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Winston Churchill Report

Winston Churchill Report

Report by Kathryn Prentice
2002 Churchill Fellow

Consent to study innovative models of child sexual abuse - Primary, Seconday and Tertiary Prevention Programmes

I understand that the Churchill trust may publish this Report, either in hard copy or on the internet or both, and consent to such publication.

I indemnify the Churchill Trust against any loss, costs or damages it may suffer arising out of any claim or proceedings made against the Trust in respect of or arising out of the publication of any Report submitted to the Trust and which the Trust places on a website for access over the internet.

I also warrant that my Final Report is original and does not infringe the copyright of any person, or contain anything which is, or the incorporation of which into the Final Report is, actionable for defamation, a breach of any privacy law or obligation, breach of confidence, contempt of court, passing-off or contravention of any other private right or of any law.

Signed: Kathryn Prentice

Acknowledgements

I would like to thank the Churchill Trust for the wonderful opportunity they afforded me to further my knowledge, skills and experience in this complex field of work.

Thanks to Councillor Denise Williams, Margret Watson, and especially to Merritt Ilatt for his support and encouragement.

Special mention to the Staff and Management Committee of the Bundaberg Area Sexual Assault Service, Queensland, Australia, who enabled me to take the time I needed to complete this study.

Many people were generous with their time and knowledge overseas. Particular mention to Mark Dalton, Coventry NSPCC in the United Kingdom. Thanks to Gail Ryan, Director of the Perpetration Prevention Programme, Kempe Children’s Centre, Denver, United States of America, for sharing her original thinking, and also her wonderful food stories, symbolic of all she works towards. Thanks to Yvonne Cournoyer, Stop It Now! Minnesota, USA, for being so generous with her knowledge and helping me to take the risk. Special thanks to Janis Bremer, who welcomed me not only into Project Pathfinder, Minnesota, USA, but also into her beautiful home, sharing both with great humour.

Finally thanks to Ron, Michael and Kevan, who make everything worthwhile.

Executive Summary

Kathryn Prentice,
Co-ordinator,
Bundaberg Area Sexual Assault Service,
PO Box 1206,
Bundaberg,
Queensland,
4670
Australia.

Phone: 07 – 4153 4299
Fax: 07 – 4153 4117
Email: This email address is being protected from spambots. You need JavaScript enabled to view it.

 


 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).


 

The Programme

PLACE ORGANISATION / PROJECT MAIN CONTACT
UNITED KINGDOM    
Coventry, West Midlands NSPCC Mark Dalton
Shrewsbury, Shropshire NSPCC ASOP Colin Watt
Black Country, 
West Midlands
NSPCC 
Black Country Project
John Taylor
Coventry Register Custodian Birgitta Lundberg
Stafford NSPCC 
Stafford Project
Fiona Richards
UNITED STATES    
Denver Colorado Perpetreation Programme 
Kempe Children's Center
Gail Ryan, M.A.
Denver Colorado Foster Care Project 
Kempe Children's Home
Heather Tausig, PhD
Denver Colorado Therapeutic Pre-School 
Kempe Children's Home
Lynette Disheroon 
Head Teacher
Denver Colorado Denver Children's Home Jerry Yager, Psy.D
Denver Colorado Foster Care Inirative 
Kempe Children's Home
Margaret Tulley 
M.S.W./L.C.S.W.
Denver Colorado Child Protection Team Andy Sirotnak MD
Denver Colorado Families First Joanne Blum
Larkspur, Colorado Emily Griffith Center Tony Hodes
Denver, Colorado Early Childhood Initiative Dr. Larry Edelman
Denver, Colorado Autism Clinic Judy Reaven, PhD
St.Paul's, Minnesota Adolescent Services 
Project Pathfinder
Janis Bremer, PhD
St.Paul's, Minnesota Adolescent Services 
Project Pathfinder
Dr. Mo Smith
St.Paul's, Minnesota Adolescent Services 
Project Pathfinder
Dr. Tim Wright
St.Paul's, Minnesota Adolescent Services 
Project Pathfinder
Julie Hanna, M.A.A.T.
Minneaplois, Minnesota Illusion Theater Karen Gundlach
St.Paul's, Minnesota Stop It Now! Yvonne Cournoyer
Minneapolis, Minnesota Sensibilities Inc. Cordelia Anderson M.A.
Minneapolis, Minnesota PACER Center Jennifer Basta
St.Paul's, Minnesota Injury & Violence 
Prevention Unit 
Department of Health
Amy Okaya M.P.H.
St.Paul's, Minnesota Minnesota Center for 
Crime Victim Services
Paula Weber

