Facilitating interviews with children who may have been sexually abused

The introduction of the Memorandum of Good Practice on interviewing children who have been sexually abused has had an important unifying effect on professional practice. However, because of the traumatic nature of sexual abuse there will be a group of children about whom there are high levels of suspicion and where arrangements need to be made for their future care, protection and treatment. These include children who have learning disabilities or communication problems, have psychiatric disorders associated with abuse, or where there have been considerable delays since allegations were first made. Such children require a second-stage facilitative assessment interview. These include different forms of questioning, and the use of a wide range of prompting materials including art work, free and structured play context and the use of anatomically correct dolls. These approaches are reviewed and illustrated through case studies.     

The assessment of drawings from children who have been maltreated: a systematic review

This paper presents a systematic review that aims to identify studies using drawing techniques with maltreated children. The paper first introduces the relevant developmental theory relating to children's drawings and its application to practice. Studies using drawing techniques with maltreated children were identified from both the research and practice literature. These were summarized and compared. The evidence from the studies appears relatively inconclusive as to the value of children's drawings for the identification of possible maltreatment, although they do apparently help in aiding recall of important events. Drawings are widely used to assess maltreatment and neglect of children. However, researchers advocate caution in generalizing and interpreting drawings from children with differing experiences. Copyright © 2002 John Wiley & Sons, Ltd.     

Anatomical dolls: their use in assessment of children who may have been sexually abused

This article examines anatomical dolls in interviews of children who may have been sexually abused from three perspectives. The article summarizes research findings on anatomical dolls, discusses advantages and disadvantages of using them, and describes endorsed doll uses. Although additional, ecologically-valid research is needed on anatomical dolls, the selective use of anatomical dolls, as communication aids, when interviewing children who may be reluctant or unable to describe sexual abuse is warranted.     

Professional perpetrators: sex offenders who use their employment to target and sexually abuse the children with whom they work

Professionals who use their work as a cover for targeting and sexually abusing children have become the focus of public, media and legislative concerns in recent years. In the past 15 years, scandal after scandal has led to review investigations and public inquiries. These in turn have led to legislative changes to help improve childcare practices and prevent perpetrators from gaining access to children through institutions and organizations. This paper explores the literature and research studies which examine institutional abuse and professional perpetrators. Copyright © 2002 John Wiley & Sons, Ltd.     

Evaluating community-based treatment programmes for men who sexually abuse children

The currently dominant multi-factorial explanations of sex offending have been reflected in the widespread adoption of cognitive-behavioural groupwork methods where treatment foci are those attitudes, beliefs, cognitions and behaviours believed to contribute towards the maintenance of sexually abusive practices. Community-based programmes have mushroomed during this decade, with 97% of regional probation services now having provision for sex offender treatment. However, these relatively recent and dramatic developments of practice have to a large extent occurred outside of a framework of rigorous planning and evaluation. This article begins by outlining a rationale for both the treatment of sex offenders and evaluating programmes. This is followed by a framework for evaluation within which treatment providers can consider the issues involved (including the methodological difficulties) in setting up research designed to evaluate treatment effectiveness. It is suggested that, while small-scale (in-house) research may tell us something about the success or otherwise of individual programmes, it is the larger-scale projects carried out by independent researchers that will inform us as to the impact of cognitive-behavioural group work on recidivism and offence-related psychological variables. Such research has the potential to assist policy-makers and to aid managers and practitioners in the development of effective treatment programmes. © 1998 John Wiley & Sons, Ltd.     

A signs of safety approach to assessing children with sexually concerning or harmful behaviour

The Junction is a Barnardo's children's service based in northern England that provides assessment and intervention in the lives of children and young people who have sexually concerning or harmful behaviour. It is developing methods of assessment that move away from more established approaches to provide a service that attempts to address more comprehensively the circumstances of individuals and families, utilizing a Signs of Safety approach. The principles and methods of this approach are outlined with examples of practice. Copyright © 2005 John Wiley & Sons, Ltd.     

