Public Engagement with ATSA & NOTA

The blog has previously discussed the importance of enging with the public on sexual harm and the potential outcomes (Public Engagement and Changing Attitudes about Sexual Abuse), the current blog posting follows on from this discussion by highlighting a series of past and forthcoming public engagement events held over the last year by ATSA (San Diego, October 2014; Montreal, October 2015) and NOTA (Dublin, September 2015).

The engagement events are designed to bring members of the public as well as professionals together to discuss how we understand, respond to and prevent sexual harm. In this respect what is meant by the term'public' we use it in the broadest possible sense to refer to any one that does not work in the sexual harm field or anyone working working in the criminal justice areana. The reason for this broad defination is twofold (1) that we all come from communities that are more or less informed and therefore will benefit from these conversations, and (2) we all have a broad social network that we share information with that we are more likely to respond postively to information shared by people that we closely identify with apposed to strangers. Therefore the events are to inform, educate, engage and start a conversation.

ATSA 2014

The first public engagement event was held at ATSA 2014 as a result of a conversation between myself, Katie Gotch and Maia. I had seen an advertisement for the festival of dangerous ideas and thought that maybe we could organise a similar event based around sexual harm at ATSA as way of educating the public and increasing societal understandings around sexual harm. We started by discussing what the topics should be and agreed upon four areas (1) sexual abuse as a public health issues; (2) general information about sexual offending; (3) collaboration in the sexual abuse field; and (4) preventing sexual abuse and bystander intervention. We then thought about who would be best to talk on these issues? We considered local, regional, national and international speakers (specifically those who were attending the conference), and reached out to and confirmed 8 speakers (Elizabeth Letourneau; Bob Geffner; David Prescott; James Cantor; Tom Tobin; Sandra Henriquez; Joan Tabachnick; Tracy Cox).

The format of the event was to get speakers to talk on one topic for a maximum of 10 minutes, without powerpiont, on one topic in plain English. The idea being that anyone could come to this event with no significant subject or area knowledge and walk away feeling informed, educated and empowered. We decided to group the speakers in to groups of two as predetermined topics, (1) sexual abuse as a public health issues (Elizabeth Letourneau; Bob Geffner); (2) general information about sexual offending (David Prescott; James Cantor); (3) collaboration in the sexual abuse field (Tom Tobin; Sandra Henriquez); and (4) preventing sexual abuse and bystander intervention (Joan Tabachnick; Tracy Cox)

So how to get people through the door? Always an issue! The first question is who are the public in this context and how do we reach them. We wanted to reach out to people that reflected and represented members of the wider community or engaged with them (community leaders and/or people from community groups). We developed a marketing and media strategy utilising social media (twitter, facebook, linkedIn and traditional email) via our contacts in the community (religious groups, sports clubs, schools, charities and NGO’s). After many months of advertising and dissemination the night of the event came around and we ended up with approximately 70 participants from the city of San Diego and the ATSA conference.

The event was chaired by myself and Katie Gotch who introduced and concluded the event as well as holding the speakers as well as the Q & A to time (easier said than done!). The attendees asked numerous questions about how to implement a public health approach, how to overcome the barriers that working with communities on sexual harm throws up, how we manage these perpetrators effectively and how we are going to change the conversation about sexual abuse. None of these questions and answers where confrontational and the event ended with a buzz in the room where the debate continued, people networking and reaching out to each other.  (We recorded the event as an educational tool, please see - https://m.youtube.com/channel/UCwkom_2lxMlZ6-A3BOugdKg). The event was viewed as a success because of the conversation that it started and the people who were in the room to have the conversation; but it was felt next time we should have less speakers and more conversation.

NOTA 2015

The conversation about hosting an event at NOTA started at the ATSA 2014 public engagement event, which members of the NOTA NEC attended (Gail McGregor, Marcus Erooga and Jon Brown), and when the NOTA 2015 conference committee started to plan the finer details of the conference we approached them to ask if we could do a similar event in Dublin. They agreed and we started working! The first thing we agreed was that the event should be very much part of the conference and that the public should be invited into the event.

