Wednesday, October 30, 2019

The SAVVY CONSUMER – A Guide for professionals working with children and young people in relation to pornography use and harmful sexual behaviour

By Cyra Fernandes, Australian Childhood Foundation & Russ Pratt, Prime Forensic Psychology

Please note: This is a slightly longer blog than usual but it was felt that the whole blog needed to be presented in its current form. Kieran

In our previous blog (August 2019), my co-author, Dr Russ Pratt, and I discussed a number of issues to do with youth viewing pornography, and specifically how pornography might influence youths’ sexual practices, behaviors, attitudes, and perceptions.
We discussed that we ha[d]
“…created a developmentally focused, “savvy consumer” model for youth which advocates ‘zero-tolerance’ for pornography viewing for very young children, combined with a ‘harm-minimization’ model for older adolescents. The model has, at its heart, the belief that the ability to both critique the falseness of pornography, and highlight positive, real-world sexual health practices will ensure that the qualities of healthy, safe, and desired sexual practices remain in-focus during treatment.
In particular:
·         Respect,
·         Mutual consent,
·         Equality and partnership,
·         The freedom to say no, and;
·         The freedom to negotiate equally regarding healthy, respectful sexual pleasure and activity. (ATSA Blog, 2019)”
In today’s blog, we do just that.
Any professional who has worked with families where harmful sexual behaviors, problem sexual behaviors and/or sexually abusive behaviors are present has most likely heard the question;

“How can I help my child understand that what they see in pornography does not represent real-life sex?” 
We have already “set the agenda” that – in our views - pornography strongly influences and thus shapes the sexual beliefs, desires, expectations and practices of young people.  Further, we have stated that it plays an influential role in the development of harmful sexual behaviour with many of the young people we work with. Particularly at-risk are those youth who utilise pornography to make-up for sexual inexperience, however poor parental role modelling and supervision, or even absent parents also raises risk. Those youth suffering developmental issues (intellectual disability, autism spectrum disorders and ADD/ADHD) which impact impulse control are also ‘at-risk’. Unfortunately, this cohort seem to experience difficulty in seeking support from adults who might have helped them make sense of what they had seen in regards to ‘pornographic scenarios’ viewed (Prescott & Schuler, 2011; Pratt and Fernandes 2015).
Gaining understanding of effective work with sexually abusive youth impacted by pornography

During 2016, we conducted a survey of practitioners who worked with sexually abusive youth aged up to 18 years. The world-wide survey attracted 183 valid responses, with the majority of participants coming from Australia, the United States, The United Kingdom and Canada.
Regarding the main findings from the survey, several key points emerged, as noted below;
·         Overwhelmingly, respondents believed that their sexually abusive clients were influenced by the pornography they were viewing,

·         They were seeing younger children presenting for treatment and they believed this was due to younger onset viewing of pornography,

·         They believed that pornography provided a “see-all” template or technical manual for youth who were sexually inexperienced,
·         Whilst they indicated they were comfortable working with sexually abusive youth, they indicated they wanted more ‘tools’ that were specifically designed to engage their young clients in regards to both viewing pornography and being influenced by it.
In response to the issues raised by the survey (and in particular the last point), my colleague and I created a series of points, which, when expanded, we believe provides a developmentally-driven (and thus developmentally appropriate) model  – a 9-step guide (initially a 12-step guide) with a focus on working with young people to understand and – where developmentally appropriate – engage in healthy, respectful and safe sexual practices. At the same time, the model aims to highlight the ‘unreal-ness’ and ‘falsity’ of what Crabbe () refers to as “porn world”. We called this model of work the “Savvy Consumer” model, as we felt that the best way to ‘bullet proof’ our young people to porn’s impact was to assist them to “…critique the product” as any savvy consumer would (and porn is a product).
The Savvy Consumer model is developmentally focused - advocating for zero tolerance of pornography viewing for very young (pre-pubescent) children however then combining this with a harm minimisation approach for post-pubescent youth. Additionally, the model advocates on commencing this training from a very young age, however commencing with “E-safety” rather than porn per se, based upon our belief that the internet is a rather dangerous place to hang out whatever your age may be. The model can be utilized in working both with general population of children and young people as well as those who have engaged in harmful sexual behaviour. We set out the model, below, in detail.
1.     Education regarding risks on the internet (not just pornography) must start in early childhood (by six-years of age). Education commences with safety-skills enhancement around safe use and does not mention sex or pornography. If you are old enough to scroll, you are old enough to get into trouble online. We need to begin the conversation early with children about the importance of being safe and very cautious when sharing private information about yourself.  It is also important that adults closely monitor both the content that children are viewing and what they might want to send out into the cyber-world. This is the age to begin education about what is suitable for their child to watch and how this will change as they progress to adolescence.

