Tuesday, December 20, 2016

Star Wars and Sexual Abuse Treatment

Weary from many long hours of assessments, treatment, travel, and training, I went with my family to see the new Star Wars movie. I’m a dreadful Star Wars fan; most of the time I smile my way through these movies because I don’t know what’s going on. They are pleasant to look at though, and remind me of when I waited in line for an hour or more to see the very first one in the theaters in the late 1970s, probably wearing the fashions of the times: an oversized down jacket and light-colored Frye boots.

Four decades on, I found myself resentful. Why are these characters considered heroic when my colleagues aren’t? After all, the people I work with may occasionally make mistakes or become misguided, but every one of them puts their all into a shared mission of healthier lives and safer communities. As many have observed, the beneficiaries of our work will never know to say thank you because they won’t have been abused. My colleagues are not, as one defense attorney in Wisconsin once said to me, the “Death Star.” The vast majority of people working from all perspectives towards the goal of eliminating abuse are all over-worked and under-paid. Maybe it’s that our costumes and transport aren’t as cool as the Star Wars characters. I’m quite certain I would not look as lithe climbing up the ladder of a spaceship as some of the figures in the movie.

Then I realized the difference: These characters don’t have to do case notes. They don’t know from DAP and SOAP formats, and couldn’t formulate a SMART goal if Princess Lea’s life depended on it. To my knowledge, there are no ethics-codes considerations around the use and misuse of protocol droids… or any robots for that matter. These characters have never done paperwork, nor worked with someone whose job involves cracking the whip on therapists to submit their documentation. It’s no wonder they’re all so attractive and confident. They’ve probably never had to write or review an incident report after a long shift!

Meanwhile, while we are working, no one who observes us is moved to eat popcorn. When we solve problems, we don’t know if they are actually solved until the researcher (probably from Canada) with the statistical-analysis package says it worked. But that is only 15 years into the future, and even then the final report will say that “more research is needed.” It’s deeply unfair; Star Wars doesn’t have a meaningful control group… and I don’t even get to have a John Williams soundtrack! All I get is the occasional Survey Monkey request for a research project studying PTSD symptoms of professionals in our field. And worse, no one is studying the dirty little secret of our work: the most piquant symptoms of trauma often come not from vicariously reliving the worst moments of others’ lives, but from our interactions with state licensing audits.

Although I have known some professionals who might be deserving of an award for their ability to bring drama into the workplace, I have to conclude that my colleagues are people whom few know to thank for their efforts. My neighbors and family long ago learned to be very careful about asking me how things are going at work, as the answer might cause them to dissociate. As I have joked many times, describing our work to an outsider often “makes their face go straight to screen-saver.” Indeed, we often forget how much work goes into protecting the sensitivities of those around us. Thanks to our professional boundaries and ethics, there is no room for anything that sounds like “Rogue One” in our field.

We may give up some dreams going into the work of eliminating sexual abuse, but I would argue that our dream is better and in some ways already coming true. The ordinary heroes that work in our field can point to a track record of reduced violence across the time since the first Star Wars movie came out. We can’t always prove that it was our efforts, but we are definitely part of the trend.

I hope everyone has a wonderful Holiday Season… and then gets back to this excellent, meaningful work.

David S. Prescott, LICSW

Thursday, December 15, 2016

Child Sexual Abuse in organisations and institutions

Over recent years we have seen a growing recognition of the problem of child sexual abuse, both historically and non-recent, ranging from  sexual abuse by celebrities, institutional child sexual abuse and sexual abuse within the criminal justice system (i.e., the police & prison service); which have resulted in a series of Inquiries in to institutional child sexual abuse in England and Wales (Independent Inquiry into Child Sexual Abuse, the Office for the Children's Commissioner's report into CSA in the Family Environment), Scotland (Scottish Child Abuse Inquiry), Northern Ireland (Historical Institutional Abuse Inquiry) and Australia (Royal Commission into Institutional responses to Child Sexual Abuse. It is not surprising given what these inquires have suggested, especially the historical ones, that there may be more revelations to come, and indeed three weeks ago with had the revelation of historical Child Sexual Abuse at the heart of Football in the UK.

Continuing revelations, disclosures and conversations of cover up raise a host of questions about the reality of Child Sexual Abuse, the locations of the abuse and the reality of safeguarding in these places. Whether it be about institutions (i.e., Care Homes, etc.) or organizations (i.e., the Football Association [FA], BBC, etc.) there are a number of commonalities that need to be considered:

-          Safeguarding: All organizations should have safeguarding in place, those working with children and other vulnerable groups; but this must be more than documentation, it needs to be the lifeblood and within the culture of the organization. The issue is often not that there are not any safeguarding policies or procedures in place, but rather that they are not upheld or badly managed. With regard to the FA they indicate that safeguarding and policy conversations are harder to monitor, as well as uphold, at the amateur levels and we hear that policies are not always put into practice at grassroots level. This results in some institutional recognition of guilt, which is often after the fact, and a recognition that practice needs to change.


