How Children Disclose and Process Sexual Abuse

Wow [Applause] you hello everyone it is 12:30 it's actually I think maybe one minute pass so we are going to go ahead and get started we've got lots to cover today thank you all very much for joining us if you have ink slides and then I will introduce our speaker as you heard when you logged in all the phones are muted on our end until the very end and which time we will unmute for questions if you're listening to this as a live webcast or as a recording you can get category 1 a MapR a credit I will I will tell you how to do that at the very end so stay tuned till the end to figure out how to do that with either the survey in your webinar appointment or in the notes section for it's a video for questions you can use the chat button at the top right-hand side of your screen find Alex you can send me your messages and I will ask the presenter if they're urgent if not we'll wait till the end and also going to the end we will unmute the phones for questions and discussion this is my 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issues about local experts and it's all free today we have a very special guest in our kind of ongoing series of child sexual assault we have Christina Ralph she has a Masters in Social Work from Radford has been in the field for ten years she is currently at Children's Trust she is the program director for the Child Advocacy Center and the lead forensic interviewer and with that I will go ahead and turn it over to her for the presentation thank you all very much for joining us great thanks Alex so I have quite a bit of information for you all for the next thirty minutes so at times I may speak quickly just to ensure that I get through the entirety of the content for you and hopefully leave some minutes at the end for questions just because I've been working at Children's Trust and interviewing children primarily who have been sexual abuse victims I tend to go off topic just because all of the information is really good information and I find it very important to educate community members professionals in the field that are working with these victims to give them an overview of kind of what to expect and what they may see in the field so with that if I go quickly this is archived so you may have to listen back to it to get all of the information obviously this is my disclosure okay so a lot of times people don't really understand the importance of statistics and research in regards to the kinds of cases that you're working with I get out a little bit in regards to statistics and research so I find numbers very fascinating and I always think it's a good idea to know kind of the baseline of where you're at to understand the picture that you're looking at the problem with sexual abuse statistics is we're only getting data that's actually reported and as you all know child sexual abuse is most underreported kind of abuse that there is so our data snapshot that we get seems to be on the low end but again these are just kids who have actually come out and have made disclosures the national statistic right now is that one in ten children will be sexually abused before the age of 18 it used to be one in four girls and one in six boys but they kind of generalized a little more I think that's pretty profound if you think about all of the children in your own lives or kids that you've come into contact with and just that that number of kids that have experienced sexual abuse most of these kids again aren't talking about their abuse so these are kind of our silent victims I've broken down kind of the kids that we've seen at the Children's Advocacy Center by jurisdiction our Children's Advocacy Center serves Roanoke City Roanoke County Salem's Radford Bedford Montgomery County Pulaski but we also see a lot of outlying jurisdictions that bring our kids bring their cases to a sped furbot etat Craig so this is just a very small snapshot of the kids that have come into our Center who have made allegations of abuse and neglect primarily sexual abuse that we've conducted forensic interviews for and I'll talk a little later about the process of what happens with a case once it gets reported and the Children's Advocacy Center and how we get involved overall in Virginia over 2000 children had child sexual abuse investigations in the state and again you may think that this is a very low number and that's about that 2000 caseload represents about 10% of the totality of cases that the Department of Social Services actually investigated so the whole idea of us talking about child sexual abuse today is that people don't hear about it if you think about the last time you heard of a child sexual abuse case in the media or in your community it was probably a long time ago or maybe one not a lot child sexual abuse is not reported and most people don't want to talk about it the stigma attached to child sexual abuse whether that's the victim or the offender themselves people just would much rather turn their head and close their eyes sweep it under the rug then acknowledge that this kind of abuse happens in our own community and it's happening every day the scary thing about child sexual abuse is it's evolved over the years and if you're a product of the 80s or grew up in the 80s it was all about stranger danger people in the bushes men in trench coats these were people that we thought were our offenders on our kids in actuality about 85 to 90% of our perpetrators and child sexual abuse cases are family members it's an interest a million type of abuse meaning that most of the time it's parents stepparents parents paramours boyfriends girlfriends of mom and dad grandparents essentially any individual especially an adult who has a relationship with a child the closer that relationship is the higher risk they are of becoming a victim of sexual abuse so when you think about educating our own kids about being aware of offenders it's not stranger danger anymore so I would hope that we like to get away from that speech to our children about don't talk to strangers in actuality it's kind of like a dual