Interventions in the treatment of sexually abused children

and supporting the non-abusive parent

Gordana Buljan Flander, Assoc.Prof, Ph.D

REGIONAL CONFERENCEStopping sexual violence against children –

Ratifying and implementing the Council of Europe Convention on the Protection of Children against sexual Exploitation and Sexual Abuse

Zagreb, 27 - 28 October 2011

A CHILD NEEDS HELP; NOT ONLY AFTER THE ABUSE,

BUT ALSO IN SEVERAL DIFFERENT PHASESS/HE IS GOING THROUGH

1. WHAT WAS THE CONTEXT OF CHILD’S LIFE BEFORE THE ABUSE?

• supporting the child, quality of family relations, developmental characteristics

• assessment of the child’s vunerability and/or resilience before the abuse

• the child’s and family’s existing beliefs and values

• the stressfulness of child’s life conditions

2. CHARACTERISTICS OF THE EVENT / ABUSE

• What happened?• How do the child and it’s family cope with facts

and detalis about the abuse:⁻ type of sexual abuse⁻ presence of violence ⁻ frequency, duration⁻ threatening the child⁻ defences and coping strategies...

3. WHAT WAS DISCLOSURE LIKE?

• what do people in the child's surrounding know about what happened

• characteristics of the child’s disclosure (voluntary or forsed)

• child’s symptoms• reactions of child’s surrounding and institutions

of the system

4. PERIOD AFTER DISCLOSURE

• Longer period of time (app. two years) in which investigation, legal consequences and child’s treatment are included.

• Orientated to child’s recovery.

• Orientated to changes in child’s behaviour, child’s adaptation and support s/he receives.

CHILD’S REACTIONS AND SYMPTOMS

REACTIONS TO SEXUAL ABUSE ARE INDIVIDUAL ANDDEPEND ON THE PERIOD BEFORE THE ABUSE,

CHILD’S COPING STRATEGIES, SUPPORT WITHIN THE CHILD’S SURROUNDING, AS WELL AS THE REACTION

OF THE SYSTEM

Meaningful support must be focused on:

safetyprotectionchild’s wellbeing

INTERVIEW OF THE CHILDconducted by educated professionalsbased on contemporary scientific and clinical

knowledgements about how to interview a child after sexual abuse

includes establishing relation with the child, reviewing understanding the difference between the trooth and a lie, assessment of child’s development, facts about the abuse, assessment of the emotional status and traumatization and further needs of the child

SUPPORT: normalisation of sympthoms according to child’s age, identification of available support system, orientation towards the future, treatment planning

INTERVIEW OF THE PARENT, ASSESSMENT AND SUPPORT

Conducted:1. before the child’s interview

- data about the child and it’s family- data about the suspicion of abuse; what’s the

suspicion, who did the child confide to, child’s and family reactions, relationship with the abuser, data about child’s life, what was the child told about where s/he is going and what did s/he reply

2. after the child’s interview- supporting the parent, providing information,

empowering to provide support for the child

If a child is reffered by an institution:

• additional informations about a child• informations about child’s family• data about undertaken acts

Mandatory report about the suspition of sexual abuse to institutions of the system

(Social Welfare Centre, the Police, State Attorney)

report about the abuse based on facts provided by the child

breif assessment of child’s conditionassessment of child’s protectionassessment of child’s safety

MULTIDISCIPLINARY ASSESSMENT

→ psychologist→ psychiatrist → social worker→ paediatrician → educational specialist

Fewer professionals depending on child’s age, traumatization assessment and child’s availability.

Multidisciplinary report

Consists of: child’s health status, conditions and dynamics in which

child is growing up developmental and intelectual characteristics and

psychological profile provided by the assessmentcharacteristics of child’s social and emotional development

and his/hers competences level of traumatization, existence or absence of

psychopatology (diagnosis according to ICD) suspicion of exposure to sexual abuse (what type, distinct

description of the casepossible additional exposure to violent / abusive

behaviour, as well as assessment of protection

Multidisciplinary report (continued)

recommendation for further child protection and treatment / therapy

recommendation of the need for the parent to be included in counseling or treatment

recommendation for siblings to be assessed as well if there is a perceived possibility that they also might be victims of abuse

Trauma focused treatment of sexually abused child

General aims: reducing behavioral difficulties related to sexual

abuse traumahelping the child and it’s family to incorporate

traumatic experience into their livesmaintaining normalan course of child’s development

“WORK THROUGH THE TRAUMA” – place the trauma into child’s life experience so it could become it’s constituting part which is not omnipresent and will not disturb further normal functioning.

A child feels

fearshameangeranxietydisgustdepressionsexual distressuncomfortable during

physical contact

low self-esteem guiltdifficulties within close,

emotional relationshipsphysical difficultiesdissociationintrusive imagesconfusion

A CHILD NEEDS: support and patience feeling of being cared for / safety and protection

of abuse clear informations, feeling that he/she is being

seen/heard continuence of usual daily activities knowledge that s/he is NOT GUILTY for the

sexual abuse right to express feelings sense that others are trying to understand

him/her and they want to help respecting individual characteristics

→ TIME ITSELF DOES NOT HELP, WE DO IN TIME!

PARENTAL SUPPORT AND CHILD’S ADJUSTMENT

Support from a non-abusive parent is one of the most important predictors of child’s adjustment ;

more important than characteristics of the abuse itself

more important than the form of treatment

POSSIBLE PARENT’S REACTIONS TO CHILD ABUSE:

denialshameSelf-protection diminishing abuse as

a problemshock

grievingangerguiltfearsadnesshelplessness

IS THE NON-ABUSIVE PARENT PROVIDINGPROTECTION FOR THE CHILD?

Does the parent protect the child from the abuser?

Does s/he efficiently respond to child’s needs?How does s/he cope with child’s behaviour

and reactions ?Is s/he emotionally supporting the child?

Path from being the non-abusive parent to being a supportive parent:

directing to empowerment against shame

identification of the protective role

Supporting the non-abusive parent

individual support and counselingpsycho educationinclusion in child’s treatmentgroup supportpossible individual therapy for the parent

(after empowering him/her for supporting the child)

Leaflets for parents

IT’S HAPPENED? …WHAT NOW?

Signs and consequences of sexual abuse Myths and facts about sexual abuse Family support for the sexually abused child Treatment of the sexually abused child Most frequest parents’ queations

FOLLOW UP

untill the end of court process if the child’s treatment is finished

if new circumstances in child’s life appearassessment in a new phase of lifeanother traumatic eventappearance of old / new symptomatology

CHILD PARENT SYSTEM

INTERVIEW ANDSUPPORT

INTERVIEW, ASSESSMENT,

SUPPORTREPORTING

(POLICE, SOCIAL WELFARE, ST.AT.)

Multidisciplinary assessment of the child,

needs assessment

Multidisciplinary report

TreatmentSupport

for the parent

Follow up

The main goal:The main goal:

A child who is feeling loved and safe!

A child who is feeling loved and safe!