Let’s talk about emotions: An NL-ATSA webinar

By Minne De Boeck, Rosa Oranje, Cathy van Harten, Kasia Uzieblo

Emotion regulation in the treatment of people who committed sex offenses (PCSO) is a topic that has long been underexplored in practice and especially in research. Initially, the assumption was that sexual offending behavior originated mainly, if not only, from sexual deviant fantasies. In line with this assumption, the main aim of the early behavioral interventions was to recondition sexual offending behavior through for instance aversion therapy. Treatment programs of PCSO’s gradually started to focus more on cognitions and self-control. Hence, we started to abandon the mere stimulus-response principle by paying more attention to other psychosocial factors such as attitudes, beliefs, and interpersonal relationships, and the way these factors may underly the client’s offending behavior. Today, cognitive-behavioral therapy (CBT) is the most widely used therapy for PCSO’s and has to date received the strongest empirical support compared to other approaches (see for an overview of its history, Moster, Wnuk, & Jeglic, 2008). But CBT is not all about cognitions and behaviors. CBT techniques also help individuals to gain control of emotions. Although this component of CBT seems to have been a bit neglected over the years, there seems to be a recent uptick of interventions that focus on emotion regulation in these clients (e.g. emotion-focused therapy, mindfulness). Given the importance of emotion regulation as a risk factor for sexual recidivism, the Dutch-speaking association of ATSA, NL-ATSA, organized an online conference on emotion regulation. The aim of the conference was to share best practices in emotion regulation interventions. Three therapists were given the opportunity to present their interventions to 100 practitioners from the Netherlands and Flanders (Belgium). 

The first session was presented by Sabine Noom (Msc) and Marc Lexmond (Msc), who work in the Van der Hoeven Clinic, a Dutch inpatient treatment center for offenders with psychiatric problems, including PCSO’s. Their unit provides treatment to medium- and high-risk PCSO’s. The treatment duration usually ranges from 6 months to 2 years. The goal of the treatment is to reduce dynamic risk factors and increase protective factors. Their treatment program focuses on (1) behavior through role-play and psychomotor therapy; (2) the connection between patients and therapists on the one hand, and amongst patients on the other hand; (3) learning how to take care of each other and how to communicate with one another; (4) creating a positive life plan; (5) acknowledging the person behind the perpetrator; and (6) learning how to behave in a prosocial way by the process of trial and error. The therapists also develop a workbook ‘My Emotions’ with the patients. This methodology is based on schema therapy. They most often start with the so-called ‘side model’, by exploring the healthy side of the patient, his/her fighter and destroyer side, and his/her protector side among others. The client learns how to talk to his/her different sides after identifying which side is claiming a big role in specific situations. This way clients learn to understand their offending and present behavior.

In the second presentation, Ellen Gunst (PhD; FIDES) focused on Emotion-focused therapy (EFT), a therapeutic approach based on the premise that emotions are key to identity and which emphasizes the adaptive nature of emotions. The primary focus of EFT is to promote the client’s instantaneous experience. This framework postulates that controlling emotions cannot be learned consciously but can be acquired implicitly (e.g. by experiencing emotions and experiences). Hence, the aims of EFT are to create a genuine empathic valuing relationship and deepening the client’s experiencing in therapy. In order to facilitate intimacy and connectedness in their patients, various EFT techniques can be used. During her presentation, Ellen Gunst illustrated the so-called Two-Chair Task. This task aims to resolve the intra-psychic conflict within by evoking emotional responses in the client. This technique was illustrated with a case example. This patient was initially difficult to motivate for and engage in therapy, but after a year the therapists succeeded in forming a minimal form of connection with the patient. The two-chair technique was applied to help him gain insights into his anger, frustration, and sadness. With this case example, Ellen Gunst demonstrated that it is possible to teach these patients how to acknowledge their feelings and to facilitate their empathic abilities. 

In the final presentation, Martine Ruijter (Msc; Antes) explained how she applies visual techniques of visualization with PCSO’s. According to Martine Ruijter, PCSO’s are more open to discussing their behavior, thoughts and feelings by making them visible. The focus lies on the patient’s story, not the interpretation by the therapist. The advantage of this therapy is that in case a proper therapeutic relationship does not ensue, the client can still focus on the material, which in turn might help to (re)build therapeutic contact. There are four levels on the ‘expressive therapy continuum’, namely: (1) Kinetic to sensory, (2) Perception to affect, (3) Cognition to symbolic, and (4) Creativity. The goal is to get the client to the fourth level and to create balance in his emotional experiences. Martine Ruijter also observes some remarkable differences between different PCSO’s in their artwork: the artwork of patients who have committed rape seems to be more chaotic and often cracks are drawn, whereas patients who have abused minors seem to be more creative but difficult to reach throughout the conversation. According to Martine Ruijter visual therapy should be regarded as complementary to CBT.

Important take-home messages were that in therapy we sometimes need to pay more attention to non-verbal expressions of emotions. Clients need to learn how to regulate their emotions through practice (e.g. visual therapy, role play). Therapists should also dare to slow down, explore the emotional experiences in-depth, and pay attention to physical experiences and traumas. The interventions that focus on emotional expression can be considered as a valuable addition to CBT interventions that focus on cognition and behavior. However, all presenters also emphasized the need for empirical insights into the efficacy of emotion regulation interventions in terms of the well-being of PCSO’s and the risk of recidivism.

