Friday, January 17, 2020

1 in 5 experienced child abuse in England & Wales: A call for prevention

By Kieran McCartan, PhD, & David Prescott, LICSW
New official statistics from the Crime Survey for England and Wales (CSEW) state that one in five adults in the UK aged 18 – 74 have experienced at least one form of child abuse before the age of 16. The survey estimates this at approximately 8.5 million people. While this figure may seem shocking at first, it actually reinforces what we know about child abuse prevalence and hints that this maybe the tip of the iceberg, with these numbers being an underestimation and not an overestimation. The report indicates that (please note that the below statistics are directly quoted from the report);
  • Many cases of child abuse remain hidden; around one in seven adults who called the National Association for People Abused in Childhood’s (NAPAC’s) helpline in the last year had not told anyone about their abuse before.
  • In the year ending March 2019, Childline (a free service where children and young people in the UK can talk to a counsellor about anything) delivered 19,847 counselling sessions to children in the UK where abuse was the primary concern; around 1 in 20 of the sessions resulted in a referral to external agencies;
  • As of 31 March 2019, 49,570 children in England and 4,810 children in Wales were looked after by their local authority because of experience or risk of abuse or neglect;
  • Around 4 in 10 adults (44%) who were abused before the age of 16 years experienced more than one of emotional abuse, physical abuse, sexual abuse, or witnessing domestic violence or abuse. This proportion is higher for women than men (46% compared with 41%);
  • Sexual abuse was reported in around two-thirds (63%) of calls to National Association for People Abused in Childhood’s helpline;
  • Around half of adults (52%) who experienced abuse before the age of 16 years also experienced domestic abuse later in life; compared with 13% of those who did not experience abuse before the age of 16 years.
Previously in this blog we have talked about the challenges of understanding the base rate data on experiences of sexual abuse, which is just as important for broader definitions of abuse. We know that there is under reporting, under recording, poor prosecution rates, cases being dropped, and acquittals within the system. The volume of people sentenced for abuse does not accurately reflect the volume of abuse that there is. This new data from England and Wales, as Scotland and Northern Ireland collect and record data separately, data is more than likely an underestimation, especially given the way that the CSEW is constructed. That is, it relies on (1) self-completion modules of Survey by men and women aged 16 and over who are resident in households in England and Wales, & (2) offences reported to and recorded by the police. Therefore, if you have not reported a crime to the police or are not a home owner you are unable to take part. Interestingly, in recent years the CSEW have contacted some children between 10 -15 to take part to get a broader spectrum.
The data from the CSEW highlights the challenges that child abuse causes in England and Wales, especially in terms of trauma, Adverse Childhood Experiences, ongoing development impacts and the costs/demands on the social care and criminal justice systems. The growing recognition of ACE’s and past trauma in our adult victims and perpetrators population is massive in the UK, with Scotland and Wales putting it at the heart of their social care and social welfare policies; however, it has not been as straightforward for England and Northern Ireland. The CSEW data really highlights the need for a more preventative/interventionist approach to child abuse. We need to intervene sooner and develop more coherent secondary prevention approaches to reduce child abuse. We also need to provide those at risk of abusing others with the skills to prevent offending and to assist those at risk of being victimized to be better safeguarded. 

Friday, January 10, 2020

Pornhub’s 2019 Year in Review

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

Not many professionals are aware that the world’s largest adult pornography site, Pornhub, publishes annual statistics about its use and users. Obviously, readers will want to be judicious in how they read the report (in the language of porn, the website itself is NSFW or “not suitable for work”), although the findings themselves are presented in a provocative but not necessarily offensive manner. Each reader’s opinions will vary.

What have we learned about Pornhub this year? Once again, the numbers are vast: In 2019 alone, there were 42 billion visits to the site (averaging 115 million per day), 39 billion searches performed, and 6.83 million uploads. For just the videos uploaded in 2019, if one were to watch them all in sequence, beginning in 1850, they would still be watching today. Reading such statistics as “6597 petabytes of data transferred” is a little bit like trying to come to terms with the national debts of nations; it can be nearly impossible to comprehend.

