Friday, September 24, 2021

26th Annual Conference of the Directors of Prison and Probation: The Importance of critical discussion!

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

Over the last 18 months, many in our field have been homebound, working online. This is something that we have mostly gotten used to, even if we haven’t liked it. As we start to emerge from COVID-19, we look forward to being in a room together having conversations and learning together. While we are not at a place where live, in-person conferences are the norm we are starting the long path back to that place. It is important to note that while online or hybrid conferences are still taking place, and will quite likely remain post-pandemic, there is also the place, where possible, for in-person conferences. But what are the implications for critical conversations, being heard and respected, while also generating new ideas? Do we simply refine our processes or is it about starting over again to create a new dialogue?

This week, Kieran and Kasia were in Madeira at the 26th Annual Conference of the Directors of Prison and Probation. This conference is typically an annual, in-person, event where the heads of Prison and Probation come together to discuss the major topics of the day. In the past, this has included electronic monitoring, incarnation data, and release programmes. This time, it included people within the criminal justice system with issues related to their mental health, people convicted of sexual offences, the impact of covid on prison and probation, as well as the implications of artificial intelligence for the criminal justice system. The conference had over 80 attendees, including experts, partner organisations (for example, EuroPris, the Confederation of European Probation), Council of Europe members and committee representatives, and the directors of prison and probation from 29 countries (including, Spain, Portugal, UK, Ireland, France, Sweden, Azerbaijan, Cyprus, Moldova, and Belgium). Although the conference was interesting, with topics directly and indirectly to those featured in this blog, we have decided to focus our attention on the session around people convicted of a sexual offence.

The reason for Kieran and Kasia’s attendance at the conference was to talk about and analyse the forthcoming Recommendations on the assessment, treatment and management of people convicted or accused of sexual offences” by the Council of Europe. The development of these recommendations where lead by Kieran (UK) along with Marianne Fuglestved  (Norway) and Harvey Slade (UK). In the coming months, we will write a more detailed blog on the recommendations, which ATSA as well as NOTA, IATSO, and NL-ATSA to name a few, were also involved as critical friends. The role of the recommendations is to create common and good practices across the Council of Europe (CoE) area. The CoE is 46 countries from across the boarder European landscape – it is important to note that the CoE, European Union, and European Commission are all separate organisations with different memberships. So, while the UK left the European Union, it has not left the Council of Europe or the European Commission.

The Council of Europe (CoE) started working on the recommendations in early 2018. Initial conversations at the PC-CP (the committee for penological co-operation), the committee handling the development of the recommendations for the CoE, revolved around what should recommendations focus on. It was discussed whether the recommendations should address definitions of sexual abuse, laws surrounding sexual abuse or the system that has developed to respond to sexual abuse. It was decided to focus on the process that people convicted or accused of a sexual offence would go through upon arrest, conviction, imprisonment, and release into the community. The recommendations would focus on risk assessment, treatment/rehabilitation, community integration, research, media engagement and data sharing. Previously to the conference the recommendations had been drafted and redrafted, this was their first public airing ahead of sign off and approval later in 2021. In their session, which took place twice, the three speakers touched on all these points.

-       Kieran McCartan (UK) outlined the recommendations, why they were important and their context. Kieran highlighted that sexual abuse was an international issue, that was as much about communities as individuals and that we needed to look to a more holistic, public health approach. He argued that risk assessment was important as individuals needed the treatment that addressed their needs.

-      Kasia Uzieblo (Belgium) built on Kieran’s presentation in arguing that while risk assessment is important, especially in terms of treatment, what as more important was that people understood and could communicate the risk assessment tools, and their outcomes, clearly. She argued that judges, as well as other experts who were not trained in risk assessment, did not always understand the results and this had challenges for treatment and management. Even apart from the communication issue, she stated professionals needed to tie their risk management strategies directly to the outcomes of risk assessments. She also argued that it is important to use established risk assessment tools, which not every country in the CoE does, and not simply use any Structured Professional Judgement tool just because it has a better feel to it, which some countries in the CoE do; a topic which was a debated topic in the development of the recommendations. Kasia used examples from the Netherlands and Belgium, who are at different points in their risk assessment and management journey, to highlight her points.

