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Solution-focused approaches to caring for

children whose behaviour is sexually harmful

manage the sexual risk posed to other


Judith Milner introduces the work of Barnardos The children. However, foster children
Junction1 with children whose sexualised behaviour whose behaviour is sexualised are not
threatens their foster placement stability. A safety building only particularly testing and potentially
approach to working with children, their carers and dangerous, they are also emotionally
teachers is described, using examples of work carried out needy and vulnerable children, who
with children taken into care after discovery that they respond to previous experiences of
have been both sexually abused and abusive in their birth abuse with self-harming, aggression and
families. sexual risk-taking (Hackett, 2004).
Pollock and Farmer (2005) suggest that
their broad spectrum of distress means
Judith Milner is a Introduction that they require intervention on several
freelance solutions fronts:
Children who have an adverse sexual
therapist who has
worked as an history prior to care are the ones most in
external consultant need of a reparative family life experi- work on the impact of the sexual
behaviour per se;
to Barnardos The ence but the safety issues involved make
Junction for seven
years
the fostering task especially difficult interventions aimed at addressing
(Sargent and OBrien, 2004). Their multiple separations and rejections (they
Key words: sexual- sexually abusive behaviour poses a are highly likely to have had more than
ised behaviour, foster powerful threat to the foster familys one placement);
care, safety building sexual safety. Just how is a foster carer
supposed to respond when a 12-year-old educational interventions to counter
learning delay;
boy steals her knickers from the wash
basket, masturbates with the bedroom protection from sexual risks or their
door open and creeps around the house own risky behaviour.
in the dark? Or when a 13-year-old girl
is found playing bottom games with Thus, therapeutic interventions are most
the carers young grandchildren? Or effective when the sexualised behaviour
when a seven-year-old boys teacher is managed within the context of other
reports that he is taking his penis out in challenging behaviours. This article
class, following pupils into the toilet looks at ways in which this hard-to-
and touching their private parts. The reach group of children can be helped to
research shows that foster carers develop sexual safety for others and
responses to such behaviour include emotional and sexual safety for them-
feeling frightened, humiliated, shocked, selves.
betrayed, guilty, incompetent and hope-
less. Not only do few carers receive The Junction
training in handling sexualised behav- The Junction provides a specialised
iours but very often their support service for seven to 17-year-olds whose
workers also lack skills in this area sexual behaviour is a problem. This
(Pithouse et al, 2004). includes children and young people who
When such children are referred to have acted out sexually, who have
Barnardos The Junction, the social abused someone sexually or who have
workers main concern is about how to been convicted of an offence. It also

1
The Junction is a specialist service for children and young people with sexually concerning or
harmful behaviour and their carers. As well as providing assessments and interventions, it also offers
training for carers involved in safe care and management.

42 ADOPTION & FOSTERING VOLUME 32 NUMBER 4 2008


provides support and safe care for Myers, 2005; Myers and Milner, 2007).
younger children, as well as protective This approach looks at the times when
behaviour training for schools. Central the child could have exhibited sexual-
to the service is the provision of support ised behaviour but didnt (exceptions to
and advice to parents and carers both the problem), using the childs strengths
individually and in groups. Experienced and resources to build on these so that
groups of parents and foster carers are a safety is increased. Additionally, a
valuable resource to the service.2 Most narrative approach is used to enable
referrals are from the local authorities children to externalise their sexually
providing regular funding (Barnsley, concerning (and other problem) behav-
Doncaster and Rotherham), but there is iour (Freeman et al, 1997). A commonly
also a small team of external consultants found example of an externalisation of
who work with referrals from other sexually harmful behaviour is the child
local authorities. The case examples deciding to name it the touching pro-
below are from the practice of the blem, although any name agreed makes
author who is one of the external it possible for them to talk about it more
consultants to the service. easily. Then they can begin to develop
Initially, the service used a cognitive strategies for reducing and, ultimately,
behaviour approach, such as that out- eliminating the behaviour as preferred
lined by OCallaghan and Print (1994), ways of being are identified (for more
concentrating on distorted thinking details, see Myers et al, 2003). How the
patterns and attempting to break a pre- risks posed by children whose behaviour
sumed cycle of abuse. This perspective is sexually concerning are balanced with
was employed because the early attention to their emotional needs is
research indicated that sexual offending described below.
at an early age was an indicator of likely
recidivism (see, for example, Morrison Creating a safe, consistent
et al, 1994; Hanson, 2004). Doubts environment
about the effectiveness of a cognitive Children who have been sexually abused
behavioural approach (Polaschek, 2001; and whose behaviour is sexually abusive
Hackett, 2004; Mair, 2004) and the have grown up in homes where moral,
experience of Junction workers led social and emotional boundaries have
to a radical rethink, following which been breached and opportunities to
solution-focused and narrative develop socially, emotionally and
approaches were adopted. These are intellectually have been denied. Thus,
collaborative approaches in which the they tend to have at least some degree of
skills and relationships of parents, foster learning delay, a low level of social
carers and teachers who have day-to-day skills and a high degree of secretive
care of the child are identified and behaviour and untruthfulness. They need
utilised. clear rules, routines and expectations; to
be kept safe; to know that they are safe;
The method and that others are safe from them
A solution-focused approach to safety (Hardwick, 2005). Faced with the need
building and responsibility-taking to protect other children in the family,
involves identifying childrens potential and themselves, from allegations, foster
for controlling their own behaviour carers usually institute a number of
rather than depending solely on carers to safety measures, such as baby alarms to
manage risks, specifically a signs of tell if the child leaves the bedroom in
safety approach (for a fuller account, see the night, rules about leaving bedroom

