Safety Planning 101 & The Chaperone Program

2. Safety Planning 101 & The Chaperone Program

3. Presenters • Tanya L. Snyder, M.Ed., LMHC • Director of Juvenile Services • Timothy L. Sinn, M.A., LMHC • Executive Clinical Director • The Counseling and Psychotherapy Center, Inc.

4. Learning Objectives 1. To learn how to understand risk and develop appropriate safety plans. 2. To provide workshop participants with a working knowledge and understanding of the Chaperone Program and its role in community safety and re-integration. 3. To provide outlines of both Safety Plans and Chaperone Program development.

5. Safety Planning 101 is designed to provide an overview of how risk in youth is understood and treated, including through the use of safety plan development for risky situations the youth encounters. The Chaperone Program is designed to provide another level of supervision to clients by educating their support network about sexually inappropriate behaviors and the skills needed to provide increased assistance to these youth while in the community. This program creates another layer of supervision and monitoring while in situations that are deemed risky to a particular youth. Safety Plans and The Chaperone Program are utilized to increase victim and public safety and to increase client’s ability to successfully self-regulate and re-integrate into society.

6. CPC Overview The Counseling & Psychotherapy Center, Inc. (CPC) is an agency comprised of clinicians, victim advocates and criminal justice professionals who operate specialized management and treatment programs in many locations throughout the United States for those who have displayed sexually inappropriate and abusive behaviors. We specialize in setting up services in communities who express a need to reduce risk.

7. We currently operate in 7 states - Oregon, California, Maine, Massachusetts, Rhode Island, New York and North Dakota. Services vary from state to state. • Juveniles and adults • Males and females • Institutions • Community • Probation/parole • Self-referred • Family • Individual • Marathon sessions • Group therapy • EMDR, PPG’s, Abels, Behavioral Treatment, Polygraphs • Juvenile group home in California

8. CPC developed the R.U.L.E. Treatment Program and brings specialized services to people who have acted out in a sexual manner.

9. R.U.L.E Responsibility:The impact the child’s behavior has had on those he hurt, himself, and others. Understanding:Theexperiences and decisions that have led to this point. Learning:New patterns of appropriate behavior. Experience:The benefit of using new skills in relating to others and in managing strong negative emotional states.

10. “When healthy or normative sexual behavior is not understood, professionals and parents may worry that sexual behavior in a child is a sign of undetected sexual victimization. More recently, sexually aggressive behavior is sometimes viewed as a signal for perpetrating sexual violence. It is essential that professionals understand sexual behaviors in children to determine how best to respond to a child's behavior and, when appropriate, clarify what treatment is needed.” David Prescott, LICSW- “Understanding the Sexual Behavior of Children” NEARI Newsletter, May 2009

11. What is “Normal” Anyway?

12. Sexual Development Birth - Age 5 • Taking off clothes- not modest. • Rubbing/Touching own genitals (begins in infancy). • Curiosity about familiar adults and children’s private parts-learning about male and female differences. • May expose self to and try to look at or touch others who are familiar, but redirects easily. • Asks about genitals, breasts and babies. • Erections begin in infancy, so does lubrication in females. • Interested in bathroom behavior of others, again as it relates to differences and function. • Interest in own feces. • Plays house, role playing male & female roles-marriage. May begin to play doctor.

13. Funny Quote(Taken from “Everything you NEVER wanted your kids to know about SEX (but were afraid they’d ask)” by Justin Richardson, M.D. AND Mark A. Shuster, M.D, PH.D. “Look at my wiener! I can make it stand up. I rub it and it stands up and it feels good. Sometimes I rub it a lot and it feels very, very good.” (Three year old boy in the Masters and Johnson Files)

14. Sexual Development: Ages 6-9 • Sexual behaviors begin to be more “out of sight” of others. • Modesty begins around age 6 - desire for privacy around bathing and dressing. • Show interest in own and other’s bodies. May seek out understanding of organs and functions. • Continue to play house, exploring relationships such as marriage, partnerships. Also play looking or touching games, like truth or dare or doctor without penetration or oral sexual contact. Increase in physical arousal (9+). • Touching/rubbing own genitals. Masturbation for age 9 + • Feelings about opposite sex become more ambivalent. May begin to have relationships that are short-lived with little personal involvement. Feel attraction (9+ years old). • Imitate behaviors such as holding hands, kissing & dating. • May tell sexual jokes/use sexual words with peers-written or spoken. Often accompanied by giggling.

