Introduction to Sexually Harmful Behaviour

Intro
Dispel Myths
Legislation, Public Protection & Criminal Justice pathway
Risk Assessment & Intervention
Self-Care practices
Co-working practices

Sexual offense = Sexual act committed by one person against another

against will (lack of consent)
or where consent cannot validly be given (child, mentally ill)
or where the difference in power between 2 parties is such that one is not in a position to make a truly free choice

Contact Offenses

Rape - penetrative sex (anal, oral, vaginal) by object/ body part
Indecent assault
Unlawful sex
Lewd & libidinous practices & behaviors
Grooming

Non-contact Offenses

Internet abuse images (revenge pornography, watch child porn, threat to disclose intimate images, etc.)
Showing sexually explicit materials
Exhibitionism, flashing
Voyeurism
Indecent telephone calls/ emails/ conversations etc.
Stalking

Prevalence

1 in 20 children in UK have been sexually abused
1 in 5 women will be the victim of a sexual offence in adulthood, 1 in 30 adult men

Symptoms:

withdrown, clingy, problems sleeping, wets the bed/ soils clothes, nightmares, risk-taking,

Myths

Sexual offending by adults fluctuate year by year
Only 13% Sexual offense against adults are by strangers

Partners are most common perpetrators of assaults (55%), threat (58%)
Strangers are likely to commit indecent exposure (70,9%), unwanted touching (39.9%)

Men who view indecent pictures of children are NOT at high risk for contact offense.

Internet Only = highly unlikely. Recidivism rates very low
Dual = may not be linear
Contact = likely to offend. Recidivism rates low
Look for the good things in this group's life, don't get over-scared by the rhetorics that they'll go on to offend

10-30% of children who were sexually abused will offend as adult

1 in 8 men victimised go on to abuse
strongest correlation found with men who abuse boys

Most sexual offenders DO NOT have diagnosable mental illness

Recidivism rates

Sexual conviction 13.7% (not high compared to others)
Non-sexual violent conviction 14%
Any violent conviction 25%
Any conviction 36.9%

Is this group highly deviant?

Determined 23% serial offenders, deviant, mnipulate environment to create opportunities
Opportunistic: 41% first time sex offenders/ versatile criminal history. Sexually indiscriminate/poor self control. Respond to temptations
Situational: 36% first time for any offense. First & last time.

Female offenders - unknown, under-prosecuted. Assumed to be 10-20% of offenders. No specific risk assessments or clear steer on treatment.

Treatment for those who sexually offend is effective: those who attend & cooperate are less likely to reoffend than those who reject intervention.
Bottom line

Low re-offending are low, most is non-sexual
Most sexual-reoffending by offenders managed in the community is not seriously harmly
Non-sexual offending by sexual offenders may cause as much & sometimes more serious harm than sexual offending
We focus too much on sex and not enough on other types of violence.

MAPPA: Multi Agency Public Protection Arrangements

Categories

Cat 1: All Registered Sexual Offenders
Cat 2: Violent or other sex offenders not subject to notification requirements
Cat 3: Other dangerous offenders

Levels

Lev 1: ordinary, managed 1 one lead agency with consultation
Lev 2: coordinated management
Lev 3: Senior Managers of the agencies are involved

Community Payback Order

Name and describe all the requirements that may be imposed as part of a Community Payback Order

Supervision (meet regularly with social worker)
Unpaid work
Compensation
Programmes (assigned by social worker, group work on specific behaviors, relationship work)
Conduct (not enter the shop)
Restricted Movement (stay in one place 12 hours/ day, stay away from an address 24 hours/day)
Treatment (mental health, drug, alcohol)
Residence (stay at certain address, e.g. w parents)
Restriction

What are the three most likely requirements imposed in a sexually offending case?

Supervision
Unpaid work/conduct

What are the three most common sentence types for sexual offences for males?

Custody
Financial

What are the three most common sentence types for sexual offences for females?

Custody
Community sentence
Financial
Others

What is medication protocol?

Serial, deviant fantasies, hypersexual, etc. -- Voluntary, regular bloodtest & organ checks
Anti-depressants dull sexual urges

What services do Stop it Now provide?

Counseling, 1-1, groupwork
Children w learning disabilities' sexual urges are not taken seriously
SOLD

What other specialist NHS or other services are available in your area?

Forensic/ community health support

Are services availability a postcode lottery?

