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Children and Young People with Harmful Sexual Behaviours Simon Hackett RESEARCH REVIEW Children and young people with harmful sexual behaviours Simon Hackett www.rip.org.uk RESEARCH REVIEW Children and young people with harmful sexual behaviours Simon Hackett Research in Practice Children and young people with harmful sexual behaviours Quality Mark This review has been peer-reviewed by a range of academics, practitioners and staff working in this field who are committed to the development of evidence- informed practice. Research in Practice is extremely grateful to Stephen Barry, Jon Brown, Nick Hindley, Helen Masson, Kate Mulley, Bobbie Print, Rowena Rossiter, Connie Smith, Eileen Vizard and Mette Whittaker for their help and assistance. Author’s Acknowledgements I am grateful to the contributors who have provided the promising practice examples included as part of the review and to colleagues at Research in Practice for all their help during the process of preparing the review. With thanks to my family for keeping me going and, in particular, to Helen for her tireless support. Editor Steve Flood © Research in Practice 2014 Research in Practice A CIP catalogue record is The Granary Dartington Hall available from the British Library Totnes Devon TQ9 6EE tel 01803 867 692 ISBN 978-1-904984-49-8 email [email protected] Hackett S (2014) Children and young The full text of this review people with harmful sexual behaviours: is available on our website: Research Review. www.rip.org.uk Dartington: Research in Practice RESEARCH REVIEW Foreword Foreword This review deals with an issue that presents significant challenge to the sector, and yet has not received commensurate national attention or leadership. Official statistics highlight the scale of the problem of children and young people with sexually harmful behaviour. Children and young people account for approximately a quarter of all convictions against victims of all ages (Vizard, 2004) and a third of all sexual abuse coming to the attention of the professional system in the UK (Erooga and Masson, 2006). The need for a coordinated service response to engage with children and young people as perpetrators as well as victims is clearly illuminated. The stigma and shame surrounding this issue can inhibit how children, young people and families engage with services. Studies show frequently harmful sexual behaviours are one factor in a range of predisposing experiences and vulnerabilities facing these children and young people – such as domestic violence, neglect and poor mental health. Professional consciousness on this issue has steadily grown over the past twenty years. However, the picture across England remains patchy. Since the early 1990s in the UK, a range of specialist assessment and intervention services have developed piecemeal, whilst significant gaps in services remain. Knowledge and awareness amongst professionals also varies widely, with a lack of confidence evident across many disciplines. Pockets of excellent practice do exist – with a number detailed in this review, offering a solid base upon which to develop effective local practice. Currently, though, at a national level no overarching strategy or service delivery framework exists. However, positive movements are being made in this direction, led by key players within the voluntary sector. We are pleased to be providing a timely review of the research to inform these discussions. The findings of this review provide much needed evidence on what we know about effective interventions and the core elements of a good service response. This review highlights the need for holistic assessment approaches and tiered interventions that focus on broad-based behavioural and developmental goals. Services need to engage parents and carers to address the wider circumstances within which abuse develops. LSCBs have a key role in ensuring adequate local assessment and intervention services, and supporting the training and development of professionals. We hope this review will be of real value to those involved in commissioning and designing services; to colleagues working in social care, health, education and criminal justice; and those involved in professional training and development. We are confident that if the determination and commitment of the sector can be matched by clear national leadership, significant progress can be made in identifying and supporting children, young people and families affected by harmful sexual behaviour. Dez Holmes Director, Research in Practice 3 Research in Practice Children and young people with harmful sexual behaviours Contents 10 Chapter One Introduction: The problem of children and young people with harmful sexual behaviours 10 The focus of the review 12 How the review was developed 14 The structure of the review 15 Indicators