Young People Who Display Harmful Sexual Behaviors and Their Families: A Qualitative Systematic Review of Their Experiences of Professional Interventions

Approaches to Assessment and Intervention With Children and Young People Who Engage in Harmful Sexual Behavior: A Scoping Review

This paper reports the findings of a project that conducted a rapid review of evidence regarding assessment and intervention approaches responding to children and young people who engage in harmful sexual behaviors. A literature review was conducted using a systematic search of academic databases and consultation with subject matter experts. The process resulted in 27 scholarly publications being included and analyzed to explore what was known about effective approaches with children and young people who have engaged in harmful sexual behavior. The review found that the current state of knowledge was limited, with few of the included papers reporting research outcomes. In the absence of a sound evidence base, additional theoretical literature and expert commentary have been drawn upon to better understand issues in this complex practice area. A key finding of this review was that growing awareness that children and young people who engage in harmful sexual behaviors are, first and foremost, children. They should not be regarded as soon-to-be-adults who are engaging in adult offending. This shift in thinking informs contemporary assessment and intervention approaches, challenging those models that previously focused on measuring risk using forensic approaches to predict the likelihood of future offending. A critical failure to understand the needs of specific cohorts of children and young people was also evident.

What is Currently Understood About the Impact of Sexual Violence Activism for Higher Education Student Sexual Violence Survivors?

Objective: This systematic literature review maps the landscape of higher education and student sexual violence survivors who become involved in sexual violence activism. It was undertaken to understand what drives student sexual violence survivors to become activists, the negative and positive impacts of this activism on the students, how higher education institutions might work with sexual violence activists to foster effective prevention and response, and how activism has been negotiated by and within practice, policy and research. Method: A qualitative evidence synthesis methodology was used to identify research which examines drivers to and consequences of sexual violence activism for student activists. Searches across seven databases were conducted using six keywords combined in various ways, with further inclusion criteria of published in English between 2010 and 2020. Searches of grey literature were also carried out. Results: 28 sources met the inclusion criteria. Thematic analysis, conducted in NVivo, resulted in identification of four themes: survival from harm, community, labour in the personal made public and power between activists and institutions. Conclusions/Recommendations/Limitations: Inadequate institutional response was a key driver of student sexual violence activism. Activism had positive and negative impacts on the activists. Recommendations are that activists, institutions, researchers and policy makers work as coalitions to bring about enduring cultural change. Review limitations were the small number of studies in this field; additionally, they were dominated by US and UK perspectives.

Help-Seeking and Help-Related Experiences of Commercially Sexually Exploited Youth: A Qualitative Meta-Synthesis

This interpretive qualitative meta-synthesis (QMS) aims to systematically review what we know about the help-seeking and help-related experiences of commercially sexually exploited youth (CSEY). A comprehensive search of the relevant databases was conducted to identify published qualitative peer-reviewed papers and research reports about the experiences and perceptions of CSEY. A corpus of 34 qualitative studies was compiled and synthesized, using the conceptual framework of help-seeking and QMS guidelines. The QMS reveals that although help-seeking of CSEY are rarely the focus of the inquiry, the reviewed studies include meaningful information about help-related experiences of CSEY. Thus, the synthesis of the available data yields novel insights about how CSEY perceive their involvement in CSE, define the problems they deal with, decide to seek help, choose the proper help, and engage in helping relations. Particularly, the QMS underscores that CSEY do not always perceive their involvement in CSE as problematic, nor do they identify themselves as victims of exploitation. The findings highlight the significance of developing social services that specialize in helping CSEY, the importance of actively identifying CSEY and reaching out to them, and the need to enable CSEY to be involved in decisions about the extent and type of support they are provided.

Engaging young people and their caregivers in support services following harmful sexual behaviors: Qualitative analysis

BACKGROUND

Harmful sexual behavior (HSB) displayed by children and young people under the age of 18 has been described as developmentally inappropriate, may be harmful towards self or others, or be abusive towards another child, young person, or adult. Early intervention and treatment completion are crucial to cease HSB, reduce impacts and address underlying issues for the child who has displayed HSB. Considerable shame attaches to seeking help for this stigmatized behavior which may result in dropout from support services. Understanding young people and caregivers' experiences of what facilitates or hinders their engagement with support services is therefore critical to preventing re-occurrence of HSB and keeping children safe.

OBJECTIVE

This article draws on the first-hand experience of young people and caregivers to address the question: What have they found helpful and unhelpful when engaging with services for harmful sexual behavior?

