Reducing harm in individuals who commit sexual abuse

By Kieran McCartan, PhD, & David Prescott, LICSW

Professional discussion about preventing sexual abuse is often couched in absolutes, especially when it comes to anti-social behavior. In our field, we often talk about eliminating abuse and/or stopping people from abusing, whether before it starts or after it has occurred. We find ourselves asking… is it really that easy? It is striking how rarely our discussions focus on harm reduction or how we might influence the nature of offending, offenses, or reconviction. By thinking in absolutes, we may be cutting ourselves off from innovative research and treatment practices.

Ultimately, all of our efforts are aimed at moving an individual from one end of a spectrum (offending) to the other end (desistence) in a short, often pre-determined time. In reality, meaningful behavior change takes time, faces unpredictable challenges, and has its stumbling blocks; genuine change can be a messy process. All of this begs the question of whether we are setting ourselves up for failure when we recognize only black or white in the management and treatment of people who sexually offend?

A client treated by the second author (David) many years ago serves as an example. This young man entered treatment after an extremely serious sex crime. After nearly two years of treatment, he re-entered the community where he lived safely for one year. He then committed a lesser property crime. It was at that point that he realized what lay ahead in his future if he didn’t make even deeper changes. He lived offense-free as a stable and occupied person for many years thereafter. What can we make of this trajectory? Some would believe that his subsequent arrest is an indication that treatment didn’t work. Others would be encouraged by the fact that the severity of his behavior had decreased significantly. He would be coded as a recidivist in some studies but not those focusing solely on sexual re-offense. We believe his case highlights how a harm reduction perspective can be helpful. Harm reduction policies and practices build upon the notion that people desist from specific harmful behaviors one step at a time, are guided in that process by professionals and the system is set up in a way that enables positive change. In many respects harm reduction policies are very closely linked to the notion of quaternary prevention (that is, actions taken to protect individuals from interventions that are likely to cause more harm than good). This approach is built on the understanding that behavior change takes time.

Harm reduction can be a perspective, approach, or outcome. The key element is that the person in questions stops most damaging behavior and engages in a process of working on their other problematic behaviors systematically. A focus on reducing harm or the most problematic behavior, at the expense of other behaviors, is not an excuse for offending or an apology for it. It is a central part of many criminal-justice approaches (such as with youthful offending), health care (for example, drug addiction) and mental health treatment populations. Yet harm reduction is not fully embraced when it comes to working with people who commit sexual abuse.

In treating addictions, professionals do not expect a heroin addict to stop completely overnight. Instead, they consider intermediate approaches such as Methadone or Suboxone. Likewise, with alcohol abuse we talk about reducing an individual’s daily intake and enabling them to cut down their dependence over time. When it comes to the field of sexual abuse, the expectation placed on those who have abused is that they must recognize and eradicate every aspect of their problematic behavior overnight. In some areas, even minimizing the harm of one’s actions has been enough to deny entry into treatment programs. Keeping people out of treatment doesn’t make them less likely to cause harm.

Practitioners in our profession don’t talk in terms of reducing harm, especially from a policy, political and public view; instead we often talk about complete and immediate harm eradication. This is likely because the narrative surrounding the reduction of harm in regard to people who commit sexual offenses can be (and often is) misconstrued as an absolution for problematic behavior. Harm reduction requires nuanced thinking and practical approaches, and too often flies in the face of our more absolute ideals.

Recalling the earlier example, yes, he still committed an offense and still displayed problematic behaviors. However, the level of harm was reduced substantially. This does not justify his property crime, but history showed it to be a lesser crime on the road to desistance.

It seems worth mentioning that the recent evaluation (2017) of the prison-based Core Sex Offender Treatment Programme in the UK (which ultimately lead to its being abandoned) demonstrated a reduction in harmful behavior by participants. Within the outcomes, it found that there were a group of service users that were reoffending, but not at the same level or in the same fashion that they originally offended. Asking questions about the nature and use of interventions that contributed to de-escalation of these people’s offenses, and the time frames in which they took place would have been helpful.

Likewise, Karl Hanson recently spoke at the ATSA 2018 conference in Vancouver about how risk is dynamic. He argued that with the correct support and interventions, risk can drop from high to low over a 20-year period. All of this begs the question, how long does behavior change take and what does the journey look like?

