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Hearing the narrative, seeing the person: Considering the appropriate research methodology

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Hearing the narrative, seeing the person: Considering the appropriate research methodology

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By Kieran McCartan, PhD, and David Prescott, LICSW

A memorable case discussion attended by the second author featured a consultant recommending multi-systemic treatment (MST) for an adolescent who had been acting out aggressively ever since his father’s death. The case manager was concerned about his behaviour and had just overseen an unsuccessful course of MST with this client. Despite the fact that MST hadn’t worked, the consultant recommended that it be repeated, not because it was the correct intervention for that particular individual (for whom grief counselling might also have been appropriate), but because of the strength and quality of the MST research. The situation calls to mind words from a UK practitioner during a conference in 2012: Are we personalizing our manuals or manualizing our persons?

It often seems that our field is governed by large-scale studies and quantitative evidence indicating that a particular treatment, intervention, or process either works or doesn’t work. Understandably, we look at the broader outcomes of re-offence and risk reduction to drive future processes. We (the authors) are not saying that this is wrong, but rather that practitioners should remember the individual in the process, as well as the greater cohort. Sexual abuse (and treatment for sexual abuse) is as much about personal narratives and context as it is about processes and outcomes. Sadly, our most sacred studies don’t always take into account the experiences of those who have lived through the interventions.

The prevention, treatment, and management of people who have committed, or may commit, sexual offences include features that range from the individual through to the social and cultural. One implication is that we must use multiple research methodologies to answer a range of questions that include the “service user”, the “service provider” and the facilitating institution; their “voices”. A single research methodology, epistemology, ontology, or form of data analysis will not work in all circumstances; especially given that research and practice linked to sexual abuse cross many social (politics, law, policy, sociology, criminology, psychology) and physical (chemistry, biology, psychology) disciplines, and everything in between (public health). We need quantitative studies to look at large cross-population samples and answer broad-based questions. However, is a quantitative approach the best one for small-scale, small-cohort, individualised, practice-based, policy-based or process-driven questions? No, it isn’t. We often need to consider case studies or qualitative research methods to answer these more personalised, individualized, and small cohort questions. The research question, who is asking it and why they are asking it are central drivers as different disciplines and different groups have different agendas; which is fine, as long as its transparent and clear!

We need to use the research (and treatment) method that enables us to answer the question that we are asking. We can’t fit a particular research question into a certain methodology for artificial reasons because, in reality, it will fail and jeopardise the outcome.  Certain research questions linked to prevention, treatment, management, and community integration need to be qualitative so that we can capture the appropriate narrative and understand whether the process or intervention is working at a ground level. We need a qualitative, or case-focused, approach to hear and understand the “service user” experience, or the expert voice, within the cohort sample and a larger outcome. This is essential because we need to connect research and treatment in a coherent way that does not create paradigm extremes (quantitative being the choice of “research” and qualitative being the choice of “treatment”). This happy medium incorporates multi-stage, multi-methodology, and multi-disciplinary studies in order to focus on the larger research questions as well as capturing the personal narrative. A multi-methodology approach enables us to explore treatment, research, and policy questions and facilitates a more holistic response.

Working in a politically, socially, and personally, sensitive area demands that we think ethically about the research that we do and the way that we do it. Often times we need to do the complex, expensive research study that allows us to understand the reality of the situation. Unfortunately, this type of research does not happen as much, or in as much of a nuanced way, as it should. 

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Dying of shame: prevalence and prevention of suicide among those arrested for IIOC offences

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Dying of shame: prevalence and prevention of suicide among those arrested for IIOC offences

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Dr Frank Farnham, Dr Alan Underwood, Rebecca Key and Tom Squire

This reprint of a piece from NOTA News volume 86 (Nov/Dec 2018). Kieran

This 90-minute workshop focused on the work and, in particular, the research undertaken by the Suicide Prevention Working Group [SPWG] set up through the National Police Chief’s Council [NPCC] Pursue Board, in relation to the prevalence and prevention of suicide amongst men under investigation for IIOC offences.

At the outset of the workshop, Tom provided an overview of the work of the Stop it Now! Helpline.  The Helpline has three key target groups – (1) adults who have sexually abused or are at risk of abusing children; (2) adults concerned about another adult’s behaviour; and (3) parents / carers concerned about a child or young person with worrying sexual behaviour – and Tom spoke about how Helpline operators respond to different callers’ needs. Focussing on calls from men under investigation for offences involving indecent images of children [IIOC], Tom highlighted the increase in calls from this group since the Helpline’s inception in 2002.  In 2017, approximately 1500 of these individuals called the Helpline, many at a point of crisis and experiencing suicidal ideation.

Alan then provided some background information about the prevalence of suicide amongst this population.  For example, in 2014, the Police arrested 660 people suspected of IIOC offences as part of Operation Notarise.  Twenty-four (4%) of them committed suicide at an estimated cost to the public finances of £34.8 million.  Alan also shared the key findings of the systematic literature review undertaken by the SPWG in this area.  Some studies found the risk of suicide amongst this group to be 230 times that of the general population and several times that of people with a diagnosed mental health disorder.  Many of those under investigation had professional backgrounds, were often married with children and had no prior criminal history.  The highest risk periods for suicide were observed during the 48 hours post discovery/arrest and risk factors were associated with shame, a loss of social status, and irreparable reputational damage.  The SPWG hypothesised that suspects’ private justifications for their offending collapsed in the face of exposure, which, combined with a lack of belonging and increased burdensomeness, led to an increased risk of death by suicide.

