What’s New? (And What Isn’t?)

By David S. Prescott, LICSW

Recent changes involving ATSA have inspired discussions about change. Over the years, ATSA has been many things to many people, inspiring comments such as “the ATSA conference is like coming home.” Not surprisingly, some discussion has focused on changes in leadership: Our Executive Director (Amber Schroeder) and new members of the professional staff are fully settled into their roles. The office itself is primarily virtual, with ATSA staff spread through various parts of the US (and if the pandemic has taught us anything, it’s that this kind of arrangement can be as effective as it is economical). Each of the individuals involved are getting excellent reviews by ATSA’s board of directors. And to top it off, ATSA’s leadership has updated our mission statement:

Creating a world where ending sexual harm is a shared responsibility and an achievable goal.  ATSA champions research and treatment, informs public policy, and advocates for best practice. Together, we can shift narratives on preventing sexual abuse perpetration.

It doesn’t end there, though. Every individual involved, in the office and on the board, has worked to make and adapt to the many changes necessary in the times. These changes have been as singular as getting task force reports finished and as broad as addressing the economic realities of the times. It is therefore no surprise that many would have questions about the direction the organization is going in. Indeed, there has just been a survey to inform the next iteration of our strategic plan. Some members have naturally expressed confusion, while others have observed that change is hard.

A Look Back

This all seems worth mentioning against the backdrop of our history. So much has changed. Memories of my earliest experiences with ATSA include listening to speakers such as Elaine Hatfield speaking about the history of romantic love and Dennis Doren discussing the evidence behind his approaches to risk assessment. Fran Henry, the Founder of Stop It Now! Talked about sexual abuse through a public health lens, which authors such Joan Tabachnick and Geral Blanchard were also beginning to discuss. Bill Marshall gave a plenary address in which he discussed the emerging but little-known Good Lives Model. At the time, these were all true innovations. Even the idea that sexual abuse is preventable was arguably in its infancy.

The Present Landscape

Fast forward to the present: in the past several weeks, I’ve had the privilege of attending the MnATSA and MATSA/MASOC conferences. To name just a few of the topics (and with apologies to all that are not mentioned):

·       Sexual behavior in the current era (with researcher par excellence Debby Herbenick reviewing her findings on the prevalence of rough sex and choking)

·       Treatment of clients with high levels of psychopathic traits (which was not the dominant belief at the turn of the century)

·       How to communicate with the media (in which Kelly Socia provides hair-raising examples; it is no wonder he has been asked to speak at so many conferences)

·       Sex positivity and inclusivity (presented by different people, such as Bud Ballinger and Molly Shepard in different locations, with Nikole Nassen presenting elsewhere on the topic in the coming weeks)

·       Cultural reverence, humility, and competence (with Apryl Alexander, although Tyffani Dent has spoken on this elsewhere many times in the past few months)

·       Assessments of the Impact of Race and Culture (a/k/a IRCA assessments

·       Raising awareness of the challenges faced by LGBTQ+ people (multiple workshops!)

This is not to say that these newer topics have crowded out the advances in other critical areas. Andrew Brankley gave an excellent presentation at MATSA/MASOC on controversies surrounding pedophilia, and progenitors David Thornton and Robert McGrath are slated to appear at the New York State ATSA/NYS Alliance to Prevent Sexual Abuse conference next month in Saratoga. Recently, on the circuit has been Mark Olver, giving excellent talks on topics such as offense-analog behaviors and psychopathy.

Ongoing Challenges

Things have indeed changed, often very dramatically in recent years. Some of these changes have confused and even angered some professionals. What remains fundamentally important to our field, however, is that we keep talking about the issues.

With all of these changes, however, some things still really need to change. Just during this week, we have seen Harvey Weinstein’s conviction in New York overturned (readers will remember the allegations as having sparked the #metoo movement). Likewise, the US government agreed to pay a $138.7 million settlement over the FBI’s botching of Larry Nasser’s infamous sexual assaults. It is no wonder so many people who are sexually assaulted don’t wish to come forward and don’t trust the systems involved. Where the legal system once did not take sexual abuse seriously enough, it now seems we have to come to terms with the fact that our attempts to improve it are still too far from producing the results we need.

Welcome Aboard!

If you’re new to this work, welcome aboard! We need more of the innovations and conversations mentioned above. If you’ve been around a while, please stay! We need your wisdom! Our work has evolved, and yet there is still so much to be done.

 

 

 

Sibling Sexual Behaviour and Abuse: UK-Canada knowledge exchange trip

By David Russell, PG Cert, Sophie King-Hill, Ph.D., & Kieran McCartan, Ph.D.

Before we begin it is important to set out the language we are using in this piece as it has been part of an important discussion of late. In our work over the past four years focussing on this issue we have seen many instances and examples of the behaviour between siblings being clearly sexual abuse and sexually abusive. However, there are also key examples where this is not the case and that the issues present as sexually inappropriate and/or sexually problematic. This is an important distinction, and with this in mind, for this blog, we will use ‘sibling sexual behaviour and abuse’ (SSB/A). We would also like to acknowledge that terminology in this space always evolves and that SSB/A is not a static term and is likely to change as we begin to understand more about this issue.

#SiblingsToo day is held in April each year and hosted by Nancy Morris, based in Ottawa, Canada. Nancy first developed and introduced the #SiblingsToo awareness day in 2023. This day brings together a range of lived experience and professional voices within the complex theme of SSB/A. A survivor of SSB/A, Nancy hosts a range of discussions via podcasts and videos tackling themes such as the impact, prevention and societal responsibility within the context of SSB/A.  