15. Sexual Development: Ages10-12 • Masturbation • Increased sexual drive and interest and fantasies involving acts. • Increased sexual activity with same aged peers- sexual talking, touching, kissing & genital rubbing. Some includes same sexed peers-this does not reflect sexual orientation- it is developmental. • Some begin to view pornographic magazines/material with peers. • Puberty begins around 9-10 years old for most girls. (6/7-13 typical range) Boys typically around 11, (average range 9-14 years old). • Self-conscious about bodies. • Desire for privacy when undressing. • Increase in questions about sex, sex organs & functions. • Group dating, individuals pairing within the group, dancing, playing kissing games, dry humping. • Increased sexual jokes and behaviors such as mooning.

16. Funny Quote(Taken from “Everything you NEVER wanted your kids to know about SEX (but were afraid they’d ask)” by Justin Richardson, M.D. AND Mark A. Shuster, M.D, PH.D. “In 1943, one research group interviewed 291 boys to find out what it was that gave them erections. The boys dutifully provided an exhaustive list. It included, among other highlights, sitting in class, sitting in church, sitting in warm sand, and setting a field on fire. The national anthem was also responsible for a few erections. So was finding money (understandable) and, for a few unfortunates, being asked to go to the front of the class. Good grades and hurricanes do indeed give Max erections, but at age ten, there are a few new items on the list. Like underwear ads.” (By the way the same applies to girls).

17. Sexual Development: Ages 13-18 • Masturbation (Up to once/day). • Engaging in oral sex and intercourse with partners, much like adults. • Use of pornographic materials. • Relationships with others are the focus. • More focus on establishing emotional attachments in relationships as one matures. Romantic Love.

18. What Isn’t Normal?

19. How to Identify Inappropriate Sexual Behavior • Using sexual language beyond age- may mean exposure to sexual material. • Sexual acting out behavior in school other public places. • One of the children was more than 2 years older. • One of the children was bigger or more powerful than the other, regardless of age. • One of the children was more aggressive than the other, regardless of age. • One of the children used bribes, tricks, force or threats to gain compliance.

20. How to Identify Inappropriate Sexual Behavior • One of the children has been involved in sexual behaviors previously and continued even though told to stop. • Children are simulating adult sexual behaviors. Trying to get another child or adult nude or to engage older children/adults in sexual behaviors. • The sexual contact was intrusive such as oral, vaginal or anal penetration. • Excessively provocative behaviors. • Children engaging in non age appropriate sexual behaviors. • Children involved do not have an ongoing relationship of any kind.

21. How to Identify Inappropriate Sexual Behavior • Overly attentive behavior towards younger children (3 years younger or more). • Adolescents who make repeated calls to sex talk lines or talk to others using extensive sexual talk. • Stealing of underwear or other intimate objects. • Exposing of genitals to others. • Adolescents who are regularly seen masturbating. • Behavior that appears to be obsessive or compulsive. • Adolescents encouraging the use of drugs/alcohol in order to obtain sexual contact with peer aged partner.

22. How to Identify Inappropriate Sexual Behavior • Others are complaining about the behaviors. • When anger is a part of the sexual behaviors. • When a child uses distortions to explain behaviors (for example, she liked it- although crying). • Sexual contact with animals. • Viewing pornography or others having sex, prior to age 11. (Burton, MATSA/MASOC 2011: Sexual Offending children see twice as much pornography post age 10 that delinquent peers). • Secrecy is involved. This is different than privacy. • Presence of STD’s- may be being molested.

