk. By explicitly stating this definition in the policy document, the problems associated with people using only self-report are reduced e.g. Distorted information, failure to recognise a potential risk, etc. Each of these steps in the violence risk assessment process could be, and perhaps should be, defined as a standard. Document & Communicate Background

68 Principles What is the context of the risk assessment? What? Where?
When? How is it to be used? Is the risk posed suitable for the HCR-20 or is a different scheme more appropriate Is the risk concerned with the community, hospital, prison, etc. When, is this a risk assessment for current management, management in 15 years time once they have served a life sentence? Skills and expertise: Do I have the right training and expertise to do this assessment? Proper use of SCJ approaches to violence risk assessment requires considerable professional skills and judgement and expertise in the following areas: mental disorder (the person is recognised by their own regulatory body as possessing the sufficient skills to assess and diagnose mental disorder) Expertise in individual assessment (the ability to conduct and analyse assessments of areas relevant to understanding the violent offender) Knowledge of the violence literature (e.g. the aetiology, assessment and management of violent offenders) Knowledge and relationship with the person: Have you treated this person or known them in any other capacity? Professional Biases: Is this referral from a source where you have had conflict or a disagreement before? Personal Biases: Does this case raise any personal issues for you? Other conflicts of interest:

69 Principles Am I the right person to contribute/take responsibility for the assessment? Skills and expertise Knowledge and relationship with the person Professional Biases (see Garb, 2005) Personal Biases (see Garb, 2005) Other conflicts of interest Do I have enough time to do a good job? Is the risk posed suitable for the HCR-20 or is a different scheme more appropriate Is the risk concerned with the community, hospital, prison, etc. When, is this a risk assessment for current management, management in 15 years time once they have served a life sentence? Skills and expertise: Do I have the right training and expertise to do this assessment? Proper use of SCJ approaches to violence risk assessment requires considerable professional skills and judgement and expertise in the following areas: mental disorder (the person is recognised by their own regulatory body as possessing the sufficient skills to assess and diagnose mental disorder) Expertise in individual assessment (the ability to conduct and analyse assessments of areas relevant to understanding the violent offender) Knowledge of the violence literature (e.g. the aetiology, assessment and management of violent offenders) Knowledge and relationship with the person: Have you treated this person or known them in any other capacity? Professional Biases: Is this referral from a source where you have had conflict or a disagreement before? Personal Biases: Does this case raise any personal issues for you? Other conflicts of interest:

70 Comprehensive data sources
Comprehensive review of all files from a range of sources Police Social Work Health School Parents/Carers Children’s Hearings Observations Specialist Assessments Pay attention to detail

71 Structured Professional Judgement
Risk Assessment Scenarios Formulation Structured Professional Judgement Risk Factors Management Violence risk assessment in forensic mental health settings includes the process of gathering information for use in making clinical/forensic decisions. A detailed assessment can involve many different modalities and methods of information collecting and may include, for example, interviews with the service user, interviews with family members, employers, friends, victims, administration of specialist tests such as personality disorder and intellectual assessments, a review of health, social work, police, prison, education, employer records etc. A violence risk assessment is the process of gathering information in order to: Background: Ensure a detailed and comprehensive knowledge of the person’s background. This ensure that all potential risks (not just the index offence type) are identified and assessed. It also is essential to producing a detailed formulation as it is only through the process of examining the person’s background that factors that help us explain the behaviours can become apparent. Risk Factors: Ensure a thorough analysis of the risk factors shown in the research and clinical literatures as being relevant to the types of risk posed Risk Formulation: Produce a risk formulation (narrative) of the nature of the person’s risk (4Ps model). This is the process whereby the evaluator pulls all the relevant information together to produce a coherent explanation or narrative of the person’s history, their risk factors and how and when these risks function in order to increase the likelihood of the risk. Risk Scenarios: Make a projection about the likelihood of this risk in given circumstances (scenarios) Identify areas in need of intervention and inform the timing and context of these interventions Risk Management: To assist in the selection of other risk management interventions and to determine the level of input required to manage the risk. The content and comprehensiveness of a risk management plan will be dependent on the quality of risk assessment information. In some circumstances the right recommendation will be simply to gather more information. In other circumstances you might be in a position to make recommendations about treatment, monitoring, supervision and victim safety planning. Irrespective of what, the policy should make it clear that all patients should have a risk management plan. Communication. It is futile to spend time completing a detailed risk assessment and risk management if it is not communicated. From a policy perspective, it is also impossible to audit or govern practice if it is not written down. A policy statement should therefore state clearly that a key purpose of violence risk assessment is to communicate and document risk. By explicitly stating this definition in the policy document, the problems associated with people using only self-report are reduced e.g. Distorted information, failure to recognise a potential risk, etc. Each of these steps in the violence risk assessment process could be, and perhaps should be, defined as a standard. Document & Communicate Background

