Listen to thisAbstract: During the last ten years, child sexual abuse has become recognized as a major social problem. Like other human service professions, child care workers are involved with many children who have been sexually abused. Indeed, there are indications that as many as one of two children in group care programs have been victimized by sexual abuse. Considering the prevalence of the problem particularly in settings where child care workers are likely to be employed, it is important for child care workers to understand the nature and effects of sexual abuse and to develop skills in helping abuse victims.
Recent research findings
In recent years research into child sexual abuse has proliferated. Key
areas of studies have included prevalence, risk factors and the effects
of sexual abuse. Many disciplines have been involved in the research
effort. Unfortunately, to judge by the contents of the two major child
care journals, virtually none of this research has been conducted within
our profession. Accordingly most of our understanding of the problem is
borrowed from other fields. Nevertheless, the information developed to
date has important implications for child care practice. A brief
overview of key findings is presented below. A detailed review of
relevant research studies published to date can be found in Finkelhor’s (1986) excellent book, A Sourcebook on Child Sexual Abuse.
Prevalence
Determining the incidence of child sexual abuse has proved to be a
difficult ask. The main problem is that for ethical and legal reasons it
has not yet been possible to survey children directly. Thus data comes
from the retrospective reports of adults. This creates problems of
reliability as some older survey respondents are asked to recall events
which took place twenty, thirty or even more years previously. The
picture which emerges from such reports is necessarily out of date; it
reflects the situation as it existed at the time the respondents were
children.
Recent evidence indicates that one in five females and one in ten males have been sexually involved with an adult as a child. These rates are obtained from such authoritative reports as Finkelhor (1979) and Badgley (1984). Other studies have reported rates as low as 6 percent and as high as 62 percent (Finkelhor, 1986). The variability in findings may, in part, be attributed to the different definitions of sexual abuse which were used in the studies and to the range of methodologies which has been employed.
An important consideration for child care workers is that when clinical populations are surveyed, the rates of sexual abuse increase dramatically. Several such studies have reported rates of 50 percent or more. Consistent with this is the finding by Young (1985) that about half of the residents in two residential treatment centers had previously been sexually victimized.
Risk factors
Many explanations of child sexual abuse have been advanced. Social
factors such as lack of opportunity; parent-related factors including
background, social position, as well as personality and character
traits; child-related factors such as handicaps, behavior and
appearance; and situational factors including relations between parents,
social isolation and family conflict have all been suggested as possible
causes. Many of these suggested factors have not yet been investigated
empirically or have not been supported by findings. Specifically, social
class and social isolation of the family have so far been found to be
unrelated to child sexual abuse.
On the other hand, several risk factors have been identified. Females between the ages of eight and twelve seem to be at the highest risk. Children who are relatively isolated from siblings and friends appear also to be at particular risk. Finally, parent-related factors have been shown to be important:
Girls who are victimized are (1) more likely to have lived without their natural fathers; (2) more likely to have mothers who were employed outside the home; (3) more likely to have mothers who were disabled or ill; (4) more likely to witness conflict between their parents; and (5) more likely to report a poor relationship with one of their parents. Girls who lived with stepfathers were also at increased risk for abuse (Finkelhor, 1986,79).
The effects of sexual abuse
A range of short and long-term effects have been associated with child
sexual abuse. Some effects have been described in the clinical
literature while others are found in empirical studies. Since the late
seventies mental health workers have been finding that “a large number
of their female patients in unselected clinical populations had
experienced sexual assault as children, and that those assaults were
often causally related to later clinical problems” (Bagley, 1984,16). As
well, studies of runaway children, juvenile prostitutes, drug and
substance abusers, and adult rape victims have revealed that as many as
one half of the females in these populations have been the victims of
child sexual assault.
Child victims of sexual abuse suffer physical effects such as venereal disease and pregnancy. In addition, many are tormented by feelings of fear, guilt and shame and become depressed. Frequently their ability to form or maintain relationships with peers and adults becomes impaired. As adults the victims of child sexual abuse exhibit about twice as much mental health impairment as their non-victimized counterparts (Finkelhor, 1986). Specific effects include depression, anxiety, sleep problems, eating disturbances, sexual adjustment problems, low self-esteem, and difficulties in relating.
The severity of these adverse effects varies with the individual and with the circumstances of the abuse. In general, the following circumstances tend to increase the trauma: a long-lasting experience; multiple incidents; the abuser is the father or stepfather; the use of force. One problem in helping victims overcome these adverse effects is that many incidents of sexual abuse are not reported. A major study in Canada (Badgley, 1984) has shown that only 41 percent of female and 26 percent of male victims report the assault. It is likely that a majority of those who do not report the assault do not receive any help with problems which may result. If the rate of timely reporting could be increased, early help could be provided to more victims, thus reducing the overall impact of child sexual abuse.
Some implications for child care work
The findings summarized above strongly imply that many young people
residing in group care settings have been the victims of child sexual
abuse. It is also suggested by the research that in the case of a
majority of victims the abuse has not been reported but nevertheless has
an ongoing impact on the young person's behavioral or emotional
functioning. As the problems which result in group care placement are
often described in tertns of emotional or behavioral functioning,
residential programs need to develop the capacity to help young people
who have been the victims of sexual abuse. Several strategies for doing
so are presented below.
