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Tulare County Child Sexual Abuse Treatment Program

Responding to Child Sexual Abuse
by

April Dodd

on 30 March 2016

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Transcript of Tulare County Child Sexual Abuse Treatment Program

Tulare County Child Sexual Abuse Treatment Program
Responding to Child Sexual Abuse
Individual work with victims
Collateral work with non-offending parent
Collateral and family work with siblings
Family sessions with victim, non-offending parents and siblings.
Individual work with adolescent offenders
Possibly family sessions with victims and their offenders
Services for Sexual Abuse Victims and Their Families
Survivors Group--based on age and gender
Young child (boys and girls, ages 5-8)
Latency (girls or boys, ages 9-12)
Adolescent (girls, ages 13-18)
Adolescent Sexual Responsibility Program
Adolescents (boys and girls combined)
Adult Groups-Healthy Boundaries Program
Groups for non-offending parents, adult survivors of sexual abuse, and adult offenders, English and Spanish

Group Therapies
Individual and Family Therapies
Recommended Protocol for Offenders and Families
Crime reported
No Contact:
Visual, phone, letters, cards, gifts, etc.
Premature contact STOPS victim’s and offender’s therapeutic process
Alleged offender moves out
Or child is removed from home
Recommended Protocols
Involved family members begin counseling (individual and group)
Victim
Non-offending Parent
Siblings
Alleged Offender
Any family member with a drug or alcohol problem is to be concurrently enrolled in a substance abuse treatment program, with reported progress in treatment
Recommended Protocols Con’t.
First contact between victim and offender is to occur in a therapeutic setting.
Victim must feel safe and be strong enough to confront offender with his/her behavior. Victim will prepare a list of concerns, questions, and statements to share with offender.
Offender assures victim that he/she will not molest him/her again. This will include:
Not being alone with him/her
Asking victim to report immediately if he/she feels uncomfortable
Explaining precipitating emotions/attitudes that allowed him/her to molest and demonstrating how he/she has changed these
Recommended Protocols Con’t.
First visitation of any kind to occur only after successful victim-offender sessions and:
If victim is willing
If supervised (by mother if appropriate)
If short (one afternoon or evening)
When all parties feel ready
Visitation (frequency and time) increased, depending on success of therapy
Recommended Protocols Con’t.
Signs & Symptoms of Child Sexual Abuse
Loss of appetite (or sudden increase in appetite)
Newly acquired bodily complaints, especially stomach aches
Altered sleep patterns
Bedwetting
Restlessness
Nightmares
Fear of Sleeping Alone

*In 90% of sexual abuse cases, there is no medical evidence. Even penetration will not always create injury.
Genital or anal injury
Urinating or defecating in clothing
Sexually transmitted infections
Genital pain or itching
Change in neatness of appearance
Gaining weight
Compulsive masturbation
Signs and Symptoms of Abuse
Physical Indicators
Drop in grades
Irritable or short-tempered
Precocious sexual knowledge in play or verbalizations
Inappropriate expression of affection to adults
Self-conscious of body
Hostility and aggressiveness toward adults
Increased focus on pleasing adults
Isolation/Withdrawal
Shying away from touch
Low self-esteem
Extreme shifts of emotions/moods
Fears and phobias (especially aimed at one person or location)
Restlessness/Hyperactivity
Pseudo-maturity—Acting adult-like
Regression- acting child-like
Frequent absences from school
Signs and Symptoms of Abuse
Behavior & Attitude Indicators
Financial problems and unemployment
Substance abuse problems
Marriage problems
Extreme isolation
Family history of physical or sexual abuse
A “special needs” child
Extreme attitudes towards sexual matters
Children Are at a Higher Risk of Incest in Homes Where There Are:
Mistrust of others
Feeling “different” from others
Promiscuity
Problems with concentration
Problems with sexual functioning
Suicide
SHAME
Eating disorders
Self-destructive behavior
Teen pregnancy
Depression
Poor boundaries
Feeling powerless
Drug and alcohol abuse
Possible Effects of Child Abuse
They don’t recognize inappropriateness
They feel embarrassed
They don’t want to get perpetrator in trouble
They do not have the language to report the abuse
They have fears:
Afraid of the offender/threats
Afraid of breaking up the family
Afraid of reactions
Afraid of getting in trouble
Afraid of being blamed/shamed/at fault

Fears are often warranted
Why Kids Don’t Report
Factors that Correlate with the Most Traumatized Victims
Pleasure
Sexual pleasure appears to correlate with the guilt felt by the victim, which encourages traumatic feelings.
Factor #1:
Sexual Responsiveness

When terror is separated from violence, there appears to be a process of anticipation. Those patients who appeared to be most traumatized experienced a pattern of anticipation, which resulted in long periods of agony, “waiting” for the abuse to occur. The entire period of anticipation maximized traumatic responses.
Factor #2: Terror
Those victims who had a positive view of the offender were inhibited from identifying the abusers as criminal.
When positive feelings toward the offender occurred (from the victim or from significant others), trauma was increased.
Factor #3:
Offender Identification
Those victims who seemed resilient to trauma had positive self-esteem and identified themselves as innocent.
The most traumatized victims could not see themselves as innocent and were severely traumatized due to low self-esteem and guilt.
Factor #4:
Distorted Victim Identity
Two coping skills seem to emerge frequently for the most traumatized research subjects:
When victims adapted a coping skill of “self-abuse,” they manifested many trauma factors.
When victims used a coping skill of distorted or vague memories (including amnesia and dissociation), they appeared to be more traumatized. It seemed clear that victims who did not have a clear memory were symptomatic without understanding the etiology of the trauma.
Factor #5: Coping Skills
Pleading Child
What was wrong with me
I’ll do better next time
Give me another chance
Please love me
Raging Child
I hate you
How could you do this to me
I want to hurt you like you hurt me
But wait, it wasn’t my fault
Perpetual Pain
The most traumatized victims appeared to be those who were in a trauma bond with the offender. These individuals had an on-going connection to their abuser, which provided the “hook” of trauma bonding.
Factor #6:
Trauma Bond with Offender

