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MEETING THE NEEDS OF SURVIVORS OF CHILD SEXUAL ABUSE – UNDERPINNED BY ROUTINE ENQUIRY MEETING THE NEEDS OF SURVIVORS OF CHILD SEXUAL ABUSE – UNDERPINNED BY ROUTINE ENQUIRY IN MENTAL HEALTH ASSESSMENTS AND SEXUAL VIOLENCE • IMPLEMENTATION OF VIOLENCE AND ABUSE POLICY

LEARNING OUTCOMES • Participants will: • Have the confidence to routinely and consistently ask LEARNING OUTCOMES • Participants will: • Have the confidence to routinely and consistently ask about violence and abuse as part of assessments they conduct • Have greater knowledge and awareness of the potential consequences of child sexual abuse for mental health • Be able to respond appropriately to disclosures of child sexual abuse • Have the confidence to apply their skills in providing support to service users who disclose abuse

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WHAT DO WE KNOW • List anything you know about • Convicted sex offenders WHAT DO WE KNOW • List anything you know about • Convicted sex offenders and the outcome of cases

ENQUIRY FINDINGS OPERATION YEWTREE 2013 600 people have come forward with information. About 450 ENQUIRY FINDINGS OPERATION YEWTREE 2013 600 people have come forward with information. About 450 of these are expected to be linked to Savile, mainly alleging sexual abuse. • 214 criminal offences have been recorded across 28 police force areas. • The allegations span 54 years. The earliest reported incident was in 1955 in Manchester. The last took place in 2009. The bulk of offending took place in Leeds, Savile's home town, and London, his main place of work. • The peak rate of offending was between 1966 and 1976, when Savile was between 40 and 50 years old. • Of offences recorded against Savile, 126 are indecent acts with 34 involving rape or penetration. The reported victims ranged in age from eight to 47 at the time of abuse, with 73% aged under 18. The bulk were aged 13 to 16, with 82% being female. • • The majority of victims had never reported their experiences to authorities before, saying they feared they would not be believed or did not trust the judicial system.

YEWTREE FINDINGS • Victims have complained of abuse connected to Savile's work at the YEWTREE FINDINGS • Victims have complained of abuse connected to Savile's work at the BBC between 1965 and 2006, up to the final recording of Top of the Pops. Abuse was reported at Leeds general infirmary, where Savile had close links and worked as a voluntary porter, between 1965 and 1995. At Stoke Mandeville hospital, for which he was a major fundraiser and often stayed overnight, reported offending happened from 1965 to 1988. At Duncroft school, which he also visited regularly, there allegations from between 1970 and 1978. Broadmoor high-security psychiatric hospital, St James Leeds Hospital, High Royds Psychiatric Hospital, Dewsbury Hospital, Wycombe General Hospital, Great Ormond Street Hospital in 1971, Ashworth Hospital, Exeter Hospital, Royal Portsmouth Hospital, St Catherine's Hospital in Birkenhead, and Saxondale Mental Health. Incidents reported between 1963 -2009

OPERATION FAIRBANK- MIDLAND, AND ENAMEL • The police investigation known as Operation Fairbank was OPERATION FAIRBANK- MIDLAND, AND ENAMEL • The police investigation known as Operation Fairbank was first set up under conditions of • • secrecy. The Independent on Sunday[8] reported that it focused on claims of sexual abuse and the grooming of children, involving parties for men at the former Elm Guest House in Rocks Lane, close to Barnes Common in south west London, during the late 1970 s and 1980 s. . A party was raided by the police in 1982, following which 12 boys gave evidence that they had been abused by men at the house. Kasir was convicted of the charge of running a disorderly house, but allegations of abuse against children, and a subsequent reported investigation in 2003, were apparently not pursued. [8] In January 2013, The Independent on Sunday reported that police were investigating claims that Cyril Smith, a former Liberal MP who died in 2010, sexually abused young boys at Elm Guest House, which the article claimed "was allegedly used by a powerful paedophile network whose members are said to have included former leading Conservative politicians. "[9] Smith is reported to have been a regular visitor to Elm Guest House. [10] A Metropolitan Police spokesman said: "We can confirm Cyril Smith visited the premises. "[11] In February 2013, it was reported that police were investigating allegations that in the early 1980 s a "paedophile ring of VIPs" abused boys from the Grafton Close Children's Home in Richmond, south-west London. It also claimed that Kasir had photographs or video of many establishment figures at Elm Guest House, one photograph allegedly showing a former cabinet minister in a sauna with a naked boy. [12] In February 2013, one alleged victim of abuse at Elm Guest House said that at the age of 13 he and his 12 -year-old brother, both orphans, were sent there for parties when they were residents at Grafton Close Children's home. He said boys were plied with alcohol before being abused by men at the guesthouse. [3] In March 2013, The Independent on Sunday reported that at least three men named in documents as visitors to the Elm Guest House were later convicted of multiple sexual offences against children. [13]