Facilitating disclosure
Unless a young person discloses that he or she has been abused sexually,
efforts to provide services may fall far short of the mark or miss the
target entirely. Indeed, the results of such misdirected helping efforts
may be ultimately harmful to the child as would be the case when
successful reconciliation of the family results in retuming the child to
an abusive situation. Group care programs thus need to give priority to
creating a milieu which will help those children who have been sexually
abused to disclose such history.
In this regard, the quality of the overall environment is important. The program should convey an atmosphere of caring and warmth and provide ample opportunities for the development of a trusting relationship between workers and children. An important norm which should prevail in the program is that “it is possible to talk about difficult things here.” Child care workers need to be alert to subtle clues and indirect messages from children, especially children who have one or several of the risk factors listed above in their background. It is important that workers have well developed interviewing and counselling skills and are knowledgeable about child sexual abuse so that when a child is ready to share information, they are able to respond in a sensitive and skillful manner.
Once disclosure has taken place, child care workers should communicate an understanding that disclosure of this problem may put the child in a very difficult situation with members of the family. It is important to remain supportive of the young person and to convey hope that things can be worked out and relationships can be reestablished. It may be tempting to begin to gather specific information but workers should not lose sight of the fact that from a helping perspective only information relevant is that which can be helpful to the victim in working through the difficulties created by the disclosure.
Finally, child care staff should avoid creating a situation in which too much attention is being paid to the victim. Disclosure often attracts much staff attention and consequently the young person may begin to feel special and different from other residents. This is counterproductive because one of the goals of helping should be to help the child recognize that she is not unique; that, sadly, many young people are sexually abused.
Working through feelings and improving
self-concept
As has been noted, victims of child sexual abuse are often left with
feelings of anger, fear, shame and guilt. It is also possible that their
sense of self-esteem will be impaired. Also, many young people consider
themselves to be responsible for the abuse and see themselves as unique
and different from other children. Finally, the disclosure itself may
create feelings of disloyalty and confusion. Many clinical workers
believe that these feelings and perspectives are related to problems in
behavioral and emotional functioning. Thus a key goal is to help the
young victim resolve some of the feelings and to assist them in
developing more realistic perspectives on the abuse.
Residential settings would seem to be ideally suited to accomplish some of this work. In child care work much effort is directed towards helping children to work through their feelings and to develop more constructive perspectives on their problems, regardless of the specific nature of the problem. These same goals are important in work with sexually abused children. To the extent that workers can feel comfortable with an emotionally laden issue such as sexual abuse, commonly used child care intervention skills can be of considerable help.
In addition, children's groups may be a particularly useful modality for helping. Group work has been reported to be effective with non-residential populations (Blick and Porter, 1982) and since most residential programs will probably serve several abuse victims at any one time, formal groups can be readily established. Such groups can help members see that they are not unique or responsible and can also provide the opportunity to express and work through commonly held problematic feelings such as anger or fear. In addition, groups can provide considerable support for members, both in-group and outside. Child care workers will find a variety of techniques useful for leading groups for the sexually abused: discussion, role-play, information sharing, expressive artwork and journal keeping are among the more obvious possibilities.
Improving the ability to relate
It was noted above that difficulties in forming relationships are among
the serious effects of child sexual abuse. For young people in group
care this problem will manifest itself as isolation from peers and lack
of trust for adults.
Isolation from peers may be reduced through some of the group techniques described above. These can help the victim see that she is not unique and can connect the young person to peers within a support network. Some of the normal activities and programs in the residence may also help to re-involve the abused child.
A lack of trust for adults can be particularly problematic in a residential program. Child care workers rely on their ability to develop trusting relationships with children as the basis for all their other efforts, but they must recognize that sexually abused children have suffered a betrayal of trust, usually from their previous care-giver. Male workers may face additional problems as the perpetrator is most likely to have been male and the victim may have generalized her feelings of anger and fear to all males. Yet relationships with males are important because they can provide the opportunity to work through issues. Such a relationship can be a bridge to being able to trust males again and it can also be a context of leaming appropriate ways of relating to males.
What can male staff members do to develop relationships with abuse victims? Some male workers recognize that they threaten the child too much and stay away from her thus allowing the child to relate primarily to female workers. While it is important to be sensitive to the feelings which the victim may have towards males, male workers should not fall into the trap of avoiding her. Instead, they should attempt to create a common ground for relating. One way of accomplishing this is by talking about trust in general and later moving to a more personalized discussion of trust. For example, an invitation to “tell me why it’s hard for you to trust me,” can open the door to an effective and constructive exchange.