23. “However, normative (or expected) sexual behaviors are usually not overtly sexual, are more exploratory and playful in nature, do not show a preoccupation with sexual interactions, and are not hostile, aggressive, or hurtful to self or others.” RECOGNIZING HEALTHY AND UNHEALTHYSEXUAL DEVELOPMENT IN CHILDRENby Phil Rich, Ed.D., LICSWExcerpt taken from Selfhelp Magazine Online- Dated 4/29/02

24. Take away points… • Adolescents (13-17) who act out sexually are NOT “mini-adults” and should NOT be treated as such. • Children with sexual behavior problems (12 and under) are a whole different category as well. These are NOT “mini adolescents” either and should NOT be treated as such.

25. Children with Sexual Behavior Problems(SBP) Ages 12 and Under

26. Children with Sexual Behavior Problems (Under 12 years Old)Information taken from- Report of the ATSA Task Force on Children With Sexual Behavior Problems • The Task Force defines children with SBP as children ages 12 and younger who initiate behaviors involving sexual body parts (i.e., genitals, anus, buttocks, or breasts) that are developmentally inappropriate or potentially harmful to themselves or others. Although the term sexual is used, the intentions and motivations for these behaviors may or may not be related to sexual gratification or sexual stimulation. The behaviors may be related to curiosity, anxiety, imitation, attention seeking, self-calming, or other reasons (Silovsky & Bonner, 2003). • It is important to distinguish SBP from normal childhood sexual play and exploration.

27. Children with Sexual Behavior Problems (Under 12 years Old)Information taken from- Report of the ATSA Task Force on Children With Sexual Behavior Problems • In determining whether sexual behavior is inappropriate, it is important to consider whether the behavior is common or rare for the child’s developmental stage and culture; the frequency of the behaviors; the extent to which sex and sexual behavior has become a preoccupation for the child; and whether the child responds to normal correction from adults or continues to occur unabated after normal corrective efforts. In determining whether the behavior involves potential for harm, it is important to consider the age/developmental differences of the children involved; any use of force, intimidation, or coercion; the presence of any emotional distress in the children involved; if the behavior appears to be interfering with the children’s social development; and if the behavior causes physical injury (Araji, 1997; Hall, Mathews, & Pearce, 1998; Johnson, 2004).

28. Children with Sexual Behavior Problems (Under 12 years Old) ContinuedInformation taken from- Report of the ATSA Task Force on Children With Sexual Behavior Problems • Childhood sexual behavior problems (SBP) can range widely in their degree of severity and potential harm to other children. Although some features are common, virtually no characteristic is universal and there is no profile or constellation of factors characterizing these children. • Given the diversity of children with SBP, most intervention decisions including decisions about removal, placement, notifying others, reporting, legal adjudication, and restrictions on contact with other children should be made carefully and on a case-by-case basis. Because children and their circumstances can change rapidly, decisions should be reviewed and revised regularly.

29. Children with Sexual Behavior Problems (Under 12 years Old) ContinuedInformation taken from- Report of the ATSA Task Force on Children With Sexual Behavior Problems • Despite considerable concern about progression on to later adolescent and adult sexual offending, the available evidence suggests that children with SBP are at very low risk to commit future sex offenses, especially if provided with appropriate treatment. After receiving appropriate short-term outpatient treatment, children with SBP have been found to be at no greater long-term risk for future sex offenses than other clinic children (2%-3%). • On the whole, children with SBP appear to respond well and quickly to treatment, especially basic cognitive-behavioral or psycho-educational interventions that also involve parents/caregivers. Intensive and restrictive treatments for SBP appear to be required only occasionally or rarely.

