1. Carol Carson and The AIM Project
Guidelines for Understanding and Managing Sexually Problematic / Harmful Behaviours in Residential Settings
Carol Carson and The AIM Project
copyright 2010 carol carson associates ltd

2. 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 unit level
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3. copyright 2010 carol carson 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

4. What the Guidelines Cover
Part One
Section One – Information from Research and Practice on understanding sexually problematic and harmful behaviours
Under 10s
Adolescents
Adolescents with a learning disability
Section Two – Checklists to evaluate sexual behaviours
Section Three – Managing Sexual Behaviours
Departmental Level
Unit Level
Individual Level
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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
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Healthy Harmful
Mutuality Exploitation
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
Out of balance
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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
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8. 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
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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
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10. 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
Media and peer pressure to be successful sexually
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11. copyright 2010 carol carson associates ltd
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
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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
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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
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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
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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
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Pattern Mapping
Vital importance of good detailed recording and good assessments which are shared ( Farmer and Pollock 1998)
Assessment is an ongoing process:
helps the child or young person see progress
ensures they do not get labels for life
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 their behaviour?
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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)
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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
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3rd Stage: Take the working assumptions and decide how to check them out
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
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Managing Sexual Behaviours
Departmental Level
Unit Level
Individual Level
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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
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Individual Level – Managing Risks
Internal risk and needs form
Supervision and Monitoring
Honesty and Openess
Confidentiality vs Protection
Being part of the assessment process
Motivation to change
Taking responsibility for their past, present and future behaviour
Work on their sexual behaviour
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Individual Work – Ideas for Sessions
Getting Started – building up resources; co-working; 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