Sessions held on the phone: some ideas and helpful pointers for clinicians

By Avon and Wiltshire Mental Health Partnership NHS Trust Be Safe Service

In the context of this unprecedented national situation, it seems increasingly likely that telephone calls will become the safest way in which we are able to remain supportive and in contact with families and hold appointments over the next period of time. This document is intended to give clinicians some helpful ideas about how to manage calls and some creative ideas in response to this situation. Making calming and continuing contact with young people and their families is likely to serve a very important stabilising function at this difficult time.

I found this a helpful read- https://www.childrenscommissioner.gov.uk/2020/03/17/supporting-children-during-the-coronavirus-outbreak/

Our primary contact will be the parents, but it may feel possible to have helpful talks and appointments with young people over the phone. If we are talking with young people it might be helpful to establish who is around and available after the call should the young person feel distressed or need support and remind them that if we feel worried we will call parents/carers to let them know following the call.

Be aware that some resources are not appropriate for everyone and may go out of date as the advice changes so please check appropriateness before recommending.  and you may have many more to add.

General wellbeing checks over the phone

Exploring creative ways to stay busy in the home

  • Building in time in which children and young people can play or be in their rooms having quiet time alongside time when parents and children come together to feel more connected might help structure the day.
  • Thinking of something new and novel that could be done each day e.g. tidying rooms, helping with any chores, garden work or DIY, starting any creative projects together, researching new topics on the internet, arts, and crafts, board games, cooking. If children or young people are off from school, they are likely to be given home packs so parents might help children and young people to structure their time around this.
  • Regular mealtimes and bedtime routines might be even more important in times of uncertainty than they are normally.
  • Helping families to think about ways to do any exercise in the home might also be really helpful and finding fun videos online to help do this. https://youtu.be/d3LPrhI0v-w

Managing uncertainty and anxiety –

  • Recap on any emotional coping strategies already covered in sessions might be helpful alongside exploring family strengths and resources.
  • It’s important that parents keep up to date with announcements from the government and public health England (https://www.nhs.uk/conditions/coronavirus-covid-19/) but it might also be worth highlighting that reading lots about the situation on social media can also increase anxiety in ways that may not be manageable or helpful for some parents. It might be helpful to, therefore, think with parents about striking a balance around this and monitoring how social media is affecting parents’ own mood and anxiety.

Free resources to assist with calming and reassurance – 

https://blog.calm.com/take-a-deep-breath

Assessing risk and safety planning on the phone –

  • Calls can establish if any new concerns or any risk issues have emerged or increased and how to have the parents managed these. Clinicians need to update risk information on care notes so that if other clinicians need to take over calls and support if primary clinicians themselves are not at work. Remind parents that they must let us know if new concerns emerge and that we will be endeavoring to provide those in most need with additional support.
  • Remind young person and parents of any agreed safety or risk management plans. Check if they have printed copies of these at home and if not send out. It might be that any existing safety plans need to be amended to reflect more time being spent in the home.
  • If there is a history of self-harm or suicidality parents should remove all sharps and all medications should be locked away as per any risk planning.
  • Parents of young people with siblings or other foster children need to be reminded about bedrooms and bathrooms being private spaces and that supervision of children and young people needs to be tight whilst everyone is in the home all the time.
  • It might be helpful for families to agree a family plan or contract at this time that helps them to deescalate conflict should this arise and how people can have space and calm down if they are not leaving the house
  • If children are off school and the safety plan advises that they should not be left unaccompanied we will need to think supportively and creatively with parents who may be on low wage incomes, liaise with social care and other agencies such as citizen advice to help parents feel able to stay at home to support young people who are deemed at risk.

Useful places to signpost families for mental health support

Love in the time of COVID?

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

Please note this is a joint blog with ATSA/SAJRT blog site, take care, Kieran.

Like everyone else, we’ve had our share of worries and concerns as we enter the rising side of the COVID-19 curve. Canceled trainings, travel, and classes, ensuring the safety and wellbeing of loved ones have shaped the lives of many for a long time to come. For many of us, it’s the state of not knowing that is the most frustrating. On the other hand, there are some areas of good news, such as indications of decline in some areas, and medical advances in others. And proving the axiom that “Alone I travel faster; together we travel further”, the word “caremongering” has entered our lexicon.

