Interventions and Prevention of Child sexual abuse

Introduction

The UN Children’s Fund mentioned in their released report that up to five percent of boys and up to 10 percent of girls in rich nations suffered from severe sexual abuse during their childhood on October 6, 2009. Up to three times that proportion experience some form of sexual abuse in industrialized countries and in general it is estimated that throughout the course of their childhood, five to 10 percent of girls and up to five percent of boys suffer penetrative sexual abuse which is the most serious form of sexual abuse.

This is one of the shocking news for the world as there are more than 1.8 billion children populations in the year 2010 all over the world and it means that around 0.18 billions of girls and 0.09 billions of boys are at risk of suffering penetrative sexual abuse all over the world.

But still accurate statistics on the prevalence of child and adolescent sexual abuse are difficult to collect because there is no universal definition for child sexual abuse and the problems are normally under-reported. Even though there is no accurate statistics, the child protection professionals as well as the mental health professionals noticed day by day that the child sexual abuse is common and is a also a serious problem nowadays.

Definition of Child and Sexual Abuse

In internet encyclopedia, the Wikepedia defined a child as any human being between the stages of birth and puberty. But still the legal definition of child generally refers to a minor, otherwise known as a person younger than the age of majority.(http://en.wikipedia.org/wiki/Child)

According to the United Nations Convention on the Rights of the Child (UNCRC), the Article number 1 stated that a child means every human being below the age of 18 years unless under the law applicable to the child, majority is attained earlier.(UNICEF)

There is no universal definition for sexual abuse but any abuse that is the dominant position of an adult that allows him or her to force or coerce a child into sexual activity is generally defined as sexual abuse.

Child sexual abuse includes masturbation, oral-genital contact, digital penetration, vaginal and anal intercourse and even fondling a child’s genitals. Sexual abuse is not only physical touch but also non-contact such as exposure, voyeurism, and child pornography are also included.

In this paper, I would like to identify the different components of “Child Sexual Abuse Accommodation Syndrome(Summit, 1983)” to one sexual abuse victims, 14 years old girl, who has been sexually abused by a 45 years old man when she was an age of 11 years old, from the country Myanmar.

The Child Sexual Abuse Accommodation syndrome (CSAAS), introduced by Roland Summit, M.D in 1983, is a simple and logical model to understand and accept the ways in which children react to sexual abuse.

The followings are the five most typical reactions of child sexual abuse victims which is defined by CSAAS:

Secrecy
Helplessness.
Entrapment and Accommodation.
Delayed, Conflicted And Unconvincing Disclosure.
Retraction.

In the case of Myanmar child sexual abuse victim, she manifests the “Secrecy” component of CSAAS as she wish to keep the abuse as a secret firstly. She might has many variety of reasons but the most prominent one is she is afraid of the abuser. We can also later notice that the abuser promised safety to this child if the child keeps it as a secret.

She also undergoes the process of “Helplessness” as she is emotionally immature and being a child of the rural village level, there is no proper social support system from the authority. These all trigger her to be in a dangerous situation. She has tried her best to protect herself but finally it fail, leading to believe that she is helpless at that time. We also observed that eventually she stop trying to protect herself and she might undergone dissociation process which is a way in which she survive abuse by escaping mentally while the abuse is happening. According to her re-telling of her experience, her mind and the body mind seems to separate during the abuse. She also mentioned that while her body is being hurt, she no longer feels anything and she believed that her mind manages to escape to a safe place. While she was in an Entrapment and Accommodation stage, she learns to accept her situation and survive. She eventually blames herself and believes that due to her fault, it was happened. Like her, almost all the sexually abused children employ defensive mechanisms such as dissociation or blocking out the memory in an attempt to accommodate to the abuse.

When the child protection case worker asks this girl to disclose abuse, she undergoes acute crisis which is also mentioned in the CSAAS, Delayed, Conflicted And Unconvincing Disclosure. As per the record of the case worker, we observed the initial disclosures with inconsistencies and anxiety. At that stage, the case worker noticed that the girl has used various defensive mechanisms to cope the abuse. Her memory is also fragment at that time and her perceptions are also altered and so the information that the case worker received is scattered and sparse.

