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 – R atifying and implementing the Council of Europe Convention on the Protection of Children against sexual Exploitation and Sexual Abuse Zagreb, O ctober 2011

A CHILD NEEDS HELP; NOT ONLY AFTER THE ABUSE, BUT ALSO IN SEVERAL DIFFERENT PHASES S/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 AND DEPEND 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: safety protection child’s wellbeing

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 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 condition assessment of child’s protection assessment 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 assessment characteristics 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 case possible 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 trauma helping the child and it’s family to incorporate traumatic experience into their lives maintaining 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 fear shame anger anxiety disgust depression sexual distress uncomfortable during physical contact low self-esteem guilt difficulties within close, emotional relationships physical difficulties dissociation intrusive images confusion

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: denial shame Self-protection diminishing abuse as a problem shock grieving anger guilt fear sadness helplessness

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 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 counseling psycho education inclusion in child’s treatment group support possible 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 appear assessment in a new phase of life another traumatic event appearance of old / new symptomatology

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

The main goal: A child who is feeling loved and safe!