At this writing, numerous state chapters of ATSA, regional branches of NOTA (NOTA Scotland) and ANZATSA have had to cancel or postpone their conferences, workshops, seminars and trainings.. Ditto with the otherwise seemingly indestructible NAPN conferences. Many trainers are taking to web-based and videoconferencing technologies, where the questions of the day involve the best ways to break participants up into small group discussions and paired practice exercises. Everywhere we look, discussions abound about how to balance the needs and rights of our clients with our own obligations for self-care and safety. These discussions have ranged from how many clients in group therapy in some areas to whether or not clinicians can work with videoconferencing platforms and which methods adhere to confidentiality laws. Additionally, these discussions raise questions of access to online technology, which can be a challenge to some of our clients because of the conditions to their license conditions, the speed of internet in certain areas and whether professionals can work from home (i.e., access to encrypted networks and client reports).

One opportunity that we all have in these uncertain times is to work on our messaging. As the world talks about “social distancing”, we are painfully aware of the elements of social isolation that have long been recognized as a risk factor for offending and re-offending. Professionals in our field find themselves in a subtle bind: Social isolation is a risk factor in some respects, and yet social distance is a protective factor in others. How do we ensure that we don’t approach clients as if they are one more surface to sanitize?

Maybe it’s time to move beyond focusing on the construct of social distance and turn our message in other directions. Instead, we might think of this in terms of promoting “physical distance and safety” and “creating a healthy space”. From a prevention perspective, social distance can facilitate abuse and create the conditions where people at risk of committing an offense, whether for the first time or as part of an ongoing pattern may be more likely to do so. For this reason, we should also think of increased social isolation as an opportunity for us to intervene and talk about prevention.

Of course, creating and transmitting healthy and safe spaces can begin with maintaining a positive and hopeful attitude (which itself is a protective factor against illness) and with being careful with media coverage. In some ways, the rapidly escalating strong emotions inspired by media coverage may be a bigger risk factor for negative outcomes all around. As one comedian observed, “If I don’t watch the news, I’m uninformed. If I do watch it, I’m misinformed.”

The messaging from leaders is also a lesson for all in our field and provides an opportunity to reflect on what messages our clients and colleagues get from us. One world leader has already tried to monetize the eventual vaccine. Another has blithely reminded us that many of our loved ones will die. Yet another, from Ireland — a country that knows about staring directly into the eyes of violence, starvation, and despair— reminded his country that “Together we can save lives.” This last example gives us an opportunity to reframe our message to our clients, ourselves, and each other: at the very least, we’re all in this together. That’s one small step we can take to reduce social isolation.

Finally, there is one small message that we can remind ourselves about providing excellent assessments and treatments to people who have abused. For years, our field has grappled with providing the best evidence-based services, while implementation science has reminded us that optimizing service delivery can take years. Every time we’ve thought about the importance of implementing best practices, we’ve also thought about how long it takes to implement even the most basic of safety interventions, such as handwashing and seat belt usage. One silver lining to the Coronavirus crisis is that at least handwashing is up. As with reducing sexual violence, simply getting people to talk about the issues and forge a way forward can change lives for the better.

Many organizations have offered advice for professionals in this field;

British Psychological Society: https://thepsychologist.bps.org.uk/volume-33/april-2020/coronavirus-psychological-perspectives

British Association for Counselling and Psychotherapy: https://www.bacp.co.uk/about-us/contact-us/faqs-about-coronavirus/

Centers for Disease Control: https://www.cdc.gov/coronavirus/2019-nCoV/hcp/index.html

Yorkshire-Humberside NOTA roundtable

By Jenny Greensmith-Brennan, Safer Lives

You may have heard that the NOTA conference is to be held in Leeds this year. It is common practice that the local branch is involved in the sourcing of speakers, venues and entertainment, amongst other things. This was proving difficult in Yorkshire as the local branch had not met for 18 months and had no Chair or Secretary to get things moving again.

After discussions with the General Manager, a small group of local members decided to reconvene the branch but with a different ethos. One of collectivism, as little hierarchy as possible and roles for any person who wanted them. There is a variety of reasons for this, but they are for another day.

