A qualitative investigation of policy for youth with problematic sexual behavior

Review of Policies and Practices to Prevent Technology-Facilitated Child Sexual Abuse Within Youth-Serving Organizations in the United States

Technology-facilitated child sexual abuse (TF-CSA), or child sexual abuse that occurs online or through electronic communication, is a preventable public health problem that can be addressed within youth-serving organizations (YSOs). This study is a review of a purposive sample of organizational policies and practices designed to prevent TF-CSA collected from 13 national and local YSOs in the United States. Documents were coded to identify practices to prevent TF-CSA related to YSO activities or YSO staff, volunteers, or participants. Qualitative analysis indicated that YSOs included seven common practices to prevent TF-CSA in their documents. These practices included transparent electronic communication between youth and YSO staff; codes of conduct and online behavior agreements related to youth; monitoring the YSO's online presence; parental controls for youth online activity; safety behaviors for online activity for staff, parents, and youth; parent and youth trainings for youth online engagement and prevention of TF-CSA; and practices to address staff policy violations. Most prevention practices documented by YSOs identified in this study are consistent with emerging literature on TF-CSA prevention. Key gaps include protections for youth from groups inequitably burdened by TF-CSA and evaluation of the implementation and effectiveness of practices in preventing TF-CSA across settings and populations.

Children with sexual behavior problems: Ties to child maltreatment, family functioning, and help-seeking

Although the literature on children's sexual behavior problems (SBPs) has indicated that maltreatment and family dysfunction are linked to SBPs, several facets of these factors have remained unexamined. Prior research has largely focused on SBPs more broadly, though interpersonal SBPs (ISBPs) are likely a distinct, more severe SBP subtype. The aim of the current study was to examine potentially relevant, unexplored factors, including the number of types of and total allegations of maltreatment as well as familial characteristics (i.e., parenting attitudes and behaviors, discipline methods, family functioning, and help-seeking) in relation to SBPs and ISBPs. The present study included 8-year-old children (N = 1,011, 51.1% female, 53.8% Black) and their caregivers from the Longitudinal Studies of Child Abuse and Neglect (LONGSCAN) study. In the model for SBPs, externalizing symptoms, the number of types of maltreatment allegations, maladaptive discipline methods, and help-seeking were associated with SBPs, whereas child's gender, race/ethnicity, internalizing symptoms, total maltreatment allegations, income, family functioning, and parenting attitudes were unrelated, r2 = .23. When ISBPs were examined, only child's gender and externalizing symptoms were tied to ISBPs, r2 = .09. However, child's race/ethnicity and internalizing symptoms, as well as maltreatment experiences, family factors, and help-seeking, were not associated with ISBPs. These findings highlight the importance of broader externalizing symptoms for both SBPs and ISBPs as well as the role of multiple types of maltreatment, parenting behavior, and help-seeking in the context of general SBPs.

Impressions of child advocacy center leaders: How problematic sexual behavior in children and adolescents is perceived by community professionals

BACKGROUND

Consistent with the goals of National Children's Alliance, Children's Advocacy Centers (CACs) are optimal for addressing needs related to problematic sexual behavior (PSB) of youth due to their multidisciplinary approach and emphasis on community-level evidence-based interventions (Kelley et al., 2019). To promote child well-being and safety, decisions of the CAC's multidisciplinary team must be based on an accurate understanding of youth with PSB, child sexual development, and best-practice responses. However, misperceptions about youth who have engaged in PSB appear to broadly persist (Hackett, Masson, et al., 2013), leading to obstacles for CACs in addressing PSB.

OBJECTIVE

To better understand and address the training and service needs of CACs across the country, the goal of this study was to assess CAC community professionals' (e.g., MDT members) perceptions of children and adolescents with PSB, as reported by CAC leaders.

PARTICIPANTS AND SETTING

Participants were 351 CACs from 47 US states, a representative sample based on regional and community distributions.

METHOD

A designated point-of-contact (e.g., the Director) for each CAC completed an online survey reflecting on their CAC's professional community's perceptions of youth with PSB.

RESULTS

Findings suggested that a number of misperceptions about youth with PSB, particularly adolescents, are commonly reported for CAC professional communities. Prevalent misperceptions surrounded the etiology of PSB, treatment-related needs, and differences between youth with PSB and adults.

CONCLUSIONS

Results can be used to inform policy, practice, training, and resource utilization to address youth with PSB in CACs, with specific recommendations provided to enhance an evidence-based approach.

