The European Commission’s mapping criteria for Help Seeker and Perpetrator Prevention Initiatives in Child Sexual Abuse and Exploitation.

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

Earlier this week, the European Commission published a new document titled “Help seeker and Perpetrator Prevention Initiatives - Child Sexual Abuse and Exploitation.” Its aim is to support initiatives for Child Sexual Abuse (CSA) help-seeker and perpetration prevention. The idea is that by creating a common taxonomy of prevention programs for several different stakeholders, we can collectively understand and share best practices around CSA prevention initiatives. The report is a step towards the creation of a European Union (EU) knowledge platform on CSA prevention initiatives, which will support EU Member States to develop and roll out tailor-made prevention policies according to their respective cultural and societal environments and needs.

On May 11, 2022, the European Commission published a proposal to prevent and combat CSA, with a strong emphasis on prevention; but even though preventing and combatting child sexual abuse is a priority of the European Union, there has been no common EU-wide approach or concrete framework to highlight what member states had already accomplished. A plethora of different terminologies and taxonomies exist to describe prevention programmes (a common issue across the EU in general), making the information about such initiatives limited, unclear, and unstructured.

Collectively the JRC, DG HOME, the newly emerging prevention network developed by the team, and a number of interviewed practitioners and experts reached a common consensus on the idea that to raise awareness of existing prevention programmes for people at risk of committing sexual offenses it was necessary to categorize and evaluate them. For this purpose, a dedicated working group was established, and the output of this common effort are 14 classification criteria that will support EU Member States to develop, implement and research prevention work in different countries. The 14 agreed classification criteria are:

1.       TARGET identifies to whom the initiative is addressed, such as people who fear they may offend.

2.       CONTEXT refers to the environment in which the intervention is given.

3.       METHODS refers to the tools, treatments, support opportunities and programmes proposed to the targets.

4.       INITIATIVE PROVIDER refers to the nature and main activities of the entity or initiative provider that is offering the program and/or treatment as well as  the one that implemented it.

5.       FUNDING refers to the money allocated to the program and/or treatment.

6.       COSTS refers to the costs that would be sustained by the entity proposing/setting up the program

7.       THE FOUR PREVENTION STAGES (Primary, Secondary, Tertiary, Quaternary, described in previous blog posts and the extant literature).

8.       EVALUATION aims to capture the outcomes of the initiatives.

9.       ACCOUNTABILITY of the programmes refers to the processes and mechanisms put in place by the initiative provider to appraise the programme at different stages to ensure that the programme remains accountable, and that it is working towards the goals.

10.   LEGISLATION refers to the legal national framework under which the specific programme/intervention is being deployed.

11.   COLLABORATION refers to the synergies and complementarities that can be established with different entities involved in the prevention of CSA.

12.   DISSEMINATION refers to the actions taken to raise awareness about the prevention initiative among (potential) stakeholders.

13.   TARGETS’ RIGHTS are explored in terms of privacy, anonymity, and safety to preserve and assure confidentiality, assurance of empathy, etc.

14.   ACCESSIBILITY refers to several elements of the preventive programme that can be related to: the language of the resources, the availability of complementary tools to the traditional text-based ones, the standardisation of tools provided, and he cultural responsivity factors.

 

(The criteria are adapted/replicated from document)

 

The 14 classification criteria were then applied to five case studies (PedoHelp – France; Parafilik – Czech Republic; Out of the Net - Spain; Sexual Aggression Control – Spain;  Circles of Support and Accountability (CoSA) - European union-united kingdom) to see how they aligned. The results indicated that the five case studies did align and that the criteria were useful in the development and implementation of prevention programs. Additionally, the report goes on to discuss a series of international prevention mapping tools (i.e., INHOPE prevention initiative report, Eradicating Child Sexual Abuse (ECSA), PedoHelp, Helplinks (a Europol website as part of the Police2Peer project) and the UNICEF promising programmes to prevent Child Sexual Abuse and Exploitation report. The report finishes off with a series of smaller sections describing relevant information on several programmes for people who fear they may offend, for people going through criminal proceedings and post criminal proceedings, as well as those for minors.