This year David Russell (Thriving Survivors, UK), Professor Kieran McCartan (University of West of England, UK) and Dr Sophie King-Hill (University of Birmingham, UK) marked #SiblingsToo day by embarking on a trip to Canada to share international approaches in responding to SSB/A, sharing research, learning and practice considerations.  The trip started in Ottawa at Nancy’s famous office, reflecting on the #SiblingsToo data collection and testimonial portal where hundreds of survivors have currently placed their experiences of SSB/A from all over the world.  An incredibly powerful experience, the portal highlighted the international need for bespoke supports for survivors impacted by SSB/A and the need for international co-ordination and coalition.  This supported the four of us to use the time together and record a podcast discussion called ‘in five years’. This podcast explores our professional and lived experiences to consider what needs to happen in the next five years to address the SSB/A. 

We made the most of our five days in Canada and met with a range of professionals and groups.  This included a thought-provoking meeting with volunteers at Circles of Support and Accountability (CoSA) held in Ottawa. CoSA in Ottawa works to help integrate men convicted of a sexual offence (Core Members), mainly against children, back into the community post release. Throughout the course of the conversation we learned that in addition to the traditional child sexual abuse interventions that CoSA run they also had some which were based on cases of SSB/A, which was interesting to hear especially given some of the restorative, integrative and desistence challenges these posed. This discussion highlighted some interesting themes for us all which influenced our next discussion with Dr Christine Gervais, an Associate Professor from the University of Montreal who has spent many of her academic years focusing on the rights of the child.  We then had a productive meeting with academics from The Police and Public safety Institute at Algonquin College in Ottawa, where we looked at cross over in our work and practice and potential collaborative projects.

Academically and professionally we are collectively passionate about the role of health and child protection has within SSB/A. We were particularly keen to see how frontline health and child protection teams respond and intervene with families affected by SSA/B.  To explore this further we met with child protection professionals at Childrens Hospital of Eastern Ontario (CHEO). The team here work with a range of children and young people including but not exclusive to those impacted by child sexual abuse (CSA) and those that display harmful sexual behaviour (HSB), specifically during immediate crisis.  This conversation allowed us to share learning and explore gaps within health provisions both within Canada and the UK.  Keeping with the health theme, we were interested to unpack this further and specifically understand what the current mental health service provision was in Ottawa and its role within supporting children and young people affected by SSB/A, HSB and CSA.  This established a meeting with Heidi Nichilo and her team at the Youth Services Bureau, Ottawa.  A passionate and proactive group of professionals, we were truly refreshed to hear about the fantastic work they do.  We discussed the prevalence of SSB/A within health services and explored potential ways to ensure children, young people and families have safe routes to access to supports and disclosure pathways in relation to SSA/B. 

Our final day of the trip was in the beautiful Montreal, requiring a 4:30am wake up for a train ride from Ottawa to meet Anaïs Cadieux Van Vliet, a PhD student exploring the role of siblings that have not harmed, or been harmed in a family experiencing SSB/A. An area in much need of exploration.  A quick breakfast and discussion with Anaïs and we were on route to the University of Montreal to deliver our panel input on ‘International approaches in responding to SSA/B: Research & Practice’ at the Centre International de Criminologie Comparée (CICC).  This panel input included a fascinating Q&A session and discussion, providing a safe place for an in-depth discussion.  We felt incredibly privileged to share a space with academics, students and those with lived experience, our sincere thanks to the team at the University for facilitating this and for their hospitality.

The learning from this trip has been significant and the opportunity to meet with so many passionate people working in this field has gained us further connections which we hope will support our mission in tackling SSB/A on an international level. 

This trip could not have been possible without the huge support of Nancy Morris, we are incredibly grateful to Nancy and her husband Jim for their fantastic hospitality and eclipse hunting expertise.  

For more information or support around sibling sexual behaviour/abuse please see the Thriving Survivors website: https://www.thrivingsurvivors.co.uk/

To register for the Thriving Survivors 2024 conference addressing sibling sexual behaviour/abuse please see: https://www.thrivingsurvivors.co.uk/event-details/ts-annual-conference-2024

 

The Adolescent Risk Assessment Paradox

 By David S. Prescott, LICSW

A recent conversation among ATSA members on risk assessment with adolescents sparked both new ideas and old memories.

It all seemed so simple a few decades ago. Science was marching forward in developing methods to assess dangerousness among people who had been violent toward others. There were even references to “hitting the forensic sound barrier,” with the development of high-quality measures. Understandably, the most pressing issue was how we could best classify people according to risk. Entire books were written on the topic; many of the older writings are still worth a read. It was only after we had a solid understanding of risk assessment methods in forensic settings that we could focus more on other areas. Our understanding of dynamic risk naturally led to a clearer understanding of treatment needs. Fast forward to the present, and we have promising measures for assessing protective factors. It is now thirty years since Chris Webster and his colleagues (Vern Quinsey, Grant Harris, Marnie Rice, and Catherine Cormier) published the first version of the Violence Risk Assessment Guide. It may not seem so now, but it has been an exciting few decades to be alive and watching these developments.

It has been equally exciting to watch similar efforts in the adolescent world, but for very different reasons. It was natural that researchers would attempt to develop risk assessment measures for youth. The first version ot the JSOAP was described in April 2000 in what is now Sexual Abuse, affectionately known as “the ATSA Journal.” At around the same time, James Worling and Tracey Curwen made the ERASOR available. In 2003, Drs. Prentky and Righthand published the JSOAP—II, this time with a caution that has been quoted many times in conference presentations and conversations: “No aspect of their development… is fixed or stable. In a very real sense, we are trying to assess the risk of ‘moving targets.’”

