Part 2: Navigating Uncomfortable Conversations about Normative Child Sexual Development and Behavior

Talking with kids about their sexual development can certainly be uncomfortable. When you are a caregiver or a Family Services worker, having those conversations with a child you barely know might feel doubly uncomfortable. Add to that a limited knowledge of normative sexual development; maybe sprinkle in some myths, values, and a healthy sense of shame instilled upon you in your own upbringing, and you’ve got yourself one heck of an uncomfortable conversation.

In this episode Tammy Leombruno will talk about using a continuum of behavior to help us identify when sexual behavior is normative, of concern or potentially problematic; how to respond in the moment; when to reach out for help and she’ll suggest some resources to support you in your own learning.

Guest Info:

Tammy Leombruno, M.A., LCMHC

Tammy is a Training and Outreach Specialist on the Kin Foster and Adoptive Family Team at VT CWTP. She came to the Partnership from a career as a therapist and clinical consultant specializing in working with trauma-impacted children, youth and families.

Host Info:

Leslie Stapleton, MSW

Leslie is a Training and Outreach Specialist on the Workforce Team at VT- CWTP. She is a former supervisor, district director and trainer at DCF – Economic Services and an adoptive parent of a 9-year-old.

Show Notes:

For more info Tammy recommends that you check out the following sites:

National Child Traumatic Stress Network:

National Center on the Sexual Behavior of Youth:

Stop It Now:

Sexuality information and Education Council of the United States: (with a section called AmazeJr.)


Cassie Gillespie (00:02):

Hello, I’m Cassie Gillespie and you’re listening to Welcome to the Field podcast produced by the University of Vermont’s Child Welfare Training Partnership and the State of Vermont.

Cassie Gillespie (00:13):

Welcome to the Field is designed for child welfare workers, caregivers, and community partners. However, this season, we will be talking all about uncomfortable conversations and each episode will touch on a different type of uncomfortable conversation. So even if you’re not working or caregiving in the child welfare field, this season might be for you. Today, we’re welcoming back Leslie and Tammy, to part two of navigating uncomfortable conversations about child sexual development and behavior. Now it’s important for me to know that this is part two of a two part series, and I know you just heard me say that, but the reason I wanna stress it is that if you have not yet listened to part one, it’s really important to go back, give that a download and a listen, because it’ll set you up with baseline information about normative sexual development. Okay, great. Now that we’re all caught up. Let’s move on to part two. Here we go.

Leslie Stapleton (01:09):

Thanks Cassie. Welcome back Tammy to part two of navigating uncomfortable conversations about child sexual development and behavior. Okay. So we’re moving up the continuum to talk about the more concerning or problematic behaviors caregivers might be noticing. I think it’s important to state before we begin that some of the examples Tammy might be sharing with us today might be triggering for some. So please take care of yourselves, take a break from this, reach out for help and support if you need it. Okay. So part one, we talked about the continuum of sexual behaviors and we focus primarily on the normative end, Tammy, can you quickly summarize the continuum for us?

Tammy Leombruno (01:46):

Yes. Thanks Leslie. So the continuum on the lower end we have the normative, typical sexual behaviors. We then move up to kind of, of concern. Oh, not sure what these are. They don’t seem okay. All the way up to the seek professional help category, which is the problematic sexual behavior.

Leslie Stapleton (02:03):

You know, we didn’t take this up in part one, but I’ve been thinking about it. We’re using the term normative instead of normal. Why is that?

Tammy Leombruno (02:11):

Well, normal I’m always like, what does normal mean? Right. But normative just suggests kind of what we were talking about or mentioned last episode, which is what kind of happens for most people at a certain stage or developmental phase in their life. So we’re kind of thinking about it in that way. Normal doesn’t really, we’re not gonna use that here.

Leslie Stapleton (02:28):

Yeah. it has a lot of connotation to it, doesn’t it?

Tammy Leombruno (02:30):

It doesn’t seem to fit, but language in general is very important. Particularly with this group of kids we’re talking about.

Leslie Stapleton (02:36):

Yeah language matters. Let’s take a minute to talk about language, maybe just to sort of set the tone for today. What is some terminology that we should know or, or use when we’re talking about problematic sexualized behaviors today?

Tammy Leombruno (02:48):

So I’m gonna make it correction so problematic sexual behavior.

Leslie Stapleton (02:51):

Sexual, yes thank you.

Tammy Leombruno (02:52):

Because sexualized just has its own meaning. That’s okay. So we wanna make sure we’re using person-centered child first language super important to always remember, we are talking about children, you know, age four or five, six all the way to, to 12. So instead of using a term that might not fit, we wanna make sure we’re saying, you know, this is a child who is engaging in boundary violating behavior or a child who is demonstrating inappropriate sexual behavior. A child, even if we’re kind of bumping up on the continuum, a child who’s engaged, you know, had a, a sexual act out or engaging in sexually abusive behavior. That’s gonna be a term we want to be really careful about what, but there are a group of kids that we we’re gonna use that. And in general, just, you know, labeling kids, we have to be developmentally sensitive and how we’re talking about the children, how we’re talking about their behaviors and certainly about how we’re talking about gearing, our interventions and supports.

