Self-care in self-isolation: The social, mental, physical and spiritual dimensions.

By Andrew J. R. Harris, ATSA Member

“Physician, heal thyself” (King James Version, Luke, 4:23)

Newly incarcerated people are occasionally referred to the psychologist for depression and despair after being locked away in a very small cell for what must seem like forever.  And now, thanks to COVID-19, my wife Tracey and I are on day 7 of a 14-day quarantine after international air travel.  Our home is nothing like a jail cell, but it may be time to take a bit of my own medicine. 

When working with a person new to jail, I ask them what is truly important to them, deep down, to the person they are.  This discussion almost invariably reveals four concepts integral to who we are: social connection, physical health, mental stimulation, and spiritual connection.  Psychologists and other care providers tell the incarcerated that being in jail does not mean the end of their relationship with family, friends, or indeed the world, but that it will take extra effort to maintain these connections.  In jail, this usually means writing snail-mail letters and scheduling scarce, critical phone calls.  Here in the new COVID-19 universe Tracey and I have been calling friends and family more often just for a chat and to check-in.  Also, we have been taking advantage of social-media platforms and some amazing new free programs and apps that allow video conferencing.  When working in jail, we encourage the person to take advantage of exercise time in the yard and not to lie on their bunks through their exercise time.  Fresh air is restorative.  Tracey and I have upped our outdoor walks and are making use of some in-home exercise equipment.  While options are admittedly limited during the initial days of incarceration, mental activity and growth can be maintained most easily by reading.  For us, it is tempting to spend the evening Netflixing.  Tracey is painting and we are both trying to get more practice on our musical instruments.  We have the most difficulty interpreting the fourth concept, the spiritual.  Despite starting this note with a biblical quotation, traditional spiritual connection is not top of mind for us, realizing that spiritual connection and religious observance form a major life support for many people.  In jail, religious texts are available, and I frequently recommend a visit from a spiritual leader or tribal elder.  Under the present circumstances, an online church service or a pastoral phone conversation may provide comfort.  For the two of us, this need is filled by maintaining close connections with family and friends of long standing who truly form our sustaining community.  At home we godless heathens survive on stand-up comedy specials (Billy Connelly videos lighten the load) but, admit this may reflect the vacuous nature of our all-too mortal souls.  Very recently a close friend reminded me that much like the new inmate sitting alone in his cell, those of us in home isolation cannot control the impact of COVID-19 – but we can control our response to it. 

Love in the time of COVID?

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

Please note that this is a joint blog with NOTA blog site, take care, Kieran & David.

Like everyone else, we’ve had our share of worries and concerns as we enter the rising side of the COVID-19 curve. Canceled trainings, travel, and classes, ensuring the safety and wellbeing of loved ones have shaped the lives of many for a long time to come. For many of us, it’s the state of not knowing that is the most frustrating. On the other hand, there are some areas of good news, such as indications of decline in some areas, and medical advances in others. And proving the axiom that “Alone I travel faster; together we travel further”, the word “caremongering” has entered our lexicon.

At this writing, numerous state chapters of ATSA, regional branches of NOTA (NOTA Scotland) and ANZATSA has had to cancel or postpone its conferences, workshops, seminars, and training.. Ditto with the otherwise seemingly indestructible NAPN conferences. Many trainers are taking to web-based and videoconferencing technologies, where the questions of the day involve the best ways to break participants up into small group discussions and paired practice exercises. Everywhere we look, discussions abound about how to balance the needs and rights of our clients with our own obligations for self-care and safety. These discussions have ranged from how many clients in group therapy in some areas to whether or not clinicians can work with videoconferencing platforms and which methods adhere to confidentiality laws. Additionally, these discussions raise questions of access to online technology, which can be a challenge to some of our clients because of the conditions to their license conditions, the speed of internet in certain areas and whether professionals can work from home (i.e., access to encrypted networks and client reports).