This is an invaluable resource for policy makers, practitioners, and researchers alike. The report demonstrates the development of good practice available in developing interventions for people at risk of committing a sexual offence or those who have. I would strongly recommend looking at it and learning from its findings.

Spirituality in Treatment?

 By David S. Prescott, LICSW

When I was a very, very new clinician, I worked in a residential treatment program for adolescents. One day, I was tasked with handling the admission of a new student. Typical of many of our admissions, he was escorted to our program with all of his belongings in a couple of clear plastic bags. He had a few changes of clothes, numerous pairs of old sneakers, and a poster with a drawing of a wolf and the words “spirit animal.” 

At the time, as now, there were periodic discussions in the media about how adults, and in particular schools, handled the topics of religion/spirituality and sex education. The bottom line was that each was a third-rail issue and among the fastest routes to being the subject of an official grievance or complaint. I asked the adolescent about the poster and with standard teen reticence he stated only that he had a connection to wolves. Leaning more in the direction of avoiding trouble than deep understanding, I let the matter drop and helped him to settle in. It’s a decision I’ve regretted for years; there are any number of ways I might have been more helpful in that moment. Instead, I took an easy way out. While we were able to talk about his spiritual path later on in treatment, I’d already established a relational template in which these discussions were less likely to occur. I’d also provided a lesson in adult discomfort with some topics. 

Fast forward a few decades to when I worked in a civil commitment program. A notorious client refused any treatment and all but a few interactions with the administration. He angrily complained to the facility director that because he worshipped the Norse God Thor he should be allowed to keep a sword in his room, along with a blacksmith’s hammer and anvil. This situation seemed to require little clinical nuance: The Security Director took over the discussion and said that he could have a piece of cardboard painted silver to resemble a sword and left it at that. Were we closer? I think not. 

In this second case, contextual factors ruled out serious discussion. This person was refusing treatment while exercising his rights. The clinical staff all had far more urgent matters at hand, or so it seemed. Had someone been able to listen to this person not just to resolve the issues, but with a goal of deeply understanding the client, it might have led to an honest discussion of how they might work together to find religious items that represented this man’s beliefs. 

Even more recently, after pondering the above, I came to find that one of the few books, probably the only book written on the topic of managing objections by self-identified Christians to participating in abuse-specific treatment is long out of print and unavailable; it had been self-published. Likewise, my (and others’) search for an expert who can talk about how to help Muslims place treatment goals and activities into the context of Islam has also turned up no leads despite some promising starts. 

Meanwhile, within the field of treating individuals who’ve sexually abused others, it is unusual to see discussions of enlisting spirituality in treatment. In some cases, modifications made by administrators and clinicians to the Good Lives Model involve tucking spirituality away under the broader rubric of inner peace. I’m confident that many clinicians do excellent work in this area, and yet we seem to remain so quiet about it. After a certain point, I have to wonder what this says about us.  Are we afraid to discuss these matters that we could help make stronger as protective factors, as in the first example? Do we not consider spirituality because it only seems to connect to a small portion of the principles of risk, need, and responsivity? Or are we too busy to consider spirituality, as in the second example? Or do we consider it unlikely that our clients have bona fide spiritual paths? Or do we, in some cases, actually believe them incapable of redemption or of building a more solid spiritual base? 

I don’t have answers to these rhetorical questions and don’t consider myself to have any particular expertise in spiritual matters. I once visited a country that had experienced significant strife over religious freedoms. When conversing with someone new, one never inquired about where the other had gone to school, since that would be an indication of religious beliefs. For them, it seemed that spirituality had become a kind of demilitarized zone. 

A colleague recently commented that in her region in the American south, Christianity is indeed a focal point of treatment. A colleague in South America recently stated the same. As an outsider, I’ve often wondered about programs that describe themselves as having a spiritual foundation in only one direction. Are we really doing enough? 

