Relationships, Sex and Health Education: a critical tool in prevention of Child Sexual Abuse

By Sheona Goodyear, PhD student, University of Birmingham.

My Granny became ill with cancer and died when I was eight.

I resisted being left alone with my Grandfather before her death and have been perceived as ‘difficult’ ever since. On one occasion, I screamed “f**k off!” at my Dad, in desperation to be allowed to stay behind at a friend’s house. This was not typical behaviour in my family.

I tell you this because it happened when I was young: younger than year 4.

The government has issued a new Draft Relationships Education, Relationships and Sex Education (RSE) and Health Education: Statutory guidance for governing bodies, proprietors, head teachers, principals, senior leadership teams, teachers (DfE, 2024). In addition, the government has launched a consultation which ends 11th July 2024.

The guidance states its aim is to ‘keep children safe and informed about growing up and the challenges this may present’ (DfE, 2024, p.7). It emphasises a need for appropriate teaching which should be delivered by ‘a trusted adult’ and a wish to ‘help’ and ‘support’ ‘prevention of harm and early intervention’. At the outset this nonspecific language leaves the guidance open to interpretation which is at best a concern. The inclusion of age limits for when topics deemed sensitive should be taught in schools could compound the lack of clarity or be a dangerous backwards step in practice to safeguard young children.

The Secretary of State for Education insists parents hold the main responsibility for teaching Relationships, Sex and Health Education (RSHE). In an ideal world, perhaps parents could deliver outstanding RSHE, but how many children live in an ideal world? Not all children even live with parents. And with experiences of home education fresh in parents’ minds, how many would wish to take on the complexity of the RSHE curriculum?

Another consideration would be whether parents are invested in preventing harm. While most parents undoubtedly nurture their children and promote their best interests, in some home environments this is not the case. While the guidance asserts it has been grounded in advice from an independent expert panel, it seems that evidence commissioned by the government has not been considered. In areas the guidance upholds inaccurate stereotypes, for example, that risks of sexual harm are likely to occur from strangers. The Home Office funded Centre of Expertise on Child Sexual Abuse repeatedly confirms child sexual abuse is most likely to be carried out by someone known to the child (Karsna and Kelly, 2021). Furthermore, 53% of victims and survivors of child sexual abuse who contributed testimony to the government’s Independent Inquiry into Child Sexual Abuse (IICSA) reported that the abuser was a member of their family, foster family or a residential carer (Jay, et al., 2022).

The guidance for the primary stage does direct schools to deliver relationships education to ‘equip pupils to recognise and report abuse’ (DfE, 2024, p.17). This is crucial: 79% of victims and survivors reporting to IICSA were aged 11 or younger when sexual abuse started (Jay, et al., 2022).  The Centre for Expertise on Child Sexual Abuse found 55% of victims and survivors were age 11 or younger when abuse began (Karsna and Kelly, 2021). Another consideration is the finding from DfE that more than half of children on child protection plans with significant risk of sexual harm were age 9 or younger (for the year ending 31 March 2021) (Jay, et al., 2022).

Meanwhile, IICSA and other sources agree the prevalence of child sexual abuse is impossible to determine. Only 33% of the IICSA Truth Project participants reported the abuse when it was happening. The Government’s Tackling Child Sexual Abuse Strategy (2021) states:‘it is difficult to truly understand … how many victims and survivors remain unidentified because of under-reporting, under-identification of victims and survivors by agencies, and a lack of robust survey data’(p.138).

Appropriately delivered RSHE is an important tool giving children knowledge to identify harm, whether intra or extrafamilial, and in whatever form. It provides alternative opportunity for a child to consider telling someone if they have experienced sexual abuse. This is particularly significant if adults in the family environment cannot be trusted to act when a child discloses abuse. High quality RSHE might also give a child the vocabulary to be able to tell, so the significance of what the child is experiencing comes across clearly.

IICSA reported that ‘relationships and sex education in schools did not reflect the current challenges facing children and was mostly inconsistent and inadequate’ (Jay, et al., 2022, p.127). If interpreted openly, in the spirit of reducing stigma and enabling children to talk about the challenges their relationships may involve, this guidance could secure better advice for children and young people and support development of healthy, positive relationships in their futures. However, ambiguity in the guidance leaves opportunity for it to be misinterpreted and to undermine the sensitive approaches required which were encouraged in previous documentation. In addition to this, observing rigid age limitations for sharing of information may leave children unprepared for their own development, ill-equipped to identify dangers in their worlds and as unable as I was to explain if something harmful happens to them.

References:

Department for Education (DfE) (2024) Draft Relationships Education, Relationships and Sex Education (RSE) and Health Education: Statutory guidance for governing bodies, proprietors, head teachers, principals, senior leadership teams, teachers. Available at: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1090195/Relationships_Education_RSE_and_Health_Education.pdf (Accessed: 22 May 2024).

His Majesty’s Government (HMG) (2021) Tackling child sexual abuse strategy 2021. Available at: https://assets.publishing.service.gov.uk/media/605c82328fa8f545dca2c643/Tackling_Child_Sexual_Abuse_Strategy_2021.pdf (Accessed: 22 May 2024).

Jay, A., Evans, M., Frank, I. and Sharpling, D. (2022) The report of the Independent Inquiry into Child Sexual Abuse. Available at: https://www.iicsa.org.uk/reports-recommendations/publications/inquiry/final-report.html (Accessed: 22 May 2024).

Karsna, K. and Kelly, L. (2021) The scale and nature of child sexual abuse: Review of evidence. 2nd edn. Available at: https://www.csacentre.org.uk/documents/scale-nature-review-evidence-0621/ (Accessed: 22 May 2024).

Relationships, Sex and Health Education policy for schools will inhibit preventative and early intervention work for child sexual abuse and harmful sexual behaviour.

 By Sophie King-Hill, Ph.D., & Kieran McCartan, Ph.D.

Today the government released their updated Relationships, Sex and Health Education policy for schools for England. The policy states that it aims to ensure that sex and relationship education is age appropriate and fit for purpose; however, upon scrutiny, it is evident that this is far from the case and the new proposals are embedded within dangerous and discriminatory ideology rather than robust research. These new proposals will impact adversely upon the early intervention and prevention of child sexual abuse (CSA), child sexual exploitation and harmful sexual behaviour (HSB) in children and young people. This new draft guidance is contextualised within an election year and much of this appears politically motivated (The Guardian).