POLICY DRIVERS • Outlined in detail in Implementation Guidance: Gender • • • and POLICY DRIVERS • Outlined in detail in Implementation Guidance: Gender • • • and Women’s Mental Health (DH 2003) Routine enquiry is a requirement of revised CPA Guidance (DH 2008) Inclusion in the National Mental Health Minimum Dataset (April 2011) It underpins e. g. Equality Act 2010; New Ways of Working; assessing risk linked to suicide prevention; Safeguarding procedures; drives to improve inpatient care and deliver genuine needs-led services

CPA GUIDANCE STATES THAT: • ‘Questions should be asked by suitably trained staff at CPA GUIDANCE STATES THAT: • ‘Questions should be asked by suitably trained staff at assessment about the experience of physical, sexual or emotional abuse at any time in the service user’s life. The response, with brief details, should be recorded in case records/care plans. If the specific question is not asked, the reason(s) for not doing so should be recorded. ’ • Refocusing the Care Programme Approach, Policy and Positive Practice Guidance, Section 4, March 2008

 • Abuse during childhood: Findings from the Crime Survey for England Wales, year • Abuse during childhood: Findings from the Crime Survey for England Wales, year ending March 2016 • Crime Survey for England Wales (CSEW) between 1 April 2015 and 31 March 2016 asked adult respondents aged 16 to 59 whether they had experienced a range of abuse while a child. The questions were restricted to abuse carried out by an adult and included psychological, physical, and sexual abuse and also having witnessed domestic violence or abuse in the home. • 9% of adults aged 16 to 59 had experienced psychological abuse, • 7% physical abuse, • 7% sexual assault • 8% witnessed domestic violence or abuse in the home. • With the exception of physical abuse, women were significantly more likely to report that they had suffered any form of abuse asked about during childhood than men. • In most cases of child sexual abuse (70 per cent) the abuse was not reported to the police. Almost 90 per cent of survivors have not seen their abusers brought to justice. (DOH seen and heard 2016) • 1 -in-3 women worldwide will experience physical or sexual violence in their lifetime, • usually from a male partner. (Care Norway 2015) • 1 in 20 children has been sexually abused as a child DOH 2016

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KAYLEIGH HAYWOOD MURDER: LUKE HARLOW GUILTY OF FALSE IMPRISONMENT 28 JUNE 2016 • A KAYLEIGH HAYWOOD MURDER: LUKE HARLOW GUILTY OF FALSE IMPRISONMENT 28 JUNE 2016 • A man who used Facebook to groom a 15 -year-old girl who was later raped and murdered has been found guilty of false imprisonment. • Luke Harlow, 28, of Ibstock, Leicestershire, admitted grooming and sexually touching Kayleigh Haywood but had denied taking her captive. • Stephen Beadman, 29, who admitted raping and murdering Kayleigh, was found guilty of imprisonment on Monday. • Both men are due to be sentenced at Nottingham Crown Court on Friday. 1 st july • Kayleigh's body was found in a field, five days after she was dropped off outside Ibstock Community College, on Friday 13 November. • Kayleigh Haywood was raped and murdered by Stephen Beadman Her family thought she was joining a friend but she was actually meeting Harlow, who had been grooming her through social media and text messages. • Kayleigh, from Measham, was given "substantial amounts of alcohol" and "sexually touched" by Harlow, according to the prosecution, on that Friday evening. • The following day, Beadman arrived at the flat and the jury agreed Kayleigh was kept prisoner by both men between about 21: 00 BST and 03: 00 the next morning. • '