The skipping over harm reduction in treating sexual abuse is particularly worrisome when its core tenants correspond to desistence, strengths-based approaches, and the Good Lives Model. Integrated treatment that focuses on harm reduction reflects research on offending behavior across the lifespan. We hope our field will recognize through the research on adverse childhood experiences and the increasing use of trauma-informed care that the path towards offending is long and nuanced. Why would we think that the path to desistence and non-offending wouldn’t be equally complex?

Beyond Referrals: Multi-agency enablers and barriers to addressing harmful sexual behaviour in schools


Dr Jenny Lloyd, Research Fellow, University of Bedfordshire

Note: This article was originally printed in the March/April 2019 edition of NOTA news. Kieran

 
“It occurs so much through the day that you kind of blank it out… in that moment you either choose to reprimand that student and deal with the backlash and get even more verbally assaulted, or you choose to get the work done for that lesson and ignore that behaviour” (School staff focus group).


Young people report experiencing sexual violence and abuse at school by their peers. From sexist name calling in the corridor, unwanted touching in the playground and abuse through image sharing online, schools are places where young people display and experience harmful sexual behaviours (HSB). In my session, I presented findings from a research study looking at multi-agency enablers and barriers to addressing HSB in schools in England. The study was led by Dr Carlene Firmin and supported by myself and Joanne Walker at the University of Bedfordshire.


In the UK multiple calls have been made for schools, the government and agencies to do more to tackle sexual harm and abuse in schools between students. In 2015 the BBC revealed that more than 4000 allegations of peer-on-peer sexual abuse and 600 rapes were reported in schools between 2011and 2013. Evidence submitted to the Women and Equalities Committee (WEC) inquiry in 2016 revealed that 29% of 16-18 years olds had experienced unwanted touching at school and 71% of boys and girls aged 16 -18 heard terms like ‘slut’ used towards girls daily or a few times a week (YouGov 2010).


Until recently, statutory advice and guidance to schools for peer-on-peer sexual abuse have focussed on the need for referrals to social care and the police. But referrals are not enough. From speaking with schools and practitioners we have learnt that many schools face challenges of what changes to make within schools when harm happens there. The research, therefore, aimed to support schools to move beyond referrals to social care and consider the factors within schools themselves that can prevent and respond effectively to HSB. 


While the research highlighted the prevalence of HSB in some schools it also identified the successful work of school practitioners to identify and prevent HSB and the important roles of peers in supporting one another. However, we also identified a number of challenges in relation to the practice, as this extract shows:


“We had a student who reported that she was sexually assaulted by another student, and I don’t know if anything ever happened from that.  I don’t think she knows, she didn’t feel like anything happened from that, and so she was really, it definitely upset her, because she was being really, one, her behaviour was quite bad, but I think it was because she was angry. And I ended up having a conversation with her, just saying “you’ll leave school and encounter situations like this outside of school, you’ve got to learn to like be resilient”.  That was sort of the only thing I could really say to her, just help her to understand that [inaudible 24:29], society [inaudible 24:31], it’s not just, you know, like, yeah, which is kind of a sad conversation to have, but at the same time it’s realistic I guess.”(Staff focus group 1).


Analysis highlighted four keys areas: the structures and systems in use by schools; approaches taken to prevent harmful sexual behaviours; how schools identify HSB; and, the response and intervention following incidents. Furthermore, the research suggests that preventing sexual harm in schools should not just fall upon education providers but requires multi-agency and holistic responses. This needs schools and multi-agency partners to work together. Inspectorates play a key role in addressing the issue and identifying safeguarding concerns. However, in order to do so, schools, agencies and inspectors need to know what enables and prevents HSB developing. 


As a result of this work, the research team have developed a range of tools and resources, designed for senior leadership and designated safeguarding leads that support secondary schools and Further Education providers to assess how they are responding to sexual harm in schools. 


The tools cover a range of factors identified as playing a role in addressing HSB in schools, including what the referral pathway is for school staff; the relationship between the school and local partnership; the role of the physical environment of the school; and, the quality of education on relationships and sex. 


