Creshonda Smith

: Examining Traumatic Issues and Trauma- Informed Interventions in Child Sexual Abuse Creshonda Smith 27 March 2013 The Ohio State University One definition of child sexual abuse currently being used defines it as a form of child abuse in which an adult or older adolescent uses a child for sexual stimulation. This can be a single event or series of events occurring in a child’s life. It is prevalent across cultures, social classes, and both sexes. Its ramifications are serious mental health problems for the victim including fear, anxiety, low self-esteem, and low mood. The effects also vary across age ranges. Sexual abuse in children is a worldwide concern. It is an insidious, persistent, and serious problem that, depending on the population studied and definition used, affects 2-62% of women and 3-16% of men as victims (Johnson, 2004). Pain and tissue injury from child sexual abuse can completely heal in time, but psychological and medical consequences can persist through adulthood. Associated sexually transmitted diseases (such as HIV) and suicide attempts can be fatal. All physicians who treat children should be aware of the manifestations and consequences of child sexual abuse, and should be familiar with normal and abnormal genital and anal anatomy of children (Johnson, 2004.). These children have lasting mental health problems that can turn into things such as sexualized behavior, unsuccessful intimate relationships, and despair/feelings of guilt (Johnson, 2004.). This is such an enormous problem because it impacts not only the child, but their families have to deal with the aftermath as well. The impact of child sexual abuse lasts into adulthood. There are four trauma-causing factors that a child experiences in the aftermath of sexual abuse. These factors are traumatic sexualization, betrayal, powerlessness, and stigmatization (Finkelhor & Browne, 2010). The aforementioned factors are not unique to sexual abuse, they also occur in other forms of trauma as well. But the conjunction of these four dynamics in one set of circumstances is what makes the trauma of sexual abuse unique, different from such childhood traumas as the divorce of a child’s parents or even being the victim of physical child abuse. These dynamics alter children’s cognitive and emotional orientation to the world, and create trauma by distorting children’s self-concept, worldview, and affective capacities (Finkelhor & Browne, 2010). For example, the dynamic of stigmatization distorts children’s sense of their own value and worth. The dynamic of powerlessness distorts children’s sense of their ability to control their lives. Children’s attempts to cope with the world through these distortions may result in some of the behavioral problems that are commonly noted in victims of child sexual abuse (Finkelhor & Browne, 2010). In regards to groups that are affected, it has been found that some groups have more frequent occurrences such as those in foster care, children with disabilities, and those who grow and develop in impoverished communities (L, D. E., & M, I. B., 2007). Children who are victims of sexual abuse recurrently are involved in disorganized families and may be somewhat socially deprived (L, D. E., & M, I. B., 2007). Many times these children are deemed as more susceptible because they are in an environment in which there are a lot of risk factors. For example, poverty, lack of communication amongst family members, social deprivation, developmental delays/disabilities, and also lack of resources (food, health care, transportation) contribute to the stress and pressure placed on families in underprivileged communities (L, D. E., & M, I. B., 2007). Solution Focused therapy is goal-directed and focuses solely on the future as opposed to the past. The goals of the intervention are solution building, positive goal development, identification of desired outcomes, and increasing the frequency of current useful behaviors. SFT builds on the client’s vision and determines what skills and resources are needed/available to achieve the desired outcome. Lastly, education is key throughout this entire process. This is especially true when dealing with an intervention that focuses so heavily on the future in an attempt to not have traumatic events repeat themselves. It is advantageous to use SFT because it is inexpensive; also, the amount of time to implement the strategies is shorter than other models. Solution-Focused Therapy is an up and coming model that has shown positive outcomes. In Solution-Focused Therapy, as previously mentioned, the main goal is for the therapist to work with the client to problem-solve in a way that helps them to achieve a more desirable future. The specific techniques implemented in Solution-Focused Therapy are typically a series of questions used at a particular stage in a client’s progress. For starters, there’s the “Miracle Question”. This question is asked during the initial session in an attempt to help the client to envision how the future will be different when the problem