Wednesday, August 21, 2019

The Jeffrey Epstein case and why language matters


 A statement from the Association for the Treatment of Sexual Abusers

The country has understandably been shocked and appalled by the heinous actions, both confirmed and alleged, involving the sexual abuse and trafficking of children perpetrated by Jeffrey Epstein. However, high-profile cases such as Mr. Epstein’s also bring much-needed attention to a complex public health issue facing not only our country, but all communities worldwide – sexual abuse.

Sexual violence affects millions of people each year in the United States, with more than 1 in 3 women and nearly 1 in 4 men having experienced sexual violence involving physical contact at some point in their lives. International research focused on violence against women has estimated that 35% of women worldwide have experienced either physical and/or sexual intimate partner violence or sexual violence by a non-partner (not including sexual harassment) at some point in their lives. The prevalence of child sexual abuse can be difficult to determine because it is often not reported, but it is estimated that one in four girls and one in six boys will be victims of sexual abuse before age 18.

Sexual abuse is a complex public health issue that requires accurate information in order to support prevention efforts, and the media plays an integral role in information dissemination. However, the media does a disservice to prevention efforts by using terminology such as “pedophile” and “child rapist” interchangeably, as seen in the many articles about Mr. Epstein.

Pedophilia is an attraction to children who have not yet reached puberty. A person with pedophilic interests may or may not act on those desires. In contrast, a child molester is a person who has chosen to sexually abuse a child. In the latter case, even though the abuse is sexual in nature, the motivations for the behavior may not be driven by sexual interest. Other motivations for sexual abuse include but are not limited to, a desire for power and control, general antisocial thinking/beliefs, and intimacy deficits and loneliness. Hence, not everyone who sexually abuses a child has pedophilic interests and not everyone with pedophilic interests will sexually abuse a child. Attraction is not action and action is not attraction.

Whatever Mr. Epstein’s motives may have been, he chose to act on those desires and abuse minors. Unfortunately, his personal wealth allowed him to act with relative impunity. This was exacerbated by those around him either not recognizing what they were seeing due to a lack of awareness about sexual abuse, supporting and benefiting from his behavior, being indifferent to it, or being afraid to report his actions. People who knew him may have minimized his behavior and dismissed their concerns because, with his status and prestige, Mr. Epstein couldn’t be “that guy.”

Mr. Epstein’s case, as well as the cases of Jerry Sandusky, Larry Nassar, and Bill Cosby, are stark reminders that anyone can be “that guy.” Those who commit sexual harm come from all walks of life. They can be people we admire, people we like, people we trust, or people we despise. They cross all socioeconomic, educational, gender, age, and cultural lines.

But another misuse of language – using terms such as “predator,” “monster,” “pedophile,” and “pervert” – to describe individuals who sexually abuse others artificially separates those who cause sexual harm from the rest of us, and does nothing to help the public understand who may perpetrate sexual abuse or develop effective strategies to prevent those actions. Instead, using this kind of language makes it harder to accept that even people we know and trust could be at risk to sexually abuse others.

We must embrace the harsh realities of who commits sexual harm:
·       -  93% of sexual abuse involving minors is perpetrated by someone known to the minor, not a stranger.
·        - 73% of rapes against females age 12 and older are perpetrated by someone known to the victim.

Those who commit sexual harm are those we know and even love, trust, and admire much more often than they are strangers. Effectively preventing sexual abuse requires we all learn about the complexities of sexual abuse, how to protect our children, and how to provide them with the necessary skills to protect themselves across their lifespan. It also requires us to recognize that sexual abuse is not perpetrated by the “monster” other, but by everyday people, famous people, and sometimes even those closest to us.

Accurate information and a shared approach to prevention are the keys to ending sexual abuse. Focusing on sexual abuse as a public health issue provides us with the correct lens to adequately tackle this pervasive issue by moving us beyond ensuring the health of individuals to the health and safety of an entire population. Through education, collaboration, and the involvement of everyone – community members, violence prevention professionals, victim advocates, law enforcement professionals, those who provide treatment to victims/survivors of sexual abuse, and those who provide treatment to persons who have perpetrated sexual abuse – the prevention of sexual abuse can become a reality.

Treatment is not only available to help prevent individuals at risk of abusing children from acting on their thoughts, it is also available to help individuals who have abused refrain from doing so again. The Association for the Treatment of Sexual Abusers offers access to treatment providers who can help individuals receive the assistance they need to avoid sexually abusing children and others. If you are seeking help for yourself, a family member, or a friend, visit www.atsa.com and click on “Referrals” to find a provider near you.



Thursday, August 15, 2019

Understanding and Responding to Pornography Use with Adolescents Who Have Engaged in Harmful Sexual Behavior: Developmental Considerations

By Russ Pratt & Cyra Fernandes

Introduction: ‘Teen rituals’

Fifteen-year-old Mikey* sits in his room, finishing his homework. From time to time, he closes the window on what he is working on, and watches a bit more of his most recent ‘favorite’ pornographic movie, After looking at this for a few minutes, and, becoming aroused, he picks up his phone, and scrolls through the dozen or so pictures of naked and semi-naked young women he goes to school with. All of them sent these ‘pics’ to him after he asked them to do so. They, in turn, have pictures of him, some requested, and some not. He hears his mother coming up the stairs, so quickly returns to his computer and homework. 

Is the above paragraph fantasy, fact, or somewhere between the two? Well, recent research suggests that this scenario is closer to the facts of the matter, rather than any responsible parents’ nightmare scenario. Not only is exposure to, or viewing of, pornography in adolescence now a normative experience, with research indicating that the majority of adolescents have viewed or been exposed to pornography by age 15 years (Lim et al, 2017), but also that the sending and receiving of naked pictures by adolescents has become a normative adolescent experience (Fisher, et. al., 2019; Smith, Mitchell, Barrett & Pitts, 2009; Mitchell et. al., 2014, Lim et. al., 2017).  In an Australian-based study of 2,136 15 to 17-year-olds, over half the sample had received a sexually explicit text message and had been sent a sexually explicit nude or nearly nude photo or video (Mitchell, et al., 2014). Over one-quarter of them had sent a sexually explicit photo to someone else. Thus it seems that sending and receiving sexually explicit (nude) pictures of themselves or others is the current broadly-acceptable, teenage courtship ritual.  

