Friday, May 29, 2020

Child Sexual Abuse Imagery in the Pandemic: Taking the Public Health Direction as We Emerge Into the New “Normal”

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

With endorsements by former Prime Minister Theresa May and Eric Schmidt, an Executive Chairman for Google, Internet Watch Foundations (IWF), a charity organization that works to remove child abuse imagery from the internet, reports having had nearly 133,000 such webpages of taken down in 2019. IWF’s 2019 data is sobering: 46% of the imagery they report to law enforcement was of children age ten or younger, 92% was of females, and 1% was of children aged two or younger. Twenty percent showed sexual activity between adults and children, “including rape or sexual torture including self-penetration.” Another 20% included images of non-penetrative sexual activity. What is less clear at present is to what extent these findings from this spring have outpaced the same period last year. IWF’s data from 2019 shows the greatest growth in indecent images of children not falling in the above categories. In the UK this has lead Simon Bailey, police lead on child sexual exploitation online, to state that we cannot simply arrest our way out of the issue of child sexual exploitation material (CSEM) and online sexual exploitation. We need another approach.

With an unseen number of people around the world confined to their homes, a significant rise in these numbers is expected. Unfortunately, these worries are being confirmed. Last week, The Daily Mail, a British newspaper reported that during the months of March and April of this year, there were 8.8 million attempts to view child abuse images online from the UK. The increase is not unique the UK.  Countries around the world are sounding the alarm: they report a staggering demand for child abuse images. For instance, a recent study by the India Child Protection Fund noted an increase of almost 200% in access to these images since a nationwide lockdown was implemented. A higher demand prompts higher production rates, as observed in countries like the Philippines. Untold millions of families lost their income during the lockdown, creating an incentive for peddling child abuse images. Stop it Now! Flanders (Belgium) signals another worrisome pattern in help-seeking behavior. Before the pandemic most calls (80%) came from people who were worried about their own behavior, whereas 20% came from worried family members and friends. Now an opposite pattern is being observed, with 65% calls coming from others.

Picking up where recent blogs have left off, it is clear that these numbers, like the activities they describe, are completely unacceptable. Understanding them is nearly paradoxical: On one hand, they make clear what professionals in the field have known for years: that sexual abuse is not perpetrated by a small number of individuals but is best considered from a public-health perspective. On the other hand, the numbers are so vast that it is easy to lose sight of the harm done to the individuals involved, calling to mind the famous quote from Joseph Stalin that “one death is a tragedy; a million deaths is a statistic.”

All of this raises the question of how we can start to combat the challenges of CSEM and online sexual abuse in the new world order. This is difficult because we do not know what the new normal will be, but what we do know is that online platforms and the internet will be a significant element in moving forward. It’s about collaboration! The notion of the internet as unregulated space will have to change significantly as we have seen new forms of problematic and anti-social behavior creeping in, like “Zoombombing” that won’t simply go away. We think that more than just a criminal justice approach is needed to combat and prevent online sexual abuse. Any solution requires a multidisciplinary public health approach.  Instead of responding to the offence, we need to think about how we intervene pre-offence (primary and secondary prevention) and post offence (tertiary and quandary prevention), as well as a range of social groups/frames (individual, personal, community and societal). Currently, we focus on the individual and societal elements, sending out strong primary and tertiary prevention messages, but we need to do more in helping those at risk to abuse. The access and impact of CSEM as well as online abuse is going to continue in an adapted way. Like everything else in a pandemic, life and behavior find new ways to adapt and thrive. Let’s take stock, reevaluate, and move forward with purpose.