These developments were welcome. Other scales came along as well, including the JSORRAT—II, the SAVRY, the MIDSA, and others. The authors of the JSORRAT—II, JSOAP–II, MIDSA, and ERASOR earned reputations for making themselves available to questions, ideas, and discussions in both public and private settings. The results seemed consistently good but not great. The tentative progress of the adult world led these same authors to urge great caution. However, the contexts in which professionals worked soon came to expect a lot from risk assessments. Behind the scenes, I’ve heard of cases where judges would order assessments using a specific measure, causing dilemmas for evaluators who felt the tools were helpful but not the final word in assessment.

Over time, professionals noticed that the ultimate referral questions seemed to be different for kids than for adults. While adult risk assessments often focused on establishing a baseline of likelihood for future sexually violent acts, the implicit question for many professionals assessing juveniles was often closer to, “What do we need to do the help this kid make it into adulthood without hurting more people?”

As all of this was happening, thought leaders in the adolescent world had been talking about areas like the neurological impact of trauma since the 1990s. Some authors, including Janice Bremer and Jane Gilgun, began publishing on protective factors as long ago as the late 1990s (although not with the same rigor that the adult world does now). Kevin Creeden was among the first to question why we were focusing on risk when there was so much work to do with trauma and neurodevelopment. Most importantly, Gail Ryan and her colleagues (including Sandy Lane and Tom Leversee) published articles and entire books on the importance of understanding the developmental processes and environmental context of youth to best serve them. These are all ideas that gained greater credibility in the adult world later.

While this may all seem like a history lesson, some of the questions involved along the way have been maddening:

 - Given the meta-analyses by Michael Caldwell, which argues that recidivism rates have decreased since 2000, and Patrick Lussier (et al.), which argues that in fact recidivism rates have been low all along, what can any professional meaningfully say about risk for sexual re-offense?

- If we recognize that adolescents are far more likely to re-offend non-sexually, shouldn’t we abandon our sole focus on risk for future sexual harm? Or at least put it in the context of other potential harms? And strengths? And possibilities?

- How do we best understand a young person’s risk when it is so dependent on the environments in which they live, go to school, etc.? How much noise is there in the system that makes any form of prediction impossible?

Even today, a conference presenter quipped that, “Kids change so fast. Even when I go back and interview them a week later, it seems like they’ve gotten a foot taller.”

These are major reasons why the change in focus of recent years has been so welcome. The newest generation of measures, based both on research and experience, are focused far more on understanding adolescents, including their development, context, protective factors, needs, progress already made, etc. Important questions remain as to their various properties, but the thought that has gone into their development is encouraging. Their structure enables clinicians to reflect on and understand clients while developing recommendations. They help us to see past the age-old questions of risk and focuses on what professionals and caregivers can meaningfully do to mitigate whatever risks exist.

Sometimes the highest risk that adolescents pose is not to live up to their full adult potential.

The most recent conversations have focused on what to call our reports. The most common answers seem to center on the idea of needs assessments, as a few predicted many years ago.

Perhaps our greatest risk is forgetting that across world history, including time, place, and cultures, adults have always had trouble predicting how kids will turn out. The current focus in many quarters on helping kids become adults may be what we were best suited for all along.

The well-being of professionals: a shared responsibility

By Kasia Uzieblo, Ph.D.

Many professionals working with individuals who have committed sexual offenses often find it challenging to discuss their work with those around them due to fear of misunderstanding or trying to avoid any awkward silences. However, we should be extremely grateful to all these professionals for their daily dedication to preventing sexual violence and their willingness working with these clients. This type of work is far from easy and significantly affects the well-being of these professionals. They may experience emotional and psychological stress from repeated exposure to disturbing and traumatic accounts. Professionals may feel frustration, helplessness, or burnout when dealing with individuals who have committed sexual offences. Additionally, there may be ethical dilemmas and challenges in maintaining objectivity during treatment or supervision of offenders. The nature of the work can also impact personal relationships and social interactions, as professionals may encounter stigma or negative judgment from others. These challenges may partly explain why we face high staff turnover within our forensic services.

It is interesting but especially encouraging to see a growing focus in research on the forensic professional and how they experience their work. To illustrate, two recently published articles underline the impact of working with people who committed sexual offences.

Taylor and colleagues (2024) studied the effects of working with sexual offenders on Canadian probation officers. They interviewed 150 professionals and found that while some probation officers reported no significant impact, many struggled with the nature of their work. Repeated exposure to detailed stories of victimization and perpetration was linked to reduced mental well-being and the development of disorders such as PTSD among professionals. The gender of the professionals was identified as a vulnerability factor, as the field predominantly employs female professionals while working with mainly male offenders who may exhibit dominant behaviour and hostility towards women, which may lead to complex and even threatening interactions between the client and the professional. The personal circumstances of the professional, such as entering into new intimate relationships or the birth of a child, were also intertwined with the experienced negative impact.

Similarly, Maguire and Sondhi (2024) explored the extent and nature of work-related stress among police officers investigating rape cases and serious sexual offenses. They found that despite experiencing work-related stress, a substantial number of police officers continued to work. Many felt compelled to do so either by themselves or through pressure from colleagues or superiors. However, this coping mechanism often proved inadequate and led to negative consequences such as dissociation and compassion fatigue towards victims. While many officers knew where to seek support for psychosocial issues, most felt that their police department did not focus enough on promoting well-being and providing professional psychosocial support.

