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Winston Churchill Report

 Winston Churchill Report - Page One

This study explored innovative models of childhood sexual abuse primary, secondary and tertiary prevention programmes, visiting centres of excellence in both the United Kingdom and the United States of America.

Programmes in both countries are able to offer a more comprehensive and integrated range of responses than those which are currently offered within Queensland, Australia.

In order to provide this approach within an Australian context, sexual violence will need to be declared a public health, as well as a criminal issue.
Government Departments which are key stakeholders in this area will need to address sexual violence by developing a collaborative approach, rather than the present fragmented responses, including the investment of joint funding. This would involve the development of integrated, comprehensive services, with a focus not only on tertiary prevention, but also upon primary and secondary prevention. Within these models, a continuum of care is required to offer a range of therapy settings.

A public health approach is currently being developed by integrating funding from the Queensland Health Service, and funding from the Department of Families, Queensland, at the Bundaberg Area Sexual Assault Service, Queensland, Australia. This involves the trial of a range of the programmes visited overseas, for adaptation to an Australian context.

Stop It Now! Australia, (Queensland), is also a new initiative of the Bundaberg Area Sexual Assault Service, and it is hoped this innovative response will be explored by other States in Australia.

Introduction
I was introduced to the field of sexual violence in 1980, and since then have worked with both the men, and to a much lesser degree women, who have been sexually violent towards others, adolescents and children with sexualised and sexually abusive behaviours, and those men, women and children who have suffered the often devastating impact of being sexually violated. My work has taken place within challenging environments: Forensic Secure Units, Prisons, the British Probation Service, the Gracewell Clinic, UK, and Non-Government Organisations.
Over the last twenty three years I have watched as Academia, Governments and Society have struggled to become more informed about this huge social and health problem in both the UK and Australia. Yet still nothing seems to change.

Imagine a childhood disease that affects one in five girls and one in seven boys before they reach 18 years of age; a disease that can cause dramatic mood swings, erratic behaviour and even severe conduct disorders among those exposed; A disease that breeds distrust of adults and undermines the possibility of experiencing normal sexual relationships; A disease that can have profound implications for an individual's future health by increasing the risk of problems such as substance abuse, sexually transmitted diseases, and suicidal behaviour; A disease that replicates itself by causing some of its victims to expose future generations to its debilitating effects.

Imagine what we, as a society, would do if such a disease existed. We would spare no expense. We would invest heavily in basic and applied research. We would devise systems to identify those affected and provide services to treat them. We would develop and broadly implement prevention campaigns to protect our children.

Wouldn't We?
(Mercy, 1999).

Educative responses to preventing sexual violence have developed from the ‘stranger danger’ approach, to providing protective behaviour skills to young children, with the expectation they will then be able to protect themselves and speak out against often the person who is entrusted with their care, and whom they may at the same time love, and be terrified of.

Legal responses, mainly in the UK and USA, include Sex Offender Registers, which now have young people aged eleven registered for life. Sex Offender Registers have been troubled with low compliance rates, and obviously will not address those who go ‘underground’ or are never caught. Another strategy, the public notification of sex offenders released into neighbourhoods, is often fuelled by the media, is punishing to the person who has been sexually abused, who is also often a child and a relative. This strategy is largely ineffective and unfunded ( Freeman-Longo and Blanchard, 1998). Australia is still in its infancy in developing such legal responses, and hopefully will learn much from the lessons of others.

Therapeutically, there is still a deep divide between those who work with offenders, and those who work with victims, none more so than within Queensland, Australia.

Services for children and young people who have been sexually abused are virtually non-existent, though at the time of writing this report the Queensland Government Future Directions Project is funding two trial services, and offers an established Sexual Abuse Counselling Service within its Department of Families, Brisbane. Funding to support adults who have been subjected to sexual violence receives the loose change at the bottom of the Government’s purse, and totally ignores adult males who have been sexually offended against.

The response for children and young people with sexualised behaviours is even more dismal, and they are often reliant on therapy from counsellors with no specialist training or skills in this field. The main therapy and expertise in Queensland for adults who have been sexually violent is often found within the prison system, the bottom line deterrent for sexual violence, where men can spend their sentences in total denial.

Within Queensland responses to sexual violence are minimal, and from a public health perspective focus mainly on limited tertiary prevention: working with individuals when sexual violence has already occurred.

Sexual violence is a crime that requires more than a judicial response; as a public health approach should decrease the likelihood that sexual violence will occur in the first place, then it will be complementary to the criminal justice approach, of dealing with violence after it has occurred.

Strategies developed must also focus on specialist responses required for those who are often the most marginalised within society, people with disabilities, Indigenous people and those from non-English speaking backgrounds.

My questions are therefore about best preventative practice in this field, focusing upon robustly researched programmes. Can comprehensive, integrated Services using a public health framework provide the most effective responses to the prevention of sexual violence?

A Public Health Approach
The ‘general’ public health approach to the prevention of disease aims to enable people to increase control over and improve their health, and involves working with the whole population, rather than just those at risk, or who already have the ‘disease’.

Primary prevention works to protect people’s health by building resources in people, increasing knowledge about the harmful effects of a particular factor involved with the disease, and removing the causes or harm that could lead to disorders. An example of this might be anti-smoking media campaigns.

Secondary prevention advocates for early detection and prompt intervention to correct departures from good health, and to reduce the duration of a health problem. An example of this might be breast screening in women over the age of 50 years.

Tertiary prevention uses measures to reduce long term impairments or disabilities and provides rehabilitation to enable early recovery. An example of this might be the ‘Heart – Start’ programmes for people who have been hospitalised for cardiac conditions.

Although sexual violence is very rarely a result of physical pathology, a public health approach to its prevention would ensure a comprehensive framework within which to provide an integrated response.

The Cost of Sexual Violence
Non-Monetary Costs
People who have been sexually violated may experience a variety of different responses which could include:

non-monetary1

 

non-monetary2

non-monetary3

non-monetary4

non-monetary5

Those people who have committed, or been convicted of sexual offences also will find their lives changed:

non-monetary10

non-monetary7

non-monetary8

non-monetary9

non-monetary10

 

Monetary Costs
Sexually violent acts against children (aged birth – 14 years) cost $71 Billion every year, or 61% of the cost of all violent crime associated with this age group
Sexual violence against young people (aged 15 – 24 years) costs $45 Billion every year, or 29% of the cost of all violent crime associated with that age group
The average cost of mental health care for a child sexual abuse victim is estimated to be $5,800.00.
(Minnesota Department of Health, 2000)
Every time a child is abused and the abuser is apprehended, prosecuted, convicted and incarcerated, it costs between $138,000.00 and $152,000.00. (Pithers, 1992).