-          Prevention: Tied to ideas of safeguarding is the need for work to be done in organizations and institutions to prevent, as well as respond, to child sexual abuse. Quite often the discovery of child sexual abuse results in an institutional response, a change in policy, a criminal conviction and/or an inquiry; however, if we are thinking about prevention being part of the fabric or organizations and institutions then some of this best practice should already be happening. The prevention of Child Sexual Abuse is a growing field but it has clear benefits for organizations and institutions in terms of workforce, development, policy, and practice.


-          Communication: We know from years of research and practice that child sexual abuse thrives in cultures of isolation, where there is poor communication and little transparency. Perpetrators often convince victims that no-one will listen to them, victims are sometimes vulnerable and do not believe that they have anywhere to turn and society thinks that the state (police, social work, prison system and government) do not do enough and when they do engage it does not go far enough. Therefore, theoretically, this means that the more that we talk about child sexual abuse and neglect the more we become aware of it and are better able to navigate, prevent and respond to it. However, it’s not that simple as we do not talk about child sexual abuse consistently and when we do it can be in  pejorative terms that reinforces social norms (i.e., “offenders -  bad, mad or sick”; “victims -  vulnerable, at risk or at fault”; “the state not doing enough for victims and too much for perpetrators”; and “it’s not societies fault or responsibility”) and pushes the blame away, which we have seen not infrequently in the historical child sexual abuse scandals (“there is bad practice and poor safeguarding, but it’s really down to a few bad apples”). We need to think about how we discuss child sexual abuse in our homes, schools, institutions, organizations and society so that the narrative is evident and available there and people feel more free to talk.


-          Disclosure and discussion: The recent FA historical and non recent abuse allegations and disclosures are, as with the care home and institutional ones, particularly salient as they focus on boys and men. Research and practice has indicated that boys and men find it harder to disclose sexual abuse as it impacts their sense of masculinity and may indicate weakness in arenas, like football, were weakness is not tolerated. We need to work with young players to help them realize that disclosure is not a weakness and that they need to come forward and disclose abuse; there have been  recent campaigns around this, since the FA allegations came to light a few weeks ago including a helpline and two video campaigns one lead by Wayne Rooney and another by David Beckham. The FA’s quick response to the allegations and historically cases enforces the need to make itself an organization that puts preventing and responding to child sexual abuse at its core; similar to what the NFL has done around domestic violence and sexual assault. 


-          Vulnerability: The conversations that have started to emerge from historical institutional child sexual abuse discussions have highlighted the degree of vulnerability of the victims. This vulnerability can be deeply ingrained in them because of their social class, culture, mental health of mental capacity; but it can also be situational, as has been seen in the recent FA disclosures, were victims talked about wanting to progress, to succeed and to move on and getting close to (as well as pleasing) the coaches was a way of doing this. The vulnerability that children experience can make them a target, or at least more susceptible to child sexual abuse by individuals who recognize and want to use that vulnerability. This reiterates the need for confident, trained and responsive organizations and intuitions that are able to identify, prevent and respond to signs of child sexual abuse when they present themselves at the earliest opportunity.

Although, the focus of the conversation is currently centered on football it seems like it may be only a matter of time before this crosses into other sports, nationally and internationally. We as a society need to recognize that we have to be able to work to prevent child sexual abuse, as well as respond to it, in a proactive way that sufficiently safeguards children,  and opens up communication in a proactive fashion to discussions about how can all play a role in protecting children and in preventing abuse and exploitation. We could say that “child sexual abuse in football, just another example of a few bad apples slipping through the net” or we have the opportunity to be more proactive and recognize that child sexual abuse is a more endemic problem in all our communities and in many of our institutions and we have now have the opportunity to refocus our efforts on prevention and early intervention and on ensuring that the victims, survivors and those who have caused the harm get the help they need.

Kieran McCartan, PhD, & Jon Brown, MSc.

Friday, December 9, 2016

A milestone: Our 200th blog posting

Let me first say that I am extremely honored to be making this 200th post to the sajrt.blogspot.com site.

In the fall of 2010, I was approached by then-editor James Cantor of Sexual Abuse: A Journal of Research and Treatment. In tandem with Sage, the Association for the Treatment of Sexual Abusers was establishing a blog site and I was asked to be the inaugural blogger, as it were. I was all too happy to accept.

The original intent of the blog was to highlight and discuss findings in the published research – as a way to bring the science to the masses. However, it was not long before the perspectives reflected in posts transcended this initial focus. Indeed, sajrt.blogspot.com became a place where applied issues could be raised and, to some extent, debated. Although generally in response to or highlighting of research findings, the blog became less about hardcore research and more about what we should do about research, or where more research was necessary.

I received my initial training in this field as a researcher and, somewhat romantically, I still consider myself to be a researcher – even though the nature of my work has become progressively more applied as the years have gone by. As the nature of my work changed, so did the degree of attention I could pay to the blog, as well as the topics I thought I could responsibly handle. This led to the invitation of two associate bloggers: David Prescott – with his keen understanding of the application of research to practice, and Jon Brandt – who has consistently demonstrated a unique talent for highlighting the intersections between research, practice and, most importantly, policy.

