Childhood Abuse and Trauma Assessment


Soap bubbles

Image via Wikipedia

Childhood Abuse and Trauma Assessment

©2008,2009 Kimberly M. Hartfield

Abstract

The goals of child trauma investigations include forensic and clinical assessments, which should be done by forensic interviewers. All psychological evaluators of abused children should be trained in assessment techniques, child development, child interviewing, forensic psychology, child memory issues, play/art therapy, and cultural diversity.  An important fact to remember is that one supportive person in the child’s social network improves the negative effects and stops the progression of the cycle of child abuse.

Childhood Abuse/Trauma Assessment

            The primary goals of childhood trauma assessment include forensic assessment, whenever a crime is involved and clinical assessment in every case.  Forensic goals in assessment of childhood trauma address questions of interest to a legal procedure.  Clinical Goals in assessment of childhood trauma attempt to identify problems in functioning along with an intervention plan.  Medical exams should be performed and documented in every case of abuse, to insure there is no enduring or permanent physical damage.  Both investigators and therapists must examine their own personal emotions and biases concerning child abuse, whenever investigating these types of cases.  Investigations should not be conducted by the child’s therapist, but rather a well trained forensic interviewer should conduct the investigation to minimize conflicting interests.  A familiar and structured interview technique should be used by the interviewer.  The interview should be recorded preferably by video tape to insure accurate behavioral body language is recorded, but at the very least, by audio tape with very detailed notes, describing any relevant behavioral observations.

The interviewer should be aware that preschool children are prone to fantasy/reality confusion.  The child’s ability to distinguish between truth and falsehood must be measured in some way by the interviewer.  The interviewer should also be aware that abused children frequently mimic any abuse or sexual activity they have experienced.  True accounts of abuse always contain minor details, which are logically set in the context of the child’s narrative.  Anatomically detailed drawings, dolls, etc. are considered to be useful with sexually abused children under age five, who may not be able to verbalize their experiences very well.  A free narrative from the child is the most accurate technique in investigating cases of abuse.  Any suggestiveness or coerciveness by an unskilled investigator increases inaccuracies in the statement. One technique that insures an objective investigation is the Statement Validity Analysis (SVA) technique.  This is a forensic interview technique, which uses analytical procedures to obtain and evaluate statements in an objective manor.   It discourages premature conclusions that may possibly be made by the investigator, by forcing a systematic consideration of the whole body of data.  SVA incorporates three typical procedures:  Obtaining a free narrative statement from the child, using Criteria Based Content Analysis (CBCA) that analyzes the statement for general characteristics, specific contents, and motivation related contents, and a Validity Checklist that analyzes all data relevant to the case.  SVA looks at the psychological characteristics of the child, the interview characteristics of both the child and the examiner, motivational factors relevant to all those involved and exploratory questions concerning data consistency and realism. Some questions that are frequently asked in the psychological assessment of child trauma victims are: how seriously has the child been affected by the trauma, what therapeutic interventions are recommended, can caretakers successfully  prevent further harm to the child, and do other psychological problems co-exist?  Another important question is what would be the psychological effect on the child if separated and later returned to the caretakers, due to their own involvement in the alleged abuse?

There are four basic assessment procedures.  The first tool of assessment is to build the relationship and develop rapport with the child.  The interviewer should conduct the investigation of the alleged abuse with the child alone whenever possible, to prevent bias. A complete objective assessment avoids biases from other alliances with family members or other agencies that may be involved. The investigator should keep a strict hands-off policy because the child may associate even comforting touches with prior abuse. The interviewer should obtain developmentally appropriate informed consent from the child, along with the guardian’s written consent, whenever possible.  Investigators should obtain any family information and allegation details prior to seeing the child to base conclusions on the most comprehensive information available.  The interviewer should get on the child’s level, using drawings, dolls, puppets, toy phones, etc. to facilitate the obtaining of a full and complete narrative.  The second tool of assessment is finding the facts.  The investigator should use the child’s language level and forensically defensible questions, which seek information to explain the progression of events.  The investigator should receive the child’s feedback in an emotionally appropriate manner, while exploring alternative hypotheses, comparing statements with other test findings, and recognizing and recording “behavioral reenactment” of the abuse.  The third assessment tool is using assessment measures, which obtain an estimate of cognitive ability and language functioning for clinical significance and forensic relevance.  Proof of the child’s competence to understand and answer interview questions is necessary.  The interviewer also needs to obtain some measure of the child’s understanding of the difference between the truth and falsehood.  Assessment measures also seek the degree of psychological impact, using trauma, depression, and dissociation inventories, behavioral rating scales, personality inventories, and projective techniques. Some investigators endorse the use of anatomically detailed forensic drawings and dolls to facilitate the process.  The final tool of assessment evaluates the credibility of abuse allegations, including the motivations of everyone involved.  Assessment for co-morbid clinical conditions identify any conditions that the child may have in addition to the alleged child abuse, such as Neurological Dysfunction, Learning Disabilities, Mental Retardation, ADHD, Affective Dysregulation, and Personality Disorders, which may affect the case in question.  Some assessment protocols that interviewers need to be aware of are the mandated reporting of any suspicion of child abuse,  releases need to be very clear about where written reports go, specialized training and supervision is needed, and any supervision that takes place must be recorded in child’s chart.  All psychological evaluators of abused children should be well-trained in assessment techniques, child development, child interviewing, forensic psychology, child memory issues, play/art therapy, and cultural diversity.