“But they must have known”: Am I getting this wrong?

This blog was written by an individual from the UK who wanted their story heard but wishes to remain anonymous.

This is a blog in a continuing series about the impact of the arrest & prosecution of individuals convicted of having Indecent Images of Children on their families (please see a previous blog by a professional and a family member). The author of this blog has wished to remain nameless, but please be aware that the individuals who contribute to these blogs, while anonymous, are different individuals. Kieran

The “But, they must have known!” blog presented the story of an ex-partner of an IIOC and her experience and emotions in the five years since ‘the knock’. My situation is almost identical, just five years on, and I wanted to highlight how the focus on the event and the immediate aftermath is not enough, and how the situation continues to evolve, and even heighten, as the years progress. I am an ex-partner of a man arrested for IIOC offences 10 years ago. He received a community sentence and 5 years on the SOR. My children do not know. 

On the night that my ex-husband was arrested, my 2 sons (3 and 6) were playing in the living room. We had a great family, the kids loved their dad, and contrary to what people may imagine, there were no signs, we were very happy, and for the children, that meant an unexpected decimation of the family. Ten years on they still don’t know about their Dad, but this is what I imagine THEY FEEL.

Confused

Every day after the knock my eldest asked me: “What did Dad do wrong?” Every day I distracted him with: “Look what your brother just did”. One day, about a year after the arrest, he asked me: “Did Dad kill someone?” and I vowed that the next time he asked I would tell him the truth. He never asked again! I struggle to imagine another situation where, what appears to be a happy and stable family unit would be terminated without the permission to grieve or to talk about the trauma. I told my children (and friends and family) that we decided to separate because we weren’t making each other happy. When people say: “The children will be better not hearing the arguments, or living with the tension”, I envy those families because my children were not better without the arguments or tension because there were no arguments and there was no tension. Is it akin to the death of a parent? I imagine in that situation there is permission to talk about Dad and how great he was. The children don’t have to see their Dad unemployed and broken, but silent as to why this has happened. It’s a world based on lies, deception and, ultimately, a disengagement, because the topic cannot be discussed. I hope that they are too young to dwell on the inaccuracies and the contradictions, but I fear that may be false hope.

Scared

I think my children feel scared. When your world falls apart in an instant, one of the outcomes is hyper-vigilance. Within a day their mum turned from a laid back, happy person to someone who panics at the sound of the phone or knock at the door, who over-reacts when school phone to tell her you have done something wrong, and who often breaks down at things she never did before – without explaining why. While mum used to have lots of friends, enjoy a glass of wine and relish the chance to mix with other adults, she makes excuses to avoid seeing people, she rarely goes out and she doesn’t talk much anymore. For the (ex)partners of IIOC offenders, the crime has a life sentence – the lies, the deceit, the fear,  it consumes you to a point where the safest option is to retreat, and for my children, that overnight transformation must be terrifying.

Do they know?

I think that one of the hardest parts of being the remaining safeguarding parent is projecting every emotion you feel onto how your children might feel. Are they scared or is that my emotion? Are they confused, or does this all wash over them? And feeling the intense and unrelenting desire to tell them why their life changed so dramatically, but all the time knowing that, once said, that cannot be unsaid. These are thoughts, emotions and behaviours that are not recognised or supported by agencies set up to deal with offenders, victims or children of prisoners (the overwhelming majority of IIOC offenders receive a community sentence). For my children, and for me trying to parent them, there is no guidance or support, and the overwhelming feeling I have is: “Am I getting this wrong”.

Prevent It – meeting and treating users of Child Sexual Abuse Material online

By Elin Söderquist, Allison Park, Charlotte Sparre, Katarina Görts Öberg, & Christoffer Rahm.

“There is definitely a way to stop viewing CSAM, and I wish this study will lead to a wider effort to help those stuck in the same pattern as I was a few months ago”

-Prevent It participant

The need for new preventative initiatives working to prevent child exploitation online are acute. With the rapidly increasing numbers of shared material, especially during Covid lockdowns, we need to take action in every way possible. What if some of the users of Child Sex Abuse Material (CSAM) actually want to stop viewing pictures/films of prepubertal children, and just need some qualified help to do so? This is what experiences from Stop it Now and other help lines suggest, and this is where the idea of Prevent It comes in.

Prevent It is an anonymous international online therapy for people who want to stop using CSAM and want personal professional support. It is being tested with the best available scientific method, a blinded randomized clinical trial, designed to evaluate its effects, the change in consumption of CSAM.

Online recruitment began in April 2019, first only on onion sites dedicated to the spread of CSAM, sometimes called the “darknet”, and later, in the beginning of the summer 2020 recruitment expanded to also include discussion-forums on the open parts of the internet, sometimes called the “clearnet”. Prevent It is unique in that we are able to reach out to all corners of the world.

