“Young girls like me – we just need some help to move forward” : a trauma-informed approach to supporting sexually abused children

Abstract

The research question addressed in this thesis asked what the minimum requirements are within a supportive relationship which give it the potential to enable children who have been harmed through child sexual abuse and exploitation (CSA/E) in the UK to recover. The aim was to give local health and social care commissioners the confidence to commission CSA/E recovery services thereby reducing the scarcity of such therapeutic support in the UK; and, as part of this, to bridge a perceived gap between child and adolescent mental health (CAMHS) and voluntary and community sector (VCS) CSA/E recovery services. The fieldwork methodology was qualitative and approached from the perspective of hermeneutic phenomenology. Preparation included a scoping exercise to identify the issues and the mainstream positions relating to CSA/E recovery services in the UK. It focused on: 1) the prevalence of CSA and CSE, the context of UK national CSA/E service provision and local strategies supporting the commissioning of CSA/E recovery services for children; 2) trauma, multiple trauma, CSA/E and the impact of CSA/E, and 3) the development of mainstream therapeutic approaches to recovery from trauma. Results from the latter were used to inform a conceptual framework of minimum requirements needed for a supportive relationship to be effective in helping children to recover following CSA/E. The requirements were deconstructed into practical activities which were then consulted on with 15 children, their specialist CSA/E service keyworkers and social workers; and their management/service commissioners (36 participants). The fieldwork was carried out with three local authorities and a commissioned VCS organisation. A post-fieldwork scoping exercise was then undertaken exploring VCS CSA/E service practice more generally, to understand whether the requirements identified in the fieldwork services, were replicated in the VCS sector. From the research findings four key themes emerged. The first of these was that the minimum requirements for a supportive relationship appear to be identifiable, effective and potentially generalizable. Furthermore, CSA/E recovery services could be commissioned from the VCS because they are based on the same established psychotherapeutic knowledge base as CAMHS (and the VCS CSA/E services are already supporting children with CAMHS Tiers 2 and in some cases Tier 3 levels of need). The second of the key themes was that to be optimally effective and sustainable social pedagogic and strengths-based CSA/E recovery services need a whole service/organisation and multi-agency approach – to support children’s recovery and avoid staff burnout. The third key theme was that CSA/E recovery services can only be successful if they recognise that service users may have multiple traumas; and look to respond to early childhood CSA to minimise revictimisation. The fourth key theme was that failure to maintain a child’s educational achievement following CSA/E is a serious concern, in view of the potential life changing consequences of becoming an adult without the basic academic qualifications which support access to the workplace and further training. Finally, the publication and prioritisation of a CSA strategy by senior management in local areas is needed, to assist promotion of an effective local response to CSA/E and address some of the gaps in local service provision, including in particular, those highlighted in the four key themes. These conclusions might be summarised by a Theory of Change; in which the stakeholders are the keyworker and the child. The change is from the state of trauma at point of referral to being ‘on the road to recovery’. The activity is: creating for the child the experience of ‘being in relationship’ and the experience of ‘achievement’. The principle enablers (resources) needed to achieve the change are: an appropriately skilled practitioner and a sufficient time period to consolidate the change. The intermediate output/outcome is: the establishment of a relationship of good quality and appropriate length. The final goal is: the positive relationship and achievement experiences which the child takes into her future – as the essential cornerstone on which a lifetime of recovery can be built. Prompted by the research findings listed above, and others, the five suggestions for further research are to explore: 1) the findings with a larger sample to enhance confidence in their generalisability; 2) how to ensure that children who are victims or survivors of CSA/E in their early (or pre-pubescent) childhoods are identified and provided with the appropriate support when the abuse occurs; 3) how to ensure that children who are victims/survivors of CSA/E are supported to complete their education; 4) ways of significantly improving victims/survivors’ sense of safety in their environments and associative lives; and 5) how services and organisations can better contain or support frontline staff in order to sustain high quality, effective CSA/E recovery services.