Risk Assessment Tools
Physical Abuse, Neglect, Emotional Abuse and Sexual Abuse
Risk and Vulnerability Matrix
The simplest approach to initial risk assessment is to reference the factors that create resilience or undermine it for children, and to map these along the risk and vulnerability matrix. Some of these are set out previously and are replicated below, however the risk factors for sexual abuse and exploitation should also be considered:
Sources of vulnerability Sources of resilience Young age Higher IQ Disability Good attachment Earlier history of abuse Good self-esteem
Parent or Carer
Sources of vulnerability Sources of resilience Domestic violence Social support Serious substance misuse Positive parental childhood Chronic serious psychiatric illness Good parental health Severe learning disability Good relationship with sibling History of victimisation - abused as a child Education Work role
Family and Environment
Sources of vulnerability Sources of resilience Run-down neighbourhood Committed adult Poor relationship with school Good school experience Weak fabric of social support Strong community Poverty Good services/supports Social isolation Inter-generational cycle of abuse
Consider the following questions when assessing resilience in children:
- People around me I can trust, and who love me no matter what.
- People who set limits for me so I know when to stop before there is danger or trouble.
- People who show me how to do things right by the way they do things.
- People who want me to learn to do things on my own.
- People who help me when I am sick, in danger or need to learn.
- A person people can like and love.
- Pleased to do things for others and show my concern.
- Respectful of others and myself.
- Willing to be responsible for what I do.
- Sure things will be all right.
- Talk to others about things that frighten me or bother me.
- Find ways to solve problems I face.
- Control myself when I feel like doing something not right or dangerous.
- Figure out when it's a good time to talk to someone or take action.
- Find someone to help me when I need it.
- The child has someone who loves them unconditionally.
- The child has an older person outside their home they can talk to about problems and feelings.
- The child is praised for doing things on its own.
- The child can count on their family being there when needed.
- The child knows someone they want to be like.
- The child believes things will turn out all right.
- The child likes others and takes pleasure in doing things that make them be liked in return.
- The child believes in power greater than seen - has a conscience or sense of right and wrong .
- The child is willing to try new things.
- The child likes to achieve.
- The child feels that what they do makes a difference to what happens.
- The child likes itself.
- The child can focus on a task, and stay with it.
- The child has a sense of humour.
- The child makes plans to do things.
Factors should be mapped across the Risk and Vulnerability Matrix below:
1. Identify the factors that create and evidence resilience in the child, and those that indicate a protective environment.
2. Identify the factors that create vulnerability in the child and their circumstances.
3. Identify the factors that are creating adversity at this point in time.
4. Ascribe each of these a value between 1 and 5, with 5 being strong and 1 being weak.
5. Plot where you assess the child to be on the matrix according to these values - that is which quadrant do you assess the child as being in?
Is this a hypothesis or do you have enough information to evidence this? How will you now test it out and ensure that you develop a safety plan that moves the child towards Quadrant 1?
Clearly children who are assessed as being predominantly in Quadrant 4 are the most vulnerable and will need a safety plan in place to increase protective factors and promote resilience.
You can use the matrix with family members and with your assessment colleagues, including in supervision, to map out how safe you consider that children are at any point in time, as well as to test out your hypothesis about how strong some 'protective' factors really are. Putting a numerical value to your assumptions and plotting a pictorial diagram is a good way to clarify and test out thinking across professionals and with children themselves.( Adapted from Daniel and Wassell (2002) Assessing and Promoting Resilience in Vulnerable Children (Workbooks 1, 2 & 3, The Early Years, The School Years and Adolescence), London: Jessica Kingsley Publishing).
Paul Brearley: Hazards, Dangers and Protective Factors
This model is based upon a set of questions developed by Paul Brearley and used initially in risk assessments carried out by the NSPCC. By considering the possible danger and then dividing the hazards - the things that might cause the danger to occur - into two types, workers and the family are helped to examine the processes which may lead to a child being harmed, and to consider how this might be avoided. It is consistent with the approach taken by the Assessment Framework as it focuses upon both adverse and protective factors in the family and community networks that might heighten or reduce the danger to the child. It also encourages professionals to identify gaps in information and their implications for child safety.
The following steps should be taken:
1. Summarise the information which you have collected in relation to the factors present in each area being assessed, i.e. child's developmental needs, parenting capacity, family and environmental factors.
2. List the dangers - what are we worried about in relation to the danger of harm to the child? This should be specific, for example, that y will be/is being neglected by mum/dad, y has few friends and is becoming isolated and introverted, is vulnerable to strangers and may be sexually exploited, engaged in criminal activity etc. The danger is something you want to avoid, so what possible events would you fear in these circumstances? Consider not only the significance of these dangers, but the chances of them occurring.
3. List the hazards in the case and divide them into two - a hazard is something which might result in the danger being realised, or which increases its likelihood - something which brings about the danger you want to avoid - refer to the adverse factors in the Assessment Framework.
Hazards should be divided into those which are predisposing, or static, and those which are situational, or dynamic.
- predisposing hazard - something which creates vulnerability and therefore makes the danger more likely. It may need to be activated by something else, such as a situational hazard
- situational hazard - this is something which happens, and which has an immediate effect directly related to the danger
Predisposing hazards (static factors) are the sort of risks which are factual, and usually fixed at the time of the assessment, for example, the child is under 5 years old and has special needs, or a child has been sexually abused (and is therefore vulnerable to further abuse).
Situational hazards (dynamic factors) are more dynamic, and concern events or developments in the case, such as parents stop co-operating, or the protective parent decides to re-unite with the child's abuser, or a parent loses their job and faces debts and stress as a result
The latter are factors which are more likely to be amenable to change, and should be the key focus of the child protection plan. They may also indicate the greatest level of risk. The more hazards identified the greater the level of risk.
4. List the strengths - list what you consider to be the strengths in the case - those protective factors whose effects counteract the danger and make it less likely to become a reality.
5. Balance these out - make a judgement - you need to balance these out, by making direct links between hazards and strengths and their inter-relationship between the three Domains so that you are making a professional judgement about which strengths offset which hazards. What are the remaining hazards? Can these be offset by the provision of services or by further work? In what way, and upon what evidence do you base your judgement? Unresolved hazards will increase the likelihood of the danger being realised. This will be your risk outcome - is it acceptable? You should also refer to the weighting guide below.