Due to understandable reasons, individuals with ongoing CSAM use are very concerned with their privacy. Therefore, the Prevent It treatment platform is accessible both through traditional web browsers and TOR, specifically designed to protect the integrity and safety of the user and used to access onion sites. We never ask for identifiable information or personal contact details. Recently we also made the treatment program no longer require an e-mail address when signing up nor require the enabling of JavaScripts.

The anonymity gives individuals an opportunity to seek care and be more open and truthful than they might be with an in-person therapist. In this way, we also reach out to individuals that law enforcement often does not.

The treatment contains weekly module content, assignments between modules, as well as weekly individual therapist feedback over eight weeks. Repeatedly, the participants are also asked if they know about any at-risk children, and it is clearly stated that any such information is immediately reported to the Swedish Social Services.

Many participants that apply to Prevent It describe that they suffer from psychological ailments such as anxiety, depression, and sometimes even suicidal thoughts. They also explain what a release it is to speak openly about their sexuality to someone – sometimes for the first time in their lives outside of the CSAM- chat forums. This study is already giving us new unique knowledge about this group that the research community knows so little about. Or as one participant said:

“Going through this treatment helped me understand my own sexuality more and helped my anxiety in that I felt that I could just talk about what I felt and thought to SOMEONE at all who wouldn’t judge me in a way I fear others close to me would.”
-Prevent it, participant

For more details please visit the following links:

Prevent It homepage: https://www.iterapi.se/sites/preventit/ Study pre-registration ISRCT

Prevent it registration link:
https://www.iterapi.se/sites/preventit/register


Swedish Ethics Appeal (Reference No.: Dnr Ö 1-2019)

Deceit, Sex, and Sexual Assault: Where are the Lines?

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

Please note that this blog is also published on the SAJRT Blog website too – Kieran.

While working in a large residential treatment center for youth about twenty years ago, the first author (David) ended up with a note passed between two students. In it, a 16-year-old male client claimed to a female client from a different campus that he had a condo near the casinos in Atlantic City, New Jersey. It was bittersweet at the time, reflecting the age-old attempts by young men to impress young women while displaying epic ineptitude. It would have been obvious to nearly anyone that he possessed few social skills, much less a condo that they could escape to. The author found reason for hope that the young man would someday be able to have the relationships he desired, while at the same time being concerned about the young man’s methods in the short term.

From here, however, things too often take a darker turn. Seemingly consensual activities in the context of getting a job or advancing within one. If the job or advancement doesn’t come through, how best to understand the results? Fraud, sexual assault? There is an entire style of pornography devoted to tricking women into being filmed having sex through the false promise that they are auditioning to become porn stars. What is the source of gratification beyond the sex in these situations? The gullibility of the woman being filmed? And of course, much of the #metoo movement resulted from the experience of being pressured into sex if one wanted to continue working in one’s chosen field.

A recent case in the UK adds to these important but thorny questions. Jason Lawrance was found guilty last summer of sexually assaulting a woman twice. Although the sex had at first been consensual, he had lied about having had a vasectomy. He subsequently texted her to say that he was “still fertile. Sorry.” She took emergency contraception and eventually had an abortion. Fraud? Sexual assault? Intrinsic gratification from the deception itself (sometimes known as “duping delight”)? The issues abound in a situation with a truly tragic ending.

The more immediate concern, however, is that Lawrance’s convictions were overturned. The Court of Appeals reportedly said that the “convictions were unsafe.” Meanwhile, Lawrance is currently serving time for other sexual assault convictions and remains in prison. Ultimately, the court said that “Lawrance’s “lie about his fertility was not capable in law of negating consent”.

This view of deceit is interesting and worrying because it drills to the very heart of the problem: the absence of “informed consent” is at the very core of sexual assault. However, of concern to the court was the nature of the actions that remove consent. The challenge here is a truly grey area. At what point does deliberate trickery become the coercion that is central to sexual assault? After all, gaining children’s compliance through trickery has long been recognized as a hallmark of child molestation.

The issue is almost not whether it is true that Lawrence had a vasectomy (as with David’s student and his fictitious condo), but rather that they said that they did and were believed. The woman in question made an informed decision based on false data that was created for the purpose to deceive. Further, by all appearances, Lawrance made an informed decision to create an illusion of informed consent.

It’s possible to discuss this situation from a number of perspectives, from the possible sexual and nonsexual motivations of an egregious behavior to questions about what specific crime categories this might fall under. What is clear, however, is that the idea of what constitutes consent is again back under discussion. In our opinion, this decision undermines decades of advancement in determining the importance of actual, meaningful consent. In some ways, it is similar to revenge porn posted in a technically legal fashion because the filmed partner simply consented and did not draw up a proper legal contract to define the parameters of the consent and the conditions under which the video could be distributed and viewed.

What is clear is that should the current decision be accepted as a legal precedent; it will take considerable public dialog to create new laws that are both sensible and meaningful. The overarching problem, in this case, is that it will likely dissuade victims of sexual offences from going forward because they feel that they won’t be believed, especially in situations where “consent” is difficult to establish or refute.

“But, they must have known!”: The perspective of a non-offending partner of a man convicted of downloading indecent images of children.

This blog was written by an individual from the UK who wanted their story heard but wishes to remain anonymous.