The big questions involved where would the event take place, at what point in the conference and who would speak. We agreed that it should be a mixture of local, national and international speakers [like the ATSA event]; therefore giving a range of perspectives. We agreed that the format, content and structure of the event should be similar to the ATSA; except shorter and more focused [8 was too much in two hours, so we agreed on 4 in 90 minutes]. Therefore, we agreed on two topics and four speakers (two practitioners and two academics, two regional speakers and two international) agreeing upon (1) “preventing sexual harm” (Elizabeth Letourneau and Sharon Beattie, Safeguarding Board for Northern Ireland) and (2) “sex offenders 101” (Micheal Seto and Niall Muldoon, The Children’s Ombudsman for Ireland).

As with ATSA 2014 we reached out to people that reflected and represented members of the wider community (religious groups, sports clubs, schools, charities and NGO’s) or engaged with them (community leaders and/or people from community groups) via marketing and media engagement through social media (twitter, facebook, linkedIn and traditional email). After many months of advertising, dissemination and even media coverage (it was in the Irish Independent a couple of weeks prior to the event) we had to close the registration a week in advance as we had 90 applicants. These participants were all from the local and regional community with people from the Republic of Ireland and Northern Ireland.

The event itself was a success with 60 plus participants showing up, which is fantastic given that it was 6pm on a midweek evening on the outskirts of Dublin (with a car accident and rush hour traffic to contend with). The event was chaired by Mary Tallon and Marcella Leonard who introduced and concluded the event as well as holding the speakers as well as the Q & A to time (easier said than done!). The attendees asked numerous questions about how to implement a public health approach, what paedophilia is, what the function of treatment is, how we manage these perpetrators effectively and we are going to change the conversation about sexual abuse. All of these questions and answers where not necessarily confrontation free (which is simultiuously the risk and the benefit of doing these events), with lively debate over the innate/biological nature of paedophilia and whether treatment should be used at all. The interesting thing is that following the event there was a buzz in the room with the debate continuing, people networking and reaching out to each other.

ATSA 2015

ATSA will be hosting another public engagement event at the start of this year’s ATSA conference (ATSA Conference, 13th October, Montreal 2015 – see http://www.atsa.com/publicengagement). However, in Montreal we have an added dimension language, therefore we have to provide an English and French speaking version of the event; which meant that although the event is only going to be an hour we have to do it twice in too languages with different speakers (some presenters cannot not speak English, while others cannot speak French) to make sure all the topics are covered. We decided upon four topics and 6 speakers for the event, including (1) sexual victimization (Delphine Collin-Vezina & Isabelle Daigneault); (2) child sexual abuse imagery (Caroline Girard); (3) sex offender treatment innovations (Patrice Renaud);(4)the sex offenders register (Josee Rioux & David Herni). As with previous events we having been advertising through social media [see the ATSA website for more information] and are building up a healthly interest in the english and french events; but with two weeks to go we can not be complacent and would encouarage anyone in the area to publise the event.

CONCLUSION

So where these two public engagement events a success? Yes, as they engaged members of communities who would not necessarily have access to this information as well as facilitating a conversation and got people engaged and involved. Will it have an impact on community understandings and responses, only time will tell but it is a step in the right direction? If you are at the ATSA conference or based in Montreal please do come to the next event!

Kieran McCartan, PhD

Personal Spheres of Influence: talking prevention with Robin Goldman

At a Forum on Sex Trafficking in St. Paul, MN, in June, 2015, featuring Senator Amy Klobuchar and Cindy McCain, Robin Goldman used her day off to listen and learn. She was interested in part because at her Church she’s been a long-term member of the Compassion & Justice Committee. When someone suggested sex trafficking as a new area of focus, Robin felt compelled to work on it.  Listening to the speakers at the forum and to the discussion after, she heard the emphasis on responding to women and children who’d been trafficked in a compassionate way, to provide safety and to make it easier for them to seek help and to report those who had been involved in abusing/exploiting them.  She recognized that as important as these goals are, after Patty Wetterling raised the need for more attention on primary prevention, Robin wanted to validate her perspective. Additionally, Robin raised the issue of what faith communities could do in terms of a compassionate and socially just response to help change the social norms in which this continues to happen.

As an audience member there, I felt the intensity of interest in Robin’s points. The support came from a range of groups who are already doing work within their communities of faith, as well as from influential business leaders like Marilyn Carlson Nelson, in addressing sex trafficking, who also recognized the potential of doing more with and through faith communities. Robin noted that after the forum several people approached in appreciation of her comment, to talk about what they were doing and to connect.  She said, “What followed was a stream of emails between attendees and other members of the Compassion and Justice Committee at my church, invitations to share resources and establish some collaborative initiatives.  It is exciting to expand the web of connections in this work.  Partnering with others has so much more potential to expand our resources, opportunities and influence, especially given limited time.”