This involves listing the identified dangers, hazards, risks and protective factors in the relation to each of the 3 Domains of the Framework for the Assessment of Children in Need and their Families then ascribing a weight to each factor as follows:
Risk: On a scale of 1 to 10, how concerning is each risk factor in relation to the danger posed to the child or children? 1 is lowest risk, and 10 is highest. - the danger is, as above, the feared outcome for the child, which needs to be clearly stated in language that everyone understands.
Protective Factors: On a scale of 1 to 10, how positive is this in protecting the child from the identified danger, and/or meeting their needs? Why do you think this? How has it been tested?
Compare the totals: Where there is a significant difference between a) and b), the situation is one of high risk, and you now need to consider what the expected impact of intervention will be in lowering the total.
Repeat the process including different support services as possible protective factors, and determine whether this lowers the total sufficiently for the core group to agree that the risk is acceptable. You should include in this exercise what the optimum level of service should be, and then repeat it to reflect what is actually available and used by the family? How significant is any mis-match?
Obviously the weight ascribed to each factor will be crucial to determining the final outcome, and this can only be a matter of professional judgement based upon our knowledge of research into child abuse and the long term impact of adversity on children.
Research suggests that adverse factors, or risks, within the Domain of Parenting Capacity tend to have a more significant impact than those in other Domains, and that these should therefore be more highly weighted than other factors.
Research is also clear that the greater the number of adverse factors present, the higher the likelihood of poor long term outcomes for children. The advantage of this model is therefore that it reflects the presence of a high number of adverse factors with a high overall score, and therefore will provide a clear indication that intervention is needed to safeguard and promote the child's welfare.
Supervisory guidance should be used to ensure that decisions arising from an assessment are shared, agreed and lead to an appropriate level of service provision and intervention, with clear measurable objectives related to the outcomes sought for the child.
Neglect and emotional abuse
The Salford Graded Care Profile may be used for all situations where actual or likely neglect is the key risk identified in the information gathered to date. It is also helpful in emotional abuse in focusing discussion on the behaviours that demonstrate this so that professionals can be specific about what it is that needs to change. It is designed to be completed with the family, over several sessions, and can be adapted to suit the individual family circumstances and to engage them in discussion and debate about what is reasonable for children to experience. Young people can also be asked to complete it and a comparison made between their perceptions and those of their parents or professionals.
Guidance on using the Graded Care Profile and the Graded Care Profile form is available here.
The following identifies two key models for understanding and responding to sexual abuse: Finkelhor's four preconditions, and Ward's Pathways. This is followed by mapping the risk factors identified in international research as they apply to sexual abuse and offending in different settings including the factors that increase risk in 'victim' families. Finkelhor provided the seminal work on which the risk assessment tools developed here are based. However, the detailed research into risk characteristics that follow on from his original work are referenced to ensure that there is a broad understanding of the presumptions and evidence that underpin the risk assessment and management approach being recommended. This does not preclude specialist assessment and indeed where relevant this is also referenced, for example in the management of sibling abuse or adolescent sexually worrying behaviour.
An overview of the research relating to Harmful Sexual Behaviour in children and young people is also presented here, and there is then a final summary overview of relevant factors to consider.
Finkelhor's 4 preconditions
David Finkelhor identified four preconditions for sexual offending:
Motivation - Predisposition to offending/ sexual predisposition to children (being sexually aroused by children, sometimes including having an emotional congruence with children which becomes sexually motivated or driven)
Overcome internal inhibitors - distorted thinking (ie. Overcome conscience or moral taboo, self- persuasion that it is not wrong, children like it, etc. Use of alcohol to lower own inhibitions?)
Overcome external inhibitors - create opportunity (groom or manipulate the environment to disempower any protective adult and ensure one does not get caught; consciously or unconsciously put oneself in a position where there are vulnerable children and an opportunity for 'temptation' )
Overcome resistance - undermining or overcoming the child's resistance to the sexual abuse (groom and manipulate the child - threats, persuasion, trickery, use of alcohol or drugs)
Finkelhor's model has been greatly developed through the work of the NSPCC, Barnardo's, and the Lucy Faithfull foundation and it provides a helpful and evidence based framework for understanding the experience of the child and the potentially protective parents and network, and therefore a means of evaluating and managing risk.
Some assumptions that can be made
Child sexual offenders are not an homogenous group. They will cover a spectrum of behaviour and preferences from those who will only offend once, in certain circumstances, against one child, to those who prefer boys, or girls or prepubescent children of either sex, to those who believe that children have a right to sex with adults and have no preference for age or gender. Others believe that they are showing the child 'love'. Whatever the nature of offence, there will be certain similarities which can assist both in identifying the level of risk and in understanding the child's experience, and that of the non-abusing parent:
- The alleged abuser holds a position of power in the family and family network
- All offences are premeditated.
- The role of fantasy and masturbation is central.
- The offender will try to deny all/some of the offence by denial, e.g., justification, distortion, minimisation.
- They will seek to lay the responsibility for the offence elsewhere- usually on the child or the non-abusing parent.
- They will say that the offence is 'out of character'.
- They will have built up a compulsive cycle of behaviour.
- The offender will say 'I won't do it again'.
- There is no "cure", only control.
The offender's behaviour will follow the following pattern:
The cycle is characterised by denial, excusing and justifying of behaviour, and the alleged or actual abuser will have followed this cycle and may have done so over a period of years. For prolific offenders, the cycle will be completed in a matter of hours and there may be minimal guilt following the assault on the child. The important factor for initial assessment of risk is to consider the first stages of the cycle in terms of the level of planning and manipulation carried out by the alleged offender to gain access to the child. This will give some insight into the experience of the child and the protective adults, as they will have been manipulated to gain their trust and to isolate the child from someone who might protect them, or who will believe them when the abuse is discovered or disclosed.
The child themselves may well also believe that the abuse was their fault, and for many young people, that no abuse has actually occurred but that they have been engaged in a relationship based on 'love'. The abuser will have created in the child fear of consequences, shame, confusion, or loyalty as a result of the 'special attention' which has surrounded the abuse. The child may well mourn the loss of this aspect of the relationship, which has taken the place of a healthy loving parental relationship.
Finkelhor also suggests the following categories to help professionals understand the impact of child sexual abuse:
- traumatic sexualisation,
- stigmatisation ,
- betrayal and powerlessness.
