Adolescents who sexually offend: What do you need to know?

Adolescents who sexually offend: What do you need to know?

WORKING WITH YOUTH WHO SEXUALLY OFFEND & THEIR FAMILIES Sara Jones PhD, APRN, PMHNP-BC [email protected] A LITTLE ABOUT ME FIRST My Background Education Practice Research

AND NOW THE AUDIENCE CHILD SEXUAL ABUSE (CSA) CHILD SEXUAL ABUSE & YOUTH WHO SEXUALLY OFFEND Over 58,000 cases reported in the US (2014) 42%-80% of adult offenders: sexually deviant interests & offenses began as adolescents

Juvenile sexual offenders account for approx 30% of sexual abuse cases against SO WHAT? A deeper understanding of juveniles who sexually offend (JSOs) will: Strengthen our abilities to provide Appropriate assessment & monitoring Effective treatment & management Assist in disrupting the cycle of abuse Ultimately. It will aid in the prevention of

child sexual abuse! OBJECTIVES Review juvenile sexual offending per AR law Understand who JSOs are Explore explanatory models & typologies of juvenile sexual offending Identify assessment tools available to

help predict risk of recidivism Discuss sex offender-specific treatment approaches & available programs in AR Discuss current research: Exploring brainbehavior relationships of JSOs AR STATUTORY REFERENCES TO SEXUAL ASSAULT AR 5-14-101 RAPE AR 5-14-103 A person commits rape if he: Engages in sexual intercourse or deviate sexual activity with another: By forcible compulsion* Who is incapable of consent Who is <14 yo

If victim is <18 years old & actor is: Guardian, Other family >3 years older CONSENT BY VICTIM NOT A DEFENSE SEXUAL ASSAULTS AR 5-14-103 First degree: State worker, professional, or person in place of trust/authority Victim <18 yo,

actor >3 years older Second degree: Actor is teacher, victim is student <21 yo Actor is <18 yo, victim is <14 yo Third degree: Actor is <18 yo, victim is <14 yo 3 years older If victim <12 yo, actor 3 years older

If victim >12 yo, actor 4 years older JUVENILE SEX OFFENDER ASSESSMENTS & REGISTRATION AR 9-27-356 Court may order sex offender screening & risk assessment if: (>13 yo) Adjudicated for: Rape, sexual assault 1 or 2, Incest Engaging children in sexually explicit conduct for use in visual or print medium Any offense with an underlying sexually motivated component

Not automatically required to register! Prosecution may file request Assessment team may make recommendation Adam Walsh Child Protection & Safety Act (2006) JUVENILE SEX OFFENDER REGISTRATION AR 9-27-356 Factors considered for registration: Seriousness of offense, Level of planning & participation, Previous sexual offenses Protection of society Availability of facilities/programs to rehabilitate Sex offender assessment, including mental,

physical, educational & social history Can NOT consider juveniles refusal to admit Approximately 10-15% required to register (AR) Juvenile can petition to be removed at any time while in courts jurisdiction or upon turning 21 Remains on list for 10 years if no other offenses SO, WHO ARE THEY? Juveniles who sexually offend (JSOs):

Less likely to have deviant sexual fantasies or arousals Do not meet the criteria for sexual predator or pedophilia as designated by the DSM-V Are more responsive to treatment (adolescence) Few (5%) demonstrate the same long-term tendencies to commit sexual offenses as adult sex offenders Non-sexual recidivism rates are higher for JSOs than adult sex offenders Strangers; 7.00% SO, WHO ARE THEY?