Robin, like many ATSA members, has a wealth of expertise and a wide network of resources she could link congregates to, but very little time.  She remembered that an early influence and inspiration in her life was Fay Honey Knopp, who during her life had been a huge influence on the field as Director of Safer Society Program, then a national referral service for sex offenders seeking treatment.  Robin described how gracefully Fay connected people who had shared interests in doing this work.  She said Fay would often come to her saying “I need you to meet someone” and then would drag her across the room to assure a real connection.  Robin recognized how that action bridges opportunities and resources in a valuable way. Now Robin is practicing being the person who identifies people who need to connect and makes sure they do. She recognizes she can’t do all the work, but she can help launch efforts by getting the right people and resources together.

With 33 years under her belt of working with those who’ve committed sex offenses, Robin knows the power in using her knowledge about sex offenders and applying it to prevention. She practices being that voice at the table who brings the information about preventing perpetration, especially for our young boys.  Robin’s learned how equally important it is to work with those who work with victim/survivors, to hear their perspective and for them to hear hers and to partner on recommendations for actions and policies needed.

Robin’s story reminds us that we all have many spheres of influence in which to use our knowledge and influence to advance prevention.  When it comes to making a difference in and through her church, Robin says, “I also see the opportunity in faith communities to invite a dialogue that will facilitate honest and open discussions about sensitive issues that affect all of us, including sex trafficking.  I am aware that my faith community, like all communities, includes youth and adults at risk to be victimized and at risk of perpetrating sexual abuse.  Faith communities can educate and support members and families to seek understanding, help and support. They can provide a place that nurtures healthy sexual attitudes and compassionate actions.”  

Even if we don’t have much time to give, we can offer the resources we know of to inspire others to take action and make their work a lot easier.  While the work at Robin’s church is only just beginning, she believes in building on the power of faith communities to help members rethink what we see all around us (children and adults) and to transform destructive social norms into constructive ones… to put into practice compassion and justice.

Related Resources:

A Time to Build: Creating Sexually Healthy Faith Communities, 2^nd Edition, by Rev Debra Haffner, (2012)

Robin Goldman, MA, LP, works at Minnesota Department of Corrections-Lino Lakes, where she is the Sex Offender Treatment Program Director. Robin is also an ATSA Clinical Member. PLEASE NOTE; Robin’s personal statements and opinions shared should not be assumed to reflect the views of the Minnesota DOC. 

Cordelia Anderson, MA, Founder/Director, Sensibilities Prevention Services, her training and consultation business based in Minneapolis, MN has been working to prevent child sexual abuse, exploitation and sexual violence since 1976. She is a member of the ATSA Prevention Comm

NOTA Annual Conference, Dublin 2015

The annual NOTA conference took place from the 16th - 18th of September in Dublin, this years theme was "Sexual Offending Research and Practice: sharing our knowledge to make a difference". The conference was a real mix of research, practice and engagement with colleagues, as well as the general public. In this blog I am going to take you on a whistle stop tour of the event, hold on!

This years key note addresses where a combination of academic research, practice and innovate appraoches. The plenary sessions covered a range of topics including online Child Sexual Abuse, grooming, risk assessment and Restorative Justice in sexual harm. The Keynotes included, Micheal Seto discussong innovations in work with online sex offenders, highlihting his new Child Pornography Offender Risk Tool (CPORT); Gray O'Reilly discussing his work on CBT with use through the compute game as well as App called "Pesky gNATS"; Anne Marie McAlinden discussing her ongoing research into the role of gooming Child Sexual Abuse; Duncan sheppard and Mark Blandford discussing the development and implementation of the polices Active Risk Management system (ARMS); Marir Keenan discussing the use of restortative justice in working with adults who commit sexual harm, being joined on stage by a victim of sexual harm who had progressed through the process; Vince Mercer discussing the role of Restorative Justice with youths who have commited sexual harm andsome of the challenges of working in this way with this group; and last, but not means leat, the Geese Theatre Company who put on a play about Restorative Justice with youths who commit sexual harm reinforcing alot of the evidence and practice that had been discussed in the earlier papers.

