SEXUAL ABUSE OF CHILDREN

By sexual abuse of children, we mean:
•A sexual act the child is not mature enough for, cannot understand, and cannot give informed consent to.
•The act violates the child’s integrity.
•The act can occur both within and without the family.
•The adult exploits the child’s dependence or the adult’s own position of power.
•The act is based on the needs of the adult.
•The activity breaks social taboos, or is illegal.
•Children (and youth) are defined as up to 16 years of age.

This definition has its basis in the relation between children and adults, but sexual abuse can also happen between children and youth of the same age, or between children and youth of different ages. As many adult abusers begin their “career” at a young age it is important to include sexual activity between children and adults where pressure, trickery, threats and violence has been used (sexual assault against children, a guide for support, published by the Norwegian Directorate for Health and Social Affairs in collaboration with the Department of Children and Families 2003).
Actions in the case of sexual assault against children will, in most cases, necessitate several services working together, such as child welfare services, police, and the services for special health. Securing the protection of the child against new assaults will be a prioritised goal both in the immediate phase, and in further actions. The child welfare services will have a central role, possibly also with the police. In many municipalities, there are currently interdisciplinary teams for consultation, who can assist with the procedure and coordination when revealed, as well as further relief measures. There is a stipulation that the local crisis team coordinate their effort with consultation teams, child welfare services, police, and other assistance services. For a review of the role of different services when there is a case of sexual assault against children, see “Sexual assault against children, a guide for support”.
In Bergen and Hamar they have established Children’s house where all measures around questioning, examination, and planning of relief measures is under the same roof. The Children’s houses are organised with the department of Justice, and is in connection with legal practitioners, psychologists, as well as child welfare and medical personnel. They also accept inquires about counselling to other services and private citizens.

1.    The mobilisation phase

Objectives: To learn about and secure contact with those in need of psychosocial follow-up after sexual assault against a child.
Measures: The objectives can be reached through clear, written routines for offering the victim, next of kin, the perpetrator and their next of kin contact with the crisis team, possibly also having particular follow-up measures within the services for special health.

Notification:
•The responsible person in the crisis team can for example be the community nurse, psychiatric nurse, or a psychologist. In some cases, members of the crisis team will also have to be participants in the municipal consultation team for violence and sexual assault. It would be natural for the person in question to involve the crisis team when necessary, and that they coordinate the further actions of the other assistance services.
•The leader of the crisis team will inform the consultation team, if there is one in place, about the help the crisis team can give and makes sure that this is passed on to those involved.
•If the involved agree to it, the responsible person in the crisis team will contact the people it concerns.
Target groups for follow-up:
•The victim of assault
•Parents and other relatives, especially note children
•The perpetrator and the perpetrator’s next of kin.

2.    The emergency phase

Objectives: Soften the immediate reaction and limit the feeling of loss of control by reducing stress. When there is a sexual assault within the family, the entire family system will be in crisis, and the parents (in cases where the assault was not perpetrated by them) will need support and assistance to attend to the care for, and support of, the child. The perpetrator’s family will also be in a crisis, and will be in need of information, support, and guidance. If both the victim and the perpetrator are members of the same family (for instance when the assault is from siblings) there will be a particular need for support, advice, and guidance.
Measures: Ensure emotional first aid through care, information about case procedures, reactions and handling of reactions. Make sure to give an overview through gathering information from the various services involved, coordinate the relief effort, protect the people involved and create a calm environment.

Coordination and responsibilities:
•Clarify who will coordinate and lead the follow-up. In many cases about sexual assault against children, it would make sense for the child welfare services to coordinate and lead the follow-up. In some cases, it would be natural for the child welfare services to lead and coordinate the assistance for the victim, while the crisis team leads and coordinates the assistance for the perpetrator’s family.
•In cases where the child welfare services have deemed it necessary to remove the child from the family, it could be necessary for the crisis team to take the responsibility for the follow-up of the family.
•In all cases involving assault against children, it is important to coordinate measures for assistance in the case of any criminal investigation: Police, Children’s houses or consultation team can provide advice about this.

