Harmful sexual behaviour (HSB) in childhood is a complex and contested field of practice. While traditionally viewed through criminological and risk-oriented lenses, contemporary scholarship increasingly recognises that such framings inadequately capture the developmental, relational and social contexts in which children's sexual behaviours emerge. This paper critiques the enduring dominance of forensic paradigms in the conceptualisation and management of HSB, arguing that these approaches risk casting children into a conceptual "sin bin" that obscures their status and rights as children. Drawing on insights from childhood studies, developmental psychology and critical social theory, the paper repositions HSB as a phenomenon of disrupted childhood. It advocates for a reframing of policy and practice that foregrounds children's agency, social ecologies and developmental trajectories, while resisting reductive narratives of risk and recidivism. The paper concludes by proposing a rights-based, developmentally informed framework for understanding and responding to HSB that recognises both the complexity and humanity of the children involved.PRACTICE IMPACT STATEMENTThis paper applies insights from childhood studies to reframe harmful sexual behaviour as a problem of disrupted development rather than criminal deviance. It calls for proportionate, trauma-informed interventions that strengthen developmental pathways, rebuild relationships and foster children's long-term wellbeing, rather than simply interrupting behaviour.

ABSTRACT Background Developing literacy and numeracy skills among patients in secure care/forensic inpatient settings can significantly support recovery and rehabilitation. Some patients in secure care/forensic services can have specific or generalised learning disabilities. In comparison to the Programme for the International Assessment of Adult Competencies (PIAAC) there is a notable disparity in literacy and numeracy skills between forensic inpatients and the general population. Aims This service evaluation aimed to explore how patients perceive the role of literacy and numeracy education within their treatment and recovery journey. Specifically, it sought to identify both the educational and personal impact of engaging with an ‘in‐house’ education service. Methods A cross‐sectional survey design was used. Twenty‐one male patients accessing an NHS education service within a secure care/forensic inpatient hospital in the North East of England completed a bespoke questionnaire. Participants included individuals with specific and generalised learning disabilities. Additionally, routinely collected data assessing the literacy and numeracy levels of 28 patients were reviewed. Results The initial assessment findings show that the majority of adult patients, with an age range of 18 to 65, accessing the education service in a secure care unit had an equivalent level of 5–7 years age for English and 7–9 years in Maths. In survey responses from patients who had accessed educational sessions they reported experiences of improved confidence in literacy and numeracy, along with perceived improvements in relationships, meaning‐making, and personal interests. Conclusions This evaluation highlights the multifaceted value of literacy and numeracy education within secure settings. Beyond skill development, education services may foster therapeutic benefits that support recovery. Further research and systematic evaluation would support understanding of long‐term outcomes and inform future service provision.

This paper examines how broader economic and labour market forces influence family separation and the placement of children in residential care in Cambodia, amid ongoing child care deinstitutionalisation reforms. While global evidence highlights the harm caused by residential care and promotes family and community-based alternatives, Cambodia's reform efforts remain largely reactive and institution-focused, paying limited attention to structural drivers of family separation. This study identifies key macroeconomic factors influencing child care practices in Cambodia by drawing on qualitative insights from those directly involved in family separation and child placement processes. Following a review of relevant literature and key policy documents, the research involved a total of fifty-five participants, including caregivers, National Non-Governmental Organisation (NGO) staff, and government social workers and managers with experience in residential care placements. Data were collected through semi-structured interviews and focus group discussions, and were then thematically analysed to identify recurring patterns and structural influences. Participants highlighted widespread labour precarity, high labour migration rates, a growing reliance on intergenerational kinship care arrangements and household overindebtedness as key contributors to family separation and subsequent residential care admissions. This context reflects Cambodia's neoliberal political economy, characterised by inadequate social safety nets and weak regulation of labour and financial markets. Cambodia's child care reforms, aligned with global deinstitutionalisation policy models, primarily focus on institutional gatekeeping and reintegration efforts but insufficiently address the structural socioeconomic contexts that drive family separation. This paper argues for an expanded child care deinstitutionalisation framework that includes labour policy and economic considerations alongside child protection. By incorporating structural determinants, such an approach can better prevent family separation and improve long-term outcomes for children and families. These findings contribute to policy and programming insights for reforming child welfare systems in Cambodia and comparable contexts, highlighting the need to move beyond symptom-focused interventions toward addressing the underlying causes of family vulnerability.