The workshops spanned a full ranging of topics including, Risk and Risk Assessment (Matthew Lister; Micheal Seto; Roger Kennington & Gail McGrergor; Hazel Kemshall; Ioan Ohlsson), Online sexual offending (Danielle Kettleborough; Hannah Merdian; Derek Perkins ), youth who commit sexual harm (Elizabeth Latourneau; Anne Marie McAlinden; Libby Ashurst; Mark Rivett & Stacey McDonald ), and Circles of Support and Accountability (Kieran McCartan; Hazel kemshall; Bob Webb; Deborah Marshall & Carol Butler) to name a few. The workshops where agood mix of research, evaulation, practical working, professional learning and knowledge exchange.

In addition to the traditional cnference activities NOTA 2015 also had a series of special interest acativities, including (1) NOTA's first public engagement event which welcomed 60+ members of the community into the conference to discuss prevting and responding to sexual harm with  an all Ireland and International panel [Michal Seto, Niall Muldoon (Childrens Obudsman for Ireland), Elizabeth Latourneau and Sharon Beattie (Safeguarding Board for Northern Ireland)]; & (2) a session by the International working group on best practice in management of online sexual offending (Maggie Brennan, Hannah Merdian & Derek Perkins) which updated and highlighted the work that they d in sharing, as well as developing, good practice in defining, understanding, preventing, responding to, treating and legislating around those individuals who commit sexual harm online.

As you can see NOTA 2015 fitted a massive amount of material in across three days, watch the blog over the next couple of months for blog posts from authors who attended the conference [I did some scouting].I have come away informed, refreshed and looking forward to next years meeting in Brighton (28th - 30th September 2016). On to the next conference in the season ATSA 2015 in Montreal from the 14th - 17th of October.

Kieran McCartan, Ph.D

Civil Commitment: Another program is found unconstitutional

On Friday, September 11, 2015, the Missouri civil commitment program (known as SORTS) was declared unconstitutional, the second such instance since the start of this summer. For readers unfamiliar with the US civil commitment laws (AKA “SVP” laws), the short version is that 20 states and the federal government have laws that allow states to indefinitely confine sex offenders who are assessed as having a mental diagnosis that predisposes them to acts of sexual violence and meet statutory criteria of risk for future re-offense. There are controversies at every possible turn in these laws, their processes, and subsequent programs, and the US Supreme Court rulings allowing civil commitment have passed by as little as one vote. Because the author was an expert witness in the Missouri case, this blog post looks more at the big-picture issues rather than at that specific case. What seems clear is that there is an evolving consensus in the courts that civil commitment as it is practiced in many areas is unconstitutional and that governments and programs must work together closely to keep it lawful.

As in the Minnesota case decided earlier this summer (see an earlier series of blogs on this case – part 1, 2 and 3), the Missouri case involved a treatment program in operation for many years (roughly 15 in Missouri’s case and 20 in Minnesota’s) from which few have been released and no one has ever been fully discharged. On one hand it is clear that there are some people who are civilly committed and are truly dangerous (the author has worked with people openly determined to re-offend). On the other hand, there is no bona fide form of treatment that takes a minimum of 15 years to complete. Add to this concerns that these programs were not assessing risk in a timely manner, and that each exist in a political climate that is unconducive at best, and the dye for these outcomes was cast long, long ago. At what point does our field step back and say, “This is unacceptable”?

For all our advances in assessment and treatment, we seem to be producing no improved outcomes in the civil commitment arena whatsoever. A study that has not garnered the amount of discussion that it deserves is Grant Duwe’s 2014 study of the effects of civil commitment. Among his findings was that only 28% of his sample would likely have re-offended again in their lifetime, raising further questions as to whether states have simply cast their nets too wide. Where “Blackstone’s Formulation” that, "It is better that ten guilty persons escape than that one innocent suffer" has been taught in schools throughout much of American history, the idea that that some people are held indefinitely beyond the expiration of their sentences really ought to give anyone pause. In fact, the principle behind Blackstone’s Formulation goes back to antiquity. For example, in the Bible, Genesis 18:23-24 states, “Then Abraham approached him and said: “Will you sweep away the righteous with the wicked? What if there are fifty righteous people in the city? Will you really sweep it away and not spare the place for the sake of the fifty righteous people in it?” What are the implications for civil commitment?

