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11.8 Assessment of the Sexually Abused Child

Contents

  1. Issues to be Addressed
  2. We should also Embrace the following Areas in the Assessment
  3. Issues to be Assessed
  4. Framework for Information Collection
  5. A framework for Self Protection/Personal Safety Skills Work
  6. A Framework for Direct Work with a child
  7. A Framework or Assessing the Viability of Contact between the Perpetrator and Children in Sexual Abuse Cases
  8. Frameworks for Understanding the Process of Sexual Abuse
  9. Ten Impact Areas (Porter et al, 1982)
  10. The Child's Relationship with their Mother
  11. Assessment after Contact has been Suspended
  12. Supervised Contact: Half-way House or Harmful Pursuit?
  13. Differentiating 'Normal' from 'Abusive' in Young People


1. Issues to be Addressed

In assessing the abused child/children the following need to be addressed:

  • Is she/he showing signs of recovering from the trauma of the abuse?
  • Is she/he still symptomatic after a considerable passage of time since the disclosure?
  • Is the identified offender, including psychological abuse still abusing the child?
  • Is an unidentified offender abusing the child?
  • Is the care being offered for this child with their family adequately meeting the child's needs?
  • Can the child judge safe people and situations?
  • What is the child's attachment to the offender? A child may be strongly, but negatively attached. Does the child minimise or rationalise the abuse?
  • Is she or he sufficiently assertive, confident, with improved self-esteem?
  • Who has the child bonded with which is sufficient to disclose any future concerns?
  • Have traumatic flashbacks disappeared or decreased?
  • Has the child and understanding of the offender's grooming
  • Has the child been able to speak about the abuse experience in reparative work undertaken?
  • Has the child knowledge about her/his body; about appropriate and inappropriate touching?
  • Is the child able to place the blame for the abuse where it belongs i.e. with the offender?
  • What coping strategies has she/he developed?
  • Has she/he developed positive relationships?
  • Has she/he developed communication skills?

At the conclusion of this assessment there should be evidence from the child that indicates that she/he is supported and is being helped to address most of the above. Workers need to be aware that saying that rehabilitation can take place when "the child is ready" places too much responsibility on the child and also involves them in a decision, which is not role- appropriate. Adults should reach this decision.

If a child or young person does not want to live with the offender, whereas the non-abusing parent is committed to rehabilitation, child protection workers need to assess how the child or young person can maintain contact with her family, without having to deal with the offender.

The following issues need to be assessed:

  1. Does he/she want family reconstruction?
  2. Have their key issues been addressed in therapy?
  3. Is he/she felt to be under pressure to say/do certain things?
  4. The degree to which they accept the offender was responsible for abusing.
  5. Their relationship with their mother - has work been done to address any issues?
  6. Have they got outside support and feel able to tell if he attempts to re-abuse in the future?
  7. Do they understand and feel comfortable with any new family rules - have they contributed to these?
  8. Any changes that have taken place in their relationship with the offender and their feelings about this?
  9. Do they feel the offender is sorry?
  10. The degree to which they have been able to express their feelings to the offender and their mother about what he has done
  11. Has self-protection work been undertaken - are they clear about appropriate and inappropriate behaviour?
  12. Has the victim moved away from the position of being victimised generally in their life, i.e. vulnerability?
  13. Their distorted thinking regarding the abuse
  14. How he or she views their position within the family (including extended family) - are they fully accepted and loved by all including siblings?
  15. Their understanding of how Sexual Abuse has affected them
  16. Do they feel able to say if they are concerned about the offender's behaviour in the future?
  17. Is family re-construction in the child's best interests?


2. We should also Embrace the following Areas in the Assessment

1. Allegation of details

  • Provides a context and reason for involvement
  • Names reality
  • Sets the scene for the need for protection
  • Sets the scene for the need for assessment

Where disclosures have been made often these are incomplete in their detail at this stage due to feared consequences and levels of denial and self-blame

2. Understanding of cause for concern and identified risks

Influences:

  • The establishment of the initial therapeutic relationship in assessment
  • Awareness and understanding of perpetrator's responsibility for abuse
    • Their ability to accept the need for protective strategies including removal of  the perpetrator from the home

Victims will often object to protective strategies such as removal of perpetrator. This is due to a complex combination of self-blame; feared reaction of their mother and their siblings; and the habit forming attachment between perpetrator and victim through positive secondary gains which creates distorted loyalty patterns

3. Child's Development History

Provides information on:

  • Healthy developmental patterns
  • Deficits in development
  • Disruptions in development
  • Attachment difficulties including defence patterns

4. Relationship with Protective Parent

Nature of relationship from birth onwards can indicate

  1. Successful/unsuccessful attachment/bonding which will influence the degree of vulnerability of victim to abuse
  2. Potential for victim's recovery

5. Relationship with perpetrator

Nature of relationship from birth onwards will indicate

  • the extent to which victim is under the psychological power and control of the perpetrator
  • the degree of distorted attachment patterns
  • the nature of the grooming process and manipulation that has taken place: past and present
  • the victim's response to protective strategies

We should remember that the offender usually has power and control over victim, the more attached in a distorted way the victim is to the perpetrator will influence the victim's ability to accept the protective strategy of removing perpetrator from the home

6. Relationship with Siblings

Provides information on

  • how siblings were manipulated and groomed to maintain the secrecy
  • their perception of role of victim, perpetrator non-offending parent and selves in relation to the abuse
  • possible supportive alliances for victim

Siblings will have been manipulated and groomed and thus unwittingly played a role in maintaining the secrecy of the abuse.