We arranged a branch event on February 28th and 27 people attended. We asked if people e would be happy to informally talk about their work, to share their roles with others so we all could go away having learned something.

Andy Green chaired the day and six people spoke for 10/15 minutes each. This included those working in custodial settings, the community, with young people, with adults, with those who have harmed, with those who have not harmed., academics, researchers, public sector and private sector workers. There was a mild amount of panic as some realised PowerPoint was not readily accessible but once we were passed that we talked and we ate and we drank (it was a Friday, there was a pub involved)

Kieran McCarten kindly came up from where he’d last managed to lay his head and spoke about the role of hope in what we are all trying to do; support people to move on from their past harmful behaviours or to seek a hand in not harming in the first instance.

The bonus of the day, for me anyway, were the conversations with people I’d never met before. The faces I could now put to names. There appeared to be an enthusiasm to support each other just for the sake of support.

It was simply a very good day. All it needed were a few emails to get 27 people in a room to talk about where we go from here. 27 people who had to organise their overloaded diaries to join us. We spent the last hour of the day figuring out how we could involve more people. How we would communicate, what we wanted our branch to be about, how we ensured fairness of future meeting locations and ideas to be discussed.

Perhaps most importantly, should Humberside really be known as East Yorkshire?

It was evident that we are branch members recovering from years of austerity that applied brakes to anything above the ‘day job’. Not all who were at the meeting will get funding to attend the Conference. One person had needed to take a day’s leave to simply attend this meeting. As an ex probation officer who now has the luxury of more choice when organising my diary and priorities, I understand the pressures on some people in the room. The parallel with some of our clients and service users is not lost. When barriers are in place to any kind of development or reflection it may be easier to stay exactly as you are. With that in mind, I reiterate the thanks to all who attended, speakers, listeners, and doodlers. We’ve got this.

I do hope to see you in Leeds this year.

At the crossroads 2.0: Future directions in sex offender treatment and assessment

By Kasia Uzieblo, PhD, Minne De Boeck, PhD, & Kieran McCartan, PhD

NL-ATSA (the chapter of ATSA based in the Netherlands and Belgium), the University Forensic Centre) (UFC) and the University of Antwerp organized the second edition of the conference “At the Crossroads: Future directions in sex offender treatment and assessment” in Antwerp, Belgium. The second edition took place from the 6th – 7th February in Antwerp, following on from two days of pre-conference sessions focused on treatment and risk assessment. The conference was a real mix of research, practice, and policy with approximately 250 participants from the Netherlands, Belgium, Germany, Slovenia, Spain, Iceland, USA, Canada, and UK; in addition, Zuhal Demir, Flemish Minister of Justice and Enforcement opened the conference and attended the first session on the first day. In this blog, we are going to take you on a whistle-stop tour of the event.

The conference had 2 pre-conference sessions, which were separate from but connected to the main conference, on Static-Stable-Acute training (Wineke Smid, Minne De Boeck, and Kasia Uzieblo) and how to effectively apply Risk-Need-Responsivity principles to treatment (Sandy Jung). The first day of the conference was all keynote sessions, which included, Maia Christopher (ATSA) on working with victims organization to co-create effective public policy;  Erick Janssen (KULeuven) on the relationship between arousal and emotions on decision making in risky sexual behaviors and/or sexual offences; Georgia Winters (Fairleigh Dickson University) on sexual grooming behaviour; Ross Bartels (University of Lincoln) on the sexual fantasies and their role, or not, in sexual offending; and Nicholas Blagden (Nottingham Trent University) in the importance of the rehabilitative climate and how prison can be a place for therapeutic change. The second day the conference had started out with two back to back workshop sessions: There were 5 sessions and they were repeated twice which enabled the attendees to get the most out of the conference. The workshop sessions were more practice-based and focused on online sexual offences (Hannah Merdian, University of Lincoln), risk communication (Daniel Murrie, University of Virginia), case formulation incorporating risk assessment (Leam Craig, Forensic Psychology Practice, LTD), sibling sexual abuse (Peter Yates, Edinburgh Napier University) and professional self-care (Joanna Clarke, Petros People). The second half of the second day focused on keynotes from, Klaus Vanhoutte (Payoke) talking about human trafficking, sexual exploitation and how the “lover boy method” could be used to understand this process;  Eric Beauregard (Simon Frasier University) on research and practice into serial sexual homicide and what that means for practitioners; desistance from online sexual offending (Hannah Merdian, University of Lincoln); and how we move on from the crossroads in terms of using evidence in policymaking (Kieran McCartan, University of the West of England). On the second day, like the first, there were about 10 poster presentations during lunch (21 in total) that highlighted the breadth and depth of research in the Netherland, Belgium, Germany and UK on sexual abuse, including, research on BDSM, Minor Attracted Persons, Stop it Now!, COSA & Circles Europe, and desistance.

