Thursday, August 27, 2020

“The Train Keeps a’Rollin” … 10 Years Later

 By Kieran McCartan, Ph.D., David Prescott, LISCW, & Kasia Uzieblo, Ph.D.

In the UK we do not have high school reunions, they seem to be something quite American or reserved for 80’s movies; but if this blog had a reunion, this post might be it.


Ten years ago, in July 2010, Robin Wilson started the blog with the blessing of Maia Christopher and James Cantor as a way of continuing the public and professional outreach of ATSA and its Journal, Sexual Abuse. The blog was to be a platform for discussing, via concise messaging, the main issues, challenges, and progress of the sexual abuse research and treatment field. The aim of the blog was to be informative but critical in an accessible way. Whether the blog has accomplished that is for its readership to decide and comment on. What the blog has done is provide a commentary on the reality of sexual abuse for professionals and the public for 10 years. Just to give a behind-the-curtain snapshot: over this period we have produced 372 posts, averaging between 30 – 45 annually, with approximately half a million individual hits across the life of the blog, means that we average 200-250 hits per day, from across the world (although westernized, anglophone countries are where most off our readers come from).


Over the last 10 years, the blog has had a number of in-house writers (Robin Wilson, David Prescott, Jon Brandt, Kieran McCartan, Alissa Ackerman, and Kasia Uzieblo). We have also had a number of external writers, some invited and others who volunteered themselves or ideas (including Norbert Ralph, Michael Seto, Danielle Harris, Jill Levenson, Don Grubin, Tyffani Dent, Franca Cortoni, Joan Tabachnick, and Cordelia Anderson, to name a few as we have had over 30 contributors please do have a look at the back catalog to see who else has contributed ). In sum, the blog has had strong influences of practice, academic, and international approaches to it. Over the course of this period, we have covered topics, including risk assessment, treatment, polygraphy, residence restrictions, the (non-)impact of Halloween, myth-busting, desistence, re-offending, community reintegration, professional practice, prevention, individual and systematic issues (i.e., gender, race, vulnerability, etc), and policy. The blog has often reacted to current affairs, as well as discussed ongoing debates in the field and society; we have never shied away from touchstone issues and won’t going forward either.


So, as this is our anniversary, what has changed and what has not? We believe the public policy landscape in the USA and internationally has shifted somewhat We also believe our field now discusses sexual abuse prevention even more than in the past. We have seen beginning increases in the use of person-first language in our communications, just as the field has started to take more of a client-centered approach. Finally, we are starting to see more nuanced public discussion in the media.


However, not everything has changed: we still see punitive policies, a fractured use of the evidence base, and emotion/ideology clouding the development of realistic policy and practice. Budgets are cut routinely, and professionals are expected to do more with less. Ten years on it feels like the deckchairs have been re-arranged when a wholesale redecoration is what has been needed.


This is not to say that there are no signs of hope for the future. The advent of the #metoo movement, increases in bystander intervention, corporate “wokeness”, the rise in awareness brought about by movements such as Black Lives Matter, increased victim advocacy, the debate surrounding the best ways to help people who are attracted to children and to prevent offending, and an increasing realization that sexual abuse is a (public) health issue, as well as a criminal justice one, mean that a new vision for the future is underway.


Change takes time and ours and related fields have a long way to go. On balance, it seems we are on the right path. Professionals need to keep emphasizing the importance of using the available evidence and making our knowledge and experience available to others as a concrete means of preventing as well as responding to sexual abuse. We also need to keep an open mind to new perspectives and learn from our colleagues in both westernized and non-westernized countries.


In ten years, the biggest strength to the blog has been the voice of contributors, both in-house and external, and to that end, we encourage anyone, and everyone from all around the world, to contribute. We are always open to new voices and perspectives. Here is to another 10 years, it’s not an ending rather a marker on a never-ending journey!

Wednesday, August 12, 2020

Developmental perspectives on "lying and manipulation" in juveniles who sexually offended.

By Norbert Ralph, PhD, MPH, private practice, San Leandro, CA.

As a clinician working with juveniles who sexually offended (JwSO) I find that these youth are frequently described as "lying and manipulative" which is presumed to be part of the pattern of behaviors that led to sustained criminal charges. Such behaviors might include things like denying or minimizing harmful behaviors and the effects on victims, for example. A developmental perspective can be useful to understand these behaviors from the youth's point of view, and importantly also adult reactions to them, and the interaction between the two. It can help in developing strategies and interventions to avoid future harmful behaviors and develop prosocial behavioral patterns in the youth.

