Interventions in the treatment of sexually abused children and supporting the non-abusive parent

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• Interventions in the treatment of sexually
  abused children and supporting the non-abusive
  parent
• Gordana Buljan Flander, Assoc.Prof, Ph.D
• REGIONAL CONFERENCE
• Stopping 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

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• A CHILD NEEDS HELP
• NOT ONLY AFTER THE ABUSE,
• BUT ALSO IN SEVERAL DIFFERENT PHASES
• S/HE IS GOING THROUGH

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• 1. WHAT WAS THE CONTEXT OF CHILDS
• LIFE BEFORE THE ABUSE?
• supporting the child, quality of family
  relations, developmental characteristics
• assessment of the childs vunerability and/or
  resilience before the abuse
• the childs and familys existing beliefs and
  values
• the stressfulness of childs life conditions

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• 2. CHARACTERISTICS OF THE EVENT / ABUSE
• What happened?
• How do the child and its 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...

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• 3. WHAT WAS DISCLOSURE LIKE?
• what do people in the child's surrounding know
  about what happened
• characteristics of the childs disclosure
  (voluntary or forsed)
• childs symptoms
• reactions of childs surrounding and institutions
  of the system

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• 4. PERIOD AFTER DISCLOSURE
• Longer period of time (app. two years) in which
  investigation, legal consequences and childs
  treatment are included.
• Orientated to childs recovery.
• Orientated to changes in childs behaviour,
  childs adaptation and support s/he receives.

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• CHILDS REACTIONS AND SYMPTOMS
• REACTIONS TO SEXUAL ABUSE ARE INDIVIDUAL AND
• DEPEND ON THE PERIOD BEFORE THE ABUSE,
• CHILDS COPING STRATEGIES, SUPPORT WITHIN THE
  CHILDS SURROUNDING, AS WELL AS THE REACTION OF
  THE SYSTEM

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• Meaningful support must be focused on

• safety
• protection
• childs wellbeing

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• INTERVIEW OF THE CHILD
• conducted by educated professionals
• based 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 childs
  development, facts about the abuse, assessment of
  the emotional status and traumatization and
  further needs of the child
• SUPPORT normalisation of sympthoms according to
• childs age, identification of available support
• system, orientation towards the future, treatment
  planning

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• INTERVIEW OF THE PARENT, ASSESSMENT AND SUPPORT
• Conducted
• 1. before the childs interview
• - data about the child and its family
• - data about the suspicion of abuse whats the
  
• suspicion, who did the child
  confide to,
• childs and family reactions, relationship
  with the
• abuser, data about childs life,
  what was the child
• told about where s/he is going and
  what did s/he
• reply
• 2. after the childs interview
• - supporting the parent, providing information,
  
• empowering to provide support for
  the child

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• If a child is reffered by an institution
• additional informations about a child
• informations about childs family
• data about undertaken acts

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• 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 childs condition
• assessment of childs protection
• assessment of childs safety

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• MULTIDISCIPLINARY ASSESSMENT
• psychologist
• psychiatrist
• social worker
• paediatrician
• educational specialist
• Fewer professionals depending on childs age,
• traumatization assessment and childs
• availability.

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• Multidisciplinary report
• Consists of
• childs health status, conditions and dynamics in
  which child is growing up
• developmental and intelectual characteristics and
  psychological profile provided by the assessment
• characteristics of childs 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 case
• possible additional exposure to violent / abusive
  behaviour, as well as assessment of protection

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• 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

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• Trauma focused treatment of sexually abused
  child
• General aims
• reducing behavioral difficulties related to
  sexual abuse trauma
• helping the child and its family to incorporate
  traumatic experience into their lives
• maintaining normalan course of childs
  development
• WORK THROUGH THE TRAUMA place the trauma
  into childs life experience so it could become
  its constituting part which is not omnipresent
  and will not disturb further normal functioning.
  

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• A child feels

• low self-esteem
• guilt
• difficulties within close, emotional
  relationships
• physical difficulties
• dissociation
• intrusive images
• confusion

• fear
• shame
• anger
• anxiety
• disgust
• depression
• sexual distress
• uncomfortable during physical contact

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• 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!

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• PARENTAL SUPPORT AND CHILDS ADJUSTMENT
• Support from a non-abusive parent is one of the
• most important predictors of childs adjustment
  
• more important than characteristics of the abuse
  itself
• more important than the form of treatment

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• POSSIBLE PARENTS REACTIONS TO CHILD ABUSE

• grieving
• anger
• guilt
• fear
• sadness
• helplessness

• denial
• shame
• Self-protection
• diminishing abuse as a problem
• shock

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• IS THE NON-ABUSIVE PARENT PROVIDING
• PROTECTION FOR THE CHILD?
• Does the parent protect the child from the
  abuser?
• Does s/he efficiently respond to childs needs?
• How does s/he cope with childs behaviour and
  reactions ?
• Is s/he emotionally supporting the child?

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• Path from being the non-abusive parent to being
  a supportive parent
• directing to empowerment against shame
• identification of the protective role

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• Supporting the non-abusive parent
• individual support and counseling
• psycho education
• inclusion in childs treatment
• group support
• possible individual therapy for the parent (after
  empowering him/her for supporting the child)

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• Leaflets for parents
• ITS 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

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• FOLLOW UP
• untill the end of court process if the childs
  treatment is finished
• if new circumstances in childs life appear
• assessment in a new phase of life
• another traumatic event
• appearance of old / new symptomatology

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• CHILD PARENT
  SYSTEM

INTERVIEW AND SUPPORT
INTERVIEW, ASSESSMENT, SUPPORT
REPORTING (POLICE, SOCIAL WELFARE, ST.AT.)
Multidisciplinary assessment of the child, needs
assessment
Multidisciplinary report
Treatment
Support for the parent
Follow up
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The main goal
A child who is feeling loved and safe!