The NL-ATSA conference really highlighted the diversity of sexual abuse and how wide, although interconnected, the field is. The multi-day conference connected all the domains from theory to treatment with each other. Current trends and lesser-known phenomena were also cited. For if we don’t understand sex and sexuality in everyday life, how can we tell normal/accepted sexual practices from “deviant”/non-normal ones? How can we understand the way that the public, as well as policymakers, attitudes to sex and sexual abuse are formed, and therefore how they impact real-world responses to sexual abuse? If we do not know the difference between fantasying and doing, or viewing and doing, how can we present first time offending or recidivism? If we do not know how people groom, offend or behave, how can we prevent or respond to sexual abuse? This also means that we must hear the client as the service user and recognize professional experience and knowledge to frame best practice. So that we can build rehabilitative climates that are fit for purpose, help treat people and stop burn out in staff. Therefore, we must recognize that rehabilitation is possible and that desistance can happen. The evidence base in sexual abuse is often varied, but we do know that treatment/interventions are more effective than doing nothing. Do we acknowledge that enough? And how do professionals and researchers convey that to the public and policymakers? This conference highlighted and incorporated all these points. Yes, we are at a crossroads and we have been there for a time, but we need to go forward not back. We go forward together united in a multi-disciplinary, multi-agency way and by connecting all the different subdomains within our field. The conference reinforced the importance of international collaboration, conversation, and research.

The myth of ‘absolute knowing’: when is the evidence enough?

Note: This blog is a repost from the Centre for Expertise on Child Sexual Abuse. Kieran

By Anna Glinski, Deputy Director for Knowledge and Practice Development at the Centre of Expertise on child sexual abuse.

Over the years that I’ve specialised in sexual abuse work, as a social work practitioner, manager and trainer, and now in my current role at the CSA Centre in developing evidence-based professional practice in child sexual abuse across the country, I am continually struck by two things:

  1. the hard work of committed social workers and other professionals who strive every day to make children safe; and
  • that despite this, they face significant obstacles in trying to evidence concerns about a child being sexually abused.

We know that a great many more children are experiencing sexual abuse than those that come to the attention of statutory services and when they do, sexual abuse is seldom explicitly named or adequately addressed. There are many obstacles that contribute to this stark reality but one that perhaps limits us the most from being proactive is a hesitancy to name child sexual abuse as a concern.

‘What if I’m wrong?’

In cases of child abuse and neglect, social work decisions on whether to act or not rest upon one central question – ‘On the balance of probabilities, do we have the evidence to intervene?’. These are, and should be, complex decisions whatever the nature of suspected abuse; however, when it comes to child sexual abuse, a whole myriad of additional conscious and unconscious thoughts and processes come into play. Our mantra (and that of the people we need to persuade) becomes ‘what if I’m wrong?’, in particular, ‘what if I wrongly accuse someone of this heinous crime?’ 

The implications of being right can be overwhelming – emotionally (thinking the unthinkable, hearing difficult information, considering the sexual abuse of a vulnerable child) and practically (the need to have difficult conversations, ask alleged perpetrators to leave the family, the implications to an already busy caseload). In this context, strong supervision, containing management and organisational support are essential, yet often inconsistent. 

