The Habilitation Service for Children and Adolescents (HABU)

ansikt

The Habilitation Service for Children and Adolescents (HABU) follows up children and adolescents (0–18 years) with congenital or early-acquired disabilities, developmental disorders, or chronic illnesses that affect functioning. HABU has a central and specialized role in working with children and adolescents who display problematic or harmful sexual behaviour (PSB/HSB).

In accordance with the “Regulation on habilitation, rehabilitation, and coordination,” HABU shall, among other things, contribute to strengthening the individual’s functional abilities and coping skills, promote participation and equality, and ensure holistic and coordinated follow-up. Sexual health is part of this holistic perspective and is addressed through adapted education, guidance, and support—not only in childhood, but throughout the lifespan.

Referral and Intake

When there is a need for specialized support in sexual health, a general practitioner (GP) can refer to HABU. A referral should include a clear description of the concern, relevant developmental history, previous interventions, any assessments from other services, and contact information for caregivers and relevant professionals. The aim is to provide HABU with a solid basis for assessment and further follow-up.

Harmful sexual behaviour (HSB) may also be identified during an ongoing referral or follow-up. In such cases, HABU will address the concern in the same manner as other referred issues.

The intake team assesses referrals in accordance with the Norwegian Directorate of Health’s prioritization guidelines for habilitation of children and adolescents in specialist healthcare services. Cases are accepted when there are significant challenges related to puberty, sexuality, and identity within the target group. This is in line with the regulation’s requirement to identify needs for social, psychosocial, and medical habilitation.

Assessment and Evaluation

When there is concerning sexual behaviour in children and adolescents with disabilities, it is crucial to understand the function of the behaviour before implementing interventions. Sexual behaviour can serve many functions, ranging from exploration and a need for stimulation to expressions of stress, trauma, or lack of understanding of social norms.

HABU works in an interdisciplinary and holistic manner and assesses behaviour in light of the child’s cognitive level, knowledge of the body and sexuality, medical conditions, and emotional development. Behaviour that may appear unusual can be developmentally appropriate given the child’s level. Lack of education may also lead to misunderstandings. Physical discomfort or somatic conditions (e.g., itching, medication side effects, pain) may also manifest as behaviour interpreted as sexual.

A comprehensive assessment is therefore essential to ensure appropriate interventions. Structured tools and methods are used to ensure thorough evaluation, such as functional analysis, the Traffic Light Tool, AIM-3 assessment, SEED-2, etc. (see Toolbox). The assessment provides a holistic picture of the child’s needs and forms the basis for further interventions, including long-term development and quality of life. HABU emphasizes that sexual health must be viewed as a continuous process, ensuring that children and adolescents acquire knowledge, skills, and confidence that last a lifetime.

Follow-up

In accordance with Section 15 of the Regulation on habilitation, rehabilitation, and coordination, training and interventions should, as far as possible, be provided in or close to the child’s usual environment. This is particularly important in cases of unwanted or challenging sexual behaviour, as interventions should take place where the child actually lives and interacts (home, kindergarten, school, residential setting, etc.).

Interventions are individually tailored and often use visual pedagogical tools to support communication. They may include talk therapy, skills training, education about the body and boundaries, environmental therapeutic interventions, trauma-informed care, and family work. Restorative approaches may also be used when appropriate.

Working in the child’s natural environment ensures better adaptation, increased safety, and greater effect of interventions. It also provides professionals in the child’s network with necessary support and guidance. Sustainable change and safe development depend on active work with the child’s environment. This includes strengthening the competence of caregivers and staff, establishing shared understanding and routines, and developing concrete environmental measures to support the child. Such measures may include clear boundaries, predictability, adult support, and safety plans, all adapted to the child’s developmental level and needs.

Safety Plans

In cases of harmful sexual behaviour (HSB) in children and adolescents, it may be necessary and important to develop safety plans. The responsibility for developing such plans primarily lies with the institution or service responsible for the child’s daily care (e.g., kindergarten, school, or residential facility). However, HABU often initiates these plans and may contribute to their development.

Safety plans should be developed for all settings where the child or adolescent spends time. They must be concrete, adapted to the child’s age and situation, and include measures to prevent further HSB, safeguard the child, and protect others. They should be evaluated regularly and adjusted as needed.

The new consent law, which came into force on 1 July 2025, provides clearer legal guidelines for assessing sexual behaviour and strengthens the protection of children and adolescents. HABU operates within this framework and ensures that interventions and assessments comply with current legislation.

Interdisciplinary Collaboration

In cases involving HSB, HABU collaborates with relevant services involved with the child, depending on the issue and referral. The service participates in interdisciplinary meetings and collaborates with regional competence centres such as RVTS (Regional Resource Centres on Violence, Traumatic Stress and Suicide Prevention) and Children’s Advocacy Centres (Statens barnehus).

HABU is also represented in several consultation teams across the country. These are interdisciplinary and inter-agency forums where professionals can discuss complex cases anonymously and receive professional support and guidance.

Interdisciplinary collaboration aligns with the regulation’s requirement for coordination across service levels and is essential to ensure holistic and lifelong follow-up for HABU’s target group.

Written in collaboration with Monica Ølmheim, the Habilitation Service for Children and Adolescents at St. Olavs Hospital.

sist redigert 29.05.26