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