2
For more details, see the Safe Care Pack for Parents and Carers produced by families who have
successfully supported their children in overcoming sexually concerning behaviour problems
available from Barnardos The Junction, 10 Nightingale Close, Rotherham S60 2AB; 01709 377157.

ADOPTION & FOSTERING VOLUME 32 NUMBER 4 2008 43


doors open when playing upstairs and parts touching. Children can practise
vigilance when the foster child is play- this with a doll before meeting up with
ing out with others. However, in the siblings.
relatively unstructured infant classroom Foster carers should also be consulted
setting or the secondary school play- about what they already know makes
ground, the child has many more oppor- the child feel safe. Seven-year-old
tunities to act out sexualised behaviour. Nicholass foster carer knew that images
So, a first step is to bring the foster of the sea made him feel safe after she
carers and teachers together to agree on found he had made himself a bed on the
a consistent approach to ensuring the floor of his blue painted bedroom and
safety of other children. Externally surrounded himself with his teddies. He
enforced safety rules minimise sexual told her it was the sea bed and she
risks, creating a safer environment in responded sensitively by painting fish
which children can then begin to on the walls. I also gave him two
develop and have confidence in their invisible crocodiles, which I explained
own safety plans. live on a strict diet of nasty things, to
After coming into care, children learn live in his bedroom. His disturbed
very quickly that what was considered nights and daytime temper tantrums
normal behaviour in their birth family reduced dramatically after his foster
is regarded as very wrong by other carer assured him that bad memories
people and often they become afraid to were like pudding and custard to the
talk about their mixed feelings of the crocodiles. During therapy sessions,
sexual abuse (not all of which will have Nicholas drew lots of sea pictures so his
been experienced as abusive) and in- teacher used this interest to reward his
ability to handle their age-inappropriate efforts at school work and his attempts
but powerful sexual urges. At the very to control his touching of other pupils
time when they need to be touched by changing his star chart to a sea chart
lovingly, their carers are most likely to with fish stickers for socially and
hesitate to touch them at all in case academically acceptable behaviour. This
sexual responses are triggered. It is was an effective way of responding to
essential to discuss this with carers and Nicholass efforts as it linked to his
decide on how safe touches can be routines in the foster home, increasing
given, such as safe hugs (from the side, his feelings of safety.
along the shoulders) and safe stroking Children with adverse sexual
(ruffling a childs hair is an acceptable experiences are also more likely to have
touch, as is stroking the childs cheeks been neglected and to have suffered
and neck with a fluffy make-up brush). multiple separations than other foster
With older children, everyone in the children (Pollock and Farmer, 2005).
family can be asked to show their appre- They also experience separations on
ciation of others by giving them invisi- coming into care as sexualised sibling
ble badges (pats on the upper arm with behaviour requires that they are placed
the finger tips). A major concern ex- separately, and their placements may
pressed by foster carers is how quickly break down under the challenges they
sexualised behaviour recurs when their pose to carers. These events make them
foster child has contact with other feel bad about themselves and reluctant
abused and abusing siblings; for to talk about their difficulties. One way
example, younger brothers or sisters around this is to ensure that the good
jumping onto older siblings knees and things about them are discussed and
cuddling up too closely. This can be celebrated; for example, Nicholass
quite simply dealt with by teaching foster carer covered one wall of his
the child how to do what one child bedroom with good memory photos and
described to me as The Santa Sit place pictures. After three years of foster care,
the younger child sideways on one knee 12-year-old Natalie had ceased trashing
so that there is no danger of private her bedroom but was still verbally

