Caregiving for Children with Sexual Behavior Concerns

Caregiving for Children with Sexual Behavior Concerns

The Power of Partnership
The Alliance for Child Welfare Excellence is Washington’s first comprehensive statewide training partnership dedicated to developing professional expertise for social workers and enhancing the skills of foster parents and caregivers working with vulnerable children and families.

Acknowledgements Parts of this training were used with permission and in collaboration with the Child Welfare Training Institute at the University of Southern Maine based in part on the training Working with Children Exhibiting Sexual Behavior Problems. Thank you! to the many Social Workers and Child Welfare Professionals for their contributions. For more information, please contact: University of Southern Maine Muskie School of Public Service Child Welfare Training Institute 295 Water Street, Augusta, Maine 04330 Parts of this training were used with permission and in collaboration with the Child Welfare Training Institute at the University of Southern Maine based in part on the training Working with Children Exhibiting Sexual Behavior Problems. Thank you! to the many Social Workers and Child Welfare Professionals for their contributions. For more information, please contact: University of Southern Maine Muskie School of Public Service Child Welfare Training Institute 295 Water Street, Augusta, Maine 04330

Competencies CCW Understands the need to develop plans and procedures to avoid DLR/CPS involvement; knows how to identify and seek services and supports available in the event of a CPS allegation. CCW Has the knowledge to distinguish between urgent questions or needs, critical incidents and emergencies and seek appropriate assistance (CA, police, fire, ambulance). CCW Understand the value of effective communication and engagement with the child welfare team. CCW Knows to listen and validate when a child discloses information related to CA/N; understands the need to report information to intake and social worker; knows to not conduct child interviews. CFAM Understands and recognizes effects of poverty, trauma, and maltreatment and to identify resultant developmental delays. CFAM Understands the need to identify and seek services, supports or training available to develop the skills needed to support and help to heal the emotional trauma of children in care. The Alliance’s trainings are competency based. Please take a moment to review the competencies associated with this training. You can also review the full list of training competencies at the Alliance website:

Competencies CFAM Knows how to encourage everyone in the home be respectful; how to provide appropriate nurturing and empathy to children. CFAM Understands how to provide structure and predictability for a child who has been maltreated. CFAM Understands when children are emotionally distressed and knows to respond with a focus of care, attention and skill building. CFAM Understands the importance of and need for a high level of supervision in the caregiving home. CFAM Understands the skills necessary to address crisis/severe behavior problems in the home: knows ways to de-escalate dangerous situations and keep everyone in the home safe; follows agency policy on nonphysical restraint of children in care. CFAM Knows and understands the influences/triggers on a child’s behavior including: developmental challenges, behavioral emotional challenges, past abuse, neglect, separation, and placement.

Competencies CFAM Understands the effect on the family of being a care provider. CFAM Understands the skills necessary to provide care to children who have special needs: developmentally delayed, or emotional and/or behavioral issues. CFAM Knows how to help children and youth with the development of a healthy sexual identity. CFAM Knows how to care for a child who is experiencing the behavioral, emotional and/or developmental effects of sexual abuse. CSELF Understands the need to seek, receive and understand all relevant placement information prior to accepting placement of a child in the caregivers home.

Agenda Part 1: Exploring Family Values and Beliefs (Yours and the child in your care) Part 2: Typical Sexual Development and “Red Flags” Part 3: Experiences that Can Lead to Sexual Behavior Problems and Their Effects on Children and Adolescents Part 4: Parent’s Role in Promoting Healthy Sexuality Part 5: Safe Family Living Part 6: Intervening with Sexual Behavior Problems

https://allianceforchildwelfare.org/
Housekeeping MORE TRAINING Child Development Effects of Abuse and Neglect on Child Development Caregiving for Children with Physically Aggressive Behavior Concerns Paper Trail: Documentation Training for Foster Parents Many more topics! A few housekeeping items before we begin: RESPECT – today’s training is going to cover very sensitive topics: Sex, sexual abuse, and sexual behaviors. In today’s training, we will commonly refer to “children who struggle with Sexual Behaviors” rather than “Sexually Aggressive Youth”. It is important to know the majority of children who struggle with sexual behaviors do not receive the full assessment as being “Sexually Aggressive Youth” Unless you have confirmed your child has this assessment, it is best to avoid using the SAY term. While “Sexually Aggressive Youth” is an official assessment and term, we want to be careful not to encourage caregivers to treat children as if their assessment, diagnosis, or behavior is all that they are. It is important to respect the child, youth, or person who has survived sexual abuse The purpose of todays training is to help educate caregivers to support the children and youth in their care, while also meeting their specialized needs A few OTHER housekeeping items: Restrooms are here We will take breaks If you are interested in taking more training on Child Development, the Effects of Abuse and Neglect on Child Development, for Children with Physically Aggressive Behavior Concerns, and many other topics, check out the Alliance website at

Part 1: Exploring Family Values and Beliefs (Yours and the child in your care)
Guiding Principles Sentence Completion Exercise True-False Quiz Impact of Trauma, Abuse and Neglect on Development Trauma Principles How Severely a Child is Impacted by Sexual Abuse Selected Definitions Unit 1: Exploring Family Values and Beliefs (Yours and the child you are caring for) In Part 1, we ask caregivers to focus on their attitudes and beliefs that will affect fostering a child with sexual behavior problems. Caregivers should be aware of their own values and beliefs regarding sex, sexual abuse, victims, perpetrators, and other issues so they may accurately assess their own strengths and weaknesses in fostering a child with sexual behavior problems. Part 1 also serves to expose the participant to the wide array of vocabulary they will encounter when they enter into several collaborative relationships with treatment, legal, and other professionals involved with children with sexual behavior problems. In this section, we will cover: Guiding Principles Sentence Completion Exercise True-False Quiz Impact of Trauma, Abuse and Neglect on Development Trauma Principles How Severely a Child is Impacted by Sexual Abuse Selected Definitions

Part 1 Learning Objectives
Know your expectations and assumptions Know your values and beliefs on issues regarding sexuality Learn characteristics of foster parents effective in caring for children with sexual behavior problems MORE

Know vocabulary and terms, including legal terms, regarding sexual abuse and sexual behavior Know some statistics about child maltreatment and child sexual abuse Recognize the damaging effects of labeling

Guiding Principles Children are more than the sum of their behaviors and history. Every child is both vulnerable and resilient and possesses strengths upon which interventions are based. As a way to assess your family values, beliefs, and comfort level with this topic, we are going to review some Guiding Principles for those working to support children struggling with sexual behavior problems. As we review each principle, please take a moment to reflect and see if you agree with the statement or if there is any part that is uncomfortable or wrong for you. It is important to consider our beliefs and values here as they will have a strong impact on any child placed in your care.

Guiding Principles There are children whose sexual behavior problems can be safely managed in the foster home setting.

Guiding Principles Foster parents are essential members of the treatment team and are central to decisions impacting the child.

Guiding Principles Continuous open communication and teamwork are the key to effective therapeutic foster parenting. Each child with sexual behavior problems is unique and requires individualized assessment, treatment, and intervention strategies. Talk to the child’s Social Service Specialist to discuss all formal assessments All children deserve emotional support and nurturance. Stress that Caregivers need to follow the Social Workers lead around formal assessments and plans

Guiding Principles Effective interventions and meaningful relationships can lead to safe management and resolution of sexual behavior problems. Children adapt and change, so foster parents must adapt and change, as well. Safety of children and the community is CENTRAL to all decisions and interventions of the treatment team.

Guidelines Take responsibility: To get what you need
To have a good learning experience To take care of yourself Openness, respectful, open-minded listening Confidentiality (See next slide)

Washington DSHS Confidentiality Rule
WAC Information may only be shared with: People directly involved in child’s case plan You may discuss ONLY with DCFS, DLR staff and state fire marshal; child-placing agency; GAL; others as directed by worker When in doubt, ALWAYS check with your child’s worker To finish our thoughts on Confidentiality and respect, lets take a look at the Washington Administrative Code (WAC) related to confidentiality.

Sentence Completion Activity
HANDOUT – Sentence Completion Activity HANDOUT –Sentence Completion Activity (15 mins) Let’s take a few moments to get to know the people at our tables while applying some of these guiding principles. Each person read the sentence and then finish the sentence when you get to the end. The next person will read the next sentence, and will finish it at the end also. We will keep going around the table until we are all done. After about 10 minutes we will pull back to the large group, and I will ask for 1 person from each table to report out 1 thing they learned or that was new from this acitivity. Sentence Completion Exercise One thing I already know about children with sexual behavior problems is… Some feelings I have when children act out sexually… What I want to know is… If you are fostering a child with sexual behavior problems, how did you first learn of these behaviors? My feelings about children masturbating are… My family taught me ____ about sex, and now… One thing I know about child sexual abuse is… Some feelings I have about child sexual abuse are… I want to know… My greatest fear about fostering a child with sexual behavior problems is… My concerns about impact on my family are… I cope with challenging situations by… I have some questions about my own ability to handle this, but the one that is most important is… The strengths I can offer a child with sexual behavior problems are… My own challenges are… I know that I also need to… Adapted with permission from Peterson, Cheryl, Preparing for Success, Illinois Department of Children and Family Services, 1993

True/False Quiz What do we know about sexuality and today’s youth?
9 Questions If the answers surprise you, we can provide you the citations so you can read more! Trainer – the citations are listed in the notes of each answer.

