Wednesday, October 10, 2018

Beyond Headline News: The Promise and Healing of Restorative Justice.

By Alissa Ackerman, PhD

On September 28, 2018, HBO’s Vice News Tonight aired a special on consent and accountability. The episode ended with a restorative justice (RJ) session that I facilitated. For the first time, a mainstream media outlet highlighted the power and depth of RJ in cases of sexual misconduct.

I have written elsewhere about the importance of RJ. During the heightened conversations around accountability in response to the Brock Turner case, Dr Jill Levenson and I co-authored several blogs on what a different conversation might look like, even appearing as guest bloggers for the Sexual Abuse blog. We have written about the importance of a change in discourse, where we no longer see those who have perpetrated sexual abuse and those who have experienced it as diametrically opposed and we have discussed the importance of actual accountability, a process that the criminal justice process seriously thwarts. Yet, in the years of engaging this work, I have not experienced the promise of a moment of reckoning such as this one.

The conversation around RJ and sexual misconduct is not new, but it has not been mainstream either. The Vice News episode on consent and accountability created an opportunity to shift popular discourse. Prior to this episode, few had even heard of the term restorative justice. One television anchor repeatedly referred to the process as reformative justice. Despite the lack of collective knowledge or understanding of what RJ promises, the responses I have received since the HBO episode aired almost two weeks ago have been both heart wrenching and full of hope.

I have heard from those who have experienced sexual abuse who want nothing more than to find closure and hope for the opportunity to sit face to face with the person who harmed them. I have heard from people – both those in my life and complete strangers – that the Vice News episode expanded their thinking about the ways they have behaved in the past. I have also heard from those who are now remembering experiences that were harmful.

For too long we have allowed our conversations around sexual abuse and misconduct to remain siloed. This includes many of us in the fields of sexual abuse treatment and prevention. There are professionals who advocate for those who have been sexually victimized and those who work with individuals who have sexually violated others. Even when we recognize that many of our clients fit both boxes, we tend to talk about “survivors” and “perpetrators” as mutually exclusive groups.

The fact of the matter is that all of us focus on the same end goals – healing and prevention.

The Vice News special featured two RJ participants, Alexis and James. I have been working closely with Alexis and James since January. Their progress, both as individuals and collectively, has been nothing short of amazing.  Both articulate how the process has helped them rediscover each other’s humanity. Alexis has seen a marked decrease in the PTSD symptoms she had lived with for the previous ten years. More healing has occurred in the last nine months than in the previous ten years, simply because the two were willing to connect in a vulnerable and authentic way.

Criminal justice processes can include RJ. In fact, most of the RJ work in which I have engaged has been with men and woman mandated to treatment after a sex offence conviction. The most life-changing and life-affirming moments have arisen from these RJ processes, but they leave me wondering what impact RJ could have at the beginning of the criminal justice process. How much harm, pain, and shame could be avoided if we engaged? How many people would take accountability for their actions, or at the very least consider the harm their behaviour may have caused if there were spaces for them to do so?

When I first began speaking about RJ and sex crimes, the very idea offended many people. Today, those same people have inquired about how they can be involved. The HBO Vice News episode finally shined a light on a process that can help heal individuals, communities, and perhaps our entire society. One cannot disentangle the timing of this episode and our current political climate. Indeed, Lara Bazelon published a piece in Slate about how we are in dire need of RJ in the wake of this most recent Supreme Court confirmation. We remain fully entrenched in an adversarial model that has proven repeatedly that it does not work.  Perhaps when we move away from such a model, healing can finally begin.


We are professionals in the field of prevention and treatment and we must be the first to step out of our silos.

Wednesday, October 3, 2018

Even Folks in Our Field Get the Blues: When Implementation of Best Practices Goes Wrong, Part 1


By David S. Prescott, LICSW

A participant in a training recently described frustration in adopting Motivational Interviewing in their practice.  This confirmed a concern I’d seen expressed in social media. As the discussion progressed, another participant expressed similar experiences. Although small in number, their concerns were important: There can be side effects when adjusting to the use of positive, collaborative, strengths-based approaches such as Motivational Interviewing (MI) and the Good Lives Model (GLM). How can this be? What can we do?