44 ADOPTION & FOSTERING VOLUME 32 NUMBER 4 2008


abusive to her foster carer and teachers, indicate whether or not her foster
and a constant concern because of her mother was getting her answers right
stealing and sex games with younger or not. A WRONG card held up meant
children. As she had failed to engage that Natasha had to explain herself, and
with previous attempts at therapy, her she took pleasure in correcting her
foster carer and I began each session by foster mother. For example, the foster
talking about what she had done well mother said that she hadnt been
over the previous week. She would swearing at all the previous week. When
eavesdrop on us from the stairs and join asked how she had done that, the
us when it became clear that her bad foster mother said it was because she
behaviour was not the only focus of our had been listening and doing what she
conversation. Children can also be was told. With much giggling, Natalie
reminded of good things they have done held up the WRONG card and explained
in narrative letters (for a fuller account, that she had done self-calming by
see Milner, 2001, Chapter 5). using silly words instead of swear
words.
Dealing with aggressive behaviour Again, it was important to work
Hardwick (2005) noted that children closely with the school in helping
with sexually concerning behaviour also Natalie develop more control over her
have anger-related and traumatised emotions. Her learning mentor had
behaviours (wetting, cutting, etc), so it provided her with an emotions book so
is important to develop safety and that she could write down her over-
control in these areas too. Anger man- whelming feelings, but after hearing
agement programmes often prescribe how Natalie was handling her anger in
coping mechanisms to be followed as the foster home, the teacher decided that
though anger is in some way a discrete, it would be more useful for her to have
easily identifiable behaviour. External- a self-calming book, detailing each
ising anger by asking children what tiny success so these could be discussed
colour and shape their anger is, where it later. For example, instead of writing
resides in their body and where it those girls wound me up at playtime
attacks when it comes out, reveals that and I wanted to hit them, Natalie would
each childs anger is unique and needs write I nearly hit those girls who keep
its own solution. One child may have a winding me up but I went to play with
red bomb-shaped anger that explodes my friend in the disabled room instead.
into violence, whereas another may have Where the emotions are so strong that
a black anger that festers into self- the child cannot bring themselves to talk
harming. Identifying the characteristics about them at all, a helping hand can be
of strong emotions helps children talk useful. The child draws around their
about them as though they are separate hand and writes the names of people
things that can be tackled rather than they trust on each digit. As children
integral parts of their badness. This whose behaviour is sexualised tend to
enables children to identify times when trust very few people whom they can
they have been able to calm themselves. talk to about not okay touching, it is
These exceptions to the upset story can helpful to suggest that they include a pet
then be developed by asking them how or an imaginary friend as well as carers
they did it, and whether they could do it and teachers. This helping hand acts as a
again, so that a story of self-control reminder that there are people who will
emerges. Even after Natalie came in listen whenever the child has something
from the staircase, she still couldnt that is difficult to say (for further
bring herself to talk about her behaviour details, see Barnardos, 2005). Alter-
so I asked her foster mother questions as natively, a secret thoughts box can be
though she was Natalie. Natalie was used. Here the child writes down an
given two cards on which were written upsetting thought on a piece of paper
RIGHT and WRONG so that she could and puts it in the box to be read later. A

