CEOP

CEOP Practice Seminar Thursday 10th February 2011, London
simon.hackett@durham.ac.uk Baseline k(now)ledge and
research indicators for practice Understanding and assessing risk Responding to families  Who are young people with HSB? A continuum of concern 
Current research indicators − demographic indicators, typologies and motivational factors 
Discussion and questions Ward and Siegert's pathways model An Intimacy Deficits Pathway where sexually abusive behaviour is viewed as primarily due to poor attachment relationships with care-givers whereby a child/young person does not develop sufficient skills and confidence that promote the formation of intimate and trusting relationships with others. This may then lead to a withdrawal from normative social interactions and a substitution of children for appropriate peer sexual and social contact.

A Problematic Sexual Scripts Pathway where exposure to sexual abuse, particularly from multiple perpetrators or a very sexualised environment, leads to sexualised and sexually abusive behaviour. Frequently this pathway relates to those sexualised as children who develop abusive behaviour which continue into adolescence.

An Emotional Dysregulation Pathway where a primary deficit concerning the ability to manage negative feelings (such as anger, frustration, and sadness) promotes the development of sexually abusive behaviour. Early occurrence of abusive behaviour reflecting this pathway is likely to be associated with a co-morbid diagnosis of Attention Deficit Hyperactivity Disorder.

An Anti-Social Thinking Pathway where a pro-criminal value system supports aggression as a viable method for securing an individuals needs for intimacy and sexual contact. Conduct Disorder is a common co-morbid diagnosis for young people whose development of sexually abusive behaviour has principally followed this particular pathway.

Multiple Pathways reflecting the developmental histories and profiles of individuals who present with a severe sexual and multiple abuse histories with both sexually compulsive and general functioning problems.

development behaviour tremendous DIVERSITY Zolondek et al. 2001 Hackett et al., in progress.
Sample of 700 British young people with HSB 97% male, 3% female.

38% learning disabled.

41% living at home, 12% with relatives.

30% S20 CA89 or care order.

6% secure.
family dysfunction social isolation sexual or physical victimisation conduct disorder learning disability Hunter's victim type categorisation More on the presentation of young people, backgrounds, behaviours in question
Evidence in support of categorically meaningful subgroups
More evidence on recidivism and risk
More consensus on content of interventions and some outcome studies
Significant developments in relation to style and modes of delivery
Overall, increased conceptual flexibility
Hackett et al. (ongoing)
Data on types of behaviours and victims

84% inappropriate touching.
50% non-contact abuse.
52% penetrative abuse.
18% violence or force.
40% had one victim, 23% had two, 14% had three, 3% had more than ten. Most had severely negative self image
Below average academic achievement
Half were regularly bullied or harassed by their peers

“In comparison with young men, these females seemed to function less effectively at virtually every level. A possible hypothesis is that young women only come to commit sexual abuse when they start to suffer serious behavioural and psychological problems.”
in our current large study of 700 yp, we found that 50% had histories of sexual abuse, 50% physical abuse abuses young girls in family We found:
Victims: 19% male, 51% female, 30% both.
Victims: 53% extra, 25% intra, 22% both.
Age of victims: ten and under (74%), 11-17 (45%), 18+ (17%).
Victim characteristics (peer v child molesters?)
Offence characteristics (specialists v generalists?)
Personality characteristics (abused, delinquent, criminal)
Pathways models? (pre-adolescent v adolescent onset?) Understanding differences? male Hendriks and Bijleveld (2006) sample of 10 female adolescent sex offenders, age between 11-18, (half under 13)
The majority used considerable or serious violence during the abuse; hitting, kicking or threatening the victim with a stick
Most of the offenders committed the criminal acts in a group context or in childcare situations
Neglect and abuse were identified among a large majority. Only one was not a known victim of sexual abuse
High levels of family breakdown and DV In our study: 23 young women

90% white.
50% home, 32% care order, 4% secure
38% learning disabled.
65% victim of sexual abuse, 50% of other abuse.
31% noncontact, 75% touching, 21% penetration, 10% violent.
52% extra, 33% intra, 15% both.
5% conviction of caution.
Under 10 (75%), 11-17 (20%), 18+ (5%) 38% of our sample of 700 young people were identified in the case files as having a 'learning disability'

