Guidelines for Understanding and Managing
Sexually Problematic / Harmful Behaviours in
Residential Settings
Carol Carson and The AIM
Project
copyright 2010 carol carson
associates ltd
AIM: To develop confidence in understanding and
managing sexually problematic and harmful behaviours
in residential settings
Objectives:
•To provide information from research and practice
about why children and young people may engage in
these behaviours
•To provide a framework for initial assessments in
residential settings
•To provide information on understanding and
managing young people who are sexually exploited
•To consider ways of managing sexual behaviours on a
copyright 2010 carol carson
unit level
associates ltd
•To consider ways of managing sexual behaviours on an
individual level, including pattern mapping and stages of
managing risk, and suggestions for individual work
•To allow participants to reflect on their own practice
and to share practice with others and to develop action
plans.
copyright 2010 carol carson
associates ltd
What the Guidelines Cover
Part One
Section One – Information from Research and
Practice on understanding sexually problematic and
harmful behaviours
a) Under 10s
b) Adolescents
c) Adolescents with a learning disability
Section Two – Checklists to evaluate sexual
behaviours
Section Three – Managing Sexual Behaviours
a) Departmental Level
b) Unit Level
copyright 2010 carol carson
associates ltd
c) Individual Level
Section Four – Ideas for individual work
PART TWO
Form One – Admission Risk Assessment sheet
Form Two – Internal Residential Care risk and needs
assessment
Form Three – Detailed intra/inter agency planning
Form Four – Agreement/Contracts
Form Five – Recording Form
Form Six – Timeline/
Chronology
Sheet
copyright
2010 carol carson
associates ltd
Healthy
Harmful
Exploration
Intent to cause harm
Choice
Force/coercion/threats
Fun, Laughter
Distress, anxiety, shame,
No intent to cause harm
Planning/ Secrecy
No power differential
Persistent/ frequent
Periods of disinhibition
Compulsive/ Hard to
dissuade
Mutuality
Exploitation
Out of balance
copyright 2010 carol carson
associates ltd
Understanding Younger Children
•Lack of research and statistics
• Girls are also displaying these behaviours
• Healthy sexual development is disturbed or
disrupted either through abuse or highly
sexualised environments
•Their bodies may have become sexualised and
they are overwhelmed with feelings they cannot
comprehend
•Emotional and physical space violated leaving
feelings of anxiety, distress, anger related to sex
copyright 2010 carol carson
associates ltd
If not abused, but exposed to sexual information,
confusing messages and poor boundaries can also
create confusion, tension and anxiety related to sex
Other factors, unpredictable and unstable backgrounds;
violent or chaotic environments; little warmth or
empathy; sex paired with aggression or as an exchange
commodity
In general the sexual behaviours are a way of dealing
with intense negative emotions and sexual sensations
that may be overwhelming for them, and scary and they
may not have any positive ways in which to manage
them
copyright 2010 carol carson
associates ltd
Gil and Cavanagh-Johnson Continuum
Group One – Normal Sexual Exploration
Group Two – Children who are Sexually Reactive
Group Three – Extensive Mutual Sexual Behaviours
Group Four – Children who Molest
copyright 2010 carol carson
associates ltd
Understanding Adolescents
Adolescents make up approx 1/3of those convicted of
sexual offences. Many have distorted or stereotypical
views about relationships and sexual relationships in
particular
Reasons they engage in the behaviours is also to meet
internal needs; overwhelming anger, anxiety, fear,
loneliness etc.
Puberty means body changes, and hormones creating
intense sensations and emotions in their bodies
copyright 2010 carol carson
associates ltd
Media and peer pressure to be successful sexually
Not all adolescents who display these behaviours go on
to be adult sex offenders. Work now more holistic
looking at all aspects of their life; viewed as young
people with needs and social and developmental deficits
Factors from research and practice
Neglect & Emotional Abuse
Conduct disorder
Sexual Abuse
Other behavioural problems
Physical Abuse
Gender and Ethnicity
Social Inadequacies
Healthy and Harmful as for the Young Ones
copyright 2010 carol carson
associates ltd
O’Callaghan and Print Continuum
Normal Behaviours
Behaviours suggesting monitoring/ limited response
Behaviours suggesting assessment and intervention
Behaviours requiring a legal response, assessment and
treatment
copyright 2010 carol carson
associates ltd
Understanding Adolescents with Learning
Disabilities
Over represented in surveys eg 37%. Not more
harmful, more likely to be caught or admit to
the offence.