True or False? Approximately 1 in every 4 girls and 1 in every 6 boys are sexually abused before age 18.

Approximately 1 in every 4 girls and 1 in every 6 boys are sexually abused before age 18.
TRUE. Nearly 70% of all reported sexual assaults (including assaults on adults) occur to children ages 17 and under. An estimated 39 million survivors of childhood sexual abuse live in America today. APPROXIMATELY 1 IN EVERY 4 GIRLS AND 1 IN EVERY 6 BOYS ARE SEXUALLY ABUSED BEFORE AGE 18. True Nearly 70% of all reported sexual assaults (including assaults on adults) occur to children ages 17 and under. An estimated 39 million survivors of childhood sexual abuse exist in America today. Source: Hopper, J. (1998). Child Sexual Abuse: Statistics, Research, Resources. Boston, MA Boston University School of Medicine.

Children are usually sexually abused by a stranger.
True or False? Children are usually sexually abused by a stranger.

Children are usually sexually abused by a stranger.
FALSE. 30-40% of victims are abused by a family member. Another 50% are abused by someone outside of the family whom they know and trust. Approximately 40% are abused by older or larger children whom they know. Only 10% are abused by strangers. CHILDREN ARE USUALLY SEXUALLY ABUSED BY A STRANGER. False 30-40% of victims are abused by a family member. Another 50% are abused by someone outside of the family whom they know and trust. Approximately 40% are abused by older or larger children whom they know. Only 10% are abused by strangers. Source: US Department of Justice. (1997) and Finkelhor and Ormond. (2001).

Most children tell someone about their abuse.
True or False? Most children tell someone about their abuse.

Most children tell someone about their abuse.
FALSE. Many children do not report that they have been abused. Evidence that a child has been sexually abused is not always obvious. Young victims may not recognize their victimization as sexual abuse. Almost 80% initially deny abuse. Only about 1 in 200 reports of sexual abuse made by children is a fabrication. MOST CHILDREN TELL SOMEONE ABOUT THEIR ABUSE. False Evidence that a child has been sexually abused is not always obvious, and many children do not report that they have been abused. Over 30% of victims never disclose the experience to ANYONE. Young victims may not recognize their victimization as sexual abuse. Almost 80% initially deny abuse or are tentative in disclosing. Of those who do disclose, approximately 75% disclose accidentally. Additionally, of those who do disclose, more than 20% eventually recant even though the abuse occurred. Fabricated sexual abuse reports constitute only 1% to 4% of all reported cases. Of these reports, 75% are falsely reported by adults and 25% are reported by children. Children only fabricate ½% of the time. Source: Hanson, R.F., Resnick, H.S., Saunders, B.E., Kilpatrick, D.G., & Best, C. (1999). Factors Relating to the Reporting of Childhood Sexual Assault. Child Abuse and Neglect, (23) ; FBI Law Enforcement Bulletin

Sexually abused children primarily have emotional reactions.
True or False? Sexually abused children primarily have emotional reactions.

Sexually abused children primarily have emotional reactions.
FALSE. Victims are more likely to have physical health problems. Victims report more school problems. Victims are more likely to experience major depressive disorders as adults. Young girls who are sexually abused are more likely to development eating disorders as adolescents. Victims are 2.5 times more likely to develop alcohol abuse issues. SEXUALLY ABUSED CHILDREN HAVE BOTH EMOTIONAL AND PHYSICAL REACTIONS TO THEIR ABUSE. True Children who have been victims of sexual abuse are more likely to experience physical health problems (e.g., headaches). Victims of child sexual abuse report more school problems than non-victims. Victims of child sexual abuse are more likely to experience major depressive disorder as adults. Young girls who are sexually abused are more likely to develop eating disorders as adolescents. Children who have been sexually abused are 2.5 times more likely develop alcohol abuse. Children who have been sexually abused are 3.8 times more likely develop drug addictions. Adolescents who suffer violent victimization are at risk for being victims or perpetrators of felony assault, domestic violence, and property offense as adults. Nearly 50% of women in prison state that they were abused as children. Sources: National Institute on Drug Abuse 2000 Report & Child Abuse & Neglect Study by Arthur Becker-Weidman PhD and National Clearinghouse on Child Abuse & Neglect Information. Long-term Consequences of Child Abuse & Neglect 2005

A child who is sexually abused always proceeds to abuse others.
True or False? A child who is sexually abused always proceeds to abuse others.

A child who is sexually abused always proceeds to abuse others.
FALSE. This is a widespread myth not supported by any scientific evidence or research. Studies have shown that the majority of sex offending adults have NOT been sexually abused as children. Victims of childhood sexual abuse are NOT more likely than non-victims to be arrested for sex offenses. A CHILD WHO IS SEXUALLY ABUSED ALWAYS PROCEEDS TO ABUSE OTHERS. False There is widespread belief that child sexual victimization leads to sex offending. Often referred to as “The Cycle of Sexual Abuse” this myth is perpetuated in the media, in the courts, and throughout child welfare literature. Does research support this belief? The following comes from the United States General Accounting Office. The GAO found that: There was no consensus among the 23 retrospective and 2 prospective studies reviewed, that childhood sexual abuse led directly to the victim becoming an adult sexual abuser; Although some of the retrospective studies concluded that childhood sexual abuse may increase the risk that victims will commit sexual abuse later, most of the studies noted that the majority of sex offenders had not been sexually abused as children; The prospective studies, which tracked sexually abused children into adulthood to determine how many became sex offenders, studied sample populations that may not be representative of the entire population of childhood sexual abuse victims; and The prospective studies found that victims of childhood sexual abuse were not more likely than non - victims to be arrested for sex offenses.

Online enticement of children occurs about 10% of the time.
True or False? Online enticement of children occurs about 10% of the time.

Online enticement of children occurs about 10% of the time.
FALSE. Based on a survey of 1,501 teens and preteens, 19% received unwanted online requests to engage in sexual activities or to provide intimate sexual information, within the last year. In 15% of those incidents, approximately 35 youth, solicitor attempted to contact the youth in person, over the telephone, or by mail. ONLINE ENTICEMENT OF CHILDREN OCCURS ABOUT 10% OF THE TIME. False Based on a study of 1,501 teens and preteens, 19% of the young people surveyed received unwanted online requests to engage in sexual activities or to provide intimate sexual information in the last year. In 15% of those incidents (approximately 35 of all the youth), the solicitor attempted to contact the youth in person, over the telephone or by mail, incidents the study called “aggressive solicitations.” Less than 10 percent of these sexual solicitations were reported to authorities such as a law-enforcement agency, an Internet service provider, or a hotline. Most families do not know where to report Internet offenses. Source: David Finkelhor, Kimberly J. Mitchell, and Janis Wolak. Online Victimization: A Report to the Nation’s Youth. Alexandria, Virginia: National Center for Missing & Exploited Children, 2000

Most people who sexually abuse have multiple victims.
True or False? Most people who sexually abuse have multiple victims.

Most people who sexually abuse have multiple victims.
TRUE. Nearly 70% of child sex offenders have between 1 and 9 victims At least 20% of child sex offenders have 10 to 40 victims. MOST PEOPLE WHO SEXUALLY ABUSE HAVE MULTIPLE VICTIMS. True Nearly 70% of child sex offenders have between 1 and 9 victims; At least 20% have 10 to 40 victims. Source: Bolen, R. & Scannapieco, M. (1999). Prevalence of child sexual abuse: A corrective meta-analysis. Social Service Review, 73,

True or False? Growing up in a violent home may lead to sexual behavior problems, even if there was no sexual abuse in the family.

Growing up in a violent home may lead to sexual behavior problems, even if there was no sexual abuse in the family. TRUE. Additional risk factors include: Incidents of trauma Neglect Exposure to domestic violence Physical abuse GROWING UP IN A VIOLENT HOME MAY LEAD TO SEXUAL BEHAVIOR PROBLEMS, EVEN IF THERE WAS NO SEXUAL ABUSE IN THE FAMILY. True There are risk factors other than sexual abuse history. Incidents of trauma to include physical and sexual abuse, neglect, exposure to domestic violence and other experiences almost universally appear in the histories of adolescents who later develop offending behaviors. Risk factors will be the topic of discussion in a future unit. Source: McMackin, Leisen, Cusack, LaFratta and Litwin, 2002

Sexual offense rates are higher than ever and continue to climb.
True or False? Sexual offense rates are higher than ever and continue to climb.