2.     Net-nanny filtering, password protection, age verification and parental monitoring are all pro-active and vital strategies used to protect “the accidental user” and the “interested [in all the wrong things] user”. Many children and young people report accidentally stumbling onto pornography because of innocently clicking on pop-ups.  Other youth report keeping their usage of sites that their parents would likely not approve of secret. Adopting a strong internet filtering and monitoring processes will reduce the likelihood of these situations occurring. Of course, good relationships with your kids and talking about risk is also vital.

3.     From a developmental perspective, it is important to practice Zero Tolerance for viewing Pornography where kids are under 12 years of age (really, prior to puberty). When comparing early onset viewing versus later onset viewing of pornography, limited research suggests problematic outcomes for the early onset viewers including higher rates of casual sex, greater levels of and tolerance for aggression, violence and sex being linked (for adults see Wright, Tokunaga & Kraus, 2015). Also, increased consumption of pornography later in life, and higher rates of bestiality (Owens, et. al., 2012; Skau, 2007, Skau & Barbour, 2011).  

4.      “Pornography Sex” has a tenuous relationship to “Real Sex”.   Although at times uncomfortable, it is vital that we start conversations with young people in which we are clear (in matter-of-fact ways) that pornography has very little in common with real-life, healthy sexual behaviours and both romantic or sexual relationships.  We want them to understand very clearly in pornography we see actors following a script – and that the script is often demeaning and disrespectful to women.
5.    Approaching puberty (around 11-12 years of age) sex education should incorporate both the physical and the relational aspects of sexual activity. As well, at this age, simple information and education about internet-based pornography commences.  There should be opportunities for children and young people to gain education and information about sex from a variety of sources such as schools, parents, and specialist-educators, rather than the internet itself.  At this stage, sex-education focuses upon mutual consent, respect, boundaries, laws, and pleasure and therefore presents sex as enjoyable by both parties.  Given what we have seen over the past several years in regards to how pornography seen on the internet has shaped and influenced youth’s sexual belief systems, these ‘educational steps’ regarding children’s beliefs about the difference between real sex and porn sex will be vitally important in developing respectful relationship within our community over the next few important formative years.

6.     The Savvy Consumer model assumes that by 13 or 14 years of age (as supported by research), most youth will have viewed pornography (Lim et. al., 2017; Mitchell, et. al., 2014).  Realistic discussion of what they are seeing has to commence. As parents and practitioners; it is crucial that we maintain a curious and non-judgemental stance when talking to youth about their porn usage This is likely to assist in more open and ongoing conversation with young people and allows us to help shape their understanding that the internet-images seen are not realistic reflections of healthy sexual relationships and behaviours.

7.     By the age of 16 (and likely younger), sex education has to include “What women want and what men want” and what porn suggests women want. Sex education should address issues such as the prevalence and practice of heterosexual anal sex, multiple sex partners (mainly seen on the internet is multiple men and one women) in the real world as opposed to on pornography.

8.     Education programs should not be heteronormative or assume that females do not watch pornography.  Whilst most pornography is viewed by males (Ogas & Gaddam, 2011); research is suggesting that significant number of women are viewing pornography regularly (Fischer, et. al., 2019). Additionally, a significant number of gay, lesbian, bisexual, transsexual, intersex and queer young people are accessing the internet for information in relations to “their” sexual behaviour (Lim et. al., 2017). Sex Education programs that are not inclusive of these populations risk derision and critical rejection by all youth.

9.     Sex-education skills should include skills-building regarding the ability to critique pornography. We cannot stop young people using the internet and accessing pornography – even if we wanted to. As authors we have debated how likely it is that we can even successfully achieve ‘zero-tolerance’ for the pre-pubescent (see point 3), however we concluded it was too important a point not to try and achieve.   Rather than an abstinence model into later adolescence, which would likely be unsuccessful, our resources should be directed towards educating and supporting youth to develop skills to consider and critique both the pornography they might see, as well as the roles that pornography assigns to the participants within the movies. Who has power, how do the participants treat each other and what might that be like to be treated in that way? What role does pain, humiliation and degradation play in pornography and why would people enjoy this? In other words, how does pornography “fit in” with their beliefs, desires and (if applicable) sexual practices.  It might be the case that youth who are are particularly susceptible to the influence of pornography might require broader, ongoing support by key adults to assist them to display the confidence to “speak up” about what they have seen.