 • Groomed and killed in just two weeks • , was found dead • Groomed and killed in just two weeks • , was found dead on 18 November 2015 31 October - Luke Harlow begins grooming Kayleigh Haywood on Facebook, sending her a message reading: "Hey, how's it going? " Further electronic messaging, which she kept from her parents, then takes place on Facebook and Whats. App. • 13 November - Kayleigh's father drops her off outside Ibstock Community College at about 18: 00 GMT, after she agrees to spend the weekend at Harlow's home in George Avenue, Ibstock. At Harlow's request, Kayleigh tells her parents she is staying with a friend. • 14 November - Kayleigh speaks to her parents on her i. Phone in the morning. At about 21: 00, Kayleigh's mobile phone ceases to send messages to her friends. • 15 November - Between 03: 00 and 03: 30 a witness sees a young woman being pinned to the ground by a man who is wrongly assumed to be a policeman because of a reflective strip on his coat. A loud frightened scream of "mummy" is heard by another witness as Kayleigh is attacked by Stephen Beadman and then killed on farmland. EVENTS • At about 9: 30 Kayleigh's smashed i. Phone is found on a main road near the defendants' homes. A passerby who finds the handset uses the Sim card to dial the last number called and gets through to a friend of Kayleigh, who in turn contacts the schoolgirl's mother. Kayleigh is then reported missing. • 16 November - Detectives arrest Harlow and Beadman in connection with Kayleigh's disappearance as officers search for her on parkland at a property. • 17 November - Police appeal for anyone with information or sightings of the schoolgirl to come forward. Later the same day, Kayleigh's parents Stephanie Haywood and Martin Whitby - make an emotional appeal through police for her to come home. • 18 November - Leicestershire Police announce that officers are treating the disappearance of Kayleigh as murder after finding items of clothing they believe belonged to the teenager in Ibstock and Diseworth. Police find Kayleigh's body in undergrowth near a stream at about 22: 00. • 19 November - Leicestershire Police charge Beadman, then aged 28, with the murder of Kayleigh Haywood. Harlow, 27, is accused of grooming and two counts of sexual activity with a child.

QUESTION • What is childhood sexual abuse? QUESTION • What is childhood sexual abuse?

WHAT IS CHILD SEXUAL ABUSE? Child sexual abuse is a sexual crime in which WHAT IS CHILD SEXUAL ABUSE? Child sexual abuse is a sexual crime in which a child is used for sexual gratification by someone who has power over the victim(s) – an adult, an adolescent or another child. Offenders abuse in a variety of settings, including the Internet: • Display child pornography / violate children in its production • Expose their genitals; coerce children to masturbate them • Anal and vaginal rape / oral assault (throat rape) • Coerce children to sexually perform for them on Webcams • Sexually exploit children through e. g. prostitution; paedophile ring

ESTIMATING PREVALENCE OF CHILD SEXUAL ABUSE: IN ADULT MENTAL HEALTH SERVICES • A review ESTIMATING PREVALENCE OF CHILD SEXUAL ABUSE: IN ADULT MENTAL HEALTH SERVICES • A review of 46 studies (n=2604) of women in-patients and out-patients revealed that 46% reported having been subjected to sexual abuse and 48% to physical abuse in childhood. • The figures for men (31 studies n=1536) were 28% sexual abuse and 50% physical abuse. Read et al (2005)

OPERATION DOTEFORD (ROTHERHAM) • Four men were sentenced at Leeds Crown Court to a OPERATION DOTEFORD (ROTHERHAM) • Four men were sentenced at Leeds Crown Court to a total of 51 years for child GODDARD REPORT sexual exploitation. • Tariq Islam (sentenced to 13 years), Nasir Sultan (12 years), Amir Zaman (11 years) and Zafar Iqbal (15 years) were sentenced for committing rape and other sexual offences against a child aged 12 to 14 between May 2010 and September 2012 and were convicted by a jury yesterday. Also convicted of offences of a sexual nature were Arshid Younis, Abid Younis, Farahk Younis, Junaid Rashid, Shazabe Hussain, Zafar Iqbal and Awais Butt. They will be sentenced at a later date. • Andrew Penhale, Deputy Chief Crown Prosecutor, CPS Yorkshire and Humberside said: • “Ten individuals have been convicted of offences which involve a shocking catalogue of child sexual exploitation. The victim was targeted by older men precisely because of her youth and vulnerability. The offences involved an appalling breach of trust - the victim was groomed and plied with cigarettes, alcohol and drugs to make her compliant. The defendants then showed a complete lack of remorse for their actions, with ten of them claiming throughout the contested trial that the allegations were fabricated, or that they believed the victim to be over 16. • “This was a complex and difficult matter to bring to court and prosecuting it has required extremely detailed and painstaking work. It demonstrates that the use of special measures such as screens or giving evidence over video-links helps vulnerable victims of even the most horrifying sexual exploitation to give their account before a criminal court. ”

WHAT DOES A SEX OFFENDER LOOK LIKE? • A well-dressed professional? • The ‘nice WHAT DOES A SEX OFFENDER LOOK LIKE? • A well-dressed professional? • The ‘nice man’ next door? • A woman? • A teenager? • Could you spot one in a crowd? • Do you know one… yes you do!

FINKELHOR’S 4 FACTOR MODEL FINKELHOR’S 4 FACTOR MODEL

FINKELHOR’S 4 FACTOR MODEL 1. There is a person who wants to abuse (motivation). FINKELHOR’S 4 FACTOR MODEL 1. There is a person who wants to abuse (motivation). 2. The person overcomes internal inhibitions about abusing (self-talk). 3. The person overcomes external inhibitions (gaining access to the child). 4. The abuser overcomes the child’s resistance and ensures silence (grooming).