Does pornography influence sexual practices, behaviors, attitudes, and perceptions 

Well, the short answer to this question seems to be “yes” it does. And not only for adults, but clearly for adolescents commencing their sexual-developmental journey. Pornography significantly influences sexual practices, behaviors, and perceptions of both adults and adolescents when it comes to their view of “…what sex looks like. (Pratt & Fernandes, 2015)” In particular, it seems that consuming pornography (Fisher, et. al. 2019; Lim, et. al., 2017; Mitchell, et. al., 2014) is related to more permissive sexual attitudes and gender-stereotypical sexual beliefs, and, for those youths who view pornography at a very young age (pre-pubescent) we see earlier-onset sexual intercourse, higher rates of casual sex by early adulthood, and higher levels of sexual aggression by adults, in terms of both perpetration and victimization (Bridges, et. al., 2010; Wright, Tokunaga & Kraus, 2015),

The ‘young’ consumer

What do these young people who most frequently view pornography look like? As research indicates that the majority of young people have viewed pornography by 15 years of age, it seems more difficult now than ever before to ‘characterize’ what a ‘frequent consumer’ of pornography looks like, as compared to those who are not. As, authors, researchers, therapists, and even parents, we know how quickly the digital and online world is changing, and thus the patterns of usage we saw even ten years ago may not apply right now. This also means that less-recent research might not portray what the current situation is, as much as we would like. Peter and Valkenburg’s (2016) excellent 20-year summary of the research is a case in point. Findings cited by those authors may now relate to findings from before 1996 – well before the ‘digital revolution’. Given that pornography consumption is now ‘normative’ behavior for adolescents, it might be the case that we can only say that; more males than females view pornography; they (males) view it on a more frequent basis than females, and it is likely that the majority of young viewers do so for commonplace reasons, such as learning about sexual behaviors, and to achieve sexual arousal (Pratt & Fernandes, 2015). 

The role of pornography

So, what is the role of pornography in the development and maintenance of adolescent harmful sexual behavior? The answer is frustratingly unclear. While it is neither possible nor accurate to state that adolescent pornography use leads to harmful sexual behavior, it may be the case that repeated exposure to pornography might lead to desensitization and contribute to distorted views of what are normative, acceptable, or desired sexual behaviors and relationships. For some children and adolescents, this exposure could provide such a “skewed template” for the “how-to” and “what” of sexual behavior, and, more importantly, provide information and images that are so inappropriate for their developmental stage (Pratt & Fernandes, 2015) that it cannot be decoded nor understood; 

Young people who engage in sexually abusive behavior often present with deficits in important psychosocial skills (Peter & Valkenburg, 2016), and may lack the developmental maturity to both understand the explicit sexual content of pornography, and that it may not represent ‘real-life’ sexual relationships and behaviors and what people seek in sexual relationships (Pratt & Fernandes, 2015). 
In addition, due to sexual inexperience, learning disorders, intellectual disabilities and autism spectrum disorders, some youth may be even less able to critique and comprehend that what they see in pornography is not what “real-world” sex looks like. They may also be either reluctant or unable to seek support from adults to help them make sense of what they saw in pornography.

Conclusion

To conclude (and there is so much more to say), educating adolescents about healthy sexuality is a key component of treatment. For adolescents who have engaged in harmful or sexually abusive behaviors, the development of healthy sexual practices is key. Whilst sex education should include a focus on the relational aspects and boundaries of sexual behavior, more is needed. The authors have created a developmentally focused, “savvy consumer” model for youth which advocates ‘zero-tolerance’ for pornography viewing for very young children, combined with a ‘harm-minimization’ model for older adolescents. The model has, at its heart, the belief that the ability to both critique the falseness of pornography, and highlight positive, real-world sexual health practices will ensure that the qualities of healthy, safe, and desired sexual practices remain in-focus during treatment. 
In particular:
Respect,
Mutual consent,
Equality and partnership, 
The freedom to say no, and;
The freedom to negotiate equally regarding healthy, respectful sexual pleasure and activity.

References

Bridges, A J.,Wosnitzer, R., Scharrer, E., Sun, C., & Liberman, R. (2010). Aggression and Sexual Behavior in Best-Selling Pornography Videos: A Content Analysis Update, Violence Against Women 16(10), 1065-1085.

Fisher, C. M., Waling, A., Kerr, L., Bellamy, R., Ezer, P., Mikolajczak, G., Brown, G., Carman, M. & Lucke, J. (2019). 6th National Survey of Australian Secondary Students and Sexual Health 2018, (ARCSHS Monograph Series No. 113), Bundoora: Australian Research Centre in Sex, Health & Society, La Trobe University. 

Lim, M.S.C., Agius, P.A., Carrotte, E.R., Vella, A.M., & Hellard, M.E. (2017). Young Australian’s use of pornography and associations with sexual risk behaviours, Australian and New Zealand Journal of Public Health, 2017 online, doi: 10.1111/1753-6405.12678.

Mitchell, A., Patrick. K., Heywood, W., Blackman, P., & Pitts, M. (2014). 5th National survey of Australian secondary students and sexual health 2013. ARCSHS Monograph Series No. 97,  Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Australia.

Peter, J., & Valkenburg, P. M. (2016) Adolescents and pornography: A Review of 20 Years of Research, The Journal of Sex Research, 53:4-5, 509-531.