To conclude
We have set out a case – based on research (ours and others) that pornography significantly influences young people’s sexual beliefs, expectations and practices. Also, children and young people who are broadly “at risk” are more likely to be vulnerable to porn’s influence due to trauma’s impact on their ability to understand the nuances associated with determining ‘real-life’ and ‘porn-world’ sex.
We believe that the Savvy Consumer model provides a simple, effective framework for professionals and parents to assist children and young people – from an early age – to critique both pornography and its influence. Additionally, the Savvy Consumer model will assist in developing their understanding of healthy sexual practices. 
We use the analogy of the Die-Hard action films to make our final point. Most youth have seen the Bruce Willis/Die Hard series. They understand that the violence and damage inflicted is pure fantasy, most likely due to having experienced being hit/hurt/injured at some point in childhood. Sex is a different matter – they have nothing to critique pornography against. As we cannot stop adolescents viewing pornography, we can teach our children and young people to critique it – and be savvy consumers. We want them to treat pornography with contempt, or perhaps like the Die-Hard action films –outrageous fantasy, pure and simple!

Fisher, C. M., Waling, A., Kerr, L., Bellamy, R., Ezer, P., Mikolajczak, G., Brown, G., Carman, M. & Lucke, J. (2019). 6th National Survey of Australian Secondary Students and Sexual Health 2018, (ARCSHS Monograph Series No. 113), Bundoora: Australian Research Centre in Sex, Health & Society, La Trobe University.

Lim, M.S.C., Agius, P.A., Carrotte, E.R., Vella, A.M., & Hellard, M.E. (2017). Young Australian’s use of pornography and associations with sexual risk behaviours, Australian and New Zealand Journal of Public Health, 2017 online, doi: 10.1111/1753-6405.12678.

Mitchell, A., Patrick. K., Heywood, W., Blackman, P., & Pitts, M. (2014). 5th National survey of Australian secondary students and sexual health 2013. ARCSHS Monograph Series No. 97, Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Australia.

Ogas, O, & Gaddam, S, (2011): A Billion Wicked Thoughts: What the World's Largest Experiment Reveals about Human Desire, Dutton, UK,

Owens, E.W., Behun, E.W., Manning, R.J., & Reid, R.C. (2012). The impact of internet pornography on adolescents: A review of the research. Sexual Addiction & Compulsivity, 19, 99-122.

Pratt, R., & Fernandes, C. (2015). How Pornography May Distort Risk Assessment of Children and Adolescents Who Sexually Harm. Children Australia, 40, pp 232-241 doi:10.1017/cha.2015.2.

Pratt, R., & Fernandes, C. (2015). Understanding and Responding to Pornography Use with Adolescents Who Have Engaged in Harmful Sexual Behavior: Developmental Considerations. ATSA BLOG

Prescott, D.S., & Schuler, S.A. (2011). Pornography and its Place in the Assessment and Treatment of Adolescents who have sexually abused. Neari Press. Holyoke, MA.

Skau, B. (2007). Who has seen what when? Pornography’s contribution to the social construction of sexuality during childhood and adolescence. Unpublished Doctoral Thesis, Wilfrid Laurier University, 2007.

Skau, B. & Barbour, H. (2011). The pursuit of “Good Sex” in a pornified world: Assisting adolescents in constructing positive sexual scripts. Paper presented at the 30th Annual ATSA Conference, Toronto, Ontario, Canada.

Wright, P.J, Tokunaga, R.S., & Kraus, A., (2015), ‘A meta-analysis of pornography consumption and actual acts of sexual aggression in general population studies’, Journal of Communication, 66(1), 183-205.





Wednesday, October 16, 2019

Repressed and Recovered Memories: Implications for our field

By David S. Prescott, LICSW

Many professionals (and the lay public) came of age at a time when it was believed that traumatized people commonly repressed all memories of having been abused. It made sense at the time: If the abuse was bad enough, the mind could just completely block it from memory. The mind is an amazing thing, right? The motivations were certainly positive, with the idea that bringing abuse to light could help people to live better lives. Those who lived through those times will recall that these recovered memories often occurred against a backdrop of maxims such as “always believe the victim” without questioning the methods by which people came to believe themselves to have been victimized.

Not long after these efforts, researchers came along and produced findings that were nowhere near that simple. Elizabeth Loftus has become a champion of explaining the myriad vagaries of memory, while Scott Lilienfeld has documented a number of ways that false memories have caused life-altering harm. In a conference presentation on hypnosis in therapy attended by the first author, Michael Yapko once described the recovered memory movement as a near-death experience for hypnotherapy. Havoc ensured, often referred to as the “memory wars”. Since those days, it has been increasingly clear that people might not remember every detail of their traumatic past, but research simply hasn’t confirmed the complete repression/blockage of memory that has driven so many therapeutic interventions.