 

 

Primary Prevention
I chose to visit a number of organisations in the UK and the USA, which offered a wide range of primary prevention programmes.

The NSPCC and Stop It Now! engage in primary prevention by directing energy not only towards the general community, but particularly towards potential offenders, and send out the message that child abuse is a crime. Stop It Now! uses media campaigns to urge potential sexual offenders to reach out and seek help, and provides a phone in line to help them to take the first step towards stopping their abusive behaviours.
The N.S.P.C.C - United Kingdom
The NSPCC was founded in 1884 to protect children from abuse and neglect and to support vulnerable families, and today it remains the UK's leading charity specialising in child protection and the prevention of cruelty to children.

The NSPCC believes it has a moral responsibility to bring about changes that will put an end to child abuse. The NSPCC carried out an appraisal of its services, and it believes that cruelty to children can be eliminated in the UK.
In March 1999 the NSPCC launched it's ‘Full Stop' media campaign. This invites people of the UK and Northern Ireland to support the NSPCC in its aim of ending cruelty to children. It is working to increase communities awareness of issues surrounding child abuse, and to bring about changes in attitudes and behaviour towards children. The achievement of these goals relies on involvement of Organisations and individuals across all sectors of society, co-operating in five action programmes led by the NSPCC:

Protecting the Child
Child in the Family
Child in School
Child in Community
Child in Society

Real Children Don't Bounce Back. Media Campaign.

real-children

In March 2002, the controversial media campaign ‘Real Children Don’t Bounce Back’ Television Commercial was launched, on air for 60, 30 and 10 second formats. This was backed up by leaflets, a smart card, an improved website and billboard posters depicting the theme of the campaign and placed in major towns and cities across the United Kingdom. The film depicts a father being physically abusive to his son, which is a cartoon figure. The father hits, throws, shakes and stubs out a cigarette on his cartoon son. It culminates with the father throwing the cartoon son down the stairs where he lands behind a sofa. As the camera pans round the sofa, we see a real child laying on the floor, and on screen the words ‘Real Children Don’t Bounce Back’ appears with information to get help to prevent child abuse. Cartoon music is played throughout, and unlike real children, the cartoon characters bumps and bruises magically disappear. (NSPCC, 2001).

"Stop it Now", United States of America
Stop it Now! is a non – profit organisation, launched by Fran Henry in 1992, with the National Office based in Haydenville, Massachusetts. Fran’s beliefs were that individuals and society can change and challenge sexually abusive behaviours towards children. It is based on the premise that to prevent child sexual abuse adults need to be responsible for prevention, rather than children.
Since its inception, Stop It Now! has been testing a social marketing approach to preventing child sexual abuse. It aims to create long term and comprehensive social change through education, policy and research, to:

Develop awareness among people who are being sexually abusive or at risk of being sexually abusive to children.
Provide mechanisms for abusers and people at risk of abusing to stop the sexual abuse and seek help.
Work with families, peers, and people regarding methods to talk with those they know who may be sexually abusing a child.
Change the social, political, and public policy climate such as that child sexual abuse will be no longer tolerated.
Stop It Now! is based on US public health campaigns which have been successful in changing attitudes and behaviours related to such issues as drink driving, safer sex etc…

The program focuses on two main areas:

Changing the way target audiences deal with sexual abuse – moving the individuals awareness and behaviour from misinformation to meaningful action.
Working with the professionals who provide services or set policy for families who have experienced child sexual abuse to create policies that will encourage adults to take responsibility for their reactions.