Whether working with individuals who have committed sexual offenses has a greater impact on well-being compared to working with other forensic populations remains debatable. Nevertheless, these and other studies emphasize that resilience and adequate self-care strategies are necessary when working in this field, which is also highlighted in a recent blog written by David Prescott, Janet DiGiorgio-Miller, and Sarah Snow Haskell. Self-care strategies are however not enough; support from colleagues and supervisors is also essential. It is not solely up to the individual professional to seek necessary support for psychosocial issues, work-related stress, moral dilemmas, etc., but colleagues and supervisors should also be attentive to possible signs of decreased well-being and pro-actively promote collegial or professional support. Caring for the professional is thus a shared responsibility.

The intersection of online and offline behaviours in sexual abuse: reframing approaches

 By Kieran McCartan, PhD & Sophie King-Hill, PhD

Over recent years there has been a rise in conversations about sexual abuse in the online environment. These conversations encompass a wide range of online behaviours such as catfishing and its impacts, sexual and relationship education in UK schools, the production of Child Sexual Exploitation material internationally, as well as the nature of pornography on legal sites (i.e., Pornhub). The main premise that all these conversations have in common is how the relationship between sexual abuse and exploitation is understood in the online and the offline world.

There are different components to consider when addressing the issue of online sexual abuse. These include education, safeguarding/child protection, law enforcement, and the responsibilities of online companies. These all need consideration when attempting to understand and change social norms in relation to the online world. Many of the solutions that are offered are rooted in established models and ways of thinking because they are familiar to us does, however due to the differing complexities of the online world they may not be fit for purpose. One of the first steps in this process is to recognise the differences between online and offline sexual abuse.

Research has been ongoing into the online world for the past 30 years, with knowledge and practice moving on significantly. Due to this there is a relatively good understanding of the practices that occur online, who partakes in them, the reasons why they engage in these activities, and how we can prevent reoffending. The understanding of the relationship with technology and the online world has evolved and it is not simple.

The online and offline worlds are becoming increasingly intertwined in our daily lives and identities. In relation to young people, the boundaries between these two worlds are not present and are seamless. Therefore, it is important that professionals recognise how identities are evolving on and offline. There needs to be a shift in the understanding of behaviour and action and how we think about this issue needs to shift.

Online sexual behaviours need reframing to recognize that our current ideas about the online world and how to approach the issues that it presents are not fit for purpose. The relationship between the online and offline worlds needs to be redefined in respect to sexual abuse. Consideration needs to be given to how conversations are framed in society and how change policy and practice can influence this. Realistic education and awareness programmes are needed that put this debate at their heart, that don’t see talking about the online environment as a bolt on or afterthought and that actively involve the users.

It is therefore important to recognise that our perspectives of this are rooted in our experiences and knowledge of the offline world and these need to adapt and evolve to fully tackle the issue of online sexual abuse and harmful sexual behaviours.

Finding joy in our work and our lives

By David S. Prescott, LICSW

Reviewing the blog posts and ATSA communications for the membership (The Wire, the Catalyst newsletter) of the past few weeks provides a wonderful snapshot of the work we all do. From risk assessment to protective factors, and empirically sound treatment, it’s all in there. As we’ve said before, the people in this field can be real superheroes.

Of course, there are topics that can be difficult to talk about. A recent survey found many of us experiencing the signs and symptoms of burnout despite having good overall self-care practices. Likewise, last week’s blog, about imposter syndrome  generated lots of agreement (ironically, almost all through private channels).

None of these topics address the joy that can be found in doing this work. It is easy to overlook and often fleeting.

If I may share an example: In the mid-1990s I worked in a residential treatment program for adolescents. I had provided treatment to a young man who had caused significant harm to his siblings.  They had all been horribly abused by their stepfather. He had been placed in another program that was shut down by the state because of rampant sexual abuse by the staff against him and others. Working with him was a challenge. Privately, some staff had even given him the lighthearted nickname of “the Hurricane.” We worked to put his life back together, address his own victimization, his actions towards his brother, and everything one might expect. After much work, we were able to step him down to a program much closer to his home.

In the hours after he left the program and I was preparing for more cases to come my way, my supervisor said, “Nice work, David. You never violated the relationship.” She was right, but it would take many hours for the full impact to set in. I had focused for so long on the tasks of treatment and the various case-management and documentation needs, that I had forgotten the sheer joy of the work itself. I had never considered the joy that comes with providing a relationship centered on helping the other to reach their full potential. And I had never considered the joy of taking one step closer in the direction of being a better therapist, citizen, and man. It’s fundamental to the reason any of us do this work: we want to help, and it feels good to get it right.

Why is it that we don’t discuss joy in our work more often? Is it because it’s not always so well defined? I went to the Merriam-Webster dictionary online, and its first definition was “the emotion evoked by well-being, success, or good fortune or by the prospect of possessing what one desires.” Personally, I wonder about some of this. What kind of success, fortune, or possessions? Is this a materialistic sort of joy? Is there more? Maybe our difficulty defining it contributes to our difficulty talking about it? Maybe we don’t talk about joy because so much of it is beyond words? Maybe it’s because we often bond with one another talking about our pains, fears, and misfortunes? Maybe it’s because the joy we experience is often so fleeting? (After all, the joy in the case above was time-limited by my need to open another case the same day!)

