Family Resource Proposal

CHILD SEXUAL ABUSE AND THE FAMILY UNIT

FAMILY RESOURCE PROPOSAL

BY: ASHLEY BIGHAM

CHILD SEXUAL ABUSE DEFINED

• “Child sexual abuse (CSA) is defined as: Any use of a child for sexual gratification by another person. It can be perpetrated by an adult, an older or more developmentally advanced child, or even a child of the same age if coercion is present.” (Olafson, E., 2011).

RISK FACTORS FOR CSA

• Berliner (2011) lists the following risk factors for CSA:

• Girls are at greater risk of being sexually abused than are boys.

• Children with disabilities have almost double the reported incidence of CSA than do children with no disability.

• Both boys and girls who have lived without one of their natural parents are at risk.

• Lower socioeconomic status does not appear to be a risk factor.

ETHNIC DIFFERENCES CONSIDERED

• “Retrospective surveys do show minor ethic differences: African American and Caucasian women report similar rates, whereas Native American women report somewhat higher and Asian women somewhat lower rates. Hispanic adolescent girls report significantly higher rates of CSA.” (Olafson, 2011; Berliner, 2011).

SIGNS & SYMPTOMS OF CSA

• According to Nichols (2014), Exploration may be indicated if a child shows any of the following symptoms:

• Sleep disturbance

• Encopresis or enuresis

• Abdominal pain

• Exaggerated startle response

• Appetite disturbance

• Sudden, unexplained changes in behavior

• Overly sexualized behavior

• Regressive behavior

• Suicidal thoughts

• Running away

(p.38)

SIGNS & SYMPTOMS CON’T

• When CSA is severe and long lasting, symptoms can include:

• Disabling PTSD

• Dissociative disorders

• Drug and alcohol dependence

• Anxiety disorders

• Conduct disorders

• Vulnerability to revictimization

• High-risk sexual behaviors (Olafson, E., 2011, p.12)

SEVERITY AND DURATION OF SYMPTOMS

• Olafson (2011), states that the following variables affect the severity and duration of victim symptoms and behaviors:

• Prior or concurrent traumas

• Pre-existing psychological disorders

• The nature of the abuse

• Relationship to the perpetrator

• Duration of the abuse

• Level of support by the non-abusive caregiver

• Gender

(p.12)

CAUSES FOR POOR LONG-TERM OUTCOMES

• Olafson (2011) goes on to state that, “ Poorer longer-term outcomes are associated with the following abuse characteristics:

• Contact rather than non-contact abuse

• Penetration

• Sexual abuse with aggression, violence, or coercion

• Sexual abuse that begins early and lasts through more than one developmental stage

• A close relationship (generally familial) with the perpetrator.

(p.12)

PSYCHOLOGICAL EFFECTS OF CSA

• CSA has been linked to:

• Depression across all age groups

• Generalized anxiety disorder

• Panic disorder

• Phobias

• Posttraumatic stress disorder

• Substance abuse and dependence

(Molnar, Buka, & Kessler, 2001)

EMOTIONAL EFFECTS ON CAREGIVERS

• According to Tavkar and Hansen (2011), Initial reactions by non-offending caregivers may include:

• Anger toward the perpetrator

• Displaced anger toward family members

• Guilt

• Self-blame

• Helplessness

• Panic

• Denial

• Shock

• Embarrassment

• Feelings of betrayal

• A desire for secrecy

• Fear for the child victim (p.189)

EFFECTS ON CAREGIVERS CON’T

• Non-offending caregivers may also experience considerable social, emotional, and economic consequences (e.g. stigma, increased feelings of isolation, loss of partner, loss of income, disruption of the family especially with intrafamilial CSA , change of residence, and dependence on government assistance; Elliott & Carners, 2001).

(Tavkar & Hansen, 2011, p. 189)

EFFECTS OF CSA ON SIBLINGS

• Tavkar & Hansen (2011) express that siblings may face several adverse effects, including:

• Psychological distress of having viewed or known of the abuse

• Greater risk of victimization

• Change in family dynamics

• Change of residence

• Change of school districts

• Loss of friends

• Increased feelings of isolation, shame, and stigma

• Reduced family income

(p.189)

ASSESSMENT STRATEGIES FOR CSA

• “The CANS-Trauma Comprehensive is a unique trauma-focused assessment strategy and multi-purpose tool that is comprehensive yet flexible. It is an approach that is designed to integrate all the information gathered about child and family in one place, including multiple types of information (such as other measures, interviews, observations, etc.). The CANS can be used for tracking client progress over time and it also acts as a helpful “translational” tool for service and treatment planning.”

