Harmful sexual behaviour by children and young people: Expert Group report

Annex G: Some Prevention and Response Programmes

Primary Prevention

The National Sexual Violence Prevention Programme

The programme was developed by Rape Crisis in 2012 following extensive consultation of relevant literature and consultation with partner agencies, and is regularly updated including through consultation with young people. The external evaluation in 2015 indicated it was highly successful in improving young people's knowledge and attitudes in relation to sexual violence. It is funded by the Scottish Government through the Children, Young People and Families Early Intervention Fund and the Violence Against Women and Girls Fund, and is expected to reach 23,000 young people each year by 2020, supporting them to develop equal, mutual and consensual relationships by:

• exploring the influence of gendered norms, attitudes and behavioural expectations, including the role of pornography and sexualised media in shaping these;
• learning about the wide-ranging impacts of sexual violence including trauma, developing empathy and replacing myths and victim-blaming narratives with accurate information;
• understanding what the law says about forms of sexual violence, consent and issues relating to sexual images;
• building young people's capacity and skills for consensual and mutual sexual relationships and for positive social change: how do we communicate consent; how do we recognise where we have greater power and make sure the other person doesn't feel under pressure; how do we (safely) challenge problematic attitudes and behaviours; how to we respond to people who disclose abuse?; and
• using a range of scenarios and examples which demonstrate different forms of violence, reflect compound power dynamics and include diverse groups of young people.

The programme also supports young people to take their own action to tackle sexual violence, for example through delivering training to teachers, speaking at events, blogging and posting.

Some feedback from the Borders Area where nine secondary schools had invited Rape Crisis to deliver:

'Lessons and presentation were excellent. Pitched at a good level, engaging and explained everything very clearly - to the extent even children with learning difficulties and English as a second language had no problems accessing the sessions.' Teacher, Peebles, 2017

'I think they are really good because I feel a lot of young people now (particularly teenage boys) have a distorted idea of what is okay and what is harassment/ sexual violence' Female 15 yrs

'The lessons were extremely informative. Thank you!' Male 14 yrs

'That consenting to one thing doesn't mean you consent to everything' Female 14 yrs

'That persuasion is not consent' Female 14 yrs

'The sessions were good and taught me a lot about Consent and Sexual Violence' Male 15yrs

'That giving consent matters a lot' Male 15yrs

'That sexual harassment is actually a really big thing' Female 14yrs

'What sexual violence is and what stereotypes are and how it can affect people's lives' Male 14yrs

Diagram showing topic areas included in the programme

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Gender
Consent
What is sexual violence
Sexualisation and pornography
Impacts and support
Social media
How can we help prevent sexual violence

Equally Safe at School

This is a pilot 'whole school approach' to gender based violence prevention developed by Rape Crisis Scotland in partnership with Zero Tolerance. It encompasses a range of measures addressing policy, curriculum, staff practice and school ethos with participation by students and staff to improve prevention of and response to gender based violence across the whole institution. In brief, prevention entails promoting gender equality and educating on violence before it happens; response entails effective and consistent interventions into behaviours across the continuum. The Theory of Change model show below has been developed by evaluation partners the Social and Public Health Sciences Unit, University of Glasgow, with input from Rape Crisis Scotland and Zero Tolerance:

Figure: Equally Safe at School Theory of Change 2018-2019 pilot, University of Glasgow with Rape Crisis Scotland and Zero Tolerance

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Top line

Problem
Intervention
Mechanisms of change & Intermediate outcomes
Outcomes

Column 1

Sexual, physical or psychological violence experienced by students and staff as a result of gender-based power inequalities and discrimination.
Includes gender inequality and discrimination, gender based bullying, and sexual harassment.

Drivers

• Harmful norms, roles, stereotypes, inequalities based on gender in wider society and played out in school environment.
• Inconsistent and/or discriminatory application of rules and policies.

Column 2

Whole-school assessment

• Qualitative review with subset of staff and student body.

Action Group

• Student and staff membership.
• Develop and implement action plan based on whole-school assessment.

Staff training

• Basic for all staff; enhanced for core staff group.