The resources include a traffic-light tool for self-assessment and a series of webinars. These tools offer a framework for considering changes within school. The resources can be accessed free here:
https://contextualsafeguarding.org.uk/publications/beyond-referrals-levers-for-addressing-harmful-sexual-behaviour-in-schools
For more information on the study please contact jenny.lloyd@beds.ac.uk

References
Lloyd, J. (2018) Abuse through sexual image sharing in schools: response and responsibility. Gender and Education. doi.org/10.1080/09540253.2018.1513456

Prevention programmes aimed at carers need to look beyond awareness raising and confidence building

NOTA BLOG

Prevention programmes aimed at carers need to look beyond awareness raising and confidence building

By Mike Williams, NSPCC

Prevention programmes aimed at family members are big business these days. Sexual abuse prevention programmes, in particular, have a history stretching back to the 1970s in the United States of America, where they were first developed. The first programmes were delivered to children, and in the 1980s they were extended to parents.  Programmes delivered to parents take the form of one-off meetings, two to three hours long. Programmes aim to increase knowledge, improve attitudes and intentions, increase carer communication with children about abuse and improve behaviours believed to reduce risk. Programme effectiveness is determined by measuring user change against these outcomes.

 Although helping carers to improve knowledge, attitudes, communication and behaviours is laudable, it is questionable as to whether achieving these outcomes reduces the likelihood of children being abused. The use of these outcomes as indicators of programme effectiveness rests on several questionable assumptions:

  • Gains in knowledge and attitudes lead to behavioural change.
  • Carers’ reported increases in desired behaviour are accurate.
  • Changed behaviours effectively lower likelihood of abuse.

Evaluation of prevention programmes targeted at children suggest these assumptions do not always hold, that is to say, positive programme outcomes do not necessarily lead to a reduction in abuse. Increases in correct verbal responses do not always lead to an improvement in behavioural response. Using learned self-protective behaviours to guard against threats or attempted assault does not always impact on whether abuse occurs. Children who understand prevention messages can go on to be sexually abused.

Could it be, therefore, that prevention programmes are missing a vital piece of the jigsaw? Could it be that prevention programme organisers have failed to understand the challenges to identify and lower risk?

A recently published report on work done to support mothers lower risk in the home suggests the answer to both of these questions is yes. The work was done with Somali mothers but the findings are applicable to female carers across communities and to a lesser extent, male ones. The report has identified a number of issues that prevention programme organisers, focused on informing mothers about abuse and prevention behaviours, should attend to:

  1. Mothers need to be persuaded that their children may be at risk of abuse, not just informed. Getting people, with whom mothers can identify, to recount personal stories of abuse is a good method of persuasion.
  2. The journey towards identifying risk in the home is an emotional one, not just an intellectual one. Some mothers may find contemplating  the risk of abuse and discussing the issue with family members sufficiently distressing that they cannot accept the possibility of abuse. In these cases, they may require one-to-one counselling to effectively address the issue.
  3. Mothers need to find a way of accepting the possibility of abuse in their community, family and home while maintaining a sense of pride and respect for these same things. It could help to introduce the idea that while communities have values and standards, not everyone chooses or is capable of meeting them.
  4. Mothers considering the possibility of abuse, like mothers handling disclosures of abuse, experience ambivalence about whether abuse can happen. Successful acceptance of the possibility of abuse may require programme organisers to give mothers the space to express and work through their ambivalence.
  5. Mothers may accept the possibility of abuse without attempting to assess the actual risk posed to their children. They may need encouragement and support to carry out such an assessment, and support to ensure that the assessment is accurate.
  6. Mothers may identify areas of risk, without feeling able to safely negotiate and lower that risk. They may need support to think about how they can either discuss the issues safely or sidestep explicit discussion and find indirect ways of effectively lowering the risk. They may need support to deal with the fact that there is no easy or safe way to lower the risk.
  7. Part of the distress experienced by mothers when contemplating discussing the issue of abuse with family members is a fear of the consequence of breaking with expectations that women should not discuss sexual matters or question the integrity of men. Helping mothers protect their children may be facilitated by campaigns directed at men and women to effectively challenge community attitudes on what is acceptable for women, men and children to discuss.

In short, while the traditional focus of prevention programmes on improving knowledge, raising confidence and increasing communication with children may make the difference in some cases, where programmes do not work with carers to address the perceptual, emotional and social barriers to identifying risk and taking action, they risk failing some children. Supporting carers in identifying and overcoming the challenges is likely to be more resource intensive than a blanket information campaign, but it may turn out to be a more effective, and therefore a more cost-effective method of preventing abuse.

