Thursday, July 19, 2018

Is there such thing as “sexual harm” or is it always Abuse or Trauma?

Danielle Arlanda Harris, PhD, Deputy Director Research, Griffith Youth Forensic Service, Griffith Criminology Institute, Griffith University
Toni Cash, Manager, Practice Advice and Support Team*
Kerri Wyeth, Manager, Practice Response Team*
Kieran McCartan, PhD, Professor, University of the West of England-Bristol

(*Both teams located within Practice Connect under the Queensland Department of Child Safety, Youth, and Women).

The #metoo movement has been called a watershed moment in the way that we think about, respond to, and prevent sexual abuse and harassment. People are talking, which is fabulous. We want people to talk, but language matters, and we need to use the right words.

The Weinstein “event” has led to an increasing number of “brave men and women” coming forth to share their stories. Those stories have been differentially described as revelations, allegations, accusations, disclosures, and delusions. Similarly, the responses by those alleged to have abused have included denials, excuses, justifications, apologies, lies, and responsibility taking. Individuals have been named, shamed, fired, silenced, and “tried by twitter.”

Talking heads are now engaging in nuanced public discussions about the difference between sexual abuse, sexual assault, sexual exploitation, and sexual harassment. These are not the same thing, they do not have the same consequences, or carry the same penalties, and should not be viewed similarly. We have discussed the semantics of sexual abuse, harassment and the #metoo movement on the ATSA blog before. Here, we consider the specific phrase of “sexual harm.” It is challenging to expect members of the public or non-related professions to understand as well as use terminology correctly when even those in the field struggle with language.

We acknowledge the need to use person first language (Willis, 2018) and are beginning to opt for the apparently clunkier “person convicted of a sexual offense” rather than the more pejorative “sex offender” (or worse “predator”). As Nicole Pittman reminded us recently (ATSA conference, 2017): “they’re worth the extra words.” As we continue to negotiate our use of language, it goes without saying we must navigate both legislation and legal jargon as it is used across numerous jurisdictions in multiple countries but also the most sensitive of topics where euphemisms are rife.

ATSA is an international community. Many of us work and travel abroad often.  One can always get mileage out of the flip flop/thong/g-string situation. Since returning to Australia for example, Danielle has had to relearn the language—both legal and practical—to engage in respectful discourse. It was during this process that she came to learn of the challenges and, in some sectors, very strong views about the use of the phrase “sexual harm.”

“Sexual harm” is frequently used as a catchall phrase intended to include various types of violence, abuse, assault, and harm that results from sexual abuse or violence of a sexual nature. The idea of harm—as opposed to other language (i.e., abuse, trauma, etc.)—comes from the field of Zemiology, based on the idea that “harm” is more proactive and adaptive than other terms. It is thought that it is therefore more helpful for people who have experienced sexual abuse or assault and people who have sexually abused others and/or committed sexual offences to move on. However, the word “harm” is divisive in the field of sexual abuse, especially from the perspectives of criminal justice and victim advocacy groups who argue that “harm” lessens the impact and consequences of exactly what a person experiences as a result of sexual abuse.

According to the Queensland Department of Child Safety, Youth, and Women, the harm that a person experiences as a result of sexual abuse is either:

(1) Emotional/psychological harm,

(2) Physical harm or,

(3) Both emotional/psychological and physical harm.

By way of example,

-       If a 16 year old girl reports to her Child Safety Officer that her arm was broken three years ago during an argument with her stepfather, she would be referred to a medical practitioner to ensure that the arm was set properly and the break has healed (thus treating the physical harm) and would likely also be referred to a counsellor to attend to the emotional stress and trauma caused by the same incident (thus treating the psychological harm).

-       If a 16 year old girl reports to her Child Safety Officer that she was vaginally penetrated three years ago by her stepfather, she should similarly be referred to a medical practitioner for an internal exam to ensure that there is no lasting damage, that her vagina has healed (thus treating the physical harm) and would also be referred to a counsellor to attend to the emotional stress and trauma caused by the same incident (thus treating the psychological harm).

Basically, if we understand the harm to be physical then we can target our intervention to the physical harm. Examples include getting medical treatment for damage to the child’s genitals or anus, or diagnosis and appropriate medication for the sexually transmitted infection that the child has contracted. 