STAGE 1: THE ILLEGAL SEXUAL FANTASY (MOTIVATION) • Burglar Sexual offender • House full STAGE 1: THE ILLEGAL SEXUAL FANTASY (MOTIVATION) • Burglar Sexual offender • House full of antiques • Or… • Stealing a car; a bicycle from a garden shed; rob a bank; burgle a factory… Only boys Only girls Boys or girls Child of particular age Specific sexual act

STAGE 2: SELF-TALK (OVERCOMING INTERNAL INHIBITIONS) • Burglar Sex offender • I need the STAGE 2: SELF-TALK (OVERCOMING INTERNAL INHIBITIONS) • Burglar Sex offender • I need the money • Rich enough to afford it • Get it back on the insurance • They’ll hardly miss it • I deserve it Teaching them about sex Keeping it in the family It won’t hurt Showing how I love them They are asking for it

STAGE 3: GAINING ACCESS – PLANNING STAGE (OVERCOMING EXTERNAL INHIBITIONS) • Burglar • Find STAGE 3: GAINING ACCESS – PLANNING STAGE (OVERCOMING EXTERNAL INHIBITIONS) • Burglar • Find the right house, car, bank… - easy access - no alarms - watching for owners’ habits - expensive contents on view - constructing an alibi - having ‘fence’ to sell goods on to Sex offender Find the right ‘child setting’… - siblings, own children, step- children, grandchildren - befriend women with children / become a babysitter - work with children in voluntary / professional capacity

STAGE 4: DOING IT AND GETTING AWAY WITH IT (GROOMING AND SILENCING) • Burglar STAGE 4: DOING IT AND GETTING AWAY WITH IT (GROOMING AND SILENCING) • Burglar Sex offender • Getting in unseen • Covering your tracks • Getting rid of the goods • Having an alibi • Getting the cash, getting away with it, on a ‘high’ • Chance of doing it again? Silencing the child, grooming Across the spectrum: Threats & violence ‘You’re so special’ Child hasn’t told, got away with it. Chances of doing it again?

VICTIM TO PERPETRATOR? REVIEW OF ASSESSMENT INTERVIEWS (HINDMAN & PETERS, 2001) 1988 - 1994 VICTIM TO PERPETRATOR? REVIEW OF ASSESSMENT INTERVIEWS (HINDMAN & PETERS, 2001) 1988 - 1994 Ordinary interviews Using polygraph Abusers who said they were victims 65% 32% Abusers who said they first abused < 18 years 22% 68% Average no of victims 2. 5 13. 6 Stated gender of their victims 83% F 17% M 53% F 47% M

CHILD EXPLOITATION AND ON-LINE PROTECTION CENTRE (CEOP) • CEOP is part of the UK CHILD EXPLOITATION AND ON-LINE PROTECTION CENTRE (CEOP) • CEOP is part of the UK police service and is dedicated to educating children and adults about the dangers of the Internet; identifying and rescuing children; identifying and prosecuting abusers. Its website includes information for parents, young people and professionals: www. ceop. police. uk/

QUESTION • Why do individuals disclose? • Why don’t individuals disclose? QUESTION • Why do individuals disclose? • Why don’t individuals disclose?

WHY DID I EVENTUALLY TELL…? • I was concerned that my abuser posed a WHY DID I EVENTUALLY TELL…? • I was concerned that my abuser posed a risk to other • • children/siblings I felt safer to do so e. g. - being in a new relationship - living away from home sex education Life events triggered memories I was asked the question at assessment SILENT WAYS OF TELLING Overeating, refusing to eat, bulimia abusing laxatives anorexia, compulsive eating Bed wetting, retaining urine, soiling constipation diarrhoea, retaining faeces, smearing feaces, withdrawing, not communicating , no friends, being perfect, STD’s drawing sex, inappropriate sexual behaviour, writing stories about sex, more knowledge than age group.

NO DISCLOSURE • • • I didn’t recognise it as abuse I loved my NO DISCLOSURE • • • I didn’t recognise it as abuse I loved my abusers, they made me feel special I was threatened by my abuser(s) I was afraid of the consequences – for myself and others/ community There was no-one safe to tell or how do I tell I didn’t have the words to describe what was happening I was frightened of not being believed or getting negative responses I felt I should have told when it was happening I felt it was my fault – was ashamed/blame I buried/blocked out the memories I was frightened of my abuser’s reaction

THE IMPACT OF CHILD SEXUAL ABUSE < What happened? > < Who did it? THE IMPACT OF CHILD SEXUAL ABUSE < What happened? > < Who did it? > < How many times? > < How long for? > < Did they tell? > < Were they believed? > < Were they blamed? > < Were they protected? > < Were the police involved? >

LONG-TERM CONSEQUENCES • Anxiety / fear • Anger / aggression, eating problems • Unhappiness LONG-TERM CONSEQUENCES • Anxiety / fear • Anger / aggression, eating problems • Unhappiness / depression • Lack of confidence / low self-esteem • Feeling dirty / damaged / guilty • Physical health problems • Sleep disturbance • Intrusive memories • Inability to trust others

CONSENT • WHAT DOES IT MEAN? CONSENT • WHAT DOES IT MEAN?