The new policy guidelines outline restrictions that include online gaming and social media not being taught before age 7-8, puberty not being taught before age 8-9, sex education not being taught before age 9-10, sexual harassment not being taught before age 11-12, direct references to suicide before age 12-13 and bans any explicit discussion of sexual activity before age 14-15. The logic for this is not based in evidence but appears to be grounded in the concerns of conversative MP’s and their voters (see press release for more context). Interestingly head teachers, educators and related charities do not share the same view, instead asking for a more considered and nuanced approach (BBC newsBrook’s response). The guidance seems to be ideologically informed as it is not evidence based.

When considering the prevention and early intervention of CSA and HSB the real juxtaposition is how the policy seems to be at odds with the current public health and criminal justice joint approach highlighted in the recent, child sexual abuse strategy (2021) developed by the same government. The strategy states that.

‘Children are given the best start in life, including access to information and education around healthy and abusive behaviours.’

In the strategy the government talks about upskilling professionals who work with children’s parents/carers and young people about the reality of sexual abuse, how to notice it, prevent it, and respond to it.  The new draft guidance also appears to be in conflict with the United Nations Convention on the Rights of the Child  articles which highlight the rights of those under the age of 18 to education, information and support that will keep them safe (see specifically Articles 3, 13,  17 and 28). Access to good RSHE is the right of the child and young person as it can allow then to make informed choices as they grow and protect them from CSA and HSB.

Some of the central conflicting aspects of the guidance being taught too late when considered in the context of CSA and HSB prevalence and ages. They include not teaching what constitutes harmful sexual behaviour, that making and sending indecent images is a crime, the laws around sexual exploitation, abuse and grooming and the risks of inappropriate images before ages 11-12. This is further contextualised by the draft guidance stating that details of sexual acts and the concept and laws relating to sexual violence, including rape and sexual assault, and not teaching the details of violent abuse before ages 14-15.

However, if most sex and relationship education is not being taught until ages 11-12 then a direct conflict with how younger children are protected from CSA arises. CSA prevention research and practice shows that primary (broad based social education on CSA and HSB, including but not limited to school, organisational, and intuitional) helps upskill individuals and communities, and that secondary prevention (working with at risk communities, both the individuals with the potential to sexually harmed and those at risk of being harmed) can reduced  problematic and harmful sexual behaviour in children and adults (Di Gioia, Beslay, Cassar, & Pawula, 2023). Reducing first time, as well as repeat, sexual abuse and providing safe spaces where CSA can be disclosed leading to early intervention is often embedded within education. One example of this being Together for Childhood (TFC) spearheaded by the NSPCC and partners, which takes a community-based approach to the prevention of CSA. The TFC approach involves school and community education about the reality of sexual abuse in childhood, the warning signs and how to respond, which is in line with the CSA prevention strategy conflict with the recommended RSHE guidelines published today. Additionally, the guidance also seems to contradict the work of the Centre for Expertise in Child Sexual Abuse, Children’s commissioner for England, and the Independent Inquiry into Child Sexual Abuse, all of which talk about making the conditions where sexual abuse can happen tougher for potential offenders by upskilling, informing, and equipping communities with the skills to identity and report sexual abuse, this includes education. The risks of online grooming from a young age are clearly outlined by the current guidelines reinforce silence and victim shaming, they reinforce the idea that sexual abuse is not talked about and implies that it is taboo, shameful and problematic, which can create the conditions that make CSA and HSB more likely and sustained.

The need to have age-appropriate conversations about sex and relationship education is not up for debate, but the answer is thinking about and developing resources that allow school, and related organisations to do this. It is important to consider how conversations are framed about relationships and sex, online and offline, talk about attitudes to women and children, as well as consider the impact of problematic and abusive behaviour. These are complex questions and need thoughtful and considered answers, not blanket bans. A more realistic conversation that needs to be had that is inclusive of all parties, including CYP which are missing form this debate (see King-Hill, 2024, for the views of CYP on current RSHE).

Child sexual abuse, including harmful and problematic sexual behaviour carried out by CYP, are social and community issues. This needs to be embedded holistically across the socio-ecological model and maker school a lynchpin and safe space to have these conversations, because as we know from research and practice that for many CYP home, and family life, are often the places where sexual harm can occur. The new draft guidance, in the context of CSA and HSB, is dangerous and risks resulting in long term adverse outcomes for children and young people.

NOTA 2024 Annual Conference review

By Kieran McCartan, PhD., & Dulcie Faure-Walker, Ph.D.

The annual NOTA international conference took place in Birmingham, England, last week.  Despite it being NOTA’s 24th annual conference it was the first time that it had been held in the UKs second-largest city. There were over 280 attendees, across three days, with six keynotes and 36 parallel breakout sessions. For this blog post, we talk through the highlights of a successful, engaging, and thought-provoking conference.

The conference kicked off on Wednesday morning with a keynote from Marcella Leonard  where she talked about the role of child protection and safeguarding in sport. Marcella has worked with several sports organizations and governing bodies over the years and really highlighted the need for organizations to do more to protect children, but especially boys in sport. The presentation highlighted the importance of protecting children and young people’s mental health as well as their physical health, and that there needs to be more accountability in professional practice nationally as well as internationally. Marcella’s presentation was followed by one from Nina Vaaranen-Valkonen from Suojellaan Lapsain, Protect Children who discussed the data and outcomes of their recent anonymous multilingual surveys on the dark web with CSAM users. The survey reached and engaged with over 35,000 individual participants across 21 different languages, and is the first to give a more in-depth, global view of CSAM use and how it factors into an array of sexually abusive behaviors, online and offline. The data highlights that CSAM users have been exposed to CSAM material at a young age, often when they were children themselves, that it’s a gendered activity (i.e., men looking at images of young girls), that they are a higher risk of contacting a child, and that there has been an increase in livestreamed CSAM material. Nina’s research is based on the largest population sample of CSAM viewers, offering us real insights to this group and their activities to better frame prevention and well as treatment.