Two specific examples of assessment instruments, which are utilized for research as well, are the Childhood Maltreatment Interview Schedule-SF (CMIS-SF) and the Initial Trauma Review-Revised (ITR-R).  The Childhood Maltreatment Interview Schedule-SF was adapted from the original CMIS.  The items included on the test ask about potential maltreatment experiences and can be used by researchers according to their individual interests.  Its successful use in various studies suggest good reliability, with predictive and construct validity. The Initial Trauma Review-Revised (ITR-R) is a behaviorally-arranged, structured interview that evaluates most major forms of trauma exposure.  It inquires about subjective distress in response to trauma as required by DSM-IV’s A2 criteria for Post Traumatic Stress Disorder.  The Child Sexual Behavior Inventory is specifically used in identification of suspected cases of childhood sexual abuse.  It is completed by child’s primary female caregiver.  It is used along side projective tests, child interviews, and physical exams to give a well-balanced view to investigational procedures.   This inventory requires no formal training, though graduate level psychological training with additional training in the field of childhood sexual abuse is highly recommended before utilization, scoring, and interpretation.  It measures sexual behaviors in children ages 2-12, the frequency of those behaviors on a 4-point scale, and monitors changes in sexual behaviors during and after therapy.  The subscales measure nine domains of sexual behaviors, including boundary problems, exhibitionism, gender role behaviors, self-stimulation, sexual anxiety, sexual interest, sexual intrusiveness, sexual knowledge, and voyeuristic behavior.  The Trauma Symptom Checklist for Young Children (TSCYC) is a 90 item caretaker report instrument developed for the assessment of children age 3-12.  Its clinical scales had good reliability and were predictive of exposure to childhood sexual abuse, physical abuse, and witnessing domestic violence.  It measures Posttraumatic Stress symptoms such as intrusion, avoidance, arousal, sexual concerns, anxiety, depression, dissociation, anger, and aggression.

Some facts investigators, therapists, and counselors should know about child abuse are that while alcohol consumption is more frequently associated with physical maltreatment of children, cocaine use is more frequently associated with sexually abused children.  The greater the frequency, severity, and duration of abuse is associated with more severe effects and less success in treatment.  The absence of a biological parent and the presence of a non-biological male counterpart, poses a greater risk for childhood sexual abuse, along with maternal unavailability and domestic violence.  Another important fact is that even one supportive person, even the therapist, in the child’s social network, both improves the negative effects of child abuse and stops the progression of the cycle of abuse to the next generation.

Most treatment plans focus on helping the victim and family cope with the initial impact of the discovery of abuse and to prevent the development of short and long term psychological consequences. Treatments need to assess the victim and family needs, set realistic goals for meeting them, develop a treatment plan to reach those goals, and evaluate the success of treatment with standardized objective measures. There are four basic therapeutic aims, which include relieving symptoms by encouraging behavioral and cognitive changes, de-stigmatizing by group affirmation of the child’s experience and providing emotional support from therapist and others, increasing self-esteem through cognitive and interpersonal exercises, and the prevention of future abuse by modification of the victim’s environment, behaviors, and awareness in that environment.  Types of treatment plans are individual therapy, dyad therapy with the non abusing parent, group therapy, and family therapy. Younger children are usually directed into individual therapy in which the goal is to reduce acute responses to abuse with its short and long term effects and the prevention of further disruption of the child’s social, emotional, and personality development.  Peer Support Group Therapy Treatments are geared toward children age ten and above.   Dyad or Group therapy that includes the non-offending parent along with the child has been shown to reduce the severity of negative effects.  Some group therapy focuses on the reactions from the abuse, while others focus on the abuse itself.  Some approaches may use effective treatment models from other clinical populations with similar symptoms to reduce behavioral symptoms.  They may utilize role plays, therapeutic games, art activities, storytelling, writing, structured discussions, and trust building techniques and are often used in combination with Individual Therapy Treatments.  Family Therapy is usually only initiated after individual and group therapy and sometimes includes confrontational techniques with the perpetrator. Family therapy encourages the acceptance of responsibility by the parents, attempts to enhance the parent/child relationship along with the marital relationship, and seeks to resolve marital-sexual conflicts between the parents, though family structure may change as a result of abuse.  The family’s reactions have a significant impact on the victim’s ability to recover in a positive atmosphere.