message you tell your child not to talk to a stranger and then you go through the McDonald's drive-through and you're talking to a stranger so kids don't quite seem to understand that so we need to be more aware about the adults that are having contact with our kids specifically in the family the other thing about child sexual abuse is it's very secretive in nature these offenses aren't happening in public they're typically behind closed doors and there are usually only two people involved the offender and the child and if that child relationship with the offender is closed but say it's a parent and a daughter no one would question why that dad is behind a closed door with their child so it's very secretive in nature it's also very secretive in the sense that kids aren't aware of what's happening especially if it's the younger child their world view of sexual interactions is non-existent so things that happen in regards to child sexual abuse they don't understand that what that is is wrong or not okay so it's very secretive in nature again there's no witnesses in my experience we have never had a case where an offender has brazenly abuse actually abused a child in the presence of another individual so these make this fact that there are no witnesses make these cases very extremely hard to work because you're going off of what the child has disclosed to you and if you put a four-year-old against an adult in the community let's say that adult offender is a prominent community member the reality is most people are going to believe that adults over that child so not having any other type of evidence or corroborating evidence makes these cases very hard to prosecute if you think about child sexual abuse it's not just physically abusive and in actuality most child sexual abuse cases there are hardly any ever any physical evidence I think right now the statistic is 3 percent or less of cases have any physical findings from child sexual abuse and I know Heather Smith who's one of our forensic nurses just talked about child pediatric forensic exams and how there's hardly over any physical evidence so we don't think about a child standing a physical injury in sexual abuse cases whereas if you have a physical abuse case or neglect case there's typically a lot of evidence to go hand-in-hand with that actually occurring it's both mentally and emotionally abusive for our kids we're going to talk about the disclosure process and some of the systemic things that happen to children as they experience sexual abuse and how they process that sexual abuse that have long lasting impacts that can be extremely detrimental for them moving into adulthood the biggest thing to think about and remember about child sexual abuse is that when a child discloses abuse that's the exception most people don't ever talk about it and don't ever report it so if you're in a situation where you have a child or you have a patient that has is disclosing or is making some type of disclosure to you that's gold that's super important to take that and kind of build our case off of so just remember disk loading is the exception rather than the rule so as I mentioned before child sexual abuse you can't put every victim of child sexual abuse in the same box every child is different how they present as a victim is going to be different the variables that go into play in their victimization is going to be different and where they are in their disclosure process is going to be different so a lot of times we get the questions of well is she a typical abuse sexual abuse victim well there is no typical sexual abuse victim every kid is different so if you if you've already have in your own mind a child that you think about as being a sexual abuse victim completely erase that vision of what that victim looks like because every child is different and it's always changing these victims are always presenting in different ways so when a child does decide to disclose there are two ways that that typically happens there's accidental disclosures which are essentially information is revealed by chance and then there's purposeful disclosures where children are making that conscious decision to tell someone about what they're experiencing the sad thing is that the ratio between accidental disclosures and purposeful disclosures is about 70/30 so most of our disclosures we get in regards to sex abuse are accidental these aren't kids who are making that conscious decision to reach out to someone and tell about what's going on with them most of the time it's an accidental scenario for example if you have a young child perhaps three or four who's playing with their toys and is putting their two Barbie dolls in compromising sexual positions and is making one doll do a sexual act to another doll and the parents thesis or is observing this behavior and says hey what are you doing and the child may say something like this is what me and Johnny do this is what me and Sara do that's an accidental disclosure that child is not consciously deciding to tell an adult that hey this is happening to me it's of them just happens dancing filling you in on information a lot of times we see these accidental disclosures with children who have sexual behaviors beyond their developmental age range that's typically a large group of those kids and then we have our purposeful disclosures these are children who seek out an adult or a trusted individual who want to tell about the abuse that they've endured most of time these purposeful disclosures are coming from our older kids or teenagers and a lot of the times at that point they make that conscious conscious decision to tell to make the abuse stop they just want it to be done and over a lot of times these purposeful disclosures also common situations when there are other siblings in the home so the child who is being victimized purposefully decides to tell because they want to protect their other siblings from becoming victims as well so once a child decides to tell which again emphasizing the importance of how magical those moments are when they make that decision to tell they