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 (ryan_shields@uml.edu) and Julie Patrick (jpatrick@raliance.org)

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? 

Thursday, May 17, 2018

Families of the perpetrator: The hidden victims of online sexual abuse


By Kieran McCartan, PhD

Please note this is a reposting of a NOTA blog post by the same author, the original can be found here – kieran.
Late last week I attended a conference on online perpetrators of sexual abuse hosted by the Lucy Faithful Foundation, the aim of which was to make us reflect upon the reality of downloading and viewing child sexual abuse imagery in the UK (i.e., that is 100,000 individuals downloading material in the UK currently), but especially in the South West of England, as well as how to best respond to it. Although the conference was interesting, informative and worthwhile, it was the questions that were not answered or addressed that had the biggest impact on me. Not the questions about perpetrators, policing or offence characteristics; but rather, the questions about the collateral consequences of downloading and viewing child sexual abuse imagery on the families, friends and communities linked to the perpetrator.

When we talk about sexual abuse we tend to talk about perpetrators and victims. We do not tend to talk about the surrounding family and peers that are indirectly affected by the abuse and its consequences. Often there is an assumption in contact offending that the perpetrator is offending against members of their families, that members of their families are always at risk and that partners are complicit in the abuse; but this is generally not true. If it’s not true for contact offenders, is it also not true for individuals who download and view child sexual abuse imagery? The short answer is that we don’t know!

The conference really highlighted to me that we do not really know, empirically, what the impact of having a parent convicted of online sexual abuse, viewing inappropriate images, grooming children online or networking with other perpetrators on the dark web is. There is a perception that the collateral consequences of being convicted of viewing online child sexual abuse imagery is the same for the perpetrator and their families as being a contact offender, that is

-          That perpetrators receive a prison/community sentence, they go on the sex offenders register, are often being exposed in the press &/or community during their trial, have the  possibility of losing their family, friends, peers, home, job and  have a resultant social stigma;

 
-          That families of perpetrators are too being socially stigmatised because of their relationship to the perpetrator, can be exposed in the press &/or community by default have the possibility of losing a family member/friend, might lose their home, may lose additional income, may lose social standing and suffer from suspicion around complicity (i.e. a feeling that somehow you should have known).

These assumptions are problematic as we do not really know if they are as true in online offending as they are in contact offending. What we do know, which the conference discussed at length, is the recognition that the lives of people related to the online perpetrators have their worlds turned upside down, directly and indirectly, by the behaviour and that they struggle to cope with the related outcomes (i.e., the removal of technology, the police investigation, the re-evaluation of who the perpetrator is and what you really knew about them); but that there is not a lot of support for these indirect victims of online sexual abuse (i.e., they were not abused but they have been impacted by it). Which is problematic because families feel at a loss because of the nature of the offence and that there are many misconceptions about the perpetrators of online sexual abuse, the risk that they pose and the reality of their offences by the public – which includes members of the public misunderstanding what online offending looks like, its level off seriousness (is it as serious as contact offenders?), whether online offending leads to contact offending, whether it is easier to forgive the perpetrator compared to contact offending or who the victim is? All of which means that the families of online offenders can face collateral consequences similar to those of contact offenders, but with less understanding, nuance and (possibly) less sympathy. Over the past 10 or 15 years the level of support and help for the families of individuals who have downloaded and viewed child sexual abuse imagery has grown, but it still not common place and these individuals do not always get the help that they need. Research is starting to be done in this area. Lisa Thornhill presented on her recently concluded research on the impact of having a father or family member that has been arrested on suspicion of downloading and viewing child sexual abuse imagery. This research is important is as it will give us an empirical base to start developing and implementing appropriate services for people directly impacted by having a parent of family member who has child sexual abuse imagery so that they can understand the offences, the consequences of the offences, be helped to process and move past the impact that the offences have on their lives. Sexual abuse, in all its forms, impacts not only the perpetrator and the victims but also the communities in which it happens; therefore the more that we can help these communities understand and move past sexual abuse the more adaptive they will be.

 

Wednesday, May 9, 2018

How do we get better, really? The Achieving Clinical Excellence 2018 Conference in Ă–stersund, Sweden

By David S. Prescott, LICSW

The evidence is in, and there’s no doubt. Psychotherapy works for a wide range of conditions and behaviors. People can and do change, often suddenly and unpredictably. Among the most effective mechanisms for change is the most ancient and fundamental approach: the human conversation. 

