Problematic sexual behaviors as a juvenile outcome measure

By Norbert Ralph, PhD, MPH

 

For juveniles who sexually offended (JwSO), sexual recidivism is identified as one of the primary outcome measures. Reitzel and Carbonell (2006) titled their meta-analysis of treatment programs "The Effectiveness of Sexual Offender Treatment for Juveniles as Measured by Recidivism." Methodologically and clinically using this measure has virtues but also limitations. With sexual recidivism rates in some researchers estimated to be about 5% (Lussier et al., 2023) it would be difficult to obtain samples large enough to detect a treatment effect. Also would a reduction from 5% to even 0% be significant enough in terms of real-world impacts and cost/benefit considerations?

 

Other outcomes have been used. Nonsexual recidivism has been identified as another benchmark to assess treatment outcomes. Lussier et al. (2023) identified general recidivism for this population as 44% and Caldwell (2016) as 27% in meta-analytic studies. General recidivism has been a focus of study, and for example, Abei et al. (2022) carried out a study of high-risk JwSO youth to compare the efficacy of sexual offense-oriented therapy and social skills training in the prevention of both sexual and general recidivism. Further, the Multisystemic Therapy group used out-of-home placements, among other measures (Borduin & Munschy, 2021).

 

Another benchmark for juveniles who sexually offended is examining problematic sexual behaviors (PSB) that may not result in arrests or formal recidivism. Viljoen et al. (2007) reported a rate of such behaviors in a residential treatment program with 169 JwSO youth of 16.6% and an average JSORRAT-II score of 6.1. Ralph (2015) in a study of another residential treatment program with 129 JwSO youth reported a rate of PSB of 20.6% and an average JSORRAT-II score of 6.3. The average JSORRAT-II scores (6.1 and 6.3 respectively) of the samples indicated that both groups above the average risk levels (Epperson, 2019). In the latter study (Ralph, 2015), any sexual behavior that violated the rules of the setting was classified as misbehavior. Notably none of these behaviors resulted in charges, even though some were serious enough to be charged. Presumably, this was considered not necessary because these youth were already on probation for such offenses and were in court-ordered treatment. For context is important to note findings such as Ybarra & Mitchell (2013) which identified nearly 1 in 10 youths (9%) reported some type of sexual violence perpetration in their lifetime.

 

Another example including PSB is in Letourneau et al. (2009), which reported an outcome study regarding Multisystemic Therapy (MST) using the Adolescent Sexual Behavior Inventory (Friedrich, Lysne, Sims, & Shamos, 2004) and its Sexual Risk/Misuse subscale. Because of the nature of the scale, specific PSBs weren't possible to separate out, such as coercing others to have sex. Abei et al. (2022) in the study mentioned previously, classified as sexual recidivism not only formal charges but also PSB that may have resulted in a formal charge but did not. However, the rate of such PSB separate from charged offenses was not separately described.

 

The above information has several implications regarding assessment and treatment for these youth. One is the recommendation that such behaviors be included in outcome studies assessing treatment effectiveness and also for individual programs as part of their quality assurance procedures. These behaviors are important to address since they may have victims too and likely increase the risk of future such behaviors. Once identified, these behaviors are more likely to become an explicit focus of treatment. Notably, the Abei et al. (2022) study has already included PSB. Also, PSB may be tracked systematically in future MST studies

 

There is another consideration. It might be possible to develop risk measures to assess for PSB that do not result in formal charges. For example, in the study by Ralph (2015) youth examining PSB, who had a male victim and previous mental health treatment had an AUC (Area Under the Curve) of .74. Practically, developing risk measures to assess for PSB might be more possible than developing measures to assess sexual recidivism alone, given the low sexual recidivism rates. Clinically, such measures would be useful to assess the risk of a given youth for sexual acting out at the beginning of treatment, particularly for high-risk youth, so that treatment methods and the amount of treatment could adequately be planned.

Ethical considerations of the financial cost of resources on harmful sexual behaviour services

 By Sophie King-Hill, Ph.D., University of Birmingham

In many harmful sexual behaviour (HSB) services for children and young people (CYP) how resources are funded, developed, and delivered is coming under increasing scrutiny as frontline and third sectors organisations are having budgets cut and services reduced. Given this context, is it ever ethical to charge for these resources?

Preventing and responding to (HSB) in children and young people forms a significant proportion of the work social services, the third sector and social justice organisations carry out. Due to this there are many tools, assessments and interventions (referred to as resources) that have been developed that make a tangible and positive difference to the lives of CYP and their families. This, and the other points made in this article, also hold true for the adult criminal justice field, but it is beyond the scope of the authors expertise to discuss these in-depth and the focus will be on HSB services for CYP.

When considering HSB the moral philosophy appears to be underpinned by the reduction and prevention of sexual abuse and harm and the promotion of well-being and recovery. So the reduction of harm and the maximising of benefits. Ethics are often highlighted in practice in terms of work carried out with CYP and their families and of the practice that is delivered, and the research that is conducted. Yet these ethical considerations are sparse when considering products that are commissioned and used.

At face value the ethical principles of HSB work may appear clear-cut (i.e., work in a trauma informed way, do no harm, protect the patient/service user). However, after scrutiny, the lines seem blurred. This field is inhabited by professionals from a range of specialisms and fields (i.e., sociology, psychology, criminology, social work, police, probation, prisons, social care); therefore, HSB services are a multi-disciplinary, multi-agency area that exist at a crossroads between practices, policies, and processes. This means that the ethical considerations are somewhat complex as no core set values and principles exist as they do in medicine, law or criminal justice for instance. In social work for example, there is an explicit commitment to human dignity and worth. In medicine there is a framework that is built around doing good and no harm, free choice, justice and fairness. These are ethical principles in which professions are bound - being built around trust and held to account by bodies such as the General Medical Council.

Whilst a multi-agency approach is clearly needed for HSB, a by-product of this way of working is that no steadfast and explicit ethical principles exist due to the range of specialisms involved. This lack of a sense of measure, accountability and consistent public pledge has perhaps created an environment where profitable endeavours have gained traction and power without the rigour of adequate ethical questioning. Given that preventing and responding to HSB is both social justice and social care work, and given the rise of health approaches and thinking in the HSB field there is a strong argument that work, including tools and interventions, needs to be framed by social not private enterprises.  Therefore, profitability, in its purest form does not seem to align when considering the field of HSB and the underpinning principles of minimising harm and suffering and supporting recovery.

The impact of the financial costs of resources on practice and provision in harmful sexual behaviour services

Consideration needs to be given to the impact of the financial costs  of resources. If the costs of resources is not equitable and is the same for all, in HSB services it risks failing CYP and their families for a number of reasons, for example:

 If some professionals can access the resource and others can’t then this can result in miscommunication and misunderstanding between the differing agencies. Research tells us that multi-agency work is a crucial aspect of positive HSB outcomes, so this has the potential to cause conflict in this space.

