What to Do With Problematic Sexual Behavior in

What to Do With Problematic Sexual Behavior in Children & Youth Jamie Osborn MS & Kelly Hagenbaugh, LSW Property of Network of Victim Assistance and Edison Court

Introductions: Why do you want to learn about Youth with Problematic Sexual Behavior? Property of Network of Victim Assistance and Edison Court

Questions to be addressed • What is typical versus problematic sexual behavior in children? • How do we address problematic sexual behavior with kids, families, or as a professional or community? • Where do we send youth with PSB and their families for support? Property of Network of Victim Assistance and Edison Court

What’s the Big Deal with PSB • Historically, how have we viewed kids with problematic sexual behavior? • Child Offenders • What is the need? • 20 -25% of CAC • How have we intervened? • Offender treatment Property of Network of Victim Assistance and Edison Court

Dakota’s Story • Dakota is a 8 -year-old adolescent girl. She lives with her mother, father and two younger siblings in a single home in an affluent area in Bucks County, PA. Dakota’s father is physically abusive to her mother and occasionally hits the kids. Both parents work long hours trying to make ends meet. Dakota’s dad is a lawyer and her mother is a nurse. Dakota’s youngest brother is five-years-old and attends kindergarten. Dakota also has an six-year-old brother who attends the local elementary school. Dakota and her brothers stay with a babysitter after school until her parents come home from work. Dakota is often asked to assist with the care of her younger siblings when the babysitter is not available. • Dakota loves to write in her journal and is a wonderful student. She participates in tennis on Thursdays after school. • Dakota has a history of hugging and kissing peers. She has also been found to be touching herself in public as well as in her room at night. Dakota often watches you-tube and enjoys looking up her favorite songs. Dakota has walked in on her parents having sex several times but has never talk to them about it. • About one week ago, Dakota’s mother walked in on her performing oral sex on her six-year-old brother while her five-year older brother was in the room. Dakota’s mother immediately separated all of her children and proceeded to scream at them. After Dakota’s mother calmed down, Dakota admitted that this had occurred on multiple occasions. Property of Network of Victim Assistance and Edison Court

Understanding Childhood Sexual Development • Sexuality is more than sex • It includes our attitudes, values, feelings, interactions, and behaviors • Is emotional, social, cultural, and physical • How do infants and children learn to think about sexuality? • How do they interpret messages “Young people do not wake up on that will shape their future actions and attitudes? Ex. Consider what a parent tells their 3 -year-old child about nudity, and how it begins to shape norms and expectations Presentation property of Edison Court and NOVA, 2017 their 13 th birthday, somehow transformed into a sexual being overnight. Even young children are sexual in some form. ” -Heather Coleman, Ph. D. & Grant Charles, Ph. D. University of Calgary, Alberta University of British Columbia

Typical Sexual Development • • • Exploratory: Curiosity Spontaneous Intermittent By mutual agreement With child of similar age, size or developmental size Not accompanied by anger, fear Occurs throughout childhood. Becomes more concealed in school age children Occurs with children they know Accessibility Property of Network of Victim Assistance and Edison Court

How Does Problematic Sexual Behavior Relate to a Teen Brain? -Impulse control -Reward center -Not thinking of future consequences -Based off emotional responses Property of Network of Victim Assistance and Edison Court

Curiosity and Culture • Curious about the world • https: //youtu. be/j. U 2 Wz. Cj. Tk. F 4 Property of Network of Victim Assistance and Edison Court

Technologies Impact on Sexual Development • Devices • Smart phones, tablets, music players, gaming systems • Modalities • Texting/chatting/messaging, social networking, emailing, blogging etc. • Child Pornography vs. Youth Produced Images • Consider legal consequences (distribution of child pornography) • Adverse impact on child who appears in image/ long term consequences Presentation property of Edison Court and NOVA, 2017

Indicators Of Problematic Sexual Behavior • Harm: force, intrusive behaviors, elicits fear, intimidation, emotional distress • Frequency: Typical sex play happens every once and a while. Problematic is when it is at high frequency, or does not respond to correction • Developmental considerations: when there is disparity in age. Behavior interferes with daily functioning Property of Network of Victim Assistance and Edison Court