Within the past month, Henry Otgaar, Mark Howe, Lawrence Patihis and their colleagues (including Scott O. Lilienfeld and Elizabeth Loftus) have just published a paper on the current status of “recovering” memories of trauma that clients had long repressed. A pre-publication version can be downloaded here. The findings are sobering. From the abstract:

We show that the belief in repressed memories occurs on a non-trivial-scale (58%) and appears to have increased among clinical psychologists since the 1990s. We also demonstrate that the scientifically controversial concept of dissociative amnesia, which we argue is a substitute term for memory repression, has gained in popularity. Finally, we review work on the adverse side effects of certain psychotherapeutic techniques, some of which may be linked to the recovery of repressed memories. The memory wars have not vanished: They have continued to endure and contribute to potentially damaging consequences in clinical, legal, and academic contexts.

To be clear, the authors are referring to repressed memories as the “complete blockage” of memories related to trauma. There’s no question that our minds can distance us from painful memories, but the standard response to trauma is more likely to be the inability to forget about it. There is any number of implications that follow.

First, there is a question about the sequelae of adversity and trauma as experienced at different ages. Under what conditions does it become unhelpful to explore past experiences? Examples from recent publications provide points to consider. A recent BBC article explored the concerns of clients in treatment having to describe their abuse of others in excruciating detail. A recent book describes, also in detail, the role of recovered memories in the infamous Jerry Sandusky case, and the harmful effects of treatment administered with the assumption that it was helping. Whether one is exploring what one has done or had done to them, it is vital to recall that treatment poorly delivered is not a benevolent event; any problem professional can make better they can almost certainly also make worse.

Second, whether treating abuse or preventing further harm, it can be easy to minimize the vulnerability and suggestibility of clients in treatment. Research into coerced false confessions is just one example of how powerful professionals can be, and how easily they can manipulate the people in their care. Can therapists seeking to uncover past events be certain that they are not involved in similar processes?

It maybe worthwhile for professionals to return periodically to the codes of ethics of their professions in order to consider the risks and benefits of the programming they deliver and to reconsider to what extent they have the truly informed consent of their clients. Likewise, there remains a question of what the least restrictive alternative is: Do programs that compel complete accountability inadvertently create new risks or cause new forms of harm that our field hasn’t yet explored?

Ultimately, with all of the sequelae from trauma and adversity in evidence in the lives of so many clients, it seems there is a question of why we don’t spend more time looking forward at constructing a better life and less time over-emphasizing the deconstruction of the past. Important to emphasizes is that many programs are working today to get this balance right, and many resources exist for providing treatment for abuse and aggression that minimize the potential risks. The findings of Otgaar et al described above are not entirely new. However, they do point to the ongoing necessity to consider our actions. It seems that while therapeutic fads come and go, we still face obstacles to understanding and helping our clients.

Friday, October 11, 2019

ATSA Engagement event 2019

Over the last five years as part of its annual conference ATSA a public engagement event on the issue of sexual abuse and how we can engage communities in preventing it as well as responding to it; this year is no exception! The engagement event at this year’s ATSA conference will take place at the Hyatt Regency in Downtown Atlanta on the 7th November 2019 from 15.00 – 17.00 hours.

The aim of the event is to engage professionals who have safeguarding as part of their jobs, but that it’s not their main role, and therefore would not be attending the ATSA conference. These professionals would include, but are not limited to, teachers, nurses, health care professionals, social carers, foster carers, youth workers, members of charities and NGO’s or people who would with vulnerable groups. The event will consist of 4 talks, each approximately 15 minutes, followed by a question and answers session with the panel and a networking event with representatives from the conference, members of ATSA as well as GASTA (The Georgia chapter of ATSA). This year’s topics and speakers include;
Ann Snyder, MMS, is the Public Affairs Coordinator for ATSA. She has more than 20 years of experience in media relations and crisis communications. She will discuss ways to develop effective messaging, address controversial issues, use questions from the media and public as educational opportunities, and help ensure your organization's message is heard. Ann Synder

Hayley Entrekin, EdD, LPC, ATSAF, CPCS is the ATSA Georgia Chapter (GATSA) president. She works as the Clinical Director at Haralson Behavioral Health Services, which is a rural county mental health agency. She is also the owner of Response & Prevention Counseling, where she is an evaluator of juveniles who have been charged with a sexual offense and teaches children safety empowerment strategies as a radKIDS instructor. Hayley will be briefly discussing where Georgia professionals can seek help: From prevention to acute/emergency situations to how to find/coordinate services for those that have a history of sexually harmful behaviors. 

