NEARI Press and Training Center Newsletter - Volume 10, Issue 6: November 2017
Impact of Childhood Adversity and Out-of-Home Placement for Male Adolescents Who Have Engaged in Sexually Abusive Behavior 
Greetings!
Welcome to NEARI Press and Training Center’s November 2017 e-Newsletter. This month, we look at the article “Impact of Childhood Adversity and Out-of-Home Placement for Male Adolescents Who Have Engaged in Sexually Abusive Behavior” by Kelcey Hall, Jill Stinson, and Michele Moser  that examines how out-of-home placement and Adverse Childhood Experiences (ACEs) may be key in determining outcomes among adolescents who have perpetrated harmful sexual behavior. You’ll be interested to read how the authors’ findings support the current federal guidelines for child welfare agencies to prioritize family preservation if the safety of the child can be assured and necessary resources provided.

Have you had a chance yet to look at NEARI Press’s just-published 2017-18 catalog (online here ) ? If you’re interested in receiving a hard copy of the catalog or are sponsoring an event at which you’d like to distribute it, please email Alisa at: http://aklein@neari.com . The catalog includes several new, revised, and soon-to-be-released books that every clinician will want for their library and to use with their clients: Dr. Robin Wilson and Peel Behavioural Services’ book, Passport to Independence: A Good Lives Model Workbook , and Rene McCreary’s Youth with Sexual Behavior Problems: A Practical Guide for Therapists Working with Youth and Their Families are just two of the new books we’re excited to offer.
 
NEARI Press and Training Center FREE 2017-18 Webinar Series is rocking! Our first two webinars of the season, Robert Wright on developing cultural competence for our field and Cordelia Anderson on the effects of pornography on the sexuality, development, and sexual behavior of children and youth , have been among the best-attended and most-lauded in the history of our webinar series. Check out the webinar poster below and on our website to get more information. We continue to seek sponsors for our webinar series so that we can keep the webinars free and accessible to as many clinicians and other professionals as possible. If you'd like to become a sponsor, please see below or check our website for the list of benefits to you and how to sign up.
 
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As always, we look forward to hearing from you about the articles, authors, and topics you’d like us to cover in the NEARI e-Newsletter, our webinars, and our in-person trainings. Please contact Alisa if you have ideas and thoughts about the particular kinds of books, workbooks, and training you’d like to see NEARI Press and Training Center offer in the coming year. 
 
Thank you for your interest in NEARI, and for the vital work that you do to keep children and adults safe from sexual harm,
 
Craig Latham, Executive Director, NEARI 
Alisa Klein, Director, NEARI Press and Training Center, aklein@neari.com  
This month, David S. Prescott and Alisa Klein examine the article:
Impact of Childhood Adversity and Out-of-Home Placement for Male Adolescents Who Have Engaged in Sexually Abusive Behavior
AUTHORS
Kelcey L. Hall, Jill D. Stinson, & Michele R. Moser 
(Please see below for full citation and abstract.)

THE QUESTION
Do out-of-home placements increase the likelihood that adolescent males who have endured Adverse Childhood Experiences (ACEs) will display earlier onset of aggressive and sexually harmful behaviors?

THE RESEARCH
Previous research indicates that youth involved with child welfare and social service systems are 30 times more likely than children living with two biological parents to have experienced four or more ACEs. Further, a large number of out-of-home placements results in poor outcomes such as adult criminality, substance use, and risky sexual behavior for young adults. This study examined the records of 120 adolescent males who had received treatment for sexually abusive behavior. The authors determined the young men's total ACE scores, which capture the impact of their trauma; and calculated the number of out-of-home placements they had experienced. Out-of-home placements were defined as:

  • Residing in the homes of family members or friends; or
  • Being placed in foster care, group homes, residential treatment centers, and detention facilities.
 
Psychiatric placements were not included in the calculations because of their short duration and because they were related to mental health problems, not systems’ direct responses to parental maltreatment. 
 
 RESULTS AND CONCLUSIONS
More than three quarters of the 120 adolescents studied had documented instances of four or more adverse events as defined by ACE scoring, and approximately one third of the adolescents had ACE scores that indicated they had experienced significant cumulative instances of abuse, neglect, and household dysfunction in earlier childhood. Ninety-three percent of the adolescents studied had at least one out-of-home placement, most frequently in a residential treatment center (86 percent), 48 percent in non-familial foster care, 45 percent in familial foster care, 45 percent in a group home, 39 percent in a detention facility, and 4 percent in a friend’s home.

The results suggest that the adolescents studied did indeed experience more cumulative trauma than the comparison group of community-based adult males, and that this trauma, along with out-of-home placement instability, were “significantly associated with the probability of onset of aggression and sexually abusive behaviors.” 

IMPLICATIONS FOR PROFESSIONALS
Many implications follow for those working at the front lines of sexual abuse. These include:
 
  • Going the extra mile to recognize the symptoms and sequelae of childhood adversity. Not all adverse experiences result in traditional diagnoses such as PTSD (which developed out of clinical experience and research with adults). Just the same, the effects of adversity can be pervasive across a young person’s life nonetheless. As the saying goes, we should not wonder what’s wrong with a client but rather what happened to him or her.
 
  • Understanding that trauma can be so pervasive that it is easy not to see. The symptoms and sequelae of trauma, including anxiety, depression, hypervigilance, irritability, and emotional numbing, can be so common in the daily experience of professionals that we may be tempted to minimize or ignore them. It can be very easy to lose sight of the fact that problematic and treatment-interfering behaviors are themselves symptoms and not just bad behavior. 
 