Supervisors and managers often replicate the same emotional and practical reservations, consciously and unconsciously, to the possibility of sexual abuse. The ‘what if I’m wrong?’ becomes ‘where’s your evidence?’, and the unconscious desire to find the answer that proves we are indeed wrong, that sexual abuse is not taking place, can override our decision-making and thought processes.  Identifying an alternative hypothesis for our concerns is easy – they must have seen that behaviour on YouTube; it must be their disability or condition; it’s because of other difficulties in their life (a loss, a move, a trauma, a friendship issue, an argument or fight at home)…and alongside this, they haven’t actually verbally told us they are being abused, so it cannot be abuse. And when we find an alternative explanation to the behaviour of concern, we often fail to keep the sexual abuse hypothesis live.

Sometimes the alternative explanations we consider may well be true, and our concerns of sexual abuse will, of course, not always be founded, but we fail to consider that sexual abuse could be occurring alongside those other factors.  A child can be both on the autistic spectrum and being sexual abused; or experiencing domestic abuse and being sexually abused; or struggling with a friendship and being sexually abused. We must hold in mind all the hypotheses even when there are other possible reasons for our concerns and even when the implications of it being sexual abuse are hard to consider.  We must also be aware of and actively challenge the preconceived ideas about who perpetrates abuse and who the victims are which form our unconscious biases on gender, ethnicity, sexual orientation and class and can mean that some children’s experiences of sexual abuse are less likely to be identified and acted on.

‘Beyond reasonable doubt’

Throughout the investigation process, a common phrase we hear is ‘we don’t have the evidence’, from ourselves, our managers, our police and health colleagues, our legal advice. But what does this actually mean? The police may not have the evidence ‘beyond reasonable doubt’ to be able to take further action, however on the ‘balance of probabilities’ do we, as social workers and social work managers, have the evidence?  On the balance of probabilities, we may have a catalogue of concerns around sexualised behaviour and emotional or behavioural presentation, indications of abusive behaviour from adults or siblings in the home, a child who has disclosed but retracted, or is demonstrating in every which way other than verbally that something harmful is going on for them. That is not evidence beyond reasonable doubt, but it is most certainly evidence of real concern about a child’s wellbeing that needs responding to. 

And anyway, how realistic and achievable is it that we will get evidence beyond reasonable doubt?  How could we absolutely know, without doubt, that abuse has occurred?

  • We saw it happen with our own eyes?
  • Someone else, who is ‘reliable’, saw it happen and reported it?
  • The alleged perpetrator admitted it?
  • The victim clearly, verbally told us what happened with accurate recall on timescales and attention to detail despite the trauma of the incident/s; has managed to repeat the story on at least 2 occasions; has managed to persuade a jury while being questioned by an adult defence lawyer?
  • We have medical evidence that proves sexual abuse took place?
  • We have film footage of the abuse taking place?

What are the chances of any of the above happening?  Sexual abuse is a hidden crime, enacted in secrecy. Getting caught risks the loss of liberty, family, respect and employment and so abusers are unlikely to admit it. The trauma of abuse impacts memory and recall. The process of abuse distorts, disrupts, confuses and silences, meaning victim testimony is often challenged. Medical evidence is often deemed inconclusive – abuse is rarely reported within forensic timescales; if injuries are caused children heal quickly; sexually transmitted infections may have other causes*.  We may have photographs or film footage of abuse, and with the rise of technology there are increasing prosecutions on this basis, but still, many abusers would not risk this approach.

And yet…despite the serious unlikelihood of finding this evidence, we say, repeatedly, and as if it is a good enough reason to take no further action – ‘we haven’t got the evidence’.  This is what I call the myth of absolute knowing – the myth that we will, despite the fact sexual abuse is a hidden crime, where it is most often one person’s view (the child) over another’s (the adult), actually be in a position where we have this level of evidence. It guides our thinking and decision-making in the most unhelpful way, while also giving a sense that we have done all we can to protect a child in the circumstances: ’we haven’t got the evidence, so there is nothing we can do’.