Friday, May 22, 2020

Emerging lessons from pornography in the pandemic

By David S. Prescott, Kieran McCartan, & Kasia Uzieblo

The first author was reminiscing about experiences at Grateful Dead concerts way back in days gone by. While much of their concert experiences are now legendary, there were two elements in particular that completely changed the way people think about music and its performance. The first were the spinners, who sought out far-flung parts of the arena to dance, seemingly in their own world. Even more thought-provoking were the deafheads, deaf people attending concerts simply for the experience, sometimes holding balloons through which they could feel the vibrations of the music. It all may seem ridiculous from the outside looking in (why attend a concert if you can’t see or hear the act?), but the band later created entire sections for them, providing additional speakers for the spinners. And by doing so, the band redefined its actions in response to what they were learning about their followers.

Although it may seem a strange analogy, clearly the pornography industry is also evolving in response to trends in the pandemic era. A recent in-depth examination by The Economist is fascinating:  During the past month, pornography usage at Pornhub (the world’s largest site, that offers user data as part of its marketing) has remained 22% higher than average, while significant spikes were noted in various countries with the pandemic’s onslaught in March. Spending on porn-related sites has nearly doubled. Traffic on “premium” portions of otherwise free sites is higher than ever. Is this really just about having more time to access porn during shelter-in-place orders or a full lockdown? Additionally, Pornhub’s “giving back” (or increasing traffic, depending on your perspective) gave free access to its premium accounts to some of the most impacted countries during lockdown (including, but not limited to, Italy, Spain, and France). Therefore, not only were people more willing to access pornography during the pandemic they were also more able to do so. All of this raises further questions of where exploitation begins and ends in these circumstances.

At the same time, there are increasing trends where porn performers are engaging in more direct marketing, eschewing directors, and others viewed as middlemen. This involves filming themselves with smartphones and the like and uploading the results to adult social media sites. While economically this makes sense (why lose money to a middleman if you can do without them), it also has the effect of bringing the audience closer to the performer. It is also possible that it creates a kind of authenticity to the experience (something we have blogged about previously). In the current business model, viewers willing to spend extra can get personalized performances for example, with the performer speaking to them by name, etc.). These trends have led  to increased divergence in the market with more amateur material being produced, innovations in the production of material, but also an increase in revenge porn and recorded sexual abuse; therefore, as with other industries, a reshaping of the pornography industry. At a time when so many people are rightly concerned about abuse, it seems strange that the abuses of revenge porn and related issues of consent have not become more prominent in public dialog.

As we have stated many times throughout the history of this blog, there are many aspects to the debates about pornography by people who have abused and by society beyond. Recalling the well-known therapeutic axiom that one must always “meet the client where they’re at” in treatment, however, it seems that these changes to how sexually explicit media is delivered is worthwhile to understand. Clearly, the emerging structure of sexually explicit adult social media sites demonstrate that there is more to porn than sex acts, just as there can be more to a concert than the music and the partying.

Furthermore, the sheer volume of sexually explicit media being consumed and the money spent (especially when there is already so much free porn) highlights that the desires of people consuming it are more complex than many might have believed in the past. In the end, the theme of viewers wanting to experience some form of connection to the performers, no matter how illusory it may be, is hard to miss. In the case of men who sexually abuse others, it can be easy to miss just how important this theme of connection and relatedness to others can be, especially when their histories of violating connections can be so florid.

We must ask ourselves, as we emerge from lockdown towards whatever the new normal will be, what does all of this mean for the production, use, and consumption of pornography? Will this period be looked back on as a blip, a holding pattern, or a time of redefinition? Thinking about the impact on sex, sexuality, relationships, and paraphilia. Have people discovered, or confirmed, suspicious about their sex and asexuality preferences? How will this impact themselves and others moving forward? We need to try and rationalize the current surge in pornography use as we move towards the new normal, therefore some key questions might be;
-     What pornography was I looking at during lockdown?
-      How much pornography did I consume at this time? Was it more than before?
-      How did my interpersonal and intimate relationships change over lockdown?
-      Did the pornography that I looked at change? 
-      Am I more interested in the new pornography that I am viewing? 
-      How do I feel about lockdown ending and “normal” relationships resuming?

