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Engaging with child sexual abuse

2011; Wiley; Volume: 20; Issue: 2 Linguagem: Inglês

10.1002/car.1179

1099-0852

Nicky Stanley,

Child and Adolescent Psychosocial and Emotional Development

Less prominence has been given to sexual abuse in recent debates on child protection. In England and Wales, government figures for children in need experiencing sexual abuse have stayed at a low and steady rate since 2005 (Department for Children, Schools and Families, 2009), eclipsed by the giant of child neglect. Both the US and Canada have experienced a decline in reported child sexual abuse rates (Finkelhor and Jones, 2004; Trocmé et al., 2005). This has been attributed to a number of factors, including the effectiveness of prevention and interventions programmes and increased public awareness of the issue, as well as to decreased willingness to report child sexual abuse and changes in agency management and classification of abuse. It may be the case that the stigma and fear that continue to surround sexual abuse have led to a relabelling of the phenomenon by professionals. This issue of Child Abuse Review switches the focus back to child sexual abuse and includes a range of papers that together span the aetiology, management and prevention of sexually abusive behaviour. We also bring together research from different countries and contexts. Colin Hawkes' (2011) study contributes to understanding of the dynamics of sexual abuse experienced and perpetrated by children who were attending a specialist national centre in London, while Graham Connon and colleagues (2011) examine the effectiveness of the Irish criminal justice system's management of child sexual abuse. Sylvie Parent and Guylaine Demers (2011) report on a Canadian study that addresses prevention of sexual abuse in the context of sport and Ian Barron and Keith Topping (2011) explore programme fidelity in relation to a sexual abuse prevention programme delivered in Scotland. Sadly, Colin Hawkes' paper is published here shortly after his sudden and untimely death from a heart attack while cycling to work. He will be greatly missed by many colleagues in the fields of probation, social work and mental health. His research (Hawkes 2011) drew on the case files of 32 boys under ten who were treated for sexually harmful behaviour by the Young Abusers' Project at the National Clinical Assessment and Treatment Service. This sample therefore constituted a group with particularly complex needs who, as the author notes, may not be representative of all children with sexually harmful behaviour. However, the young age of this sample offers the opportunity to study the onset of this form of abusive behaviour together with the initial responses of parents, carers and professionals. All the boys studied were known or suspected to be victims of child sexual abuse from an early age. High levels of other forms of abuse and neglect, together with a range of parental problems and separation from birth mothers for nearly half of the sample, indicated insecure attachment patterns. Aggressive and anti-social behaviour evident prior to their own experience of sexual abuse took on a sexual character following their experience as victims of sexual abuse. The file analysis found evidence that sexually abusive behaviour could be triggered by the vulnerability and anger evoked when these children were left unsupervised or with responsibility for other younger children. This study also highlights the ways in which adults failed to respond effectively to these children. Children's experiences of abuse and expressions of distress or arousal were met by angry or rejecting responses from caregivers who lacked the capacity to contain or mediate responses to abuse. Professionals also appeared to recoil from the boys' abusive experiences in their use of euphemisms and jargon in the files and this acted to disguise the detail of the abuse. Most worryingly, although onset of sexually harmful behaviour was recorded at an early age, there was evidence of considerable delay in assessment or treatment. The author suggests that this lack of an official response confirms the experience of rejection for the child. Connon and colleagues (2011) focus on the capacity of the criminal justice system to contain and manage the distress of sexually abused children. This study involved completion of a questionnaire designed to measure satisfaction with the criminal justice system together with completion of standardised measures of children's and parents' adjustment. Forty-three children, over 100 parents and 80 professionals, including mental health practitioners, police and lawyers, participated in the study. Most of the children participating in this research were middle-class girls who may have had more favourable attitudes toward the criminal justice system. However, it is often the case that participants in research that collects direct testimonies from victims of trauma are ‘positive’ survivors. Their accounts remain valid and useful, although ways also need to be found to capture the perspectives of those who have less positive experiences of services. Despite this bias in sampling, the authors conclude that children's experiences of the Irish criminal justice system were ‘predominantly negative’ (Connon et al., 2011, p. 118). Those aspects of the system that children found most distressing included: their contact with the defence barrister; the implications of a decision not to prosecute by the Director of Public Prosecutions; the experience of attending court and testifying, as