7. Relationship with extended family members

Will indicate

  • possible supportive alliances for victim
  • perception of roles of victim, protective parent, perpetrator, siblings and self in relation to abuse
  • possible manipulation by extended family members leading to increase in vulnerability/risk to child
  • other sources of risk to the child

8. Perception of role of self, non-offending parent, perpetrator, siblings and extended family in abuse

Will indicate

  • awareness of perpetrator's responsibility for abuse
  • level of self-blame
  • awareness of the degree of impact issues of abuse
  • awareness of perpetrator's manipulation of self, protective parent and other family members
  • the level of awareness of who is responsible for protecting the child

The victim will feel responsible for own protection in initial stages - will blame self for not preventing the abuse and for their perceived part. Victim will lack awareness of being manipulated and groomed.

9. Impact Issues

Knowledge of impact issues

  • indicate the degree of vulnerability to and therefore risk of further abuse
  • assist in the formulation of a recovery programme
  • inform professional of the particular responses from significant others

NB  A thorough awareness and understanding on everyone's part of impact issues will only take place over time and only in the context of ongoing work. Impact uses will not be clear to assess at start of work.

10. Expectations and hopes for future:  reality versus ideal

Will indicate

  • levels of self awareness in relation to own impact issues
  • levels of awareness as to who is responsible for the abuse
  • awareness of who is their protector
  • a recognition and acceptance of their vulnerability to further abuse
  • awareness of their need to be protected

11. Assessment of siblings or other children and young persons in the household

Sexual Abuse is something that distorts family life by promoting an atmosphere of secrecy and dishonesty. If, during and after the investigation, a family member is excluded from the family home, this will have profound effects on all family members. It is important, therefore, to include in the assessment: the views and feelings of any other children in the household. Specifically assessors need to ask:

  • what have they been told about the incident, and about the involvement of the child protection agency?
  • have they received accurate and honest information about the abuse?
  • who do they perceive as responsible?
  • can they be helped to understand the dynamics of Sexual Abuse and place the responsibility with the offender?
  • what is their relationship and attitude towards the abused person?

Additionally, assessors need to go through many of the same issues as the child victim.

Each child needs to be listened to and spoken with separately in a safe, private place.  Their needs and vulnerabilities must each be assessed as individuals in their own right.

There are a number of issues to be considered when examining whether a child should be told regarding what, when, how and by whom. It cannot be that the child being told is a stand-alone discreet piece of work, whether classified as self-protection work or not.  It is only one part of a risk management plan and should fit in to the developmental progress of that plan. A balance needs to be struck between not telling the child and the risk of the child discovering information in an unplanned way, for example from others. It is suggested that this is done by giving the child some age-appropriate information and letting this be re-worked/added to as the child gets older or circumstances change. 

A balance needs to be struck between not telling the child and the child subsequently being abused and learning that the risk was not shared with them. This could create a situation where the child feels doubly re-victimised, both by being abused and by not being protected by those who have the responsibility of acting in a protective way. A balance needs to be struck with regard to the telling, not placing the responsibility upon the child to protect themselves. It has to be located within a range of activities/strategies, which include the child knowing who also knows who they can tell if something occurs and in relation to the wider supervision/surveillance activities, put in place with regard to the offender. Thus it connects with the creation of a set of rules, for example regarding privacy, bathing etc.  Some explanation does need to be offered to the child as to why these rules are in place or why things have changed, otherwise they may see themselves as to blame, for example in relation to their naughtiness, or it is because they are not being loved anymore that the changes have been introduced. 

A balance needs to be struck regarding the potential damage to the relationship between the child and offender in telling, and any other family members. It is suggested that a route through this tension is to distinguish between not liking a person's behaviour while still loving/liking them.  This allows the focus to be on behaviour(s) rather than the relationship itself.

A balance is to be struck regarding not telling and combating false, inaccurate or partial information that the child may have, perhaps supplied by the offender. It does seem that at a minimum some checking needs to be done with regard to what knowledge/belief the child has - it may be that they are caught up in the dynamic of blaming associated with the uncovering of sexual abuse.  If so, accurate information is part of the process of placing the responsibility where it needs to be placed, i.e. with the offender.  If the child asks questions these need to be responded to.

A balance also has to be struck between not telling and allowing the child to participate in decisions, for example regarding rehabilitation, contact arrangements and so forth. It is important that the child is involved, but is not given the responsibility or indeed the power to decide, but have their views/feelings heard and be taken into account.  Their participation can be re-worked at different times depending on age and circumstances and in different ways.


3. Issues to be Assessed

The following issues need to be assessed:

  1. Their knowledge and understanding of the offender's behaviour
  2. Their feelings about what has happened and towards the offender/victim
  3. The degree to which they appropriately place responsibility with the offender
  4. Whether or not they have ever been victims of Sexual Abuse or witnessed such abuse
  5. Do they want the offender back in the home and if so, the reasons?
  6. Whether or not they understand the effects of Sexual Abuse upon the victim
  7. Their relationship with their mother
  8. Their supports outside of the family and the degree to which they would feel able to tell
  9. Do they understand and feel comfortable with any new family rules?
  10. Are they clear about what is appropriate behaviour and what is not (sex education)?
  11. Has work been done with them on self-protection?
  12. Do they feel able to say if the offender's behaviour concerns them in the future?
  13. As individuals, how vulnerable are they?
  14. Have any therapeutic needs been addressed?
  15. Is family reunification in the child's best interests?