-      Oscar Herres Mejis (Spain) started by introducing us to some of the new developments, particularly new treatment programmes, in the treatment of people convicted of a sexual offence in Spain. Oscar stated that risk assessments are not commonly done in Spain, which he felt was unfortunate and needed to change as all people convicted of a sexual offence, regardless of risk level, take part in the same 18-month program, which is challenging. He asked the audience to recognise that a balance that needs to occur between the evidence base, which at times in the treatment of people convicted of a sexual offence can be contradictory, and professional judgement and insight. As a practitioner, Oscar talked about how the recommendations are a useful compass in allowing him, and Spain, to orientate their national practice and improve treatment outcomes for their clients while making communities safer.

Throughout the two sessions, there was a great deal of audience participation and debate, which included conversations on,

-  The role and the need for separation of individuals convicted of a sexual offence within the prison system.

-  The role of risk assessment in treatment and who should do the assessment (is the professional delivering the treatment and/or someone else?).

-   The role of denial in the treatment of people convicted of a sexual offence.

-  What provision, if any there should be, for people convicted of a sexual offence of different risk levels.

-  How we keep the human in treatment and rehabilitation and not simply make it’s a mechanised outcome.

The conference, and the sessions contained within, were a welcome return to “normal” with people being able to present and discuss freely, something that was rarely possible during online sessions. It was interesting as it was Kieran and Kasia’s first in-person conference since the pandemic started over 18 months and while it took us both a bit of time to find our feet it resulted in productive conversations and insights. So, while online training and conferences have their place, you cannot really take the human interaction out of the process.

Thursday, September 16, 2021

Child Sexual Abuse in religious organisations: A moral juxtaposition that needs addressing!

By Kieran McCartan, Ph.D., Kasia Uzieblo, Ph.D., and David Prescott, LICSW

Recently in the UK the Independent Inquiry into Child Sexual Abuse (IICSA) published a report, as part of its mandate, on the extent and impact of Child Sexual Abuse (CSA) within religious organizations. Unfortunately, the report indicated that child sexual abuse was often commonplace, underreported, and that the organizations defended (or at least did not condemn or remove) the person committing the abuse. Further, they found that these organisations did not support those who had been victimized. While this is very troubling, it is not uncommon either in terms of abuse within religious organizations or organisations per se; we have seen this internationally (with a similar story being published in Belgium this week and in the Netherlands last year). These revelations raise the question: why we have not moved further forward in responding to and preventing sexual abuse in organisations?

When thinking about writing this blog, the authors toyed with what was the most significant thing to focus on. As we’ve noted, religious organisations failing those have been sexually victimized is not news. This in turn leads to further questions about safeguarding, disclosures, prosecutions, treatment, and reintegration. Even then, it feels as though we are rewriting previous blogs!! Then, the authors came across a quote from Professor Alexis Jay, chair of the inquiry:


"Religious organisations are defined by their moral purpose of teaching right from wrong and protection of the innocent and the vulnerable. However, when we heard about shocking failures to prevent and respond to child sexual abuse across almost all major religions, it became clear many are operating in direct conflict with this mission. Blaming the victims, fears of reputational damage and discouraging external reporting are some of the barriers victims and survivors face, as well as clear indicators of religious organisations prioritising their own reputations above all else. For many, these barriers have been too difficult to overcome."


Indeed, a recent Dutch study into child sexual abuse within the community of Jehovah’s witnesses emphasizes Prof. Jay’s statement. In 2019, 751 people reported to an anonymous hotline set up by Dutch researchers for (alleged) victims or people who have knowledge of abuse within this community. Three quarters of the victims find the handling of their report within the community by the Jehovah’s community inadequate. Many of these alleged victims stated that the Jehovah’s Witnesses are mainly guided by the biblical principle that they should not take a brother to court. And this is not only a dynamic that we observe in their community; despite all high-profile cases of child sexual abuse in the church of the past few years, it is still far too common to sweep these issues under the rug.