Please note: a few weeks ago, we had a blog from Anna Glinski, which prompted a conversation with the author of this blog about their experiences being the partner of a person convicted of possessing Indecent Images of Children. Kieran

What is it like being the non-offending partner of an IIOC perpetrator? Hard. Everything about it is hard.

In 2015 my ex-husband was given a 3-year Community Order and 5-year SHPO for downloading >1000 indecent images of children from 2011-15 across all three categories (majority B). No videos.

The knock on the door by the Police came as a complete shock as I had no inkling that he had a sexual predilection to underage girls. For the first couple of weeks after the arrest my sons, aged 3 and 6, had no contact with their Dad as per his bail conditions. I then signed a Supervised Access Only Contact Agreement with Children’s Services that I was advised would remain in place indefinitely. This, combined with the overwhelming fear of the predicted media exposure, prompted my decision to relocate.

Everything about my past, present, and future suddenly had a whole new perspective. I went from being a full-time mum who lived in a nice part of my hometown with children attending the local faith school and a husband with a very good job, to a divorcee with a vague backstory of why I needed a fresh start somewhere new.

As he remained part of society at every stage of the Judicial Process, we have had to find a new way of being with him as part of our world. The ramifications of this crime do not get less significant in time and the effect on children evolves as they grow up. I FEEL

Angry/restricted. None of this is fair. I have done nothing wrong, yet I need to make unending compromises to protect my family against negative community response because of our association with an abhorrent crime that we were innocent by-standers to every aspect of life is affected, from social interactions to employment options. I do not foresee this changing when his sentence is completed in winter 2020.

Judged/marginalized. From day 1 I felt as though I was being assessed whether I was a good enough Mum by anyone I had contact within a professional capacity, however as I ticked the right boxes, none proactively maintained any contact with us after 3 weeks post-arrest. To begin with, the lack of attention from authorities was akin to relief, but as time has progressed, I perceive this demonstrates that my boys are the unseen victims of this crime and the impact on their childhood seemingly acceptable collateral damage to achieving a conviction. I thought people would think I was stupid for not knowing about his online behaviour, or in denial, and would wonder whether I had the same interests too, plus would question any historical interaction their children had with mine. Now I know, through lived experience, I am invariably judged for allowing my children to still have supervised access with their Dad.

Unsupported Even though I hate the thought of my kids being considered vulnerable, this scenario triggers several Adverse Childhood Experiences, which means that they are. At the start, when I became aware of something I was blind to before, I desperately needed help to protect them from this significant threat to their well-being. Unfortunately, as we were(are) not classified as Victims, I could not find any support for us from any source. I struggle to find professionals who fully empathise with our situation, therefore am simply left alone to make up appropriate safeguarding measures for my boys as I go along. The impact on my mental health has been significant: after being repeatedly declined anti-depressants, with a long waiting list for NHS therapy, I have had no other option than to self-fund counseling.

Resentful. From the start, he had a network around him to help him live life forward. Police made it clear that any break in confidentiality about the nature of the investigation could increase his suicide risk. I took on the responsibility of keeping secret the reason behind my sudden change in circumstances which consequentially created distance within pre-existing friendships. Until the charges were made public in Magistrates Court I lived in limbo for 5 months not knowing the full scope of the investigation to protect his Right to Privacy. Probation monitored him regularly and supported getting him back into employment. He managed to meet and move in with a local woman who accepted his conviction. I have had nothing as I moved to a place that gave us anonymity.

Sad. I feel heartbroken that my boys have been robbed of a traditional father figure. I can only protect them from this for so long before they will learn preciously early in life that people are not always what they seem. They are going to have to face a huge emotional and psychological challenge as teenagers when they grow to understand what their Dad did.

Strong/proud. I had to forgive myself that I could not have seen what he took such great care to hide. As someone who has had a relationship with a man convicted of this crime I have felt: confused; naïve; misunderstood; full of self-doubt; disappointed in myself for missing it; burdened with a family secret; scared; isolated; lonely; ashamed; torn; irrelevant; guilty; fearful for the future; bereaved; like a victim. Yet I have got back up each time this situation has brought me to my knees and that makes me resilient.

How the pandemic challenges and questions our perspectives on and work with people who have sexually abused


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

By Kieran McCartan, Ph.D., Kasia Uzieblo, PH.D., and David S. Prescott, LICSW

Over the last couple of months, we have focused on what the challenges and realities of living in lockdown with COVID-19 are, but this is starting to change as lockdown is ending. What is the new “normal” and how will this impact the prevention, management, and integration back into the community of men convicted of a sexual offence? Now it feels like there are more questions than answers, which can present a daunting challenge! Sometimes we cannot see beyond what we know, but we also know that need that drives change. In the months and years ahead, we will not return to the way things were before, 2021 will bear little resemblance to 2019. The nature of the game and its rules has changed. So, what does this mean in reality?

Here are some points that occur to us as of this week (and who knows what tomorrow may bring?)

Changing perspectives on causes and responses to sexual offences: What COVID-19 has taught the world is that health and wellbeing are connected to everything that we do. A healthy population is an engaged, productive population. Therefore, we need to continue to integrate health and wellbeing into the work that we do in preventing as well as responding to sexual offences. This involves maintaining the public health approach, thinking about the impact of adverse experiences and trauma as well as considering the impact of these in framing desistence and integration. 