 If, because of the cost, only a few professionals in one agency can access certain resources then this may also risk the dilution and misuse of what has been paid for. This points to a flawed and unsustainable model – and may also indicate that in social welfare contexts a model based purely on profits may make the overall issues worse, not better.

 Training costs will always have to be ongoing if there is a commitment to a certain resource, which again may be unsustainable for agencies with small budgets. High staff turn-over may result in resources not being used adequately as the trained experts will have left. Additionally, when the case loads of those who are trained are full, what then happens to CYP who need support.

The exclusion of CYP and families from accessing services if professionals aren't trained or have knowledge is also inadvertently causing them harm. This runs the risk of a two tier model – even in the same service with some CYP and their families getting good support and others not. When something exists that can make a tangible positive difference to the lives of CYP and their families in an area as damaging as HSB, with no equitable approach, can be measured against ethical principles as inherently morally wrong.

The financial cost of resources can, inadvertently, create a postcode lottery of service delivery and interventions. For example, services in poorer socio-economic areas may not have the resources to pay for resources and therefore CYP and their families maybe excluded from accessing services.

Additionally, consideration needs to be given as to how resources are commissioned and adopted by services and how this is supported by them as well as by government and local authority budgets and spending. If resources are shown to be working and making a measurable difference to the lives of CYP, and their families, then large-scale funding and commissioning should be considered. This may negate the issues with the profiting from damaging social welfare issues that have gained traction.

What can be done?

It is important to consider the role, impact, and purpose of charging for resources on the HSB sector has. If the purpose is to positively support CYP who have sexually harmed or been harmed in an evidence-based way to reduce harm, then of course the materials used need to be based on research as well as expertise. The reality is that costs need to be covered, this is not unrealistic. And to protect their fidelity through this should always be considered. However, questions need to be asked in terms of the level of profitability over social good and where this is ethically situated.  A pure profitability perspective still appears ethically flawed in this field and considerations of revenue sacrifice, when bearing in mind the positive impact on people’s lives, should be made. Perhaps a case could be made for a ‘robin hood’ model of working when charging for services in this arena. In its simplest form this means charging those that can afford it more and providing subsidies, resources and free services, to those who can’t. This model emerged in the 1970s as can be seen in the work on cataracts by the Aravind Eye Care Hospital in India at this time. Other businesses have followed suit such as Warby Parker (buy one, give one for glasses) and Cotopaxi (donating money for social good from profits) and is underpinned by increasing social responsibilities of profit-making businesses. With the right policy transfer frameworks in place this application of values and approach can work in the field of resources and interventions that are being charged for in the field of HSB.

Work in field of prevention of and response to HSB is a moral and ethical issue, it is carried out by professionals who, in the main, deeply care and are motivated to help the people they work with, and therefore should be given access to the best resources available, regardless of cost. This is even more relevant in working with children and young people in this space. Therefore, should businesses that trade in this arena be held to account and be bound to shared ethical principles, standards, and safeguards. These principles could be set out in a charter mark for example, that has a clear ethical criterion when making profit in this field that is underpinned by the aim of maximising benefits and minimising harm to CYP and their families.  The aim should be geared around considering where they can make profitable sacrifices to maximise benefits and reduce harm - being held to account when this is not evidenced, via an ethical framework. It can be argued that in this field that the outcomes for CYP and their families should be paramount and a recognition first and foremost for the lives of the people who can benefit from services should be at the forefront of any business considerations. That public benefit, as outlined by the Charity Commission, is a key component of work in this area, especially in frontline services (i.e., social work, policing, child protection) that are publicly funded. The landscape, when explored through the lens of ethics, provides a concerning picture of an environment where the lack of consistent ethical principles means there is no bar to measure against. Therefore, when considering maximising benefits and minimising harm, in the field of HSB this lack of accountability runs the risk of becoming incredibly dangerous.

 

The Second Edition of ATSA’s Task Force Report on Children with Sexual Behavior Problems is now Available

 By David S. Prescott, LICSW & Amanda Pryor

In 2005 and 2006, I was fortunate enough to be a part of ATSA’s task force on children with sexual behavior problems. The task at that time was simple; we would write a report summarizing what is known, and provide recommendations for assessment, treatment, and policy.

Chair Mark Chaffin made the task simpler still. He organized the task force members into three groups, each of which would tackle one of the content areas and produce a section three pages long He would then edit the document and send it on to the board. Not surprisingly, none of the groups could limit their contribution to just three pages, but this clever approach made the process significantly easier, and the result was both comprehensive and concise.

In 2018, ATSA’s leadership requested an update to this report. The idea was not to start from scratch, but merely to update the first edition.  Again, this seemed like an easy task, but became more complicated along the way, including by significant changes in the office and the onset of the pandemic. The project that started with Phil Rich as the board liaison was then shepherded by Amanda Pryor, who succeeded Phil. Although I had been asked to Chair the task force, the final document reflects collaboration between many players in the task force, the ATSA office, ATSA’s Executive Board of Directors, and its Child and Adolescent Committee.

In other words, both the content and the processes changed over the years, and resulted in a stronger yet more flexible document in an era where the level of scrutiny by stakeholders has only grown higher. This document, which emphasizes person-first language, has been as thoroughly reviewed and considered as any document that ATSA has produced.

 What else has changed over the years?

To start, the research in this area has come a long way. Many people are to be congratulated for this. This research has emerged from many areas, from the University of Oklahoma to the United Kingdom.

During the initial review of the first edition, it became clear that we needed more of a focus on trauma and adversity. Anyone working with children and teens has long had an appreciation for the importance of understanding the role of trauma and adversity in the lives of our young clients. However, our understanding of these areas has become much more granular over time. Working with the task force was a great opportunity to reflect on this.

The role of technology has also changed dramatically. When the first task force report came out, the iPhone was still in development, early exposure to sexually explicit media was less common, and social media was in its infancy. Further, the “tube” sites (a generic term for online pornography sites that provide free content) had begun to flourish only at around the same time as the first edition of the task force’s report.

It is also important to note that our field’s understanding, sensitivity, and appreciation of diversity has also come a long way, in research, professional discourse, and clinical practice. This focus has included considerations related to LGBTQ+ youth and other marginalized communities.

There has been impressive innovation in treatment approaches and modalities. This includes more sophisticated think about family involvement, group-based approaches, and individual therapy. We now have even greater confirmation of the important and very noble role that families and other caregivers can have in helping children emerge into a safer adolescence.

