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Winston Churchill Report

 

Healthy Futures Programme
The third project I looked at was Healthy Futures, and Heather Tausig, PhD, the Program Director was generous with her time and information. This research project uses comprehensive assessments, mentoring/advocacy and skills groups to work with children between the ages of nine and eleven years in foster care placements in Denver County, over a nine month period. It's aim is to enable positive development and reduce risk behaviours of children who are in foster care placements due to abuse and neglect. The project also includes work with the foster and kinship carers, and where appropriate the birth parents.

Finally, secondary prevention of sexual violence needs to address those children with sexualised behaviours, and those young people who have began to be sexually abusive towards others.

Research indicates that adolescents make up a significant percentage of those who commit sexual offences (Abel et al, 1993), and if there is a risk, no matter how small, that these children and young people could go on continue these behaviours into adulthood, when behaviours become more entrenched, then it is imperative they are addressed at the earliest possible stage.

As I was not interested in therapy per se, having been involved in it's delivery for a number of years, my interest was in the range and context in which therapy was provided within the community for this group of children and young people and to identify from this, possible gaps in Queensland's response.

A continuum of care is essential to allow interventions that are more or less restrictive as required, and which allow offence specific strategies to be more or less specific within a basic concept of ‘abuse is abuse' (Bengis, 1997).

I was able to observe a care continuum in the UK and the USA, which provided:

  • Therapy for children and young people living at home.
  • Therapy for children and young people in "out of home" placements.
  • Residential Therapy Programmes
  • Locked Residential Therapy Programmes.

Although I chose not to visit secure facilities in Detention Centres and Hospitals I did spend time at the Emily Griffith Centre in Larkspur, Colorado, which has a locked facility.

Therapy for Children and Young People Living at Home and in "Out of Home" Placements

Kempe Perpetration Programme
The Kempe Perpetration Programme is the smallest of the Departments at the Kempe Children’s Centre, and is particularly interesting as perpetration prevention is a relatively new idea in the field of sexual violence. The programme works with youth within the context of ‘abuse is abuse’, which recognises that children and young people are more at risk of re-offending in non-sexual ways than sexual ways, particularly after therapy, therefore the focus needs to be on living a non-abusive life-style, as well as being offence specific.

During my placement with Gail Ryan at the Kempe Centre, I participated in a week long training which specialises in this mode of working with young people who have committed sexual offences, and also received training to deliver the training modules:

Therapeutic Care
Informed Supervision
Project Pathfinder, St. Pauls, Minneasota
I spent two weeks based at Project Pathfinder, under the wings of Janis Bremer, PhD, who is the Director of Adolescent Services. Pathfinder is a non- profit making organisation, and it provides a comprehensive community therapy programme for children, adolescents and adults with sexualised and/or sexually abusive behaviours. Assessment and evaluation for court, individual and family therapy are all offered at Pathfinder for clients. There is a comprehensive range of group therapies offered, and I particularly liked the focus for multi-cultural clients, and clients with learning disabilities.

Groups Included

  • Children's Goal Orientated Groups
  • The Healthy Sexual Boundaries Group
  • The Family Experience
  • Hispanic Families Rebuilding Strength
  • Behaviour Management Group
  • Cambodian Group
  • Sexual Offences Group Programme
  • Practice-based Group for Youth with Learning Difficulties
  • Process-based Group
  • Generalised Harm Group
  • Emancipation Group
  • Hispanic Inclusive Group
  • The NSPCC, United Kingdom
  • The NSPCC provides funding for fifteen ‘Young Abuser’s Teams’ throughout the UK, and although the name does not appeal, their concept is well developed. The teams provide a specialised service, which involves risk assessments, individual and group therapy, court reports and case conferences.

 

The Shropshire Model
In the mid 1980’s in Shropshire County it was identified there was a need to provide a response to children and young people with what was defined as ‘sexually harmful behaviours’ as there was a dearth of such services. A reference group, including the local Social Services, thus began to develop the ‘Shropshire Model’.

In 1992 the National Children’s Home survey looked at what services were available for children with problematic sexual behaviours, and the Shropshire Model was identified as a potentially effective strategy for targeting resources towards. Slowly resources increased, and in 1998 a partnership was developed between the NSPCC and the Local Authority, the NSPCC providing the day to day management and the Shropshire and Telford Social Services providing Social Workers and resources. Gradually the NSPCC has developed more services, and I also spent time at the Staffordshire Project and the Black Country Project. The Staffordshire project has developed through the NSPCC, Social services and the Youth Offending Service, thus promoting the three key principles in the Department of Health’s ‘Working Together to Safeguard Children’, 1999:

That there should be a co-ordinated approach on the part of Youth Justice, Child Welfare Agencies and Health,
That the needs of children and young people who abuse others should be considered separately from the needs of their victims,
That an assessment should be carried out in each case, appreciating that these children may have considerable unmet developmental needs, as well as specific needs arising from their behaviour