PARTICIPANTS AND SETTING

Participants were recruited from public health and youth justice services in the state of New South Wales, Australia. The 31 participants included 11 young people (aged 14 to 17) and 20 caregivers (parents, foster or kinship carers).

METHODS

Qualitative data were collected through individual semi-structured interviews, following which thematic analysis was conducted.

RESULTS

Data analysis identified three helpful responses: (1) non-judgmental recognition of crisis; (2) child-centred and family-focused orientation; and (3) multi-dimensional interventions. Unhelpful responses included: (1) closed doors (an inability to access a service) (2) stigmatization of HSB; and (3) reduced caregivers' autonomy.

CONCLUSIONS

Greater involvement of caregivers, non-stigmatizing language and coordinated responses between generalist and specialist services are needed to facilitate service engagement.

Interrater reliability and experiences of Assessment, Intervention, and Moving-on 3 Assessment Model in a multidisciplinary Norwegian sample

Background

Assessing minors with harmful sexual behavior (HSB) is a complex and sensitive task. The AIM3 Assessment Model was developed to assist practitioners with information collection and HSB evaluations.

Objective

In this study, we explore the interrater reliability and the practitioners' experience with the AIM3.

Participants and setting

The multidisciplinary sample (n = 56) was recruited in Norway. The participants' mean age is 43.2 years (SD 9.5). The sample is 79% female and 21% male. Mean years of experience is 17.6 years (SD 9.5).

Methods

The participants used the Norwegian version of the AIM3 to score three case vignettes. A survey containing questions about competence and experience was filled out. We used the intraclass correlation coefficient (ICC) to estimate interrater reliability as well as descriptive statistics to show experience.

Results

The estimated ICC for overall AIM3 factors is 0.547 (95% CI = 0.471, 0.634); for domain scores, the estimated ICC is 0.697 (95% CI = 0.548, 0.852). Both are in the moderate range. The majority of the participants reported that they will probably use the AIM3 in the future and that their experience with the AIM3 was highly useful with, for example, empirically informed decision-making and for intervention and safety planning.

Conclusion

The moderate ICC results and the sample's generally positive experience with the AIM3 may indicate further usefulness in a Norwegian multidisciplinary setting. We provide recommendations on how the AIM3 and similar HSB assessments can be further evaluated and developed.

The Prevalence of Adverse Childhood Experiences Among Children and Adolescents Who Display Harmful Sexual Behaviour: A Review of the Existing Research

There is no systematic review focusing on the prevalence of adverse childhood experiences (ACEs) among children and adolescents who display harmful sexual behaviour (HSB). This study addresses this gap to further our understanding of the aetiology of HSB among children and adolescents. The full text of 87 articles was retrieved and assessed for eligibility, following which 10 articles were deemed relevant for inclusion in the review. These 10 studies were then subjected to quality assessment, data extraction and synthesis. The present review included only studies that used data pertaining to both males and females, and some studies provided a comparison between males and females. There were higher rates of sexual victimisation among females who display HSB. Additionally, child sexual abuse perpetrated by female caregivers is likely to be higher than most of the existing body of research suggests. The findings of the present review corroborate many of the hypotheses discussed in the introduction, emphasising that children and adolescents who display HSB are more likely to have come from backgrounds of trauma, signaling the importance of multi-agency responses, early intervention and the importance of protective factors.

Cognitive-behavioural therapy (CBT) interventions for young people aged 10 to 18 with harmful sexual behaviour

BACKGROUND

Around 1 in 1000 adolescents aged 12 to 17 years old display problematic or harmful sexual behaviour (HSB). Examples include behaviours occurring more frequently than would be considered developmentally appropriate; accompanied by coercion; involving children of different ages or stages of development; or associated with emotional distress. Some, but not all, young people engaging in HSB come to the attention of authorities for investigation, prosecution or treatment. Depending on policy context, young people with HSB are those whose behaviour has resulted in a formal reprimand or warning, conviction for a sexual offence, or civil measures. Cognitive-behavioural therapy (CBT) interventions are based on the idea that by changing the way a person thinks, and helping them to develop new coping skills, it is possible to change behaviour.

OBJECTIVES

To evaluate the effects of CBT for young people aged 10 to 18 years who have exhibited HSB.

SEARCH METHODS

In June 2019, we searched CENTRAL, MEDLINE, Embase, 12 other databases and three trials registers. We also examined relevant websites, checked reference lists and contacted authors of relevant articles.