4. Framework for Information Collection

A more detailed framework for information collection is set out below:

1. Understanding of cause for concern and risks identified

Influences

  • the establishment of the initial therapeutic relationship in assessment
  • awareness and understanding of perpetrator's responsibility of abuse
  • their attitude towards the victim/perpetrator/protective parent
  • their ability to accept the need for protective strategies including the removal of perpetrator from the home

2. Educational and Social Behavioural Development

This will assist professionals in planning intervention and contact with the child.

3. Relationship with Protective Parent

Quality and nature will indicate possible roles and boundaries, communication patterns, alliances

Blurred boundaries and roles will exist in intra-familial cases and communication patterns will be closed.

4. Relationship with the perpetrator

Will indicate

  • extent to which child is under the psychological power and control of the perpetrator
  • nature of grooming process and manipulation past and present
  • child's response to protective strategies

We should remember that the child will be groomed and manipulated by the perpetrator

5. Relationship with Victim

Will indicate

  • extent to which siblings have been groomed and manipulated by perpetrator
  • their perception of role of victim, perpetrator protective parent and self in relation to the abuse
  • possible supportive alliances for victim
  • levels of secrecy within the family and communication patterns

The relationship will have been negatively affected through the grooming and manipulation of the perpetrator.

6. Relationship with other siblings

Will provide information on

  • the grooming patterns and manipulation used by perpetrator
  • family dynamics
  • possible roles and boundaries within the family

Various degrees of loyalty to perpetrator, jealousy and rivalry issues exist.

7. Relationship with Extended Family Members

Will provide information on

  • possible supports and protection for siblings
  • perception of roles of victim, protective parent, perpetrator, siblings in relation to abuse
  • possible manipulation by extended family members leading to increase in vulnerability for each sibling
  • other sources of risk to each sibling

There may be an abusive extended family history; different levels of loyalty to perpetrator may exist.

8. Perceptions of role of Self, Victim, Protective parent, Perpetrator and Other Siblings in relation to the abuse

Will indicate the level of

  • awareness of perpetrator's responsibility for abuse
  • self-blame
  • awareness of impact of siblings disclosure on self
  • awareness of perpetrator's manipulation of self, victim and other family members
  • awareness of who is responsible for protecting the child

Siblings will be unclear about roles and responsibilities regarding abuse and protection, siblings may blame victim and non-offending parent particularly if perpetrator is removed from home.

9. Impact Issues

Will provide information on

  • the impact of the disclosure on each sibling
  • the areas that need to be identified for future work

NB The impact of the disclosure of abuse will evolve over time and may also change as each child is provided with more information about what has happened. Siblings will experience a range of impact issues.

10. Expectations and hopes for future:  reality versus ideal

Will provide information on their

  • levels of awareness and understanding of who is responsible for the abuse
  • understanding of own need to be protected
  • understanding of impact of abuse on victim
  • understanding and realisation of impact of abuse on self
  • understanding of impact of abuse on protective parent and other siblings

Reality formation will take place over time with increasing awareness of all the issues.

This information should then be located within the following outcome framework:

Increased vulnerability Lowered vulnerability
History of the abuse and consequences have only been half-told and are kept secret.
  • Are age-appropriately aware of abuse and consequences.
  • Are on or have been on Child Protection Register in any category.
  • Have been interviewed and given time to talk with trusted adult outside the family.
View victim as "naughty" or "different" in other ways - scapegoated victim/disbelieve or blame.
  • Understand nature of "therapy" offered to victim.
Have no adult whom they trust.
  • Strong, assertive personality.
  • Poor educational record.
Family rules have been established regarding privacy, personal care etc.
  • Disability/communication problems.
  • Protection/preventative strategies discussed.
  • Concerns about possible neglect/physical abuse/failure to thrive/emotional harm.
  • Age-appropriate sex education.  Can identify appropriate adults who are safe and can be trusted.
  • Over compliant, non-assertive personalities
 
  • Feels "less-favoured" in the family.
 
Poor eye contact/self-image.  
  • Feels discriminated against because of race, culture or class
 

The above factors should also be considered in relation to children in extended family or children who are frequent visitors to the household.


5. A framework for Self Protection/Personal Safety Skills Work

Self-protection work is never a solution to a problem.  It cannot make everything safe for a child.  It can only be a starting point for identifying what each individual child needs and what he/she needs from the safe adults around them.

Why Children Need Safety Skills

  • All children are vulnerable to Sexual Abuse.
  • All children are powerless.
  • Uniformed children trust all adults.
  • Young children are incapable of assessing adult's motives.
  • Children are taught that goodness equates with obedience to adults.
  • Children are curious about their own bodies.
  • Children are deprived of information about their own sexuality.
  • Uniformed children do not realise that abusive behaviour is wrong.
  • Sexual abuse is often presented as evidence of affection.
  • Children are even at risk in their peer groups.
  • Children are confused by sexual misbehaviour.
  • Children are seldom encouraged to express their anxieties and fears.

Self protection work or safety skills work is only one part of the information a child needs to help him/her make some sense out of what happened, to unlearn some of the destructive patterns of responding in relationships generally, and to help keep himself/herself safer, within an effective and protective support system.