The primary goals of childhood trauma assessment include forensic and clinical assessments. Investigations should be conducted a well trained forensic interviewer to minimize conflicting interests.  A free narrative from the child is the most accurate technique in investigating cases of abuse.  All psychological evaluators of abused children should be well-trained in assessment techniques, child development, child interviewing, forensic psychology, child memory issues, play/art therapy, and cultural diversity.  An important fact for therapists to remember is that even one supportive person in the child’s social network, even if that person is the child’s therapist, both improves the negative effects of child abuse and stops the progression of the cycle of abuse to the next generation.  Most treatment plans focus on helping the victim and family cope with the initial impact of the discovery of abuse and to prevent the development of short and long term psychological consequences.  Treatments need to assess the victim and family needs, set realistic goals for meeting them, develop a treatment plan to reach those goals, and evaluate the success of treatment with standardized objective measures. Types of treatment plans are individual therapy, dyad therapy with the non abusing parent, group therapy, and family therapy. How the child’s family reacts to the disclosure of abuse significantly impacts the victim’s ability to recover.

References

Bernt, F. (no date) . Review of the Child Sexual Behavior Inventory. [On-line] , Available:    http://www.caseassist.com/psychtests.htm

Beutler, L., Williams, R., & Zetzer, H. (1994) . Efficacy of Treatment for Victims of Child Sexual Abuse. The Future of

Children. [On-line] , Available: http://www.futureofchildren.org/usr_doc/vol4no2ART9.pdf

Brier, J. (1992) . Childhood Maltreatment Interview Schedule Short Form.  [On-line] . Available:     http://www.johnbriere.com/cmis.htm

Brier, J. (2004) . Initial Trauma Review – Revised. [On-line] . Available: http://www.johnbriere.com/ITR-R.htm

Brier, J. (2001) . Trauma Symptom Checklist for Young Children. [On-line] . Available:      http://www.johnbriere.com/tscyc.htm

McGarrah, N. (2001) Child Sexual Abuse Investigations: Multidisciplinary Collaborations; Psychological     Assessment of Alleged Child Sexual Abuse Victims. [On-line] . Available:   http://childabuse.gactr.uga.edu/both/mcgarrah/mcgarrah1.phtml

McGarrah, N. (2001) Child Sexual Abuse Investigations: Multidisciplinary Collaborations; Psychological     Assessment of Alleged Child Sexual Abuse Victims. [On-line] . Available:   http://childabuse.gactr.uga.edu/both/mcgarrah/mcgarrah3.phtml

McGarrah, N. (2001) Child Sexual Abuse Investigations: Multidisciplinary Collaborations; Psychological     Assessment of Alleged Child Sexual Abuse Victims. [On-line] . Available:   http://childabuse.gactr.uga.edu/both/mcgarrah/mcgarrah4.phtml

McGarrah, N. (2001) Child Sexual Abuse Investigations: Multidisciplinary Collaborations; Psychological     Assessment of Alleged Child Sexual Abuse Victims. [On-line] . Available:   http://childabuse.gactr.uga.edu/both/mcgarrah/mcgarrah5.phtml

McGarrah, N. (2001) Child Sexual Abuse Investigations: Multidisciplinary Collaborations; Psychological     Assessment of Alleged Child Sexual Abuse Victims. [On-line] . Available:   http://childabuse.gactr.uga.edu/both/mcgarrah/mcgarrah6.phtml

McGarrah, N. (2001) Child Sexual Abuse Investigations: Multidisciplinary Collaborations; Psychological     Assessment of Alleged Child Sexual Abuse Victims. [On-line] . Available:   http://childabuse.gactr.uga.edu/both/mcgarrah/mcgarrah7.phtml