Each category includes the process by which the perpetrator sets up the abuse, as well as its impact on the child or young person, and the impact will relate to many factors, including the relationship with the abuser, the length of time, the severity of abuse and the degree of emotional manipulation and betrayal. Every child is different, and every assessment must recognise this and seek to understand the child's experience of the offender cycle.
In assessing risk, the practitioner must also consider:
What is the role of the non-abusing parent, if there is one?
Are they complicit, or are they potentially protective?
Research and experience tells us that, in the majority of cases, the mother is unlikely to have known, or if they have suspected are unlikely to have been able to cope with the implications this involves. Their initial reaction is therefore most likely to be one of denial and research suggests a reaction which is akin to bereavement - shock, denial, anger, confusion, depression, acceptance.. The non-abusing parent has usually been targeted and groomed - how did they meet? How has the perpetrator undermined the relationship between the mother and her child so that external inhibitors have been overcome?
However, it is also possible that the woman is complicit, or indeed is the main perpetrator, and this hypothesis needs to be considered at the initial stages and either discounted or evidenced to the extent that it is at least, a continuing possibility. Research suggests that women abuse for different reasons than men, and assessment and intervention will require a different emphasis in the longer term. However in the short term the process is the same - to avert the danger of further abuse for the child and to identify safe caring adults who will help the child to recover whilst longer term plans are put in place.
Where there is a non-abusing parent, the key focus of assessment and intervention needs to be on rebuilding the relationship between this adult and the child if the family are to heal and recover.
This grooming may have extended to wider family and friendship networks, and also to community and work environments. Potentially protective adults may not therefore believe the child and, as above will experience very powerful emotions associated with bereavement.
An alleged offence in a family, must give cause to questions about the alleged perpetrator's interaction with and access to other children.
These assumptions should form the basis of risk assessment and planning aimed at protecting children in future and repairing the damage to familial relationships in order for the child to be believed and accepted and for therapeutic recovery work to begin.
The risk assessment should consider static and dynamic factors (see earlier comment re these terms), that is, predisposing and situational factors as outlined in the Brearley model.
The Structured Assessment of Risk and Needs used by the National Offender Management Service identifies four main domains of dynamic risk factors for the abuser:
- Sexual interest
- Social and emotional functioning
- Distorted attitudes
These are the areas on which risk assessment must focus, but they must be evaluated in the contest of the situation and environment in which the perpetrator and the victim/child are living and operating. Understanding this can provide a clear guide to what the potential dangers are to a child, and what possible controls can be put in place to safeguard them. As above, it must always be remembered that offender will probably have manipulated the environment to provide opportunity and remove resistance, and this may have been deliberate or on a 'subconscious' level' which has enabled distorted thinking to predominate.
The table below summarises the risk factors identified through Finkelhor, as already described, and also through Ward's Pathways model, which builds further upon Finkelhor's approach.
Finkelhor's 4 preconditions model: Preconditions/individual factors Social/cultural factors Motivation to sexually abuse
Arrested emotional development
Need to feel powerful and controlling
Re-enactment of childhood trauma to undo hurt
Fear of adult women
Traumatic sexual experience with adult
Inadequate social skills
Masculine requirement to be dominant and powerful in sexual relationships
Erotic portrayal of children in advertising
Male tendency to sexualise all emotional needs
Repressive norms about masturbation and extramarital sex
Overcoming internal inhibitors
Failure of incest inhibition mechanism in family dynamics
Social toleration of sexual interest in children
Weak criminal sanctions against offenders
Ideology of patriarchal prerogatives for fathers
Social tolerance of deviance committed while intoxicated
Male inability to identify with needs of children
Overcoming external inhibitors
Mother is absent or ill
Mother is not close to or protective of child
Mother is dominated or abused by father
Social isolation of family
Unusual opportunities to be alone with child
Lack of supervision of the child
Unusual sleeping or rooming conditions
Lack of social supports for mothers
Barriers to women's equality
Erosion of social networks
Ideology of family sanctity
Overcoming the resistance of the child
Child is emotionally insecure or deprived
Child lacks knowledge about sexual abuse
Situation of unusual trust between child and offender
No availability of sex education for children
Social powerlessness of children
Source: Finkelhor, D. (1984, pp. 56-57).
Ward's Pathways Model
The work of Ward and Siegert (2002) is regarded among researchers as being very instructive for investigating the individual's role in committing child sexual abuse. Their theory is often referred to as Ward's Pathways Model. It is differentiated by its explanation of how offenders use apparently normalised interactions to gain both trust and access to victims.The Pathways Model is a psychological theory that suggests that certain pathways are the key to child sexual abuse perpetration. These pathways stem from "clusters" of problems that are found in the psychology of adults who sexually offend against children. These clusters are:
• difficulties in identifying and controlling emotional states;
• social isolation, loneliness and dissatisfaction;
• offence-supportive cognitions (e.g., belief that everyone sexually abuses children and that children enjoy the abuse); and
• deviant sexual fantasies.
There can be more than one cluster apparent in any one individual. Clusters are different from the pathways in that they are clinical phenomena that are found among child sexual abusers, whereas the pathways are associated with different psychological and behavioural profiles (Ward, Polaschek, & Beech, 2006).
There can be overlap between the various pathways. The five aetiological pathways that were identified are discussed below.
Ward's Pathways Model
Pathways and developmental trajectories in Ward's Pathways Model
Pathway Developmental trajectory Multiple Dysfunctional Mechanisms Distorted sexual scripts*
Dysfunctional ideas about children's sexuality
Deviant sexual arousal
Heightened self-esteem based on perceived legitimacy of actions
Deviant Sexual Scripts and Relationship Schema Distorted sexual scripts* plus dysfunctional relationship schema
Vulnerability in seeking sexual activity
Relationships perceived in sexual terms
Relationships are unsatisfying, short-term and with periods of rejection
Intimacy Deficits Normal sexual scripts*
Insecure attachments, which lead to problems in adult relationships
Maladaptive strategies to avoid unsuccessful adult relationships
Intimacy deficits and feelings of loneliness
Substitutes child as a surrogate
Emotional Dysregulation Normal sexual scripts*
Emotional regulation problems
Unidentified emotional structures
Early established link between sex and emotional wellbeing
Sex used as soothing strategy
Unable to mobilise social supports when stressed
High anger and emotional dysregulation
Child used to satisfy sexual need and punish partner
Antisocial Cognition Normal sexual scripts*
Possesses pro-criminal attitudes and beliefs
General antisocial tendencies
Patriarchal attitude and sense of own superiority
Disregard of social norms re: children and sex
Exploits opportunities to self-gratify
Notes: * Sexual scripts are "the cognitive representations individuals acquire during the course of their development that specify how to behave in sexual encounters" (Ward et al., 2006, p. 64).