DEFINITION • Consent is an act of reason; the person giving consent must be DEFINITION • Consent is an act of reason; the person giving consent must be of sufficient mental capacity and be in possession of all essential information in order to give valid consent. A person who is an infant, is thought not to have capacity , or is under the influence of drugs is incapable of giving consent.

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EFFECTS ON RELATIONSHIPS – SEX AND SEXUALITY • Difficulty with any physical • • EFFECTS ON RELATIONSHIPS – SEX AND SEXUALITY • Difficulty with any physical • • • contact Avoiding sex Blanking out during sex Difficulty with certain sexual acts Needing to be in control Lacking sexual knowledge • Confusion about • • • sexual orientation Unable to say “No” Being obsessed with sex Being sexually exploited Having multiple relationships Having flashbacks

EFFECTS ON RELATIONSHIPS – PARENTING • Lack of positive role-models • Difficulty setting boundaries EFFECTS ON RELATIONSHIPS – PARENTING • Lack of positive role-models • Difficulty setting boundaries • Over-protectiveness • Life events triggering memories e. g. childbirth • Children may become young carers However, many survivors make very good parents in spite of (or because of) their past experiences.

COPING MECHANISMS • • Minimizing: “It wasn’t that bad. ” • • Rationalizing: Explaining COPING MECHANISMS • • Minimizing: “It wasn’t that bad. ” • • Rationalizing: Explaining away the abuse. • • Denying: Pretending it didn’t happen or it had no impact. • • Forgetting: Repressing memories, either short or long term. • • Splitting: Separating the offender’s behaviour from the offender. • • Dissociation: Leaving one’s body; feeling separate and unconnected. • • Control: Needing to control anything and everything. • • Chaos: Maintaining control by creating chaos. • Spacing out”: Not being present. • • Super-alertness: Avoiding surprises, always know what is happening. • • Busyness: Keeping very busy to escape. • • Escape: Running away physically or emotionally. • • Mental Illness: The line between fantasy and reality blurs. • • Self-mutilation: Hurting one’s self and believing that physical pain is better than the emotional pain of abuse. • • Addiction: Temporary means of escape. • • Isolation: Cutting one’s self off from people; if no one is close, no one can hurt. • • Relationship Addiction: Going from relationship to relationship (may or may not involve sex). • Suicide Attempts: The ultimate (or final) escape.

DIAGNOSES – KEY MESSAGES • Child sexual abuse may be a significant factor in DIAGNOSES – KEY MESSAGES • Child sexual abuse may be a significant factor in • • all diagnoses, presentations and behaviours The diagnostic process focuses on symptoms and not underlying causes (except PTSD) Addressing violence and abuse requires a clinical shift i. e. consideration of “What’s happened to this person? ” as well as “What’s wrong with this person? ” Note of caution: ensure you continue to ‘see’ the person behind the diagnostic label

DIVERSITY ISSUES Staff, like service users, come from diverse backgrounds where it may not DIVERSITY ISSUES Staff, like service users, come from diverse backgrounds where it may not be the norm to: • talk openly about sexual matters e. g. sexual acts; contraception; sexual dysfunction • recognise people who are lesbian, gay and trans-gender • accept sex outside marriage • regard women and men as equal partners in heterosexual relationships Whatever your personal views or discomfort, it is your clinical and legal responsibility to comply with the Equality Act 2010: if you experience any difficulties, do seek support from your supervisor.

ATTITUDES TO SEX AND SEXUALITY • Our attitudes towards sex can make it easier ATTITUDES TO SEX AND SEXUALITY • Our attitudes towards sex can make it easier or • • more difficult for clients to talk to us about it The more comfortable we are about talking about sex and sexuality, the less embarrassed we and our clients will be We need to adopt a non-judgemental approach to clients’ sexuality and sexual language

SEXUAL LANGUAGE: EXERCISE Providing accessible and sensitive services: LIST MALE GENITALIA, FEMALE GENITALIA SEXUAL SEXUAL LANGUAGE: EXERCISE Providing accessible and sensitive services: LIST MALE GENITALIA, FEMALE GENITALIA SEXUAL ACTS • Using language that service users understand • and feel comfortable with Clarifying what service users say and what they mean, rather than making any assumptions

