Don’t wait for them to tell us: recognising and responding to signs of child sexual abuse

By Jane Wiffin, Practice improvement advisor, Centre for Expertise in CSA

(Note: This blog was originally posted on the Centre for Expertise on Child Sexual Abuse – Kieran)

The Centre of Expertise on Child Sexual Abuse recently published ‘Key messages from research on identifying and responding to disclosures of child sexual abuse’. In this blog the CSA Centre’s Practice Improvement Advisor for Social Work, Jane Wiffin, reflects on what those key messages mean for the safety of children and young people and what needs to be done within the statutory child protection system to best respond when children signal or speak out about the abuse and harm they are experiencing.

The first major issue raised by current research (and indeed the safeguarding practice environment) is that it is very clear that far more children are being sexually abused and harmed than we are currently identifying or safeguarding.  This should be of major concern.

The current statutory child protection approach to responding to concerns that a child is being sexually abused puts too much responsibility on children and young people to recognise the abuse they are experiencing and then to seek a trusted adult to talk about what is happening to them. This is a heavy, and frankly unrealistic responsibility. Children cannot and should not be the only witnesses to the harm they experience; it is the responsibility of the adults around the child to respond to help-seeking behaviour and to safeguard them.

Talking openly about child sexual abuse

Most professionals work very hard to notice and understand what is happening to the children they are in contact with and to enable them to talk about their concerns and worries including those that relate to experiences of abuse. Children are not always able to recognise that what is happening to them is abuse and so it is important that they are encouraged to speak to a trusted adult whenever something doesn’t feel right or something is upsetting or hurting them. Despite the need for professionals to support and encourage children to tell us when something is worrying or upsetting them, we also know that many children may not be able to articulate their concerns and may demonstrate their unhappiness and discomfort in other ways.  Professionals need to recognise when children might be telling us something is wrong (through their actions as well as their words) and support them to help us understand so we can respond appropriately. 

However, while the importance of identifying and responding to concerns of CSA is embedded in practice, interpretations of child protection guidance which encourages practitioners to avoid asking ‘leading or suggestive questions’ often drives a cautious response which in reality means many practitioners avoid questions altogether.

When professionals notice a child or young person with a bruise or a burn, they would not hesitate to ask what had happened and how the child or young person was feeling. The resulting response would likely lead to a multi-agency holistic assessment process where all aspects of a child and their family’s life and circumstances would be considered; why is child sexual abuse treated differently?

Messages from many serious case reviews find that these concepts of asking leading questions or contaminating evidence (“avoid encouraging a child to talk about the alleged offence” – p28 Achieving Best Evidence in Criminal Proceedings) are not fully explained in guidance or training, and the limitations not explored. It is therefore unclear to practitioners what the difference is between what the guidance warns against and asking professionally curious questions, being child focussed and exploring the child’s lived experience. This caution also introduces a natural uncertainty or hesitancy in the professional response, hardly conducive to creating an environment which supports and enables children to articulate what is happening and feel able to talk openly about such a sensitive and complicated issue. Ultimately this can result in children’s help-seeking behaviour going unidentified, their voices remaining unheard and the child not being safeguarded.

In recent years guidance has been introduced to ensure that professionals ask women about whether they have been subjected to domestic violence when they are pregnant, have small children or where there are safeguarding concerns. This is because there is recognition of the culture of secrecy that surrounds domestic abuse and the implication of coercion and control; why is child sexual abuse treated differently?

Barriers to disclosure

We know that children rarely verbally disclose to professionals (particularly social workers and police officers) that they are being sexually abused; they often wait until adulthood before telling professionals.  In many cases children are more likely to tell a friend, a safe parent or another trusted adult and their reaction and ability to respond to protect the child will impact upon whether the child feels able to repeat their disclosure. Sadly, some children are never able to tell anyone. This should be of concern to us all.

The reasons for not disclosing are many; children may not recognise that abuse is happening; they may not be able to articulate what is wrong but demonstrate their discomfort through their behaviours, they may communicate non-verbally because of their disabilities or cognitive impairments and English may not be their first language. Those who perpetrate abuse may have normalised sexual abuse, children may have been groomed in such a way that they do not recognise the abuse and tactics of threats, coercion, and control that may have been used.

