Tips on How to Assess Possible Sexual Abuse in the Preschool Age Child

Sexual abuse among children is not always talked about in many African families. This is taboo especially as it would expose the family to ridicule and embarrassment. This therefore makes the assessment of possible sexual abuse in a preschool age child a complex undertaking.

According to Walker there are two goals of assessing abuse in a preschool age child are:
1. To provide a sufficient amount of information from which to determine the child’s current emotional status so as to design a treatment plan if necessary.
2. To assess who did what to the child in order to provide future protection of the child." Not all mental health professionals agree with respect to the ‘correct’ procedure or technique.

When assessing sexual abuse among preschool age children the following four parts should be taken into consideration:
• Medical evaluation and diagnosis of the child;
• Psychological evaluation of the parents;
• Evaluation of the family dynamics and home life; and
• Developmental and psychological evaluation of the preschool age child.

Ideally the psychologists assessing possible sexual abuse in the preschool child should interview all members of the family, the babysitter, the preschool teacher, and any other persons who might have knowledge about the child and the family. The following key components should be covered prior to interviewing the child.
• The child’s personal history, including psycho-sexual development.
• The child’s family history.
• History of the child’s development.
• A list of persons having access to the child.
• A list of what the child calls each member of the family group, including pets.
• A list of what the child calls the genitals and elimination functions.
• An idea of the child’s daily routine activities.
• Observations of usual and unusual behaviors.
It is important for the child’s parents to be asked about their marital history, custody, visitation, and what limits they set on their own sexual behavior in the presence of the child victim.

When observing the young child and his or her respective parents, particularly if there is the possibility that allegations in the context of a custody dispute may be false can be very helpful. Custodial parents may protest vehemently, claiming it will traumatize the child and that the child has no relationship with the other parent or is terrified of him. Sometimes these concerns may be legitimate, whereas at other times they point to a parent trying to suppress certain information. The medical expert needs to weigh the risks against the benefits of observing the child with the alleged perpetrator when he is a family member.

Generally, the interview of the child for possible sexual abuse is divided into the following phases:
• establishing rapport and giving permission to talk;
• obtaining the history of abuse;
• probing for details and validating information;
• Closure.

In most cases, it is rare to get conclusive physical evidence of sexual child abuse in preschool children. As such, the medical practitioner has to base his or her judgment about the credibility of an accusation on statement, emotions, and behaviors of the child and the child’s family. There are two basic processes that a medical practitioner can follow during an interview and when assessing whether the alleged sexual abuse took place or getting the child to confirm the medical practitioner’s belief that the abuse indeed took place.

Medical practitioners who are interested in assessing whether abuse took place should try to use all means possible to avoid distortion of the interview data via unsuitable suggestion or undue influence. Generally, these professionals have to be much more nondirective in their approach to the interview. Medical practitioners interested in confirming that the abuse did take place are able to justify through the use of more disturbing methods. Some examples of methods used in an intrusive manner are leading questions and anatomically ‘correct’ dolls. It is worth noting that both of these methods have their own pros and cons.

Some experts have argued that the person assessing the child should know nothing about the alleged abuse before the interview with the child. Furthermore, such information will predispose the practitioner to ask certain types of questions which will ‘suggest’ certain types of responses from the child. In some cases, other experts contend that leading questions are necessary with preschool age children.
Similarly, while using anatomically correct dolls with alleged victims, it is suggested that the practitioner needs to present the dolls to the child victim of abuse and say, "let’s pretend that this is you.’ If the child does not name the adult dolls, the practitioner can say, ‘Let’s pretend that this is mommy’ (or daddy, or whoever), and suggest a situation, such as bedtime...Any information about where the sexual abuse took place or the suspected offender can be induced in the ‘let’s pretend’ situation".

Others have suggested that the child should not be given any directions about what to name the dolls or which situation to put them in. They contend that doing so might suggest wrong information to the child, which may misdirect the interview in one direction, and reduce the chances that some other type of abuse that the child victim has experienced will be exposed.

To conclude, one can say that with the current differences of opinion regarding the methodologically appropriate method to be used in a preschool child sexual abuse assessment probably the best advice for both the mental health and legal community is to videotape all interviews with the child.
Do realize how complex it is to Assess Possible Sexual Abuse in the Preschool Age Child

References
1. Children in need of care regulations, 2005
2. D. Schetky & A. Green, Child Sexual Abuse; A Handbook for Health Care And Legal Professionals 117 (1988).
3. L.E.A. Walker, Handbook On Sexual Abuse Of Children 175, 1988.
4. Schetky & Green, supra not 4 at 63-71 write that the objectives of a clinical evaluation for child sexual abuse are: (1) understanding the child and allegations in the context of family dynamics and the child’s development; (2) validating sexual abuse; (3) evaluating the need for treatment; (4) diagnosis; (5) assessing competency to testify; (6) preparing the child emotionally for the physical exam; and (7) developing and implementing disposition plans.
5. Haugaard & Reppucci, The Sexual Abuse Of Children A Comprehensive Guide To Current Knowledge And Intervention Strategies 156 (1988).
6. T. Musty, Preschool Children’s Erroneous Allegations Of Sexual Molestation, 148 American Journal Of Psychiatry, 1988.
7. L.E.A. Walker Supra Note 6..
8. Schetky & Green Supra Note 4 .