The most traumatized victims appeared to be those whose abuse occurred in early development, there was no report filed, and they did not receive treatment.
Factor #7:
Under the Age of 12
In connection with the abuse occurring at a young age, the most traumatized victims again did not have their abuse reported. This combination resulted in keeping the secret of sexual abuse throughout many critical years of development, allowing the memory to “move and subsequently change and evolve over time.”
Factor #8: Withheld Report
The way in which the system responded to victims is a critical factor in increasing or decreasing trauma.
Victims who were traumatized, despite the reporting of abuse in childhood, shared the common experience of having the report met with a disastrous response.
Factor #9:
Disastrous Response
Precognitions of offender/victim status
Those who understood themselves to be “victims” and the offender to be an “offender” during the assault showed less trauma.
Immediate report
Victims who understood their status as “innocent” and the offender as “criminal” made an immediate report.
Report response
Victims who reported and received sensitive treatment (reaffirming the offender/victim identity) seemed to have the best chance for recovery.
Prognosis
- In summary, victims who were more successful in avoiding future trauma had a clear understanding of what occurred in the abuse scenario.
Factors That Reduce Trauma
Treatment Goals
Tell the entire story of abuse
Identify and work through feelings about the abuse/abuser
Belief/Support/Validation
Identify offender as completely responsible
Empowerment
Strengthen boundaries
Safety plan
Victim’s Treatment Goals
Unequivocally believe the victim
Identify indicators of abuse in children
Know the grooming patterns and sexual offense history of partner
Clearly believe the potential for re-offense exists
Encourage and model open communication
Prevent children from becoming isolated
Maintain the established family safety plan
Non-Offending Parent Treatment Goals
Accept full responsibility for his/her offense
Not blaming victim, system, spouse, or substances
Identify thought distortions that allowed offense
Examples: rationalizations, minimizations, etc.
Identify how to get needs met in healthy ways
Identify their offense cycle and grooming pattern
Create a relapse prevention plan
Offender Treatment Goals
Types
Pedophiles
Primary sexual attraction is to pre-pubescent children

Hebophiles
Primary sexual attraction is to adolescents

Situational/Opportunistic/Incest Offenders
Fear of adult relationships
Feelings of inadequacy
A sense of powerlessness

Will continue to offend until intervention is initiated through the legal system and mental health services
Offenders
Support and validate child’s experiences.
Nurture and encourage.
Set consistent limits and boundaries; ask permission to touch.
Pay attention to own “stuff” and its impact on child—seek appropriate support and counsel with adults as needed.
Participate in treatment. Abuse is not an isolated act; caregivers are a part of the healing process.
Advocate for family healing; protect others as needed.
Special Considerations for Foster and Kinship Care Providers
Guilt
Modalities used in therapy:
Eye Movement Desensitization and Reprocessing
Trauma Focused-Cognitive Behavioral Therapy
Dialectic Behavior Therapy
Motivational interviewing
Equine facilitated psychotherapy
Art Therapy
Biblio-therapy
Play Therapy
Measurements used to track client progress:
Youth Functioning Scale
Beck Depression Inventory
Hamilton Anxiety Scale
Parenting Stress Index
Eyberg Child Behavior Inventory
Thank You for your Participation.
We appreciate your continued support.

A special Thank You to Children's Trust Fund & The United Way

Tulare Youth Service Bureau, Inc.
327 S. "K" Street
Tulare, CA 93274
(559)688-2043

Tim Zavala, LCSW Clinical Director

April Dodd, LMFT Sexual Abuse Treatment Team Lead
Program Funded by Children's Trust Fund,
United Way, and Tulare County HHSA

Resources


Know your triggers.
Utilize supervision/consultation.
Know your coping skills.
Know your defense mechanisms.
Work together! Share the load!

Counter transference

Don’t underestimate the need for self care.
Don’t underestimate how this work can/will affect you.

laugh, run, dance, read, go to therapy, drink tea, exercise, meditate, journal, create, pray, spend time with friends, play, fly a kite, watch the clouds, take a class, garden, yoga, aromatherapy, get a massage, be spiritual, hike, have good relationships with co-workers, eat healthy, paint, eat mindfully, take mindful breaks, sex, take mini vacations, watch a movie, snuggle, draw, consult, enjoy a glass of wine, spend time in nature, play/snuggle with your animals/kids/spouse, walk, crossfit, go to lunch, give a gift, volunteer, keep good boundaries, take a walk when a client no-shows, dinner with friends, leave work at work, Just Say No, hot bath, listen to music, clean, have rituals, keep a routine, time management, prioritizing, play an instrument, listen to trickling water, think positive, drink lots of water, take yourself to the Dr., take pictures, walk barefoot, make daisy chains, use your favorite lotion, get eight hours of sleep, use positive self talk, be grateful, treat yourself on occasion, pamper yourself
Self-Care. Just Do It!
APSAC-American Professional Society on the Abuse of Children
Toni Cavanaugh-Johnson
Ana M. Gomez
Bessel van der Kolk
Bruce Perry
ATSA-Association for the Treatment of Sexual Offenders
ACE Study
Interventions....
Don't forget!!
Very Important!!
Remember!!

SELF-CARE
Full transcript