Aquaint.s; 59.00% Modus Operandi (MO) MOs can change Babysitting Incest (opportunities), friends, strangers Play, coercion, forcelying/manipulation is frequently part of their MO The Cycle- Victim to Victimizer Not approach most often used

all victims become sexual abusers General Delinquency Family Members; 34.00% ONE EXPLANATION: VICTIM TO VICTIMIZER JSOs with personal history of sexual victimization Multiple studies with varying rates, 0-86% Meta-analysis of 50 studies of JSOs: Data included 9,957 JSOs Sexual victimization rate = 42.72%

Residentially placed youth = 54.9%. THE CYCLE OF SEXUAL ABUSE Many of sexually abused sexual offenders repeat what was done to them There are similarities between: The relationship of the youth to their perpetrator(s) & to their victim(s) The gender(s) of their perpetrator(s) & their victim(s) matches The MO of their perpetrator(s) & their victimization(s) Acts of their perpetrator(s) & the acts they committed against their victims

(significance=.05) THE CYCLE OF SEXUAL ABUSE Sexually abused JSOs compared to sexually abused juvenile delinquents, JSOs will: be more closely related to their perpetrators be more likely to have been sexually victimized by a male perpetrator have a longer duration of sexual victimization

have been subjected to more forceful sexual victimization not be younger at the time of their sexual victimization be more likely to have experienced penetrative acts during their victimization (significance= .05) ANOTHER EXPLANATION: GENERAL DELINQUENCY Factors associated with general delinquency:

Antisocial personality traits, Conduct problems Pro-criminal attitudes & beliefs Substance abuse Association with delinquent peers Adolescents with these traits- higher recidivism rates, including all types of offending Sexual offending tends to be one instance along a trajectory of criminal history (Progression) When re-offense occurs, crimes thereafter most

likely to be non-sexual in nature GENERAL DELINQUENCY Many JSOs also have a history of multiple non-sexual offenses More criminogenic environments Starts younger & lasts longer However Non-sexual juveniles offenders: Have more extensive criminal histories than JSOs

Score higher than JSOs on measures of conduct problems, such as disruptive behaviors, fighting, truancy, & substance abuse OTHER ETIOLOGIES* Poor childhood attachment (Bowlby) Social incompetence Atypical sexual interests Impaired cognitive abilities Psychopathology (?) ULTIMATELY, ETIOLOGY IS MULTIFACTORIAL!

TYPOLOGIES: CLASSIFICATIONS Classification methods: Victim age Age 10 / 12 or younger Offender-victim age discrepancy Victim 5 years / 4 years younger Combination of both

Victim is peer or adult No more than 2 years difference, or older Mixed offenders Multiple victims, no apparent age discrepancy THOSE WHO OFFEND AGAINST CHILDREN Greater psychosocial functioning deficits lack

of confidence more anxiety or depression view themselves as socially inadequate fear ridicule & are rejected by peers less aggressive offense, less likely to use a weapon less likely to be under the influence more likely to offend against a relative Due to social deficits with peers, they are drawn to develop relationships with younger children less force since a relationship is already established THOSE WHO OFFEND AGAINST PEERS/ADULTS*

More aggressiveness when offending More antisocial traits Hostile Masculinity & Egotistical-Antagonistic Masculinity Use more coercion & force More likely to have more extensive criminal hx Sexual offenses happen with other delinquent acts Sexual offending is an opportunistic offense with little or no planning

Victims are more likely female acquaintances rather than relatives Correlated with higher prevalence of exposure to domestic abuse towards women & community violence ASSESSMENT Essentials Who, what, when where, how NOT Why???!! This is the point of treatment Calm, clear, slow, quietly

Confirming & disconfirming information Warm, genuine, open, non-judgmental approach Timing of questions, speed of questioning, note taking/ recording Questions DETAILS of their sexually abusive behavior Definition of abuse may not be shared! How did they get the victim to? Progression? Fantasies, timing, frequency, content, relationship to abuse

Normal sexual experience? ASSESSMENT: CLINICAL JUDGMENT VS. EMPIRICALLY-GUIDED JUDGMENT In recidivism studies of JSOs: empirically-guided judgment of risk can be more effective than clinical judgment alone Usually there are not set rules for totaling

scores Specific probability of reoffense cannot be determined by total score Assessment tools Empirically guided Actuarial (validated) Assessments TOOLS FOR ASSESSMENT Used to: Predict risk of recidivism Guide development of individual interventions &

treatment plans Determine level of supervision required for monitoring Properly inform others involved in risk management process Conducted: After offense occurs Intermittently through treatment or following significant life eve Upon completion of treatment Assessing need for registration ESTIMATE OF RISK OF ADOELSCENT SEXUAL OFFENSE RECIDIVISM

