Up the junction

A 13-year-old boy’s sexually inappropriate beh  aviour had
led him to be assessed by a variety of mainly medical specialists –
without much success. However, a breakthrough came when   the
Junction Project introduced a more holistic, child-centred
approach. Graham Hopkins reports.

As joint working becomes the norm, one benefit has been the
pivotal role the voluntary sector is taking in co-
ordinating services which were once the domain of statutory
services. The Junction Project, a Barnardo’s agency in
Rotherham, South Yorkshire, which works with social services
departments in the area, is an excellent example of how a voluntary
service can thrive when – as well as cash – it is given respect,
trust and responsibility.

Positive partnership working came together in the case of
13-year-old Matthew Holmes, who was referred to the project 18
months ago because of his inappropriate sexualised behaviour, which
included touching his sister. Matthew, even for a young person, had
quite a history of involvement with health and social services.

However, this had, by and large, been restricted to medical
interventions by psychiatrists, psychologists and family
therapists. “He’d been pathologised by all of this and
had internalised a lot of it,” says Marie McLaughlin, social
worker with the Junction Project. “My first meeting with him
was very interesting. He wouldn’t come out of the kitchen and
asked me, ‘Are you from education?’ I said no, and that
I had come to talk to him about the assessment I needed to do.
Tellingly, he replied: ‘I’m allergic to
assessments.’ It was obvious this kid had been assessed up to
the eyeballs.”

McLaughlin quickly realised there needed to be “a shift
from Matthew being treated in the medical model to it being about
him – and him taking responsibility and contributing. I brought
along a lot of material to show him how we work,” she says.
“We do work to a very child-centred and holistic model. It
helped convince Matthew. This first session went very well.
However, unfortunately, there followed an episode of inappropriate
sexual behaviour, followed by another one at the school.” Two
male pupils brought three counts of indecent assault against
Matthew.

A case conference around this time placed Matthew and his sister
on the child protection register. It was also felt that Matthew
needed a special residential placement, where he would be out of
the family home and community but have access to an appropriate age
group. “The family also needed some work on boundary-setting
and on managing his sexual behaviour,” says McLaughlin.

However, despite the long-term aim, Matthew remained at home.
“We had to do some safe-care work, working successfully with
a social worker from south Yorkshire. We also did some assessment
work with Matthew’s parents. It was a really positive
experience, although some of their beliefs were quite challenging:
for example, what they felt was acceptable about privacy and
secrecy. But they were very receptive to the educative techniques
we used. We gave them hand-outs and books, which they read. They
set boundaries and kept to them and Matthew, although unhappy about
it, stuck to them as well. It felt a lot safer.” Research
suggests a better outcome for young people who engage in this
behaviour when the families support the work and provide a
protective environment.

Following the court case – Matthew was given a supervision order
for one year – a specialist diagnosed him as having
Asperger’s syndrome. His name was also placed on the sex
offenders’ register. “He was quite shocked by
that,” says McLaughlin.

A planning meeting agreed to continue the safe-care work in
partnership with social services, and to involve Sova, a voluntary
group providing supportive services for young people in the
criminal justice system, in taking Matthew out to offer the family
some respite. Education also played its part: “The outcome is
so much better when kids have specific education plans,” says
McLaughlin.

A “helping team” was then set up, and Matthew got to
say who would be in his team. “It was great,” says
McLaughlin. “He said, ‘I have a problem – and I need
help with it.’ He didn’t fall back on his
Asperger’s, saying he couldn’t help what he was
doing,” she says.

Things are progressing well. Matthew has gone from being
categorised as high-risk to medium-risk. However, a residential
school placement remains a possibility. At the moment,
Matthew’s education is being managed by his local
authority’s behaviour support service. He receives one-to-one
tuition, and his tutor is awaiting training in teaching people with
Asperger’s. “Matthew said ‘nobody ever lasts with
me’ – but he’s more positive about his future now, more
positive about himself and that he can change,” says
McLaughlin. And by instilling that confidence, all those working
with Matthew have shown, that believing in potential is half the
battle won.

