Thursday, April 26, 2018

The importance of multi-agency working to prevent sexual abuse

By Kieran McCartan, PhD

Yesterday I presented at an event, in London, which examined the role of multi-agency working in child protection across England. The event was framed around new changes being implemented in social work across England as part of the Putting children first agenda and the Children and Social Work Act, 2017. The event had an interesting mix of attendees and presenter’s from across the board including policy makers, members of parliament, police, social work, child protection, academics, survivors/victim charities (including, Barnardo’s, NSPCC), schools and research/policy organizations (incl., Centre of Expertise on Child Sexual Abuse and Internet Watch Foundation).

The day consisted of a series of talks, approximately 10 in total, which focused on how we can protect children better, how we can learn from good and bad practice, as well as how we can work better together to prevent sexual abuse. The talks covered a range of areas, including serious case reviews, local safeguarding boards, child protection investigations, school based education around sexual abuse, the use of materials in the prevention/discussion of child sexual abuse, the role of partnership in supporting victims of abuse, understanding perpetrators and preparation better as well as the role of schools in supporting child protection.

Some of the main themes and issues that arose for me from the event included,

-         A lot of the presenter’s discussed how effective multi-agency working was the best way of responding to sexual abuse and exploitation, a clear example of this came through the discussion of the new Child House that is due to open soon in Camden based on the Icelandic model (Barnahus). In addition, presenters felt that there was a lot to be gained from the multi-agency working that went into serious case reviews, child safeguarding practice reviews and joint targeted area inspections.


-         Schools were seen as the lynchpin in effective child protection, but there was recognition that all schools may not have all the resources that they need to be able to facilitate this safeguarding properly. The speakers from schools and with an education viewpoint argued that schools need the resources to deal with the safeguarding issues that they face on a daily basis, suggesting that when social workers and counselors are placed within schools then the establish can effectively respond and the experiences of everyone involved is improved.


-         Cassandra Harrison from the Centre for Expertise in Child Sexual abuse discussed their research and ongoing objectives, highlighting that there is still more about the reality and prevalence of child sexual abuse that we need to understand so that we can respond to it as well as prevent it more effectively. Cassandra directed attendees to their research agenda, publications and ongoing collaborations for more information on their work.


-         A representative from the Internet Watch Foundation, Michael Tunks, discussed their annual report, emphasizing the increase in child sexual abuse imagery on the internet, the adaptive ways in which it is being embedded online and an increase in reporting of inappropriate material from members of the public. The IWF emphasized the importance of getting men, especially young men, to report child sexual abuse imagery posted on traditional pornography sites or on other forums where they would not expect to find it.


-         Jon Brown from the NSPCC called for a national strategy in preventing child sexual abuse, indicating that we needed clearer and more joined up thinking on the issue. The only way that the prevention of sexual abuse was going to happen in practice was through a public and coordinated commitment to it.


-        Donna Smalley discussed the work that they have done with victims’ families to create a number of child sexual exploitation films (i.e., Kayleigh’s love story) to use with children when discussing sexual abuse, grooming and online behaviour. This promoted a lot of debate within the audience with some participants suggesting that that these types of material should not be used as they are harmful (referencing the work of Jessica Eaton) or that they should only be used in a certain way, with certain groups with appropriate resources (i.e., counsellors, etc.) on hand.


-         The importance of language in preventing and responding to child sexual abuse was discussed with some presenter’s (including myself and Jon Brown) arguing that the way that we frame the issue of sexual abuse has important ramifications for the way that the issue is processed. Which was seen as salient in the way that we talked about perpetrators, the use of terminology (i.e., treatment vs. rehabilitation vs. risk management, etc.) and the differences between exploitation and abuse.


-        Across all the presenters, the attendees and the chair’s there was recognition that sexual abuse was a health issue, not simply a criminal justice one.


-        The sharing of material, resources and training was a point for discussion across the day with participants questioned how to be access up to date information when there was a lot of varying information coming from a range of sources; how to prioritize? The question was raised, whose responsibility was it to streamline and prioritize this new information so that it could be used effectively.

The event and the presentations across the day really highlighted the importance of working together to prevent as well as respond to child sexual abuse. One of the final statements made by the chair was that change had to come from communities and that if communities saw organizations working effectively together it would enforce that something was being done to tackle child sexual abuse and that they should have trust in, as well as participate with, the system.