After disclosure, she feels guilty, fear and feelings of betrayal or confusion which is also mentioned in the CSAAS under Retraction stage.

Even though, many text books mentioned that this is a “model” describing reactions and not an absolute but still one practical case that I encountered seems possess all these aspects of CSAAS.

Various intervention and prevention towards child sexual abuse
Intervention towards victims

There are many psychological treatment models which have been demonstrated that these contributed the positive benefits for child sexual abuse victims.

These include:

Individual psychotherapy
Group psychotherapy
Treatments involving the entire family

Individual psychotherapy treatment involves the child and a therapist meeting and it conducted for serials of sessions. This type of early individual psychotherapy treatment, if it is proper structured, trauma-focused, and also targets the specific symptoms of sexual abuse, the treatment is effective resulting in reducing the short-term and long-term psychological side effects of abuse. But the therapist should be a skilled social worker, psychologist or psychiatrist. This therapist must have specific training and experiences in working with child victims of sexual abuse. Different therapist use different techniques to handle and minimized the sexual abuse experience, to facilitate the normalization reactions, and to develop various adaptive and coping strategies towards depression, anxiety, and post traumatic disorder syndrome. Child friendly trauma-focused intervention such as play therapy, art therapy and cognitive-behavioral therapy are normally used for child sexual abuse.

Group-based psychotherapy is also used for group of sexual abuse victims and it is particularly powerful because they are exposed to other victims and feeling that they are not alone. This modality is also useful for helping child victims to receive the confident back by understand that people cannot simply identify them as a sexual abuse victim.

Treatment involving the entire family focus is to strengthen the relationship between parent-child order to help process the trauma healing and ultimately restoring the family functioning balance.

Intervention towards offenders

On the other hand, the offender of sexual abuse also needs to undergo the treatment. The goal of the treatment of sexual offenders is to minimize risk of re-offending. This is normally done by modifying various psychological factors such as cognitive, emotional, behavioral and environmental. These various modification methods support the offender to reduce the risk of desire, capacity, and opportunity to offend again. Relapse prevention which is a part of cognitive-behavioral therapies is also effective practically for reducing the recidivism rates. Treatment normally conducted in a group therapy and involves several weekly sessions. Adjunct treatments are also used when the offender did not respond well with standard group therapy. The emphasis of the Relapse prevention treatment is to help the offender to understand their pattern of offending so that they can identify themselves and can prevent them from re-offending.

Prevention

There are generally three levels of prevention i.e., primary, secondary, and tertiary prevention.

Primary preventions such as public awareness campaigns to the general population significantly prevent the occurrence of child sexual abuse.

Secondary preventions, such as child assault prevention programs and safety education taught to children in schools, towards high risk specific groups result in high prevention results from the occurrence of child sexual abuse. The aim of secondary preventions increase knowledge of sexual abuse, how to respond etc which all finally reduce child sexual abuse from occurring.

Tertiary preventions with the various psychotherapies for the victims of child sexual abuses help the victims to minimize the negative psychological short term and long term effects.

But the most challenging part of the prevention is the lack of adequate resources (man, material etc) and efficiency of the services. Adequate resources are needed not only for the treatment of victims but also for the prevention services to reach to every corner of the population.

Conclusion

Child sexual abuse becomes one of the social problems that affect individuals of all racial and socioeconomic backgrounds. By understanding the short-term and long-term psychological effects of sexual abuse victims, our social worker can come to understand more about how to provide the therapy towards the victims to provide normalization for their rest of the life. And also in the meantime, the therapy towards offenders can be one of the prevention methods. Furthermore, if the child-friendly legal system is available, it can also provide the child sexual abuse victim to minimize further helplessness, distress and preventing to get the trauma during the legal process.

Dominquez, R. Z., Nelke, C. F., & Perry, B. D. (2002). Encyclopedia of Crime and Punishment (Vol. 1): Sage Publications, Thousand Oaks http://en.wikipedia.org/wiki/Child.
Summit, R. C. (1983). Child Abuse & Neglect, 7, 177 – 193.
UNICEF. Implementation Hand Book for the Convention on the Rights of the Child.