Source: Adapted from Ward et al. (2006).
The Pathways Model makes it clear that it aims to explain adult perpetrators' behaviour, not problem sexual behaviours or sexually abusive behaviours that may be exhibited by children who sexually abuse other children. Ward and Siegert (2002) argued that the Multiple Dysfunctional Mechanisms pathway is exhibited by "pure" paedophiles; that is, those who can be diagnosed with paedophilia. Perpetrators with the Deviant Sexual Scripts and Relationships Schema are those who may have a possible history of child sexual abuse themselves.
As Ward et al. (2006) noted, "in the pathways model situational triggers are hypothesised to interact with the various predispositions of individuals to sexually abuse children. The nature of the situational triggers will vary according to the particular profile of causes underlying each individual's offence trajectory or pathway" (p. 73) This is closely aligned to the assumptions that are outlined in the Finkelhor model above, that is, that in assessing and managing risk we must make some assumptions until we are able to understand the particular pathology and distorted thinking pattern of the alleged abuser, and the likely stressors that will trigger this thinking and enable him to manipulate the situation in order to gain access to and abuse children.
As above it is important to understand that not all abusers are the same, and that not all abusers will re-offend. However without treatment and control, there is a very high likelihood that they will do so. Risk management and prevention must therefore make the assumption of risk and focus on creating an environment around them and the children in their orbit that will identify and react to any indication that risk is increasing and that the abuser has opportunity to isolate and abuse a child.
Mapping risk factors
Research results on perpetration risk factors
This section presents the risk factors for child sexual offending across the identified relationships and contexts. Before doing so, it is useful to consider what factors have been associated with child sexual abuse overall. These differ from those identified for child abuse (maltreatment) more generally:
Risk factors associated with child abuse and maltreatment (Centre for Disease Control and Prevention, 2014)
- Individual risk factors:
- parents' lack of understanding of children's needs, child development and parenting skills;
- parents' history of child maltreatment in family of origin;
- substance abuse and/or mental health issues, including depression in the family;
- parental characteristics, such as young age, low education, single parenthood, large number of dependent children, and low income;
- non-biological, transient caregivers in the home (e.g., mother's male partner);
- parental thoughts and emotions that tend to support or justify maltreatment behaviours.
- Family risk factors:
- social isolation;
- family disorganisation, dissolution, and violence, including intimate partner violence; and
- parenting stress, poor parent-child relationships, and negative interactions.
- Community risk factors:
- community violence;
- concentrated neighbourhood disadvantage (e.g., high poverty and residential instability, high unemployment rates, and high density of alcohol outlets), and poor social connections.
While there is a crossover with these child maltreatment risk factors, the literature on adult perpetrators of child sexual abuse also emphasises factors such as:
- their history of violence and delinquency;
- their maladaptive sexual behaviours, such as deviant sexual fantasies;
- social deficits, such as lack of empathy and social skills deficits; and
- attitudinal and cognitive variables, such as their attitudes towards rape, the "sexual precociousness of children" and cognitive rationalisations
Indeed, in their meta-analysis of 89 studies of sex offender risk factors, Whitaker and colleagues (2008) found that child sex offenders were more likely than non-offenders to have poorer family functioning, more harsh discipline, poor attachment and generally worse functioning in their family of origin.
Child sex offenders also demonstrated:
- poorer social connectedness to others (e.g., loneliness, poor social skills);
- significantly higher sexual externalising problems;
- higher sex drive and preoccupation with sex;
- more deviant sexual interests;
- greater sexualised coping;
- attitudes that are more tolerant of adult-child sex; and
- cognition that minimises perpetrator culpability.
On most of these measures, there were no significant differences between child and adult sex offenders. Whitaker et al. (2008) concluded that while child sex offenders are different from non-offenders, they are not different from adult sex offenders. In other words, while both child and adult sex offenders share a number of risk factors with general (non-sexual) offenders, the point of difference relates to the sexual component of their behaviour. This is echoed in other research on the attitudes of child sex offenders, which finds that their beliefs and attitudes in relation to children as sexual objects; general preoccupation with sex; and beliefs about entitlement, authority or control distinguish them from a range of other offenders.
Perpetrator risk factors
- Biologically unrelated male: A well-documented risk factor for certain forms of child sexual abuse is the presence of a biologically unrelated male. In authority, care and extra-familial relationships this can mean a male who has unrestricted access to a child due to their authority status (e.g., a teacher or priest) or by being considered trustworthy by the family (e.g., a neighbour). Within a familial relationship, the male can be an uncle, step-father, de facto or boyfriend to the mother who is biologically unrelated to the child. This risk factor has been calculated from victim response surveys and other records where the offender's relationship to the victim is detailed. In cases of online perpetration, research indicates that males unknown to the victim are the main offenders.
- Young: Generally means the perpetrator is under the age of 25 years, although for peer and sibling abuse it means under 18 years.
- Psychological deficits: The perpetrator has a low IQ or is cognitively impaired.
- Traditional gender values: Generally understood to be values that place women and children in an inferior position to the male offender's wants and needs. It can mean also acting on these held values; for example, through preventing a female partner from controlling her own finances, expecting children to be deferential to the offender's authority within the family, etc.
- Interest in child exploitation material: The offender has accessed and used such material.
- Computer savvy: The perpetrator is a very competent user of information technologies. They can upload material, connect with other users, encrypt their uploads and downloads, can possibly access a "dark-net" (anonymous online file sharing service), and find ways of evading detection on the Internet.
- Substance misuse: When perpetrators currently or at the time of the child sexual abuse have alcohol or other substance abuse issues.
- Highly sexualised environment: A highly sexualised environment for adult perpetrators is usually defined as one where there is high pornography consumption and a high degree of sexual discourse between adults, and where the children are often exposed to this behaviour. It does not necessarily mean creating or accessing child exploitation material. For peer and sibling offenders it often means they have witnessed sexual acts between adults in their home, or have been exposed to high levels of pornography. It has been measured from self-reports, or from online offenders, generally from details taken about their search and browsing histories prior to their arrest.