ERASOR (Worling & Curwen, 2001) Purpose: to assist evaluators to estimate the risk of sexual re-offense for individuals ages 12-18 Includes risk factors of adult sexual recidivism Despite differences, it was assumed that some information regarding sexual & interpersonal functioning would overlap

Designed to assess risk for short-term periods, at 6 months Not intended to predict long-term risk Dynamic & Static risk factors JUVENILE SEXUAL OFFENDER ASSESSMENT PROTOCOL J-SOAP-II (Prentky & Righthand, 2003) Purpose: to guide the assessment of risk,

needs, & outcomes expected from each adolescent Originally designed to be a good measure of impulsive, aggressive, conductdisordered behavior Contains several questions that relate to general recidivism versus sexual recidivism Not for changes over time in treatment JUVENILE SEXUAL OFFENSE* RECIDIVISM RISK ASSESSMENT TOOL J-SORRAT-II (Epperson, Ralston, Fowers &

Dewitt, 2005) Purpose: to bring greater accuracy and utility to risk assessments specifically for male adolescents who sexually offend Considered it necessary to limit application of adult risk factors associated with sexual offending in adolescent assessment tools To better facilitate placement, programming, & supervision of the adolescent Differ state-by-state OTHER ASSESSMENTS Risk Treatment Grid

Need to assess non-sexual recidivism as well! Risk assessments for General Delinquency YLSI/CM: Youth Level Service Inventory/Case Management Version SAVRY: Structured Assessment of Violence Risk in Youth TREATMENT APPROACHES Cognitive-behavioral therapy Psychoeducation Trauma Therapy Relapse prevention model

Good Lives Model Motivational interviewing Group therapy Social Skills training Multisystem therapy Family therapy COGNITIVE-BEHAVIORAL THERAPY* Socratic Questioning & Cognitive Restructuring

Correct cognitive distortions related to sexually inappropriate behaviors to elicit change Psychoeducation Basic social & legal rules regarding appropriate sexual behaviors & relationships Trauma Therapy Understand trauma- effects on behavior Alter cognition & emotions paired with abuse

Pathways: A Guided Workbook for Youth Beginning Treatment (Kahn, 2001) RELAPSE PREVENTION MODEL* Risk-Need Model Confront & admit offense Identify circumstances that triggered offense Identify consequences Develop empathy Goal: Learn to cope with

triggers to prevent reoffense Self-Regulation Model (Ward & Hudson, 1998) Multiple pathways leading to offense & relapse Considers developmental stage of adolescents Focuses on strengths, enhancing life & maintenance FOCUS ON STRENGTHS & ENHANCING LIFE??? Primary Goods: Knowledge

GOOD LIVES MODEL (Ward, 2003) Excellence in work & Focuses on developing a balanced, prosocial personal play identity Friendship by utilizing strengths to attain goals All human beings are goal-directed & seek primary goods Communit to attain a fulfilling life y Problematic behaviors are a result of using inappropriate means to achieve antisocial goals in attempt to gain the Spirituality primary goods ASOs lack abilities & resources to adaptively pursue primary Happiness goods & use maladaptive strategies instead

Creativity Treatment: highlight strengths, focus on interests & adapt to living situation to enhance overall well-being MOTIVATIONAL INTERVIEWING A client centered, directive technique method for enhancing intrinsic motivation to change Preby exploring & resolving ambivalence. contemplation Express empathy (Rogers) Develop discrepancy Contemplation Elicit

change statements from client Roll with resistance Determination Resistance vs. Non-compliance Action Attacking ambivalence can increase resistance Maintenance Support self-efficacy But do NOT accept denial Relapse

GROUP THERAPY Yaloms key group factors Altruism, Universiality, Sharing information, Instilling hope, Role modeling Peer confrontation Role play Social Skills Training Regulating affect, assessing intention, encouraging engagement, & interpreting

verbal & nonverbal cues MULTISYSTEM THERAPY* What role does family play? JSOs vs. non-sexual offenders: JSOs have more family criminality & mental health problems, more parental substance abuse & selling (Burton & Duty, 2006) FAMILY THERAPY JSOs treatment effectiveness is improved up to 75% when a childs family (or other support system) is directly involved in treatment What if the victim is a sibling?