This is significant and important to unpack, as CSA (and any abuse for that matter) is anathema to the role, function, and mission of religious organizations. Without getting too philosophical about the role and function of religion in modern society, the mandate of all – especially mainstream religions – is to provide a sense of moral direction within a shared community where followers are respected, supported, and able to live their lives with a sense of common purpose and compassion.

All major religions have compassion at their centre. This includes understanding and working together to support the most vulnerable in society. The roots of community and religion are often intertwined. This makes sexual abuse within religious communities (especially within religious communities that work to downplay it or dismiss it) even more worrying, since in turning a blind eye to abuse they are going against these core values and shared ideals. Saying that religious organizations are flawed when it comes to child sexual abuse is significant: the message is that it’s not just the organisation and processes that are flawed, but that the underlying belief system is as well. Therefore, these organizations are on the horns of a dilemma: They wish to appear compassionate, and they wish to protect their reputation and often that of the accused. It seems that with each passing day, it becomes less tenable to try to do both, and those who have been harmed are not letting them off the hook.

The challenge for religious organisations is how to acknowledge and respond to claims of CSA, as the “blame it on a few bad apples” approach no longer holds water given the volume, nature, and scope of CSA within religious organizations and they’re at-best lacklustre response to it. The moral paradox of CSA for religion is that they should be supporting the least valued and vulnerable in society and not the people harming them. They should be welcoming and supportive of victims of CSA and not of the people committing CSA. While religious organizations should promote forgiveness and redemption this should only take place after acknowledgement, acceptance, and accountability have taken place. Restoration should be a cornerstone of responding to CSA but only after recognition. Until then, those who have been harmed can neither forgive nor forget.

Religious organizations need to consider their responses to CSA not only from process and policy perspectives, but also from a moral and philosophical level. How does CSA resonate with their spiritual and beliefs, and how does that translate into their social norms and behaviors? Although we’ve blogged about so many of these issues before, it behooves all of us to keep the discussion and information flowing if no fundamental changes are being observed.

Friday, September 10, 2021

Putting New Practices into Place: What Gets in Our Way?

By David S. Prescott, LICSW

A woman who attended a workshop I gave in the mid-2000s contacted me this summer looking for more information. I was astonished not so much by the number of years that I had passed, but by the circumstances. The training was part of efforts to implement motivational interviewing (MI) in the institution where I worked. After leaving my position, one of the staff apparently asked that they be allowed to revert to their erstwhile and less-motivational approaches now that I was gone. Following my departure, another administrator’s campaign to have all staff focus on becoming kinder towards the clients was also reportedly controversial. Several years later, approaches focusing on strengths and motivation had become the norm in this and most other institutions of its kind.

As much as I would love to say that I was ahead of my time and ahead of the curve, I wasn’t. By this time, MI had been the subject of hundreds of randomized controlled trials and several meta-analyses. The truth is that implementing any best practice takes time and teamwork. As just one example, Dean Fixsen and his colleagues have emphasized that implementing any human-service practice can take years. More recently, in a study of Feedback-Informed Treatment (FIT) by Heidi Brattland and her colleagues in Norway found that implementation efforts took two years to bear fruit.

From the author’s perspective, several things are important to keep in mind. First, we often hold onto the myth of the guru. In this myth, there is a guru whose training one must have in order to be considered an expert (sometimes referred to as “one and done” training). While having an expert come in to train is always a good idea, programs and practitioners often seem to neglect the importance of having ongoing consultation to ensure that what was taught is actually being implemented and practiced. As a part of this, it’s easy to overlook the importance of building up the internal “champions” who will carry the implementation efforts forward within each agency after the guru goes home. As an ATSA member once quipped, “An expert is an out-of-towner with slides.”