Vermont

Findings:

1. Abusers will call for help:
Of the 657 calls received in the first four years, some of the findings were:

15% Were from abusers
50% were from people who knew the abuser and/or victim
The remaining 35% were made by agencies and requests for information.
The fact that people who abused called for help contrasts with society’s typical view that they will not seek help.

2. An increase in adults who can talk about sexual abuse:
There was indication of changes in awareness, in that the number of Vermont residents who could explain issues related to childhood sexual abuse shifted from 44.5% in 1995 to 84.5 % in 1999.

3. Adults need to develop better skills to stop abuse:
In 1995 27.5% of Vermont residents could name at least one warning sign of an adult/young person with sexual behaviour problems; in 1999 this had risen slightly to 38%

4. Abusers stopping the abuse:
Through interviews and surveys Stop It Now! Vermont, determined that:
118 people had voluntarily sought help for sexual behaviour problems
25 people had turned themselves voluntarily into the legal system
(Stop It Now! Report #5, October 2000)

Philadelphia
Since 1998, Stop It Now! Philadelphia has partnered with the Joseph J Peters Institute to launch Stop It Now! Philadelphia, with a focus on social marketing.

Minnesota
In 2002, Stop It Now! Minnesota commenced, and I was fortunate enough to spend two days with the Programme Director, Yvonne Cournoyer.
Stop It Now! Minnesota is based at Project Pathfinder, a non-profit public benefit corporation located in down town St. Paul, Minnesota. Their vision and mission is to prevent sexual violence and abuse by intervening at the earliest possible time. Yvonne had only been employed by Project Pathfinder for six weeks, but imparted a wealth of background information to me about Stop It Now!, and gave me an excellent induction into it’s operations. The National Office provides support to Yvonne with setting programme goals, technical assistance on program related issues, the sharing of useful strategies, and the development of media materials.

media-tools

 

community-action-tools

Yvonne outlined all aspects of developing a new Stop It Now! Site, and emphasised the importance of attracting FUNDING as a first, and getting initial ‘buy in’ from Government Systems for support of the concept of Stop It Now!
Yvonne had also recently been successful in gaining a funding grant from the Centre for Disease Control and Prevention (CDC) to further the aims of Stop It Now! Minnesota. The CDC is the US Federal Agency responsible for the prevention of health problems, and has been working on issues related to violence and public health for over fifteen years.

The Kempe Children's Centre. Denver, Colorado, U.S.A

kemp-centre

The Kempe Children’s Centre is based close to down-town Denver, dramatically set against the foothills of the Rocky Mountains. It is an internationally renowned research based organisation, and a thriving legacy to Dr C. Henry Kempe, one of the founding fathers in the field of child abuse, who described the ‘battered child syndrome’ in 1962.
It’s mission states "the Kempe Children’s Centre will provide and improve direct clinical services, improve clinical services delivery systems, and provide training, education, and consultation programs to prevent and treat child abuse and neglect in Colorado and throughout the nation"...
(Annual Report, 2001).

Many of the programmes at Kempe have implications for primary prevention.

Kempe Perpetration Programme

gail-ryan

My time at the Kempe Centre was based with Gail Ryan, M.A., Director of the Kempe Perpetration Programme. This programme not only works with young people who have sexually abused other children, but also continuously studies the dynamics associated with abusive behaviours, and factors that increase or reduce the risk of a young person going on to commit sexual offences as an adult. The programme is also the lead agency in the National Adolescent Perpetration Network, which facilitates communication between those people who work in this challenging field sharing knowledge and providing support.
During my two weeks at the Kempe Centre I worked with Gail to be accredited to provide three of her training curriculum. The first of these, ‘Understanding and Responding to the Sexual Behaviours of Children’ can be used with parents, professionals, and all those who have direct contact with children. It aims ‘to promote adult understanding of children’s sexual behaviour and to teach appropriate adult responses in order to be more aware and intervene earlier in the development of sexually abusive patterns’ (Ryan et al, 1988). The training promotes the development of healthy sexuality in children and young people, and offers an excellent model for primary prevention.