Likewise, if we understand the harm to be emotional then we can target our intervention to the emotional harm. Examples here include providing counselling to help the child understand that it was not their fault that the sexual abuse happened to them; or offering assistance that might also focus on the potential risk that the young person poses to others, including safety planning and counselling. 

To be clear, “sexual violence” describes the behaviour that someone is responsible for committing. The “harm” is the resulting impact on the person who has experienced the sexual violence. Quite simply, when someone experiences violence, their resulting physical harm can be treated by a medical doctor and their resulting emotional harm can be treated by a counsellor. The challenge with the use of the phrase “sexual harm” is that it can lead to confusion over how best to help the actual harm that the person has experienced. By observing the presence of the resulting physical and emotional harm that results from the commission of sexual violence we can offer a clear direction for interventions that best cater to the needs of the individual and the actual harm they have experienced.




Friday, July 13, 2018

Toxic Masculinity and How It Can Inform Treatment with Black Boys

By Tyffani Dent, Psy.D.

I work with adolescents who have engaged in problematic sexual behavior. Many of the clients with whom I work are males. Being that within our juvenile justice system there is an over-representation of those who come from marginalized communities, specifically Black and Brown ones---with many explanations for this given from over-policing, racial profiling, poverty not permitting access to services expect through “systems”, etc.---it is not surprising that a significant portion of those I serve are Black. Taking into consideration that the large majority of sexual offenses committed by juveniles are committed by males (Finkelhor, Ormrod, & Chaffin, 2009) it does not surprise me when clients I serve are overwhelmingly black boys, due to a skewed engagement with the juvenile justice system.

When addressing problematic sexual decisions with the boys I counsel, oftentimes the topic of their own early sexual experiences emerges. In these conversations, there are times when they report initiation to sexual behavior occurring at the hands of much older adolescent or adult females and in some cases, male caregivers. Yet, in these discussions, many of them do not view such interactions as sexual abuse or sexually inappropriate, in part, because my community does not often “permit” our boys access to the concept of it being acceptable to not want sexual contact.

Recently, Terry Crews, a famous Black actor, came out and discussed his own #MeToo moment. He disclosed his own experiences with sexual victimization. While some praised him, others including the Rapper 50 Cent, in a tweet, and Senator Feinstein, in a congressional hearing, gave a response with which I am more familiar with--- 50 Cent viewing Mr. Crews’s victimization as discounting his manhood and Senator Feinstein questioning why a big male such as Mr. Crews did not fight back.   This toxic masculinity, which is the push towards hypermasculinity and belief in traditional male stereotypes, is prevalent within our Black and Brown communities in part because of the historical emasculation of Black males since slavery into Jim Crow. The current climate which we live in continues to downplay options for healthy development of a male identity within the Black and Brown communities due to mass incarceration. Such ingrained hypermasculinity impacts not only the starting point in which one engages with Black boys related to what healthy sexual decisions look like, but also in reframing  discriminatory selection of sexual partners as being empowering instead of a sign of “weakness”.

How should the knowledge of toxic masculinity impact our work with especially Black boys who have engaged in problematic sexual behavior?

  1. Explore early sexual experiences-address and normalize feelings of discomfort around sexual contacts with those who were much older and provide them the language to describe it as unwanted and problematic. Allow them the safe space to process this.

  1. Assist in examining how they define manhood. Where did the definitions come from? How do they inform their views of sex and sexuality? The Young Men’s Work curriculum and the book Dare to Be King offer great resources on beginning this discussion from a gender and a racial context.

  1. Reframe masculinity as being an advocate for healthy relationships and being a catalyst for assisting other males in doing the same.

  1. Examine how (if applicable) these boys own problematic sexual decisions were informed by toxic masculinity/hypermasculinity.

  1. When possible, engage other Black men in their lives who can serve as a model for healthy masculinity. When not readily available, identify movies, books, and other mediums in which there are positive portrayals of black manhood. Interwoven in this should also be those stories of black men and boys who have experienced victimization, struggles with their own identifies, and other traumas---which can provide a framework for further exploration of the impact of trauma and how it may play out uniquely for black boys.



Thursday, July 5, 2018

The assessment and treatment of sex offenders with intellectual disabilities: A work in progress.

