Breaking the cycle of sexual offending

At the age of 14, Jude* was reported to social workers in London after displaying harmful sexual behaviour (HSB) towards a seven-year-old child known to his family.

This kick-started a children's services investigation into his chaotic home life, which was found to be typified by easy access to pornography and incidents of domestic violence.

It emerged he had also been the victim of sexual abuse at the age of 11 by another child.

The teenager's relationship with his mother was another concern. Although social workers found no evidence of her sexually abusing him, there were concerns their close, isolated relationship, with its blurred physical boundaries, was contributing to Jude's skewed sexual development.

He went on to be referred to the NSPCC's National Clinical Assessment and Treatment Service (NCATS), which assesses and treats children displaying HSB.

After assessing Jude, the NCATS team recommended he and his mother attend family therapy and that Jude attend one-to-one therapeutic sessions to help him understand and control his behaviour, as well as learn about appropriate, healthy relationships. Local children's services are working with the family to ensure that takes place.

Launched in 1992, NCATS is one of only a small number of HSB specialist assessment and treatment schemes in the UK. While the support it offers is paid for by referring authorities, such as children's services or youth offending teams, other services are provided free by charities, while some councils have set up their own in-house schemes (see boxes).

But according to a Research in Practice report last year, this specialist response is lacking in many areas. The report - Children and Young People with Harmful Sexual Behaviours - highlighted a lack of confidence among children's services at senior and frontline levels in tackling HSB.

To help address this, a coalition involving organisations working with children - including the NSPCC, Barnardo's, sexual health charity Brook, the Local Government Association and Youth Justice Board - has launched a "national operational framework".

This guidance document aims to highlight good work already taking place, set out the latest research about HSB, and encourage children's services to develop a better and more consistent way of tackling HSB among children.

Aimed at local safeguarding children boards and senior children’s services managers, it will be made available in 2016. An online version will also be available UK-wide, with amendments made based on evaluation from eight councils, including Cornwall and Surrey.

Among the myths the framework aims to smash is the notion that children with HSB are "mini-paedophiles", who will sexually offend into adulthood.

Interventions and support

Instead, latest research highlighted in the report found that "most children and young people who demonstrate HSB will not go on to be adult offenders, particularly with the right preventative interventions and support".

When NCATS launched, it was in response to working with adult sex offenders whose HSB had started in childhood, explains team manager Susan Haacke.

"But over the years, and as we began seeing more young people and more research was published, everybody was surprised that they are actually a different population than adult sex offenders," she adds.

Brook's child sexual exploitation lead Georgia Johnston says getting this message across is particularly important as too often therapy programmes designed for adult sex offenders are being used inappropriately for children with HSB.

Addressing misconceptions around children with HSB is also key because of the stigma attached to such behaviour, says Johnston.

"It can be very damaging to put the wrong label on young people," she says. "HSB is often linked to other issues in their life such as attachment problems, which are relatively easy to remedy. We have to see them as young people first. Where people go wrong is to look to address the behaviour, not the issues behind it."

Stigma associated with HSB among children compounds families' reluctance to report incidents. Instead, "their attitude may be to deal with it themselves", says Haacke.

Another factor is a lack of understanding among families and professionals of what type of sexual behaviour is harmful.

Brook's Sexual Behaviours Traffic Light Tool is among useful resources flagged up in the framework to help families and professionals better understand HSB.

There is much confusion, says Johnston, who cites the example of a primary school teacher who recently called her for advice.

"She was panicking because a fiveor six-year-old girl in her class knew the word vagina," she says. "But for me, it's good a child knows the correct word for that part of the body."

Among other "green behaviours" considered to be part of healthy and safe sexual development is enjoying nakedness and being curious about genitals and the differences between boys and girls.

So-called "amber behaviours" are those with the potential to be a concern, as they are unusual for a particular child or age group, or are occurring with greater frequency. These include pulling down children's pants against their will, using adult slang when talking about sex and a preoccupation with adult sexual behaviour. Brook advises professionals to monitor such behaviour and speak to their safeguarding lead when such incidents occur.

Tackling serious behaviours

For "red behaviours", children's professionals are urged to take immediate action and refer on to specialist services, such as the police or children's social services. Such behaviour includes persistently touching the genitals of other children, simulating sexual activity in play and forcing other children to engage in sexual acts.

The National Crime Agency's Child Exploitation and Online Protection Centre (Ceop) was also involved in developing the framework. Dr Elly Hanson, a clinical psychologist and consultant at Ceop, says an important part of the guidance highlights the need to tackle HSB within peer groups, including gangs.

"Often, people see HSB as an individual young person issue, and often it is," she says. "But there are trends indicating there is a lot of HSB that is peer group-based and therefore the intervention needs to be with the peer group.

"In some gangs, a sexual assault is part of a gang code. But gangs is just one example. In schools, there are also very hostile sub-cultures emerging in which HSB is part of daily life."

Ceop child protection adviser Eva Bari says group-led HSB is also happening online, with group members competing with each other to blackmail young victims to send graphic images of themselves. "They are telling their victims 'I have a picture of you and you need to send more or I'll post it on Facebook'," says Bari.

Access to free, online pornography is also fuelling HSB among individuals and groups, adds Hanson. She would like to see compulsory sex and relationship education in schools "that gives us the footing to start discussing issues around HSB".

Youth work also needs to play a greater role, she believes, particularly when it comes to tackling HSB in groups, but concedes funding cuts to youth services has hindered such efforts.