Pratt, R., & Fernandes, C. (2015). How Pornography May Distort Risk Assessment of Children and Adolescents Who Sexually Harm. Children Australia, 40, pp 232-241 doi:10.1017/cha.2015.2.

Smith, A. P., Mitchell, A., Barrett, C., & Pitts, M. (2009) Secondary Students and Sexual Health 2008: Results of the 4th National Survey of Australian Secondary Students, HIV/AIDS and Sexual Health, Australian Research Centre in Sex, Health and Society (Latrobe).

Wright, P.J, Tokunaga, R.S., & Kraus, A., (2015), ‘A meta-analysis of pornography consumption and actual acts of sexual aggression in general population studies’, Journal of Communication, 66(1), 183-205.

Wednesday, August 7, 2019

When we become the barriers to progress


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

At first, it all seems so easy. The large institution or agency decides they are going to get serious about professional development and quality improvement. “I’ve done some research on evidence-based practices and have concluded that we need to implement the Forensic Version of the XYZ-PSB model. It has all the qualities that we’re looking for, combining elements of all the popular models that are available, and even has some mindfulness. The fact that there are some deep breathing exercises at the start of some sessions qualifies it as a biopsychosocial approach.”

We’re kidding, of course. It often seems to us that the latest/greatest models make the largest promises until the implementation effort begins. The history of psychotherapy is certainly replete with examples of fad treatments, each one appearing to be bigger, better, faster, or just plain more. Many a well-intended agency and director (including the first author, David) have sought training in a particular method because it had worked in some other setting or been proven in a study or two, only to find out that the old adage is true: All too often what is new is not what makes a treatment approach effective. At the same time, what makes the same treatment effective is not new.

The above example of the fictitious XYZ-PSB: FV is ironic because there is a chance that it will work if implemented with diligence, confidence, and a shared belief between therapists and clients that it will work (Wampold & Imel, 2015). In other words, the belief that something will work very often contributes to its success. This is one reason why we have science: to understand not only what works, but how and in what ways.

The rest of the picture may not be so pleasant, however. The unfortunate reality at the front lines, often not reported in research, is that there are any number of ways that good treatment can go bad under the wrong conditions. Let’s take the above director’s plan for implementing XYZ-PSB: FV. Even before implementation, what kinds of exploration of the agency’s needs and staff attitudes takes place? Are the staff excited for the opportunity or feeling beleaguered that they are having to learn yet another approach at high risk of passing into history like the others?

Other questions follow. Will the director participate in the training? The absence of key decision-makers from the process itself can have a significant effect on staff, even though it is not mentioned in any manuals. Likewise, does the agency or institution bring in an outside trainer who trains, perhaps does some consult calls, and leaves without a succession plan? Some way to keep the spirit and practice of the treatment alive? And then during the initial phases of this implementation, what other barriers occur, such as the director getting a new job, or another influential actor going out on medical leave?

Of course, the picture can become even more pernicious. Are there other challenges competing with the meaningful implementation of a high-quality approach? For example, many agencies experience severe pressure to ensure complete adherence to complicated licensing requirements or accreditation. At what point is the search for excellence – that burning desire to become more effective – compromised by the need to ensure timely documentation? Does adherence to regulations end up compromising adherence to a new model? Do we then expend so much effort pursuing fidelity to the model that we then forget to maintain fidelity to the actual client and his or her individual characteristics?

These are questions too often omitted from any manual or introductory training, but they threaten treatment integrity nonetheless. This is why collaboration between researchers, trainers and professionals is so important in the creation of evidence-based practice that is fit for purpose in the real world (see another blog by Kieran on the importance of co-creation).  One of the sadder outcomes of implementation efforts, in our view, is when professionals work treatment jargon into case notes as a signal to auditors and licensors that they were using a model when in fact they really weren’t.

We (David and Kieran, along with our collaborator Danielle Harris) have argued in our training, and in a recent paper, that we can learn a lot about improving services by listening to the voices of the service user. Yet, most treatment providers work in environments where the same service user has little or no voice in their treatment planning.

Out hope is that by raising these questions we may better inspire dialog among professionals, researchers, and trainers as to how we might better anchor our practice in the evidence. All too often the enemy to successful implementation is ourselves.

Wednesday, July 31, 2019

ANZATSA Biennial Conference 2019


By Kieran McCartan, Ph.D.

The biennial ANZATSA conference took place from the 24th – 26th July in Brisbane. The conference was a real mix of research, practice, and engagement with colleagues from across Australia, New Zealand and internationally (with attendees and speakers from a range of countries including the USA, Canada, UK). In this blog, I am going to take you through the conference highlights.

On the first day (Wednesday) there were 11 ½ day workshops that focused on a range of topics, including Risk Assessment (David Thornton; Simon Hackett & Marcella Leonard; Maaike Helmus; Ray Knight & Judith Sims-Knight); the registration and disclosure of information relating to people who had committed sexual offences  (Katie Gotch, Margret-Anne Laws, Karla Lopez & Kieran McCartan); the voices of victims on the integration of people who have been convicted of sexual offences back into the community (Kelly Richards, Jodi Death, Carol Ronken & Kieran McCartan); the prevention of sexual abuse (Stephen Smallbone); and treatment/interventions (Richard Parker; Sharon Kelley) The workshops enabled professional, policy and practice conversations to take place in a controlled, informed environment.

The 2019 plenaries combined research, practice and innovate approaches from an international group of speakers, most of whom were from outside Australia and New Zealand. The Thursday keynotes addressed children who had committed Harmful Sexual Behaviour, their client voice and the impact of treatment/interventions, on their life course desistence as well as how we could adapt our practice to better serve them (Simon Hackett). This was followed by a discussion of what matters and what works in risk assessment and how it ties to reducing risk of recidivism (David Thornton), The third keynote on Thursday was a panel discussion on the process and impact of the Australian Royal Commission, which highlighted the challenges of implementing its recommendations in practice (Gary Foster, Kathryn Mandla & Professor Stephen Smallbone).