By Prof. Kasia Uzieblo & Marije Keulen-de Vos, PhD. (Dutch Chapter of the ATSA, NL-ATSA)
On June 11th NL-ATSA, the Dutch Chapter of ATSA, organized a masterclass on the assessment and treatment of sex offenders with intellectual conjunction with the International Forensic Mental Health Services at the IAFMHS conference 2018 in Antwerp (Belgium).  
A considerable number of sex offenders exhibit intellectual disabilities (ID). These offenders require bespoke assessment, support, and treatment. However, in practice ID and its role in sexual deviant behavior are not always fully recognized nor well understood. To enhance the effectiveness of support and treatment programs for sex offenders with ID, it is of great importance for professionals to be aware of the presence of the ID’s, to understand its influence on (sexual) behavior, and to have knowledge of effective treatment programs.
By organizing this masterclass, we also wanted to honor the works of Prof. William R. Lindsay who unfortunately has passed away in March 2017. William Lindsay had dedicated his career to further our understanding of offending behavior among people with ID and to improve assessment and treatment tools in these offenders. He was mainly passionate about identifying the pathways into forensic services of ID offenders, developing adequate assessment tools and establishing effective, evidence-based treatment programs for these offenders. Notwithstanding his very busy research agenda, he also found sufficient time throughout his career to acquire extensive clinical experience with ID offenders: To honor his invaluable work, the masterclass gave ample attention to Prof. Lindsay’s research throughout all sessions. In order to ensure that in-depth insights into Prof. Lindsay’s views and work would be shared, only presenters who had collaborated with Prof. Lindsay in terms of education and/or research were included in the program.
The presenters of the first session, Prof. Kasia Uzieblo (Thomas More and Ghent University, Belgium) and Dr. Petra Habets (OPZC Rekem, Belgium), focused on the assessment of ID in offenders, a topic that even in books on (sex) offenders with ID is often being overlooked. Given the important consequences of an ID diagnosis in offenders, this observation is rather striking. There is ample evidence showing that the assessment of ID in both research and practice comprise several substantial problems and limitations and does not sufficiently adapt to significant evolutions in intelligence research. The convergent validity of the current measures for IQ (e.g., the Wechsler Scales and the Raven’s Progressive Matrices) exhibits substantial problems. For instance, a study by Habets, Jeandarme, Uzieblo, Oei, and Bogaerts (2014) showed that despite positive correlations among intelligence measures, differences between scores on repeated and different IQ measures of 10 points and more occur far too often. In addition, current intelligence measures seem to not sufficiently tap into the various intellectual abilities as described in current theoretical frameworks of intelligence, including the Cattell-Horn-Carroll Model (CHC-model). Another assessment problem arises when taking into account the second diagnostic criterion of ID, i.e. deficits in adaptive functioning. In contrast to previous editions, the fifth version of the Diagnostic and Statistical Manual for Mental Disorders as well as the upcoming 11th edition of the International Classification of Diseases (ICD-11) underline that it is not the IQ score but rather the level of adaptive functioning that determines the level of support needed. Hence, a reliable assessment of adaptive functioning on the conceptual, social and practical domain becomes of utter importance. However, adaptive functioning is often neglected in the assessment procedures or is not sufficiently taken into account when diagnosing ID. This problem might be intertwined with another issue: There is a lack of reliable, valid, and comprehensive measures for adaptive functioning. Unfortunately, this is not all. Many additional problems, including the lack of culturally fair assessment practices and the effect of comorbid psychiatric disorders on ID assessment, merit attention. In sum, Uzieblo and Habets highlighted the need for adequate, comprehensive assessment procedures for ID that align with the most recent theoretical frameworks of intelligence.
The second presenter, Prof. Leam A. Craig (University of Birmingham, UK), focused on the prevalence of ID in sex offenders, etiological explanations of sexual offending behavior in ID offenders, treatment effects, and risk assessment. Prevalence rates of sex offenders with ID typically range from 21 to 50%. However, we have no way of knowing how accurate these percentages actually are. Prof. Craig offered several etiological explanations of sexual offending in offenders with ID. Some studies on sexual abuse in people with ID suggest that behavioral problems (i.e., sexual inhibition) are a consequence of sexual abuse but not of physical abuse. Another hypothesis is that sex offenders with ID are more impulsive than their non-disabled counterparts, although findings on grooming suggest that individuals with ID do demonstrate delayed gratification. One of the most influential explanations is the counterfeit-deviance hypothesis which assumes that sexual deviant behavior is precipitated by a lack of sexual knowledge, poor social skills, limited opportunities, and sexual naivety rather than deviant sexual interests. However, several studies contradict this assumption. In sum, the developmental pathways into sexual offending in people with ID are not well understood yet. With regard to treatment programs for sex offenders with ID, CBT principles are the most commonly applied in these programs. But two problems occur. These programs are typically based on existing non-ID programs. And there is empirical support for their effectiveness. The latter is partly due to methodological problems, such as few randomized clinical trials and the fact that comparison groups are often not available. Next, Prof. Craig provided an overview of commonly used risk methodologies and instruments. Often, the same instruments are used in offenders with ID and non-ID offenders, such as the SVR-20, Static-99, and the Risk Matrix-2000. The ARMIDILLO-S is an instrument specifically developed for sex offenders with ID. Because of the extensive use of risk assessment within the management and treatment of sexual offenders with ID, the accuracy of predictions is of utmost importance. Prediction, however, remains a tricky thing. We have to be aware of what we are actually predicting. Also, the predictive value of risk offender instruments is dependent on definitions of sexual deviant behavior, sex offender ID characteristics (e.g., higher incidence of family psychopathology, behavioral disturbances at school, sexual naivety, and poor impulse control) and base rates. Given the variation in base rates and recidivism rates across risk categories
in samples of sexual offenders with ID, it appears that it is more helpful to report relative levels of risk rather than absolute rates of recidivism.