With the addition of these two key contributors, the breadth of topics the blog could tackle increased considerably. Further, the periodic invitation of guest bloggers contributed to even greater breadth of perspective. During my tenure, I was privileged to contribute to or sponsor posts addressing controversies in diagnostics, best practices in working with juveniles who sexually offend, and hard-hitting examinations of social policy in sexual violence prevention. I believed that we were making real contributions to these important discussions. However, my professional practice continued to change – the unfortunate consequence being that I could no longer retain my role as the Chief Blogger. Enter Kieran McCartan...

I first met Dr. McCartan when he was a first time ATSA presenter at the Atlanta conference. Dressed in a light blue suit, sporting a heavy metal-esque beard, and speaking in a thick Irish brogue, he immediately impressed me with his discussions of the impact of media and public perceptions in sexual violence prevention. He was clearly the best candidate to succeed me as Chief Blogger. This was recently revalidated in his appointment to Associate Editor for Social Media for our parent journal SAJRT.

Over the past couple of years that Kieran has headed the blog, in collaboration with David and Jon, posts have been regular and consistently of high quality. Indeed, many of the most thoughtful and hard-hitting perspectives in our field have been reflected in sajrt.blogspot.com posts. I am proud to have gotten the ball rolling, but these three fellows have done a much better job than I ever could have in fulfilling the promise of this blog site.

And, it is on that note that I commend Kieran, David, and Jon on their continued high quality product. I am a strong believer in knowledge transfer and I am frequently reminded by my children that there are other ways to learn things than by reading books and journals. Even an old guy like me has had to concede that social media plays an increasingly important role in our quest for true sexual violence prevention.

Going forward, the challenges we face as a field are ensuring true adherence to evidence in establishing practice guidelines, getting further upstream in our prevention efforts, and inviting greater participation by ordinary citizens in the community safety endeavor. Here’s to another 200 posts!!

Dr. Robin J. Wilson, ABPP

Friday, December 2, 2016

Developing a Prevention Perspective: Discussing the work of Joan Tabachnick

Prior to 2009, many of us working in the field of sex offender research and treatment never considered our work as “prevention” work. In 2010 ATSA and the National Sexual Violence Resource Center joined together to present an award that recognizes people who have made significant contributions to preventing sexual violence through their work to facilitate effective partnerships between advocates working on behalf of victims and survivors and those working in the area of sex offender management and treatment. This prestigious award is in honor of Gail Burns-Smith who was a radical idealist, who believed we could have a world free of sexual violence. Gail co-founded the National Alliance to End Sexual Violence which focuses on public policy advocacy. The Alliance was instrumental in securing passage of the U.S. National Violence Against Women Act and the related funding of programs for services to victims of sexual assault and other violence. She was a founding Advisory Council member for the National Sexual Violence Resource Center from 1999-2004. While Gail has a storied passion demonstrated throughout her career, she always wanted others to continue her work, knowing that it would take all of us working together to fulfill her vision.

It is with great honor as a colleague, friend and champion in the challenge to prevent sexual violence that I introduce Joan Tabachnick as the 2016 Gail Burns Smith Award recipient in recognition of her outstanding leadership and tireless efforts in raising awareness about the necessity of preventing sexual violence, in promoting the dissemination of information about prevention strategies, and in helping every person to engage in prevention at whatever level possible.

At ATSA the term “prevention” has become synonymous with Joan Tabachnick. She is the first person who comes to mind when prevention is mentioned. She has championed all things prevention, not only highlighting for us the important contributions to prevention that we as clinicians and researchers make, but also broadening our perspectives to realize we can do more, that our work of preventing the next abusive sexual act should be expanded to stopping any sexual violence from ever occurring. She has provided us with a frame for the picture of our work that couches it in the broader perspective of prevention, encouraging us always to see that developing a prevention perspective and supporting and generating prevention programs will ultimately be the path to ending sexual violence altogether.

Joan possesses many personal and professional qualities that distinguish her and elevate her to a status comparable to Gail Burns Smith. She is warm, engaging, genuine, and passionate in everything that she does. Despite the long line of people waiting for the opportunity to engage her on multiple issues, Joan nonetheless, finds time for everyone, and when she sits face-to-face with each person she manages to communicate to each that this is the most important activity she could be doing at this moment.  She is truly supportive and helps all she encounters to hone their ideas, focus their communications, and fashion their presentations so that others will listen and hear.

Joan has served two terms on the ATSA Board of Directors and has chaired the Prevention Committee during her tenure on the Board.  It is largely because of her creative energy and tenacious efforts that this committee has been so productive. She has also been instrumental in helping ATSA develop a strategic plan, and she has mastered the ability to keep many people on track through the length of the plan. This is only a small part of the work she does.  She has worked tirelessly in the state of Massachusetts on numerous public policy issues, and as part of her work at NEARI Press she has helped us all to stay current on the best evidenced-based practices.