Beyond this, the statistics track, to the best of their abilities, who the most popular stars are, what people search for, what they actually watch, for how long, and where. They also report on the age and gender of their viewers, leading to questions of how they are able to divine this information (and is there a bias in the direction of attracting advertisers). Nonetheless, the data is remarkable.

Digging a little deeper, however, it seems that there is much we can learn about sex and sexuality that can inform our understanding of clients in assessment and treatment situations. First, of course, is obvious: Porn is ubiquitous. Even the best available research does not show it to be a risk factor for re-offense, as this earlier blog describes. Pornography continues to be controversial, with some politicians declaring it a public health crisis despite the most recent scientific findings. To our minds, the most interesting and concerning questions have to do with the effects of pornography on children, adolescents, and other vulnerable people. The reality is that porn without context, as ill-informed sexual education, lays problematic, difficult and unrealistic notions of sex and sexuality; as indicated in a recent BBC poll suggesting that women’s exposure to violent sex and violence during sex is on the increase. Hence, we need sex education, informed debate and realistic relationship expectations in modern society.

Questions arise: These findings show that what people search for is not necessarily what they end up watching. Further, as the authors of the report note, there is a trend in the direction of real people and not simply actors. “Amateur” was amongst the most frequent search terms, leading to questions about to what extent viewers are looking for the most authentic or genuine experience (as opposed to the gymnastics of many of the more commercially produced videos). At the same time, however, animated pornography is also at the top of the list, speaking to the role of novelty and fantasy for many viewers. These trends raise questions for how we understand our clients in treatment as well as those on other problematic pathways. As the Internet Watch Foundation points out child sexual abuse material, and related content, is often viewed on Facebook, Twitter, and other legally accessible internet sites, not purely on the dark web. Most of this accessible material is homemade, not “produced” which is in line with trends in mainstream porn.

Many more questions follow regarding what people watch. There is plenty to be offended by and concerned by. The prevalence of incest themes (mothers, fathers, stepmothers, stepsisters, “Daddy” etc.) can and should raise any number of questions for those understanding the sexuality of clients in treatment. On one hand, many professionals working with adolescents who have sexually abused report seeing cases in which these themes were used in the service of abusing within families. On the other hand, one wonders about the underlying allure of the relational aspects. As repulsive as incest is to society, do these videos also, however strange it may seem, provide a sense of connection to viewers? What is clear is that, as we have argued in the past, viewing porn through the lens of our own individual sense of morality is not a tenable approach to understanding or treating people who have abused.

In the end, the statistics provide more questions than answers. What do we really know about the sexual interests of viewers? 32% of visitors were female, indicating that it’s not as simple as men wanting to look at naked women. What will be the long-term effects on young people who grow up porn-educated and without funding for meaningful sex education in schools? And ultimately, what are people really looking for when they enter the search terms that they do?

Wednesday, December 18, 2019

Race, Bias, and Risk Assessment

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

Note: We are grateful to Tyffani Dent for her contributions to the discussions that led to this post.

On August 1, 2014, in a speech about risk assessment processes, then–United States Attorney General Eric Holder said of the available measures:

Although these measures were crafted with the best of intentions, I am concerned that they may inadvertently undermine our efforts to ensure individualized and equal justice.  By basing sentencing decisions on static factors and immutable characteristics – like the defendant’s education level, socioeconomic background, or neighborhood – they may exacerbate unwarranted and unjust disparities that are already far too common in our criminal justice system and in our society.

His points were well-taken and yet not without considerable push back. The most common response at the time was that the existing tools certainly outperformed the unstructured judgment that in turn was wildly susceptible to bias. This point, too, was a good one. Earlier this Autumn, Jennifer Skeem, associate dean of research and associate professor of social welfare and public policy at the University of California, Berkeley, stated in a major address to the National Forum on Criminal Justice that extensive review of post-conviction risk assessments of federal convicts found “no evidence of predictive bias by race.”

Perhaps that’s one of the issues we need to address first; many aspects of racism take place beyond the awareness of those who work within the structures where racism is found.

As outside observers who have tried to watch developments in risk assessment closely, there is no question that the right risk assessment methods can be useful, but we question whether there isn’t evidence of inherent bias available right in plain view. For example:

-  It’s well-established that people of color are more likely to be arrested, often as a result of over-policing. They are incarcerated at a rate of more than five times that of white people. 