Dakota’s Story • Dakota is a 8 -year-old adolescent girl. She lives with her mother, father and two younger siblings in a single home in an affluent area in Bucks County, PA. Dakota’s father is physically abusive to her mother and occasionally hits the kids. Both parents work long hours trying to make ends meet. Dakota’s dad is a lawyer and her mother is a nurse. Dakota’s youngest brother is five-years-old and attends kindergarten. Dakota also has an six-year-old brother who attends the local elementary school. Dakota and her brothers stay with a babysitter after school until her parents come home from work. Dakota is often asked to assist with the care of her younger siblings when the babysitter is not available. • Dakota loves to write in her journal and is a wonderful student. She participates in tennis on Thursdays after school. • Dakota has a history of hugging and kissing peers. She has also been found to be touching herself in public as well as in her room at night. Dakota often watches you-tube and enjoys looking up her favorite songs. Dakota has walked in on her parents having sex several times but has never talk to them about it. • About one week ago, Dakota’s mother walked in on her performing oral sex on her eight-yearold brother while her five-year older brother was in the room. Dakota’s mother immediately separated all of her children and proceeded to scream at them. After Dakota’s mother calmed down, Dakota admitted that this had occurred on multiple occasions. Property of Network of Victim Assistance and Edison Court

What about Dakota? • What are some of the typical sexual developments that we saw with Dakota? • What were some indicators of problematic sexual behavior? • How would you respond if you were a parent? • How would you respond if you were the professional assigned to this family? Property of Network of Victim Assistance and Edison Court

Characteristics of Children with PSB • No distinct profile for children with PSB or clear pattern of demographic, psychological, or social factors • Both children or adolescents typically have distinctly different characteristics then adult sex offenders (i. e. power and control, deviant arousal etc. ) • Co-occurring diagnoses • Disruptive behavior disorders: ADHD, ODD • Trauma related disorders: PTSD, adjustment • Other internalizing disorders: depression/anxiety • Learning and language delays Presentation property of Edison Court and NOVA, 2017

Where does PSB come from? • • Modeling of Sexuality Modeling of Coercion Family Adversity Child Vulnerabilities Property of Network of Victim Assistance and Edison Court

Silovsky, 2015 Healthy boundaries supported & modeled Protection from harm & trauma Adaptive coping skills Successful experiences / skills Open communication about feelings with a trusted adult Supportiv e& Protectiv e Factors Parental guidance & supervision Healthy friendships

What about Dakota? • What are some of her protective factors? • How do you think she started to engage in problematic sexual behavior ? • How does Dakota’s behavior effect her family? Property of Network of Victim Assistance and Edison Court

How to Respond to PSB: Families and Professionals • Remain Calm- helps to understand it’s a behavior not the child you do not approve of. • • Make sure children are dressed and safe. Separate children (does not necessarily mean removing a child from residence). Remind children of rules that were broken. Possible consequence and problem solving with the child. Redirect behavior. Eyes on supervision. Reach out to a professional for support. Safety Planning Presentation property of Edison Court and NOVA, 2017

Safety planning • Provide caregivers with recommendations for safely supervising children with PSB • Examples from safety plans include: • Continuous visual supervision • Close monitoring of electronic devices, social media/internet use, gaming systems, etc. • Child should not be put in a role of authority over other children • Child should not enter other children’s bedrooms without continuous visual supervision • More at NCSBY. org (National Center on the Sexual Behavior of Youth) Presentation property of Edison Court and NOVA, 2017

Ways to Reduce Stigma • • • Avoiding shame-based labels Normalizing Instilling hope Providing helpful information Appropriate language: • • Child with PSB Child Actor Child with Behavior problems Child first language *Consider resources such as National Center on the Sexual Behavior of Youth (NCSBY) and National Child’s Alliance Presentation property of Edison Court and NOVA, 2017

Problematic Sexual Behavior has a Systemic Impact: • Parents, siblings, extended family • Family Structure • School • Community • Childcare • Job status • Financial • Family time • Relationships Property of Network of Victim Assistance and Edison Court

Current Challenges in the Field • Many states have no outpatient evidence-based services for children or youth with PSB • Rely on residential care that is expensive • Often uses adult models of treatment • Community detaches from youth • No family services or families not able to participate due to travel • Or ignore the sexual behavior of the child or young teen • “Boys will be boys” • Some youth worsen and escalate then the system responds