IMPLICATIONS FOR THE FIELD
Perhaps the most dramatic implications of this study are for our field and society beyond. Clearly, it’s time to move beyond the “presenting problem” paradigm. While many people come to understand a person’s symptoms as indicative of a specific diagnosis, these findings highlight the importance of “moving upstream” from presenting problems to a deeper understanding of how life experiences have affected each of our young clients.
 
Further, given the high number of ACEs experienced by our clients, approaches towards them should honor their resilience. It is worth considering how many professionals would endure adversity as well as these young people.
 
ABSTRACT
Child maltreatment and household dysfunction have long been linked to delinquency, adult criminality, and sexual offending. However, the association between adverse childhood experiences (ACEs), factors related to out-of-home placement, and the onset of maladaptive behaviors has not thoroughly been explored in adolescents who have engaged in sexually abusive behavior. In the present study, we examined archival records of 120 male youths who have received treatment for sexually abusive behavior. As expected, the male adolescents in this sample have experienced higher rates of ACEs than samples of adult males in the community, adult males who committed sexual offenses, and juvenile justice–involved males as reported in the literature. Discrete-time survival analyses yielded increased risks of onset of aggression and sexually abusive behavior during early childhood and mid-to-late childhood, with significant associations between higher ACE scores and a greater number of out-of- home placements. Implications and future directions are discussed. 

CITATION  
Hall, K.L., Stinson, J.D., Moser, M.R. (2017). Impact of Childhood Adversity and Out-of-Home Placement for Male Adolescents Who Have Engaged in Sexually Abusive Behavior . Child Maltreatment , https://doi.org/10.1177/1077559517720726 (published online).           
A brand new guided workbook by Robin J. Wilson, Ph.D., and Peel Behavioural Services, Passport to Independence provides therapists with time-tested and proven Good Lives activities and discussion points that have been modified by input from clients themselves. Passport to Independence covers all of the components of life that clients in treatment need to consider to be successful.


"At last! This guided workbook, Passport to Independence , focuses on an extremely important area -- the Good Lives Model. It is a welcome resource that will make treatment more accessible to many clients. The Good Lives Model has been helpful to clients and professionals alike around the world. Peel Behavioural Services has done us all a tremendous favor with this project." 

-- David S. Prescott, LICSW
Robin J. Wilson, Ph.D.
WHO Publishes New Guidelines on Responding to Children and Adolescents Who Have Been Sexually Abused  
In September, the World Health Organization (WHO) released its new report and clinical guidelines, Responding to Children and Adolescents Who Have Been Sexually Abused . These evidence-based guidelines for health workers and others state that the sexual abuse of children and adolescents is “a gross violation of their human rights and a global public health problem…with devastating consequences for their health and well-being which often last into adulthood.”
 
The key recommendations in the report include:   

  1. Provide first line support that is child or adolescent-centred and gender sensitive in response to disclosure of sexual abuse. 
  2. Minimize additional trauma and distress while taking medical history, conducting the examination and documenting the findings. 
  3. Offer post-rape care that includes HIV post-exposure prophylaxis and adherence support, emergency contraception, STI presumptive treatment where testing is not feasible and Hepatitis B and HPV vaccinations as per national guidance.
  4. Consider cognitive behavioural therapy (CBT) with a trauma focus to those who have PTSD symptoms and diagnosis, and where safe and appropriate to do so, involve at least one non-offending caregiver.   
  5. Where required to report child sexual abuse to designated authorities, health care providers should inform the child or adolescent and their non-offending caregivers about the obligation to report the abuse and the limits of confidentiality before interviewing them.

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Federal Legislation:
Youth Access to Sexual Health Services Act

Introduced in July, 2017 in the Senate as S. 1650 and in the House as H.R. 3559 , the Youth Access to Sexual Health Services Act authorizes the Department of Health and Human Services to fund grants for sexual health services to marginalized youth. Grants would fund services such as the provision of sexual health information; promotion of effective sexual health-related communication skills; and training for individuals who work in sexual health promotion with marginalized youth. In the Senate, the bill was read twice and referred to the Senate Committee on Health, Education, Labor, and Pensions. In the House, the bill was referred to the Committee on Energy and Commerce, which referred it to its Subcommittee on Health, where it is currently being read.
By: Toni Cavanagh Johnson, Ph.D.
Duration: 3-4 hours; CE Credits: 4

By:   Joan Tabachnick
Duration: 1-2 hours; CE Credits: 2

By: David S. Prescott, LICSW
Duration: 3-4 hours; CE Credits: 4

By: Steve Bengis, Ed.D., L.C.S.W. 
Duration: 4-5 hours; CE Credits: 5

By Reverend Debra Haffner & Joan Tabachnick 
Duration: 3-4 hours; CE Credits: 4

by Jamie Suvak, L.M.H.C. 
Duration: 1-2 hours; CE Credits: 2




Please consider becoming a sponsor of our exciting 2017-2018 NEARI Press and Training Center Webinar series. We have a great lineup of nationally recognized authors presenting their workbooks, research, and approaches to working with youth with sexual behavior problems. 

For $98 as an individual, or $250 as an organization, we will guarantee you up to 14 seats for the webinar AND you have access to FREE CE credits . We do all of the work to sign you up each month, and as a thank you for your support, we also offer you two free NEARI Press books. We will proudly publicize your sponsorship in all of our promotional literature and on the webinars themselves. 

For more information or to sign up, visit our website at www.nearipress.org OR contact Diane Langelier at 413.540.0712 x14, email info@nearipress.org .
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