Children with harmful sexual behaviours

There is no universally accepted terminology to describe children with harmful sexual behaviours. As noted, in this volume we use the term ‘harmful sexual behaviours’ to cover the full spectrum of sexual behaviour problems in children. We also use ‘problematic sexual behaviours’ to refer to behaviours that fall outside the normal or age-appropriate range for younger children, and which may only harm the child exhibiting the behaviours. We use ‘juvenile sexual offending’ to refer to behaviour that falls within the legal definition of a sexual offence, where the child could be held criminally responsible for their conduct. For fuller definitions of these terms, see ‘Key terms’ in Chapter 1.

As at 31 May 2017 the Royal Commission had spoken with 6,875 survivors in private sessions. About one in six of them told us about sexual abuse by children in institutions. Contemporary data from the criminal justice system points to an ongoing problem of child sexual abuse by children with harmful sexual behaviours within institutions and in the wider community. We believe that there may be thousands of children harmed by other children’s sexual behaviours in Australia each year.

Of the survivors who spoke to us in private sessions and told us they had been sexually abused by another child or children, 61.8 per cent were male and 38.1 per cent female. Of this group of survivors, 86.3 per cent said they were abused by a boy. This is consistent with research that shows that children with harmful sexual behaviours are overwhelmingly male.

In private sessions, the duration of sexual abuse described to us by survivors who told us they were sexually abused by a child was similar to that described by survivors who told us they were sexually abused by adult perpetrators.

A number of adverse experiences in childhood have been identified in cohorts of children displaying harmful sexual behaviours. These include trauma, prior sexual and physical abuse and exposure to family violence and pornography. We also believe exposure to violent or harmful practices in an institutional context is a risk factor for exhibiting harmful sexual behaviours. Institutions may have played a role in enabling harmful sexual behaviours by allowing a culture of violence and intimidation to prevail so that abuse was ‘normalised’.

We learned that adults in institutions have struggled to recognise, react and respond appropriately to incidents of children displaying harmful sexual behaviours. We believe future responses to the problem must be informed by a better understanding of children’s sexual and psychological development and increased knowledge about harmful sexual behaviours exhibited by children.

Institutional leadership and culture are overarching factors that provide strong situational influences on children’s behaviour in institutions. Leaders influence the culture within an institution, which may be protective of children and facilitate appropriate responses when children are harmed or threatened with harm, or may enable abuse of children by endorsing harmful attitudes and behaviours. We heard about aspects of institutional cultures that may have contributed to children exhibiting harmful sexual behaviours, including aspects of cultures in institutions that are effectively ‘closed’ to outside influences. These include:

• encouragement of sexualised behaviours
• physical and emotional abuse and neglect
• bullying and initiation rituals
• hierarchical structures where children held power over other children
• lack of supervision of children
• lack of understanding of children’s sexual development and of harmful sexual behaviours
• inadequate provision of sex education to support healthy behaviours.

Research about children with harmful sexual behaviours indicates a low rate of recurrence of the behaviours. Studies show average recidivism rates for harmful sexual behaviours that reach a criminal threshold range from 3 per cent to 14 per cent. This challenges a common assumption that children who commit sexual offences will inevitably become adult sex offenders. In addition, we heard of therapeutic interventions that can reduce recidivism.

It is important that children’s harmful sexual behaviours are identified early. If children are provided with an appropriate assessment and a therapeutic response that is tailored to their particular needs, background and situation, then the behaviours are more likely to cease and less likely to escalate. In turn, children are less likely to require a criminal justice intervention.

There are significant inconsistencies and gaps in Australia’s approach to harmful sexual behaviours in children. We have found there is a general lack of knowledge and limited education about the issue within the community, and this is reflected in the inadequate institutional responses we learned about.

We have identified some of the key problems with institutions’ reactions and responses to incidents of harmful sexual behaviours by children, including:

• not identifying that harmful sexual behaviours were occurring
• minimising the harmfulness of the sexual behaviours rather than recognising them as serious matters requiring intervention
• inadequate institutional policies and procedures for handling complaints about children engaging in harmful sexual behaviours
• not communicating with affected parties, including parents of the child engaging in the harmful sexual behaviours and the parents of the victim/s
• excluding the victim/s from the institution.

Institutional responses are connected to broader government responses to this issue. Australia’s overarching policy for protecting children is set out in the National Framework. Children with harmful sexual behaviours are explicitly referenced in Strategy 6.2 of the National Framework. However, apart from a 2010 report mapping therapeutic intervention services across the country for children with harmful sexual behaviours, we are not aware of any coordinated progress on this issue.

In January 2017, we asked states and territories for information about their current policies applicable to children with harmful sexual behaviours. Despite the National Framework, state and territory governments have not yet adopted a nationally consistent approach to preventing, identifying and responding to children with harmful sexual behaviours. Policy responses have been incorporated into education policy, child protection guidelines or mandatory reporting rules with nature and scope of these policies varying widely across the jurisdictions. There is currently minimal evidence regarding the effectiveness of these policies.

