National Clinical Assessment and Treatment Service (NCATS)

What is NCATS

Support when there are concerns about harmful sexual behaviour

National Clinical Assessment and Treatment Service (NCATS) is a national service that offers assessment, treatment, consultation and training for and about children and young people where there are concerns about harmful sexual behaviour (HSB).

How NCATS works

We run NCATS in partnership with the Oxleas NHS Foundation Trust. We provide assessments and a range of specialist interventions for children and young people displaying harmful sexual behaviour. We work with children and young people (and their families or carers) up to the age of 21. We also provide training and consultations for professionals.

A young person’s harmful sexual behaviour can be understood within the context of a number of different factors – including their social, family and developmental history. The young person may need specialist assessment and intervention, combining a range of approaches.

The NCATS team is multi-disciplinary, with expertise in social work, clinical psychology, counselling, criminal justice and the Dynamic Maturational Model of Attachment.

We can work closely with you to ensure a joint and holistic approach to safeguarding and risk management.

Services we offer

Professional consultation support

We offer consultation services such as advice and recommendations to professionals about managing cases that are complex or involve high-risk harmful sexual behaviour. This may include guidance or oversight on work that has been completed, or when there is an active police investigation which may mean an assessment can’t be completed at the same time. We can also provide advice about issues affecting the case, to help decide whether an assessment would be appropriate.

A consultation includes a meeting between NCATS and the professional network involved. We will read all relevant documentation. We will provide a written report with recommendations for case management and suitability for assessment or intervention. The consultation process doesn’t involve meeting with the child or their parents and carers and isn’t an assessment of the child’s risk or needs.

We can also offer ongoing consultations to teams or organisations on a regular basis as part of a batch consultation process. This can be delivered through existing partnerships or as a bespoke service, dependent on the needs of your team. It can include case discussion, reflective space on themes emerging as part of HSB work or advice and support about handling HSB.

Assessment

We meet with young people, their parents or carers, and professionals to produce a multi-disciplinary assessment report. The assessment process consists of a professionals meeting, psychometric assessments, followed by clinical interviews with the young person and their parents or carers. We advise that an assessment take place 12 weeks from the point we receive all the necessary paperwork. Within the assessment report we aim to:

make sense of the harmful sexual behaviour
provide analysis of risks and needs
give recommendations on case management, safety planning, placement and treatment options.

We take a trauma-informed, attachment-based approach to our assessments.

We can also offer an additional assessment of attachment for children and their parents or carers. This is informed by the Dynamic Maturational Model of Attachment.

Treatment and intervention services

Following assessment we can offer individual or family-based interventions. This will usually happen alongside other care and treatment the young person is receiving. This can include things like helping the young person and/or family to:

make sense of their behaviour
develop strategies to meet their needs in healthy and non-harmful ways
improve their capacity for managing their emotions and relating to others.

The Safe Home Programme

We also offer interventions for parents or carers using a programme called Safe Home, a 12-15 session psycho-educative and therapeutic programme for the parents and carers of young people who have been displayed HSB. It was developed to address recommendations from the NICE HSB guidelines (2016)¹ and our HSB framework to work with parents and carers alongside interventions for children and young people.

The Safe Home programme aims to:

improve parents’ or carers' knowledge of harmful sexual behaviour
introduce pathways and risk factors for harmful sexual behaviour
help parents and carers recognise patterns of problematic behaviour and know how to provide support early
provide a safe space for parents and carers to pause and process what has happened, usually for the first time. This might include putting these feelings into words and having them listened to and validated.

Teaching and training

We provide tailored training packages to social care and health agencies, universities or at conference events around the UK.

Evidence and evaluation

The evidence base

Most of the children and young people who display harmful sexual behaviour have experienced some kind of abuse or trauma, such as:

physical abuse
emotional abuse
sexual abuse
severe neglect
parental rejection
family breakdown
domestic violence
parental drug and alcohol abuse

(Hackett, 2014).

Evaluation of NCATS

What we’ve learnt

Evidence from NCATS has been used to develop the practice guide, A treatment manual for adolescents displaying harmful sexual behaviour: change for good (McCrory, 2011).

This treatment manual is used in delivering Turn the Page and we’ve evaluated its use.

> Find out more about our evaluation of the way the Change for Good manual is used in Turn the Page

How we’re evaluating this service

We use a range of standardised psychometric measures before and at the end of the programme.

Make a referral

Who is NCATS for?

Children and young people up to the age of 21, and their families, can be referred to NCATS.

Children and young people may present with a range of emotional and behavioural challenges, developmental needs and learning difficulties. This includes:

historical and/or persistent harmful sexual behaviours
escalating concerns about a young person’s sexual behaviours
police involvement or convictions due to harmful sexual behaviour.

Teams and organisations

We can also offer bespoke work to teams or organisations. For example, a school who has concerns about HSB within a peer group or organisations managing cases involving HSB who would benefit from a regular space to discuss work.

Guidance about case management or treatment

Professionals can also contact us if they’re in need of detailed guidance about case management or treatment of harmful sexual behaviour cases.

Locations

NCATS is based in north London, but assessment, consultation and training can take place in locations across the UK. Our treatment service takes place at the NSPCC London and South-East Regional Hub in Camden.

Making a referral

If you’d like to make a referral, please call or email us with more details. We can advise whether we are a suitable service for the family you are working with, or for your wider organisation, and will send you a referral form.

We welcome referrals from a wide range of organisations, including local authorities, youth offending services, courts and Child and Adolescent Mental Health Services (CAMHS) throughout the UK.

Referral criteria

Before we can accept a referral to NCATS, we will ask you about any safeguarding measures in place for the young person’s own safety and any measures helping to prevent further harm to others. To accept a referral for a young person or family, we require:

a local authority social worker to be allocated to the family for the duration of any consultation, assessment or intervention work we provide
funding to be agreed for proposed work.

Call 020 3772 9905 or email NCATS@nspcc.org.uk for more information, costs and to make a referral.

References and resources

Evaluation reports

Hawkes, C. (2011) Description of a UK study of onset of sexually harmful behaviour before the age of ten years in boys referred to a specialist assessment and treatment service. Child Abuse Review, 20(2): 82-101.

Hawkes, C. (2009) Sexually harmful behaviour in young children and the link to maltreatment in early childhood: conclusions from a UK study of boys referred to the National Clinical Assessment and Treatment Service (NCATS), a specialist service for sexually harmful behaviour. London: NSPCC.

Evidence base

Hackett, S. (2014) Children and young people with harmful sexual behaviours: research review. Dartington: Research in Practice.

McCrory, E. and Walker-Rhymes, P. (2011) A treatment manual for adolescents displaying harmful sexual behaviour: change for good. London: Jessica Kingsley.

Other resources

Harmful sexual behaviour
Find out what harmful sexual behaviour is, how to recognise it and to respond to concerns.

Working with the health sector
Evidence-based resources to help health sector professionals respond to children and young people displaying HSB, mitigate risk and prioritise children's safety.