What Happens Now? Reporting Childhood Sexual Abuse

• Childhood Sexual Abuse
• The Children’s Advocacy Center
• Advocacy and Case Management
• Forensic Interview
• Child Protective Services
• Law Enforcement
• Mental Health Treatment/Therapy
• Moving Forward/Conclusion

Isabella’s stomach is tight as she squirms in her chair. She is wringing her sweaty hands and can feel a lump in her throat. She is scared. Isabella swallows hard and then begins to disclose to her school counselor that her stepfather is sexually abusing her.  

Childhood Sexual Abuse

Sadly, Isabella is one of many children and adolescents being sexually abused around the world. Childhood sexual abuse (CSA) is a global social epidemic that is overwhelming for all who are connected to it.

The Centers for Disease Control (CDC) estimates that 1 in 4 girls and 1 in 13 boys in the United States will experience child sexual abuse before their 18th birthday. Ninety percent of this occurs at the hands of someone known and trusted by the child or the child’s family. We will follow Isabella’s journey as she moves through the multidisciplinary systems she encounters following her disclosure, which I hope will be helpful to fellow clinicians working with sexually abused children.

The Children’s Advocacy Center

Isabella’s school counselor reports the sexual abuse to the child abuse reporting hotline. This sets the wheels in motion for Child Protective Services (CPS) and law enforcement to intervene. Isabella’s mother is wrought with fear and anxiety when she receives a call from a detective. She was instructed to bring Isabella to the local Children’s Advocacy Center (CAC). As she drives to pick up Isabella from school, she experiences a surreal sense of shock and numbness.  

Back in the day, many years ago, disclosures of childhood sexual abuse were met with fragmented investigative responses with children like Isabella participating in multiple interviews. Not only was this potentially traumatizing for the child, but it also resulted in inconsistent findings for various disciplines and poor outcomes for our youth and families. This changed in 1985 with the formation of the first Children’s Advocacy Center (CAC) in Huntsville, Alabama. Uniting law enforcement, criminal justice, child protective services, medical, and mental health services under one roof, the CAC movement revolutionized our response to sexual abuse allegations. Today, the CAC approach is the best practice for multidisciplinary professionals battling child abuse and neglect. The force monitoring and accrediting our CACs is the National Children’s Alliance (NCA) which oversees nearly 1,000 CACs.

Advocacy and Case Management

Upon entering the CAC, Isabella and her mother are greeted by Jordan and Rose. Jordan is a family advocate and case manager for the agency. Rose is a child engagement advocate. Jordan explains that she will be helping Isabella and her family during their time at the CAC and beyond. Rose explains that, as a child engagement advocate, she will be helping prepare and alleviate as many stressors as possible for Isabella today. Despite Jordan and Rose’s friendly demeanor, Isabella is cautious, and her stomach remains just as tight as it was when she disclosed to her counselor.

Isabella and her mother follow Jordan and Rose down the hallway into a clean, tidy room with a couch and toys. Rose notices Isabella’s anxiety and offers some fidgets, coloring sheets, and a snack. Rose showed her a book with pictures and names of the people she will be meeting today and explained the jobs they do at the CAC. Isabella begins to relax.   

As previously noted, most perpetrators of child sexual abuse are known to their victims. The CDC estimates the 90% of sex offenders are known to their victims and their victim’s family. In some instances, the perpetrator lives in the home or is the breadwinner for the family. As a result, the aftermath of a disclosure of CSA can leave a family with another crisis. The CAC’s family advocacy team helps to support the non-offending family members as well as the victim. Family advocates are the first to greet victims and their families, and are a consistent presence. They provide advocacy within the multidisciplinary team (MDT), emotional support as victims proceeds through the judicial system, information about client’s case, and assistance with tangible needs such as bills, clothing, food, housing, transportation and other aspects of daily living.

Research shows children fare better throughout the investigative process when they know what to expect. Child engagement advocates attempt to decrease traumatization and alleviate stressors victims may experience while at the CAC through preparing them for what they will be experiencing, using play, and trauma-informed care.  

Forensic Interview

While Rose was playing with Isabella, Jordan brought her mom back into the room. After a bit, another lady came into the room and Jordan introduced her colleague, Abby. Rose had shown her a picture of Abby in the book earlier and told her she was a forensic interviewer. Earlier, Rose had explained that “forensic interviewer” was a name for someone who was going to ask Isabella some questions. Abby smiled as she greeted them and asked Isabella to come to the “talking room.”

Isabella felt the knot return to her stomach as she looked first at Rose and then at her mom. She stood and gave her mom a hug before following Abby to the “talking room.” Once in the room, Isabella looked around. There were not any toys in this room. Abby started out by asking Isabella a lot of questions about herself. Isabella’s knot got a little looser as it wasn’t hard or scary to spell her name and talk about her pets. Abby explained to Isabella that only “true” things that happened can be talked about in the talking room. Isabella told Abby about what happened with her stepdad. Abby asked a lot of questions with a lot of details. Isabella felt anxious but she remembered her breaths that Rose taught her. Abby let her take breaks when she needed them. Abby had Isabella draw on a diagram of her body where her stepdad touched her. When they were done in the “talking room,” Isabella went back to the original room where her mom, Jordan, and Rose were waiting.  