There could be many reasons why we don’t always focus on joy as much as we could. After all, too many of us work in joyless environments with clients who have never experienced joy. Is it too easy for us to become numb and jobless as a part of working in close proximity to abuse? Do we lack the skills not just to self-regulate, but to co-regulate with others as a partial result of bearing witness to suffering? Is returning to a place of joy a skill that we can develop? I believe it is.

I watched ATSA Past President Dr. Tyffani Dent give a speech to some colleagues while accepting an award a few years ago. She talked about her experiences of “Black joy,” those moments somewhere between fulfillment and ecstasy that she and others experience simply by virtue of being Black. Despite the horrific legacy of racism, this Black joy has never gone away. I came away with the impression that it is indestructible, at least from the outside. If I’ve read correctly between the lines, Tyffani actively and intentionally maintains an awareness that joy is possible, and takes effective action to find it, with others, in her life. Can we all do something similar?

As the reader will notice, I do not profess to having the answers, only questions. If I may be permitted some lighthearted humor, no one knows better than me that I will never directly experience Black joy. But just being in its presence for those moment gave me deep hope for the future. How can we become aware of the possibilities for joy all around us? Probably more accurately, how can we return to our places of joy more frequently and deeply? Despite the challenges of our jobs, the work itself provides many opportunities for joy.

Imposter Syndrome

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

At last year’s ATSA conference, David had the good fortune to facilitate two discussion groups for people who, due to their circumstances, don’t have many colleagues with whom they can speak openly. By far the two biggest topics that came up were working in isolation and imposter syndrome, also known more recently as “imposterism.”

During these sessions, newcomers to the field heard from us old-timers, who all agreed that we still feel it often. It all reminded me of the time — years ago — when a world-famous researcher openly discussed how even his submissions have occasionally not been accepted for the ATSA conference. While many simply acknowledged having had the same experience, many more thanked the researcher profusely, saying they were grateful to know that they were not alone; it can happen to anyone! 

Have you ever had that feeling that someday you will be outed as the fraud you fear you might be? I (David) am very lucky that I was far along in my career, with nothing to prove to anyone, when a disgusted colleague approached me.  My name had come up in conversation with a prominent researcher who said, “Don’t forget… He’s not Dr. Prescott, just Mr. Prescott.” My response was probably along the lines of “whatever,” but doubtless it would have hurt had I still been an early career professional. Not everyone has been so lucky. 

The reason I mention all this is not because of all the research showing just how common imposterism is across professions. Nor is it to illustrate that men are just as prone to it as women and nonbinary people. It’s to emphasize something about ATSA members learned across many decades now: we have your back! We support you and want you to succeed! What you do and who you are matters. As much as we may argue over research and practice within ATSA, the work you do on a day-to-day basis is likely to help our clients and communities. 

While there are legitimate questions about treating and over-treating the truly low risk, and similar questions about the structures of our laws (lifetime supervision, civil commitment, etc.) the fact remains that everyone doing this work has something to contribute to our broader goals of stopping offending, helping clients live better lives, and building community safety. 

If there is anything most ATSA members learn from membership and attendance at our conferences, it’s that we all support each other and especially our newer members and students. As a part of this, it’s worth mentioning that those of us who are further along in our work lives don’t always have to project a perfect image of ourselves. Allowing ourselves to be open about our doubts and failures can also be inspiring and reassuring precisely to those who look up to them or are making their way in the field. We all have an obligation to help the next generation along.

Psychologist Jill Stoddard recently wrote a book on this topic titled, Imposter No More. In it she advocates flexible thinking skills that can help individuals find their way through the often crippling effects of imposterism. In her TED Talk and interviews, she discusses her own experiences, including how her family teased her with weight-related nicknames. She is now a highly regarded practitioner of Acceptance and Commitment Therapy, often referred to simply as ACT. Every time she shares her story, making herself vulnerable along the way, she touches hearts and inspires others. Her work is worth a look. 

In his recent interview with ATSA Executive Director Amber Schroeder, Karl Hanson also emphasized the importance of proceeding fearlessly with our careers while remaining open to the feedback that helps us become more effective. 

In the end, the message from ATSA’s leadership and blogging team is simple. We have your back! If you’re feeling like you have no one to talk with, feel free to reach out. No one should feel alone in this work.

The challenge of balancing human rights for all

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

Last week’s blog post focused on an unfortunate reality: We can’t always discuss things publicly lest we be labelled as political partisans. Although no one is without some degree of biases and leanings, it is simply too easy to attack and be attacked for statements taken out of context. We recall the sad fate of someone who commented in social media that balancing the human rights of the client and the community can be a challenge. His statement was sent to a local politician, who went to the media and scored significant political points saying that this doctoral level researcher and policy wonk had a “catch-and-release policy towards predators.” (It is worth noting that many human rights are enshrined in international law as well as state and agency policies; the Tokyo Rules are one example. In the US, the death penalty has been ruled unconstitutional for sex crimes, but that hasn’t stopped some states from trying.)

Working in the criminal-justice field often presents many paradoxes and contradictions that leave professionals conflicted about their roles, and/or their belief systems. In some cases, we have to and having to justify our roles to others. On the one hand, compassionate treatment approaches are the most effective. On the other hand, the practitioner may have to work hard to to look beyond their own biases and beliefs to do so. Important to remember is that having compassion for someone does not mean that you condone or endorse their behavior; it means that you can see into their situation, try to understand, and prioritize their highest needs (which means developing a lifestyle free of harming others).

Over the years, this blog’s authors have written about the early-life adversity that has influenced our clients and the need for trauma informed practice in order to ensure the most effective participation in treatment. What we often talk about less is human rights, although many have done so. It’s easy to respect the human rights of law-abiding people, but more difficult top do that for people who have hurt and harmed others.

