Caring for Child Survivors of Sexual Abuse

250 Pages·2012·5.49 MB·English

Caring for Child Survivors
of Sexual Abuse
Guidelines for health and psychosocial service
providers in humanitarian settings
First Edition
Cinotreer nCAhtiliodn SAelx uAl AbuSe
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Cover Photo: UNICEF/Jill Connelly/Democratic Republic of the Congo, 2010

© 2012 by International Rescue Committee
All rights reserved.

International Rescue Committee
Agency Headquarters
122 East 42nd Street
New York, NY 10168
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[phone]

www.Rescue.org
For more information about the Caring for Child Survivor’s Resources please contact
the IRC Women’s Protection and Empowerment Technical Unit at [email protected]. To down-
load the CCS Guidelines electronically, please go to www.gbvresponders.org.
This publication was funded in part by the Bill & Melinda Gates Foundation and the U.S.
Department of State’s Bureau of Population, Refugees, and Migration (PRM). The findings
and conclusions contained within are those of the authors and do not necessarily reflect
positions or policies of our funders.
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ACKnowledgementS
The Caring for Child Survivors (CCS) of Sexual Abuse Guidelines were developed to respond to
the gap in global guidance for health and psychosocial staff providing care and treatment to child
survivors of sexual abuse in humanitarian setting. The CCS Guidelines are based on global research
and evidenced-based field practice, and bring a much-needed fresh and practical approach to help-
ing child survivors, and their families, recover and heal from the oftentimes devastating impacts of
sexual abuse.
On behalf of the IRC, I would like to extend a special word of appreciation to the U.S. Department of
State’s Bureau of Population, Refugees and Migration, the Bill & Melinda Gates Foundation and the
United Nations Children’s Fund (UNICEF) for making the development of these guidelines possible.
This generous support has allowed the IRC to develop a child-centered model of care and accompa-
nying guidelines to support humanitarian field staff caring for child survivors of sexual abuse. I would
like to also recognize UNICEF for their role as technical partners in the CCS Initiative.
I would like to extend a special thank you to Abigail Erikson, the principal author of these guidelines.
Abigail’s extraordinary commitment, expertise and energy have been central to this effort and we
are deeply grateful to all of her hard work. I would also like to thank members of the CCS Technical
review panel. This panel of gender-based violence (GBV) and child protection experts were instru-
mental in ensuring the guidelines are rooted in best practice and global standards. Deep appreciation
and thanks go to the following IRC experts: Laura Boone, Senior Technical Advisor, Child Protection;
Eduardo Garcia Rolland, Technical Advisor, Child Protection; Dhammika Perera, Senior Technical
Advisor, Reproductive Health; Karin Wachter, Senior Technical Advisor, Women’s Protection and
Empowerment; Janel Smith, Clinical Care for Sexual Assault Survivors Specialist, and Eve Puffer,
Technical Advisor, Research, Evaluation and Learning. In addition, Mendy Marsh, GBV Emergency
Specialist, UNICEF and Chen Reis, Clinical Associate Professor and Director of the Humanitarian
Assistance Program at the University of Denver, provided key technical input and technical advice.
A very special thank you goes to the IRC Women’s Protection and Empowerment Team in Thailand
and the Community Wellbeing Initiative and Child Protection Teams in Ethiopia. The time and effort
made available by the IRC Field teams to pilot test the CCS tools and resources has been invaluable
to the successful development of the CCS guidelines.
We hope these guidelines will benefit child survivors in humanitarian settings throughout the world,
as well as the individuals who help to provide for their care and treatment.
Thank you,
Heidi Lehmann
DIRECTOR, WOMEN’S PROTECTION AND EMPOWERMENT TECHNICAL UNIT
INTERNATIONAL RESCUE COMMITTEE
CCS Guidelines | Page 1
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tAble oF ContentS
introduCtion 4
Overview of the Caring for Child Survivors (CCS) Resources
CCS Theory of Change
Using the CCS Guidelines
Glossary of Terms
ChaptER OnE: CORE Child SExual abuSE KnOwlEdgE COmpEtEnCiES 21
Core Child Sexual Abuse Knowledge Competency Areas
Guidelines for Assessing and Monitoring Core Knowledge Competencies
ChaptER twO: CORE Child-FRiEndly attitudE COmpEtEnCiES 51
Core Child-Friendly Attitude Competency Areas
Guidelines for Assessing and Monitoring Core Attitude Competencies
ChaptER thREE: CORE SKillS: Engaging and COmmuniCating with
Child SuRvivORS 59
Developing a Helping Relationship through Safe and Healing Communication Strategies
Best Practices for Communicating with Child Survivors
Guidelines for Communicating with Children about their Experience of Sexual Abuse
Addressing Common Communication Challenges