The possibility for practical challenges and ethical tensions is ever-present. On the other hand, those assisting individuals who have abused have long faced ethical challenges in the routine performance of their everyday duties. Still, it’s more common to see requests for immediate concerns such scoring risk scales and what kinds of travel restrictions might limit where clients may travel in particular US states. 

In the end, every human being has a desire to know how they fit into the universe around them, as described in Robert Emmons’ book, The Psychology of Ultimate Concerns. Perhaps it’s time for a broader conversation in our field?  

Desistance, Recovery and Justice Capital: Putting it all Together.

By Hazel Kemshall, Kieran McCartan, & Joy Doal 

On the afternoon of the 16^th November we presented a session for the Academy of Social Justice on our new HMI Probation research insight paper called “Desistance, recovery, and justice capital: Putting it all together”. After the presentation there where several conversations and discussions, most of which were responded to at the time, but not all were. This blog is a response to some of those additional or detailed comments and questions that we did not have time to discuss fully on the day in question. The blog is broken down into four main themes, each of which will be answered in turn;

1. Role of the probation officer including PQUIP training.
2. Community engagement in understanding and responding to crime.
3. Improving the focus on prevention.
4. Responding to diversity and exclusion.

 

Role of the probation officer

The role of Probation officers and their responsibilities align with a focus on desistance, recovery, and justice capital.  His Majesties Prison and Probation Service
(HMPPS) emphasise “Preventing victims by changing lives”, and works to enhance access to pro-social capital, increasing skills, and enabling more positive decision making are all shown as contributors to desistance over the long term (Kemshall 2021, and Kemshall et al, 2021).  What kind of activities work well? The following practices are supported by research:         

                   

• Modelling and encouraging reciprocity, that is, mutual exchange rather than merely appropriating things. Social norms and the smooth running of society is rooted in reciprocity so it is important service users can implement it (Best, Musgrove and Hall, 2018; Kemshall, 2021; Weaver, 2015).

 

• Identifying and accessing routes to building trust between the service user and others, and between the service user and the key groups that can afford opportunities to change (Christakis and Fowler, 2009).
• Providing dignity and value to the service user combined with appropriate boundaries on conduct and behaviour (Bush et al., 2016; Rex and Hosking, 2016).

 

• Fairness and justice in applying legitimate sanctions and the appropriate use of ‘supportive authority’ (Bush et al., 2016; Maruna, 2012).

 

• Hearing the service user ‘voice’ and offering individualised service delivery based on a comprehensive and holistic assessment (McNeill, 2006).

 

• Partnership with the service user where possible, realistically recognising the barriers to joint working, and accepting that, at times, particularly in the early stages of supervision, the practitioner may have to be the ‘senior partner’. The practitioner should be an ‘enabler’ not a ‘rescuer’ (Kemshall, 2022b; Rex and Hosking, 2016).

 

• Creation of positive networks of opportunity and routes to change (Christakis and Fowler, 2009; Kemshall, 2021; McKnight and Block, 2010).

 

• The importance of recognising trauma and adverse experiences in the lives of service users; taking a trauma-informed approach recognises the importance of the life course in people’s pathways into and out of criminogenic behaviour practice (McCartan, 2020).

 

• Recognition of the impact of stigma, marginalisation, structural disadvantage, and intersectionality on service users (Alliance for Women and Girls at Risk, 2017; Barlow and Weare, 2019; Byrne and Trew, 2008; Farrall, 2019). It is important to see the individual in the socio-ecological environment that they exist in, and to understand that the different levels of this environment all contribute to preventing reoffending, successful risk management, and desistance. 

( See Kemshall & McCartan, 2022 for information and full references)

 

Community Engagement

Statutory agencies like Probation and more broadly HMPPS may struggle with community engagement, not least because of their statutory role and dependence on government funding.  However, there are good examples of community engagement and community wide initiatives, often by the third sector, that have demonstrated effectiveness in this area.  Some not only raise public awareness but also innovate new approaches to crime reduction.  Most use Public Health methodologies to crime reduction, and most notable in the UK are:

 

• Merseyside (Merseyside’s Violence Reduction Partnership, 2022) and
• London (London's Violence Reduction Unit, 2022), and
• the Violence Reduction Programme in Scotland (Violence Reduction Unit, 2022).