Treatment: Education, roles, apologies, communication Family norms? Key role in relapse prevention BUT IS TREATMENT EFFECTIVE? Study of 4,724 adult male SOs; 15 year follow-up 76% not charged with or convicted of another sexual offense Meta-analysis (2002) 43 studies, n=9,454 Recidivism rates: 10% treated 17% untreated

BUT IS TREATMENT EFFECTIVE? Meta-analysis of JSOs (2006): 9 studies, n=2986 Sexual recidivism rates: 7.37% treated 18.93% untreated TREATMENT FACILITIES IN ARKANSAS

Family Treatment Program (ACH) Arkansas State Hospital (inpatient unit) Piney Ridge (NWA) Youth Villages (Memphis) Consolidated Youth Services (Group home, Jonesboro) Transitional Homes Arbor House Margie House (Pine Bluff) Simple Solutions (Memphis) Correctional Treatment Facilities Arkansas Juvenile Assessment & Treatment Center (Alexander) Dermott Youth Services (ages 18-21) ALSO IN ARKANSAS

Association for the Treatment of Sexual Abusers (ATSA)- Arkansas Chapter Sexual Abuse Management (SAMs) Teams Central Arkansas Reentry Coalition Multidisciplinary team of professionals at judicial level which monitor & manage each case of sexual abuse involving ASOs Assist people in making the transition from confinement, incarceration, probation & parole to living a productive & meaningful life as members of society Arkansas Time After Time

An independent legislative advocacy group dedicated to making communities safer by raising awareness about sex offender laws CURRENT RESEARCH Exploring neural correlates of empathy & emotion regulation in juveniles who sexually offend: An fMRI study Using functional neuroimaging (fMRI) to explore the relationships between sexual victimization & juvenile sexual offending in adolescent males Study Aim: To define the shared & unique neural processing correlates that mediate core constructs in victims & offenders WHAT PEAKED MY

INTEREST Adolescent girls with & without hx of assault Assault exposure associated with significantly greater activation of neural network responsible for fear & increased severity of PTSD sx Adult women w/ exposure to early life stress (ELS) Neural connection patterns with ELS & resiliency Adult males with cocaine dependence

Decreased neural activity in regions responsible for impulse control Adult women w/ PTSD, treated Repeated Exposure to Traumatic Memory, based on a fear extinction model Tx engaged & modified connectivity pathways of neural regions implicated in fear extinction OTHER RESEARCH RELATED TO SEXUAL ABUSE

Trauma victims- greater activity in regions responsible for emotion & salience processing regions, & less activity in regions for executive function & cognitive control regions Adult pedophiles: Possible development of abnormalities in the temporal & frontal regions of the brain, which are responsible for sexual arousal & behavior inhibition EMPATHY & EMOTION REGULATION Exploring 2 core constructs found to be significantly impaired in JSOs & considered to be foci of treatment: *Empathy *Emotion regulation

Incorporated into tx & used to evaluate outcomes Assessed when classifying risk of recidivism But, still controversial. No objective methods to assess effective treatment Difficulty with follow-up to evaluate recidivism BUT WHY USE FMRI??? Neuroimaging provides a means to objectively assess & identify core neurobiological deficits that are specific to each individual Are empathy & emotion regulation truly deficient in JSOs? If so.neuroimaging could be used to:

Help assess risk of recidivism Evaluate treatment efficacy Promote the development of interventions that can be tailored to address personal core deficits If JSO demonstrates an intact empathetic response, but is deficient in emotion regulation, tx would focus less on empathy & emphasize emotion regulation skills STUDY POPULATION Juvenile males, ages 12-20 3 groups: Control (-/-) Non-victimized JSOs (-/+) Victimized JSOs (+/+)