Leslie Stapleton (03:43):

Okay. So a child who’s engaging in blank behavior, as opposed to, I’m gonna throw out some terms, see if we can get a reaction outta you here. that we hear folks use. Sexual predator.

Tammy Leombruno (03:55):

Are you gonna stop with that one or you gonna add any or just.

Leslie Stapleton (03:59):

Well, okay, well I’ll just list them. All right.

Tammy Leombruno (04:00):


Leslie Stapleton (04:00):

Sexual predator. A child is sexually deviant. That child’s a pedophile. That child’s molesting another child.

Tammy Leombruno (04:07):

Mm-Hmm .

Leslie Stapleton (04:08):

The use of the term child pornography. Put ’em all out there for dramatic effect.

Tammy Leombruno (04:10):

I take them all a bigger response. Yeah, we absolutely, absolutely do not wanna use that language to describe children again, child first, they are growing, everything is fluid and dynamic. This is not in large part about sexual gratification and the way that we think about it with much older teens or adults, this is one part of a child’s whole kind of being. So we just have to be super respectful and the terms, you know, perpetrator pedophile, they don’t fit. They are incredibly damning, incredibly damaging. For kids, you know. Imagine that in your school file or on your, at the doctor or, you know, even in the, at the local designated agency to have that associated with your name. Right. It does not accurately at all reflect what the behaviors are or even describing children.

Leslie Stapleton (04:58):

Yeah labels.

Tammy Leombruno (04:59):

And I freak out sometimes in meetings it’s like, no. Yeah. You know, or actually encourage people to the degree that they can, like in a meeting or something or talking with another provider to make sure they’re using the language like, oh, this is, oh, it sounds like this is a child who may be having, you know, some struggles with respecting boundaries, respecting personal space. This sounds like a child again, who, who may be demonstrating some inappropriate sexual behavior. So we’re kind of model it. If nothing else, we can model that behavior and how we describe.

Leslie Stapleton (05:25):

And then just to come back around again to child pornography. It’s child sexual abuse, right? It’s the terminology that we’re using instead of child pornography, we hear that in the national news, even that term is still being used.

Tammy Leombruno (05:36):

So it’s kind of for us today. I mean, I think it’s really more just talking about what kids might be exposed to. Yeah. And what kind of, what some behaviors, but yeah. A little side note is that it’s not, you know, the term child pornography. So now it’s referred to as child’s sexual abuse material, mm-hmm cause it’s essentially in most cases I would say, I don’t know if I can take that any further, but it’s really, these are kids who are being exploited and sexually abused. And so here’s an example right? Of describing something that’s happening what’s pornography mean? Or people say porn, which even shortens that more. It’s like, no, this is child sexual abuse material. Yeah. But for today, right. We’ll talk about, maybe that’s gonna be more about a discussion about children sending images or taking pictures and that, that is not child pornography.

Leslie Stapleton (06:17):

Thanks. So we’re armed with a little guidance around language, which I think will be helpful. What are some of the behaviors that we’re talking about here? How would you describe, or, or define these problematic sexual behaviors?

Tammy Leombruno (06:29):

Well, it’s kind of, you know, last episode talking about that normative piece and, and the aspects of it that make it kind of it’s sexual play, it’s curiosity, exploration. When we’re talking about those behaviors that are kind of in that middle place, which is like, Ugh of concern not sure. And then all the way up to kind of like, oh, this clearly feels like problematic sexual behavior. We’re gonna be looking at those dynamics again. So it’s gonna be behavior that is occurring often or more frequently than expected. It’s taking place between children of different ages, like a significant age gap or developmental kind of stage. It occurs between children with different capacity. So it could be someone who has an intellectual disability, a developmental delay, another sort of other ability. And so that dynamic is concerning. The other part we’re gonna look at how is the other child feeling? Is it like, oh, it was that silly, embarrassed kinda lighthearted because this was spontaneous and okay. Or it’s no, it’s something that’s associated with strong upset feelings and it could be anxiety, fear, anger. It could go all the way up to feeling stress distressed traumatized. And it could cause physical harm. Certainly we know there’s emotional harm. And then the other really important piece is that the behaviors and kind of strategies that caregivers are using, that children are not responding. So the behaviors are continuing.

Leslie Stapleton (07:48):

Yeah. Like you’re trying to set a boundary. You’re trying to redirect, you’ve talked about it still happening.

Tammy Leombruno (07:52):

Yeah. You’re setting, you know, like you’re like here are what we call safety rules in this treatment, you know, or privacy rules. And here are the expectations and kids are not respecting those. Okay. And I don’t mean like, okay, they do it one other time. This is kind of more more persistent. And then the other piece certainly is if there is overt force coercion threat, that’s definitely gonna bump it up pretty high. Like that is fairly unusual for kids in this age range. And then, so I just wanna say again, we’re looking at those dynamics, cuz we talked a lot last episode about again what’s happening, not just the actual behaviors themselves. So to repeat it’s if this behavior is excessive, if there is persistence. Okay. if kids are demonstrating these behaviors to the exclusion of other activities

Leslie Stapleton (08:33):

Okay. Like you’re preoccupied with it.