We acknowledge the research regarding harmful sexual behaviours in children is emerging and current policies are developing. We are encouraged by information provided by some jurisdictions that suggests the issue is starting to be addressed in a more comprehensive and holistic way.

Child protection responses to children displaying harmful sexual behaviours may be necessary and appropriate, but we believe child protection should not be the sole focus of government and community efforts in addressing this issue. The statutory child protection system is typically reactive and overstretched and has some inherent limitations. Instead, we believe expertise and resources should be directed towards prevention and early intervention to address children’s harmful sexual behaviours. It is also our view that governments should ensure children exhibiting these behaviours have access to specialist assessment and a range of therapeutic interventions that can address their varying levels of need and be tailored to the child’s particular background and situation.

A small proportion of children with harmful sexual behaviours enter the criminal justice system. Where abuse of a child by another child has been severe, a custodial sentence may well be appropriate to protect the community and take account of the serious harm done to victims. Nevertheless, support and therapeutic intervention services are important for children with harmful sexual behaviours, both during detention and upon release.

The public health approach is an established model that has been applied in Australia and internationally and there is support for using this approach to address child protection issues. We believe a public health model can be applied to preventing problematic and harmful sexual behaviours by children.

The public health model encompasses three tiers of interventions – primary, secondary and tertiary. We believe this model can be applied as an overarching framework that will improve prevention as well as allow a range of interventions to be implemented so that children with harmful sexual behaviours receive a response that is tailored to their unique situation and context.

Multi-agency collaboration should be at the heart of a public health approach to children with harmful sexual behaviours. Child protection, police, health, therapeutic treatment services, juvenile justice and institutions where a child has exhibited harmful sexual behaviours will all have expertise and particular insight that can inform interventions for the child. Information sharing is key to achieving the best possible outcomes.

Primary interventions for harmful sexual behaviours

Primary prevention initiatives are directed to the whole community and aim to educate adults and children to help prevent children from engaging in harmful sexual behaviours. There has been a lack of understanding of children’s harmful sexual behaviours in the general community and within institutions. We have heard that harmful sexual behaviours are often not recognised and adults in institutions can struggle to know how to react when these behaviours become apparent. Consequently, we believe primary prevention should:

• outline the difference between developmentally appropriate and harmful sexual behaviours by children in a non-stigmatising way
• give children clear guidance on what sexual behaviours are acceptable, what peer and adult behaviours are wrong, and where they can seek help if they feel unsafe
• take into account gender, age, cultural context and disability.

Secondary interventions for harmful sexual behaviours

Secondary prevention focuses on early intervention to prevent children’s problematic sexual behaviour from escalating to the point where they might harm other children. Secondary intervention should be directed to children who are at higher risk of displaying harmful sexual behaviours than other children and towards institutions with higher situational risk. We acknowledge that the presence of risk factors does not guarantee abuse will occur, but can serve as a guide for the allocation of resources. Risk factors for children displaying harmful sexual behaviours include adverse childhood experiences, intellectual impairment and learning difficulties, being in out-of-home care and institutional cultures that are hierarchical and hyper-masculine (such as those existing in some elite sporting clubs, male boarding schools, or defence force settings).

Institutions should have clear policies on how to deal with harmful sexual behaviours in children. These policies should support adults within institutions to react to these behaviours when they occur and respond to incidents in an appropriate, informed and calm manner, while prioritising the safety of all children involved. An institutional response to an incident where a child displays harmful sexual behaviour should include:

• monitoring the wellbeing of all children involved – the victim, the child who caused the harm, and any witnesses or other children who have been impacted
• communicating with the children involved, their parents or carers and relevant agencies, including police and child protection where relevant
• documenting events and sharing relevant information with relevant agencies, where necessary and appropriate.

These practices should be outlined in the institution’s complaint handling policy. We discuss complaint handling in detail in Volume 7, Improving institutional responding and reporting. An effective complaint handling procedure should clearly outline roles and responsibilities, approaches to dealing with different types of complaints, including complaints about children with harmful sexual behaviours, and reporting obligations.

Tertiary interventions for harmful sexual behaviours

Tertiary interventions for harmful sexual behaviours displayed by children include child protection and criminal justice responses as well as therapeutic assessment and interventions. Referring a child with harmful sexual behaviours for specialist assessment is necessary to determine the most appropriate therapeutic intervention for that child. Interventions to address the behaviours cannot take a ‘one-size-fits-all’ approach. Each child who exhibits harmful sexual behaviours does so within the context of their current family situation and against the background of their unique upbringing and life circumstances, which may have contributed to the development of those behaviours. In institutional settings, the institution provides part of this context. Therapeutic interventions should be tailored to the child’s behaviours as well as their particular situation.