Despite our responsibility and desire as social workers to protect and support children affected by sexual abuse, we seem to have adopted the ‘beyond reasonable doubt’ threshold as if it is our own.  This is somewhat unhelpfully fuelled by the family courts, who, in my experience, often address issues of sexual abuse with a criminal burden of proof, leaving social workers disempowered to protect children they feel certain are at risk of sexual harm.  Recent data on the scale and nature of sexual abuse indicates that on average only 14% of cases of sexual abuse reported to police go to charge (NOTE: this is not just those that get convicted, but those that go to charge) due to a lack of ‘beyond reasonable doubt’ evidence. So what about the remaining 86% of cases (which will include, undoubtedly, those disabled children who struggle to verbally communicate) who on the ‘balance of probabilities’ may be being sexually abused? If we fail to respond in any meaningful way to this majority of children, can we honestly say that we as social workers and managers are doing our job effectively?

What if you’re right?

As a profession, let’s move from asking ‘what if I’m wrong?’ to asking ‘what if I’m right?’, ‘what if this child is being sexually harmed?’, and then ‘what do we need to do, in the absence of ‘solid evidence’, to make this child safer?’

Whilst holding in mind the need to be balanced and to give sufficient weight to all possible hypotheses, we need to apply the current knowledge and existing theory on sexual abuse to our practice. This will allow us to think about all possible pathways to change and safety. Children rarely care about legal thresholds and outcomes – they need us to use the skills we already have as social workers, to sit with the uncertainty, the emotional pain and the practical challenges and to do what we can to support them and protect them from sexual harm.

This, of course, requires knowledge, skills and confidence. The CSA Centre has been trialling different approaches to increase practitioners’ confidence in practice and access to evidence around child sexual abuse, including developing and piloting our Practice Leads’ Programme. It is clear, however, that addressing the current gaps in training on child sexual abuse on both pre- and post-qualifying courses for social workers and other professionals must be a priority.

*There are many benefits of medical examinations where there are concerns about child sexual abuse additional to finding forensic evidence.

Stop it Now! Scotland: Going upstream to prevent Child Sexual Abuse

By Stop it Now Scotland!

Stop It Now! Scotland is a small team based in Edinburgh who works with adults and adolescents who have sexually abused children, viewed child sexual exploitation material or who are worried about their sexual thoughts and feelings towards children. This week we have launched an online resource that distils what we have learned from those who offend or at risk of offending, providing information for communities in Scotland and the professionals who serve them about the practical things we can all do to prevent child sexual abuse in the first place.

The aim of the resource is to help adults who are protective to become more effective in their efforts to prevent sexual abuse and to help those who present a risk of harm to children to make safer choices.

Upstream was funded by the Scottish government and based on a CD-ROM (remember them!) we developed in 2011 to help build the capacity of individuals and communities to prevent child sexual abuse in Scotland.  As time moved on it became apparent that a CD-ROM was no longer fit for purpose. But also we reached a stage where we needed to comprehensively refine and strengthen the Toolkit, properly test and evaluate its fitness as a practical resource to prevent abuse before it might occur, and align us to effectively deliver (in a systematic and evidenced way) primary prevention of child sexual abuse and sexual exploitation in Scotland.

It was at this point that we started to develop the online resource. Whilst the content of the existing toolkit was an important ‘starting point’ in our work we also wanted to include more information and resources to help in the changing task of keeping children safe. A big part of this is strengthening the capacity of adults to safeguard children and also building the resilience of communities to keep children safe.  We also want to help anyone who is around children to identify the risky behaviour of themselves or others to allow them to intervene and prevent child sexual abuse before it occurs. We wanted to include materials on prevention of harmful sexual behaviour in childhood and adolescence. And we wanted to ground all of this in bystander theory – the idea that there are practical things we can do to make a difference when we encounter behaviours that are inappropriate or potentially harmful.

The new resource is broken down into five sections. These are Learn, Identify, Prevent, Act and Engaging Communities. There is also a Get Help section for anyone in a situation that needs immediate action.

The resource gives practical advice based on a wide range of scenarios and frequently asked questions that often come up during our work. “What if I don’t like the way my uncle is playing with my daughter?” or “What are the warning signs that a child is being abused” or “How do I make my church group safer for children?”. We have tried to make the language as accessible as possible without losing some of the detail and nuances of the complex world that we live in. The Engaging Communities section contains a range of resources that professionals can use when engaging the public about prevention.