Tammy Leombruno (08:36):

Yeah so.

Leslie Stapleton (08:36):

Spending a lot of time with themselves then they’re no longer playing with the kids in their neighborhood. Maybe there’s a change in behavior.

Tammy Leombruno (08:41):

Yeah. And, and this could be a ch a time to, I don’t know if we wanna talk about this right now, but certainly kids who are, let’s say they’re in their room or they’re on social media a lot or they’re, you know, they’re looking at material sexual abuse material. They’re looking at this stuff or something that, you know, know just kind of explicit images or just, just again, to the exclusion of maybe being in a club or doing their schoolwork or hanging out with friends that it’s noticeable. So that, that is something that’s certainly important to consider. And those are gonna be those, again, those dynamics and kind of context that bump things up.

Leslie Stapleton (09:11):

Okay that’s helpful.

Tammy Leombruno (09:12):

And I can talk if that’s okay. Leslie, to add a few more things. I was just thinking just to be a little bit more specific about what some of the behaviors actually are not just kind of describing.

Leslie Stapleton (09:21):

Yes. That’s where I was going.

Tammy Leombruno (09:22):

So, okay. So it could be frequent or maybe even compulsive self touching. Okay. For young kids, we’re gonna probably say self touching for older, the older kids on this end. We’ll we could say the term masturbation.

Leslie Stapleton (09:33):

Okay self touching, self touching. Not, self-pleasure not masturbation self touching.

Tammy Leombruno (09:37):

Well, well, self, self touch again is just really describing, literally describing a behavior. Masturbation describes it in a way that we typically associate with kids who are a little older. Okay. So those 10, 11 twelves in this, in this group. Yep. We may say that term. Okay. Cause that again, masturbation, that’s really more about sexual kind of response and gratification and that’s kind of, what’s behind it for younger kids. It usually, that’s not what we’re talking about. It just kind of feels good.

Leslie Stapleton (10:00):

Oh, okay. That’s a, it’s important.

Tammy Leombruno (10:02):

Yeah. So again, so this could be, so some of these behaviors that are in that kind of that mid-range to the upper range, explicit sexual talk behavior, or play that just isn’t stopping persistent nudity or, you know, with that masturbation could be then trying to expose oneself you know, having to get, having a bit of an audience engaging. So in attempts or touching other private parts, like literally touching bodies, this is kind of moving things up.

Leslie Stapleton (10:28):

Sure well there’s a, there’s a, I mean that could be a sort of normative thing, right? Like in kindergarten kids are like, hey, let me show you one, I’ll show you yours. That’s sort of normative stuff. You’re like, Hey, we’re gonna redirect. That’s not appropriate. So you’re talking about something a little bit more involved in that.

Tammy Leombruno (10:39):

Yeah. It’s just interesting cuz sometimes like, oh yeah, these categories will help us a lot. Yeah. And sometimes it’s still really,

Leslie Stapleton (10:45):

It’s nuanced.

Tammy Leombruno (10:46):

It is, it’s nuanced. And we have to look at all these dynamics. So it’s aside from an overt force and what we’ll talk one example or you know, a big age difference. And there’s a very clear sexual scenario that, you know, we’re like, okay, is, is clearly not okay because of age, because of all those things we just mentioned a force or something like that. The other ones we have to look at the age again and who are they with? And what’s the context and are they friends and are they kind of, it’s more the giggly, the silly, or is it something else? And there’s so much gray yeah. Along this continuum. So it is I know sometimes I wanna say like, no, these kind of charts and again like Tony Kavanaugh Johnson, like, you know, her chart that spells it out specifically or other places there’s still a fair amount of gray to be fair. So, so those are kind of examples of things that might signal the need to kind of have, you know, more immediate response and support and intervention and follow up. Yeah. Some of the other ones, they’re not like those kind of question mark ones could maybe even be kind of handled within a family.

Leslie Stapleton (11:40):

Yeah. Great. Thanks. I think that’s helpful. I wonder if it might be even more helpful maybe to talk through some scenarios or examples, to get an idea of what, what it could situation might look like and then talk about how we might respond.

Tammy Leombruno (11:52):

Okay, sure. So you know, one example could be kind of that extensive, maybe it’s frequent and maybe compulsive self touching could be the masturbating, if this is a little bit of an older child and maybe it’s kind of initially in the house, but then it starts to happen at school. And that there could be maybe in conjunction with that looking at pornographic material online. Yeah. You know, those other things, like not engaging in those other activities with other peers or with the family or like if they played an instrument or sport or in a club, those kinds of things. So that could be an example. And now that could be like stay kind of in that midrange you know, of the concern and maybe wanna, certainly wanna introduce some interventions or supports and kind of focus on that or it could kind of bump up higher kind of on the, the higher end of the continuum. And I think you were asking about like intervention or is that what you were saying?

Leslie Stapleton (12:46):

Yeah. I mean, I think your first intervention would be like, Hey, you know, let’s talk about this. Let’s set some boundaries. It’s not appropriate to do that in school. It’s a private let’s, you know, in, in your room, what’s going on. Right. There’s, let’s talk about what’s happening for you cuz I notice you’re not playing with the kids in the neighborhood anymore, spending a lot of time to yourself. You try to address it by having conversations about it and setting some boundaries and, and that’s not working. And is that sort of when you’re finding that it’s potentially bumping up on that continuum.

