Child Sexual Abuse

Checklist for Clues:

No	Clues	Y or N
	Phobia/fear specially of certain places or people like uncles, aunts teachers, servants etc( hints, indirect comments or statements about abuse)
	Social withdrawal (such as poor or deteriorating relationships with adults and peers)
	Showing unwillingness to talk about a person or experience
	Sudden accumulation of money or gifts. Mostly seen with money or sweets. (need to find out casully where and how they got)
	Mostly staying quiet, being passive, displaying low self esteem and being under confident.
	Preferring to stay alone.
	Appearing mysteriously.
	Becoming aggressive and short tempered.
	Crying excessively
	Eating and sleeping problems. (eat /sleep a lot or does not eat/sleep) nightmares etc.
	sexual problems. (excessive touching, preoccupation with private parts or excessive masturbation)
	Delinquent behavior, stealing things, excessive lying and running away from home.
	Age-inappropriate sexual awareness or interest. Sexual play with toys peers or adults. (Sexual knowledge in languages or behavior)
	Learning problems, inexplicable fall in academic grades, poor memory and concentration
	Relationship problems with peers or family members. (withdrawal/clinging to parents peers).
	Self injurious behavior,( gradual/sudden) suicidal attempts or ideation.
	Itching bleeding, cuts, and laceration in genital area, difficulty in walking Nausea/upset stomach.
	Excessive bathing or poor hygiene.
	Anger and mood changes. Attention seeking behavior.
	Difficulty in walking or sitting
	Discomfort in urinating or defecating, recurrent urinary infections
	Reluctance to participate in physical or recreational activities
	Regression to younger behaviour, such as thumb-sucking, acting like a baby, bedwetting and/or speech difficulties
	Tendency to cling or need constant reassurance
	Complaining of headaches, stomach pains or nausea without a physiological basis, fatigue
	Looks depressed, Powerlessness, worthless
	Developing fears, phobias and anxieties (A fear of a specific place related to abuse, a particular adult, refusing to change into sports/swimming clothes)
	Wearing of provocative clothing, or layers of clothes to hide injuries and/or to appear unattractive
	Child running away from home/school.
	alcohol or drug abuse, getting in trouble with law
	Shame, guilt, and self-hatred.
	Alienatation from their bodies.
	Questioning their sexuality and gender.
	Perfectionism and workaholism.
	Decreased concentration , Restlessness
	Aversive to touch
	Victim syndrome-Self-blame
	Feeling over responsible
	Parentification (trying to become a parent )
	Refusal to be left alone.
	Cruelty to animals (more characteristic of male victims)

Accommodation Syndrome

The most important effect of child sexual abuse, in order to understand from the perspective of the child is the Accommodation Syndrome.

Children sometimes enjoy the sex and the relationship.
Sometimes children do not enjoy the sex but still need the relationship.
Many others do not enjoy the sex and do not want the relationship, but feel they cannot tell.

All of these children adjust, or accommodate, to the abuse by convincing themselves that the behavior is good, the abuser is good and something is wrong with him/her.

All of these children need to keep the secret in order to protect their offender, because if they tell, it's the child's fault when the offender goes to jail or when the family gets broken apart.

Sometimes the children are threatened with harm, but usually they are threatened with loss of love. In almost all cases, the child is the one who feels the shame, guilt and responsibility for the sexual relationship. The only way to cope with this adult responsibility is to accommodate, like a religious conversion, with the belief that what is happening must continue to happen.

The accommodation syndrome is the reason children cannot tell, or after disclosure they recant, or even hesitate on the witness stand.

SYSTEMS

Common System:

1 Check for clues – in case of atleast 2 (obvious ones) or 4 subtle ones of the above, Probe in detail, write a detailed case history.

2. Refer to the counselor , social worker to continue to work with parents / family/ neighbours at least once a week.

3. Counselor and SW to meet once a week , before the SW goes for the Home Visit or talks to family, neighbours etc so as to exchange information both have which will aid in the short term goals for the child.

System for the social worker:

1. At least 4-6 sessions with the child, 1 or 2 home-visits within a span of 30 days for case history : covering family interaction, interaction with friends, neighbours , behaviour of the child in general , in center, as described by the parents/guardians/neighbors/ friends history, their concepts of friendships, romance , girl friends/ boy friends , their recreation aspects , substance history if any, their interests .

2. Full Plan for the child/youth to be decided along with the counselor. SW would follow up everything at home, in case of any new information pass to counselor, monitor the plan jointly made for the child, work continuously with family in terms of parenting, other ways to monitor and help the child through parents. Home visit plan to vary as per child and case

System for the Counselor :

1. Counselor at least 6-8 sessions with the child for stabilization within a span of 30-60 days. To meet atleast twice a week – can vary as the sessions progress.

2. Full Plan for the same to be decided along with the Social Worker. Exchange information regarding the child and the status of the child. Discuss concerns with the SW to get their help for any further information, or help from family.

LANGUAGE

Use the language the child understands
Don’t use very directive statements, make them more generic
Don’t use leading questions regarding the act, keep them open ended at least in the beginning
Don’t label their emotions “you are feeling..” , instead ask them “you MUST be feeling …. , isn’t it?” This gives scope to them to correct you in case its not correct- They know the best what they feel, we don’t.