 

The Cure Violence (2022) public health initiative on a criminal justice issue has now spread to over 20 countries worldwide. The initiative takes a health-based approach to prevent and respond to violence, as well as violent crime, working at individual, interpersonal, community, and societal levels. The approach importantly contextualises the causes and responses to violence and then works to change individual and social norms around it. In recent years, Cure violence has developed to the point where it sees violence as a global epidemic that requires a structured population-level response. In addition, interventions at the societal level, particularly through social and criminal justice policies, have more recently focused on developmental factors and the reduction of adverse life events (Public Health England, 2019; Public Health Wales, 2015; Scottish Government, 2018); and interventions targeted at life-course events and mitigating crime trajectories (McCartan, 2020). 

 

Although we all, professionals and members of the public, recognise the need for greater messaging and a stronger community engagement strategy regarding the prevention of and response to criminogenic behaviour, especially sexual and violent offending, what strategies work best in communicating with the society at a broader level;

• Clear messages with a focus on success.
• Examples of what has worked and why.
• Do not fuel prejudice and “crime anxiety”, rather
• Tell the public what positive steps they can take.
• Emphasise partnership working to reduce crime.
• Build trust by being as transparent as you can be, and focusing on crime solutions.
• Work with local leaders, “opinion formers” and those trusted locally- general campaigns especially via the media are less successful and are prone to being “hijacked”.

(See Kemshall, and Moulden, 2016 for information and full references)

 

Improving the focus on prevention

One of the main challenges in reducing crime, especially first-time offending, is the lack of a systematic approach to crime prevention strategies. Quite often crime prevention strategies are piecemeal and bespoke with different regions and cities in the UK taking different approaches, often spearheaded at a local level by innovative and well-intentioned individuals. Which poses a challenge to a national, or country level, as there is often not a clear evidence base or consistent approach, which means that when HMPSS OR Ministry of Justice look to engage with the preventative intentions they cannot do so from a well-informed position. The reality of preventive approaches is that they are “practice informed” rather than “evidence based” which means that you are taking a calculated gamble on an innovation which you think will work. This is a challenge at the best of times, but especially in the current economic climate. Therefore, what do we do? The solution seems to be emerging through work that is linking public health and criminal justice together in new, innovative approaches to preventing criminogenic behaviour (i.e., the Together for Childhood project spearhead headed by the NSPCC which looks to create a city wide placed based approach to the prevention of child abuse). The development of closer ties between public health and the prevention of criminogenic behaviour means that we can reconceptualise offending behaviour, re-establish it in a developmental frame and think about it across the socio-ecological approach (i.e., individual, interpersonal, community and societal) which means that prevention of first time offending (primary and secondary prevention) is as relevant as prevention of repeat offending (tertiary and quaternary prevention), thereby opening the door to a reasoned debate about the potential for a systematic and sustainable approach to prevention. We have seen this in the development of new policies like the Council of Europe’s Recent Recommendations on “the assessment, treatment and management of people accessed or convicted of a sexual offence”.

(see McCartan, 2021, 2022; McCartan & Kemshall, 2021 for information and full references)

 

Responding to diversity and exclusion

Practice focused on the delivery of positive, ethical, and person-centred assessment and interventions that are trauma-informed, compassionate, and cognisant of the contextual issues surrounding the person, including issues of multiple disadvantage, are the most likely to respond effectively to diversity and exclusion.  Anawim provided an excellent example of this, with attention to culturally relevant interventions and activities (often including food), person centred assessments, skill building, and practices aimed at enabling service users to become fully functioning and well-embedded citizens. Anawim and women’s centres more broadly, by working alongside Police or Probation can address women’s intersectional needs holistically and as staff tend to represent the communities the women are from, can relate better. As they are not in the enforcement role they can build more genuine relationships which can also (funding allowing) continue those relationships after court Orders are completed. The social relationships and peer support gained by interacting in the centres and attending groupwork and courses also extend outside of the confines of the Orders.