JSOs from ASH, CYS @ Jonesboro, & AJATC Total: 53 FMRI Resting task Social empathy task Emotion regulation task EMPATHY TASK Whole-brain Comparison Analysis No significant differences (p<.05, corrected*) in clusters of activation between Controls vs. JSOs or JSO+ vs. JSORegions of Interest (ROI) Analysis

A voxel-wise one-sample t-test across the entire sample revealed several clusters of activation significantly related (p<.05, corrected*) *Minimum cluster size: 65 voxels *Clusters identified closely correspond to regions canonically implicated in theory-ofmind: TPJ, posterior cingulate cortex, medial PFC, dorsomedial PFC, etc. t = 5.00 t = 2.67 t = -2.67 t = -5.00 ROI ANALYSIS

No significant differences (p<.05 corrected) in clusters of activation between Controls vs. JSOs or JSO+ vs. JSO No differences observed when controlling for age & ethnicity (ps>.07 uncorrected) No differences when testing # of victims, length of offending, or PTSD symptoms (ps>.1 uncorrected) *Empathize vs. Watch *Empathize vs. memorize EMOTION REGULATION TASK Whole-brain Comparison Analysis: Significant differences (p<.05, corrected) between Controls vs. JSOs & JSO+ vs. JSOControls vs. JSOs JSOs demonstrated:

Less engagement in the ventral visual stream (A) Greater engagement in the temporal parietal junction (TPJ;B) *JSOs actively attempted to recruit attention & orient to the task emotionally; used lessCenter visual identification while trying to Cluster of Mass Contrast Peak t Coordinates do so Region size (# voxels) Negative

View vs. Reapprai se BL ventral visual cortex Left TPJ X Y Z 423 -6.32

-3 -65 -21 121 5.90 -58 -22 27 105 4.31

55 -28 32 (BA 40) Right TPJ (BA 40) EMOTION REGULATION TASK JSO+ vs. JSOJSO+ demonstrated: Greater engagement in the right ventral visual cortex (C) Less engagement in the right middle frontal gyrus (D), right anterior insular cortex (E), & left middle temporal gyrus (F)

*Required greater cognitive demand, but increased difficulties with salience processing & inhibiting negative emotions^ Contrast Region Negative View vs. Reapprai se C: Right ventral visual cortex (BA Cluster size (#

voxels) Peak t Center of Mass Coordinates X Y Z 125 9.32 22 -74 23

104 -8.78 41 3 40 96 -6.58 41 16 0

31) D: Right middle frontal gyrus (BA 6) E: Right anterior insular cortex (BA 13)^ SO WHAT?

Empathy Previous literature is conflicting re: the presence, extent, & type of empathy deficits in JSOs Findings support the lack of significant difference in affective & cognitive processing of general empathy Emotion Regulation JSOs tried harder to focus on the task & their emotions, but used didnt use as much visual processing to do so JSO+ (again) cognitively tried harder, but still were less able to inhibit/regulate negative emotions fMRI: An additional means to assess & identify core neurobiological deficits that are individual-specific? REFERENCES

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EXPERIENCES Child Sexual Abuse: Who is Affected? Siblin gs Why Parents??? While there may be commonalities across parent responses, we must listen, ask questions, & learn from each parent with whom we work. Research consistently finds that to best help the child, we need to support the parent . (McCurley & Levy-Peck, 2009) Victims: Who are they?