Such preventative action is backed by Stuart Allardyce, deputy children's manager at Barnardo's Skylight/Lighthouse programme, which works with children with HSB in Edinburgh and West Lothian. He says early intervention is crucial to reducing the number of victims and the risk of HSB escalating.

"Support usually takes place after serious incidents have happened, but should be happening before," he concludes.

*Name changed

Harmful sexual behaviour key statistics

• A third of all sexual offences against children in the UK are committed by other children and young people
• Half of all sexual offences perpetrated by teenagers involve a sibling, but just 19.5% of sibling abuse victims report abuse at the time
• 84% of sixto 12-year-olds displaying HSB have long histories of sexual abuse
• 19% of HSB incidents involving sixto 12-year-olds happen in school
  
  

CORNWALL TREATMENT BASED ON ATTACHMENT

A need to provide cheaper, more effective and local support to children displaying HSB was the key reason Cornwall County Council set up its own specialist service called Gweres Kernow in 2002.

"We were spending a huge amount of money sending young people out of county to specialist residential units," explains Denise Jackson, the service's senior social worker. "There was also a human cost to the young people being separated from their community and family."

Gweres Kernow has a strong focus on local care, with children remaining with their family and within their school where possible. This helps strengthen healthy relationships in their lives and avoids isolating those with HSB from their local community, says Jackson.

The service's bespoke treatment programmes are all based around an attachment model and usually involve one-to-one weekly sessions. "These look at their life story and quality of the attachments they have with their primary carer," says Jackson "We are always looking for strengths."

The programmes last around six months, but can span years for more complex cases.

Another focus of the service, which treats about 100 young people of all ages a year, is to ensure they and those close to them are safe.

"We start with managing risk and making sure there's a safety plan," says Jackson. "Over the years, we have had young people on the receiving end of hate campaigns, so we have to make sure they are safe and in turn they are not able to harm any more victims."

Since the service was launched, there have been no reconvictions for sexual offences among those referred through the justice system. Of the small number of re-referrals, most are children and young people with learning disabilities or on the autistic spectrum.

While Cornwall is a relatively remote county, Jackson says the service is keen to forge links with other HSB specialists across the UK. This is a key reason why it signed up to be one of eight councils that will be evaluating the use of the national operational framework.

SURREY SERVICE CATERS FOR WIDE RANGE OF AGES

Run by Surrey County Council since 1995, the Assessment Consultation Therapy (ACT) service was among the UK's first specialist services to assess and treat children who display HSB.

"It was very innovative back in the day," says manager Amanda Carpenter. "There was an acknowledgement across youth justice, social care and the police in Surrey that there was an increasing number of young people coming through the youth justice system facing serious charges for sexual assault. We wanted to join forces and see what we could do differently with this group and prevent them going down the custodial route."

Since then, the range of young people and children the service supports has broadened, with 354 enquiries last year related to children as young as three, as well as calls related to older adolescents charged with serious offences.

For those who are referred, the team decides whether they should go on to be assessed and receive ACT's range of therapeutic treatments. These include drama, art and play therapy as well as talking therapies, with the team having a caseload of between 80 to 100 children at any one time.

From 2006 to 2012, the service saw the average age of children it supported drop from 14 to 11, with the proportion of girls being referred increasing over that time.

A greater recognition among children's professionals of HSB and the need to seek specialist support has been a factor in the service seeing a broader range of children, says Carpenter. However, she recognises many are still "uncomfortable" dealing with this sensitive subject.

"The message we want to get out there is if you have a concern, pick up the phone," she says. "The saddest thing is when we get a child who has committed a serious sexual offence and you look back at their chronology and realise there could have been opportunities to intervene earlier."

UK-WIDE HSB THERAPY TACKLES ANGER MANAGEMENT

The NSPCC's Turn the Page scheme was developed five years ago to offer a free service to support youth offending and children's services to treat young people with HSB.

For most of those referred, the Change for Good programme is used. This was developed by the charity and Eamon McCrory, a professor of developmental neuroscience and psychopathology at University College London, and involves between 26 and 30 therapy sessions. These are social worker-led and contain four modules, called engagement, relationships, self-regulation and roadmap to the future.

Tess King, children's services practitioner with the service, says the four modules are designed to build up a child's understanding of their behaviour and develop the skills to manage their emotions, especially anger.

"A strong theme among those with HSB is their struggle to manage anger," she says. "HSB is often primarily not motivated by sexual feelings, but other strong feelings such as anger, isolation and distress."

The treatment is tailored to each child, with a greater use of play therapy for younger children and those with learning disabilities. In some cases, there is also a stronger involvement of the child's family or carer.

The bulk of those seen are teenagers, although Turn The Page also supports children as young as seven. During 2014/15, its 13 Turn the Page treatment centres, located across England, Wales and Northern Ireland, took 413 referrals, with 340 accepted. Many of those who were not accepted were referred on to other services.

Turn the Page is currently undergoing an extensive evaluation, tracking the progress of those who have been supported. The results are expected to be published in 2016.

Among those supported by Turn the Page is Adam*, who was 16 when he was referred by his local youth offending service after he had sexually assaulted another young person. It helped him deal with his reliance on alcohol and the effect of family bereavements and a chaotic home life on his behaviour. This included helping him rebuild long-term friendships and working with his parents to offer more support.

"Adam has really grown up and matured," says the NSPCC. "He can understand the impact his actions had on the victim. He has successfully completed the programme and seems really settled. He is now in full-time employment, engaging in social activities such as sports and generally doing well."

*Name changed