It was developed specifically for a Scottish audience but we hope this resource can be used more widely. Have a look, and if it is useful, share the resource with colleagues, friends and family or tell people about it on social media. The message of Upstream is simple; together we can protect the next child from harm.

ATSA Annual Conference 2019

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

The annual ATSA conference took place from the 6th-9thNovember in Atlanta, Georgia. The conference was a real mix of research, practice, and engagement with over 1,200 participants from the USA, Canada, UK, Australia, New Zealand, Sweden, Netherlands, Norway, France, Belgium, and Israel to name a few. In this blog, we are going to take you on a whistle-stop tour of the event. 

The 2019 ATSA conference had 31 pre-conference presentations covering a range of topics including Risk Assessment, online offending, youth who sexually offend, treatment and interventions as well as a session for students on training and career development. The keynotes this year whereby Professor Teresa Gannon (Are treatment Programs for sexual offending effective), Professor Paul Bloom (Against Empathy), Linda Dahlberg (Going Upstream: The fundamentals, evolution, context, and practice of primary prevention) and a conversation between Kurt Bumby and Kristen Houser on communication/messaging about working in the field of sexual abuse. The main conference had 100 workshop presentations and 36 poster presentations, with approximately 200 speakers presenting, covering prevention, victims, youth, adults, learning disabilities, minor-attracted youths, policy, assessment, risk, management, and community engagement. In addition, this year saw the lifetime significant achievement award go to Jill Levenson, the Gail-Smith Burns award go to David Fowers, and the Early Career Award goes to Kelly Babchishin, Congratulations to all!!! 

For Kieran, the highlight of the conference was the first two keynotes, Teresa Gannon’s & Paul Bloom’s; although very different they talked to core ideas surrounding treatment and intervention. Teresa Gannon gave us an overview of her recent meta-analysis on the success of treatment programs, which showed that treatment can work but to do so the skills and the training for providers matters. Treatment success is about more than just program structure and integrity, the human delivering the treatment matters! This complemented Paul’s keynote on against empathy, which really made us focus on what empathy is and how effective it is in treatment and risk management. Empathy is a controversial topic in treatment programs and interventions for people convicted of a sexual offence, so it was pleasant to hear about it from a philosophy-political-social-psychological point of view, rather than just a treatment one. Do we need our clients/service users to have empathy for their victims to stop them from re-offending or even to stop offending in the first instance? Is it compassion, insight, and self-regulation that we are really looking for in them? Also, how much empathy do we need to have to be competent and skilled therapists, treatment providers and researchers? It was an interesting talk that went beyond pure semantics and allowed us to think about the role of empathy in the field and everyday practice. To Kieran, these keynotes set the tone of the conference as ATSA has always been about reflection and being a critical friend to each other. 

The international roundtable this year was focused around risk assessment, risk management and treatment/interventions with 7 speakers from 7 different countries (USA, Canada, UK, New Zealand, Israel, Netherlands, Belgium). The session ran differently this year with the roundtable focusing on 4 topics and the speakers addressing how each topic was handled in their country, therefore we could see the comparison first hand. Which worked well and stimulated a lot of debate. Again, as in previous years, the roundtable really cements ATSA as an international conference! 

The entire conference was a high point of the year for David. Although pinpointing specific moments is next to impossible, this year was noteworthy for the quality of the participation. At a workshop titled “The Pornography Debate”, those in attendance proved the axiom that intelligence often comes in asking the right questions rather than having the right answers. In this case, these questions came in the form of “Is any porn user ever entirely satiated” and “Is it possible to have a sexual encounter that does not involve at least a little objectification?” Likewise, participants in a workshop on the often traumatic effects of the legal system on clients were open to discussion in ways that are far rarer in other conference situations. This year was a lesson that not only does ATSA boast some of the best workshop experiences in the field, it also has amongst the most knowledgeable and thoughtful attendees. 

One of the primary benefits of being an ATSA member and attending the annual conference is the opportunity to connect with friends, colleagues, and collaborators from around the world. The primary take-away from these conference experiences for the two of us was the importance of working together towards common goals so we could participate in “shaping the future”, as the conference theme appropriately described it. We are looking forward to ATSA 2020 in San Antonio, Texas!!

