On Wednesday 5 July 2015 the IICSA held a second day of seminars focusing first on the presentation and discussion of what can be gleaned from academic literature in respect of effective support services for child victims. This was by reference to a Rapid Evidence Assessment (“REA”) completed by Professor Lorraine Radford and her team at the University of Central Lancashire titled “What can be learnt from other jurisdictions about preventing and responding to child sexual abuse”.
Given the public nature of the inquiry, and concerns regarding re-traumatising young victims, the voice of child victims was represented by adult survivors and representatives from children’s charities such as the NSPCC and Barnardo’s. The panel acknowledged that although the IICSA to date has focused on historic CSA, the problem of child abuse, child sexual exploitation, human trafficking, online and peer on peer abuse are not historic issues and are being grappled with by the state and voluntary sectors today.
The key findings in respect of support for child victims specifically are:
- There are concerns regarding the levels of support provided by state services. The REA identified there to be a shortfall in the provision of therapeutic services of over 57,000 places, long waiting times and children having to travel many miles to access services. A Barnardo’s study found that a quarter of Children Safeguarding Boards in England were unable to implement the guidance on provision for children affected by child exploitation. The research noted that services focused upon disabled children and those from black and ethnic minorities were limited, some services contacted as part of the research having no experience of these groups. Other areas where focused support was lacking included online abuse and services for victims of trafficking and exploitation.
- The REA highlighted a campaign by ECPAT to introduce a guardianship system. The aim of the scheme is to assist victims by enabling a long term, trusted relationship to develop between victim and guardian, thereby facilitating better access to specialist support, advocacy services, and ensuring children do not go missing from care. Panel members drew the IICSA’s attention to the Scottish Guardianship scheme, which how shown positive outcomes with trafficked young people.
- Professor Radford highlighted the good work undertaken by the voluntary sector in supporting child victims, particularly Bernardo’s 4 A’s programmes and NSPCC Childline. In panel discussion, victims spoke of the difficulties they faced in persuading individuals within schools or social services that they were suffering abuse and for action to then be taken. Victims and survivors spoke of how they would have used Childline or similar services had these been available to them. The panel discussed the efficacy of a “drop box” system within schools, where children could place notes detailing any concerns in a box. Victims within the panel were sceptical of how useful these would be, particularly whether even a trained professional would be able to identify abuse from a handwritten note. The panel felt that trained and experienced professionals offering pastoral care within a school setting would be the most effective way of identifying concerns.
- The REA discussed the effectiveness of different therapeutic treatment programmes on the recovery of victims and survivors. The key messages from the research is that it cannot be assumed that therapy is in itself helpful and that although there is bias towards psychotherapist approaches there isn’t one single therapeutic approach which will meet all the needs of a particular child:
- Cognitive Behavioural Therapy (“CBT”),- The greatest area of research was in the area of CBT, studies finding that although CBT was superior to other treatment models, particularly with PTSD and behavioural problems, the effects of CBT were described as “moderate at best”. Research identified that FT-CBT, which combines supportive therapy with a psychodynamic element such as play or drama therapy was most effective. These alternative therapies offer children an outlet when they are unable to verbalise or engage with talking therapy. The panel and research highlighted that CBT was not appropriate for very young victims (under 5’s) and Lorraine Radford acknowledged that there was limited evidence regarding the efficacy of treatment for very young victims.
- Narrative Component in Therapy – studies examining the impact of adding a trauma narrative component to FT-CBT, where children are assisted to produce a detailed account of the sexual abuse experience, concluded that 8 sessions of intervention were effective in reducing a child’s abuse-related fear and general anxiety and ameliorating a parent’s abuse-specific distress.
- Other Therapeutic Approaches – Authors of an American study recommended that the introduction of animals (dogs) be considered, as they found that children who undertook therapy involving dogs showed significant decrease in anxiety, depression, anger and PTSD symptoms. The research also identified promising outcomes in the “Modular approach” which includes multifaceted interventions including CBT, relaxation, problem solving and relationship building and psychoeducational procedures for parents on coping and positive parenting. This model allows practitioners to choose which modules fit with the needs of a child and family. An example of the modular approach is the Hope for Families programme currently being empirically tested in the UK.
- The research highlighted that as abuse often occurs alongside other additional vulnerabilities, such as homelessness, poverty or drug dependency, a range of services will be required to meet these needs. Support offered will need to vary according to age and developmental stage; a teenage boy requiring different services than a young girl. In respect of delivery, the most promising models identified were those offering coordinated and co-located multi-sector teams, as illustrated by the University of Bedfordshire’s “hub and spoke model” which places experienced individuals throughout a geographical area, thereby spreading and building expertise.
The final session within the July research seminar series discussed the commissioning of support from a provider’s viewpoint, details of which are to follow in tomorrow’s blog post.
Written by Louise Roden, trainee solicitor at BLM