Why even mention this? Those working in the fields of violence and trauma (including sexual abuse) too often believe that people who harm others are either unwilling or unable to change, despite decades of evidence. Too many professionals argue over lesser findings or ask the wrong questions. While searching for the randomized controlled trial showing that treatment can reduce risk, we overlook other findings, such as that people who complete programs very commonly have lower rates of re-offense. What can we learn from these studies? And more importantly, from the clients that can inform our approaches? There are entire bodies of research in psychotherapy, criminology, and education that go unnoticed and under-discussed.

The research points to greater differences between the least and most effective therapists within treatment methods than differences between the methods themselves. This uncomfortable truth is that we may be looking in the wrong place for success when we pin our hopes on trainings about the latest technique or model. Instead, we might want to look inward at what we can do to become more effective, one client at a time.

One path to professional development is feedback-informed treatment (FIT), which we have discussed in previous blogs. Critical to understanding FIT is that it is not enough to engage in routine outcome monitoring through the use of measures such as the Outcome Rating Scale (ORS) and Session Rating Scale (SRS). Practitioners don’t always respond with adequate professional self-development based on the feedback they’ve received. This has led to a movement within psychotherapy aimed at focusing on specific steps clinicians can take to become more effective and involves solitary, deliberate practice between sessions.

As revolutionary as much of this information may seem, the ACE 2018 Conference took the discussion to a new level. Routine outcome monitoring cannot result in actual improvement without the clinician actively working to improve performance based on the results. Some measures of outcome (such as the ORS) can provide benchmarks of success in performance, while others (such as the SRS) yield insights for practice aimed at improvement.

At the start of the conference, researchers Bruce Wampold and Scott Miller reviewed the evidence for what works in treatment. Wampold took careful note of emerging evidence that the effects of cognitive-behavioral therapy (CBT) may have declined over the years, and wondered aloud if that isn’t a natural part of the evolution of methods. That is, that the pioneers of CBT had started out as highly trained therapists in general, whereas therapists are now trained more in the methods than in the core conditions of effective therapy. Also significantly, Wampold noted that therapists often overlook the most important therapist skills (e.g., the effective demonstration of empathy) in favor of novel techniques. He emphasized that “basic counseling skills” should be re-framed as “critical counseling skills.”

Birgit Valla, the director of Stangejelpa in Norway, provided a narrative of how her agency became demonstrably more effective in helping clients. She took issue with approaches to mental health agency development based on the traditional medical model. Valla described differences between how successful business and mental health agencies operate in designing actions that will be useful and effective for their customers. Her agency has defined the development of wellbeing as its primary product rather than over-emphasizing diagnoses and focusing exclusively on problems. She further described an agency culture in which “helping people is a team sport” and that before starting employees understand they will be expected to practice deliberately in response to client feedback.

Scott Miller gave a keynote address that reflected his recent provocative article titled “How Psychotherapy Lost its Magick.” In his address, he noted that in recent years, more people have visited psychics than have seen therapists. He concluded that, in part, this was because too often therapists practice within a narrow framework of models and techniques that may look impressive, but are not actually as helpful to clients as they could be.

Ultimately, there is a difference between models and techniques as developed and intended versus how they get applied in actual practice.  Implementation and integration of models can bring many challenges. Perhaps the most heartfelt example of this at the ACE 2018 Conference was Heidi Brattland. In her keynote address, she described going to see a therapist as part of her training to become a psychologist. By her account, the biggest lesson she learned was the resolve never to become the kind of psychologist she had gone to see.

Finally, Daryl Chow urged every professional to develop a broader view of the work we do. He is the first researcher to have published on deliberate practice approaches in psychotherapy.

Where does this leave the rest of us? Take-home messages include:

·    Basic counseling skills are only basic in theory. Combining them in actual practice is an advanced skill.
·       Conversation can be curative.
·     The most effective professionals in our field engage in solitary, often very difficult practice between sessions.
·    Treatment sessions are best thought of as performance that is different from the practice aimed at improving performance.
·       Clinicians in our field can learn from trends happening elsewhere.


I hope that the links provided throughout this post offer ideas for the way forward for readers.

Wednesday, May 2, 2018

Person-first language: Establishing a culture that transcends labels

By Gwenda Willis, PhD, Alissa Ackerman, PhD, & David Prescott, LICSW

The joint MASOC/MATSA conference took place earlier this month in Marlborough, Massachusetts. In a presentation on establishing person-first language across the fields of sexual abuse treatment and prevention, we (Gwen and Alissa) began our session introducing ourselves by several of the labels we hold. Gwen introduced herself as New Zealander, wife, friend, colleague, researcher, clinical psychologist, ATSA member and advocate. Alissa followed with mother, wife, lesbian, friend, colleague, professor, ATSA member, public speaker, advocate, and survivor, among others.