still go through different stages of disclosure so there's denial tentative active recanting and reaffirming so obviously denial kids will adamantly deny whatever every fiber in their being that it didn't happen so this may be a situation where someone did walk in on a sexual act or crime being committed on a child and there's evidence that something did in fact happen that child will still adamantly deny that anything happened to them or that anyone touched them we've seen this a lot in cases where there have been photographs or video images taken of the sexual acts where we know there's hard evidence that these kids have been victimized sometimes these kids still deny that they were abused another stage of disclosure is the tentative stage so these kids may stay some information about their abuse but not all the information these are children that typically say I forgot or it was a long time ago or I don't remember when you start to try to ask additional questions from them young kids may even say I was just kidding or it didn't happen to me it happened to my brother so again they're divulging but they're not providing the totality of their experience active disclosing kids these are the kids that typically have that purposeful disclosure they've made that conscious decision to tell and they're actively telling all of the information that they have about their abuse scenario again unfortunately children a small percentage of children are ever in the act of disclosing phase and we'll talk about some of the barriers they experience when they do disclose recanting a child tells and then for whatever reason whatever variable existed they take back their original telling of the story this is a huge population of our children most often I always anticipate a recantation happening when we're dealing with child sexual abuse cases and we'll talk about why recantations happen when we talk about the barriers typically it's due to the lack of support of the non-offending caregiver reaffirming these children tell they recant and then they come back and reaffirm their original telling of the story the really difficult part with children who recant and who reaffirm is their question of credibility has already come into play by the system as a whole whether that's investigators or prosecutors or the public at large these children already deemed to be not credible because they took back their initial disclosure I would like to import everyone to not be swayed by children who recant or reaffirm their abuse I actually find those kids more credible just due to the variables that take place so the other thing about disclosing is a lot of times we get cases where we jump to conclusions we hear pieces of information what that's third party or from a child's disclosure to ourselves it doesn't quite make a hundred-percent connection for us where we jump to conclusions that that child was in fact a victim and so then when we start going into the information with the child we may get denials we may get some tentative things were no abuse actually occurred at all so it's really important for our mandated reporters and our first responders to engage with these children in an appropriate way so that we're not chasing a rabbit down a rabbit hole when we don't need to so young children under the age of five they are really good tellers of their experiences if they have seen something if they've heard something or if they've experienced it with their own body so a child who has an accidental disclosure maybe they have some sexual knowledge that's beyond their developmental years and someone's concerned that that child may have been victimized sexually that may be true but that may also be a case of a child who's being exposed to inappropriate language or inappropriate images in the home so they've seen sexual things but they themselves have not been physically sexually abused so we always want to keep our minds open to what these kids are experiencing so there are two models that came about mid 880's in regards to how we understand children's coping mechanisms of how they've experienced their victimization the first one is the child sexual abuse accommodation syndrome and this is about by dr. Roland summit and when he turns the coin syndrome he who's good at doing a good thing this is not a medical syndrome it's not diagnostic and so he kind of got a lot of backlash in regards to that because you can't label someone with having this accommodation syndrome essentially the accommodation syndrome just helps explain the experiences that children go through so there kokin behaviors of children that they experience so secrecy helplessness entrapment delayed disclosure and retraction the setting with coping behaviors and children is they typically don't meet adult expectations so we as adults don't understand why a child may do certain things if they're experiencing child sexual abuse because as an adult I wouldn't behave that way so why is this child not doing what an adult would do so it feeds into that disbelief and non credibility of children because their coping behaviors don't make sense to us which is sad because that results in further abandonment of these victims which then drives victims further into self-blame alienation and potentially revitalization themselves so just because a child discloses abuse to you and how they dealt with that abuse before they report it doesn't make sense to you as an adult don't negate their disclosure it's really important to understand that sexual abuse again is going to be different for every person and how a child takes that abuse and processes it may look unusual so obviously with secrecy these are the phases of the abuse when everything is done in secret basically it's the source of fear and the promise of safety so these are parents or offenders who tell the child keep it a secret don't tell anybody what we're doing and again it goes back into sexual abuse in general it's secretive in nature and typically with the secrecy there's some combination of a threat or guilt or shame that make that child keep that secret the child who's