The ethical and moral framework of professionals involved with juvenile justice youth is an important factor in the probation process. Sexual violence, whether by adults or juveniles, is among the most serious crimes, a cultural taboo, and significant harm is often done to victims. Societal and personal ethical reactions to sexual crimes by juveniles often becomes part of the legal and probation process and evoke strong negative emotional reactions. This moral view of juvenile transgressions may also resonate with the psychiatric categorization of juvenile delinquency. For example, DSM 5 criteria for Conduct disorder includes, "Often lies to obtain goods or favors or to avoid obligations (i.e., “cons” others)" (American Psychiatric Association, 2013).

Evidence-based models contrast with these personal moral attitudes regarding sexual crimes. For example, the How I Think Questionnaire (Barriga, Gibbs, Potter, & Liau, 2001) assesses offense-related thinking patterns based in part on Kohlberg's theory of moral development. For example, the instrument has scales which assess developmental immaturity and egocentricity, sometimes described as thinking errors, such as Lying, Self-Centered, Blaming Others, and Minimizing/Mislabeling. These thought patterns are viewed as part of developmental immaturity using Kohlberg's framework for moral development and not fixed and presumably untreatable traits.

A complementary model is Hy and Loevinger's (1996) work on ego development which provides an evidence-based theory of psychosocial development throughout the lifespan. Adolescence is a period of rapid psychosocial development. Most older teens and young adults score at the I-4 or Conformist level which reflects an internalized sense of socially appropriate behavior, rules, and laws. The next lower level, the I-3 Self-Protective level is most prevalent in pre- and early adolescence, from age 10 to age 13. In one study of JwSO, 92.5% were either classified at the I-2 Impulsive or I-3 Self-Protective (relatively lower levels of ego functioning), compared to 43% of a non-clinical 14-year-old sample (Ralph, 2017a). Similar to Europeans in the Middle Ages who viewed the Earth as the center of the universe, youth at the I-2 or I-3 level view their own needs and goals as paramount, and don't have a differentiated model of external rules, laws, and rights of others that facilitate prosocial and "win-win" interactions as might be present in higher developmental levels found more frequently in adults. For these youth, rules, or facts (e.g., you missed your appointment) that get in the way of things the youth wants to do, are seen as something to deny or avoid, unfair so they can be ignored, not true, wrong, mistaken, etc., rather than youth at a higher level than see "facts are facts" and "rules are rules", and like it or not, they are just there.

Ralph (2017b) describes factors and treatment methods that promote psychosocial maturity for the general juvenile probation population, and specifically for JwSO. These interventions view deficits in prosocial reasoning as a modifiable risk factor for delinquent and harmful behaviors that are treatable. These methods help the youth "up their game" to use more effective and mature methods of social-emotional reasoning about the choices they make. Complementary literature described in Ralph (2019) reports that incarcerated youth who psychosocially mature in detention have improved the frequency and severity of recidivism. More psychosocially mature youth have more sophisticated internal models or paradigms of "how the world works" and can do the "cost-benefit" analysis to avoid future problems. For example, Ezinga, Weerman, Westenberg, and Bijleveld (2008) in a community sample found more delinquent behaviors in youth at the I-2 or I-3 level in contrast to higher levels.

A developmental perspective on harmful behaviors by youth may help explain adults’ reactions to JwSO. Adults who are at the I-4 Conformist level, higher than the I-2 and I-3 levels have an internalized sense of rules, laws, and expectations, different from one's own wishes. People are either "good" and moral, or "bad" and immoral. The assumption of adults in this stage is that teenagers involved in harmful behavior know right from wrong and are deciding to be "bad" because they think they might get away with it. In my experience, this perspective often dictates that the most effective approach with youth with moral immaturities include verbal criticisms and severe sanctions. Such measures, while in some circumstances appropriate, if over-utilized may further traumatize youth where trauma itself had been a factor in offending, and also there is evidence that "get tough" approaches are not effective (Lipsey, 2009). This "get tough" view of JwSO and appropriate interventions may "bump up" against a developmental perspective. This disparity in perspectives may account for conflicts regarding disposition planning advocated by treatment providers on the one hand, and judges, probation officers, and district attorneys on the other.

In summary, risk factors, and treatment interventions for JwSO optimally should include developmental considerations, among other approaches. It is useful not only in designing more effective treatments and disposition planning for JwSO, but also in every day clinical work with these youth and consultation with the probation and legal system. In real-life clinical work these behaviors when can provide a useful framework for considering therapeutic "next steps" for youth in therapy and treatment planning.


