SHAPE: A review of a group-based intervention for sexually harmful male youth

Introduction

N JUNE 2015, there were 11,490 individuals in prison having received an immediate custodial sentence for a sexual offence. 99 per cent of these were male, and making up 15.8 per cent of the total prison population at that time. These figures represent a continued increase in sentences for sexual offences (Ministry of Justice, 2015). As up to half of adult sexual offenders disclose that they committed their first sexual offense during adolescence (Abel et al., 1993; Knight & Prentky, 1993; Rasmussen, 2004) more needs to be achieved with this population in order to prevent sexually harmful behaviour in adolescents, both convicted and un-convicted.

In the US, sexually harmful adolescents account for 12.5 per cent of all arrests for rape, and 14 per cent of all arrests for other sexual offences (United States Department of Justice, 2009), whilst Miner (2002) found that adolescents commit at least 15 per cent of all reported sexual offences in the US. In the UK in 2013 and 2014, 1653 children and young people aged 10–17 were convicted of a sexual offence (Youth Justice Statistics 2013/2014, 2015). UK studies suggest that 25–30 per cent of all reported sexual abuse involves young, mainly adolescent perpetrators (Cawson et al., 2000; Horne et al., 1991; Kelly et al., 1991; Morrision, 1999; Prentky et al.; 2000), and placed the recidivism rates for young people who have sexually abused at 3–14 per cent. Though as the self-reporting versus actual conviction data is being reported as 25:1 (Elliott et al., 1985) it is likely that the recidivism rate is actually much higher. Although children account for a minority of those who commit sexual offences their presence is established on the professional ‘map’ within the UK (Hackett, 2004), and this along with the reported recidivism rates highlights the needs for interventional work with this age group. Previous research has also found that adolescent sex offender interventions appear to be more successful than those with adults (Kim et al., 2015), again underlining the critical need for more intervention with this group.

Adolescent sexual offending is defined as a youth who ‘commits any sexual act with a person of any age, against the victim’s will, or in an aggressive, exploitative, or threatening manner’ (Geradin & Thibaut, 2004, p.79). There is a drive towards more evidence

based approaches within health and social care services (Sheldon & Chilvers, 2000) in order to create effective interventions. The report of the National Task Force on Juvenile Sex Offending (1993) suggested that the goal of interventions should be community safety. Becker and Hunter (1997), however, adopted a broader view, putting forward three main treatment objectives when working with sexually abusive adolescents; preventing further victimisation, stopping the development of further psychosexual problems, and helping the young person develop age-appropriate relationships with peers.

A review by Hackett et al. (2003) found a large degree of agreement about the core intervention goals of UK based service providers who work with young people who have sexually abused. Within the review a consensus was found on the importance of four core intervention goals: To help young people understand and accept responsibility for their behaviour, and to develop strategies and coping skills to avoid abusing or offending again. To promote the physical, sexual, social, and emotional wellbeing of children and young people who have sexually harmed or abused. To ensure community safety, and to prevent further sexually abusive behaviours and further victims, as well as for carers to acknowledge what their child has done. Finally, to believe in, and support change, and to take responsibility for changing the context of the family. These goals take into account not just the child, but also the wider family, highlighting the importance of working with parents and carers in order to provide the best outcomes for the child.

When working with children and young people who sexually abused (Hackett et al., 2003) highlighted the importance of developing interventions for children rather than simply adult sex offender models adapted for young people. They state; ‘Children who display sexually harmful behaviours are first and foremost children, and should not be regarded as mini adult sex offenders’ (Hackett et al., 2003). A result of this notion is that the highly challenging and emotionally demanding methods traditionally used in the treatment of adult sex offenders has been replaced with a strong call for childfocused and holistic interventions, thereby targeting both abuse specific areas as well as more generalised areas of unmet need (Hackett, 2004).

Reported intervention approaches when working with children who have sexually abused vary greatly, with Chaffin, Letourneau and Silovsky (2002) noting approaches from behavioural conditioning, ‘cycle’ based approaches, to ecological multisystemic approaches. Whilst there is a wide range of intervention approaches on offer within the UK and North America the preference is for an intervention that is loosely based on a cognitive behavioural model (Masson & Hackett, 2003, Burton & Smith-Darden, 2000). The cognitive behavioural approach to treatment of children who sexually abuse is the belief that abusive behaviours emerge as a result of inappropriate and maladaptive thinking and beliefs (Hackett, 2004). As such, this approach focuses on the attitudes of the young person as well as changing beliefs, identifying risk situations, and developing strategies to manage such situations.

During the development of approaches for intervention with sexually abusive children, there was recognition that approaches that focus exclusively on sexually abusive behaviours were somewhat limited in value (Righthand and Welch, 2001). Instead, approaches should also be supported by attention to enhancing the young person’s broader life skills, addressing social isolation, opening up access to appropriate opportunities in the education system, and addressing family difficulties. There is however, divided opinion on the effectiveness of such approaches, with Chaffin et al. (2002) pointing out there is an absence of any published studies that compares outcomes for adolescent sex offenders randomly assigned to treatment conditions, and as such, making it impossible to empirically demonstrate the effectiveness of intervention. Others however, suggest that those who complete a cognitive-based intervention approach have lower recidivism rates (Worling & Curwen, 2000).

Interventional work should focus not just on the problematic behaviours but also on helping young people develop their strengths and developmental competencies, and as such resilience approaches fit well in this area of intervention (Hackett, 2004). The aim of such an approach is to identify ways in which identified factors can be developed or bolstered in children who have experienced significant adversity in their early lives. This would have relevance as an intervention with young people who have sexually abused others, whose levels of self-esteem are frequently low, and those who as a result of their abusive behaviours are often managed and controlled in a manner that limits their life opportunities, as well as undermining their capacity to set their own goals and determine their future (Hackett, 2004).

Group-based approaches have previously been suggested as the preferred treatment modality for young people (National Task Force on Juvenile Sex Offending, 1993), and for sexually abusive behaviours. These group-based approaches can offer a level of peer support to an often otherwise isolated group, and afford opportunities to challenge each other where appropriate. There has been little empirical support for the use of such a modality previously (National Task Force on Juvenile Sex Offending, 1993; Hackett et al., 2003) and therefore there needs to be continuing evaluation of groupbased approaches; something that this study aims to address.