YP with LD and HSB
As likely to engage in assaultive abuse, but more likely to engage in ‘nuisance’ behaviours (public masturbation, exhibitionism, voyeurism)

YP LD abuse equally against males and females
YP LD show low specificity for victim age
Many YP LD behaviours more associated with circumstances and opportunity, rather than sexual preference Hickey et al.'s (2006) onset categorisation High rates of early difficult temperament; inadequate parenting; childhood maltreatment; multiple changes of home placement; and insecure attachment.
Non-sexual anti-social behaviours displayed by this trajectory also begin early and tend to persist through childhood and adolescence.
Also characterised by high rates of SAB against a diverse range of victims. This trajectory was also associated with the highest rate of abusing male victims. Early onset trajectory Late onset trajectory Characterised by lower rates of poor parenting, maltreatment, and non-sexual anti-social behaviour in childhood.
However, by adolescence high rates of non-sexual anti-social behaviour were evident, as were high rates of substance misuse.
The SAB of those on this trajectory was characterised by more targeted victim selection in relation to female and child victims, and a greater use of verbal coercion. Chu, C.M. and Thomas, S. (2010) 'specialists' v. 'generalists' Compared 71 ‘specialists’ (i.e. the young people who had only sexually offended) with 77 ‘generalists’ (i.e. those with other criminal behaviours in addition to the sexual offending)

Examined the different offence characteristics and recidivism in these groups
overall specialists generalists ■Key components of assessments
What does research tell us about risk and protective factors?
■Models and frameworks for risk evaluation Chaffin et al. 2002


Detailed exploration of the child’s prior experiences of victimisation: including as much information as can be gathered about the dynamics of any abuse and, especially if the abuse was sexual in nature, the abusive behaviours that the child was involved in, as these can cast light upon the child’s subsequent sexualised behaviours Thorough analysis of the problematic sexual behaviours including their onset, motivating factors, types of behaviour exhibited, changes in the behaviours over time and the child’s responses to attempts by caregivers to correct or distract the child away from such behaviours Detailed social history of both the child and the family, with specific attention given to significant family losses or other traumatic events, child moves and episodes of substitute care Analysis of the child’s wider social functioning, relationships and interactions, including both strengths and competencies, as well as risks and deficits
Other behavioural issues which may be related to the problematic sexual behaviours, such as conduct problems, ADHD, or post-traumatic responses exhibited by the child

The family environment, including how sex and sexuality is viewed and expressed by parents in the home, parenting styles and competencies, disciplinary practices in the home, the level of supervision afforded to children in the home and the carers’ previous attempts to manage and respond to the child’s sexual behaviours.
Risk Generally, “young people grow out of offending” but... Common assumption that young people who sexually abuse
“grow into offending and are at high risk of escalating into adult sex offenders"? components of an overall assessment Worling and Curwen (2000) collected recidivism data on 148 aso’s assessed at a specialised community programme.
Follow-up period averaging 6 years, mean age at follow-up= 21.5 yrs
Compared ‘treated’ adolescents against non-treated
Comparison group Treated group

Any criminal off. 54% 35%

Sexual assault 18% 5%

Violent non-sex off. 32% 19%

Nonviolent off 50% 21%

this is helpful but it doesn't tell us a great deal about what factors lead to recidivism..... three studies that help... Parks, G. and Bard, D. (2006) Risk Factors for Adolescent Sex Offender Recidivism: Evaluation of Predictive Factors and Comparison of Three Groups Based Upon Victim Type, Sexual Abuse, A Journal of Research and Treatment,18:319–342
Chu, C.M. and Thomas, S. (2010) Adolescent Sexual Offenders: The Relationship Between Typology and Recidivism, Sexual Abuse: A Journal of Research and Treatment, 22(2) 218–233
Hickey et al. (2006) Links between juvenile sexually abusive behaviour and emerging severe personality disorder traits in childhood. DH Parks and Bard examined 156 male juvenile sex offenders who were or had been in the custody of a state juvenile justice agency in Oklahoma