Tyffani Monford Dent, PsyD is a licensed psychologist and the Clinical Director at a residential treatment center in Ohio. Dr. Dent has served as a consultant and trainer under various federal and state grants in the areas of working with juveniles who have engaged in problematic sexual behavior, supporting survivors of sexual abuse, family reunification after sexual abuse, sexual violence in juvenile correctional systems, and prevention/response to campus sexual assault. She will be addressing her work on both sides of the aisle of sexual violence and the importance of the collaboration between those who work with survivors and those who work with those who cause them harm.

Jocelyn Cooper is the Georgia and East Coast Outreach Coordinator for The Younique Foundation. The Foundation's mission is to heal the one and protect the many from sexual abuse. She will be highlighting a few best practices that can serve as tools to empower everyone to lead the discussion on prevention and healing in their respective circles of influence.

Kieran McCartan, PhD, is a Professor of Criminology from the University of the West of England in the United Kingdom and a member of the ATSA Board of Directors. Kieran will be discussing the causes of sexual abuse, focusing on the many reasons why a person will commit a sexual offence and how we can by better understanding these reasons, effectively prevent and respond to sexual abuse. Kieran's presentation will focus on sexual abuse from a  health, social and developmental perspective, rather than just looking at the issue from a criminal justice one.
We look forward to meeting you at the event.

Friday, October 4, 2019

Halloween and sexual abuse prevention: The mythical “Halloween effect”

A statement from the Association for the Treatment of Sexual Abusers.

As October arrives and families begin preparing for Halloween, it is always a priority to ensure children’s safety during this holiday. It is important to learn the facts and know the risks to your child during this festive time. A heightened risk of being sexually abused is NOT one of the dangers children face at Halloween.

The simple fact is that there are no significant increases in sex crimes on or around Halloween. There is no “Halloween effect.” There is no change in the rate of sexual crimes by non-family members during Halloween. That was true both before and after communities enacted laws to restrict the activities of registrants during Halloween.

The crimes that do increase around Halloween are vandalism and property destruction, as well as theft, assault, and burglary. In addition, according to the Centers for Disease Control, children are four times more likely to be killed by a pedestrian/motor-vehicle accident on Halloween than on any other day of the year.

Fully 93% of sexual assaults on children are perpetrated by someone known to, and trusted by, the child and the child’s family. But due to the myths regarding child sexual abuse that focus on “stranger danger,” communities and lawmakers often endorse policies that do little to prevent sexual abuse and instead unnecessarily stretch limited law enforcement resources.

Jurisdictions that ban individuals on sex offender registries from participating in any Halloween activities, require registrants to post signs in their yards during Halloween, or round up registrants for the duration of trick-or-treating do not make children safer. Instead, these approaches create a false sense of safety while using law enforcement resources that could be better spent protecting children against the higher risk they do face during Halloween – injury or death from motor vehicles.

Child sexual abuse is a serious public health issue that faces all communities. Although the prevalence of child sexual abuse can be difficult to determine due to under-reporting, researchers estimate that one in four girls and one in six boys will be victims of sexual abuse before age 18.

For concerned parents, the best way to protect children from sexual abuse is to know the facts about sexual offending and take precautions based on facts, not fears. Parents can visit to learn more about sexual abuse and prevention.

For more research and analysis on this topic please see a previous blog by Jill Levenson called “Halloween & Sex Crime: Myth vs. Reality” – Kieran

Thursday, September 26, 2019

NOTA Annual Conference 2019

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

This is a reprint of a NOTA Blog - Kieran

The annual NOTA conference took place from the 18th – 20th September in Belfast. NOTA, the National Organisation for the Treatment of Abuse, is a long-time partner to ATSA. This year’s conference was a real mix of research, practice, and engagement with over 300 colleagues from across the UK, Ireland and internationally in attendance (with attendees and speakers from a range of countries including the USA, Gibraltar, Norway, Ireland, and from all four countries of the UK). The conference focused on abuse within and across systems, with even Brexit getting a mention. In this blog we are going to take you on a whistle-stop tour of the event.