• Levels of Care Locked Secure Facility $ COST PER CASE $$$ Secure Residential Presentation property of Edison Court and NOVA, 2017 Residential Treatment Facility Transitional Programs Therapeutic Foster Homes Intensive Outpatient (RFP)

The Restoring Families Program • Created by professionals at The University of Oklahoma in conjunction with The Office of Juvenile Justice and Delinquency Prevention (OJJDP) • • • Restoring Families Program, A collaboration between Edison Court and NOVA Comprehensive Program for child actors, child victims and caregivers. Outpatient model Highly structured and interactive Directly addresses sexual behavior Rule-based learning experiences- Sexual Behavior Rules Uses parenting strategies Psycho-educational; Cognitive Behavioral Format Includes child and parent/caregiver components Property of Network of Victim Assistance and Edison Court

Key components of Program • • Psycho-educational Comprehensive: Child Actor, Family, Victim Directive Mutual support • Considerations made for parents who are divorced, foster and biological parents, etc. • Group Format • Learn from one another • Social support • Reduces shame Reunification if Needed Presentation property of Edison Court and NOVA, 2017

Most Effective Elements of Program • The elements that directly contributed to a decline in PSB and other behavioral problems • Caregiver practice elements • Behavior Caregiver Training • Rules about sexual behaviors and boundaries • Sexual Education • Abuse Prevention Skills • Child practice elements • Self control skills Presentation property of Edison Court and NOVA, 2017

Research on Program Effectiveness • 10 year follow-up data on CBT for PSB • Carpentier, Silvosky, & Chaffin (2006) • Long-term follow up • ATSA funded student research • 10 -year follow up on children with PSB (ages 5 -12) • Control group: Children with disruptive behaviors seen at same time and same location • Administrative records from Child Welfare, Juvenile Court, and Oklahoma State Bureau of Investigations • Subjects • 54 CBT for PSB group therapy • 64 Dynamic Play therapy group • 156 Comparison- Disruptive behavior disorders • Similar ages and races (more males than females) Presentation property of Edison Court and NOVA, 2017

Research Contd. • Children with PSB treated in PSB-CBT group showed a 2% sexual recidivism rate as adolescent or adult • General clinical comparison-3% sexual recidivism rate as adolescent or adult • Children with PSB in Play therapy group- 11% sexual recidivism rate as adolescent or adult • In other words, children with PSB who were provided with short- term CBT had future sex offense rates that were both very low and indistinguishable from those of the comparison group (children with common non-sexual bx problems such as ADHD) Presentation property of Edison Court and NOVA, 2017

Community Risk without Intervention • Lack of psycho-education promotes continued boundary • • • issues and inappropriate modeling. Increased recidivism rates. Trauma symptoms Isolation from peers and pro-social activities = increased criminal activity. Stigma Adjudication Sex offender registry • employment, residency, school participation, relationships. Property of Network of Victim Assistance and Edison Court

Take a Minute… • Take a minute… • How might this information help you engage with Dakota’s family in a different way? • Things to remember: • Protecting each child does not =resistance • Watch your language • Stay calm, listen Property of Network of Victim Assistance and Edison Court

Family Feedback • • • “ Thank you! This Program is a long overdue blessing. ” “ This program should be in all schools. ” “My child love coming here and will be sad for group to end. ” “ I love my counselors they have helped me a lot. ” “ This is a safe and nonjudgmental place. I felt so alone and confused, but coming here has made it easer. ” • “ This is one of the first places where I feel like people aren’t judging me. ” Presentation property of Edison Court and NOVA, 2017

Questions? Resources: www. ncsby. org http: //www. nationalchildrensalliance. org/psb Property of Network of Victim Assistance and Edison Court

“ In this process we need to make sure we do not forget that these are our children. ” Barbara Bonner Property of Network of Victim Assistance and Edison Court ”

References • National Center on the Sexual Behavior of Youth (NCSBY) • Office of Juvenile Justice and Delinquency Prevention (OJJDP) • Center on Child Abuse and Neglect, University of Oklahoma Health Sciences Center • • • The National Child Traumatic Stress Network (NCTSN) National Sexual Violence Resource Center National Children's Alliance (NCA) Contact us: Jamie@novabucks. org kellyh@novabucks. org Presentation property of Edison Court and NOVA, 2017