Tammy Leombruno (13:12):

Again, back to those dynamics, you know, like it’s persistent even with these kind of supports in place and the clear explanation of what the expectations are and the rules again, we call them, we can say safety rules, privacy rules, and yeah. So you just wanna kind of cover your bases and then some of those skills that we talked about last week, right? Like try to remain calm, try to get some information first about what are the, the norms, you know, in terms of this age range and, and self touch or masturbatory behavior. And we certainly wanna be again clear try to pull in as much factual information resources we wanna stay away from punitive and making kids feel badly. Yeah. We want these behaviors to stop and we have to kind of do what you just said. And so again, some of those basic parenting skills that we wanna pull into play here.

Leslie Stapleton (13:54):

Yeah. And I don’t know if you wanna take this up now, but we’re talking about kids in care. So we’re talking generally our audience is either family services, workers or caregivers. What’s the responsibility of the caregiver to inform FSD or to stay in contact with family services around these behaviors and sort of what they’ve done and, and what to do next.

Tammy Leombruno (14:12):

I think, well, I have a couple of different thoughts about that. So, so firstly, I mean there are a couple other scenarios we can maybe talk about that might be more clear about if and when do I contact someone else.

Leslie Stapleton (14:22):

We can hold onto that.

Tammy Leombruno (14:23):

Yeah. So make sure I go back to that one. So, if we, so another scenario let’s say there are two classmates, they happen to be female and they are they’ve had some sleepovers together and let’s say they’ve had, I don’t know, two or three sleepovers. And there’s a caregiver who is just noticing that the child let’s say they are, I don’t know. Let’s make them 10. Sure. Let’s say they’re 10, 11 year olds different. Maybe they’re in the same class. They’ve been friends again, but the caregiver’s noticing that the child is seeming upset or not herself maybe looking stressed out or something.

Tammy Leombruno (14:58):

So let’s say then the caregiver just says like a check in at dinner or after school or something and says, hey I’m are you okay? You know, or I’m noticing whatever. And, and so maybe the, the child says give some indication that they’re not feeling so okay. And so the caregiver asks like, have you had a hard time at school? Is it like you’re having a hard time with a friend and because the caregiver may have no idea that there might be an issue. And so the child is able to convey in some way that something happened with this particular friend.

Leslie Stapleton (15:24):


Tammy Leombruno (15:24):

And so the caregiver knows that there have been some overnights and maybe the caregiver’s like, oh boy, is it something? So the caregiver says, I noticed maybe you’re you look sad or upset. And the child’s able to, at some point say something about, well, there was touching and the child maybe gets teary, definitely looks impacted, distressed.

Tammy Leombruno (15:42):

And so there’s a conversation. This caregiver does a beautiful job, right? Of saying, yeah, what’s going on, I’m here for you. I wanna make sure you’re feeling okay. And the child is able to describe a progression of some touching behaviors with this friend. Like the first, overnight, they were just being silly and maybe getting dressed and the other friend wanted to do some touching. And so the child that’s talking to the caregiver, did a little touching. There was some over the clothes or before they were changing and noticing a bodies. The second time on a sleepover that the other child really wanted to have. And this person, maybe, maybe this, this child that’s talking to the caregiver is a little more reserved, is a little more, I dunno, has a difficult time maybe saying no. Wanted to say no. So she’s able to say to the caregiver, I didn’t wanna do that. We did it again. It wasn’t my idea. I was mad and then I pretended to be asleep at some point. And then this person is texting her or messaging her or talking with her. There was a third overnight where there was much more behavior that this child talking to the caregiver absolutely did not wanna do. Felt like she couldn’t say no. And so here we are.

Leslie Stapleton (16:43):

Yeah. In my mind, this is definitely of concern. And I’m wondering if it comes in at the problematic level, as my mind is as the parent potentially listening.

Tammy Leombruno (16:51):

Right. And I think it, it could kind of stay in this of concern, but we still wanna have some sort of response to this is problematic. And so even if we kind of conceptualize it in that space, in between, on that continuum, it sounds like we need to do something. So one of the things, and this is kind of what you were, I think asking just a minute ago.

Leslie Stapleton (17:08):

Yeah. What do I, if I’m the caregiver, what do I do? What am I doing next? Am I I’m calling a report

Tammy Leombruno (17:13):

Or are you saying, oh my, do I just call the FSW? And so maybe that’s enough. So at the very least, I would say if it’s it’s a child in care, you definitely need to talk with the FSW. I think it’s really important to be very conscientious about how you’re presenting the information to the caregiver. I think it’s important to share with your child, with a child in care what you are going to do.

Leslie Stapleton (17:36):

Yeah full transparency. Here’s my responsibility. I wanna let you know, here’s what I need to do. Here’s what I’m gonna do. You’re safe.

Tammy Leombruno (17:42):

Right and here’s what I,

Leslie Stapleton (17:43):

You’re not in trouble.

Tammy Leombruno (17:44):

Right, right. Absolutely.