(Retrieved from http://cctasp.northwestern.edu/resources/)

ASSESSMENT STRATEGIES FOR CAREGIVERS

• Caregiver Strain Questionnaire: This tool is provided to the caregiver at intake and upon discharge from a program.

• The CGSQ assesses:

• The effects of the child’s problem behaviors on the individual and the family, such as missing work and disruption of family routines.

• Other family members suffering negative mental or physical health effects as a result of the child’s problems.

• Youth getting into trouble with neighbors, community and/or law enforcement.

• Financial and family relationship strain due to child’s problem behaviors.

• Level of disruption of family social activities and feelings of social isolation

• Level of exhaustion and toll child’s behavior is having on caregiver.

• Feelings of sadness, anger, resentment, guilt, and embarrassment as a result of child’s problems.

• How well they feel they relate to the child.

• Concerns about the child/family’s future.

EFFECTIVE INTERVENTIONS

• “Based on the Office of Victims of Crime (OVC) guidelines for empirically supported treatments for child physical and sexual abused, only one treatment, Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) was found to be well supported and efficacious. It also provides support and skills to non-offending parents to effectively respond to their children and cope with their own emotional distress.” (Tavkar & Hansen, 2011, p.191)

• According to Rubin (2010), TF-CBT is considered the gold standard for treating traumatized children and their non-offending caregivers. (p.121).

EFFECTIVE INTERVENTIONS CON’T

• Rubin (2010), suggests that along with TF-CBT, Eye Movement Desensitization and Reprocessing (EDMR) is one of the two interventions with the most empirical support for treating adult PTSD (the other is Prolonged Exposure Therapy). Its protocol for adults has to be translated to the appropriate developmental phase when treating children, and the evidence supporting its effectiveness with children is growing.” (p.121).

EFFECTIVE INTERVENTIONS CON’T

• “The Project SAFE Group Intervention was designed to address 3 critical target areas impacted by sexual abuse: the individual or self (self-esteem, internalizing distress); relationships (social support, communication, externalizing problems with peers and family); and sexual development (sexual knowledge and abuse-related issues…Project SAFE utilizes a parallel design, where youth and parent groups meet separately, but concurrently to discuss similar topics in developmentally appropriate way.” (Tavkar &

Hansen, 2011, p.196).

STEPS TO ENHANCE PRACTICE AND POLICY

• According to the National Plan to Prevent the Sexual Abuse and Exploitation of Children (2012) the following steps should be taken to enhance practices and policy:

• Identify and advance specific policies and practices that, according to research or best practices, prevent all types of sexual harm to children

• Promote prevention programs that are evidence based and adapted to the needs of various communities, organizations, agencies, and institutions.

• Disseminate information about productive policies and practices that can be emulated.

• Advocate for research and best practices-based treatment services for individuals at risk to perpetrate sexual abuse.

(p.12)

REFERENCES

• Berliner, L. (2011). Child sexual abuse: Definitions, prevalence, and consequences. The APSAC handbook on child maltreatment (3rd ed., p. 215-232). Los Angeles, CA: Sage.

• The center for child trauma assessment and service planning website (2013). Retrieved from: www.cctasp.northwestern.edu/resources/

• Molnar, B.E., Buka, S.L., & Kessler, R.C., (2001) Child sexual abuse and subsequent psychopathology: Results from the National comorbidity survey. American Journal of Public Health, 9: 5, p.753-760.

• National coalition to prevent child sexual abuse and exploitation. (2012). National plan to prevent the sexual abuse and exploitation of children. P. 1-32 (Rev. ed.). Retrieved from: www.preventtogether.org.

• Nichols, M.P., (2014). The essentials of family therapy (6th ed.). P. 39-47. Upper Saddle River, NJ: Pearson Education, Inc.

• Olafson, E. (2011). Child sexual abuse: Demography, impact, & intervention. Journal of child & adolescent trauma, 4: 8-21. Cincinnati, OH: Taylor & Francis Group, LLC.

• Rubin, A. (2012). Clinician’s guide to evidence-based practice: Programs & interventions for maltreated children and families at risk. p.121. Hoboken, NJ: John Wiley & Sons, Inc.

• Tavkar, P. & Hansen, D.J. (2011). Interventions for families victimized by child sexual abuse: Clinical issues and approached for child advocacy center-based services. P.187-199. University of Nebraska-Lincoln: Faculty Publications, Dept. of Psychology.