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Variability of Causes for Sexual Behavior Challenges and Other Concerns

当您在第四课学到时，儿童和青年受到性行为挑战的影响的原因是有所不同。这些行为可能是性虐待的结果;但是，这可能并不总是如此。如果您怀疑性虐待，如果儿童或青少年报告他们已经受到性虐待，或者如果孩子或青年已经与已知的性虐待者联系，则重要的是要制定强制性报告。有关强制性报告的更多信息，请参阅虚拟实验室学校（VLS）儿童虐待的第三课：识别和报告课程。万博体育下载手机版

作为照顾者和教育者，了解儿童和青年中性虐待的迹象是很重要的。然而，意识到问题性行为或严重性行为的其他潜在原因也很重要。儿童和青年notbeen sexually abused may also exhibit sexual behavior challenges. Consider a child with developmental delays who struggles with issues of personal space and inappropriately touches themselves or others. Or a child who mimics sexually explicit material they saw on TV after an older sibling left the TV on. Children may also display sexual behavior challenges to self-soothe through masturbation in response to traumatic events. These are all examples of paths to sexual behavior challenges that are not the result of sexual abuse. According to the National Child Traumatic Stress Network (2009), the following experiences and needs of children are risk factors for sexual behavior challenges:

• 暴露于创伤体验，例如滥用，自然灾害或事故
• Exposure to violence in the home
• Excessive exposure to adult sexual activity or nudity in the home (including media exposure through television or the internet)
• Inadequate rules about modesty or privacy in the home
• Inadequate supervision in the home, often as a result of parental factors such as depression, substance abuse, or frequent absences due to work

其他可能导致性行为挑战的情境因素包括：

• 在邻居的玩伴
• 兄弟姐妹的诞生
• 共沐浴
• 打扮时的隐私较少，去洗手间或沐浴
• Viewing another child or adult in the bathroom
• 看到他们的母亲母乳喂养
• 共病诊断，如品行障碍、注意力缺陷多动障碍、创伤后应激障碍或对立违抗障碍（儿童通常有多个诊断）
• Developmental level of child or youth

照顾经历性行为挑战的儿童和青少年的护理者和教育者应了解以下社会、情感和行为症状：

• 冲动和倾向于在他们思考之前采取行动
• Difficulties following rules and listening to authority figures at home and in the community
• Problems making friends their own age and a tendency to play with much younger children
• A limited ability to self soothe (calm themselves down), so they may touch their own genitals as a way to release stress and calm down

如果儿童或青年经历这些挑战或需求，请与您的计划领导层传达您的疑虑。他们将帮助决定您应采取的下一步，并与家庭有关资源和支持沟通。这些可能是挑战性的对话，主要是因为性行为挑战的儿童一直被滥用。如果报告或涉嫌滥用，则需要进行强制性报告。尽早沟通并作为一支球队签订，为家庭提供支持的选择，可以防止一个危险因素促进性行为挑战的危险因素。

潜在的干预选择

作为照顾者和教育工作者，它超出了我们的培训和技能，为表现出性行为挑战的儿童和青少年提供干预。但是，我们可以教育自己的干预选择，适合拥有具有性行为挑战的孩子的家庭。重要的是要意识到不同的计划和学校通过各种名称提及这些资源。在虚拟实验室学万博体育下载手机版校，我们认为熟悉可能与经历性行为挑战的家庭的潜在专业或职称的潜在专业或职称是至关重要的。例如，心理健康专业人员可以包括辅导员，心理学家，精神科医生或社会工作者。这些专业人员可以提供治疗，干预或治疗。某些设置还可以包括专家，例如，董事会认证的行为分析师，职业治疗师和干预专家。

家庭应该接受那些了解性发展、儿童和青少年发展以及研究性干预的提供者的干预（NTCSN，2009）。心理健康专业人员将考虑其他条件，并从整体上看待儿童或青少年，同时考虑他们的环境、养育方式、家庭和社会因素。每项评估都是独特的，治疗决定是在个案的基础上作出的，旨在实现限制性最小的治疗选择（Martin，2019）。针对性行为挑战的两个主要研究性实践是以创伤为中心的认知行为治疗（TF-CBT）和问题性行为认知行为治疗（PSB-CBT）。

During the child or youth’s initial assessment, the mental health provider may ask that you as the caregiver or educator contribute to the assessment of the child. 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 problematic sexual behavior, the presence of additional mental health concerns, or previous unsuccessful treatment.

As intervention progresses, the mental health provider will work with the child or youth and with the family, possibly in individual and or group/family therapy formats, to create a developmentally appropriate intervention plan. Often times, counseling will consist of, but is not limited to, learning to identify and establish healthy boundaries, self-regulation skills, and parent management training. The following are examples of what intervention for sexual behavior challenges may look like based on the recommendation of a mental health professional:

• 当哥哥姐姐不看电视时，模仿性露骨行为的孩子可能会被建议每周进行门诊干预，包括所有家庭成员，以建立健康的界限，并支持改善父母的监督。
• 使用不恰当的触摸的发展延误的孩子可能会受益于每周两到三次的门诊咨询，以帮助父母和孩子建立健康的界限，并解决孩子的其他需要领域。
• The child who self-soothed through masturbation due to traumatic events may be best served in a half-day outpatient setting to learn coping skills for their traumatic stress responses and appropriate times of when to explore their sexuality. If, in that intensive outpatient setting, the mental health professional identifies that the child’s home life is more of a risk factor or that trauma is more intense than originally diagnosed, the child can be moved into an inpatient or residential care facility. Depending on the facility, the child may have limited interaction with their family and increased daily structure with regular therapeutic interventions that can include individual and group counseling. While the child or youth intervention plan is confidential, it is crucial to be aware of what you as a caregiver or educator can do to help the child or adolescent, especially if and when they reintegrate back into your program.