6. A Framework for Direct Work with a child

The purpose of direct work as outlined here is to explore alongside a child the impact of their experiences and untangle some of the confusion within themselves. Whatever you name the work any work with a child involves communicating and takes on the same basic principles:

  • Every child's experience is unique and as such needs an individualised response.
  • Some knowledge and understanding of child development is important.  Children's abilities and methods of communication vary according to age, stage of development (cognitive and social).  There are added complexities for children who have a disability or who are from a different culture, where there may be language differences or different cultural norms which would need to be understood at the planning stage.
  • An understanding of some basic principles in communicating with children.  Through play children may be able to communicate what they cannot express in words.  Children are seldom comfortable with an interview type situation, their responses are often guarded and direct eye contact may feel quite oppressive to a child.
  • Communicating with a child is a dynamic process.  Our aim should be complete the task alongside the child, at his/her pace in a way that allows the child to feel accepted, gain insight into parts of his/her struggles, and to test out feelings and responses against new information/skills acquired during the process.
  • A child does not come to us in isolation.  The child has a family, safe carers, social networks and a history.  His/her own ecosystem.  If the child is to learn new information/skills and incorporate them into his/her life how will he/she do this, who needs to know, help and support the child in the process of change?

Before starting any piece of work with a child we need a clear framework (see diagram below).  Plans may need to be adapted as work progresses and dependant on what the child brings to the sessions but without any frame of reference for the boundaries of the work there is a danger that it will be unfocused, unclear and ultimately less helpful to the child.

Click here to view Some Questions to ask before Starting a Piece of Direct Work Diagram.

Planning

Think About:

  1. Time to plan and complete the work.  If you cannot commit to the sessions consider whether starting the work is appropriate.  Often the children we work with have experienced rejection, loss, hurt and pain.  Don't be another adult who lets him/her down.
  2. Clear Aims.  A clear framework is essential to be able to stay on track.  However be adaptable and creative and notice what is important for the child in sessions.  Be aware that some children have learnt to respond and survive to chaos.  Responding to each and every issue a child brings up may be helpful to some children but not to others.  Some immediately presented needs might require attention - perhaps this could be built into the work, by mutual agreement with the child, at a later date.

    Some immediately presented needs might not be appropriate to include in the sessions.  If this is the case explain to the child:
    • Why not?
    • What do you both think might be the place/time/person the child could take the problem to?

      It is important to remember you cannot make right the whole of the child's confusion in one piece of direct work, but helping a child through one identified area allows them to also recognise that some parts of their lives are manageable and with help to gain insight they can regain some of their confidence, self-worth and self-mastery.
  3. Venue - Where will the child feel comfortable and safe
  4. Agreement  Do children and young people always know why we are seeing them, what will happen when we see them, how long will we be seeing them for, when, where and how and what will happen afterwards.  A useful way of addressing these issues with children and young people is through a written agreement?  Given that this is most beneficial in the initial stages of work, it can also be a 'tool' for establishing safety, trust and a working relationship.

Components of a template agreement might be:

1) Between who image 1
2)  When image 2
3) Where  image 3
4)  Who will deliver    +    collect
5)  Where will image 5
6) Why are you there
  1. To look at any worries or troubles
  2. To talk about why..................
  3. To find a reason for.................
7) What are "the rules"
  • It's OK to say no
  • Don't have to talk about anything you don't want to
  • Don't have to stay
  • OK to be angry/sad/happy/loud/quiet
  • How will worker know if x is any of the above.
8) Who will you be talking to about sessions Police
Courts
"boss" in supervision  
family members  
others
9) What will happen if a child/young person talks about them or other children being hurt non-accidentally or abused in some way.

10) The young person can see the notes you make.  Maybe read and sign at beginning of each session

image 10

11)  Complaints - Wirral's Complaints Procedure (if appropriate)
12)  How long will this go on for image 12
13)  Need to review regularly and check out that it's still clear and OK for the child/yp.  It is always helpful for the child/young person to check out about half way through the sessions what they are feeling; what still needs to be covered and whether they feel it is still the right work plan or do changes need to be made.
14)  How can it be fun/not boring?  What could be a fun thing to do to prove we are human and can have a laugh?
15) Who can the child tell if they want to stop coming to sessions.  This should be someone easily accessible to the child.  The child needs to know they don't have to give reasons, but he/she does have a choice.

  1. How many sessions will I need? Always at the beginning consider what happens at the end.

    If a child is made to feel important for a time, if they share their inner feelings and emotions, their best/worst memories, if they begin to trust. How do they feel when they can no longer receive your time or attention.

    If a child is involved in the planning they know what the rules and boundaries are.  They know that for the agreed amount of sessions it is their special time,  they have some involvement in the process, content and reviewing of these areas.  It allows them to share the control of the work - to really feel included, involved and confirms that what they have to contribute is important.  It also acknowledges that the work has a focus and time limit (which may or may not be reviewed and flexible).

    The initial session(s) can be used as ice breakers.  Get to know what the child likes, dislikes, what makes him/her laugh, what his/her perceptions on life/family/friends/relationships/adults etc are.  Check out what they do/don't know, what developmental level they are at.

    Engaging a child is the start of sharing something with a child - part of a journey.

    Initial sessions are about conveying a message to the child; that he/she is important, you want to know more about them, their views, opinions, ides, even if these are different to your own; that you enjoy spending time with the child, validating their 'self', acknowledging that they are worth being listened to

    At the outset of the piece of work you will have a framework for what it is you hope to achieve

    The child should have some knowledge of sessions and purpose, but will experience a very simple level in the initial session, whether you are really interested in him/her or not.  Whether you are interesting to be with, to a child, doesn't mean having to entertain them, be funny, clever or witty, it simply means using all of your senses to notice what he/she enjoys doing - noticing, listening, allowing a child to show you who they are.