First, it’s important to examine the context. In many instances, the complaint centres on probation officers and other supervising agents who come away from trainings believing that they now need to behave like therapists. Others have complained that they have to pay attention to how they respond and use reflective listening rather than focus on efforts at rehabilitation. Still, others feel cornered into working in a fashion that is at odds with their personal style. One person lamented that clients are challenging their treatment before they even get started. The result, in the estimation of these professionals, is that clients can appear more hostile, often with a sense of entitlement. Where public safety and client care are on the line, these are important concerns.

What do we know? First, the jury has returned on many of the characteristics of effective treatment for people who have abused. Marshall (2005) summarized findings showing that the most effective therapists are those who are warm, empathic, rewarding, and directive. In practice, any one or two of those qualities can be easy, but balancing all four can be a challenge. Three years later, Parhar and her colleagues demonstrated in a meta-analysis that the more coercive the treatment experience for mandated clients, the less effective they are. There’s really no question that the often harsh and confrontational practices of yesteryear don’t work and can make matters worse. It is no wonder that Moyers and Miller (2013) argued that low levels of demonstrated empathy are toxic. Since that time, the use of MI (and its derivatives) with criminal justice populations has only become more widespread. Earlier this year, Blasko and Taxman (2018) found that clients who perceived their probation officer as fair and respectful had lower rates of violating their conditions and returned to prison less frequently.

Does that really mean that effective practices create more problematic clients? I don’t believe so, although it’s an important question. Here’s what I mean:

First, clients feeling free to challenge their treatment and treatment providers at the outset may actually be preferable in the long run to clients who give the surface impression that they are actively engaged but in fact participating minimally. As the old adage goes, “A man convinced against his will is of the same opinion still.” Although every case is different, there may even be real merit in challenging one’s circumstances prior to making peace with them and getting involved in meaningful change processes. This idea is central to self-determination theory, which holds that extrinsic motivation often precedes intrinsic motivation. In the long run, pushing back against extrinsic motivators as a pathway to awakening internal motivation can have real value in treatment.

Further, there are contextual challenges with our training approaches. All too often, trainees are “voluntold” to attend trainings and adopt the new practices (that strange experience of being volunteered by a supervisor to participate against one’s will). Not surprisingly, there is a strong parallel process between the practitioner who is ambivalent about adopting new treatment methods and the client who is ambivalent about change. As much as agencies focus on what they believe are best practices, it is easy to forget the importance of the change process for the professional. Further, the fact that some agencies prefer some evidence-based approaches over others speaks to the fact that we are often not as evidence-informed as we would like to think.

Then, there are other problems with implementing new approaches. Often overlooked, an entire body of research has examined how treatment implementation efforts succeed and fail. Bringing in the expert from out of the area to do training is easy; implementing with fidelity and minimal attrition and client drop-out is another matter entirely. Often, this can occur when professionals only learn the basics and are expected to jump into practice. For example, many MI trainees wonder how they will carry out parts of their job (sometimes known as “telling the hard truth”) without having learned the explicit methods for doing so (for example, the elicit-provide-elicit method of providing information and feedback).

Finally, all of these efforts rest on the foundation of a strong working alliance. The alliance is often mistaken for having a good relationship with a client, but in fact has been defined for decades as having an agreement on the goals and tasks of treatment, as well as agreement on the nature of the working relationship. More recent conceptualizations consider the strong personal values and beliefs of the client. In my experience, many programs who seek enthusiastically to develop expertise in a specific model or set of techniques can also be those that rate themselves as doing well enough with their alliances that this needn’t be an ongoing area of focus for them. This is despite the fact that simply ensuring a solid alliance is itself a highly evidence-informed practice.  

In the end, when clients become challenging despite the available collaborative approaches, it may be as simple as returning to basic discussions about what the client wants out of the experience in order to establish goals. After that, the practitioner can work on gaining clarity on the exact nature of who the practitioner and client are so that they can agree on the nature of the relationship. Next, the practitioner may want to ensure that his or her approach is a good fit for the client, and consider a person’s unique characteristics, culture, values, and beliefs.