Closer to street level, two particular cases, apparently among many, made the news last year. The first was a young man who had sexually abused others at an early age. From a media account:

The four court-appointed experts argued that T’s early sexual offenses as a juvenile were influenced by his own sexual victimization, and that his behavior was likely exacerbated by his attention deficit hyperactivity disorder (ADHD) and untreated trauma. The experts also noted that most juveniles who act out sexually do not continue to offend as adults. “There is little evidence to suggest that T is a dangerous sexual offender who poses a significant risk to public safety,” the experts wrote.

After considerable legal debate, it seemed that T would be placed on some form of supervised release, but by all appearances, that has not happened a year after his case was before the judge.

Another case involved the only woman civilly committed as a sex offender in that state. From a different media account:

B’s case has proven to be even more vexing for the state. As the only woman ever civilly committed to MSOP, it’s clear officials had little idea what to do or how to treat her. … she suffered a traumatic upbringing: abused by her father, brother and two of her uncles starting as early as 5 years old and continuing through young adulthood. She had a child at 14, and as an adult, sexually abused two boys.

(A)nother of the court-appointed experts  … characterized B’s offenses as “reactive” to her trauma as a child. As an adult, B is “flirtatious” and “forward” and easily stimulated in discussions of sexual activities. All of which means that treating her in an all-male program, with group therapy sessions, might have actually made things worse, W said. “She is in a group with men, focusing on issues of men and living with men.”

Like the earlier example, there are no reports that this woman has been moved to more conducive circumstances after more than a year since that hearing. Similar cases (such as this juvenile-only example or this 65-year-old man who reports 24 therapists in his 20-plus years of commitment) have been reported in the media, and yet the status quo continues.

Clearly, each of these cases involve people who are difficult to treat on a good day. For a sense of scale, though, the woman described above was civilly committed during Bill Clinton’s first year in office, 22 years ago (although others have been committed longer). Likewise, World War II lasted roughly six years while people are not deemed as being below the statutory threshold for civil commitment despite participation in treatment for two and three times that amount of time. One commentator described the lack of outcry around these circumstances as having the same emotional valence as fishermen noting that they sometimes get dolphins caught in their tuna nets (and it is worth remembering that these programs typically house hundreds of residents).  At what point is remaining silent about the judicial findings, and the many task force reports and outside evaluations they are based on, no longer acceptable?

Sadly, the people working at the front lines are often directed by policy and supervisors not to discuss these issues openly. In the author’s experience, some people care more deeply than others about balancing the rights and welfare of the community with the beneficence and rights of the client in treatment. There is no question that there are good people at the front lines trying to do the right thing and wrestling with deeply personal questions about the way forward. Still, given that two exercises of civil commitment statutes have been deemed unconstitutional – and in the eyes of many that is another way of saying fundamentally un-American – questions emerge for all practitioners:

At what point do professionals in these circumstances openly acknowledge to them/ourselves that we are participating in systems that are openly unconstitutional and therefore unlawful according to the standards of much of the western world? Even beyond American law, consider the case of Shawn Sullivan, who fled the US and was on Interpol’s most-wanted list. One of the UK’s highest courts found that the state’s program to commit sex offenders indefinitely to treatment violates European human rights law. From the article:

On Wednesday, Lord Justice Alan Moses said returning Sullivan for trial with the possibility of later being placed in the sex offender system would be a "flagrant denial of his rights" under European law. 

With that in mind, professionals might also want to ask at what point we are violating basic human rights when we are providing treatment that no one can complete and not providing empirically based risk assessments and taking action based on the results.

Meanwhile, some programs do appear to be working in general, such as Wisconsin’s program at Sand Ridge and New York’s system involving intensive community supervision. However, even these programs, like the formerly all-outpatient Texas civil commitment program, are seeing their constitutionality threatened by broad residency restrictions and policies that restrict where resident can be discharged to; for some residents in Wisconsin, for example, the process can and does take years. Texas, of course, has recently moved to a more inpatient model.

As a profession, we have the research, the tools, and the templates for prompt and adequate treatment and yet find ourselves in political climates where we can’t use them. We can reduce the harm of sexual abuse, but we tend to forget that in the interest of political expedience. At what point do we as individual professionals, or as professional organizations take a stand against practices that are clearly not working to anyone’s long-term benefit? One need only look at the recent experiences of the American Psychological Association and its involvement with torture to see how collective inaction can bring disgrace to a profession.