of the scale of the problem 16 Terminology 18 Disentangling normal, problematic and harmful sexual behaviours in children and young people 23 Summary 24 Chapter Two Children with problematic sexual behaviours 25 Normal sexual behaviour in pre-adolescence 26 Problematic sexual behaviour 28 Causes of problematic sexual behaviour in children 30 Typologies of children with sexual behaviour problems 34 Families of children with problematic sexual behaviours 35 Summary points 4 RESEARCH REVIEW Contents 36 Chapter Three Young people with harmful sexual behaviours 36 Characteristics of young people 37 Gender 37 Age and onset 38 Ethnicity 38 Background and attachment histories 39 Abuse histories 42 The nature of young people’s harmful sexual behaviours 44 Categories and sub-types of young people with harmful sexual behaviours 48 Young women with harmful sexual behaviours 53 Young people with intellectual disabilities who present with harmful sexual behaviours 55 Young people who commit internet-related and technology-facilitated sexual offences 59 Young people who sexually abuse others in the context of groups and gangs 60 Families of young people with harmful sexual behaviours 61 Summary points 62 Chapter Four Assessment 62 Assessment of pre-adolescent children with problematic sexual behaviours 65 Assessment of young people with harmful sexual behaviours 68 Assessment frameworks and models 75 Summary points 5 Research in Practice Children and young people with harmful sexual behaviours 76 Chapter Five Interventions 76 Interventions for children who have experienced sexual abuse 78 Interventions for children with sexual behaviour problems 82 Interventions for young people with harmful sexual behaviours 82 Abuse specific approaches 83 Developmental and holistic approaches 84 Multisystemic Therapy 86 Rehabilitative approaches 86 Resilience and desistance models 92 The Good Lives Model (GLM) 95 Restorative justice 99 Family-support approaches 104 Safe care and working with young people in residential settings 109 Summary points 110 Chapter Six Policy, service delivery and inter-agency working 110 The current state of service delivery across the UK 113 Inter-agency policy and national guidance 114 Risk, recidivism and the need for early interventions 117 A tiered approach 117 Managing children and young people in the child protection and youth justice systems 117 Assessment and interventions 119 Summary points 6 RESEARCH REVIEW Contents 120 Chapter Seven Conclusions and recommendations 120 Key findings on children, young people and families 121 Key findings on interventions 122 Key findings on policy and commissioning 124 References 139 Index 145 Biographies 7 Research in Practice Children and young people with harmful sexual behaviours Index of tables and figures Figures 18 One: A continuum of children and young people’s sexual behaviours (Hackett, 2010) 66 Two: Offences committed by adults (n=4632) who had previously committed sexual offences as juveniles, England and Wales, April 2010 to March 2011 Tables 20 One: Brook Sexual Behaviours Traffic Light Tool 27 Two: Developmentally problematic sexual acts performed by 127 6 to 9-year-old children (Gray et al, 1999) 31 Three: Outline typology of sexually abused children with sexualised behaviour (Hall et al, 2002) 45 Four: Summary of offender and victim characteristics comparing adolescent ‘rapists’ with ‘adolescent child abusers’ (Beckett and Gerhold, 2003) 89 Five: Resilience-based versus deficit models (adapted from Hackett, 2006) 8 RESEARCH REVIEW Contents Index of promising practice examples 51 Sharron Wareham (Taith): Developing assessment tools and intervention resources for girls who display harmful sexual behaviour 57 Lisa Saint (Lucy Faithfull Foundation): The ‘Inform Young People’ Programme 73 Bobbie Print (G-map): Developing the AIM2 Initial Assessment Model 79 Stephen Barry and Mel Turpin (Be Safe): An evidence-based Cognitive Behavioural Therapy Psycho-Educational Programme for Children with Problematic Sexual Behaviours and their Parents/Carers 87 Peter Fonagy and Jessie Greisbach (University College London): Multisystemic Therapy for Problem Sexual Behaviour (MST-PSB) and the Services for Teens Engaging in Problem Sexual Behaviour (STEPS-B) Research Trial 93 Laura Wylie (G-map): Using the Good Lives Model with young people who display harmful sexual behaviours 97 Vincent Mercer (AIM): A restorative approach to young people with harmful sexual behaviours 101 John Harrison (NSPCC): Working with parents and carers of children and young people with harmful sexual behaviour 105 Karen Parish and Peter Clarke (Glebe House): Providing safe care in residential settings for young people with harmful sexual behaviours 107 Sarah Morris and Alice Hunt (Lucy Faithfull Foundation): Strengths-based assessment
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