On Thursday the conference started with Anna Glinski from the Centre of Expertise in Child Sexual Abuse discussing their research on the prevalence and lived reality of child sexual abuse. It is important to note that this was the center for expertise’s first time delivering a keynote at NOTA, and I dare say it won’t be their last. Anna discussed the under reported and under recorded nature of CSA, that professionals needed to be support better through training and supervision to do challenging work, as well as that need to work together in a multi-disciplinary, trauma informed way to prevent and respond to CSA. Like in the previous day the conversation of the under reported nature of sexual abuse victimization of boys was raised and stated that we needed to do more to support boys in reporting, as well as recovering from sexual abuse. Anna’s talk was followed by a split keynote on females who sexually abuse by Anna Motz and Kate Fraser, which was a much welcome to return to conference for an issue we have nor discussed for several years. The keynote was a perfect balance of research, clinical practice, and frontline engagement. Anna as a researcher and clinician discussed the reality of females who sexual offend and what this means in terms of sexual interest, motivation, offending and rehabilitation; whereas Kate talked about the challenges that females face in the prison system and how this impacts their time inside and, ultimately, if it helps of hinders their rehabilitation. This was a welcome keynote to an often-overlooked population in the treatment of people who sexually offend.

The final day of the conference started with Professor Alexis Jay who discussed the main processes, findings, and outcomes of the Independent Inquiry into Child Sexual Abuse. Alexa highlighted the need for them to be a real social and political legacy to the enquiry and that it needed to make a significant contribution to making children’s lives better. Although the research of the inquiry came out at a challenging time for the government, Liz Truss resigned as Prime Minister on the same day, Alexis assured the audience that the conversation was not finished and that there were still ongoing conversations about what to implement and how best to do it. This led to the final keynote of the conference by Professor Aisha Gill on her recent research on policing race and gender. Aisha gave an engaging and thought-provoking talk on the relevance of understanding intersectionality, but especially race and gender, in policing sexual abuse and the need to really tailor practice, and understandings, to the communities that you are working in. Aisha highlighted the challenges, and opportunities, to keep in mind while engaging with diverse communities and how the state needs to change its approach to being more nuanced and trauma informed.

Across the Wednesday and Thursday afternoon we had 36 breakout sessions covering topics as broad as research and treatment on sibling sexual abuse, harmful sexual behavior in young people, risk assessment, sexual abuse prevention, masculinity and sex education, treatment, desistence, and updates from HMPPS on current policy as well as practice. In addition, we also had a number of lunchtime fringe events, including one on the future development of NOTA Northern Ireland branches, a discussion of a Child Sexual Abuse prevention framework for England and Wales lead by NSPCC and Barnardo’s, as well as a session jointly lead by the NOTA research and student committees on developing and conducting a PhD.

This year the conference had a special online edition of the Journal of Sexual Aggression curated by Dr. Nadine McKillop; readers are invited to go to the journal website and twitter account for more information.

In closing, the conference was a great success. It was a great opportunity to reconnect and reengage with colleagues as well as learn about innovative research, policy, and practice. The next NOTA conference will be in Belfast in Early May 2025, we hope to see you there!

Sibling Sexual Behaviour and Abuse: UK-Canada knowledge exchange trip.

By David Russell, PG Cert, Sophie King-Hill, Ph.D., & Kieran McCartan, Ph.D.

Before we begin it is important to set out the language we are using in this piece as it has been part of an important discussion of late. In our work over the past four years focussing on this issue we have seen many instances and examples of the behaviour between siblings being clearly sexual abuse and sexually abusive. However, there are also key examples where this is not the case and that the issues present as sexually inappropriate and/or sexually problematic. This is an important distinction, and with this in mind, for this blog, we will use ‘sibling sexual behaviour and abuse’ (SSB/A). We would also like to acknowledge that terminology in this space always evolves and that SSB/A is not a static term and is likely to change as we begin to understand more about this issue.

#SiblingsToo day is held in April each year and hosted by Nancy Morris, based in Ottawa, Canada. Nancy first developed and introduced the #SiblingsToo awareness day in 2023. This day brings together a range of lived experience and professional voices within the complex theme of SSB/A. A survivor of SSB/A, Nancy hosts a range of discussions via podcasts and videos tackling themes such as the impact, prevention and societal responsibility within the context of SSB/A.  

This year David Russell (Thriving Survivors, UK), Professor Kieran McCartan (University of West of England, UK) and Dr Sophie King-Hill (university of Birmingham, UK) marked #SiblingsToo day by embarking on a trip to Canada to share international approaches in responding to SSB/A, sharing research, learning and practice considerations.  The trip started in Ottawa at Nancy’s famous office, reflecting on the #SiblingsToo data collection and testimonial portal where hundreds of survivors have currently placed their experiences of SSB/A from all over the world.  An incredibly powerful experience, the portal highlighted the international need for bespoke supports for survivors impacted by SSB/A and the need for international co-ordination and coalition.  This supported the four of us to use the time together and record a podcast discussion called ‘in five years’. This podcast explores our professional and lived experiences to consider what needs to happen in the next five years to address the SSB/A. 

We made the most of our five days in Canada and met with a range of professionals and groups.  This included a thought-provoking meeting with volunteers at Circles of Support and Accountability (CoSA) held in Ottawa. CoSA in Ottawa works to help integrate men convicted of a sexual offence (Core Members), mainly against children, back into the community post release. Throughout the course of the conversation we learned that in addition to the traditional child sexual abuse interventions that CoSA run they also had some which were based on cases of SSB/A, which was interesting to hear especially given some of the restorative, integrative and desistence challenges these posed. This discussion highlighted some interesting themes for us all which influenced our next discussion with Dr Christine Gervais, an Associate Professor from the University of Montreal who has spent many of her academic years focusing on the rights of the child.  We then had a productive meeting with academics from The Police and Public safety Institute at Algonquin College in Ottawa, where we looked at cross over in our work and practice and potential collaborative projects.