In the end, we are left with massive societal questions. The same article also discusses how STRASS, the French union for sex workers estimates that out of roughly 35,000 sex workers in France, 1.3 have moved to online activities, and of that only 10 % are making ends meet. While there have been historical assumptions about victimization histories, trafficking, and other coercion into these activities by men, the current situation shows how exploitation of one sort or another appears present at nearly every level of sexually explicit media production. It is impossible to predict where this is all going, but the current trends can teach us something about the people we see in treatment, including both those who have abused and those who have been abused.

Wednesday, May 13, 2020

"But they must have known!" Effectively working with non-abusing parents.

By Anna Glinski (Deputy Director for Knowledge and Practice Development at the Centre of Expertise on Child Sexual Abuse).

This blog was first published by the CSA Centre on the 18th March 2020  – Kieran.
Imagine for a minute how it would feel to receive a knock on the door from a police officer and social worker, who proceeds to inform you that an allegation of sexual abuse has been made against someone close to you, a family member, your partner, a friend – someone, you trust - would you believe it?  What if the allegation was made by your son or daughter?  Would you be able to think clearly enough to make some speedy decisions about what needed to happen next?  I suspect not.  More likely, you would be overwhelmed with feelings of shock, anger, confusion and disbelief. 
Effective multi-agency working with non-abusing parents is absolutely key to the future welfare and safety of the child. Research indicates that feeling believed by your main caregiver is one of the strongest mediators of the long term mental health issues caused by sexual abuse. This parent/caregiver will need to play a central role in protecting their children from the person of concern, implementing safety plans and managing risks; and, they will need to support their child with the immediate and longer-term impacts of their abuse. These are hefty responsibilities for someone who is also coming to terms with the fact their child has been abused by someone they may have loved and trusted and is also likely to be experiencing other pressures as a result.
After the shock
The consequences of believing someone in your family has abused a child (either on or offline) can be enormous: shame, guilt, feelings of responsibility, an end of a relationship, the loss of a home or an income and loss of support. And fear - fear of losing your child or your partner, of a hostile response from friends and family, of what people will think of you, of loss of autonomy, of retribution from your partner. For many, it is not surprising that denial kicks in: a normal and functional defence that allows us to protect ourselves against something that is painful and distressing. As Still observes in her useful book on assessing and intervening with non-abusing parents“It is not uncommon to see the mother in a state of confusion and ambivalence, swinging on a pendulum between believing the child completely one minute and not the next, or believing some but not all of it: ‘I can believe this, but I cannot believe that’.”
For those from Black, Asian and minority communities, or with English as a second language, or whose residence in this country is threatened, there may be additional and significant consequences for what has happened. Additionally, for those who have experienced sexual abuse themselves this process is likely to be even more complex, confusing and painful. And what if one of your children has abused the other/s?
Working effectively with non-abusing parents
For professionals to give the best opportunity to non-abusing parents to be able to fulfil the tasks of support and protection, every interaction should be in the context of building their strength and resilience, offering support and understanding through an empowering approach. The limited research that does exist indicates that non-abusing parents and carers often do not receive the necessary empathy, time, support or information to help. They can feel judged by professionals, ‘they must have known’ (while battling with their own guilt about what has happened).