Victims and survivors also say that there are many barriers to telling adults about the harm and abuse they are experiencing. This includes shame, self-blame, fear of what will happen to them and their family after disclosures, fear of reprisals, fear of getting into trouble and not trusting anyone.

Asking the right questions

Research suggests that in order to identify CSA children need to be asked direct questions about what is happening to them and what they are worried about. Children report they did not disclose sexual abuse because they were not asked direct questions. Children want professionals to notice their emotional distress, behavioural difficulties, self-harm, eating disorders, anti-social behaviour, depression, mental health difficulties, social isolation, disruption and criminal behaviour as potential indictors of early trauma, abuse and specifically sexual abuse.  Professionals need to be aware of how their own and wider society’s bias and stereotypes, about different children and different forms of abuse, can result in abuse being minimised or dismissed.  These are not unreasonable requests.

The concept of asking direct questions was endorsed by the 2000 Department of Health publication “Communicating with Vulnerable Children”. This publication advised professionals to ask children:

  • Has anybody done anything that upset you/makes you unhappy?
  • Has any person hurt you/or touched you in a way that you don’t like?
  • Some children talk about being upset or hurt in some way. Has anything like this happened to you?

This is a long way from how the current advice is often interpreted: as a need to be guarded and cautious. This caution appears to have been driven by a belief that professionals could put ideas into children’s heads and criminal proceedings could be compromised. There is currently little evidence that children report sexual abuse when it is not so and it is often a long and painful journey from disclosure to any sort of safeguarding action or criminal conviction. The reality is that very few cases of child sexual abuse currently progress to a prosecution for many reasons and yet we allow a fear of possibly affecting a criminal case, which is unlikely to happen, limit our proactive steps to understand what is happening to a child and act to protect them from that harm.

Improving practice

It is important that everyone who has a stake in working to protect children has the skills and confidence to identify, talk about and act on verbal and non-verbal disclosures from children in order to best safeguard them from further harm and ensure that they feel believed and supported.

When responding to a disclosure of child sexual abuse, practitioners should aim for child-centred practice and ensure that outcomes and next steps are clearly communicated to the child: when children disclose they are not wondering what protection order they will come under or which agency is leading an investigation, they want concern, compassion, action, and protection and that is a joint responsibility for all agencies and adults around the child.

The CSA Centre is working to build the confidence, knowledge, and skills amongst frontline practitioners working with children in order to best identify and respond to children’s help-seeking behaviours and disclosures of sexual abuse. As well as the Key messages from research paper released this week, we have developed and piloted a Practice Leads’ Programme to help ‘lead workers’ in Children’s Services further develop their understanding and confidence around child sexual abuse. One of the core topics of this programme focuses on the disclosure process, the barriers, and enablers. We are also now planning a practice development project looking specifically at how to best support children to disclose abuse and respond effectively to help-seeking behavior.

NOTA Annual Conference 2019

By Kieran McCartan, PhD., & David Prescott, LISCW

The annual NOTA conference took place from the 18th – 20th September in Belfast. NOTA, the National Organisation for the Treatment of Abuse, is a long-time partner to ATSA. This year’s conference was a real mix of research, practice, and engagement with over 300 colleagues from across the UK, Ireland and internationally in attendance (with attendees and speakers from a range of countries including the USA, Gibraltar, Norway, Ireland, and from all four countries of the UK). The conference focused on abuse within and across systems, with even Brexit getting a mention. In this blog, we are going to take you on a whistle-stop tour of the event.