Risk management vs management: We talk so much about “risk” and what that means for people with a conviction, not to mention criminal justice agencies, therapists, victims, and the public; but the reality is that the terms risk and risk management mean different things to different people, each of whom has different roles. Ultimately, what we are all saying is that we are helping and supporting people to manage their own behaviour. This reframing is important because the individuals themselves are not always the sole source of risk (an internal locus of risk) but often the circumstances of the outside world are also the source of risk (an external locus of risk). The pandemic has shown once again that circumstances do matter and that they should be incorporated more often in our risk assessment and management. Therefore, how they manage themselves in various and sometimes extreme circumstances as during the pandemic matters.

Changing regimes: We have seen that because of COVID-19 our ways of working have changed, sometimes for the better and other times for the worse. We need to evaluate these changes and learn from them. Does remote working improve prevention, treatment, management, and integration? Or does it make it worse? In what ways? How does it impact relationships with clients? How does it impact staff working, resilience and confidence?

Changing processes and conditions: COVID-19 has taught us that prison may not be the answer with lower risk and people on shorter sentences getting released under supervision. This begs the question whether they needed to go to prison in the first place? Was community management a better approach? And was it adequately considered? Further, what does community management look like in a computer-enabled age? Especially with individuals who may not have access to the internet or technology, because of their conditions of release or the fact that they live in socio-economic areas that suffer from poor internet access. 

Improving Partnership & collaboration: It has become obvious through lockdown that working together, in a collective evidence-informed way is possible. Therefore, we need to up the stakes in terms of partnership working, communication and collaboration between the public and the system, across all levels of prevention and forms of (risk) management; we need -more than ever- to be on the same page to take on all these old and new challenges. 

“But they must have known!” Effectively working with non-abusing parents.

By Anna Glinski (Deputy Director for Knowledge and Practice Development at the Centre of Expertise on Child Sexual Abuse).

This blog was first published by the CSA Centre on the 18th March 2020 – Kieran.

Imagine for a minute how it would feel to receive a knock on the door from a police officer and social worker, who proceed to inform you that an allegation of sexual abuse has been made against someone close to you, a family member, your partner, a friend – someone you trust – would you believe it?  What if the allegation was made by your son or daughter?  Would you be able to think clearly enough to make some speedy decisions about what needed to happen next?  I suspect not.  More likely, you would be overwhelmed with feelings of shock, anger, confusion and disbelief. 

Effective multi-agency working with non-abusing parents is absolutely key to the future welfare and safety of the child. Research indicates that feeling believed by your main caregiver is one of the strongest mediators of the long term mental health issues caused by sexual abuse. This parent/caregiver will need to play a central role in protecting their children from the person of concern, implementing safety plans and managing risks; and, they will need to support their child with the immediate and longer-term impacts of their abuse. These are hefty responsibilities for someone who is also coming to terms with the fact their child has been abused by someone they may have loved and trusted and is also likely to be experiencing other pressures as a result.

After the shock

The consequences of believing someone in your family has abused a child (either on or offline) can be enormous: shame, guilt, feelings of responsibility, an end of a relationship, the loss of a home or an income and loss of support. And fear – fear of losing your child or your partner, of a hostile response from friends and family, of what people will think of you, of loss of autonomy, of retribution from your partner. For many, it is not surprising that denial kicks in: a normal and functional defence that allows us to protect ourselves against something that is painful and distressing. As Still observes in her useful book on assessing and intervening with non-abusing parents“It is not uncommon to see the mother in a state of confusion and ambivalence, swinging on a pendulum between believing the child completely one minute and not the next, or believing some but not all of it: ‘I can believe this, but I cannot believe that’.”

For those from Black, Asian and minority communities, or with English as a second language, or whose residence in this country is threatened, there may be additional and significant consequences for what has happened. Additionally, for those who have experienced sexual abuse themselves this process is likely to be even more complex, confusing and painful. And what if one of your children has abused the other/s?

Working effectively with non-abusing parents

For professionals to give the best opportunity to non-abusing parents to be able to fulfil the tasks of support and protection, every interaction should be in the context of building their strength and resilience, offering support and understanding through an empowering approach. The limited research that does exist indicates that non-abusing parents and carers often do not receive the necessary empathy, time, support or information to help. They can feel judged by professionals, ‘they must have known’ (while battling with their own guilt about what has happened).

We know that there are parents who sexually abuse their children, or who do not act protectively when they become aware of the abuse of their child, and this needs to be properly investigated. However, non-abusing parents are too often perceived to have been actively involved in the abuse. As Chaffin states “From a trauma processing perspective, features such as denial, unfocused anger, minimisation of the problem and ambivalence toward both the alleged victim and abuser would be considered part of the course, rather than evidence of toxic parenting or deep-seated psychopathology.”

Professionals have an important role in understanding non-abusing parents’ reactions, providing support to enable them to process what has happened and ensuring that children are safeguarded. Effective assessment is an important part of this. The safety of children is imperative and so even though denial is understandable, children still need to be safeguarded as soon as possible.