Sexual offense rates are higher than ever and continue to climb.
FALSE. Actual rate of reported sexual assault has decreased slightly in recent years. Rate of reported rape among women decreased by 10% from 1990 to 1995 Arrest rates for all sexual offenses dropped 16% between 1993 and 1998. SEXUAL OFFENSE RATES ARE HIGHER THAN EVER AND CONTINUE TO CLIMB. False Despite the increase in publicity about sexual crimes, the actual rate of reported sexual assault has decreased slightly in recent years. The rate of reported rape among women decreased by 10% from 1990 to 1995 (80 per 100,000 compared to 72 per 100,000). In 1995, 97,460 forcible rapes were reported to the police nationwide, representing the lowest number of reported rapes since 1989. More recently, when examining slightly different measures, it appears that rates have continued to drop. The arrest rate for all sexual offenses (including forcible rape and excluding prostitution) dropped 16% between 1993 and 1998. In 1998, 82,653 arrests were logged for all sexual offenses, compared to 97,955 arrests in 1993. Source: Greenfeld, Federal Bureau of Investigations, 1997 and 1998.

Definitions and Terms Handout Trauma Consent Compliance Cooperation
Sexually Abusive Behavior Abuse Reactive Behavior Juvenile Sex Offender Enmeshed Post Traumatic Stress Disorder Developmentally Appropriate Behaviors Sexual Misconduct Coercion Sexual Offender Pedophile Transference Counter Transference Ritualistic Abuse Sexual Exploitation Pornography Sexualized Behaviors Psychosexual Assessment There are a lot of technical terms and definitions that are often misused or misunderstood when it comes to sexual behaviors, clinical terms, assessments, and legal jargon. We are going to review some of the terms and definitions used in child welfare around these topics.

Trauma “A single event or series of events over time, which can tax or overwhelm a person or community’s resources and sense of wellbeing.” The information in this section was adapted from the Journal of Traumatic Stress, written by Mary Harvey. Definition of Trauma “Trauma: a single event or series of events over time, which can tax or overwhelm a person or community's resources and sense of wellbeing.” Most of us have experienced some type of trauma over the course of our lives, and our responses and recovery processes are all different, based upon various factors in our lives.

How an individual responds to trauma depends on:
The person (age, ethnicity, gender) Event (when, where, with others, number of occurrences, weapons, threats) Environment (where they live, support systems in place, family and police response, relationship to abuser) How an individual reacts to trauma depends on a number of variables in their lives. Three of these variables are: The person (their age, ethnicity, gender) The event (when it happened, where it happened, were there others around, one time or a series, was a weapon used, threats) The environment (where they live, support systems they have, the relationship to the abuser, family response, police response) None of us is immune to experiencing trauma, however much we may try to protect ourselves. We are differentiated by the specific traumas we experience, the personal resources we possess, and the context in which we live. For some, trauma results in devastation of the spirit that is never repaired, with or without therapeutic intervention. For others, a similar trauma, while initially devastating, is blended into the person's totality of experience and they recover successfully, with or without therapeutic intervention.

How Trauma Appears Feeling of helplessness Impacts sense of safety
Why did it happen? PTSD (Post- Traumatic Stress Disorder) Changes in Central Nervous System Sensory Attachments Shame-Based Contagious Perspective Trauma might show up in people’s lives in a number of different ways, which are described briefly below. Remember, that these are just a few of the ways in which people might respond to trauma. Everyone responds to trauma differently, according to who we are and where we have been. Feeling of Helplessness: The feeling of helplessness reorganizes the lives of trauma victims; memories and cues maintain the helpless feeling. Safety: Trauma destroys the victim’s sense of safety; if it happened once, it can happen again. Victims of trauma may expect the worst and view the world that way. Why did it happen?: A victim of trauma may be driven to search for an explanation of why it happened to them: What could I have done differently? Did I deserve it? Could I have stopped it? Can I prevent it from happening again? Post Traumatic Stress Responses: Many survivors of trauma develop Post-Traumatic Stress Disorder (PTSD) similar to war veterans - e.g., flashbacks, hyper-vigilance, startle responses, etc. Changes in CNS: The experience of trauma may temporarily or permanently change the central nervous system; may result in “hyper” behavior seen sometimes in adults and children who have been traumatized. Sensory Experience: Trauma is primarily a sensory experience. Attachments may be severed: Trauma can threaten to or actually eliminate attachments; children wonder why the person who is supposed to protect them is hurting them; trust is lost. Shame-based: Trauma is shame-based; trauma victims feel that they should have been able to prevent it. Contagious: Trauma is contagious; people who hear details of the trauma may experience similar responses, as though they themselves experienced the trauma; other children may get hooked into the ‘post-trauma’ play of the child victim. Perspective: The experience of trauma can be put into perspective; people develop strengths that carry them through life. Therapy may be helpful for many people, but others rely on resources and supports from friends, family, and other types of service providers.

How Severely a Child is Affected by Sexual Abuse
Abuse - Nature and Physical Contact Abuser - Abuser’s age, relationship to child, and how many abusers Child - Age and developmental age The severity of a child’s reaction to sexual abuse depends on these variables: Abuse - Depends on the nature and physical contact of abuse and frequency (acute, episodic or chronic) Abuser - Depends on abuser's age, relationship to child, and how many abusers (usually more damaging if big age difference between abuser and victim and/ or if a trusted adult or in close relationship Child - Depends on the age and developmental age of child (usually more damaging if emotional age is under age 6 or child is emotionally fragile), family situation, adult and family supports, family reaction to disclosure (more damaging if family rejects or ridicules the child’s feelings; disclosure is not accepted by the family; the family is disrupted or dissension is stirred by the disclosure; and/ or the child is rejected or abandoned by the family), child’s experience of and emotional reaction to the events (feared for life, participated, enjoyed it)

Consent Agreement including ALL of these: Understanding Knowledge
Awareness Assumption of equal respect Voluntary, and By a person who is mentally competent. A child cannot give consent (by definition) to sexual activity because of lack of knowledge and maturity. Consent Agreement including all of the following: Understanding of what is proposed based on age, maturity, developmental level, functioning and experience, Knowledge of societal standards for what is being proposed, Awareness of potential consequences and alternatives, Assumption that agreements or disagreements will be respected equally, Voluntary decision, By a person who is mentally competent A child cannot give consent (by definition) to sexual activity because of lack of knowledge and maturity.

Compliance Passive action, no apparent resistance.
Compliance can occur WITHOUT consent. Compliance Passive action without overt resistance in spite of opposing beliefs or desire. Compliance may occur without consent.

Cooperation Participation regardless of beliefs or desire.
Cooperation, like compliance, may occur WITHOUT consent. Cooperation Participation regardless of beliefs or desire. Cooperation may occur without consent.

Sexually Abusive Behavior
Behaviors that involve coercion, threats, aggression, secrecy, or developmentally inappropriate sex acts with or between children Behaviors where one person has an unequal power base Sexually abusive behavior These behaviors involve coercion, threats, aggression, secrecy, or developmentally inappropriate (precocious) sex acts with or between children, or where one participant relies on an unequal power base.

Abuse Reactive Behavior
Pattern of sexualized and/or developmentally inappropriate sexual behaviors Occurs in reaction to past or current abuse OR inappropriate exposure to sexual situations Child who exhibits a pattern of sexualized and/or developmentally inappropriate sexual behaviors that persist despite limit setting or redirection and that are in reaction to past or current abuse, exposure to sexual stimuli, and/or a sexualized, enmeshed relationship with an adult. This may or may not involve physical touch with anyone else and isn’t necessarily abusive. i.e. excessive masturbation, provocative/seductive interactions.

Juvenile Sex Offender Describes youth who has engaged in an offensive sexual act against victim’s will, without consent Often overused term, often used incorrectly to describe a youth with sexual behavior problems May be adjudicated or non-adjudicated.

Enmeshed Overly close relationship in which one person is overly responsive to the emotional life of another, outside of developmental or cultural norms.

Post Traumatic Stress Disorder
Diagnostic label, applied to children and adults, based on continuing reaction to a traumatic event. Symptoms might include flashbacks, nightmare, dissociation, hyper-vigilance, and reenacting trauma.

Developmentally Appropriate Behaviors
Normal or typical behaviors within a particular stage of development.

Sexual Misconduct Behavioral act of engaging in sexually offensive or abusive behaviors Describes the behavior; does NOT label the person.

Coercion The act of forcing or compelling someone to do something
Uses threats, intimidation, power

Sexual offender Common label used to identify someone who has engaged in sexually offensive behaviors. NOT a diagnosis

Pedophile Diagnostic Label Assigned to an adult (16 or older)
Person has primary or exclusive sexual interest and arousal toward children DOES NOT describe all sexual offenders and is often misused

Transference Having feelings awakened or triggered by someone with whom you are interacting Based on past relationships with someone significant

Counter-Transference
Emotional reactions or feelings of a person in a therapeutic role toward someone he or she is working with Involves the therapist’s “own stuff”

Ritualistic Abuse Bizarre, systematic, formalized, repetitive abuse
Mentally, physically, and/or sexually abusive Ritualistic sexual abuse is usually painful, sadistic, and humiliating

Sexual Exploitation Purposefully manipulating or taking advantage of another person to obtain some sexual benefit or sexual gratification.

Pornography Writings, pictures, videos depicting explicit or implied sexual behaviors

Sexualized Behaviors Learned use of sexual behaviors to meet basic nurturance needs. Using sexual behaviors as a way to relate to people. Everyday behaviors and interactions have a sexualized meaning.

Psychosexual Assessment
Specialized assessment Psychologist, psychiatrist, neuro- psychologist usually assesses Assesses inappropriate sexual behaviors, sexuality problems, or sexual abuse concerns or allegations.