Autism – work ongoing about this
Similar routes into the sexual behaviour as the
others
copyright 2010 carol carson
associates ltd
Specific Factors
Klinefelters Syndrome
Lack of understanding about consent or impact on others
May not have mainstream concepts of social mores about
sexual boundaries
Lives more restricted generally; social contacts more
limited
Denial of appropriate sexual
education
copyright 2010
carol carson
associates ltd
Checklists for evaluating Behaviour
• Based on a continuum from Healthy to Harmful, with
eight areas (questions) all based on research and
practice
• Needs to be checked against all the areas to have a
balanced picture. Any gaps should provide a prompt to
seek the information.
• Assessment on partial information should be viewed as
temporary.
• Behaviour is likely to fall within one part of the
continuum or straddle two
• Where behaviour is placed depends on how many
answers are in each section
copyright 2010 carol carson
associates ltd
Pattern Mapping
Vital importance of good detailed recording and good
assessments which are shared ( Farmer and Pollock
1998)
Assessment is an ongoing process:
a) helps the child or young person see progress
b) ensures they do not get labels for life
c) Helps the group decide on whether the level of risk
has reduced
Key Questions
• What is the possible cause of the behaviour?
• What is the pattern of the behaviour?
• What is the meaning of the behaviour for the
child/young person?
• How motivated is the child/young person to work on
copyright 2010 carol carson
their behaviour?
associates ltd
Cause of the behaviour: Understanding facilitated by
good assessments
Pattern of the behaviour: Frequency,
increase/decrease, gaps, trigger factors, patterns leading
up to incidents
Meaning of the Behaviour: Linked to trigger factors
such as emotions; what do they get out of the behaviour;
how do they use the behaviour ie to control, intimidate
Motivation to Change Behaviour: how able are they to
talk about the behaviour, and how willing are they to work
on their behaviour and develop internal controls ( Miller &
Rollnick 1991)
copyright 2010 carol carson
associates ltd
Pattern Mapping
1st Stage: SW and YOT to compile chronology from files
of key events. Put into a timeline
2nd Stage: Pull all the past and current information on
sexually prob/harmful behaviours to provide a visual
reference. Put into a time line
If other significant behavioural problems eg. violence
then do a time line of these incidents as well
Put the time lines together and compare: Draw up
working assumptions
NB: Working Assumptions are just that, assumptions and
not facts
copyright 2010 carol carson
associates ltd
3rd Stage: Take the working assumptions and decide
how to check them out
a) Recording and monitoring
b) Direct work with the individual child/young person
c) Decisions around issues like contact/ rehabilitation
home
Make a plan which has measurable outcomes (short
and long term)
This helps to measure progress and whether or not the
risk is reducing
copyright 2010 carol carson
associates ltd
Managing Sexual Behaviours
•Departmental Level
•Unit Level
•Individual Level
copyright 2010 carol carson
associates ltd
The role of the worker
1. Stability, Security and Consistency
2. Individual time and attention
3. Emotional Literacy
4. Self esteem and Life skills deficits
5. Celebrating Achievement
6. Desexualise the environment
7. Culture of the Unit/role modelling
8. Good Recording
copyright 2010 carol carson
associates ltd
Individual Level – Managing Risks
1. Internal risk and needs form
2. Supervision and Monitoring
3. Honesty and Openess
4. Confidentiality vs Protection
5. Being part of the assessment process
6. Motivation to change
7. Taking responsibility for their past, present and future
behaviour
8. Work on their sexual behaviour
copyright 2010 carol carson
associates ltd
Individual Work – Ideas for Sessions
1. Getting Started – building up resources; coworking; making time; identifying needs
2. Planning the work – Focus and structuring of
sessions and examples
3. Ideas for sessions
a) emotional literacy; b) self esteem; c) functional
coping mechanisms; d) communication skills;
e) Relationship and social skills; f) problem solving
and decision making skills
copyright 2010 carol carson
associates ltd