This blog article relies on research and evidence that is referenced in the full report, which you can read here: https://learning.nspcc.org.uk/media/1547/four-steps-to-the-prevention-of-csa-in-the-home.pdf

You can read a report on how the programme organisers worked with the Somali community in a collaborative fashion to develop the work with mothers here: https://learning.nspcc.org.uk/media/1546/working-with-community-to-prevent-csa-in-the-home.pdf

NOTA Annual Conference 2018

NOTA BLOG

NOTA Annual Conference 2018

Kieran Mccartan

Kieran Mccartan

The annual NOTA conference took place from the 19th – 21st September in Glasgow. The conference was a real mix of research, practice and engagement with colleagues from across the UK, Ireland and internationally (with attendees and speakers from a range of countries including the USA, Australia, Norway, Ireland, and from all four countries of the UK). In this blog I am going to take you on a whistle stop tour of the event.

The 2018 plenaries combined research, practice and innovate approaches from a very international group of speakers. The conference started on the Wednesday with two keynotes addressing the reality and impact of Pornography on youth understandings and perceptions of sex as well as their sexual experiences (Maree Crabbe) followed by an overview of the research on systematic pathways of development across the lifespan, ACE’s and the impact of trauma (Dr Jamie Yoder). The second day of conference (Thursday) had keynotes that talked to current research and understandings around normal sexuality, deviant sexuality and whereof our morality and ethical principles come into play in debate as well as treatment (Dr Rajan Darjee); as well as presentation of focusing on trauma inform care and practice on the frontlines in Scotland (Dr Lisa Reynolds). The last day of the conference (Friday) had 4 keynotes, the first two focused on a range of topics including, the effectiveness of professionals perspectives terminology, learning and good practice around Child Sexual Exploitation (Jessica Eaton); and an update on desistence research and the importance of community engagement and the “service user” voice in the integration of people who have committed sexual offences into the community in a pro-social way (Dr Beth Weaver). The last two keynotes of the conference focused on sexual abuse in Scottish Football, discussing the work of the review and the interim report into the scale and nature of said abuse (Martin Henry); and finally, a presentation on the reality, impact and scale of sexual abuse with private schools over the past 30 (or so) years (Alex Renton). All the keynotes tied together ideas of the importance of Adverse Childhood Experiences in the lives of people who sexually offend, the roll of trauma in shaping their behaviour and that prevention is needed, but more centrally that prevention is everyone’s responsibility.

The workshops spanned a full range of topics and speakers (of which this is just a flavour) including, integration of people who have sexually offended back into the community (Karen Parish & Jane Dominey; Kieran McCartan; Tammy Banks & Sarah Thompson); public health approaches to sexual abuse and prevention (Kieran McCartan; Tamara Turner-Moore; Tammy Banks; Stuart Allardyce; Nicolas Blagden; Donald Findlater); online offenders (Donald Findlater; Roger Kennington); youth who sexually harm (Simon Hackett; Dale Tolliday; Jacqueline Page; Stephen Barry; Carol Carson; Stuart Allardyce & Peter Yates); female sexual offenders (Andrea Darling); treatment (Eleanor Woodford & Ben Evans; Gallagher; Geraldine Akerman); sexuality and sexual abuse (Michael Miner; Rajan Darjie) as well as pornography (Maree Crabbe). The workshops were a good mix of research, evaluation, practical working, professional learning and knowledge exchange.

In addition to the traditional conference activities NOTA 2018 also had an engagement event. This year we changed our focus from members of the public to professionals. We advertised the engagement event to professionals who have safeguarding as part of their jobs, but that safeguarding is not their main role (and therefore would not be attending the NOTA conference) including, teachers, foster carers, members of charities and NGO’s, etc. We had 150 participants sign up to attend the event but, unfortunately, bad weather in Glasgow lead to the closing of Glasgow Central Train Station which resulted in approximately 50 – 55 people attending; which, in the circumstances, was a good outcome. The session heard from national (Stuart Allardyce, Graham Goulden & Kieran McCartan) and international (Maree Crabbe) speakers about the impact of pornography on youth, especially young men; what we can do to reduce toxic masculinity and the “crisis” surrounding young men; and how to promote positive, healthily sexuality.