Further, the process led us (and this was really Amanda’s contribution) to produce this as a foundational document focusing on assessment, treatment, and placement considerations. Across the coming months, there will be addenda produced to address specific areas. These include considerations in the areas of technology, sexuality, culture, intellectual and developmental disabilities, sibling abuse, policy, and collaboration with Child Advocacy Centers.

Also in the background is knowledge that the document we produced is aimed at primarily North American audiences and that additional materials with more of an international slant would also likely be welcome. While ATSA is truly an international organization, it also recognizes that North American practitioners can sometimes face unique challenges.

Ultimately, no document can be all things to everyone, but this project, thanks to uncountable numbers and drafts across many years, will hopefully guide many professionals in a more empirically grounded and helpful way.

Download the document: https://www.atsa.com/CSBP-2023

‘Tis the season of restoration

 By Kieran McCartan, PhD

Our friends in America celebrate Thanksgiving this week, a sometimes fraught and challenging holiday.  Families and friends come together to celebrate reunion, restoration, and a rekindling of relationships. It sounds easy, but it’s not! It can be difficult and sometimes irreconcilable. Establishing and re-establishing a sense of family or community is not always easy.

Interestingly, this week is also Restorative Justice week. Across Europe, it’s a time to discuss restorative practice in the criminal justice system. Like Thanksgiving in the US, restorative practice is also challenging and complex. It can also help people resolve issues, rebuild lives, and move forward from the trauma they experienced or caused. Restorative practices are common across social justice; we have seen them used in personal, community, and social conflict cases. My first exposure to restorative practice was long before studying criminal justice; it was in my native Northern Ireland, where the process was encouraged as a community-building device in the peace talks and the creation of the Good Friday agreement. However, there is one area where restorative practice is not always accepted, where it’s seen as challenging, difficult, and, at times, a risk: Sexual abuse!

Last week, Thursday and Friday, I chaired two separate and quite distinct events for the Thriving Survivors organization. One was an event hosted by the Lord Provost of Glasgow, where members of the organization discussed their work and highlighted their good practices. The second event was a traditional conference focusing on restorative justice and sexual abuse, calling for the need to have systematic change in the way that restorative justice is responded to. The events focused on the need for a coherent restorative practice to offer to victims of sexual abuse, one that’s victim-led, holistic, strengths-based, and sustainable. The conference illustrated how those who are victimized by sexual abuse should have access to and engagement with the services that they want, not just the services that the state and third parties want to offer them (or, even worse, feel that they should have). The conference showed that sexual abuse is a complex and multifaceted issue that cannot be separated from real life, especially when the abuse is committed by and connected to family systems, friend groups, and peer networks. Sexual abuse needs to be confronted, and people who are victimized seek help as well as support in whatever form they feel comfortable. The speakers (including Dr Marie Keenan; Dr Estelle Zinsstag; and David Russell) and organisations (Stop it now Scotland; The Consent Collective; Restorative Justice Council; All party working group on restorative justice) reiterated the importance of personal choice, support, collaboration, and taking a victim-centred approach. This was brought together by a keynote from Professor Judith Herman, who talked about her new book emphasizing the importance of the voices of those victimized in the healing process. That system-wide change is needed to make the criminal justice system less traumatizing for victims. One way of doing that is through thoughtful, well-planned restorative practice.

The two days reinforced the importance of personal choice and careful, detailed, trauma-informed, and strengths-based services. If done well, restorative practice can support victims in moving forward and finding closure or acceptance. Restorative practice needs to be victim-led, flexible, and accessible to all. The system needs to change to hear the voices of those harmed. In this season of restoration, please ask yourself what everyone needs to come together and talk about and the best way to do this.

Bridging Science and Various Practices: Insights from NL-ATSA Symposium

 Kasia Uzieblo & Minne De Boeck

An essential goal of the Dutch-speaking affiliation of ATSA, NL-ATSA, is to bring science closer to local professionals, and thus, strengthening the bridge between theory and practice. In our countries, professionals traditionally attend fewer international scientific conferences due to limited budgets and language barriers. Often, our researchers travel abroad to share their insights, having limited chances to connect with local professionals.  Therefore, NL-ATSA provides a platform for individuals who have spoken at the annual ATSA conference. This year, NL-ATSA organized a 'Best of ATSA' symposium with a specific focus: offering Dutch-speaking colleagues who presented at the ATSA conference in 2022 the opportunity to share their insights with local professionals. Additionally, we invited Russell Pratt from Australia as our international guest speaker.

Russell Pratt's Insightful Lecture

Forensic psychologist and D. Psych, Russell Pratt delivered an online lecture titled 'Treating Youth Engaging in Harmful Sexual Behaviour: Considering Developmental Trauma and Pornography Consumption.' Pratt emphasized the importance of approaching minors engaging in sex offenses from a developmental perspective rather than an adult one. He explored how developmental trauma impacts adolescent behavior, including harmful sexual behaviors, through its influence on attachment and brain development. Pratt expressed concerns about easy access to pornographic material and its impact on the well-being and sexual behavior of minors. He stressed the need for addressing such issues from an early age through educational programs, preferably starting at age 6. He discussed The SAVVY CONSUMER Model, a simple, effective framework for professionals and parents to assist children and young people to critique pornography as well as assist in developing their understanding of healthy sexual practices.

Insights from our Dutch Professionals

Minne De Boeck (criminologist and program manager Stop it Now! Flanders) and Kelly van den Heuvel (Stop it Now! the Netherlands), presented The Stop it Now! model of perpetration prevention. On the occasion of its 30th anniversary in 2022, the following three questions were discussed: Where are we now? What innovative projects are currently being implemented? And where do we need to go from here? They described how CSA can be approached using the comprehensive framework for the prevention of child sexual abuse (Smallbone et al., 2008), and demonstrated how specific preventive initiatives (e.g., helpline services, online self help tools, conversation guides, support groups for relatives…) fit in this framework and contribute to the prevention of CSA. By means of the framework, they discussed what is needed for effective prevention of offending behaviors according to Stop it Now!. Furthermore, they presented a case study to illustrate how Stop it Now! helplines work and how prevention can be achieved. They concluded with current common challenges, like the extensive grow of CSEM material, uncertain funding and difficulties with professional secrecy and the rules of mandatory reporting. Furthermore, they formulated suggestions to move forward in offender-oriented prevention, emphasizing the need of social awareness, research, and a public and political shift.

