Treatment for children and adolescents with problematic or harmful sexual behavior – knowledge and experiences from the Nordic countries and Great Britain – proposals for a national structure

None of the countries included in this study have succeeded in establishing a Public nationwide structure to ensure equal treatment for children and adolescents with HSB. Britain has made a significant contribution in this field, including the AIMproject and development of the common policies, NICE and NSPCC.

HSB must be seen in the context of the child’s age, development, functioning and the context of the behaviour. The sexual behaviour must be considered in a continuumfrom normal to problematic and harmful sexual behaviour, and requires a continuum of responses.

The central tools to categorize sexual behaviour and for risk assessment is the Sexual Behaviours Traffic Light Tool, ERASOR and AIM2. The tools are mainly standardized for boys aged 12 to 18 years who have previously committed a sexual assault. The AIM2-framework is the most current and evidence-based tool that is available in this field, and can be used to evaluate interventions and therapeutic needs. Working with people with mental disabilities and SSA, it is recommended to use the tools like AIM2, Static-99R, RRASOR and ARMIDILO-S to assess risk. Risk assessments should never be based on tools alone.

It is necessary to have a broad assessment that includes the child’s psychological functioning, the underlying reasons for the HSB, the child’s life-circumstances, resources, strengths and protective factors. The evaluation must aim to understand the child’s behaviour on the basis of the child’s environmental and cultural context. The tools and the broad evaluation should form the basis for further decisions on the types of interventions and treatment that is needed.

The work with children and young people with HSB requires collaboration across disciplines and agencies. The majority of the children and young people with HSB will need outpatient care. None of the countries included in this study have succeeded in establishing a Public nationwide structure to ensure equal treatment for children and adolescents with HSB. Britain has made a significant contribution in this field, including the AIMproject and development of the common policies, NICE and NSPCC.

HSB must be seen in the context of the child’s age, development, functioning and the context of the behaviour. The sexual behaviour must be considered in a continuum from normal to problematic and harmful sexual behaviour, and requires a continuum of responses.

The central tools to categorize sexual behaviour and for risk assessment is the Sexual Behaviours Traffic Light Tool, ERASOR and AIM2. The tools are mainly standardized for boys aged 12 to 18 years who have previously committed a sexual assault. The AIM2-framework is the most current and evidence-based tool that is available in this field, and can be used to evaluate interventions and therapeutic needs. Working with people with mental disabilities and SSA, it is recommended to use the tools like AIM2, Static-99R, RRASOR and ARMIDILO-S to assess risk. Risk assessments should never be based on tools alone.

It is necessary to have a broad assessment that includes the child’s psychological functioning, the underlying reasons for the HSB, the child’s life-circumstances, resources, strengths and protective factors. The evaluation must aim to understand the child’s behaviour on the basis of the child’s environmental and cultural context. The tools and the broad evaluation should form the basis for further decisions on the types of interventions and treatment that is needed.

The work with children and young people with HSB requires collaboration across disciplines and agencies. The majority of the children and young people with HSB will need outpatient care. In situations where the care at home is not adequate, there will be a need for placement in a specialized foster care. For a smaller group of children and young people with very severe and harmful HSB, and the family cannot provide sufficient care, it will be necessary to place the child in a specialized institution.

To ensure that children and young people with HSB are offered a coordinated and consistent approach that recognizes both the needs of children and the risks they may pose to themselves and others, we propose the following possible overall coherent structure:

• Maintaining the national competence network to ensure that all regions have high expertise on prevention, risk assessment, evaluation and treatment of children with HSB.
• The Regional Health Authorities have been commissioned by the Ministry of Health and Care Services to create a national clinical network for the treatment of children and adolescents with HSB. The main purpose of the network should be to coordinate clinical work related to the treatment of children and adolescents with HSB, associated with the CAMHS.
• The regional resource centres for violence, traumatic stress and suicide preventions (RVTS) should have an overall responsibility for the establishment and maintenance of regional expertise and consultation team on HSB. The coordination of the teams may be transferred to other services.
• To ensure a coordinated and consistent treatment for children with HSB it should be established specialized HSB-Regional clinical treatment units linked to the child and adolescent mental health services.
• It should be ensured that cases of children with HSB are discussed in regional and local interdepartmental cooperation team. It should always be established such interdisciplinary collaboration in connection with the severe HSB-cases.
• Children and young people suspected of HSB should be offered specialized child-informed interviews at the National Children’s Houses. This should also apply to mentally disabled children, adolescents and adults with HSB.
• Employees of the municipal coordination units and the habilitation service for mentally disabled should have basic training in mental disabilities with HSB. These agencies should cooperate in these matters.
• It must be developed good procedures for referral and collaboration between law enforcement, restorative justice services and child protective services that ensures that the child or adolescent are getting proper assistance and care.
• A model with reinforced foster care with specific HSB expertise should be considered in those matters where the child or adolescent cannot stay home. Public institutions, specifically for youth with HSB, should be established in cooperation with the national and regional networks.