Conclusion

This blog has been a response to questions and issues raised in regard to our HMI Probation insights paper and resulting talk, it looks to expand upon what we have said and clarify some main theses. The important thing to remember is that desistence is being promoted as part of the recovery capital being delivered by HMPPS through their good, effective, and engaged practice (justice capital) but that we are often not good at recognising it and highlighting it. Justice capital is essential to good, effective engagement which results in desistance but in order to achieve it as a system wide level we need to highlight it in training, recognise it in practice and discuss it in public.

 

The importance of trauma-informed care

By Minne De Boeck (president NL-ATSA, criminologist University Forensic Centre, coordinator Stop it Now! Flanders), Floor Somers (intern University Forensic Centre) & Kasia Uzieblo

 

Approaching individuals who commit sexual crimes (ICSC) from a holistic perspective, can give insight in their trauma histories. While it is not possible to say that trauma caused a person to commit a sexual offense, there is growing evidence that certain types and the number of adverse childhood events (ACEs) are associated with different types of sexual crimes. Hence, it is important to gain insights into the impact of these traumatic experiences and - by doing so - to gain insight in the connection between past and present behavior.

 

On December 5, 2022, a symposium about the impact of trauma on ICSCs was organized by the University Forensic Centre (UFC) in Antwerp, Belgium. At the start of the symposium the chair, the criminologist of UFC, (Msc.) Minne De Boeck, explained the importance of trauma-informed care in ICSC, and described how the topic obtained more scientific attention thanks to strengths-based approach to offending behaviors. Nonetheless, she noted that there is still a lot of hesitation and reluctance in practice to pay attention to trauma in ICSCs. Possible reasons for this reluctance are a lack of knowledge about and training in trauma treatment, a fear of being manipulated by the client when focusing on the trauma, and a fear that these traumas would be used as ‘excuses’ or ‘justifications’ for their behavior.

 

The first presenter was, Dr. Melissa D. Grady, who received her M.S.W. and Ph.D. from Smith College School of Social Work. Her clinical experience includes clients who have experienced trauma, depression, anxiety, anger management problems as well as other mental health issues. In addition, she practices, writes about, and conducts research and trainings on ICSCs and evidence-based treatment. At the symposium, she discussed trauma, the connection with sexual offending, and possible treatment programs.

 

Trauma-informed care (TIC) shifts the focus from ‘what is wrong with you’ to ‘what happened to you’. Grady emphasizes that to understand trauma one needs to be person-centered, because every adverse event can be experienced differently in intensity. Small or large traumas cannot be universalized. Being left alone at the playground for 10 minutes can have an enormous impact on someone, while a car accident for another person can be less of a shock.  ACEs can have lasting effects on health, behaviors, and life potential. Research finds that 45,7% of male ICSCs have 4 or more ACEs comparing, whereas in the general population 9% experiences 4 or more ACEs. Thus, ICSCs are a very traumatized population. A higher ACE score not only elevates the chance of committing a sexual crime, it also increases the chance to commit more different types of crimes. A study of Melissa Grady and colleagues (2022) on the therapeutic needs of clients, suggests that the vast majority requests to discuss their traumatic past. Clients assert that there is a strong connection between their traumatic histories and their subsequent offending behavior. Some describe their offending as a repetition of their own past victimization. However, many clients also note that potential connections between trauma and offending are rarely discussed or acknowledged in treatment. This shows a big discrepancy between the clients’ needs and the focus of clinicians. The question arises how we - as clinicians - respond to such findings? Are we really exploring enough in therapy? Ms. Grady suggests questioning our own practices. A comment was made from the audience about trust issues these people face and therefore the unwillingness to speak openly about their traumas. Someone else mentioned not feeling comfortable or specialized enough to dig deeper into the traumas. It is therefore important that clinicians, working with ICSCs, have expertise in how to discuss trauma, how to treat in a trauma-informed way or that they know where to refer the client to.