Curriculum enhancement

• Lesson plans and resources.
• Support to subject departments to promote gender equality.

Policy review and development

• Review and refine key school policies and behaviour codes.

Student led projects

• Activities in response to identified need e.g. assembly presentations, campaigns, student led training for teachers.

Column 3

• Enhanced commitment and belonging.
• Stronger social support structures.

Contingencies

• Intervention coherent to schools
• Teach/student ‘buy-in’ to intervention and willingness to put in effort
• Fits with goals and activities of school
• Effects are clear to schools

Column 4

• School culture and climate supports norms of respect, equity and tolerance.
• School rules/policies are gender equitable, fair, clearly understood and visible.
• Incidents of violence, bullying, harassment dealt with effectively.
• Increase in awareness and understanding of inequality and GBV issues.
• Decrease in adherence to harmful norms and stereotypes.
• Increase in responsibility, respect and gender equity in relationships.

Column 5

Primary outcomes

Decrease in student:

• sexual harassment, coercion and violence;
• psychological distress

Secondary outcomes

• Increase in self-esteem among students.
• Decrease in student emotional and physical abuse in intimate relationships.
• Increase in teacher confidence in dealing with sexual harassment, coercion and violence.

Bottom line

Inputs: Rape Crisis coordinator: facilitates whole school-assessment, early support to Action Group and student led projects, runs staff training, facilitates curriculum and policy review. Strong links to community based organisations; support from parents/carers. Budget: Small budget (£300 per school) to action group to run an activity/initiative.

In its first year, the pilot ran in two secondary schools, where RCS and ZT worked closely with management, staff and students to develop activities and tools and find the best ways of integrating them into the schools' ethos, culture, curriculum and policy framework. Facilitated by the coordinator and with support from ZT, staff and students took part in an assessment, formed an action group and began delivery of a plan, took part in training, enhanced gender equality across the curriculum and developed their policy framework. Through these activities young people took the lead in making support more accessible, developing videos and posters on sexual harassment and supporting staff to develop their understanding of social media and peer group issues. Each school has a sustainability plan to help continue to roll out the programme and continue to develop the work already underway. The project has now moved into two new schools and will move into a further four schools in its final year.

The following diagram is a further illustration provided by Rape Crisis Scotland around the gendered drivers of violence against women and girls drawn from an Australian primary prevention framework.

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Title:

What drive and reinforces violence against women?

Top line:

The triangle represents the gendered drivers of violence against women
Factors outside the triangle can reinforce the gendered drivers to increase the probability, frequency or severity of violence against women

LHS:

And support the normalisation, justification and tolerance of violence against women
Underpin and produce these specific drivers of violence against women
The structures, norms and practices of gender inequality, in the context of other social inequalities

Triangle:

Condoning of violence against women
Rigid gender roles and stereotyped constructions of masculinity and femininity
Men’s control of decision-making and limits to women’s independence in public life and relationships
Male peer relations that emphasise aggression and disrespect towards women
Gender inequality in public and private life
…and in the context of other forms of social inequality

RHS

Condoning of violence in general

• Normalised or valorised as an expression of masculinity
• Condoned or excused for men in certain circumstances

Experience of and exposure to violence against women

• Witnessing violence against women
• Child abuse
• Racist violence, lateral and community violence, conflict/war

Weakening of pro-social behaviour (e.g. harmful use of alcohol)

Backlash factors (increases in violence when male dominance, power or status is challenged)

Socio-economic inequality and discrimination

Bottom

Source: Change the story: A shared framework for the primary prevention of violence against women and their children in Australia, Our Watch, ANROWS and VicHealth (2015).
https://www.ourwatch.org.au/getmedia/0aa0109b-6b03-43f2-85fe-a9f5ec92ae4e/Change-the-story-framework-prevent-violence-women-children-AA-new.pdf.aspx

The Inform Young People Programme

The Lucy Faithfull Foundation developed the 'Inform Young People' Programme for young people who have used the internet or new media in a way that may be harmful to themselves or others. It is an educative programme for 16 to 21-year-olds in contact with the police or other professionals following inappropriate use of technology, such as sending intimate images of themselves or the possession or distribution of indecent images of children, as well as other risky online behaviours.