In this interactive presentation, we prompted attendees to explore the labels they use to describe themselves and the people they work with.  Like us, attendees were spouses, parents, clinicians and advocates.  Some were animal lovers and some were music lovers. All participants used positive labels to describe who they are. Next, we asked participants to describe who they work with and we explored which of these might not be self-selected by the very people we work with. Overwhelmingly, the labels we used to describe the individuals we work with were those that our clients might not use to describe themselves. Some of these labels included “victim”, “ex-prisoner”, “sexually violent person” and “offender”.

Importantly, there was agreement that use of such labels in our field is widespread: beyond their use in everyday conversation, such language is rife in the names of treatment programs, agencies, professional organisations and academic publications.  The American Psychological Association (APA), The National Association of Social Workers (NASW) and most professional organizations even tangentially related to our field articulate the need for person-first language in their Codes of Ethics, and yet in our field, we tend not to honor this need. Do we have an ethical dilemma? 

As part of our presentation, we considered core ethical principles of helping professionals including respect for human dignity, professional integrity and beneficence and non-maleficence.  We discussed how the “victim” and “survivor” labels might be self-selected by some people and not others, despite similar lived experiences.  Similarly, we acknowledged that some individuals with pedophilic interests self-identify as “pedophiles” while other individuals with pedophilic interests would find the “pedophile” label repulsive. 

We cannot assume which labels people want to use to describe themselves and if we truly honor human dignity, we must call people by what they prefer to be called. It is a matter of basic respect. For example, in our introductions, Alissa used the label “lesbian” to describe herself, while Gwen did not, despite both of us being married to same-sex spouses.

Discussion turned to the inaccuracies that normative labels such as “offender” and “abuser” portray – that anyone assigned such a label has the same (i.e., high) risk of reoffending.  As professionals working to address misperceptions about sexual abuse we highlighted the importance of communicating accurately about individuals who have abused, in the hope that they will have opportunities to live safe, fulfilling and offense-free lives. We turned to labels with scientific validity, including “psychopath” and “pedophile”, and conversation returned to their potential to stigmatise and ostracise.  Finally, we explored how labels might hinder the work we do to promote desistance from offending as well as healing from sexual abuse: What messages do the “offender” and “victim” labels communicate?  Possibly that this is how we see you. In the criminological literature, labelling theory suggests that the individuals internalize the labels we use to describe them and often live their lives accordingly.

How might we transcend potentially stigmatizing labels?  We introduced person-first language as an alternative to potentially stigmatizing language, which separates the person (e.g., man, woman, young person, individual, child) from a condition, disorder or behavior (e.g., individual adjudicated for a sexual offense, people who have committed crimes of a sexual nature). 

Labels are commonplace in every-day communication, and when self-selected they can aid communication.  However, assigned to us, labels have potential to stigmatise and harm.  As highlighted by Brene Brown (2017):

“The sorting we do to ourselves and to one another is, at best, unintentional and reflexive.  At worst, it is stereotyping that dehumanizes.  The paradox is that we all love the ready-made filing system, so handy when we want to quickly categorize people, but we resent it when we’re the ones getting filed away” (p. 48)

Person-first language avoids making assumptions about how someone wants to be labelled.  Additional exploration of issues raised in this blog and guidance on person-first language can be found in the 6th edition of the APA Publication Manual (American Psychological Association, 2010) and in Willis (in press).

In some quarters, the push towards person-first language has existed for years. It has occurred in other areas of psychology and human service (Willis, in press) as well as the field of treating adolescents who have sexually abused. Although it has long been known that adolescents can change dramatically over time, it is also worth remembering that adults can, and very often do, change as well. Further, the contexts in which they live their lives can change dramatically as well Now that our field knows what it does about building desistance and managing risk, it is clear that the use of labels has now outlived its usefulness. Indeed, it can cause harm.

References

American Psychological Association. (2010). Publication Manual of the American Psychological Association (6th ed.). Washington, D.C.: American Psychological Association.

Brown, B. (2017). Braving the Wilderness. New York, NY: Random House.

Willis, G. M. (in press). Why call someone by what we don’t want them to be? The ethics of labelling in forensic/correctional psychology. Psychology, Crime & Law doi: 10.1080/1068316X.2017.1421640

Thursday, April 26, 2018

The importance of multi-agency working to prevent sexual abuse


By Kieran McCartan, PhD

Yesterday I presented at an event, in London, which examined the role of multi-agency working in child protection across England. The event was framed around new changes being implemented in social work across England as part of the Putting children first agenda and the Children and Social Work Act, 2017. The event had an interesting mix of attendees and presenter’s from across the board including policy makers, members of parliament, police, social work, child protection, academics, survivors/victim charities (including, Barnardo’s, NSPCC), schools and research/policy organizations (incl., Centre of Expertise on Child Sexual Abuse and Internet Watch Foundation).