In the final presentation, Prof. John Taylor (Northumbria University, UK) discussed several tools for practice. He specifically focused on the added value of Finkelhor’s precondition offending model as a shared multidisciplinary and valuable approach. In this approach, the motivation to sexually offend is dissected in four stages. Stage 1 focuses on aspects that influence motivation, such as sexual arousal to inappropriate stimuli and experience of abuse. Stage 2 addresses overcoming self-control. More specifically, cognitive distortions, stress, drug/alcohol abuse and organic factors may lead to disinhibition. Stage 3 emphasizes external control. For example, external factors such as social isolation, discontinuation of supervision or structure, and unusual living/sleeping arrangement may increase the risk of offending. Finally, stage 4 focuses on overcoming victim resistance. Different influencing factors may be prominent in different offenders. Based on these factors, an individualized risk management plan including the level of risk, probability of risk, clinical interventions and management strategies can be developed. In the Northgate Sex Offender Treatment Program (Northumberland, Tyne & Wear NHS Foundation Trust) patients are encouraged to work through three developmental levels over the course of 12-24 months. First (phase 1, pre-treatment group) patients are desensitized to working in a group setting. Next (phase 2, intermediate group, patients are encouraged to discuss more personal issues, emotional difficulties and other things they would like to change. Finally (phase 3, is the offence related group), patients are encouraged to consider behavior related to their offences.

Several discussions with the participants during the masterclass indicated that many practitioners are struggling with the assessment in and treatment of ID offenders. There is clearly an urgent need to share best practices and to develop evidence-based assessment and treatment tools for practice. Since Prof. Lindsay has highlighted these necessities in his first studies, this field has moved forward, mainly thanks to his work. But we are obviously not there yet, as was made very clear throughout the presentations. Hence, it is of vital importance that experts, including Leam Craig, John Taylor and many others working with ID offenders, will proceed with their invaluable work in research and practice. We should also remain working on that two-way bridge between research and practice that Prof. Lindsay had been striving for. Maybe it is utopian to think that we will ever find a solution for all the problems we encounter when working with ID offenders. But nevertheless, we should follow in the footsteps of William Lindsay, and at least aspire to reach this destination.

Want to know more about the aforementioned topics? Some good reads:

Craig, L. A. (2010). Controversies in assessing risk and deviancy in sex offenders with intellectual disabilities. Psychology, Crime & Law, 16(1-2), 75-101.

Craig, L. A., & Lindsay, W. R (2010) Sexual offenders with intellectual disabilities: Characteristics and prevalence. In, L. A. Craig., W. R. Lindsay., & K. D. Browne, (Eds.), Assessment and Treatment of Sexual Offenders with Intellectual Disabilities: A Handbook. (pp. 13-36). Wiley-Blackwell.
Craig, L.A., Stringer, I., & Moss T. (2006). Treating sexual offenders with learning disabilities in the community: a critical review. International Journal of Offender Therapy and Comparative Criminology, 50(4), 369-390.