A descriptive analysis of children seeking medical attention for problematic sexualized behavior

Introduction

Problematic Sexualized Behavior (PSB) in children is an increasingly prevalent and often misunderstood issue that impacts the well-being of children. Quantifying the numbers of affected children is challenging due to inconsistencies in how these children are identified, as well as misperceptions surrounding the issue and lack of a coordinated community response.

Methods

In this single-center retrospective case review, we attempt to report data on child demographics and case characteristics for children presenting to one Child Protection Program (CPP) medical specialty team for concern of PSB.

Results

A total of 224 children were identified as having engaged in PSB during the study period. 110 (49%) of these children were referred to the CPP for medical evaluation and medically triaged by the team. The remaining 114 children (51%) were identified through the medical triage of the presenting cases as having engaged in PSB with the index children, but were not referred to CPP for medical care themselves. The majority of children who were referred (69%) were the recipient of the PSB, compared to being the displayer of the behavior (20%). Of the recipient cases, the child displaying PSB was also referred to the CPP only 14.5% of the time.

Discussion

These results highlight that the number of children presenting for medical evaluation with concern of PSB is a significant underestimation of the prevalence of PSB in the community. This notable gap in identification of children engaging in PSB prevents service delivery for these children, including medical evaluation. The results also demonstrate that children displaying PSB were disproportionately missing from care and represent a specific area of missed opportunity for intervention and support by medical professionals.

A conceptual analysis of system responses to the issue of problematic sexual behaviors in children and recommendations for future work in Children's Advocacy Center multidisciplinary teams

Problematic sexual behavior (PSB) in children is a common, yet frequently misunderstood and mishandled issue facing communities. Because of the intersection of children both causing harm and being harmed, societies across the globe struggle with whether to punish or support during these times. For Children's Advocacy Centers (CACs), whose mandate it is to support victimized children, this tension is exacerbated. CACs have historically relied on identifying a "perpetrator" and "victim" when providing their services, however PSB displaying youth do not fit this classic dichotomy. Compared with other children, PSB displaying youth are more likely to experience greater incidents and types of violent childhood trauma, have increased parent instability, decreased familial support, and struggle with co-occurring mental health diagnoses. Due to the stigma and fear surrounding sexual behaviors in children and systemic barriers including varied definitions of PSB, uncertainty regarding how to respond within the context of child-serving roles, and the criminalization of children's behaviors, access to supportive services is complicated and challenging. Treatment completion rates for this population are as low as 13%, despite most methods being short-term, non-invasive, and community based. This conceptual analysis paper identifies five key themes in the literature that influence these barriers and proposes an interdisciplinary approach for CAC multidisciplinary teams (MDTs) to better support this vulnerable population.

Enhancing Early Engagement (E3) in mental health services training for children's advocacy center's victim advocates: feasibility protocol for a randomized controlled trial

Background

Child maltreatment is a major public issue in the United States, yet most children affected by abuse or neglect never engage in evidence-based practices (EBP) for child mental health. Children’s Advocacy Centers (CACs’) are uniquely situated to serve as Family Navigators who connect children impacted by maltreatment to appropriate EBPs. In fact, the CAC position of Victim Advocate mirrors the Mental Health Family Navigator national initiative.

Methods

The feasibility study protocol is to develop, implement, and evaluate web-based and consultative training for Victim Advocates to enhance early engagement in services (E3 training). The interactive web-based training embeds key targets of knowledge and skills related to family engagement, trauma, and EBP services. Participating CACs were randomized to E3 webinar-based training, E3 webinar plus consultation, or delayed training. The project will test the E3 training’s impact on key mechanisms of change (e.g., knowledge, skills) to improve rates of screening, referral, and access to EBP services. The feasibility of implementing the training program and differential impact and costs by level of training will be examined.

Discussion

The overarching goal of this project is to test the feasibility of training that is readily implemented through CACs and examine the mechanisms for improving early engagement and, ultimately, child, and adolescent mental health outcomes. Results and cost findings will be used to plan a large-scale comprehensive, mixed-methods hybrid type II effectiveness-implementation and cost-effectiveness trial of family navigator E3 training. If outcomes are positive, considerable infrastructure exists to support the scale-up and sustainability of E3 training nationwide, by embedding the training in national CAC training protocols.

