Adult survivors & their families: current needs & service responses

Emerging Science & Voices: Exploring Recovery Emerging Science & Voices: Exploring Recovery Opportunities & Evidenced OutcomesOpportunities & Evidenced Outcomes

23/01/2013

D. Seddon, A. Krayer, C. Robinson & H. Gwilym (D. Seddon, A. Krayer, C. Robinson & H. Gwilym (Bangor University) Bangor University) in collaboration within collaboration with

G. McKeown & C. Hodrien (G. McKeown & C. Hodrien (Victim Support Wales)Victim Support Wales)

Funded by the National Institute for Social Care & Health Research, Funded by the National Institute for Social Care & Health Research, Welsh GovernmentWelsh Government..

Overview of presentation ion

From a range of stakeholder perspectives:

Highlight key challenges following the disclosure of sexual abuse.

Consider service responses & their perceived effectiveness.

Implications for future policy & practice.

Purpose of the study

To provide an evidence base to inform future developments in policy, practice & service provision to better meet the needs of adults who experienced sexual abuse during childhood.

Method

In-depth interviews with 30 strategic & operational staff in statutory & third sector organisations:

• Discussions framed by a topic guide.

In-depth interviews with 30 adults (18 years /over) who experienced childhood sexual abuse:

• Stories were elicited using the biographical narrative interview method.

Project Reference Group informed the research process.

Survivors

6 male & 24 female survivors of abuse, ranging in age from early 20s to late 70s.

Not all of the interviewees identified the abuser, but those who did (n = 25) all referred to someone known to them.

Generally, this was a father, step-father/mother’s new partner, uncle or brother.

Survivors

Multiple types of abuse and neglect in the family.

Individuals likely to be vulnerable to further physical, emotional and sexual abuse, often by peers or partners throughout periods in their lives.

Unfolding lives

Abuse Non-disclosure vs. disclosure

Self over time: Emotions – Thoughts - Behaviours Memories – Self-concepts

Triggers: Live events (positive/negative) Stress/pressures Flashbacks

Seeking support & help Disclosure

Moving towards healing & recovery

Reactions: +/-

Context: Family dynamics – Life experiences– Cultural and social values – Social support

Family

Partners/ friends/family Professionals

Other survivors

Adulthood Childhood/teens

Moving on

Self over time

Emotions, thought and behaviour patterns Guilt, self-blame and low self-esteem. Isolation and lack of trust. Anger and feeling of no control. Unhealthy behaviour patterns such as self-

harm, promiscuity, substance misuse including alcohol.

It’s hard to say what my life was like. I was using alcohol a lot. I self-harmed (…). I was very isolated throughout. I never went anywhere. Survivor 21.1

Self over time

Memories and self-concept Disconnectedness and suppression of

memories – sometimes described as a coping strategy and sometimes experienced as distressing

Questions around: who am I, who could I have been, what if, why me?

Following the abuse I buried it basically. (…) The analogy I can use is that I put it in a compartment in my head, locked it away and threw away the key, and that is where it stayed. Survivor 10.1

Disclosure

Disclosure in childhood/teenage years Disbelief at early disclosure of sexual abuse to

family members will lead to damaging consequences.

Disclosure is a complex process and on-going during adult years (friends, partners, family members and professionals).

Criminal justice system Challenge of reporting historic sexual abuse &

lack of evidence for historical abuse cases - low conviction rates

Variability in sensitivity & understanding of police staff

Clash in expectations

We need to remember that the police are there to establish the facts; to do this they can’t get emotionally involved; yet victims expect more, they expect the empathy. Police 48.6

I don’t know, they were almost asking me some questions that seemed like “Is this true”, you know, a couple of times and I just felt like, well, breaking down really at that point. Survivor 4.1

Seeking support and help Seeking support as a result of live events; stress

and pressures.

Emotionally and practically very difficult.

Seeking support can take years and is an on-going and very individual process.

Support needs to be timely and appropriate.