All too often, the problems lie not in the methods or models, but in the ways, we attempt to implement them. This can be especially problematic when we attempt to use newer methods without first ensuring a solid working alliance. 

Wednesday, September 26, 2018

NOTA Annual Conference 2018

By Kieran McCartan, PhD.
This blog is a reposting of a previous NOTA Blog posting – Kieran
 
The annual NOTA conference took place from the 19th – 21st September in Glasgow. The conference was a real mix of research, practice and engagement with colleagues from across the UK, Ireland and internationally (with attendees and speakers from a range of countries including the USA, Australia, Norway, Ireland, and from all four countries of the UK). In this blog I am going to take you on a whistle stop tour of the event.
 
The 2018 plenaries combined research, practice and innovate approaches from a very international group of speakers. The conference started on the Wednesday with two keynotes addressing the reality and impact of Pornography on youth understandings and perceptions of sex as well as their sexual experiences (Maree Crabbe) followed by an overview of the research on systematic pathways of development across the lifespan, ACE’s and the impact of trauma (Dr Jamie Yoder). The second day of conference (Thursday) had keynotes that talked to current research and understandings around normal sexuality, deviant sexuality and whereof our morality and ethical principles come into play in debate as well as treatment (Dr Rajan Darjee); as well as presentation of focusing on trauma inform care and practice on the frontlines in Scotland (Dr Lisa Reynolds). The last day of the conference (Friday) had 4 keynotes, the first two focused on a  range of topics including, the effectiveness of professionals perspectives terminology, learning and good practice around Child Sexual Exploitation (Jessica Eaton); and an update on desistence research and the importance of community engagement and the “service user” voice in the integration of people who have committed sexual offences into the community in a pro-social way (Dr Beth Weaver). The last two keynotes of the conference focused on sexual abuse in Scottish Football, discussing the work of the review and the interim report into the scale and nature of said abuse (Martin Henry); and finally, a presentation on the reality, impact and scale of sexual abuse with private schools over the past 30 (or so) years (Alex Renton). All the keynotes tied together ideas of the importance of Adverse Childhood Experiences in the lives of people who sexually offend, the roll of trauma in shaping their behavior and that prevention is needed, but more centrally that prevention is everyone’s responsibility. 
 
The workshops spanned a full range of topics and speakers (of which this is just a flavor) including, integration of people who have sexually offended back into the community (Karen Parish & Jane Dominey; Kieran McCartan; Tammy Banks & Sarah Thompson); public health approaches to sexual abuse and prevention (Kieran McCartan; Tamara Turner-Moore; Tammy Banks; Stuart Allardyce; Nicolas Blagden; Donald Findlater); online offenders (Donald Findlater; Roger Kennington); youth who sexually harm (Simon Hackett; Dale Tolliday; Jacqueline Page; Stephen Barry; Carol Carson; Stuart Allardyce & Peter Yates); female sexual offenders (Andrea Darling); treatment (Eleanor Woodford & Ben Evans; Gallagher; Geraldine Akerman); sexuality and sexual abuse (Michael Miner; Rajan Darjie) as well as pornography (Maree Crabbe). The workshops were a good mix of research, evaluation, practical working, professional learning and knowledge exchange.
 
In addition to the traditional conference activities NOTA 2018 also had an engagement event. This year we changed our focus from members of the public to professionals. We advertised the engagement event to professionals who have safeguarding as part of their jobs, but that safeguarding is not their main role (and therefore would not be attending the NOTA conference) including, teachers, foster carers, members of charities and NGO’s, etc. We had 150 participants sign up to attend the event but, unfortunately, bad weather in Glasgow lead to the closing of Glasgow Central Train Station which resulted in approximately 50 - 55 people attending; which, in the circumstances, was a good outcome.  The session heard from national (Stuart Allardyce, Graham Goulden & Kieran McCartan) and international (Maree Crabbe) speakers about the impact of pornography on youth, especially young men; what we can do to reduce toxic masculinity and the “crisis” surrounding young men; and how to promote positive, healthily sexuality.
 