Why is this so important? In the author’s opinion, it’s not just about the mechanics of implementing best practices, but about the mentality. When implementing any model, method, or approach, agencies have an opportunity to build up the professionals in their employ. This attention to local ownership of models and methods can help build professional longevity and reduce turnover as well as improving services, and yet it is easy to miss. Even more important is to keep in mind that putting new practices into place simply takes time and work. For this reason, it’s vital to build in some self-compassion along the way. Implementing new approaches often not only upsets the apple cart of historical treatment methods employed but can cause personal and interpersonal challenges as well. For example, the person who has always been in a position of implicit power within an agency may find their influence diminished with agency-wide attempts to master new approaches.

In recent discussions with colleagues, three less obvious barriers to implementation have also become apparent. They are worth mentioning so that those seeking to innovate might be better prepared for pushback:

The first is the belief that “We already do this.” Many people who receive introductory information about new approaches form premature judgments about it. In particular, they may take note of the elements that seem most familiar (for example, that many skills in MI, FIT, or the good lives model [GLM] can be found elsewhere) and arrive at the conclusion that they are already proficient at implementing the method. Sadly, it is sometimes difficult for people to dissuade themselves of this notion. It can come in the form of, “I’ve already gotten training on this kind of thing.” By this time, extra work can be required for the person to learn what is new, different, or unfamiliar about the approach.

The next is the belief that “This is easy.” It is indeed easy to read a paper or even a book and assume one can quickly develop expertise in a given method, model, or approach. In order to prevent this, training is most effective with the trainer reminds trainees to suspend their beliefs or disbeliefs until they understand the entire model and how its components interrelate. Further, the most effective way to learn a new approach is with guidance, supervision, and coaching. Receiving feedback on one’s practice is one of the most effective ways to improve one’s performance.

Finally, there is the response that, “We’ve seen these new models come and go.” This can also take the form of, “We tried that and it didn’t work.” Again, this is where the truth became inconvenient: it takes time and effort to implement new practices. Very often, the best antidote is for the person who is learning the new approach to either experience it for themselves (for example, to engage in a motivational dialog with a skilled practitioner) or to apply it within their own life (for example, understanding how the GLM might apply to their own behaviors).

Fixsen’s work reminds us that for every approach one tries to implement it’s important to let go of two other approaches that are no longer serving the program or practitioner. Ultimately, however, we can all be at our best when we let go of everything else and simply seek to become the most effective practitioner we can be; one skill at a time and one client at a time.

Note: The author is grateful to many colleagues who contributed ideas to this blog post, including Gwenda Willis, Christine Friestad, and Ingeborg Sandbukt Jenssen.




Friday, September 3, 2021

Under attack on Twitter: How gruesome tweets can highlight the importance of our language

By Kasia Uzieblo, Ph.D.

I have an ambivalent attitude toward Twitter. I find it primarily a platform for individuals who have an opinion on really anything and feel it necessary for everyone to know about it, as well as for individuals who find even just about every thought that passes through their brain cells of such value that it must be shared with the world. And then you have those with both opinions and thoughts. At the same time, I can also lose myself in Twitter. I like to scroll through it just to have a chuckle with or to willingly get all stressed out by all those stories, opinions, and thoughts of others. But usually, it all just goes too fast for me – I’m getting older after all – and therefore I try to limit my Twitter use by mainly reading or posting work-related things. What I am also sometimes guilty of is shameless self-promotion by, for example, announcing my upcoming presentations on Twitter, hoping that someone might be interested, whilst ignoring the sobering number of likes and retweets of the past. But last Friday it finally happened. I couldn’t believe my eyes; I have never seen such a high number flashing red on my Twitter-icon. A few seconds later, I regretted that my narcissistically driven curiosity had urged me to open the Twitter app.