Kempe Community Caring Programme
One of the most well known primary prevention programmes is the home visitation programme, nurtured and developed by such visionaries as Dr Henry Kempe, and Dr David Olds, at the Kempe Children’s Centre. The original programme focussed on the use of universal home visitation programmes to help new families, and to provide support and education. Out of this has grown the Kempe Community Caring Programme. This has included providing home visitation to first time mums and their infants in Denver City, and provides education within the community to ensure the development of healthy mother-child relationships.

Families First
The Director of Families First is the inspiring Joanne Blum, who also had worked at the Kempe Children’s Centre. Families First is a Non-Government Organisation, based in the outskirts of Denver. The organisation aims to provide services that ‘strengthen family relationships before problems occur, before parents resort to terror and violence, before abuse and neglect’.
(Annual Report, 2001).

Some of the strategies used to reach these aims include:

Infant Massage Classes
Parent support and education groups. Workshops
A Family Support phone-in Line.
Structured Groups for Children
Families First also provides secondary and tertiary prevention within their Children’s Centre, a residential service for children in need of out of home care for intensive therapy.

Educating children, young people and adults about sexual violence, and how to respond to it is the most usual primary prevention strategy. The most common education programmes for children and young people are provided within public and private schools, and teach such skills as assertiveness, self-defence and saying ‘no!’ Many place the responsibility on the child, who is expected to protect themselves from bigger, more powerful young people and adults who are more cognitively skilled. They usually have a familiar relationship with the older person, who would be entrusted with their care.

I am concerned that prevention and education programmes for children and young people do not place the onus of responsibility for stopping abuse on the child or young person, but educate them about issues of abuse, and help increase their safety levels using exciting mediums to get messages across, rather than lectures and discussion based programmes. I was interested in programmes that would help children retain knowledge by being offered over time, rather than ‘one-offs’ and would also suit their differing developmental levels.

The Pacer Center, Minneapolis
The Parent Advocacy Coalition for Educational Rights Centre was founded in 1977 by parents of children and young people with disabilities to help other parents and families facing similar challenges. One of the ways they do this is by helping students, teachers and other educational professionals create accepting environments for students with disabilities.

The ‘Count Me In’ puppet show was developed for preschool and elementary aged school children to foster positive attitudes and acceptance of children with disabilities in their schools and communities. Such was the success of the programme that they developed the ‘Let’s Prevent Abuse’ Puppet shows in 1984 for children, their parents and professionals to create awareness and develop skills to prevent sexual, emotional and physical abuse. Since that time the puppet shows have been presented to over 80,000 students with excellent responses.

jennifer-basta

I was able to attend a puppet show with Jennifer Basta, the Puppet Co-ordinator during my time in Minnesota. Jennifer and two puppet volunteers presented the show to approximately 50 children. I was surprised by the puppets, which were the size of a five year old child. They are very cute multi-cultural puppets, with one girl puppet having a physical disability and requiring the aid of a wheel chair. The children loved the puppets, were very attentive, and interacted throughout the show with the puppets and the Jennifer, who was the show convenor.

The puppet shows:

Defined physical, sexual and emotional abuse
Discussed feeling of isolation and shame associated with abuse
Discuss how to talk about abuse, and
Looked at who children could tell (and tell) if they were abused.
Disclosures of abuse occur during and after the shows, and this did occur at the show I attended; there is a lot of pre and post show preparation by teachers, and also teachers and the School social worker are present at the shows if this occurs. Further action is then taken as appropriate.

illusion-theatre

The Illusion Theatre was founded in 1974 by Michael Robins, and aims to use the power of theatre, to facilitate personal and social change. It supports artists in their goal of producing new work that reflects a variety of cultural perspectives.

In 1977 the Hennepin County Attorney’s Child Sexual Abuse Prevention Programme and the Illusion Theatre collaborated to produce a nationally acclaimed sexual abuse prevention play. Since then the Illusion Theatre has developed an Education/Prevention Programme that works within society to address difficult issues, using theatre as an educational vehicle. The Illusion Theatre educational messages have reached an audience of over 3 million people world wide by incorporating the use of video and commercial television. I met Karen Gundlach, the Education Director, at the beautiful old theatre, to explore what the education programme could offer.