WHY IS IT IMPORTANT TO ASK AT ASSESSMENT? • Survivors want to be asked WHY IS IT IMPORTANT TO ASK AT ASSESSMENT? • Survivors want to be asked (Stafford, 2007; Nelson, • • 2001) By asking the question at assessment, you are saying it is OK to talk about violence and abuse This acknowledges that such experiences are seen as relevant to mental health Routine enquiry increases the rate of disclosure (Read & Fraser, 1998) Avoidance of ‘false memory’ allegations – responses to routine questions in assessments are less likely to be challenged as ‘therapist-induced false memories’ should a case go to court

ASKING THE QUESTION – PREPARING THE SERVICE USER • At the start of an ASKING THE QUESTION – PREPARING THE SERVICE USER • At the start of an assessment: • Acknowledge that ‘some questions might be • • difficult’ Make the boundaries of confidentiality clear: “It is my duty to pass on specific details, if disclosed, of any serious risk of harm to yourself or other people” If the client’s answer is “Yes” to the abuse question, re-iterate this duty so they can make an informed choice about how much to disclose at this time

ASKING THE QUESTION – CAUTIONS • If a service user’s partner, carer or family ASKING THE QUESTION – CAUTIONS • If a service user’s partner, carer or family member is • present during the assessment If the accompanying adult is suspected of being their abuser • If English is not the service user’s first language • Asking the question in CAMHS

ASKING THE QUESTION • “Have you experienced physical, sexual or emotional abuse at any ASKING THE QUESTION • “Have you experienced physical, sexual or emotional abuse at any time in your life? ” • Yes No disclosure Not asked • If ‘Yes’, record brief details • If question not asked, please state reason

What might prevent you from asking the question to a client “Have you been What might prevent you from asking the question to a client “Have you been sexually abused”?

TRIAL RUN • Asking the question: • “Have you experienced physical, sexual or emotional TRIAL RUN • Asking the question: • “Have you experienced physical, sexual or emotional abuse at any time in your life? ”

HEARING A DISCLOSURE – PART ONE Don’t presume: • The abuser was a man HEARING A DISCLOSURE – PART ONE Don’t presume: • The abuser was a man • They were abused by just one person • They are no longer in contact with their abuser(s) • It was a traumatic experience • Other children are being protected

HEARING A DISCLOSURE – PART TWO • Acknowledge the disclosure • Have they told HEARING A DISCLOSURE – PART TWO • Acknowledge the disclosure • Have they told anyone before? How did that go? • Do not try to gather all the details • Do they relate their current difficulties to their abuse? • Is it an issue that they need help with?

HEARING A DISCLOSURE – PART THREE • Is this the right time to deal HEARING A DISCLOSURE – PART THREE • Is this the right time to deal with it? • Who would they like to receive help from? • Recording brief details accurately • Responding to survivor confidentiality requests in case records

SAFEGUARDING CHILDREN REQUIREMENTS • Clarify your safeguarding obligations • Record what is disclosed any SAFEGUARDING CHILDREN REQUIREMENTS • Clarify your safeguarding obligations • Record what is disclosed any subsequent actions • Establish if the survivor knows where the abuser is and if • they have contact with children. - within the family e. g. their children, grandchildren - in a professional capacity e. g. teacher, priest, nurse - in a voluntary capacity e. g. youth worker, babysitter If there is any possibility of child protection concerns, report to Social Services

SAFEGUARDING ADULTS REQUIREMENTS • Applies to service users in all our services who meet SAFEGUARDING ADULTS REQUIREMENTS • Applies to service users in all our services who meet the definition of ‘vulnerable adults’ (‘No Secrets’, DH/HO, 2000): • “who is or may be in need of community care services by reason of mental or other disability, age or illness; and who is or may be unable to take care of him or herself, or unable to protect him or herself against significant harm or exploitation. ” • If client still at risk from their abuser(s), refer to Social • Services under Safeguarding Adults procedures. • However, no action can be taken without client’s • permission unless they are judged to ‘lack capacity’.

SAFEGUARDING CONTACTS • Check intranet for current information. SAFEGUARDING CONTACTS • Check intranet for current information.