The day consisted of a series of talks, approximately 10 in total, which focused on how we can protect children better, how we can learn from good and bad practice, as well as how we can work better together to prevent sexual abuse. The talks covered a range of areas, including serious case reviews, local safeguarding boards, child protection investigations, school based education around sexual abuse, the use of materials in the prevention/discussion of child sexual abuse, the role of partnership in supporting victims of abuse, understanding perpetrators and preparation better as well as the role of schools in supporting child protection.

Some of the main themes and issues that arose for me from the event included,

-         A lot of the presenter’s discussed how effective multi-agency working was the best way of responding to sexual abuse and exploitation, a clear example of this came through the discussion of the new Child House that is due to open soon in Camden based on the Icelandic model (Barnahus). In addition, presenters felt that there was a lot to be gained from the multi-agency working that went into serious case reviews, child safeguarding practice reviews and joint targeted area inspections.

 

-         Schools were seen as the lynchpin in effective child protection, but there was recognition that all schools may not have all the resources that they need to be able to facilitate this safeguarding properly. The speakers from schools and with an education viewpoint argued that schools need the resources to deal with the safeguarding issues that they face on a daily basis, suggesting that when social workers and counselors are placed within schools then the establish can effectively respond and the experiences of everyone involved is improved.

 

-         Cassandra Harrison from the Centre for Expertise in Child Sexual abuse discussed their research and ongoing objectives, highlighting that there is still more about the reality and prevalence of child sexual abuse that we need to understand so that we can respond to it as well as prevent it more effectively. Cassandra directed attendees to their research agenda, publications and ongoing collaborations for more information on their work.

 

-         A representative from the Internet Watch Foundation, Michael Tunks, discussed their annual report, emphasizing the increase in child sexual abuse imagery on the internet, the adaptive ways in which it is being embedded online and an increase in reporting of inappropriate material from members of the public. The IWF emphasized the importance of getting men, especially young men, to report child sexual abuse imagery posted on traditional pornography sites or on other forums where they would not expect to find it.

 

-         Jon Brown from the NSPCC called for a national strategy in preventing child sexual abuse, indicating that we needed clearer and more joined up thinking on the issue. The only way that the prevention of sexual abuse was going to happen in practice was through a public and coordinated commitment to it.

 

-        Donna Smalley discussed the work that they have done with victims’ families to create a number of child sexual exploitation films (i.e., Kayleigh’s love story) to use with children when discussing sexual abuse, grooming and online behaviour. This promoted a lot of debate within the audience with some participants suggesting that that these types of material should not be used as they are harmful (referencing the work of Jessica Eaton) or that they should only be used in a certain way, with certain groups with appropriate resources (i.e., counsellors, etc.) on hand.

 

-         The importance of language in preventing and responding to child sexual abuse was discussed with some presenter’s (including myself and Jon Brown) arguing that the way that we frame the issue of sexual abuse has important ramifications for the way that the issue is processed. Which was seen as salient in the way that we talked about perpetrators, the use of terminology (i.e., treatment vs. rehabilitation vs. risk management, etc.) and the differences between exploitation and abuse.

 

-        Across all the presenters, the attendees and the chair’s there was recognition that sexual abuse was a health issue, not simply a criminal justice one.

 

-        The sharing of material, resources and training was a point for discussion across the day with participants questioned how to be access up to date information when there was a lot of varying information coming from a range of sources; how to prioritize? The question was raised, whose responsibility was it to streamline and prioritize this new information so that it could be used effectively.

The event and the presentations across the day really highlighted the importance of working together to prevent as well as respond to child sexual abuse. One of the final statements made by the chair was that change had to come from communities and that if communities saw organizations working effectively together it would enforce that something was being done to tackle child sexual abuse and that they should have trust in, as well as participate with, the system.

Friday, April 13, 2018

Supporting policy to prevent harm: Identifying gaps to support children with sexual behavior problems

By Hannah Laniado (Prevention Program Manager, MNCASA at hlaniado@mncasa.org) & Julie Patrick (National Partners Liaison, Raliance at jpatrick@raliance.org)
 
Recently, the Minnesota Coalition Against Sexual Assault (MNCASA) published, Children with Sexual Behavior Problems: Improving Minnesota’s ability to provide early identification and intervention services through policy and practice recommendations (June 2017), a comprehensive report outlining the data collection, literature review, and formation of recommendations for implementation. This is the first in-depth look at how one state can create change to improve intervention, prevention and response to children with sexual behavior problems.
 