experiencing helplessness these are young kids again they rely on adults to keep them safe and feed them and nurture them and house them and so they may feel helpless in their abuse that's what's happening to them they don't have the power or the authority to change their situation so their helplessness and been what is going on a lot of shame and self blame come into into the forefront with helplessness they may think that what is happening to them is their own fault or they brought it on themselves so they have a lot of those feelings we see a lot of helplessness when we have offenders who who are in authoritative roles so coaches mentors someone a teacher someone who has an authoritative rove most often these kids feel extremely helpless in their victimization and are less likely to disclose entrapment these are kids who typically have ongoing abuse more than one incident and it's typically the same style of abuse over and over again and they feel that they have their only coping mechanism is to embrace what is happening to them and this is the biggest one that doesn't make sense for adults so I'll give you a case scenario a 15 year old victim was being sexually abused by mom's boyfriend and this abuse occurred every day when mom would go to work in the evenings mom will go to work offender would come into a room sexually assault her leave and that happened multiple times over and over and over again and the biggest question would be why didn't you tell why didn't you do something to stop it you knew that he would be coming into your room every day when your mom left for work so why didn't you change your sister scenario she felt helpless she felt trapped in her environment a lot of times entrapment includes kids who previously tried to disclose and it and it didn't work so those are hard cases to figure out the delayed disclosure these are kids who are maybe in their teenage years disclosing abuse that happened when they were kids why didn't you tell there may have been lots of situations why they didn't tell earlier maybe they did try to tell earlier no one believes them so delayed disclosures are really hard cases to work as well and then obviously their attraction cases where the kids take it back the other model the trauma genic model is very similar to rollin summits it includes betrayal the traumatic sexualization that one's really important because that's where we start folding in those emotional and mental injuries in regards to kids where that disconnect of what a normal healthy sexual relationship should look like gets rewired in their brains and becomes a traumatic sexual ization and the powerless and the stigmatization we see a lot of times as well so when we talk about why kids don't disclose we talk about barriers this is a really nice infographic or Venn diagram to kind of pull it all into place so obviously if a child has any disabilities whether that's their physical disabilities or mental disabilities they're already at a higher risk of becoming abuse first of all but there are much more likely not to be able to disclose especially if their disability has anything to do with speech or cognitive function if a child can't tell what's happening to them they're in a situation where their abuse never may be uncovered the biggest blocks that we see in the field when we're investigating these cases are familial blocks and interviewer induce and perpetrator induced so some familial blocks would be the non supportive care caregiver and the disbelief of the child people not believing what the child is saying especially if a child discloses and that person who they've disclosed to says shut your mouth we don't talk about that kind of stuff much most likely never going to tell again so any special needs if they're hard-of-hearing or if there's a language barrier that's a huge issue perpetrator induced these are the threats the bribes the coercion if you tell I'll kill your dog if you tell I'll kill your family these are real things for kids and so that the threat just that sentence alone keeps a kid from telling our interviewer induced us ourselves so what bias do we bring to a case am i wearing my police uniform am i wearing my gun when I'm trying to talk to a child all of those things fold into a barrier of whether or not a child is going to disclose any information to us so kind of reiterating a child is more likely to disclose if they have supportive caregiver they're in a structured environment the further the relationship is from the offender so if it's a stranger and a child they're more likely disclosed as that relationship gets closer so parent to a child they're less likely to disclose it was a one-time incident and female victims tend to disclose more often than male victims do what kind of decreases the likelihood of disclosure is that non familial support that close relationship multiple incidences though chronic abuse over multiple years previous attempts to tell someone that something's happened to them and the threats and the brides and the coercion those are big key variables when we talk about these cases so obviously it's important that we understand how kids process child sexual abuse because then we know how to approach these kids you know the big hot topic thing now is trauma-informed approach trauma-informed care with our victims if you don't understand how kids they're processing child sexual abuse and you have that kid sitting in front of you or that patient sitting in front of you you're not sure how to handle them or even take what they're saying with any credit or merit so we have to know how they've experienced their trauma and how they're processing it in order for us to approach them in the best way to help understand what actually happened so we do really good job of educating our first responders and our mandated reporters on a minimal facts interview prior to an investigation starting this is kind of your tipping point for or you're kicking off point on how to start an investigation but the minimal facts are our WH questions are what where when who it's really imperative that our first responders