72 Risk Management Scenarios Formulate Background & Risk Factors Assess
Risk Formulation Formulate Management Background & Risk Factors Risk Management How do we use this information to evaluate and manage risk? If i can take you back to this slide when I was explaining the shift in the paradigm towards risk management, I mentioned the need for a formulation based approach Communicate Assess

73 Precipitating Factors/Destabilisers Protective/Inhibitors
Predisposing Factors Drivers/Motivators Precipitating Factors/Destabilisers Protective/Inhibitors Factors Perpetuating Factors Causal roles Drivers/Predisposing: factors that impel the individual towards the decision to be violent Disinhibitors/Precipitants: factors that decrease the perceived costs of violence Destabilisers/Precipitants: general factors that adversely affect the person’s decision-making abilities or psychosocial adjustment Probably in order of importance – things that drive offending – Hostile schemas, malevolent intent, angry thoughts, poor behavioural control, impulsive, paranoid fantasies e.g., planted a tape recorder in his head Things that disinhibite the person or reduces the cost of offending e.g., callousness, lack of empathy, lack of anxiety, minimisation, denial Dr Caroline Logan has provided a working definition of Risk Formulation. Drawing on her description of what a risk formulation is, the key elements can be considered as: Disrupt the persons lifestyle, stability, plans, causes stresses, discomfort Moves beyond listing risk factors to providing an explanation/story about the person’s risk Includes inferences about: factors may have predisposed the person to behaving violently factors that may have motivated or driven the behaviour factors that may be maintaining the risk for future violence factors that may be protective/inhibitors ‘factors that maintain a problem’ (Lemma, 1996, p.51) Protective factors are those factors that provide positive resources such as personal characteristics and strengths such as insight, motivation for treatment, responsivity to intervention, etc. and social resources such as supportive professionals, supportive family etc. These protective factors are used by the person to manage their risks. VIOLENCE

74 Instigator Facilitator Inhibitor Disinhibitor Tedeschi & Felson (1994)
Instigator – directly causes aggressive behaviour Facilitator – increases the likelihood or intensity of aggressive behaviour but has no effect in the absence of instigation Inhibitor – decreases the likelihood or intensity of aggression Disinhibitor – makes it more likely that aggressive behaviour will coccur or may intensify aggressive beaviour with both instigators and inhibitors are present

75 Risk Management Scenarios Formulate Background & Risk Factors Assess
Risk Scenarios Formulate Management Background & Risk Factors Risk Management How do we use this information to evaluate and manage risk? If i can take you back to this slide when I was explaining the shift in the paradigm towards risk management, I mentioned the need for a formulation based approach Communicate Assess

76 Characterising the Risk
Type Significant Threat Likelihood Severity Characterising the risk refers to the process where the violence or the hazard is defined in terms of : Type Severity of the physical and psychological harm associated with the risk Imminence frequency of thoughts or behaviours related to the risk; (2) severity of threat; (3) imminence; and (4) likelihood, etc. in order to ascertain whether there is a significant threat there. Frequency Imminence

77 Possible & Plausible Futures
Risk Scenarios (not prediction) Possible & Plausible Futures What could happen Scenarios are descriptions of possible futures essentially short narratives designed to simplify complex issues in a way that facilitates their communication to decision makers Scenarios are used to facilitate practical decision making under conditions of uncertainty They are not about what will happen but about what could happen Speculate about the kinds of violence the person might commit Primary hazards or concerns Describe plausible scenarios Informed speculation Short narratives

78 Scenarios Improve Repeat Escalation Twist Best Case Worst Case
The number of scenarios is almost limitless BUT Only a few distinct scenarios that are reasonable, credible, or internally consistent in the light of the facts and theory – other scenarios deemed to lack credibility can be pruned Essentially this is a professional task based on the best scientific evidence for risk factors Given any case there is usually substantial agreement amongst practitioners about plausible futures based on the theory, research and experience They help you plan Prune implausible or redundant scenarios Six basic “possible futures” Repeat Escalation Worst case (lethal) Twist, Twist scenario --- someone who engages in domestic violence and following a break up in relationship starts to stalk victim Improvement Best case (desistence) Worst Case