Academically and professionally we are collectively passionate about the role of health and child protection has within SSB/A. We were particularly keen to see how frontline health and child protection teams respond and intervene with families affected by SSA/B.  To explore this further we met with child protection professionals at Childrens Hospital of Eastern Ontario (CHEO). The team here work with a range of children and young people including but not exclusive to those impacted by child sexual abuse (CSA) and those that display harmful sexual behaviour (HSB), specifically during immediate crisis.  This conversation allowed us to share learning and explore gaps within health provisions both within Canada and the UK.  Keeping with the health theme, we were interested to unpack this further and specifically understand what the current mental health service provision was in Ottawa and its role within supporting children and young people affected by SSB/A, HSB and CSA.  This established a meeting with Heidi Nichilo and her team at the Youth Services Bureau, Ottawa.  A passionate and proactive group of professionals, we were truly refreshed to hear about the fantastic work they do.  We discussed the prevalence of SSB/A within health services and explored potential ways to ensure children, young people and families have safe routes to access to supports and disclosure pathways in relation to SSA/B. 

Our final day of the trip was in the beautiful Montreal, requiring a 4:30am wake up for a train ride from Ottawa to meet Anaïs Cadieux Van Vliet, a PhD student exploring the role of siblings that have not harmed, or been harmed in a family experiencing SSB/A. An area in much need of exploration.  A quick breakfast and discussion with Anaïs and we were on route to the University of Montreal to deliver our panel input on ‘International approaches in responding to SSA/B: Research & Practice’ at the Centre International de Criminologie Comparée (CICC).  This panel input included a fascinating Q&A session and discussion, providing a safe place for an in-depth discussion.  We felt incredibly privileged to share a space with academics, students and those with lived experience, our sincere thanks to the team at the University for facilitating this and for their hospitality.

The learning from this trip has been significant and the opportunity to meet with so many passionate people working in this field has gained us further connections which we hope will support our mission in tackling SSB/A on an international level. 

This trip could not have been possible without the huge support of Nancy Morris, we are incredibly grateful to Nancy and her husband Jim for their fantastic hospitality and eclipse hunting expertise.  

For more information or support around sibling sexual behaviour/abuse please see the Thriving Survivors websitehttps://www.thrivingsurvivors.co.uk/

To register for the Thriving Survivors 2024 conference addressing sibling sexual behaviour/abuse please see: https://www.thrivingsurvivors.co.uk/event-details/ts-annual-conference-2024

Reflections on the recent NOTA & Lucy Faithfull Foundation sexual abuse prevention conference.

By Megan Hinton, Victim and Survivor Advocate, Marie Collins Foundation.

I recently joined the Marie Collins Foundation (MCF) as a Victim and Survivor Advocate. My role involves working alongside those with lived experience of technology-assisted child sexual abuse, to champion and amplify their voice and embed it into policy, practice, and academia.

As a survivor myself part of my position includes speaking about my lived experience at conferences and events. So, when the Lucy Faithfull Foundation reached out to ask if I wanted to give the opening address at the Preventing Child Sexual Abuse Conference organised jointly with NOTA, I felt honoured.

Prior to the conference I had little to no knowledge about prevention methods and believed most prevention work was done through PHSE lessons in schools and charity led awareness campaigns. Joining the conference, I felt intrigued to learn in order to identify any cross over that may help with my role. But I also felt apprehensive about attending as I knew the conference would heavily focus on perpetrators, rather than the voice of survivors.

During my presentation I spoke about the importance of prevention from a survivor’s perspective, referencing my own experience and embedding key messages from MCF’s Lived Experience Group. During my address I quoted one of our Lived Experience Group Members who said, “survivors get a lifelong sentence”. I also emphasised that whilst child sexual abuse can take place over many years it can also happen in as little as a few hours and yet the impact is the same, it fundamentally changes who you are as a person. My hope was for my address to encourage attendees to anchor their thoughts on the children, victims and survivors they work to protect. I wanted attendees to challenge their thinking and reflect on how they could apply learning from the conference to their work and day-to-day life.

My apprehensions about the content of the conference quickly dissipated as I listened to the presentations that followed my own. It was heartening to see each speaker cover a point I had made during my address, which ensured the voice of survivors was visible throughout the day. Some key points which I was particularly happy to see focused on included challenging stereotypes of victims and offenders and highlighting that schools cannot be the only place where conversations about child sexual abuse take place. MCF’s Lived Experience Group told us they want to ‘blow the lid off’ child sexual abuse and the silence that surrounds it. Victims and survivors regularly tell MCF that sexual abuse is still rarely spoken about and that makes it difficult for children to identify abuse or find the words to explain what is happening to them. So it was encouraging to hear practitioners with similar views who were committed to raising awareness and involving wider society in conversations about child sexual abuse.

The impact of child sexual abuse can be profound and devastating and that impact does not stop with the victim or survivor, it can ripple through ‘secondary victims’ such as family, friends and the communities that surround the child. So, it was excellent to see each presentation looking at prevention through a multi-agency public health lens. The presentations were informative and easy to digest and covered a range of different aspects to prevention. I particularly enjoyed learning about the three levels of prevention – primary, secondary and tertiary – and how these would fit into a public health model. I also appreciated the level of detail given so that I could begin to understand the thinking and evidence base which supports compassionate and restorative intervention work.

The conference really challenged my own way of thinking in a positive way. One personal learning point was the realisation that tertiary prevention work is not about justification, excuses or minimising the harm caused to victims, it’s about preventing reoffending and protecting children. I found it encouraging to hear about the success rates of these types of interventions.

The conference definitely inspired people to learn and improve but also celebrated how far prevention work has come in such a short space of time. Seeing people so passionate about their work, recognising the challenges that they face and striving to improve their services gave the conference a real undertone of hope.

As a survivor myself, the concept of prevention rarely crossed my mind. I could lose years of my life thinking about ways my abuse could have been prevented but wasn’t. As many other victims and survivors will know, we often feel blame and accountability for our abuse, and it can make it seem as though it was inevitable. But this conference allowed me to consider how prevention strategies and services work, how they can improve and enabled me to reflect on how we can better evaluate outcomes.

Leaving the conference, I felt passionate about the messaging in primary prevention, and how difficult it is to assess and measure outcomes for this type of intervention. In early prevention work we often see too much responsibility placed on children to ‘keep themselves safe’ particularly online. Through MCF’s direct work with children and their families affected by technology-assisted child sexual abuse, we know this e-safety messaging can silence victims from disclosing as they expect blame and shame. Instead, we must focus on creating an environment where children and young people and adults feel empowered to talk about these issues without threat or fear of victim-blaming.