In recent weeks there have been many cases across Europe that have called for us to have respect for others, to call in question our moral lens and to advocate for human rights in difficult cases. We have seen a call for care homes to be built for aging individuals convicted of sexual crimes, an individual being tried and convicted of manslaughter on the grounds for diminished responsibility for the murder of three people last year in the UK, and the change in incarceration conditions for Josef Fritz as a result of his dementia diagnosis. These cases beg the question of how we best treat those whose who have committed horrific crimes when their capacity to understand their punishment is gone. Where are our human rights thresholds?

Not surprisingly, many have found it difficult to tread a line between compassion and punishment, especially when the system is built on the grounds of punishment. Public, as well as political, sentiment often reflects that. However, its important to remember that many professionals are in the field of rehabilitation, even as we work in environments that stem from punishment.

Rehabilitation, treatment, and support cannot be seen as an afterthought or an add-on to punishment. We all want people to come out of the criminal justice system better able to manage themselves in society than when they went in, or at least no worse. We have seen the damaging legacy of doing nothing through the failed “nothing works” doctrine of the 70’s and 80’s started by Robert Martinson, and that became a hallmark of the Reagan-Bush and Thatcher eras. We know though research and practice that treatment works, but that it can take effort and that it works in different ways, at different times, for different people. This can make it complex and not easy to rationalize or fund when one can’t entirely predict the outcomes. Although it can seem like we are in a revised nothing-works era currently, that is not true with the influence of public health and prevention policies in criminal justice. We are still talking about treatment and rehabilitation; but it’s challenging for professionals at times to engage in these conversations and find support.

We need to be compassionate in our work and think about the human rights of often risky and at-times dangerous people. How can we hope for them to reduce their risk and to integrate back into society if they can’t learn about pro-social, empathic, and good behavior from us? How can we best accept our clients even as we don’t accept their behaviors? How do we process our work with others? How do we explain it? Where do we seek help? And, more importantly, do we get help when we ask? It is important to provide a rationale, critically discuss, and support each other in the challenging times we are experiencing. Supporting people who have seriously offended and are dangerous is as much a collective endeavour as an individual one.

 

We’re Losing Ground Again

By David S. Prescott, LICSW, ATSA-F

I’ve long felt sympathy for our colleagues working in the area of family and interpersonal violence. These issues are widespread but receive little attention. It is well known that violence against women has only gotten worse in recent years, and yet many governments have considered abandoning the Council of Europe Convention on Preventing and Combating Violence Against Women and Domestic Violence, known as the Istanbul Convention. Too often, the reasons have been political, with governments claiming that while they are against family violence, they want to preserve traditional family values. Observers are quick to note the political aspects of these decisions; one media outlet noted Turkey’s objection to “promoting LGBTQIA identities” (although the treaty’s only reference to sexual orientation merely stipulates non-discrimination).

Of course, it’s not just governments that have difficulty finding ways to prioritize ending family violence. One might reasonably ask how we can end violence when so much of our media and political discourse contain violence and violent themes? Recent media coverage of ideologically based death threats suggests that matters are only getting worse. In my former state of Maine, a Diversity, Equity, and Inclusion coordinator recently fled the state in response to threats made against his life.

A central concern of this blog post is that at a time when too many people view violence as normal and sometimes desirable, those seeking to reduce its harm are too often lost in the mix. Whatever the data may show in one legal jurisdiction or another, we are all up against a cultural maelstrom in which violence and threats of violence have somehow become more acceptable.

What’s not acceptable is that our attempts to stop violence have become wrapped up in politics. Further, most people in our field understandably don’t want to talk about politics. As recently as a few days ago, a listserv for psychotherapists was taken offline for a period of time because of arguments over the current situation in the Middle East. It seems that even when we are open to talking about politics, we’re not particularly good at it.

ATSA has always championed ending sexual abuse. Unfortunately,  at the individual member level, too many potential discussions are off-limits because they are so hard to talk about. Wouldn’t it be great if professionals could talk about the relevant issues without political impediments?

All of this seems relevant at a time when a former US President has recently been found liable by a jury for sexually assaulting a woman. Another jury awarded her more money than most of us can realistically imagine. Lest readers think that mentioning this reflects a political agenda, it is vital to remember that there have been plenty of allegations across the political aisle, including in the 1990s. Indeed, questions of sexual abuse in national politics is nothing new.

It makes sense that discussing the actions of our leaders is difficult at best. Nonetheless, some important points emerge

- Sexual abuse and other forms of violence exist at all levels of society.

-  Current public debates make even acknowledging this fact challenging.

- Many of our policymakers have engaged in the same behaviors they seek to regulate.

- Given all of these things, we are compelled once again to look at sexual abuse through a public-health lens.

-  It would be unconscionable for us, and society, to soften our stance on ending violence simply because there is so much of it on the world stage. In truth, the mission has only become more critical.

What has research ever done for us?

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

This week Kieran has been involved in several different conversations about research outcomes, Key Performance Indictors (KPI) and how we measure them. This has been equally engaging and frustrating. This week has really enforced in Kieran the need to emphasis the role, purpose, and use of research, which is often an afterthought or a bolt on for many organisations and programmes. This is a shame, as research should be seen as core business and essential to the development, roll out, and maintenance of any service or endeavour. This blog discusses why research matters and why we should all be concerned about doing it and getting it right.