85% of child victims never tell, or delay telling until adulthood Difficulty of disclosure is dependent on relationship to perpetrator It takes tremendous courage to tell When a child decides to tell, its usually to a Parent. As a parent #1- Believe the child Stay calm & steady Re-establish safety Free the child of self-blame Do not interrogate the child Report immediately & Get help

I forget.. Wait a minute. Something yucky happened. Its a secret. Im not supposed to tell. As a parent, DO Allow the child to lead the discussion Answer questions to the best of your ability Help the child maintain a normal routine. Routine helps children feel safe & settle anxiety Control your own emotions. Your reactions could make the child feel guilty for upsetting you Allow the criminal justice system to work

Encourage the child to the story in her/his own words I am glad you told me, thank you. You are very brave and did the right thing. It wasnt your fault. I am proud of you for telling me. DONT Ask probing questions Respond negatively to the abuse with such comments as, How could you be so stupid? or Why didnt you try to stop it? Try to ignore the incident; deal with the disclosure. Support the child, report the

incident, and get them the help he/she needs. Threaten to harm the perpetrator. If the perpetrator is a loved one, the child may still love him/her Along the way Respect childs privacy Do not make promises you cant keep Let him/her talk about it at his/her own pace Try to resume normal life Dont dismiss your childs feelings- no matter the time frame! Dont label or have unrealistic expectations Talk to siblings about the situation Understanding the child. Parents will wonder what the child is feeling #1- the experience is individualized

Fear of the perpetrator That no one will believe them What will happen next Guilt & shame Feels responsible for the abuse Guilty about upsetting the family Ashamed of positive physical sensations Understanding the child. Confused & conflicted Who to trust Protective and/or loving towards the perpetrator Regrets having told; may even take back the disclosure May assume mom/dad knew all along Hope & relief

The burden of secrecy has been lifted While Parents may feel Anger Rage towards the perpetrator Betrayed, deceived & manipulated Towards the child for not telling sooner Guilt & Shame Self-blame for not having seen what was happening Unable to protect the child How others will view you as a parent Parents may feel Shock & Disbelief Hard to accept May search for other explanations Out of Control Overwhelmed

Unable to protect Frustrated with the legal system Parents may feel Fear About how the child will be affected Fearful about the family's future Loneliness & loss Grieving the loss of the life had, or thought to be had, before disclosure of the abuse Isolation Dont let the trepidation of tomorrows take away from the needs of today. * When the perpetrator is a loved one Ambivalence Initial response- belief

Latter response- disbelief Spontaneous, natural defense, emotional response to traumatic events Contradictory Feelings- Allegiance ? Guilt/shame for loving or caring about the perpetrator Concerned about the consequences for the perpetrator Towards Service Providers Parents feel: Profoundly frustrated by the way theyre treated Disrespected & disregarded Unsupported & blamed Not good enough

Told what NOT to do, rather then what to do Implications for Practice When both the father & mother accompany the child to the hospital, the child scored as having less psychopathology.. Having more than one stable caregiver is a powerful buffer to the stress & abuse. Implications for Practice Be an advocate Provide resources Provide competent representation Use strength-based approaches

Instill hope & power Teach them how to teach their children PARENT S Perpetra What about the parents tor of the perpetrators? Juveniles commit approximately 30% of sexual assaults against children in the US Parents describe the event as unlike any other family crisis Initial Discovery of the Offense One of three responses follow: Acceptance of the offense, with intent to help the

child Denial of the offense, with refusal to accept it occurred Acknowledgement of the offense, accompanied by anger & rejection of the child Feelings about Self Good parent Bad parent Parents experiences It can be like something has died and gone forever. Conviction & Sentencing Inpatient treatment Outpatient treatment 24/7 sight sound supervision We dont even need to bring up how [CPS] treats us.

History of person sexual victimization Relationships Family and Peer Groups Child that offended When can I trust my child again. After this has happened? Sexual Relationships Professional Feeling of out of control with treatment provider With society It feels like going around with a label on you. Like other people can see whats going on in your head and what has happened. Family Support of the Adolescent Sex Offender: The Parents View Pilot Study (2008) Purpose: To examine family support provided to the adolescent who has sexually offended while he is in offenderspecific treatment

Qualitative Study- Individual Interviews Being There The interaction between parent & child How the parent provides support to the child Includes 3 factors: 1) The parent is in a constant state of providing love & moral support 2) The parent maintains expectations of the child & acknowledges his responsibilities in treatment & in life 3) When the child opposes the court orders or treatment plan, the parent holds him accountable & renders consequences Parents aspirations for the childs future Parents want their child to not only get through the program, but also become a functional adult & a good person