Part 2: Normal Sexual Development
and Red Flags What is “normal” Red Flags Part 2 provides information on the typical sexual development of children and adolescents, which usually proceeds in a predictable sequence. To know whether a child’s behavior is sexually abusive or simply curious, one needs to understand normal sexual development. This unit teaches participants that there is a wide range of behaviors considered ‘normal’ or typical. This information is important for participants who are considering a child or adolescent’s sexual behavior and determining what is normal behavior.

Know the range of sexual behaviors considered “normal.” Know the ages and stages of “normal” sexual development. Part 2 Objectives Clarify and explore through group discussion the range of sexual behaviors that are considered normal or typical. Present information on the stages of normal sexual development in children and adolescents.

“What is Normal?” Small group activity (5 mins)
Handout “What is Normal?” Small group activity (5 mins) Your group will be given a flip chart page with an age range on it. You are asked to come up with a list of “normal” sexual behaviors you would see in children of that age range. Large Group Discussion (15 mins) and review of Handout – Stages of Sexual Development What is normal? Use flip charts with age ranges on it, or give each table an age range (0-6; 5-10; 10-12; 12-18) 5 minutes – have the groups discuss among themselves. 10 minutes – have each group report out top answers 5 minutes – review HANDOUT – Stages of Sexual Development Stages of Sexual Development Ages 0-6 Born sexual – boys often born with erect penises, girls with lubricated vaginas Very curious about their bodies Masturbation is a self-soothing activity, and done in public Interested in looking at others’ bodies Interested in physical differences and function of body parts Assume different positions to urinate and copy other positions Bathroom behavior very interesting to them Like to talk about elimination, call each other names using bathroom lingo Preschool ages, in general: Exploratory touching of each other’s private parts if permitted; respond to limit-setting by adults May show genitalia to peers; respond to limit-setting by adults Become more modest and demand bathroom privacy Ages 5-10 Continue to touch and fondle their own genitals, but with more modesty. Boys compare penis size Interested in sex words and dirty jokes Imitate seduction (i.e. flirting or kissing) Genital or reproductive conversations with peers or similar age siblings Age 6 Playing “Doctor” Question ‘Where do babies come from?’ Age 7 Less interest in sex Age 8 Provocative giggling and whispering; ‘Jake loves Sue’ notes passed in class Ages 9-10 Seek sex information Look for books and diagrams to satisfy their curiosity and explain their bodies Swearing Greater interest in children of opposite sex Ages 10-12 Masturbation continues Establishing relationships with peers and may engage in sexual activity like kissing, fondling, whether with same sex or opposite sex Interest in viewing bodies of same or opposite sex, usually in publications Viewing sexually explicit pictures Sexually explicit conversations with peers Ages 12-18 Body has matured Uneven and rapid growth Peers more important than family; tests authority Sexual desire strong Sexual intercourse and/or oral sex Impulse control uneven Questions about sexual orientation, sexual identity Emergence of same sex experimentation Cultural and religious standards affect activity

Red Light, Green Light Green Light Behavior: Healthy sexual play for children 12 and under Yellow Light Behavior: Concern/Possible Intervention Needed Red Light Behavior: Adult supervision and confrontation needed - possibly therapeutic intervention

Green Light Behavior Exploration with children of similar age and size; usually not siblings Voluntary, spontaneous - usually not shame, fear or anxiety Sexual behavior balances with curiosity about rest of their world May still need limits or intervention (Just because it’s normal doesn’t mean it’s OK) Green Light Behavior - Healthy sexual play for children 12 and under is characterized by: Exploration with children of similar age and size Generally mixed gender friends rather than siblings Voluntary, i.e. “I’ll show you mine if you show me yours” Affect is light-hearted, spontaneous, silly, excited (possible confusion and guilt, but not shame, fear or anxiety) Sexual behaviors are balanced with curiosity about other aspects of their worlds May still need limits or intervention by foster parent, but not considered pathological

Yellow Light Behavior Cause for concern/possible intervention needed
Preoccupation with sexual themes Attempts to expose other’s genitals Sexually explicit conversation, graffiti, innuendo Precocious sexual knowledge or language Mutual/group masturbation Simulated foreplay with dolls or peers (clothed) Yellow Light Behavior (Cause for concern/ possible intervention needed) Preoccupation with sexual themes (especially sexually aggressive ones) Attempting to expose other’s genitals (pulling others’ skirts up or pants down), Sexually explicit conversation with peers Sexual graffiti (especially chronic or impacting individuals) Sexual innuendo/ teasing/ embarrassment of others Precocious sexual knowledge or language Single occurrences of: peeping, exposing, obscenities, pornographic interest, rubbing genitals against others or objects Preoccupation with masturbation Mutual masturbation/ group masturbation Simulated foreplay with dolls or peers with clothing on (petting, French kissing)

RED LIGHT BEHAVIOR MORE
Requires adult supervision, confrontation, and therapeutic intervention Sexually explicit conversations with others of significant age difference Touching genitals of others Degradation/humiliation of self or others with sexual themes Forced exposure of others (hazing) Inducing fear/threats of force Sexually explicit proposals Red Light Behavior (Requires adult supervision, confrontation, and possible therapeutic intervention) Sexually explicit conversations with others of significant age difference Touching the genitals of others Degradation/ humiliation of self or others with sexual themes Forced exposure of others’ genitals in the context of hazing (such as pulling down pants or exposing breasts) Inducing fear/ threats of force Sexually explicit proposals/ threats including written notes MORE

RED LIGHT BEHAVIOR Repeated or chronic (or with younger children) peeping, exposing, pornographic interest, rubbing genitals against others or objects Compulsive masturbation (task interruption to masturbate) Female masturbation that includes vaginal penetration Simulated intercourse with dolls, peers, animals, or clothed peers Oral, vaginal, anal penetration of dolls, children, animals Forced touching of genitals Simulating intercourse with peers (nude) Repeated or chronic (or with younger children): peeping, exposing, use of obscenities, pornographic interest, rubbing genitals against others or objects Compulsive masturbation/ task interruption to masturbate Female masturbation that includes vaginal penetration Simulated intercourse with dolls, peers, animals (humping) or children with clothes on Oral, vaginal, anal penetration of dolls, children, animals Forced touching of genitals Simulating intercourse with peers with clothes off

Definite Need For Therapeutic Intervention
Extensive preoccupation with sexual themes Angry, violent, forceful in sexual behavior with others Compulsive sexual behavior; not necessarily enjoyable Age-inappropriate sexual activity Sexual activity with much younger or much older child Definite Need for Therapeutic Intervention Child appears preoccupied with sexual themes for extended periods, often with confused or anxious affect or child appears secretive, anxious, or confused about sexual matters Child is angry, violent, or forceful in his or her sexual behavior toward others, is using objects, or is inserting objects or fingers in other children Child compulsively engages in sexual behaviors, does not seem to enjoy the activity but keeps doing it, or seems to be unable to stop Child is engaged in sexual activity inappropriate for his or her age or sexual activity includes intercourse or oral sex between young children, or child attempts sex with animals Child is involved in sexual activity with a child of a large age difference Based on the work of Gail Ryan and Bernard and Joan MacNamara, Adoption and the Sexually Abused Child, 1990.

Part 3: Experiences That Can Lead To Sexual Behavior Problems And Their Effects On Children And Adolescents Family Risk Factors for Children Developing Sexual Distress and Sexual Behavior Problems Impact on the Foster Family Impact on Development Impact of Fetal Alcohol Syndrome on a Child Effects of Sexual Abuse on Various Developmental Domains In Part 3 we will help participants to identify the kinds of childhood experiences that are associated with sexual behavior problems and to understand the effects of these experiences on child and adolescent development and how they may vary.

Participants will recognize the nature of experiences that can lead to sexual behavior problems in children and adolescents. Participants will know the potential effects of these experiences on development. Objectives Discuss the nature of premature sexual experiences and other abusive experiences that can lead to sexual behavior problems. Identify and discuss behaviors of children and adolescents that are delayed, repetitive, or inappropriate for their age level, due to premature sexual and other abusive experiences.

Group Activity: Brainstorm!!!
Why do children have sexual behavior problems?

Sexual behavior problems may result from:
Sexualized anxiety, not pleasure-seeking Confuse affection with sexualized behavior Making sense of what happened to them Physiological arousal + sexuality = sexualized behaviors May not know what is appropriate Masturbation reduces tension, loneliness, fear, isolation, confusion, anxiety, etc.

Group Activity: Brainstorm!!!
What are some family risk factors for children developing sexual distress and sexual behavior problems? For example - sexual abuse, domestic violence, and physical abuse are common risk factors in children who later develop sexual behavior problems Can you think of others? Certain family characteristics and experiences might lead to sexual confusion, distress, and behavior problems in children. Here are some family risk factors that might lead to a child developing sexual distress and sexual behavior problems: sexual abuse, domestic violence, physical abuse Group Activity: Give the group 5 minutes or so to discuss as a large group, or at their tables, or number them off and use flip charts.