Some Phrases That Encourage Disclosure	Some Phrases that Discourage Disclosure
"We know this is difficult for you"	"We know how you feel"
"We're here and we care"	"It's god's will"
"It's all right to cry"	"You'll see that its all for the best"
"This is scary isn't it?"	"Can you sum it up? We're running out of time"
"It doesn't seem fair does it?"	"If you think you have it bad you should hear about..."
"You must feel like your going crazy"
"This seems painful to you"

Some Do’s and Don’ts

Do's

Don'ts

Let them know you believe them.
Reassure them
Let them know you do not blame them.
Let them know that you are glad that they have told you.
Give them time to talk to you at their pace.
Make time to spend with the child so you can talk privately.
Be open and clear with them.
Allow the child to talk about the confused way that they may feel.
Try to be calm when talking with the child as they may be confused by anger.

Blame the child for what happened.
Suggest that it would have been better if they had stayed quiet about the abuse.
Tell the child that he or she blame her/his self.
Tell the child to forget it ever happened.
Tell the child not to talk about it.

TREATMENT

Safety book

- a story book which talks about preventive aspects and how to communicate what ever is happening to you to your guardians/parents The three integral components of the methodology are providing age-appropriate information, developing assertiveness and decision making skills and promoting self-esteem to translate learning into practice.

Phase-oriented treatment involves three steps:

Stabilization – building trust, be non judgmental, listen, give scope for expression , encourage regular expression, encourage positive statements to help cope, help them look at their strengths, calming down, help build hope for future (start the process)
Processing and dealing with the trauma – use specific techniques
Reconnection or reintegration – e.g., forming new relationships

Techniques for stabilization:

Yoga
Deep breathing exercises
Grounding chord – sit with feet on floor, relax, breath deeply, bring to mind present feeling, visualize a chord going through your body – head, spinal chord, leg, feet, into the ground
Mental slide show: control and manage your emotions, visualize pleasant scenes such as mountains, streams etc. Let them close their eyes and visualize as you narrate the scenes. (opens up your senses and calms you down)
Coping cards: Cards with positive statements – these statements don’t match with the patient’s perspective at the time of making the cards.
Hope kit: In a box or envelope, put chits of all the resources that anchor you to life. This could be any quality, object, person, or reminder that helps you cope with the present situation better. Develop resources for any situation in which the child needs confidence, courage, and strength.
Writing a daily diary
Mood logs: Keeping a ‘feelings’ journal
Future movie: writing a script about your future

Some Stabilization Indicators

willingness to talk
looks happier
starts taking interest in activities around
sleeping, eating appropriate
personal care
attempting to initiate friendships
appropriate communication
speech overall become slightly positive
clues identified are diminishing
willingness to start thinking about future
hope present
identified a way to express regularly

Processing and dealing with the trauma: Use support group

Role plays, story writing with a different end, a story where he/she was able to avoid the situation, story – drawing where they were able to empower the situation

Reconnection or reintegration

Teach skills to handle life. Help them to connect to their problems and work them out. Goal setting, life plan, preventive tips

References:

http://www.tulircphcsa.org/

www.sahil.org

http://www.cptcsa.org/

Work with parents

Parent's Practical Response to Child Sexual Abuse addressing parents' anxieties regarding child sexual abuse, and giving them information to assist them in participating in their children's protection. Besides providing information on child sexual abuse, it suggests ways for parents to talk to their children on the subject and how they should respond if they suspect or know that their children have been abused. Ideas for introducing children to personal safety touching rules is also an important aspect of the book.

Prevention tips

Know where your children are, who they are with, and what they are doing.

Accept responsibility for their safety.

Ask your children what happens when they are alone with other adults or friends.

Pay attention to your children and their behavior. Take time to be an understanding listener.

Encourage your children to talk to you about any problem or question they may have, and not to keep secrets about touching.

Respect your children's concerns and questions.

Have your children practice saying "NO!" and tell them to get away when a situation makes them feel unsafe.

Teach your children about sexuality, and give young children a vocabulary for private body parts.

How to respond

On the one hand, supportive responses from the victim's family and friends can lessen the impact of the abuse. On the other hand, negative responses (seen commonly in cases of incest where one parent tries to protect the other parent) could compound the damage done.

Believe

Children rarely invent stories. They hesitate telling because they fear nobody will believe them. Believing a child is a major step in helping him/her overcome the trauma. Statements like, "I believe you" or "It's not your fault" will help in the healing.

Be calm

A child may misinterpret your anger at the abuse as disgust for him/her. Staying calm will also help him/her regain his/her dignity, which is often the first to go. Assurances like, "Other children have had similar experiences," or "Let's see what we can do," could encourage the child to be more open.

Be affirming

Abused children are often confused about their feelings, as a result of manipulation by their abusers. They must be allowed and encouraged to say what they feel. And their feelings must be taken seriously and affirmed. "I know this isn't easy," and "You're very brave to be opening up," conveys empathy, concern and support a child needs.
Prepare the child for what will happen next.

Abused children feel helpless. They need to know that there are people who can help. They must also be told what they could do, i.e. how to relate the incident, whom to tell, and what support is needed.

Be supportive

Talking about the abuse can be as traumatic as the abuse itself. Adults must give the child as much support as possible, especially when the child begins to open up. Reassure the child that you'll be there for as long as it takes, and that you'll go through it together.