Residential and Locked Residential Therapy Programmes

denver-home

The Denver Children’s Home (DCH) is the oldest non-profit organisation in Colorado, and it provided the first day therapy centre in Denver. It is a huge rambling building, housed in a leafy Denver suburb. It was originally built as an orphanage, and over time their mission has changed to provide a therapeutic safe place for emotionally distressed children, adolescents and their families to heal and grow. DCH enrols more than 500 children per year in it’s residential and outpatient programmes, and also provides therapy for 1200 family members, in an attempt to stop the traditional cycle of abuse and neglect. By the time they reach DCH, a third of all children and young people will have been involved with the Juvenile Justice system, and most would have passed through Social services. Within DCH there is a ‘Short Term Diagnostic Unit’, which specialises in providing assessment services to children and their families. The ‘Long Term Treatment Program’ is tailored towards youth with a variety of complex problems, and Jerry Yager, the Director of Residential Services estimated approximately 15% would have sexually offended. Children in this category would participate in the Kempe Perpetration Program, as well as in-house therapies. The latest addition to DCH is Discovery Home, which is a transition home where eight young people live together with support in a family environment as a stepping stone to independence.

The Outpatient services include:

  • The Day Treatment Program, which has been developed to meet the needs of children who are not thriving within a traditional school environment
  • The After School Program, which provides intensive counselling for children with severe emotional and behavioural problems
  • The Intensive In-home Program provides counselling for families their home to help provide a stabilising force in families overwhelmed with mental health issues, substance abuse, neglect and physical and emotional abuse

The Emily Griffith Center, Larspur, Rocky Mountains

 emiliy-griffith-center

equestrian-programme

The remaining boys would have a variety of mental health, behavioural and social issues. A large number of them would be classed as adjudicated sexual offenders according to U.S. Law, and may be on the sex offender register. A lesser number would be non-adjudicated. The average length of stay could be up to three years, and the boys live in mountain lodges, with a lot of thought put into ages, offences, physical size etc… There is a TLC facility for those who require care within a locked facility. All residents attend school, and individual, group and family therapy takes place at Emily Griffith, which includes the innovative ‘Trails to Trust’ equestrian program. In learning to care for and be responsible for the horses, the boys begin to develop empathy, maintain relationships and improve their own communication skills. The social functioning of the herd, and mare-foal interactions help them gain an understanding of trust and boundaries in relationships. The boys are then encouraged to transfer their skills to day to day life by the Centre Staff.

The Centre also makes use of the local environment, and often youth will be involved in wilderness experiences which could mean month long camping trips, biking, back packing – all are goal oriented and aim to increase empathy, safety and intimacy within the groups. Emily Griffith also places a priority on giving to the community, and participates in many programs, including highway clean ups, landscaping, to as far as taking three llamas to visit residents in a Nursing Home!

Tertiary Prevention
Tertiary prevention involves working with children, young people and families when sexual violence has already occurred and traditionally it has been the usual response to addressing the issues of sexual violence.

The UK and the USA both demonstrate a wide range of statutory and non-government services that work with those children, young people and their families who have been sexually violated. There does not appear to be a particularly co-ordinated approach to the provision of such services however in either country.

Similarly, there are many more services available in both of these countries that work with adult males who have committed sexual offences, and with a wider range of options across the care continuum.

Conclusions
I was privileged to be able to visit some centres of excellence in the area of child sexual abuse prevention, and would have to say that the NSPCC provided one of the most comprehensive models in terms of primary, secondary and tertiary prevention, although no one organisation provided a totally comprehensive range of services to address the issues of sexual violence.

At the present time, Queensland provides a good response for women who have been subjected to sexual violence within its twenty seven (27) services funded by the Sexual Assault Support and Prevention Programme, Queensland Health. However, this does not provide a response for children or males who have been sexually assaulted, and there is a very poor response for those children and young people with sexualised and sexually abusive behaviours.

Queensland is in a fortunate position to be able to now develop a comprehensive response in this area, by funding services to address issues of sexual violence within a comprehensive, integrated model.

This model however would need to be sensitive to what is already working; it would need to ensure that women centred service environments are maintained, and that overall services remain sensitive to the needs of those who have been sexually assaulted, for example, services for adults who have been sexually abusive would not be provided in the same building as those who have been abused.

Within Queensland, primary and secondary prevention must now become a focus for funding bodies, if any real impact is to be made on the tragic number of children who continue to be sexually abused every day.

Recomendations
That sexual violence is declared a public health, as well as a criminal issue, and that funding be provided to reflect the seriousness of this vast criminal, social and health issue.

That Government Departments which are key stakeholders in addressing the issues of sexual violence, eg. Health, the Department of Families, the Department of Police and Community Corrections, etc… fund a discrete, Department of Sexual and Family Violence, and develop best practice policy to address these important issues.