My tweet on our IATSO session on help-seeking behaviour in minor-attracted persons was indeed a hit, but not in the way I hoped for. My tweet was under attack, I myself was under attack. I want to spare you the worst ones, but this tweet kind of sums it all up. A Machinegun for Every Child[1] tweeted: “I’m perfectly willing to accept that pedophiles have no control over what they are attracted to and thus need help. But referring to pedos as ‘minor-attracted persons’ is a good way to ensure pedophilia is normalized and anyone using the phrase should be regarded as a threat.” [2] Many wanted to kill all “pedos”, some wanted to kill me. A few even found the missing link between me, “pedos” and the Taliban. It didn’t stop for days; it was pouring shocking reactions and retweets until I finally found that ‘block’ button.

At first, I reacted indignantly and almost smugly. What do these people know? How short-sided are they? But when the initial emotions subsided, I took a moment to reflect on this. What does this all mean? Most of the tweets strongly questioned the term “Minor-Attracted Person (MAP)” and wanted me to call these people “pedophiles” or other variations of this spelling. Some even wanted to “help” me out with spelling. “The word you’re looking for is “pedophile”. I’m glad to be of help”, one tweeted. So, it made me wonder, why are so many struggling with the term MAP? Why does it evoke so much resistance even when it refers to a similar concept? Shouldn’t it be applauded that we have succeeded in finding 1 term for this heterogeneous group of people with sexual interests in minors? The tweeters, some of them also refer to their own victimhood, made it clear: The term MAP doesn’t feel negative enough, it doesn’t feel accusatory enough, “Minor-attracted persons” is a far too fancy word for “these people” … I wasn’t really shocked by the assessment that pedophilia was equated with child sexual abuse. But the great need in so many to use “pedophilia” for people with sexual interests did take me back, emphasizing the importance of the language we use.

In recent years, we – both researchers and professionals in the field – have paid a great deal of attention to the language we use for our patients and clients. First-person language for example, has become more and more ingrained in our speaking and writing about persons who have committed sexual offenses as well as for those who exhibit sexual interests in minors. We changed our language to diminish the negative effects of our language on those who have committed horrific crimes, to ensure they feel acknowledged as a human being. Maybe our use of first-person language is also a way for us to cope with all the horrific stories we are confronted with; it enables us to see the human being beyond their deviant interests, beyond their crimes. But the public is clearly struggling with our language. Maybe their language should also be considered to cope with sexual offenses and their fear for possible future offences by people exhibiting such interests. Changing terminology, changing perspectives clearly takes time. It took decades to change our language within psychiatry: we have moved from “this is an autistic man” to “this a man with autistic characteristics”. And even in that context, many continue to use labeling terms.

This experience also emphasizes how difficult it must be to seek help when you are indeed struggling with your sexual interests and/or with your behaviours. Coming out could mean losing everything and everyone; for some it could even mean a death sentence, as was graphically illustrated in several tweets. When trying to promote preventive measures for people who have committed (sexual) violence in Belgium, there is always someone in the audience (often professionals and students) who states: “Yes, but sexual predators do not feel the need to seek help.” Or “Pedophiles enjoy it and do not want to be helped.” The coordinator of a Belgian anonymous helpline for the prevention of violence that targets victims, bystanders and those committing violent acts, recently told me he was very surprised that they barely receive phone calls from the latter group. But is it really that surprising that their request for help remains so under the radar, if we, including professionals, media, and policymakers, use terms like “perpetrator”, “offender”, “predator”, “pedo”...?

Change takes time. Will we ever succeed in finding terminology that will appease all? Probably not. But we should keep on explaining to our colleagues, to media, and policymakers how crucial our language is, if we want to reach people exhibiting such interests and/or behaviours. In any case, these confronting encounters on social media should not stop us from moving the field onward. It will not stop me. I’m looking forward to posting my tweet on our ATSA-session on help-seeking behavior, especially now I know that there is a block button.

[1] I’m not making this up.

[2] Writing errors were deliberately not corrected.