Additional Family Risk Factors May Include:
Exposure to adult sexual activity Access to sexual materials Extreme parental dominance Family sexualizes routine interactions Secrecy is a norm Unclear family roles, unhealthy boundaries and relationships Extreme over- protectiveness Special privileges for one child over another Unequal roles, unequal power Additional Family Risk Factors may include: exposure to adult sexual activity, visual, auditory, or participatory access to sexual materials (videos, magazines, 900 phone numbers and some 800 numbers, Internet) extreme parental dominance not allowing child to have friends; rigid control over friends family sexualizes routine interactions extremely enmeshed, unhealthy attachment between a parent and child secrecy is tolerated and encouraged and is a norm in the family unclear family roles and unhealthy relationships allow a parent to involve a child in keeping secrets from other parent, a parent to confide in a child about the other parent and try to get child to take sides, and/or a child to play one parent against the other (triangulation) extreme over-protectiveness special privileges given to one child over another unequal roles, unequal power, devaluing of certain roles, unhealthy sex roles (boys who are expected to be stoic and self-sufficient and not admit feeling powerless or helpless are more likely to re-enact abuse on others; girls who are conditioned to be submissive are more likely to be victims) MORE

Additional Family Risk Factors May Include:
Inappropriate adult roles for children Parent is jealous of child Isolated from community and supports Extreme reaction to sex education materials Excessive use of alcohol or drugs Intolerance of/denial of/lack of empathy for feelings Lack of consequences for sexual behavior problems Covertly sexualized atmosphere, seen in attitudes toward nudity, privacy, toileting, bathing, sexual teasing, virginity, etc. Additional Family Risk Factors may include: inappropriate adult roles for children; encouraged outside of what is developmentally appropriate parent acting jealous of child isolated from community and supports extreme reaction to sex education or prevention materials non-offending parent minimizes abuse allegations, encourages denial excessive use of alcohol or drugs intolerance of/ denial of/ lack of empathy for feelings lack of consequences for sexual behavior problems covertly sexualized atmosphere - family’s difficulty setting and respecting personal boundaries (examples: sleeping with children without clothes, entering bathrooms unannounced while children bathe, inspecting the developing bodies of pubescent children, confiding in children about sexual and romantic matters and sharing intimate details about their sex lives) reflected in attitudes and behavior about: nudity privacy bathing toileting bedroom and bathroom doors (when open, when closed) masturbation sibling sexual activity- viewed by family as incest or not? virginity sleeping arrangements joking about sex sexual teasing teaching about sex punishment for sexual activity Remember, no one factor deems a family to be predisposed to abuse! It is important to look at the entire family system, not just one risk factor or distorted attitude. All families fall somewhere on a continuum of healthy versus unhealthy attitudes and interactions for promoting healthy sexual development. It is important to determine if families thrive and grow, or whether this behavior or attitude is inhibiting growth and development.

Impact on the Foster Family
LARGE GROUP DISCUSSION: Keeping in mind the risk factors that a foster child may have encountered while in their birth family: How will a child’s experiences in their birth family, impact your family? How will a child’s experiences in their birth family impact how you parent that child? Let’s take a few moments to discuss this information and consider some questions as a group. Keeping in mind the risk factors that a foster child may have encountered while in their birth family, How will a child’s experiences in their birth family, impact your family? How will a child’s experiences in their birth family impact how you parent that child?

Impact of Trauma on Development
Significant developmental delays in one or more areas Can be caused by genetics, prenatal drug exposure, environmental factors, or abuse, neglect, and direct trauma The Nature of Developmental Delay and Disruption Children impacted by abuse or neglect often have significant developmental delays in one or more areas of development. Some delays are caused by genetics. Some are the result of prenatal exposure to drugs or alcohol. Some are the result of poor prenatal care or from situations in which children lived after birth. Some delays are the direct result of trauma, abuse, and neglect. As a result, many children in substitute care will have developmental delays as well as problems with developing healthy self-esteem.

Neurological Impacts of Trauma
Maternal use of alcohol during pregnancy may impact many areas of a child’s development and can result in neurological disorders such as Fetal Alcohol Spectrum Disorder

Physical, cognitive, social & emotional development Intellectual Developmental Disorders (formerly mental retardation) Learning disabilities Intrusive, poor judgment, overly talkative Behavior problems No understanding of cause and effect Some children may behave in sexual ways that could misinterpreted as “aggressive” when they are more related to judgement Impacts of Neurological Damage Physical Development Cognitive Development Social Development Emotional Development Facial malformations, cleft palate, growth deficiencies Mental retardation, learning disabilities Intrusive, poor judgment, overly talkative Behavior problems, lack of understanding of cause and effect

Some children may behave in sexual ways that could misinterpreted as “aggressive” when they are more related to judgement.

When it comes to behavior, consider: CAN’T vs WON’T SKILL vs WILL

Effects of Sexual Abuse
Sexual Behaviors Emotional Social Intellectual Physical Spiritual Moral

Possible Effects: Sexual Behaviors
public and/or excessive masturbation sexual aggression toward children if unsupervised sexual gestures toward peers that escalate toward aggression lack of impulse control unusual interest in sex and sex language inappropriate to age seductive behavior promiscuous behavior inappropriate touching Exhibitionism Peeping sexual behavior with animals/ toys peeing in inappropriate places playing with feces Sexual Behaviors public and/or excessive masturbation sexual aggression toward children if unsupervised sexual gestures toward peers that escalate toward aggression lack of impulse control unusual interest in sex and sex language inappropriate to age seductive behavior promiscuous behavior inappropriate touching exhibitionism peeping sexual behavior with animals/ toys peeing in inappropriate places playing with feces

Possible Effects: Emotional
nightmares night terrors depression anger anxiety phobias hyper-vigilance lack of affect compulsive bathing shame & low self-esteem guilt / sexual guilt (guilt derived from sexual pleasure) fear of abandonment fear of appropriate intimacy fear of school or Y changing rooms need for (too much) control obsessive/ compulsive behavior lack of empathy bedwetting (enuresis) soiling (encopresis) loss of innocence Emotional nightmares night terrors depression anger anxiety phobias hyper-vigilance lack of affect compulsive bathing shame & low self-esteem guilt sexual guilt (guilt derived from sexual pleasure) fear of abandonment fear of appropriate intimacy fear of school or Y changing rooms need for (too much) control obsessive/ compulsive behavior lack of empathy bedwetting (enuresis) soiling (encopresis) loss of innocence

Possible Effects: Social
lack of healthy boundaries with strangers or in dating withdrawal from friends & family controlling fighting obsession with being powerful/ tough fascination with fire/ gore/ violence immaturity play with adults or younger children vs. peers entrenched defenses cruelty to pets fire setting fear of certain gender charming/ flirtatious with adults wearing many layers of clothing regardless of weather not bathing or compulsive bathing weight gain making self look unattractive promiscuity prostitution (95% of teenage prostitutes have been sexually abused) higher rates of juvenile delinquency & sex offending difficulty with attachment & with authority figures Social lack of healthy boundaries with strangers or in dating withdrawal from friends and family controlling fighting obsession with being powerful/ tough fascination with fire/ gore/ violence immaturity play with adults or younger children vs. peers entrenched defenses cruelty to pets fire setting fear of certain gender charming/ flirtatious with adults wearing many layers of clothing regardless of weather not bathing or compulsive bathing weight gain making self look unattractive promiscuity prostitution (95% of teenage prostitutes have been sexually abused) higher rates of juvenile delinquency & sex offending difficulty with attachment & with authority figures

Possible Effects: Intellectual
School failure attention problems/ dissociation frequent absence or tardiness (sometimes with excuses/notes from one parent) Intellectual School failure attention problems/ dissociation frequent absence or tardiness (sometimes with excuses/notes from one parent)

Possible Effects: Physical
Injury STD’s Infections Pregnancy substance abuse (70 – 80% of sexual abuse survivors report excessive use of alcohol & drugs) eating disorders self-destructive behavior don’t trust body sensations high tolerance for pain or accident prone psychosomatic or stress-caused illness Physical Injury STD’s Infections Pregnancy substance abuse (70 – 80% of sexual abuse survivors report excessive use of alcohol & drugs) eating disorders self-destructive behavior don’t trust body sensations high tolerance for pain or accident prone psychosomatic or stress-caused illness

Possible Effects: Spiritual
Loss of hope higher suicide rate helplessness feeling abandoned/ betrayed by God and world - alone and not worthy “hole in soul”/ emptiness vulnerable to fanatical or cult religions or gangs sometimes find sense of higher power and hope through prayer Spiritual Loss of hope higher suicide rate helplessness feeling abandoned/ betrayed by God and world - alone and not worthy “hole in soul”/ emptiness vulnerable to fanatical or cult religions or gangs sometimes find sense of higher power and hope through prayer

Use Your Best Judgement
Be careful not to be overzealous in identifying children with some of these indicators. Any indicator alone does not necessarily mean a child has been sexually abused. These are GENERAL indicators of stress. Severe, extreme and pervasive behaviors may indicate sexual abuse. Verbal disclosure is the best indicator. Be careful not to be overzealous in identifying children with some of these indicators. No indicator alone does not necessarily mean a child has been sexually abused. These are GENERAL indicators of stress. Severe, extreme and pervasive behaviors may indicate sexual abuse. Verbal disclosure is the best indicator.