Based upon the index offence and any documented prior sexual offences identified for inclusion in one of three groups:

(a) offenders against children (n=74) (<10 yrs, 4yrs age diff)

(b) offenders against peers/adults (n=51)

(c) mixed type offenders (n=31)

Retrospectively investigated differences in recidivism risk factors (J-SOAP-II) and traits associated with psychopathy (PCL:YV) among the 3 groups
Based upon both juvenile and adult recidivism data, 6.4% of the sample reoffended sexually and 30.1% reoffended nonsexually.
Those who offended against peers or adults appeared to exhibit a relatively low level of sexual preoccupation measured by the J-SOAP as compared to child offenders….
The mixed type offenders exhibited a particularly high level of these characteristics by comparison. While they exhibited deviant arousal toward younger children, their sexual preoccupation was more pervasive and, therefore, extended to a wider variety of location, social situations, and potential victims.
Peer/adult offender group reoffended sexually at more than twice the rate of the child offender group (9.8% vs. 4%).
General delinquent behavior was associated with increased risk for both sexual and nonsexual recidivism.
Chu and Thomas looked into the characteristics of 156 male adolescent sexual offenders referred for assessment at courts over an 11 year period
Compared 71 ‘specialists’ (i.e. the young people who had only sexually offended) with 77 ‘generalists’ (i.e. those with other criminal behaviours in addition to the sexual offending)
Examined the different offence characteristics and recidivism in these groups
Hickey et al. (2006) Well supported risk factors:

Deviant sexual interests in children
High levels of sexual preoccupation and drive
Numerous past sex offences
Selection of stranger as a victim
Mixed type offences (child and peer/adult victims)
History of violent offences and general criminality
Incomplete offence-specific intervention
Promising risk factors:

Impulsivity
Environment which supports opportunity to reoffend
Selection of a male victim


Unlikely to be predictive

Denial of the sexual abuse
Lack of victim empathy
Penetrative sexual assaults
Young person’s own history of child sexual abuse
Early onset J-SOAP II Prentky and Righthand 2 static scales 2 dynamic scales 28 item risk assessment tool
designed for 12-18 year olds
with HSB Sexual drive/ preoccupation scale Impulsive/ antisocial
behavior scale Intervention scale Community stability/
adjustment scale "This item is simply the total number of prior charged sexual offenses that involved physical contact. Conviction is not necessary. Do not count the current, governing, or index sexual offense(s). Scoring: 0= None. 1= one offense. 2= more than one offense" Item 17: Accepting Responsibility

0= Accepts full responsibility for sexual and nonsexual offenses without any evidence of minimsing

1= Accepts some (but not total) responsibility. Although occasional minimizing may be present, individual does not deny offending

2= Accepts no responsibility, or there is full denial. Score also if there is partial denial and frequent minimizing protective factors Resilience Desistance Positive peer and adult interactions
Low degrees of defensiveness and aggression and high degrees of cooperation, participation and emotional stability
A positive sense of self
A sense of personal power rather than powerlessness
An internal locus of control
At least one significant adult in their lives
Directive and supportive parental supervision
Multiple pathways to desistance
Within general criminological literature, some of the most important factors appear to include:
Attachment to a conventional other (e.g. partner/ spouse)
Stable employment
Transformation of personal identity
Aging
Family based interventions
What works anyway?
Effectiveness and developmental outcomes Calder's identification of the families of young people with HSB:

Distant parent-children relationships
Domestic violence
Children experiencing physical violence from a parent
Lots of family changes or breakdown with children being cared for by different people
Fathers who take little or no responsibility for parenting
Blurring of family roles- especially children taking on too much responsibility, older children being treated as babies, parentified child, etc.
Lack of parental warmth to children
A lack of supervision of children by parents (parents often not knowing what the children are doing)
Lack of openness in the family- lots of unhealthy family secrets
Parental criminality and poor role models
Unresolved parental abuse histories
Children seeing siblings or parents having sex in the family
Overt sexual environment in the family
Family rules that are too strict and stop the children developing- e.g. all sex is bad, etc.
Intergenerational patterns of sexual abuse