30. Why do kids develop sexual behavior problems?Information taken from- Report of the ATSA Task Force on Children With Sexual Behavior Problems • Children who have been sexually abused do engage in a higher frequency of sexual behaviors than children who have not been sexually abused (Friedrich, 1993; Friedrich, Trane & Gully, 2005), and sexual abuse histories have been found in high percentages of children with SBP (Johnson, 1988,1989; Friedrich,1988). • The last decade of research suggests that many children with broadly defined sexual behavior problems have no known history of sexual abuse (Bonner, Walker, & Berliner, 1999; Silovsky & Niec, 2002).

31. Why do kids develop sexual behavior problems?Information taken from- Report of the ATSA Task Force on Children With Sexual Behavior Problems • Current theories emphasize that the origins and maintenance of childhood SBP include familial, social, economic and developmental factors (Friedrich, 2001, 2003). Contributing factors appear to include sexual abuse but also physical abuse, neglect, substandard parenting practices, exposure to sexually explicit media, living in a highly sexualized environment, and exposure to family violence (Friedrich, Davies, Feher, & Wright, 2003). • Hereditary also may be a contributing factor (Langstrom, Grann & Lichtenstein, 2002).

32. Why do kids develop sexual behavior problems?Information taken from- Report of the ATSA Task Force on Children With Sexual Behavior Problems • For some children, SBP may be one part of an overall pattern of disruptive behavior problems (Friedrich, in press; Friedrich et al. 2003; Pithers, Gray, Busconi, & Houchens, 1998), rather than an isolated or specialized behavioral disturbance.

33. Assessment Children with SBP

34. Risk principle: Match the level of service to the offender’s risk to re-offend. Need principle: Assess criminogenic needs and target them in treatment. Responsivity principle: Maximize the offender’s ability to learn from a rehabilitative intervention by providing cognitive behavioral treatment and tailoring the intervention to the learning style, motivation, abilities and strengths of the offender. (Andrews & Bonta, 2006)

35. Assessment of Youth with Sexual Behavior Problems(Parenting Assessment: A Tool For Youth Offending Teams, developed by Clem Henricson, Dr. John Coleman, Dr. Debi Roker for the Trust for the Study of Adolescence, March 2000 and Report of the ATSA Task Force on Children with Sexual Behavior Problems) • Should include a parental assessment- one such tool is the Parenting Assessment: A Tool For Youth Offending Teams, developed by Clem Henricson, Dr. John Coleman, Dr. Debi Roker for the Trust for the Study of Adolescence, March 2000. • Addresses such areas as: supervision/monitoring, discipline, communication and support, living arrangements, substance use, health, mental health, victimization, parenting style, marital/couple issues, child rearing practices, sibling issues/safety, parents own struggles, needs of family and child in regard to income, education and employment. Protective factors such as positive aspects of relationship, other supports to child and family. Parents should be included in treatment, if appropriate.

36. Assessment of Youth with Sexual Behavior Problems(Parenting Assessment: A Tool For Youth Offending Teams, developed by Clem Henricson, Dr. John Coleman, Dr. Debi Roker for the Trust for the Study of Adolescence, March 2000 and Report of the ATSA Task Force on Children with Sexual Behavior Problems • Additionally important to look at other aspects of the child’s life such as extended family, community, school and peer influences. Can also involve these parties in treatment. • Focus should be on what factors are involved in maintaining the inappropriate behavior, what factors serve to help the client to refrain from behavior and future concerns in these regards. • Failing to admit is not necessarily an indication of poor prognosis or being in a pathological state of denial. May bring up own trauma or may have forgotten about it or fear getting into trouble.

37. Assessment of Youth with Sexual Behavior Problems( Report of the ATSA Task Force on Children with Sexual Behavior Problems) • The Child Sexual Behavior Inventory - III (CSBI-III; Friedrich,1997) is designed for children ages 2 – 12 and measures the frequency of both common and atypical behaviors, self-focused and other-focused behaviors, sexual knowledge and level of sexual interest. Since the development of the third edition of the CSBI, Friedrich has added four items that assess planned and aggressive sexual behaviors (Friedrich, 2002). Age and gender norms are available for the CSBI, and can help discriminate between developmentally normal and atypical sexual behavior. None of the four added planned/aggressive items were endorsed by current normative samples.