Good quality research is essential for developing an evidence base that informs practice and policy; we all know that. We look to organisations like ATSA and NOTA through their publications and conferences that facilitate our access to this research and allow us to learn methods, theories, and outcomes. But it must be stated that not all areas of sexual abuse share a research parity or depth. Some areas may be over-researched (e.g., risk assessment, treatment, work with adolescent and adult males) and other areas having less (e.g., prevention of sexual abuse, women who sexually offend, Siblings/intrafamilial). This changes by country and region (e.g., outside of north America sex offender registries are barely researched). To borrow a phrase, “All research is equal, but some research is more equal than others”!

In universities, many researchers are adapting their methods towards being more impactful and being more grounded in practice, professional development, and policy rather than just being about publications. As a result, more research is about being collaborative and about co-creation with professionals, policymakers, and service users/clients. This means that research can also help shape ongoing policy and practice, research needs to be at the start and in the lifecycle of our professional activities, not [as is far too often the case] bolted on at the end or neglected all together. Research needs to be central to good practice and building an evidence base, but it’s also central to commissioning, funding, recruitment and retention of staff, referrals, partnership working, sustainability, and quality assurance. However, the value of research is not always seen as these things with frontline services not always seeing the value reading studies and wanting to focus more, and understandability so, on their clients and practice. In worst case scenarios research can be seen as an add-on or a costly burden, which can mean that it’s not always well developed, well-funded, or at times well executed.

Therefore, it’s important to understand the role and purpose of research and what it brings to practice and policy. One of the best ways to do this is to think about research as a core business for any organisation and/or practice. So, whether you are working in sexual abuse prevention, treatment with men convicted of sexual offences, community risk management or policing; what does research mean to you and your organisation? Maybe the place to start is to think about the role that research has played in your daily practice, in shaping what you do and how you do it. To borrow from and emulate Monty Python…

What has research,
what has research,
what has research ever done for us?

An practice evidence base.
What?
...they, they gave us a practice evidence base...

Yes, they did give us that, that's true
And evidence for future funding Yes, that too
A practice evidence base I'll grant is one
thing the research may have done
And the policies, now they're all new
And the great theories too

Well, apart from the theories and evidence,
And the risk assessment tools
Public health for all the nation
Apart from those, which are a plus,
what has research ever done for us?

Along these lines, it may be helpful to think about how research has improved our professional lives (as well as our personal lives, such as research into health care). Research in our field has informed our understanding of assessment and evaluation measures; how we communicate risk; what goals to work on in treatment; how to work with different individuals; how to understand denial; how to understand human sexuality, etc. In some corners of social media but also in practice and policy, it has become fashionable to disrespect science and scientists. At the end of the day, however, we would do well to stay respectful and keep current with the advances of science; it often advances in multiple directions (as we blogged about last week).

Extending a Previous Blog Post: Ethical Considerations on the Costs of Resources

By David S. Prescott, LICSW, ATSA-F

In our December 13, 2023 blog post, Dr. Sophie King-Hill asks:

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? . . . 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. . . 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.”

This last sentence regarding “profitable endeavors” is particularly intriguing and leads to questions about how we prioritize and think about resource allocation. In her discussion, she also notes the way some services are trained and delivered. She raises the age-old question of how best to combine implementation and training efforts in situations where staff turnover is a reality (this blog post from 2015 explores this question further).

Here in the US, I’ve long wondered about how we prioritize not just our resources, but the way we think about them. I’ve never forgotten an experience many years ago in which I was on a grant to implement an empirically supported trauma treatment package. The content of this treatment was clinically sound and under most circumstances easy to implement. However, it had been developed for use with adult women, while our agencies were tasked with implementing it with adolescent males and females. The positive findings in studies had occurred in outpatient treatment settings. We were tasked with implementing it in home-based services. In some cases, the clients were very clearly not ready to advance at the pace of the curriculum, while for others the curriculum itself was getting in the way of more substantive conversations that the clients were desperate to have. The curriculum had not been written specifically with the caregivers of these young clients in mind.

The clinicians in this project found themselves in a dilemma: meeting each client’s needs to ensure treatment engagement meant slight changes in adherence to the manual. On the other hand, even the slightest changes were considered a problem for treatment fidelity and needed to be approved by the outside consultant. Further, every session was video recorded for quality assurance purposes, making clinicians more likely to make momentary clinical decisions that prioritized the video review over the needs of the client. All of this took place in a context where those licensed professionals charged with administration of the curriculum had to take their orders from an unlicensed and sometimes irritable consultant.

There were many ways that these dilemmas could have been resolved, and doubtless many who are reading this post could have helped move the process forward. Unfortunately, the constellation of players was, as a group, ill-suited to get this implementation right. It can serve as a lesson for all of us. These were high-stakes circumstances: some of the clients felt retraumatized after participating in this treatment. The problem was not the content, which was indeed evidence-based, but in the implementation processes, which were not.

Virtually everyone wants to engage in evidence-based practice (EBP). Yet so many of us remain unaware that there is more to EBP than the research studies telling us that a treatment method has found to be effective. For example, the above efforts would have benefited from a solid foundation in implementation science, which examines the application of research. For example, Dean Fixsen and his colleagues outlined numerous conditions under which implementations of EBPs will be more and less effective. As encouraging as some studies can be, others have found that it can take a considerable amount of time to demonstrate significant improvements in wellbeing at the individual-client level.