That comprehensive, integrated models of service delivery are developed to address sexual violence, using a public health model of primary, secondary and tertiary prevention, in order to provide models of prevention, as well as intervention, and that these are replicated throughout the State.

That a continuum of care approach be developed, to include at least one specialist residential centre for those children and young people who require higher levels of supervision than what could be reasonably provided within a local community.

Stop It Now! will provide Australia with a unique opportunity to eliminate childhood sexual abuse using a social marketing approach, and providing a phone in help line not only for children, young people and families where sexual abuse has occurred, but also for use by those people with sexualised and sexually abusive behaviours.

The author recommends that prevention programs for children and young people are offered as part of the school curriculum, including developmentally appropriate sex education that promotes knowledge, use of language, and healthy sexual behaviours and beliefs; this would need to be offered at various times throughout a child’s education, expanding the breadth of information given as the child progresses developmentally. At the same time prevention education would be offered for teachers and parents.

That the funding bodies continue to ensure universal programmes are provided to families, to build the resilience and protective factors required for first line prevention against sexual violence.

Applications
A few days after commencing this Study, I was notified that my place of employment, the Bundaberg Area Sexual Assault Service, had been granted funding under the Queensland Government's Future Directions Initiative, to trial a sexual abuse service for children and young people.

As a trial exploring innovative practice, we have been fortunate to be able to begin adapting and applying some of the programmes I visited within an Australian context.

These include:

The 'Future Directions' Therapeutic Pre-School.
Fostering Healthy Futures - A Therapeutic and educational programme for children and young people in 'out of home' care, their foster and kinship carers.
The 'Lets Prevent Abuse' Program is being developed following the release of the four puppets from Australian Customs!
Funding is currently being appied for to enable the Illusion Theatre to visit Queensland and develop TRUST sites within the Australian context.
The Training Programs developed within the Kempe Perpetration Programme are available now within Queensland.
In addition to the above, the following are further ways my learning will be made available to others:

All information and resources gained from my study are located at the premises of the Bundaaberg Area Sexual Assault Service, Bundaberg, Queensland.
This report will be made available through the Service's Web site at http://cwppb.slq.qld.gov.au/basas as well through the Winston Churchill Memorial Trust of Australia.
A paper on the study will be presented at The 2nd conference on domestic and Sexual Violence to be held in Queensland, Australia in 2003 and at further appropriate Conferences and Workshops.
'Stop it Now!' (Queensland) has commenced operation as a project of the Bundaberg's Area Sexual Assault Service.

References
Mercy, J. Having new eyes: Viewing child sexual abuse as a public health problem. Sexual Abuse: A Journal of Research and Treatment, Vol. 11, No. 4, Pgs 317 – 321, 1999. Plenum Publishers, New York.

Ryan, G. in Juvenile sexual offending: Causes, Consequences and correction. Editors Gail Ryan and Sandy Lane pg 450 Jossey – Bass Publishers, San Fransisco.

Bengis, S. (1997). Comprehensive service delivery with a continuum of care. In G. Ryan & S. Lane (Eds.), Juvenile sexual offending: Causes, consequences and correction. pp. 211 – 218. San Francisco: Jossey-Bass.

Department of Health, Home Office & Department for Education and Employment (1999). Working together to safeguard children. London: The Stationary Office.

Freeman-Longo, R.E. & Blanchard, G.T. (1998). Sexual abuse in America: Epidemic of the 21st century. Vermont: The Safer Society Press.

Kempe Centre (2001). Annual Report. Denver: Kempe Centre, University of Colorado Health Sciences Centre.

Mercy, J. (1999). Having new eyes: Viewing child sexual abuse as a public health problem. Sexual Abuse: A Journal of Research and Treatment, 11, (4), 317-321.

Minnesota Department of Health (2000). A Place to start: A Resource Kit for Preventing Sexual Violence. Minnesota: MINNCOR Industries, Minnesota Department of Health Facilities Management and Support Document Centre.

NSPCC (2001). The full stop campaign. London: NSPCC National Centre.

Ryan. G. (1997). Perpetration prevention. In G. Ryan & S. Lane (Eds.), Juvenile sexual offending: Causes, consequences and correction. pp. 433 – 454. San Francisco: Jossey-Bass.

Ryan, G., Blum, J., Sandau-Christopher, D., Law, S., Weber, F., Sundine, C., Astler, L., Teske, J., & Dale, J. (1988). Understanding and responding to the sexual behaviour of children: Trainer’s manual. Denver: Kempe Centre, University of Colorado Health Sciences Centre.

INDEX
ACKNOWLEDGEMENTS
EXECUTIVE SUMMARY
INTRODUCTION
A PUBLIC HEALTH APPROACH
THE COST OF SEXUAL VIOLENCE
STUDY PROGRAMME
PRIMARY PREVENTION
SECONDARY PREVENTION
TERTIARY PREVENTION
CONCLUSIONS AND RECOMMENDATIONS
APPLICATIONS
REFERENCES