Method:
•Direct, in the form of conversation with the involved to map the need for measures of assistance. Information about procedure and a review of the course of events from the time any suspicion arose, through the discovery and it being reported can be important. Advice and support conversations can also be important.
•Indirect, in the form of advice and information to the school and workplace.
•Help to inform, possibly mobilise the social network

Measures for the child:
Information about what is happening and what is going to happen in the future regarding questioning, examination of the child, and with the perpetrator (in most cases it would make sense for this to be taken care of by the child welfare services or the Children’s house). For specific advice about the information and conversations with children, see the collection of articles Conversations with young children in cases of the children’s law, published by the Ministry of Children and Equality.
•When necessary: Possibly accompanying to questioning and examination if the next of kin cannot, this is coordinated in most cases with child welfare services, but in some cases it might be more practical for other assistance services do it.
•Information and clarification that assault is always the responsibility of the adult.
•Information about normal reaction and what can help in the event of recurring thoughts, nightmares and anxieties (see reactions and methods of self-help).
•What information is given will depend on the situation, whether the perpetrator is closely related, whether the parents are able to take care of and protect the child moving forward. When father or stepfather is the perpetrator it might be necessary for the mother and child to move out to protect the child, in some cases to a crisis centre (see conversation guide for children at the crisis centre). In some cases, the child might experience that the parent who did not perpetrate the assault does not believe them. In these cases, it is especially important for the child to be followed-up closely, among other things, being given information about why adults might sometimes choose not to believe their child in these situations.
•Help to keep the daily routines and social connection with school, hobbies and friends, even if the child is moved out of the family.

Measures for next of kin:
•Information about further treatment and probable investigation and examination, as well as support and guidance to inform the child about this.
•In cases of child rape: Counselling for parents with a view to support the child and give information about normal reactions for children who have been subject to assault.
•Guidance and help to take care of the child and talk to the child about what has happened.
•Support for the next of kin to accompany the child to examination and questioning.
•Guidance in taking care of the child and helping the child handle their own reactions.
•Help to handle their own reactions and regaining control. Especially if the assault has happened within the family, carers who were not involved in the assault might feel as if their whole world is crumbling. These people might need a lot of support and guidance to handle their own crisis reactions. It is important to give help rapidly to make the carer able to support and help the child. The carer’s ability to do this and to protect the child must constantly be evaluated.
•Guidance in reference to informing the school or nursery about what has happened, as well as help to give this information.

Measures for the school/nursery:
•In some cases, school or nursery will be the place where the child first tells someone about assault, or it will be where the first suspicions of assault might arise. This can lead to reactions in the people who have been involved and with all the employees. An offer of assistance to school or nursery can be important. This assistance would be a review of the chain of events, routines for notification, and other routines with regard to suspicions and discovery of assault.
•Information about normal reactions to assault and consequences for the daily routines of the school/nursery.
•Advice with regard to educational plans for the exposed child/youth.
•In cases where the assault has happened between pupils, relevant measures would be: Advice, help to handle the event with information for the students, information for the parents, routines to make the victim safe and to protect them, as well as making sure the perpetrator receives help.
•When the perpetrator is an employee of the school, see the guide for Suspicion about employees’ sexual assault against children, guide for preparation of a plan for handling crises.

Time frame and transfer to further follow-up:
•The immediate emergency phase when the crisis team begin their measures is often ended after one week.
•If the municipality has a low population and has a small area, the crisis team’s professionals will do the follow-up, because the municipality often will not have many other professionals to draw on. The team will then create a plan for further follow-up of the family or the different people or groups involved.
•If the municipality has a high population and they live close together (for example cities), the crisis team will be in touch with professionals within the municipality who are responsible for the immediate area where the involved live. The crisis team will recommend the extent of further follow-up based on what measures have already been done or started with regard to the involved.
•Some central guiding criteria for who should specifically receive follow-up:
•    The victim.
•    The victim’s closest relatives (adults and children).
•    The perpetrator.
•Some central criteria which increase the need for further and more intensive follow-up:
•    When the perpetrator is a member of the family (effort has to be coordinated with child welfare services)
•    When it is apparent that adults are not able to fulfil their role as a carer, for instance toward minors or elderly and disabled.
•    When the family of the victim or the perpetrator’s next of kin has a bad/small social network.
•    When the victim/next of kin have had psychological problems previously, or has experienced painful losses.
•    The family of the perpetrator, with special focus on any children or youth.
•To secure as much stability as possible for the involved, the person from the crisis team who has had the most contact with the family should preferably be the contact for the individual/family, also in the later follow-up. This person should communicate closely with the general practitioner who will be central in the further follow-up of the individual person. Child protective services will in most cases be involved with regard to the children of the perpetrator (in cases where the perpetrator is not part of the family)
•The leader of the crisis team (or possibly another responsible person in the crisis team or the child welfare services) should have the responsibility to make sure later follow-up is started, and for any transference to other services.