What is, however, most impressive about Joan is that the efforts of one person can truly make a substantial difference in addressing the need for prevention perspectives and programs. Joan has made many contributions to moving prevention into the public consciousness. In addition to all the work I  have just described, Joan has also co-authored A Reasoned Approach: Reshaping Sex Offender Policy To Prevent Child Sexual Abuse, (2011) and Engaging Bystanders In Sexual Violence Prevention, (2008, 2009).

Joan brings nearly 30 years of experience to her work in nonprofit and social change organizations. For the past 20 years she has worked in the field of sexual abuse prevention with a special focus on preventing the perpetration of child sexual abuse. Her most recent work is an NSVRC publication, Engaging Bystanders in Sexual Violence Prevention, and she is in the process of creating an online course of the same name. Joan’s expertise is evident in her numerous publications in peer reviewed journals, in her award winning public service announcements and public information materials, in the invitations to participate on national expert panels, and in the frequent media requests for expert advice on sexual coercion that she receives. Joan continually reaches across the aisles of victim advocacy and sex offender treatment, and between research and application. Most recently Joan was awarded a fellowship with the SMART office to develop a dialogue between treatment, supervision, and law enforcement orientations and to help frame the work of prevention that is at the core of all three. Because of Joan’s tireless work this fellowship has been extended.

Joan holds an MPPM from the Yale School of Organization and Management. Her unique background blends expertise in management, strategic planning, public dialogue, and social marketing. Over her career she has designed programs and products for children’s and women’s issues in local, regional, national and international settings. Gail Smith Burns would be proud of the work that Joan does, and I can think of no more deserving person for the Award named in her honor.
Becky Palmer, MS

Friday, November 25, 2016

Abuse is Abuse

This might be a good time to simply “rip the bandage off” and get back to the basics: Abuse is abuse. Part of what makes it abuse is that one can never know the outcome. As co-blogger Jon Brandt recently noted, research has shown a particularly challenging truth; that those who are abused don’t necessarily view their experience as abuse. He states:
One insidious characteristic of non-violent sexual abuse is that it may be unrecognized.  When people are asked why they didn’t report the abuse, they sometimes say they felt duped, perhaps complicit, but mostly confused.  And when victims otherwise liked their offender, they often didn’t report because they were afraid of the uncertainty of the aftermath – for themselves and for the offender.
This leads us to question where violence begins and ends. Does it need to be overtly and blatantly violent to be abuse? Australian psychologist James Ogloff and his colleagues examined survivors of child sexual abuse after 45 years and found:
Overcoming many limitations of previous studies, this study revealed that, in general, CSA victims were 1.4 times more likelyto have some form of contact with the police for any matter compared with other members of the general community. Although most (77%) CSA victims did not have an official criminal record, CSA victims were almost five times more likely than others to be charged with any offence, with the strongest associations yielded for sexual and violent offences and breach of orders.
These findings call to mind what many professionals have said in treatment across many decades. To paraphrase Stanton Samenow, you don’t need to shoot someone or leave them lying in a pool of blood to have committed an act of violence; “no one was hurt” is a common post facto rationalization made by people who have committed serious acts of violence. We hear this minimizing from perpetrators, victims, family members and society through the myths that surround abuse; especially historic child sexual abuse ("why complain now years later?"), rape ("why didn't they fight back?") and inappropriate/under wanted touching ("it wasn't that bad, it wasn't rape!"). Which begs the questions, how we understand, discussion and recognize abuse as a society as well as an individual? We all know the terminology, language, labels and (for the most part) where to seek help and/or justice; but do we really recognize and process abuse? So we say - "sexual abuse is a broad constellation of acts that is everything and anything"; "sexual abuse happens to other more vulnerable people, not to me and people I know"; "sexual abuse is a caused by other more deviant not by people I know"; and "well, the system isn't fit for purpose so why bother reporting". We hear so much, see so much that we become desensitized and need the extreme case to come along to enact a conversation, so not the daughter sexually harmed by her father but the football coach that abuses multiple children in their care.
Taken together, these findings remind us that:
1)      The effects of violence, including sexual violence, can be brief or last a lifetime.
2)      The effects of violence can occur beyond the awareness of the person who has been abused.
3)      Abuse poses an unacceptable risk of harm, even if it does not cause acknowledged harm in every case.
Of course, there are other implications:
·         Abuse exists at every level of society; it is in our communities and all too often in our own families.
·         Only a small minority of those who are known to have sexually abused are at high risk to be re-arrested for sexual abuse.
·         People who abuse often do so until they are caught and cautioned by an authority; Being sanctioned in some way for abuse can have dramatic effects on one’s behavior.
Why are these points so important to mention?
First, the world has watched as many of our favorite people have recently come to light as having sexually abused others (e.g., a parade of entertainers, athletes, politicians). Perhaps, more importantly, ATSA members, other professionals, and the lay public are once again challenged to re-visit not only what abuse is, but what it means in our lives. ATSA’s Executive Board of Directors recently issued a statement that caused some controversy among ATSA members; some members felt it singled out one side of the political aisle, while other members noted that sexual misconduct seems equally distributed over time across parties. Even beyond our organization, many have expressed concern about the actions of political leaders, while others have appeared to use the actions of others for their own political gain. It often seems that no one is blameless in recent world events.
2016 has been an unforgettable year in world politics, and many of us – the authors included – experience grief that there is not more we can do to influence events around the planet. Just the same, it is vital that we not take our eyes of at least one prize: the elimination of sexual abuse.
David Prescott and Kieran McCartan