is no longer present. From here, there are “scaling questions” that are asked to help the client identify useful differences for the client and may help establish goals as well. Client will be asked to rate their current position, identify resources, exceptions, and a preferred future. Next, another technique that will be implemented in this process is “Exception-seeking” questions. These questions seek to explain to the client that there is always a time when the problem is less severe or absent. Questions such as “What did you do differently?” are asked in an attempt to have the client determine what they did that would cause the problem not to occur as it previously has. By doing this, the client is more likely to repeat what worked in the past and help gain confidence to improve the future. Lastly, there’s “coping questions”, which are questions designed to help the client realize other skills they may already have in place that are coping skills they may not recognize. Between the client developing new skills and realizing the things they may do already that serve as a skill, they can begin acquiring the necessary resources to improve their future. One technique in particular that is also used in Solution-Focused Therapy is “problem-free talk”. Problem-free talk is just used to discuss the clients values, strengths, and beliefs and other available resources. There is no specific questioning process or anything used in this technique, there is just informal speech in which the client is able to just talk openly and honestly. This method of talking will be used at the end of each session as a way to unwind, and again, to discuss the worksheets and how the client is doing that particular week. According to a systematic review on SFT, the majority of best evidence from this review shows improvements following SFBT intervention in: children’s externalizing behavior problems (for example, aggression, co-operation, truancy) and children’s internalizing problems (for example, shyness, anxiety, depression, self esteem, self-efficacy) (Cepukiene & Pakrosnis, 2010; Conoley et al., 2003; Corcoran & Stephenson, 2000; Emanuel, 2008). Further to this, there is some emerging evidence from one or two studies, in each of the following areas, that indicates SFBT’s effectiveness in: reducing recurrence of child maltreatment (Antle et al., 2009; Corcoran & Franklin, 1998); providing a supportive structure for first sessions with parents of children with learning disabilities and improved goal setting for families of children with behavior problems (Adams et al., 1991; Lloyd & Dallos, 2008). The objectives of the study were: 1. What is the evidence for the effectiveness of SFBT in relation to work with children and families? For what types of child and family problems is SFBT found to be most effective?; 2. What are the cost-benefits of SFBT in relation to work with children and families?; 3.What are the implications of the findings for the use of SFBT within the English context where children are considered to be suffering, or likely to suffer, significant harm? Also, there is a specific technique implemented in Solution Focused Therapy in which the counselor asks coping questions in order to better understand how the client copes and how they are able to overcome stressors (O'Connell, B., 2005). This is especially beneficial because I am aiming to increase the client’s coping skills in my evaluation proposal. Also, because one of the specific goals of the intervention is to increase the frequency of current useful behaviors, that further reinforces the goals of my logic model in regards to coping mechanisms and behaviors. Relevant theories from one article in particular for child sexual abuse and Solution-Focused therapy are that SFBT demonstrated small but positive treatment effects favoring an SFBT group on the outcome measures (d = 0.13 to 0.26). Only the magnitude of the effect for internalizing behavior problems was statistically significant at the p < .05 level, thereby indicating that the treatment effect for SFBT group is different than the control group. Conclusions were that this study allows social workers interested in solution-focused brief therapy to examine the empirical evidence quickly and with more definitive information (Kim, 2008). Also, another article stated that solution focused therapy has been highly successful in school settings in regards to mental health problems experienced by children and adolescents. It contains empirical support that follows 71 cases in which those students who were experiencing similar effects of child sexual abuse such as fear, anxiety, depression, and PTSD were shown to have better coping skills, sought more available resources and also they reported better results in symptom change as opposed to those students that hadn’t received solution focused therapy interventions. How the students were performing academically as well as socially were also taken into consideration. Most of the results were done through direct observations (Gingerich & Wabeke, 