纳入干预策略

除了接受干预,孩子with sexual behavior challenges who will continue to attend your program may be asked to follow recommendations. Mental health specialists may request that you incorporate strategies into your daily routines to reinforce what the child 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 children 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 children and youth to be more open in discussing these sensitive, challenging topics. Interventions are important to consider as preventive--before learning of a child or adolescent with sexual behavior challenges or in response to a presenting sexual behavior concern).

Programs are charged with keeping all children safe while in care. With this in mind, caregivers need to consider ways all children and youth stay safe. To address this concern, you may be asked to provide additional supervision for children receiving intervention for sexual behavior challenges. This may mean you will want to create a supervision or safety plan with the child or youth’s parents or caregivers and program administrators to ensure the safety of all children. This is especially important if the child or youth who exhibited sexual behavior challenges toward other children or youth.

Supervision plans can include:

• Adult-only supervision of child or youth.
• 在儿童或青年到达时、休息和午餐期间以及离开时对其进行监督。
• 在较少结构或减少监督的那一天的其他时候监督儿童或青年。
• 指定的游乐区。
• 监督儿童或青少年使用洗手间。
• 体育监督，包括改变区域（例如，在游泳池处）。
• Procedures for the child or youth to check in with a designated adult throughout the day.
• A plan to respond to subsequent inappropriate sexual behavior, which may include a set of escalating consequences.
• 具体的行为管理策略，包括加强适当行为的计划。
• A plan to involve the child in positive activities with peers.
• 一个通信计划，指定如何和与其共享谁。
• 指定的案例经理（最好是程序管理员）。
• 计划和更新计划和规则的清晰沟通。
• Implementation of coping or calming skills, including those for the caregiver or educator similar to the CAPPD model in第一课自我照顾策略第四课of the VLS Focused Topics Trauma-Informed Care in Child Care Settings course.

重要的是，随着儿童或青少年在干预方面的进展，应定期审查安全和监督计划（对小学儿童问题性行为的回应，1999年）。

计划干预措施

计划可以实施政策和预防措施，以解决性行为发展，并成为儿童或青少年的支持因素，有问题的性行为或性行为挑战。这些可以包括：

• 审查有关性教育宣传的政策，促进防止虐待，并与受性行为挑战影响的家庭合作。
• 为家庭提供性教育，使其融入整个支持系统，就适当的性发展进行健康的交流。
• Employing school counselors or collaboration with clinical counselors to implement classroom developmental lessons on healthy boundaries, self-regulation skills, and safe touch. School and clinical counselors can also meet individually with children and youth or with families to assist with supervision plans and discuss counseling referrals.

Reoccurrence

根据国家儿童联盟的说法，随着干预，支持性父母或监护人，以及正在进行的监测，再次发生的可能性。这是一个常见的误解，让孩子和青年具有性行为挑战将成为性犯罪者。这不是真的。早期识别行为作为非规范性，精神卫生专业人员的指导，并拥有父母，监护人，照顾者和教育工作者的支持网络，儿童和青少年可以学会自我调节和控制他们的挑战性行为。

看到

具有性行为的儿童挑战受益于基于研究的干预措施。首先，俄克拉荷马州健康科学中心大学的许可专业顾问Millington描述了有问题的性行为 - 认知行为治疗（PSB-CBT）和创伤 - CBT）。这些干预措施由训练有素的心理健康专业人员提供。然后，Amanda Mitten，也是俄克拉荷马大学健康科学中心的持牌专业顾问，股票的建议示例，即精神卫生专业人员可能要求育儿计划。

Intervention for Sexual Behavior Challenges

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As noted in Lesson Two, promotion and prevention are common terms used in the Virtual Lab School. As you think about your role as a professional working with infants, toddlers, preschool children, or school-age children and youth, reflect on what you can do to be a part of a supportive team. Consider these guidelines and standards of care for professionals working with children and youth with sexual behavior challenges, provided by the National Center on the Sexual Behavior of Youth:

• 认识到您促进社区和家庭安全工作的重要性。
• 了解您的做法可能对青年及其家人有重大影响和改变生命的影响。
• 告知儿童，青年及其家人，专业人士是虐待儿童的任务记者。
• 确保儿童或青少年在发育和认知的适当语言中完全了解。
• 随着家庭的同意，与外部专家和机构合作，因此儿童的干预感觉就像团队努力。
• 遵循相关的实践指南和道德标准（例如，性虐待者的介入协会的标准和指导方针以及您的职业的协会）。