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How Prepared are MFT Trainees to work with Child Sexual Abuse?
Colleen Friend, PhD & Vasavi Charathram, MS(Counseling) - California State University
4 Broad Themes of the MFT Trainees’ Qualitative Study
• Theme 1. Inadequacy of course work• Theme 2. Availability and inadequacy of
practical training • Theme 3. Preference for specific techniques• Theme 4. Recognition of need to have
experience in working with CSA at different stages of MFT trainees’ development and education.
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Key pointsChildren with developmental disabilities are more at risk of sexual and physical abuse than the general public
– Studies vary, but consistently show that there is a link between children with disabilities and abuse (Sobsey, 1991)
– 1 in 3 children with an identified disability for which they receive special education services are victims of some type of maltreatment.
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Developmentally Sensitive Applications of Trauma Focused-Cognitive Behavioral Treatment
Set ground rules at the onset and modify as needed - and have the child practice!
Short, simple sentencesAvoid shifting words (pronouns & unclear references)Do not finish sentences for the childEnsure a clear transitionRepeat what victim says to clarify what was saidSexual knowledge inventory
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Visual, Auditory & Kinesthetic Stimulation Parents need to become Co-Regulating Agent for
child’s behavior Vigilance Symptom - safety can be a trigger too! Watch for responses that ‘aimed to please’ Avoid “yes/no” questions if possible First try open-ended questions to see if child can
respond in narrative If the child does not seem to understand questions
or is unable to provide narrative, then proceed to direct questions, multiple choice, or yes/no questions
Use of sensory focus questions How did that make you feel? Tell me what you heard? Tell me what you saw? Tell me what you felt?
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Developmentally Sensitive Applications of Trauma Focused-
Cognitive Behavioral Treatment
Soft tone of voice and face
Organize (time management, regularity)
Offer choices
Touch and physical proximity
Hear what child is anxious about
End and let go!
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The Interview
• Use of tools: drawings, dolls, photographs, mood charts
• Pace the interview• Allow for long pauses -
processing issues• Be careful not to interrupt• Be aware of interview stress -
use breaks• Shorten interview - focus on
questions to essential information rather than peripheral details
• Consider multiple interviews - scaffolding
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Forensic Interviewing with Pre-School Childrenby Jackie Block-Goldstein,MSW
Shift your goal from
Prosecution
to Protection !
1 in 4 girls is
victim of sexual
abuse
1 in 6 boys
is a victim of
sexual abuse
At 27 months and younger, the
child is unable to express the
narrative verbally
At 36 months and older, the
child is able to give a
narrative
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Forensic Interviewing with Pre-School Childrenby Jackie Block-Goldstein,MSW
2 Types of
Memory
Procedural
Explicit
Free Drawing - best because it
aids the narrative
Anatomical drawings, 2-3 years and older
Anatomical dolls - endorsed by APRI when used properly, 4 years old and older
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Forensic Interviewing with Pre-School Children
‘Good’ touch vs. ‘Bad’ touch, now ~ ‘Touch’ Inventory
Picture Test no longer used because it is time consuming
Prepare the young child before the interview, do your work in familiarizing yourself with the details
Rapport building with the child
Developmental screening of the child
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Forensic Interviewing with Pre-School Children
• Scaffolding Procedure
• Explore Alternative Hypothesis
• Standard Structural Protocol
National Children’s Advocacy Center [NCAC] Model Extended Forensic Evaluation, since 1990s
– Philadelphia Model very similar
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What is Project Kariñu?
¥ Kariñu is an early childhood initiative usinga Public Health approach that will servechildren age’s birth through five years.
¥ Kariñu will provide screening, assessment,mental health promotion and consultation,family education, and individualized servicesand supports.
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Assessment: Ages & Stages
Questionnaire 3rd Edition
21 Questionnaires used to assist with screening and monitoring children
from 1 thru 66 months of age.
Designed to screen young children for
developmental delays
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Assessment: Ages & Stages Questionnaire -
3rd Edition
Each questionnaire contains 30 developmental items written in simple and straight-forward language.