The 2019 plenaries combined research, practice and innovate approaches from a very broad group of speakers. The Conference started on Wednesday with Professor Teresa Gannon presenting the findings of her recent meta-analysis, which included this year's HMPPS report, on the effectiveness of treatment programs for men convicted of a sexual offense. The headlines from Professor Gannon’s presentation was that treatment does have a positive effect on behavior change, including recidivism, compared to none and that the role of consistent, well trained and engaged providers is important. Following on from this we had a “conversation with Karl Hanson” whereby Professor Don Grubin discussed with Karl a combination of pre-submitted audience questions and his own thoughts. The topics ranged from risk assessment, treatment, risk management and professional practice; it was an insightful alternative to a traditional keynote that allowed participants to gain more of an insight into Karl’s work and thinking. The Thursday started with a keynote from Professor Anne-McAlinden on peer-to-peer abuse, based on NOTA research committee funded work (a good a reminder of the annual research grant scheme that was also launched at the conference), which indicated that we need to potentially reconceptualize risk in the context that young people live and doing so would enable us to prevent as well as respond to sexual abuse better. The was followed by a trio of Ireland based practice initiatives which were focused on children who committed sexual harm and/or engagement with their families (Carol Carson talking about AIM 3; Rhonda Turner talking about the work of the National Inter Agency Prevention Program; and Gareth McGibbon talking about the development of the Capacity & Ability to Supervise and Protect Framework [CASP]), all of which demonstrated best practice and a series of tools that conference attendees could take home with them. The final day of the conference opened with Professor Erick Janssen discussing research on sex, emotion and risk, followed by a roundtable of police experts (from England, Ireland, Wales, Scotland, Northern & Gibraltar) on the potential impact of Brexit on cross border co-operation and data sharing. The roundtable was fascinating and raised several questions about the impact of a no-deal Brexit and the issues that changing data sharing agreements would have on risk management, background checks, and deportation. The conference closed with a powerful and very relevant piece by the Geese theatre group examining the interactions of abuse within the family system and how it spills into other closely aligned systems (school, sport and the community). 

The conference had 40 parallel sessions with over 50 speakers across the Wednesday and Thursday afternoon, spanning a full range of topics and speakers (of which this is just a flavor) including, integration of people who have sexually offended back into the community (Public Protection Arrangements Northern Ireland), people who have committed sexual abuse as service users and hearing their views (Kieran McCartan, David Prescott; Lynn Saunders; Karen Martin), trauma-informed care (Catherine Gallagher, Maggie Tai Rakena); youth who sexually harm (Carol Carson; treatment (David Briggs; Adam Deming; TUSLA; AIM project Eleanor Woodford & Ben Evans; Gallagher; Geraldine Akerman); sibling sexual abuse (Jacqueline Page; Melissa Maltar, Nancy Falls): 3 sessions dedicated to research and another on important issues for practitioners in critically engaging with research by the research committee. The workshops were a good mix of research, evaluation, practical working, professional learning, and knowledge exchange.

In addition to the traditional conference activities NOTA 2019 also had an engagement event that was open to all co-organised with Public Protection Arrangements Northern Ireland and took place away from the conference site. We advertised the engagement event to professionals who have safeguarding as part of their jobs, but that safeguarding is not their main role (and therefore would not be attending the NOTA conference) including, teachers, foster carers, members of charities and NGO’s, etc. We had 60 participants sign up to attend the event, all of whom attended.  The session heard from national (DSI Paula Hamilton, Julie Smyth & Kieran McCartan) and international (Eileen Finnegan & Maia Christopher) speakers about the etiology, prevention and risk management of people convicted of sexual offenses in the community.

NOTA 2019 saw Professor Simon Hackett step down as Chair of NOTA and Professor Sarah Brown take over the role. Unfortunately, Simon could not be in Belfast with us but his contribution to the organization was applauded in his absence and he was thanked for all his hard work. Also, NOTA 2019 was Gail McGregor’s last conference as conference chair and she too was thanked for all her hard work.
NOTA 2019 fitted a massive amount of material in across three days, which left us informed, refreshed and looking forward to next year’s meeting in Leeds.

Thursday, September 12, 2019

The purpose and outcomes of treatment

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

As we prepare for this year’s NOTA conference, we have been again discussing many of the controversies of our field, among these are the effectiveness of the work that we do. An important 2017 article by Karl Hanson and his colleagues is among the most recent to indicate that truly low risk/need people very often require no abuse-specific treatment at all. We certainly agree and continue to urge considerable thought in this area, as we did in 2017. However, it’s important to distinguish abuse-specific treatment from other mental health services that can help people lead a more fulfilling lifestyle in which offending is undesirable and unnecessary. One concern we have in the subsequent discussions is that it may become easy to confuse “doesn’t need treatment aimed at reducing his risk” with “doesn’t need treatment, period.” This leads to broader questions about what our goals are when providing treatment.