Parental toll Feelings of frustration, anger, & personal defeat Occurs as a result of the prescribed treatment & the interaction with the child Affects the relationship with the child Parental Toll >>> Study #2 What is the lived experience of parents of adolescents who have sexually offended? The Experience: I am a survivor The initial reaction Relationship with the child Dealing with it I am a survivor THE INITIAL REACTION Disbelief He did not admit to it at first. And that there caused a lot of

stress on meIt made it a whole lot worse. So thats, forever so long, I blocked it out. I bet I blocked it out for 5 months. Making up Excuses He was an 11-year-old boy and the testosterone hit and he didnt have any other coping skills. He knew what he had seen. He knew what had been done to him and thats what he acted out. So I dont want to feel like I make excuses for him, but thats just kind of the way I see him. Hes a very gentle soul. Alone There is no coping to deal with that. There was no outlet. There was no support. Nothing. I asked through the courts, I asked through here, I asked through other therapists that he was going to what kind of support was out there, and theres just no one. Ashamed

Judged But I was still embarrassed knowing that it happened to me. Taking Responsibility There was a period of time where we assumed that, we had felt strongly that he was being sexually abused somewhere down the line. If we would have just intervened earlier. They looked right at my kid like he was nothing but a monster, as somebody that couldnt get help. Ill never forget the way those people looked at my son. RELATIONSHIP WITH THE CHILD Anger Questions

Hopes I literally wanted to strangle him. When I first found out, I had literally severely punished him as far as spanking. And I think I was letting my anger out, which was very wrong. I think I almost hated him. [It was] hardening, if that makes sense. Then I felt nothing. It was my son, but I think I almost hated him to the point that I didnt want nothing to do with him. When he wasnt progressing in therapy and youve got to sit there and ask the therapist in dealing with him, are we talking about psychopathic here? Is it possible that hes not ever going to get past this? Is it possible? Do I need to look into that issue? A lot of what you envision for [your] child to be, the future that you see for your child, because now its altered and what you had hoped for them, what you had wished for them.we have to grieve for what our hopes had been.

DEALING WITH IT Need Information Telling Effects on Family Overwhelmed Knowing how to get him medical care, knowing how to request things, knowing how to get the right treatment. What treatment options are available for different locations that are available? [It] just requires a lot of research on your partsadly I did just what I knew and I started asking questing and started to my own research. Because one person finds out in a small school, everybody knows. And its almost like hes a sitting target in that school. Thats what Im afraid of.

We all worked together to avoid contact. We have a big extended family, so we get together several times throughout the year, so we usually end up leaving before anyone came, so it wasnt obvious to the rest of the family. I think the hardest part is just that the initial shock and thats kind of how you operate in shock one you find out, once youre notified that your child has offended, it is numbing, you go on auto-pilot, and you just kind of function and you get done the things that you need to get done. I processed this real slowly. I am a Survivor Yes, [it has] affected every area my life, but I have survived. What dont kill you only makes you stronger. Hold your head up. There is a light at the end of the tunnel. And its not the end of the world and that they will survive. Its going to be hard. Its going

to be very hard. But just hold your head up. And boy! I am a survivor! How do they cope? Coping with the initial response Coping with feeling responsible Coping with feeling alone & overwhelmed Benefits from Treatment Coping with the Initial Response Hardening. If that make sense. I felt nothing. It was my son. But I think because I almost hated him to the point that I wanted nothing to do with him, because of the embarrassment, the failure on my part. But it wasnt me. I realize that now There was numbness, like blocking out my son. I hate to say it, but almost wishing I didnt have him to cause me this pain. Talking to him. Not shutting him out. Not talking to him, for sure, but just talking with him, seeing how things are going with him. Just let him know that I am there to support him and that everythings going to be all right.