-  It’s also established that people of color are less likely to be referred to diversion programs, and can be subject to bias even within that referral process. All of these points can result in higher scores on risk assessment instruments compared with whites, especially against a backdrop of true crime rates remaining unknown. 

-  Likewise, racial disparities can be found in the bail system. This fact often goes missing in broader discussions of racial disparities in the legal system.

-  Obviously, not all risk assessment methods are created equally; many rely on items that lend themselves, more and less, to racial bias. Items related to family (for example, past family incarceration) and community stability scored outside of an understanding of their context may not accurately reflect a person’s propensity to commit crime.

In some circumstances, further questions arise as to whether many instruments aren’t more effective at predicting who will be arrested than predicting who will commit crimes.

People of color tend to experience intersectionality more than white counterparts, which means that their different socio-political and individuals labels put them at risk of being a victim of crime and of, potentially, being someone who could commit a crime. In addition, people of colour, sometimes because of factors crystalized through intersectionality, are more likely to experience trauma as well as adverse experiences; which matters in how we work with and respond to them. This means that there is an opportunity for better primary, secondary, tertiary & quaternary prevention (see previous blog). However, because of the socio-political aspects of race, vulnerability, trauma, economics, and access to social care in America (and worryingly so in the UK as well) issues related to intersectionality, race and crime never gets truly understood or dealt with.  A clear example of this is a recent report that indicates that UN peacekeepers from multiple countries, of multiple races committed systematic sexual abuse while in Haiti. Experiences of sexual abuse, whether through victimisation or perpetration, does not have a race determinate; but race does play a significant role, though intersectionality and socio-economic-political factors, in the way that we define, prevent and respond to sexual abuse.

Of course, we are not the first, by far, to address this and related topics. We do, however, believe that professionals can become more effective by studying the myriad issues involved that this blog post is only barely able to touch upon. Despite the excellent advances made by our risk assessment instruments, very serious challenges remain.  

Monday, December 16, 2019

A Statement from the Association for the Treatment of Sexual Abusers

As an organization, our mission is to prevent sexual abuse. We believe every individual has the right to live free from sexual victimization. We believe that people who commit sexual abuse should be held accountable for their actions and supported in their rehabilitation, while supporting the victims of sexual abuse.

ATSA promotes evidence-based treatment and guidance for individuals at risk of committing abuse and for those who have abused others. Our ethical standards demand high ethical behavior and professional integrity among our members, without exception.

We know that individuals who sexually abuse others cross educational, socioeconomic, gender, and ethnic lines, and are frequently respected members of families and communities. 

On December 9th, ATSA learned that Dr. Kurt Bumby had been charged with sexual abuse. He has been a respected member of ATSA, and a past leader in the organization and in the broader sexual abuse research and treatment community. Once we learned of the charges, the Executive Board immediately suspended Dr. Bumby’s membership pending the outcome of the case.

These allegations have shocked and saddened all of us at ATSA. Like any community, we are dealing with the emotional and practical impacts of this situation. We are experiencing the ripple effects of allegations of abuse and how it impacts everyone involved in these situations. 

Our mission to end sexual abuse will continue. And, as always, we encourage you to be part of this effort.

Friday, December 13, 2019

Shining a light on sexual violence helps prevent it

 A statement from the Association for the Treatment of Sexual Abusers

One of the most effective ways to prevent sexual harassment and violence is to shine a light on it.

When organizations are transparent about incidents of sexual abuse, they help everyone understand the factors that can lead to sexual abuse and how to develop systems and processes to prevent that abuse.

Uber’s recent release of sexual abuse data is an example of that. The level of transparency Uber has displayed is a credit to their commitment to end sexual harassment and assault. By providing this information, they are taking a step toward preventing future victimization.

We already know some of the factors that can encourage perpetration – isolated working conditions, significant power and pay disparities, hierarchical organizations that discourage reporting or lack independent investigatory channels, and male-dominated fields. The data from Uber may enable us to shine more light on these and other factors that contribute to sexual assault in the workplace.