Criminal justice policy and practice, internationally, typically indicates that something should be done with people convicted of an offence, including sexual offences, parallel to their punishment/incarceration. These programs, including treatment and other interventions, are usually pro-social, educational and designed to help people integrate back into society and desist from future offending. However, it might behoove each us to ask ourselves honestly what our motivations are in believing in the effectiveness or ineffectiveness of abuse-specific treatment. Is it that we believe that an individual should receive treatment because it is the best outcome for them or is it because we feel that we are providing treatment to someone because something needs to be in response to their problematic behavior and treatment is the path of least resistance in the public as well as the political domain? Do we believe in treatment because we believe that people can change or because we want to be seen to be doing something and that treatment is an acceptable outcome? To what extent do we view treatment, and the accountability it brings, as part of required punishment and/or justice for the people who have been convicted of a sexual offence? Therefore, what is the purpose of treatment, especially “mandated” treatment?

Different readers will have different responses to the questions above. Much debate in our field has emerged from findings such as those by Schmucker and Lösel in 2015. That study found re-offense rates of 10.1 and 13.7 percent for treated and undertreated people convicted of sex crimes respectively. Although this represented a relative reduction of 26.3 percent, the numbers are clearly not what anyone would like them to be. Nonetheless, other studies have found that people who abuse very often believe that treatment is important and can be helpful. How should we understand all these findings?
A recent article in the New Yorker addressed problems in understanding statistics. Within the article, the author took note of a now-classic study:

Take a clinical trial on aspirin run by the Oxford medical epidemiologist Richard Peto in 1988. Aspirin interferes with the formation of blood clots, and can be used to prevent them in the arteries of the heart or the brain. Peto’s team wanted to know whether aspirin increased your chances of survival if it was administered in the middle of a heart attack.

"Their trial involved 17,187 people and showed a remarkable effect. In the group that was given a placebo, 1,016 patients died; of those who had taken the aspirin, only 804 died. Aspirin didn’t work for everyone, but it was unlikely that so many people would have survived if the drug did nothing. The numbers passed the threshold; the team concluded that the aspirin was working.

The story of these findings is a reminder that our findings are best understood when placed into a broader context. Obviously, there are differences between baby aspirin (where the benefits will nearly always outweigh the risks) and treatment for sexual abuse (where some clients have faced consequences from their treatment disclosures despite attempts to protect their rights against self-incrimination). Nonetheless, the numbers themselves remind us that even a small level of impact in sexual violence can produce dramatic improvements in the quality of life of both those who have abused and the people who won’t be abused thanks to our interventions. Marshall and McGuire compared various kinds of treatment in 2003, and in their conclusions suggested that using a harm reduction index to estimate effect sizes for treatment with sexual offenders would produce more meaningful results.”

Although treatment for people convicted of a sexual offence is rooted in language around reducing reoffending, this may not be the only outcome we should consider. We must remember this! Treatment for people convicted of a sexual offence does not stop offending behavior, it provides individuals with the skills to understand and manage their behavior better. Treatment is a process and not an outcome! Hence, we need a “what works”, individualized approach that is orientated towards the client, what they need, what they respond too and what will help them change their lifestyle.

Whatever the finer points may be, we keep returning to what the research shows:

·     Across time, place, and setting, people can benefit from talking to professionals to get on track and stay on track with their lives.
·      Punishment-only responses have not worked in any of the large-scale analyses that have taken place (e.g., Smith, Goggin, & Gendreau, 2002)
·       Treatment for sexual aggression can help to reduce re-offense and build better lives
·   For those returning to the community, treatment combined with supervision can increase its effectiveness
·        As others have observed, the safest person who has abused is:
o   Stable
o   Occupied with work or education
o   Accountable to others in his or her life
o   Has Plans for the future
o   And has everything to lose by doing it again

As we move into conference season, with the NOTA and ATSA annual conferences occurring over the next couple of months, we can continue these discussions and consider how our policies can most effectively put these principles into action. 

Thursday, September 5, 2019

Crossing the Social Ecological Pond at the 2019 National Sexual Assault Conference

By Deirdre D’Orazio, PhD

I find myself feeling inspired this Monday morning.  Typically, Mondays are a bit overwhelming when I look at the work week’s “to do” list for my state and private practice jobs in sexual abuse intervention. My inspiration comes from having “crossed the pond” last week, over to the National Sexual Assault Conference.   “What pond is she talking about?” you ask.   The pond I speak of is a metaphor for a few valuable things.

First, on an individual level, I “crossed the pond” from where I live in California to Philadelphia, Pennsylvania. I was born and raised right outside of Philly and since my parents are the first generations from their families to live in America (from Italy and Poland), there was a sense of homecoming. 