Nina ten Hoor, clinical psychologist and psychotherapist at De Waag, a forensic outpatient service in the Netherlands, shared her research on utilizing EMDR treatment for individuals who have engaged in sexual offending. Her exploration included restructuring distorted implicit cognitions and personal vulnerability factors, reducing emotional responses associated with offending, and addressing deviant sexual arousal. In addition, she looked at how EMDR can also help our clients with processing one’s own trauma as well as offending-related trauma. She presented a case study of a man convicted of child sexual abuse, highlighting the application of EMDR therapy to directly address one’s deviant sexual arousal. A 5-year follow-up conversation with the former client revealed that although his interest in young girls seemingly returned, this client to avoid letting these feelings overwhelm him.

Eveline Schippers, project manager and researcher at the Forensic Care Specialists (the Netherlands), presented her doctoral research on understanding the origins of deviant sexual interests. Defining sexual deviance proves challenging, and Schippers emphasized that we mainly tend to consider its impact on the individual and/or others, and not the nature of the sexual interests/behaviors itself. Despite acknowledging the risks associated with deviant sexual interests in our clients, theoretical explanations for their development remain limited. Still, it is vital to gain insights into how these develop so that we could implement more targeted interventions. Schippers discussed factors such as the excitation transfer between emotions and sexual arousal, highlighting how emotions like dominance/aggression and fear can contribute to stronger sexual arousal. In addition, she presented her study in which she found evidence for four overarching themes within unusual sexual interests, being "forbidden-extreme," "light BDSM" and "BDSM-heavy" and "fetish-forbidden, emphasizing that these interests occur in the general population. Finally, she discussed her meta-analysis showing that child abusers with pedophilia exhibit stronger sexual interests in children than control groups, but at the same time exhibit less sexual interests in adults, suggesting that the latter may be a meaningful factor in treatment.

Promoting Collaboration across Work Fields

The symposium served not only as a meeting ground between theory and practice, but also as a successful meeting ground for professionals working with offenders and those working with victims of sexual offenses. This cross-pollination of ideas, insights, and experiences between the two fields is encouraging and should be stimulated. It became for instance evident that professionals working with offenders may not fully appreciate the many questions those working with victims often have regarding the underlying mechanisms of sexual violent behavior and prevention, amongst others. Encouraging further collaboration between these fields is crucial in our collective effort against sexual violence.

In conclusion, the symposium highlighted the importance of bringing together science and various practices. The engaging lectures underscored the need for ongoing collaboration and the sharing of knowledge to enhance our collective understanding of and response to sexual offending behavior.

 

 

The Impact of World Events on Our Work.

By David S. Prescott, LICSW

I recently discussed the Good Lives Model with a psychologist from the UK. She was not the first to ask a question along the lines of, “How do I work in treatment with a client on the goal of ‘living and surviving’ when they have no job, little help from the government, and are at risk of losing their residence?” It became apparent that the best way forward under the circumstances was to provide resources for her client to remain housed and employed. She had been thinking of living and surviving in the abstract, viewing it through a purely clinical lens.

 

At a time when so many are focused on maintaining fidelity to evidence-based treatment approaches, we can miss the fact that our clients sometimes have urgent needs. Therapeutic conversations and case management can have a role in our work. We may even overlook not only the solutions around us, but our own strengths and resources in finding solutions with our clients. In so doing, we can improve our alliances and specific responsivity. 

 

It's clear that many aspects of our changing world have at least moderately close relationships to risk. Global conflicts, climate change, decreased funding, and the evolving nature of public discourse around inclusion and equity can all influence client risk and protective factors. Although we have historically improved our ability to understand individual clients’ functioning, there is much we don’t understand about how a changing and increasingly uncertain world intersects with re-offense risk. To examine this further:

 

·         While climate change is beyond the scope of this blog and ATSA’s mission beyond, if the trends continue, treatment providers, supervising agents, and clients will all be affected. For example, how does extreme weather interact with risk factors such as relationship stability, self-regulation, and proneness to rapidly escalating affect and emotions? We’ve already seen how community distress can quickly result in looting. Are treatment programs and providers in a position to address these challenges with their clients?

 

·         Recent reports show that housing  and food insecurity are growing, while resources to alleviate them are not. These have occurred contemporaneously with deaths of despair and domestic violence. Meanwhile, within our field, many professionals have had difficulties finding staff due to cost of living increases. One might reasonably ask how we are all doing managing our own risk factors? Have our anxieties had an effect on our own self-regulation skills?

 

·         Further, in many quarters, funding for treatment has decreased, while expectations around billing, documentation, and the threat “clawbacks” of payments already made to providers have increased. At the same time, many states maintain high standards for professionals working in this field. One wonders about a possible collision course between decreasing pay and the ever-increasing responsibilities that come with this work.

 

·         Finally, there are the lingering after-effects of the pandemic. We still don’t know the full impact of the past several years on other forms of interpersonal violence, although we know that violence interacts with sexual re-offense risk.

 

Other questions remain. What are the effects of other world events? As of this writing, there are two major wars in the headlines. Coverage of them has been rife with partisan rhetoric that can make violence seem acceptable in the eyes of clients who have their own violent histories. 

 

Speaking only for myself, I’ve experienced both sensitization and desensitization in response to world events and the ways that media outlets report on them. It can be difficult to place current events into any meaningful or predictive context. Certainty about anything in short supply. We professionals are experiencing these changes, often intensely.  There is no way our clients aren’t as well. The question is how we respond to this, empirically and in practice.

 

Professionals in our field, like our clients, can be remarkably resilient and creative. The hope of the author and the intent of this blog post is that by outlining some questions that don’t often get discussed, we may be better poised to find solutions.

 

Halloween and Crime

 By David S. Prescott, LICSW

As a young clinician, I recall the director of a residential treatment facility for adolescents bemoaning Halloween. “Those of us who work in this field wish this ‘holiday’ would just go away,” he said. He wasn’t entirely wrong. The troubled teens we worked with were angry that they wouldn’t be able to party that night, and they had often gotten in trouble because of Halloween-related activities. As I got older, I recall one neighbor (a teacher) who was particularly vulnerable to students who covered his trees in toilet paper. During this time, I also sought to help my own kids get through each Halloween gracefully, exercising both caution and restraint against going too far.

Looking back over my career, however, I don’t recall ever hearing that a client had abused a child while trick-or-treating. I also don’t recall ever hearing about sex crimes on Halloween from colleagues, despite it being a topic of discussion this time of year. It seems worthwhile to mention all of this because people on probation who’ve been convicted of sex crimes often deal with a heightened level of scrutiny and restriction on Halloween, no matter the nature of their crimes.

While I don’t question the importance of appropriate supervision methods and restrictions in helping clients prevent further crime, I do wish that these took place in a more evidence-informed way.