NOTA 2018 also was covered by the Scottish Herald, which had a two-page piece in the main edition and this was republished on their website as well. The herald piece focused on the prevention of sexual abuse, including interviews with Stuart Allardyce, Marre Crabbe, Graham Golden, Lisa Reynolds and myself. For those interested please access it here.

NOTA 2018 fitted a massive amount of material in across three days, which left me informed, refreshed and looking forward to next year’s meeting in Belfast.

Restorative Justice or Dangerous Liaisons?

NOTA BLOG

Restorative Justice or Dangerous Liaisons?

This Blog is a reprint of an article in NOTA NEWS 85. The NOTA NEW article is based upon research conducted over a three-year period resulting in a book chapter published in 2017 (Wager & Wilson 2017). The publication of the chapter and its contents also formed the basis of a workshop at last year’s NOTA Conference held in Cardiff.

Nadia Wager (Reader in Criminology, University of Huddersfield)
Chris Wilson
(PhD Student, Cardiff University)

This Blog is a reprint of an article in NOTA NEWS 85. The NOTA NEW article is based upon research conducted over a three-year period resulting in a book chapter published in 2017 (Wager & Wilson 2017). The publication of the chapter and its contents also formed the basis of a workshop at last year’s NOTA Conference held in Cardiff.

It has been a commonly held belief that restorative justice has no place in the field of interpersonal and gender-based violence. However, recently, this widely held orthodoxy has been challenged with the development of a number of small projects that seek to facilitate victim-initiated restorative justice. The positive outcomes for those who have engaged with these projects (Koss, 2014) have led to some practitioners re-evaluating their previously held beliefs on the subject. Evidence of this sea change was seen at the 2015 NOTA National Conference in Dublin, where delegates heard the powerful testimony of both the survivor and practitioner’s experience as to the benefit of such a process. The growing evidence of a positive therapeutic impact relating to victim-initiated restorative justice requires serious consideration for both policy and practice.

In 2002, the UK government funded three Circles of Support and Accountability (CoSA) pilot sites, introducing the Canadian scheme into the British Criminal Justice System. CoSA is based upon the three restorative principles of repair, stakeholder participation and transformation (Newell, 2007) and seeks to safely reintegrate known sex offenders being released from prison back into the community. It achieves this by recruiting volunteers to represent the local community and support an offender in their acquisition of social capital and realization of the Good Lives Model (Ward and Stewart, 2003). The success of the scheme in the UK was due to its adaptation to work in partnership with the statutory agencies, through the Multi Agency Public Protection Arrangements (McCartan, 2018) and that success can be measured, in part by CoSA’s growth across the UK and Europe. By 2016 there were 16 projects delivering CoSA in England and Wales with projects established in Scotland and 8 other European countries.

Evaluation of the government funded pilot projects highlighted that significant numbers (25%) of its volunteers were survivors of sexual violence (Bates et al., 2007) and that this percentage appeared to be replicated as new projects became operational both in the UK and across Europe. In 2012, Circles UK commissioned work to explore restorative practice that contributed to the wellbeing of the survivor-volunteer. This initially concerned itself with the examination of the attitudes and beliefs of CoSA Coordinators towards this group of volunteers. The methodology used for this was a web-based survey followed by a workshop.

There is no national policy relating to CoSA Coordinators asking volunteers about their potential survivor status, therefore practice is inconsistent. Both the survey and workshop evidenced a collection of strong emotional reactions and opinions from all Coordinators, those in favour and those opposed to asking such a question. Those who did ask the question appeared to have found sensitive ways of doing so, recognising that disclosure may not only be difficult but will come if and when the person is ready. However, those that asked the question perceived it as important to know and saw benefits relating to their duty of care towards the volunteer. Those Coordinators reluctant to ask the question, perceived doing so as too intrusive and insensitive. More concerning however, was that among some existed a belief that to ask such questions could potentially result in opening ‘Pandora’s box.’

What was of interest, whether for or against, was the degree to which some Coordinators pathologised victims of sexual crimes. Such a perspective should not come as a surprise, the majority having previously worked in an environment where pathologising victims of sexual crimes was institutionalised (i.e. it is only relatively recently that it has been argued that such experiences would preclude a person form working on Sex Offender Treatment Programmes for fear of the Prison Service being sued (Brampton, 2010)). It was therefore evident that any further work on this subject needed to promote a Salutogenic (focusing on strengths, coping and resilience) approach (Antonovsky, 1987) challenging this pathological perspective of survivorship.