Leslie Stapleton (17:45):

You did not do anything wrong.

Tammy Leombruno (17:47):

Yeah. Right and even kind of saying that, that sometimes kids do this kind of, you know, if there hasn’t been a conversation before the other piece is sometimes I don’t know about this particular scenario, but sometimes it’s a call to the other caregiver. Oh yeah. You know, and just to say, Hey, listen, I just wanna let you know, this is what happened. I mean, that’s tricky. Right? Cause you’re not sure how that’s gonna play out, but it, it does seem like that might be important to alert that other caregiver or set of caregivers, whoever, you know, lives there. It depends too on, you know, how well do you know this child? So there could be a lot of factors yeah. To take into consideration, but you definitely wanna then assure your child. That just what you said, that we’re gonna talk to this person we’re gonna make sure you feel safe if you still wanna have her as a friend and you guys. You wanna spend time together. Maybe we could go to a movie or do something together as with an adult just while they’re kind of checking it out.

Leslie Stapleton (18:33):

What do you need, what do you need moving forward? Because you’re gonna be in school with this person. what would be helpful? What can we do?

Tammy Leombruno (18:39):

Yeah, how do you navigate that? So that could be one that, you know, you’re like, okay, we’re we talked about it a little bit with the, you know, the, maybe in, maybe you decide, you wanna talk to the medical provider, the pediatrician or doc or not. I mean, I think that one depends.

Leslie Stapleton (18:51):

Oh I feel like I just need to take a breath after that.

Tammy Leombruno (18:53):

Again, take a breath.

Leslie Stapleton (18:54):

A little bit, it’s a lot, it’s heavy.

Tammy Leombruno (18:56):

It is a lot. And I appreciate you saying that because you know, it is true and we wanna take care of ourselves when we hear about these things. Certainly if you’re in it, if you’re the caregiver of the child, that’s talking about it to you or the caregiver of the other child who may have their own reaction, like, oh gosh, I don’t want my child to be doing something and they may have their own response. And certainly, you know, try to figure out what you need for each of the kids actually. In turn, I was thinking of another example, love it or couple. And then we

Leslie Stapleton (19:22):

Do. I think, I think examples are super helpful.

Tammy Leombruno (19:24):

So let’s say there’s a situation where there are siblings and these are siblings who have been in care for a while. Let’s say they’ve bounced around that. They, that it is well known that these children have experienced great adversity. Okay. So they let’s say there was some neglect. And then there was you know, the, the home was definitely not safe in lots of ways that there were unsafe adults around that the caregivers had sexually abused. The children. So they’re coming from this place of multiple trauma insults and these things that have happened to them.

Leslie Stapleton (19:59):

Are they, they’re placed together.

Tammy Leombruno (20:00):

They’re placed together. And so the FSW is aware of at least some of the trauma history, not all it, but the kids were removed, all that kind of jazz. And so let’s say these kids who are similar in age, maybe two years apart. And they are engaging in frequent extensive sexual behavior. That includes all kinds of sexual touching, includes intercourse.

Leslie Stapleton (20:23):

With each other,

Tammy Leombruno (20:24):

With each other. Yeah. And they, they are having a hard time stopping this, stopping this behavior. So this is, this is definitely kind of bumping up. And I think this one is kind of an important example because we’re like, oh, folks have a sense that there’s a trauma history. Yeah. So maybe this is where that comes from. That maybe, you know, in part from that. Or maybe it’s about, I mean, we’re gonna talk about that, I think a little bit later, but is it about how they connect or how they just, how they relate to each other, but it’s definitely something we don’t want to continue. So the behavior. And so, and so the, the caregivers who took, let’s say if it could be a kinship caregiver or a foster caregiver who had a sense about this and tried to set up some rules, this is an example of kids who really, they really can’t stop this behavior.

Leslie Stapleton (21:05):

Yeah. You, you definitely need a qualified clinician and you need

Tammy Leombruno (21:09):

To work these children. Yeah. And safety plans. And it’s, it’s probably, you know, most likely these kids cannot stay in the same home together. But boy, there be so many things to consider. Like they should have contact because they have this relationship. Sure. But it will be something that bumps up. We definitely don’t want this to continue.

Leslie Stapleton (21:25):

Alright well that is a for sure red zone. Yeah.

Tammy Leombruno (21:28):

Red zone and with like, oh gosh, it’s so clear where this comes from. And it was modeled and it was taught and they’re abuse and they’re traumatized these children and they’re both gonna need a lot of intervention. And then we could think about an example, let’s say the one that feels a little bit more clear. So let’s say there’s an 11 and a half year old who is in either kinship or foster care. And, you know, we don’t even have to necessarily know what that child’s history is, but maybe they grew up in a place that was really challenging or no boundaries in the home, or maybe there was violence. Okay. And there’s a younger child in the home. Oh. Who just turned four. Yep. And there are, you know, caregivers who are they’re, they’re great. They’re, they’re good. You know, caregivers, they may know a little bit about the histories and a caregiver is noticing that the younger child is appearing really upset. And for four that can mean lots of things like temper tantrums or crying or just like clingy.

Leslie Stapleton (22:17):

But you’re noticing a difference in their, an effect or their behavior.