- Social isolation: The offender has not had close or significant friendships and relationships in their childhood or early adulthood.
- Low socio-economic status: The perpetrator may be unemployed, or have low-level employment.
- Low education: When the perpetrator has education only up to high school graduation level.
Childhood history and past behaviours
- Child sexual abuse history: If the perpetrator was a victim of child sexual abuse when a child, they are more likely to become a child sexual abuse perpetrator themselves.
- Childhood neglect: This is usually defined as the perpetrator having experienced neglect as a child or adolescent rather than referring to someone who neglects their own children. There are not always substantiated or reported cases of neglect in the history of the perpetrator, so this is often measured by self-reports describing childhoods that have been characterised by neglect.
- Childhood physical abuse: The offender was physically abused as a child.
- Large family size: The perpetrator grew up in a family with three or more children.
- Early parenthood: The perpetrator was aged 15 to 20 years when their child was born.
- Prior sexual criminal behaviour: The perpetrator has a history of sexual crime, not necessarily against children.
- Prior non-sexual criminal behaviour: Criminal behaviour of a non-sexual nature either while an adolescent or adult.
- Violent behaviour: The perpetrator has a history of violent and abusive behaviour. This is usually defined as other, non-sexual, criminal behaviour (for adults or adolescents) or problems with regulating emotional outbursts in children. For adults and adolescents it has been measured by looking at criminal records, reports from child protection services or self-reporting from the perpetrator.
Victim risk factors
- Poor family cohesion: This is usually defined as a family where one parent may be absent due to personal/health issues (e.g., depression or substance abuse), where parents may be emotionally or physically absent and the child is being raised by other family members, or where there is poor health in the family. It is often linked with low-income families. Where there is poor family cohesion an offender may have more opportunities to sexually abuse children, or in the case of female, Indigenous and peer/sibling offenders, they may themselves have a history of poor family cohesion that has led to behavioural and developmental issues.
- Domestic violence in the family: Child sexual abuse is often found in families where there are other forms of violence and abuse being perpetrated against the children or the perpetrator's partner. Familial and some Indigenous offenders of sexual abuse may also be committing domestic violence. Peer/sibling sexual abuse perpetrators may have witnessed domestic violence in the family; likewise female offenders. It is measured through self-reports or reports from the police or child support authorities, or the offender may have been first reported for domestic violence and it is through this that their sexually abusive behaviours are discovered.
Risk factors for adult familial offenders
The following risk factors for familial offenders have been identified by the research:
- biologically unrelated male (including step-father, de facto boyfriend of mother)
- traditional gender values
- highly sexualised environment
- social isolation
- prior non-sexual criminal behaviour
- poor family cohesion and
- domestic violence in the family
This is not to suggest that all families presenting with these risk factors will have child victims of sexual abuse, but there is a higher likelihood of child sexual abuse within a family where these risk factors are present than one where they are not.
It has been noted that it is extremely difficult to distinguish between the risk factors for perpetrators within or outside a familial relationship because the majority of studies combine various types of child sexual abuse (Black et al., 2001).
There is disagreement about whether having a history of child sexual abuse is a risk factor for adults who commit sexual abuse against a family member. Smallbone and Wortley (2001) reported that 57% of currently incarcerated intra-familial offenders reported having a history of being a victim of child sexual abuse, whereas other research has found lower rates of offenders reporting being the victim in childhood of sexual abuse.
Extra-familial offending risk factors
The difficulty with categorising risk factors for adult acquaintances or neighbours of the family is that there seems to be only one major risk factor in the perpetrator's background: that they are a biologically unrelated male with access to the child. There is conflicting evidence about whether neglect, substance misuse, low socio-economic status, a history of physical abuse and child sexual abuse, interest in child exploitation material, or violent behaviour are risk factors associated with this cohort of offender.
Risk factors for authority and care relationships
Risk factors for child sexual abuse perpetration in authority and care relationships are relatively broad:
- biologically unrelated male
- young (Sullivan & Beech, 2004, who found that 68% of perpetrators had offended against a child by the age of 21); and
- child sexual abuse history
As the above list illustrates, the risk factors for authority and care offenders is very circumscribed. Unlike other child sexual abuse perpetrators, this limited number of risk factors suggests that screening for child sexual abuse perpetration tendencies in authority and care contexts would be very difficult. The list below includes the variety of risk factors that have been tested for in authority and care offenders, but where research has concluded that they were notrisk factors:
- psychological deficits;
- traditional gender values;
- interest in child exploitation material;
- computer savvy;
- substance misuse;
- highly sexualised environment;
- social isolation;
- low socio-economic status;
- childhood neglect;
- childhood physical abuse;
- large family size;
- early parenthood;
- prior sexual criminal behaviour;
- prior non-sexual criminal behaviour;
- poor family cohesion; and
- domestic violence in the family.
This cohort of child sexual abuse offender therefore does not exhibit the risk factors that can help easier identification in other relationships and contexts. Without these risk factors these offenders would be difficult to detect by traditional pre-employment screening means (due to their lack of contact with authorities).
Risk factors for female offenders
As mentioned previously, while the number of female child sexual abuse perpetrators is very low, it is useful to point out where female and male adult sexual abuse perpetrators are similar and different. Researchers agree that the following risk factors contribute to a woman committing child sexual abuse against a child. They may also be risk factors for female professional perpetrators, although female professional perpetrators are more likely to have risk factors relating to their context rather than the more general risk factors for female perpetrators.
The risk factors for females perpetrating child sexual abuse appear to be slightly different to those associated with male perpetrators both within and outside familial relationships. Most interesting is how having a low education and socio-economic status, along with having experienced multiple forms of child abuse, can be risk factors for sexual abuse perpetration in women.
The risk factors for female offending include:
- young (16-25 years)
- low-socio economic status
- low education child sexual abuse history
- childhood neglect poor family cohesion; and
- domestic violence in the family
Risk factors for online offenders
Teens involved in sexting or online sexual harassment are not included here.