    We all like to feel valued as people, to be listened to, acknowledged, included.  Children are no different, but they are not mini-adults.
  2. Know some information about the child. What do they like/dislike, interests, hobbies.  Is he/she active or quiet, does he/she like drawing, making things, being creative.  What is he/she good at?
  3. Inform the child's carer of the plan and explain: the aims of the work.  The carer can then support the child if any difficulties arise e.g. upset, answer questions.  Agree with the child and carer what level of information will be shared with the carer.
  4. Recording the work - departmental guidelines.  Who is the information for?  Case Files, Planning, Courts etc.
  5. Supervision - perhaps ask for a consultation with another more experienced worker/or resources within the department.


7. A Framework or Assessing the Viability of Contact between the Perpetrator and Children in Sexual Abuse Cases

Introduction

The aim of this practice guidance is to provide a broad framework that will facilitate professionals in making an assessment that is child-centred, whilst also providing information to assist the court in its judgement. Contact is often viewed from the perspective of the rights of parents, with the inherent assumption that this will simultaneously be in the best interests of the child. The 1989 Children Act makes the assumption that contact between a parent and their child is therefore to be promoted.

The abusive act is the culmination of a series of psychological distortions or thinking errors that the perpetrator has had to achieve. The Sexual Abuse of a child is not an event, but a planned process that can take a long time to progress. The perpetrator develops the capacity to deny and reframe his thoughts, feelings and actions to himself and others. Knowledge of the process of abuse for the perpetrator must be applied by the worker when assessing the child's needs in relation to contact. At the initial stage, the worker can make the following assumptions:

  • The development of the relationship between the perpetrator and the child is based on a distortion of thinking and action.
  • Within the relationship there will be blurred role boundaries.
  • There will be long-standing cognitive manipulation of the child.
  • The child will lack conviction that what happened was wrong and/or was not their fault.
  • The relationship between the child and his/her mother is also likely to have been distorted by the perpetrator.
  • The child will believe in the domination and power of the perpetrator.
  • The non-abusing carer will not have had time to unpack the overwhelming and conflicting range of emotions for herself, let alone those of her children.
  • Siblings will have experienced distortions in their relationships with other family members.

The nature of the abuse indicates that change will be an involved and gradual process. Physical separation from the perpetrator does not in itself change distorted thinking or emotional damage. The implications of all this are that in families where a child has alleged sexual abuse, contact with the perpetrator, needs to be suspended. A failure to do this leaves the opportunity for the controls exerted on the child to be further exploited. The risk of any temporary damage to the adult-child relationship is far less significant than the risk of on-going damage for an abused child. If the allegation or concerns are unfounded and there are positives for the child in maintaining a non-abusive relationship, then it should be equally possible to repair any distance engendered by the separation.

Given that Sexual Abuse is a process rather than an event, we should reverse the presumption of contact in cases of Sexual Abuse, at least in the first instance whilst we assess clearly the potential problems for the child of contact. It is the right for the child both to embrace and reject the need for contact, which must be protected and promoted by the protective adults around them.

The role of the professional in these circumstances is two-fold; they must represent the wishes and feelings of the child and place these, and other relevant views within the context of their assessment of the welfare of the child. This inevitably leads to some consideration of the effects or consequences of contact for the child. How a worker approaches this, will depend on whether their starting point about contact is that it should promote the welfare of the child, and thereby be of positive benefit, or whether the issue is that welfare is assured as long as contact is not detrimental to the child. I will argue that for those children who have experienced Sexual Abuse, the approach of the worker including their starting point has to begin with the assumption that until there has been fundamental change, contact for the child with their perpetrator, will be detrimental.


8. Frameworks for Understanding the Process of Sexual Abuse

The Sexual Abuse of children follows a predictable pattern of stages or phases (Sgroi, 1982) and mothers will have an increased ability to understand the impact of Sexual Abuse when they understand the process through which Sexual Abuse usually progresses. It will also help them to understand why it is often so difficult for the child to tell.

Engagement or entrapment stage

The perpetrator initiates the contact with the child by offering bribes or rewards or by offering special attention and affection. This is referred to as 'grooming' the victim. Sexual Abuse usually is well planned by the perpetrator who uses his close and trusted relationship with the child and/or family to access the child.

Sexual interaction stage

Once the child responds to this special attention, the adult begins some form of sexual activity. The sexual interaction is usually progressive and may include one or more of the following: showing pornographic pictures, using sexually graphic language, undressing, touching, masturbation, kissing, vaginal/anal penetration, fellatio, etc.

Secrecy stage

Once the sexual activity has begun, the adult imposes secrecy by threatening that no-one will believe them if they tell; the pets will be hurt if they tell; the family will be split up if they tell; something bad will happen to the abuser if they tell; or that the child may be removed from the family. It is for these reasons that some children never tell of their abuse, and if they do, it is many years later. For example, Etherington (1995) found that the average duration for male victims to disclose was 20 years.

Disclosure stage

Disclosure occurs when secrets are told or discovered and this creates the crisis discussed in detail earlier in this chapter.

Suppression stage

This is a critical stage for the child who has disclosed. If family members react by blaming or dismissing the allegations, the disclosure may be withdrawn. Without adequate supports, the child may believe the threats from the abuser. Recanting is most common in situations of incest and other family members do not support them. Recantation can occur also when the child realises the consequences of their disclosure.