Part 4: Caregiver Roles in Promoting Healthy Sexuality
Positive Messages to Children about Sex and Sexuality Suggestions for Prevention Education for Children with Sexual Behavior Problems Answering Children’s Questions About Sex: “Can of worms” Part 4: Parental Role in Promoting Healthy Sexuality Children with sexual behavior problems and/or children who were sexually abused have confused emotions about sex and sexuality. Sex may have been used (and may be used by them) for power and control over others. Foster parents need to recognize that sex and sexuality are highly charged issues, and they may see reactions in the child. A common myth is that children who have been exposed to sex at an early age know more than the average child does. On the contrary, the child with premature sexual experiences is often more confused. They have heightened awareness of sex and sexuality but not necessarily the correct information. In Part 4, we will discuss Caregivers’ roles in promoting healthy sexuality Positive Messages to Children about Sex and Sexuality Suggestions for Prevention Education for Children with Sexual Behavior Problems Answering children’s questions about sex: “Can of worms”

Know the issues and messages that can promote healthy sexuality in children. Be able to respond appropriately when children and adolescents discuss their sexual experiences. Explore reasons foster parents MUST talk about sex and sexuality with children Explore ways foster parents can talk about sex and sexuality with children Identify scenarios in which need to educate children about sexuality and boundaries may occur Define positive messages around sexuality

Personal Experiences My parents taught me everything I needed to know about sex. My parents shared this information in a way that was comfortable for me. The messages I received from my parents about sex were: a. That it is something special b. That it is very private and not to be discussed c. They were open and very matter-of-fact.

Personal Experiences My parents encouraged me to ask questions.
I felt comfortable asking questions.

Brainstorm List negative messages children may have received about sexuality from sexual abuse, domestic violence, early exposure to sexual activity, images and language in homes with poor boundaries, substance abuse, neglect, television, internet access.

Additional Questions Do children who have had early exposure to sex know more than children who have not? What possible misinformation and gaps in information might they have? Give examples. What might be the consequences of such misinformation?

Correct Anatomical Terms
Vagina, penis, anus, breast, nipple, buttock, urination, bowel movement, defecation, feces, urine, masturbation, orgasm, ejaculation, semen, sperm Are you comfortable talking about this? What is hard about it?

Wayne Duehn thoughts: “Yes, I know what the words ‘dick,’ ‘cock,’ ‘rod,’ and ‘prick’ mean. I’ve heard them before and at times may have used them myself. But in this family, we will use the appropriate sexual terms when talking about what happened sexually to you and others. This will let you know that I respect you, I am listening to you, and I do care. The words ‘dick’ or ‘prick’ may be the only words you now know and are most comfortable using. That’s OK. I just wanted you to know the reasons why I will use the word ‘penis.’ I want to show you respect and make sure you feel safe.”

Positive Messages to Children About Sex and Sexuality
Handout Positive Messages to Children About Sex and Sexuality Sex and sexuality is normal Feelings, thoughts, and fantasies about sex are a normal part of growing up, and EVERYONE has these feelings Touching yourself is a normal part of sexual activity Sexuality has responsibilities and obligations, and carries ethical and moral considerations HANDOUT – Positive Messages to Children About Sex and Sexuality

Prevention Education for Children with Sexual Behavior Problems
Teach about Different Kinds of Touch Role-Play, Set up a Safety Plan around Touching Problems Personal Space and Boundaries Regular Sexuality Education Birth Control Information STD Prevention Information Teach About Differing Kinds of Touches Even young children understand that some touch hurts (pinching, biting, hitting) and is not allowed. Some touches feel good and are good to give (such as hugs, kisses, handshakes). Other touches may either hurt or feel good, but are not okay. These include when people touch you in your private places or force you into sexual touch. This message will be presented differently depending on the age of the child, but it is a good message for all ages. There are many books and videos addressing this topic that will supplement your message. “Sexual touching between kids or between adults and kids is not allowed and neither are touches that hurt others” are house rules that should be repeated often. Role-Play Or Set Up A Safety Plan Around Touching Problems If a child has an on-going problem with touch, help him set up and practice a plan for the next time. Ask them about their feelings and practice a set response (such as “when I feel I want to hit, I will hit a pillow instead.” “If I feel I want to kiss, I will come to you and ask if it is okay first.”). Use The Idea Of Personal Space To Reinforce Boundaries For young children or children with learning delays, using a concrete exercise may help with the idea of personal space. For example, have the child step into a hula-hoop. “Inside this bubble is your personal space and someone needs to ask permission before they come inside your bubble.” Use whatever language works for you and the child to reinforce the learning. “You are in my personal space.” Or “Don’t go in my bubble without permission.” Don’t Forget About Regular Sexuality Education Talk with children about changes in their bodies and their sexual feelings. As children change, so will their needs for information and skills, so talk to your children regularly. Make it okay to ask about any sexual matters, (even if you don’t know the answer - great chance to role model finding it!) Reprinted with permission from the self-study course Dealing with Sexually Acting Out Behaviors in Foster Care by Aileen McGinnis, Alaska Foster Parent Training Center, Fairbanks, Alaska.

Activity: Answering Children’s Questions About Sex
You will be asked to participate in a group activity regarding how to respond to questions by children about sex. You will survive! (and be better prepared) First, let’s review some guidelines

Guidelines for Responding to Questions About Sex
Answer all the child’s questions about sex and sexuality (unless they are repetitive and you believe the child is becoming over-stimulated by the conversation) Try to understand what the child needs to know and at what developmental level (make sure you understand the question or confusion and look for questions behind questions) Give just the information they are asking for or demonstrating a need for and wait to see if they want to know more.

Guidelines for Responding to Questions About Sex
Give the information honestly, accurately, simply and directly (using correct names for body parts). Let them know by the way you respond that you are open to these kinds of questions on an on- going basis (even if you have some embarrassment) and that sex is a good thing when they are old enough and find someone special with whom to share their intimate and sexual feelings! Your local Planned Parenthood Center has great handouts and workshops about this and you can call them for consultation.

Part 5: Safe Family Living
House Rules Preventing False Allegations of Sexual Abuse Checklist Treatment that occurs in the foster home is one part of reducing and/or managing the child’s sexual behavior problems. The foster parent’s daily role of managing these behaviors involves ensuring safety, setting boundaries and expectations, and enforcing limits. Foster parents should be aware of the importance of offering a safe environment for children with sexual behavior problems, and assuring the safety of everyone in the household.

Participants will identify and practice limit-setting and expectations regarding privacy and boundaries Participants will understand the nature of safety in the home, for the foster child and the entire family Participants will know the approaches for reducing sexual behavior problems in the home setting.