The items are organized into five areas:
1. Communication 4. Problem Solving2. Gross Motor 5. Personal-Social3. Fine Motor
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“ Sample “
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Assessment : Mental Health
Ages & Stages Questionnaire : Social-Emotional
Used in conjunction with ASQ-3
Seven Behavioral Areas:
1. Self-Regulation 5. Autonomy 2. Compliance 6. Affect and3. Communication 7. Interaction4. Adaptive with
Functioning People
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“ Sample “
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Human
Figure
Drawing
Female, 5 yrs
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Additional Inferences ~
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ChildSexual
BehaviorInventoryQuestionnaire
9 Domains of CSBI:- Boundary Problems- Exhibitionism- Gender Role Behavior- Self-stimulation- Sexual Anxiety- Sexual Interest- Sexual Intrusiveness- Sexual Knowledge- Voyeuristic Behavior
Developmentally Related Sexual Behavior - Reflects level of age- and gender-appropriate behavior
Sexual Abuse Specific Items- SA Hx after controlling for effects of maternal education and family income.
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ChildSexual
BehaviorInventoryQuestionnaire
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Child Sexual Behavior Inventory Score Sheet
[CSBI]
*Developmentally Related Sexual Behaviors***
**Sexual Abuse Specific Items
59 and below Nonsignificant
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Trauma Symptom Checklist for Young Children
TSCYC
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TSCYCQuestionnaire
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TSCYCQuestionnaire
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The Application of Parent Child Interaction
Therapy (PCIT) for Traumatized Children
• Designed to treat children age s 2 through 7 years exhibiting disruptive behaviors
• Work with caregiver and child together
• Intervention done in ‘real’ time
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The Application of Parent Child Interaction Therapy (PCIT) for Traumatized Children
Two Phases:1. Relationship Enhancement
2. Strategies to Improve Compliance
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PCIT Phase One: Relationship Enhancement
The focus is on enhancing the parent-child Interaction, also known as the Child-Directed Interaction, or CDI
– Shift attention to child’s desired behavior– Focus on recognizing and praising positive child
behavior– Avoid controlling and negative parent behaviors– Shape child behavior through selective attention
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PCIT Phase 2: Strategies to Improve Compliance
The focus is on improving child compliance, often described as Parent-Directed Interaction, or PDI- Focus on giving clear and direct commands- Make sure parent follows through with commands- Structure child consequence for non-compliance-Teaching an effective time-out sequence- Develop a mastery of skills related to managing child’s non-compliance- Mastery of PDI skills signals end of treatment
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Trauma-Focused Cognitive Behavioral Therapy (TF-CBT)
for Traumatized Children & their Families
Cognitive Triangle : Thoughts, Feelings & Behaviors
Doing
Feeling
Thinking
Trigger
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Trauma-Focused Cognitive Behavioral Therapy (TF-CBT)for Traumatized Children and their Families
PRACTICE Components - Skill-building - The Narrative Unfolds - Personal and Body Safety
‘Pair positive, healthier emotions with traumatic memory
to make it more approachable.’
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(TF-CBT)
P sycho Education & Parenting Skills
R elaxationA ffective Expression & Regulation
C ognitive CopingT rauma Narrative Development & Processing
I n vivo Gradual ExposureC onjoint Parent-Child SessionsE nhancing Safety & Future Development
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A Pilot Study Comparing TF-CBT to TF-Integrated Play
Therapy
3 components of PTSD : Re-Experiencing, Avoidance, Hyperarousal
Are certain children better matched to certain kinds of therapy?
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Trauma-Focused Integrated Play Therapy TFIPT
Combination of
directed & nondirective approaches
to advance structured,
goal-oriented therapy
Attends to developmental needs
of young children
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Post traumatic play
appears to be child’s natural way to introduce gradual exposure, narrative formation and
trauma processing
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DiagnosticReferences
Diagnostic and Statistical Manual, Version IV, Text Revised [DSM-IV-TR] [DSM-V, May 2013]
Diagnostic Classification of Mental Health & Developmental Disorders of Infancy and Early Childhood: Revised Edition [DC:0-3R]
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DSM-IV-TR Multi-axial Assessment
Axis I Clinical DisordersOther Conditions That May Be a
Focus of Clinical AttentionSexual Abuse of Child (Victim)
Axis II Personality DisordersMental Retardation
Axis III General Medical ConditionsAxis IV Psychosocial & Environmental ProblemsAxis V Global Assessment of Functioning
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Diagnostic Classification
of Mental Health & Developmental
Disorders of Infancy and Early Childhood: Revised
Edition
[DC:0-3R]
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DC: 0-3R Multi-axial Assessment
Axis I: Clinical DisordersOther Relationship
DisturbancesAxis II: Relationship ClassificationAxis III: Medical & Developmental
Disorders and ConditionsAxis IV: Psychosocial StressorsAxis V: Emotional & Social Functioning
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Thank you for helping us to heal!