“It is easy to imagine the psychological weight that parents must carry as they care for children with sexual behavior problems, most of whom have also been sexual or physical abuse victims, particularly when they believe there is no one with whom they can talk about their private anguish” (Pithers et al., 1998)
General intervention areas with parents:

Child’s developmental history
Quality of parent-child relationships (distant or close, warmth or hostility?)
Supervision
Domestic violence
Physical punishment and violence
Family changes or breakdown, experiences of multiple caregivers
Parental roles, including role of fathers
Parental abuse history
Family criminality

Sexual abuse specific intervention areas with parents:

Understanding of what has happened, level of acceptance, views about why their young person has behaved in an abusive way, etc.
Assisting parent to monitor and supervise the child’s sexual behaviours/ risk management
Exploration of attitudes and feelings about sex, sexuality, sexual abuse and sex offenders
Awareness of the impact of sexual abuse on victims
Parents’ overall knowledge of normal child/ adolescent sexual development
How to find a safe and appropriate support
In summary Sexually abusive behaviour exists on a wide continuum, motivated by very many differing underlying influences, underpinned by significant differences in background, personality and experience.

Variability of pathways into abusive behaviour suggests the need for qualitatively and quantitatively different practice responses... what works anyway? “As a result of the weakness of empirical support for risk prediction and group distinctions, juvenile sex offenders, while a heterogeneous population, are subjected to generic treatment models that may fail to address specialized treatment needs (Hunter et al., 2003). Furthermore, it appears that clinicians tend to overestimate risk based upon clinical judgment alone (Smith & Monastersky, 1986), which potentially results in the failure to preserve the most intensive and restrictive treatment options for the highest risk adolescents.” (Parks and Bard, 2006, p. 321)
Letourneau and Swenson (2005):

“treatment is largely focused on addressing individual characteristics and, with few exceptions, generally does not include substantial components that address family and almost never addresses peer or school correlates (apart from addressing such correlates solely with the youth)” (p.255)
Abuse specific Holistic Supportive Multimodal MST Finding the Fit
Positive & Strength Focused
Increasing Responsibility
Present-focused, Action-oriented & Well-defined
Targeting Sequences
Developmentally Appropriate
Continuous Effort
Evaluation and Accountability
Generalization why has it been shown to be effective? Treatment targets underlying influences on delinquency (in this case HSB): family relations, peer relations, school performance, community factors;
Approach emphasises accountability- young person, family, professional system;
Treatment is family driven and occurs in the young person’s natural environment;
Significant energies are devoted to developing positive interagency relations; and
Highly resourced Henggeler, S., Letourneau, E., Borduin, C. and Chapman J. (2009)Mediators of Change for Multisystemic Therapy With Juvenile Sexual Offenders, Journal of Consulting and Clinical Psychology, Vol. 77, No. 3, 451–462
“The findings suggest that MST empowered caregivers to better identify friends who were having a negative influence on their adolescents, advise them to stop associating with such friends, and follow through on planned discipline. These behaviors, in turn, led to decreased antisocial behavior and deviant sexual interest/risk behaviors on the part of the adolescent sexual offenders.

Assuming that this conceptualization of the mediational processes is at least partially correct, these findings support a central emphasis of MST—the empowerment of caregivers to provide more consistent discipline to their delinquent youth and to attempt to extract these youth from their deviant peers.”
outcomes? and finally.... what ever happened to.... J-SOAP research:

•The Sexual Drive/Preoccupation scale to predict sexual recidivism significantly (Hecker et al., 2002).
•High scores on the Impulsive/Antisocial Behaviour to indicate significantly more likelihood that the individual will be rearrested for any new offense (Waite et al., 2005).
•A strong relationship between higher scores on Impulsive/ Antisocial Scale and non-sexual recidivism (Parks and Bard, 2006).
sexual drive/ impulsive/
preoccupation antisocial behaviour

Rachel: 6/16= 37% 1/16= 6%
Alan: 8/16= 50% 5/16= 31%
Liam: 4/16= 25% 13/16= 81% Rachel Alan Liam