Habets, P., Jeandarme, I., Uzieblo, K., Oei, K., & Bogaerts, S. (2015). Intelligence is in the eye of the beholder: investigating repeated IQ-measurements in forensic psychiatry. Journal of Applied Research In Intellectual Disabilities, 28(3), 182–192.

Lindsay, W.R., & Taylor, J.L. (2018). Offenders with Intellectual and Developmental Disabilities. Research, Training, and Practice. John Wiley & Sons Inc.

Taylor, J.L., & Halstead, S. (2001). Clinical Risk Assessment for People with Learning Disabilities who Offend. The British Journal of Forensic Practice, 3(1), 22-32.

Uzieblo, K., Winter, J., Vanderfaeillie, J., Rossi, G., & Magez, W. (2012). Intelligent diagnosing of intellectual disabilities in offenders: food for thought. Behavioral Sciences & the Law, 30(1), 28–48.

Thursday, June 28, 2018

Her Name Was ……

By Cordelia Anderson, MA.,  and Alissa R. Ackerman, PhD.
Say your name, how your feel about being here, a hope you have for this circle of accountability, what your brought for an object of meaning to you and why you chose it for this circle…
And so begins the restorative justice circle we’d been planning for weeks. We had been thinking about what it would mean for survivors to know the healing power of telling the truth of their victimization in front of someone who had committed such an act. No, he did not rape anyone that is in this room. He raped a woman when he was in college – decades ago. He didn’t know or remember her name and there is no way he can be held accountable through traditional criminal justice sanctions; he tried. He wants to help other men speak to the truth of past harms they have done, and who want to be accountable somehow. He agreed to being part of this circle for accountability.
One of the participants, Alissa Ackerman, is a public survivor and criminologist, who has facilitated and participated in meetings with over 370 men who have committed sex offenses. She has lived the reality that sitting face to face with men who’ve committed such egregious acts of harm to other women, is healing for her. She calls this work “vicarious justice.” She also believes that part of the accountability for those who committed sex offenses– outside of and along with their criminal justice system and therapy work – is listening to her stories and the stories of other survivors. Being heard matters. In this circle she participated as a member of the circle, not as the facilitator.
The Circle Keeper, Cordelia Anderson, is trained in restorative justice and circles and has extensive experience doing circles with those who’ve caused harm and with those who have been harmed. Sometimes they are all in the same room; there are many ways to approach restorative processes and circles for healing, for intervention and for prevention. Serving as Keeper of this circle for accountability, (e.g., where the majority of the participants are survivors, and the one wanting the process for accountability has one person of support with him), was new.
For three hours and 15 minutes a talking piece was passed from person to person. When the talking piece came to the next person, they could speak to the question at hand or they could pass. After the opening pass, and rituals to set the stage and tone, participants were asked to speak to whatever it is they want to say, at that moment about:
-          Why they are here today
-          What the impact of what happened to them/or that they did, was for them
-          How they are responding to what they’ve heard
-          What they need to have happen next
-          How to keep the confidentiality discussed as part of the opening values, while also clarifying how they will talk about today’s experience with others
-          What it is they are taking away from today’s gathering
Part of the closing was the keeper reading from a piece written by Ashley Judd. In the 5/26/18 piece she wrote for TIME, about Harvey Weinstein, she said:
I was hopeful Harvey would plead guilty, that his surrender was volitional, so that in addition to carving out a singular position of disgrace, he could come forward as the predator who walks out of shame onto a new path of humility, introspection, accountability and amends, thereby leading our men and country in the necessary and inexorable of trajectory of restorative justice. It seems that Harvey, though, will not be the person to do that, as he is pleading not guilty and still maintains, in the face of so many accusations that all sex was consensual. Denial can stand for “I don’t even know I am lying,” and it appears that is where Harvey still lives.
So as these current steps of justice in New York City unfold, and the system does its necessary and important thing, we still wait for an accused who can and will embody what the #metoo movement and our society needs and wants: someone who can navigate the duality of having aggressed and address their abuse of power with culpability and integrity. Restorative justice is also dual; in order for survivor-victims and society to embrace and restore the reformed, the reformed must have been genuinely transformed, shedding layers of toxic masculinity, exiting the denial/apology tour and standing in a new and collective space where both the person is and the narrative are made whole and unified.
As ATSA members, who work very hard to treat those who’ve committed sex offenders or conduct research to better understand them or treatment process, or who work as victim advocates and/or for prevention, restorative practices and vicarious justice, offer additional opportunities for healing and accountability. Too often our work is in siloes that separates the life experiences and truth of survivors from the life experience and truth of those who’ve committed sex offenses.  We all feel the limits and the benefits of our work. These processes offer an additional way for individual and collective healing and accountability.