Guidelines for Assessing and Monitoring Core Communication Skill Competencies
ChaptER FOuR: guiding pRinCiplES and KEy iSSuES 87
Guiding Principles for Working with Child Survivors of Sexual Abuse
Caring for Child Survivors Key Issues
Issue 1: Mandatory Reporting Requirements
Issue 2: Confidentiality Protocols in Child Cases
Issue 3: Ensuring the Best Interest of the Child: Balancing Roles in Decision-Making
ChaptER FivE: CaSE managEmEnt FOR Child SuRvivORS 105
Introduction to Case Management
Steps of Case Management for Child Survivors of Sexual Abuse
Step 1: Introduction and Engagement
Step 2: Intake and Assessment
Step 3: Develop Case Goals and Action Plan
Step 4: Implement the Case Action Plan
Step 5: Case Follow-up and Monitoring Progress
Step 6: Case Closure and Evaluating Service
Step 7: Service Evaluation
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ChaptER Six: pSyChOSOCial intERvEntiOnS FOR Child SuRvivORS 187
Integrating Psychosocial Interventions into a Child and Family’s Care and Treatment
Assessing the Psychosocial Needs of Child Survivors
Guidelines for Implementing Core Psychosocial Interventions
ChaptER SEvEn: bESt pRaCtiCES FOR CaSE COORdinatiOn
bEtwEEn SERviCE pROvidERS 231
Best Practice in Coordinating Child Case Response
Final nOtE tO thE REadER 239
CCS toolS
Please note: related staff monitoring tools and/or sample case management forms are
included at the end of each chapter. A list of the CCS tools and relevant page numbers are
included below.
CCS KnOwlEdgE aSSESSmEnt tOOl (CCS-Ka) 45
CCS attitudE SCalE 57
CCS COmmuniCatiOn aSSESSmEnt tOOl (CCS-Ca) 83
Child nEEdS aSSESSmEnt and CaSE aCtiOn plan 170
Child CaSE FOllOw-up FORm 172
Child CaSE ClOSuRE FORm 174
Child CliEnt SatiSFaCtiOn QuEStiOnnaiRE 175
CCS CaSE managEmEnt SKillS aSSESSmEnt tOOl (CCS-Cma) 180
CCS CaSE managEmEnt ChECKliSt 183
Child and Family pSyChOSOCial nEEdS aSSESSmEnt tOOl 225
Tools and other reference documents not specific to a particular chapter are included
at the end of the guidelines.
minimum StandaRdS FOR CaSE managEmEnt 240
gbvimS intaKE and aSSESSmEnt FORm 241
CCS Guidelines | Page 3
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introduCtion
OvERviEw OF thE CaRing
FOR Child SuRvivORS (CCS)
RESOuRCES
The International Rescue Committee (IRC), in partnership with the U.S.
Department of State, the United Nations Children’s Fund (UNICEF) and
the Bill & Melinda Gates Foundation have dedicated resources toward
developing a program model of care1 and guidelines for implementing the
gOal
model of care for child survivors of sexual abuse across humanitarian set-
The ultimate goal of the tings. The purpose of developing these resources is to provide guidance
Caring for Child Survivors on how to:
Resources is to enable
» Build the capacity of health and psychosocial service providers on the
and empower staff in
foundational (or “core”) knowledge, attitudes and skills to work with
humanitarian aid con- child survivors of sexual abuse.
texts to provide high » Adapt case management for child survivors.
quality care to children » Implement targeted psychosocial interventions.
» Improve coordinated care across multiple sectors and service providers.
and families affected by
» Monitor the quality of service provision.
sexual abuse.
1 The CCS Program Model is also referred to as the CCS Theory of Change. This refer-
ences the logical framework developed to help child survivors recover and heal from
sexual abuse.
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The Caring for Child Survivors (CCS) Resource Package is based on global research on child
sexual abuse and evidence from field practice. The CCS Resource Package brings a much-
needed comprehensive and practical approach to helping child survivors and their families
recover and heal from the impacts of sexual abuse. The three main components are:
» literature Review: An in-depth literature review of available evidence and promising prac-
tice to improve case management, psychosocial care, and clinical care for child survivors
of sexual abuse.2
» CCS program model: The logical model or “theory of change” that outlines the service
delivery components necessary to help children recover and heal from sexual abuse.
» CCS guidelines: The CCS Guidelines (this document) provide step-by-step guidance on
how to implement the main aspects of the CCS Program Model. The CCS Guidelines is
the “how-to” guide for instructing health and psychosocial field staff responding to chil-
dren who have experienced sexual abuse. The CCS Guidelines include multiple tools for
monitoring and evaluating the program model, such as: knowledge and skills competency
assessments and case management monitoring and evaluation tools.
CCS thEORy OF ChangE and
intEndEd OutCOmES
The technical guidance outlined in this document comes from the CCS program model or
“theory of change” outlined on the next page. The CCS theory of change posits that children
can be supported in their recovery and healing from sexual abuse with child-specific, compas-
sionate and appropriate care and treatment. The theory of change outlines the key elements