One of the main themes of the conference was hearing different voices and it's fitting that the Indigenous voices (Maori, Aboriginal and Tori Strait Islanders) and the victim's voices (through conversations on the Royal Commission) were front and center in the plenaries as well as in the parallel sessions. These sessions were important and thoughtfully developed, highlighting the ways that Australia and New Zealand where moving forward in the arena of hearing and respecting the Indigenous voices and how we can develop appropriate risk assessment, treatments/interventions, and integration strategies developed with traditional peoples in mind. Which should give all participants, especially from anglophone northern hemisphere countries, pause for thought in the way that we address these issues in our own countries. In addition, it was good to see and hear a focus on the victim's voice at a treatment and management conference for people convicted of sexual offenses as it reinforced that these two sides of the field are not as detracted from each other as they are often portrayed; the only way to truly understand, respond to and prevent sexual abuse is to hear all voices.

The National Office for Child Safety led two co-design workshops for the development of a National Strategy to Prevent Child Sexual Abuse on the last day of the conference. Which was interesting to attend and quite innovative in the context of a conference as policymakers got to discuss issues with researchers and practitioners, hearing each other’s voices and building approaches that were fit for purpose. These sessions where quite innovative and I would recommend that sister conferences in the field (NOTA, ATSA, ATSA-NL, CoNTRAS-TI & IATSO) would consider doing the same thing.

Other parallel workshops spanned a full range of topics and speakers of which this is just a flavour) including, integration of people who have sexually offended back into the community; public health approaches to sexual abuse and prevention; youth who sexually harm; institutional sexual abuse; & pornography. The parallel sessions were a good mix of research, evaluation, practical working, professional learning and knowledge exchange.

The second day of the conference (Friday) closed with an interesting mix of keynotes, a panel session that focused on the voices of Indigenous peoples (Lynore Geia, Neil Campbell, Carol Vale, & Claire Walker), another that addressed research on typologies of people who commit rape (Ray Knight) and how much we know about undetected sexual abuse (Sharon Kelley).  All the keynotes tied together ideas of the importance of assessment, management, and integration in a thoughtful, fit for purpose fashion tying together research, practice and policy effectively.

In addition to the traditional conference activities, ANZATSA 2019 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 ANZATSA conference) including, teachers, foster carers, members of charities and NGO’s, etc. They had approximately 70 participants sign up to attend the event. The session heard from national (Detective Inspector Rouse, Professor Martine Powell & Carol Ronken) speakers, chaired by Nance Haxton (the wandering journo), about how to raise informed and confident children that can discuss sexual abuse, and exploitation, and able to ask for help. The engagement event reinforced the main theme of the conference and highlighted that we as a community need to come together to stop child sexual abuse.

ANZATSA 2019 fitted a massive amount of material in across three days, which left me informed, refreshed and looking forward to 2021’s meeting.

Friday, July 26, 2019

Prevention of sexual abuse and the treatment of people who have committed sexually violent behavior: A current state of affairs


By Kasia Uzieblo, Jeffrey Lauer, & Minne De Boeck (Dutch Chapter of ATSA, NL-ATSA)

Five years ago, two colleagues, Wineke Smid, Jan-Willem van den Berg (Van der Hoeven kliniek, Utrecht, the Netherlands) and Jules Mulder (De Waag & Stop it Now! Netherlands) dreamed of founding a Dutch Chapter of ATSA (NL-ATSA). With this chapter, they wanted to enhance Dutch and Flemish practitioners’ knowledge on evidence-based and best practices in prevention, assessment, and treatment of sexually deviant behavior. They also wanted to encourage and facilitate a fruitful two-way interaction between North-American and Dutch speaking researchers and practitioners. A mere five years later, NL-ATSA has become a fully-fledged chapter of ATSA. Moreover, the chapter can be regarded as a prominent player in both the Netherlands and Flanders (Belgium), when it comes to informing practitioners about the scientific understanding of sexual violence and the treatment of people who have committed sexual offences. Proud of its achievements, NL-ATSA doesn’t want its fifth birthday to pass quietly and organizes two events to place this festive year into the spotlight.

A first event took place on the 25th of June. This event was entirely devoted to a special edition on sexually deviant behavior published by the Dutch Journal of Sexology which was edited by former and current NL-ATSA board members, Jan Willem van den Berg and Kasia Uzieblo. During each conference, session experts elaborated on a topic depicted in the special edition by zooming in on best (research) practices within this particular field.

The first presenter, Eveline Schippers (De Waag, Utrecht, the Netherlands), described the results of her innovative study on creating sexual deviance through incentive transfer in a male community sample. Antisocial behavior and sexual deviant interests are regarded as two important risk factors for sexually deviant behavior. However, current knowledge on how these sexual deviant interests originate is very limited. The Incentive Motivational Model (Smid & Wever, 2018) describes sexual arousal as an emotion, that is triggered by a competent stimulus signaling potential reward, and comparable to other emotions coupled with strong bodily reactions. According to this model, sex can be used to regulate emotional states, and emotions can be used to consciously or automatically regulate sexual arousal. Excitation transfer implies that one emotion triggers or reinforces another. But there might also be a sexual component to it. An example of sexual excitation transfer is when athletes become sexually aroused when they won a competition (i.e., when euphoria leads to sexual arousal). With the current study, Schippers aimed to examine whether people become more sexually aroused when experiencing a strong positive and/or negative emotion than when they are in an emotionally neutral state. Her first results suggest that mainly movie clips depicting aggressive content seem to elicit sexual excitation transfer and that genital excitation transfer might not fully align with the subjective (thus self-reported) experience of sexual arousal. This coupling between emotion and sexual arousal could provide interesting new avenues for treatment programs.