or even the people that a child is closest to aren't giving kids full interviews those happen later in the investigation so especially the child not volunteering any information you don't want to be asking a lot of questions to them and most of the time other information can be gathered from other sources such as the person the child initially told other people in the family so it may not be necessary to actually talk to the child victim on scene at that time so just a couple of tips for individuals if you do have a child that discloses to you in in your realm of work or in your profession the biggest thing is we need to remain calm and control of our feelings kids are very intuitive and can kind of read adults very well and if we have a look of shock or surprise on our face when a child tells us saying we're sending a message to them that these are things we shouldn't talk about and so we need to kind of put our poker faces on and really allow that child to tell us thing in a neutral manner we have to listen very carefully to what the child is saying if you have an opportunity to write down that child's initial disclosure verbatim I would highly suggest doing that that initial disclosure is the most reliable piece of information we have to go off of it's okay to tell the child it's not their fault depending on the age of the child you may want to let them know you're going to have to make a report or tell someone else whose job it is to keep them safe and obviously if the opportunity arises to give them privacy you want to make sure you try and do that there are obviously things we don't want to do when a childís closes abuse to us because again the process works the investigation will take place after that child leaves your office so we don't want to ask the child any direct questions about the abuse as a mandated reporter all you need is a suspicion that something's happened to make a report you don't need to know the details of who and the what and how it's not relevant at that point don't make promises you can't keep obviously as humans were nurturing species and we want to make sure kids feel safe and so sometimes we say things like I promise that won't happen to you again but in actuality we can't promise that the judge can't even promise that so don't make promises don't push a child in to give details about the abuse when they're not ready this could be very detrimental later on down the road if that child has multiple interviews depending on who's talk to them how they were talked to could lead to misinformation and miscommunication and obviously you don't want to discuss the disclosure with anyone not directly involved with helping the child or that case so if you're listening to this webinar I assume most of you are mandated reporters there are some states in the country that every individual every community member is a mandated reporter which I think's fantastic I think it's our responsibility to protect our kids in our community but all you need is a suspicion of abuse I like to kind of use the tag line of tagline of when in doubt just check it out you're not going to be in trouble for making multiple calls about a concern of a child you want to make sure you call the Department of Social Services or law enforcement if it's a case where the offender is not a caregiver social services doesn't get involved in those cases but law enforcement does if you want to do diligence you can call both entities and let them work it out what I will say is in the system of investigating these cases that Social Services and law enforcement work hand in hand in all child sexual abuse investigations so the Children's Advocacy Center is really a we of the hub of the wheel that brings together all of the investigating agencies that work these kinds of cases and we work in a multidisciplinary team approach so investigators through DSS law enforcement the prosecutors and prosecuting attorneys our mental health folks our victim witnesses our forensic nurses who provide our medical we're all working these cases together in a coordinated effort to ensure that that child goes through the system in the best way of appropriately a lot of times these cases like I said are hard to work and so we're all there working the cases hand in hand jointly sharing information that's relevant to the case to ensure that that child has a positive outcome now when I say positive outcome I don't mean we put offenders in jail every time because we don't but what I mean is that that child was put first throughout the investigation their needs were first to ensure that they potentially are put on a path of forming into a healthy adult as possible this infographic just elaborates how efficient Children's Advocacy centers are what I love is that the prosecution rates for cases that go through the Children's Advocacy Center or the prosecution rates that have multidisciplinary team approaches are higher than cases that don't and that make sense the more coordinated and effort is when investigating child abuse cases the better outcome for everybody so um to kind of wrap it up in summation the bottom line is if you're in a situation where a child discloses to you do minimal facts if it's appropriate however if a child says you know daddy touched my peepee there's not much more you really need to know from that so go ahead and make the call as a mandated reporter getting the minimal information you need without tainting the investigation kind of staying in your lane staying in your box that's really important and always always keep the best interest of the child in mind and following best practice is important as well so I think that wraps us up there are additional resources in there that you may look at as far as children's advocacy centers and just some national statistics and some research articles again if you like to nerd and geek out about those things those two articles at the bottom are really good to kind of help add up how kids process child sexual abuse okay thank you very much Christina I know that was a lot to cover and I know that you usually probably could