2001). Theories guiding these models are that therapy facilitates recovery. It is believed that the passage of time alone does not heal without the accompanying factor of therapy and some behaviors may not be able to be improved. In regards to weaknesses within the intervention, research has shown that there does need to be more conclusive evidence in regards to exactly how effective this treatment is but it has been shown to be effective overall. Further limitations include the ways in which child sexual abuse has been operationalized over time. Sexual Abuse is any incident of sexual contact involving a child that is inflicted or allowed to be inflicted by the person responsible for the child's care (Feather & Ronan, 2009). Also, sexual abuse of a child is inappropriately exposing or subjecting the child to sexual contact, activity, or behavior (Gingerich & Eisengart, 2000). Sexual abuse includes oral, anal, genital, buttock, and breast contact. It also includes the use of objects for vaginal or anal penetration, fondling, or sexual stimulation. This sexual activity may be with a boy or a girl and is done for the benefit of the offender. In addition, exploitation of a child for pornographic purposes, making a child available to others as a child prostitute, and stimulating a child with inappropriate solicitation, exhibitionism, and erotic material are also forms of sexual abuse. It was noted that having so many definitions for such a prevalent problem can be troublesome in the sense that it causes practitioners and others to sometimes do a disservice to their clients because of guidelines surrounding particular word usages and such. Also, it becomes more difficult to have outcomes that are measurable because there is so much focus on what exactly child sexual abuse is and what constitutes certain treatments. There are several reasons as to why a personal interest was taken with children who are sexually abused. As the literature and research has shown, there are such severe ramifications and trauma associated with sexual abuse for children, that it is imperative as social workers that we advocate on their behalf and spread awareness as well. These children have no control over their situations and therefore advocacy and education is key in addressing ways to combat the traumatic effects of sexual abuse. Also, each of us has interned within a school setting for the academic year. From middle school to high school we have each seen cases of child sexual abuse and the effects that it can have not only emotionally and mentally, but also on the student’s academic performance. Children who suffer traumatic effects from child sexual abuse often times exhibit externalizing and internalizing behaviors that serve as a hindrance to their learning process. These behaviors translate into disruptive behavioral problems in school. In addition to the aforementioned reasons, as social workers we believe it is important that we are aware of how to contest such a prevalent issue amongst our youth. It is key to take preventative measures to help youth be more conscious of what sexual abuse is in order to thwart its occurrence. Also, in the instance that it does take place, it is beneficial to have the knowledge of how to promote empowerment, build self-worth, and distribute information on healthy relationships with family and friends. Lastly, we have taken a personal interest in children who have experienced sexual abuse because we are currently implementing therapeutic techniques that have proven to be efficient with this population and issue. In addition to Solution-Focused Therapy, Trauma-focused cognitive behavioral therapy is another technique that has shown to be beneficial in developing coping skills after a child has been sexually abused (Feather, J. S., & Ronan K. R., 2009). We want to ensure that the interventions that we are using to help children are up to date, supported, and overall effective. References Feather, J. S., & Ronan K. R. (2009). Trauma-focused CBT with maltreated children: A clinic-based evaluation of a new treatment manual. Australian Psychologist, 44(3), 174-194. Doi: 10.1080/- Finkelhor, D., & Browne, A. (2010, March 24). THE TRAUMATIC IMPACT OF CHILD SEXUAL ABUSE: A Conceptualization - Finkelhor - 2010 - American Journal of Orthopsychiatry - Wiley Online Library. Wiley Online Library. Retrieved October 8, 2012, from http://onlinelibrary.wiley.com/doi/10.1111/j-.tb02703.x/abstract Gingerich, W. J. and Eisengart, S. (2000), Solution-Focused Brief Therapy: A Review of the Outcome Research. Family Process, 39: 477–498. doi: 10.1111/j-.x Gingerich, W. J., & Wabeke, T. (January 01, 2001). A Solution-Focused Approach to Mental Health Intervention in School Settings. Children & Schools, 23, 1, 33-47. Johnson, C. F. (January 01, 2004). Child sexual abuse. Lancet, 364, 9432, 31. L, D. E., & M, I. B. (January 01, 2007). The Problem of Trafficking in Women in Social Risk Groups. Sociological Research, 46, 1, 6-19. O'Connell, B. (2005). Solution-focused therapy. Sage Publications Limited.