Ólöf Ásta Farestveit – leader of Barnahus PROMICE – 16th June 2016

Forensic interview

The interview room Specially designed Child friendly setting Neutral/Safe Camera No distractions (no toys) Age and developmentally appropriate Information about all present Everyone can ask questions through the questioner

Interviewer Use of evidence based protocol Warm and friendly presence Put the child at ease Don´t sit interrogation style across table Use of developmentally appropriate language Avoid jargon – use precise language Neutral and open minded Respectful Interrogation – yfirheyrslulega Jargon – hrognamál/tæknimál

Interviewer Convey interest in child and what they have to say Strong presence that shows „You can tell me anything and I can handle it“ Avoid showing own reaction or opinion Pace the interview – allow for short pauses Be careful not to interrupt Don´t finish sentences for child Be aware of interview stress Keep the interview short Focus on questions to essential information Make sure that the child sticks to the matter but be diplomat

Timing Is the child tired? What time does the child take medication, if any? Has the child eaten? Is the child missing fun activities? Does the child need to use the restroom?

Forensic interviewing Evidence based protocol (NICHD / NCAC) Non-judgemental Truth seeking Neutral in tone Accurate, credible, complete information Precise documentation DVD recording

The goals of the interview Maximize information from he child Minimize the impact of the interview on the child Minimize contaminatin effects on the child´s memory Maintain integrity Integrity - heiðarleiki

Fundamental principles Emphasize on open-ended questions Be smart with direct questions „Funnel approach“ „Pairing“ Think about and use what child has just said Listen more – talk less

Question types

Question types Closed questions Yes / No questions Multiple choice/forced choice Leading Elicit recognition memory Should be delayed Children tend to answer with one word Less likely to elicit complete responses Results in additional information – some correct, some incorrect Risk of contamination greater with youngest children Fá fram - elicit

Question types Open-ended questions Narrative invitation Focused narrative request Detailed question / Wh- Elicit recall memory Speak able and important Open questions elicit 3-5 times more information Considered more reliable Less influenced/contaminated by interviewer

Yes / No questions „Was your Mom at home?“ „Did _ say something to you?“ Risks and benefits Useful to introduce new topic Increases incorrect responding Too many yes/no questions can discredit an interview May be difficult to know if child understood question

Forced/multiple choice question “Did _ happen one time or more than one time?” “Were you sitting down, or standing up, or something else? Used to clarify detail question Offer alternatives to choose from May in fact not include the correct one Children answer such questions even when the correct alternative is not given Last option bias Always include 2 alternitives and an open ended option: „....or something else?“

Leading questions „It´s ok to tell me that your father has been doing bad things to you“ „Didn´t he hurt you?“ Introduces information not previously mentioned by child Asks the child to react to information Lead to the desired response Avoid using these questions But if you must ... Always follow by pairing with an open ended invitation

Narrative invitation The ultimate open-ended question Free recall Designed to let the child provide details without any input from the interviewer Gives child most control over topic and conversation Gives child opportunity to give information about things that they would not have been asked about “Start at the beginning and tell me everything that happened” “Tell me more about __” “Tell me the next thing that happened” “Then what happened?”

Focused narrative request Interviewer requests more information about topic already mentioned Cued open questions About a person, object, action, time segment, location “Tell me more about __” “You said __, tell me everything about __” “Tell me everything that happened from __ until __” “Explain/describe __”

Detailed question Important for the investigation May cue child to provide a missing element Should be delayed until narrative invitation and focused narrative requests exhausted Who? What? Where? When? How? But never why? They are blaming

Keep in mind Open ended questions are prudendt to avoid leading questions The more open-ended the question. The greater confidence you can have in the response Use as many open-ended questions as possible Use general or focused questions & only resort to multiple choice or Y/N if the former aren´t eliciting any information Revert to a more open ended approach following multiple choice or Y/N questions

Reflections Research show that young children, 4-5yrs, gave two times more information for every “tell me about” question than “yes or no” question 8-9yrs children gave equally much information as younger children if they were asked “yes or no” questions BUT they gave four times more information fore every “tell me more” question