NOTA 2018 also was covered by the Scottish Herald, which had a two-page piece in the main edition and this was republished on their website as well. The herald piece focused on the prevention of sexual abuse, including interviews with Stuart Allardyce, Marre Crabbe, Graham Golden, Lisa Reynolds and myself. For those interested please access it here.
 
NOTA 2018 fitted a massive amount of material in across three days, which left me informed, refreshed and looking forward to next year’s meeting in Belfast.

Thursday, September 20, 2018

Redefining campus sanctions for sexual misconduct as a strategy for prevention

By Alison Hall (Executive Director, Pittsburgh Action Against Rape (PAAR) at alisonh@paar.net), Julie Evans (Director of Prevention& Victim Response, PAAR) at juliee@paar.net) & Julie Patrick (National Partners Liaison, RALIANCE at jpatrick@raliance.org)

The continued prevalence of sexual misconduct on college campuses requires sanctioning models that address current offending behavior while working to prevent future offenses.  If we truly want to engage students who are causing the harm we need innovative strategies to connect them with the needed services and prevention programs. This requires a collaborative response inclusive of key players from universities, sex offender treatment, and victim services.

Pittsburgh Action Against Rape (PAAR) brought together victim services, colleges and sex offender treatment professionals to examine sanctioning practices at three Allegheny County, Pennsylvania universities.  The team reviewed best practices in sex offender treatment and developed recommendations for training to assist universities in accessing a variety of accountability options.

What’s in a sanction?

The first step of the project was to review current sexual misconduct, Title IX responses, interventions, remedies for victims and sanctions for respondents found responsible for sexual misconduct. Existing sanctions lacked the key elements needed for campus safety - building prosocial skills with the goal of changing behaviors. Rather than intervene and change behaviors sanctions ranged from watching an online video to expulsion with no options along the continuum. Ultimately, college conduct boards lack the necessary tools and expertise to promote safer campuses.

College conduct boards were not asking behavioral questions which would identify risk and protective factors such as: how does the respondent view the person harmed, how does the respondent view the behavior? These are the questions ATSA members are utilizing in their work with offenders.

Recommendations

Sanctions must address current behavior and intervene to promote behavior change. Campuses need a tool to comprehensively look at the whole student, risk and protective factors and developing specific interventions and sanctions to promote safer campuses and prevention of sexual misconduct. This requires campuses to collaborate with sex offender treatment providers. Additionally, any sex offender treatment provider working with a college should follow ATSA’s standards.

What’s next?

PAAR is grateful for support for support from RALIANCE, a national partnership among leaders in the prevention of sexual harassment, misconduct, and abuse. Founded in 2015 through a multimillion-dollar seed investment by 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. 

PAAR is actively seeking additional funding to move into the next phase: development of a tool that utilizes a holistic approach to identifying and working with risk and protective factors.







Thursday, September 13, 2018

Good Things Happening in Poland and Italy

By David S. Prescott, LICSW

I had the honor of spending several days training in Wroclaw, Poland, last week. Two days went into a Master Class series training trainers and supervisors in their various areas related to Motivational Interviewing (MI), two days at a conference on MI and trauma, and three other days providing consultation on the use of the Good Lives Model (GLM) and MI for private organizations interested in implementing these approaches in Poland and Italy.

The real heroes of the story are people who work days, nights, and weekends to ensure the best possible services in the areas of trauma and addictions in their various countries. Iga Jaraczewska is a clinician who has worked diligently for over ten years to bring MI into Poland to replace older status-quo approaches to addictions. This has brought an increase in understanding how clinicians and other professionals can best respond to trauma. Iga has organized trainings all over Poland, as well as international conferences in Krakow, Warsaw, Torun, and other locations to bring in outside voices. These often involve a progression of introductory and advanced trainings with consult and supervision. Similar efforts are rising in Estonia, with the work of Inga Karton. Following along the same basic path as Iga Jaraczewska in Warsaw, is Domink Meinhart, located in the area surrounding Wroclaw. He has worked to ensure training, master classes, and supervision circles to put these methods into place with fidelity.

