1. ‘Working with Adolescent Girls who Display Sexually Harmful Behaviour’ Sharron Wareham Social Worker/Research Practitioner

2. Introduction to the Taith Service  Established in 2000  Specialist service for children and young people with harmful sexual behaviours, (8-21 years)  Dedicated staff team and expert consultancy  Work with circa 120 young people per year  Over 1000 referrals  The Taith Service accepts referrals across Wales

3. Girls with Sexually Harmful Behaviour  Work with circa 120 young people per year  13% referral rate Taith (2012/13)  Big Innovation lottery funding 2012/15

4. Girls with Sexually Harmful Behaviour Incidence and Prevalence  Approx. 5% of adult sexual offences committed by women (Cortoni and Hanson, 2009)  Males (c.f. females) considerably more likely to report being sexually abused by female (Finkelhor, 1990)  Aprox.30% of all sexual assaults committed by predominantly male, adolescents  2%-11% of sexual assaults against children estimated to be committed by female adolescents (Roe-Sepouliz and Krysik, 2008, Vandiver, 2010).

5. Girls with Sexually Harmful Behaviour Issues  Under reporting, social meaning of gender, role expectations inconsistent professional responses (Frey, 2010)  The lack of a gender specific analysis of patterns of female SHB (number and type of victims), motivational types and how different motivations are expressed by girls as opposed to boys  Lack of gender specific standardised measures and assessment tools normed on girls  Consequent lack of means to target risk factors, measure treatment change and conduct risk assessments.

6. What do we think we know about girls and SHB?  Own sexual victimisation may be higher GIRLSBOYSSTUDY 96%70% Hickey et al, 2008 64%50% Kubik et al, 2002 72%50% Miccio-Fonseca, 2000 78%43% Mathews et al, 1997 100%63% Bumby and Bumby, 1997

7. What do we think we know about girls and SHB ?  Trauma, PTSD more prevalent-impact on mental health  Relational development is important  Parental, particularly maternal relationship may be key  Exposure to domestic abuse, leads to negative beliefs about self and relationships

8.  Early maturation, risk of increased sexualisation/exploitation  No one single motivation to offend  ADHD/conduct problems more likely to be undiagnosed  Relational or other aggressive behaviour present

9. One size does not fit all!  Like adult male, adult female and adolescent boys, girls who display SHB are a heterogeneous group  Assessment should be about this girl with good case formulation  Although… there may be some common risk and protective factors

10. Taith Service information for girls and boys STATIC Unchangeable factors in a young person’s life DYNAMIC Factors that are changeable over time N=78 girls N=658 boys

11. Static factors

12. Dynamic factors

13. Referring Agency

14. Assessment suggestions  Offending behaviour - victim (s) age, relationship, motivation, nature of behaviour  Own victimisation - what, by who, how long, believed at disclosure, messages gained - sexual attitudes  Conduct/behavioural difficulties - aggression, lying, stealing, vandalism, truancy, exclusion  Relational development/identity - socially adequate, friends, supportive adults, family dynamics, self esteem, emotional loneliness

15. Assessment suggestions  Current co morbid diagnosis e.g. depression, PTSD, ADHD, conduct disorder  Parental relationship/modelling  Access to situations that increase risk  Early maturation, risks of own exploitation  Sexual Knowledge  Engagement, help them feel liked

16. Girls Measures Self esteem (Thornton, 2008) Emotional loneliness (Russell et al,1980) General empathy (Davis, 1980) Children and Sex (Beckett, 2001) Victim Distortion Scales (Beckett et al, 2012) Social Sexual Desirability (Unpublished) Novaco Anger Scale (Novaco, 2003) Alcohol and Drug use Trauma Checklist (Briere,1992) SDQ (Goodman et al, 1998) SERAF (Barnardo’s, 2007) Parent Adolescent Relationship Questionnaire (Robin et al, 2009) Sexual knowledge - age banded (unpublished)

17. Normal Adolescent Males and Females Compared Normal males (n=92) Normal females (n=157) Sig. Diff. MeasureMean SDMeanSD Self Esteem5.114.72.6yes Loneliness3684012yes Perspective taking14.85.2154.8no Empathic concern17.44.218.44.8no Fantasy15.95.815.55.1no Personal Distress11.23.6165.5yes Cognitive distortions17(n=56)5.49.4(n=27)5yes