SAFEGUARDING • For urgent queries requiring advice outside of the advice line times lead SAFEGUARDING • For urgent queries requiring advice outside of the advice line times lead nurses and senior managers can contact the safeguarding adult’s specialist nurses or professional lead/trust lead directly for further discussion. • For inpatient services, where an adult at risk requires a safeguarding referral, in hours, this should in the first instance be highlighted to the safeguarding team. • All adults at risk within the community should be referred to the relevant local authority following discussion with line manager or more senior manager. Leicester City LA 0116 454 1004 (0900 -1700 hrs) • Leicestershire County LA 0116 305 0004 (0900 -1700 hrs) • Rutland LA 01572 72257 (0900 -1700 hrs) • LPT on call manager 0116 2256000 to bleep • Police Referral Desk 0116 248 5311

IMPACT ON FAMILY • Case example • Philip is a 63 yr old man IMPACT ON FAMILY • Case example • Philip is a 63 yr old man married with 3 children and 4 grandchildren. Works as a teacher, recently disclosed that his father sexually abused him, father has just died. • Question • What would be the impact of disclosure on the family?

IMPACT ON THE FAMILY • Consequences can be devastating • Family members tend to IMPACT ON THE FAMILY • Consequences can be devastating • Family members tend to ‘take sides’ • Issues in individual services e. g. • • • - survivor may have to care for their abuser - children concerned about telling and what might happen next - clients in LD Services may think they were wrong to tell Various ways of confronting their abuser

CRIMINAL JUSTICE ISSUES • Provision of Therapy for Vulnerable or Intimidated Child / • CRIMINAL JUSTICE ISSUES • Provision of Therapy for Vulnerable or Intimidated Child / • • Adult Witnesses Prior to a Criminal Trial False memory allegations Providing support at every stage of the reporting process (including supporting survivors in attending court) Protection of case notes • www. cps. gov. uk/publications/prosecution/pretrialadult. html • www. cps. gov. uk/publications/prosecution/therapychild. html

ONGOING SUPPORT – FOR SURVIVORS How staff can help • Hearing an empathic response ONGOING SUPPORT – FOR SURVIVORS How staff can help • Hearing an empathic response may be enough • Helping them to feel safe and supported • Empowering them to work at their own pace • Not all survivors want therapy (but some do)

LOCAL VOLUNTARY SECTOR SERVICES • Quetzal 0116 253 3383 • FREEVA 03003336533 city only LOCAL VOLUNTARY SECTOR SERVICES • Quetzal 0116 253 3383 • FREEVA 03003336533 city only • First Steps 0116 254 8535 • Rape Crisis 0116 255 8852 • Lamp Directory • Women’s Aid 0116 285 6079 • Survivors Trust • SARC (Police) • Victim support 0300 303 1947 • Note We should be meeting the needs of our service users unless they choose to access voluntary sector services.

Leicester Domestic Violence Helpline 15 Wellington St , Leicester, LE 1 6 HH Leicester Leicester Domestic Violence Helpline 15 Wellington St , Leicester, LE 1 6 HH Leicester Domestic Violence Forum 15 Wellington Street Leicester , Leicester, LE 1 6 HH Disablement Information & Advice Line The Guild Hall Colton St , Leicester, LE 1 1 QB Housing Advice Centre Alliance House 6 Bishop Street , Leicester, LE 1 6 AF Victims of Crime Support Scheme 3 rd Floor Market Centre Offices 11 Market Place, Leicester, LE 1 5 GG Profile Trade - Mens Sexual Health Project 15 Wellington Street , Leicester, LE 1 6 HH Profile Open Door Leicester HIV & Sexually Transmitted Infections Information Service Leicester Lesbian Gay & Bisexual Centre Ltd. Castle Community Rooms 2 Tower Street , Leicester, LE 1 6 WR Leicester Royal Infirmary Sq , Leicester, LE 1 5 WW 15 Wellington Street , Leicester, LE 1 6 HH P Profile

CONTACTS • voluntary sector agencies : • • • ring 0808 802 0028 for CONTACTS • voluntary sector agencies : • • • ring 0808 802 0028 for the DSV Helpline (in a few weeks their website will be up www. uava. org. uk). You can also look at the Council’s website http: //www. leicester. gov. uk/your-community/emergenciessafety-and-crime/domestic-and-sexual-abuse/ • • • CEASE police website and resources Jenkins centre for offenders Children and young people Call Child. Line for advice and support 24 hours a day for free on 0800 1111. Adults and professionals or wants advice can contact the NSPCC for free 24 hours a day by calling 0808 800 5000, emailing [email protected] org. uk, texting 88858 or using an online reporting form.

A SAFETY MODEL FOR SURVIVORS OF SEXUAL ABUSE Safe ventilation techniques Allow for personal A SAFETY MODEL FOR SURVIVORS OF SEXUAL ABUSE Safe ventilation techniques Allow for personal space Form a list of safe contacts Exercise grounding techniques Time out and relaxation You are not alone

SAFE VENTILATION TECHNIQUES It is suggested that you help your client to: • Examine SAFE VENTILATION TECHNIQUES It is suggested that you help your client to: • Examine their coping mechanisms and make a commitment to stay within safer boundaries. • Explore different ways of expressing their feelings safely – write them down, talk to a friend, use a creative skill such as art. • Put together a personal self-injury support kit and aim to minimise the harm to themselves.