Philadelphia is considered a symbol of freedom and American values, because it is the birthplace of the United States of America, where the Liberty Bell rang and the Declaration of Independence was signed after America won its freedom from Great Britain in the Revolutionary War in the 1700s.  Not too long after, Pennsylvania and the other Union states played an important role in the American Civil War opposing slavery and the secession of the southern states. In the early 1900s huge waves of immigrants settled in Philadelphia, along with a Great Migration of African Americans. Philadelphia was known as a melting pot where many ethnicities assimilated into a new America.  Despite this inspiring legacy, a shadow side of Philadelphia as the archetype of freedom is clearly evident in its subsequent long history of racial injustice, and earlier history of having been taken from its first residents, the Native American Lenape tribe.  Likewise, the milieu of the National Sexual Assault Conference seemed to embody both a zealous actualization of sexual abuse’s demise and also a wounded awareness of complex layers of collective, cultural, and personal trauma affecting this public health problem.

A second “pond” is a crossing over from the familiar land of treating sexual abusive individuals to that of a conference hosted an organization that focuses on abuse recipients. There is a valuable relationship to be further strengthened between we “ATSA types” and our allies in fighting sexual abuse that come from victim service organizations.   The conference theme, “Beyond the Breakthrough” was impressively apparent in workshop programming right at the growing edge of sexual abuse prevention. This was not a conference singularly focused on victims/survivors of sexual abuse. This conference was about acknowledging advancements over the past year exemplified with the “#me too” movement, celebrities accused and/or convicted of a sexual offense AND using that momentum to break through new prevention territory.

Workshops were inspiring and deeply thought-provoking. For example, Alan Heisterkamp and Michael Fleming’s session on Men’s Accountability Around #Me Too; Captain Noah Coakley and Sergeant Jessica Whitestone’s session on Sexual Assault and Direct Victim Services in the Air Force; Lisa Winchell-Caldwell’s session United in Mission:  Coordinating Intervention and Prevention Efforts. The conference also hosted an ATSA track where Maia Christopher, Kieran McCartan and I provided sessions that discussed what is known about sexually abusive individuals, their treatment and how we can work toward developing collaborative partnerships to progress our shared goal of ending sexual abuse. 

A third “pond” crosses time. It has to do with taking a step beyond a typical ATSA perspective to what is going on now in our communities and society.  This is a lens of social justice and it rewinds to the point in time before abuse happens in the first place.  Workshops tied together with the best from numerous intersecting fields to talk seriously about small and large changes that can have a big impact on preventing sexual abuse.  For example, Nwando Ofokansi’s session on The Other Birds and Bees:  Discussing Healthy Sexuality with Kids; Rolanda McCall’s The Sexuality of Black Women:  From Traumatized to Empowered, and Social Justice as Our Prevention Framework by Nubia Pena.

With our own children, do we model consent, respect boundaries, teach healthy sex, and disavowal coercion?  Examples are: asking kids’ consent to be hugged; retiring the common parenting tactic, “because I told you so” and getting that discussion about sex started before the hormonal flood of puberty.  As community members, are we showing our commitment to ending sexual abuse?  Intervening instead of being a passive bystander when abuse is happening; initiating, instead of avoiding, conversations about “what I do for a living” to get thoughtful dialogue going about the kinds of things everyday people can do on an everyday basis to prevent abuse; volunteering to do a talk for a local group; listening thoughtfully and openly to all perspectives.  

Workshops also addressed deep societal and cultural realities that support abuse and its root cause, - oppression.  For example, how the media and entertainment industries promote the sexualization of children and “rape culture”; the ongoing effects of slavery and racism on the high prevalence and low prosecution rates of sex crimes against black women; the lost boys of sexual abuse, the males that are recipients (and often future perpetrators) of sexual abuse; and the impact of verbiage such as “predator” on outcomes and expectations.  For example, Elizabeth Stahler and Alexandra Lenzen’s session Missing Nuance:  How Dehumanizing Perpetrators Can Cause More Harm than Good.

There has been increasing talk lately about how ATSA members can improve our efforts to prevent sexual abuse.   Attending the National Sexual Assault Conference proved a valuable journey across the social-ecological pond. There are exciting opportunities at individual, relationship, community, and social levels. Actualizing our goal of preventing sexual abuse starts with ourselves as individuals and how our behaviors align with our “no more abuse” goal. It includes promoting equanimity in how we relate to others and finding ways to collaborate in our communities and “across the pond.”  Small changes now can help evoke the social change we envision.