9. Ten Impact Areas (Porter et al, 1982)

The following framework highlighting the ten impact areas has been very influential in the field of practice. The authors note that the first five impact areas are likely to affect all children who have been sexually abused, regardless of the identity of the perpetrator. The last five issues are much more likely from intra-familial Sexual Abuse victims, although they cannot be excluded from other groups.

'Damaged Goods' Syndrome

In most cases, a child victim of Sexual Abuse feels damaged by their experiences. The 'damaged goods' syndrome is an amalgam of reactions: (1) physical injury or fear of physical damage; and (2) societal responses, particularly those of the immediate family who may reinforce the victim's feelings of damage.

Guilt

Some sexually abused children do not feel guilty about their behaviour prior to the disclosure of the secret of the sexual activity. However, intense guilt feelings following disclosure of Sexual Abuse are practically a universal victim response. Children who have been sexually abused usually experience guilt on three levels: (1) responsibility for the sexual behaviour; (2) responsibility for the disclosure; and (3) responsibility for the disruption to all the family members.

Fear

All child victims of Sexual Abuse can be expected to be fearful of the consequences of the sexual activity as well as the disclosure. Child victims may also fear subsequent episodes of Sexual Abuse both before and after the disclosure as well as reprisals from the abuser after disclosure. These fears may be expressed on a conscious level or they may be manifested by sleep disturbance, especially in the form of nightmares.

Depression

Nearly all victims will exhibit some symptoms of depression after the disclosure of Sexual Abuse. Children who are victims of ongoing Sexual Abuse may appear depressed prior to disclosure as well. There may be overt signs of depression with the child appearing sad, subdued, or withdrawn. Or it may be masked and expressed as complaints of fatigue or physical illness. Some children may act out their despair with self-mutilation or suicide attempts.

Low self-esteem and poor social skills

Fear of physical injury, societal response to the sexually abused child, experiencing guilt and shame for participating in the sexual behaviour, for disclosure and the subsequent disruption - all these feelings tend to undermine the victim's self-esteem. Low self-esteem combined with a feeling of being somehow spoiled or damaged in turn tend to undermine the child's self-confidence. Many victims of intra-familial child Sexual Abuse have been pressured by their parents to limit outside relationships and to depend only upon interaction with other family members to meet their social needs: thus causing them to possess few social skills. This is aggravated further if they have attempted, and failed, to make friends of the same age. Victims often feel helpless and are rarely assertive on their own behalf. They also often describe themselves in derogatory terms. Some find themselves so unappealing that they will initiate a series of sexual relationships to prove they are 'desirable'.

Repressed anger and hostility

Although they may appear outwardly passive and compliant, most Sexual Abuse victims are inwardly seething with anger and hostility. They are angry with the perpetrators for abusing them; they are angry with non-abusing parents for their failure to protect; they may be angry at neighbours, extended family and friends, possibly for their responses to the disclosure. In most cases, the anger is repressed rather than expressed or acted out. It may be characterised by depression or withdrawal, and occasionally in psychotic symptoms.

Inability to trust

A child who has been sexually victimised by a known and trusted person can be expected to have difficulty in developing trusting relationships thereafter. The degree of impairment will depend on a variety of factors, which might include:

  • The identity of the perpetrator.
  • The relationship between the victim and the perpetrator.
  • The age of the young person when the abuse began and the length of time over which it occurred.
  • The extent of the abuse.
  • The type of sexual activity involved in the abuse.
  • The degree of pleasure or discomfort experienced as a result of the abuse.
  • The degree of force used to coerce the child.
  • How others responded to the child's disclosure.
  • The support persons that was available to the child post-disclosure.
  • The point at which the abuse was disclosed.
  • The personality structure and coping style of the victim

The significance of these will vary from child to child. Frequently, the child's inability to trust is a direct consequence of broken promises from the perpetrator and others. No two children are alike and thus every child's reaction to their experiences of abuse will be unique. One child may fall apart whilst another will not.

Blurred role boundaries and role confusion

Child sexual abuse is disorientating because the victims frequently experience role confusion due to the inevitable blurring of role boundaries between the perpetrator and the child. For an adult who occupies a power position to turn to a relatively powerless child for a sexual relationship implies a profound disregard for the usual societal role boundaries. Although the sexual activity is primarily in the service of non-sexual needs, the premature and inappropriate sexual experience with an adult generates a great deal of role confusion for the child victim. If the adult is a parent then the role confusion is magnified.

Pseudo-maturity and failure to complete developmental tasks

Child Sexual Abuse is disruptive because the extensive stimulation and preoccupation with the sexual relationship tends to interfere with the accomplishment of age-appropriate developmental tasks of childhood and adolescence. In addition, role confusion often leads to the child's premature assumption of an adult role in the family. As sexually abused children assume more adult responsibilities, the gap widens even further between them and their peers. If this is identified by peers then this isolation becomes permanent.

These frameworks clearly highlight that Sexual Abuse is a betrayal of trust and a distortion of relationships and involves a degree of stimulation that is far beyond the child's capacity to encompass and assimilate. Consequently, there is interference with the accomplishment of normal developmental tasks. The progression of mastery of one's self, environment, and relationship with others is significantly disrupted by the child's permanently altered awareness and new role vis-à-vis the perpetrator.