Criminal Justice Pathway

Charged
Court Appearance
Convicted –requirement to register (time on register can be correlated to length of CPO)
Pre-sentence assessments completed -CJSWR/Programme delivery /psychiatric/ Psychological
Sentence imposed community/custody - Supervision
Post Programme Reports (where completed)

Custody & Licence Conditions

Life sentence
Determinate

Risk-Assessment & Intervention

Tools:

Risk Matrix 2000 (RM2000) - static tool based on historic factors (things that cannot be changed)
Stable (SA07) - dynamic tool updated yearly, identify treatment needs
Acute (SA07) - current risk factors, current immediate supervision monitoring

what do we need to watch out for now?

LSCMI (level of service case management inventory)
AIM3 - young offenders displaying sexual harmful behavior
SARA - spousal assault risk assessment
SAM - stalking assessment & management
RSVP - risk of sexual violence protocol

Stable-2007 measures ‘stable dynamic’ risk factors (potentially changeable but may endure for months or years). The instrument incorporates a guided interview schedule which covers 13 major risk areas:

significant social influences,
capacity for relationship stability,
emotional identification with children (more emotionally attached, secure with children than adults)
hostility toward women, (purple = Intimacy Deficit: capacity for relationship)
general social rejection,
lack of concern for others,
impulsivity,
poor problem-solving skills,
negative emotionality, (blue = Self Regulation)
sex drive and preoccupation,
sex as coping,
deviant sexual preferences, and
cooperation with supervision (therapeutic relationship).

Items are scored on a 3-point scale of 0 to 2 from no problem, some problem and significant.

Acute-2007 measures ‘acute dynamic’ risk factors (highly transient conditions, change in weeks/hours) 7 areas of risk:

victim access,
hostility,
sexual preoccupation/ very high sex-drive,
rejection of supervision,
collapse of social support,
emotional collapse and
substance abuse.

These items are scored on a 4-point scale from 0 for no problem, 1 for some problem, 2 for a significant problem and IN for intervene now.

PREDICTION FOR SEXUAL RECONVICTION/ REOFFENSE

Denial is actually NOT a predicting risk factor. :(

We think "until they admits, they cannot do any work around their offense". Do not try to make people admit. Generally, by reasearch, people who deny aren't at higher risks than others. We can still work with them without pressuring them to admit.
There're good reasons for no public admission.
We think "it feel risky", they are "hiding it" if they minimize or blame others. We deal harsher sentences. Yet we should look at the positive aspect of how their social identity is at work.

Poor Empathy is actually NOT a predicting risk factor. :(

We think that if they say things in a "matter of fact" way, uncaring towards victims. This upsets police & social workers. Yet they may still be able to reflect upon themselves. We shouldn't over-react to this.
Some people antisocial, psychopathy, extremely callous to everyone = no empathy for anyone then this is a factor. But if they're only non-empathetic towards victims, it's not a huge risk factor.

Being a victim of sexual abuse is NOT a predicting risk factor. :(

Offenders who have been victims isn't any more riskier at re-offending than those who don't.

Low self-esteem is NOT a predicting risk factor. :(

People who struggle with shame, negative sense of self, will find it hard to have relationship. We might think this affects, and might try to boost their self-esteem. Yet this approach doesn't solve the issue.
Those who regard themselves lowly are not riskier than those who are confident.

Age is a predicting factor. :)

Sex drive, impulse control -- young people are likelier

Offense seriousness is not a predicting risk factor. :)

If they do something very serious, we think their circumstances may be very serious and make it likelier. "What do you mean they're low risk? It's disgusting what they've done!" - However, they're not likelier to reoffend. Murder has a low recidivism. Lighter crimes e.g. flashing might be more common.

Gender of victim is a predicting risk factor. :)

People who offended against male victims have a higher risk than against female victims.

General offending is a predicting risk factor. :)

Impulsivity, problem-solving, anti-social attitude, history of general offending is a risk factor

Offence type is a predicting risk factor :)

Flashing, deviant behaviors = higher risk

Relationship with victim is a predicting risk factor :)

Right in their homes = not a lot of barriers
Offend someone whom they've not known in the past 24 hours = they can overcome really high barriers ==> higher risks!!!

Actuarial Risk Assessment: uses factors identified through large-scale research, often historic. Used widely in the insurance industry.

Single (not sustained a marriage-like relationship for 2 yrs), male, aged 18-24
Volume, diversity & early onset of sexual offending
Unrelated or stranger victim
Male victim
Conviction for non-contact sex offense
General criminality (anti-social) ------ Thornton (2001)

Dynamic Risk Assessment: look at behavioral & personality factors linked to offending. These are potentially amenable to change.