The importance of prevention strategies was highlighted in the second plenary session by Minne de Boeck (University Forensic Centre and Stop it Now! Flanders, Belgium) and Jules Mulder (Stop it Now! Netherlands). Taking into regard the high prevalence rates of child sexual abuse and the gravity of the impact of sexual abuse on someone’s life, it is astonishing that only a few programs focus on the prevention of sexual abuse on a primary -and even- secondary level. Notably, most of these projects focus on (potential) victims and on the environment (e.g., parents and school) of potential victims - and exceptionally- perpetrators, but not so much on the (potential) perpetrator him-/herself. Also, most of current prevention programs focusing on the (potential) perpetrator are situated on the tertiary level and hence focus on the prevention of recidivism, and not on preventing sexual abuse of ever happening in the general population (i.e., on the primary level) or in specific risk groups (i.e., on the secondary level). The presenters emphasize that if we want to be serious about preventing sexual abuse, all stakeholders (e.g., schools, sports clubs, practitioners, and policymakers) should start thinking in terms of prevention on the three levels and should start developing initiatives accordingly. De Boeck and Mulder presented three real-life cases (a case of child sexual abuse in a daycare center, sexual abuse by Jehovah’s witnesses, and sexting). These illustrations elicited inspiring discussions with the audience on the benefits and limitations of preventive strategies.

In the third and final plenary session Zohra Lkasbi and Daniël Neves Ramos (ZNA University Psychiatric Center for Children and Youth, Antwerp, Belgium) discussed the assessment in and treatment of minor perpetrators of sexually violent behavior. It is astonishing to note that this topic receives so little attention in literature and practice. Current theoretical knowledge on this issue remains very limited. And in practice they are often confronted with denial from different agencies: even for professionals, it seems to be difficult to acknowledge the existence of such behavior in minors, with all that this implies for the treatment of these minors. The presenters described the limited empirical knowledge on prevalence rates, the risk and protective factors for sexual violent behavior in minors, and interventions. The presenters illustrated the problems they are encountering in practice by describing a clinical case. With this case, they demonstrated that their patients are often minors who exhibit a wide range of psychosocial problems and risk factors. It also became clear that many of these patients have experienced traumatic events and that treatment programs should sufficiently take these traumas into regard. Finally, these clinicians often struggle with pharmaceutical interventions given that little is known about the efficacy and side effects of these interventions.

In the afternoon, four workshops took place. In a first workshop Jan Willem van den Berg and Marc Lexmond (Van der Hoeven kliniek, Utrecht, the Netherlands) presented “A Positive Life Plan”, which is a treatment plan developed by van den Berg and colleagues. With this treatment, plan practitioners are offered a tool to develop a treatment module that adheres to the principles of the Good Lives Model (Ward & Stewart, 2003). In the second workshop, Els Van Daele and Kris Vanhoeck (I.T.E.R., Brussels, Belgium) focused on the factors that might facilitate the development of a therapeutic alliance with clients who have committed sex offences. Through role-plays with the participants, they developed suggestions on how to avoid pitfalls and create opportunities to develop such an alliance with their client. The third workshop of Kasia Uzieblo and Eelco van Doorn (Van der Hoeven kliniek, Utrecht, the Netherlands) aimed to counter the most prominent myths about psychopathy and to illustrate that positive treatment outcomes can be obtained in patients with psychopathic traits. In the final workshop, Kim Ellen Biesmans, and Lieke Nouwen (STEVIG, Forensic Care and Centre of Expertise, the Netherlands) introduced a treatment program that they developed for individuals with intellectual disabilities who committed a sexual offence. This treatment program uses the Integrated Theory of Sexual Offending (ITSO; Ward & Beech, 2005) as a reference point.

This successful, sold-out event was again a reminder of what Wineke Smid, Jan Willem van den Berg and Jules Mulder have accomplished: Five years after the launch of NL-ATSA, the chapter plays a crucial role in building bridges between the production of knowledge and its diffusion to Dutch and Flemish practice and broader, to society. Hence, we are in great debt to the founders of NL-ATSA.

And for the curious readers amongst you: Our second birthday event will be a four-day conference on the assessment and treatment of sex offenders, which will take place from February 4 until February 7, 2020, in Antwerp, Belgium. More information is coming soon!

References
Smid, W. J., & Wever, E. C. (2018). Mixed emotions: an incentive motivational model of sexual deviance. Sexual Abuse, doi: 1079063218775972.

Ward, T., & Beech, A. R. (2006). An integrated theory of sexual offending. Aggression and Violent Behavior, 11(1), 44–63. http://dx.doi.org/10.1016/j.avb.2005.05.002

Ward, T., & Stewart, C. A. (2003). The treatment of sex offenders: Risk management and good lives. Professional Psychology: Research and Practice, 34(4), 353–360. http://dx. doi.org/10.1037/0735-7028.34.4.353.


Thursday, July 11, 2019

ATSA’s Role in Addressing Campus Sexual Misconduct as an Opportunity for Prevention


By Joan Tabachnick Katie Gotch

Please note that this is a joint blog by the ATSA prevention and policy committees - Kieran 


Over the past ten years, the media and a growing advocacy movement have focused the public’s attention on campus sexual misconduct. Campuses throughout the world are facing this issue, and a growing number of countries are issuing guidelines that call on colleges and universities to improve the way they respond to and prevent sexual misconduct on campus. 

Advocates worldwide acknowledge that preventing sexual misconduct on college and university campuses requires comprehensive prevention strategies and policies for students, faculty, staff, and institutions.  A comprehensive prevention strategy includes providing services to all persons impacted by sexual harm – those who have been harmed, those who have caused harm, those at risk to cause harm, and the people connected to these individuals.

Given the importance of this issue, you may ask yourself: what could ATSA and its members provide in addressing campus sexual misconduct?  