We know that there are parents who sexually abuse their children, or who do not act protectively when they become aware of the abuse of their child, and this needs to be properly investigated. However, non-abusing parents are too often perceived to have been actively involved in the abuse. As Chaffin states “From a trauma processing perspective, features such as denial, unfocused anger, minimisation of the problem and ambivalence toward both the alleged victim and abuser would be considered part of the course, rather than evidence of toxic parenting or deep-seated psychopathology.”
Professionals have an important role in understanding non-abusing parents’ reactions, providing support to enable them to process what has happened and ensuring that children are safeguarded. Effective assessment is an important part of this. The safety of children is imperative and so even though denial is understandable, children still need to be safeguarded as soon as possible.
The CSA Centre’s work on effectiveness in services for children and young people who have been sexually abused identified that suitable services to non-abusing parents are essential to children’s safety and recovery. This built on earlier findings by the NSPCC  which highlighted the importance of keeping children safe and well by working with non-abusing parents. When a child is sexually abused, we must first ask ourselves what that child needs, including their needs in the context of their family.
Facilitating necessary discussion
Sexual abuse can be hard to talk about even for professionals and so the likelihood of family members being able to talk about what has happened without being supported to do so, is low. As helping professionals we have the skills to talk about difficult matters and to help others do the same.
Professionals need to facilitate discussion, and therefore healing and recovery, between non-abusing parents and family members of a child who has been sexually abused. Sexual abuse thrives in secrecy, and in not doing so we risk colluding with this silence, and miss the opportunity to repair family relationships, and to address feelings of guilt, responsibility, anger, distress, jealousy, blame and torn loyalties which so often exist when a child is abused within the family. Just think how much useful intervention we could provide by giving the opportunity, for example, to a non-abusing parent to say they feel sorry to their child for what happened to them; to tell them that they didn’t know it was happening and if they did they would have intervened; to tell their child that what has happened as a result of their disclosure is not their fault but the fault of their abuser?
In my practice experience, so many survivors have spoken about the harm the abuse caused not just to them individually, but to every relationship within their family. As such, I believe we have a duty to use our skills and roles with families to attend to this integral part of their lives.
Educating families about the signs, indicators and impact of sexual abuse is equally as vital for prevention and effective response, and there are already some excellent online resources available for them, and the professionals supporting them. 
  • Parents protect has a wealth of guidance and resources for professionals and families, including a sexual abuse learning programme
  • Stop it now supports adults to play their part in prevention through providing sound information and educating members of the public. People who are worried about their own or someone else’s sexual behaviour can call their helpline too. 
  • The upstream project is a Scottish resource (though available and relevant to other areas) which offers tools and support on identifying, preventing and acting upon child sexual abuse. In terms of keeping children safe from harm on the internet.
  • In terms of keeping children safe from harm on the internet Think u know offers advice to children, young people, parents/carers and professionals.
  • Mosac provides supportive services for non-abusing parents and carers whose children have been sexually abused.
Working with non-abusing parents will be a key consideration in the CSA Centre’s future work to develop useful resources and guidance to support professionals in working with children, young people and their families, whether or not their allegations of sexual abuse is proceeding through the criminal justice route.