Friday, June 15, 2018

The importance of being ethical when conducting research

By Kieran McCartan, PhD

Recently, I was asked to speak at a research event at my university on the challenges of ethical research with high risk populations. At first I thought that this was going to be an easy presentation because all researchers should be on the same ethical and moral page, but I soon realized that there is a lot of different notions of good research vs. good enough research and the related research governance, in general, never mind with “high risk populations”.  

All research presents ethical issues and dilemmas which mean that the researcher should be a reflexive and considerate person. A researcher should be thinking about the consequences of their research on the research population, related organization's/institutions and their research organization (i.e., in my instance a university, but it does not always need to be); but, this is not always the case for sometimes see that a researchers allegiance can be to their findings and publications. This is not to say that researcher’s should not be mindful of their findings and the dissemination and impact of those findings; but, rather that they should be committed and mindful of the whole process not just the end point. A reflexive and considerate researcher is a good researcher. Being a good, creditable researcher is essential when dealing with high risk, risky or vulnerable populations. I recognize that these terms (high risk, risky or vulnerable) are sweeping generalized terms, loaded terms and intertwined terms, quite often someone who is risky is also vulnerable, someone who is a perpetrator is also a victim, etc. The populations that we research with (people who have committed sexual abuse, victims of sexual abuse and those impacted by both) present their challenges to us in terms of consent, confidentiality, anonymity, disclosure, health and safety as well as researcher wellbeing (physically, emotionally and psychologically). Therefore we need to start any research in the field of sexual abuse from a place of reflection, consideration and sensitivity.

I believe that there are four main components to any research project that need to be in constant consideration, all of which become essential when dealing with high risk/challenging populations;

-        The researcher:  The researcher always needs to consider their own physical, emotional and psychological wellbeing. Are they supported throughout the research process? Does the researcher have the capacity to access all the different the types of support they need? Can the researcher receive physical support if necessarily in a confrontation, who can they discuss the challenges of the research with and are they able to withdraw from the research process if it becomes to challenging or difficult? Have they considered why they are involved in the research and what that means for their own going mental health? The person conducting the research is as central to the research process as the questions being asked or the data collected, therefore we have to make sure that they are supported throughout the process.


-        The person being researched: Quite often research participants can be boiled down to numbers on an excel or SPSS spreadsheet, they can be dehumanized. Good ethical research reinforces the humanity of participants. We need to make sure that the understand the research process, the research questions, that they can consent to the research (as well as understand what that consent means), that they are not tricked, that they do not incriminate themselves or indirectly cause harm to themselves (or others). This means that we need to consider their vulnerabilities, capacity and degrees of “powerlessness” in the research process. As researchers we need to make sure that research participants are treated fairly and that the data that we obtain through them is fit for purpose.


-        The various institutions and partners: As researchers we have a responsibility to the institutions that we work for (maybe universities or research bodies, but not always) and the institutions where we research (maybe prisons, probation/parole offices, police stations, etc.) to research in an ethical fashion. We are carrying the name and responsibility of these institutions with us. On one level this means conducting all research ethically, getting the appropriate clearance, responsible data sharing, agreeing confidentiality with host as well as partner organization's and being honest about the data that you are collecting/storing/disseminating. Remember that you are representing your institution, and your field of study, and any unethical research practice not only reflects poorly on you, but them too as well as other potential researchers in the future.


-        The research itself: When conducting research it is essential to make sure that all the necessary rules, regulations and guidelines have been adhered to. Have you got ethical clearance from your institution? Does the host institution or organization need to give you approval (the police, probation, parole, prison, charity, NGO, etc.)? Do you need external body ethical clearance (the NHS, Department of Justice, etc.)? Do you have a safe and secure place to store your data? Have you made it clear to participants what you are going to do with their data? Do you have data sharing agreements with all necessary organization's, institutions and collaborators? It’s essential that your research is coherent, watertight, ethical and adheres to all aspects of research coherence because if it’s not your findings can be jeopardized.