There is a growing focus on ensuring research is accessible and inclusive to individuals traditionally not represented. To be truly inclusive, the broader context needs to be explored, as barriers might not only be linked to population characteristics but also to the complexity of their environment, and limited research opportunity within certain healthcare professions. The SCHEMA trial is a randomised controlled trial evaluating whether interpersonal art psychotherapy is effective at reducing aggressive behaviour in individuals with learning disability or borderline intellectual function in secure care. The trial illustrates the challenges and solutions to conducting research in secure care settings, a challenging environment, with an underrepresented patient population and healthcare professionals unfamiliar with conducting research. To better understand the challenges, a survey was circulated to understand site staff’s general experience with research and their specific experiences of the SCHEMA trial. Difficulty of balancing research with other responsibilities and a fear of making a mistake were the most common barriers. The top two facilitators were working with collaborators and the presence of clear guidelines and protocols. Site setup was identified as the most challenging stage of the trial, while follow-up data collection was identified as the least challenging. In response to these challenges, the central trial team worked closely with site staff to provide tailored support to address the unique needs of the healthcare professionals and participant population.

Abstract Background Parental Intimate Partner Violence and Abuse (IPVA) is a complex issue, which requires a sensitive response from a range of services. This review aimed to identify and synthesise qualitative research examining the perceptions and experiences of parents and children affected by IPVA and their interactions or engagement with various child welfare, health and legal systems and services. Methods We conducted a systematic review of the international literature, searching 11 electronic databases from inception to November 2023 and supplemented this with a grey literature search. Studies were included if they provided qualitative accounts from adult and/or child victims/survivors of IPVA and/or adult perpetrators reporting on experiences of child welfare, health, and/or criminal justice intervention. Results A thematic synthesis of 39 individual studies (38 papers and 1 book chapter) which include the perspectives of (n-825) mothers/adult females (n-107) children and (n-58) fathers was undertaken. Three overarching themes were identified: (1) the importance of supporting the family whilst safeguarding the child (2) systems failing of services to hold the perpetrator to account and (3) systems that retraumatize the Family. Conclusions Services should provide a whole-family approach, which responds to the needs both the parent and child victim/survivor, and recognises the parental identity of the perpetrator. Interventions with adult victims/survivors should take a strengths-based approach, whilst holding the perpetrator to account. Particular care is needed when families are involved in family court to avoid re-traumatisation.

BackgroundChildren and young people with long-term physical health conditions (LTPHCs), such as Juvenile Idiopathic Arthritis (JIA), are at increased risk of mental health difficulties, including anxiety and depression. Despite this, access to psychological support in paediatric healthcare settings remains limited. Group Art Psychotherapy Intervention for communicating the Needs of children with long-term health conditions (GAIN) was developed as an online, manualised group intervention to support the psychological well-being of children with LTPHCs and their families.AimsThis service evaluation aimed to assess the acceptability of the GAIN intervention as an online, home-based treatment, explore the suitability of standardised outcome measures, and develop a logic model to inform future implementation.MethodsTwelve young people with JIA participated in two age-stratified, six-session online art psychotherapy groups, facilitated by an HCPC-registered art psychotherapist. Data were collected via focus groups with therapists, patient and parent questionnaires (PedsQL, RCADS, SDQ), therapist session notes, and supervision reflections.ResultsThe intervention was well-received, with participants reporting increased social connectedness, emotional expression, and empowerment. Four themes were identified from the thematic analysis: Peer support and discussion, Youth centred empowerment, Barriers and revisions, Age group differences. A logic model for the GAIN intervention is presented, and the acceptability of the questionnaires is reported.ConclusionsThe GAIN intervention demonstrated strong acceptability and potential benefits for children with LTPHCs, particularly in promoting peer support and emotional expression.Implications for practice/policy/future researchThe evaluation informs future adaptations and the development of the evidence base for art psychotherapy in paediatric healthcare settings.Plain-language summaryChildren and young people with long-term physical health conditions, like Juvenile Idiopathic Arthritis (JIA), can sometimes feel worried, sad, or lonely. Getting mental health support is not always easy. The GAIN programme (Group Art Psychotherapy Intervention for communicating the Needs of children with long-term health conditions) is an online group art therapy designed to help children and their families. In this study, twelve young people with JIA joined online art therapy sessions led by a trained art therapist. They made art, talked, and shared their experiences. Feedback came from children, parents, therapists, and group discussions. The results showed that most children enjoyed the sessions and found them helpful. They felt less alone, more confident, and better able to express their feelings. The sessions also helped them connect with others going through similar challenges. Overall, GAIN seems to be a helpful and supportive programme for children with long-term conditions. The feedback will be used to make the programme even better and to guide future research on art therapy in children's healthcare.

