Abuse or neglect: Talk to the children

Silje Braastad: Let's talk about it.

Dr Alfons Crijnen: real treatment is essential.

First-hand information form abuse victims is essential, trauma experts say

Talk to the children

Children who are traumatized by abuse or neglect should be listened and talked to directly by their doctors, psychologists and social workers. Child abuse experts – gathered in San Diego at the 2017 International Conference on Child and Family Maltreatment – seem to strongly agree on the importance of receiving first-hand information from young victims.

Social counselors Silje Braastad and Trine Norevik (Bergen, Norway) have presented their prevention programme Let’s talk about it at the San Diego Conference. Their SMISO care centre, originally equipped for survivors of sexual abuse, now is one of the leading organizations in Norway for preventative work at elementary schools. “Talking about sexual abuse appeared to be a sensitive thing in Norway. Teachers were uncomfortable about it, thought it might be damaging or that the parents would react… So, they asked us to do it”, says Braastad who is responsible for the implementation and teaching of Let’s talk about it. “The secretiveness around the subject is in itself is a problem. It protects the anonymity of the perpetrators, and the children have nowhere to go to. Not discussing sexual abuse is part of the cause – of the traumatic problems and of repetition of the abuse. Children do not talk about it, sometimes out of loyalty to the perpetrator, and often because they don’t have a language: how do you start, who do you trust?”

Good and bad adult behavior
The Norwegian programme is primarily educational – “It teaches them about good and bad adult behaviour, good and bad secrets, good and bad touching” – and if the counselors detect maltreatment, they will organize confidential disclosure talks with the children. “In a group of 25 children we usually find that an average of two to three children who have experienced unacceptable sexual behavior or abuse. Talking about these subjects in the group will help those who have experienced it to disclose. This way, we detect the abuse early and we hope to reduce the level of post traumatic symptoms”.

Safe relationship

“Talking to the children about abuse is most important, both in a preventive way and for disclosure of actual experiences of maltreatment. To be able to treat them, I need to have them talk to me directly”, says child psychiatrist Alfons Crijnen (Amsterdam, Netherlands). child psychiatrist with a special focus on children who have witnessed murder. “The safety of the relationship with their doctor or psychologist should be crystal clear to these children from the beginning. I always start by introducing myself and defining the relationship– Hi, I am doctor Crijnen – which mostly explains that they are in an environment where it is safe to talk.”

Kill the beast, save the child
San Diego experts appear to agree that the old credo of avoiding the explicit details in front of the children, is obsolete and counterproductive. Several San Diego workshops and lectures focus on how to talk to children, both for mental health practitioners and legal specialists and often focused on specific issues (view the abstracts below). Crijnen finds that well-operated forensic conversation does not have to be hurtful for a traumatized child, and could even be of therapeutic value. And furthermore, he is convinced that first-hand information from the young victims is indispensable for child psychiatrists. “I am pretty sure that deciding about a treatment based on a diagnostic report is not good enough and doctors will miss essential symptoms by not talking to the child themselves. His two-part lecture on Child and murder shows his strategy of Kill the beast, save the child: first create a sense of safety and then approach the child closely enough to allow real treatment such as EMDR. Crijnen: “Stabilizing the child by all kinds of psychosocial support services really is not enough. My case story shows me talking to a traumatized child that instantly moves from a state of frozen hypo-arousal to full hyper-arousal, facing the essence of its trauma. This may cause an enormous fatigue and backlash, but it also is the beginning of the cure: an acknowledgement of the what has been done to the child and a real relief.”