Their most exciting programme was the innovative TRUST Peer Education Programme. (Teaching Reaching Using Students and Theatre). This gives organisations the right to perform the Illusion Theatre’s educational plays within their own communities. Sites receive training, scripts, and direction from the Theatre Staff to enable High School Students to perform the plays for primary and high school students. Of particular interest were the four plays which focussed on sexual abuse and violence prevention.

Although primary prevention is often the area that receives the least funding, it is evident that there are numerous programmes that have been established, or are presently being researched, that offer great promise in this much neglected area of prevention.

Secondary Prevention
When we translate public health secondary prevention methods to sexual violence, then we begin to focus on interventions with individuals at risk. We want to detect and intervene early enough to minimise harmful effects, and provide support and therapy if required, when sexual abuse has already occurred. This would include improving the responses of adults to reports of disclosure by children and young people, whether they are parents, carers, or professionals.

Secondary sexual violence prevention must address the needs of those children and young people who are at risk of developing sexualised behaviours due to all forms of child abuse, those who have been in sexualised environments, and those who have been exposed to sexualised models of compensation. These groups of children and young people are usually over-represented in therapy programmes and foster care (Ryan,1997).

From a secondary prevention perspective, it also makes sense that if those people at risk of committing sexual offences can be identified before offending commences, and there is an understanding of what factors could motivate or influence someone to commit a sexual offence, then programmes that work towards alleviating these factors could be developed.

Identified risk factors include:

Child maltreatment and abuse, including witnessing domestic violence and sexualised environments
Being in out of home care.
Poor attachment with parents or other caregivers.
Violence condoned by society, for example, in the media.
The Kempe Theurapetic Pre-School
One of the most exciting secondary prevention programmes I visited was the Kempe Therapeutic Pre-school, which I was fortunate enough to participate in under the wings of Lynnette Disheroon, the Head Teacher. The Pre-school is based on the site of the Kempe Childrens Centre, and is a highly specialised therapy programme which works with disturbed three to six year old children who have been abused and neglected. The Pre-school offers a range of services, which supports children’s return or transition into regular pre-schools. The staff provide a safe, predictable environment that allows the children to develop trusting relationships, positive self-esteem and acceptable social interactions. Children who attend the pre-school may have a psychiatric diagnosis, but many do not.

The Pre-school runs for five days a week from 8:00a.m. – 12:00noon, and provides a healthy breakfast and lunch for the children. The average length of attendance at the Pre-school is three to seven months, and in the ten years of the Pre-school they have rarely had children return for further attendance. The children have daily sessions that focus on developing cognitive skills and feelings and managing conflict. They also receive therapy twice a week from the ‘Meeting Girls’, who are usually Psychologists on placement in the Pre-school. They focus on assessment and therapy, usually non-directive play therapy and cognitive behavioural therapy.

Kempe Infants in Fosterand Kinship Care
Another intervention which offers sound secondary prevention is the focus that Kempe has on providing services to children and young people in foster and kinship care, and supporting foster and kinship carers. I spent time with several professionals involved specifically in this area, where three main projects are being developed.

Dr Rob Clyman was passionate about the need to give foster children a voice on the policy table. He stated approximately 750,000 children were in foster care in the USA, 45% being infants and children. Millions of dollars have been spent on programmes that have been demonstrated not to work.

The Infants in Foster and Kinship Care holds great promise, and is a longitudinal research study. It offers services to every infant and child who enters foster care in Denver. It aims to have a demonstrated positive impact on the child’s developmental and mental health issues, reducing the need for interventions at a later stage and therefore easing psychological and emotional suffering, and the cost of expensive therapies at a later stage. I spent time with Margaret Tulley, M.S.W., who stated that their team was working with between one hundred and one hundred and twenty infants per year from age birth to eighteen months. Therapy was home based, and would be provided for the infant and carer, and if appropriate for the birth mother and baby.

Margaret also discussed a new project which has been funded initially for three years. This is a mental health project which places four clinicians in the District Health Service. They are available for consultation by case workers who are involved with children aged birth to five years, who are at risk. They may be at home, or in foster care. Training is also provided for foster parents, professionals, Judges and Attorneys, in fact anyone who might be involved with children at risk.


 

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