10. The Child's Relationship with their Mother

Research highlights clearly that the perpetrator shapes and controls the relationships they have both with adults as well as children in order to abuse. This clearly raises the importance of examining the distortions which may exist for the protective carer. At the point of disclosure, mothers experience major cognitive and emotional dissonance. The impact reduces the likelihood that they will seek support or be able to unpack what sort of help they need. If contact is to be of positive benefit to the child it will be within the context of their relationships at home and with their main carer.

The worker must, therefore evaluate the nature of those relationships and ensure that they do not perpetuate any of the distortions established in the process of the abuse. For many, this will require some fundamental changes. It is likely that many of the practical, physical functions of parenting will have been achieved by the protective carer, but the psychological functions are likely to have been undermined. For example, boundary setting, role modelling, psychological nurturance. This can result in a reversal of roles and the systems of communication between the protective carer and the child can become impaired, and this is perpetuated with the keeping of the 'secret' of the abuse.

As well as the direct impact on the relationship between the mother and child, it is likely that the mother's relationships outside the family and with their partner are also distorted. Their own needs or the need to develop strategies to survive may have resulted in the woman's' own mental ill-health, alcohol or drug misuse. They may also be victims of violence and abuse themselves.

The issues for assessment and change for the protective carer may be seen as:

  • Impaired trust.
  • Poor self-image, including; past history, difficult adult relationships including those that have been abusive, distorted body awareness, a sense of failure, limited belief in self, depression, diminished parenting skills.
  • Denial.
  • Distorted expectations of partner and children.
  • Victim empathy.
  • Poor or distorted boundary setting.
  • Anger.
  • Ability to communicate.
  • Assertiveness.
  • Impaired socialisation/social skills.
  • Poor concrete environmental support.

In order for a protective carer to understand and make changes to the distortions and then participate in planning for any future contact between the perpetrator and their children that will be safe, they need time, information and more time. The mothers need to know that they are not being judged for the actions of their partners, nor are they helpless victims in the solution.


11. Assessment after Contact has been Suspended

Once contact is stopped the assessment will fall into five possible areas of work:

  • Individual work with the child.

    This work should address both the effects of the abuse for the child; validate their feelings, and counter-act the distortions.
  • Individual work with the protective carer.

    This needs to occur at their pace and ensure they have time and opportunity to assimilate the information. It should include supporting the carer in managing the impact on.
  • Work with the siblings (non-abused).
  • Work with the child/ren and the protective together.

    This work should promote the strengthening of their relationship and systems of communication.
  • Individual risk assessment and treatment of the perpetrator.
  • Where there is not a clear allegation and/or the perpetrator denies any cause for concern, it is important that the assessment explores the functioning and relationships within the family as well as the original reasons for concern. At the very least, the child needs to have increased self-esteem and an understanding of where the responsibility for any abusive behaviour lies. Without the necessary changes, the physical, emotional and psychological risk to the child is unacceptable. The task, therefore in any consideration for the renewal of contact is to provide evidence that this risk is no longer significant, rather than the assumption that parent-child interaction can continue whilst an abusive 'act' does not occur.


12. Supervised Contact: Half-way House or Harmful Pursuit?

Promoting contact where it is supervised does not in itself safe-guard the child from harm nor does it promote their well-being, if the areas of change have not been identified and progressed successfully.

If contact is supervised a tremendous responsibility lies with the supervisee. There are some fundamental ground-rules that need to be established and agreed with the child, the perpetrator and non-abusing carer. This may fall into a number of areas:

  • The purpose of contact; is this an assessment session, is it to facilitate the child therapeutically, is it taking place because of direction from the court etc?
  • Venue; ensuring visibility and safety.
  • Time and duration; is it sensitive to the needs of the child, including school commitments, tiredness, time of abuse etc?
  • Role of the supervisor/s; there must be a shared understanding as to whether the supervisor is there to observe and intervene if concerns are raised or has a more proactive role in facilitating the contact. It will also be important to establish for the child whether the supervisor is neutral and therefore does not have a relationship with the child, or is their ally and clearly there to empower the child.
  • Child's arrival and departure from contact; who will bring and take the child, who leaves first, greetings and goodbyes allowed particularly in relation to physical contact?
  • Agreed activities during contact; contact needs to be carefully planned and should reflect the interests of the child. It should also maximise the positive aspects of the adult's parenting skills. This should be based on the acquired knowledge of what, if anything, positively binds the child and adult together.
  • Agreements about talking and touching; it is important to clarify whether kissing, hugging, sitting on knees etc is alright or not. It is also helpful if the worker establishes with the child anything that they do not wish or is inappropriate to talk or be asked about by the adult i.e. the abuse, passing messages home, providing information.
  • Time alone with the child; it is crucial that everyone knows whether the child and parent are allowed to be alone together unsupervised at anytime. This may involve making plans for if the child needs taking to the toilet or a drink or snack making etc.
  • Presents; it is not unusual for estranged parents to want to bring gifts for the child. The meaning of this for the abused child must inform any decision about it.
  • Intervention; the supervisor must be clear with the child and the adult how they will intervene if they are concerned during contact and what response they expect from the parent.
  • Recording; if the contact is part of an ongoing assessment, agreement must be reached about what will be recorded, how it will be recorded and where the information may be shared.
  • Worries and safety plans; It is important that the child identifies to whom and how they can communicate any worries they may have during contact. In my experience it can be useful to agree an 'emergency code word' that the child chooses and can use during contact if they become anxious and/or need the contact to stop. It is also useful if the child has access and permission to speak with an adult not involved in supervising the contact with whom they can express any feelings they may have.
  • The protective carer; It is likely that the non-abusing carer will have their own feelings about the contact, and it will be important to ensure that the child understands what is to be fed back and by whom. It may also be necessary to identify what part the child wants the protective carer to play after contact i.e. don't ask me any questions about it, I need time on my own, I need you to hug me etc.
  • There should also be an agreement about immediate action the perpetrator should take to stop contact if they are aroused, and the process of debriefing within the context of any treatment they receive.
  • These and any other issues relevant for the individual situation must form the basis of a written agreement both with the child and the adult. The agreement with the child must reflect their age and understanding and can make use of pictures or diagrams where words are not understood. The starting point should be that the perpetrator has apologised to the child and that they alone are responsible for the abuse. The supervisor should feel confident that they are in control of the contact. The impact for the child needs to be evaluated and should take into account not only what happens during contact but what is said and how the child behaves and presents following contact.