18. Normal and SHB Adolescent Girls compared Normal Girls (n=157) SHB Girls *( N=19) !(N=5) Sig. Diff. MeasureMeanSDMeanSD Self Esteem4.72.63.8*2.6no Loneliness401242*8.6no Perspective taking154.88.2!4.4(Yes) Empathic concern18.44.814.8!1.8(Yes) Fantasy15.55.114.4!1.8(No) Personal distress165.517.4!4.8(No) Cognitive distortions9.4(n =27)7.511.5(n=16)7.2No

19. Normal Women and SHB Adolescent Girls compared Normal girls (n=157) Normal women (N=72) Sig. Diff. MeasureMeanSDMeanSD Self Esteem4.72.66.82.0yes Loneliness401235.28.5yes Perspective Taking154.817.94.7no Empathic concern18.44.821.43.3yes Fantasy15.55.114.55.1no Personal Distress165.511.28.5yes Cognitive distortions9.4 (n 27)7.510.26.8no

20. Development of new measures Focus group made up of young adult females Asked to consider several themes around sexual attraction, likes and dislikes Also retrospectively regarding teenage years

21. Responses ‘looks are more important than intelligence or qualifications, at school I preferred the captain of sports team over the geeks’ (prawns) ‘They can’t be underweight/overweight or shorter than me. I keep myself trim, I think sex is less enjoyable for the man if I’m overweight’ ‘hygiene is important, I wouldn’t perform oral sex on a male who hadn’t shaved his genitals. Men prefer girls to have little or no pubic hair too’ ‘If I find him attractive then I’ll do most sexual stuff that pleases him’

22. Responses ‘I’d definitely send a picture or meet someone I had spoken to on line if I was attracted to their profile picture’ ‘Sexting is great fun, I think it is cheating if your already in a relationship but it’s not as bad as actually having sex with someone’ (snaking) ‘I like to know if a man finds me attractive’, I enjoy flirting. ‘ If I’m with an attractive man I think about sex’

23. Development of Sexual Knowledge Measure  Focus group with girls aged 15-18 + PSHE co- ordinator  Measures are age banded 12-15 and 16+  Influence of social media on sexual knowledge - year 7/8 friends with year 10/11  Internet influence - all young people had viewed pornography on line and had been sent links from friends-moral high ground

24. Victim Impact Victim Distortion Scales (Beckett et al,2012) Measures the extent to which the young person:-  Victim blames  Perceives the victim as compliant  Perceives the victim as being unharmed by the behaviour ITEMS Thinking about the person involved (victim), would you think he/she  Enjoyed what happened  Was in control of the situation  Was sexually aroused by what happened  Was harmed in the long term by what happened  Rated on a scale from “very much” to “not at all”

25. Victim Distortion Scale Vignettes A 14-year-old girl was asked to baby-sit for a seven year-old girl, Chloe, whilst her parents went to the cinema. During the evening they had tea, chatted and cuddled up on the sofa to watch Chloe’s favourite TV programme. At bed time Chloe asked to have a story. After the story the girl tucked Chloe into bed. While she was doing this the girl kissed Chloe, touched her private parts and did sexual things with her. Chloe never told anyone about what had happened. Laura aged 15 years old, had been going out with Sophie aged 14 for a couple of weeks. One night the girls were at Laura’s house watching a film together. Laura begun kissing Sophie and then tried to put her hand up Sophie’s top. Sophie objected and said she did not want to go that far. Laura kept trying and held Sophie down while putting her hands on her breasts and genitals.

26. Victim Distortion Scale Vignettes Sarah aged 14 years old was at a youth club with a few friends. Two younger boys at the club made nasty comments about her appearance. The boys laughed and the girls sniggered. Sarah then pushed the two boys into a store room where she hit and kicked them both. She then threatened the boys to make them take off their cloths and made them do sexual things to each other. One evening a 13-year-old girl was playing hide and seek upstairs with her six-year-old brother. Their parents were downstairs watching television. While they were playing the girl closed the bedroom door and told her brother to take off his pants. After he had done this she touched his private parts and then did sexual things with him. Later when the boy went down stairs he said nothing to his parents about what had happened.

27. Case Studies/Types Child abuser Trauma/Abuse reactive Peer abuser Co offender Anger motivated Experimentation

28. Treatment needs  Own victimisation, physical, trauma and neurological impact  Healthy sexual and non sexual relationship skills and identity  Self Esteem, also address guilt and shame  Emotional Loneliness-access to supportive adult and peers  Sexual attitudes  Assertiveness training  Family dynamics and positive maternal modelling  Problem solving skills

29.  Sexual exploitation  Self destructive behaviour e.g. self harm, substance misuse  Self sooth/regulation  Sex education  Education  Positive outlook for future - hope

30. For any further information, please contact me on the email below sharron.wareham@barnardos.org.uk