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Child Abuse Institutions

Child Abuse Institutions are more common nowadays..

In all countries around the world today, there is no empirical evidence that counters the assertion that institutionalised children are exposed to multiple disadvantages and are vulnerable to both physical and sexual abuse (Utting, 1997; Tolfree, 1995).

The problems associated with orphanhood have reached new psychological, social, economic and political dimensions. It is evident that orphans face a plethora of problems stemming from abuse by those who are supposed to protect them, such as their caregivers, religious leaders and even teachers. They face impoverishment, stigmatisation, isolation and rejection by members of society because of their HIV status (STPA, 1999). Some of the emerging problems from the implementation of the Orphan Care programme in Botswana include separation of orphan siblings between relatives for ulterior motives.

Relatives strive to have custody of orphans in order to access their monthly food basket and other benefits such clothing and toiletry. On the basis of these problems, the Government has been involved in extensive consultations with stakeholders to find ways of addressing the myriad problems faced by orphans and other vulnerable children. As a result the Government is developing Foster Care Regulations known as Children in Need of Care Regulations which will regulate and formalise the fostering of orphans. Some of the orphans can not be fostered by anybody because they are visibly showing signs and symptoms of AIDS and as such, residential care becomes the only option for such children.

A total of 189 countries, including Botswana, signed the United Nations Declaration of Commitment on HIV/AIDS in June 2001. This Declaration is particularly relevant to children growing up without families. Articles 65–67 of this Declaration spell out the obligations of states in relation to the care and protection of orphans and other children made vulnerable by HIV/AIDS. Article 65 spells out that by 2003, develop and by 2005 implement national policies and strategies to build and strengthen governmental, family and community capacities to provide a supportive environment for orphans and girls and boys infected and affected by HIV/AIDS. This include providing appropriate counselling and psychosocial support, ensuring their enrolment in school and access to shelter, good nutrition, health and social services on an equal basis with other children. Further more, to protect orphans and vulnerable children from all forms of abuse, violence, exploitation, discrimination, trafficking and loss of inheritance, as reflected under Article 66. The Declaration wants to ensure non-discrimination and full and equal enjoyment of all human rights through the promotion of an active and visible policy of de-stigmatisation of children orphaned and made vulnerable by HIV/AIDS as stated under Article 67.

Finally, the Declaration will pressurise the international community, especially donor countries, civil society, and the private sector, to complement effectively national programmes. These would also support programmes for children orphaned or made vulnerable by HIV/AIDS in the affected regions and in countries at high risk and to direct special assistance to sub-Saharan Africa.

References

Short Term Plan of Action (STPA) on the Care of Orphans in Botswana. Ministry of Local Government, Lands and Housing. 1999. Gaborone. Botswana.

Tolfree, D. K. (1995) Roofs and Roots: The Care of Separated Children in the Developing World. Aldershot. Arena.

Tolfree, D.K. (2003). Save the Children Sweden. Stockholm. Sweden.

Toynbee, B (1998) " Children of despair." The Guardian, 3 June, 22.

Triseliotis, J., Sellick, C. and Short, R. (1995) Foster Care. London: Batsford.

Female Genital Mutilation (FGM) Declared Inhuman, barbaric and degrading to the girl child

At the second Pan African Summit on Children(Africa Fit for Children Summit) in Egypt, Ministers responsible for children’s affairs declared female genital mutilation inhuman, barbaric and degrading to the girl child. As such, there was a call for action for it to be abolished forthwith. Some countries had reservations that this practice was culturally acceptable and that some communities would not easily accept its immediate abolishing.

The worst thing about FGM is that elderly women who have gone through this practice at an early childhood stage are the ones who administer the barbaric act of circumcising young girls. They don’t seem bothered and do not show any remorse because they want to fulfill the cultural obligations. It is believed that female circumcision is done on girls so that they could not experience sexual gratification. This is also done to please their male partners during sexual encounter.

Female genital mutilation is common in the eastern, central and West African countries. Some African countries have take steps towards elimination of FGM.

In the United Kingdom the Prohibition of Female Circumcision Act of 1985 makes female circumcision, excision or infibulation (female genital mutilation (FGM)) an offence, except on specific physical and mental health grounds.