One opportunity that we all have in these uncertain times is to work on our messaging. As the world talks about “social distancing”, we are painfully aware of the elements of social isolation that have long been recognized as a risk factor for offending and re-offending. Professionals in our field find themselves in a subtle bind: Social isolation is a risk factor in some respects, and yet social distance is a protective factor in others. How do we ensure that we don’t approach clients as if they are one more surface to sanitize?

Maybe it’s time to move beyond focusing on the construct of social distance and turn our message in other directions. Instead, we might think of this in terms of promoting “physical distance and safety” and “creating a healthy space”. From a prevention perspective, social distance can facilitate abuse and create the conditions where people at risk of committing an offense, whether for the first time or as part of an ongoing pattern may be more likely to do so. For this reason, we should also think of increased social isolation as an opportunity for us to intervene and talk about prevention.

Of course, creating and transmitting healthy and safe spaces can begin with maintaining a positive and hopeful attitude (which itself is a protective factor against illness) and with being careful with media coverage. In some ways, the rapidly escalating strong emotions inspired by media coverage may be a bigger risk factor for negative outcomes all around. As one comedian observed, “If I don’t watch the news, I’m uninformed. If I do watch it, I’m misinformed.”

The messaging from leaders is also a lesson for all in our field and provides an opportunity to reflect on what messages our clients and colleagues get from us. One world leader has already tried to monetize the eventual vaccine. Another has blithely reminded us that many of our loved ones will die. Yet another, from Ireland — a country that knows about staring directly into the eyes of violence, starvation, and despair— reminded his country that “Together we can save lives.” This last example gives us an opportunity to reframe our message to our clients, ourselves, and each other: at the very least, we’re all in this together. That’s one small step we can take to reduce social isolation.

Finally, there is one small message that we can remind ourselves about providing excellent assessments and treatments to people who have abused. For years, our field has grappled with providing the best evidence-based services, while implementation science has reminded us that optimizing service delivery can take years. Every time we’ve thought about the importance of implementing best practices, we’ve also thought about how long it takes to implement even the most basic of safety interventions, such as handwashing and seat belt usage. One silver lining to the Coronavirus crisis is that at least handwashing is up. As with reducing sexual violence, simply getting people to talk about the issues and forge a way forward can change lives for the better.

Many organizations have offered advice for professionals in this field;

British Psychological Society: https://thepsychologist.bps.org.uk/volume-33/april-2020/coronavirus-psychological-perspectives

British Association for Counselling and Psychotherapy: https://www.bacp.co.uk/about-us/contact-us/faqs-about-coronavirus/

Centers for Disease Control: https://www.cdc.gov/coronavirus/2019-nCoV/hcp/index.html

Public & Policy engagement: A one-page overview on juveniles who have sexually offended

By Norbert Ralph, PhD, MPH

In consultations to probation officers, attorneys, judges, and mental health colleagues, I often find that many have no prior clinical or research background regarding these youth. However, these professionals are often in the role of having to make decisions regarding youth who have offended, decisions that have consequences both for public safety and the youth's future.

I've tried a variety of methods to provide relevant information including providing articles and presentations. Most recently I found the most useful method that seems to make a difference is to provide these individuals with a one-page handout regarding basic information. I am offering it here with the hope that others might find it useful. Its goal is to provide basic facts for decision-makers. The information included is reasonably "fact checked" and relevant references are noted. Although the handout is evidence-based, it reflects my own analysis of the literature. Others might develop different models and I would encourage that. The advantages of having a one-page handout that will be actually read, are counterbalanced with not having a more extensive discussion of the literature, including methodological limitations, considerations of cost and practicality, and competing models and theories, and this would be a limitation of the present method.