Tammy Leombruno (22:20):

Yeah. So you’re noticing a difference and maybe kind of a little bit similar to one of the scenarios that that the caregiver maybe asks the question, or maybe the preschool’s noticing something that there is really something going on with this child. Okay. And when there’s a little bit of asking then maybe there could be, you know, there could be an injury if there is any kind of force, this child appears scared. So this is something that’s incredibly concerning. And you’ve got an older child in the home who maybe has been trying to get some alone time with this child or kind of doing that. And maybe being nice to them some ways, but as the caregiver, you’re like, I don’t know, this doesn’t feel genuine.

Leslie Stapleton (22:53):

Yes you’re you got a feeling.

Tammy Leombruno (22:54):

Yeah. And then once kind of questions are asked and this child is able to say something, you discover that there has been, you know, weeks and weeks of sexual behavior and the sexual behavior involves oral genital contact. It involves perhaps penetration. There’s definitely a message about you can’t tell anyone. The younger child doesn’t quite have the words for what’s happening. Maybe at first they were kind of okay with at least getting some attention from the older child cuz they wanted that. That feels like an example that, you know, that doesn’t, I mean, it doesn’t happen often. But when I think people think about problematic sexual behavior, I think they go right to that kind.

Leslie Stapleton (23:32):

Yeah. And when I think about a situation like that, if I were a caregiver, I’d be like, my gut reaction would be like, I don’t know if this kid can stay here.

Tammy Leombruno (23:40):


Leslie Stapleton (23:41):

What, what do you have to say about that Tammy?

Tammy Leombruno (23:43):

Well, well that very well may be the case. And I think that in terms of how to respond like there’s.

Leslie Stapleton (23:49):

Well, that is a for sure call to centralize intake in services, right? You that’s a re that’s reportable.

Tammy Leombruno (23:55):

It is, is yes. And even, right. And thanks for saying that because sometimes I think you’re gonna be back and forth about is this reportable because our audience, I think for the most part are kinship and foster caregivers or adoptive caregivers. You’re gonna have maybe a little bit of sense of history and you’re gonna have a relationship hopefully with FSW and you’ll know about reporting, like what I’m hoping. Right? What mandated reporting means. So they’ll call in. And so it is gonna be, I mean, ultimately a report is to centralize intake, but at the very least to the FSW and yes, this is going to require a quick response and it could very well be, you know, sometimes it’ll be a quick a safety plan just for the, for a day or two if they don’t know where to put the older child, let’s say, cuz this is still we’re talking about just like an 11 and a half year old. This isn’t a 16 year old. This isn’t a, you know, older child, but yes. An absolutely meter response different than some of the other ones. Right? Like with the, the girls and the sleepover, that’s a little bit different.

Leslie Stapleton (24:47):

I think that’s an important distinction because I think, you know, sometimes caregivers regardless will be like, this child cannot stay here. But it’s important to know and remember that with short term intervention of setting a boundary, some redirect, some behaviors that are of concern will go away and the child can obviously be safe in a home with other children. Right. And I, we need to be careful not to sort of jump to the, oh my gosh, this kid can’t stay here. Right? Because it’s important. We want kids to be able to stay in their placements. We don’t want kids bopping around.

Tammy Leombruno (25:21):

Right. But this, you know, with this example, I mean, cuz what we have to take into consideration obviously is the kids are in the same home and there’s a child who, the younger child who’s clearly impacted and appears to be, you know, victimized could be traumatized by what’s happening. Yeah. So that would warrant again that immediate response and teaming and discussion and collaboration about what to do. And again, that’s the high end. These do not happen. This is not your typical kind of sexual act out or problematic sexual behavior. This is kind of the high one. And I just wanted to make sure that we had an example of that in these discussions, you know, the other one, it could be, we’re just gonna talk about like the safety plan and who can sleep where, and kind of just really focus on what you were saying. So just to kind of, to know that okay, that connection and that communication with FSW is necessary.

Leslie Stapleton (26:05):

So in this, this example, it’s definitely of concern, right? A lot of kids in care already have therapists, right. They’re already working with a mental health clinician. Can you expect that most therapists will be capable or willing to treat kids who have problematic sexual behaviors?

Tammy Leombruno (26:23):

Hmm. Well I think a quick response to like the high, high end, like those, when that happens, it doesn’t happen very much, but when it does probably not. Okay. and I don’t think we should expect clinicians like a general practitioner to be able to have that knowledge and sense of what the resources are and the treatment. So we shouldn’t expect that. Okay. In terms of kind of the, even, you know, the, the kind of mid-range like, I don’t know of concern, like maybe the example of the, that compulsive self touch or the girls in the sleepover. You know, maybe, and maybe what you could do is just if you’re saying, if the clinician, you know, if it’s the FSW or if it’s the caregiver or maybe the caregiver and the child talking with the provider, who’s already on board, you can kind of figure out what that provider can or can’t do or is comfortable doing. So the answer is kind of yes and no.