well as the perceived fairness of court procedures and outcomes; and the impact of court delays on their emotional state and personal safety. These organisational features may act to compound the effects of the original abuse and delay recovery. The researchers emphasise the need to address systemic delays, for court procedures and the environment to be child-friendly, and for systems to be established which will protect children from contact with the abuser. The need for psychological support for children and their families is highlighted. They also note that only 59 per cent of police and none of the lawyers who participated in the study had received specialist training in child sexual abuse and suggest that delivering such training might contribute to a more child-friendly culture. Parent and Demers' (2011) study identifies the barriers to developing preventive strategies and policies on sexual abuse in the context of sport. Their research, undertaken in Quebec, Canada, involved a survey and interviews with 27 sports stakeholders, including sports administrators, coaches, athletes and athletes' parents. Prevention of sexual abuse was viewed negatively and associated with fear and false allegations. A lack of relevant training resulted in an absence of confidence and leadership in relation to the issue and, when incidents of sexual abuse had been disclosed, they had exposed the organisations' lack of readiness to respond. Although such incidents were described as resulting in the introduction of complaints procedures, participants also considered that sports organisations ‘reacted too late and did too little’ (Parent and Demers, 2011, p. 126–127). Practice in relation to prevention of sexual abuse was found to be generally undeveloped. The authors emphasise the need for action on a number of fronts and for change to take place at both federal and local levels. Barron and Topping's (2011) Scottish study addresses prevention of sexual abuse from a different angle and considers the implementation of sexual abuse prevention programmes, focusing on the issue of fidelity in programme delivery. They note that while the level of programme fidelity − the extent to which a programme is delivered as originally specified − can impact on efficacy, it is rarely considered as a factor in programme evaluation. Their paper describes an evaluation of the fidelity of a programme delivered to children aged six to 13 years in both a secondary school and a survivors' organisation. Implementation of the Tweenees programme is guided by a manual; the programme itself is described as based on practice wisdom developed in the course of delivering support to survivors of child sexual abuse. The fact that the programme was delivered in a school where a teacher worked alongside a worker from the survivors' organisation to lead the sessions allowed for consideration of the extent to which programmes become diluted when they are delivered in real-life settings by non-specialist staff. The methodology involved observation and video-recording of the sessions in which the programme was delivered. Interactive behaviours were recorded every 30 seconds and three ten-minute samples of video-tape were analysed from each session using a framework of observation developed from an earlier recoding of a programme session. The authors note that ideally two independent observers should participate in video analysis, although this was not possible for this study. The approach is clearly intensive and time-consuming and this may explain why so few evaluations of programme fidelity are undertaken. The study found key differences in the facilitative behaviours adopted by the worker from the survivors' organisation and the teacher. While the structure and content of all the sessions analysed conformed to the programme manual, it was clear that the question of who delivered the programme in what context mattered. Again, the confidence and preparedness of staff to engage with the issue of sexual abuse appear important. One of the key implications for services to emerge from all four of the papers included in this issue is that, without the confidence and knowledge conferred by specialist training, professionals may refuse to acknowledge or fully engage with the issue of child sexual abuse. Finally, this issue includes a review (Wilmer, 2011) of Paul Hambke's personal account of sexual abuse in childhood co-authored with Martin Calder. Numerous personal accounts of abuse published in the last 20 years have contributed to increased public awareness of the issue, although, as the studies in this issue indicate, reluctance to confront it at the level of individual experience remains. Graham Wilmer, the author of this review, emphasises the authenticity of the account and draws attention to the long-term impact of child sexual abuse and the need for correspondingly long-term and extensive therapeutic intervention. His review challenges the terminology of child sexual abuse; while Hambke proposes the term ‘sexual assault’, Wilmer advocates utilising the language of trauma. The one term criminalises the experience, the other medicalises it. The evidence included in this issue does not indicate that moving child sexual abuse into either the criminal justice or the medical spheres of knowledge and activity would increase service responsiveness. Instead, research could perhaps usefully focus on those factors which impede and delay carers' and professional responses to child sexual abuse, distinguishing what might make for an increased readiness to detect and work with this form of harm.