In 2009, Mark Chaffin, Jill Levenson, Elizabeth Letourneau, and Paul Stern produced an excellent study titled, “How Safe Are Trick-or-Treaters? An Analysis of Child Sex Crime Rates on Halloween” for the Sexual Abuse journal. The abstract from that paper speaks for itself:

“States, municipalities, and parole departments have adopted policies banning known sex offenders from Halloween activities, based on the worry that there is unusual risk on these days. The existence of this risk has not been empirically established. National Incident-Base Reporting System crime report data from 1997 through 2005 were used to examine daily population adjusted rates from 67,045 nonfamilial sex crimes against children aged 12 years and less. Halloween rates were compared with expectations based on time, seasonality, and weekday periodicity. Rates did not differ from expectation, no increased rate on or just before Halloween was found, and Halloween incidents did not evidence unusual case characteristics. Findings were invariant across years, both prior to and after these policies became popular. These findings raise questions about the wisdom of diverting law enforcement resources to attend to a problem that does not appear to exist.”

Five years later, Jill Levenson wrote a post for this blog on this topic, pointing out that in her research with Chaffin et al:

“We then examined over 5 million crimes that took place in 30 states on or around Halloween in 2005.  The most common types of crime on Halloween and adjacent days were theft (32%), destruction or vandalism of property (21%), assault (19%) and burglary (9%).  Vandalism and property destruction accounted for a greater proportion of crime around Halloween compared to other days of the year (21% vs. 14% of all reports).  Sex crimes of all types accounted for slightly over 1% of all Halloween crime. Non-familial sex crimes against children age 12 and under accounted for less than .2% (2 out of every thousand crimes) of all Halloween crime incidents.

“Other risks to children are much more salient on Halloween. According to the Center for Disease Control, children ages 5 to 14 are four times more likely to be killed by a pedestrian/motor-vehicle accident on Halloween than on any other day of the year.  These findings call into question the justification for diverting law enforcement resources away from more prevalent public safety concerns on Halloween.” 

Many years of work in residential treatment later, it still amazes me how much our decision-making can be swayed by the emotions that holidays bring out in us. For example, poorly constructed family visits at Christmas that would never have been considered at another time of the year have sometimes led to life-altering consequences. Again, Jill Levenson summarized the emotional elements well:

“Lest some critics suggest that by pointing out the limitations of these laws I am demonstrating a lack of concern for the safety of children, I'd argue that we are all on the same side. We all want to live in safer communities and I agree that public awareness generated by these laws has led to important dialogue about intolerance of sexual violence. But as tax-paying citizens, don't we also want our resources to be utilized in ways that are most likely to achieve the expected goals? And don't social scientists have an obligation to help inform strategies designed to enhance the public good?”

The above points may be even more important today than when they appeared in 2014. It often seems that our public policies today are driven more by in-the-moment emotion than by facts. Here in 2023, as we prepare for more anxiety around Halloween, I hope we will remember all the other threats to children in the world and take the right actions accordingly.

Discovering what was already there: The (re)emergence of Sibling Sexual Abuse

 By Kieran McCartan, PhD, David Prescott, LICSW, and Kasia Uzieblo, PhD

It’s interesting to consider the ebb and flow of academic and professional interest. We have seen on the blog over the years (this is post 510 and the blog has been running since July 2010) different topics come and go, some having periods of significance and periods of dominance. We have seen prevention become established, while risk assessment developments roll along in the background and the polygraph remains controversial, sometimes even divisive.

One topic that seems to have emerged strong and is now dominating the conversation, especially in the UK and parts of Europe, that no one really saw coming is sibling sexual abuse (SSA). This month, the Journal of Sexual Aggression had a special issue dedicated to it, as well as the journal of Child Abuse & Neglect; so why the sudden increase in research (and in some areas, practice like the development of a new mapping tool for assessment and treatment planning) interest when SSA is not a new phenomenon?

Controversies about incest and psychology have been with us since Freud. In the US, sexual abuse within families and among siblings became a focus of mental health interventions in the 1980s. At the time, authors such as Chloe Madanes used techniques for family-based interventions that appear harsh and misguided by today’s standards. Her contemporary, Jan Hindman, wrote at length about clarification of abuse and demonstrated how treating those who abuse can assist the healing of those abused. Within the field of treating adolescents who sexually abused, authors such as Jerry Thomas and Joann Schladale emerged in the 1990s and 2000s and addressed SSA through a family-therapy lens. Much has been written outside of scholarly research about the experience of surviving SSA; much less about those who commit the abuse. And fewer still have conducted scientific inquiry into SSA until now.

While the above practice developments took place in the US, there has been a growing conversation amongst professionals about SSA over the past five years in the UK and Europe. This has often emerged from the study of harmful sexual behavior in childhood, with research by the Centre for Expertise on Child Sexual Abuse developing a range of policy, practice, and research papers that indicate that it’s the most common form of intrafamilial violence.

These papers have started to change conversations and perspectives, particularly away from the typical perspective of father (or male caregiver)-daughter incest being the most prevalent form. This changing conversation has led to scoping studies and emerging research conversations across the UK that have indicated a professional and practice interest in the area. A main driver has been the emergence of SSA as a bespoke form of abuse that is not the same as child sexual abuse, peer-on-peer abuse, or other sexual exploitation. SSA involves a combination of different forms of abuse, neglect, and exploitation (sometimes across multiple contexts), which makes it complicated and nuanced not only for professionals and policy makers, but also for the children being harmed, the children harming, their family, and peers.

The complexity of SSA means that those who are victimized do not always feel seen in the system. They may not recognize themselves in service provision, nor in prevention campaigns against sexual violence, which means that they do not necessarily seek help or support. In many cases, they may not realize that they have been abused. The implications of this are that the true prevalence of SSA is unrecognized and underrepresented in children and adults services; this is a problem because if we truly want to prevent and respond to all forms of sexual abuse we need to recognize and see all forms. This means that professionals need to rethink, reconceptualize and redevelop some of their existing practice in this area.

It is important to state that in the flurry of research and practice activities related to SSA (full disclosure: Kieran and Kasia are researching and publishing in this area while David has produced book chapters and trainings in this area), we must balance the old with the new. It is essential to recognize that we need to look at the full picture and consider existing research and practice from other areas and what role they can play in professional discourse, rather than simply creating new information.

SSA sits at the crossroads of Psychology, Sociology, Social Work, and Children’s Studies. We therefore have to consider what these disciplines say about trauma, family dynamics, abuse, violence, and their interactions with each other. The CSA Centre and special edition of the JSA have done this well. It will be wise to acknowledge and recognize what we know before we adapt and develop it for a new perspective or audience. Additionally, it’s important to look towards other trends and norms that are feeding into the establishment of this emerging topic (particularly in light of what we are seeing with the lingering impact of COVID, lockdowns, the presence of trauma and adversity, and the growing influence of pornography on young people). Regarding this last point, with respect to pornography, practitioners are reporting a rise in brother-sister/stepsibling content on relevant sites.  Each of these considerations speaks to how we need a broader social and community recognition of SSA and that conversations around prevention need to happen in homes, schools, and communities.

