Dr. Peter Yates p.yates@napier.ac.uk Twitter: @pyates316 NOTA Conference, Brighton

1. “It’s just the abuse that needs to stop”Social worker decision making regarding sibling living and contact arrangements in cases involving sibling sexual behaviour Dr. Peter Yates p.yates@napier.ac.uk Twitter: @pyates316 NOTA Conference, Brighton 28th September 2016

2. This afternoon… • Brief overview of the literature on sibling sexual abuse • Brief outline of the study methods • Overview of key findings • Some discussion

3. Ballpark estimates of prevalence • Somewhere between 1/5 and 1/3 of all sexual abuse in the UK involves children as perpetrators (Hackett, 2004) • Nearly 66% of the contact sexual abuse reported by children involved perpetrators under the age of 18 (Radford et al., 2011) • Between 1/3 to 1/2 of victims of children with HSB are siblings or close family members (e.g. Beckett, 2006; Ryan 2010) • Estimates of the prevalence of sibling sexual behaviour within the general population range from 2% (Russell, 1986) to 4.7% (Griffee et al., 2014), 6.5% (Atwood, 2007), 7.4% (Hardy, 2001) and 13% (Finkelhor, 1980)

4. 3 types of sibling sexual behaviour (Johnson, 1991, 2003; Araji 2004) • Developmentally appropriate, exploratory, harmless behaviour between young children • Mutually initiated behaviour that falls outwith developmental norms, which is harmful to both children involved (Johnson 2003) • Abusive sibling sexual behaviour

5. How to differentiate? • We’re not really sure what is normal sexual behaviour for sibling children • Young children • Exploratory, information gathering process • Similar age, size, and developmental status • Voluntary, light-hearted and playful • Diminishes if instructed to stop by an adult • Balanced by a curiosity to explore all sorts of other things in the child’s world. (Johnson 2003)

6. Otherwise… • Large age gaps • Use of threats, force, other forms of coercion • Significant power imbalances • BUT… • Krienert and Walsh (2011) 13,013 incidents of sibling sexual offences – many with only small age gaps • Cyr et al. (2002) 72 girls abused by fathers, brothers – only 30% of brothers used force • If no large age gap, no force or other clear coercion, need to examine sibling relationship dynamics (Allardyce and Yates, 2013)

7. Impact of child sexual abuse (by adults) • Depression, anxiety, dissociation, low self-esteem, hypersexuality (e.g. Davidson and Omar, 2014) • Complex PTSD (e.g. Kisiel et al., 2014) • Cardiovascular, immune, reproductive disorders (D’Andrea et al., 2011) • Unexplained chronic pain (e.g. pelvic pain, irritable bowel syndrome, lower back pain, fibromyalgia) (Spiegel et al., 2016) • Some survivors develop few, if any, psychological problems (Bak-Klimek et al., 2014) • 20 to 40% of survivors do not go on to develop psychological problems (Finkelhor et al., 1990)

8. Impact of sibling sexual abuse • May be at least as harmful as sexual abuse by a parent (Rudd and Herzberger, 1999; Cyr et al., 2002) • PTSD, emotional and behavioural problems, depression, low self-esteem, alcohol and substance misuse, relationship problems… (see Yates (in JCN forthcoming) for summary) • Always? • Stroebel et al. (2013) anonymised computer-assisted interviews with 137 adults who reported sibling sexual experiences – sibling incest less harmful than parent-child incest on some measures, but harmful for perpetrator as well as victim (depression, hyper-eroticisation) • Symptoms may not be immediately apparent (to the victim or observer) (Finkelhor and Berliner, 1995)

9. Some practice literature: Removal of perpetrator • Remove and assess (e.g. Costin, Schuler et al. 2009; Ballantine 2012) • Take each case on its merits (e.g. Fahy 2011, Caffaro 2014) • “The current emphasis on the wishes of the child victim of abuse cannot always be privileged, nor in our opinion, are of more importance than the needs of the offending sibling. After all, this young person is also a child.” (Keane et al., 2013:248)

10. Contact and Reunification literature • Reunification as a staged process (e.g. Haskins, 2003; Thomas and Viar, 2005; Schladale, 2002) • E.g. Thomas and Viar, 2005 suggest a 7 stage process including Clarification meeting Supervised contact Trials of home contact Full reunification

11. My study: • Sibling sexual behaviour • Full or half siblings under 16 • Remain living together • Have contact with each other • Could return to live together again

12. What I did • 6 local authorities in Scotland • Interviewed 21 social workers regarding 21 families • 54 children involved in sibling sexual behaviour • 3 examples of sexual behaviour regarded as mutually initiated • Constructivist grounded theory methodology (Charmaz, 2006)

13. “It was just question marks.” (Jenny) • What actually happened • When it happened, how often • Chances of it happening again • Parents’ abilities to stop it happening again • And on and on…

14. Frames A frame is like a mental filter. The world is not perceived directly but through a mental filter, comprising of templates of interpretations of prior experiences, concepts and constructed knowledge.

