Child Sexual Abuse : A Victim-Centered Approach

by Child Welfare Information Gateway

(Page 5 of 5)

Professionals often feel pulled in several directions in their work on child sexual abuse cases. Although most professionals want to help the victim, potentially competing concerns include the feeling that sex offenders should be punished, a concern that the offender may be dangerous to others, a belief that sexual abuse is a mental health problem, a concern about the impact of disclosure upon the mother, a belief that the mother is partly responsible for the abuse, an awareness of the effect of sexual abuse and intervention on nonvictim siblings, and a feeling that everyone in the family needs help.

Taking a victim-centered approach is a way of dealing with conflicting goals in sexual abuse intervention. A victim-centered approach is one in which considerations of what is in the victim's best interest override competing concerns.

What is in the victim's best interest? That may vary depending on the case, and it may not always be easily discernible. Ascertaining the victim's best interest usually begins by finding out what the victim wants to happen, the older the child the more weight given to the victim's wishes. Does she want to be removed from the home or have the offender removed? Does she want the offender to be prosecuted or to get some help? Of course, there are times when what the victim wants is not in her best interest, because it risks her safety or psychological well-being. In such cases, the child's best interest should be pursued, but with a developmentally appropriate explanation to the child about why her wishes cannot be granted.

The Potential Iatrogenic Effects of Intervention

For some time professionals have been concerned with iatrogenic or system-induced trauma. One of the reasons that pursuit of the victim's best interest is so important is that a fundamental trauma resulting from sexual abuse is a sense of powerlessness. The victim's body is used by the offender for his gratification; the child is psychologically intimidated by the offender into cooperation with the sexual activity; and the child may be compelled by the offender to keep the sexual abuse a secret. Additionally, out of concern for the impact of disclosure on the family, the victim may feel forced not to disclose or that the consequences of disclosure may be worse than the abuse itself.

The complaint of many victims is that when the sexual abuse is discovered, things get worse rather than better because their lives continue to be controlled by others, and they experience all sorts of additional traumas. These may be repeated, insensitive, and humiliating interviews; a frightening medical exam; a confrontation involving the perpetrator or the victim's family; an unpleasant placement experience; treatment that the child finds unhelpful or traumatic; and court testimony. Often the most problematic aspects of intervention are not knowing what is going to happen and having no say in decisions. It is important that the intervention not exacerbate the child's sense of powerlessness.

Strategies for Minimizing the Trauma of Investigation

There are some fairly universally accepted strategies for diminishing the trauma of investigations of child sexual abuse. The interview process can be made less problematic. First, the number of interviews can be minimized, either by videotaping investigative interviews, having professionals who need to hear the child's account behind a one-way mirror, or having more than one professional in the room, usually with one asking the questions. Second, the use of a skilled and sensitive interviewer can minimize the negative effect of disclosure and even make it a cathartic or empowering experience. Third, allowing a support person to be with the child during part or all of the interview can diminish its traumatic impact. Fourth, conducting the interview in a facility that is private and designed to create comfort can be helpful. The potentially iatrogenic effects of the medical exam can be decreased by obtaining the child's consent to the exam and by using a skilled and sensitive health professional. That person explains that the purpose of the exam is to ensure that the child is "ok;" usually does a complete physical, not just a genital exam, and both informs the child, at each step of the exam, what will happen next and allows the child some control over the process. If the child is resistant to the exam, even when properly undertaken, then serious consideration should be given to not doing it. If it is deemed medically necessary, it might be rescheduled, when the child is less upset, or it might be done under anesthesia.

Children should not be subjected to polygraph exams during the course of investigation. Subjecting children to polygraphs gives the message that they are not to be believed and must "prove" themselves. The efficacy of polygraphs has not even been established for adults, let alone for children.

Strategies for Ensuring That Intervention Is in the Victim's Best Interest

When an investigation substantiates child sexual abuse, professionals must decide what to do. Basic issues for the child are safety and rehabilitation. In addition, decisions about the use of the courts to protect the child and to prosecute the offender impinge heavily on the child's well-being. Related to these issues are questions about family separation. Does the family remain intact, does the offender leave, or is the child removed? Professionals agree that it is preferable to remove incest offenders from the home. However, there are cases in which, to protect the child, to prevent her/his psychological abuse, or to relieve the victim of the experience of family turmoil, the child needs to be placed outside the family. If the family has been separated, the question of family reunification has to be addressed.

There are two basic strategies that can enhance the probability that case decisions will be made in the child's best interest. The first has already been mentioned: the child should be asked what she/he wants. Second, case decisions should be preceded by a careful assessment and should be made in consultation with a multidisciplinary team, whenever feasible.

About the Author

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Formerly the National Clearinghouse on Child Abuse and Neglect Information and the National Adoption Information Clearinghouse, Child Welfare Information Gateway provides access to information and resources to help protect children and strengthen families. A service of the Children's Bureau, Administration for Children and Families, U.S. Department of Health and Human Services.