Turn the Page
A treatment programme for adolescents with harmful sexual behaviour including girls and young people with learning difficulties.
Type of intervention
Target groups, level of prevention and subgroups
- (Potential) Offenders | Tertiary prevention | Children (6-11 years), Young People (12-17 years), Young Adults (18-20 years) | Male and female | Individual work | Interventions for those with disabilities/learning difficulties | English
The NSPCC's Turn the Page service is a manualised treatment programme for adolescent males aged 12- 18 years displaying harmful sexual behaviour.
In 2012 the Turn the Page service extended its criteria to include the following groups with sexually harmful behaviour: females, younger children (i.e. under 12 years) and young people with learning disabilities.
The National Society for the Prevention of Cruelty to Children (NSPCC) - a UK based charity/ NGO specialising in child protection.
Mode and context of delivery
For boys and young men aged 12-18 years: a guided and structured treatment programme which is described in detail in a manual as the ‘Change for Good’ programme.
For girls, younger boys and for children with learning disabilities: it is adapted and delivered as individualised treatment programme, based on assessed needs. It is important to keep in mind the ‘Change for Good’ manual's overarching goals of “Building a positive therapeutic alliance” and “Building systemic support” as essential guiding principles (McCrory, 2011: 56-57).
Level/nature of staff expertise required
Professionally qualified and experienced social workers and psychologists who have been trained in cognitive behavioural approaches and in the treatment approach in the manual.
Intensity/extent of engagement with target group(s)
‘Change for Good’ consists of 26 structured 1:1 sessions, plus four individually tailored sessions. The manual recommends joint or co-working and can be delivered by two social workers working together. On the other hand, where it is assessed that one worker is sufficient or only one worker is required in the room, the other worker may be engaged in the family work, debrief and reflective practice, all related to the case.
It is a matter of professional judgement which model of service delivery is undertaken by professionals, i.e. co-work, joint work or lone work. This professional judgement should be articulated within the case work plan and reviewed through the 90 day review process. This judgement should take into account what is in the child and young person’s best interests, as judged professionally, but also the wishes and feelings of the child/young person themselves.
For the other target audiences, individually tailored programmes will vary in length depending on need.
Description of intervention
'Change for Good’ is a 26 session treatment programme for males aged 12 -18 years who display sexually harmful behaviour, which has been developed, tested and evaluated by specialist psychiatric and psychology staff at NCATS (National Child Abuse Treatment Service). The model is described by McCrory, one of its originators, in Change for Good (2011). It is underpinned by a cognitive behavioural approach and draws on attachment theory, mentalisation theory and psychodynamic and systems theories. The NSPCC is evaluating whether this programme can be effectively delivered by trained social workers with the guidance of a manual. This could make the intervention more widely available and improve consistency.
The ‘Change for Good’ programme runs for 30 weeks. It is made up of 26 structured sessions and four additional sessions for addressing individual issues. The 26 sessions are grouped into four modules:
- Engagement module (four sessions)
- Relationship module (nine sessions)
- Self-regulation module (eight sessions)
- Road map for future (five sessions)
The manual comes with structured session plans and notes, worksheets, images of people of different ages with different expressions and of locations and home projects to be completed by the young person at home between sessions. The treatment manual has been published by Jessica Kingsley (2011).
For the other target audiences (females, younger children and those with a learning disability) more individualised/child specific approaches are used rather than purely using the above manualised approach (see below for brief intervention guidance):
- Keep in mind the ‘Change for Good’ Manual’s overarching goals of “Building a positive therapeutic alliance” and “Building systemic support” as essential guiding principles (McCrory, 2011: 56-57).
- Ensure an agreed and robust safety plan that is reviewed regularly.
- Work in a planned, structured and goal oriented way that is informed by assessment and formulation. Having an agreed treatment plan to encapsulate this is helpful.
- Agree a multi-agency review process that includes parents/care givers, key family members and the child’s support network. Find ways to either include the child in this process or at minimum their views.
- Any intervention programme that is offered must include work with the child, parent/caregivers, family, extended family and support network and incorporate the treatment components identified above drawing from programmes with a sound evidence base.
- Practitioners must have the skills, support, training and supervision to do so and be clear on their roles.
- Practitioners must be able to engage with the child, their parents/caregivers, family and support network, hold the potential for change and have an ability to create a therapeutic alliance. Being child centred and respectful, within a framework of child protection and safeguarding is important.
- Any programme of intervention must take into account the child’s age, gender, cultural needs, specific developmental needs including whether there are any learning disabilities or language difficulties, as well as the nature and degree of concern.
- It is important to use a range of approaches that are engaging and that address different styles of learning
- Approaches that are concrete, simple, fun, interactive, and supportive are essential.
- The use of puppets, games, toys, scenarios, role plays, sand tray, drawing and story-telling can be helpful. Approaches that draw from Trauma Based CBT have been highlighted to be helpful with this group of children (Hackett, 2004; Carpentier et.al., 2006; Kahn, 2007)
- The opportunity to practice and rehearse skills is helpful.
- It is important to agree a clear process of feedback throughout.
- Session Planning and Preparation is essential. Making reference to and adapting the framework in the Change for Good Manual may be helpful in this regard (pp. 58-60).
The programme is being evaluated by the NSPCC Evaluation Department with advice from Richard Beckett, consultant clinical and forensic psychologist. The evaluation has both quantitative and qualitative elements. A range of standardised measures are administered pre and post programme with young people and parents/carers to measure change on the main treatment components of the manual. The qualitative evaluation takes a case study approach and involves in-depth interviews with young people, their parents/carers, the referring social worker or youth justice worker and the NSPCC practitioner delivering the work to understand the barriers and facilitators to young people engaging with and making progress on the programme.
Evaluation findings will be published on the NSPCC website.
ATSA Forum, 1-21. 10 Year Follow-up Supports Cognitive-Behavioral Treatment for Children with Sexual Behavior Problems: Implications for Services, Treatment Implementation, and Future Directions.
Carpentier, M., Silovsky, J.F., & Chaffin, M. (2006). 10 year follow-up supports cognitive-behavioral treatment for children with sexual behavior problems: Implications for services, treatment implementation, and future directions.
Department of Health (2006) Needs and Effective Treatment of Young People who Sexually Abuse: Current Evidence.
Hackett, Simon, What works for children and young people with harmful sexual behaviours? Barnardo’s, 2004.
Kahn, Timothy J., Roadmaps to Recovery: A Guided Workbook for Children in Treatment, 2nd Edition, 2007, Safer Society Press.
McCrory, E. (2011) Change for Good: A Treatment Manual for Adolescents Displaying Harmful Sexual Behaviour. Jessica Kingsley, London.
INFORMATION CORRECT AT NOVEMBER 2020