Characteristics of sexually abusive youth with ‘special needs’

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Chapter 2 Methodology

The purpose of this clinical file audit study was to create a profile of sexually abusive male and female children (aged 12 years or younger) and youths (aged 13 to 19 years) referred to the three main specialised community treatment programmes in New Zealand between January 1995 and June 2004.
Currently in New Zealand there are ten specialist community adolescent sex offender treatment programmes and one residential unit. The three main community specialised treatments programmes for children and youths are the SAFE Youth Programme (Auckland), WellStop2 Adolescent Programme (Wellington), and STOP Adolescent Programme (Christchurch). Smaller, satellite programmes are currently run in other regional centres; Hamilton (SAFE Network), Napier, Gisbourne, Palmerston North (WellStop) and New Plymouth (affiliated with WellStop) and Dunedin and Invercargill (STOP Trust). These programmes cater for the majority3 of sexually abusive youth in New Zealand referred for specialised treatment (Lambie & Seymour, 2006). This study focuses on the three main sites of Auckland (SAFE), Wellington (WellStop) and Christchurch (STOP), as these three programmes provide services to the majority of youths who receive specialised community treatment in New Zealand. Over the 9½ year period this study covered, there were 886 referrals to the community programmes (an average of 93 referrals per year).
Specialised community treatment programmes in New Zealand provide assessment and therapeutic services to children and youths with sexually abusive behaviours and their families. Most programmes use a psychoeducational and cognitive-behavioural therapy (CBT) approach (SAFE Network Inc, 1998; STOP Trust, n.d.). The New Zealand programmes provide group, individual and family therapy. The treatment agencies provide a range of services, including social work services and specialised programmes for sexually abusive youth with intellectual and learning disabilities and developmental delay, children (aged 12 or younger), and females. SAFE Auckland also offers a Wilderness programme and STOP Christchurch has an Adventure Therapy component, designed to enhance group cohesion and help engage clients in the therapy (Lambie et al., 2001; Mortensen, 2006). These programmes incorporate a range of locations and challenging and interesting activities such as “hiking, canoeing, caving, rafting, rock climbing, scuba diving, sailing, mountain biking and skiing” (Lambie et al., 2001, p. 188). The treatment programmes provide specialist services for Māori clients. All the programmes in 2 WellStop was previously called Wellington STOP 3 There is one residential unit in NZ which can cater to up to 12 youths.
Study One New Zealand offer individualised therapy plans when this is considered more appropriate. This may include individual and family therapy.
The conclusion of the treatment occurs when staff, in conjunction with family/whānau4 and/or caregivers and others involved in the case (e.g., Child, Youth and Family5 social workers) are satisfied that significant change has occurred in the client’s behaviour and cognitions to result in a reduction of risk. That is, when the client has substantially reached their goals they are considered to have successfully completed treatment. Progress is assessed in each of the key treatment components (e.g., understanding their abuse cycle, developing skills to interrupt the abuse cycle and relapse prevention) in order to “determine the degree of commitment the client has to maintaining a safe and non-abusive lifestyle in the future” (Flanagan & Hayman-White, 2000, p. 66).
Sexual abuse is defined not just by sexual behaviour but also by “the nature of the interaction and the relationship” (Ryan, 1999, p. 424). Sexually abusive interactions therefore include lack of consent and inequality and/or coercion (Ryan, 1999). Children and youths who attend specialised community treatment programmes for sexually abusive youth in New Zealand have rarely been convicted of sexual offence(s) and include a mix of both mandated (that is, they have been directed to attend by external agencies such as the Police, Courts, or Department for Child, Youth and Family (CYF) and non-mandated (voluntary attendance) children and youth. All children and youths included in this study were identified as having a history of engaging in sexually abusive behaviours. Therefore, within the context of this research, they are considered to be eligible for inclusion by virtue of their sexually inappropriate behaviour meeting the criteria for referral and/or entry into the treatment programmes.
Defining sexual abuse Children and youths were referred to specialist community sexual offender treatment programmes in New Zealand for a range of sexual behaviours including:
1. ‘hands off’ (non-contact) behaviours such as voyeurism (peeping), exposure and public masturbation, sexualised language, and obscene phone calls or letters/emails,
2. ‘hands on’ (contact) behaviours such as sodomy (anal penetration), vaginal penetration (penile, digital or object), indecent assault (e.g., sexualised touching), and genital oral contact, and
3. bestiality (sexual acts with animals).
New Zealand has a unique youth justice system which is designed to keep children and young people out of the adult justice system. Within this system young people are not necessarily charged with offences, resulting in few being convicted for their offending. The youth justice
4 Whānau – a Māori word referring to extended family and/or family group
5 Department for Child, Youth and Family (CYF) is the national child welfare agency
Study One system in New Zealand sees youth being accountable to their victims, families/whānau and local community through Family Group Conferences (FGC) for their offending and attempts to keep them out of the adult justice system. Those invited to attend an FGC include the young person, their families/whānau, victims of the offence, support people, Police, social workers, schools, mental health workers, treatment programmes, etc. An FGC is designed to address offending through reaching an agreement between victims, offenders and their families and communities on how the offending should best be dealt with (Ministry of Justice, 2005). Recommendations from an FGC may include community service, treatment recommendations, reparation and apologies to victims.
Sample This study involved an audit of clinical files of children and adolescents who had been referred for treatment at the three main community treatment programmes for sexually abusive youth in New Zealand (SAFE Auckland, WellStop in Wellington and STOP Christchurch).
To meet the inclusion criteria children and youths must have been referred to the programmes after 1 January 1995 and have left the programme (i.e., had their files closed) by 1 July 2004. All age groups, genders, ethnic groups and those with ‘special needs’ were included in the sample. Included were all those who during the study period were:
• referred to the programmes and/or
• commenced assessment and/or
• completed assessment and/or
• commenced treatment and/or
• completed treatment
A total of 886 individuals were identified as having been referred to the programmes within the period of interest. One hundred and eighty-four were excluded resulting in a study population of 702 individuals.
Ninety-two individuals were excluded as they fell outside the study period. Thirty-four clients were excluded as their files were held at the main treatment programme (e.g., at STOP Christchurch) but they had received treatment from a satellite programme (for example, Dunedin). Six were excluded for other reasons that made them ineligible for inclusion in the study, such as being incorrectly included on the Adolescent Programme lists but actually being referred to an Adult Programme. Fifty-two were excluded due to insufficient information being contained within the file (e.g., no full name, date of birth or offence details). This group were excluded as there was insufficient information available to identify them with any level of certainty or be sure they had engaged in sexually inappropriate behaviour/s.
Study One Therefore, the 702 individuals included in this study represent 93% of those referred to the three main specialised community treatment programmes in New Zealand during the study period. A summary of recruitment is presented in Figure 1 below.