Disclosure needs to be received in an accepting and non-judgemental way.

Moving towards healing Issues to be addressed revolve around:

Accepting the abuse happened.

Dealing with painful emotions such as loss and anger.

Placing responsibility where it belongs.

Working through difficulties and developing coping strategies.

Building support networks.

Accepting oneself by resolving ambivalence: the abuse has influenced who I am – it happened but I can move on.

Seeking/finding closure Taking the abuser to court.

Confronting the abuser - face-to-face or in writing.

Forgiving the abuser – linked to faith.

Knowing and accepting who one is and looking towards the future.

Seeing opportunities and working towards making a difference.

Service responses - supporting a difficult to reach group

Staff describe the reluctance of survivors to seek help & access services in general & in particular:

Male survivors. Older survivors (aged 55 years plus). Survivors from Black & Minority Ethnic groups. Survivors from some faiths.

Survivors identify fear of not being believed & rejection as barriers to seeking help, as well as stigma & a sense of shame:

Being believed, now that’s a big issue. I’m not lying people, I’m not lying. Survivor 29.1

The need for flexible, responsive services Survivors feel health & social care services are delivered at

the providers’ convenience rather than flexibly in ways that meet their needs:

You’re frightened of disclosing something too deep near the end of a one hour session because you know you have to deal with it on your own when you leave. You become very selective about what you talk about in those sessions…they need to realise that we are all different. Survivor 29.1

Limited, inflexible range of services – gaps include practical & social support & advocacy.

Staff acknowledge policy ideals are not always translated into practice.

Service responses - recruiting & retaining people to work in this field

Third sector rely on experienced volunteers - BUT- difficult to attract people to work in this field & volunteer numbers are declining.

Affects the capacity of organisations to offer specialist support:

The waiting list at the moment I think is about forty plus. It has been, I am disgusted to have to say it but it has been up to two years. It depends on the intake of counselors. That’s the limiting factor. Staff 59.6

Service responses - funding Funding deficits have a detrimental affect on the availability of services

& the ways in which services are delivered:Well money is a huge thing actually, there isn’t the funding, there isn’t finance and there isn’t adequate support. People just aren’t

looking at the bigger picture. Joint Staff Interview 36.6 & 61.6

Current service provision is compromised: E.g. Counselling is usually restricted to a maximum of 12 sessions.

Future service development activities are compromised: 24 hour on-line & telephone counselling. Services that support transgender clients. Services that support families/significant others.

Provokes strong reactions from survivors & is demoralising for staff:We’re alive. We are human beings. We didn’t ask for this to be

done to us. You know, we were the victims as children. We’ve survived it. Aren’t we worth it? Survivor 35.1

Service responses – a joined-up approach??

Staff endorse the principle of working in partnership & ensuring clients lie at the heart of partnership arrangements - BUT- it’s difficult in practice.

  Limited understanding of professional roles – e.g. confusion about

domestic violence & sexual violence.

Confusion undermines confidence in the appropriateness of referrals to organisations:

…mental health services cannot deal with them so they have actually passed them on to the voluntary sector. Especially if they get a disclosure of abuse. Oh we still shouldn’t be dealing with that, we deal with Schizophrenics or we deal with other stuff. We don’t deal with sexual abuse…Staff 51.6

Survivors report a lack of effective signposting & coordination between services. E.g. lack of a coordinated approach to dealing with drug & alcohol dependency & eating disorders.

Policy & practice implications Innovative thinking around service design & delivery:

Commissioners to work with survivors to develop responsive provision, supporting individuals to achieve personalised outcomes.

Provision of on-going support (non-therapeutic): Practical, e.g. help seeking employment.Social & emotional, e.g. help establishing relationships &

overcoming feelings of isolation.Advocacy, e.g. help to understand the benefit system.

Strengthen partnership working: Clearer understanding of the roles & complementary skills of

stakeholders to help:address difficulties relating to inappropriate referralsencourage the sharing of expertise and good practice