The 2019 plenaries combined research, practice and innovate approaches from a very broad group of speakers. The Conference started on Wednesday with Professor Teresa Gannon presenting the findings of her recent meta-analysis, which included this year’s HMPPS report, on the effectiveness of treatment programs for men convicted of a sexual offence. The headlines from Professor Gannon’s presentation was that treatment does have a positive effect on behaviour change, including recidivism, compared to none and that the role of consistent, well trained and engaged providers is important. Following on from this we had a “conversation with Karl Hanson” whereby Professor Don Grubin discussed with Karl a combination of pre-submitted audience questions and his own thoughts. The topics ranged from risk assessment, treatment, risk management, and professional practice; it was an insightful alternative to a traditional keynote that allowed participants to gain more of an insight into Karl’s work and thinking. The Thursday started with a keynote from Professor Anne-McAlinden on peer-to-peer abuse, based on NOTA research committee funded work (a good reminder of the annual research grant scheme that was also launched at the conference), which indicated that we need to potentially reconceptualize risk in the context that young people live and doing so would enable us to prevent as well as respond to sexual abuse better. The was followed by a trio of Ireland based practice initiatives which where focused on children who committed sexual harm and/or engagement with their families (Carol Carson talking about AIM 3; Rhonda Turner talking about the work of the National Inter Agency Prevention Program; and Gareth McGibbon talking about the development of the Capacity & Ability to Supervise and Protect Framework [CASP]), all of which demonstrated best practice and a series of tools that conference attendees could take home with them. The final day of the conference opened with Professor Erick Janssen discussing research on sex, emotion and risk, followed by a roundtable of police experts (from England, Ireland, Wales, Scotland, Northern & Gibraltar) on the potential impact of Brexit on cross border co-operation and data sharing. The roundtable was fascinating and raised several questions about the impact of a no-deal Brexit and the issues that changing data sharing agreements would have on risk management, background checks, and deportation. The conference closed with a powerful and very relevant piece by the Geese theatre group examining the interactions of abuse within the family system and how it spills into other closely aligned systems (school, sport and the community).. 

The conference had 40 parallel sessions with over 50 speakers across the Wednesday and Thursday afternoon,  spanned a full range of topics and speakers (of which this is just a flavor) including, integration of people who have sexually offended back into the community (Public Protection Arrangements Northern Ireland), people who have committed sexual abuse as service users and hearing their views (Kieran McCartan, David Prescott; Lynn Saunders; Karen Martin), trauma-informed care (Catherine Gallagher, Maggie Tai Rakena); youth who sexually harm (Carol Carson; treatment (David Briggs; Adam Deming; TUSLA; AIM project Eleanor Woodford & Ben Evans; Gallagher; Geraldine Akerman); sibling sexual abuse (Jacqueline Page; Melissa Maltar, Nancy Falls): 3 sessions dedicated to research and another on important issues for practitioners in critically engaging with research by the research committee.

The workshops were a good mix of research, evaluation, practical working, professional learning and knowledge exchange.

In addition to the traditional conference activities NOTA 2019 also had an engagement event that was open to all co-organised with Public Protection Arrangements Northern Ireland and took place away from the conference site. 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 60 participants sign up to attend the event, all of whom attended.  The session heard from national (DSI Paula Hamilton, Julie Smyth & Kieran McCartan) and international (Eileen Finnegan & Maia Christopher) speakers about the aetiology, prevention and risk management of people convicted of sexual offences in the community.

NOTA 2019 saw Professor Simon Hackett step down as Chair of NOTA and Professor Sarah Brown take over the role. Unfortunately, Simon could not be in Belfast with us but his contribution to the organisation was applauded in his absence and he was thanked for all his hard work. Also, NOTA 2019 was Gail McGregor’s last conference as conference chair and she too was thanked for all her hard work.

NOTA 2019 fitted a massive amount of material in across three days, which left us informed, refreshed and looking forward to next year’s meeting in Leeds.

The Mersey Care Prevention Service

By Lisa Wright

The Mersey Care Prevention Service, launched last year, developed from discussions between Mersey Forensic Psychology service, part of Mersey Care NHS Foundation Trust, and Merseyside Police. The Police recognised that some of the people they had arrested for sexual abuse may not have gone on to commit these offences if they had received help earlier. Knowledge of our work with convicted adults in the region led them to approach us and we jointly created and funded the new service.

The original idea was a service aimed at adults who had become concerned about their own sexual feelings or behaviours and were motivated to engage in psychological intervention to reduce the chances of them acting in an abusive or illegal manner. The ideal client would not have committed any illegal act but be concerned that they may do so without help. The Police hoped to identify individuals who came to their attention for problematic sexual behaviour but not reach the threshold for prosecution and we also sought referrals from GPs, counselling and mental health services and Social Care. However our criteria was later expanded due to difficulties in recruitment – very few ideal clients came forward!

We based the intervention approach on our prior work with adults who had sexually offended and our smaller client group of those people professionals had considered to pose a risk of sexual offending.