ALLOW FOR PERSONAL SPACE Suggest your client considers: • Rescheduling time within their daily ALLOW FOR PERSONAL SPACE Suggest your client considers: • Rescheduling time within their daily routine to consider and express their thoughts. • Telling those close to them that they may need space at times, and develop a system so that people know when to leave them alone. • Their need to set boundaries with those around them re physical and sexual contact, who they want to know about it.

FORM A LIST OF SAFE CONTACTS Suggest your client thinks about: • Who do FORM A LIST OF SAFE CONTACTS Suggest your client thinks about: • Who do they feel safe talking to about these issues – family, friends, professionals, helplines? • Making a list of names and ’phone numbers to use in a crisis including when they are available – keep the list at hand. • Asking friends about their contact limits – how much support are they able to give, how late at night?

EXERCISE GROUNDING TECHNIQUES Help your client learn about safe grounding techniques by: • Identifying EXERCISE GROUNDING TECHNIQUES Help your client learn about safe grounding techniques by: • Identifying a place where they feel safe to go if they’re experiencing flashbacks, memories • Reminding themselves of where they are, look at the things around them, staying in the present • Writing down their experience as soon as they feel able to, or discussing it with someone • Identifying a safe grounding object – a piece of jewellery, a soft toy, a key ring, something they can keep at hand

TIME OUT AND RELAXATION Encourage your client to take time out and relax, so TIME OUT AND RELAXATION Encourage your client to take time out and relax, so help them think about how they can do this: • Exploring several activities that they can use to take time out from their abuse • Scheduling daily time in their routine to take time out and relax – they deserve this • Trying out new hobbies / rediscovering old ones • Considering their coping mechanisms and make a list of those that help them to relax safely This is good advice for you as a practitioner too!

YOU ARE NOT ALONE… • Help your client to realise that: • Others have YOU ARE NOT ALONE… • Help your client to realise that: • Others have been at the stage they are in at the moment, and survived. • Things will get better for them with time, patience and support. • Joining a support group will help them to see how others are coping, and to share their frustrations with those who understand what they’re going through.

A RESPOND TREE Leaves = presenting difficulties Branches = emotions and psychological effects Roots A RESPOND TREE Leaves = presenting difficulties Branches = emotions and psychological effects Roots = cause(s) of distress

CASE STUDY Hannah – 23 year old woman Age 5 -14 step father and CASE STUDY Hannah – 23 year old woman Age 5 -14 step father and mother sexually abused her. Currently underweight, binges and vomits, feels depressed and suicidal. At weekends binges on alcohol and has unprotected sex. Has few close friends as relationships break down and no regular partner. Has repeating nightmares, anxiety and occasional flashbacks. Her support network consists of 2 younger sisters who are there in a crisis. She doesn’t relate her abuse to current issues first disclosure at 23. Use the response tree to explore how her current difficulties may relate to her abuse.

USE THE TREE TO DESCRIBE WHAT EMOTIONS MAY APPLY • What would the roots USE THE TREE TO DESCRIBE WHAT EMOTIONS MAY APPLY • What would the roots say • What would the leaves represent • What would the branches say

AN EXAMPLE RESPOND TREE Sexual problems Self-harm Phobias Violence Eating disorder Nightmares Anxiety Depression AN EXAMPLE RESPOND TREE Sexual problems Self-harm Phobias Violence Eating disorder Nightmares Anxiety Depression PTSD fear anger guilt pain inability to trust Physical abuse Compulsive behaviour shame low selfesteem Sexual abuse Emotional abuse

ONGOING SUPPORT – FOR STAFF • Staff who are well supported will support their ONGOING SUPPORT – FOR STAFF • Staff who are well supported will support their clients well. • Adequate support involves: • Team support / emotional ‘offloading’ • Managerial and clinical supervision • Access to specific expertise in abuse if required www. seenandheard. org. uk

SUPPORT FOR STAFF – SPECIFIC TO THE TRUST • Safeguarding Lead Doctors • Confidential SUPPORT FOR STAFF – SPECIFIC TO THE TRUST • Safeguarding Lead Doctors • Confidential staff counselling services Amica • Tracey Alexander – Dynamic Psychotherapy Gwendolen house • Lois Dugmore Nurse Consultant Dual Diagnosis HPC 0116 295 3028 • Safeguarding Leads (Children & Adults) • Professional development opportunities multi-agency Sexual Abuse Forum run by Tracey Alexander • Line Managers

AND FINALLY… • Thank you • Is everyone OK? • Any burning questions? AND FINALLY… • Thank you • Is everyone OK? • Any burning questions?