Breaking the Cycle: Promoting Safe and Respectful Relationships for Children & Young People

Breaking the cycle: Promoting safe and respectful relationships for children & young people in care

An action research project

Project Brief

November 2016

Dr Gemma McKibbin & Prof Cathy Humphreys Melbourne Alliance to End Violence Against Women and their Children, University of Melbourne

With Dr Robyn Miller, Dr Nick Halfpenny & Edith Loch MacKillop Family Services

Contact: [email protected]

0437 281 543

1 Background Children and young people in out-of-home care are at significantly increased risk of living with domestic & family violence, as well as being victimised through harmful sexual behaviour and sexual exploitation (Royal Commission into Institutional Responses to Child Sexual Abuse, 2016; Royal Commission into Family Violence, 2016; Commission for Children and Young People, 2015).

Many children and young people are living in care because they have experienced domestic & family violence in their families of origin (Royal Commission into Family Violence, 2016). When children & young people live with domestic & family violence they are more susceptible to developing abusive behaviours or to being victimised in the future (Holt, 2008). These abusive behaviours are sometimes sexually harmful and at other times involve intimate partner violence. Further, domestic & family violence is the key risk factor for harmful sexual behaviour carried out by children and young people (Pratt & Miller, 2012).

Definitions The Family Violence Protection Act (Victorian Government, 2008) defines domestic & family violence as behaviour by an individual that is physically, emotionally, sexually or financially abusive against a family member. Domestic & family violence is most often carried out by men against women but can also be carried out by children & young people (Lang & Humphreys, 2013). Harmful sexual behaviour carried out by children and young people is developmentally inappropriate and may be abusive towards self or others, including children, young people or adults; and child sexual exploitation is a type of sexual abuse that involves a child or young person receiving goods, money, power or attention in exchange for sexual activity (Hackett, Holmes, & Branigan, 2016).

Focus on secondary prevention This project adopts a public health approach to prevention with a particular focus on secondary prevention. This means that the interventions developed will target risk factors and strengthen protective factors associated with domestic & family violence, harmful sexual behaviour and child sexual exploitation in out-of-home care settings (see Figure 1).

Figure 1: A focus on targeting risk factors and strengthening protective factors

Programs to address domestic & family violence in out-of-home care Aside from the provision of trauma-informed out-of-home care, services and programs to specifically respond to the needs of young people who are displaying violence, including intimate partner violence and harmful sexual behaviour, in out-of-home care appear to be underdeveloped.

2 In the area of family violence, a review of men’s behaviour change programs undertaken by Carmody, Salter, and Presterudstuen (2014) concluded that programs are predominantly offered to adult men and that those targeting younger men are offered in a school environment rather than in an out-of-home care setting. Further, the authors found that prevention programs have a greater impact on men and boys when they are delivered as single gender programs and that men’s behaviour change course content that focuses on challenging male privilege and power may not be relevant for boys from impoverished socioeconomic backgrounds. It may be that young males in out-of-home care are unlikely to view violent behaviour through a prism of power, when in reality they are likely to have experienced disenfranchisement and disempowerment through their experience with Child Protection, youth justice or other welfare interventions in their lives. This view is supported by an Australian report by Tayton, Kaspiew, Moore, & Campo (2014) about groups of women and girls who are at higher risk of being victims of domestic violence. The authors found that as a large number of children and young people in out-of-home care – particularly those at higher risk of becoming perpetrators of, or vulnerable to, family violence in adulthood – are often disengaged from education, it is unlikely that they will have access to either targeted behaviour change or universal approaches such as Respectful Relationships Education by virtue of being too young for men’s behaviour change programs or disengaged from school.

Organisational responses to harmful sexual behaviour The Royal Commission found that a number of factors can inhibit the accurate identification of sexually harmful behaviours in out-of-home care, including that organisational staff often do not understand the complexities of sexually harmful behaviours (Royal Commission, 2016) Children and young people have the right to live free from sexual abuse (United Nations, 1989). In the out-of-home care context, this is a complex responsibility for staff who are supporting children who have experienced significant trauma that may include sexual abuse prior to coming into care. Clear learning and development strategies are required to ensure staff are equipped to navigate these issues with the children in their care. In reality many young people leave care without ever having properly examined the impact of the violence within their family of origin, and how they can work towards safe and respectful relationships in adulthood (Royal Commission, 2016). Further, the Royal Commission (2016) identified that the use of social media can support child exploitation and that access to pornographic material on the internet puts children in out-of-home care at risk. The maintenance of safe online environments for children and young people remains a challenge for providers of out-of-home care and it is likely that the challenge will continue as technology evolves.