Trial registration

NCT04221633

Date and version identifier

March 25, 2021; Vers. 1.0 (original); September 11, 2021; Vers 2.0 (revision); October 29, 2021; Vers. 3.0 (revision)

Comparison of children's advocacy center responses to harmful sexual behavior among siblings: An international perspective

BACKGROUND

Harmful sexual behavior (HSB) is sexual behavior exhibited by children and adolescents that is developmentally inappropriate and/or harmful or abusive towards themselves or others. Victims of children with HSB are commonly siblings. Multiple professionals may be involved in cases of youth HSB involving siblings, which places Children's Advocacy Centers (CACs) in a key position to directly address intrafamilial HSB. Approximately 25% of all cases seen at CACs in the U.S. are youth-initiated HSB. However, no known research has examined how CAC professionals approach decision-making and response to intrafamilial and sibling HSB, particularly across regions and cultures.

OBJECTIVES

To examine the perspectives of professionals from three separate CACs in Israel, eastern U.S., and southwestern U.S. regarding their decision-making and response process for sibling HSB.

PARTICIPANTS AND SETTING

Thirty-seven multidisciplinary team members from the three CACs, including representatives from child welfare, law enforcement, family advocacy, mental health, and the court system, among others, participated in the study.

METHODS

Participants completed focus groups that asked them to discuss how their system would respond to a vignette case. Dedoose was used for thematic analysis.

RESULTS

Using qualitative thematic analysis, results indicate all sites perceived sibling HSB as a family crisis, and they prioritized establishing safety and providing therapeutic interventions. Differences across sites were on how to establish safety and when to use legal actions.

CONCLUSIONS

The study draws attention to the influences that formal policy and community contexts have on CAC decision-making, particularly around the availability of evidence-based treatments and caregiver engagement.

Barriers to Accessing Treatment Services: Child Victims of Youths with Problematic Sexual Behavior

Child sexual abuse (CSA) remains a significant public health problem. Although the deleterious effects on the child victims could be mitigated through evidence-based interventions, victims often fail to be identified and receive clinical assessment and therapy services, particularly when they have been victimized by another youth. Given that at least a third of CSA cases are committed by another youth, understanding the process of identifying and addressing the needs of CSA victims of youth is the focus of the present study. Factors impacting services for child victims of youths with problematic sexual behavior (PSB) were examined through qualitative interviews (N = 226) with mental health agency administrators, direct service providers, and community stakeholders from eight geographically diverse communities across the United States. Responses focused on macro and micro level barriers to the identification and service provision for child victims of PSB of youths. Implications for clinicians and policymakers are discussed, along with strategies to enhance access and provision of services to meet the needs of the child victims.

Sustaining Treatment for Youth with Problematic Sexual Behavior: Administrator and Stakeholder Perspectives Following Implementation

This study examines administrator and stakeholder perspectives on factors influencing the sustainability of Problematic Sexual Behavior Cognitive Behavioral Therapy (PSB-CBT). After initial implementation of PSB-CBT, qualitative interviews (N = 42) on the sustainability of services were conducted with treatment program administrators (n = 10) and community stakeholders (n = 32) from six sites across the USA. Interviewees discussed key facilitators and barriers for sustainability and identified the following factors as impacting the sustainability of PSB-CBT: public relations, policy, inter-agency collaboration, funding, and workforce issues. Results were overall consistent with the EPIS (Exploration, Preparation, Implementation, Sustainment) model for implementation in public service sectors, but proposed modifications are also noted. Findings underscore the value of qualitative research in identifying best practices for sustaining valuable therapeutic interventions. The authors argue that future efforts to sustain evidence-based interventions, especially those dealing with sensitive topics around which misinformation and stigma are associated, should prioritize public relations (i.e., outreach, education) in addition to the intervention.

Early identification of youth with problematic sexual behavior: A qualitative study

BACKGROUND

Early intervention efforts designed for youth with problematic sexual behavior (PSB) have strong promise. Prompt identification of youth with PSB is critical to ensuring early intervention and effective response.

OBJECTIVE

The current study explored the complexities of how PSB of youth is identified in the community.

SETTING

A qualitative semi-structured interview approach was utilized to explore the perceptions and experiences of community members involved in cases of youth with PSB.

PARTICIPANTS

Participants included 100 community members from eight geographically diverse locations in the United States.

METHOD

Themes involving identification of PSB were classified by qualitative analyses, beginning with thematic analysis followed by focused coding.

RESULTS

Results indicated multiple pathways for the identification of youth with PSB involving a variety of professionals and agencies. Victim disclosure and witnessing the PSB were the most common identification pathways, with caregivers and school personnel the most common initial identifiers. Once identified, cases were reported to child welfare, law enforcement, and/or behavioral health agencies. Complications due to unclear response pathways and fears held by caregivers were notable.

CONCLUSIONS

Developmentally appropriate, evidence-informed policies and procedures for the identification of and response to PSB in youth within and across professions would facilitate a public health response to for prevention and early responses to PSB of youth.