13. Differentiating 'Normal' from 'Abusive' in Young People

There are a number of reference points by which sexual behaviour can be evaluated:

  • Legal: does the behaviour constitute an offence as defined by law?
  • Developmental: is the behaviour contrary to what would be generally accepted at that chronological age?
  • Contextual: is the behaviour acceptable in that context?
  • Interpersonal: are interactions mutual; insensitive; exploitative or abusive? We may not be able to assume that two young people with a learning disability of the same age have a mutual ability to give informed consent to sexual activity.

It is important for workers to carefully consider whether the referral information provided is indicative of 'abusive' sexual behaviour, not least because of the impact of labelling on the young person if it is incorrect. The following guidelines are designed to provide a map and compass for staff when considering what action, if any, is required in the case.

What is the age relationship between participants?

Most would agree that a five-year age difference is abusive, although it would be unwise to see this as the sole difference between normal and abusive behaviour. We would also consider issues of size, power, ability and authority in the judgement. The narrower the age difference, the more difficult it becomes to make the judgement. We have to remember that it is not always the older child who is the initiator of sexual behaviours, particularly where the child is dis-empowered in some way.

What is the social relationship? In what context did the abuse occur? Are they related?

The symbolic meaning of the sexual activity is important, particularly where is involves an abuse of power or authority. A very frequent scenario for sexual abuse is the baby-sitting arrangement where they are abusing an assumed authority and position of trust. We need to assess what part power differences play in the activity or generally in the relationship - are they bigger? Stronger? More assertive? Where difference exist, abuse should be considered. We then need to consider what purpose the behaviour serves for the abuser. Where no power difference is evident, the context should be considered.

What type of sexual behaviour is exhibited?

Is it consistent with the juvenile's intellectual, emotional and social functioning? Are these developmental levels below chronological age? If they are, we need to consider what part the sexual behaviour is a function of any immaturity. We also need to consider what other functions the behaviour may serve e.g. anxiety reduction. Does the incident involve acts, which have sexual implications through physical assaults involving sexual parts of the body, or the use of sexual language, which is offensive or which make explicit sexual suggestions? Is the behaviour age-appropriate? How sophisticated is the activity? Was the behaviour planned or spontaneous? Is there any aspect of victimisation in the behaviour? Are they imitating something they have seen? What is the purpose of the behaviour? Have they been confronted about their behaviour in the past? How often, and for how long did the activity happen?

What is the experience of the victim?

Do they see them as abusive? Do they blame themselves? Are they able to consent in the activity even if they have expressed no concerns? How did the victim feel about what happened? What was the victim's contribution to what happened? Have there been any attempts to secure secrecy by any of the individuals involved? Why?

How does sexual contact take place?

There needs to be an assessment of whether the sexual contact has occurred by mutual agreement, deception, enticement, intimidation, threat, physical force or violence. All sexual activity that is not based on mutuality, reciprocity and consent is considered abusive.

How was the sexual activity revealed?

Was it discovered taking place in an appropriate place? Or in public? Did the victim disclose with the hope they would be helped? Is there an indication that they are feeling uncomfortable about what happened? Abusers rarely self-disclose.

How persistent is the sexual behaviour?

Repetitive inappropriate behaviour may indicate a preoccupation with sexually abusive activity, and may imply the development of abusive sexual preferences. How often and how long has the behaviour been occurring? What preceded the behaviour? Whilst one incident may be abusive, the more frequent or persistent the activity, the more there should be concern that it is inappropriate.

Evidence of Escalation

Is there any evidence of escalation in the nature or frequency of sexual behaviour under consideration? Has the pattern of activity changed over time? e.g. the victims are getting younger. A changing pattern of behaviour can indicate that the young person is developing a pattern to the behaviour. Has there been any escalation in the use of actual or threatened physical force or violence? Are there any discernible patterns in the type of behaviour or choice of victims? Is the behaviour ritualistic in nature?

Sexual Fantasies

What is the nature of the sexual fantasies that precede, accompany or follow the sexual behaviour? These may indicate problems with sexual identity and preferences, or highlight inappropriate sexual interests, for example in children. Those who fantasise about these scenarios may be more likely to enact these in abusive situations. Fantasies can indicate the way in which the abuser views themselves, sex and sexual behaviour.

What are the characteristics of the victims?

These may include: age, sex and social relationship to the abuser, some sort of physical or intellectual handicap or some other form of vulnerability. Discernible preferences for particular victims may indicate developing sexual interests, motives, underlying the sexual behaviour, or reflect the abuser's own experiences of abuse. They may also target particular geographical areas to find victims.

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