Measures

Data were collected based on a retrospective, detailed review of files held by the treatment programmes using an instrument designed for this research. This data collection form was developed based on the literature (e.g., Ford & Linney, 1995; Gretton, McBride, Hare, O’Shaughnessy, & Kumka, 2001), existing risk assessment tools (e.g., Worling & Curwen, 2000b), consideration of information collected by the programmes and entered into their databases, and the Youth 2000 Survey in New Zealand (Adolescent Health Research Group, 2000). This form was developed for this study, and feedback was obtained from a range of experts within the fields of youth justice and child protection in New Zealand, cultural advisors, academics working nationally and internationally in the field of sexually abusive youth and the management and staff of the three main treatment providers in New Zealand.
The measure was piloted on a sample of twenty files and refined. Some variables were removed as information was not adequately or consistently recorded within the programme files. The variables collected from the extensive file audit included the child or young person’s age at referral, gender, sexual and nonsexual offending history, age of first known sexual offence, educational history, school achievement, family structure and history, placement history, history of sexual and physical abuse, and social, behavioural and psychological issues. See Appendix A for a copy of the data collection form.

Procedures

In order to conduct this research and to ensure that appropriate ethical standards were met, approval was obtained from a number of ethics committees. Ethical approval was granted for this project by the University of Auckland Human Participants Ethics Committee (UAHPEC). Approval was given for this project in 2004 by the UAHPEC for a period of three years (reference number 2004/163). Approval was also granted by the Research Access Committee (RAC) of the Department of Child, Youth, and Family Services.
Confidentiality agreements were also signed with Child, Youth and Family, and each of the three treatment programmes involved in this study to ensure that individuals would not be identified in any written or verbal reports or presentations that may result from the research. The researcher also underwent a police check.

Chapter 1 Introduction
Sexual abuse
Prevalence
Characteristics of sexually abusive youth
Family characteristics
Placement histories
Summary of individual and family characteristics
Sexual offending
Characteristics of sexually abusive youth with ‘special needs’
Characteristics of female sexually abusive youth
Characteristics of children who sexually abuse
Theories
The New Zealand Context
Chapter 2 Methodology
Measures
Procedures
Chapter 3 Results
Individual characteristics
Living / placement histories
Educational history
Abuse histories
Socialisation and activities
Sports and hobbies
Co-morbid mental health, physical health and behaviour problems
Offending histories
Sexual offending histories
Nonsexual offending histories
Family characteristics
Chapter 4 Discussion and Recommendations
Special populations
Implications for prevention and policy development
Implications for treatment programmes
Service provision
Limitations and strengths of study
Conclusion
STUDY TWO – Treatment outcomes
Chapter 5 Introduction
Specialised treatment programmes
Defining recidivism
Review of recidivism research
Utilization of comparison groups
Directions for research
Conclusion
Chapter 6 Methodology
Specialist treatment programmes in New Zealand
Ethical considerations
A. Recidivism
B. Psychometric measures
Chapter 7 Results – Recidivism
Treatment details
Comparing treatment groups
Youth recidivism
Adult recidivism
Overall recidivism data
Survival analysis
Chapter 8 Results – Psychometric measures
Youth Self Report Form (YSR)
Child Behavior Checklist (CBCL)
Millon Adolescent Clinical Inventory (MACI)
Chapter 9 Discussion and Recommendations
STUDY THREE – Predicting outcomes
Chapter 10 Introduction
Predicting risk of recidivism
Predicting treatment dropout
Conclusion
Chapter 11 Methodology
Sample
Procedure
Analysis
Chapter 12 Results
Predicting sexual recidivism
Predicting nonsexual recidivism
Predicting treatment dropout
Chapter 13 Discussion and Recommendations
Limitations and future research
Conclusion
OVERALL DISCUSSION AND CONCLUSION
Other implications for treatment, prevention and policy development
Limitations and strengths of study
Future research
Conclusion
APPENDICES
REFERENCES
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