Interview structure Stage 1 Rapport Stage 2 Substantive Phase Introduction Early engagement Interview instructions Narrative practice Family Stage 2 Substantive Phase Transition to the topic Narrative description Follow-up questions Clarification Closure

Interview instructions If I ask you the same question more than once Don´t guess - if you don’t know the answer Let me know if you don’t understand the question Correct me if I’m wrong Difference between truth and lies Contract about the truth

Body map

Use of human figure diagram Introduce the diagram Have child label parts of the body Can also ask about function Include questions about positive and negative “touches” Conversation about “touches” Conversation about “rules about a child´s body”

Narrative practice Increases informative responses in the beginning of the interview Opportunity to: Observe linguistic functioning Learn witch questioning formats elicit the most narrative responses Observe if the child is reluctant

Transition to the topic Question(s) whitch invite child to discuss substantive issues Start broad and become progressively more focused Funnel approach „Tell me why you are here today“ „What did your mom/dad tell you about coming here today?“ „I understand something might have happened, tell me about that“ More focused prompts „Is someone worried about you?“ „Are you worried about something?“ „Has something happened to you?“ „Have there been any problems?“ Narrow the focus of questions very gradually as needed (funnel approeach), rather than

Narrative description Elicit narrative using recall prompts „Tell me more...“ „Tell me all about...“ „Then what happened?“ „You said _ tell me more about _“ „Tell me what happened from the beginning to the end“ „help me to understand“ Ask for explanation or further description Avoid rush to specific questions

Follow-up and clarification Questions eliciting further details Keep questions as open as possible Questions seeking clarification of previous terms or statements „Earlier you said that your dad French-kissed you. Explain French-kissed“ „Is there anything else that you think I should know?“

Closure Sum up, using child´s words Return to everyday conversation or neutral topic discovered in the rapport Answer questions or concerns Thank child for the participation, time and effort (not the content) Discuss safety plan Who can you tell if you are worried about something

Memory and suggestibility

Recall memory Triggered by non direct, open-ended questions Info that is most salient / understandable / speak able to the child Risk – errors of omission Accessed through open ended prompts Greater accuracy rate „Tell me everything about ...“ „What happened next?“ Mikilvægast – orð barnsins notuð og þeirra sýn á hlutinn Issues: developmentally/ culturally influenced

Recoginition memory Triggered by specific focused questions, Yes/No questions and multiple choice questions Questions prompting recognition memory are necessary Delay as long as possible Additional info – some correct, some incorrect Contamination risk – youngest children Contamination risk – weak info

Whenever possible, elicit recall memory by asking open-ended questions Carefully use focused questions to elicit recognition memory for crucial details

Suggestibility The degree to which one’s memory or recounting of a event is influenced by suggested information or misinformation Can be the result of: Being told what to say Being questioned in a way that alters your recollection of the event Children 10 and over are no more suggestible than adults

Suggestibility Greater risk with younger children Greater risk with children who have less developed cognitive skills Greater risk when using recognition prompts (as opposed to recall prompts) Greater risk for peripheral details

Avoid introducing new information about the topic of concern Some mildly suggestive questions may be necessary, but words should be chosen with care Can seriously compromise accuracy when child is 5 yrs or younger OR if repeatedly interviewed

Case example - annie

Exploratory interview Annie talkes briefly about school, her hobbies and interests (introduction and early engagement) Ground rules explained Narrative practice about a seperate, nonabusive event Annie was asked why she was here today She said she did not know

Exploratory interview Annie was told that here children came to talk if something had happened to them She told about a car incident she hat been through, in free narrative Annie was told that sometimes children came to talk about their body and if someone had done anything to their bodies She told about recent sexual play with peers at the playground

Exploratory interview Annie was asked if anyone grown up had done anything to her body She immediately answered „Yes my father“ Annie was asked „Tell me about that“ She gave a very good free narrative that she had spent a night at her grandparents one year ago and her blodfather was there. She disclosed that her father touched her private parts and made her touch his Exploratory interview was stopped and Annie told that she had to come back and tell more

Investigative interview Annie´s disclosure was very detailed, she described one occasion of a very serious sexual abuse (touching of private parts, masturbating, attempted penetration). She demonstrated this all very clearly while disclosing. She described her father´s genitals very well and that something came out of it that was wet.