The sexual exploitation of young people in out-of-home care In relation to the experience of violence against young people in out-of-home care, there is a link between the issue of sexual exploitation and family violence. These issues share many of the same risk factors (Carmody, Salter, & Presterudstuen, 2014). In the experience of MacKillop workers, some

3 young people in out-of-home care seek out intimacy as a form of connection, comfort and belonging, and some adults will exploit those needs. As a group, young people in residential care can be vulnerable when in public and may attract people who perpetrate against them. Young people who have experienced an abusive home life may have a distorted safety ‘barometer’ and unintentionally place themselves in situations, and establish relationships with people that increase their vulnerability to abuse. This practice is sometimes referred to as “sexually reactive behaviour” (Szanto et al., 2012). The Royal Commission outlined a range of strategies employed by perpetrators to groom children including:  initiate and encourage the development of a ‘friendship’ with children and young people

 send taxis to pick up children from their placements to take them to ‘parties’

 provide tickets to sporting events

 entice the child with notions of becoming a model or an actor

 provide driving lessons to children in residential care

 provide drugs, alcohol and money in return for sexual acts.

There is no doubt that children and young people who have experienced a disruptive home life are less likely to have engaged in formal education and may not have learnt how to recognise safe relationships and safe adults. Having experienced disrupted attachment and few appropriate relationships with adults, it can be difficult for traumatised young people to recognise and move away from an abusive relationship. As noted above, healthy relationships programs may not impact on young women in out-of-home care because of disengagement and exclusion from school (Tayton et al., 2014).

The views of young people exhibiting harmful sexual behaviours In a study focusing on the prevention of sexually harmful behaviours drawing upon the insights of young people who had been sexually abusive, McKibbin, Humphreys, and Hamilton (2016) found that young people who had sexually abused identified three opportunities for preventing sexually abusive behaviour:  Make their relationships safe – many of the young people indicated that if their relationships had been safer, then the sexually abusive behaviour would have been less likely to occur.  Reform their sexuality education – young people said that the sexuality education was delivered too late in the trajectory of the sexually abusive behaviour, and that the content of the education did not contain messages about such behaviour.  Help their management of pornography – some young people implied that the likelihood of them sexually abusing could have been reduced if pornography had not been present in their lives – their sexually abusive behaviour may have been prevented had pornography not combined with other factors to cause the behaviour

4 McKibbin, Humphreys and Hamilton (2016) argued that these opportunities could inform the enhancement of the sexually abusive behaviour prevention agenda:  New primary prevention initiatives could involve: incorporating prevention messages about sexually abusive behaviour into Respectful Relationships Education; targeting mothers and caregivers with a social marketing campaign about sexually abusive behaviour; and introducing governmental regulation of the pornography and telecommunications industries.  New secondary prevention initiatives could involve: formulating sexual health policies for groups of children and young people vulnerable to developing sexually abusive behaviour; and implementing an early intervention Stop it Now!-style program to support desistance from child sexual abuse.  New tertiary prevention initiatives could involve: adjusting treatment models for sexually abusive behaviour to reflect young people’s use of pornography; and developing service delivery to support young people in treatment to seek justice for their own childhood abuse.

Gaps in provision of prevention initiatives for children and young people in out-of-home care The Commission for Children and Young People (CCYP) Inquiry (2015) into the adequacy of the provision of residential care services to Victorian children and young people who have been subject to sexual abuse or sexual exploitation whilst residing in residential care argued that there is very little consistent education provided to children and young people in residential care about healthy and safe relationships, sexual health and the safe use of the internet and social media. The CCYP (2015) found that sexual health and wellbeing education for children in residential care should include:  Information about sexual health

 Positive relationships

 Reproduction

 Issues related to consent

 Safe use of the internet and social media platforms

 Safe sex practices and protective behaviours

 Information that counters the influence of pornography. The report identified a program implemented in Massachusetts, North America, as presenting useful way forward. The program – My Life My Choice – is a preventative program facilitated by a clinician and a trained adult survivor to educate adolescent girls about sexual exploitation. The group program is delivered in schools, out-of-home care facilities and other community-based services. New evidence indicates that boys are at as high a risk of sexual exploitation if they have been victims of child sexual abuse (Krahe & Berger, 2016).

