Short and long term psychological support Bruxelles 14 June 2017 Child and Youth Protection Center of Zagreb, Croatia Gordana Buljan Flander, PhD, Director

Abused children are: Terrible Crazy Fat Cowards Stupid Bad Black Loose Dead Small Lazy

Importance of support Many relevant research highlight the importance of providing support to children victims and/or witnesses of violence Evidence-based support without undue delay Kim, Noh & Kim, 2016; Miller-Perrin &Perrin, 2007; Cohen, Deblinger, Mannarino & Steer, 2004; Kolko & Swenson, 2012

Introducing Standard 8 Standard 8. Therapeutic Services 8.1 Assessment and treatment : Assessment and treatment is routlinely made available for child victims and witnesses that are referred to the Barnahus/Center. 8.2 Staff: Mental health services and treatment are provided by professionals with specialised training and expertise.

Introduing Standard 8 (cont.) Standard 8. Therapeutic Services 8.3 Information and child participation: Children and family/care-givers receive adequate information regarding available treatments and can influence the timing, location and set up of interventions. 8.4 Crisis intervention: The Barnahus has a clear organisational structure and permanent staff, which routinely offers crisis support intervention for the child and non-offending family members/care-givers if needed.

Modalities of supporting the child/family Support and access to information Crisis support interventions counselling psychotherapy Treatment Short term support Long term support

Support and access to information Children and family/care- givers receive adequate information regarding available treatments Importance of information and psychoeducation: e.g. myths and facts about child abuse, signs and consequences, information about treatment and other sources of support

Treatment plan Multidisciplinary team assessment results serve as a basis for developing an evidence-based and trauma- informed treatment plan Treatment is adapted to the individual characteristics of the child, including age, development, linguistic, cognitive and social level, cultural background and emotional state

Ensuring child participation Children and family/care-givers are given opportunity to influence the treatment plan and process

Trauma focused treatment Interventions with the parents (support and counselling) Joint sessions (children and parents prepared) Interventions with the child Trauma-focused cognitive- behavioral therapy as therapy of choice in most trauma cases (TF-CBT) Cohen & Mannarino, 2008

“WORKING THROUGH THE TRAUMA” Placing 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.

Training of professionals Educated professionals – importance of specialised training in treatment approaches evidence-based trauma-informed therapy regular training opportunities: continous training, supervision and counselling

Forensically sensitive therapy Challenges What if child needs support, but due to ongoing court process, we do not want the treatment to jeopardize child`s testimony? Forensically sensitive therapy court proceedings are unfinished, but the child needs immediate treatment projective techniques and interpretations of child’s play and drawings are avoided working on symptoms without going into content of child`s story

6 year old boy, child victim of abuse „I feel a thousand times sad.”

From non-abusive to supportive parent Support from a non-abusive parent is one of the most important predictors of child’s adjustment (Cohen i Mannarino, 2008) more important than characteristics of the abuse itself more important than the form of treatment Path from being the non-abusive parent to being a supportive parent - identification of the protective role

„I want to withdraw my statement because of my mom, they love each other so I don't want him to go to jail. She called me a hundred of times, asking me not to take her husband away from her. Now mom will be happy, and I will be happier for her. It's my fault that he behaves badly towards her. All of it happened, but my mom never believed me, nor did my teacher, or anyone else I told. Often I can't sleep at night because my mom doesn't trust me. I feel like I don't have anyone. I want my mom to be happy, then she will love me.” From non-abusive to supportive parent

FOLLOW UP A child needs help; not only after the abuse, but also in several different phases s/he is going through

during the court process, if the treatment has ended if new circumstances in child’s life appear assessment in a new phase another traumatic event appearance of old or new symptomatology

Because without the dark we could never see the stars Don`t underestimate yourself – we are all worth the same. Find your strength, inner drive for life and all it is bringing. Because without the dark we could never see the stars

gordana.flander@poliklinika- djeca.hr Thank you www.poliklinika-djeca.hr/english gordana.flander@poliklinika- djeca.hr