Researching challenging and high risk populations can, and does, have rewards in that it can impact upon changes to policy and practice; but, it should be done ethically, carefully and with a great deal of reflection.

Friday, June 1, 2018

Supporting Help-Seeking Behaviors: Help Wanted

By Ryan Shields, PhD ( and Julie Patrick (

How can we make help-seeking behaviors that prevent sexual harm the norm? The Moore Center for the Prevention of Child Sexual Abuse at Johns Hopkins University’s answer to this question is the Help Wanted project, an online prevention intervention to educate and support help seeking behaviors for adolescents with a sexual attraction to children who have not yet acted on their attraction.

This American Life

The impetus for Help Wanted came from an April 2014 interview by reporter Luke Malone with a young man named “Adam” who identified as a “non-offending pedophile” on his experience seeking help on NPR’s This American Life . The segment illuminated how the stigma of pedophilia and the fear of criminal consequences keep these adolescents from seeking help. The fear of being turned away by professionals, or difficulty in finding the right professional with appropriate expertise, leaves many to struggle alone with the collateral consequences of their attraction.

Malone also spoke with Dr. Elizabeth Letourneau at the Johns Hopkins Bloomberg School of Public Health. Given that approximately half of child sexual abuse cases in the US are committed by other youth, more must be done to address prevention with youth. Letourneau, Dr. Ryan Shields and colleagues conceptualized a prevention program to advance the healthy and safe development of adolescents attracted to younger children.

Phase 1: Help Wanted

The team conducted a qualitative study with young adults (aged 18-30) who identified as being sexually attracted to younger children on how they successfully managed their attractions when they were younger. Study participants commonly noted a sense of isolation and hopelessness during adolescence and wanting access to better information, treatment services, and role models.

The project team concluded that a prevention-focused intervention for youth recognizing an attraction to younger children was critically needed and must meet youth where they are – online. A web-based model helps reduce fear of requesting help in person and reduces difficulties with transportation, geographic dispersion, availability, cost, and stigma. To be sure, some youth will undoubtedly require more intensive services than can be provided via a web-based platform.

Of note, the Help Wanted intervention focuses on primary prevention of child sexual abuse and in this respect differs from Prevention Project Dunkelfeld (PPD) and related efforts to address youth sexually abusive behavior. As described in several publications, PPD provides an intensive treatment to men and, more recently, adolescents who are formally diagnosed with pedo- or hebephilia and who have acted on their attractions without being caught or who have not acted on their attractions but need assistance. The PPD intervention typically lasts one year and consists of a formal diagnostic assessment followed by weekly in-person group treatment sessions (Beier et al., 2015). Such an expensive and intensive intervention is incompatible with the diffusion of primary prevention interventions (Rohrbach, Grana, Sussman, & Valente, 2006). Moreover, as Letourneau and others have demonstrated, there are well-validated treatment interventions for youth who have engaged in sexually abusive behavior and been identified in formal systems (e.g., juvenile justice, mental health, child welfare) (Letourneau et al., 2013; Letourneau et al., 2009), but very few resources for youth who are sexually attracted to children but have not engaged in harmful behavior.

Phase 2: Support from Raliance

To build this online tool, the Moore Center sought additional funding from Raliance, a national partnership among leaders in the prevention of sexual harassment, misconduct, and abuse. With seed-funding from the National Football League, Raliance is dedicated to ending sexual violence in one generation and supports an impact grant program with a specific funding category to prevent primary perpetration.

A collaborative process ensued uplifting the expertise of consultants in the field to create 5 key foci for the online intervention tool. Such consultants include: Ms. Karen Baker, Pennsylvania Coalition Against Rape/National Sexual Violence Resource Center; Ms. Maia Christopher, Association for the Treatment of Sexual Abuse; Ms. Geraldine Crisci, Geraldine Crisi & Associates; Mr. Gerald Hover, INTERPOL Crimes Against Children; Dr. Jill Levenson, Barry University; Dr. Michael Miner, University of Minnesota Program in Human Sexuality; Dr. Daniel Rothman, Forensic Psychological Services; and Ms. Joan Tabachnick, DSM Consulting. Project consultants also include non-offending young adults with a sexual attraction to children.

