Presentation on theme: "Working with children and young people who display harmful sexual behaviour Stuart AllardyceCYCJ/ Barnardo’s Lorraine Johnstone CYCJ / F-CAMHS."— Presentation transcript:
Working with children and young people who display harmful sexual behaviour Stuart AllardyceCYCJ/ Barnardo’s Lorraine Johnstone CYCJ / F-CAMHS
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 Aims and Objective
Adolescent Harmful Sexual Behaviour – An Epidemic?
This never used to happen in the past, did it?
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 3 basic errors to avoid (Letourneau and Miner, 2005)
Between 1/5 and 1/3 of all cases of sexual abuse in the UK involve children or young people as perpetrators (Hackett, 2004)
Criminal Justice statistics Child protection research (Glasgow et al 1994) Victimisation studies (Radford et al 2012) Sources
H Number of recorded crimes in Scotland (all ages) (Police Performance Framework, Nov 2013)
Number of recorded crimes (8-17)
Glasgow et al 2004
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. Radford et al. (2012)
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
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.)
Joel is 14 and has had sexual intercourse with his 8 year old sister on 6 occasions
Amy, age 5 asks her classmates if they want to have sex with her
Kobe, age 16 is pressurised into sending a picture of his penis to his classmates' mobile phones
Simon, age 11 exposes his genitals in the local park with the intention of being seen by passers-by
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? Key Questions
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) Definition – Harmful Sexual Behaviour
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) Understanding heterogeneity
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) Useful resources
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. Significant recent studies
For young people with harmful sexual behaviour, what proportions have been abused? Data on 492 children and young people referred to services in Scotland in relation to HSB, 2004 – 2008 Suffered abuse Suspected of suffering abuse Not known
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
How many are boys? Girls Boys N= 492
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
Hutton, Whyte 2006 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
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
Age of onset
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. Key Messages
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.
Review of 56 recidivism studies Overall sexual recidivism rate of 12.4% Some Factors linked to recidivism (Richardson, 2009)
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 Langstrom, 2002 Langstrom and Grann, 2000 Rasmussen, 1999 Worling, 2002 Epperson et al., 2005 Rombouts, 2005 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 Poole et al., 2000 Santman 1998
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 Khan and Chambers, 1991 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)
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
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? A Good Assessment Should Answer the Following Questions :
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 A Good Assessment will include…
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
Assessment tools Commonly used in UK AIM2 J-SOAP II ERASOR SHARP Less Commonly used MEGA J-RAT J-SORRAT J-RAS AR-RSBP
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
Scale 1: Sexual Drive/Preoccupation Scale Scale 2: Impulsive, Antisocial Behavior Scale Scale 3: Clinical/Treatment Scale Scale 4: Community Stability/Adjustment
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 SHARPS
MEGA Aggregates 1.Neuropsychological 2.Family 3.Antisocial 4.Sexual Incident 5.Coercion 6.Stratagem 7.Relationship 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:
LSCMI – Roll out across Scotland Criminal and Youth Justice
Narrow conceptualisation of SPJ Risk factors rated for presence Numerical coding Cumulative Risk Models Adjusted-Actuarials Ecological Fallacy
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
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
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.
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?
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.
Reliance on Delinquency Models Jake Henry Jenny
“The Hubble hypothesis and the developmentalist’s dilemma” (Richters, 1997)
Heterogeneity and Homogeneity Low intelligence Emotional congruence Poor supervision
Heterogeneity and Homogeneity Homicidal ideation Interpersonally dominant Sexual deviation (sadomasochistic)
Principles What is the context of the risk assessment? –What? –Where? –When? –How is it to be used?
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?
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
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
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.
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%).
What works in intervention 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 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).
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 Requirements in relation to work with young people who display harmful sexual behaviours
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; Common Treatment Goals
OLD LIFE 87 Intervention and Planning with Young People who Sexually Harm 2011
Have my own place A family of my own Lots of girlfriends Own my own garage Feel close to my Mum and Dad Rich Kevin’s New Life Having people in my life – intimacy Achievement - status Being healthy – sexual satisfaction Having people in my life Being healthy - emotional health – less stress Achievement Security Being my own person Having people in my life Achieving -status Achievement – status Being healthy -emotional well being – control - respect 88Intervention and Planning with Young People who Sexually Harm 2011
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) Common issues / experiences
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) Family assessments
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. Areas of intervention / support
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).
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)
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 Key Resources
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. References