We believe that ATSA has a unique lens and expertise in this growing conversation based upon our collective expertise and understanding of the perpetration and prevention of sexual misconduct.  The Centers for Disease Control and Prevention (CDC) in the United States has argued for the importance of this lens, stating that “a decrease in the number of actual and potential perpetrators in the population is necessary to achieve measurable reductions in the prevalence of sexual violence” (DeGue, Simon, Basile, Yee, Lan, & Spivak, 2012; DeGue, Valle, Holt, Massetti, Matjasko & Tharp, 2014).  Therefore, by incorporating the available knowledge and ATSA’s expertise on the assessment, treatment and prevention of abusive, illegal, or harmful sexual behaviors, a college or university’s ability to prevent and respond effectively to campus sexual misconduct will be strengthened. This includes what we know about effective interventions and protective factors for individuals who have committed some form of sexual harassment, misconduct, assault, or violence. 

To help articulate this point of view, ATSA’s Public Policy Committee and ATSA’s Prevention Committee joined together to develop a document outlining our contributions to this important conversation.  The document discusses the need to identify evidence-informed policies and practices that: 

hold individuals who perpetrate sexual assault accountable for their behavior; 

provide safety and support to individuals who have been harmed to facilitate healing; 

provide services for those who have caused harm with the resources necessary to stop their harmful behavior; and 

prevent sexual assault from happening in the first place.

The document additionally offers some key recommendations which are provided as suggestions to build a more effective response and prevention approach targeting the perpetration of sexual misconduct.  The recommendations include: 

connect with local expertise on the perpetration of sexual misconduct;

appropriately sanction and provide treatment to those who have caused sexual harm that is grounded in an individualized evidence-based approach; and

include perpetration prevention lens to existing prevention programs.

It is our hope that, by including the current knowledge regarding individuals who have sexually harmed with the emerging research and programs that show early and effective interventions can stop sexual misconduct, colleges and universities will be one step closer to achieving the important goal of preventing sexual misconduct. 

For more information, including additional resources on this important topic, check out the ATSA document: Addressing Campus Sexual Misconduct. It is a resource for all and we encourage you to share it widely!

Tuesday, July 2, 2019

Norway is increasing their focus on systematic treatment to high-risk persons who have sexually offended

By Ingeborg Jenssen Sandbukt

In 2015, the Norwegian Directorate of Health allocated money for a three year pilot project offering treatment to high-risk, sex-convicted persons. The project, BASIS (an acronym derived from the Norwegian name, Behandling Av Seksuallovbruddsdømte I Sør-øst) was carried out in the period 2016-2019 in the South-Eastern region of Norway. The project collaborated closely with international experts to implement a Good Lives Model-derived individualized sex offence treatment approach in Norway. Up until then, individual treatment aiming to reduce recidivism was rarely offered to this group while in prison, and the Correctional Service called for better and more systematic treatment options.
 
Norway’s structural policies are closely aligned with what Braithwaite called reintegrative shaming. (Reintegrative shaming, which focuses on the individual’s behavior and is related to the trend towards positive criminology, is not to be confused with traditional shame, in which the person feels bad about who they are.)  Sentences are relatively short in length, and persons convicted of sexual offences live side by side with other prisoners. Rehabilitation is considered a corner-stone in the Norwegian Correctional Service, and there are no registries after release.
 
However, there has been a substantial increase in the proportion of prisoners serving sentences for sex offences for the past 20 years, and the increase is seen as a challenge for the Norwegian Correctional Services. Persons convicted of sexual offences now make up about 19 % of the total prison population, compared to about only 6 % in 2000. The main reason for this increase is not a higher number of persons convicted of sexual offences (although we have seen a small increase in convictions as well), but a new Penal Code leading to more severe punishment for serious crimes, including longer prison sentences for sexual offences. Current court practice witness of an extensive increase in lengths of sentencing for some types of sexual offences for the past ten years, and it has been argued that Norway’s penal state has moved in a more punitive direction (Shammas, 2016). Several Continental European countries have in fact for the past years enacted more restrictive laws on sexual offending (McAlinden, 2012). In addition to longer sentences for sexual offences, other less severe crimes are more often than before subject of other forms of punishment than imprisonment, leading to a larger proportion of persons convicted of sexual offences in Norwegian prisons (Shammas, 2016).
 
Through the BASIS project, the health sector has collaborated with the Correctional Service to identify and locate high-risk individuals. All sex-convicted persons in the chosen region have been subject to a systematic risk screen using the STATIC-99R. Persons with a risk score of 4 and higher have been offered further assessment and individual treatment with trained psychologists. The STATIC-99R has not yet been validated in Norway, but the project group is working on results from a retrospective follow-up study to confirm validity.
 
Individual treatment using the Good Lives Model has been successful among patients (n=21) in the BASIS project. The future- and strengths-based approach seems to fit with the Norwegian values and the focus on rehabilitation and re-inclusion after release. Patients have stayed motivated and most have wanted to continue treatment after conditional release from prison. The collaboration between treatment providers and Corrections staff has been a key factor to succeed in implementing this new method for patient inclusion and treatment in Norway. Furthermore, the BASIS psychologists have had the opportunity to participate at international conferences like ATSA, and quality of treatment has been secured through regular supervision sessions with outside consultants.
 
A final conference marking the end of the BASIS project was held in Oslo June 4, 2019, with attendees participating from around Norway. The BASIS project’s final report, launched at the conference, recommended that systematic risk screening and individual treatment of the high-risk group is implemented nationally to reduce sexual recidivism among sex-convicted persons. As a result of the systematic work through these three years, authorities have allocated money to offer similar treatment in all health regions in Norway, based on the BASIS model. This is great news, and an important step in the direction of ending sexual abuse. Systematic risk-screening will be continued as a first step in including patients, and The Good Lives Model is the chosen treatment approach.
 