Forensic interviews (FIs) of children and adolescents provide key evidence to guide investigations and support decisions regarding whether to pursue criminal prosecutions or continue interventions by child protection. Forensic interviews (FIs) may be requested by law enforcement and child protection. Occasionally, the District Attorney’s Office may request an FI. Typically, the FI is scheduled as close to the disclosure as possible. These interviews are done blindly, meaning the highly trained forensic interviewer does not know the details of why the victim has been brought to the CAC. FIs are legally justifiable, fact-finding interviews with a child conducted by specially trained forensic interviewer.  

In cases of childhood maltreatment, the overarching goal of a forensic interview is to gather information from a child in a neutral, non-leading way. The purpose of a forensic interview is to minimize the number of times a child must tell their story. Forensic interviewers provide an opportunity for a child to disclose abuse. If abuse is disclosed, the interview is used to gather details about their victimization. CPS and law enforcement observe the interviews to assist in their investigations.

Interviews are recorded to minimize the number of times a victim must detail their trauma and to increase the accuracy of the information provided. The FI is viewed in another room by law enforcement and child protection. Caregivers are not allowed to observe their child’s interview. Although the video recording itself does not substitute for a victim’s testimony in a court of law, it is utilized by the multidisciplinary team as part of the investigation and must meet certain legal criteria. A forensic interviewer is not responsible for proving or disproving an allegation.

Child Protective Services

After the forensic interview, Isabella returns to the room where her mother, Rose, and Jordan are waiting. Her mother has paperwork in her hands and is busy reading and signing forms. Jordan explains the next steps of the process and provides resources that might be helpful for Isabella and her mother. She tells them that an investigator with Child Protective Services (CPS) will be coming to speak with them shortly. Isabella wonders if the CPS worker was one of the people who was watching during her forensic interview. 

CPS is responsible for identifying and intervening in cases of childhood abuse or neglect. The overall purpose is to ensure child safety. During the investigative stage, interviews are conducted, pertinent records are reviewed, and a home visit is conducted. As in Isabella’s case, the CPS investigator was present at the CAC during the forensic interview and has information on what Isabella has experienced.

Based on the totality of the investigative information, Child Protective Services makes decisions regarding whether a child may remain in their home or not. In Isabella’s case, the mother is protective. She decided to stay at the home of relatives until the stepfather is out of the home or other housing is obtained. Given that the protective concerns are addressed, the CPS case is closed. This is not always the case.

Some family systems require ongoing services from CPS. For example, if the non-offending caregiver does not believe a child’s disclosure and is not willing or able to protect the child from the alleged offender, CPS may stay involved with the family. They may need to have a child, and their siblings, temporarily placed outside of their home with a relative or a foster home. Given the mandate to preserve families, CPS would have the family members participate in a case plan that will support the eventual reunification of the child with their caregiver. Case plans may include therapy and substance abuse treatment. Each state has their own child protection agency and services may vary from jurisdiction to jurisdiction.  

Law Enforcement

As the CPS worker finished the last few questions, a man wearing a suit and tie entered the room. As he gets closer, Isabella realizes he also has a badge and a holster. The man introduces himself and explains that he is a detective with the local police department. He also observed the forensic interview and believes there is enough details to pursue filing a criminal complaint against the stepfather. The detective meets with Isabella’s mom. 

Not every disclosure of CSA is investigated by law enforcement. This can occur for a variety of reasons. For example, due to the inherent pressure in cases of CSA, a child may recant their original disclosure and state abuse did not occur. Another example would be instances when the victim was unable to provide specific details or was unable to recall dates.

In cases involving law enforcement, an investigation will ensue to determine if the CSA can be charged criminally. Some investigations are closed due to lack of evidence. If the law enforcement officer believes there is enough evidence to hold the offender criminally culpable, the case will be passed on to the district attorney’s office for consideration for prosecution.  

Mental Health Treatment/Therapy

Approximately two weeks later, Isabella’s mother received a phone call from the Client Intake Specialist (CIS) Cheyenne. Cheyenne is from the Clinical Department at the CAC. She let Isabella’s mother know that she received a therapy referral for Isabella from Jordan and wanted to know if mother was interested in services for Isabella. Isabella’s mother expressed interest in services. CIS explored times that would work both for mother and Isabella, as well as assigned a therapist named Jackie. Following the initial intake, Isabella receives ongoing therapy to process and integrate her history of CSA. 

Different forms of therapy can be utilized with Isabella post trauma including, Dialectical Behavioral Therapy (DBT), Eye Movement Desensitization and Reprocessing (EMDR), Play Therapy, and Trauma-Focused Cognitive Behavioral Therapy (TF-CBT). Therapists may incorporate expressive media including play, sandtray, kinesthetic movement, and expressive arts (i.e., art, music, dance) into treatment.

The intake session allows the therapist an opportunity to gather psychosocial information to ensure the client receives the best therapeutic services available. Depending on availability and resources, the CAC may also offer services to non-offending family members. In some cases, referrals are made to trauma-informed providers outside of the CAC.   

Moving Forward/Conclusion

 Isabella completes therapy, and, for the most part, her functioning appears to be developmentally on track. Intermittently, she experiences episodes of posttraumatic distress and receives booster therapy sessions as needed. Isabella testified in the criminal trial against her stepfather. This adds another layer of complexity to her therapy and to her family.

The short- and long-term impact of childhood sexual abuse is well established. Timely and comprehensive interventions are essential to protect children and strengthen families. This includes the multidisciplinary work covered in this article. Cases of CSA are multilayered and complex. The investigatory and therapeutic process may not be as streamlined as it was for Isabella. It is crucial members of the MDT operate in their scope of practice. Additionally, support from the non-offending caregiver and society at large is crucial for the overall welfare of victims.