Treatment for young abusers left to chance

With access to therapy for children who display sexually harmful behaviour resembling a postcode lottery, experts believe a national strategy is essential, writes Chloe Stothart

When nine-year-old James* told his mother that he had engaged in sexual behaviour with another boy at his primary school, she contacted the school. She expected support for her and help for James but instead he was excluded, sent home with work and little other educational input.

At a strategy meeting, the police said they could not intervene because James was below the age of criminal responsibility, and child and adolescent mental health services said they could not assess him.

The school failed to tell social services, which only became aware of the incident when James’s mother called them about her son’s exclusion. Over the next 16 months James was passed between six social workers. Nothing happened until the final one referred him to child protection charity the Lucy Faithfull Foundation.

By this point, his mother, who had struggled to restore normality in their lives, described revisiting the behaviour as “like having a wound reopened”.

James, who also has moderate learning difficulties, could not understand why the incident was being brought up again so long after it took place. He described himself as a “monster” and saw himself as too dangerous and unsafe to be in school, an indication that he was beginning to see the behaviour as an integral flaw in himself, which could make it more difficult to alter.

The Lucy Faithfull therapist who helped James, Paul Eggett, said the behaviour was found to be linked to problems his family faced at the time and that it was not as predatory as the school had assumed. After therapy James did make good progress, but his education had suffered and he was largely cut off from his peers because most parents kept their children away from him.

James is far from unique. Studies of adolescent sexual offenders in the UK found between one-third and a half had learning disabilities, according to a paper published by the NSPCC. A 2005 research paper for the Youth Justice Board revealed a shortage of services for them, with nearly half the professionals surveyed reporting the provision in their area to be inadequate or worse.

Many specialists think a national strategy for children with sexually harmful behaviour would ensure a more even spread of services around the country and guide professionals on handling cases. “It would ensure uniformity of response rather than a postcode lottery,” says Eggett.

The previous government did promise a national strategy for children who abuse in October 2006. In February this year Phil Hope, then care services minister, said that by this summer the Department of Health aimed to publish a framework for service development for young people who display sexually harmful behaviour.

The new government is making no such promises. A DH spokesperson said: “This is an important and sensitive issue that ministers need to consider in detail before setting out further plans.”

Lack of national guidance leaves some social workers, teachers and doctors uninformed on how to react when they encounter a child with learning disabilities and sexually harmful behaviour. They often fear that nobody can help, lack confidence in their own skills, worry about penalising the child or feel uncertain about what is normal sexual development.

This is compounded by other agencies claiming that either learning disabilities or sexually harmful behaviour are excluded from their remit. Stephen Barry, principal clinician at the NSPCC’s Be Safe service, says: “There is evidence practitioners are intimidated and do not know what to do. That is even more the case with practitioners dealing with learning disabilities. When they decide they want to go somewhere, they find there is nowhere to go. There is a real lack of services.”

The other fear is that professionals may overreact to behaviour that was not risky to other children and part of normal development. In these circumstances children could end up excluded from school and isolated unnecessarily from other young people, as James did.

“Over-zealous containment can curtail their development and social skills,” says Rowena Rossiter, consultant clinical psychologist at the Surrey and Borders Partnership NHS Foundation Trust. Alternatively professionals may under-react, playing down serious behaviour that should be tackled in the belief that the child does not understand what they are doing because of their learning disability. This attitude could result in more victims and the behaviour becoming ingrained and harder to change, she adds.

Good work is going on in several parts of the country. There is a proposed pilot for a treatment scheme tailored to young people with learning disabilities at Kent University; a few local authorities and health trusts have specialist workers and strategies; and there are training courses for professionals and therapeutic projects run by charities such as the NSPCC, G-Map, Respond and the Lucy Faithfull Foundation.

Despite these positive examples, Eggett, Rossiter and many other professionals fear improvements will continue to be piecemeal until there is a national strategy. Until then it will be a matter of chance whether children like James receive the treatment they need.

* Name has been changed

Top tips for social workers

● Find out which local agencies have referral powers.

● Take serial behaviour seriously; don’t excuse it due to the child’s learning disability.

● Don’t punish the child.

● Get advice from specialist agencies and charities.

● Consider the needs of both the child with the worrying behaviour and the person on the receiving end of it.

● Involve the police if the behaviour merits it. The Assessment Intervention Moving On process, your local safeguarding policies and procedures, or Ryan’s research (see resources panel, right) will provide information on whether the police should be informed and local guidelines on safeguarding may determine which professionals or agencies take the decision and whether a safeguarding meeting is needed.

● Keep detailed records.

● Work with others to implement a safety and support plan for the child.

● Agree the approach, policies and procedures that your agency will adopt and approaches across agencies.

● Assess the level of risk to the young person and to other people.

● Find the most effective mode of communication for that child; visual and non-visual approaches may work better than verbal ones.

● Consider other areas of the child’s life. Why have they got to this point? Do they live in a safe place?

● Offer appropriate help from sex education to specialist therapy.

● Check the child’s understanding of sexual matters and terminology, and of their safety plan

● Be concrete and repetitive in the messages you give.

● Involve parents and carers.

● Be aware that it can often take time to make progress.

Source: Stephen Barry, NSPCC, and Rowena Rossiter, Surrey and Surrey and Borders Partnership NHS Foundation Trust

Resources

● The Assessment Intervention Moving On (AIM) project provides training and an assessment tool for children with sexually harmful behaviour and learning difficulties www.aimproject.org.uk/index.php/training

● Ryan’s continuum of sexual behaviours in children and adolescents (published in Ryan G, Lane S (eds), Juvenile Sex Offending. Causes, Consequences and Corrections, Lexington Books 1991)

● Charities that provide services and support to the family: Lucy Faithfull Foundation, NSPCC’s National Clinical Assessment and Treatment Services, G-Map, Respond, SWAAY, and Barnardo’s Taith project.

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This article is published in the 16 September issue of Community Care magazine under the heading Treatment for young abusers left to chance