BACKGROUND:At least 50 % of child sexual abuse involves perpetration by children, referred to as "harmful sexual behavior". Recently, the sexual abuse sector has focused, importantly, on the child behind the "perpetrator" to support developmentally-appropriate and trauma-informed practice. However, the experiences of victim-survivors of children's sexually abusive behavior are underexplored. OBJECTIVE:The aim of this study, funded by the National Centre for Action on Child Sexual Abuse, was to describe the experiences of victim-survivors sexually abused by other children, including their profiles and those of children with harmful sexual behaviors. Also explored was what victim-survivors say about patterns of perpetration, cessation, and disclosure. PARTICIPANTS AND SETTING:Twenty-five victim-survivors of children's harmful sexual behavior participated. Twenty-one were female, three were male, and one non-binary. They were aged between 18 and 69 years, and from a range of Australian states. METHODS:The study was informed by the research question: What is the nature of victim-survivors' experiences of children's harmful sexual behavior? In-depth individual interviews were conducted between October 2023 and January 2024 and the data were investigated using Content Analysis. The purpose of this paper is to present a map of survivor experiences (not to provide in-depth qualitative analysis) to gauge their range and patterns, and to identify potential trends. Ethics clearance was obtained from the University of Melbourne Human Research Ethics Committee (ID: 26926). RESULTS:Most victim-survivors reported that the sexual abuse by another child began in preschool and primary school, and more than half disclosed their abuse to one or more person. Victim-survivors identified 56 children involved in carrying out their sexual abuse. Eight perpetrators continued to abuse the victim into adulthood. Most harmful sexual behaviour (86 %) involved victimising intent, and physical coercion and violence (71 %). The most long-term and severe abuse was carried out by brothers and male cousins. CONCLUSION:The findings are discussed in terms of dominant constructs and narratives about children's harmful sexual behaviour, and a model of "safe, problematic, and harmful sexual experience" is proposed to augment therapeutic practice. It is our hope that the voices of victim-survivors can be amplified in policy and practice so that the child behind the victim becomes as visible as the child behind the harmful sexual behaviors.

Victim-survivors of children's harmful sexual behaviors have rarely been given a voice in academic research. The aim of this study, funded by the Australian National Centre for Action on Child Sexual Abuse, was to establish how victim-survivors interpret their experiences of harmful sexual behavior. Research questions were as follows: (1) How do victim-survivors interpret their experiences of harmful sexual behavior? (2) How do researchers inform those interpretations? Twenty-five victim-survivors of children's harmful sexual behavior participated. Interpretivist Phenomenological Analysis (IPA) was adopted for the methodological design. Semi-structured interviews were carried out between October 2023 and January 2024. Five constructs emerged through the data analysis: (1) Shifting identities; (2) Unspeakable betrayal; (3) Tenacious resistance; (4) Alternative justice; and (5) Hard-won recovery. The results are discussed in relation to knowledge translation into policy and practice, and the current evidence base.