Next, Rebecca presented the findings of the primary research undertaken by the SPWG, involving three exploratory qualitative studies with (1) 16 police officers; (2) 6 Helpline operators; and (3) 5 men who had either attempted suicide or experienced high levels of suicidal ideation following investigation for IIOC offences (recruited through the Lucy Faithfull Foundation).  The findings resonated with those of the literature review.  For example, high risk periods included the 48 hours after the onset of a police investigation as well as the days leading up to court appearances and sentencing; the studies highlighted the toxic levels of shame experienced by those under investigation; and the men’s anxiety about public exposure and media reporting.  In addition, participants described the different responses of professional groups: the police and the Stop it Now! Helpline were seen as supportive in terms of their interaction with those under investigation while the response of healthcare professionals was reported as more mixed.

In conclusion, the research of the SPWG found that men under investigation for IIOC offences are a highly vulnerable group, at high risk of suicide.  At the point of arrest, they are faced with a traumatic life event, resulting in feelings of shock, numbness, helplessness, hopelessness, intense worry and increasing shame.  For many this response fits the criteria for an adjustment disorder, a recognised mental illness that occurs when a person has great difficulty coping with, or adjusting to, a particular source of stress such as a major life event.  Consequently the SPWG made a number of key recommendations:  (1) all suspects should be considered as being at high risk of suicide; (2) their risk should be reassessed at critical points during the life of the investigation; (3) training on how to discuss suicide risk should be provided to police officers; (4) all those under investigation should see a health professional before leaving custody, and, where possible, (5) be provided with a mobile phone; (6) the prospect of media exposure should be considered; (7) wider education and training for healthcare workers be developed; and (8) there is an overall need for more multi-agency working to manage suicide risk.

The workshop concluded with some wider discussions about next steps, including research into the impact of death by suicide on the family members of IIOC suspects, as well as developing a more robust evidence-base about which individuals, in particular, amongst this group may be most at risk of death by suicide.

Dr Frank Farnham, Dr Alan Underwood and Rebecca Key, North London Forensic Service, Barnet, Enfield and Haringey Mental Health NHS Trust

Tom Squire, The Lucy Faithfull Foundation

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Rape myths are still alive and well: But abuse is still abuse

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Rape myths are still alive and well: But abuse is still abuse

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By Kieran McCartan, PhD, & David Prescott, LICSW    

A recent high-profile rape case in Ireland has reinforced the ubiquity of rape myths in the legal system. During the trial, the barrister for the defence encouraged the jury to consider the nature of the victim’s underwear, a thong, on the night in question. The clear indication was that the nature of the victim’s underwear showed that she was “consenting” and that she knew what was going to happen. This approach, in conjunction with the rest of the evidence and arguments, resulted in dismissal of the case with a verdict of no rape. The fact that it was a jury trial suggests that the case reflects beliefs held across society. The trial reinforces that rape myths are alive and well in 2018, not only in Ireland but internationally.

Rape myths are attitudes and beliefs that reinforce sexual assault as acceptable and shift the blame away from the person who perpetrates sexual violence onto the person who is victimized. (See Cambridge Rape Crisis centre for a breakdown for these rape myths.) Often by shifting responsibility into the complexity of sexual relations, these myths reinforce actions that perpetuate victim blaming. The collateral consequences of rape myths are significant and normalise social attitudes around sexual abuse and toxic masculinity. These same beliefs defy logic; looking attractive is not the same thing as wanting to be violated. It’s like saying that the ducks wanted the hunter to shoot them or they wouldn’t have been flying so close to a lake, or that someone deserves to have their data stolen because their network lacks adequate protection against hacking. There is no evidence suggesting that wearing particular clothes increases risk for assault; those who work in the field know that there is no definitive profile of either victim or abuser.

Research indicates that rape myths are still prevalent in society (Breines, 2012) as well as in the legal system (Smith & Skinner, 2017; Temkin, Grey & Barrett, 2016). This acquiescence to rape myths is worrisome given their persistence despite being challenged in recent years internationally, including through the #MeToo movement and the recent exhibition of rape victims clothing in Belgium. Each instance has shown that rape myths are ingrained in our social norms and beliefs. Changing social norms and beliefs are difficult in the best of times, but this change becomes harder when it focuses on topics like sexual violence and harassment—topics that we, as a society, are not always willing to discuss in education or in communities more broadly. 

We need to reconsider how best to (re)educate communities and individuals about rape myths and how we can all push back against victim blaming. As we and many others have noted, here and elsewhere, our communities will benefit from improved bystander training and community engagement. This involves shifting our focus from a criminal-justice approach to a public health approach towards sexual abuse. This is particularly important given the recent rise in the reporting, recording and sentencing of sexual abuse cases in the UK over the last 5–10 years as a result of increased trust in the system and a belief that their case will be taken seriously. Unfortunately, the persistence of rape myths and victim blaming undermines the victim journey and damages trust in the system.

The response to the Irish trial has been varied, indicating that people are pushing back on rape myths, including MPs speaking out in the Irish parliament, protests in Belfast, as well as online condemnation via the hashtags #IBelieveHer and #ThisIsNotConsent. Our challenge is how we change the social complaisance toward rape myths so that juries have a realistic understanding of them and can make better informed decisions, and that the system —particularly judges—can challenge inappropriate outcomes.

A final point that too often goes undiscussed in media accounts is that those who perpetrate abuse and society at large aren’t the only ones internalizing these myths. All too often, in our experience, people who survive sexual assault come to believe that they didn’t deserve better. And, of course, everyone deserves to be free from abuse.

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

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

By Mike Williams, NSPCC

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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

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Restorative Justice or Dangerous Liaisons?

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Restorative Justice or Dangerous Liaisons?

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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