Investigatvie interview Annie said that while this was happening she was listening to a well known lullaby in her fathers laptop over and over again. She also mention this in the exploratory interview Annie said that after this, her father had fallen asleep and she had gone to her grandmother´s bed. She said that her father began snoring

Investigative interview Right after the investigative interview Annie drew a picture in the waiting room for the interviewer without being asked The picture shows her and her father in the bed Police takes the picture and it is used in court

Medical examination According to the doctor who examined Annie no clear medical evidence were found Urine and blodsamples were normal Annies blodfather was HIV positive so this was a big relief

Case example - Annie Annie was diagnosed with PTSD both in Barnahus and at the child psychiatric unit

Case example - Annie TF-CBT in Barnahus 16 sessions Playful inventions Made a trauma narrative (book) Acute admission to childrens psychiatry unit in April 2015 Agressive behavior towards younger brother Annie has finished her therapy and is doing well Annie might need further therapy when she gets older (reaches puberty)

Annies final outcome

Case example - Annie Prosecution issued an indicement 20.08.2015 Annies therapist writes a report Main court procedure is 23.11.2015 Annies therapist gives testimony

The evidence No conclusive physical evidence No admittance from accused Denied in court but admitted to police that he did not remember anything but something might have happened without him knowing since he was on drugs Letter to Annies mother in July 2015 Annies testimony Various testimonies

Annies statement Very clear Free recall Very graphical Discloses many details Judical conclusion that Annies statement is very clear and credable and that she is describing own experience

Other vitnesses Annies mother Annies grandmother Describes Annies disclosure in most part in harmony with Annies statement in Barnahus Describes serious changes in Annies behavior Supported by Annies stepfathers testimony Annies grandmother Stated that the girl slept in her fathers bedroom Denied that her father was on drugs at that time Denied that she heard music from his room Stated that she would have heard if music was played Stated that Annie did crawl to her bed during the night Stated that nothing was unusual with the girl the day after

Expert vitnesses Child psychiatrists from the childrens psychiatry unit Stated about Annies acute admission in April 2015 Stated about Annies diagnosis of PTSD Annies therapist in Barnahus Stated about Annies therapy Stated about Annies feelings and mental health Agressive behavior, behavioral changes, shame, guilt, mixed feelings towards father Key factor: Using expert testimony to explain child´s statement and the effect of the abuse

Court Judgement of the South Iceland District court January 18th 2016 Father charged with sexually abusing his 8 year old daugther Found guilty of all charges exept for rubing Annies vagina and putting finger in her anal Annie did not disclose about that in the interview Blodfather sentenced for 5 ½ years in prison

Assessment

Assessment Provides a picture of what´s going on with the child Helps to determine Presenting symptoms The need for treatment What type of treatment is best fit? Helps in development of treatment plan Enables therapist to assess treatment progress Methods: Formal, Standardized Measures Clinical interview Clinical observations

Therapy

Type of therapy Evidence based and best practice Therapy in Barnahus is based on cognitive behavioral therapy (CBT) Psychoeducation Family therapy Group therapy Play / sand therapy Building self esteem /self respect

Type of therapy According to WHO (world health organisation) for children with PTSD (post traumatic stress disorder) TF-CBT (Trauma-focused cognitive-behavioural therapy) https://tfcbt.musc.edu/ CPT (cognitive-processing therapy) https://cpt.musc.edu/ EMDR (eye movement desensitization and reprocessing)

Family therapy Three family therapists in Barnahus Always two therapists When the abuser is a family member Young „offender“ When severe conflicts in the family interrupts child´s recovery When the non-abusive parent is not supportive

Group therapy For adolesents that have finished therapy Two therapists Same sex – similar age Meeting others who have been through similar experiance 6-8 sessions Focus on self esteem, self respect, self regulation

Play/sand therapy For young children TF-CBT through playful interventions Sand, art, games, puppets, stories Has proven to be effective for children Play is the language of children Motivate children to participate in treatment