Mersey Forensic Psychology Service is foremost a therapy service, providing formulation based individual psychological therapies aimed at reducing risk of offending or re-offending. This takes place in the community and within North West prisons. The therapy approaches used vary and are based on the methods that we assess as most suited to the client and their formulation. We utilise EMDR and Schema Therapy most frequently as they are best suited to re-processing the trauma that we frequently find lies at the heart of the problematic behaviour we encounter.

These therapies have been used in mental health services to change the emotional and physiological feelings arising from trauma that drive problematic behaviours, including sexual behaviours, and have transitioned well to our setting. Clients feel understood, emotionally connected to the origin of their problems and report significant change in sexual feelings and behaviours.

The range of clients that have been referred to the prevention service has been varied and far from the ideal we had envisaged. Often Social Services have referred men who have raised concerns by behaving in inappropriate ways towards children but have not been prosecuted and are attempting to prove that they are not a risk to their children. They are therefore unlikely to ‘open up’ and engage in intervention. Other clients have already offended, been involved in on-going Police investigations or may believe that they have not offended but it emerges that they have committed a criminal act. These types of cases we are duty bound to discuss with the Police, causing some distress to the individuals involved –  not ideal! These referrals have led to us revising the information provided to prospective clients and referrers to make clearer the remit and legal obligations of the service and avoid any of the above issues recurring.

We have had some more appropriate and successful referrals – men who appear not to have offended and are motivated to understand and change their feelings and behaviours – but they have been the minority of our overall referral list. Therefore in order to generate more interest we publicised the service in the local press.

The reaction to the publicity for the prevention service might help to explain why people we are attempting to reach are not coming forward. The hatred, anger and aggression expressed on social media towards people who might experience a sexual attraction to children was horrific. It’s not surprising that the vast majority of our clients have already come to the attention of a professional and then been referred on rather than deciding independently to seek help.

Increasing awareness of the service, in a way that minimises the risk to potentially interested people and doesn’t create negative publicity, is tricky. Furthermore, the referral process, approaches to safeguarding issues and reporting of information are obviously heavily influenced by both the founding organisations’ policies and procedures, which may be a significant barrier to engagement for some people but is difficult to get around.

We have now expanded the service to include individuals who have convictions for exposure. This was based on Police concerns and case examples of young men who had committed exposure and then later gone on to commit violent sexual contact offences. This has increased the numbers of appropriate referrals and widened the aims of the service.

We are therefore continuing to adapt to the situations we are faced with in trying to provide a meaningful and effective service to those who want it and to make it more attractive to those that currently don’t. The men who have engaged in therapy are progressing well and reporting significant psychological change. Overall then, the results of our intervention for those who have engaged in therapy, are largely positive and we will continue to explore ways of reaching more people who would benefit from the interventions that we can offer.

NOTA 2019 Conference Preview

What is the theme of this year’s conference?

I am giving a flavour of this year’s conference on behalf of the whole conference committee (board members, branch representatives, our general manager, and admin team) and I would like to record my thanks to them all for their enthusiasm, focus, hard work and humour!

This year’s conference is based on the theme of “Sexual Abuse in Systems” and responses to this.  This is picked up in some of the keynotes but particularly in the workshops and seminars that are selected. 

As with most of our recent conferences, we try to include content of interest to our members working with people across the developmental spectrum, in direct practice, in academic and training roles, policy and operational disciplines.

 Why was this theme chosen?

Conference themes are chosen by the planning committee to reflect either feedback on the previous year’s conference from members and delegates or issues and concerns that have emerged in our professional community or the media over the last year (and sometimes both of these).

It is hard not to sound like we’re nagging since we know that as well as being great fun, conference attendance can be emotionally and cognitively taxing and it can be a real effort to give written feedback at the end of a session.  However, workshop and keynote presentation evaluation forms are really influential in evaluating what has or has not worked and planning for the next time.  Thanks to all of you who take the time to give us your thoughts and ideas, whether briefly or in more detail.  We do read and consider them all (usually in October after the conference) and it can be quite a challenge to reconcile feedback which often reflects vastly different reactions to the same presentation!

For me, this underlines the essence of what NOTA conference is about – producing a response from our active engagement with information that can either reinforce our existing knowledge and practice or challenge us to think and act differently. Both processes are valid and affirming regardless of our length of experience.  The conference themes try to offer something for both seasoned professionals with established reputations and for those at the early stages of their careers.