Monday, November 21, 2016

The families of perpetrators of sexual harm: The silent minority

Often times we forget about a silent but impacted group of individuals related to sexual abuse, the families of the perpetrators. I spent some time on Friday talking about this with prison staff in the context of the men in their establishment and the regularity as well as reality of visitation time; but I think that it engagement between perpetrators and their families goes much further than this one issue as it impacts their rehabilitation as well as reintegration through having a support structure on the outside. We as researchers, professionals and treatment providers spend our time discussing perpetrators, victims and the criminal justice system but we can give little (or sometimes no thought) to the family members sitting on the side-lines impacted by the abuse and how it affects their lives. It is important to recognise that not all family members want to maintain contact with perpetrators, but some do and others change their mind over the course of time and reopen potentially sealed doors. However, do we really support, aid and help the families of perpetrators? The reality of the situation is, compared to other offending populations and risky populations, probably not, no. The families of perpetrators face a range of ongoing issues and live out the experiences of perpetrators simultaneously, because:

-         Dealing with the label of having a family member who is in prison, or in the community, as a “Sex offender”. Whether this be children of the perpetrator, the wire/partner of the perpetrator having to live in the community [or the house] where the abuse happened. While not everywhere has public disclosure of sex offender information the court case is often printed in local papers and the local “gossip” machine will spread knowledge. However, no one tells family members how to respond, cope and manage with this, epically if it is coupled with the idea that they were aware of the abuse and kept quiet or that they “might be sex offenders too”?

-        Tying in with the label of sexual abuse familiarise are also stigmatised by association, epically if they decide to stick by the perpetrator and work with them. Walking away in some instances garners social support and acceptability; but staying suggests that families are sympathetic and supportive. The stigma that families can face does not recognise the complexity of relationships or abuse, it reiterates a simplistic societal judgement that does not exist for other risky groups (addicts, alcoholics, etc).

-        Quite often families, like victims, blame themselves for what the perpetrator has done regardless of whether the sexual harm was in the home, community or completely unknown. Families will carry this guilt, self-blaming and annoyance (at themselves and the perpetrator) with them while the perpetrator is in prison and post release.

-        They often receive little or no support, financial or emotional, while their family member is imprison. Quiet often these families have lost a means of finical support, either because the main breadwinner has lost their job but also maybe the remaining family member has to give up work [or reduce their hours] to care for the family in the perpetrators absence.

-        Family members are dealing with their own trauma in respect to the perpetrators sexual abuse, in that someone they thought they knew well had done this. How do they process this trauma, where do they go for help and how do they vocalise. In addition, there may be other forms of abuse, trauma and dysfunction that they may have been exposed to at the same time that the sexual harm was happening elsewhere. Who can they turn to for help, support, counselling and/or advice? Some areas have resources and support but this is by no means universal or free.

-        Given the secretive nature of sexual harm and the impact that it has, this means that families carry an additional burden of not being able to discuss the abuse or its consequences; which places them under more internal and external pressure.

-        Visitation, as already mentioned, becomes an issue as the perpetrator may be sent to a prison too hard to access and/or that because you cannot bring children, or minors, with you to a sex offender establishment means that families may not be able to visit (if they wanted to). This means that often time families are divided via practicality rather than choice. Which means that perpetrators and their families are artificially, but meaningfully, separated in a way that does not happen for other types of offenders.

-        The fact that the perpetrator, whether they want them to be or not, is omnipresent in their lives; by default, by actions and by association.  The family may want to help and support the perpetrator, but they may not. If they don’t want to support the perpetrator they may share the same surname, circle of friends and may have to see/hear/discuss them through conversations that they have with family members that still contact them (parents, siblings or children).

The families of perpetrators of sexual harm are placed in a difficult and often invisible situation. We as the providers of research, treatment and support for victims and perpetrators need to think about how we can best assist and support all of those impacted by sexual harm.

Kieran McCartan, PhD

Friday, November 11, 2016

ATSA 2016 Conference Highlights

ATSA’s 2016 conference flowed seamlessly, no audible complaints beyond the usual disagreements over the best use of air conditioning. As always, old friends gathered and caught up on their work and lives, and newcomers had the opportunity to see the largest conference of its kind in the world. Many participants joked about the odd juxtaposition of our work with certain Disney characters, but once at the venue there was nothing unusual, except perhaps the utter enormity of the Swan and Dolphin resort itself. The author’s favorite memory of the facility was a seasoned professional from Northern England trying to come to terms with the loud music, warm air, and the magenta lights on the palm trees in the walkway between buildings at night.

