Young People with Learning Difficulties who are involved

Young People with Learning Difficulties who are involved

Young People with Learning Difficulties who are involved in harmful sexual behaviour Prof. Bill Lindsay Danshell Health Univ West of Scotland, Paisley, Bangor Univ. Deakin Univ. [email protected] Jennifer van der Zwet Social Work Department Falkirk Council CYCJ National

Youth Justice Conference, Dundee Young People with Learning Difficulties who are involved in harmful sexual behaviour Prof. Bill Lindsay Danshell Health Univ West of Scotland, Paisley, Bangor Univ. Deakin Univ. Jennifer van der Zwet Social Work Department Falkirk Council

Why Address harmful sexual behaviour HSB Because there are Victims Progression from adolescent to adult offenses described in retrospective studies (Burton 2000; Zolondek et al, 2001). one half of adult sex offenders report a childhood or adolescent onset for sexual behaviours cause for long-term concern, Children with HSB may pose potentially long term risk to children in the community. Over reaction? Proposals for tracking systems, segregation, intense treatments Some states in U.S. -lifetime sex offender registration from 9 years Harmful sexual behaviour HSB Peak ages for sex crimes is late adolescence and early adulthood

Lakey 1994.- rising incidence of sexual crimes Children against Children. Davis & Leitenberg 1987 20% of rapes and 50% of sexual assaults committed by teenagers Theriot 2006 Teenagers have 20.5% of all sex offence arrests Approx 50% of all sexual abuse on children Probable underestimate offences unreported; excused; seen as normal sexual curiosity; diagnosed emotional adjustment reaction Programmes tend to be adult oriented addressing sexual deviancy, poor empathy, victim grooming, cycles of offending. Assessment and Treatment Alcohol awareness (Lindsay, Smith and Allan 1994,5) Sex offender treatment ( Lindsay and Smith 1998,9 Lindsay 2009) Anger management ( Lindsay et al 2003,4)

Anxiety and depression (Smith and Lindsay 1997. 2007) Mental illness ( Haut and Brewster 2009) Social problem solving (Lindsay et al 2009) Drug awareness (Allan, Smith and Lindsay 2004) Periodic clinical effectiveness reviews (Lindsay, Smith et al 2002,04,06,09) The reviews have led the interventions on assessment and treatment eg. Anger management treatment. Percent of each cohort reoffending (any reported incident) up to 20 year follow up. Lindsay, Haut et al (2013), CBMH Other off. N=126 50 45 40

35 30 Sex offenders N=156 Females N=27 25 20 15 10 5 0 Reoffending

Harm Reduction (Lindsay, Haut, Steptoe and Brewster 2013): Reduction in number of incidents (total cohort) 1400 1200 1000 * 800 600 2 YEARS BEFORE UP TO 20 YRS AFTER

* 400 200 0 SEX OFF OTHER OFF WOMEN Characteristics of adolescents who show HSB Kavoussi et al (1998); Fehrenbach (1996); Theriot 2006 Socially isolated; lack sexual knowledge; disturbed family relationships.

Unusually high incidence of sexual and physical abuse. Multiple abuse victims Studies inconsistent on substance use 3% - 47% Recidivism studies 3-12% sexual.. 50-70% non sexual Kempton & Forehand 1998 adolescent Sex offenders V violent offenders - fewer externalising and internalising problems. Counterfeit deviance (Hingsburger, Griffiths & Quinsey 1990) DEVELOPED FOR INTELLECTUAL AND DEVELOPMENTAL DISABILITIES PARTICULAR RELEVENCE FOR ADOLESCENTS Developmental Educational Social Medical

These authors are not apologists Counterfeit Deviance Counterfeit deviance (Hingsburger, Griffiths & Quinsey 1990) HSB by teenagers with IDD for a range of reasons. Some HSB is due to sexual deviance and sexual drive these authors do not deny deviance and drive Poor and inadequate developmental experiences. Poor sexual knowledge Inadequate knowledge of appropriate & inappropriate behaviour Limited developmental opportunities to learn social and sexual interaction Counterfeit Deviance Theriot 2006. Adolescents - Assessment and treatment Issues in Harmful sexual behaviour (HSB)

Cognitive ability Sexual Knowledge Abuse in childhood Mental health issues & impulse control Sexual deviance Social background and family attachment issues Emotional stability

Cognitions consistent with HSB Inappropriate Sexual Behaviour SSKAAT (Griffiths & Lunsky 2002). SEXKEN (McCabe, Cummins & Deeks. RIDD, 1999, 24154). ASK (Galea, Butler, Lambrick et al.. JIDD, 2004, 350-65). Puberty, parts of the body, sexual health, contraception, having sex, relationships, use of alcohol, safety, pregnancy and childbirth, masturbation, legal issues. Counterfeit Deviance Counterfeit Deviance - Sexual Knowledge. IDD v non IDD. (Lindsay et al 1994) IDD NON IDD

45 40 35 30 25 20 15 10 5 0 anat/y BC bound/s

STDs Pub/ty Int/crs Abuse in childhood in Offenders with ID. (Lindsay, Steptoe and Haut 2011. J.Int.Dis.Res.) * 60 50 40 Male Sex Off

* Other Male Off. * 30 Females 20 10 0 CSA NAI

Impulse control in Offenders with ID. (Parry & Lindsay 2003 J.Int.Dis.Res.) 50 45 40 35 Sex Off * Other Off. 30 Non

Offenders ID 25 20 15 10 5 0 Barratt Impulse control in Offenders with ID. (Snoyman & Aicken 2011 Psychol. Crime & Law.) 86 84 82 Sexual