Their efforts are remarkable. Around the world, an ongoing phenomenon shows people like these working incredibly hard, often with little reward, to ensure that treatment services to marginalized people are as effective as can be. Among other areas of focus, Iga and Dominik have each taken a great interest in how MI and the GLM can be used to treat people with a variety of problematic sexual behaviors. Both approaches are inherently collaborative and strengths-based, an important consideration in light of research finding that the more coercive the treatment experience the less effective it likely it is to be and that low therapist empathy can be toxic. Iga produced an edited volume focusing in these areas, while Dominik has recently collected articles for the Polish Terapia. Each have built well-received organizations that focus on disseminating these methods with fidelity across a spectrum of professional disciplines.

Equally encouraging are the efforts of the students and other participants in these trainings. People routinely travel from around the country in order to attend various trainings and supervision sessions, often with little incentive beyond becoming a better therapist. As in the implementation of various models and methods in North America, these therapists submit recordings of their sessions to be reviewed by a supervisor, transcribed, and discussed in a group session with other therapists. I had the opportunity to sit in on a day of feedback sessions and felt fortunate to see just how supportive these groups can be.

Similar efforts are bringing these approaches into more areas of the criminal justice system in Italy. Previously, this blog focused on a group in Milan (https://sajrt.blogspot.com/2016/05/whats-on-in-milan-successes-and.html) including pioneers Carla Xella and Paolo Giulini. Now, a group led by Giacomo Salvanelli is working to expand these methods into other areas within Italy.

Most impressive of all is how all these people work to secure funding for their efforts. Very few people enter the human services with an eye on developing expertise in fundraising in challenging times. And yet, this is often what makes or breaks their efforts to ensure high-quality services for people who often have no voice in the systems that order their lives. Of course, much of the same happens around North America.  There are any number of people doing amazing things with unreasonably scant resources. Having had the great privilege of visiting many programs, it is always an honor to witness the efforts of people working behind the scenes to make trainings, conferences, and other forms of professional development happen.


Taken together, the efforts of these professionals show that therapeutic services improve when like-minded professionals get together with a common goal and purpose to exchange resources and ideas.

Friday, September 7, 2018

Integration into the community of people who have committed sexual abuse

By Kieran McCartan, PhD, David Prescott, LICSW, & Alissa Ackerman, PhD.
Over the years, our field has talked a lot about the use of language and the power of narratives in the field of sexual abuse. Words have impact. Words matter.  We often discuss whether we should use “victim” or “survivor” to discuss people whom have been directly impacted by sexual abuse and whether we should use labels at all. We have also discussed terms such as “sex offender” or the broad array of first person language that has emerged over recent years to describe the individuals that have committed sexual abuse. Likewise, there is the question of whether therapeutic activities should be called “treatment” or “management”. However, the one thing that we have not really discussed (and possibly one of the most important) is “reintegration” vs “integration”. This may seem like a minor semantic difference, but it’s more than that. It is an important debate, especially in terms of the experience of those who have victimized and those who have experienced sexual violence. This language can affect society’s view of each as well as the work that professionals do in the field. It is a conversation about transition and desistence.

The issue with reintegration is the addition of the prefix “re”. It indicates a return or a re-entry—this poses a problem? It assumes that they have been integrated into the community to begin with. In talking with anyone who works in the field of sexual abuse, it is common to hear them discussing their work in terms of changing people, changing attitudes and, most importantly, changing behaviors. The common thread that winds through discussion among police, probation, parole, treatment providers, and counsellors who work in the field of sexual abuse is that the person who has committed the abuse comes out of their service (i.e., prison, counselling, treatment, etc.) different, that they are a changed person. Herein lays the problem with the “re” in reintegration: We are not returning the person to the point that they were at pre-offence or pre-sentence, because that is a problematic and potentially harmful place. We are trying to integrate people who have committed sexual abuse into society, to successfully integrate many of them for the first time. What we see with these men (it’s mostly men that we are talking about) is that their lack of integration (whether socially, culturally, personally, psychologically or emotionally) contributed to their sexually abusive behavior in the first place. We are trying to help them move forward into a positive, productive, and engaging life, not back to the lifestyle that they had before.  