While we recognize and welcome the increased conversation about SSA in the professional, policy and research arena, we think that it’s important to state that this is not a new phenomenon. Rather, it is a shift in focus regarding a long-existing concern, and a need to address a real issue in the lives of individuals and families. Sadly, this problem receives scant attention in the media and that it is not a topic regularly discussed in clinical practices outside our field. It thus remains taboo. Nevertheless, we hope that with increased scientific attention to this topic, interest from the community, counseling, policy etc. will also significantly increase. Because there are still so many questions that remain unanswered, such as, what interventions are adequate with this group? What prevention measures can make a real impact? How can we also better support adult victims of SSA? To answer these, we need input, insights, and expertise from all services providers and users. Let’s not wait until a serious case appears in the media before we really start investing time, money, and efforts to prevent sibling sexual abuse.

 

It’s all about taking full responsibility.

 By Kasia Uzieblo, Ph.D

Oh Belgium, dear Belgium. A small European country, unknown to many. You can say a lot about Belgium, but you can't say it's boring here politically. For example, a politician has now been discredited for making racist statements toward the Roma community. He made these statements against some police officers on a night out. This news has dominated the Belgian news since Sept. 21, but it was not until Oct. 5 that the politician in question apologized for his behavior at a press conference. During this press conference, he acknowledged that he made wrong statements. Here he emphasized that he does not remember well what was said, that he was going through a heavy period and had drunk too much, and that the statements took place in yet an amicable atmosphere: “Even though it was drunk talk and even though he was joking, I still want to apologize.” During the press conference, he did not mention the word "racist." He would not understand should the public prosecutor prosecute him for racism. "That's up to the prosecutor's office. But it takes an intentional element. You have to want to hurt and offend someone. You really have to be intentional about a group. …that intentional element is absent with me. Also, the state I was in. You really shouldn't put any value on what was said there at the time."

In recent weeks several politicians have been discredited because of their behavior, and each time we heard the excuse: I was drunk. What does this have to do with sexual violence you may think? Well, because it is a behavioural and cognitive pattern we recognize in many clients. Now take the following example. This same politician had coincidentally previously been discredited in the context of sexually transgressive behavior. Although these cases have since been dropped because of a lack of evidence, his arguments during a TV interview still resonate. When asked if he had engaged in transgressive behavior, he stated that it is difficult to determine what transgressive behavior actually is, since that boundary is different for everyone. In the same breath, he stated that it is essential that others have to indicate when this boundary is crossed.

To be clear, I do not mean to imply that this politician nor others I’m referring to have exhibited sexually transgressive behavior, but the rationalizations one hears (e.g., I don't remember it well, I had too much to drink, it wasn't meant to be hurtful, it was not intentional, others have to set boundaries), we also often hear from our clients. And in that sense, their sense of responsibility or rather, lack of, is relevant, also to our field.

We often observe similar defensive reactions and rationalizations in our clients, and this raises several issues and questions. People in public office, such as politicians, should be well aware that they are role models. Obviously, they are also human beings, and people make mistakes. But when you make mistakes, you must take full responsibility and minimize neither the behavior nor the consequences. This is also what we focus on, among other things, while treating our clients. But what are our words about taking responsibility worth, when our clients turn on the TV, hear similar rationalizations from politicians and see that they can get away with it? Another question I’ve been struggling with is the apparent ambiguity that we, both as a society and as professionals, assume in this. Why do we go along with myth-strengthening and cognitive distortions of some people while we condemn the rationalizations of others – and certainly of the target group we work with? Moreover, within the group of people who committed sexual offences we see that we differentiate: with some offenders we seem to accept such arguments as it were, while with others who may be less empowered, less eloquent, have less status and/or have committed more heinous acts, we do not accept these rationalizations at all. My argument is not that we should accept this passing on of responsibility in everyone, but rather that we ourselves adopt ambiguous attitudes, and by doing so, we give ambiguous messages to our clients: some may cross boundaries when drunk, but not you. And it is this ambiguity that we must dare to question, as a society, but also as professionals.

 

A New Era: The 2023 ATSA Conference

 By Kieran McCartan, PhD, and David Prescott, LICSW

Last week, newcomers to the field and seasoned professionals came together once again for the ATSA conference, which took place in Aurora, Colorado (near Denver). As it has been since the 1980s, it was a time to reconnect with like-minded professionals, learn, discuss the current status of the field, and upskill. ATSA is always one of the highlights of the conference season, not only for North American delegates but for those from overseas.

The first thing to say about the conference was a change to the traditional schedule with some events being dropped and others added (a closing reception) and others being adapted (moving the Next Generation reception to a luncheon, turning the welcome evening into a pre-conference welcome and networking event). The other big change was that the pre-con sessions where on the same day as the opening keynote. This is the first time that ATSA opened on the evening of the pre-con day. These changes where good to see as the structure and function of the ATSA conference has not changed in the 15 years that Kieran has been going (his first one was in Atlanta 2008, when David was ATSA President!!). It will be interesting to hear attendees' feedback and see what sticks for next year.

All things considered, it was an excellent experience. The ATSA Office staff and Executive Director Amber Schroeder, along with Conference Co-Chairs Apryl Alexander and Tom Leversee, had clearly thought out every angle of the experience, down to the background colors of the main stage. They are to be commended for their efforts. While no conference goes without minor hiccups (a missing room number here, a noticeable typo in the program there), the classic “ATSA conference vibe” was in full swing by the end of the first day, with people from around the world connecting with one another.

The plenary addresses this year set the tone for the conference and balanced all the elements that the Conference Committee and Office hoped for. They ranged from issues of the day (sexual compulsion, the impact of online abuse on those who experience it) to the systems we work in (juvenile court) to what has and hasn’t worked since before the living memory of attendees (an 80-year metanalysis).

The first plenary address was by Nicole Prause, PhD, who addressed what we do and don’t know about sexual compulsion as a “disorder.” Central to her work is that if we can’t completely understand the issues involved in sexual compulsion, our efforts to provide treatment related to it will be severely compromised. Dr. Prause reviewed the science thoroughly, often using screenshots of the research she drew upon for her slides. Dr. Prause has often attracted unwanted attention and criticism from those who believe fully in the construct of sexual addiction, and was understandably highly prepared with a very considerable wealth of research to back up her points. For David, this was one of the highlights of the conference. It is easy to read articles, while finding someone with expertise who can summarize the actual science (and not the public’s opinions) is a far greater challenge.