15. The social workers’ practice mindset

16. Children as vulnerable and intending no sexual harm to others • Doubting whether the behaviour happened • Resisting labelling the behaviour as abuse • “But I always kind of felt that it was more ex-, experimentation than, sexual abuse as such…And it did seem, well, maybe it wasn't a one-off, we don't know • …I know it's sexual abuse but it did still seem more, I don't, I think in her wee [little], in her head, I'm not sure whether she'd got any satisfaction out of it as such.” (Liz)

17. Child frame continued… • The perpetrator is a child, but the victim is the child • Frame stronger the younger the child, the closer the social worker’s relationship with the child, the more remorseful the child

18. Sibling relationships as non-abusive and of intrinsic value • Requiring a second incident • Focusing on safety “There was no evidence at the time of contact being damaging…although what had happened was very serious and actually probably was quite traumatic for Paul, erm. We didn't stop to question these things. That's what I'm thinking just now…I didn't stop to think whether contact was appropriate or not. I just assumed that it would be important to maintain a bond.” (Scott)

19. Sibling relationships… • Separation not a long-term solution “They are family members and there's only so long that you can go without introducing them back together.” (Angela) “There just became a time where we thought, right time's getting on now…I don't think there was any particular incident or something happened or work done…the decision was made because of a lapse of time rather than…any particular change in risk.” (Liz) Frame stronger if siblings had lived and grown up together, and the more the social worker was acquainted with the children as siblings

20. Parents as well-intentioned protective • ‘On board’: • Someone I can work with • Having a shared understanding of the problem • Did they report the incident? • Are they willing to accept support? • Do they show commitment to both children, but seem willing to prioritise the victim?

21. “Er, the parents. And I think it was the fact of the parents were fully on board… They were the ones that went ahead to social work. They didn't have to disclose that, who would know? They were the ones that went ahead with the information. They wanted support. They fully wanted support. They recognised that he might be accommodated, but they wanted to try at least attempt to have him at home.” (Mary) • Expected to engage more meaningfully in longer-term, but not if under pressure, e.g. of time and resources

22. Breaking rules “She still chose to make poor decisions and expose the children to harm…no responsibility, you know, doesn’t want to hear or accept, either unwilling or, I’m not…convinced if it was unwilling or unable to kind of, um, to take responsibility, I think it was unwilling.” (Fiona) Making allowances:

23. “So that's how we knew that this really had…been premeditated. Um, yeah, it did worry us. But,…I think the fact that he was able to talk about it, and we were able to address it and look at his safety planning,…it didn't prompt us into saying, right let's get him right out of there. Er, 'cause I think there was a lot of guilt attached to it for him. He did feel bad about it. So, yeah. I don't think that, any more so than anything else, was a trigger. So, it was the reporting part, mum not reporting and then not accordingly shifting bedrooms, in terms of, let's look at this risk that's presented [that made us question whether the children could remain living at home].” (Emma)

24. “By that point I was actually past the thinking that we need to accommodate these kids. I was quite past that, because [the parents] were engaging really well by that point.” (Emma) Frame stronger for social workers who know and like the parents • In 8 out of 9 cases where parent (7 cases) or foster carer (2 cases) were ‘on board’ and decision made to keep siblings together, there was a further incident involving sibling or other close family

25. The social workers’ practice mindset

26. When under pressure and faced with considerable complexity, social workers tend to reduce decision making processes to a limited set of manageable strategies (Platt and Turney, 2014)

27. Some key heuristics • Parents engaging and cooperating with services • Incident believed to be the first and only incident • The age of the child • Do they express remorse? • Can we prevent any further sibling sexual behaviour

28. Extending the rule of optimism • Dingwallet al.’s (1983) rule based on parental ‘natural love’, the assumption that parents are “honest, competent and caring” = well-intentioned and protective AND • Children are vulnerable and intend no sexual harm to others • Sibling relationships are non-abusive and of intrinsic value • Loss of focus on the child victim experience