A Survey of the First Five Years' Work of a Child Sexual Abuse Team

This paper describes a survey of the first 5 years' work of a specialist NHS child sexual abuse team (CSAT), which provides a post-disclosure treatment service to young people aged between 13 and 19. Information was obtained on the demographic characteristics of young people referred, the nature of their abuse and its perpetrators, and the type, length and outcome of the treatment provided. The survey was also used to ask four questions. Was the team providing a service to its target population, young people whose sexual abuse had been severe? Did the severity of abuse predict the intensity or length of therapy provided? Were there differences in the service provided to boys as opposed to girls? Finally, did experienced therapists achieve different results when compared with non-experienced therapists? It was found that the service was being used by its target group and that severity of abuse was associated with longer or more intensive therapy. The service did not appear to be adequately meeting the needs of boys. There was some indication that experienced therapists achieved the same treatment outcome as inexperienced therapists in a shorter period of time.     

Factors Influencing the Degree and Pattern of Parental Involvement in Play Therapy for Sexually Abused Children

Although much has been written about the role of therapists in children's recovery from child sexual abuse, relatively little attention has been paid to the role of nonoffending parents. This study investigated the work of a team of therapists who sometimes included such parents in therapy sessions with children. The study sought to understand what factors were influencing the degree and pattern of parental involvement and to understand what effect these patterns of parental involvement were having on the process and outcomes of therapy. The study successfully identified a range of factors influencing the patterns of parental involvement, but more research will be needed to understand the effect on outcomes.     

Shame and Guilt in Men Exposed to Childhood Sexual Abuse: A Qualitative Investigation

This study examined the experiences of shame and guilt in adult males sexually abused as children. Seven participants attending a service for male sexual abuse completed measures of shame, guilt, dissociation, and childhood trauma history and subsequently participated in a focus group. All participants experienced childhood sexual abuse in the “severe” range and showed elevated scores for shame, guilt, and dissociation. Four superordinate themes with associated subordinate themes emerged: (a) self-as-shame (foundations of self-as-shame, fear of exposure, temporary antidote: connection), (b) pervasiveness and power of doubt and denial (from others, from self, consequences of incredulity), (c) uncontrollability (of problems after disclosure, of rage, of intrusions and emotional pain), and (d) dissociation. Results are discussed with reference to the existing literature and the emerging “self-as-shame” construct, which appeared to encapsulate participants’ view of themselves.     

Complex Couples: Multi‐Theoretical Couples Counselling with Traumatised Adults Who have a History of Child Sexual Abuse

One of the major ways child sexual abuse can have an impact on individuals is in their later ability to have and maintain fulfilling couple relationships. Survivors may experience avoidance behaviours that become problematic in their adult intimate relationships. If couple therapists fail to focus on these traumatic imprints, the therapy may founder. This paper proposes that a multi‐theoretical approach enables the couple therapist to deal with the complex problems such couples present including sexuality and intimacy concerns. Such an approach integrates trauma theory, attachment theory, feminist principles, body‐oriented psychotherapy, and systemic couple therapy.     

Parental Perspectives on the Emotional,Relational and Logistical Impacts on Siblings of Youth Who Sexually Offend

This qualitative study explored parents’ perspectives on the collateral consequences of youth sexual offending on siblings through the analysis of interview data among 16 caregivers from 10 Canadian families. Using thematic coding procedures, findings indicated that parents identified a range of safety, emotional and interpersonal impacts on siblings beginning with the criminal justice and child welfare investigations of the sexual offending and extending to siblings’ relationships with the offending youth, their caregivers and other relatives. Results demonstrate the need for greater acknowledgement of, and parent‐informed interventions that specifically address the impact of youth sexual offending on siblings by professionals and non‐professionals (e.g. relatives) alike.     

Childhood Sexual Abuse and Brain Development: A Discussion of Associated Structural Changes and Negative Psychological Outcomes

The effects of traumatic exposure have been researched for many years and studies have shown that the parts of the brain affected by sexually traumatic experiences in childhood are also linked to many physical and psychological problems, such as depression, posttraumatic stress disorder, somatic complaints and suicide. Neuroimaging studies have provided a breadth of evidence that childhood sexual abuse is related to structural changes in the brain. Taken together, childhood sexual abuse affects brain development, leading to differences in brain anatomy and functioning that have lifelong consequences for mental health. Several limitations of neuroimaging research on childhood sexual abuse are discussed, including a lack of refined and sensitive neuroimaging measures and problems interpreting results of structural imaged subjects with associated psychiatric conditions. Future, large‐scale studies are warranted to examine the type and severity of the sexual abuse and how each of the levels of childhood sexual abuse contributes to structural and functional changes. Furthermore, future studies are needed to control for comorbid psychiatric conditions in order to disentangle the effects of childhood sexual abuse from psychiatric conditions that damage brain development. © 2018 John Wiley & Sons, Ltd.