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Juveniles who Sexually Offended (JwSO)

The most recent research on sexual recidivism for JwSO is encouragingly low, at about 3%. Of course, recidivism causes significant harm to victims, and so each case should be considered individually. The total recidivism for these youth is estimated to be 30%, which includes nonsexual crimes (Caldwell, 2016).
The peak age of persons accused of sexual offenses against children is age 13, a rate of almost 120/100,000 in the population, which drops off rapidly at 18 by about half (Statistics Canada, 2014). Dr. Barbara Bonner, Director of the National Center on Child Abuse and Neglect, describes early adolescence as a "high risk transitory period for sexual offending", and most JwSO can be treated successfully in the community (Bonner, 2012). It is this concept of offending being transitory that often gets lost in discussions of supervision and treatment.

Risk factors for recidivism in one research include being a victim of physical or sexual abuse, special education status, multiple victims, crimes committed in public places, and prior juvenile convictions of any type (Epperson, Ralston, Fowers, DeWitt, & Gore, 2006). Denial of the sexual offense at the beginning of treatment does not predict outcome or recidivism (Langton, et al, 2008). Factors which promote positive treatment outcome for juveniles who sexually offended are similar to those for the general probation population which include counseling methods that promote social problem-solving and skill building, rigorous probation supervision, and wraparound services (Lipsey, 2009; Kettrey & Lipsey, 2018).

Delays in social judgment and impulse control are an important risk factor for sexual offending for adolescents which can be remediated which is associated with positive outcomes (Ralph, 2019). Important elements of treatment include a review of specific sexual charges with the family, a Safety Plan, skill building to promote social problem-solving, what consent means in sexual relations and relevant laws, healthy sexual relationships, risk factors for the instant offense, developing a relapse prevention plan, and a plan for healthy prosocial relationships. Regular involvement and appropriate counseling of parents is essential. Dr. Bonner has a free guidebook for parents/caregivers of youth who sexually offended, Taking Action (Bonner, 2009). For a given youth, there is no evidence residential or secure placement compared to community placement promotes better outcomes (Lipsey, 2009).
 
References

Bonner, B. (2009). Taking Action (Adolescents) - PDF Download. [online] Safer Society Press. Available at: https://safersocietypress.org/store/taking-action-adolescents-download/ [Accessed 8 Mar. 2020].

Bonner, B. (2012, November 01). Don’t Shoot: We’re Your Children. What We Know about Children and Adolescents with Sexual Behavior Problems. Retrieved February 20, 2017, from Boy Scouts of America, http://www.scouting.org/filestore/nyps/presentations/Children-with-Sexual-Behavior-Problems-Bonner.ppt

Caldwell, M. F. (2016). Quantifying the Decline in Juvenile Sexual Recidivism Rates. Psychology, Public Policy, and Law. Advance online publication. http://dx.doi.org/10.1037/law0000094

Epperson, D., Ralston, C., Fowers, D., DeWitt, J., & Gore, K. (2006). Actuarial risk
assessment with juveniles who sexually offend: Development of the Juvenile Sexual Offense
Recidivism Risk Assessment Tool-II (JSORRAT-II). In D. Prescott (Ed.), Risk assessment of youth who have sexually abused (pp. 118 169). Oklahoma City, OK: Wood N Barnes.

Kettrey, H., & Lipsey, M. (2018). The effects of specialized treatment on the recidivism of juvenile sex offenders: a systematic review and meta-analysis. Journal of Experimental Criminology, 14(3), 1-27.

Langton, C. M., Barbaree, H. E., Harkins, L., Arenovich, T., McNamee, J., Peacock, E. J., Dalton, A., Hansen, K. T., Luong, D., & Marcon, H. (2008). Denial and minimization among sexual offenders: Posttreatment presentation and association with sexual recidivism. Criminal Justice and Behavior, 35(1), 69–98. https://doi.org/10.1177/0093854807309287

Lipsey, M. W. (2009). The primary factors that characterize effective interventions with juvenile offenders: A meta-analytic overview. Victims and Offenders, 4, 124-147. 23.