OBJECTIVES:This study aimed to compare time to diagnosis among patients with psoriatic arthritis (PsA) with that of patients with rheumatoid arthritis (RA) and compare initial treatment and outcomes. METHODS:Patients with PsA were identified from the National Early Inflammatory Arthritis Audit between May 2018 and October 31, 2019, and matched to patients with RA (1:1) on age and sex. Patient characteristics and time to diagnosis were compared between PsA and RA groups. Further comparisons were made, restricted to matched pairs of patients with polyarticular PsA, including disease activity, disease impact, and treatment initiation. RESULTS:In total, 2120 patients with PsA were matched to patients with RA, of which 1250 had polyarticular disease. Symptom duration before referral was longer in patients with PsA than that in patients with RA. Patients with PsA had a longer time from general practitioner (GP) presentation to diagnosis (mean, 112 v 89 days; hazard ratio [HR], 0.87; 95% CI, 0.79-0.96; P = .007), including a delay in diagnosis once referrals were received in secondary care (HR, 0.86; 95% CI, 0.80-0.95; P = .002). In patients with polyarticular disease, less disease-modifying antirheumatic drugs (DMARDs) were prescribed at baseline to patients with PsA compared with those to patients with RA (54.0% and 69.0%, respectively; P < .001). Patients with RA had a higher Disease Activity Score in 28 joints at baseline, but by 3 months, the average score was 0.27 (95% CI, 0.13-0.4) higher in patients with PsA. CONCLUSIONS:Compared with patients with RA, patients with PsA have a longer duration of symptoms before referral and a longer interval between presentation to the GP and receiving a diagnosis. Most people agreed a treat-to-target strategy but fewer DMARDs were commenced for patients with PsA than those for patients with RA and a lower improvement in disease activity was achieved at 3 months, suggesting undertreatment.

The inclusion of young people in urban planning is vital for creating equitable, healthy cities. Global frameworks like UNICEF's "child-friendly cities" and the UNCRC (UN 1989) emphasise rights to participate, however, balancing participation with rights to protection is critical, particularly in addressing sensitive issues like violence and abuse. Schopenhauer's 'porcupine's dilemma', where the desire for closeness conflicts with the risks of proximity, offers a metaphor for the dynamic interplay between seemingly indivisible rights of children and youth. For marginalised youth, this tension highlights the need for participatory processes that are both inclusive and safe. Using a contextual prevention lens, making spaces safer and enhancing wellbeing rather than merely reducing crime, urban planners can address the social and spatial dynamics of safety in ways that resonate with young people's lived experiences. Based on literature review and a study with boys who have displayed harmful sexual behaviour in Scotland, this paper explores how reshaping public spaces can enhance safety and empower youth. Framing youth participation as protection highlights its transformative potential in urban planning, promoting coexistence and well-being. This paper emphasises context-sensitive approaches to address youth violence and harm, advocating for safer, healthier environments that respect young people's rights and experiences.

There is a lack of evidence base to understand and evaluate arts psychotherapies (Art Psychotherapy, Dance Movement Psychotherapy, Dramatherapy and Music Therapy) interventions increasingly provided for adolescents with mental health difficulties, a population with rising need.We aimed to understand which arts psychotherapies interventions are used with adolescents with mental health difficulties and what their mechanisms of action are. We aimed to assess what the outcomes of arts psychotherapies interventions are, and how they are measured.Literature was sourced through database searches (CINAHL, EMBASE, the Cochrane Library, PsycINFO, PubMed, Scopus, APA PsycNet) and hand searches (January 2007 - June 2023).3403 papers were screened, 47 met inclusion criteria for synthesis. Risk of bias in included studies was assessed.Findings were narratively synthesised, and a logic model drawn, mapping out intervention components, potential mechanisms of action (generic psychotherapy factors and factors unique to arts psychotherapies), and intervention outcomes. The logic model produced can inform more consistent evaluation strategies across arts psychotherapies approaches.Despite shared outcomes recognised through narrative synthesis, there is wide range of outcome measures used to assess benefits of these approaches. This is a barrier to establishment of a strong evidence base as it emphasizes differences rather than commonalities.