SELECTION CRITERIA

We included all relevant randomised controlled trials (RCTs) using parallel groups. We evaluated CBT treatments compared with no treatment, waiting list or standard care, irrespective of mode of delivery or setting, given to young people aged 10 to 18 years, who had been convicted of a sexual offence or who exhibited HSB.

DATA COLLECTION AND ANALYSIS

We used standard methodological procedures expected by Cochrane.

MAIN RESULTS

We found four eligible RCTs (115 participants). Participants in two studies were adolescent males aged 12 to 18 years old. In two studies participants were males simply described as "adolescents." Three studies took place in the USA and one in South Africa. The four studies were of short duration: one lasted two months; two lasted three months; and one lasted six months. No information was available on funding sources. Two studies compared group-based CBT respectively to no treatment (18 participants) or treatment as usual (21 participants). The third compared CBT with sexual education (16 participants). The fourth compared CBT (19 participants) with mode-deactivation therapy (21 participants) and social skills training (20 participants). Three interventions delivered treatment in a residential setting by someone working there, and one in a community setting by licensed therapist undertaking a PhD. CBT compared with no treatment or treatment as usual Primary outcomes No study in this comparison reported the impact of CBT on any measure of primary outcomes (recidivism, and adverse events such as self-harm or suicidal behaviour). Secondary outcomes There was little to no difference between CBT and treatment as usual on cognitive distortions in general (mean difference (MD) 1.56, 95% confidence interval (CI) -11.54 to 14.66, 1 study, 18 participants; very low-certainty evidence), assessed with Abel and Becker Cognition Scale (higher scores indicate more problematic distortions); and specific cognitive distortions about rape (MD 8.75, 95% CI 2.83 to 14.67, 1 study, 21 participants; very low-certainty evidence), measured with the Bumby Cardsort Rape Scale (higher scores indicate more justifications, minimisations, rationalisations and excuses for HSB). One study (18 participants) reported very low-certainty evidence that CBT may result in greater improvements in victim empathy (MD 5.56, 95% CI 0.94 to 10.18), measured with the Attitudes Towards Women Scale, compared with no treatment. One additional study also measured this, but provided no usable data. CBT compared with alternative interventions Primary outcomes One study (59 participants) found little to no difference between CBT and alternative treatments on post-treatment sexual aggression scores (MD 0.09, 95% CI -0.18 to 0.37, very low-certainty evidence), assessed using Daily Behaviour Reports and Behaviour Incidence Report Forms. No study in this comparison reported the impact of CBT on any measure of our remaining primary outcomes. Secondary outcomes One study (16 participants) provided very low-certainty evidence that, compared to sexual education, mean cognitive distortions pertaining to justification or taking responsibility for actions (MD 3.27, 95% CI -4.77 to -1.77) and apprehension confidence (MD 2.47 95% CI -3.85 to -1.09) may be lower in the CBT group. The same study indicated that mean cognitive distortions pertaining to social-sexual desirability may be lower in the CBT group, and there may be little to no difference between the groups for cognitive distortions pertaining to inappropriate sexual fantasies measured with the Multiphasic Sex Inventory.

AUTHORS' CONCLUSIONS

It is uncertain whether CBT reduces HSB in male adolescents compared to other treatments. All studies had insufficient detail in what they reported to allow for full assessment of risk of bias. 'Risk of bias' judgements were predominantly rated as unclear or high. Sample sizes were very small, and the imprecision of results was significant. There is very low-certainty evidence that group-based CBT may improve victim empathy when compared to no treatment, and may improve cognitive distortions when compared to sexual education, but not treatment as usual. Further research is likely to change the estimate. More robust evaluations of both individual and group-based CBT are required, particularly outside North America, and which look at the effects of CBT on diverse participants.

Experiences of Young People with Harmful Sexual Behaviors in Services: A Qualitative Study

Young people are responsible for a significant number of the sexual offenses that are committed every year. These young people are generally referred to specialist services for treatment. This article explores the health characteristics and service experiences of 117 young people with sexual behavior problems, and the issues that services face when working with them. The study is based on analysis of 117 case files, identified from nine specialist services in the UK. The case files were thematically analyzed. Case files provided information on the following topics: the reasons why the young people were referred to harmful sexual behavior services; the young people's personal characteristics; their medical and mental health problems; the young people's interests and aspirations; their attitudes toward services and interventions; continued problematic sexual incidents in services; progress in services; and post-service experiences. Overall, the findings of the study indicate that these young people have a number of strengths, but often have problems across a range of personal and health domains. A number of them continue to remain sexually and generally violent in services, particularly in residential settings, which has risk management implications for staff.