American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Publisher.

Barriga, A.Q., Gibbs, J.C., Potter, G.B., & Liau, A.K. (2001). How I Think (HIT) Questionnaire manual. Champaign, IL: Re-search Press.

Ezinga, M. A. J., Weerman, F. M., Westenberg, P. M. and Bijleveld, C. C. J. H.(2008). Early adolescence and delinquency: Levels of psychosocial development and self-control as an explanation of misbehavior and delinquency. Psychology, Crime & Law,14(4), 339-356.

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

Ralph N. (2017a). Moral Reasoning in Juveniles Who Sexually Offend. ATSA Forum, XXIX(2).

Ralph N. (2017b). Prosocial Treatment Methods for Juveniles Who Sexually Offended. ATSA Forum, 2017, XXIX(3).

Ralph N. (2019). Neuropsychological and Developmental Factors in Juvenile Transfer Hearings: Prosocial Perspectives. Journal of Juvenile Law & Policy, 23(1), 1-24.

Friday, August 7, 2020

The Color of Money: How we fund sexual offense work


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


One of the main challenges that professionals working in the broad field of sexual offending is funding; namely, how much there is and where you can get it! We have previously written about the challenges of identifying and truly knowing the extent of sexual offending that there is in society, and therefore the number of resources needed to respond to it both from a victim and perpetrator perspective. This complex mathematical, and very human, the problem has been made challenging of late as we have started to think about the prevention of first-time offending in the same breath as preventing re-offending. This means that we need to make a small pot of money go a lot further and do a lot more. But how can we achieve balance with this? 


Quite often one hears from colleagues in the sexual abuse prevention, treatment, and activism fields that times are tough and that there is not enough money to go around to fund the services that they need to (not even close to what they want to) deliver. For all the political hyperbole around sexual offending and its impact on individuals as well as communities it is underfunded, and when push comes to shove it is always first in the queue when additional cuts need to be made. This is particularly relevant when you consider the scale of sexual abuse, between one in four and one in eight people being impacted by it at some point in their lives. Sexual abuse, therefore, is not a one-off offense that randomly strikes at small groups of society. With figures like this, sexual abuse is a pandemic with a potentially greater hit rate than COVID-19. This leaves us with a paradox: we know it's common and it traumatizes people with a long-lasting effect and yet we still do not fully fund efforts at preventing and treating it! It is important to state that we are not just talking about services for people convicted of sexual offending, although the punishment side of the equation is better funded than the rehabilitation side, but also victims of sexual offenses who have also had funding cuts, and services reduced. It is across the board! 


So, what do we do about it? This is a challenge because we often hear that budgets are stagnant and that there can be no more investment. Often this is tied up with politics, governance, media discourses, and public mood, which means that asking for money at the right or wrong time can result in a feast or a famine. This is unsustainable and is often reversed later in the funding cycle or in the next funding cycle. We need a more sustained funding strategy rather than just a reactionary one. A more sustained funding strategy allows more innovation and positive adaption, rather than cutting or squeezing existing budgets to do small, underfunded projects. So where does the “new” money comes from to support ongoing work in, and develop innovative work in, sexual abuse? 


One solution, as discussed by Wilson Wong in a piece about defunding the police, is that we move and reallocate the existing pot of money to use it better. The argument here is that the best and most suitable organizations should be the ones that deliver the services and, in this instance, maybe the police are not the best ones to respond to, support, and manage those impacted by sexual offending. That work could instead be done by third party organizations and charities. In addition, it reinforces the broader move in the sexual abuse field at the minute to be more trauma-informed and service user lead. Following on from this, if we broaden our remit around sexual offending and continue to incorporate elements of health, public health, education, and local communities we can open more funding pots. With various organizations and statutory bodies funneling monies into a combined project then not only will we have more funding, but we will also have more buy-in and impact. Additionally, the way that broader society, both corporate and private, funds sexual abuse support/treatment organizations is important. If sexual offending is an epidemic, then where is the national fundraising drive or the equivalent corporate response? Sexual offending research and practice are not funded the same as cancer research, or HIV/AIDs research, but the impact that sexual offending has is the same. 


 We need to change the funding formula with respect to sexual offending, both in terms of victims and people who commit it, so that its fit for purpose. So while the defund the police movement has thrown up a suggestion on how to tackle the funding challenge in sexual offense work maybe it’s more “refund”, “change funding”  than “defund”? Funding sexual offense work should not be a deficit, it should not be taking the funding away from other sources to support it, but rather should be a reallocation to make existing practices work better.