Leslie Stapleton (27:07):

Okay. So maybe if you have a provider and they’re like, Ooh, I don’t know. I’ve never, you know, I’m not feel really fully qualified for this. Maybe they could reach out and get some consultation before they decide, you know, what we need to, we need to refer out for this. Right? Because we want, again, you’re connected to a therapist. Yeah. Kids have, if we wanna avoid change and turnover as much as possible, right? We wanna keep them connected therapists that they have a connection with. And maybe through consultation, they’ll be able to get the support. They need to continue to provide some care for that child.

Tammy Leombruno (27:36):

Yeah. That would be the ideal. You know, that again, we don’t want kids to have another adult in their life who’s trying to whatever. Right? We know how important it is to have those connections. And so if the, you know, the clinician’s okay with that, if the caregiver and FSW was like, we can do this. You know, I certainly have been called to consult on a case where it’s just, I don’t even need to meet the child or the person doing the consultation doesn’t but it’s just, you know, give that person information, talk about that a little bit and create a response. And so again, that’s ideal. And they can maybe kind of keep checking in.

Leslie Stapleton (28:04):

Yeah and you might need to be a little pushy, right? Like, so FSWs, if you’re listening, you might need to be a little pushy and advocate with that therapist. Like, Hey, let’s figure out if we can manage this through you. Let’s not jump to referring out.

Tammy Leombruno (28:17):

Right. And I wanna say that, you know, thinking of all the DAS, the designated agencies across the state, you know, hopefully there’s gonna be someone there, a clinician or a supervisor, a team lead somebody who’s got some experience with this population and is, you know, maybe they can consult in house, you know, with a, a clinician. I think a lot of these kids tend to have providers who are at the designated agencies, not all the time, but that certainly hopefully there are, I, I think there are those folks, which is really good. Yeah. So that should be helpful. But again, if we’re talking about those occasions where it’s the high end, that’s a little trickier to get, and I know if there were FSWs here, they would tell you that.

Leslie Stapleton (28:50):

Well, you’ve been using the term specialized treatment right. Or specialized interventions. Do you wanna take myths for facts? Do you wanna like take that up? We have that sort of on a list of things to cover.

Tammy Leombruno (29:00):

Yeah. Yeah. We could do that.

Leslie Stapleton (29:02):

So let’s dive into those.

Tammy Leombruno (29:02):

Okay. So one of the, I think one of the most common myths is that kids who engage in problematic sexual behavior or boundary violating behavior have been sexually abused. And that isn’t entirely true. So research suggests that between a third to a half of youth with problematic sexual behavior, have they report no personal history.

Leslie Stapleton (29:24):

A third to a half?

Tammy Leombruno (29:25):

A third to half. Did I say that right? Half to third, a third to half to half. Yeah. But that they do not report any history of, of sexual abuse. So that could, in some ways we think about that as kind of that overt hands on sexual abuse. Yeah. But these kids may have lived in environments that there are limited boundaries that maybe people talk about sex stuff too much. The adult stuff, that’s not geared for kids or appropriate.

Leslie Stapleton (29:44):

Except easy access to.

Tammy Leombruno (29:45):

Easy access to, you know the talk is sexual that there are right. The TV or phones or whatever that they have that. So we certainly wanna take that into consideration. The other one is that these kids can’t like live with other kids. They can’t be home or they can’t be in their communities. And that’s just not true as a blanket statement. You know, we’re gonna wanna take a look at all these kind of variables. And our goal is to keep kids in the community, right? And the families as much as possible. A community and to get those services and wrap those around. Same thing for school. Most of these kids should be in school and can stay in school. And if the behaviors are not happening there, we touched on this last episode, the school doesn’t may not even need to know about a lot of these. Again, we’re talking mostly right? It’s the middle to the low end is what we’re normally talking about with this stuff. I guess the other big one is that, oh, if kids demonstrate problematic sexual behavior, it’s never going away and they’re gonna turn into adult offenders.

Leslie Stapleton (30:35):

Right and that’s, well, that’s certainly a fear. That caregiver’s parents have.

Tammy Leombruno (30:38):

Right. And that’s not true or that, that it’s just gonna keep happening. And when we know that in, in truth, most kids will never engage in another problematic sexual behavior. And that, that in terms of kids who then they go through treatment, they have the interventions, those rates are between six and 9% that the behavior happens again. And this is research and data collected over the years.

Leslie Stapleton (30:58):

And that statistic is amazing. Yeah. I think if we asked people to give us a percentage of kids who again, continue to engage in behavior, sex, problematic sexual behavior. People would not be kicking out six to 9%.

Tammy Leombruno (31:12):

No, so it’s good. Good.

Leslie Stapleton (31:12):

I think it’s really, I think, I think we should probably just state it again cuz I think that’s really important,

Tammy Leombruno (31:17):

Right? Yeah. So in terms of re-engaging in a behavior engaging, continuing to, to engage in a behavior that the rates are just six to 9%. And I don’t mean to suggest that that’s not harmful or to the children on the other end of that, but that is important to

Leslie Stapleton (31:31):

Know. Well, I think it gives, if you’re a caregiver or a parent of a child who’s engaging in these behaviors, it gives you an incredible amount of hope. Yeah. Right, right. For your child.

