WELCOME Gareth McGibbon NOTA Chairperson www.nota.co.uk • Most Presentations available on NOTA website • Benefits of NOTA membership • Domestics • AGM report on website • Evaluations - online Long-term outcomes for children and young people with harmful sexual behaviours: Issues and implications: Simon Hackett http://bit.ly/1p64IYU Understanding and Managing Children with sexual behaviour problems in residential and foster care Carol Carson and The AIM Project copyright 2014 carol carson associates Ltd & AIM Project Key Messages Good assessments to give perspective and to be focused about what intervention is required It’s just another difficult behaviour Personal views and impact on workers/carers Multi-agency work Stay calm and stay focused You can do this! copyright 2014 carol carson associates Ltd & AIM Project Personal Impact of working with sexual behaviours •This work can raise levels of anxiety on a personal, professional, and organisational level, this should not be underestimated • The impact for some carers or staff may be about past personal experiences • Anxiety can be raised by trying to cope with the powerful and abusive dynamics some young people generate around their sexual behaviour some of which may be directed at staff or carers • Uncertainty is always a feature in this area of work and this is a source of stress copyright 2014 carol carson associates Ltd & AIM Project Understanding Younger Children •Lack of research and statistics • Girls are also displaying these behaviours • Healthy sexual development is disturbed or disrupted either through abuse or highly sexualised environments •Their bodies may have become sexualised and they are overwhelmed with feelings they cannot comprehend •Emotional and physical space violated leaving feelings of anxiety, distress, anger related to sex copyright 2014 carol carson associates Ltd & AIM Project If not abused, but exposed to sexual information, confusing messages and poor boundaries can also create confusion, tension and anxiety related to sex Other factors, unpredictable and unstable backgrounds; violent or chaotic environments; little warmth or empathy; sex paired with aggression or as an exchange commodity In general the sexual behaviours are a way of dealing with intense negative emotions and sexual sensations that may be overwhelming for them, and scary and they may not have any positive ways in which to manage them copyright 2014 carol carson associates Ltd & AIM Project Pathways into Sexual Behaviors 1. Child has been sexually abused 2. Child lives in a highly sexualised environment 3. Exposure to sexual information through media, social networking, older siblings etc They have either experienced it, witnessed it or lived with it. It has got to have come from somewhere copyright 2014 carol carson associates Ltd & AIM Project Understanding Adolescents Adolescents make up approx 1/3of those convicted of sexual offences. Many have distorted or stereotypical views about relationships and sexual relationships in particular Reasons they engage in the behaviours is also to meet internal needs; overwhelming anger, anxiety, fear, loneliness etc. Puberty means body changes, and hormones creating intense sensations and emotions in their bodies Media and peer pressure to be successful sexually copyright 2014 carol carson associates Ltd & AIM Project Not all adolescents who display these behaviours go on to be adult sex offenders. Work now more holistic looking at all aspects of their life; viewed as young people with needs and social and developmental deficits Factors from research and practice Neglect & Emotional Abuse Conduct disorder Sexual Abuse Other behavioural problems Physical Abuse Gender and Ethnicity Social Inadequacies copyright 2014 carol carson associates Ltd & AIM Project Understanding Adolescents with Learning Disabilities Over represented in surveys eg 37%. Not more harmful, more likely to be caught or admit to the offence. Autism – work ongoing about this Similar routes into the sexual behaviour as the others copyright 2014 carol carson associates Ltd & AIM Project Specific Factors Klinefelters Syndrome Lack of understanding about consent or impact on others May not have mainstream concepts of social mores about sexual boundaries Lives more restricted generally; social contacts more limited Denial of appropriate sexual education copyright 2014 carol carson associates Ltd & AIM Project Healthy Sexual Behaviours Mutual, consensual, choice, exploratory, no intent to cause harm, fun, humorous, no power differentials Problematic Sexual Behaviours • not age appropriate • one off incidents or low key such as touching over clothing • peer pressure • spontaneous rather than planned • self directed eg. masturbation • other balancing factors, eg lack of intent to cause harm or level of understanding, or acceptance of responsibility • other children irritated or uncomfortable but not scared, they feel free to tell someone • other factors such as parents/carers are concerned and supportive. copyright 2014 carol carson associates Ltd & AIM Project Harmful Sexual Behaviours • Not age appropriate • Elements of planning, secrecy, force or coercion • Power differentials eg. age, size, status, strength • The response of others eg fear, anxiety, discomfort • The response of the child eg. fear, anger, aggression • Child blames others and takes no responsibility • Frequent incidents or increasing in frequency and disproportionate to other aspects of their lives • Not easily distracted, compulsive despite intervention • Other difficult behaviours, conduct disorders, anger, poor peer relationships etc. copyright 2014 carol carson associates Ltd & AIM Project Checklists for evaluating Behaviour • Based on a continuum from Healthy to Harmful, with eight areas (questions) all based on research and practice • Needs to be checked against all the areas to have a balanced picture. Any gaps should provide a prompt to seek the information. • Assessment on partial information should be viewed as temporary. • Behaviour is likely to fall within one part of the continuum or straddle two • Where behaviour is placed depends on how many answers are in each section copyright 2014 carol carson associates Ltd & AIM Project Pattern Mapping Cause of the behaviour: Understanding facilitated by good assessments Pattern of the behaviour: Frequency, increase/decrease, gaps, trigger factors, patterns leading up to incidents Meaning of the Behaviour: Linked to trigger factors such as emotions; what do they get out of the behaviour; how do they use the behaviour ie to control, intimidate Motivation to Change Behaviour: how able are they to talk about the behaviour, and how willing are they to work on their behaviour and develop internal controls ( Miller & Rollnick 1991) copyright 2014 carol carson associates Ltd & AIM Project Residential and Foster Care Settings 1. Personal Impact 2. Confidentiality vs Protection 3. Importance of recording 4. Working with others 5. Safe Practice in the home – bedrooms, bathrooms, desexualise the environment, dress codes, playfighting, privacy, 6. Physical interactions – what is ok and not ok, role model healthy touching behaviours 7. Talking about sex copyright 2014 carol carson associates Ltd & AIM Project Individual Level - Meeting Needs 1. Stability, Security and Consistency 2. Individual time and attention 3. Emotional Literacy 4. Self esteem and Life skills deficits 5. Celebrating Achievement 6. Opportunities to practice and develop copyright 2014 carol carson associates Ltd & AIM Project Individual Level – Managing Risks 1. Honesty and Openess 2. Contracts 3. Supervision – realistic 4. Confidentiality vs Protection 5. Boundaries - Stop the behaviour - Define the behaviour - State the house rules - Enforce the consequence or redirect the child copyright 2014 carol carson associates Ltd & AIM Project Outcomes for parents and carers: and implications Part Two Few studies… • Concentration on identifying demographic factors and typical family characteristics (Bischof and others, 1992, 1995; Graves and others, 1996; Kaplan and others, 1988): – Useful to understand the broader family factors that might influence and shape the development of hsb – But, problem and deficit-focused – Tend to conclude that there are differences between such families and the general population, rather than looking at either strengths or similarities between the families of young people with hsb and other families – Also, the emphasis on establishing family characteristics says little about the experiences of such families once the abuse comes to light. Holistic and multimodal? • Hackett et al. (2004) reviewed national provision and found few services were working with families… • Smith et al (2013) reviewed provision in England and Scotland and found there remains a noticeable absence of family work, with services often relying on individualised interventions with young people, despite the evidence which emphasises the importance of multisystemic and family-based interventions…. Orthodox approaches to families • Deficit perspective, pathologised • Seen as: highly resistant, in denial, noncompliant, dysfunctional, high risk, chaotic, multiproblem • Fragmented involvement of multiple systems, uncoordinated care • Intersectionality underplayed: systemic issues of racism, sexism, poverty, educational inequity, other forms of criminality or violence • Parents’ needs lost within professional efforts to ‘manage risk’ Issues for families • Loss of competence (overwhelmed by problems, self blame) • Loss of connection (with peer network, wider families, distancing with professionals) • Loss of vision (undermined roles, back at square one) • Loss of hope (resignation and despair) • Loss of balance (e.g. about sex) Why don’t we know much about parents’ experiences of professional systems following their child’s hsb? • Giving users a voice means: – Handing back professional power? – Listening to their experiences and taking them seriously? – Being open to changing practices on the basis of user feedback? What would parents say? • Hackett, S. and Masson, H. (2006) Young people who have sexually abused: what do they (and their parents) want from professionals? Children & Society 20(3): 183195. • Confidential survey of 14 young people and 10 biological parents (9 women) Helpful responses for parents • The importance of professionals being clear about processes and timescales was emphasised repeatedly by parents: – “the social worker who didn’t explain what would happen”. • Importance of parents getting information about the concerns: – “Learning about what happened and having it explained by the [specialist] project as it wasn’t explained before.” Not helpful responses for parents • Overly intrusive and extensive interventions were not welcomed: – “They stayed involved too long. My child felt abused by them.” • Lack of continuity: – “I would say that the least helpful has been a change of worker. Fortunately it was not the worker my child had engaged with. We as a family are now on to our fourth social worker. This is not helpful and continuity is a must.” What should professionals do to make services better? – Get parents talking to other parents – Have sessions to explain how they work [with the child] so that parents can maybe understand the work better – More communication to parents as to where to move on after the support ends for the person involved. We have had problems getting our son to go out and return to school Outcomes for parents and carers in our recent long-term outcomes study • In the 117 cases we followed up: – 27% only intrafamilial hsb by the yp – 46% only extrafamilial hsb – 27% both intra and extra Initial responses to discovery • Anger, fear, shock, guilt, embarrassment • Ambivalence about removal • Apparent lack of concern (hsb not viewed as serious or parents with significant sexual boundary problems) But initial responses didn’t necessarily predict longer term responses or outcomes Longer-term responses • Highly varied pathways of: – Support – Ambivalence – Rejection Supportive responses • 25% families were supportive once beyond initial anger and shock: – Parents accepted the young person needed help and supported the interventions on offer – Supportive parents came from a range of backgrounds, with some from environments by separation, abuse and crisis, as well as more stable backgrounds Supportive families • Acknowledged that their child had a problem, wanted it addressing Stress • Didn’t label child as ‘sex offender’ reduction • Were able to differentiate child from their abusive actions • The burden on parents of being supportive was still great- anxiety, stress, etc. Supportive families • Of the supportive families, in 75% of cases the hsb was extra-familial or victims were more distant relatives • In the remaining 25% of cases, victims were Social and emotional siblings. distance and ‘insulation’ effect…. Supportive families Teach practical behaviour prevent their child management strategies and safety skills • Were highly motivated to from re-abusing • Often tried to maintain a protective environment at home, even if at times the methods were questionable: – X's mother was concerned about the risk that he posed to the children and would lock him in his bedroom at night-time (male aged 14). Ambivalent responses • 28% families had a more ambivalent response • Acknowledged the behaviours, but denied its seriousness or were reluctant to confront it: – Behaviour raised too much anxiety – Didn’t believe it was problematic Help parents – Didn’t want children’s serviceswork in their out lives the reasons for ambivalence Ambivalent families • Reasons given in reports for ambivalent responses varied: – Parental histories of csa used to suggest that it was more difficult for some parents to confront the fact that their own child was now ‘an abuser’ – Parental abusive behaviour: “X's mother said that she did not believe that X was involved in the abuse of the children. Allegations later emerged that X's mother and grandfather were themselves involved in the abuse” (female aged 14). – A desire to return to normality: “There was a strong desire within the family to pretend that the abuse did not happen and there was little empathy for the needs of the abused daughter. On several occasions X's mother said that she wanted to forget the incident and move on with life, and that she did not know why her daughter continued to talk about the incident” (male aged 16). Ambivalent responses • Engage male carers not just In other ‘ambivalent’ families, the dynamics females to within the family were complexexplore with some differences people in the family acknowledging and some minimising it: – “In many respects X's parents had a good relationship with him. His father was caring but to the point of being too tolerant; he