29. Conclusions and Recommendations • No evidence that assessment-based decisions are better than intuitive decisions • Need to hold these important decisions to the highest standards of accountability (Munro 2008) • Raise reflexive awareness of these frames and how they may influence decision making • Supervision may assist maintaining this level of reflexivity

30. Bring an analytical and assessment-based approach to decision making, which includes (amongst other things) an exploration and consideration of: • The behaviour according to its characteristics rather than those of the child • The (emotional) impact of the behaviour on the children • The views of the children, maintain representation of all children involved • Risk of future sibling sexual behaviour • The quality of the sibling relationship • The protective abilities and capacities of the parents

31. Dr. Peter YatesTel: 0131 455 2762E-mail: p.yates@napier.ac.ukTwitter: @pyates316

32. References (1) • Bak-Klimek, A., Karatzias, T., Elliott, L., Campbell, J., Pugh, R., & Laybourn, P. (2014). Nature of child sexual abuse and psychopathology in adult survivors: results from a clinical sample in Scotland. Journal of Psychiatric and Mental Health Nursing, 21(6), 550-557. doi: 10.1111/jpm.12127 • Allardyce, S. and P. Yates (2013). "Assessing risk of victim crossover in children and young people who display harmful sexual behaviours." Child Abuse Review22(4): 255-267. • Araji, S. K. (2004). Preadolescents and adolescents: Evaluating normative and non-normative sexual behaviours and development. The handbook of clinical intervention with young people who sexually abuse. G. O'Reilly, W. L. Marshall, A. Carr and R. C. Beckett. Hove, Brunner-Routledge: 3-35. • Atwood, J. D. (2007). When love hurts: Preadolescent girls' reports of incest. The American Journal of Family Therapy, 4, 287-313. • Ballantine, M. W. (2012). "Sibling incest dynamics: Therapeutic themes and clinical challenges." Clinical Social Work Journal40: 56-65. • Beckett, R. (2006). Risk prediction, decision making and evaluation of adolescent sexual abusers. In M. Erooga & H. Masson (Eds.), Children and young people who sexually abuse others (2nd ed., pp. 215-233). Abingdon: Routledge. • Caffaro, J. V. (2014) Sibling abuse trauma: Assessment and intervention strategies for children, families and adults. 2nd edition, London, Routledge. • Charmaz, K. (2006). Constructing grounded theory: A practical guide through qualitative analysis. London, Sage. • Costin, D., S. Schuler and T. Curwen. (2009). "Responding to adolescent sexual offending." Retrieved 22nd August 2014, 2014, from http://radiuschild-youthservices.ca/wp-content/uploads/2014/06/2010_SAO_booklet.pdf. [But see also Chapter 11 in Calder (ed.), 2011] • Cyr, M., J. Wright, P. McDuff and A. Perron (2002). "Intrafamilial sexual abuse: Brother-sister incest does not differ from father-daughter and stepfather-stepdaughter incest." Child Abuse and Neglect26: 957-973.

33. References (2) • D’Andrea, W., Sharma, R., Zelechoski, A. D., & Spinazzola, J. (2011). Physical Health Problems After Single Trauma Exposure: When Stress Takes Root in the Body. Journal of the American Psychiatric Nurses Association, 17(6), 378-392. doi: 10.1177/1078390311425187 • Davidson, L., & Omar, H. A. (2014). Long-term consequences of childhood sexual abuse. International Journal of Child and Adolescent Health, 7(2), 103-107. • Fahy, B. (2011). Dilemmas for practitioners working with siblings under 10 years presenting with harmful sexual behaviours towards each other, with complex trauma histories. What are the challenges involved in how they should be placed in local authority care permanently? Contemporary practice with young people who sexually abuse: Evidence-based developments. M. C. Calder. Lyme Regis, Russell House Publishing. • Finkelhor, D. (1980). Sex among siblings: A survey on prevalence, variety and effects. Archives of sexual behaviour, 9(3), 171-194. doi: 10.1007/bf01542244 • Finkelhor, D., Hotaling, G., Lewis, I. A., & Smith, C. (1990). Sexual abuse in a national survey of adult men and women: Prevalence, characteristics, and risk factors. Child Abuse & Neglect, 14(1), 19-28. doi: http://dx.doi.org/10.1016/0145-2134(90)90077-7 • Finkelhor, D. and L. Berliner (1995). "Research on the treatment of sexually abused children: A review and recommendations." Journal of the American Academy of Child and Adolescent Psychiatry34: 1408-1423 • Griffee, K., Swindell, S., O'Keefe, S. L., Stroebel, S. S., Beard, K. W., Kuo, S.-Y., & Stroupe, W. (2014). Etiological risk factors for sibling incest: Data from an anonymous computer-assisted self-interview. Sexual abuse: A journal of research and treatment, 1-40. doi: 10.1177/1079063214558941 • Hackett, S. (2004). What works for children and young people with harmful sexual behaviours? Illford: Barnardo's. • Hammond, K. (1996) Human judgment and social policy: Irreducible uncertainty, inevitable error, unavoidable justice, Oxford, Oxford University Press. • Hardy, M. S. (2001). Physical aggression and sexual behaviour among siblings: A retrospective study. Journal of family violence, 16(3), 255-268.