Risk factors for online offending include:
- biologically unrelated male;
- young (16-25 years)
- interest in child exploitation material
- computer savvy ;
- highly sexualised environment
- social isolation
- violent behaviour
Risk factors for sibling sexual abuse and adolescents with sexually abusive behaviours
Sibling sexual abuse has not been as widely researched as other forms of child sexual abuse; however, the research literature does suggest the following risk factors for youth who sexually abuse siblings:
- young (16-18 years) highly sexualised environment
- childhood neglect
- violent behaviour
- poor family cohesion; and
- domestic violence in the family
There are risk factors that overlap between adolescent and sibling sexual abusers, but there are also risk factors that are unique to the adolescent cohort:
- biologically unrelated male
- interest in child exploitation material
- computer savvy
- highly sexualised environment;
- childhood neglect;
- violent behaviour
- poor family cohesion; and
- domestic violence in the family
Harmful sexual behaviour in children and young people
The following provides an overview of the most recent research on Harmful Sexual Behaviour in children and young people and then provides a link to the assessment framework recently developed by the NSPCC to address this, as well as to the NICE guidance that supports the NSPCC approach.
Research Evidence - Key messages from research on children and young people who display harmful sexual behaviour - Centre of Expertise on Child Sexual Abuse :Di McNeish and Sara Scott, DMSS Research July 2018
- The term 'harmful sexual behaviour' (HSB) is used to describe a continuum of sexual behaviours, from inappropriate to problematic to abusive.
- There is a range of common and healthy behaviours at different developmental stages. When a child or young person behaves in ways considered to be outside this range, their behaviour may be called 'harmful' because it is harmful to themselves or others.
- There are no accurate figures on the full spectrum of HSB. However, one major UK study found that two-thirds of contact child sexual abuse was perpetrated by other children and young people.
- The majority of children and young people displaying HSB do not become sexual offenders as adults.
- HSB in pre-adolescent children is more likely to be at the 'inappropriate' or 'problematic' end of the continuum rather than being 'abusive' or 'violent'.
- Young children may be 'acting out' abuse they have experienced themselves, or responding to other trauma and neglect.
- The early teens are the peak time for the occurrence of HSB, most of which is displayed by boys. There are some gender differences, with girls tending to be younger when their HSB is identified.
- Children and young people who display HSB are more likely than other young people to have a history of maltreatment and family difficulties.
- Some children and young people displaying HSB have been sexually abused themselves, but most victims of sexual abuse do not go on to abuse others. It is a history of child maltreatment, rather than sexual abuse specifically, that is most strongly associated with later sexual offending.
- A significant proportion of online-facilitated sex offences are committed by young people, but limited research has been carried out into young people engaging in HSB with an online element. For some young people, there may be a link between viewing online pornography and subsequent HSB.
- There is also limited published research on effective interventions, particularly at the 'problematic' end of the HSB continuum. However, there is a general consensus that interventions need to be holistic and child focused, and involve families.
- Cognitive behavioural-based, multi-systemic and adventure-based interventions have been shown to have benefits for some children.
- Services should avoid stigmatising children and young people as 'mini adult sex offenders'.
- The most effective prevention education takes a 'whole school' approach to healthy relationships, is longer term and involves young people in development and delivery.
What is harmful sexual behaviour?
Sexual behaviours in children and young people can be seen on a continuum ranging from 'normal' and developmentally appropriate, through 'inappropriate' and 'problematic', to 'abusive' and 'violent' (Hackett, 2010) - see the table below.
Assessing what is 'normal' behaviour at each developmental stage is not straightforward, and needs to take the social, emotional and cognitive development of the individual child or young person into account. Put simply, however, some behaviours that are normal in young children are concerning if they continue into adolescence; other behaviours, normal in adolescence, would be worrying in younger children (Ryan, 2000; Friedrich et al, 2001; Friedrich et al, 1998). Behaviour outside the normative range may be called 'harmful', because it is harmful to others or to the child or young person themselves. It may range from activities that are simply inappropriate in a particular context to serious sexual assault (Hackett et al, 2015).
CONTINUUM OF SEXUAL BEHAVIOURS BY CHILDREN AND YOUNG PEOPLE (Hackett, 2010)
Shared decision making
Single instances of
inappropriate sexual behaviour
behaviour within peer group
Context for behaviour may be inappropriate
unusual and socially
No overt elements of
Consent issues may be unclear
May lack reciprocity
or equal power
May include levels of
Victimising intent or
Includes misuse of power
Coercion and force to ensure compliance
Informed consent lacking, or not able
to be freely given by victim
May include elements
violence which is
physiologically and/or sexually arousing
The extent of harmful sexual behaviour
Accurate figures for the extent of HSB do not exist, not least because HSB covers such a broad spectrum of behaviours, most of which do not come to the attention of the authorities. In one UK study, two-thirds of the contact sexual abuse experienced by children and young people was perpetrated by other young people (Radford et al, 2011), and recent figures show an increase in reports to the police alleging sexual offences committed by young people against other young people (Barnardos, 2017).
What is known about children and young people who display harmful sexual behaviour?
HSB covers a wide range of behaviours, and children and young people identified with HSB are a very diverse group. It is important to avoid generalisations and consider each child as an individual. However, the research highlights some patterns by age, gender and disability (Chaffin et al, 2002).
Pre-adolescent children: While the behaviour of some pre-adolescent children may be 'problematic', it is intentionally abusive in only a small number of cases (Johnson and Doonan, 2005). In these cases, children are likely to have experienced considerable maltreatment from early in their childhoods. Many pre-adolescent children displaying HSB have been sexually abused or exposed to developmentally inappropriate sexual experiences, such as seeing pornography (Johnson, 1988; Chromy, 2007). They may be 'acting out' such experiences as a way of communicating what has happened to them. However, such behaviour can also be an indirect response to other factors in a child's life, including other forms of trauma and neglect (Gray et al, 1999).
Normal sexual behaviours in infancy and early childhood are largely exploratory and are part of children's normal curiosity about their own and other people's bodies. However, pre-adolescent children may display a wide range of problematic sexual behaviours that are beyond what is considered developmentally normal.
Johnson and Doonan (2005) suggest that all of the following criteria should be met for any child aged 11 or under to be defined as 'sexually abusive':
1. The child has intentionally touched the sexual organs or other intimate parts of another person, or orchestrates other children into sexual behaviours.
2. The child's problematic sexual behaviours have occurred across time and in different situations.
3. The child has demonstrated a continuing unwillingness to accept 'no' when pressing another person to engage in sexual activity.