Female workers may be faced with a different dilemma. Many children hold the view that their mother has condoned the abuse or, at least, has failed in her responsibilities to protect the child. At the same time, the disclosure usually creates a great problem for the mother, putting her in a situation where she has to choose, if only temporarily, between husband and child. All this puts a strain on the mother-daughter relationship. As a result, many victims report that they feel distanced from their mother. Children may attempt to pull female workers into this vacuum and workers, out of a sense of protectiveness, may indeed be disposed toward filling the role. However, this is not very functional. While it is important to provide the support and caring which the young person may need, it is more useful if the worker can develop for herself the role of a facilitator who attempts to effect a reconciliation between child and mother. ln the long run, reconciliation can be of considerable benefit to the victim.
Other tasks
These research findings have many other implications for child care. Due
to limitations of space they cannot be elaborated here but a few will be
mentioned. Because victims of sexual abuse are at increased risk for
further sexual assault (although not necessarily by the same
perpetrator), teaching assertiveness skills and providing information
about community resources can be useful preventive measures. Also, many
victims are confused about the sexual aspects of relationships.
Providing information about human sexuality and ensuring that there are
opportunities to consider and discuss relevant issues can help to
overcome this confusion. All of the services suggested here could be
provided within the context of a well-designed life-skills program.
Consideration should be given to making such a program available not
only to sexual abuse victims but to all children in residence as a
standard part of the agency program.
Finally, modern child care work often involves the worker with members of other professions who are also providing services to the children or their families. Interdisciplinary involvement is almost certain to characterize cases involving child sexual abuse. While such efforts can benefit the child by making specialized services available to her and her family, a danger exists that a lack of coordination may lead to confused and fragmented services. Although some communities have developed child abuse coordinating services, it is just as likely that no one will be formally assigned coordinating responsibilities. In such situations, child care workers need to assume a coordinating role to help ensure that the various professional participants form an effective team. Child care workers are often diffident in undertaking such responsibilities but because they are in the closest contact with the child they have the best functional position to coordinate and to monitor the effects of the multiple interventions. Assuming this role should not pose a serious problem as many child care workers now hold case management responsibilities within their agency.
Concluding comments
Research efforts in child sexual abuse are now yielding information
which offers clues to providing effective services. This paper
considered some of the implications of these findings for child care.
Undoubtedly many child care agencies are incorporating these research
fmdings through program innovation and modification, hoping to better
serve the large numbers of sexually abused children in their care.
Unfortunately very few program developments
have been documented in the child care literature. In spite of the fact
that child care is highly involved with sexually abused children, the
field has to rely on research conducted in other settings by members of
other professions. The problem with this is that approaches which are
shown to be useful in other fields may not be as effective in child
care. At the same time, potentially more effective approaches remain
unknown and thus largely ignored within the field. Child care needs to
develop its own interventions and programs for serving sexually abused
children. A good place to start would be to begin describing promising
approaches in child care joumals. A second step would be to evaluate
such services. Finally, it would be useful if some of the empirical
research which is being carried out on sexual abuse were conducted in
child care settings. Such efforts would help to ensure that child care
is providing the most effective services possible to victims of child
sexual abuse.
References
Badgely, R. et. al. (1984). Report of the committee on sexual offenses against children. Ottawa. Govemment of Canada.
Badley, C. (1984). Child sexual abuse: A child welfare perspective. Unpublished paper.
Blick, L.C. and Porter, F.S. (1982) Group therapy with female adolescent incest victims. In S. Sgroi, Handbook of clinical intervention in sexual abuse. Lexington, MA. Lexington Books.
Finkelhor, D. (1979). Sexually victimized children. New York. Free Press.
Finkelhor, D. (1986). Sourcebook on child sexual abuse. Beverly Hills. Sage Publications.
Young, L. (1985). Adjustment in adoption. Unpublished Master’s Thesis, The University of Calgary.
Selected bibliography
Forward, S. and Buck, C. (1981). Betrayal of innocence: Incest and its devastations. London. Penguin Books.
Frude, N. (1982). The sexual nature of sexual abuse: A review of the literature. Child Abuse and Neglect, 6. pp. 211-223.
Finkelhor, D. (1984). Child sexual abuse: New theory and research. New York. Free Press.
Giaretto, H. (1982). A comprehensive child sexual abuse treatment program. Child Abuse and Neglect, 6. pp. 263-278.
Herman, J. (1981). Father-daughter incest. Cambridge, MA. Harvard University Press.
Herman, J. and Birschman, L. (1981). Families at risk for father-daughter incest. American Journal of Psychiatry, 138. pp. 967-970.
Jehu, D. and Gazan, M. (1983). Psychosocial adjustment of women who were sexually victimized in childhood or adolescence. Canadian Journal of Community Mental Health, 2. pp. 71-81.
Sgroi, S. (1982). Handbook of clinical intervention in child sexual abuse. Lexington, MA. Lexington Books.
Silbert, M. and Piven, A. (1981). Sexual abuse as an antecedent to prostitution. Child Abuse and Neglect, 5. pp. 407-411.
Wyatt, G.E. and Peters, S.D. (1986). Issues in the definition of child sexual abuse in prevalence research. Child Abuse and Neglect, 9. pp. 507-519.
This feature: Gabor, P. (1988). Recent research on child sexual abuse: Implications for child care work. Journal of Child Care. Special issue. pp. 41-48.