Friday, April 13, 2018

Supporting policy to prevent harm: Identifying gaps to support children with sexual behavior problems

By Hannah Laniado (Prevention Program Manager, MNCASA at & Julie Patrick (National Partners Liaison, Raliance at
Recently, the Minnesota Coalition Against Sexual Assault (MNCASA) published, Children with Sexual Behavior Problems: Improving Minnesota’s ability to provide early identification and intervention services through policy and practice recommendations (June 2017), a comprehensive report outlining the data collection, literature review, and formation of recommendations for implementation. This is the first in-depth look at how one state can create change to improve intervention, prevention and response to children with sexual behavior problems.
The specific key recommendations are a model for how the system could improve for all children and families. Earlier identification and appropriate response require: specialized training for all professionals working with youth; consistent guidelines and protocols for tracking behavior; clear written policies professionals who work with children can access on how to respond – including when and what to communicate; as well as education and awareness raising to reduce stigma.
MNCASA looked at what’s working and not working in Minnesota’s current systems for identifying children (12 and under) with SBPs through funding from Raliance, a national partnership among leaders in the prevention of sexual harassment, misconduct, and abuse. With seed-funding from the National Football League, Raliance is dedicated to ending sexual violence in one generation and supports an impact grant program with a specific funding category to prevent primary perpetration. 
MNCASA utilized ATSA’s definition of SBPs: children ages 12 and younger who initiate behaviors involving sexual body parts (e.g. genitals, anus, buttocks, or breasts) that are developmentally inappropriate or potentially harmful to themselves or others (Chaffin et al., 2006).
This project collected information and data in multiple forms. To facilitate the process, a set of guiding questions were identified at the outset of the project and then five chosen data collection methods answered the guiding questions (for details refer to Report #1). Exploratory interviews with 19 key informants, a scan of the empirical literature (42 documents published in the last 10 years), a web-based survey of professionals who work with children (1,022 responses total), investigative interviews with professionals who work with children with SBPs, and story gathering were collected between August 2016 and May 2017.
Key Findings
The literature review examined the latest research on incidence, identification, assessment, treatment, and policies for children with SBPs to provided an empirical basis for work to better understand how well Minnesota is doing in effectively identifying and intervening with children showing signs of SBPs.
Per the survey of professionals who work with children, parents and colleagues view them as a resource on differentiating between developmentally expected sexual behaviors in youth and concerning or problematic ones. Many professionals expressed interest in training on how to interact with children and their parents about children’s sexual behaviors.
Interviews with key informants also showed the lack of a clear process or procedure for where to report a child who is engaging in concerning or harmful sexual behaviors. In fact, many different systems (including social services, law enforcement, medical providers, child protection, probation, and school staff) all come into contact with children with SBPs and yet here is no one system charged with responding to or even tracking reports of children with SBPs. This results in great variations, county by county, to reports of a child with possible SBPs. Professionals who work with children need guidelines for how to treat behaviors as serious, educate about treatment being available, help set up effective supervision, and create protective environments. Without these guidelines, there is a tendency to either over-react or under-react resulting in children not receiving the help they need. There are also disparities across the state in terms of access to effective treatment for children with SBPs. Not all providers have specific training on children with SBPs and not all use evidence based treatment methods. Not all parts of the state have easy access to professionals who specialize in working with children with SBPs.
The specific policy recommendations in detail
1.      Make specialized training on best practices for identifying and responding to children’s sexual behaviors readily available to all professionals who work with children and families. This training needs to address the myths about children’s sexual behaviors and share the message of hope that with treatment, children are at no greater risk to grow up to be sexually abusive. A key element of this training should be how to effectively engage parents in discussions of and treatment for their child’s SBPs. Ideally this training would be incorporated into the educational requirements for students as well as offered as part of ongoing professional development or as a requirement for licensure.
2.      Develop consistent guidelines and protocols for tracking and responding to children’s sexual behaviors, including sexual behaviors between children. Ideally, all children would receive an assessment by a qualified professional who would make recommendations to address any SBPs and any safety risks the child poses to others.
3.      Create written policies professionals who work with children can access on how to respond to a child showing concerning or problematic sexual behaviors, when and what to communicate to parents/caregivers, and how to refer a child for an assessment.
4.      Develop an educational campaign that can be used to raise awareness about children’s sexual development and SBPs. This could be done by providing resources during well-child doctor visits, sharing handouts at school open houses, etc. This effort would go a long way in reducing the stigma and fear that gets in the way of effective response to children showing early signs of SBPs.
Chaffin, M., Berliner, L., Block, R., Johnson, T. C., Friedrich, W., Louis, D.G., Lyon, T., Page, I., Prescott, D., Silovsky, J. (2006). Report of the ATSA Task Force on Children with Sexual Behavior Problems. Association for the Treatment of Sexual Abusers
With gratitude:
MNCASA would like to recognize Joan Tabachnick for her guidance throughout this project including reviewing multiple drafts of the literature review as well as Jane Silovsky and Jimmy Widdifield from the National Center on the Sexual Behavior of Youth (NCSBY), part of the Center on Child Abuse and Neglect (CCAN) in the Department of Pediatrics of the University of Oklahoma Health Sciences. Many ATSA members added value to this report.

