“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

Love in the time of COVID?

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

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

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

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

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

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

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

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

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

Many organizations have offered advice for professionals in this field;

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

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

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

Yorkshire-Humberside NOTA roundtable

By Jenny Greensmith-Brennan, Safer Lives

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

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

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

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

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

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

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

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

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

I do hope to see you in Leeds this year.

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

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

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

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

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

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

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

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

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

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

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

‘What if I’m wrong?’

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

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

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

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

‘Beyond reasonable doubt’

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

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

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

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

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

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

What if you’re right?

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

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

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

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

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

By Stop it Now Scotland!

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

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

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

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

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

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

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

ATSA Annual Conference 2019

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

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

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

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

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

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

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