38. Another measure is the Child Sexual Behavior Checklist (CSBCL – 2nd Revision), which lists 150 behaviors related to sex and sexuality in children, asks about environmental issues that can increase problematic sexual behaviors in children, gathers details of children’s sexual behaviors with other children, and lists 26 problematic characteristics of children’s sexual behaviors (Johnson & Friend, 1995). The CSBCL-2nd Revision also gathers a broad range of information that is useful for assessment and treatment planning. The CSBCL-2nd Revision for children 12 and under can be completed by anyone who knows the child well (Johnson & Friend, 1995).

39. Assessment of Youth with Sexual Behavior Problems(Report of the ATSA Task Force on Children with Sexual Behavior Problems) • Should be considered time limited due to developmental changes. • Time not engaging in behaviors in more recent past, must be considered. • When out of home placement is being considered, carefully consider the negatives of this arrangement, along with benefits to the child and protection of others. The younger the child, the more consideration is needed.

40. Risk and Needs Assessment For Adolescents

41. Risk Assessment and the Risk Principle Research indicates that providing high intensity treatment to low risk offenders may increase their risk level by extensively exposing them to higher risk offenders who may “contaminate” them with anti-social attitudes, thinking and behavior.

42. Caveats to Risk Assessments with Juveniles • These are empirically-informed guides for the systematic review and assessment of a uniform set of items that may reflect increased risk to reoffend. These are NOT actuarial scales (yet). • A tool that should be used as part of a comprehensive risk assessment and never be used exclusively to make decisions about reoffense. Must be skilled and use a variety of tools and resources, as well as assess multiple aspects of functioning. • Used for adolescents 12-18, J-SOAP-II is only for Boys; ERASOR can be used on both boys and girls.

43. Caveats to Risk Assessments with Juveniles • Remember that adolescents are in a developmental and situational flux. • They are still developing social and emotional skills, attitudes and beliefs, abstract thinking and reasoning skills. • They have shorter attention spans and greater impulsivity. • Self-focus and narcissism are developmentally normal. • More dependent on social environment. • Traumatic effects may be immediate and ongoing.

44. Professionals May Be Able to Identify High-Risk Adolescents NEARI Newsletter, April 2009by David S. Prescott, LICSW In 2008, Michael Hagan and his colleagues completed a five year study that examined the accuracy of risk assessment applied to adolescents who had sexually abused. The study followed a group of 12 adolescents recommended by experts for civil commitment in Wisconsin, but who were not committed. They found that 42% of these 12 adolescents had sexually offended again after five years. The results are similar to a Washington State study (Milloy, 2006) in which 33% of a small group adolescents assessed as high-risk sexually re-offended within two years. The number of young adults in this study (as well as the study by Milloy) is too small to allow any firm conclusions. However, the results suggest that the ability of evaluators to assess high risk in adolescent males may be better than many believe. Of note, the youth who re-offended very often had previous histories of known sexual abuse. They also had been unable to complete treatment. Often, their continued general behavioral problems interfered with their ability to participate in treatment. • Hagan, M.P., Anderson, D.L., Caldwell, M.S., & Kemper, T.S. (in press). Five-year accuracy of assessments of high risk for sexual recidivism of adolescents. International Journal of Offender Therapy and Comparative Criminology, Online First, October 28, 2008).