5 Project description MacKillop Family Services will work in partnership with the University of Melbourne to co-design and implement prevention measures that respond to problems of domestic & family violence, harmful sexual behaviour and child sexual exploitation. The prevention measures will focus on children and young people in residential care settings but will be applicable through a process of tailoring to other out-of-home care settings. The action research will fill a critical gap in services for children and young people in out-of-home care. There is considerable potential to harness the expertise and experience of youth services, out-of- home care and other community agencies working with children and young to build their capacity to develop and implement prevention initiatives. Evidence will be drawn from the scholarly literature, practitioners in the field, policy-makers and young people in care or who have left care. The project will have a strong focus on collaboration with staff in residential care, experts in the field and evidence about program content tailored for residential care settings. The aim of the action research is to develop a differentially-responsive, whole-of-organisation approach to preventing domestic & family violence, harmful sexual behaviour and child sexual exploitation for children and young people living in care.

Phase One - Form an Advisory Panel This research project will adopt a co-design approach, which will involve the establishment of an Advisory Panel comprising: Robyn Miller MacKillop Family Services Edith Loch MacKillop Family Services

Ninevah Hooper MacKillop Family Services Jane French MacKillop Family Services Ilkin Il MacKillop Family Services Nick Halfpenny MacKillop Family Services Tracy Beaton Department of Health and Human Services Liana Buchanan Commission for Children and Young People Carolyn Worth South East Centre Against Sexual Assault Dale Tolliday New Street Services Boris Buick Victoria Police Russell Pratt Department of Health and Human Services Antonia Quadara Australian Institute of Family Studies Kerryann Walsh Queensland University of Technology Wendy O’Brien Deakin University Maree Crabbe Risk and Reality Project Helen Skouteris Deakin University Lesley Podesta Alannah and Madeline Foundation Lara Gerrand CREATE Foundation Bobbie Wan Office of Children’s eSafety Commissioner Margaret Grigg Department of Health and Human Services Robyn Humphries Department of Health and Human Services Cathy Humphreys University of Melbourne

6 Gemma McKibbin University of Melbourne

Phase Two – Undertake scoping review Phase Two of the research will involve undertaking a narrative scoping review drawing on the method set out by Arskey and O’Malley (2005). The authors identify five stages for carrying out a scoping review: identifying the research question; identifying relevant studies through a systematic search of the literature and consultation with organisations such as Women’s Health West, Anglicare, Berry Street and Queensland Family Planning; study selection; charting the data; and collating, summarising and reporting the results. The review will be informed by the research question: What are the promising policy and practice prevention responses to the problems of domestic family violence, harmful sexual behaviour and child sexual exploitation in residential care settings identified in the evidence base? This phase of the research will also involve applying to the Human Research Ethics Committee at the University of Melbourne in preparation to undertake Phase Three of research.

Phase Three – Carry out focus groups with residential care workers and young people This phase of the research will involve undertaking data collection using the Knowledge to Action Framework (Graham & Tetroe, 2009) in order to generate new knowledge about the prevention of sexually abusive behaviour and sexual exploitation in residential care settings, to synthesise it with existing knowledge and to translate that knowledge into prevention action (See Figure 2).

Figure 2: The Knowledge to Action Process (Graham & Tetroe, 2009)

The Knowledge to Action Process will be informed by the research questions:

7 1) What prevention initiatives could prevent domestic family violence, harmful sexual behaviour and sexual exploitation in care settings?

2) How could these prevention initiatives be implemented effectively in the MacKillop residential care settings and more broadly across Australia? Focus groups with residential care workers and young people who have left care and have been trained as peer-leaders will be conducted. The data will be analysed using a thematic analysis method set out by Braun and Clark (2006). It is likely that initiatives will include a whole-of-organisation response that is married with the Sanctuary Model1. Measures may include: universal sexuality and respectful relationships education for all children and young people in residential care; developmental and situational prevention strategies targeting children and young people who are at risk of displaying sexually harmful behaviour or sexually reactive behaviour leading to sexual exploitation; and therapeutic intervention for young people who have already displayed sexually harmful behaviour or sexually reactive behaviour leading to sexual exploitation. The prevention strategies will be structured around the public health model of prevention and the Sanctuary model of trauma-informed care.

Phase Four – Select, tailor and implement prevention initiatives Phase Four of the research will involve developing the prevention initiatives, including the resources required for each strategy, such as sexuality/respectful-relationships/porn-literacy curriculum sensitive to different ages and stages of development. It will also involve tailoring the initiatives to the MacKillop context to ensure that the training of workers and residential care environments support the delivery of the initiatives. The initiatives will be piloted at several residential care houses.

Phase Five – Evaluate and monitor the prevention initiatives Phase Five of the research will involve a process of evaluation, exploring questions like: 1) Are the prevention initiatives effective in promoting safe and respectful relationships in for children and young people living in care? 2) Do the strategies reduce the likelihood that children and young people will be exploited in residential care settings?