34. References (3) • Haskins, C. (2003). "Treating sibling incest using a family systems approach." Journal of family health counselling25(4): 337-350. • Johnson, T. C. (1991). "Understanding the sexual behaviours of young children." SIECUS ReportAugust/September 1991: 8-15. • Johnson, T. C. (2003). Sibling incest. South Pasadena, Self-published pamphlet. • Johnson, T. C. (2010). Understanding children's sexual behaviours: What's natural and healthy. Updated 2010. San Diego, CA, Institute on Violence, Abuse and Trauma. • Johnson, T. C., B. E. Huang and P. M. Simpson (2009). "Sibling family practices: Guidelines for healthy boundaries." Journal of Child Sexual Abuse18: 339-354. • Keane, M., A. Guest and J. Padbury (2013). "A balancing act: A family perspective to sibling sexual abuse." Child Abuse Review22: 246-254. • Kisiel, C., Fehrenbach, T., Liang, L.-J., Stolbach, B., McClelland, G., Griffin, G., . . . Spinazzola, J. (2014). Examining child sexual abuse in relation to complex patterns of trauma exposure: Findings from the National Child Traumatic Stress Network. Psychological Trauma: Theory, Research, Practice, and Policy, 6(Suppl 1), S29-S39. doi: 10.1037/a0037812 • Krienert, J. L. and J. A. Walsh (2011). "Sibling sexual abuse: An empirical analysis of offender, victim, and event characteristics in national incident-based reporting system (NIBRS) data, 2000-2007." Journal of Child Sexual Abuse20: 353-372. • Munro, E. (2008) 'Lessons from research on decision making', in Lindsey, D. and Shlonsky, A. (eds), Child welfare research: Advances for practice and policy, Oxford, Oxford University Press.

35. References (4) • Radford, L., Corral, S., Bradley, C., Fisher, H., Bassett, C., Howat, N., & Collishaw, S. (2011). Child abuse and neglect in the UK today. London: NSPCC. • Rudd, J. M. and S. D. Herzberger (1999). "Brother-sister incest - Father-daughter incest: A comparison of characteristics and consequences." Child Abuse and Neglect23(9): 915-928. • Russell, D. E. H. (1986). The secret trauma: Incest in the lives of girls and women. New York: Basic Books. • Ryan, G. (2010). Sexually abusive youth: Defining the problem and the population. In G. Ryan, T. Leversee & S. Lane (Eds.), Juvenile sexual offending: Causes, consequences, and correction (3rd ed., pp. 3-8). Hoboken, New Jersey: John Wiley & Sons. • Schladale, J. (2002). "A collaborative approach for family reconciliation and reunification with youth who have caused sexual harm." Retrieved from http://www.resourcesforresolvingviolence.com/articles.html. • Spiegel, D. R., Shaukat, A. M., Mccroskey, A. L., Chatterjee, A., Ahmadi, T., Simmelink, D., . . . Raulli, O. (2016). Conceptualizing a subtype of patients with chronic pain: The necessity of obtaining a history of sexual abuse. The International Journal of Psychiatry in Medicine, 51(1), 84-103. doi: 10.1177/0091217415621268 • Stroebel, S. S., S. L. O'Keefe, K. W. Beard, S.-Y. Kuo, S. Swindell and W. Stroupe (2013). "Brother–sister incest: Data from anonymous computer-assisted self interviews." Journal of Child Sexual Abuse22(3): 255-276. • Thomas, J. D. and C. W. Viar (2005). Family reunification in cases of sibling incest. Children and young people who sexually abuse: New theory, research and practice developments. M. C. Calder. Lyme Regis, Russell House Publishing: 354-371. • Yates, P. (forthcoming) Sibling sexual abuse: Why don’t we talk about it? Journal of Clinical Nursing doi: 10.1111/jocn.13531