talk for quite a long time about that so thank you for trying to condense it down I think you have your contact info here on the next slide yes so if there are questions or someone wants to have kind of a extended conversation after this you're open to receiving communications that I will go ahead and open the phone lines up here real fast I know we're a little bit over so if you have to hang up it's okay if you want to get your CME credit just fill out the CMA link that's in your calendar appointment and for those on the recording I'll cover how to do that at the very end here so I'm going to go ahead and open the phone lines up for any questions or comments discussions that the listeners have the conference is now in talk mode okay so we're in talk mode so if you are listening please just go ahead and mute your phone that way we don't hear what's going on in your background but does anyone on the line have a question for Christina okay I did get a couple of comments coming through already I know that someone had a question about where child advocacy centers are located and I saw you had a kind of a link here I'll backspace do you want to spend just a minute or two talking about how people can find out if they have a child advocacy center in their area how they function how they're funded stuff sure so I didn't put it in here the Children's Advocacy centers actually have a state chapter and so you can go on their website which is WWE CDA org and there is a nice and interactive map of Virginia that highlights where all of our centers are there are currently 16 centers in the state of Virginia that are nationally accredited which is great because we're hearing two best practices and that's the easiest way to find out if there's a CAC in your locality the ones closest to us is obviously our office here in Roanoke we have a satellite office in Christiansburg Rocky Mount has their own Children's Advocacy Center and then you have to go down to Bristol to get the next closest one and up to Stanton and Harrisonburg and Charlottesville so that's kind of a good coverage area okay great are there any other questions or comment that anyone on the line would like to make 'shy Alex this is Lori Natalie I have a question I Laurie go ahead and I just want to confirm two things one certainly for kids who get interviewed there that the police or DSS starts that process we don't refer kids to the Child Advocacy Center is that correct yes thank you for making that clarification so in order for us to interact and give forensic interviews to children we have to have an open case with law enforcement and social services so they would be the ones that already have that report in front of them and then they make that contact to our services for the forensic interview so you guys would call DSS and law enforcement and then they would take the ball from there okay thank you and one more thing and after the child has been interviewed and whatever happens do you guys there at your facilities or some of the sub advocacy centers offer therapy for children and families or that just sort a forensic diagnose and diagnosis oh so the forensic interview is actually just kind of a fact-finding interview so if you think of us as conduits to gather information of what happened to the child we pass that information on to law enforcement so our forensic interviewers don't actually make any determinations on whether something did or did not happen we just gather information from the child in the most developmentally appropriate way and ask questions that can stand up in court once that process is over we have family advocates on-site that are working with our non-offending caregivers that make referral for mental health services so we don't have mental health on-site but we do we do work closely with Family Services family preservations and Blue Ridge behavioral health to ensure that these kids get hooked up very quickly to the mental health services wonderful thank you very much it's wonderful talk thank you very much for that question any other questions or comments from the one I'm looking here I don't see any additional questions from our online portion so I think with Beth we will go ahead and wrap this up if you are still I'll go ahead and go over don't forget to if you want your category one CME credits you should have gotten a calendar appointment which is how you log on to this you scroll down in that calendar appointment or click on the show more notes on your phone you should see a CME link that takes you to our survey you fill that out all that information gets dumped into our CME tracker system that our CME department runs it usually runs a few weeks behind so if you log on looking for something to happen today you probably will not see today's lecture on there for a couple of weeks but you can go to their CMA website which is here Karelian clinic dot org slash continuing - medical - education pala think you're on the line we got to do something to shorten that up a little bit you can find the seamy tracker system there to make sure you're registered so you can go on and see that if you're listening to this is a recording from our YouTube channel you click the show more notes show video notes that will drop down and you'll see the link to our survey that you can do and you can go onto the same site here the current clinic that org slash continuing medical education to also log into your simi tracker they all funnel into the same system you just have to find the link in different spots so with that again thank you very much steena for being here I know this is a awfully hot topic and a timely topic so we're going to discuss as soon as we hang up how we get you guys back here to do more of these I know everyone is very interested in the information but with that we're going to go ahead and wrap up today thank you all very much for joining us and we will see you again next month

Channel: Carilion Children's Outreach Education

Views: 51,358

Keywords: Children disclose process sexual abuse

Id: ZTJb8fcJwvA

Length: 42min 50sec (2570 seconds)

Published: Mon Aug 07 2017