The second day of the conference started with Judge Linda Tucci Teodosio who provided a perspective on working with young people who sexually harmed from the court’s perspectives. Kieran found this talk interesting and different from the typical ATSA keynotes as it gave voice to an often unheard, but important voice in the sexual harm debate, the judiciary. The judge reinforced the restrictions and complications the legal system is bound to, and described how ultimately a judge’s sentence may reflect the reality of the system rather than the nuance of their perspective on what works. It made Kieran think about where the voice of the judiciary is in the UK and how this might be replicated at NOTA. David, who has spent time in the juvenile justice system, also noted some controversial aspects to the judge’s approach, including compelling the young person to describe their crimes in detail at sentencing. David’s opinion was that this is better left to the clinical team treating the youth and can have adverse consequences when it takes place in a courtroom.

The third keynote at the end of the second day was from Lindsey Lobb, Director of Operations for the Canadian Centre for Child Protection. She spoke on the topic of working together to support families and victims of online sexual violence. After providing some general information, Ms. Lobb provided sobering statistics about the nature of online harassment and extortion. It is not nearly as simple as kids sharing nude photos of themselves and facing shameful circumstances. Rather, the scenarios that Ms. Lobb works with involve deep fear, humiliation, vengeance, and the threat of serious harm. In fact, the dynamics strongly resembled/intersected with domestic violence and human trafficking. These will be dynamics that therapists need to address in treatment.

The fourth and final Keynote was Patrick Lussier who, for Kieran, delivered the highlight of the conference. He discussed his meta-analysis of trends in sexual offending reconviction data across 80 years. He illustrated how public policy and public attitudes where at odds with evidence on sexual offending rates and reconviction, asking the question of what was really causing the downturn in reconviction rates across recent decades.

The conference had pre-con workshops that covered everything topics such as risk assessment, prevention, treatment, reintegration, pornography, and sex education. There was also a full array for workshops, parallel sessions, and special interest sessions. Among the more remarkable it-could-only-happen-at-ATSA experiences was a workshop by Tony Beech, David Thornton, and Mike Miner. These experts discussed sexual disorders in DSM-5, with the highlight being a fascinating Q&A at the end involving Ray Knight, who also has a long history of involvement in this area as well and who has collaborated on occasion with the others. To have several of the leading experts in the world (and across our field’s history) engaged in such lively dialog drove home what a unique experience our conference can be.

While some of the format of ATSA may have changed in 2023 its welcoming attitude and commitment to evidence-based practice and professional engagement has not. It was a marvelous accomplishment by many, many people, not least the attendees themselves. The conference was a success, and now it’s on to ATSA 2024 in San Antonio from the 16^th -18^th of October!

The Story of Scheherazade: A Fable for JwSO Therapists of Transformation through Care and Conversation (part 3 of 3)

 By Norbert Ralph, PhD, MPH, Private practice, San Leandro, CA

(Editor’s Note: Please click on the links for part 1 and part 2)

This is the third part of a three-part blog about the Fable of Scheherazade, the central figure and storyteller in "The Book of the Thousand Nights and a Night" from classic Persian literature (Burton, 1885). The second part identified four therapeutic factors in the fable that parallel the work of JwSO therapists. This third part identifies additional factors and also cautions regarding overidentification with mythic heroism.

Relapse Awareness: For a thousand nights, Scheherazade faced the possibility that the King would "relapse" and not only kill her but continue killing other women. Presumably, this possibility would not be absent from her consciousness for a day. Likewise, the JwSO adolescent, especially those treated in the community, also has the possibility every day of committing some act of sexual aggression. JwSO therapy every week is done with awareness that the harmful behavior may recur and the importance of taking appropriate measures to prevent it.

Curriculum and Fidelity: Scheherazade had a series of stories, which is a lesson plan or curriculum to last a thousand nights, which was presumably implemented with fidelity. The fable notes that she had committed to memory 1000 stories regarding past kingdoms and adventures. Baglivio and colleagues (Baglivio, Wolff, Jackowski, et al., 2018) identified factors contributing to successful outcomes for residential and secure JwSO programs. Some of the factors promoting therapeutic outcomes included whether there was a structured, manualized curriculum administered with fidelity. This would contrast with an unstructured open-ended therapy relationship or a curriculum that was not faithfully implemented. A parallel between the story of Scheherazade and the work of effective JwSO therapists is a structured and faithfully implemented therapeutic curriculum. In working with this population while having a prosocial therapeutic relationship is necessary it is not sufficient. It also involves teaching knowledge, interpersonal and problem-solving skills, and practicing new behaviors both in therapy and outside, and critically reviewing results. Deficits in knowledge and skill areas may contribute to problematic sexual behaviors. In this respect, therapy is like learning Spanish. You have to learn information and practice skills, not just have a positive relationship with the teacher.

Termination and Self-Regulation: At some point, the JwSO therapist, like Scheherazade, expresses the faith that the youth can lead a prosocial life without a lifetime label or controls by terminating therapy. Scheherazade, at the end of 1000 nights of storytelling, told the King she had no more stories to tell. The implicit message was that the support of the storytelling or therapy she was doing was not now necessary because of the skills and transformation of the King. While starting therapy was a profound act of optimism, also stopping and saying it is no longer needed, also represents an optimistic act but one that is realistic based on the acquisition of new knowledge and skills. Presumably, Scheherazade saw termination of therapy as a necessary part of the prosocial transformation of the King. Termination of the youth in therapy gives the message to the youth, the family, the courts, and the community that the youth is ready to construct their prosocial life. Taking responsibility for a prosocial life can be viewed as the last necessary step in treatment and that additional controls or management like sex offender registry or prolonged probation may not only be not helpful but counterproductive.

Discussion:

Lessons from this fable may be that there are commonalities across centuries and cultures regarding how people view the possibility of prosocial transformations of someone who has harmed others. The myth of Scheherazade was created in the ninth century with the premise that you could transform someone who had done harm to others by a conversation, relationship, and combination of skills. In that fable, the caring conversation not only promoted the prosocial transformation of the King but also impacted the Kingdom and promoted public safety and fear of ongoing evil. This is similar to the goal of the JwSO therapist who intends to promote the prosocial development of the youth and also public safety.

Most myths not only are parables to teach moral lessons about dealing with life challenges but maybe cautionary tales. Over-identification with the idea of acting heroically could lead to unwise optimism that would result in greater harm. The therapist can become so identified with heroic goals that they may ignore the dangers and negative possibilities. Joseph Wheelwright (1971), a Jungian analyst and teacher in the Bay Area, talked about how therapists should be cautious about "channeling" mythic images, such as the White Knight riding in to save others. The therapist who over-identifies with the hero's quest, and ignores realities, may end up like Don Quixote, in folly and misadventure, and worse, tragedy.