It aims to provide information, advice and support to young people and their parents, to help them devise strategies to prevent reoccurrence of concerning behaviours, and to promote safe and responsible use of technology.

The Stop it Now! helpline provides a gateway for referrals and for delivery of the service.

The programme comprises an average of one assessment and five intervention sessions per family, and includes:

• Internet safety - what are the risks for young people and how can we help them to stay safe in the future?
• Why might young people get into trouble with new media and how can we prevent this from happening?
• Why might young people access sexual material online and what are the risks of this behaviour?
• The law - if the police have been in contact, provide information about 'what will happen now'.
• Practical advice for young people and their parents on staying safe when using new media.
• Helping young people and their parents to start communicating about the use of new media and keeping safe, as well as increasing their ability to discuss sex and relationships together.
• Helping young people to explore areas such as healthy relationships, consent and sexuality.

This programme, and its roll out in Glasgow by Stop It Now! Scotland, is being evaluated by the CYCJ with the evaluation due to be completed in 2020.

Secondary and Tertiary Prevention

HALT

The Halt Service was established in 1994 by Glasgow City Council Social Work Services to work with children and young people between the ages of 5-18 who engage in a range of harmful sexual behaviour. HALT provides a range of services in relation to risk management, assessment and intervention.

Information and examples from HALT on working with younger children involved in HSB are provided below.

This diagram sets out examples of the range of approaches to preventative interventions HALT uses with children and young people:

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Level One

• Support, case management and coordination in frontline settings supported by specialised services as needed
• If required child protection processes would facilitate multi agency decision making

Level Two

• Community-based teams, including CAMHS and the voluntary sector, who can assess and offer interventions to children and young people (and their parents, carers and families
• If required child protection processes or Care and Risk Management Protocols would facilitate multi agency decision making

Level Three

• Specialist services that provide case consultation, teaching and training programmes to facilitate local services and to provide direct interventions in complex cases where young people present with complex needs and risk profiles, including serious mental health concerns and learning difficulties/disabilities
• Child protection processes or Care and Risk Management Protocols would facilitate multi agency decision making

Level Four

• Therapeutic residential facilities for children and young people displaying HSB based around the UK to allow for intensive, supervised treatment of children whose needs cannot be met safely in the community
• Child protection processes or Care and Risk Management Protocols would facilitate multi agency decision making

Adapted from: NSPCC Operational framework for children and young people displaying harmful sexual behaviours Hackett et al (2016)

Case Example

Level Two Response

Tom is 10 years old. Tom disclosed engaging in a range of sexual behaviour, unknown to adults, with other children. The behaviours came to light when Tom disclosed having sexual thoughts and was accessing sexual material on his iPad. Following the disclosure the family moved home and school. Tom has no further contact with the other children involved. Following the initial investigation there was significant period of drift. More recently CAMHS have become involved in response to Tom exhibiting symptoms of anxiety. There have been no sexual concerns for over a year. School report Tom has settled well in school although does struggle with peer relationships and can become isolated.

Harmful Sexual Behaviour Intervention:

• Input with mum on how sexual behaviours can emerge for children.
• Create a narrative with mum to have to use with Tom when the opportunity arises.

• The potential for CAMHS to incorporate some body integrity work given Tom will developmentally be approaching pre pubertal stage and the impact on a sensory level of premature sexualisation.
• Education having a focus on consent within the wider classroom teaching context and consider how this can be developed further with Tom within school and home.
• Liaison between school and mum to share sexual health and relationships material that will be covered in class. This will allow opportunities for Tom and mum to talk about any areas of confusion. CAMHS will provide additional support if required.
• Social worker will undertake individual work with Tom in school on friendship skills. School will support this and promote opportunities within school for reflective learning.

Case Example

Level Three Response

Cal is 10 years old. He stayed with his mum and her partner until he was 5 years old. Within this time he experienced physical, sexual and emotional abuse and neglect by mother and father. There were a number of adults potentially involved in the sexual abuse. Cal had a number of foster placements break down before joining his current placement. He had resided with his carers for six months prior to his referral to a specialist service.