References
 
McAlinden, A.-M. (2012). The governance of sexual offending across Europe: Penal policies, political economies and the institutionalization of risk. Punishment & Society, 14(2), 166-192. doi:10.1177/146247451143557
 
Shammas, V. L. (2016). The Rise of a More Punitive State: On the Attenuation of Norwegian Penal Exceptionalism in an Era of Welfare State Transformation. Critical Criminology, 24(1), 57-74. doi:10.1007/s10612-015-9296-1

 

 

 

 

 

Friday, June 28, 2019

Rehabilitative Climate and the Experience of Imprisonment for Men with Sexual Convictions


By Nicholas Blagden & Ralph Lubkowski

For men convicted of a sexual offence life in prison is not easy and can often be a brutal experience. They are despised by all for what they have done. They may have lost, or fear losing, the support of those who care for them. They will be at the bottom of the prison hierarchy, living in constant fear of being identified as a ‘sex offender’ and will often be the victim of physical and verbal assaults (Schwaebe, 2005). The difficulties facing these men are innumerable. Yet, despite all of these issues, we still expect these men to be rehabilitated, to volunteer willingly for, and commit to, treatment where the intimate details of their lives are laid bare (Ware & Blagden, 2016). Treatment must seem like a frightening prospect on many levels. It is important to note that while a populist response to this may be that such individuals ‘deserve’ to feel that way, it does little to help rehabilitate individuals. The goal of prison and prison rehabilitation for such individuals must be to prevent other victims and to help men lead meaningful and pro-social lives because this is what will keep people leading offence-free lives. We know that harsh environments make people worse and not better and negatively impact both staff and prisoners (Chen & Shapiro, 2007).

However, despite the environment being highly adversarial for those convicted of sexual offences, there is very little research considering the impact. The prison climate and the attitudes of staff in that prison play an important role in successful treatment and rehabilitation of offenders. In an era when the treatment of men with sexual convictions is contested and even questioned, there is a real need to take seriously the environment in which such individuals reside and understand the opportunities within that environment to help men flourish.

Rehabilitative climate of prisons for men with sexual convictions

Men convicted of sexual offences represent around 18% of those serving a prison sentence. This has brought challenges e.g. where to locate such individuals, as many are separated onto ‘vulnerable prisoner units’, but still experience threats and fear from others. One solution in England and Wales has been to increase the number of prisons specifically for men with sexual convictions.

There is some debate as to whether housing men with sexual convictions together is a good idea. Some suggest that they may share deviant fantasies, groom others including staff and create an overly sexualised environment. These are important issues, but the incidence of such events happening is not as frequent as we might think. Recent research (see e.g. Blagden & Wilson, 2019, Blagden et al, 2016) has found incidences to be unexpectedly minor given the sample. Instead in these research studies, participants expressed that they were experiencing the prison as a “different world”, one in which they were less anxious and less fearful. This was helping men have the ‘headspace’ to contemplate change.

Prisons for men with sexual convictions with a good rehabilitate prison climate promote constructive and meaningful relationships between prisoners and staff and provide opportunities for meaningful experiences to allow men the possibility to try out new identities. Relationships matter in prison, especially for this client group, as they can be testing grounds for future relationships and identities. An important aspect of meaningful relationships for this client group (and others) is creating opportunities for reciprocal relationships i.e. those that promote shared exchanges, shared learning and understanding. Two things which have been important for creating reciprocity within the prison are peer support and active citizenship. Indeed, the reciprocal aspects of these have been found to galvanise staff-prisoner and prisoner-prisoner relationships, which is important as the relational properties of both are linked to the ‘self-change’ process (Mead, Hilton, & Curtis 2001). HMP Stafford is a prison that has an active citizenship focus. Active citizenship at its heart is about creating a community and a shared sense of ownership of the space they inhabit, it helps prisoners to engage more with the people and the world around them, to reintegrate in the community (Edgar et al, 2011). Finally, we will look at what active citizenship looks like in practice.

Rehabilitative Climate in Action - Active citizenship

In 2016 HMP Stafford was rerolled to hold exclusively people convicted of sexual offences (PSOCOs). This dramatic shift in population was closely followed by a new focus on Rehabilitative Culture across the prison estate. Stafford’s approach to these two new opportunities was Active Citizenship, a simple concept of recognising, reinforcing, and recording acts seen to be doing good for the community, environment, and others. Visually striking and simple promotional materials were produced, and staff and resident champions appointed to drive the concept forward.

Initially the result was that residents strived to be in jobs linked to “citizenship” such as carers, listeners, or resident’s council reps. Citizenship was regarded as a position to be attained and closely linked to employment or activity. There were no financial rewards, nor was it directly linked to the Incentives and Earned Privileges Scheme. The only tangible benefit was a badge, however being recognised as an Active Citizen created a new identity for those willing to do good, and built momentum behind the idea of contributing to the prison community.

As Active Citizenship embedded, it evolved. Residents looked for new opportunities to contribute, and staff recognised and valued these small acts of kindness. Citizenship became less linked to specific roles or activities, and more of a way of life. Even the badges, albeit still worn proudly by those that received them, became less significant. Contributing to helping others and making Stafford a better place became a shared objective for staff and residents, the act itself being the reward. This has led to a remarkable transformation in the past 18 months. Trust has built between staff and residents, with a progressive and innovative climate resulting in what at times seems like an avalanche of new initiatives and opportunities. Many of these have been created and driven by residents and front line staff, often in their own time and with little or no resource.

Stafford is now a place where residents are given a real opportunity to change and grow, a community where people care for each other and where hope flourishes. We do not shy away from the reality of what our residents did, or what difficulties they will face after prison but Citizenship has created a climate where they can rebuild and renew themselves. They feel valued and empowered, enabling them to confront their previous life and wrongdoing and move forwards. We are still on a journey, and there is more to do, but the foundations have been built allowing us to build something truly remarkable.

References

Blagden, N., & Wilson, K. (2019). “We’re All the Same Here”—Investigating the Rehabilitative Climate of a Re-Rolled Sexual Offender Prison: A Qualitative Longitudinal Study. Sexual Abuse, DOI: 1079063219839496.