Tell us about the selection of keynotes this year

We consider feedback from members attending all of the NOTA conferences (including Scotland, Wales, Northern Ireland and the Republic of Ireland as well as the international conference) and regional training events.  We also “sample” speakers (we never actually steal ideas wholesale of course!) and gather format ideas from other conferences in related areas and professional journals.  We also include those who have had a major contribution to practice in our field and are “back by popular demand” for those who may not have had the opportunity to hear them before. 

This year we have 2 presentations reworked for NOTA based on ATSA keynotes: Professor Karl Hanson, a familiar presenter but this time in a more informal conversation (although if his co-presenter, our own Emeritus Professor Don Grubin, has his way this might be more informal than any of us had planned!).  Please submit your ideas for “Questions for Karl” and send in the questions you’ve been desperate to ask – anonymously or otherwise (conference@nota.co.uk).  Professor Erick Janssen presents his research on emotion and sexuality, offering much food for thought and quite a few giggles.  

Professor Theresa Gannon, with her recent meta-analysis data, addresses the vexing theme of the effectiveness of the work we do in our intervention systems and the dent in our collective confidence over the last 2 years.

On Friday morning we will be challenged to consider the ways in which our cross-jurisdiction risk management processes might be affected by the current changes in our political systems in a panel discussion involving a range of police representatives (we are not being incompetently obtuse in our lack of programme details; these are withheld for security reasons).  In a great tradition of both challenging our assumptions and minding our humanity, the closing presentation is by Geese Theatre Company (many of you know by now what they say about the front row in a Geese presentation…….).

Finally, keynotes are chosen to showcase excellence in research, practice and policy development in the regions hosting the conference.  Our Thursday presentations include content from both Belfast (Professor Anne-Marie McAlinden offers her compassionate views on sexual behaviour in peer relational systems) and the Republic of Ireland (Carol Carson, Rhonda Turner, and Gareth McGibbon discuss ideas based on extensive experience of working sensitively in systems dealing with children and young people).  We are also particularly grateful to Maria Quinlan for introducing us to the ideas and experiences resulting in the photo exhibition that she is sharing with us during conference.

What is the role and involvement of the regional branches for Conference?

There is a “standing committee” comprising the Conference Chair, NOTA Vice-Chair/Chair-Elect, the General Manager and our absolutely fabulous conference administrators Andi Wightman and Adelle Henson (what these two impressive women don’t know about organisation isn’t worth knowing….). 

However, the conference would not happen each time without the involvement of branches and branch reps as part of the planning committee – from the initial suggestions for the venue to leadership on regional speakers and day chairs, involvement in breakout selections, organisation of the public engagement events and even the choice of sandwich fillings!  I absolutely don’t have “favourites” when it comes to working with branches but my sincere thanks go to Paul Stephenson, Marcella Leonard, Eileen Finnegan and Julie Smyth for making this year’s process a complete joy.  All I can say is that these are the people organising our Thursday evening social event – be there or regret it!

How are breakout presentations selected?

For the programme selection meetings, held in the early part of the year after the submission closing date, in addition to the conference planning committee above, we also include the chairs of the Research and Training committees (Mitch Waterman and Roger Kennington). 

We have been particularly fortunate this year to have had a high number of submissions from which to choose and we have tried to include as many of these as possible with the room numbers available to us.  We have included more joint presentations this year in order to try to include as much content as we can.  We are really grateful to everyone who does send a submission because we know it takes considerable effort, time and bravery in putting your ideas forward.  The reasons for not accepting a submission tend to be around the number of submissions on similar themes and the need to balance each year’s programme as described above. 

We’re very much looking forward to welcoming as many of you as possible to Belfast this year!

Gail McGregor

Conference Committee Chair

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.

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

Dr Nicholas Blagden, Co-Head Sexual Offences Crime and Misconduct Research Unit, NTU

Ralph Lubkowski, Governor HMP Stafford, Her Majesty’s Prison and Probation Service

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 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 as 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 a 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.