played down X's behaviour. His mother was more authoritative and more disturbed by what had happened. She was terrified that X could reoffend” (male aged 13). Ambivalent families • Ambivalent parents often attempted to control their anger and anxiety by: Couple work – Blaming their child’s victims: “X's mother was very anxious about the intervention of the police and social services, and to some extent blamed the victim for wearing short skirts and talking to boys (male aged 15).” – Blaming each other as parents for what had happened. Ambivalent families • Tended to explain away the behaviour as ‘experimentation’ • Ambivalent responses could be counterTheto psychoproductive- sending messages the yp that educative the behaviour was unproblematic or not element around serious (and in some cases was abuseacceptable and sexual to development continue) ‘Disintegrative shaming’ responses • 7% of families responded in a highly negative way: – Shunning, shaming, rejecting – In 75% of these families, the yp had targetted a brother or sister – HSB was seen as betrayal and transformed the child into a deviant outsider who had to be removed (physically or/ and emotionally) – Tendency to label the child as a ‘sex offender and little inclination to empathise: e.g….. ‘Disintegrative shaming’ responses • “His step-mother believed that X was an ‘evil person’, and always had been” (male aged 12) • “A high level of friction existed between X and his stepmother. His stepmother referred to him as ‘a rapist’ and a ‘fat bastard’.“(male aged 15) ‘Disintegrative shaming’ responses Work on own to be • Mothers’ anger in several cases seemed victimisation linked with a perception of the child as as like an part of the ex-boyfriend or ex-partner: process of supporting – X's mother said that he reminded her of the his father hsbXwork (her ex-husband). She described as a con man. She was very angry at X's continued abuse of his sisters. She felt that his behaviour was innate. She referred to X's birth father as a ‘pervert’ (male aged 14). Consequences and change • Family responses could evolve from initial anger, into support, uncertainty or rejection: – “X made a video of himself to show his brother (who he abused) but was very sarcastic and dismissive in it. After seeing the video his mother- who had initially supported him- vowed that he would never be allowed to return home” (male aged 15). – “By the end of the treatment programme X had taken full responsibility for his offences and seemed reasonably motivated to reduce his risk level. He admitted that he thoroughly planned the assaults. X's parents were surprised and shocked by this revelation and his father began to take X's behaviour seriously” (male aged 14). Impact on family functioning Supporting the family system in • Considerable consequences for family functioning, non-hsbunder related serving to place even supportive families areas did not have considerable stress, particularly if parents a shared consensus about the seriousness of the abuse and what needed to be done about it. • A number of parents themselves appeared to have a limited capacity to cope with stress, for example because they were living in very deprived circumstances and were trying to take care of other children who had their own behavioural difficulties: Sibling responses… a surprising finding (well for me…) • Relatively little information was present in the case files concerning siblings' reactions to their brother's or sister's sexually abusive behaviour. • In many cases, siblings' voices appeared simply to have been overlooked in any of the discussions between parents and professionals about the impact of the abuse on the whole family or about the management of risk. • Whether siblings felt safe or protected in the family or whether they understood what was happening in the family was not clear in many cases. Sibling responses • Don’t leave siblingreactions, Abused siblings often had complex rehabilitation to loyalty issues and issues with reconciliation: • “X met his sister again (some years chance later), the first time since his abuse of her had come to light. X's sister told him at the end of the meeting that although she might hope to be friendly with him in the future she could not think of him as her brother. X felt considerably depressed after the meeting and desired to hurt himself” (male aged 13). • “X spent ever-increasing amounts of time with his sister and began to get involved in risky activities with her, such as going binge drinking. X's sister had developed significant personality problems. X became increasingly out of control, and potentially harmful to himself and to others” (male aged 13). Some conclusions and implications • Complexity and varied responses • Broad categorisation of: supportive, ambivalent and shaming responses on a continuum • Shift over time (both directions) • However, discovery a profound shock or trauma to parents: – “from our analysis of