In addition, we see widespread societal blame on parents, who often do all they can to safeguard their children. I believe actively engaging and listening to those with lived experience, including parents whose children have lived experience, could offer an insight into what primary prevention messages do and don’t work, and more importantly why. The incredible group of brave victims and survivors in MCF’s Lived Experience Group are testament that consultation with lived experience can, and does positively improve services, practice and policy. What we learn through our direct work can feed into prevention work, and MCF values partnership working. We know partnerships and collaboration improves outcomes for children, victims, and survivors and this conference has further cemented the long-standing working relationship with LFF, NOTA and MCF. I am excited to see how we work in partnership in the future. 

Ethical considerations of the financial cost of resources on harmful sexual behaviour services

Dr Sophie King-Hill, University of Birmingham

In many harmful sexual behaviour (HSB) services for children and young people (CYP) how resources are funded, developed, and delivered is coming under increasing scrutiny as frontline and third sectors organisations are having budgets cut and services reduced. Given this context, is it ever ethical to charge for these resources?

Preventing and responding to (HSB) in children and young people forms a significant proportion of the work social services, the third sector and social justice organisations carry out. Due to this there are many tools, assessments and interventions (referred to as resources) that have been developed that make a tangible and positive difference to the lives of CYP and their families. This, and the other points made in this article, also hold true for the adult criminal justice field, but it is beyond the scope of the authors expertise to discuss these in-depth and the focus will be on HSB services for CYP.

When considering HSB the moral philosophy appears to be underpinned by the reduction and prevention of sexual abuse and harm and the promotion of well-being and recovery. So the reduction of harm and the maximising of benefits. Ethics are often highlighted in practice in terms of work carried out with CYP and their families and of the practice that is delivered, and the research that is conducted. Yet these ethical considerations are sparse when considering products that are commissioned and used.

At face value the ethical principles of HSB work may appear clear-cut (i.e., work in a trauma informed way, do no harm, protect the patient/service user). However, after scrutiny, the lines seem blurred. This field is inhabited by professionals from a range of specialisms and fields (i.e., sociology, psychology, criminology, social work, police, probation, prisons, social care); therefore, HSB services are a multi-disciplinary, multi-agency area that exist at a crossroads between practices, policies, and processes. This means that the ethical considerations are somewhat complex as no core set values and principles exist as they do in medicine, law or criminal justice for instance. In social work for example, there is an explicit commitment to human dignity and worth. In medicine there is a framework that is built around doing good and no harm, free choice, justice and fairness. These are ethical principles in which professions are bound – being built around trust and held to account by bodies such as the General Medical Council.

Whilst a multi-agency approach is clearly needed for HSB, a by-product of this way of working is that no steadfast and explicit ethical principles exist due to the range of specialisms involved. This lack of a sense of measure, accountability and consistent public pledge has perhaps created an environment where profitable endeavours have gained traction and power without the rigour of adequate ethical questioning. Given that preventing and responding to HSB is both social justice and social care work, and given the rise of health approaches and thinking in the HSB field there is a strong argument that work, including tools and interventions, needs to be framed by social not private enterprises.  Therefore, profitability, in its purest form does not seem to align when considering the field of HSB and the underpinning principles of minimising harm and suffering and supporting recovery.

The impact of the financial costs of resources on practice and provision in harmful sexual behaviour services

Consideration needs to be given to the impact of the financial costs  of resources. If the costs of resources is not equitable and is the same for all, in HSB services it risks failing CYP and their families for a number of reasons, for example:

  • If some professionals can access the resource and others can’t then this can result in miscommunication and misunderstanding between the differing agencies. Research tells us that multi-agency work is a crucial aspect of positive HSB outcomes, so this has the potential to cause conflict in this space.
  • If, because of the cost, only a few professionals in one agency can access certain resources then this may also risk the dilution and misuse of what has been paid for. This points to a flawed and unsustainable model – and may also indicate that in social welfare contexts a model based purely on profits may make the overall issues worse, not better.
  • Training costs will always have to be ongoing if there is a commitment to a certain resource, which again may be unsustainable for agencies with small budgets. High staff turn-over may result in resources not being used adequately as the trained experts will have left. Additionally, when the case loads of those who are trained are full, what then happens to CYP who need support.
  • The exclusion of CYP and families from accessing services if professionals aren’t trained or have knowledge is also inadvertently causing them harm. This runs the risk of a two tier model – even in the same service with some CYP and their families getting good support and others not. When something exists that can make a tangible positive difference to the lives of CYP and their families in an area as damaging as HSB, with no equitable approach, can be measured against ethical principles as inherently morally wrong.
  • The financial cost of resources can, inadvertently, create a postcode lottery of service delivery and interventions. For example, services in poorer socio-economic areas may not have the resources to pay for resources and therefore CYP and their families maybe excluded from accessing services.

Additionally, consideration needs to be given as to how resources are commissioned and adopted by services and how this is supported by them as well as by government and local authority budgets and spending. If resources are shown to be working and making a measurable difference to the lives of CYP, and their families, then large-scale funding and commissioning should be considered. This may negate the issues with the profiting from damaging social welfare issues that have gained traction.

What can be done?

It is important to consider the role, impact, and purpose of charging for resources on the HSB sector has. If the purpose is to positively support CYP who have sexually harmed or been harmed in an evidence-based way to reduce harm, then of course the materials used need to be based on research as well as expertise. The reality is that costs need to be covered, this is not unrealistic. And to protect their fidelity through this should always be considered. However, questions need to be asked in terms of the level of profitability over social good and where this is ethically situated.  A pure profitability perspective still appears ethically flawed in this field and considerations of revenue sacrifice, when bearing in mind the positive impact on people’s lives, should be made. Perhaps a case could be made for a ‘robin hood’ model of working when charging for services in this arena. In its simplest form this means charging those that can afford it more and providing subsidies, resources and free services, to those who can’t. This model emerged in the 1970s as can be seen in the work on cataracts by the Aravind Eye Care Hospital in India at this time. Other businesses have followed suit such as Warby Parker (buy one, give one for glasses) and Cotopaxi (donating money for social good from profits) and is underpinned by increasing social responsibilities of profit-making businesses. With the right policy transfer frameworks in place this application of values and approach can work in the field of resources and interventions that are being charged for in the field of HSB.