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-inquiry

NetClean. (2018). The NetClean Report 2018. Retrieved from https://www.netclean .com/netclean-report-2018/#insiktermobil

Risk Management and Prevention

By Kieran McCartan, David S. Prescott, LICSW & Katherine Gotch, LPC

The field of sexual abuse continues to embrace a prevention narrative and its real-world application. Although the sexual abuse prevention narrative has traditionally focused on the prevention of reoffense (tertiary prevention – see below) or providing broad-based community/societal messages (primary prevention), there has been a focus more recently on the development of services for populations at risk of offending (secondary prevention), as well as considerations regarding the role of effective risk management and safeguarding practices after conviction to ensure our interventions themselves do not cause harm (quaternary prevention).

A major challenge in the prevention of sexual abuse is not in the framing, which is appropriate and fit for purpose, but rather the development of the evidence-base and its practical, real-world application. People and policy makers recognise that prevention of abuse is better than after-the-fact responses as prevention results in no more victims. However, prevention also creates complicated (and some would even argue, complicit) narratives around people who commit sexual abuse as prevention efforts are offered from a holistic, life-course perspective. This requires communities, individuals, and policy makers to acknowledge the complexities inherent within the perpetration of sexual abuse, something which is especially difficult within legislative systems which often require black and white solutions to complex problems. Some have also felt that a holistic, life-course perspective is used to justify and explain away sexual abuse, which is not the case at all! Prevention efforts become more effective when they are based in solid knowledge about those who abuse and this information is then incorporated within all levels of prevention. There is more to preventing sexual abuse than tick-box criteria of adverse experiences, past trauma, mental health issues, and poor socialisation – effective prevention efforts recognize the impact of contextual factors on the antecedents of sexual abuse and emphasize knowledge about how interventions can be most effective at different points to stop abuse from happening at all levels. It is about incorporating what we now know regarding the aetiology of offending and embracing the importance of recognizing warning signs, talking about problematic behaviour and developing healthy lifestyles, including support systems, that lead to effective prevention efforts.

Preventing sexual abuse is also about effective risk management, either by the individual themselves or in conjunction with their families/peers or a third party if needed (e.g., probation, parole, counsellor); however, we do not often frame the prevention of sexual abuse in risk management terms. Risk management is often seen as a punitive, controlling and restrictive standpoint – something that is done to an individual rather than with an individual. However, as research and practice have shown over the years, the effective reduction in reoffending or the curtailing of first-time offending is most successful through a partnership among stakeholders and with buy-in from the individual in question. To this end, we offer that effective risk management neatly sits within the public health prevention framework and should adhere to the socio-ecological model of prevention:

Primary Raise public awareness of the reality of sexual abuse and dispel common myths about victims and preparators. Which enables individuals and communities to be better at identifying sexual abuse, risky behaviors and be better able to support people impacted by sexual abuse. Increased education leads to increased awareness and more proactive behavior.   For instance, public education campaigns, bystander intervention, Eradicating Child Sexual Abuse, etc.
Secondary Enabling “at risk” populations to understand their potential risks, triggers and the potential outcomes of them. This means that they can seek appropriate support and be empowered to seek help. Individuals and communities better understand risk and therefore are better able to help people manage their own (potential) risk.   For instance, Project Prevention Dunkelfeld, Stop SO, Safer Living Foundation, Lucy Faithful, Help Wanted!, Stop It Now!, The Global Prevention Project, etc.
Tertiary Working with people convicted of sexual offences to hold them accountability for their past problematic behaviour, get support and move forward, integrate back into their communities. These interventions move people towards an offence free lifestyle and encourage desistence. They help people manage their own risk (i.e., treatment programmes and interventions).   For instance, treatment programmes and interventions for people who have committed sexual abuse, etc.
Quaternary This enables people to successfully integrate back into the community by protecting people from collateral consequences or risk management policies and practices. This is done through supportive integration programs that help the person who has sexually abuse, aid their re-entry and support them pro-actively to negative the range of policies and practices that negate their integration.   For instance, Circles of Support and Accountability (UK, Circles 4 EU, Canada, & USA), etc.

For risk management to work as an effective prevention strategy, it requires a foundation in the socio-ecological model that is complemented with multi-agency and multi-disciplinary collaboration in conjunction with individual involvement. Prevention is most effective and impactful when all aspects of our knowledge are incorporated into a holistic approach to understanding sexual abuse which includes risk management strategies such as the individual knowing their risk and how to manage that risk both pre and post offending.

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