Know

Consider your thoughts so far regarding sexual behavior challenges. Are you wondering what could have happened to a student to make them act out sexually in a problematic way? Or what futures look like for a student who is having sexual behavior challenges? How can you support them and their families? We explore these topics as we move through this lesson.

Variability of Causes for Sexual Behavior Challenges & Other Concerns

As you learned in Lesson Four, sexual behavior challenges can affect students for many different reasons. These behaviors can be a result of sexual abuse; however, this may not always be the case. If you suspect sexual abuse, or a student reports that they have been sexually abused, or if a student has been in contact with a known sexual abuser, it is important to make a mandatory report.

As educators, it is important to know the signs of sexual abuse in students, but it is also important to be aware of other potential risk factors for sexual behavior challenges. Students who have not been sexually abused can also present with sexual behavior challenges. Consider a student with developmental delays who is struggling to learn personal space and may inappropriately touch themselves or others. Or maybe a student repeats the sexually explicit material seen on TV after an older sibling left the TV on. Students may also display sexual behavior challenges such as self-soothing through masturbation in response to traumatic events. These are all examples of paths to sexual behavior challenges that do not involve sexual abuse.

If a student experiences these challenges or needs, communicate your concerns with your school leadership. They will help decide next steps to take, including contactingPUBLIC a specialist and communicating with the family about resources and supports. Communicating early and working as a team provides the family with options for support and can prevent a student with risk factors from developing sexual behavior challenges.

Potential Intervention Options

As educators, it is beyond our scope of practice to provide mental health services for students who present with sexual behavior challenges. However, you should be informed on intervention options for sexual behavior challenges available to students and their families. It is important to be aware that different programs and schools refer to these resources by various names. For example, mental health professionals can include counselors, psychologists, psychiatrists, or social workers. These professionals may provide counseling, therapy, intervention, or treatment. Certain settings may also include specialists, such as board-certified behavior analysts, occupational therapists, and intervention specialists. In learning about the various types of providers, you should be able to identify who the point persons in your school are for questions related to sexual behavior challenges. If you do not know, seek out this information.

Families should receive intervention from providers who are knowledgeable about sexual development, childhood and adolescent development, and research-based interventions (NTCSN, 2009). Mental health professionals will consider differential diagnoses and will look holistically at the child or youth, taking into consideration their environment, parenting style, family, and social factors. Each assessment is unique and treatment decisions are made on a case-by-case basis aiming for the least restrictive treatment option (Martin, 2019). Two research-based practices for sexual behavior challenges are Trauma-Focused–Cognitive Behavioral Therapy (TF–CBT) and Problematic Sexual Behavior–Cognitive Behavioral Therapy (PSB–CBT).

During the child or adolescent’s initial assessment, the mental health provider may ask that you, as the educator, contribute to your student’s assessment. Often, you will be provided with a questionnaire or checklist to complete. In addition to other assessment materials, your information helps the mental health professional make a recommendation for outpatient or more intensive therapy, such as inpatient or residential care, depending on the severity of the behaviors, the presence of additional mental health concerns, or previous unsuccessful treatment.

As intervention progresses, the mental health provider will work with the child or adolescent and with the family, possibly in individual or group and family therapy formats, to create a developmentally appropriate intervention plan. Often, counseling will consist of, but is not limited to, identifying and establishing healthy boundaries, self-regulation skills, and parent management training. Here are some examples of what intervention for sexual behavior challenges may look like based on the recommendations of a mental health professional:

• The student who mimicked sexually explicit acts when their older sibling left the TV on may be recommended to have weekly outpatient intervention that includes all the family members to help establish healthy boundaries and parent management.
• The student with developmental delays presenting with inappropriate touching may benefit from outpatient counseling two to three times a week to help parents and the child or adolescent establish healthy boundaries and self-regulations skills and to address other areas of need.
• The student who self-soothed through masturbation due to traumatic events may be served in a half-day outpatient setting to learn coping skills for their traumatic stress responses and also appropriate times of when and where to explore their sexuality. If, in that intensive outpatient setting, the mental health professional identifies that the child or adolescent’s home life is more of a risk factor, or trauma is more intense than originally diagnosed, they can be moved into an inpatient or residential care facility. Depending on the facility, the child or adolescent may have limited interaction with their families and increased daily structure with regular therapeutic interventions that can include individual and group counseling. While the child’s or adolescent’s intervention plan is confidential, it is crucial to be aware of what you as an educator can do to help the child or adolescent, especially if and when they reintegrate back into your classroom.