cases, it seems that it is too easy for professionals to explain away parental ambivalence or denial about their child's abusive behaviour as evidence of poor parenting, underlying personal issues or an inability to engage with professionals in a meaningful way. It is possible that their first reactions may be an understandable initial response to a serious threat to family stability and cohesion”. Conclusions and implications • If parental responses to their child's abusive behaviour are on a continuum, then the professional task becomes working with parents to educate and support them over time in managing their child's risk and in supporting the development of a non-abusive life trajectory. • At the same time, in a small proportion of cases, professionals' suspicions about parental ‘culpability’ appeared well founded as it later transpired that the child had been abused by a parent. • Highlights the need for careful assessment of family functioning and parenting practices, rather than an approach that focuses solely on the child's abusive behaviour without taking into account the context in which it has developed. Conclusions and implications • Parental responses were highly differentiated by abuse type. • The closer parents are to their child's victim, the more negatively they may respond to their abusive child. • As parental engagement and family involvement in treatment are critical elements in positive outcomes (Letourneau and others, 2009), then this would suggest that professionals need to devote specific attention in particular to the needs of parents in situations of intrafamilial sexual abuse. Conclusions and implications • Few instances where siblings were consulted as to their views and opinions, other than when they were interviewed to try to ascertain whether they themselves had been sexually abused. • Needs of siblings routinely overlooked- when we talk about family work, what do we really mean by ‘family’? • In situations where they indicated that they had not been abused, there was little indication that their needs were being considered explicitly and separately from those of the whole family • Given the extent of the negative impact of the abuse on the whole family, professionals should be alert to the fact that the welfare of siblings who are not the direct victims can be severely compromised following the discovery of their sibling's abusive behaviour. Even if the direct victims are outside the family, it can be argued that siblings in these cases are indirectly victimised. Implications • Relational stance (also matters for parents and carers as much as for young people) • Values: – Appreciative ally – Belief in resourcefulness – Collaboration – Families as experts in their own experience MST • Views parents as primary agents of change (not add ons) • Intervention plans seek to improve parents’ effectiveness and quality of relationship with young person MST (Henggeler, 2012) NSPCC Turn the Page NOTA Conference Case Study J, a 12 year old young person(M). Genogram Grandfather Grandmother x M 35 F 36 P 33 28 N 4 J 12 P 10 K 7 8 6 The journey through the emotional reactions to a child's sexually harmful behaviour as seen through the eyes of a parent. Life as we We can have a Disclosure of SHB knew it future free GROWTH from abuse SHOCK, NUMBNESS, STUNNED This can’t be true DISBELIEF, FEAR, POWERLESSNESS SKEPTICISM He wouldn’t do this She is making it all up, its lies my son is not like that Where did we go wrong? How could we have been such bad parents? If only I had been …. This is his problem, but we can help ACCEPTANCE DETERMINATION DENIAL She wasn’t really hurt. It isn’t as bad as they say. INDEPENDENCE AWARENESS HOPE SELF-PITY, MINIMISATION, DEPRESSION RESOLUTION FEAR GUILT, SHAME AMBIVALENCE ISOLATION INADEQUACY VULNERABILITY ANGER HOPELESSNESS DESPAIR TRAPPED, LOST (Adapted from Levenson J; Morrin J 2001 – Connections Workbook; Sage Publications) Our family is a mess – we can’t handle this life, it will never be the same for him or us. How will we face people? We can’t live with The situation as it is Do we still care about him? Should he stay here or go live elsewhere How could he do this? He needs to pay. I hate him. How dare he do this. Aim 2 Developmental Factors (sexual abuse, rejection, attachment problems) Trait Factors (Stable Dynamic Risk) (Anti-social behaviour, emotional loneliness, etc) Situational Triggers (Substance misuse – victim, Access, relationships, Conflict, etc) Protective Factors (resilience, skills, strengths) State Factors Acute Dynamic Risks (Harmful sexual thoughts, need for intimacy, availability of victims, etc) Sexually Abusive Act Victim resists Outsider Intervenes Young person desists Four Domains = Strengths/Concerns 1. Sexual and non-sexual harmful behaviour 2. Developmental 3. Family Issues 4. Environmental Issues Concerns/Strengths Profile = HIGH, MEDIUM, LOW Outcome Matrix = Level of Supervision Change for Good Consists of 26-30 sessions. 