Child and Adolescent Mental Health Service The Meadows Child & Adolescent Sexual Trauma Service

Child and Adolescent Mental Health Service Outpatient Teams Tier 3 North Edinburgh Team South Edinburgh Tier 4 Services Specialist Teams Tier 3/4 Midlothian Team East Lothian Team The Meadows - Sexual Trauma Service No54 – West Lothian Learning Disability PPALS Paediatric Liaison Service Edinburgh Connect SEBD Schools & Youth Justice Community Mental Health Workers Forteviot Day Programme Tipperlin Willowgrove West Lothian Team Early Psychosis Support Service Inpatient Unit Intensive Treatment Service

What We Do The Meadows team provides a multi-disciplinary approach to children and young people (0-18 yrs) and their families who are experiencing emotional, behavioural and mental health difficulties following sexual abuse We also provide a service for children who display problematic or harmful sexual behaviour.

How we do it Provide early intervention service for non-abusing parents/carers Provide individual therapies for a child/young person regarding the traumatic effects of sexual abuse Carry out capacity to protect assessments Assist the child/YP to gain a sense of control within their lives Encourage and assist the child/young person to build a supportive network within the community Provide consultation/training What happens the rest of the week is equally if not more important

What do children need immediately following disclosure of CSA? To be believed To be protected To be reassured To have some normality restored To have consistent and predictable parenting To be protected from extremes of parental distress and anger

How do children/young people experience the investigation? Supportive/sense of relief Frightening Intrusive Male/female doctors – LB: which gender abused child; set up of examination; children often quite traumatised by examination.

How do children experience a forensic medical following allegations of csa “fine”, “I don’t know”, “yucky” Having to wait a long time in waiting area/not sure what was happening Embarrassing, scary, painful “…that’s what he did to me” – confused Re-traumatised Shut down Threats from abuser Adolescents – ‘intrusive’

What Helps? Needs of child paramount Age appropriate explanation of examination - time and care Set up of room Professionals to have as much knowledge as available re nature of abuse Timing Gender of doctor

Non-abusive parents and carers

Early Intervention with parents/carers Pilot Study, Meadows Team Edinburgh Main Findings: High prevalence rate of clinically significant symptoms in the non-abusing parents All but one of the parents satisfied criteria for caseness as defined by the Brief Symptom Inventory Following intervention with parent, reduction in parental distress and degree of psychopathology 50% of children in study were not referred for individual assessment This study was carried out within the under 14's CSA service by.......... The study was carried out five years after the start of the EI service for non-abusing parents of victims of CSA Evaluated the work we did with non-abusing parents using the methods described today This report is available online parental distress levels clinically significant - so unlikely to resolve on their own team correctly identified those children most likely to need ind assessment and help BSI - evaluates current psychological symptoms experienced (within the previous week)

“The experience of the sexually abused child is highly dependent upon the support extended to the child’s mother and father in the aftermath of abuse” “Mothers and fathers whose children have been sexually abused find themselves faced with a crisis which often threatens to overwhelm them” C Humphreys et al Disclosure of Child Sexual Assault: Implications for parents An Australian study which looked into implications for parents following their child disclosing CSA concluded similar findings Mention different reactions of mothers and fathers

“…(they) spoke about the frightening level of pain and disruption which sexual abuse of their child had brought into their lives, ….they wanted information to help them make sense of their child’s behaviour, and time to talk through the extreme emotions that they described.” May not be taking in information given during interview, medical etc.

“The exclusiveness of therapy with the child was experienced as undermining….” “…felt that they had been seen at either the beginning or end of the child’s session or as part of an initial family assessment, and this had not helped them deal with the crisis which the sexual abuse had ushered in for them.” C. Humphreys Ultimately will hold their child’s recovery back as that is who we are sending them back with after each session, yet not equipping them with the time and info they need to parent them.

Early Intervention to parents/carers Secondary traumatisation of parents/carers is widely recognised and needs to be considered in any intervention with children Education about CSA, including grooming process Education about the possible impact of the abuse on the child Information about the investigative process Assessment of the parent’s and the child’s level of functioning prior to disclosure Reinforcement of competent parenting Management advice about current or potential difficulties the child may present This is done using a framework which looks at trauma dynamics

The disclosure by a child of sexual abuse can be traumatic for non-abusing parents Traumatisation can result in parental distress and reductions in self-esteem and confidence Low self-esteem and confidence can have a negative impact on ability to parent Timely interventions to contain parental distress can improve parental functioning Improvements in parental functioning will have positive outcomes for children

With careful and full assessment and analysis of the information gathered using this model, it is possible to inform and empower parents to feel able and competent in helping their child recover from sexual abuse. Often without their child needing to be seen. Also, in going through this process with the parents, their own levels of trauma and distress can be greatly reduced. THEIR CHILD IS NOT GOING TO BE OK IF THEY ARE NOT OK.

What works? Dependent of age of child and individual circumstances Range of interventions including: Psycho-education Working with and supporting the child’s system Early Intervention with parent/carer – abuse specific Longer term child/parent – parallel treatment Psychodynamic Individual Therapy CBT Play Therapy EMDR Attachment Based Therapy Systemic Family Therapy Group Therapy