McGarrah, N. (2001) Child Sexual Abuse Investigations: Multidisciplinary Collaborations; Psychological     Assessment of Alleged Child Sexual Abuse Victims. [On-line] . Available:   http://childabuse.gactr.uga.edu/both/mcgarrah/mcgarrah8.phtml

McGarrah, N. (2001) Child Sexual Abuse Investigations: Multidisciplinary Collaborations; Psychological     Assessment of Alleged Child Sexual Abuse Victims. [On-line] . Available:   http://childabuse.gactr.uga.edu/both/mcgarrah/mcgarrah10.phtml

McGarrah, N. (2001) Child Sexual Abuse Investigations: Multidisciplinary Collaborations; Psychological     Assessment of Alleged Child Sexual Abuse Victims. [On-line] . Available:   http://childabuse.gactr.uga.edu/both/mcgarrah/mcgarrah11.phtml

Sachsenmaier, S. (1998) . Investigating Child Sexual Abuse Allegations: Do Experts Agree on Anything? The            American Academyof Experts in Traumatic Stress, Inc. [On-line] . Available:                http://www.aaets.org/arts/art50.htm

Shaw, K. (2001). Child sexual abuse: Risk factors. A Summary of Literature on Child Sexual Abuse and       Exploitation: An Introduction. [On-line] . Available:            http://www.ispcan.org/Resources/Literature%20Search%20Project.htm

Advertisements

About mamaheartfilled

I am a mother of eight wonderfully challenging children and nine grandkids, of whom I am very proud. I am also a bi-vocational ordained evangelical minister, and a Christian Counselor. I received my B.S. degree in 2004, studying primarily in the areas of Psychology, with minors in Religion and English. I received my Masters Degree in 2009 in Psychological Counseling with an emphasis in Christian Counseling. I have endeavored to paraphrase the Bible, both Old and New Testaments, for the last ten years or so and am working on a final edit, now. It is my hope that it will be of some use in the great commission of Christ. My ministry is primarily geared toward victims of sexual and domestic violence, including victims of childhood sexual abuse, whether currently or in the past. Since I have personally experienced the healing hand of God in overcoming many of the life issues that Christians may face, I feel qualified and compelled to discuss them in a truthful and open manner, as God’s word tells us that “We shall know the truth and the truth shall set us free.” God has brought me through such diverse tribulations as sexual, physical, and mental abuse, being a victim of a drunk driving accident, spousal pornography addiction, adultery, divorce, remarriage, a very brief, though unjust, incarceration, and having experienced multiple miscarriages and various other trials. I have been asked to leave two Southern Baptist Churches, due to my being a female, ordained as a minister, and fired from a SBC sponsored Christian School (mostly white) for speaking out against racial prejudice in the Family of God. Through God’s merciful forgiveness of my own sins and inadequacies and God’s grace given to me to forgive those who have been a stumbling block to me, I have overcome many of these adversities. God’s word tells us that “All things work together for good to those who love the Lord and are called according to the purposes of God." Since I have this hope, I believe that God has blessed me with the ability to confront and relate these issues to the Christian community around the world. I hope to be able to use my personal experiences as a ministry of God’s grace and in the comforting of the people of God with the truth of God's mercy. I claim II Corinthians 1: 3 & 4 as my calling, which states: “Blessed be God, the Origin of our Lord Jesus Christ, the Origin of mercies, and the God of comfort; who comforts us in all our troubles, that we may be able to comfort those who are in trouble, by the comfort we ourselves have been given by God.” As I have received the gift of God’s healing, I hope to be able to bring the peace beyond understanding to others with the message of God’s mercy and grace. My love for the Sovereign Lord of my life, Jesus Christ, along with my passion for writing has drawn me to explore these commonly experienced crisis issues from the perspective of my own experience in the hope that I may bring an empathetic and compassionate insight to God’s people. I am now a published author and have several books in publication, including my autobiography, "A Little Redneck Theology." The views expressed in my writings are strictly my own insights, acquired from personal experience and diligent study of the related topics and God’s word concerning them. Though I am an ordained minister, my views should not be considered authoritative. I believe that the Christian community’s ultimate authority is the guidance of the human heart by the Holy Spirit and the Word of God.
This entry was posted in Childhood Sexual Abuse, children, counseling, education, Health and Safety, Marriage and Family, Parenting, Psychology and Philosophy, Sexual Assault and tagged , , , , , , , , . Bookmark the permalink.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s