4. The child's motivation for engaging in the sexual behaviour is to act out negative emotions toward the person with whom he or she engages in the sexual behaviour, to upset a third person (such as a parent or sibling), or to act out generalised negative emotions using sex.
5. The child uses force, fear, physical or emotional intimidation, manipulation, bribery, and/or trickery to coerce another person into sexual behaviour.
6. The child's problematic sexual behaviour is unresponsive to consistent adult intervention and supervision.
Adolescents: The vast majority of adolescents who display HSB are male, even taking into account the likelihood that abuse by girls is under-reported (Taylor, 2003; Vizard et al, 2007; Finkelhor at al, 2009; Hackett et al, 2013). The early teens are the peak time for the occurrence of HSB (Ryan et al, 1996; Taylor, 2003; Hackett et al, 2013). In some cases it is an isolated incident, or is at the problematic rather than the intentionally abusive end of the continuum. Most sexually abusive acts are perpetrated by young people who have other major difficulties in their lives such as prior experience of physical or sexual abuse or neglect, witnessing domestic violence, a lack of positive male role models, or having parents with mental health or substance abuse issues (Salter et al, 2003; Skuse et al, 1998); Glasser et al, 2001); Ogloff et al, 2012). Like other teenagers who get into trouble, they are likely to have low self-esteem, poor social skills and difficulties with anger, depression and peer relationships (Chaffin et al, 2002). HSB may be directed towards younger children, adult women or peers. Compared with those whose HSB targets younger children, adolescents who sexually offend against their peers tend to show higher levels of general delinquency and antisocial behaviours (Parks, 2007; Leversee, 2015; Leibowitz et al, 2016; Fox, 2017). Some peer-on-peer abuse takes place in the context of gangs, where the perpetration of sexual violence can be coerced or become normalised (Firmin with Lloyd, 2017). Most victims of sexual abuse do not go on to abuse others (Salter et al, 2003). Although people who commit sexual offences against children are more likely than other offenders or non-offenders to have been victims of child sexual abuse (Jespersen et al, 2009; Simons et al, 2002), it is a history of child maltreatment - rather than sexual abuse specifically - that is most strongly associated with later sexual offending (Hackett, 2016; Tougas et al, 2016). Most children and young people who display HSB do not go on to sexually offend as adults; if they are arrested later in life, this is likely to be for non-sexual rather than sexual offences (Caldwell, 2002; Chaffin et al, 2002). Those most at risk of further sexual offending are older adolescents who abuse younger children, and children and young people whose behaviours involve violence (Hackett et al, 2013). Two other factors associated with further sexual offending are general antisocial behaviour and sexually deviant beliefs and impulses (Seto and Lalumière, 2010).
Children and young people with learning disabilities: Children and young people with learning disabilities are more vulnerable both to sexual abuse and to displaying problematic sexual behaviour: in one large UK study, 38% of those referred to specialist services because of HSB were assessed as having a learning disability (Hackett et al, 2013). Such individuals may:
- have less understanding that some sexual behaviours are not acceptable
- receive less sex and relationship education than other young people
- have fewer opportunities to establish acceptable sexual relationships
- struggle with social skills generally
- relate more easily to children younger than themselves.
Girls and young women: Most research is based on male samples, so less is known about HSB in girls and young women. However, research suggests that girls with abusive sexual behaviours have experienced higher levels of sexual victimisation (including intra-familial sexual abuse, other forms of abuse and frequent exposure to family violence) than boys (Mathews et al, 1997; Miccio-Fonseca, 2000; Fromuth and Conn, 1997; Miccio-Fonseca, 2016; Kubik et al, 2003; Masson et al, 2015). In common with their male counterparts, young women who display HSB are often reported to have difficulties in school and to have relatively high levels of learning difficulties (Scott and Telford, 2006; McCartan et al, 2011). HSB tends to be identified at a younger age in girls than in boys, and tends to involve younger victims (Finkelhor et al, 2009); it is less likely to involve penetration or coercion (Allardyce and Yates, 2018). Girls are less likely to be charged with an offence, in part because they and their victims tend to be younger (Hutton and Whyte, 2006; Hickey et al, 2008).
In reviewing the research, Robinson (2009) identifies the following potential pathways for adolescent females who engage in harmful sexual behaviour:
- early maturation - sexualised behaviours for which they are not developmentally prepared, through contact with older males
- depression and victimisation
- family criminality
- poor relationships with parents, particularly mother
- lack of continuity of care
- poor peer networks
- impact of pornography related to their own abusive experiences.
Harmful sexual behaviour and the internet: Research into young people engaging in HSB with an online element is still very limited - and, given the changing context of young people's use of social media, it is a challenge to determine what are developmentally 'normal' and 'problematic' online behaviours (Hackett, 2014). For example, a 2016 UK survey found that 48% of 11-16-year-olds had viewed pornography - and among those who had done so, boys were approximately twice as likely as girls to have actively searched for it (Martellozzo et al, 2016). An earlier US study found that boys were more likely than girls to view more extreme images, more often and at a younger age (Sabina et al, 2008). Studies have estimated that young people commit 3-15% of offences involving CSA imagery, and a similar proportion of offences involving online sexual communication with children (Belton and Hollis, 2016). Some research indicates that young people who view CSA imagery may be different from those who commit other kinds of sexual offences: they may be less likely to have experienced adverse childhood experiences, and more likely to come from stable and economically advantaged family backgrounds and be achieving well educationally (Moultrie, 2006; Stevens et al, 2013; Aebi et al, 2014). There is insufficient evidence to demonstrate that viewing CSA imagery leads to other forms of CSA (Webb et al, 2007; Seto and Eke, 2005; Babchishin et al, 2015), but for some young people there may be a link between viewing online pornography and subsequent behaviour (Beech et al, 2008; Leukfeldt et al, 2014). One UK study found that, among young men displaying both online-facilitated HSB and purely 'offline' HSB, the developmentally inappropriate use of pornography had been a trigger for offline HSB in more than half of cases (Hollis and Belton, 2017).