‘Childhood sexual abuse affects brain development, leading to differences in brain anatomy and functioning that have lifelong consequences for mental health’

Key Practitioner Messages

• Childhood sexual abuse is linked to observable structural changes in the brain.
• These structural changes in the brain are associated with a myriad number of negative psychological effects.
• Research is limited in elucidating the role of childhood sexual abuse on brain development, as the bulk of the research has focused only broadly on child maltreatment.

     

Breaking the Silence of Child Sexual Abuse in the Caribbean: A Community-Based Action Research Intervention Model

In Trinidad and Tobago, little data exists on child sexual abuse, although there are many anecdotal reports of high prevalence. The Breaking the Silence Gender and Community Empowerment Model is a multidisciplinary intervention to prevent and respond to child sexual abuse in Trinidad and Tobago. It is an innovative, gender-sensitive intervention that uses a community based action research methodology anchored in a national framework. Preliminary evaluation of the Breaking the Silence model shows increased knowledge of child sexual abuse, increased willingness to discuss child sexual abuse, and an impact that goes beyond the target communities. This model can be replicated in communities to prevent and respond to child sexual abuse and adapted to address other sensitive social issues in the Caribbean.     

Adolescents with learning disabilities who show sexually inappropriate or abusive behaviours: development of a research study

This paper sets out some key issues regarding sexual abuse perpetrated by adolescents with a learning disability. The limited evidence currently available is largely anecdotal or from small‐scale/case studies, but emphasizes that much behaviour of this kind never comes to the attention of either statutory social services or the criminal justice system. It is argued here that statutory services should be involved in such cases in order both to protect potential victims and to improve the ongoing life chances of alleged perpetrators. Speci?cally, it is posited that only by naming this problem can professionals hope to make effective interventions. The various organizational structures and systems adopted by four social services departments are outlined and their possible impacts on case outcomes are discussed. Little empirical research has so far been undertaken in this highly sensitive area, but an initiative from The Ann Craft Trust (formerly NAPSAC) aims to provide new evidence to help shape future best practice in this ?eld. Copyright © 2003 John Wiley & Sons, Ltd.     

Healing from Childhood Sexual Abuse: A Meta-Synthesis of Qualitative Studies

ABSTRACT

Although the global prevalence of childhood sexual abuse (CSA) is very high, the experience of healing after such abuse has not been well documented. The goal of this study was to characterize the healing experience among CSA survivors presented in the literature. Metaethnography was used to synthesize an integrative literature review. The CINAHL, PubMed, PsycINFO, and Web of Science databases were used as data sources. Eight articles that explored healing experiences from CSA, published between 2007 and 2017, were included in the analysis. After performing a quality assessment, line-of-argument synthesis was used to construct the integrating scheme of healing experiences from CSA. CSA healing experiences included dissociating oneself from the memories of CSA, finding peace by creating a comfort zone, disclosure as the start of healing, attempting to establish identity through ongoing self-reflective activities, feeling comfort by sharing experiences and connecting with CSA survivors, and accepting CSA as part of the life history and stepping forward. Healing experiences from CSA synthesized from the analysis focused on personal growth, supporting previous theory on CSA health in the broader literature. A tailored care plan could be developed for CSA survivors who are at varying stages of healing.     

Domestic Violence and Intergenerational Rates of Child Sexual Abuse: A Case Record Analysis

Using case review at a shelter for battered women and their children, this exploratory study investigated the association between physical abuse, exposure to domestic violence and intergenerational occurrence of child sexual abuse. The charts of 570 children were reviewed in an attempt to explore the relationship between the children's experiences with sexual abuse and their nonoffending parent's own history of having been sexually abused. Results indicated that a significant percentage of nonoffending parents who reported a history of child sexual abuse also had children who were sexually abused. Additionally, we found that most (93%) of the children studied had been exposed to domestic violence, and while the base rate of sexual abuse was relatively low (11%), the rate of physical abuse of the children was substantial (41%). Logistic regression results indicated that children of sexually abused nonoffending parents may be at heightened risk for sexual abuse. Implications for treatment and intervention are discussed.