80 Driving 78 76 * Property Violent 74 72 70 68

66 Barratt Cognitive Distortion Faulty Thinking Mechanisms (Ward et al., 1997. Clinical Psychology Review) Denial of an offence Denial of intent Mitigation of responsibility through victim action- victim shares the blame, victim encouragement Mitigation of responsibility through life events life stress, lack of sexual outlets, work stress Minimisation of incident/consequences little harm, victim enjoyed experience,learning experience for victim Denial of normal state alcohol, mental illness Lindsay, Whitefield & Carson (2006), Legal & Criminological Psychology

6 5 4 SO/ID ))/ID NO/ID Mainsream 3 2 1 0 Rape

Voyeur Exhib. Children Assessment and treatment Issues in Harmful sexual behaviour (HSB)

Cognitive ability Sexual Knowledge Abuse in childhood Mental health issues & impulse control Sexual deviance Social background and family attachment issues Emotional stability Cognitions consistent with ISB CBT Treatment Methods in Harmful sexual behaviour (HSB)

Sexual Knowledge Ownership Motivation Denial & attitudes (cognitive distortions) Self regulation & impulse control Pathways and cycles of offence Skills teaching role play, social problem solving Individual issues Ownership Group rules April 2016

Treatment studies Early work was case studies Lambrick and Glaser (2002) Rose et al (2002) OConner (1996) Lindsay et al (1998) Cognitive distortions over 48 months QACSO. N=27 adolescents. age X-17.4 months 45

Reoffending = 2 cases, 7%, 15 incidents Ind Ex. all in 1st year 40 35 30 25 20 15 10 5 0 BL BL 3

6 9 12/ 18 24 30 36/ /48 Carpentier et al 2006 N= 135 teenagers with HSB N= 156 comparison teenagers with non sexual behaviour probs.

CBT 64 Play therapy = 71 CAUTION 62% m; (sexual abuse, sodomy, rape, indecent exposure, lewd molestation) 38% f (lewd molestation) Carpentier et al 2006 12 year follow up. Non sexual arrests 12 times more likely during the follow up. Carpentier et al (2006) survival curve. 12 Yr. 100 CBT Play therapy

Lindsay et al 2013 Case studies George Sexual offences against both sisters as a teenager Mum died when he was 18 Mum never disclosed. Sisters took him to GP Nick Dozens of Ind Ex and Pub. Mast. as teenager He has a brother & sister

Mum never reported but life of hell watching him. At 17 years police involved Sex offender register @ 18 I can deal with the offender issues but the families are crucial I do not deal with victims or families Adolescent Sexual Offending within the family: Taking a wider perspective Jennifer van der Zwet Falkirk Council Children and Families Social Worker Considering wider familial needs

Considering issues and needs of offender in isolation is only part of the picture Social Work must take a wider, more comprehensive view Need to consider the offender within the family context Sibling Sexual Abuse Case examples highlighted the issue of children on children sexual abuse Sibling sexual abuse illustrates the intensity of family issues most clearly Most prevalent form of familial abuse 3-5 times more common than father/daughter, step father/step daughter abuse. Complex issue highlighting dilemmas for the family and the professionals working alongside

them. Family Characteristics domestic violence physical, verbal, emotional abuse lack of nurturance Lack of supervision and boundaries, high levels of personal, social, economic stress,

substance abuse Up to 3 breakdowns in early attachments young carer responsibilities. Difficulties of Disclosure Reluctance to disclose. Feel responsible for the breakdown of family.

fear of being blamed. Under-reported. Perceived as normal childhood exploration. Fear the SW or Police response . Concern for reputation. Private family matter. Reluctance to report a son. Immediate response : Ensuring Safety/Child Protection Disclosure triggers Child Protection joint investigative interview - a right to protection from harm, abuse and exploitation. Practical steps to separate offender/victim (family fragmentation). Child Protection and legal framework Prioritise safety/ catalyst for change.

If no disclosure, services may be helpless to intervene. Offender recovery Good quality connection with parent who emotionally comfort and confront behaviour is critical Taking accountability short term, low burden, educational CBT DIFFICULTIES Confronting and supporting is a hard balance for parents Recovery compromised if offender is removed from family home Feelings of rejection /resentment.

Shame causes disconnection from family Removal causes shame Victim Recovery there is always a victim Sibling Sexual Abuse is most long lasting and damaging form of familial violence. Validation of their experiences Parental Empathy and Nurturance Parents to ensure their safety and confront sibling Challenges to recovery Parents unsure of how to support daughters emotionally

Victims feel their experiences are minimised Victims try to protect their parents from truth which creates distance. Victims feel responsible for family breakdown /pressurised into family reunification If parents support offender, this distances victim The parental role Recovery highly dependent on a family context of support and connectedness Victims wish parents to take control of justice, rather than legal forums Manage grief and shame, support both children.

Difficulties Family memories reassessed which can overwhelm /destroy families Parents struggle with shock/ blame,/shame Cannot maintain dual focus needs of victim and offender Torn loyalities Shame inhibits family from seeking help-isolation Dealing with family resistance Million dollar question Resentful of Social Work intervention which changes family SW seen as overbearing and dictatorial. Parental fluctuation between denial,

minimisation, acknowledgement and condemnation Resistance in acknowledging abuse triggers child protection concerns and focuses intervention on statutory elimination of risk More focus needed on parent and family resources Plenty of robust resources for offender Lack of specialist services/resources to offer family to aid acknowledgement and recovery Research suggests importance of systemic work with parents, between parents and victim, parents and offender Without this work, recovery is partial and stagnates at eliminating risk

Treatment of criminal issues, ISB, anger, fire interest Individual treatment motivation 1986 - 2008 Offender social skills and offencetreatment. related thinking. Psychiatric review and management

Community integration, family social contact.. Work and occupation.

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