Ralph, N. (2019). Treatment Options and Outcomes for the Other Recidivism. Sexual Abuse Blog, April 26, 2019, https://blog.atsa.com/2019/04/

Statistics Canada. (2016, May 10). Young adult offenders in Canada, 2014 Young adult offenders in
Canada, 2014. Retrieved from https://www150.statcan.gc.ca/n1/pub/85-002-x/2016001/article/14561-

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Epidemiological Criminology as a means to understand sexual offending

By Kieran Mccartan, PhD, & David Prescott, LICSW

In recent years, professionals, researchers, and other interested people have made a slow but certain shift towards understanding sexual offending as a public health issue as well as a criminological and psychological challenge. This understanding has led to conversations about the role of the developmental, psychological, social, and behavioural histories of people who commit sexual abuse as precursors to abuse. Those discussions have in turn linked to understanding and implementing adverse childhood experiences, trauma informed care, strengthens based approaches, and other elements of rehabilitation and desistance at the levels of research, theory, and practice. In the UK we are seeing a close joining together of Public Health England, The NHS, and Ministry of Justice to discuss the prevention of, and response to, serious violence. Prevention of sexual and other serious forms of violence and abuse, is gaining momentum and we are now talking about primary, secondary and tertiary prevention more in a criminal justice frame than ever before; although, we still have a way to go with quaternary prevention (which is the harmful effects of overmedicalisation on patients health, or  in criminal justice terms how overly putative criminal justice responses prevent desistence and facilitate reconviction). However, despite all this movement, the vast majority of public dialog is  about responding to individual cases and people, not at a population level.

An emerging part of criminology, which has always been a multidisciplinary endeavor by its very nature, is Epidemiological Criminology (abbreviated as EpiCrim) (Waltermaurer & Akers, 2014). Epidemiology is a subdivision of public health and it focuses on health, and health-related issues, at a population level. Ultimately it is a methodology for understanding the health of a population and how this relates to individual members of said population. EpiCrim is defined as:

“the explicit merging of epidemiological and criminal justice theory, methods and practice. Consequently, it draws from both criminology and public health for its epistemological foundation. As such, EpiCrim involves the study of anything that affects the health of a society, be it: crime, flu epidemics, global warming, human trafficking, substance abuse, terrorism or HIV/AIDS.” (Lanier, 2014)

At its core, EpiCrim is about how different disciplines can come together to explain the intersection of crime and heath, and therefore it has relevance for the prevention of crime, the response to crime and the management of people who have committed crimes (especially via prison, probation/parole and social care). So how does this translate into sexual offending and sexual abuse?

The international growth in sexual abuse prevention research and practice over the past 10 years or so speaks to the relevance of EpiCrim for our field. Sexual offending, especially in westernized, anglophone countries, is becoming rooted in a in a health and justice frame. This is clear evidence of EpiCrim in action! It is now possible to discuss the societal and individual correlates of sexual offending and the contributions of health, psychology and behavior to them. Sexual abuse research has a number of methodological approaches that link marco and micro-level data about sexual abuse together. Currently, our field is also starting to see more calls for research and funding streams linked to this intersection of health and justice, both in terms of first-time prevention and treatment/relapse prevention. Research already exists, at a theoretical level, that ties Child Sexual abuse to EpiCrim principles (Skvortsova, 2013). This indicates that EpiCrim fits a theoretical gap in the field of child sexual abuse that existing theories have not bridged because it brings together behavioral, individual and societal elements. It therefore links the individual to society. Many would argue that EpiCrim acts as an umbrella for all three of the main stages of prevention (primary, secondary and tertiary). We would argue that it also includes quaternary prevention. EpiCrim acts, therefore, as a box to house research and practice into the developmental, social, health and psychological correlates of sexual offending in a way that can be used use in a cross-disciplinary fashion. As Lanier (2014) states, EpiCrim means that we have a common point of reference and a shared lexicon across social care and justice for thinking about crime; however, we in criminal justice related fields need to learn how to convey that message to the population in a constructive, easy to navigate fashion.