There were two separate incidents of sexual behaviour. Both happened with peers and involved penetrative sexual behaviour. On both occasions the behaviour occurred within a sexual exploratory dynamic between the children e.g. curiosity about bodies. Whilst this dynamic is developmentally appropriate, Cal's experiences are significantly different to the other children and therefore the play / conversation will potentially have different meanings for him. Cal had also been accessing sexual content on his iPad. More recently other children have been complaining Cal is trying to get them to engage in sexual behaviours.

Intervention Phase 1:

Intervention goal	Specific areas	How to meet goals	Responsible Person/s
Being Healthy/ Being Safe Increase ability to discuss behaviours Risk Management	Messages for Cal to help him understand his sexual behaviour Create initial safety plan	Share hypothesis re sexual behaviour pathway Introduce aspects of turtle time	Halt worker Halt worker
Being Healthy/Being Safe Increase understanding of natural and healthy sexuality	Healthy sexuality and relationships	School sexual health and relationships input 1-1 follow up discussion	Class teacher
Confidence in who I am/Being Safe Understanding and integrating significant past adversities	Stage 1: Affect regulation body integrity, Identifying and labelling emotions. Stage 2: Narrative work	1-1 Sessions: Coaching; Reflecting; containing Lifestory work	Ed psych Key school staff Carer Project staff To be decided
Being able to communicate/ Being Safe Increase ability to meet needs in a healthy and fulfilling way	Build a sense of security in current placement Opportunities to experience self-efficacy and self-responsibility	Through routines, structure, boundaries, support, promote a positive view of himself, consistency and modelling Appropriate roles in school e.g. dinner hall duty etc	Carers Linkworker School
Enjoying family and friends Increase connectedness to positive others	Build up the positive support network around Cal and support his relationships with positive others Explore potential for re-establishing relationship with sisters	Support to maintain after school groups and community groups Build on peer relationships Process to be agreed. To include all three children	Carers Teacher Social worker Halt worker
Learning and achieving Develop goals and aspirations and internal resources to achieve	Creating opportunities to achieve such as football team, school work etc Link in with community group for drama	Build on current approach in school Attend drama group	School Carer

Safer Lives (Intervention and Planning using the Good Lives Model)

Modular intervention programme developed by G-Map in Manchester for adolescents who display harmful sexual behaviour. It is a programme written in manual form, for individual work with children and young people under the age of 18 involved with harmful sexual behaviour or sexual offending behaviour based on the strengths-based Good Lives Model. It has been rolled out to youth justice teams and other practitioners in Scotland from 2008 onwards by a group of trainers accredited by G-Map.

CYCJ evaluated the Safer Lives model in 2015 (http://www.cycj.org.uk/wp-content/uploads/2015/05/The-use-of-safer-lives-in-Scotland-report.pdf) and found that practitioners were positive about the model but there was insufficient data to comment on its impact on outcomes and recidivism. This is currently being reviewed by CYCJ.

The AIM Project (Assessment, Intervention, Moving On)

The AIM Project designs programmes that develop and support the understanding and practice of professionals working with children, young people and their families, where there are concerns about problematic or harmful sexual behaviour, through the provision of advice, information, training and the development of practice frameworks and guidance.

Managing Assessing and Reducing Risk (M.A.R.R): A Practice Manual for working with children and young people with harmful sexual behaviour and their systems.

Developed in Scotland in partnership with the HALT project and used by some practitioners and agencies across Scotland. This assessment and intervention manual recognises the diversity of children and young people exhibiting HSB and embraces it positively as a means of identifying individual interventions and risk management strategies.

It is responsive to the specific risks and needs of children and young people providing frameworks, guidance and tools to work with them, their families and other professional systems during all stages of interventions.

By adopting a child development perspective the manual facilitates an understanding of the sexually harmful behaviours from the child/young person's perspective. This informs understanding of different pathways into behaviours, needs being met, risk management and treatment issues for children and young people of all ages displaying a range of sexually harmful behaviours.