Work in field of prevention of and response to HSB is a moral and ethical issue, it is carried out by professionals who, in the main, deeply care and are motivated to help the people they work with, and therefore should be given access to the best resources available, regardless of cost. This is even more relevant in working with children and young people in this space. Therefore, should businesses that trade in this arena be held to account and be bound to shared ethical principles, standards, and safeguards. These principles could be set out in a charter mark for example, that has a clear ethical criterion when making profit in this field that is underpinned by the aim of maximising benefits and minimising harm to CYP and their families.  The aim should be geared around considering where they can make profitable sacrifices to maximise benefits and reduce harm – being held to account when this is not evidenced, via an ethical framework. It can be argued that in this field that the outcomes for CYP and their families should be paramount and a recognition first and foremost for the lives of the people who can benefit from services should be at the forefront of any business considerations. That public benefit, as outlined by the Charity Commission, is a key component of work in this area, especially in frontline services (i.e., social work, policing, child protection) that are publicly funded. The landscape, when explored through the lens of ethics, provides a concerning picture of an environment where the lack of consistent ethical principles means there is no bar to measure against. Therefore, when considering maximising benefits and minimising harm, in the field of HSB this lack of accountability runs the risk of becoming incredibly dangerous.

‘Tis the season of restoration.

 By Kieran McCartan, PhD

Our friends in America celebrate Thanksgiving this week, a sometimes fraught and challenging holiday.  Families and friends come together to celebrate reunion, restoration, and a rekindling of relationships. It sounds easy, but it’s not! It can be difficult and sometimes irreconcilable. Establishing and re-establishing a sense of family or community is not always easy.

Interestingly, this week is also Restorative Justice week. Across Europe, it’s a time to discuss restorative practice in the criminal justice system. Like Thanksgiving in the US, restorative practice is also challenging and complex. It can also help people resolve issues, rebuild lives, and move forward from the trauma they experienced or caused. Restorative practices are common across social justice; we have seen them used in personal, community, and social conflict cases. My first exposure to restorative practice was long before studying criminal justice; it was in my native Northern Ireland, where the process was encouraged as a community-building device in the peace talks and the creation of the Good Friday agreement. However, there is one area where restorative practice is not always accepted, where it’s seen as challenging, difficult, and, at times, a risk: Sexual abuse!

Last week, Thursday and Friday, I chaired two separate and quite distinct events for the Thriving Survivors organization. One was an event hosted by the Lord Provost of Glasgow, where members of the organization discussed their work and highlighted their good practices. The second event was a traditional conference focusing on restorative justice and sexual abuse, calling for the need to have systematic change in the way that restorative justice is responded to. The events focused on the need for a coherent restorative practice to offer to victims of sexual abuse, one that’s victim-led, holistic, strengths-based, and sustainable. The conference illustrated how those who are victimized by sexual abuse should have access to and engagement with the services that they want, not just the services that the state and third parties want to offer them (or, even worse, feel that they should have). The conference showed that sexual abuse is a complex and multifaceted issue that cannot be separated from real life, especially when the abuse is committed by and connected to family systems, friend groups, and peer networks. Sexual abuse needs to be confronted, and people who are victimized seek help as well as support in whatever form they feel comfortable. The speakers (including Dr Marie KeenanDr Estelle Zinsstag; and David Russell) and organisations (Stop it now ScotlandThe Consent CollectiveRestorative Justice CouncilAll party working group on restorative justice) reiterated the importance of personal choice, support, collaboration, and taking a victim-centred approach. This was brought together by a keynote from Professor Judith Herman, who talked about her new book emphasizing the importance of the voices of those victimized in the healing process. That system-wide change is needed to make the criminal justice system less traumatizing for victims. One way of doing that is through thoughtful, well-planned restorative practice.

The two days reinforced the importance of personal choice and careful, detailed, trauma-informed, and strengths-based services. If done well, restorative practice can support victims in moving forward and finding closure or acceptance. Restorative practice needs to be victim-led, flexible, and accessible to all. The system needs to change to hear the voices of those harmed. In this season of restoration, please ask yourself what everyone needs to come together and talk about and the best way to do this.

Discovering what was already there: The (re)emergence of Sibling Sexual Abuse

By Kieran McCartan, PhD, David Prescott, LICSW, and Kasia Uzieblo, PhD

It’s interesting to consider the ebb and flow of academic and professional interest. We have seen on the blog over the years different topics come and go, some having periods of significance and periods of dominance. We have seen prevention become established, while risk assessment developments roll along in the background and the polygraph remains controversial, sometimes even divisive.

One topic that seems to have emerged strong and is now dominating the conversation, especially in the UK and parts of Europe, that no one really saw coming is sibling sexual abuse (SSA). This month, the Journal of Sexual Aggression had a special issue dedicated to it, as well as the journal of Child Abuse & Neglect; so why the sudden increase in research (and in some areas, practice like the development of a new mapping tool for assessment and treatment planning) interest when SSA is not a new phenomenon?

Controversies about incest and psychology have been with us since Freud. In the US, sexual abuse within families and among siblings became a focus of mental health interventions in the 1980s. At the time, authors such as Chloe Madanes used techniques for family-based interventions that appear harsh and misguided by today’s standards. Her contemporary, Jan Hindman, wrote at length about clarification of abuse and demonstrated how treating those who abuse can assist the healing of those abused. Within the field of treating adolescents who sexually abused, authors such as Jerry Thomas and Joann Schladale emerged in the 1990s and 2000s and addressed SSA through a family-therapy lens. Much has been written outside of scholarly research about the experience of surviving SSA; much less about those who commit the abuse. And fewer still have conducted scientific inquiry into SSA until now.

While the above practice developments took place in the US, there has been a growing conversation amongst professionals about SSA over the past five years in the UK and Europe. This has often emerged from the study of harmful sexual behavior in childhood, with research by the Centre for Expertise on Child Sexual Abuse developing a range of policy, practice, and research papers that indicate that it’s the most common form of intrafamilial violence.