45. J-SOAP-II: Static & Dynamic Risk Factors for Adolescents Static Factors from J-SOAP-II • Prior sex offense charges • Number of sexual abuse victims • Male child victims • Duration of sexual offense history • Planning in sexual offenses • Sexualized Aggression • Evidence of sexual preoccupation • Sexual victimization history, physical abuse history and/or exposure to family violence. • Caregiver consistency/stability • History of expressed anger • School behavior problems • History of conduct disorder before age 10 • Juvenile antisocial behavior (10-17) • Ever charged/arrested before age 16 • Multiple types offenses Dynamic Factors from J-SOAP-II • Accepting responsibility for sex offenses • Internal motivation for change • Understanding risk factors and management • Evidence of empathy • Evidence of remorse and guilt • Presence of cognitive distortions • Quality of peer relationships. • Management of sexual urges and desire • Evidence of poorly managed anger in community • Stability of current living situation • Stability in school • Evidence of support system in community

46. ERASOR: Static & Dynamic Risk Factors for Adolescents Static Factors from ERASOR • Prior adult sanctions for sexual assault(s) • Ever assaulted 2 or more victims • Male victim • Ever assaulted same victim 2 or more times • Threats of, or use of excessive violence/weapons • Child victims • Stranger victims • Indiscriminate choice of victims • Diverse sexual assault behaviors DynamicFactors from ERASOR • Deviant sexual interest • Obsessive sexual interests • Attitudes supportive of offending • Unwillingness to alter deviant sexual interest/attitudes • Antisocial peer orientation • Lack of intimate peer relationships/social isolation • Negative peer associations and influences • Interpersonal aggression • Recent escalation in anger or negative affect • Poor self-regulation of affect and behavior (Impulsivity) • High-stress family environment • Problematic parent-offender relationships/parental rejection • Parent(s) not supporting of sexual offense specific assessment/treatment • Environment supporting opportunities to reoffend sexually • No development or practice of realistic prevention plans/strategies • Incomplete sexual offense specific treatment

47. J-SOAP-II • There are many items in the J-SOAP-II related to the risk of general juvenile delinquency. • The J-SOAP-II provides ratings of sexual re-offence risk using 28 items across four scales: • two static scales: Sexual Drive/Preoccupation and Impulsive, Antisocial Behavior. • two dynamic scales: Clinical/Treatment and Community Stability/Adjustment.

48. JSOAP-II Scoring Form I. Sexual Drive / Preoccupation Scale 1. Prior Legally Charged Sex Offense 2. Number of Sexual Abuse Victims 3. Male Child Victim 4. Duration of Sex Offense History 5. Degree of Planning in Sexual Offense(s) 6. Sexualized Aggression 7. Sexual Drive and Preoccupation 8. Sexual Victimization History Sexual Drive Preoccupation Scale Total II. Impulsive, Antisocial Behavior Scale 9. Caregiver Consistency 10. Pervasive Anger 11. School Behavior Problems 12. History of Conduct Disorder 13. Juvenile Antisocial Behavior 14. Ever Charged/Arrested Before Age 16 15. Multiple Types of Offenses 16. Physical Assault / Exposure to Family Violence Antisocial Behavior Scale Total III. Intervention Scale 17. Accepting Responsibility for Offense(s) 18. Internal Motivation for Change 19. Understands Risk Factors 20. Empathy 21. Remorse and Guilt 22. Cognitive Distortions 23. Quality of Peer Relationships Intervention Scale Total IV. Community Stability/ Adjustment Scale 24. Management of Sexual Urges and Desire 25. Management of Anger 26. Stability of Current Living Situation 27. Stability in School 28. Evidence of Support Systems Community Stability Scale Total

49. ERASOR, Version 2 – The Estimate of Risk of Adolescent Sexual Offense Recidivism • Assesses sexual re-offense risk among juvenile sex offenders. • 23 items scored by clinical staff or case manager using a weighted key. • The ERASOR 2.0 has 9 identified static items (5 - 13), with the majority (64%) of its questions tapping dynamic risk factors (i.e.,16 of 25 questions). Scales should be re-assessed at 6 month intervals and sooner if risk-relevant changes have occurred.

50. ERASOR 2.0 vs. J-SOAP-II • ERASOR 2.0: The ERASOR 2.0 has 21% more dynamic risk items than the J-SOAP-II that could give this instrument a slight edge as the protocol of choice for treatment providers conducting repeated evaluations across time to determine treatment progress.