20, No. 2
Providing a Trauma-Informed Response to Child Sexual Abuse
We know children who experience sexual abuse can be further traumatized by CPS assessments and law enforcement investigations. We also know that without appropriate treatment, survivors of child sexual abuse are at increased life-long risk for a broad array of physical and mental health problems, as well as future victimization (Hilaski, et al., 2008; O'Brien & Scher, 2013; Sachs-Erisson, et al., 2009; all cited in Flick, et al., 2014).
What can child welfare workers and agency leaders do to ensure their involvement minimizes trauma and promotes healing?
1. Practice self-care. We can't take care of others unless we care for ourselves. Workers and agencies must find ways to integrate self-care into their normal routines. Hearing horrific details of child sexual abuse, feeling the pressure of added legal scrutiny, managing uncertainty and ambiguity, and experiencing intense reactions towards the alleged offender and other family members--all this can cause workers to dread and distance themselves emotionally from these cases (van Dernoot Lipsky, 2009). Yet child sexual abuse victims need an authentic connection with an engaged and caring worker who will advocate for and support them. Professionals themselves need support and protection from the damaging effects of secondary traumatic stress. For more on this, visit http://bit.ly/1COZSUn.
2. Reduce the trauma of the investigative process. The following steps reduce the negative impact on a child while the interdisciplinary process unfolds (Aprile, et al., 2009; Saywitz & Comparo, 2014; Staller & Faller, 2010; all cited in Flick, et al., 2014):
3. Let children talk. Sometimes workers feel anything related to the abuse is a forbidden topic if there is an on-going investigation, says Jeanne Preisler, Coordinator of Project Broadcast, North Carolina's federally-funded initiative to build a trauma-informed child welfare system. "You're not conducting an interview and you don't want to probe, but the child may mention things or want to tell you how they're feeling. They may spontaneously disclose things that they haven't said to others." Children may also express feelings of guilt and responsibility, not only for the abuse but also for the upheaval that followed their disclosure. Families that have experienced sexual abuse often have cultures of secrecy and shame, and children are frequently given the message that they are to blame for what has happened (Sgroi, 1982).
As a child welfare professional, you may provide a safe place for the child to express their true feelings, and you can send the child the message that she is not to blame for what has happened. It is possible to listen empathically and reduce children's sense of shame without compromising the investigation.
4. Attend to psychological and physical safety. In child sexual abuse cases our attention is understandably focused on physical safety: making sure the alleged abuser has no unsupervised contact or access to the child. Yet it's important to remember that to heal, children have to feel safe.
Various factors can contribute to children continuing to worry even after being removed from an abusive situation, including "valid fears about their own safety or the safety of loved ones, difficulty trusting adults to protect them, hyperawareness of potential threats, and problems controlling their reactions to perceived threats" (NCTSN, 2013). Further complicating the situation, children may face "people, situations, places, or things that remind them of traumatic events," causing them to "experience intense and disturbing feelings tied to the original trauma. These ‘trauma reminders' can lead to behaviors that seem out of place, but were appropriate--and perhaps even helpful--at the time of the original traumatic event" (NCTSN, 2013).
Talk with children about people, places, and situations that make them feel worried, and those that make them feel safe. Some children more easily share their ideas about a "safe home" by creating a drawing in which they draw or list inside the house things that make them feel safe, and draw or list worrisome things outside the house.
Since children may not even be aware their reactions are related to trauma, you can also educate caregivers to look for patterns of difficult or confusing behavior that may be related to trauma reminders. Caregivers need education to help them interpret children's problematic behaviors as trauma reactions, rather than labeling the child as "bad" or "manipulative."
5. Advocate for and support effective treatment. The good news for children who experience sexual abuse is that there are effective, evidence-based treatments available. One effective model becoming increasingly available in our state is Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT). To find therapists certified in TF-CBT, visit the NC Child Treatment Program's provider map: www.childtreatmentprogram.org/NCCounties/Index.rails
What about when TF-CBT is not available, or not appropriate for a particular child? DSS agencies are important voices to advocate for increasing the availability and funding for TF-CBT and other trauma-informed treatments. Your Managed Care Organization (MCO), System of Care agencies, and current providers are all important partners in bringing effective, high quality treatment to your community.
Once children access treatment, as a child welfare professional you are a consultant for the therapist, just as they are a consultant for you in understanding what is happening for the child and how best to help. Social workers can:
See the box below for questions to ask therapists, and the following interview on the next page for tips on collaboratively supporting children's treatment and healing.