Attitudes (not in tools because not enough evidence). Targeting attitudes is not the most effective ways.

CORE PRINCIPLES & THERAPEUTIC STYLE

Integrated theory of sexual offending
Good Lives Model

Offendres are not moral strangers, not inherently different from other people
They need help finding prosocial ways to meet our needs

Risk need & responsivity: If you overtreat, the rate of reoffense is higher!
Therapeutic alliance: Warmth, Empathic, Rewarding, Directive

MFMC (Moving Forward Making Changes) 2-year Treatment Program

Score moderate+ on risk assessments. (Low risk consideration given if there are clear areas identified)
Group work aged 18+
2:1 work can be undertaken
Denial doesn't exclude someone from participation

New Influences

Evolutionary Biology (Thomas Boyce suggests about orchid and dandelion children)

Some siblings are severely affected, others can cope much better
Some people who managed to thrive despite trauma
Some has loving families yet suffer = 15-20% of all children are orchids, much more sensitive, much higher cortisols

Neuro-psychology

Window of Tolerance is narrower for traumatized people: Hyper-response (Fight & Flight), Hypo-response (Flat, difficult to work)
Hippocamus (where we store memories) severely affected by trauma. So offenders' memories can be distorted.

Trauma-informed
Attachment & Schema

Attachment styles: healthy, intimate relationship

Mindfulness
Compassion Therapy

USEFUL APPROACHES TO ASSESSMENT & INTERVENTION

Gather Info: Comprehensive file reviews, ViSOR Police & Forensic Reports, Duty to Cooperate, Offender Interviews
Analyse Info: Risk Assessment Tools, Formulation, colleagues, Specialist Delivery
Decide what you're going to do with it: Monitoring, Supervision, Treatment, Victim safety planning, contingency plans

FORMULATION 4 PARTS

Background factors? biological, attachment, social learning, socio-cultural
Why then? Substance misuse, victim access, stress, sexual preoccupation
Why might make it more likely to happen again? Intimacy deficits, self-management difficulties, problems with sexual regulation, etc.
What might protect? Social support, motivation, positive life goals

Activity: Let's keep this our little secret

Take a minute to think about something you're really ashamed of.

They make acknowledge that they have work to do, yet still deny the act.

Interviewing

Prep: practice to be comfortable with language, be confident about what you're asking and why, think about a safe environment for interview, plan for interview
Interview: create right atmosphere, questioning styles, body-language, common barries
Feedback: feeding back to the client, in Court report
Responsivity: consider any issues i.e. neurodivergence, you might need to do lots of pictorial for them

Sexual Deviance (motivation, disinhibition, opportunity to offend)

Paraphilia - intense, persistent sexual interest outside of foreplay & genital stimulation with phenotypically normal, consenting adults. (DSM 5)

Pedophilia (pre-pubescent children) - Evidence that sexual attraction to children is more common than we'd like to think, but most people learn not to offend.
Hebephilia (pubescent children, still under 16)

Frotteurism - nonconsensual touching, public spaces 9%
Feederism
Sexual Sadism (coercive sex)
Voyeurism 5%
Exhibitionism 5.4%
Public masturbation 4.3%

SELF-CARE

Critical Occupation: critical job to sustain community

High risk of exposure to traumatic events/ materials, that may exert critical impact on psychological well-being

Experiences & Reaction

Counter-transference: all our (un)conscious responses to the individual - rejection, rage, fascination, disgust, titillation
Vicarious trauma: changes in world view of worker, safety, trust, power esteem, intimacy
Burn out
Stigmatisation: you stigmatise others more than you used to

Activity

Static factors: ACEs, family makeup, years in the role, sexual identity, availability of resources that you can provide to the person, ...
Dynamic factors: moral injury, people around you (you feel isolated, you have to hold this yourself), ..
Organizational support needed: robust procedures, training, etc.

COWORKING

ADVANTAGES

Avoid collusion
Reduce impact of offending behavior on worker
Pro-social modelling (esp. male-female pair modelling)
Sharing knowledge/skills
Different roles - share tasks
Treatment drift

DISADVANTAGES

Can make it difficult to establish/maintain positive relationship w client in 2:1 setting
Can adversely affect the style of interview
Perceived over-inflation of risk
Can be confusing for client

WHAT MAKES A GOOD CO-WORKING

Prepare: get to know each other (be sensitive to each other's styles)
De-brief
Allocate follow-up tasks
Do not let problems lie - use 3rd party/supervision

Ngành công nghiệp này thật khủng khiếp. I'm worried for myself and the people around me.

nghe