The balance of plenaries was current and on point, ranging from campus sexual assault research to advances in risk classification. The concurrent workshops for juveniles featured recent innovations and areas of inquiry. One program reported on their use of the adverse childhood experiences questionnaire in residential treatments (in brief, the amount of adversity in the backgrounds of these youth is unacceptable). Another program reported on low-dose, high-impact mindfulness exercises to build responsivity with adolescents and their families in treatment. 

Importantly, the conference offered an opportunity to honor three professionals involved in the prevention of sexual violence: Joan Tabachnick, Keith Kaufman, and Leo Cotter. While many people are aware of Joan’s fantastic work with bystander prevention (She won this year’s Gail Burns Smith Award) and Keith’s work as a Past President and leader of ATSA’s Prevention Task Force (He won this year’s Significant Achievement Award), fewer are aware of Leo Cotter’s incredible work educating judges and lawmakers in Florida (He won ATSA’s Distinguished Contribution Award). All three have done far more work outside the limelight than within it.  (DP)

We also heard from Dr. Sarah McMahon about an issue that is gaining societal and political significance inside and outside of the United States: campus sexual assault and bystander intervention. Sarah’s plenary was a timely reminder that we need to confront sexually harmful behavior in all its guises, regardless of who the perpetrator is or where it happens, and that this is the responsibility of us all – it’s a societal and individual issue. This tied-in well with a workshop from Maree Crabbe on sex education in schools and how we can respond to youthful engagement with pornography. 

This year we held another public engagement event prior to the start of the conference.  It was hosted by the University of Central Florida and supported by Florida ATSA and Innovative Modular Technologies. We had approximately 40 members of the public, practitioners and campus police attend to hear speakers discuss sex offender registration (Jill Levenson, Nicole Pittman), human trafficking (Sara Lynn Ard, Greater Orlando Human Trafficking Task Force) and bystander intervention/campus sexual assault (Sarah McMahon). After the presentations there was a great question & answer session that reinforced the importance of the event and the topics discussed.  (KM)

This year’s ATSA conference offered the usual rich diversity of topics, and invaluable networking.  There were great plenary sessions, and with dozens of workshops to choose from, it has always been a challenge to pick only six workshops to attend.  But this year conference organizers provided some relief to annual agonizing over registration - attendees were allowed to go to workshops other than those for which they originally registered (space permitting).  While changes in workshop attendance requires on-the-fly logistical challenges for conference organizers, it recognizes that attendees often discover, either after registering, or at the conference, that some adjustments to their registration would make their conference experience much more beneficial.  Brilliant accommodation!

It’s always difficult to choose only a few highlights from a great conference, but I’d like to give a shout-out to some of Elizabeth Letourneau’s thoughtful plenary comments.   Elizabeth discussed some of the very challenging concerns for sexual offender management.  Elizabeth explained that sexual violations between children need to be understood as typically very different from adult sexual offending, and that, “it is appropriate and just to treat kids differently” at every stage of intervention.  Another topic was the emerging understanding of pedophilia.  Beyond the need for colleagues to support successful recovery for those who have sexually violated children, Elizabeth discussed the extraordinary challenges of supporting hope and prevention for non-offending pedophilic teens and adults.  She went on to explain how the Registry and other misguided public policies undermine recovery for offenders and their families - particularly for juveniles. 

To learn more about the challenges of civil regulations on offenders and their families, two powerful documentaries ran continuously on Thursday and Friday, in the ATSA Screening Room: “Pervert Park” and “Untouchable.”  Both featured former offenders and their families, as they bravely acknowledged their sexual offending and candidly told their stories.  Both documentaries were well produced and edited, and provided compelling perspectives on how the registry and residence restrictions interfere with recovery.  A Saturday morning plenary featured “Untouchable” producer David Feige, who discussed how he went from attorney and public defender to filmmaker. 

Michael Caldwell’s compelling 2016 research, on the low rate of juvenile recidivism, found its way into many workshops.  When fewer than three out of every 100 juvenile offenders are destined to reoffend, there are profound implications for the assessment, treatment, and management of adolescents who have sexually offended.  Changes in protocol are indicated in all areas.

There were so many great workshops, plenaries, and posters that it’s impossible to highlight all the outstanding contributions by presenters and conference organizers.  I’m already looking forward to next year’s conference in Kansas City.  And finally, let’s bring back the ATSA List breakfast!  (JB)

In the end, ATSA members continue to make differences in ways that are extremely challenging to measure. While there is much work to do in improving our assessment and treatment methods, this year’s conference was a reminder of the passion and purpose that ATSA members and their colleagues bring to our work.

David S. Prescott, Kieran McCartan, and Jon Brandt

Friday, October 28, 2016

Findings from a recent literature review to synthesise international evidence regarding risk and protective factors related to child sexual abuse in institutional contexts


In 2015 we (Keith Kaufman and Marcus Erooga) were commissioned by the Australian Royal Commission into Institutional Responses to Child Sexual Abuse a literature review to synthesise international evidence regarding risk and protective factors related to child sexual abuse in institutional contexts.