The CSA Centre’s work on effectiveness in services for children and young people who have been sexually abused identified that suitable services to non-abusing parents are essential to children’s safety and recovery. This built on earlier findings by the NSPCC  which highlighted the importance of keeping children safe and well by working with non-abusing parents. When a child is sexually abused, we must first ask ourselves what that child needs, including their needs in the context of their family.

Facilitating necessary discussion

Sexual abuse can be hard to talk about even for professionals and so the likelihood of family members being able to talk about what has happened without being supported to do so, is low. As helping professionals we have the skills to talk about difficult matters and to help others do the same.

Professionals need to facilitate discussion, and therefore healing and recovery, between non-abusing parents and family members of a child who has been sexually abused. Sexual abuse thrives in secrecy, and in not doing so we risk colluding with this silence, and miss the opportunity to repair family relationships, and to address feelings of guilt, responsibility, anger, distress, jealousy, blame and torn loyalties which so often exist when a child is abused within the family. Just think how much useful intervention we could provide by giving the opportunity, for example, to a non-abusing parent to say they feel sorry to their child for what happened to them; to tell them that they didn’t know it was happening and if they did they would have intervened; to tell their child that what has happened as a result of their disclosure is not their fault but the fault of their abuser?

In my practice experience, so many survivors have spoken about the harm the abuse caused not just to them individually, but to every relationship within their family. As such, I believe we have a duty to use our skills and roles with families to attend to this integral part of their lives.

Resources

Educating families about the signs, indicators and impact of sexual abuse is equally as vital for prevention and effective response, and there are already some excellent online resources available for them, and the professionals supporting them. 

  • Parents protect has a wealth of guidance and resources for professionals and families, including a sexual abuse learning programme
  • Stop it now support adults to play their part in prevention through providing sound information and educating members of the public. People who are worried about their own or someone else’s sexual behaviour can call their helpline too. 
  • The upstream project is a Scottish resource (though available and relevant to other areas) which offers tools and support on identifying, preventing and acting upon child sexual abuse. In terms of keeping children safe from harm on the internet.
  • In terms of keeping children safe from harm on the internet Think u know offers advice to children, young people, parents/carers and professionals.
  • Mosac provides supportive services for non-abusing parents and carers whose children have been sexually abused.

Working with non-abusing parents will be a key consideration in the CSA Centre’s future work to develop useful resources and guidance to support professionals in working with children, young people and their families, whether or not their allegations of sexual abuse are proceeding through the criminal justice route.

Blog posts give the views of the author and are not necessarily those of the Centre of Expertise on child sexual abuse.  For other blogs published by the CSA Centre see http://www.csacentre.org.uk/resources/blog/

COVID-19 – Implications for Child Sexual Abuse

By Stuart Allardyce – Director of Stop It Now! Scotland

Please note that this a re-posting of a previous blog by Stop it Now! Scotland. Kieran.

Child sexual abuse is a crime that typically happens in secret. Embarrassment, shame, lack of knowledge and understanding of what constitutes appropriate boundaries and the relationship with the abuser make it difficult for children to speak out at the time of their abuse. Abusers also often go to considerable lengths to silence their victims through grooming or threats.  As a result, only around 1 in 8 children who have experienced sexual abuse disclose their abuse at the time they are harmed.

The current health crisis means that schools are closed and children are now confined to home much of their time in many parts of the world. These are necessary measures to protect both adults and children from Coronavirus at the moment.  But for those working in child protection, we know from experience and research that home is not a safe space for many children; the majority of child abuse – including sexual abuse happens within the family home. It’s likely that for many children, the social restrictions necessary because of COVID-19 may indirectly increase risks of sexual harm. Think of the following scenarios:

  • An 8 year old girl who has been sexually assaulted by her father on several occasions. She is now isolated with her abuser and no longer has access to protective adults, or safe spaces at school, community or through extended family.
  • A 32 year old adult male now working from home and living on his own, spending large amounts of spare time accessing legal online pornography and drawn to look at more extreme material. He is interested in ‘teen’ videos on Pornhub, but is getting bored and wants to find something more ‘edgy’.
  • A 10 year old girl spending increasing amounts of time online as her parents are distracted while working from home. She feels scared and isolated and has been contacted by strangers she has met through online gaming platforms. She thinks they sound friendly and they are asking her to meet on WhatsApp so they can have private chats, share pictures and have some fun.
  • A 14 year old boy, preoccupied with lots of sexual material online, is wondering what it might be like to try out some of the things he is looking at online with his 6 year old sister. He doesn’t think he will get found out as he spends a lot of time with his sister helping her with school work in her bedroom.

I could go on – there are so many possible scenarios. Some of these situations involve online harm, and some involve offline behaviour. Some involve the interplay of online and offline worlds.

Is this speculation, or is there solid evidence of more children being at risk of abuse? It’s early days, and the secrecy and shame around sexual abuse means that it might be years before we understand the full nature of the safeguarding catastrophe we could be entering into at the moment. However, there is some evidence emerging, particularly in relation to online harm, that we need to pay attention to. At Stop It Now! Scotland for instance, in March 2020 we had upwards of 300 individuals from Scotland using our online resource every week for adults worried about their use of child sexual exploitation material. It’s a resource that can be used anonymously by adults who know they have a problem and are looking for help and resources to stop, even though they may not be known to law enforcement. These numbers are roughly 3 x what we were seeing in January 2020.