The SCHEMA trial evaluates whether interpersonal art psychotherapy reduces the frequency/severity of aggressive incidents or patient distress associated with psychiatric symptoms, compared to usual care. To describe the statistical and health economic analysis plan. A multicentre, two-arm, parallel-group, single blind individually randomised controlled trial with 150 adults within NHS secure care who have borderline to mild/moderate intellectual disability. The primary outcome is the frequency/severity of aggressive behaviour, measured on the Modified Overt Aggression Scale (MOAS) 19 weeks post-randomisation, analysed using a linear mixed-effect model, adjusted for baseline MOAS and stratification by gender and psychosis diagnosis. Changes in aggressive behaviour will be evaluated using weekly MOAS scores between 19 and 38 weeks. Patient distress relating to psychiatric symptoms will be assessed using the Brief Symptom Inventory Positive Symptom Distress Index across baseline, 19, and 38 weeks. Health-related quality-of-life will be assessed using self- and proxy-reported EQ-5D three-level (EQ-5D-3L) and Recovering Quality of Life 10-item measures, the latter to estimate the ReQoL Utility Index, across baseline, 19, and 38 weeks. The self-reported EQ-5D-3L is collected using an adapted version for people with intellectual disabilities. Resource-use is collected based on secure care records, to estimate intervention and healthcare costs over 19 and 38 weeks. HRQoL and cost data will inform cost-effectiveness based on the incremental cost per quality-adjusted life year over 38 weeks. This paper details the planned analyses and discusses recruitment challenges, sample size implications, and effect size assumptions. The plan was developed prior to database lock and unblinding to minimise analytical bias. ISRCTN, ISRCTN57406593 . Registered on 18/01/2023.

Background:The rise of artificial intelligence (AI) is promising novel contributions to treatment and prevention of mental ill health. While research on the use of conversational and embodied AI in psychotherapy practice is developing rapidly, it leaves gaps in understanding of the impact that creative AI might have on art psychotherapy practice specifically. A constructive dialogue between the disciplines of creative AI and art psychotherapy is needed, to establish potential relevance of AI-bases technologies to therapeutic practice involving artmaking and creative self-expression. Methods:This integrative review set out to explore whether and how creative AI could enhance the practice of art psychotherapy and other psychological interventions utilizing visual communication and/or artmaking. A transdisciplinary search strategy was developed to capture the latest research across diverse methodologies and stages of development, including reviews, opinion papers, prototype development and empirical research studies. Findings:Of over 550 records screened, 10 papers were included in this review. Their key characteristics are mapped out on a matrix of stakeholder groups involved, elements of interventions belonging to art therapy domain, and the types of AI-based technologies involved. Themes of key significance for AT practice are discussed, including cultural adaptability, inclusivity and accessibility, impact on creativity and self-expression, and unpredictability and imperfection. A positioning diagram is proposed to describe the role of AI in AT. AI's role in the therapy process oscillates on a spectrum from being a partner in the co-creative process to taking the role of a curator of personalized visuals with therapeutic intent. Another dimension indicates the level of autonomy - from a supportive tool to an autonomous agent. Examples for each of these situations are identified in the reviewed literature. Conclusion:While creative AI brings opportunities for new modes of self-expression and extended reach of art therapy, over-reliance on it presents risks to the therapy process, including of loss of agency for clients and therapists. Implications of AI-based technology on therapeutic relationship in psychotherapy demand further investigation, as do its cultural and psychological impacts, before the relevance of creative AI to art therapy practice can be confirmed.