 

Pornography and age verification

By David S. Prescott, LICSW

The US State of Louisiana passed a law in 2022 requiring users of pornography websites to upload state-issued identification materials to prove that they are 18 years old or older. Pornhub elected not to conduct further business in that state. More recently, Texas adopted a similar approach. The media attention has been eye-opening. Much of the coverage has noted that only a few pornography devotees have spoken out against these laws, although there have been some discussions of the free-speech implications.

From the outset, Pornhub and other websites that provide easy access to free pornography are not sympathetic players on the world’s stage; not many would rue their downfall. In the past, Pornhub has been the subject of investigations into child sexual abuse imagery and videos shared against the will of participants in them. It is understandable that these laws have met with enthusiasm. A concern remains, however: Are these laws really as effective as we would like to believe? What’s missing?

Virtually all professionals in our field are strongly aligned with not exposing children to sexually explicit materials. Speaking personally as a father, when my own children were growing up, I made considerable efforts to keep them safe from online risks; my heart goes out to parents today. We are so far removed from my generation’s occasional brush sexually explicit materials.

The articles prompt questions:

How will they keep all porn sites from operating in these states. There’s a lot of those websites out there, including related enterprises like OnlyFans, etc. There will be a number of legal issues involved over and above the usual free-speech arguments. It seems that Pornhub is also hiring lawyers and experts for future litigation.

Also, there is so much sexually explicit material in social media (one app actually advertises that it introduces strangers to one another), it’s reasonable to wonder about the intellectual honesty and long-term effectiveness of these laws. Pornhub will go elsewhere, but the issues will not. Much of the material will simply find another host. Are these laws closer to a bandage than a cure? Are our lawmakers doing the best that they can?

Further, Virtual Private Networks (VPNs) and similar end runs around technology allow users to mask their location. One implication of these technological loopholes is that while these laws may appear to restrict access, the question remains as to how well they actually protect children. Will we ignore the responsibility of adults to be aware of their children’s online activity? To what extent do these laws create a false sense of security? Will some kids simply borrow their parents’ ID?

There is a strangely amusing quality to the restriction.  It’s not just any verification process, it’s uploading a government-issued ID… to a porn website! Anyone should think twice before uploading any government-issued ID anywhere, even to a governmental entity! The risks for identity theft are simply too great. Any reasonable person would be wondering who is monitoring my activity, even as we know that websites such as Facebook, Amazon, and numerous government agencies already possess frightening amounts of personal information. Who is storing this photo ID? Further, many government agencies actually discourage sharing government-issued identification online.

Given some recent activities, such as one state’s legislature’s subpoena of the medical records of transgender patients seen at a hospital, one has to wonder where all of this is headed. What sorts of over-reach into people’s private lives may result, including in the name of child safety? It’s not clear that there are any answers at this time.

Finally, if it’s really about the best interests of kids, perhaps legislatures should take other measures as well, such as funding abuse prevention, boosting child welfare agencies, improving education funding, ensuring the wellbeing of people who have abused, and making sure kids in their state have enough to eat.

A review of the International Association for the Treatment of Sexual Offenders (IATSO) conference 2023

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

Apparently, it’s never too late to try new things! Or so they say. At least in Kieran’s and Kasia’s case, this is true. For the first time, they both attended the IATSO annual conference. David is an older hand at this and was a keynote speaker. Last week saw the 17^th bi-annual IATSO conference, which took place in Trondheim, Norway. IATSO has been affiliated with ATSA for many years, and their conference is one of the big 5 conferences that focus on the prevention, rehabilitation, and integration back into the community of people convicted of sexual crimes (with the other four being NOTA, ATSA, NL-ATSA, and ANZATSA). Despite the common focus concerning sexual violence, we experience time and time again that each conference has its own accents, brings different insights, and other opportunities to get acquainted with colleagues as not every expert can attend the big 5. The entire experience made us more enthusiastic about attending ATSA in a few weeks.

This year the IATSO conference had well over 100 papers across 3 days of keynotes, pre-conference workshops, and parallel sessions with over 400 attendees from no less than 20 countries, including Greenland. The range of choice in the parallel sessions was rich. It included talks on – among others – desistance, risk management, trauma-informed practice, compassion in treatment, staff development, risk assessment, and public and professional perceptions. The conference focused on all forms of sexual abuse (including child abuse, rape, multiple preparator abuse, online sexual abuse, sibling sexual abuse, and incels) relating to an array of characteristics (incl. gender, race, learning difficulties, neurodiversity, and age); there was a topic or area for all researchers and/or academics. The sessions also had various angles: some speakers shared their most recent research results, while others delved deeper into specific practices and cases. This way, the participants were offered a diverse mix of science and practice.

There was a wide range of engaging pre-conference workshops. Several workshops were provided by well-known ATSA, NOTA and ANZATSA speakers such as Liam Marshall, Jayson Ware, Carol Carson, Mark Olver, Jennifer Allotey, Keira Stockdale, David Prescott, Brian Judd, and Maaike Helmus. But local experts (i.e., Svein Øverland) from Norway were also given a platform. This approach was the common thread throughout the conference: local professionals and academics were given ample opportunities to share their clinical experiences and scientific insights with the public. This way, the participants not only got acquainted with the rich Norwegian culture, food, music, and nature before, during and/or after the conference, but they also gained insights into local practices and experiences regarding efforts to end sexual violence.

The keynotes also presented a mix of national and international speakers, with a strong focus on Norwegian policy and practice over the years from Knut Hemstad, who started the conference, Oddfrid Skope Tennfjord, talking about working with young people who have committed harmful sexual behaviour and presenting the tool they developed to facilitate sexual education in schools. Anja Kruse (ending the conference) talking about the role of trauma and harm, partly caused by how society and justice treated them, in the lives of men who have sexually offended. The other 4 keynotes where a mix of Canada, USA and UK speakers with Liam Marshall talking about effective treatment practices, Keira Stockdale talking about Offence Analogue and offence replacement behaviours, Mark Olver talking about the role and relevance of protective factors in risk assessment and risk management, Simon Hackett talking about harmful sexual behaviour in young people, and David Prescott talking about reflective professional development and treatment effectiveness. Although at first glance the 7 keynotes seem quite dispirit, in fact they were not, they all talked off compassion, service user engagement, desistence, and professional reflection and engagement.

IATSO was a great, engaging, and intriguing professional conference that enforced the international aspects of working in sexual abuse prevention and response. Although it was the first time that Kieran and Kasia attended, and like David, it won’t be his last. For those interested: the next IATSO conference is scheduled for August 26-29, 2025, and will take place in Poznań, Poland. All information and updates can be found on their website: https://www.iatso.org .