The next stage of this work was facilitated by the Circles South East project and consisted of a study interviewing 13 volunteers, 5 of whom were survivors, about their motivations and experiences of volunteering for CoSA. The accounts of the survivor-volunteers suggest that they do not enter into their volunteering role as a means to make sense of their own experience, neither is it about a process of self-healing. Rather, they volunteer for CoSA once they have transitioned from victim to survivor or have found a renewed sense of strength or purpose arising from a new life transition or overcoming adversity.

The study’s core theme of ‘resilience and recovery’ highlighted the differing ways in which all volunteers perceived survivorship. Pathologising survivorship was not just restricted to some of the Coordinators but was also evident in the 8 volunteers without first-hand experience of sexual victimisation. They felt that survivorship would have an impact upon the volunteering role and would serve as an intrinsic motivation for volunteering with CoSA. They believed that survivors, unlike themselves, had the potential to be less resilient and more shockable, therefore should be assessed to ensure they have recovered from their experiences. Conversely, the 5 survivor-volunteers did not see their survivor status as defining their identity. For some, the abuse was not deemed to have had a detrimental effect on their well-being and others discussed how they had transitioned from victim to survivor before coming to CoSA. Their expressed motivations for choosing CoSA were similar to all volunteers and, in contrast to seeing themselves as inherently shockable, the survivor-volunteers discussed strategies that they used to maintain their resilience.

The fact that the study was able to evidence the three restorative principles identified by Newell (2007) is testimony to the professionalism and quality of volunteer management and supervision provided by Coordinators and other professionals. Survivors who volunteer with CoSA are afforded the opportunity to objectify aspects of post-traumatic growth, such as compassion and altruism consistent with the principle of repair. Stakeholder participation is realised through the openness to the notion of survivors volunteering for CoSA and the commitment that CoSA has to ensuring that the survivors (as with all volunteers) are appropriately trained and supported. The facilitation of stakeholder participation should lead to a positive change in the way survivors are conceptualised by others, transforming the concept of survivorship into images of strong, resilient, compassionate and self-managing individuals who are fully functioning members of their communities.

The 2017 NOTA Conference workshop provided an opportunity not only to share the findings of this study but also to ask the practical questions of its delegates ‘when does a victim become a survivor?’ And ‘when does the label of survivor no longer apply’? This study highlights the importance of CoSA delivering a fair and balanced service. It cannot be acceptable to state that an offender is more than the sum of his or her offending behaviour and yet to continue to pathologise those who have been victimised. The survivor-volunteer occupies a unique space in CoSA, the dynamic and restorative nature of which we are still yet to fully understand.

 References

Antonovsky A. (1987). Unravelling the mystery of health. How people manage stress and stay well. San Francisco: Jossey- Bass

Bates, A., Saunders, R., & Wilson, C. (2007). Doing something about it: A follow-up study of sex offenders participating in Thames Valley Circles of Support and Accountability. British Journal of Community Justice, 5, 19-42.

Brampton, L.L. (2010). Working with sexual offenders: The training and support needs of SOTP facilitators. PhD Thesis, University of Birmingham.

Koss, M (2014) The RESTORE program of restorative justice for sex crimes: vision, process and outcomes, Journal of Interpersonal Violence Vol 29(9) 1623 – 1660.

McCartan, K (2018). The importance of multi-agency and partnership working in the field of sexual abuse. Confederation European Probation (CEP) Newsletter April 2018

http://www.cep-probation/the-importance-of-multi-agency-and-partnership-working-in-the-field-of-sexual-abuse/

Newell, T. (2007). Forgiving Justice: A Quaker vision for criminal justice. Swarthmore Lecture 2000. London: Quaker Books

Wager, N. & Wilson, C. (2017) Circles of Support and Accountability: Survivors as Volunteers and the Restorative Potential. In M. Keenan, E. Zinsstag and I. Aertsen (eds). Sexual Violence and Restorative Justice. London: Routledge

Ward, T. & Stewart, C. (2003). Criminogenic needs and human needs: A theoretical model. Psychology, Crime and Law, 9, 125 – 143