Blagden, N., Winder, B., & Hames, C. (2016). “They treat us like human beings”—Experiencing a therapeutic sex offenders prison: Impact on prisoners and staff and implications for treatment. International journal of offender therapy and comparative criminology60(4), 371-396.

Chen, M. K., & Shapiro, J. M. (2007). Do harsher prison conditions reduce recidivism? A discontinuity-based approach. American Law and Economics Review9(1), 1-29.

Edgar, K., Jacobson, J. and Biggar, K. (2011), “Time well spent: a practical guide to active citizenship and volunteering in prison”, Prison Reform Trust, London, available at: www.prisonreformtrust.org.uk/Portals/0/ Documents/Time%20Well%20Spent%20report%20lo.pdf (accessed July 8th, 2017)

Mead, S., Hilton, D., & Curtis, L. (2001). Peer support: A theoretical perspective. Psychiatric rehabilitation journal25(2), 134.

Schwaebe, C. (2005). Learning to pass: Sex offenders' strategies for establishing a viable identity in the prison general population. International Journal of Offender Therapy and Comparative Criminology49(6), 614-625.

Ware, J. & Blagden, N. (2016), “Responding to categorical denial, refusal, and treatment drop-out”, in Boer, D.P. (Ed.), The Wiley Handbook on the Theories, Assessment and Treatment of Sexual Offending, John Wiley & Sons Ltd, West Sussex, pp. 1564-71.


Friday, June 21, 2019

Finding pathways to prevention: An international consensus position for better management and prevention of online child sexual offending behavior

By Maggie Brennan, PhD, Derek Perkins, PhD, Hannah Merdian,PhD

A new report released today (Friday 21 June), involving over 2,000 experts in online child sex offending has made strong recommendations on how to better prevent the growing problem of child sexual offending on the internet. 

Recent surveys have found that technological developments are limiting the international capacity for the prevention, detection, and prosecution of online child sexual offending behaviour (e.g. NetClean, 2018). Moreover, “investigators still have to deal with significant numbers of offenders committing preventable crimes such as viewing and sharing indecent images and videos known to law enforcement” (National Crime Agency, 2018).

The recommendations come amid the group’s concerns about ‘epidemic levels’ of child sexual exploitation material (CSEM) offending online. The number of UK-related case referrals received by the National Crime Agency from the online industry almost trebled between 2016 and 2018 - rising from 43,072 case referrals in 2016 to 113,948 in 2018. In the year 2018 alone, the US National Center for Missing and Exploited Children received 18.4 million referrals of suspected online child sex offending cases from around the world (National Crime Agency, 2019). 

The report, developed by the International Working Group for the Prevention of Online Sex Offending (IWG_OSO), features input from a range of experts in the behaviour of online child sex offenders, including the UK National Crime Agency, Interpol, Public Health Canada, the National Society for the Prevention of Cruelty to Children (NSPCC), and the Universities of Plymouth and Lincoln, UK. 

In order to scope the nature of, and professional opinions on, the management and prevention of CSEM offending, the IWG_OSO: (1) reviewed the literature on online sexual offending; (2) conducted a Delphi survey with international experts in the management and prevention of online child sexual offending behaviour; and (3) conducted a multi-annual series of consultation events with international stakeholders in the relevant areas. 


The consultations were held between 2014 and 2019 at a range of key events, including at the IATSO and NOTA conferences, and involved clinicians, law enforcement professionals, researchers, policymakers, and offender managers and other stakeholders.

The report highlights that the prevention of online child sexual offending behaviour requires more public engagement to raise awareness and understanding of this problem, closer collaboration between behavioural experts and the online industry, a better balance between punishment and early intervention with potential offenders, as well as increased primary prevention measures to address the underlying causes of online child sex offending.

The report, entitled Best Practice in the Management of Online Sex Offending, is being officially launched on Friday 21 June at the NSPCC headquarters in London. Its recommendations for better management and prevention of online child sexual offending include:

  • Closer collaboration between behavioural experts and the online industry: Experts involved in researching, treating and preventing online child sex offending behaviour should work more closely with the online industry to help design barriers to the commission of sexual offences online. This might include collaborative work to design-out an offender’s ability to produce, share and access CSEM in online platforms and services involved in these offences, as well as further expansion of deterrence messages and splash pages into pre-offending locations online.

  • Increased public engagement with the problem of online child sex offending behaviour: Through, for example, media-supported public awareness campaigns, to increase public understanding of the problem of online child sexual offending behaviour, and to reduce the fear and stigma involved for people who wish to come forward and seek help to manage their pre-offending sexual interest in children.  

  • Better balance between efforts to prosecute and punish online sex offenders with earlier intervention methods to prevent sexual offences occurring – particularly for people with a pre-offending sexual interest in children: For example, an expansion of anonymous helplines and online deterrence campaigns targeting potential online child sex offenders, as well as greater therapeutic provision in the community.

The IWG_OSO was set up in 2014 with the support of the International Association for the Treatment of Sexual Offenders. Its members and consultees include experts in online child sexual offending behaviours, from law enforcement, academia, children’s charities, offender support services, therapeutic providers and the online industry.

The full report can be found at https://pearl.plymouth.ac.uk/handle/10026.1/14331

References

National Crime Agency. (2018). Supplementary written evidence submitted by the National Crime Agency (NCA) (PFF0011). Retrieved from: http://data.parliament .uk/writtenevidence/committeeevidence.svc/evidencedocument/home-affairs-committee/policing-for-the-future/written/82068.pdf

National Crime Agency. (2019). NCA shines light on online CSAE for public inquiry. Retrieved from https://www.nationalcrimeagency.gov.uk/news/nca-shines-light-on-online-csae-for-public-inquiryNetClean. (2018). The NetClean Report 2018. Retrieved from https://www.netclean .com/netclean-report-2018/#insiktermobil