ADOPTION & FOSTERING VOLUME 32 NUMBER 4 2008 45


good time to read the thoughts is Friday be used to make it easier for the child to
afternoon, after school and before the develop a clear vision and sense of
weekend starts. The foster carer reads control over their future behaviour. Here
out each thought and asks the child if a large sheet of paper is divided into six
they wish to talk about it this includes squares and the child is invited to draw
their own and other foster childrens the problem in the first square, how they
thoughts. Sometimes the child will say would rather be in the second, a mighty
that the thought has gone (the simple helper in the third, what a slipback
process of writing it down and putting it might look like in the fourth, how it is
in a box is sufficient for many children handled in the fifth and how success
to gain control over their emotions). At will be celebrated in the sixth (Berg and
other times, a serious disclosure may be Steiner, 2003). Thirteen-year-old Jade
forthcoming. It is also helpful for the found it impossible to talk about the
foster carer to have posted notes about bottom games she played with toddlers
any good things she or he may have every time her foster mums eye was not
noticed as this ends the reading of on her but she found cartooning fun.
thoughts on a positive note. The Her problem square depicted a stick
thoughts are then placed in a bag, sealed drawing of a sad child, whereas her
and put away safely. Like any excess solution square was more developed.
items stored in the attic, it may be years She drew herself wearing jewellery and
before anyone needs to look at them carrying a handbag, depicting when she
again. was more grown up and not doing that
stuff anymore, and her powerful
Gaining control over sexually helper was a beautiful angel called
concerning behaviours Cindy. After this, instead of showing
Learning that strong emotions happen shock and anger when she caught Jade
but are not necessarily uncontrollable out in sexualised behaviour, her foster
helps children have confidence in their carer began asking in a puzzled sort of
ability to develop strategies for handling way, Where is Cindy? I thought she
their sexually concerning behaviour. was supposed to be helping you? Very
With very young children, I Can Do soon, Cindy was around so much that
cards (www.innovativeresources.org) the foster carer was able to buy Jade her
are useful in identifying skills and first grown-up necklace.
resources. These consist of a pack of 24 Teenagers pose more of a problem for
friendly monster cards especially foster carers as they have more opportu-
designed to reinforce learning about nities to exhibit sexualised behaviour
safety; for example, I Can Say No, I away from the vigilant atmosphere of
Can Tell Others, I Can Ask for Help, I the foster home. Here, a more tangential
Can Keep Safe. Talking about these approach is helpful and work is under-
friendly monsters also opens up the taken to increase the young persons
conversation for discussion about scary respectfulness, responsibility-taking and
monsters. For instance, Nicholas was truthfulness. In order to avoid giving a
able to disclose fears about members of moral lecture (which the young person
his birth family by developing a story of is likely to evade), we use games to
how Scary Vincent and the Other Bad make discussion of respectful and
Men (his choice of names) were chased responsible behaviours more under-
off by all the animals in the zoo. standable and acceptable. For example,
Equally, Mr Men figures can be adapted the board game Mans World involves
to include good and bad characters discussion of sexual topics and moral
about whom the child may want to talk dilemmas in a relaxed way (for more
as they begin to separate from the bad details, see Myers and Milner, 2007,
characters and become friendlier with Chapter 4). Respect and Responsibility
the good ones. Bingo (www.innovativeresources.org) is
With older children, cartooning can not only fun for the whole family to

46 ADOPTION & FOSTERING VOLUME 32 NUMBER 4 2008


play but also breaks down complex con- are private, wherever they are, as they
cepts into easily comprehensible items of cover private parts (reminding him of
behaviour which the players have to material discussed in a previous
evidence before they can claim a square. session).
Games also have the advantage that the Then I asked the children to draw a
foster family can continue playing them picture of a road with two forks the
after the therapist has gone. right road to respect and the wrong
The way in which these techniques road. As David has difficulty writing
can be woven together to facilitate words, he coloured his two roads red
finding a solution to a serious slipback (wrong road) and green (right road).
on the part of 13-year-old David is illus- They then were asked to give an
trated by the inclusion below of an example of respectful behaviour: Lucy
extract from the notes shared with the said people knocking on her bedroom
family after session seven. Davids before entering; Andrew said giving
permanent placement was threatened borrowed things back, and giving them
after his prospective foster carer, back in the condition received; and
Christine, found that he had taken her David said having manners and not
and her ten-year-old daughters knickers barging. We then looked at how grown-
and stuffed them behind the bathroom ups do respect. Lucy said that mum
washbasin during a weekend visit. As shows respect by cooking for them,
they were stained, it was obvious that getting their clothes ready and stuff like
David had masturbated over them. The that. Andrew said that dad shows respect
session described below included David, by going to work and providing for
the carers, Christine and Ron, and their them everyday stuff and holidays.
two children, Lucy and Andrew. David David couldnt think of any way in
was functioning academically at about which Christine and Ron show him
seven-year level but, although steadily respect so he was reminded about what
improving, his social skills were much they are doing to provide him with a
more rudimentary. home. I explained to the children that
grown-ups show respect for children
On discovery, Christine had told David even when they are tired but that
that she was shocked and upset and that children are still learning and dont
he wouldnt be coming to live with her always remember to do respect, that
if he continued to do such things. grown-ups have to remind them and that
Davids face quivered and this was the there are consequences for disrespectful
first strong emotional response that behaviour.
David has shown. As David tends to lie They were then asked what happened
about serious issues, we re-visited the when they had been disrespectful.
earlier work on respect so that the Andrew said he got grounded or his X
knicker episode could be raised in the Box taken away, Lucy said told off or
context of wider issues to do with grounded and David couldnt think of
respectfulness towards women. any consequences. I asked him if he
Each child was asked what they had knew what a sanction was and he
done recently that had gone well. This worked out that it is what happens after
was elaborated (how did they do this?) disrespect (at his other foster home he
and celebrated before they were asked got sent to his bedroom). Christine had
what had not gone well. Lucy reported tended to show disappointment when
herself for staying out later than she had David was disrespectful as this works
been told, Andrew for being lippy (but with Lucy and Andrew but this doesnt
not as bad as he used to be) and David work well with David. David agreed that
for barging into people on a recent a sanction for any disrespect on his part
holiday in his haste to get where he was should be that he is not allowed on the
going. Christine also reminded him of computer and has to tidy up his clothes
the knicker episode and that knickers instead. The children were clear about