Thinking about integration versus reintegration enables us to view integration as being about the society, community, and individual’s social network working together to support the person. In contrast, reintegration too rarely looks beyond a return managed by professionals to similar circumstances. Therefore, we propose a view of integration that includes professionals playing a role, but that they are not alone in doing it. Integration is everyone’s responsibility, were as reintegration is often seen as the responsibility professional services. Past blogs have focused on the language that we use, what it means, and what its outcomes are. If we want people to take responsibility for their behavior and change we need to use language that reflects this goal.



Wednesday, August 22, 2018

The polygraph as applied: Are we focusing on technology at the expense of everything else that works?

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

Nothing divides the professional and academic community who work in the field of sexual abuse quite like the polygraph. It is a debate that has gone on internationally for decades. A fascinating wrinkle in policy and the law recently came to the authors’ attention. In at least one state in the USA, there is a policy holding that people on probation cannot be sent back to prison for failing a polygraph examination; which makes sense given the status of the research around the polygraph and its admissibility in court. However, in this state, the same people can be sent back to prison if the examiner believes they have deliberately manipulated the results of the test. This has resulted in at least one examiner expressing certainty that many of his examinees have tried to influence the results, with many of them becoming incarcerated because of the examiner’s belief. Which highlights the main issue that the polygraph faces, that there are a multitude of different audiences (public, judiciary, professionals, academics, etc) all with different attitudes, experiences, evidence bases and strongly held views around it.

We want to be clear that this is more a problem of how professionals use or even abuse the power that they have over clients/examinees than it is about the polygraph itself, although empirically separating the effects of the polygraph from the examiner may be more complicated than many would think. The good news is that the Department of Corrections in that state is having a fresh look at its policies. The bad news is the context of professionals believing in their approach to the detriment of their clients. In some cases, one wonders how much deception by the examiner in the process is acceptable given the potential costs and lack of truly informed consent. These kinds of ethical questions certainly exist elsewhere, but rarely get the attention they deserve with vulnerable populations such as those for whom basic liberties are in the balance.

To put all of this into perspective, it can be useful to review what research has shown time and again: Punishment on its own neither reduces risk nor deters crime. While many questions about treatment remain debatable, people who complete treatment programs emerge at lower risk. Community supervision can also further reduce risk, and yet there is still no credible evidence that the polygraph, as currently applied, is improving outcomes, except in the opinions of its adherents.

This, in turn leads to further questions. When we apply the polygraph as described above, with examiners being able to send people to prison so easily, at what point are we not only interfering with methods that would promote community safety, but also denying justice? (as a side note, it is important to note that others in our field, including therapists, can also wield undue negative influence under the wrong conditions).

We then need to turn to other questions, such as what our goals actually are? Are we using the available methods to reduce risk? Build better lives? Assist those who have been abused? Or continue the punishment? Our belief is that punishment is punishment and rehabilitation is rehabilitation, and that when we confuse the two, neither can be entirely effective.

Finally, there is a real question of the polygraph’s best use. Does a sexual history polygraph really provide as much information as one might hope or is an examination into whether someone is basically following the rules help them – and the community – more. Do other methods, such as polygraphing people on their thoughts and fantasies simply muddy the waters through a belief that one’s fantasies equals their future behavior”?

Additionally, we would also encourage a consideration of how the polygraph is used internationally. While the polygraph is not necessarily an example of American exceptionalism, it might as well be because most other countries internationally do not use the polygraph in the same way, with the same frequency or with it having the same impact in the criminal justice system as in the USA. For example, in the UK the polygraph was only introduced in 2014 for high risk individuals, it is by no means used with all people that have committed a sexual offence, and is not admissible in court. Whereas in other countries, like Australia, Israel, Sweden and New Zealand (to name a few) the polygraph is not used with individuals that have committed a sexual offence.

Unfortunately, recent dialog has focused more on choosing sides – for and against the polygraph – than sorting through the various issues and balancing them against the human rights of each client or examinee. We must keep in mind, in our desire to discover the truth and seek answers from those that commit sexual abuse, that the consequences of false positive (as well as the resulting conviction and related outcomes) can be significant for victims and the accused.



Perhaps before we can answer questions about the polygraph, it is better that we return to the basic questions of why we do this work and what all our science tells us about the way people become safer and grow beyond their traumatic experiences.