Tammy Leombruno (31:39):

And that the, and that there’s treatment that works. So there’s a treatment that the gold standard is a treatment that’s called problematic sexual behavior, cognitive behavior, behavioral therapy. It’s a mouthful. So it’s PSB CBT so problematic sexual behavior, cognitive behavioral therapy.

Leslie Stapleton (31:57):

I didn’t know there were different types of CBT.

Tammy Leombruno (32:00):

There are. And so this is, this came out of a research project from many years ago. The State of Vermont was involved University of Oklahoma and folks at Washington State. That’s cool. And this was in the nineties way back when.

Leslie Stapleton (32:11):

Ooh Vermont. Look at us!

Tammy Leombruno (32:11):

Yeah. So, so there is, so it it’s evidence based and treatment that works. They have a preschool component for folks in the Oklahoma have a preschool component. We don’t have that here, but there are. So it’s typically a short, relatively short term intervention between 16 to 18 weeks, sometimes 12 to 16 weeks. And it has to involve caregivers. So caregivers and kids coming together and it’s again, it’s cognitive behavioral, it’s teaching skills related to regulation, you know, kind of identifying what is normative expected behavior. It’s helps caregivers know how to respond. You know, caregivers get to be with one another in a situation. So kids and caregivers come together in a group format. And so caregivers have other adults in the room with them who they can kind of talk about this way that this, this kind of behavior brings up shame and embarrassment. Oh yeah. And just terrible feelings for the caregivers, as much as the kids or they both kind of feel it. And so the kids also then are in a group and they’re getting information like, oh, I’m not the only kid who has this issue or, or this kind of behavior that’s kind of getting me into trouble sometimes.

Leslie Stapleton (33:13):

If you were looking for a provider who can, what’s the right term administer? Use? Treat? You know, PSB CBT, how do you find a clinician who’s qualified?

Tammy Leombruno (33:23):

It may be that the the different DCF district offices may have a list of providers. Okay. Which might be helpful. And then again, it would say that hopefully at the designated agencies across the state, there’s gonna be some, a provider in there, or a couple of folks who at least kind of know what this model is and have some experience. And so I think you would start there. There’s so many great resources. So the problematic sexual behavior, cognitive behavioral therapy, it’s such a mouthful. So you know, you can find that you can go to the, the national center on the sexual behavior of youth. I can never string those letters together. Yeah. It’s a mouthful is right. Is a, is a great resource. Again, we stopped, we talked about stop it now before as a resource Saber Society Press right here in Vermont has a, a list of folks and providers who could, you could potentially contact, okay, there’s good video.

Tammy Leombruno (34:13):

So there, there are some resources and we’re gonna have those listed. Right Leslie? And so again, I think the, the most important part is just to remember that these are kids first, that most of these kids will never engage in another act out another problematic sexual behavior and that with support and guidance and that specialized information, that they can kind of overcome these sexual behavior problems and just kind of be regular old kid. And that, and that the other part that’s important is that kids can kind of move up and down a little bit on this continuum. And even if there’s a child who in the past has had a kind of a documented problematic sexual behavior, other behaviors that they engage in are in the normative and typical range. So we wanna kind of make sure of that too. And that the caregivers, you know, when you work with your child, that we can, that stuff can just get better and you can talk about it. We’re gonna pull in some of those basic kind of caregiving parenting skills. Yeah. And that there is hope, lots of hope for this population.

Leslie Stapleton (35:05):

Absolutely. Yes. Thank you. I think that’s an important part of this message is that there’s hope. And it’s important when some, when you, when something happens, right? Take a moment. Breathe. Think about responding better instead of reacting.

Tammy Leombruno (35:17):

Right, right. Absolutely. Right. Yeah. Right. Like catch your breath, get your feet on the ground if it’s like that high end thing yikes. Which it likely won’t be, you know, that’s about just really establishing safety and everyone’s okay. First this time it’s more take a breath, take a step away if you need to, if you need to separate kids kind of do that. Remember and hopefully you’ve done some homework and you know, maybe a little bit about kind of, of normative development stuff. Talk to your partner, talk to a friend, get on the phone and talk with your FSW. The medical provider. So do those kind of things. And just kind of, maybe you can say to yourself, oh, wait, I remember I, I saw this podcast or no, you didn’t see it. I heard this podcast, or I know this there’s this great resource. And it reminds me that it’s okay. And a lot of these behaviors are gonna be on that, on that lower end.

Leslie Stapleton (36:00):


Tammy Leombruno (36:01):

And responsive to intervention.

Leslie Stapleton (36:02):

Yes. Well, great. Thank you so much, Tammy. This has been wonderful. And I certainly have learned a lot and hopefully our listeners have as well.

Tammy Leombruno (36:10):

Yeah. Thanks Leslie. Thanks for having me.

Leslie Stapleton (36:12):

You bet.

Cassie Gillespie (36:16):

Welcome to the Field is produced by the University of Vermont’s Child Welfare Training Partnership and the State of Vermont. Our theme music is composed and performed by local band Brick Drop, and our sound production and engineering is brought to you by Egan Media Productions. We’d also like to give a special thank you to our in-house technical production assistant, Emma Baird. For Welcome to the Field, I’m Cassie Gillespie, and we’ll see you next time.

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