Prevention of Child Sexual Abuse: Special Issue of the Journal of Interpersonal Violence

By Marcus Erooga &Keith Kaufman (Co-Editors)

Link: https://journals.sagepub.com/toc/jiva/34/20

Evidence suggests that child sexual abuse remains a significant public health concern across the world. For example, the World Health Organization (2018) reported in 2018 that 20% of women and 8% of men worldwide report having been sexually abused as a child. At the same time, it is widely understood that these and other prevalence estimates represent underestimates of the true incidence of abuse (Royal Commission into Institutional Responses to Child Sexual Abuse, 2017). Of concern are the short- (Beitchman, Zucker, Hood, daCosta, & Akman, 1991) and long-term (Beitchman et al., 1992) adverse effects that are associated with many victims of child sexual abuse. Despite the prevalence and the significant consequences, there has been a relative paucity of prevention efforts to address child sexual abuse.

As part of the efforts to address this, we were invited to edit a designed to highlight a broad international sampling of cutting-edge child sexual abuse prevention articles, in the hope of both spurring additional prevention research and sharing these creative approaches to prevention. The following is a brief synopsis of the content.

In 2017, the Australian Royal Commission into Institutional Responses to Child Sexual Abuse (CSA) published a final report detailing its 5-year investigation process, which represents the most comprehensive public inquiry of its kind ever conducted. The Journal opens with an article based on findings from co-principal investigators’ Professor Keith Kaufman (USA) and Marcus Erooga (UK) comprehensive international literature review examining risk and protective factors related to CSA in institution settings for the Commission (Kaufman et al., 2016), with additional material from Professor Ben Mathews (Australia) and supported by Erin McConnell from Portland State University. This provides suggested preventive directions to address the safety risks identified in the authors’ review of more than 400 publications and reports garnered from research literature in the United States, the United Kingdom, and Australasia.

Second is a study authored by Billie Jo Grant, Ryan Shields, Joan Tabachnick, and Jenny Coleman examining data from Stop It Now!’s U.S. helpline over a 5-year period. This offers insights into the needs of the hidden population of individuals who are at risk to sexually abuse, those who have abused, as well as offenders’ and potential offenders’ friends and family members seeking support.

On the related topic of services for those seeking preventive treatment, Sarah Beggs Christofferson’s New Zealand study explores whether such provision is viable in a discretionary reporting context, that is, in jurisdictions without mandatory reporting, but where risk-related disclosures to authorities are permitted at therapists’ discretion. Based on a survey of New Zealand health professionals, she concludes that if policies and expectations are clearly defined, this could be the best way forward for viable preventive treatment.

This is followed by Professors Jill Levenson and Melissa Grady’s report on a U.S. pilot study to investigate whether it is possible to improve the provision of clinical services to individuals who self-identify as sexually attracted to minors, but who have not yet acted on their attraction. The authors describe the use of an innovative prevention approach designed to alter the knowledge and attitudes of mental health professionals to increase the pool of competent practitioners willing to provide services to this challenging population.

The subsequent article, by Professors Richard Wortley, Benoit Leclerc, Danielle Reynald, and Stephen Smallbone (from the United Kingdom and Australia, respectively), takes a different approach to the prevention of child sexual abuse. It focuses on strategies intended to alter situational dynamics in ways that make CSA less likely to occur, rather than attempting to treat individual factors in the offender (e.g., to change their inappropriate motivations and behavior). The authors suggest that by considering the perspective of the offenders themselves, they can identify significant situational safety risks that can guide the design and implementation of more effective offense-focused CSA prevention approaches.

Finally, the Special Issue concludes with a report detailing a national survey of CSA prevention education programs in Australian primary schools conducted by Professor Kerryann Walsh, Donna Berthelsen, Kirstine Hand, Leisa Brandon, and Jan Nicholson. The survey was distributed to all providers of child sexual abuse prevention programs in Australian primary schools and provides new information about the nature and scope of school-based education programming for the prevention of child sexual abuse. It also provides a template for the development of similar prevention programs in other settings internationally.

It was a real pleasure to be able to work with such highly experienced and knowledgeable authors, each an expert in their respective field and we are excited by the breadth and depth of prevention perspectives reflected in their contributions.

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.