Literature review methodology

The methodology for the review was built on the Royal Commission’s broad definition of institutional child sexual abuse. Working with the project team of graduate students Kelly Stewart, Judith Zatkin, Erin McConnell, Hayley Tews and Australian consultant Associate Professor Daryl Higgins the first step was to identify a wide range of relevant search terms that we then circulated among experts in the United States (US), the United Kingdom (UK) and Australia to solicit additional terms. A similar process was conducted to identify databases that would yield the most relevant articles for this review. We then developed final lists of search terms and databases for the review based on feedback.

Simultaneous, independent literature reviews of each of five identified areas were then conducted using the final search terms. These were conducted by the authorial team, the Australian Institute of Family Studies (Australia), the National Child Advocacy Center (US), the National Sexual Violence Resource Center (US) and the National Society for the Prevention of Cruelty to Children (UK) and focused on scientific research literature as well as ‘grey literature’ such as reports, inquiries, evaluations and dissertations.  

The nature of the reviewed literature

The review yielded more than 400 relevant documents, primarily comprising research studies from professional journals. The literature was distributed across the three key review areas of victim, perpetrator and institution and further divided across six specific types of institutional setting including faith-based settings; early childhood education, care and schools; healthcare; out-of-home care; sport; and public inquiries and case reviews. The result was a series of related literature with limited integration - in particular the documents specific to victim, perpetrator and institution are quite distinct, with little overlap and minimal cross‑referencing. Articles describing child sexual abuse in various types of institutional setting are also highly ‘siloed’. The separate nature of these research sub-areas is an important dimension for understanding the strengths and weaknesses of the available literature on child sexual abuse in institutions.


For the purposes of this blog we highlight the ‘big-picture findings’ regarding risk and protective factors pertinent to victims, perpetrators and institutions, as well as the role of prevention of institutional child sexual abuse.


Risk and protective factors regarding victims


Many children spend a significant amount of time in institutional settings and whilst all children are inherently vulnerable to sexual abuse in institutional settings where is a motivated perpetrator, some children are more vulnerable than others.

A majority of child sexual abuse victims overall are female (Finkelhor and Baron, 1986). In institutional settings specifically, Faller (1988) reported that 62 per cent of sexually abused children in a day care setting were female; while Leahy, Pretty and Tenenbaum (2002) found that females in organised competitive sports were at twice the risk of being sexually abused as males (for both elite and youth sports). However, there is concern that the rates of disclosure, while minimal for both genders, may be disproportionately low for boys. This may be due to male socialisation processes, males may possibly not recognising some sexual activity as abusive, a propensity to downplay the impact of abuse, and outright denial that abuse has occurred to avoid social stigma, particularly when the perpetrator is also male (Alaggia & Millington, 2008; Fondacaro, Holt & Powell, 1999; Holmes, Offen & Waller, 1997; Holmes & Slap, 1998; Love, 2016; Parent & Barron, 2012).

Age has been identified as a risk factor for sexual abuse victimisation generally, with younger children particularly at risk (Bohm, Zollner, Fegert & Liebhardt, 2014). In institutional child sexual abuse, the age at which abuse begins seems to vary according to the type of setting. This may be related to the fact that children use different types of institutions at different developmental stages – for example, childcare centres during their pre-school years, and residential camps during their teenage years.

Higgins (2010) suggested that the presence of any disability leads to a higher risk of sexual victimisation, with multiple disabilities further increasing the probability of abuse. Higher rates of sexual victimisation were associated with intellectual disabilities, behavioural disorders and communication disorders.

A number of family characteristics have been identified as risk factors for child sexual abuse. Peter (2009) suggests that children from families with a low socio-economic status are at greater risk of sexual victimisation. This may be because these families have access to fewer resources and often include parents who work multiple jobs, leaving children to spend more time in the care of others. In a sample of children who were abused in a hospital setting, Feldman, Mason and Shugerman (2001) identified risk factors including parental mental illness, parental substance abuse, legal problems and vindictiveness against medical service providers.

Research on child sexual abuse risk and protective factors has several methodological limitations. Perhaps the most significant of these relates to the limited generalisability of study findings. Another significant barrier is the overall lack of empirical research in this area due to the difficulty of studying a phenomenon such as child sexual abuse, which relies on retrospective data and involves significant ethical limitations (Hartill, 2005; Love, 2016).


Risk and protective factors regarding perpetrators

Institutional sexual abuse perpetrators are a sub-category of extrafamilial offenders who abuse children that they have access to by virtue of working, volunteering or otherwise being associated with a particular institution.

There is no ‘type’ or ‘profile’ relating to perpetrators in institutional settings, or elsewhere. However, in general, risk factors for sexual offending include deviant sexual interest, distorted attitudes about sex, poor socio-affective functioning and poor self-management (Sullivan et al., 2010).

