1. Barnahús – The Children´s House · www.bvs.is Cooperation, Overview of Services, Referrals and Challenges in Daily Work Barnahus Iceland Reykjavik 2016 Paola Cardenas psychologist, family therapist and expert interviewer

2. Barnahús – The Children´s House · www.bvs.is Lack of coordination between the CPS, Police, the judicial system and Health Services Lack of specialisation Lack of interdisciplinary approach There were discrepancies in children’s disclosures Children from rural areas did not get appropriate assessment, treatment and support Before Barnahus

3. Barnahús – The Children´s House · www.bvs.is The child was subjected to... –repeated interviews –conducted by many interviewers –disclosing at different locations –re-victimization/re-traumatisation was common Before Barnahus

4. Guðríður Haraldsdóttir og Paola Cardenas 4

5. Barnahús – The Children´s House · www.bvs.is Fortunatelly things have changed…

6. Barnahús – The Children´s House · www.bvs.is Mission of Barnahus To facilitate the collaboration and coordination of CPS, the police, prosecution and the medical profession in the investigation of child abuse To provide a child-friendly environment for forensic interviews, treatment interventions and medical examination To ensure the professional implementation of forensic interviews

7. Barnahús – The Children´s House · www.bvs.is Mission of the Barnahus To ensure that the child victim and his/her family receives appropriate assessment, treatment and support To establish professional work practices and guidelines through interdisciplinary cooperation To enhance specialized knowledge on child sexual abuse and domestic violenceand to mediate that knowledges as appropriate to professionals and the public alike Not to harm the child

8. Barnahús – The Children´s House · www.bvs.is Overview of Services Child abuse from ages 3 ½ - 18 years. Victims of sexual abuse, physical abuse and domestic violence and unaccompanied minors and children who seek asylum Forensic interviews Exploratory interviews Court hearing interviews Medical examination Assessment and psychotherapy Family counselling and support Instructions to other professionals Provide supervison to residency students in psychology

9. Barnahús – The Children´s House · www.bvs.is All services under one roof Cooperation between: –CPS –Criminal justice system –University Hospital –Others All professionals go to the child and not the other way around Child-friendly approach

10. Barnahús – The Children´s House · www.bvs.is COOPERATION

11. Barnahús – The Children´s House · www.bvs.is Forensic interviews Court hearing interview Cases referred to the police The court judge is in charge of the procedure Monitoring are: –The prosecution –The police –A CPS representative –The child´s legal advocate –The defence lawyer –The alleged offender, few cases Exploratory interview At the request of the CPS Only CPS is monitoring Investigative interview with unaccompanied minor/asylum seeker At the request of the CPS Monitoring are: – A CPS representative –A representative from the department of immigration –A representative from the Red Cross

12. Barnahús – The Children´s House · www.bvs.is

13. Treatment intervention/psychotherapy Specialists at Barnahus work in collaboration with the Child and Adolescent Psychiatric Ward of the National University Hospital, MST (Multisystemic Therapy) therapists, school counsellors, The State-run Treatment Home, SOK team, among others. A CPS case worker monitors the multidisciplinary team ensuring the continuous support and follow up with the child and his/her family/caregiver(s).

14. Barnahús – The Children´s House · www.bvs.is Treatment intervention/psychotherapy Barnahus psychotherapists are responsible for the treatment intervention provided to their assigned clients (children and their families). Psychotherapists at Barnahus are in regular communication with the CPS case workers. This collaboration allows for the exchange of information between Barnahus’ psychotherapists and the CPS case workers to ensure the welfare of children and families who seek services at Barnahus.

15. Barnahús – The Children´s House · www.bvs.is

16. Iceland – one Barnahus

17. Barnahús – The Children´s House · www.bvs.is Medical examination Request of the police/CPS Experienced pediatrician, nurse and gynaecologist A child friendly examination room Using video-colposcope Anaesthetization exceptional low

18. Barnahús – The Children´s House · www.bvs.is REFERRAL TO BARNAHUS

19. Barnahús – The Children´s House · www.bvs.is Who can send referrals? Child protection services (CPS) all around the country – Exploratory interview – Medical examination – Assessment and treatment Court judges all around the country –Court hearing interview

20. Barnahús – The Children´s House · www.bvs.is Suspicion of abuse Case reported to the police Case reported to the CPS Obligatory Police investigation Referral to Barnahus for an exploratory interview Court hearing interview Assesment and treatment Court judge

21. Barnahús – The Children´s House · www.bvs.is

23. Forensic interview – Referrals A referral to Barnahus is sent parallel to a request form a police investigation The forensic interview might take place at Barnahus, or at the police station (15-18 years) If the child is interviewed somewhere other than Barnahus, Barnahus receives a transcript of the interview or a comprehensive report of the child’s disclosure

24. Barnahús – The Children´s House · www.bvs.is Exploratory interviews – Referrals The suspected perpetrator is under the age of criminal responsibility (15 years) The child exhibit inappropriate sexual behavior, engages in sexual play, draws picture with sexual content –Sexual play/abuse Sibling(s) of the child victim Cases on “grey area” Children/adolescents suggest that something has happen but have not given a disclosure of sexual abuse Peers (15-18 years) Custody battles

25. Barnahús – The Children´s House · www.bvs.is Exploratory interview- Referrals Child/parents refuse to press charges –A valid explanation is required from CPS if cases are not referred to the police Consultation with the police regarding the exploratory interview, when necessary

26. Barnahús – The Children´s House · www.bvs.is Assessment and treatment intervention – Referrals All victims of sexual abuse are entitled to treatment at BH, regardless the outcome of the police investigation Victims or witnesses in physical abuse/domestic violence are entitled to treatment at Barnahus following a forensic interview. Only in cases where there is an open criminal investigation Treatment at Barnahus is provided in cooperation with CPS. Between10-20 sessions Cases of individuals between the ages of 18 to 20 who receive treatment at Barnahus have been refered to Barnahus before the individual turns 18

27. Barnahús – The Children´s House · www.bvs.is CHALLENGES

28. Barnahús – The Children´s House · www.bvs.is Challenges in daily work in Barnahus Difficult cases –Complex trauma –Taking work home with you –Working with children who have been abused Dealing with parents –Non collaborative parents/caregivers –Abusive parents/caregivers –Disstressed parents/caregivers –Child custody battles

29. Barnahús – The Children´s House · www.bvs.is More challenges Collaboration might sometimes prove to be challenging –CPS The judicial system –Testifying in court as expert witnesses –Frustration when cases are dismissed Traveling to remote areas around the country –Stuck in the middle of nowhere overnight

30. Barnahús – The Children´s House · www.bvs.is And more challenges Keeping up to date with the best practices –Forensic interviewing –Assessment –Therapy Plans might change all of a sudden –When court hearings are scheduled at the last moment –Some cases require imidiate action On the bright side….

31. Barnahús – The Children´s House · www.bvs.is On the positive side A very rewarding job –Children recover –Families reunite Specialized field of expertise Witness justice being served Keeping up to date with the best practices Dinamic work Never boring…

32. Barnahús – The Children´s House · www.bvs.is Thank you!