1. Rachael Johnson - NSPCC Aims To identify the impact of sexual abuse; To identify the need for services; To describe a model developed within NSPCC 1

2. The Impact of Sexual Abuse  Psychological  Social  Behavioural 2

3. The Four Traumagenic Dynamics Model of sexual abuse (Finkelhor and Brown, 1986) Traumatic sexualisation: The child’s sexuality is shaped in a developmentally inappropriate way. Premature sexualisation; lack of boundaries; sex is associated with negative feelings and memories; may struggle to form appropriate sexual/intimate relationships. Betrayal: child is abused in a relationship in which they expect to be cared for and protected. Trust is violated. 3

4. The Four Traumagenic Dynamics Model of sexual abuse (Finkelhor and Brown, 1986) Powerlessness: the child is made to feel helpless and powerless; may blame self because they could not stop the abuse or did not actively resist; child has no ownership over their body. Stigmatisation: a sense of badness, shame and guilt may become incorporated into the child’s self-image. 4

5. Danya Glaser (1991) added two further factors… Secrecy: the need to deal with the secrecy surrounding the abuse prior to disclosure; the fear and isolation this engenders for the child. Confusion: the confusion arising from a child possibly experiencing pleasurable feelings; ‘bad’ behaviour initiated by a trusted adult; conflicting feelings a child might have for the perpetrator of abuse; the ‘double’ life a child might have to live. These factors aren’t solely linked to sexual abuse but the combination of dynamics make this type of trauma unique. 5

6. The Need for Services NSPCC research identified a gap in services; Scarcity of evidence about what works leads to a lack of funding; CBT is not suitable for all, particularly younger children. 6

7. Letting the Future In Model Children and young people aged 4 to 17; Child has made a disclosure of sexual abuse; Where a joint investigation has taken place; Child living with a safe carer; 7

8. Letting the Future In Model  Assessment of therapeutic need  Individual work with child/young person  Individual work with safe carer  Joint work with child and carer 8

9. Therapeutic work with child/young person  Socio-educative work around sexual abuse  Identity and self-esteem; power dynamics  Helping child become aware of their feelings and manage feelings around their abuse  Helping child tell their story. 9

10. The Use of Symbolic Play with Children Play is the natural way for children to communicate about traumatic and emotional experiences. Symbolic play allows child to explore their experiences from a safe distance without getting re-traumatised. Most children re-enact the impact of their experience through play because it is foremost in their mind. Non-directive play - the role of the practitioner is to reflect the child’s play, to tune into the child’s feelings, to notice themes in child’s play. 10

11. Focussed Interventions with Children Eco Maps/Life Graphs/Life Maps – to depict important people or events in child’s life. Sand-tray work – Ask the child to use figures to depict their family; to depict scenes of before and after they told about their abuse. Picture cards – to describe feelings; child’s view of themselves; dynamics in relationships. Relaxation activities e.g. blowing bubbles; tensing/relaxing muscles. Activities to help child express feelings e.g. punching through newspaper; messy painting; ripping paper. Create supportive messages e.g. “it was really good to tell…; You are brave; What happened was not your fault”. 11

12. Support for Safe Carers The most influential factor in children's recovery is the warmth and consistency they receive from their safe carer. We know that sexual abuse can lead to a deterioration in relationships between children and carers and also that compromised relationships can make children vulnerable to abuse. 12

13. Individual Work with Carers Help carer process their thoughts and feelings about their child; grief and loss they may be experiencing. Help carers feel more understood and less isolated. Socio-educative work about sexual abuse (impact of abuse, why it’s difficult for children to tell, perpetrator’s behaviour). Help carers think about how they can support their child (nightmares, managing behaviour, supportive messages). Increase warmth and consistency. Increase their ability to be in tune with child’s feelings. Prepare for joint work with the child – repair relationship. 13

14. Evaluation Work is being evaluated by Durham and Bristol Universities; There will be a focus on the role of the therapeutic alliance; This research will involve the largest number of children. 14