‘Improving our response to children who display sexually harmful behaviour’

Rory Patterson and Jessie Greisbach explain the steps Southwark Council has taken to boost support for children and social workers

Girl head in hands
Photo: Richard Gardner/Rex (Posed by model)

By Rory Patterson, Southwark council children’s services and Jessie Greisbach, senior research assistant STEPS-B

One of the hardest areas for social workers is undoubtedly working with children displaying sexually harmful behaviour (SHB).

In Southwark we were experiencing the same difficulties when working with young people displaying SHB, as many other boroughs and regions in the UK. Although we had examples of excellent working, in general there was a need for us to improve our response. In particular, we had to provide extra support for practitioners, develop stronger joint working across agencies and create clearer referral pathways.

On a personal level, social workers were saying how difficult it was to work with cases like this and how hard it was to know what language to use when talking to families about the allegations of SHB, particularly if a parent was in denial. One newly qualified social worker pointed out that SHB wasn’t covered in their training.

We wanted to create a model of working that addressed these issues and improved the support we offered. Here are some of the steps we’ve taken:

Taking part in a research trial on new interventions for SHB

Since December last year we’ve been working with the STEPS-B project, a government funded research programme investigating multisystemic therapy for problem sexual behaviour (MST-PSB) and other interventions. The programme is running a randomised controlled trial across 14 London boroughs. Half of participants receive MST-PSB and the other half receive an alternative intervention.

To develop clear referral pathways in Southwark we decided that social workers should refer all eligible SHB cases to STEPS-B. Families are given the opportunity to decide if they’d like the opportunity to take part in the MST-PSB clinical trial. So far all families approached have agreed to take part and social workers have been positive about the scheme.

For cases that do not meet eligibility for STEPS-B, or if the family are not randomly assigned MST-PSB, we agreed that AIM (Assessment, Intervention and Moving On) would be the alternative treatment option to target SHB. AIM-trained practitioners from CAMHS, youth offending and social care co-work SHB cases with social workers when required, independent of whether the case is open to their service.

To our knowledge, we are the only borough taking part in STEPS-B  that has adopted and developed the above model. We are also the borough who have identified and referred the most SHB cases into the project so far. An evaluation of the trial is expected to be published in 2018.

Holding monthly sexually harmful behaviour forums

Our work with STEPS-B is just one part of our wider pathway for working with SHB cases. At the same time that we signed up to the research trial, we developed a steering group with managers from social care, youth offending and CAMHS to develop a more co-ordinated response to SHB.

The resulting ‘Southwark Model’ has seen us operate an SHB forum every month. The forum is chaired by a child protection expert from our social services quality assurance unit. Representatives attend from the MST-PSB team as well as CAMHS, youth offending, early help and social care leads.

Social workers complete a brief referral which is viewed by the members prior to the forum.  The social worker and manager are then invited to present their case, followed by discussion, reflections and recommendations for future work. Review dates are also set.

As a result of this model social workers have told us they have a better understanding of the services we can offer families and reflected on how valuable it is getting different viewpoints on their cases to help them develop an action plan.

Other social workers have fed back that it has been really useful to narrate a case in front of other professionals. They have spoken about the benefits of joint working and noted that there is not usually enough time for this level of reflection. The forum acts as a protected time to talk about a case.

In addition to a more confident workforce, the model has also led to an increase in cases being identified and worked with, so more children can be helped earlier. The experience of being involved in a research trial has also helped us reflect and improve our processes in identifying SHB in our borough.

We still have plenty to learn in relation to planning, practice and treatments for this client group, but we now feel that we have a stronger infrastructure to develop our learning and to support young people and their families when SHB is presented at our services.

How the model works in practice 

Aaron is 11. His cousin Keisha is aged 7 and disclosed that he sexually abused her on a number of occasions. On one occasion his younger brother was watching. Dad minimised the SHB and was angry at his sister (Keisha’s mother) for involving social care.
Aaron’s social worker presented the case at the SHB forum and it was identified that they would be suitable for the STEPS-B research trial. The family joined STEPS-B and were randomly assigned to MST-PSB. The therapist’s assessment identified multiple drivers for the SHB and developed an individualised intervention to address each driver. Below are some examples of the drivers addressed during the seven month intervention:

SHB

Post intervention there were no further reports of SHB. Aaron said it was easier to talk to Dad about difficult things and was gaining his dad’s trust again. Dad said that he has learnt a lot and believes that he can continue in supporting his son’s development of pro-social behaviours and attitudes. The social worker reported greater warmth between father and son. Following the intervention the case closed to social care.

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