House Rules Privacy Respect, courtesy Supervision Bedrooms, bathrooms
Handout House Rules Privacy Respect, courtesy Supervision Bedrooms, bathrooms Clothing, modesty Horseplay, tickling, wrestling Sexual talk, physical touch Personal touch, personal space, pets Handout - Suggested House Rules for Foster Homes Caring for Children with Sexual Behavior Problems Family members are treated in a respectful and caring manner (you will need to model and teach what this means continuously – do not assume a child knows how to do this). Sexual advances toward others are not acceptable. Supervision: Children with sexual behavior problems must have continuous eyesight supervision (by an identified, responsible adult knowledgeable about their issues) when they interact with other children. Inappropriate sexual behavior is dealt with at the time it occurs in a respectful, direct and firm manner. During adolescence, adjustment of supervision may be necessary to allow for social activities & peer contact. Teens need to be able to progressively earn freedom by demonstrating responsibility. Bedrooms: Children should sleep in their own beds and not share bedrooms. If it is absolutely necessary to share, it should be with a strong, assertive child of similar age or older who has been informed and understands about the sexual behavior problems. Monitors or door alarms should be placed on the bedroom doors of children who have problems staying in their room at night or following safety rules (and/or other children in the house who feel unsafe). A child may be able to earn the privilege of having a roommate or overnight guest or having the monitor removed by making progress and earning trust over time. Except in the case of very young children, family members should knock before entering bedrooms. Care should be taken when tucking children in at night. For children who have been abused in their beds, nighttime may be an anxious transition. Foster fathers may cause anxiety for children, so it may be more comfortable to say good night from the door in the beginning of the placements. Leave lights and doors open for children who are fearful. Playtime with other children should not take place in bedrooms. Bathrooms: One person in bathroom at a time (except for adult with a young child that needs help or supervision) – knock to let someone know you need to use the bathroom. Door closed when using toilet or showering. Children wash own private parts. Privacy: To help children learn the importance of boundaries, emphasize that everyone has the right to privacy. This may include a private spot or drawer that no one should go without your permission or knocking on the bathroom or bedroom door and waiting for permission to enter. Do not search drawers or read diaries without permission. Clothing: It is a good idea to require bathrobes or sweats around your house for all family members. Walking around naked partially clothed or in your underwear may cause embarrassment or anxiety for children. It may also arouse children who are prone to sexually acting out. Identify appropriate dress for different situations as necessary. Children should wear underwear under clothes and not wear clothes that have holes near private parts. Horseplay: Reduce or eliminate horseplay such as tickling or wrestling. While these behaviors are not bad in themselves, tickling can be coercive, and wrestling is often the starting point for more intimate behavior. Children with violated boundaries may feel anxious or coerced during wrestling. Other children may use the guise of wrestling as an excuse to sexually touch other children. Sexually abused or acting out children may find wrestling to be quite sexually stimulating. Instead of wrestling, channel kids into lots of physical activities that are appropriate. Sexual talk: Monitor sexual talk and gestures between children in the home. Talk openly about sexual matters, but make sure it is developmentally appropriate and respectful (it’s important not to treat it as a secret topic). Children who sexually molest others often groom their victims through sexual talk so keep tabs on talk in your house, especially when used as a put down or act of aggression. Keep to a minimum the presence of sexually stimulating materials such as explicit television shows, movies, magazines, music and pornography. Be aware that violent, aggressive and stimulating television shows or video games can raise the tendency toward aggression in children, at least temporarily, and it has been suggested that there is a link to sexual stimulation as well. Talk to children about what is appropriate and supervise children appropriately. Physical punishment: Foster parents are not allowed to use physical punishment with a foster child and are not allowed to use punishment that is cruel or humiliating. This includes your response to sexual behavior problems. Do not use pepper, restraining devices, slapping, or humiliating or hurtful consequences when addressing a child’s behavior. FOSTER PARENTS SHOULD REVIEW THEIR STATE’S RULES AND REGULATIONS REGARDING DISCIPLINE. Personal touch: When children first come into your home, be respectful and, even with young children, ask permission to touch. Address immediately any touch that feels uncomfortable to you or that is hurtful. Children need to know what is not acceptable, but they also need to be sensitized to good, nurturing touch. Go slow. Side hugs, brushing hair, pats on the back, tag: all are less intrusive touches that most children can handle. Allow children to say no to touch and don’t be hurt or cajole children into touches they clearly are uncomfortable with. If children need constant touch or contact with you, set limits for the child. Give a child five to fifteen minutes of sitting on your lap, and then you take a break. Schedule these times throughout the day, so the child gets his need for attention met, but learns to respect boundaries. Talk openly and often about appropriate touch safety and boundaries with all children in the family. This will let everyone know that everything can be talked about and sexual touching will not be kept a secret. Pets: If a child has any known or suspected history of abuse or neglect of an animal/ pet, there must be a supervising adult within eyesight when he/she interacts with the animal/ pet. (The pet cannot sleep with the child in his or her bedroom, for example.) It will be very beneficial to the child if the adult teaches and models proper care, handling, boundaries and love for animals.

Allegation Prevention
Keep your behavior above reproach Rule of three Separate bedroom for foster child No physical punishment Clear house rules around privacy and touching, wrestling, tickling, horseplay Good documentation Family and group therapy Good relationship with caseworker Make sure your behavior is above reproach. Do not sexually abuse, sexually touch, physically abuse, spank or use suggestive language with a child. Secure accurate information upon placement of child. Ask why the child is being placed, ask about behavior problems that are known, and ask about any history of abuse. If a child has been sexually abused, set up an effective safety plan (to be covered in Unit 8). Use the “rule of three”. If a child has a history of sexually acting out, do not leave alone with another child. Never leave the child in an unsupervised babysitting situation. If a child has a history of false allegations, when possible, do not be alone with the child for a long time. Use the rule of three. That means try to have three people in the room such as a parent and two children or two adults and a child. Put foster child in own bedroom. Leave doors open and be within earshot of another parent if you need to talk or be with child in his or her room. Do not use physical punishment. Physical punishment is not allowed in foster care and breeds resentment in children. Be clear about rules of dress, privacy and touching. Set, explain and maintain clear, firm, concise rules on dress, privacy, touching, boundaries, language, and behaviors. Ask permission to touch. Take special caution around bathroom, bedroom and dressing issues. Record any sexual acting out in writing. Send a copy of the report to child’s social worker or therapist and keep a copy for yourself. Reduce your stress. When you are caring for difficult children, schedule in a regular break for yourself. Take care of yourself! You must monitor your own emotions and own stress and get help when you need it. Address issues when they happen. If you are open and confrontative, children will learn that everything can be talked about and secrets about touching are not allowed. Avoid aggressive horseplay, teasing, suggestive or ambiguous language. Avoid sexual language, swearing, comments, whistles, things that may be misinterpreted. Keep touches appropriate: kisses on the cheek, short hugs or side hugs. Avoid lap sitting for older children. Use family and group therapy rather than confidential individual therapy with the child. The secrecy and isolation of one-on-one therapy may encourage manipulative reporting in a child who has a history of false allegations. Reprinted with permission from the self-study course Dealing with Sexually Acting Out Behaviors in Foster Care by Aileen McGinnis, Alaska Foster Parent Training Center, Fairbanks, Alaska. Her sources included Kunstal, Frank “Preventing Allegations of Abuse”, The National Advocate; Sprouse, Jacob, Defensive Parenting, American Foster Care Resources; and McNamara, Bernard and Joan, The SAFE TEAM Curriculum: Preparation and Support for Families Adopting Sexually Abused Children, Family Resources, 1990. An additional step that foster parents can take to reduce the risk of false allegations is to develop and maintain a good relationship with your caseworker. Find a communication strategy and schedule that works for both of you and KEEP IN TOUCH!

Part 6: Intervening with Sexual Behavior Problems
Understanding Different Types of Sexual Behavior Problems Toni C. Johnson’s Continuum of Sexual Behavior Problems Patricia Ryan’s 4 Step Model of Intervention Intervention Skill Building Effective limit setting is one of the most important components of treatment for children with sexual behavior problems and needs to be done consistently whenever children exhibit the behaviors. Because our society is uncomfortable with many sexual behaviors and with talking directly about sex, most parents need to practice setting limits on sexual behaviors in order to be able to do it directly and specifically in a calm, matter-of-fact way. This unit helps participants identify patterns of sexual behavior on a continuum from normal sex play to sexually reactive or molesting behaviors. Parents can then determine how to address these behaviors using a simple 4 step model developed by Patricia Ryan.

Participants will examine the nature of sexual behaviors along the continuum from normal to unhealthy Participants will discuss and practice appropriate parental responses to inappropriate sexual behaviors Participants will learn to set limits effectively on problem sexual behavior in ways that foster healthy boundaries

Understanding Different Types of Sexual Behavior Problems
When a child experiences any trauma, they may respond in a variety of ways: No acting out at all Acting out, but not sexually Acting out sexually, from inappropriate to molesting others Acting out sexually AND other behavior problems

Experts generally agree that sexual behavior problems are best understood and explained using a continuum of behavior approach. We have chosen to use the continuum developed by Toni Cavanagh Johnson. The model we have chosen to utilize in this training was developed by Toni Cavanagh Johnson, Ph.D. Dr. Johnson is considered one of the top experts in this field and has published extensively on materials that assist parents and substitute caregivers in helping children with sexual behavior problems.

Toni Cavanagh Johnson’s Continuum of Sexual Behavior Problems
Group 1: Children who engage in natural childhood sexual exploration. Group 2: Children who are reacting to sexual trauma or events. Group 3: Children who are mutually engaged in the full range of adult sexual behaviors. Group 4: Children who are sexually aggressive toward other children. GROUP ONE: Normal Sexual Exploration Children of all ages show normal sexual behavior based on the discovery and development of their physical and sexual selves. This may include exploring feelings and genitals, interest in language related to sex, and giggling about bathroom related functions. Children involved in normal sexual exploration may do it solitarily or with friends of similar age and size. They more often explore with friends rather than siblings. These encounters are voluntary and often lighthearted, fun, and silly. They do not often include feelings of deep shame, fear or anxiety. For teens, this often involves intense sexual feelings toward others and sexual exploration in relationships. These behaviors may need limits, guidance, or education, but are not considered abnormal or pathological. GROUP TWO: Sexually Reactive Behaviors Group Two exhibits more sexual behaviors than Group One and has a preoccupation with sexuality. Many of these children have been abused or exposed to pornography and sexual stimulation. These children have trouble integrating and understanding such stimulation and express deep shame, guilt, and anxiety about sexuality. Their behavior focuses mostly on themselves. When they involve other children, the difference in age is usually not great and force is not usually involved. These children respond well to therapy and education. When the anxiety is reduced or more age appropriate and less sexually stimulating environments are encouraged, the level of sexual behavior tends to decrease. GROUP THREE: Extensive Mutual Sexual Behaviors These children often approach sexuality as just the way they play and are often more resistant to treatment than Group Two. These children use coercion and manipulation but rarely resort to violence. They are characteristically without emotional affect, meaning they have neither the lighthearted spontaneity of normal children nor the shame and guilt of the sexually reactive children. These children often have a history of severe abuse and abandonment. Sex is a way to relate to their peers. These children need an intensive and rigorous relearning of social skills and peer relationships. These children will also need intensive supervision in the home setting and around other children. GROUP FOUR: Children Who Molest The children in this category go far beyond developmentally appropriate play. They are obsessed with sexual thoughts and engage in a full range of sexual behavior that becomes a pattern, rather than solitary incidents. These children need intensive and specialized treatment. These children often link sexual acting out to feelings of anger, rage, loneliness, or fear. Children with severe offending behaviors choose vulnerable and younger victims. They lack compassion for their victims and feel regret in getting caught, not with hurting another child. Most of these children have severe behavior problems at home and at school and have few friends. For some of these children, their behavior borders on compulsive behavior. Compulsive behavior means the child has lost control over it and has a very difficult time not repeating actions, even when punished or when trying to stop. These children need therapy, strong intervention, combined at times with medication to control these impulses. Examples Four-year-old Jenna climbs into the laps of men she doesn’t know and snuggles up against them. She tries to stick her tongue into the mouth of people who kiss her and makes sexual sounds. She also spends hours sitting on the couch masturbating against her stuffed animals. Jenna is being raised in a very sexualized environment. She lives in a one- bedroom apartment with her 18-year-old mother and her mother’s boyfriend. Her mother treats her as a girlfriend, not as a daughter. Frequently, her mother lets Jenna wear makeup and watch soap operas all day long. She has no age appropriate toys in the apartment and plays with no same-age friends. She sleeps on the sofa bed that her mother and boyfriend have sex on after they think Jenna’s asleep. GROUP Frank is an 11-year-old boy who is in residential care and who often bribes younger children into sexual activity, including oral sex and forced penetration of a child’s vagina or anus with his fingers. He can turn quite threatening with a vulnerable victim, threatening to never talk to him again or hurt him while he is sleeping some night. Once when he was caught sodomizing a younger child, he angrily yelled at the residential worker that he wasn’t doing anything. The staff at an elementary school was thrown into a frenzy when a teacher discovered three ten-year-old boys playing together in the bathroom with their pants down. The boys were attempting to identify which of them could stand farthest from the toilet bowl and still hit it with a stream of urine. Todd and Joey are 9-year-old boys who have been in foster and residential care almost all their lives. They are constantly trying to have mutual and willing sex with each other. These behaviors include sexual touching and oral sex. The group leader has to provide constant supervision and separation of the boys in order to stop the behavior. Even nighttime hours need to be monitored because the boys will sneak out of their bedrooms and climb into each other’s beds. GROUP _____