1.Engagement (4) 2.Relationships (9) 3.Self Regulation (8) 4.Road Map for the Future (5) Overview of Youth Justice in Northern Ireland Yvonne Adair, Youth Justice Agency Overview of Youth Justice in Northern Ireland The last decade establishment of the Youth Justice Agency including the introduction of the Youth Conference model; referrals for sexually harmful behaviour cases both from PPS and Court; establishing strong partnerships with others, including: HSC; Specialist Projects; PPS; PSNI/PPANI PBNI – Safer Lives; and AIM2/GMAP. Overview of Youth Justice in Northern Ireland YJA Practice Guidance Principles: Co-ordination Communication Co-operation Collaboration Objective is to maximise the effective delivery of: Risk management Risk reduction Therapeutic intervention Overview of Youth Justice in Northern Ireland Volume 2013/14 During 2013/14 YJA received 18 referrals (17 YPs), 9 of which were Court Ordered, the remaining Diversionary. By Trust Area: Belfast 3 Northern 2 Southern 5 S Eastern 4 Western 3 Outcomes: DYCP/YCO 17 PSR = CSO 1* Overview of Youth Justice in Northern Ireland Volume 2013/14 During 2013/14 PBNI received 3 referrals. By Trust Area: Belfast 1 Northern 2 Outcomes: CSO CRO PO 1* (see YJA referrals) 1 1 Overview of Youth Justice services in Northern Ireland Current situation Sexually harmful report ►PSNI (inc. HSC) ►PPS insufficient evidence sufficient evidence no prosecution diversion/prosecution Mitigating Public interest CP DYCR YCR PSR Overview of Youth Justice in Northern Ireland Youth Justice Agency Referral received - PPS/Police file inc. YP/Victim information (A&A if DYCR) ►Contact with YP and parent/carer ►Contact with victim and family ►substantial preparation ►liaison with Trust/Child Protection ►liaison with Police/PPU ►liaison with Specialist Projects ►assessment/PP ►restorative practice ↓ Youth Conference (YP, Appropriate Adult, YCC,YDO – plus significant others who add value/purpose) (Meeting or series of meetings) ↓ Recommendation DYCP/YCO YCO with Custody PPS/Court Discretion (alternative disposal) Overview of Youth Justice in Northern Ireland YCO/DYCP ►Intervention (Risk management - GL model strengths-based) ►Multi-agency (Trust- Programme provider –Police) ►Community ►Victim/person/family harmed ►Family: parent/carer contact is central for involvement in: - decision making; - intervention, integration with support/treatment from the beginning, throughout and until conclusion. Overview of Youth Justice in Northern Ireland Safeguarding Children’s Services Improvement Board Risky Children Subgroups Review level and type of current service provided: Existing policy and procedures Threshold for referrals/access Type of therapeutic intervention required Connection of specialist services with others (forensic psychology, PSNI, PPS, Youth Justice, PPANI etc.) ►effectiveness ►consistency ►positive outcomes Overview of Youth Justice in Northern Ireland Planned Landscape There are three main fields, namely: Not involved with/do not come to the attention of the justice system YJA: diversion and prosecution PBNI: prosecution (in partnership with Trusts and Specialist Projects) More Complex Cases/level of forensic input required ►FACTS Overview of Youth Justice in Northern Ireland Family Families: each is unique. (Approximately 50% of offences are intra-familial) Overview of Youth Justice in Northern Ireland Family Intervention & Support Parents Support Group Non-abusive parents Individual/couple/family Direct, face-to-face – (one-on-one/co-work) Staff consultation/support Family support Counselling Information Education Sexual abuse Exploitation Offending Supervision Protective parenting Coping with multi-agency systems Overview of Youth Justice in Northern Ireland Family Intervention & Support contd. Shock/trauma/isolation/unsupported/loss of usual networks Shame/self blame/’done wrong’/’missed’ Strong emotions re child’s behaviour Trigger stress from past experiences Own abuse may emerge Action: Offer range of services/multi-modal Sign-post, refer, support Equip with knowledge and skills for: Self Child Other children (siblings, grandchildren etc.) Overview of current services within Northern Ireland • NSPCC – Turn the Page (Craigavon & Foyle) • Youth Justice Agency – Diversionary & Statutory Responses • Northern Health & Social Care Trust – Making Changes Project. • Barnardo’s – working with children and families • PBNI/NIPS – Safer Lives Custody & Community for young adults under 21 years. • Independents practitioners Strategic Planning • Draft inter –departmental Domestic & Sexual Violence Strategy 2014-20. • Multiple tiers of intervention. • Early intervention through preventative education in schools is essential. • All statutory and non statutory agencies should be required to operate at defined levels. • Reducing sexual violence & abuse can only be tackled by a public health approach. • Tackling abuse is about transforming attitudes.