79 Severity Imminence Frequency/Duration Likelihood Motivation
Nature e.g., likely victims Severity Imminence Frequency/Duration Likelihood Motivation Warning signs

80 INTERVENTION

81 Barnardo’s Core Presentation Slide No. 81
Thursday, 06 April 2017 Different concerning behaviours will require different levels of intervention: Requires careful assessment Educational Help 1. Parent education to help child 2. External educational input Therapeutic help 3. Local 4. Specialist 30 – 40 minutes Given these differences in language and different terms that will be more relevant to different children and different behaviour, different responses will also be appropriate. Example of young man who has girlfriend, takes things a bit fast and she is a bit upset and dumps him Example of boy who grabs another boy’s balls at school – not a sexual assault, needs anger management and actually needs to be removed from home Example of 15 year old who is charged with the rape of a 12 year old girl

82 What works – the evidence from meta-analysis
Fortune and Lambie (2006) – 28 published studies Walker, McGovern, Poey and Otis (2004) – covered 10 studies Reitzell and Carbonell (2006) – meta- analysis of 9 studies. All had a control group. 2,986 adolescents – 7.3% sexual re-offending, 18.9% for comparison group. Mostly MST and CBT supported as treatment modalities. Average follow up 59 months.

83 Treatment effectiveness
Worling, LittleJohn and Bookelam (2010) 20 Year Prospective Follow-Up Study of Specialized Treatment for Adolescents Who Offend Sexually criminal charges were collected from a national database for 148 adolescents who had offended sexually. Adolescents were between12 and 19 years of age (M=15.5) at assessment, and the follow up interval spanned from 12 to 20 years (M=16.). Relative to the comparison group (n=90), adolescents who participated in specialized treatment (n=58) were significantly less likely to receive subsequent charges for sexual (9/21%), nonsexual violent (22/39%), and nonviolent crimes(28/52%).

84 What works in intervention
Barnardo’s Core Presentation Slide No. 84 Thursday, 06 April 2017 Lots of good ideas e.g. Good Lives Model (Print et al. 2013) Best evidenced approach – CBT But it’s only evidenced approach. Most widely reported in Hackett and Masson’s survey of 164 UK services in 2003. MST also promising (Borduin, Henggeler, Blaske & Stein,1990: Borduin, Schaeffer & Heiblum,2009, Letourneau et al.2009) Influence of familt therapy, solution focused approaches, psychodynamic approaches It is increasingly recognised that programmes of work designed to focus exclusively on harmful sexual behaviours in young people are limited in value and should be supported by attention to enhancing the young person’s broader life skills, addressing social isolation, opening up access to appropriate opportunities in the education system, addressing family problems and improving the young person’s relationships with parents or carers (Righthand and Welch, 2001). What works in intervention

85 Requirements in relation to work with young people who display harmful sexual behaviours
Holistic: focusing on the children’s needs across all dimensions of their lives and their development Systemic: involving families and parents in order to improve children’s social environments and attachment relationships Goal-specific: designed to address specific issues relating to the child’s harmful behaviours Developmentally orientated: being sensitive to the child’s age and stage of development

86 Common Treatment Goals
Themes related to participation in intervention process: motivation; denial (acceptance, honesty; openness); responsivity needs (learning style) trauma related issues; learning disability; anxiety; communication skills; emotional intelligence; family issues (learning from family experiences, timeline work; coping styles; self-care etc) Offence specific themes: Pathways into abuse; distorted thinking; consequential thinking; victim awareness; sexual thoughts and fantasy (nature, frequency, intensity); identification of risk (situational/internal); self management of risk; non sexual offending behaviours; Offence related themes: Core social skills; problem solving skills; sexual and relationship education (including experience, knowledge, sexual scripts, orientation; masculinity; relationship skills; understanding of consent): anger management: impulse control; empathy; prior victimisation: substance misuse; self-esteem; self care skills;

87 Working towards my New Life
U D L E S N W I F OLD LIFE Intervention and Planning with Young People who Sexually Harm 2011

88 Intervention and Planning with Young People who Sexually Harm 2011
Have my own place Achievement Security Being my own person Feel close to my Mum and Dad A family of my own Having people in my life Being healthy - emotional health – less stress Having people in my life Kevin’s New Life Rich Achieving -status Lots of girlfriends Own my own garage Having people in my life – intimacy Achievement - status Being healthy – sexual satisfaction Achievement – status Being healthy -emotional well being – control - respect Intervention and Planning with Young People who Sexually Harm 2011