Case notes

Practitioner: Marie McLaughlin, social worker
Field: Working with children who have sexual behaviour
difficulties
Location: Rotherham, South Yorkshire
Client: Matthew Holmes was referred to the Junction Project – a
specialist voluntary agency – because of his inappropriate sexual
behaviour.
Case history: Matthew, 13, was aggressive and he was often in
trouble at school. He had statement of special educational needs
and started to develop a sexualised language and began
inappropriate touching of adults. He was eventually excluded. He
underwent several diagnoses for his behaviour, including
semantic-pragmatic disorder and global learning difficulties. He
was then placed in a residential school for children with emotional
and behavioural problems. His family, believing he had
Asperger’s syndrome, wanted him to attend a specialist
school. However, his condition had not yet been diagnosed. There
followed two incidents at home, where he had touched his sister in
a sexual way and masturbated in front of her.
Dilemma: Yet more assessment may do Matthew more harm than
good.
Risk factor: By entrusting Matthew with responsibility, he may be
in a position to abuse or be susceptible to abuse.
outcome: Work continues with Matthew while a long-term specialist
residential school is found. Originally categorised as high-risk of
reoffending, he is now considered medium-risk.

The names of the family involved have been changed

Arguments for risk

• Matthew’s negative experiences of intervention had been
  largely caused by adhering to a medical model. It was felt that, if
  used appropriately, a more child-centred and holistic approach to
  an assessment and subsequent work, would benefit him.
• Through the assessment, Matthew displayed an enthusiasm for the
  way work with him would be handled and he indicated that, by being
  involved in decisions and given responsibility, he might accept his
  behaviour as inappropriate and change.
• Matthew’s family, while distressed, were willing to
  reflect on their parenting and work towards a better understanding
  of boundary-setting and safe-care techniques at home.
• Matthew also had his own allotment, which while causing some
  concern, was used to develop his own responsibilities. He enjoyed
  working his allotment, it helped to give him a sense of purpose
  and, indeed, his father took a greater interest in him, through
  attending the allotment with Matthew.

Arguments against risk

• On being diagnosed as having Asperger’s syndrome, it
  might have been accepted that Matthew’s inappropriate sexual
  behaviour could not be tackled effectively as he would simply be
  unable to do anything about it. People working with him could
  surmise that any work would be ultimately pointless.
• Work had been carried out for years and had brought no
  discernible improvements in his behaviour. Indeed, his
  inappropriate sexual behaviour had intensified and was getting
  worse. If permitted to remain in the community he was rated a
  high-risk to re-offend.
• Matthew also enjoyed the company of older men. There was a
  great risk to his own safety as he is a vulnerable young person and
  his descriptions of his relationships with some men gave cause for
  concern.
• Other young people in Matthew’s community also became
  aware of his behaviour and charges were made against him. This also
  made him vulnerable to attacks.

Independent comment

Young people’s inappropriate sexual behaviours often occur
in turbulent circumstances that are less than ideal for planned
therapeutic interventions. Residential placements often create
complications, dilemmas and extended aspects of risk. It will be a
challenge to find a placement that can meet Matthew’s
educational needs and be able to respond therapeutically to his
behaviour. Often family circumstances, although not perfect, are
“good enough”. This means supporting an intervention
and accepting recommendations on house safety rules. 

The Junction Project has recognised that, alongside assessing
the young person, family assessment and intervention is essential.
The workers recognised the importance of building a team of people
to help Matthew. The holistic approach has helped him take
responsibility for his actions, with an emphasis on control rather
than cure.  The work will need to explore the possibility Matthew
may have been sexually abused, and whether this has affected his
behaviour. Importantly, the work has attempted to raise his
self-esteem, and build positive activities into his life, important
features of an offence-free lifestyle.  Previous assessments have
not addressed Matthew’s sexual behaviour problems and,
unquestionably, a specialist intervention was necessary. 

There is an urgent need for local authorities to develop clear
policies for meeting the needs of young people who sexually
abuse.
Andrew Durham is the consultancy manager for the Sexualised
Inappropriate Behaviours Service (SIBS) in Warwickshire.