This group prioritized five foci: 1) access to information about child sexual abuse and why it is harmful; 2) disclosure and safety skills; 3) practical advice for self-management and coping techniques; 4) building self-identity and developing positive narratives; and 5) skill building for healthy sexuality. The curriculum for these online modules is being created and tested by those with proven success using online therapeutic and mental health interventions.

Raising awareness about supporting help-seeking behaviour is also vital to the project. Dr. Letourneau’s December 2016 TEDMED talk: Child sexual abuse is preventable, not inevitable brought this information to a wider, mainstream audience. And Dr. Shields presented to sexual violence professionals at the 2017 National Sexual Assault Conference.

Advancing to Phase 3

No project is complete without piloting, revising and evaluation. More will be shared as those exciting developments unfold.

Thursday, May 24, 2018

The forgotten risk

By David S. Prescott, LICSW & Alissa Ackerman, Ph.D

An ever-emerging body of scientific research has found that punitive responses to crime don’t actually decrease risk. The findings are so clear as to not be uncontroversial: punishment is not anything more than punitive. While punishment can have its place, we should never consider it a meaningful deterrent from crime, a form or rehabilitation, or even a fully adequate response for those who have been abused. While one can easily find media accounts of people who want those who abuse to suffer as a result of their actions, there are many more who simply wanted the abuse to stop and the person who abused them to get help. Sadly, their accounts rarely lend themselves to sensational media. Indeed, excellent documentaries of the results of America’s legal system, such as Pervert Park and Untouchable garner some attention and then too often disappear from our sustained awareness.

Likewise, what seems to go further unnoticed is that even our “intermediate sanctions” – the term that criminologists have used for measures such as registration, community notification, and residence restrictions – also produce no appreciable effects on the re-offense risk of those who sexually abuse. Many have fought these laws in court, and while some have prevailed, the courts have consistently ruled that sex crimes policies are not criminal sanctions. They are civil in nature, so many of the arguments used to fight them in court hold no water.

Let us be clear: there are no appreciable positive changes with respect to re-offense risk that have resulted from these policies. To this point, there have been no documented improvements as a result of these policies beyond occasional (and frankly, highly infrequent) anecdotes.

Followers of the risk assessment literature are aware of many of the primary risk factors for re-offense: abuse-related sexual interests, high levels of psychopathic traits, problematic responses to stress, impulsivity, all alone and in combination can serve to increase risk. It is easy to forget, however, the risks involved in the chronic social isolation experienced by people who have abused and are now attempting to reintegrate into society (or integrate for the first time).

The isolation and lack of connection experienced by registered people has been documented in the literature for over a decade. Most recently, Dr. Danielle Bailey of University of Texas in Tyler has written that the isolation experienced by registered people also extends to their significant others. Importantly, loved ones often experience disenfranchised grief when they learn about the sexual abuse that has transpired. They must learn to adjust to life after losing the person they thought they knew.

Unlike family members who experience loss as a result of a medical diagnosis such as Alzheimer’s or stroke, family members who support a registrant have little social or community support to process their grief. This leads them into further isolation. The prosocial bond formed between the registrant and the significant other may be disrupted or it may fully disintegrate as a result.

 You may be wondering how punitive measures and intermediate sanctions impact people who have experienced sexual abuse. For starters, most people who have experienced sexual victimization know the person who committed the abuse. According to Dr. Rachel Bandy’s research, coalitions against sexual assault caution against current sex crimes policies because they have the capacity to silence people who have experienced victimization. First, because the person who victimized them is often someone they know and love, they are hesitant to come forward knowing that doing so could result in a lifetime of mandates and hardships. Second, most people who have experienced sexual victimization see no reflection of themselves in current laws. Finally, current policies do nothing to promote healing for people who have experienced abuse, and, in fact, these policies may have detrimental impacts on the healing process.

The forgotten risk of isolation and disconnection stem far beyond people who have sexually abused. It permeates families and communities. It silences people who have experienced sexual victimization. Human beings are social animals. We are meant to be in close relationship with others. Research shows that social isolation is associated with health risks and early death!

And it begs the question: what is our end goal?  Do we want to decrease sexual victimization? Do we want to feel safe? Or do we actually want to be safe?