 

The pressing question that remains: how do we make the connection? What are the theoretical links between ACEs and sexual offending? Trauma can cause deficits, followed by risk factors, criminogenic needs and eventually aggression in order to regulate and self-soothe. Sexual abuse predicts, for example, the development of criminogenic needs associated to sexual offence. To understand this process better, Ms. Grady refers to the importance of the attachment theory of John Bowlby. This theory focuses on the early relationship between caregiver and child. Based on this relationship, the child develops an internal working model - a blueprint on which the child bases his/her expectations about future relationships. The attachment behaviors in the internal working model continue to follow the same pattern in the future: ‘not nice to us, so not nice to them’. People with insecure attachments experience many struggles such as mental illness and deviant regulation of affect, cognition, and behavior. Ms. Grady stresses the need for programs that preventively analyze vulnerable children to interfere with this ‘prison pipeline’. In addition, she underlines the importance and impact of building (therapeutic) trust relationships in the guidance and treatment of ICSCs. Despite someone’s insecure basis, clinicians should have the capacity to make changes in these patterns and rebuild trust.

 

Is our program trauma informed and how do we implement this in our daily practice? Trauma-informed practitioners view trauma not as a discrete event, but as a set of experiences that deeply influence the person’s world view, narrative and identity. To consider whether your program is trauma-informed, you can consult the trauma-informed principles (TIP) Scale by Cris M. Sullivan and Lisa Goodman. To implement it in practice, there are different therapy modalities and models. A useful model discussed in the symposium, is SAMHSA’s 6 key principles of TIC, commonly used in the US. These principles are: safety, trustworthiness & transparency, peer support, collaboration & mutuality, empowerment & choice and cultural, historical and gender issues. Adopting a trauma-informed approach is not accomplished through any single particular technique or checklist. It requires constant attention, caring awareness, sensitivity, and possibly a cultural change at an organizational level. In addition to trauma-informed care, Ms. Grady mentioned trauma focused treatments, like Trauma-Focused Cognitive Behavioral Therapy, EMDR, Cognitive Processing Therapy and Exposure Therapy, all designed specifically to address the individual’s trauma and to target specific trauma symptoms and reactions associated with PTSD. These treatments extend beyond TIC and require specific training and expertise.

 

The second presenter was David Prescott (LICSW), the Director of the Safer Society Continuing Education Center. As a mental health practitioner for 38 years, he is best known for his work in the areas of understanding, assessing, and treating sexual violence and trauma. He discussed the implications of trauma research for professionals treating sexual offending behaviors and offered ideas for practitioners to employ from several different approaches. Mr. Prescott started with the three important elements of sexual offending treatment: risk, need and responsivity. It is important to match the level of services to the level of risk, target dynamic risk factors/criminogenic needs and use empirically supported approaches. Responsivity refers to the offender’s ability to learn from a rehabilitative intervention by providing cognitive behavioral treatment and modifying this intervention to the individual. There is general responsivity which refers to implementing theoretically relevant and evidence-based models for individual change, such as cognitive-behavioral and cognitive-social learning models. Specific responsivity can be regarded as a ‘fine tuning’ of the cognitive behavioral intervention. Mr. Prescott addressed that there is no method or model that fits everybody. Always take into account someone’s strengths, abilities, learning style, personality, motivation, and bio-social characteristics. This may raise questions like, ‘am I the therapist that this person can respond to?’ or ‘is this the program that this person can respond to?’.

 

Furthermore, Mr. Prescott indicated that clinicians could help these individuals find constructive ways of managing their emotions. It is the goal of (trauma-informed) treatment to teach people how to investigate every feeling they have, to help people live in the present. He recommends not only using CBT but also focusing on their physical reactions and impulses, by including for example yoga and several forms of meditation, like he does in his practice. Mr. Prescott also suggests the use of basic principles in TIC like motivational interviewing and feedback-informed treatment to get more effective.

 

We can conclude that there is no concrete nor universal answer (or method) to the pressing question: How can we put TIC into practice? It is the responsibility of all clinicians to help grow the empirical evidence and best practices. We need to explore more in depth what works and why it is working. Because we cannot get around the fact that working towards a concrete evidenced-based treatment for ICSCs implies including their trauma history.