Understanding the treatment and effects of harmful sexual behaviour in boys

Around 30% of sex offences against children are convicted by other children, a finding which is replicated across countries. Harmful Sexual Behaviour (HSB) refers to problematic behaviours such as risky sexual behaviour and using sexually explicit language but also encompasses behaviours including sexual assault and rape. It is the responsibility of social services, the police and the Crown Prosecution Service to determine whether the matter should be pursued criminally. Given the relatively high rates of young people demonstrating HSB it is important that there is a clear understanding of effective interventions. Unfortunately there is a lack of published research into HSB interventions and disagreement across services about which psychological model is the most effective. A literature review was completed to compare the available evidence. This was completed systematically to ensure all papers were similar enough to compare. Thirteen papers were included and all were assessed for quality although most papers were considered fair or poor. Six studies used Cognitive Behavioural Therapy (CBT), three studies used Multi-Systemic Therapy (MST) and four studies used an eclectic approach. The CBT and MST studies concluded these models were effective however there were a number of flaws with all studies so these results should be viewed with caution. Many studies used re-offending as an outcome, problems with this were discussed in the review. Studies did not seem to be following recommended guidance for working with HSB. There is no agreement in the academic field about how to assess effectiveness of HSB interventions which makes it difficult to conclude which methods are most effective and more stringent research is needed. A study was then completed to explore the experiences of mothers and fathers who have a son who has displayed HSB. The aim was to understand their experience and explore their journey through services. Seven mothers and one father were interviewed and a qualitative analysis called Interpretative Phenomenological Analysis (IPA) was used to analyse the results. IPA involves two layers of analysis, the initial stage requires the participant to make sense of their experience, providing the first level of interpretation, secondly, the researcher consciously and systematically applies meaning to their testimonies by drawing upon psychological theory. Themes shared across participants are then grouped together. There were six main themes; 'Lack of Formulation', 'Maternal Attachment', 'Affiliation', 'Escape', 'Emotional Toll' and 'Structural Issues'. Parents noted that HSB existed within a wider context of behaviour but services typically did not acknowledge or address the broader circumstances. Parental distress often related to being overlooked by services during decision-making and feeling blamed by others or blaming themselves for the HSB. There were significant consequences on the emotional well-being of parents and many experienced significant life changes after the HSB. Parents spoke about difficulties accessing services and the value of having someone on their side. Often parents seemed more affected than the young person who displayed HSB. Services are encouraged to develop collaborative ways of working with parents, focus more on parental-well being and consider how to increase fathers involvement.