Effective assessment of children and young people displaying harmful sexual behaviour
There is little published research on the most appropriate ways of assessing children and young people presenting with HSB, although there is general agreement that assessments need to take account of the whole circumstances of the child and their family - including any prior experience of abuse and other behavioural issues (Chaffin et al, 2002; Hackett, 2014). There are a number of tools aiming to assess the likelihood of a child's HSB persisting or escalating, but none has been validated as a predictive measure (Carson, 2017; Prentky et al, 2010). There is general support for the use of holistic assessment tools to help practitioners tailor their support to children and young people. These consider both the specific risks of the young person's behaviour and motivations and their needs and strengths at individual, family and community levels (Hackett, 2014; Prentky et al, 2010; Griffin et al, 2008)
Within this context, practitioners and their managers are referred to the Brook Traffic Light Tool which provides a framework for assessment and action here
- roles of universal services
- early help assessment and risk assessment
- linking with families pre and post intervention
- key principles and approaches for intervention.
These can be accessed here
All assessments should be completed using the Child's World format and recorded within the Child's Plan, as set out within the Guernsey Child Care Procedures.
Therapeutic interventions after abuse and neglect
NICE has also published a quick guide for practitioners and managers to help and support abused and neglected children, young people and their families. The guidance includes age appropriate evidence-based interventions to consider when working with children and young people who have experienced abuse and neglect as well as principles to consider. This can be accessed here
Summary - Common factors associated with perpetration of sexual abuse
Across the various contexts and settings of child sexual abuse, there are similarities in the risk factors to perpetration, as well as similarities in the behaviours engaged in by perpetrators. The common risk factors to perpetration (biologically unrelated male, young, highly sexualised environment, childhood neglect, violent behaviour, poor family cohesion, and domestic violence in the family) can be outside the perpetrator's control; for example, being young, having a history of neglect or being a victim of domestic violence.
However, there are also numerous ambiguous findings from the research regarding other risk factors. There is disagreement between researchers about the following:
- substance misuse;
- low socio-economic status;
- child sexual abuse history;
- childhood physical abuse;
- prior non-sexual criminal behaviour; and
- violent behaviour.
This disparity may be due to differences in the research populations being approached for study. For example, incarcerated males comprise only the known and currently apprehended child sexual abusers and are more likely to be from a low socio-economic status, whereas un-apprehended child sexual abuse perpetrators are perhaps more likely to be from a more solid financial background.
Common risk factors, by relationship/context of child sexual abuse offending
Biologically unrelated male
Authority and care
Highly sexualised environment
Poor family cohesion
Domestic violence in the family
Institutional abuse or abuse of those in care settings:
Individuals committing sexual abuse in authority and care relationships do not appear to have the same risk factors to their perpetration as those in other relationships.
To understand how sexual abuse occurs within these settings it is helpful to refer to the work of Marcus Erooga, who identified terms this as a 'corruption of care' and lists 6 factors which are preconditions within the institution itself - and can be deliberately manipulated by individuals who wish to create an environment where abuse is 'normal' or ignored, drawing in others who would not in other circumstances choose to abuse children in their care:
1. Neutralisation of normal moral concerns: "This suggests that a stage of the process is, effectively, the dehumanisation of the individual: "...they [service users] have to come to be regarded as beyond the normal bounds of moral behaviour which governs relations between person and person or carer and client. They have to be seen as less than fully human". As previously, Finkelhor explains this as part of the pattern of 'distorted thinking' which enables the abuser to minimise the impact of their actions and to view the victim as either willing, or deserving of the abuse, for example.
2. The balance of power and powerlessness: The "corruption of care" is closely connected with the balance of power and powerlessness in organisations. Most of those who suffer abuse in these settings are vulnerable and powerless, either to prevent the abuse occurring, or to report it subsequently, whereas the power and status afforded to teachers, whom both children and parents trust, create the conditions for abuse of that power.
3. Stigmatised activity: "...certain populations....are.... held in less regard by society...." Children from highly deprived backgrounds and with special education needs would come within this definition. One implication, confirmed by research, is that this group of children are more likely to experience abuse, and less likely to be believed when they make allegations. Inadequate training and resources combined with challenging demands in an unusual environment with no adequate support system can lead to stress and isolation. In those circumstances power over children can possibly become a way of gaining a sense of significance for the worker. The children with whom they work, and who may be perceived as part of the source of stress, also become the most available outlet for frustration. Reduced staffing ratios, changes in routine and months at the beginning and end of the school year all had a statistically significant relationship to increases in allegations against staff in 3 studies cited by the author. Finkelhor et al (1988) suggest that much sexual abuse in these settings does not grow out of a specific conscious and pre-existing sexual preference for children of this age. Rather, they suggest that much of the abuse is opportunistic, by which they mean that it has a more general and diffuse motivation than specific sexual attraction, and that the key factor is not the particular sexual attraction but rather the availability and vulnerability of the children.
4. Failures of management: "Management failures underlie the corruption of care, referring to a comprehensive failure in a range of responsibilities by management at every level. Without clear aims and objectives for the organisation, secondary aims become predominant. The efficient operation of the organisation becomes the key concern, at the expense of consideration of the legitimate needs and interests of the individual. Care and rehabilitation become subordinate to priorities of order and control.
5. Closed" organisations: This "corruption of care", it is suggested, is more likely to occur in enclosed, inward-looking organisations. Organisations managed along hierarchical lines can become so highly controlled that it is not possible to challenge their practices. The abuser in this type of organisation is more commonly an authority figure in the institution and protected, albeit unwittingly, by the hierarchical systems in place. Common elements of such organisations can be identified:
- criticism and complaint are easily stifled;
- new ideas are discouraged and rigid and conservative routines and patterns of practice encouraged;
- group norms become so ingrained that to challenge them can be enormously personally and professionally threatening;
- an absence of any external moral or professional challenge to established practice;
- patterns of practice have increasingly low standards and aspirations become those of control, order and the absence of problems.
The distance from this to becoming a "corrupted system" is relatively small.
6. Models of authority: an autocratic officer-in-charge, protected by a strong political and administrative network, with participation in shared decision-making by staff and children discouraged, so giving both a sense of helplessness and powerlessness. The difficulty of managing children is emphasised, with implicit or overt permission to control at any cost, and so ultimately to abuse; a theoretical and ideological model is introduced that tends to "distance, dehumanize and devalue relationships with residents". Other approaches are discouraged or devalued, to increase the status of the preferred method; an "oppressor mentality" that reflects, encourages or tolerates hostility towards females, children or minorities exists or is encouraged. Within such an environment it becomes more possible for a motivated individual to abuse and to encourage others to do so.
- Worried about a child?
- Case Conference
- After the Initial Case Conference
- Supplementary Guidance