Wednesday, May 6, 2020

Prehabilitation & sexual abuse prevention

By Sarah Christofferson, PhD, Kieran McCartan, PhD, & David Prescott, LICSW

The field of sexual abuse has gone through a theoretical and multi-disciplinary shift over the last 10 to 15 years, whereby we have moved from talking about responding to sexual offences through a criminal justice-only approach to a more holistic, health-based approach that includes prevention as well. The language of sexual abuse prevention has moved practice landscapes, allowing us to better incorporate research, learning and practice from the allied fields of social work, social care, criminology, sociology, health and public health, to name a few, which has improved how we conceptualize and understand sexual abuse. As a field we now talk about prevention, the service user voice, multi-disciplinary/multi-agency working, first person language, Adverse Childhood Experiences, trauma informed practice/care, and consider working with at-risk populations good practice. Therefore, reinforcing what everyone working in treatment/interventions already knows, that sexual offending is a life course issue rooted in experiential pathways that needs a holistic response to help people manage their behavior. So, what is the next big thing to be adapted into the field of sexual abuse prevention from health? Prehabilitation!

In recent years the first author, along with her New Zealand based team including Gwenda Willis, Jacinta Cording, and Waikaremoana Waitoki, have started to consider the role of prehabilitation in helping individuals concerned about their sexuality or possible risk of committing a sexual offence. Prehabilitation reflects the bridging of therapeutic services typically offered as rehabilitation (e.g., in a prison or other justice system context after the point of conviction), with an earlier preventative approach. The term prehabilitation is not new but is new to our field. It comes from the medical literature and is tied into preparation for a stressor, such as major surgery, which can be debilitating and therefore the patient needs to prepare their body in advance to reduce the negative consequences. In such settings, prehabilitation has been described as a process of enhancing functional capacity to enable an individual to withstand these kinds of challenges (Banugo & Amaako, 2017; Ditmyer et al., 2002). Translating this to a sexual abuse prevention frame, prehabilitation can therefore be viewed as a strength training of sorts for people who experience problematic sexual interests – assisting them to enhance their functional capacity to cope with these interests, and associated stressors, in nonharmful ways (Beggs Christofferson, 2019).

So where does sexual abuse prehabilitation occur currently in the field? Prevention Project Dunkelfeld, in Germany, is a well-known example. Whether or not they have ever committed an offence, individuals with diagnosable pedophilic or hebephilic interests can self-refer to Dunkelfeld and receive therapy on a confidential basis (Beier et al., 2015). In some other parts of the world, therapy for this same purpose may be offered by independent practitioners or (less frequently) publically funded clinics, or as a brief in-person follow-up to helpline services such as Stop It Now! (Heasman & Foreman, 2019). Except for Dunkelfeld, evaluations of these kinds of services are rare, partly due to the anonymous nature of delivery.

Stand Strong, Walk Tall: Prehabilitation for a Better Future (SSWT; Christofferson et al., 2020) is a newly developed prehabilitative intervention from the New Zealand team, designed to provide access to effective services for people in the community who experience sexual interest in children. The target population is broader than Dunkelfeld – not limited to those with a diagnosis but open to any adult seeking help in relation to sexual interest in children/minors (a subsequent adaptation for youth is slated as a future priority). Design took a bottom-up approach – seeking to understand and cater to the needs of minor-attracted members of the general population, rather than simply transposing justice-setting rehabilitation approaches into an earlier prevention context. Whilst goal setting for treatment in SSWT is undertaken collaboratively with each client, taking an individualized case formulation approach and incorporating the client’s valued life goals, key broad targets of the SSWT intervention are alluded to in the name:

Stand Strong denotes self-efficacy and self-regulation building aspects;

Walk Tall denotes self-acceptance, dealing with the stigma often faced by those with sexual interest in children and tackling self-stigmatization; also a sense of forward momentum;

Better Future carries a double reference:
 the better future clients can expect because of engaging with prehabilitation; 
-  the better future we are all collectively striving towards, of a society free from child sexual abuse.

The SSWT intervention framework is informed by broad theoretical underpinnings including the strengths-based Good Lives approach, the principles of risk, need and responsivity, etiological and process models of child sexual abuse, all supported by the Hauora Māori Clinical Guide for effective bicultural practice (Pitama et al., 2017). The intervention is evidence-based; in addition to the theoretical foundations the content, targets, and delivery are further informed by the growing empirical research base regarding the target population (often referred to in the literature as minor-attracted persons or MAPs), along with the principles of feedback-informed treatment and trauma-informed care. Importantly, SSWT is by design a joint treatment and research initiative, with evaluation planning directly built in. The assessment protocols will enable not only robust evaluation but also contributions to the knowledge base regarding those who experience sexual interest in children, their treatment needs, and effective interventions. Pilot delivery is planned to commence across New Zealand and Norway during 2020.

The hope is that SSWT and similar prehabilitation efforts may offer a missing link, in the context of a behavior that all of us would like to see eradicated (child sexual abuse), system responses traditionally focusing on post-offence recidivism reduction as opposed to preventing initial offending, and a minor-attracted population in need who are often unable to access effective interventions outside of the justice system.

Readers interested in learning more about Stand Strong, Walk Tall are welcome to contact the first author, at