The specific key recommendations are a model for how the system could improve for all children and families. Earlier identification and appropriate response require: specialized training for all professionals working with youth; consistent guidelines and protocols for tracking behavior; clear written policies professionals who work with children can access on how to respond – including when and what to communicate; as well as education and awareness raising to reduce stigma.
 
Methodology
 
MNCASA looked at what’s working and not working in Minnesota’s current systems for identifying children (12 and under) with SBPs through 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. 
 
MNCASA utilized ATSA’s definition of SBPs: children ages 12 and younger who initiate behaviors involving sexual body parts (e.g. genitals, anus, buttocks, or breasts) that are developmentally inappropriate or potentially harmful to themselves or others (Chaffin et al., 2006).
This project collected information and data in multiple forms. To facilitate the process, a set of guiding questions were identified at the outset of the project and then five chosen data collection methods answered the guiding questions (for details refer to Report #1). Exploratory interviews with 19 key informants, a scan of the empirical literature (42 documents published in the last 10 years), a web-based survey of professionals who work with children (1,022 responses total), investigative interviews with professionals who work with children with SBPs, and story gathering were collected between August 2016 and May 2017.
 
Key Findings
The literature review examined the latest research on incidence, identification, assessment, treatment, and policies for children with SBPs to provided an empirical basis for work to better understand how well Minnesota is doing in effectively identifying and intervening with children showing signs of SBPs.
Per the survey of professionals who work with children, parents and colleagues view them as a resource on differentiating between developmentally expected sexual behaviors in youth and concerning or problematic ones. Many professionals expressed interest in training on how to interact with children and their parents about children’s sexual behaviors.
 
Interviews with key informants also showed the lack of a clear process or procedure for where to report a child who is engaging in concerning or harmful sexual behaviors. In fact, many different systems (including social services, law enforcement, medical providers, child protection, probation, and school staff) all come into contact with children with SBPs and yet here is no one system charged with responding to or even tracking reports of children with SBPs. This results in great variations, county by county, to reports of a child with possible SBPs. Professionals who work with children need guidelines for how to treat behaviors as serious, educate about treatment being available, help set up effective supervision, and create protective environments. Without these guidelines, there is a tendency to either over-react or under-react resulting in children not receiving the help they need. There are also disparities across the state in terms of access to effective treatment for children with SBPs. Not all providers have specific training on children with SBPs and not all use evidence based treatment methods. Not all parts of the state have easy access to professionals who specialize in working with children with SBPs.
 
The specific policy recommendations in detail
1.      Make specialized training on best practices for identifying and responding to children’s sexual behaviors readily available to all professionals who work with children and families. This training needs to address the myths about children’s sexual behaviors and share the message of hope that with treatment, children are at no greater risk to grow up to be sexually abusive. A key element of this training should be how to effectively engage parents in discussions of and treatment for their child’s SBPs. Ideally this training would be incorporated into the educational requirements for students as well as offered as part of ongoing professional development or as a requirement for licensure.
 
2.      Develop consistent guidelines and protocols for tracking and responding to children’s sexual behaviors, including sexual behaviors between children. Ideally, all children would receive an assessment by a qualified professional who would make recommendations to address any SBPs and any safety risks the child poses to others.
 
3.      Create written policies professionals who work with children can access on how to respond to a child showing concerning or problematic sexual behaviors, when and what to communicate to parents/caregivers, and how to refer a child for an assessment.
 
 
4.      Develop an educational campaign that can be used to raise awareness about children’s sexual development and SBPs. This could be done by providing resources during well-child doctor visits, sharing handouts at school open houses, etc. This effort would go a long way in reducing the stigma and fear that gets in the way of effective response to children showing early signs of SBPs.
Citations:
Chaffin, M., Berliner, L., Block, R., Johnson, T. C., Friedrich, W., Louis, D.G., Lyon, T., Page, I., Prescott, D., Silovsky, J. (2006). Report of the ATSA Task Force on Children with Sexual Behavior Problems. Association for the Treatment of Sexual Abusers
 
With gratitude:
MNCASA would like to recognize Joan Tabachnick for her guidance throughout this project including reviewing multiple drafts of the literature review as well as Jane Silovsky and Jimmy Widdifield from the National Center on the Sexual Behavior of Youth (NCSBY), part of the Center on Child Abuse and Neglect (CCAN) in the Department of Pediatrics of the University of Oklahoma Health Sciences. Many ATSA members added value to this report.