Example Vignettes Example 1 Four-year-old Jenna climbs into the laps of men she doesn’t know and snuggles up against them. She tries to stick her tongue into the mouth of people who kiss her and makes sexual sounds. She also spends hours sitting on the couch masturbating against her stuffed animals. Jenna is being raised in a very sexualized environment. She lives in a one-bedroom apartment with her 18-year- old mother and her mother’s boyfriend. Her mother treats her as a girlfriend, not as a daughter. Frequently, her mother lets Jenna wear makeup and watch soap operas all day long. She has no age appropriate toys in the apartment and plays with no same-age friends. She sleeps on the sofa bed that her mother and boyfriend have sex on after they think Jenna’s asleep. GROUP ________? Example 1 Four-year-old Jenna climbs into the laps of men she doesn’t know and snuggles up against them. She tries to stick her tongue into the mouth of people who kiss her and makes sexual sounds. She also spends hours sitting on the couch masturbating against her stuffed animals. Jenna is being raised in a very sexualized environment. She lives in a one-bedroom apartment with her 18-year-old mother and her mother’s boyfriend. Her mother treats her as a girlfriend, not as a daughter. Frequently, her mother lets Jenna wear makeup and watch soap operas all day long. She has no age appropriate toys in the apartment and plays with no same-age friends. She sleeps on the sofa bed that her mother and boyfriend have sex on after they think Jenna’s asleep. GROUP

Example Vignettes Example 2
Frank is an 11-year-old boy who is in residential care and who often bribes younger children into sexual activity, including oral sex and forced penetration of a child’s vagina or anus with his fingers. He can turn quite threatening with a vulnerable victim, threatening to never talk to him again or hurt him while he is sleeping some night. Once when he was caught sodomizing a younger child, he angrily yelled at the residential worker that he wasn’t doing anything. GROUP ________? Example 2 Frank is an 11-year-old boy who is in residential care and who often bribes younger children into sexual activity, including oral sex and forced penetration of a child’s vagina or anus with his fingers. He can turn quite threatening with a vulnerable victim, threatening to never talk to him again or hurt him while he is sleeping some night. Once when he was caught sodomizing a younger child, he angrily yelled at the residential worker that he wasn’t doing anything. GROUP

The staff at an elementary school was thrown into a frenzy when a teacher discovered three ten-year-old boys playing together in the bathroom with their pants down. The boys were attempting to identify which of them could stand farthest from the toilet bowl and still hit it with a stream of urine. GROUP ________? Example 3 Four-year-old Jenna climbs into the laps of men she doesn’t know and snuggles up against them. She tries to stick her tongue into the mouth of people who kiss her and makes sexual sounds. She also spends hours sitting on the couch masturbating against her stuffed animals. Jenna is being raised in a very sexualized environment. She lives in a one-bedroom apartment with her 18-year-old mother and her mother’s boyfriend. Her mother treats her as a girlfriend, not as a daughter. Frequently, her mother lets Jenna wear makeup and watch soap operas all day long. She has no age appropriate toys in the apartment and plays with no same-age friends. She sleeps on the sofa bed that her mother and boyfriend have sex on after they think Jenna’s asleep. GROUP

Todd and Joey are 9-year-old boys who have been in foster and residential care almost all their lives. They are constantly trying to have mutual and willing sex with each other. These behaviors include sexual touching and oral sex. The group leader has to provide constant supervision and separation of the boys in order to stop the behavior. Even nighttime hours need to be monitored because the boys will sneak out of their bedrooms and climb into each other’s beds. GROUP ________? Example 4 Todd and Joey are 9-year-old boys who have been in foster and residential care almost all their lives. They are constantly trying to have mutual and willing sex with each other. These behaviors include sexual touching and oral sex. The group leader has to provide constant supervision and separation of the boys in order to stop the behavior. Even nighttime hours need to be monitored because the boys will sneak out of their bedrooms and climb into each other’s beds. GROUP _____

Patricia Ryan’s 4-Step Model of Intervention
Handout Patricia Ryan’s 4-Step Model of Intervention STOP the behavior Define the behavior, specifically and clearly State house rule or expectation about the behavior Redirect the child and/or enforce the consequences Patricia Ryan’s 4 Step Model of Intervention Attitude: Separate the child from the behavior. Know they are behaving inappropriately because they have been hurt and have not gotten the modeling, guidance and limits they need – not because they are bad. They may not understand that what they are doing is wrong or may have difficulty controlling themselves. Strive to teach, not punish or shame. Use words that describe behavior such as “not O.K.” or “against the rules” instead of words that judge the person such as “bad” or “misbehaving” or “nasty”. Stay calm, use simple, direct and few words, set limits firmly, and help child feel your support. Patricia Ryan, Ph.D., has developed a simple technique for confronting children’s sexual behavior problems Stop the behavior – tell child to stop, remove child’s hand, separate the children, have them pull up pants, etc. Define the behavior – describe specifically and clearly what the child is doing that is not okay. The more specific and clear, the better opportunity the child has to change or relearn his behavior. If we react with general anger, the child may interpret our anger as “I’m bad” instead of “What I’m doing is wrong”. Instead of “Stop that!” or “Don’t do that!” or “That’s bad!” try “You are poking Billy’s private parts and that’s not okay.” Or “You are being sexual with the dog and we already talked about how it is not okay.” State the house rule or expectation about this behavior - Don’t lecture; state matter-of-factly with as few words as possible. “In this house…”, or “The rule is…” or “We expect everyone in our family to…” Re-direct the child (let him know what you expect him to do) and/or enforce the consequence – For younger children you can redirect the child to more appropriate behavior. End the encounter on a positive note and praise the child when he/she acts in the way you suggest. If the child is older and this behavior is repetitive, you may wish to set up a consequence and enforce it matter-of-factly and consistently.

Practicing the 4-Step Model of Intervention
HANDOUT – Intervention Skill Building Review one or more of the Situations on the handout as a large group to show the 4 step model, or ask the groups to review specific situations at their tables.

Real-Life Problems What sexual behavior problems have you encountered or do you fear about encountering with the children in your home and/or care?

In Between Behavior Problems:
Support kids to succeed Notice & reinforce appropriate, positive behavior If behavior persists, question whether it is in response to particular situation - offer therapeutic intervention Are these part of a larger pattern of generalized oppositional behavior?

THANK YOU FOR CARING FOR THE CHILDREN IN OUR SHARED COMMUNITY
CONGRATULATIONS! Thank you for completing this training! We hope you have learned more about children struggling with sexual behaviors as well as ways you can support the children in your home, and yourself. THANK YOU FOR CARING FOR THE CHILDREN IN OUR SHARED COMMUNITY

Caregiving for Children with Sexual Behavior Concerns

Similar presentations

Presentation on theme: "Caregiving for Children with Sexual Behavior Concerns"— Presentation transcript:

Similar presentations

About project

Feedback

Log in

Auth with social network:

Caregiving for Children with Sexual Behavior Concerns

Similar presentations

Presentation on theme: "Caregiving for Children with Sexual Behavior Concerns"— Presentation transcript:

Similar presentations

About project

Feedback