Preventing sexual assault and future victimization will make a significant difference in many people’s lives. The human harm caused by sexual abuse that goes unaddressed by employers is significant. It can derail careers, create a ripple effect of financial difficulties, cause mental and physical health problems, and result in long-term traumatic impacts on the person who was abused.

Businesses that work to prevent and address sexual abuse not only save these human costs, they also save money.

Data from FY2017 found that workplace sexual harassment and assault settlements negotiated by the EEOC cost U.S. companies $46.3 million that year. Because the EEOC is involved in only a small percentage of such cases, actual total litigation costs in the United States are much higher. Studies also show that businesses pay anywhere per case from $75,000 for out-of-court settlements to $200,000 and up for jury settlements. Companies also lose money through reduced staff productivity; higher employee turnover; increased insurance costs; and, occasionally, boycotts. And these economic costs are not limited to the United States. They are a worldwide issue.

By being open about the sexual abuse their drivers and passengers have experienced, Uber is giving us the information we need to help prevent these types of assaults. This is an excellent example of social and corporate responsibility that others would be wise to follow.

For more information about the factors that can lead to sexual abuse and how to prevent abuse, visit

For additional details about the costs of abuse, see the following sources:

Friday, December 6, 2019

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 the 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.

Wednesday, November 27, 2019

When Others Decide the Effects of Abuse

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

A vital study that appeared a few weeks ago has attracted surprisingly little attention. Esme Fuller-Thompson (from the University of Toronto) and her colleagues examined 17,014 survey respondents, including 651 known to have a history of sexual abuse as children. From their findings:

Remarkably, two-thirds [65%] of the childhood sexual-abuse survivors in our sample met the   criteria for complete mental health -- defined as being happy or satisfied with life most days in the past month, having high levels of social and psychological well-being in the past month, and being free of mental illness, suicidal thoughts and substance dependence in the past year. While the prevalence of complete mental health among childhood sexual-abuse survivors is higher than we had expected, it is still substantially less than that found in the general population [77%]. (p. 6)

Not surprisingly, the study found that factors such as social isolation, chronic pain, and substance dependence were impediments to “complete mental health” (a term that describes the study’s goals accurately, but may be conspicuously, even amusingly, absent in the daily life of many readers).

These findings are far from surprising. Many of those working with people who have been traumatized are familiar with post-traumatic growth, with some professionals having experienced it personally. As our colleague Alissa Ackerman has observed, “You are never more than a stone’s throw away from a survivor of abuse.”

On the other hand, these are findings that challenge traditional beliefs about abuse. The familiar refrain of abuse leaving people “scarred for life” can be harmful in its own way, including when those who have been abused hear this from friends, family, therapists, or prosecutors seeking a conviction. The simple fact is that we need a more nuanced approach in understanding abuse. The problem isn’t that all forms of abuse cause inevitable harm. The problem is that abuse poses an unacceptable risk of harm. No one has the right to state categorically how abuse affects others.

What might be most fascinating about this study is its historical context. It has only been 20 years since the 1998 meta-analysis by Rind, Tromovich, and Bauserman was condemned by a US Congress formal resolution and sparked significant controversy. They had produced similar findings, although they framed their study quite differently. From the abstract: “negative effects were neither pervasive nor typically intense, and that men reacted much less negatively than women”. Obviously, how one frames the issues contributes to how they are understood by others.

These lessons in controversy appeared again in 2009, with the publication of Susan Clancy’s book, The Trauma Myth. Clancy, too, experienced substantial push back in the media, and spent considerable time explaining her work. By this time, and in the wake of rejection by the academic community in the US, she had emigrated to Central America.

All these facts and findings suggest that understanding the nuances of harm and trauma can take years of dedicated study and practice to comprehend. Even the most seasoned professionals often find themselves surprised by what they learn in their ongoing practice. The lessons of how research findings are presented are no less significant. How we frame the issues matters, especially regarding sexual abuse where victims offer feel unheard and/or unrecognized by the system. Forcing victims into frames that help us respond to their abuse without necessarily helping them is problematic. We need to hear and respect what victims say about the abuse they have experienced and the way that it has impacted them. Musician Frank Zappa may have expressed it most succinctly when he said that, “The most important thing in art is the frame.” In this case, that means hearing and respecting the voices of those victimized.