To examine the perspectives and experiences of multi–agency practitioners involved in supporting families affected by domestic abuse (DA) to inform changes that are required to better meet the needs of affected families. This article focuses on (a) how DA is differentially understood and interpreted, (b) the possible reasons identified for differential understanding and interpretation and (c) its perceived impact on risk assessment and service delivery. A case study approach within a North East Local authority located in the United Kingdom (UK), was adopted. Thirty-one 1:1 online qualitative interviews were conducted with multidisciplinary professionals between June – December 2022. The findings are based upon a combination of deductive-inductive thematic analysis. There was an absence of a shared understanding of DA among practitioners involved in multi-agency working despite a national-level definition available in the UK. This was identified as one of the key barriers to multiagency working subsequently affecting consistent response to families affected by DA. Data from this case study emphasizes the importance of developing a uniform understanding of DA among practitioners to adequately respond to the distinctive needs of families who are affected by it. The findings from the article can also inform broader debates in the DA literature related to complexities surrounding definitions and associated interpretations. Practice and policy implications are also discussed.

This systematic review explores public views on the reintegration of men convicted of sexual offenses into the community. A search of eight databases produced 8,621 potential sources, and after screening 12 studies were included in the review. Papers were included if they used qualitative methods about the public’s views, attitudes, opinions, and/or perceptions on the reintegration of adult male sexual offenders from prison or secure care. The papers were then critically appraised and thematically synthesized. The findings highlighted four key themes: supervision, discrimination, livelihood, and interventions. Public perspectives of men convicted of a sexual offense reintegrating into the community were generally negative, fueled by media portrayals and misconceptions about the risk of reoffending. These views lead to support for stringent monitoring and restrictions, often at the expense of rehabilitation efforts. While some members of the public advocated for supportive reintegration programs, others emphasized punitive measures and expressed distrust in the effectiveness of rehabilitation. The review also highlights the significant impact of public stigma on the daily lives of offenders, particularly in relation to housing and community acceptance. The implications for future research, policy, and practice, including public education campaigns, community involvement, and enhanced support systems for reintegration, are discussed.

This systematic review examines the perspectives of victim-survivors, family members, and professionals (VFP's) on the reintegration of men convicted of sexual offenses into the community. A search of 8 databases identified 8,621 potential sources. After screening, 36 studies were included in the review. Papers were included if they used qualitative methods about VFP's views, attitudes, opinions, and/or perceptions on the reintegration of adult males who have sexually offended, from prison or secure care. The papers were then critically appraised and thematically synthesized. The findings highlighted four key themes: supervision, discrimination, livelihood, and interventions. These themes revealed the complex and multifaceted nature of reintegration, where varying perspectives highlighted a balance between public safety concerns, the potential for rehabilitation, and the profound social and emotional implications for those directly involved with the offenders. The implications for future research, and policy and practice, including support for families, professional training, and advocating for policy reform, are discussed.

Most outcome studies for children and young people who have displayed harmful sexual behaviour have focused on sexual recidivism as their primary outcome measure. Relatively little is known about broader life outcomes for children displaying such behaviours, nor about the processes involved with longer-term developmental success or failure. This paper examines long-term life course outcomes for 69 adults in the UK who presented with abusive sexual behaviour as children. Between 10 and 20 years after their childhood sexual behaviour problems, few in the sample had sexually reoffended, but general life course outcomes were much less positive. A range of individual, relational and social/environmental factors appeared to be associated with successful and unsuccessful outcomes. Successful outcomes were associated with stable partner relationships, wider supportive relationships, and educational opportunity and achievement. The findings highlight the importance of broad-based, developmental interventions in assisting those with childhood sexual behaviour problems to live successfully. Practice impact statement The findings outlined in this paper support a move away from a traditional focus on clinical programmes of "sex offence specific work" with young people towards more developmental approaches that focus actively on wider individual, relational, and socio-environmental factors associated with desistance and resilient life outcomes. This includes, but is not restricted to, interventions that are future-oriented and that promote the skills necessary for the development of supportive personal and intimate partner relationships. The importance of wider health promotion, general wellbeing and educational success is also emphasised.