Overall outcome of project The outcome of this project will be an evidence-based prevention initiative supported by appropriate resources and implemented at key MacKillop residential care pilot sites.

1 The Sanctuary Model was developed in the United States by Sandra Bloom (see for example Bloom & Farragher, 2013). The Sanctuary Model is a blueprint for clinical and organisational change which promotes physical, emotional, psychological, social and cultural safety and recovery from adversity through the active creation of a trauma-informed community. MacKillop Family Services is an accredited Sanctuary Model organisation. 8 References Arksey, H., & O'Malley, L. (2005). Scoping studies: towards a methodological framework. International Journal of Social Research Methodology, 8(1), 19-32. doi: 10.1080/1364557032000119616 Bloom, S. & Farragher, B., (2013). Restoring Sanctuary: A New Operating System for Trauma- Informed Systems of Care, New York, Oxford. Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77-101. doi: 10.1191/1478088706qp063oa Carmody, M., Salter, M., & Presterudstuen, G. (2014) Less to lose and more to gain? Men and Boys Violence Prevention Research Project Final Report, University of Western Sydney, Australia. Commission for Children and Young People, (2015). “...as a good parent would...” Inquiry into the adequacy of the provision of residential care services to Victorian children and young people who have been subject to sexual abuse or sexual exploitation whilst residing in residential care, Melbourne: Commission for Children and Young People, 2015. Hackett, S., Holmes, D., & Branigan, P. (2016) Operational framework for children and young people displaying harmful sexual behaviours, London, NSPCC. Holt, S., Buckleyb, H., & Whelanal, S. (2008). "The impact of exposure to domestic violence on children and young people: A review of the literature." Child Abuse & Neglect, 32(8), 797-810.

9 Krahé, B., & Berger, A. Gendered pathways from child sexual abuse to sexual aggression victimization and perpetration in adolescence and young adulthood. Child Abuse & Neglect. doi: http://dx.doi.org/10.1016/j.chiabu.2016.10.004 Lang, L., & Humphreys, C. (2013). Social work & domestic violence: Developing critical and reflective practice. London: Sage. MacKillop Family Services. (2013). Submission to the Royal Commission into Institutional Responses to Child Sexual Abuse Issues Paper 4: Preventing sexual abuse of children in out-of-home care. Retrieved from https://www.mackillop.org.au/preventing-sexual-abuse-of-children-in-out- of-home-care McKibbin, G., Humphreys, C., & Hamilton, B. (2016) “I knew it was wrong but I couldn’t stop”: Young people identify three opportunities for preventing sexually abusive behaviour. Policy briefing paper. Melbourne Research Alliance to End Violence Against Women and their Children. Pratt, R., & Miller, R. (2012). Adolescents with sexually abusive behaviour and their families: Best interest case practice model and specialist practice resource. Melbourne, Victorian Government Department of Human Services. Royal Commission into Family Violence. (2016). Royal Commission into Family Violence: Summary and recommendations. Parliamentary Papers, 132. Melbourne: Victorian Government. Retrieved from http://www.rcfv.com.au/Report-Recommendations Royal Commission into Institutional Responses to Child Sexual Abuse (2016) Consultation Paper: institutional responses to child sexual abuse in out-of-home care, Commonwealth of Australia, Sydney. Straus, S. E., Tetroe, J. M., & Graham, I. D. (2011). Knowledge translation is the use of knowledge in health care decision making. Journal of Clinical Epidemiology, 64(1), 6-10. doi: http://dx.doi.org/10.1016/j.jclinepi.2009.08.016 Szanto, L., Lyons, J. S., & Kisiel, C. (2012). Childhood trauma experience and the expression of problematic sexual behavior in children and adolescents in state custody. Residential Treatment for Children & Youth, 29(3), 231-249. Tayton, S., Kaspiew, R., Moore, S. and Campo, M., (2014) Groups and communities at risk of domestic and family violence: A review and evaluation of domestic and family violence prevention and early intervention services focusing on at-risk groups and communities, Australian Institute of Family Studies, Melbourne. United Nations. (1989) Convention on the rights of the child. Retrieved from http://www.ohchr.org/en/professionalinterest/pages/crc.aspx

Victorian Governemnt. (2008). Family Violence Protection Act. Retrieved from http://www.legislation.vic.gov.au/Domino/Web_Notes/LDMS/PubStatbook.nsf/f932b66241 ecf1b7ca256e92000e23be/083D69EC540CD748CA2574CD0015E27C/$FILE/08-52a.pdf