Interviewing children

Lecture by Thomas Lyon (University of Southern California) on Child interviewing, update on research and practice – M4

Child and Murder

Lecture by Dr Alfons Crijnen (Amsterdam, Netherlands) K15-d and P15-e

Abstract
What if a child witnessed the murder of his parents? Is a child able to speak about it? What if the child doesn't tell you anything – did it really see nothing? What if the child shares his experience with you—is this really helpful or will this be counterproductive? What if the child dares to confront itself with the recollection in therapy?
At the moment itself or in the months following the murder, therapists are confronted with these and other questions. Feelings of intense anxiety and anger are in the way of sorrow and grief; recollections are so overwhelming that they can't be shared; the life of the child is disorganised and there is often disturbed mourning.
In the professional treatment of children who witnessed the murder of their parent the following issues are recognized: disclosure and recognition, the management of stress and intense emotions, the development of psychopathology, the impact on the family, therapeutic interventions and treatment, and finally mourning.
In the workshop video clips of interviews of two 4- and 10-year-old children by a police officer directly after the murder and by a child and adolescent psychiatrist seeing the children for diagnosis and treatment at three months and three years after the murder will be shown. Theory and practice will be brought together and guidelines for treatment provided.

Let's talk about it

Lecture by Silje Vraastad and Trine Norevik (Bergen, Norway) on an educational programme for elementary school aged children.

Abstract
The Centre for Survivors of Incest and Sexual Abuse (SMISO Hordaland) is an organization that provides supportive counseling to survivors of incest and sexual abuse. Within its field, SMISO is also one of the leading agencies in Norway in conducting preventative work amongst school aged children.
Incest and sexual abuse are often rarely discussed issues, which in itself perpetuates the problem. Particularly in cases of incest, the perpetrator often relies on the secretive nature of the topic to facilitate the abuse. SMISO's intensions, therefore, are to empower children by providing a safe, professional and supportive forum where they are able to talk about topics that might otherwise be subjected to secrecy.
Since 2010 SMISO has successfully presented an educational program called, "Let's Talk About It" to Norwegian children between the ages of eleven and twelve (in the 6th grade).
Within a safe environment the educational program aims to:

Enhance children's knowledge about incest and sexual abuse.

Enhance their ability to recognize early signs of grooming and transboundary behavior,
Provide young children with the adequate skills to seek help if necessary.
Prevent transboundary behavior in adolescence

Description:

- Based on an open-ended dialog between children and professionals.
- Session duration: two hours.
- Topics covered: positive/negative touch and emotions, good/bad secrets, the body, private parts and sexuality, incest and sexual abuse,,substance abuse, domestic violence, physical and mental illness, children's rights, criminal offences and safe caregivers.

She says it didn't happen… Now what?

Lecture by Carrie Paschall (Dallas Children's Advocacy Center) – She Says It Didn't Happen…Now What?: When a Child Recants Sexual Abuse Allegations – G4.

Abstract
This presentation will discuss the risk factors that might be present in a case which could be indicative of a possible recant as well as potential ways to ensure both the physical and emotional protection of the child as well as immediate intervention services for both the child and the in an effort to prevent a recant in the first place. Presenter will also discuss ways for the MDT to evaluate the report of recantation to determine what to do next. Next, presenter will discuss when a second interview should occur, by whom and the adjustments that need to be made to traditional interview protocols in order to gather pertinent information.

Why the Color of the Underwear Matters

Lecture by Craig Smith (C.B. Smith Training, Canada) on Child sexual abuse interviews for the investigator — Why the Color of the Underwear Matters – L5

Abstract
There is a harsh truth within law enforcement and child protection circles; few people are anxious to investigate Child Sexual Abuse cases. Most investigators feel ill at ease with discussing sexual details with victims, witnesses or suspects. These uncomfortable details however are often the foundation upon which an officer must build a case.
The objective of this workshop is to provide investigators with interviewing strategies that can be used to elicit detailed information from both the child victim and in intrafamilial cases, from the non-offending parent. Invaluable, corroborative evidence that goes beyond the traditional search for torn clothing and seminal stains, is often present, if the investigator knows what to look for. Gathering precise details about the abuse, along with background information about the abuser, often leads to a successful interrogation of the suspect.The author is a Certified Forensic Chid Interviewer and this presentation is based upon his successful investigation of hundreds of Child Sexual Abuse files.