We’re also picking up on worrying activity online. Last week Europol’s executive director, Catherine de Bolle noted that they had seen ‘increased online activity by those seeking child abuse material’  A recent blog by the internet safety consultant John Carr, talked about ‘cappers’ – adults who trick children into doing something inappropriate, capturing an image of the act and then using it to exploit the victim further. The Canadian Centre for Child Protection has been following online conversations between ‘cappers’ over the last few weeks and intercepted the following:

” With potentially millions of boys around the world being or soon to be forced to stay home from school, potentially unsupervised if parents are working (teens in particular) now is the time for cappers to do their part to assist the quarantine efforts. There is a dire need for enriching, structured activities for all these boys to engage in.”

So with the evidence we have at the moment, it looks like we urgently need to double down on child sexual abuse prevention if we are to avoid a potential crisis for our children.

Some additional  prevention activity is already happening. There has been a lot of messaging on social media over recent weeks encouraging parents to speak to their children about online safety and boundaries. This is a great start and sensible advice. But this is only one part of the solution, and we need to be more strategic if we are tackle the different forms and contexts of sexual abuse comprehensively – whether now, or in the future.

In February of this year we relaunched our Eradicating Child Sexual Abuse (ECSA) website. ECSA is a knowledge exchange project, ensuring that practitioners, agencies, policy-makers and the public from around the world have access to advice, support and resources that they can use to prevent child sexual abuse from happening in the first place; or to prevent it from re-occurring if it has already happened.

At its heart is a public health methodology asking practitioners to consider what evidence they have of local need and dynamics around child sexual abuse in the communities they serve. It invites professionals to then think about what needs to be done in relation to universal messaging, targeting resources at more risky situations and responding to abuse after it happens. And you need to think about what all of that then means for victims (and potential victims), offenders (and potential offenders), families and situations or contexts.

So current evidence tells us that there are potentially increased risks of online solicitation for children at the moment. What would using the ECSA methodology tell us that we should be doing to prevent this form of abuse? You would need good general deterrence messaging so that all adults know that sexualised conversations with children are illegal and why it is illegal. You might need specific messaging and supports for people who are at risk of shifting into offending (e.g. adults who have a sexual attraction to children and / or involved with risk taking sexual behaviour online).  You would need age appropriate messaging for all children that can be reinforced by protective adults, but also additional inputs around online safety for more vulnerable children (e.g. children with autism or intellectual impairments, children who have already been sexually abused or experienced other forms of maltreatment etc). You might need additional supports and resources available for vulnerable families. Engagement with internet service providers and those who have responsibility for the online environments our children inhabit will also be key, along with continued diligence by law enforcement. And what works for this kind of abuse – online exploitation – might need adapted with respect to other kinds of harm such as risk of intrafamilial abuse or viewing of child sexual exploitation material.

All of this might feel overwhelming when there are so many other social challenges we are facing. But if you work in the child sexual abuse prevention field, we need to band together urgently to respond to current challenges.

So here are a couple of calls to action. Firstly, have a look at the ECSA website, and have a think about whether there are things there that you can use to help with your work around prevention in the current challenging environment. What might be the things that you need to do more of, or things you need to do differently? And secondly, follow us on twitter (Eradicate Child Sexual Abuse ECSA@ECSA54421403). Let’s start having some conversations about what we can do to prevent this emerging crisis for our children.   

COVID 19 is an overwhelming horror, a crisis of such a scale and nature that very few of us will have lived through anything like this in our life. However, imagine if this horror gave us as practitioners the impetus to get connected, to start to work pro-actively and quickly together so that we develop comprehensive and strategic approaches to prevent child sexual abuse. What if this disaster spurred us on to get things right and help parents make home a genuinely safe space for every child right now. It is achievable. But the responsibility to make this happen now sits with all of us who work in the prevention space. 

Framework and Principles for Assessment of Men’s Acute Violence in Relation to Covid 19.

By Ken McMaster & Mike Cagney (Hall McMaster & Associates Limited)

The world has changed rapidly within a short period of time as a result of the Covid 19 pandemic. We can anticipate that in times of uncertainty, where pre-existing issues exist within relationships such as family violence, that risk is likely to increase in the short term. This is due to several factors such as financial concerns and worries, quarantine back to a single place such as the family home, unemployment/underemployment, and general feelings of unwellness for those infected. These contextual issues can put severe pressure on relationships. This, therefore, is a time to support those at risk, in order to minimise harm to others.

We have gone back to first principles and have developed a resource that can guide conversations with those at risk.  

  • The foundations of assessing risk: Static, stable, acute and protective factors
  • Looking for signs of safety as a way of bringing information together
  • Considering robust conversations around risk and safety through this period (refer to the COVID-19 questionnaire proposing lines of inquiry to ‘open up’ conversations with clients). 

We invite you to use the tool and adapt accordingly to the populations you are working with. There will be other risk factors that exist across diverse populations including LGBTQ, where women are the main perpetrator of abuse, and in the area of male survivors of sexual and domestic violence. We invite those working with these populations to adapt these ideas accordingly. The factors outlined are developed from our own experience and therefore skewed to a male population who engage in abusive practices. 