Research suggests therapeutic interventions can reduce or eliminate children’s harmful sexual behaviours. It is important to note that much of the research regarding children with harmful sexual behaviours is based on children who have attended some form of therapeutic intervention. Consequently, there is very little known about outcomes for children with problematic and harmful sexual behaviours who did not access treatment. Regardless, we believe it is critical for children with harmful sexual behaviours to have access to quality assessment and therapeutic intervention. These children should be assessed by specialist practitioners who can consider the context in which the harmful sexual behaviours occurred as well the child’s background, the broader contexts they operate in and the nature of the behaviours. Effective assessment is necessary to determine the most appropriate therapeutic intervention for the child.

Different sectors and jurisdictions currently assess children with harmful sexual behaviours via different processes. We were told of some assessments conducted by professionals with insufficient training in harmful sexual behaviours. Some assessment tools do not take enough account of variables such as age, gender, disability and cultural context, often leading to a choice of therapeutic intervention that is ineffective for a child. There is a need for well-developed and contextually appropriate assessment tools that are supported by informed clinical judgement.

A research review we commissioned suggests that Multisystemic Therapy (MST) can be effective for children with harmful sexual behaviours. The review found that MST can help reduce a number of negative social outcomes for the child receiving therapy, including sexual aggression, violence and recidivism in the short- and medium-term. MST practitioners draw on a range of approaches including cognitive and behavioural therapies and family therapy. The interventions chosen are tailored to the child’s individual, family, friendship, school and community environments. MST has a strong focus on developing the capacities of the child’s caregivers. There were some limitations with this research and more work is necessary to determine if MST is effective in the Australian context. We also heard about a range of approaches, models and therapeutic techniques that show promise for children with problematic and harmful sexual behaviours that have not yet been subject to rigorous evaluation.

In Australia, therapeutic intervention for children with harmful sexual behaviours varies across states and territories. Therapeutic services use different theoretical models and modes of delivery. We were told that many therapeutic services have inadequate resources and demand outstrips capacity. Therapeutic services receive little funding for primary prevention and early intervention initiatives.

We were also told there are services gaps for some specific populations. These include:

• inconsistent treatment options for children under the age of 10
• limited or non-existent services for children in out-of-home care in some jurisdictions
• lack of training for staff to work effectively with children with an intellectual impairment, learning difficulties or emotional or behavioural disorders (including conduct disorders), who are over-represented in therapeutic services
• lack of specialist services in regional and remote communities
• lack of expertise in culturally safe services for Aboriginal and Torres Strait Islander children.

We are of the view that governments should make assessment available for children with harmful sexual behaviours, fund a network of therapeutic services for these children, and ensure there are clear referral pathways so children are able to access the services they require. We also believe these therapeutic services should apply a principles-based approach to delivering therapeutic interventions. We have developed best practice principles, which are based on research, existing overseas and domestic frameworks, and consultations with experts as well as what we have been told during our public hearings and private sessions. Our best practice principles for therapeutic interventions are:

• A contextual and systemic approach should be used. For interventions to be effective they should take account of a child’s whole environment and include family, neighbourhood and community supports.
• Family and carers should be involved. Practitioners should equip the child’s family and carers with techniques and strategies so they can play a continuing role in behaviour management and promoting positive change for the child.
• Safety should be established. An overarching safety plan must be agreed on between services, home and school that provides safe and appropriate ways of managing the child’s behaviour.
• There should be accountability and responsibility for the harmful sexual behaviours. Therapeutic interventions should assist the child with the harmful sexual behaviours to acknowledge and take responsibility for their behaviours.
• There should be a focus on behaviour change. The aim should be to guide the child towards understanding appropriate and safe ways to behave, through education which takes account of the child’s entire circumstances, including at home and at school.
• Developmentally and cognitively appropriate interventions should be used. They should be tailored to the child’s age and developmental stage and accommodate learning and language difficulties, developmental delays, cognitive impairment and other needs resulting from disability.
• The care provided should be trauma-informed. A trauma-informed approach recognises that many children with harmful sexual behaviours have trauma in their background and therefore have complex needs that require a holistic response.
• Therapeutic services and interventions should be culturally safe. In particular, Aboriginal and Torres Strait Islander children and their families may require culturally tailored approaches. Practitioners should consult with cultural experts to ensure interventions are effective.
• Therapeutic interventions should be accessible to all children with harmful sexual behaviours.

In addition, we believe ongoing evaluation is necessary to improve the implementation and delivery of interventions, to inform practice, and to demonstrate the impact of an intervention. Evaluation is particularly important for emerging fields such as working with children with harmful sexual behaviours, because it advances the limited evidence base and provides a positive direction for the development of new interventions.