3.    Further follow-up

Objectives: Give the victim of assault and his or her carers (and possibly perpetrator and perpetrator’s family) psychosocial help and support over time as they need it, so as to gradually reclaim their everyday life. Contribute to normalising thoughts, emotions and reaction as an important part of the processing of the events. Seek to keep the traumatic experience from developing into a mental or physical disease, or lead to difficulties for the involved, which make it hard to participate in work life, going to school, or have a social life.
Measures: The objectives are reached through clear written procedures for regular contact with the involved and by, with them, constantly evaluating the need for measures, further examination and possibly giving necessary help and support. Contact and offers to help should be there the first year after the assault, and for some involved, maybe even longer.

Coordination and responsibilities:
•The crisis team has to coordinate their measures with the person who has the coordination responsibility within child welfare services and the other assistance services.
•In cases of sexual assault the child/youth is often referred to the special health services, the same goes for young perpetrators. Because of this, it is important to coordinate help measures with these services, especially if the crisis team is going to follow-up with the families of the involved.

Work form:
•Directly, through support conversations and guidance for the victim and perpetrator’s families. Relevant topics may be: Thoughts of revenge, aggression towards the perpetrator, balance between protection and support for independence, information about normal reactions to increase the understanding for the child, guidance and advice to help the child further, preparation for questioning and court case, help to interpret the results of medical examinations. Later on, help to accept possible dismissal, acquittal (in the case of a court case) and continued support in the caring situation and daily tasks will be important.
•Indirectly, through counselling, information to school/nursery about further plans for the child/youth.

Measures for the child:
Support conversations with a focus on explaining reactions and help to handle reactions. Relevant topics may be: Division of blame and responsibilities, difficulties trusting others, taking care of one’s own integrity and security, the relationship to the family, relationship to friends and peers, sexuality and close relations.

Measures for the families:
•Evaluation depends on whether the assault happened within the family or without. In cases where the assault happened within the family, the focus will be on relations within the family, and protecting the child from the perpetrator.
•Other relevant topics may be:
•    Blame and the problematics of shame.
•    Thoughts of revenge and aggression.
•    Worry that other children might be involved.
•    The relationship of the perpetrator and the perpetrator’s family (to the victim and the victim’s family).
•    The relationship between the victim and the victim’s family (to the perpetrator and the perpetrator’s family).
•    Relationships within the family.

Measures within the local society:
In small, localised societies, assaults can excite strong reactions within the population, and strong reactions against the perpetrator and the perpetrator’s family may occur. This can create fronts on the victim or the perpetrator’s side, and it can split the whole society. It is important that the municipality has an active attitude to information with a focus on how the local society can help everyone involved move on together, without it being at the expense of confidentiality and professional secrecy. The same might be the case for parents at school when there has been an assault between pupils.

Duration of measures:
The contact between the victim, the victim’s family and the perpetrator’s family should frequently last through the first year after the discovery of the assault. An important criterion for ending the contact is that the involved feel they can participate in everyday life and hobbies without the reactions from the assault keeping them from participating and living their life.
•The follow-up will have a varied frequency depending on the need. One example may be: Support conversations weekly the first months, down to once per month, and after three months, depending on how well the involved is functioning and what they need. Throughout the contact with the involved, it is important to keep in mind the need for further referrals to special health services (see Mapping). This can possibly be followed up by the general practitioner in collaboration with the crisis team.
•If the involved express a lack of interest in contact, for example in the beginning or by one of the suggested contact points, one should respectfully withdraw, after having asked for permission to contact the individual at a later (given) time. If the involved does not wish for any further contact, a contact name and number for someone to get in touch with if they experience a need for help should be left with them. It is important to know that the family of both the victim and the perpetrator might not experience a need for follow-up until after a possible court case, or after the situation of the victim has started getting better.
•In case of signs of isolation or other forms of passivity, the actively reaching phase should continue past the first year.