Tuesday, April 3, 2018

Four Articles for Newcomers

By David S. Prescott, LICSW

Recent discussions in a number of venues have involved which studies and other published papers are essential for people treating clients who have abused. Each offering has been useful, from the basics in risk, need, and responsivity to effective self-care and an understanding of how early adversity influences the lives and treatment of those who abuse. Each of these areas is vital.

Following on previous writings with Gwenda Willis (for example, our only partially tongue-in-cheek call for a “who works doctrine”), it has long seemed to me that our field has overlooked some basics, and that the evidence for these basics has been around for decades. Research continues to find that there is a greater difference between therapists practicing within various methods and models than there is between the methods and models themselves (Wampold & Imel, 2015).

In 2005, Bill Marshall summarized research both in and outside the field of treating sexual violence to ask what qualities make up an exceptional therapist. The four qualities at the center of his analysis, being warm, empathic, rewarding, and directive (guiding and moving the treatment process forward), seem incredibly simple at first. In fact, these four qualities have even produced the acronym WERD, which many practitioners try to live by. Critics have noted that this paper relies on studies outside the field of treating abuse, and yet a recent blog post has highlighted the work of Brandy Blasko and Faye Taxman, who have found that even probation officers who adhere to similar principles have clients who are less likely to return to prison.

Of course, many (likely most) professionals do not view themselves as in need of assistance becoming more “WERD”. Discussions within social media often focus more on scoring items on actuarial measures and what the rules for registration are in various jurisdictions are typically more common than questions about developing these qualities. As research has shown, however, professionals both within and outside our field can overestimate their abilities in a phenomenon known as self-assessment bias.

In one of the most striking studies of self-assessment bias, Steven Walfish and his colleagues found that the average therapist rates themselves at the 80th percentile compared to their peers. 25% rated themselves at the 90th percentile and no one rated themselves below average. Although there are many possible implications of this study, it is entirely possible that one reason that fewer people seek to develop themselves in the above key areas of competency (warmth, empathy, being rewarding and directive) is that they already believe they are as good as or better than their peers in these areas.

The results of these studies beg further questions: If the working alliance and core competencies of effective therapists are so easy to over-estimate and so difficult to excel at meaningfully, are they really the basic skills that many people believe them to be? After years of listening to people who are learning to put collaborative approaches into practice, I’ve concluded that these skills are only “basic” when you are practicing one of them at a time. It’s when one tries to be warm, empathic, rewarding, and directive while staying aligned with what works for each client that these skills become much more advanced and difficult to master. What is the best way forward with this knowledge?

Enter Daryl Chow and his colleagues and their 2015 paper on deliberate practice. Their abstract puts it succinctly: therapist characteristics (e.g., years of experience, gender, age, profession, highest qualification, caseload, degree of theoretical integration) did not significantly predict client-reported outcomes. Consistent with the literature on expertise and expert performance, the amount of time spent targeted at improving therapeutic skills was a significant predictor of client outcomes. Further, highly effective therapists indicated requiring more effort in reviewing therapy recordings alone than did the rest of the cohort.

So what is the take-home message from these four studies?

·         Professionals are often not as effective as they want to believe, but they can become better.
·         This is not to say that average therapy is not good therapy; indeed, people entering treatment typically do considerably better than those who don’t.
·         The most effective therapists attend to the core competencies of therapy and work to improve themselves in these and related areas.
·         Contrary to the practices and beliefs of many professionals, attention to the fundamentals of the working alliance apply to virtually all professionals involved in treating and supervising people who have abused.

If you’re an old master, this all means you can still get better. If you’re a newcomer, it means that many of the skills out there for learning will help you in many areas of your life. I hope you stick around!