Coping with Feeling Responsible Knowing that Id done everything I possibly could and that I cannot control his every movement. Whether Im there with him or not, I know I cannot control him because hes going to be sneaky. Kids are going to be sneaky. But just knowing that I cant control it. And that I just had to quit feeling sorry for myself I guess. Coping with Feeling Alone & Overwhelmed After the disclosureI came away and I would ask, so what? What am I supposed to do with this? I dont know what to do with this... Just to have someone to process through with, an impartial party, or someone that can just listen. If you know that you could just call in the middle of the night if you needed to, because your brain doesnt

shut down. Pray. Just pray. All I can do. Pray every single day to get them through it because without God, it aint going to happen. Benefits from Treatment Parents Support Groups Parent is no longer alone Provides information Demonstrates the ability to survive the experience Individual Sessions Specific to that parents needs Allows parent to vent & ask questions When the roles overlap Sibling Sexual Abuse

Most common type of intra-familial CSA Greater degrees of coercion & violence Occurs over longer period of time More likely to involve penetration 46% more likely Compared to 28% extra-familial, 13% peer/adult Overall, increases impact on victim Victims Less likely to disclose when perpetrator is a sibling 14% vs. 50% when perpetrator is an adult Independent of level of force or coercion Greater ambiguity Trauma & neglect >> disrupted attachment & neurological changes

Victims less likely to marry More likely to have a violent partner Families No specific family types or parenting styles correlated with sibling sexual abuse Individual characteristics of the offender Many view SSA as normal childhood exploration The accountability acxiom (Welfare, 2008) What caused this to happen? Family response remains critical for recovery! Responses: Attempts to support both children Support victim & neglect perpetrator Support perpetrator & not believe victim Deny abuse even happened Interventions

Typical response: Remove perpetrator from the Home Focuses on Victim Loss of family unit Less effective for perpetrator Alternative Approach A Balancing Act (Keane, Guest & Padbury, 2013) Systematic approach #1- Safety Safety planning: partnership between parents & statutory bodies Equally consider the needs of both the victim & the perpetrator Joint work with all family members >> safe environment >> family healing

Promotes both/and approach vs. either/or approach Crucial for complete reconciliation & reunification For the Victim Must be able to process the experience: at an age-appropriate level & understand who is responsible Understand possible ambiguity Process feelings of shame/blame Dont let experience define life Address adverse impact of abuse- in all arenas Address possible future contact with offender: maintain sense of physical & emotional safety Apology/ restitution from offender For the Perpetrator Discuss & disclose abuse: at age-appropriate level & accept responsibility

Understand the influence & motivation for the behavior; able to manage in the future Demonstrate understanding of impact of the abuse Address other possible behavior problems (ex. Aggression) Able to communicate views & needs to parents For the Parents Able to accept abuse occurred & support both children Hold perpetrator accountable for his/her behavior Establish home environment that promotes physical & emotional safety Support changes that are necessary for healing Strength of parental unit >>> significantly influences childrens conduct References Hackett, S. (1988). Facing the future: A guide for parents of young people who have sexually abused. Lyme Regis, Dorset: Russell House Publishing Ltd.

Heiman, M. (2001). Helping parents address their childs sexual behavior problems. Journal of Child Sexual Abuse, 10 (3), 35-57. Keane, M. , Guest, A. & Padbury, J. (2013). A balancing act: A family perspective to sibling sexual abuse. Child Abuse Review, 22, 246-54. McCurley, J. & Levy-Peck, J. (2009). Working with nonoffending caregivers of children that have been sexually abused. Research & Advocacy Digest, 10 (5). Usher, K., Jackson, D., & OBrien, Louise. (2007). Shattered dreams: Parental experiences of adolescent substance abuse. International Journal of Mental Health Nursing, 16, 422-30. Walker, D., McGover, S., Poey, E., & Otis, K. (2004). Treatment effectiveness for male adolescent sexual offenders: A meta-analysis and review. Journal of Child Sexual Abuse, 13 (3/4), 281-293. Welfare, A. (2009). How qualitative research can inform clinical interventions in families recovering from sibling sexual abuse. ANZJFT, 29(3), 139-47.

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