These papers have started to change conversations and perspectives, particularly away from the typical perspective of father (or male caregiver)-daughter incest being the most prevalent form. This changing conversation has led to scoping studies and emerging research conversations across the UK that have indicated a professional and practice interest in the area. A main driver has been the emergence of SSA as a bespoke form of abuse that is not the same as child sexual abuse, peer-on-peer abuse, or other sexual exploitation. SSA involves a combination of different forms of abuse, neglect, and exploitation (sometimes across multiple contexts), which makes it complicated and nuanced not only for professionals and policy makers, but also for the children being harmed, the children harming, their family, and peers.

The complexity of SSA means that those who are victimized do not always feel seen in the system. They may not recognize themselves in service provision, nor in prevention campaigns against sexual violence, which means that they do not necessarily seek help or support. In many cases, they may not realize that they have been abused. The implications of this are that the true prevalence of SSA is unrecognized and underrepresented in children and adults services; this is a problem because if we truly want to prevent and respond to all forms of sexual abuse we need to recognize and see all forms. This means that professionals need to rethink, reconceptualize and redevelop some of their existing practice in this area.

It is important to state that in the flurry of research and practice activities related to SSA (full disclosure: Kieran and Kasia are researching and publishing in this area while David has produced book chapters and trainings in this area), we must balance the old with the new. It is essential to recognize that we need to look at the full picture and consider existing research and practice from other areas and what role they can play in professional discourse, rather than simply creating new information.

SSA sits at the crossroads of Psychology, Sociology, Social Work, and Children’s Studies. We therefore have to consider what these disciplines say about trauma, family dynamics, abuse, violence, and their interactions with each other. The CSA Centre and special edition of the JSA have done this well. It will be wise to acknowledge and recognize what we know before we adapt and develop it for a new perspective or audience. Additionally, it’s important to look towards other trends and norms that are feeding into the establishment of this emerging topic (particularly in light of what we are seeing with the lingering impact of COVID, lockdowns, the presence of trauma and adversity, and the growing influence of pornography on young people). Regarding this last point, with respect to pornography, practitioners are reporting a rise in brother-sister/stepsibling content on relevant sites.  Each of these considerations speaks to how we need a broader social and community recognition of SSA and that conversations around prevention need to happen in homes, schools, and communities.

While we recognize and welcome the increased conversation about SSA in the professional, policy and research arena, we think that it’s important to state that this is not a new phenomenon. Rather, it is a shift in focus regarding a long-existing concern, and a need to address a real issue in the lives of individuals and families. Sadly, this problem receives scant attention in the media and that it is not a topic regularly discussed in clinical practices outside our field. It thus remains taboo. Nevertheless, we hope that with increased scientific attention to this topic, interest from the community, counseling, policy etc. will also significantly increase. Because there are still so many questions that remain unanswered, such as, what interventions are adequate with this group? What prevention measures can make a real impact? How can we also better support adult victims of SSA? To answer these, we need input, insights, and expertise from all services providers and users. Let’s not wait until a serious case appears in the media before we really start investing time, money, and efforts to prevent sibling sexual abuse.

A review of the International Association for the Treatment of Sexual Offenders (IATSO) conference 2023.

By Kieran McCartan, PhD, Kasia Uzieblo, PhD, and David S. Prescott, LICSW.

Apparently, it’s never too late to try new things! Or so they say. At least in Kieran’s and Kasia’s case, this is true. For the first time, they both attended the IATSO annual conference. David is an older hand at this and was a keynote speaker. Last week saw the 17th bi-annual IATSO conference, which took place in Trondheim, Norway. IATSO has been affiliated with ATSA for many years, and their conference is one of the big 5 conferences that focus on the prevention, rehabilitation, and integration back into the community of people convicted of sexual crimes (with the other four being NOTA, ATSA, NL-ATSA, and ANZATSA). Despite the common focus concerning sexual violence, we experience time and time again that each conference has its own accents, brings different insights, and other opportunities to get acquainted with colleagues as not every expert can attend the big 5. The entire experience made us more enthusiastic about attending ATSA in a few weeks.

This year the IATSO conference had well over 100 papers across 3 days of keynotes, pre-conference workshops, and parallel sessions with over 400 attendees from no less than 20 countries, including Greenland. The range of choice in the parallel sessions was rich. It included talks on – among others – desistance, risk management, trauma-informed practice, compassion in treatment, staff development, risk assessment, and public and professional perceptions. The conference focused on all forms of sexual abuse (including child abuse, rape, multiple preparator abuse, online sexual abuse, sibling sexual abuse, and incels) relating to an array of characteristics (incl. gender, race, learning difficulties, neurodiversity, and age); there was a topic or area for all researchers and/or academics. The sessions also had various angles: some speakers shared their most recent research results, while others delved deeper into specific practices and cases. This way, the participants were offered a diverse mix of science and practice.

There was a wide range of engaging pre-conference workshops. Several workshops were provided by well-known ATSA, NOTA and ANZATSA speakers such as Liam Marshall, Jayson Ware, Carol Carson, Mark Olver, Jennifer Allotey, Keira Stockdale, David Prescott, Brian Judd, and Maaike Helmus. But local experts (i.e., Svein Øverland) from Norway were also given a platform. This approach was the common thread throughout the conference: local professionals and academics were given ample opportunities to share their clinical experiences and scientific insights with the public. This way, the participants not only got acquainted with the rich Norwegian culture, food, music, and nature before, during and/or after the conference, but they also gained insights into local practices and experiences regarding efforts to end sexual violence.

The keynotes also presented a mix of national and international speakers, with a strong focus on Norwegian policy and practice over the years from Knut Hemstad, who started the conference, Oddfrid Skope Tennfjord, talking about working with young people who have committed harmful sexual behaviour and presenting the tool they developed to facilitate sexual education in schools. Anja Kruse (ending the conference) talking about the role of trauma and harm, partly caused by how society and justice treated them, in the lives of men who have sexually offended. The other 4 keynotes where a mix of Canada, USA and UK speakers with Liam Marshall talking about effective treatment practices, Keira Stockdale talking about Offence Analogue and offence replacement behaviours, Mark Olver talking about the role and relevance of protective factors in risk assessment and risk management, Simon Hackett talking about harmful sexual behaviour in young people, and David Prescott talking about reflective professional development and treatment effectiveness. Although at first glance the 7 keynotes seem quite dispirit, in fact they were not, they all talked off compassion, service user engagement, desistence, and professional reflection and engagement.