ADOPTION & FOSTERING VOLUME 32 NUMBER 4 2008 47


consequences for grown-ups who are had strengthened too; it was noticeable
not respectful David made the link how they exchanged knowing smiles
with his birth parents not being allowed and were relaxed and comfortable with
to look after children after they had one another. It is important to make
done things that were sexually male carers roles explicit as they are
disrespectful. especially liable to be sidelined as a
They each drew a Mr Man type figure result of fear of false allegations being
of their disrespect. Andrew drew a Mr made (Hardwick, 2005).
Lippy with a big mouth; Lucy drew a
Mr Please Myself; and David drew a Mr Putting it all together
Just Do It. We talked about how these The solution-focused therapists task is
Mr Men took them on the wrong road to help all family members find a way
and what happened if they went down it of talking about the sexually harmful
sanctions and lack of freedom. Then behaviour, identify exceptions to it and
they drew a Mr Man figure to help them build on these to develop safety. How-
stay on the right road. Andrew drew a ever, the children and their carers
Mr Zip Gob; Lucy a Mr Watch; and knowledge is the key element. Every-
David a Mr Think. ones strengths and resources are used to
At the post-session discussion with find a unique solution. Once these have
Ron and Christine, we looked at how been identified and a way found to talk
very hard it had been for Christine to about things that are difficult and
handle the knicker episode as she was shocking, the foster family becomes
the person who had been the target. It confident in their ability to develop an
was agreed that if David does anything individual own safe care plan that meets
else that is disrespectful to girls or everyones safety needs. Family rules
women, Ron will have a brief but firm mostly evolve naturally but, for foster
talk with him about how boys and men children who have not experienced
are expected to treat women in this boundaries in their birth family, these
family. Both Christine and Ron agreed rules have to be made explicit. At the
to use the Mr Just Do It idea when beginning of foster care, or where the
talking with David about anything he is child has such a learning difficulty that
likely to lie about on the grounds that it compliance could be a problem, the safe
might be easier for him to talk about care plan will depend largely on a set of
disrespect in terms of winning and externally enforced rules and sanctions
losing his battle with Mr Just Do It (and (see specimen case example). Where the
how Mr Think is helping). As all the child has been able to develop control
children had enjoyed the right over their emotions and sexually con-
road/wrong road exercise, Ron and cerning behaviours, the safe care plan
Christine thought that this would make will be unique to the foster familys
conversations easier. needs. For example, as well as sexual
safety items, Christine and Rons plan
At the following session, Davids behav- included ask first, as all the children
iour had improved all round. There were had a tendency to raid the fridge.
no problems with sexually concerning Thus a safe care plan evolves through
behaviour and David proudly reported negotiation and explanation to fit each
that he had told no lies for a week. He familys needs and, as such, it will be
had done this by using his thinking (his one in which the foster carers have
adaptation of Mr Think). Particularly confidence. In devising the plan, foster
striking was his intellectual and social carers discover that they do have skills
progress. David was beginning to under- which they can use to handle sexually
stand the concepts involved in respect- concerning behaviour. These skills are
fulness and truthfulness, could handle vital in their consolidation of the work
complexity and was much more open of experts as foster carers are best
and chatty. His relationship with Ron placed to embed childrens new ways of

48 ADOPTION & FOSTERING VOLUME 32 NUMBER 4 2008


Bedroom and bathroom doors to be shut if you are getting dressed or washed

If you are on the toilet, or in the bath remember to shut the door

PJs/nightie and dressing gown to be worn when you come downstairs

Only come downstairs with clothes on

If you want to talk to someone and they are in their bedroom, knock on the door first;
dont walk straight in

Everyone should get dressed in their bedroom or bathroom

No play fighting

We all have someone to talk to if we are not feeling safe

Everyone to make a big effort to be honest with each other and mum and dad

Everyone to be in by their agreed in times

Everyone to support each other with our safe care plan

Ask permission to borrow stuff from each other; be polite, calm and positive
about each other

ADOPTION & FOSTERING VOLUME 32 NUMBER 4 2008 49


being in the everyday experiences of Myers S, A signs of safety approach to
foster family life. assessing children with sexually concerning or
harmful behaviour, Child Abuse Review 14,
pp 97112, 2005
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50 ADOPTION & FOSTERING VOLUME 32 NUMBER 4 2008

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