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

2. 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

3. 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.

4. 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

5. 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

6. 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.

7. 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’

8. 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

9. Non-abusive parents and carers

10. 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)

11. “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

12. “…(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.

13. “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.

14. 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

15. 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

16. 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.

17. 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