IATSO was a great, engaging, and intriguing professional conference that enforced the international aspects of working in sexual abuse prevention and response. Although it was the first time that Kieran and Kasia attended, and like David, it won’t be his last. For those interested: the next IATSO conference is scheduled for August 26-29, 2025, and will take place in Poznań, Poland. All information and updates can be found on their website: https://www.iatso.org .

What do the BBC and McDonalds have in common? A problematic workplace cultures related to sexual abuse.

By Kieran McCartan, PhD, and David S. Prescott, LICSW

The concept of culture is important in understanding how people experience and engage with the world around them. Over the years on this blog, we have talked about different types of culture and their relationship to sexual abuse. The conversation is one that never stops because although we want a society that does not allow and or promote sexual violence, we have not arrived there (although we are further down the road than where we started from). Culture change is difficult and takes time; the #Metoo and everyone’s invited movements are recent examples. However, at a local community level, cultural change should be easier and more realistic. Community culture change is more contained, and it can be easier to gain buy-in. Two stories this week from the UK serve as examples of the difficulty of culture change. These involve the BBC in one and the other, McDonald’s. In both employment-based communities, the necessary culture change that is needed to prevent sexually abuse isn’t happening. Instead, what we see is employer disengagement, denial, inaction, and risky behaviors.

Over the last two weeks, the BBC has been involved in a story about one of its leading presenters being allegedly involved in sexually exploitative practices, as reported by The Sun and based upon information from the victims’ parents. The claim from The Sun was that the presenter had been involved in an exploitative relationship over three years with a vulnerable female. It involved paying her monies totaling £35,00 for sexually explicit photos and imagery of herself. The report claimed that she was vulnerable, was using the money to pay for heroin, and that the abuse started when she was 17. In the report the parents claimed that they had approached and reported this to the BBC, who had done nothing. After the story was published many high-profile BBC presenters distanced themselves from the events, including on social media. Additionally, the victim came out and said the story was “rubbish”. Eventually the wife of the person at the center of this story came out and named her husband, Huw Edwards, as the person at the center of the story. In this statement she says that her husband suffers from major bouts of depression and is currently hospitalized.  

In short, it’s a mess. We are aware that media coverage of breaking news can be flawed. Nonetheless, it is clear that the BBC, like many other organizations, have a long way to go to prevent abuse in the workplace and by people in positions of trust.

Over the course of this story, the BBC has been criticized for not taking the claim seriously, trying to cover the story up, trying to protect the person at the center of this, and having a culture where abuse, cover-up, and mystery is commonplace. The BBC responded and said that it was protecting the human rights of person at the center of this, that that had suspended them, and a full investigation would take place. Since the release of this report, more allegations against Huw Edwards have come out from BBC colleagues.

The story highlights the need for an engaged employer who can respond to claims of abuse, that has policies and practices in place to respond, and can demonstrate that they take the claims seriously. One note of consideration about this story is why the BBC would get involved in a private case as this not between to employees? As the presenter in question is very senior and the face of a flagship news program, there are expectations of his behaviors and attitudes that go beyond the organization. Both the presenter and the organization are in positions of public trust. There are concerns of moral fiber, questions of trustworthiness, and issues related to institutional damage. Also, without phone logs we don’t know when the messages took place or whether it was on company time, with a company phone, etc.

The second story also involves the BBC, but this time in an investigatory role. Early this week, they reported on an investigation into reports of sexual abuse, misogyny, harassment, and bullying at McDonald’s restaurants in the UK. The report claimed that many victims of abuse reported them to management and to corporate headquarters but were dismissed and ignored. This often resulted in the employee leaving. Within 48 hours of the story breaking over 100 more former employees verified and expanded on the claims in the report, indicating that the culture of abuse was wider and more significant than originally thought. This case, like the BBC, involves an organization that likely is not in touch with the realities of abusive behavior in their workforce, does not listen to people who are victimized, and do not engage with the problems or the people involved. The CEO of McDonalds’ UK and Ireland admitted this, saying that they as an organization had let staff (especially young staff) down and would strive to do better in the future.

It should be obvious that everyone has the right to work in a workplace free from sexual harm and misogyny. Everyone has the right to have an employer that is engaged around these topics, takes reports seriously, and engages with staff appropriately in response. This, however, hasn’t been the case. We would suggest the BBC and McDonald’s are not outliers in this area, but that they are representative of many organizations who need to come to terms with abuse. This raises the question of what employers are doing to make their workplaces abuse free and protect their staff from harm. Are they writing policies without meaningfully implementing them or making earnest attempts to end abuse now?

In an ideal world, we would have research-informed messaging, support for staff wellbeing, trauma-informed workplaces, and activities that promote inclusion and equality; but unfortunately, we are not there yet. Here are some ideas of what employers can do:

  1. Create a culture of equality, inclusion, and diversity though actions, communication, and environment.
  2. Link together corporate policy and practice, behaviors, attitudes, and actions on the ground.
  3. Embrace compassionate leadership and create a culture that acknowledges and supports staff who have experienced trauma and difficulties.
  4. Train and upskill staff around behavioral and attitudinal expectations when in work and then hold them accountable to them.
  5. Encourage staff to speak out about abuse and offence behavior. In addition, create systems that allow this to be done in a safe and anonymous fashion if needed.
  6. Listen to staff when they do speak out and have HR/wellbeing procedures in place to respond to these issues.
  7. Make sure that anyone involved in abuse or problematic behavior is treated in fair and transparent fashion.
  8. Make sure that all messaging and communications are fair, balanced, and respectful.
  9. Post investigates make sure that staff are supported to return to/reengage with work in protected, proactive fashion.
  10. Review policies, practices, training, and the working environment regularly see if current practices are fit for purpose.

But the bigger question is how can employees and society hold employers to account to make sure that they do this and maintain standards? Do we need an industry badging system like Athena Swan (“a framework which is used across the globe to support and transform gender equality within higher education (HE) and research”)? Our belief is that there are some aspects of organizational culture that cannot always be left to organizations to monitor themselves.