There are some caveats to this document:

  • We put this together quickly to provide a resource for workers to support family/whanau through this unprecedented time. This ‘pocket tool’ is not designed to replicate existing risk assessment tools/instruments and should be used in conjunction with fuller assessment tools.
  • Recognising that in ‘lockdown’ conditions many workers may not have access to all assessment materials, this ‘pocket tool’ has been developed for front-line for workers in the men’s violence field to have a quick reference framework, to review caseloads and assess ‘in the field’  potentially acute-risk situations.   
  • We are also aware that situational risk factors as noted above (financial concerns and worries, quarantine back to a single place such as the family home, unemployment/underemployment, and general feelings of unwellness for those infected) are likely to put significant strain on family that don’t have a history of abusive practice. We may, therefore, see a group of people who would not normally present to our organisations.
  • We believe that everyone working on the frontline should seek supervision/consultation through this time. When faced with an imminent risk situation calling the Police should be the first point of contact.
  • Where issues specific to sexual harm, risk, and danger for children or adults occur, we advise you to consult and engage services and assessment tools specific to that field of practice.  
  • We have appreciated feedback from a range of people who took the time to raise a number of issues about the original document. We have considered this feedback and be more explicit regarding the target group whom we deem at the highest risk of abusive practice/family violence during this period. The purpose of this ‘pocket tool’ should be used as a guide to conversations that workers could have with people on their caseload already.

Static, Stable, Acute and Protective Risk Assessment

Not everyone who has used abusive practice/family harm is at risk of escalation during this period of time. In order to understand good risk assessment, we can think about four factors that intersect and change, depending on what is happening in somebody’s life. The framework below has been developed in relation to men’s risk of violence towards others. There will be unique factors that exist across diverse populations including LGBTQ and where women are the main perpetrator of abuse.

Static risk factors or what is commonly known as tombstone factors are unchangeable. These relate to historic aspects in someone’s life such as early childhood trauma, witnessing family violence as a child, early onset of abusive behaviour within relationships, nature, and severity of abusive behaviour, violence across multiple relationships, et cetera. We always say that these factors are the best predictor of future behaviour. They provide our starting point and who we should take a closer look at, given that the collective impact of these behaviours means that a person has a higher probability of being abusive in the future. It doesn’t mean they will, it does mean they may have a higher propensity.

Stable risk factors are what I might describe as the big drivers for abusive behaviour. These include attitudes and beliefs about violence as a problem-solving method, attitudes towards women, peer relationships, emotional regulation skills, relationship to addictive substances, and adult attachment issues. Effective interventions attempt to undermining and disrupt these drivers of behaviour, thereby reducing the influence of these factors.

Acute risk factors move quickly. These can be seen as subgroups of stable risk factors and include issues such as jealousy, substance misuse, escalation in disagreements, while static and stable indicators help us to predict issues of severity and frequency of behaviour, anticipating acute issues is the key to reducing the immediate risk of harm.

Protective factors act as a buffer to the static, stable and acute risk issues. These include attitudes of respect, problem-solving skills, emotional regulation, cognitive coping, distress management, and lifestyle management.

Signs of Safety (adapted from Turnell and Edwards 1999)  

Signs of Safety is a social work tool and framework to engage ‘with clients’ and encourage detail and summary of risk and protective factors. We use the Signs of Safety tool to summarise and promote thinking of the detail of static-stable- acute risk and to promote reflection focused conversation. As such, the framework essentially aids the formulation of the ‘picture’ of risk.

Signs of Safety recognises professional judgement is inherent in assessment and needs to be combined with actuarial tools used – a balance to each other, as it were. Similarly, actuarial tools without an appropriate structured ‘interview / engagement / interpretation’ can produce skewed results. The tool is not, therefore, intended to have an actuarial outcome measure but to promote a reflection-discussion of the question, ‘What is the risk picture here?’ and the judgments or ‘calls’ you make as practitioners.

Too often assessments only focus upon the ‘risks’. This framework invites the practitioner to weigh also to consider ‘what is protective’? Such questions are perhaps, never more relevant than in this lockdown circumstance and ironically staying in ‘bubbles of safety’, where clients and practitioners are dealing with risk in real-time. The COVID-19 questionnaire invites where possible, to open this inquiry with the client, and the two-scale questions on the Signs of safety form, aim to promote well-considered judgment.

If necessary, we urge engaging much fuller tools (in New Zealand, for example, the Ministry of Justice Code of Practice for Assessment). They require the ‘inherent professional judgment’ when interpreting what the ‘risk -picture’ looks like and respond to any changes in acute risk accordingly. We also strongly suggest staff seek supervision and ask the question “Is there another way I should be looking at this situation?”

The tool is intended as a framework guideline and we offer this ‘open source’ to fellow practitioners in the front-line. We wish you safety and wellness in these demanding and perplexing times.

The Framework and Principles for Assessment of Men’s Acute Violence in Relation to Covid 19 can be found here.

Reference:

Turnell, A. and Edwards, S. (1999) Signs of Safety A Solution and Safety Oriented Approach to Child Protection Casework, W.W. Norton and Company

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