Assessing and Treating Child Sexual Abuse

Vol. 5, No. 2
June 2000

Assessing and Treating Child Sexual Abuse

Working with cases involving child sexual abuse is demanding. Often, the temptation is to respond to children only with compassion. However, to address a problem as complex as sexual abuse, one must do more than care deeply.

To effectively address the needs of the child and the family involved in child sexual abuse, you must be motivated by your heart, but work from your head. You must evaluate your own capacity to deal with such a case (see "Personal Responses to Working in the Field of Child Sexual Abuse"), educate yourself about the impact of sexual abuse, and understand the treatment process. Following these steps will enable you to make a difference for children and families affected by sexual abuse.

Preparing Yourself

Before you can adequately assess or treat children who have been sexually abused, it is important to have a solid grasp of how and why sexual abuse happens, the typical effects of abuse on children, and the child behavior and relationship problems caused by abuse (Osmond, et al., 1998). For this it may be helpful to review "normal" childhood development so that you can contrast it with the developmental problems often seen in children who have experienced abuse (Osmond, et al.).

Before developing a treatment plan, it is important to have an understanding of why sexual abuse occurred in the particular case under investigation (Faller, 1993). This background will help you make comprehensive assessments of the child's situation and needs for help.

A good resource for developing your knowledge on these topics is "Introduction to Child Sexual Abuse," a six-day intensive training session sponsored by the North Carolina Division of Social Services Children's Services Section. In addition to exploring how and why child sexual abuse occurs, "Introduction to Child Sexual Abuse" teaches you how to prevent burnout, interview children and adults about sexual abuse, and conduct a child sexual abuse case according to policy and best practice. For class times and registration information, see your agency's current staff development calendar.

Assessing Trauma

Trauma assessment is the process used to understand the impact of sexual abuse on a child and the extent of the damage. It helps you gauge the child's perceptions of the damage from the past and current impact of the abuse, and anticipates future impact (Osmond, et al.). It is not therapy, however. Trauma assessment does not attempt to "solve" problems, but rather to recognize the impact of abuse, understand the damage, and contemplate the treatment work needed (Osmond, et al.). Assessment is your "road map" for treatment (Osmond, et al.).

Your assessment must consist of age-appropriate, established questions. Assessment is not a checklist or a survey, however. Rather, it is a guide to elicit the impact of the abuse on the child--from the child's perspective as well as your own. Because of its informal format, it will help you build rapport with the child as you gather crucial information (Osmond, et al.). It is important to keep in mind the following issues while performing the assessment, as they will influence your treatment decisions:

What is the relationship of the child to the abuser?
How stable is the family?
Are alternative support systems available? (Beutler, et al., 1994)
What are the risk factors?
Should the child remain with the family?
Do the courts have a role in the case?
Is there a question of visitation?

Finally, to formulate a relevant treatment plan, the assessment must evaluate all developmental issues, appraise social areas (e.g., self-understanding, self-esteem, perceptions of the family), and assess behavior according to what is developmentally "normal" (Carnes, et al., 1998). Treatment based on this assessment will address the child's needs one at a time (Osmond, et al.).

Treating Survivors

Sexually abused children are not a homogeneous group requiring identical treatment (Beutler, et al., 1994). Because the consequences of child sexual abuse vary widely in severity, duration, and form, it is unlikely a single treatment program will be suited to all children (Beutler, et al.).

Treatment is the process of helping the child learn to distinquish between his healthy and destructive coping skills. With help, he can maximize strengths and actively change destructive or ineffective coping behavior (Osmond, et al.) Selecting the form(s) of treatment will depend upon the goals for the child developed from your assessment, the match between the goal and service being considered, and the child's preference and likelihood of participating in and benefiting from the treatment being offered (Osmond, et al.). Ideally, effective treatment will lessen the severity of intense symptoms and guard against delayed onset of emotional disorders (Beutler, et al.). According to Osmond and colleagues, treatment goals involve:

Providing a safe release of feelings

Overcoming negative and potentially self-destructive behavior

Helping the child understand what part of his thinking has been affected by the abuse and helping him correct those distortions

Helping the child overcome self-blame and self-hatred

Helping the child build a sense of trust in himself and in a positive future

Enabling the child to gain a sense of perspective about the abuse and to gain the emotional distance necessary to keep the trauma from hurting him in the future

Supporting the child as he comes to terms with his own sexuality, including good feelings surrounding sexual behaviors and the ability to discriminate healthy sexuality from abuse

These goals can be met in a variety of ways. Typical treatment methods are individual therapy, group therapy, family intervention, and out-of-home placement. (See "Treatments for Survivors of Sexual Abuse".)

Treatment of child sexual abuse is a complex process. Emotionally, it challenges you to remain objective amidst a highly charged case. Intellectually, it demands that you understand the impacts of abuse on the child and family, as well as the possible sources of the problem. Practically, it requires you to collaborate with a variety of professionals and clients in your efforts to do what's best for the child.

However, if you meet the challenge, you will give back hope and a future to a child scarred by sexual abuse.

References

Barrett, O. W., Miller-Perrin, C. L., & Perrin, R. D. (1997). Family violence across the lifespan. Thousand Oaks: Sage Publications.

Beutler, L. E., Williams, R. E., & Zetzer, H. A. (1994). Efficacy of treatment for victims of child sexual abuse. The Future of Children: Sexual Abuse of Children 4(2), 156-175.

Carres, C. N., Wilson, C., & Nelson-Gardell, D. (1998). Extended forensic evaluation when sexual abuse is suspected: A model and preliminary data. [On-line]. <http://www.ncac-hsv-org/foreval.html> [1999, Nov. 20].

Corcoran, J. (1998). In defense of mothers of sexual abuse victims. Families in Society, 79(4), 358-369.

Faller, K. C. (1993). Child sexual abuse: Intervention and treatment issues. US Department of Health and Human Services, Adminstration on Children, Youth and Families, National Center for Child Abuse and Neglect. [On-line]. <http://www.calib.com/nccanch/pubs/usermanuals> [1999, Nov. 20].

Hepworth, D., Rooney, R. H., & Larsen, J. (1997). Direct social work practise theory and skills. 5th Edition. Pacific Grove: Brooks Cole Publishing.

Osmond, M., Durham, D., Leggett, A., & Keating, J. (1998). Treating the aftermath of sexual abuse: A handbook for working with children in care. Washington, D. C.: Child Welfare League of America.