Criminal justice staff who work with perpetrators have identified eight broad conceptual categories of perpetration motivation, some possibly causal and others contributory:
·                     developmental issues
·                     poor social competence
·                     sexual motivation
·                     need for power and control
·                     psychopathology
·                     perceived victim characteristics
·                     values and beliefs that enable child sexual abuse
·                     personality deficits (Purvis, Ward & Devilly, 2003).

Longstanding sexual interest in children is not the sole factor for choosing to perpetrate child sexual abuse. There is a useful distinction between those described as preferential offenders, who have a long-term sexual preference for children, and those described as situational offenders, who take advantage of opportunities to offend against minors. These opportunities especially arise in situations where they have access to, privacy with, and authority over children, such as when they are serving in positions of trust in institutions.

Overall, the literature presents a solid basis for identifying the background characteristics of offenders and other risk factors that may lead to institutional child sexual abuse. However, a great deal of work must still be done to further investigate risk factors that facilitate institutional child sexual abuse.


Risk and protective factors regarding institutional settings

Child sexual abuse can occur within any institution where there are children and a motivated perpetrator. Some perpetrators will actively try to manipulate institutional conditions to create an opportunity to sexually abuse. Institutions can act to reduce risk factors and enhance protective factors. This involves considering the role of an institution’s policies, climate, culture and norms.

A major risk factor is that screening processes, used to exclude unsuitable people from joining organisations, are not as effective as widely believed (Erooga et al., 2012a). This is because many perpetrators either have no criminal history or their history does not include sexual offences, meaning they would pass a criminal background screening process (LeClerc & Cale, 2015).

A lack of clearly defined policies, or variability in the comprehensiveness and appropriateness of child-safe policies, also facilitates child sexual abuse in institutions. In the US, for example, each state has a different definition of ‘coercion involving the misuse of authority’, and therefore handles sexual abuse cases differently (Weiss, 2002). This is particularly problematic as there is a gap between research and policy regarding child sexual abuse prevention (Quadara et al., 2015).

Rather than focusing solely on individuals, risk management needs to address environmental factors (Beyer et al., 2005), in what is generally referred to as a situational prevention approach. Research shows that certain characteristics of an institution can increase the risk of staff members committing sexual crimes against children. These characteristics may include the physical condition of the facility, child safety policies and procedures, the training and supervision of staff, and also the less tangible risk factors of institutional culture and environment. It is also important to consider the impact of the power differential between institutional staff or volunteers and the children in contact with the institution.

Organisational culture was cited as a key contributory factor in a significant number of recent inquiries into institutional child sexual abuse in the UK. A proportion of perpetrators surveyed stated that the culture of the organisation in which they offended did not proactively promote child welfare (Erooga et al., 2012a).

Implications for policy and practice

Overall, the literature reflects the promising nature of prevention strategies and policy initiatives for enhancing child safety. Prevention strategies span the continuum from awareness training directed at individual parents or staff members to more systematic, institution-wide efforts to identify and ameliorate environmental or situational conditions that allow child sexual abuse to occur.

In a complementary fashion, the design and implementation of key safety policies foster child safety by helping to establish clear professional boundaries, acceptable practices, and mechanisms for identifying and reporting inappropriate behaviour that places children at risk.

Prevention and policy initiatives should target the types of abuse inhibitors that Finkelhor (1984) refers to in his Four Preconditions model for understanding the conditions under which child sexual abuse can occur. The literature also highlights a compelling need to increase investment in prevention and policy initiatives as well as to better tailor such efforts to the needs and characteristics of particular institutional settings to maximise their effectiveness.

A striking feature of this review is that many of the actions described in the literature aim to implement protective systems and processes more rigorously, thoroughly and consistently.

Another major conclusion that can be drawn is the need for greater attention to be paid to the quantity and quality of research related to child sexual abuse in institutions. Systematic research programs should be tailored to various types of institutions and address key areas of concern, such as identifying risk and protective factors, promoting early disclosures and improving prevention program outcomes.

At the same time, it is important to advocate for more methodologically sound investigations of child sexual abuse in institutions. This includes a greater diversity of study approaches, more quantitative as well as qualitative studies, and approaches with greater generalisability.
The most important action that institutions and those who work in them can take is to become familiar with the key literature contained in this review. They should consider their practices in light of the information contained in this literature, and act accordingly to maximise children’s safety. It is incumbent upon institutions to not only subscribe to these strategies as a matter of policy, but to ensure that their staff adheres to these principles as a matter of routine practice on a daily basis.

In summary, the literature shows the best way to reduce the risk of institutional child sexual abuse is to avoid dangerous practice rather than attempt to screen out allegedly dangerous people. Effective prevention is predicated on creating a positive, open and inclusive organisational culture in which the safety of children is paramount. This culture should be led by senior management and wholeheartedly endorsed and owned by staff at all levels.

Marcus Erooga (me7664@gmail.com) and Keith Kaufman (cbkk@pdx.edu)
October 2016