89 Barnardo’s Core Presentation Slide No. 89
Thursday, 06 April 2017

90 Barnardo’s Core Presentation Slide No. 90
Thursday, 06 April 2017

91 Barnardo’s Core Presentation Slide No. 91
Thursday, 06 April 2017

92 FAMILY WORK

93 Common issues / experiences
intense fear of having failed in parenting; shock and denial; guilt, shame and self-blame; isolation and stigma; feelings of loss and grief; uncertainty and confusion about sex and sexuality; and feeling powerless and out of control, especially in the face of professional systems and intervention. (Hackett 2001)

94 Family assessments Aspects of family history and functioning which may predispose the young person towards engaging in sexually harmful behaviour Knowledge and understanding of the behaviour (including family’s reaction to behaviour and empathy towards victim) Providing boundaries to avoid situations of risk (including setting and maintaining family rules, boundaries around protection) Full developmental history of the child Observations about the child’s sexual behaviours attitudes Attitudes towards sex and sexuality within the family Motivation to co-operate with the work and support the young person (Calder 1999)

95 Areas of intervention / support
Provision of immediate crises support for the family, especially offering identifying sources of emotional support to reduce isolation, shame, victim blaming, withdrawal, loss of parental functioning. Enlisting parental agreement and engagement for both them and their child in assessment process Provision of information and educative help about normal sexual behaviour, understanding consent, abusive sexual behaviour and its effects. Provision of information as to how parents can most helpfully respond to both the victim and the abuser, particularly when both are in the same family. Establishing (where viable) home safety agreements to monitor and supervise the young person and protect victims. This might include: separate sleeping arrangements; privacy rules; increased parental checks; restrictions on children being alone together when unsupervised; limits on horseplay and wrestling; monitoring TV, video, computer and mobile phone access; and expectations around dress. Engaging parents/caregivers in the action planning/review process from the outset.

96 Engaging parents/ carers in longer-term work to increase openness and emotional expressiveness within the family; clarify, consolidate or restore appropriate parental and child roles; identify family strengths and needs; acknowledge and interrupt abusive family patterns; increase parental skills, confidence and competence in promoting accountable behaviour within the family and in handling negotiation and conflict; assist in apology or restorative work between abuser and victim; enhance the protective capacity, especially in relation to boundary- setting; assist them to positively structure the young person’s time and activities in terms of peer and social activities; re-negotiate family relationships and address the transitions where it is not possible for the young person to return home, in order to clarify, maintain or improve contact with the family and enable the family to be a source of continuing support and significance (Duane and Morrison, 2004).

97 RISK MANAGEMENT

98 Local protocols Frame Guidance for under 18s (on Scottish Government / WSA website) a child development perspective necessary balance care needs and risks Will be updated in 2014 with information about Care and Risk Management Processes (2014) Experience of MAPPA – Rigby and Whyte (forthcoming) Growing literature on impact of SOR on adolescents in US (Letourneau and Armstrong, 2008; Human Rights Watch, 2013)

99 Key Resources National Youth Justice Practice Guidance (Chapter 7) available at Frame under 18 guidance Hackett, Simon, (2001). Facing the Future: A Guide for Parents of Young People Who Have Sexually Abused. Russell House Publishing Safer Lives Manual (available from CYCJ) O’Reilly, G., Marshall, W. L., Carr, A. & Beckett, R. C. (2004) (eds.) The Handbook of Clinical Intervention with Young People who Sexually Abuse, East Sussex, Brunner-Routledge

100 References Glasgow, D., Horne, L., Calam, R. & Cox, A. (1994). Evidence, incidence, gender and age in sexual abuse of children perpetrated by children: towards a developmental analysis of child sexual abuse. Child Abuse Review, 3, 196/210. Letourneau, E. J. and Miner, M. H. (2005), ‘Juvenile Sex Offenders: A Case against the Legal and Clinical Status Quo’, Sexual Abuse: A Journal of Research and Treatment, Vol. 17, No. 3, July 2005 Radford, L., Corral, S., Bradley, C., Fisher, H., Bassett, C., Howat, N., & Collishaw, S. (2012). Child abuse and neglect in the UK today. London: NSPCC. Richardson, G. (2009). Sharp practice: The Sexually Harmful Adolescent Risk Protocol. In M. C. Calder (Ed.), Sexual abuse assessments: using and developing frameworks for practice. Dorset, England: Russell House Publishing.

101 Contact Details Lorraine.johnstone@strath.ac.uk


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