of care and treatment and the knowledge, skills and attitudes required for health and psycho-
social service providers to be able to provide such care.
2 The CCS literature review is titled: Advancing the Field, Caring for Child Survivors of Sexual Abuse in Humani-
tarian Settings. A Review of Promising Practices to Improve Case Management, Psychosocial & Mental Health
Interventions, and Clinical Care for Child Survivors of Sexual Abuse. May 2010
CCS Guidelines | Page 5
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CCS theory oF ChAnge
Key elementS oF CAre For Child SurViVorS oF SexuAl AbuSe
Child SuRvivORS havE aCCESS tO Child CEntEREd CaSE
managEmEnt SERviCES
Caseworkers have the knowledge, skills, attitudes and tools to provide child-
centered case management.
» Understand and able to apply child sexual » Understand and able to apply CCS
abuse concepts in case management. Guiding Principles in case management.
» Possess child-friendly attitudes that » Able to use child-friendly tools to aid
contribute to recovery and healing. effective case management services
» Able to communicate with child » Able to appropriately engage caregivers
survivors according to age and in the child’s care and treatment.
developmental stage. » Able to monitor activities using
» Able to adapt case management established tools.
services for child sexual abuse cases.
Child SuRvivORS havE aCCESS tO Child SpECializEd CliniCal CaRE &
tREatmEnt SERviCES
health providers have the knowledge, skills, attitudes and tools to provide
specialized medico-legal care for child survivors.
» Understand child growth and » Able to adapt the medical exam and
development and child sexual treatment for child survivors.
abuse concepts. » Able to ensure safe and appropriate
» Able to communicate effectively referrals and follow-up systems are
with child survivors. in place.
» Understand and able to apply CCS » Able to monitor activities using
Guiding Principles in case management. established tools.
hEalth & pSyChOSOCial SERviCE pROvidERS COORdinatE CaRE
aCCORding tO bESt pRaCtiCE
Service providers have the knowledge, skills, attitudes and tools to use referral
pathways, reporting agreements and information sharing protocols.
» Able to understand essential protocols exist.
components to case coordination. » Agreements and guidelines for
» Able to demonstrate best practice for interacting with legal and reporting
coordinating child sexual abuse cases. systems exist.
» Service provider agreements that » Able to monitor activities using
outline referral and information sharing established tools.
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CCS theory oF ChAnge
Key elementS oF CAre For Child SurViVorS oF SexuAl AbuSe
Child survivors are
Caseworkers safe and have their
provide appropriate immediate needs met.
case management
to children and
families affected by Caregivers engage
sexual abuse. positively in their
child’s healing process.
Child
survivors
recover
and heal
Child survivors
health care from
have improved health
providers offer child
outcomes and sexual
specialized medical
appropriate
care and treatment.
evidence collection. abuse
Referral pathways
and reporting agree-
referral systems
ments are developed
function and child
and utilized properly.
cases are effectively
coordinated between
info-sharing proto- service providers.
cols are developed
and utilized properly.
CCS Guidelines | Page 7
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nOtE On
languagE
The term service
provider is used when
referring to both health
and psychosocial
professionals. The term
caseworker is used
when referencing an
individual tasked with the
responsibility to provide
case management ser-
Photo: Photographer Unknown/the IRC
vices to child survivors.
uSing thE CCS guidElinES
The term caregiver is
Who can benefit from the ccS GuidelineS?
used to refer to the per-
son and/or persons exer- The primary target audience for the CCS Guidelines (referred to as “the
cised day-to-day care guidelines” from now on) is staff who provide psychosocial, case management
for a child. This includes and/or health services for survivors of gender-based violence (GBV) and/
or children in humanitarian settings. United Nations and NGO protection and
biological parents and/or
gender-related staff can also benefit from the guidelines and other compo-
other guardians respon-
nents of the CCS Resource Package.
sible for the child’s care
and well-being.
What are the GoalS and aimS of the ccS GuidelineS?
The goal is to provide staff with a user-friendly tool that offers best practice
guidance on caring for child survivors in humanitarian settings. The guidelines
aim to improve care for child survivors (and their non-offending family mem-
bers), in order to help them recover and heal from abusive experiences. The
guidelines and accompanying tools will equip field staff with the necessary
knowledge, skills and attitudes to provide high-quality care to children and
families affected by sexual abuse.
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