Incorporating Intervention Strategies

For students with sexual behavior challenges who continue to attend your school, in addition to receiving intervention, you may be asked to follow recommendations. Some of these recommendations may be things you already do as part of your classroom management to support active supervision. Mental health professionals may request that you incorporate strategies into your daily routines to reinforce what the student learned during intervention. According to Mitten, Sigel, and Silovsky (2017), discussing rules about sexual behavior is a strategy that can prevent sexual behavior challenges. It is also appropriate to communicate with families before such information is discussed with students so that families will not be caught off guard in case questions or comments occur at home after the information is presented. Presenting information in a calm manner helps students to be more open in discussing sensitive topics.

Schools are charged to keep all students safe. To address this concern, you may be asked to provide additional supervision for students receiving intervention for sexual behavior challenges. This may look like creating a supervision or safety plan with the students’ families and school administrators to ensure the safety of all students. This is especially important if the child or adolescent exhibited sexual behavior challenges toward other students. Also know that when a sexual behavior challenge has occurred, your school leadership will consult a specialist. Depending on the specialist, there can be a lag in time between when a referral is made and when the specialist is able to consult or complete an evaluation of the student. In this instance your school’s leadership will put a temporary supervision plan in place until given further guidance.

Supervision plans can include:

• Line-of-sight supervision
• Supportive shadowing (one-on-one)
• Line-of-sight supervision or supportive shadowing of the student upon arrival, during recess and lunch, and upon departure
• Supervision of the student during other times of the day that are less structured or have reduced supervision
• Designated play areas
• Supervision of the student’s use of the washroom
• Supervision for sports, including changing areas (e.g., for swimming)
• Procedures for the student to check in with a designated adult throughout the day
• A plan for responding to subsequent inappropriate sexual behavior, which may include a set of escalating consequences
• Specific behavior management strategies including a plan for reinforcing appropriate behavior
• A plan to involve the student in positive activities with peers
• A communication plan that specifies how and with whom information will be shared
• A designated case manager
• A scheduled review and update of the plan
• Clear communication of rules
• implementation of coping or calming skills, including those for the educator similar to CAPPD model in Lesson One and the self-care strategies in the Focused Topics course, Trauma-Informed Care, Lesson Four

It is important that the safety or supervision plan is periodically reviewed as the student progresses in their intervention (Responding to Children’s Problem Sexual Behavior in Elementary Schools, 1999).

School Interventions

Schools can implement policies and preventive measures to address sexual behavior and be a supportive factor for students with sexual behavior challenges by:

• Reviewing policies regarding communication about sex education, promoting abuse prevention, and working with families affected by sexual behavior challenges.
• Offering sex education for families to incorporate the entire support system to engage in healthy communication about appropriate sexual development.
• Looking to school counselors or collaborate with clinical counselors to implement classroom lessons on healthy boundaries, self-regulation skills, and safe touch. School and clinical counselors can also help meet individually with students or with families to assist with supervision plans and discuss counseling referrals.

See

Interventions to address sexual behavior challenges are individualized and based on the specific needs of each student. When working in multidisciplinary teams, both within the school setting and when collaborating with professionals outside your school, you will contribute what you know about students’ strengths, challenges, and development so teams have in-depth information to inform the assessment and intervention plans. Listen as experts speaks about the assessment process and research-based interventions for students with sexual behavior challenges.

Do

As you think about your role as a professional working with students, reflect on what you can do to be a part of a supportive team. Reflect again on your personal biases of working with students experiencing sexual behavior challenges and how these biases have an impact on the support you provide. Consider these guidelines and standards of care for professionals working with children and adolescents who exhibit sexual behavior challenges provided by the National Center on the Sexual Behavior of Youth:

• Recognize the importance of your work for promoting community and family safety.
• Be aware of the potential for significant impact and life-altering consequences that your practices may have on youth and their families.
• Inform children, youth, and their families that professionals are mandated reporters of child abuse.
• Ensure that your student is fully informed, in developmentally and cognitively appropriate language.
• With the consent of families, collaborate with outside specialists and agencies so student’s intervention feels like a team effort.
• Follow relevant practice guidelines and ethical standards (e.g., Association for the Intervention of Sexual Abusers’ standards and guidelines, as well as those of your profession).