Likewise, there is very little accumulated knowledge on adapting EBPs to meet local conditions. In the example above, applying a treatment developed in one context to another created problems and arguably caused harm to some clients. On one hand, there are the understandable concerns that changes to an empirically supported protocol reduces fidelity to the model, which in turn can potentially reduce its effectiveness. On the other hand, the APA definition of EBP emphasizes how it is a tripartite model involving the integration of best available research, clinical expertise, client characteristics, culture, and preferences. This discrepancy leads to questions about how those with genuine clinical expertise can effectively use protocols that may not be the best fit for clients. 

Dr. King-Hall’s original questions lead to others. We might well ask about the ethics not only of training costs and access to treatments, but of emphasizing implementation of a particular treatment approach without considering the evidence regarding successful implementation, or local conditions involving clinical expertise or client characteristics and culture.

 

 

Reflections on the recent NOTA & Lucy Faithfull Foundation sexual abuse prevention conference

By Megan Hinton, Victim and Survivor Advocate, Marie Collins Foundation

I recently joined the Marie Collins Foundation (MCF) as a Victim and Survivor Advocate. My role involves working alongside those with lived experience of technology-assisted child sexual abuse to champion and amplify their voice and embed it into policy, practice, and academia.

As a survivor myself part of my position includes speaking about my lived experience at conferences and events. So, when the Lucy Faithfull Foundation reached out to ask if I wanted to give the opening address at the Preventing Child Sexual Abuse Conference organized jointly with NOTA, I felt honored.

Prior to the conference, I needed to gain more knowledge about prevention methods and believed most prevention work was done through PHSE lessons in schools and charity-led awareness campaigns. Joining the conference, I felt intrigued to learn in order to identify any cross-over that may help with my role. But I also felt apprehensive about attending as I knew the conference would heavily focus on perpetrators rather than the voice of survivors.

During my presentation, I spoke about the importance of prevention from a survivor’s perspective, referencing my own experience and embedding key messages from MCF’s Lived Experience Group. During my address, I quoted one of our Lived Experience Group Members who said, “Survivors get a lifelong sentence”. I also emphasized that whilst child sexual abuse can take place over many years, it can also happen in as little as a few hours, and yet the impact is the same; it fundamentally changes who you are as a person. My hope was for my address to encourage attendees to anchor their thoughts on the children, victims and survivors they work to protect. I wanted attendees to challenge their thinking and reflect on how they could apply what they learned from the conference to their work and day-to-day life.

My apprehensions about the conference's content quickly dissipated as I listened to the presentations that followed my own. It was heartening to see each speaker cover a point I had made during my address, which ensured survivors' voices were visible throughout the day. Some key points that I was particularly happy to see focused on included challenging stereotypes of victims and offenders and highlighting that schools cannot be the only place where conversations about child sexual abuse take place. MCF’s Lived Experience Group told us they want to ‘blow the lid off’ child sexual abuse and the silence that surrounds it. Victims and survivors regularly tell MCF that sexual abuse is still rarely spoken about and that makes it difficult for children to identify abuse or find the words to explain what is happening to them. So it was encouraging to hear practitioners with similar views who were committed to raising awareness and involving wider society in conversations about child sexual abuse.

The impact of child sexual abuse can be profound and devastating and that impact does not stop with the victim or survivor, it can ripple through ‘secondary victims’ such as family, friends and the communities that surround the child. So, seeing each presentation looking at prevention through a multi-agency public health lens was excellent. The presentations were informative and easy to digest and covered a range of different aspects to prevention. I particularly enjoyed learning about the three levels of prevention – primary, secondary and tertiary - and how these would fit into a public health model. I also appreciated the level of detail given so that I could begin to understand the thinking and evidence base that supports compassionate and restorative intervention work.

The conference really challenged my own way of thinking positively. One personal learning point was the realization that tertiary prevention work is not about justification, excuses, or minimizing the harm caused to victims; it’s about preventing reoffending and protecting children. I found it encouraging to hear about the success rates of these types of interventions.

The conference definitely inspired people to learn and improve but also celebrated how far prevention work has come in such a short space of time. Seeing people so passionate about their work, recognizing the challenges that they face, and striving to improve their services gave the conference a real undertone of hope.

As a survivor myself, the concept of prevention rarely crossed my mind. I could lose years of my life thinking about ways my abuse could have been prevented but wasn’t. As many other victims and survivors will know, we often feel blame and accountability for our abuse, and it can make it seem as though it was inevitable. But this conference allowed me to consider how prevention strategies and services work, how they can improve and enabled me to reflect on how we can better evaluate outcomes.

Leaving the conference, I felt passionate about the messaging in primary prevention and how difficult it is to assess and measure outcomes for this type of intervention. In early prevention work, we often see too much responsibility placed on children to ‘keep themselves safe’, particularly online. Through MCF’s direct work with children and their families affected by technology-assisted child sexual abuse, we know this e-safety messaging can silence victims from disclosing as they expect blame and shame. Instead, we must focus on creating an environment where children and young people and adults feel empowered to talk about these issues without threat or fear of victim-blaming.

In addition, we see widespread societal blame on parents, who often do all they can to safeguard their children. I believe actively engaging and listening to those with lived experience, including parents whose children have lived experience, could offer an insight into what primary prevention messages do and don’t work and, more importantly, why. The incredible group of brave victims and survivors in MCF’s Lived Experience Group is a testament that consultation with lived experience can, and does, positively improve services, practice, and policy. What we learn through our direct work can feed into prevention work, and MCF values partnership working. We know partnerships and collaboration improve outcomes for children, victims, and survivors, and this conference has further cemented the long-standing working relationship with LFF, NOTA, and MCF. I am excited to see how we work in partnership in the future.