Personally, my belief is that we all need to talk about these issues much more than we do. Legal action and journal articles are one matter, public dialog is something else. Critical self-examination takes courage. Perhaps it starts with all of us when we say to ourselves: All sexual abuse is unacceptable, but I will not violate the rights of others in the name of reducing harm. It is time to take a stand for the rights of all human beings. 

David S. Prescott, LICSW

The more things change, the more they stay the same….... or do they?

It’s that time of the year again, especially in the northern hemisphere, where the new school year commences, in the south it’s the start of semester 2, and conversations turn to the new academic year,  education and safeguarding. This is not a prevention or a bystander intervention blog one, rather a policy and public engagement one.

Over the last couple of weeks there has been an increase in policy and bystander intervention blogs coming across my newsfeed from the UK (university inquiry, sexual harm in schools,  sexting) and USA (community colleges and sexual assualt) regarding the rate of campus based sexual harm (and I use this term broadly as the stories ranged from primary school to university level) and how to respond to it. These stories highlight a number of core factors, including;

-      that the problem is not improving (in the UK there is a feeling that the current university sexual harm prevention approaches are not working),

-       that campus culture is too blame (the recent reports in the UK about clubs and societies as well as fraternities and sororities in the USA),

-     that wider societal attitudes contribute to these factors (stories about unchanging attitudes to women, the impact of pornography and sexting behaviour across society in general – with increasing UK and USA criminalisation of as well as concerns around children and adolescents ),

-       that the government needs to step it to resolve the issues (the development of a new inquiry in the UK); and

-     that individual factors are at the centre of our health and criminal justice responses (a continued focus on the role of the victim in preventing sexual harm and the role of society in condemning it).

The presiding outcome to all of this is that it’s the same story that we have heard for a number of years in this field, as well as sexual harm in general, that something must be done (e.g., Cambridge university, USA  & in general), a ringing of hands and some new policies (intervention initiative, step up & existing evidence based practice). If we want to impact upon attitudes to sexual harm, prevent sexual harm, encourage bystander intervention and have viable public health policy that gets used we have to ingrain these changes from the start, in childhood, we need a life course perspective on this not just a repair and move on model. There needs to be coherent sexual harm education and prevention approaches starting in primary school and then following children all the way through life to secondary school, university and into the workplace. However, our perceived morality around sex and sexuality can get in the way of the education policies that need to be implemented. In the UK, at least, there are some general guidelines that all schools, colleges and universities should attend to but these are open to interpretation and then you end up with a postcode lottery of sorts regarding the message that you receive (generally workplace initiatives are better formed and better implemented). Poorly planned policy leads to weak implementation. The arguements that can be used to counter increased sexual health and sexual harm education in schools and colleges include that this is not the role of the state and that parents are having these conversations with their children at home. In the reality neither of these arguments are true as the state should be providing pro-social modelling and some of the most vulnerable children (to being a victim or potential perpetrator of sexual harm) are not getting this pro-social modelling/conversations that children need at home; therefore, if they do not get these conversations at home or in education where are they getting them - from each other, from inappropriate sources, like pornography or other adult content (like TV, Movies and Music)? People will seek out answers in the most straightforward and accessible ways, the internet has helped as well as hindered with this, but these may not be the most appropriate ways. Pornography has become the reason for sexual harm in modern society again, like it was in the late 1970’s/80’s (see the work of Professor Keith Soothill), with the argument that watching pornography leads to an increased likelihood of committing sexual harm; in some cases yes but in all cases no. The real argument is that pornography gives a distorted view of sex, sexual relationships and the impact of sexual harm (actually as does mainstream TV, Movies and Music) which can have a lasting impact if engaged in without a filter (that is as an adult we know what is appropriate/inappropriate and what to dismiss) which children do not have, so that can accept it as given.  What this all comes back to is the need to develop a clear, well thought out policy on understanding and responding to sexual harm that spans the life course, that is simple and transferable across institutions. What we need is a societal response that lays the ground work in early education that only needs attending to and maintaince in university, we should not be starting from scratch. We do not have a coherent response that the minute only a recognition that something needs to be done and that different institutions can do what they want; this is problematic we need to move towards a more integrated, thoughtful and better developed approach. If sexual harm is a public health issue we need to treat it like one.

Kieran McCartan, Ph.D