Effects of FGM on children

Available medical evidence indicates that FGM causes harm to those who experience it. The cutting of the female organs is a painful experience to the girls undergoing this process. There are reports of excessive bleeding sometimes leading to death of victims. In the UK a local authority may exercise its powers under s.47 of the Children Act 1989 if it has reason to believe that a child is likely to be or has been the subject of FGM.

Interventions to combat FGM

Local agencies that have a responsibility of protecting children should be alert to the possibility of female circumcision among the ethnic minority communities known to practice it. In local areas where there are communities or individuals who traditionally practice FGM, the focus should focus on a preventive strategy involving community education.
Development partners such as UNICEF should assist countries to develop plans and strategies geared towards the elimination of FGM.

Children should be sensitized and empowered to be on alert and report any suspects who are involved in carrying out FGM to the authorities.

What are your feelings about FGM?

Learn about Child Abuse by Children and Young People

Work with children and young people who abuse others – including those who sexually abuse/offend – should recognize that such children are likely to have considerable needs themselves, and also that they may pose a significant risk of harm to other children.

Research has shown that children who abuse others may have suffered considerable disruption in their lives. They have been exposed to violence within the family, may have witnessed or been subject to physical or sexual abuse. They also have problems in their educational development, and may have committed other offences. Such children and young people are likely to be children in need. Some will in addition be suffering or at risk of significant harm, and may be in need of protection.

Children and young people who abuse others should be held responsible for their abusive behavior, whilst being identified and responded to in a way which meets their needs as well as protecting others.

Work with adult abusers has shown that many of them began committing abusing acts during childhood or adolescence. Furthermore it has been found that a significant number of them have been subjected to abuse themselves.

Early intervention with children and young people who abuse others may, therefore, play an important part in protecting the public by preventing the continuation or escalation of abusive behavior among them.

Three key principles should guide work with children and young people who abuse others: . there should be a co-ordinate approach on the part of youth justice, child welfare, education (including educational psychology) and health (including child and adolescent mental health) agencies;
. the needs of children and young people who abuse others should be considered separately from the needs of their victims; and
. an assessment should be carried out in each case, appreciating that these children may have considerable unmet developmental needs, as well as specific needs arising from their behavior.

In assessing a child or young person who abuses another, relevant considerations include: . the nature and extent of the abusive behaviors. In respect of sexual abuse, there are sometimes perceived to be difficulties in distinguishing between normal childhood sexual development and experimentation and sexually inappropriate or aggressive behavior.

Expert professional judgement may be needed, within the context of knowledge about normal child sexuality; . the context of the abusive behaviors; . the child’s development, and family and social circumstances; . needs for services, specifically focusing on the child’s harmful behavior as well as other significant needs; and the risks to self and others, including other children in the household, extended family, school, peer group or wider social network.

This risk is likely to be present unless: the opportunity to further abuse is ended, the young person has acknowledged the abusive behavior and accepted responsibility and there is agreement by the young abuser and his/her family to work with relevant agencies to address the problem.

Discover the Effects of Bullying in schools and other Child care institutions

Bullying is common in schools and other institutions of child care.

Bullying is defined as a deliberately hurtful behavior, usually repeated over a period of time, where it is difficult for those bullied to defend themselves. The three main types of bullying are:
• physical which involves hitting, kicking, theft etc.
• verbal which involves racist or homophobic remarks, threats, name calling etc.
• and finally emotional which involves isolating an individual from the activities and social acceptance of their peer group.

The damage inflicted by bullying is frequently underestimated but it can cause considerable distress to children. Subsequently, that affects their health and development or, at the extreme, causes them significant harm including self-harm which may even be suicidal. All settings in which children are provided with services such as schools or where children are living away from home such as child care institutions should have in place rigorously enforced anti-bullying strategies.

Children, particularly those living away from home, are also vulnerable to abuse by their own peers. Such abuse should always be taken as seriously as abuse perpetrated by an adult. It should be subject to the same child protection procedures as those applied in respect of any child who is suffering, or at risk of suffering significant harm from an adverse source.

A significant proportion of sexual abuses are committed by teenagers and, on some occasions, by younger children. People working in a residential setting need clear guidance and training to identify the difference between consenting and abusive, appropriate or exploitative peer relationships. They should not rule out some abusive sexual behaviors as ‘normal’ between young people and should not develop high thresholds before taking action.

Article 19 of the United Convention on the Rights of the Child provides that the government must do everything it can to protect children from parents and other people including other children who hurt them. As such, the government must try to protect children from all kinds of physical, emotional, verbal and mental violence, injury or abuse (including sexual abuse) and bad treatment.