Why Care About the Caregiver?
Strategies for Engaging
Non-Offending Caregivers
Anna Shaw, MSEd
Education & Programs Manager
Dee Norton Lowcountry Children’s Center
Charleston, SC
Participants will
• Gain an understanding of the research regarding the
important role caregivers play in child outcomes
• Learn key tools to engage non-offending caregivers
and to help them shift to being a protective resource
for their child
• Apply knowledge of the importance of the role of
the non-offending caregiver to a variety of evidencebased treatments
Why Care About the Caregiver?
• The child victim cares.
• The caregiver is critical to the outcome for the child
victim.
• The caregiver can confirm the child’s reality of the
abuse and appropriately assign responsibility for the
abuse and for any failed protection.
• The caregiver is the best external control for future
child safety and protection.
• The caregiver is a positive moderator for child
resilience.
Importance of the Caregiver
• Children whose mothers believed sexual abuse was
possible disclosed at 3.5 times the rate of children
whose mothers denied any possibility of abuse
(Lawson, Chaffin, 1992)
• Children whose mothers doubted the abuse
allegations were less likely to disclose (Elliott, Briere,
1994)
• Lack of support is associated with psychopathology
for the victim and higher rates of out of home
placement (Everson, et.al., 1989).
Non-offending Caregiver as a
Moderator to Resiliency
• Resiliency is successful adaptation despite risk and
adversity (Masten, Sesma, 1999)
• Trauma may result in a reduced ability to cope for
both the child and the non-offending caregiver
• Abuse can negatively impact family relationships.
• Consistent care & support from primary caregivers
is a primary factor in resiliency (Masten, Sesma,
1999) (Masten, Cicchetti, 2010)
Finkelhor’s Four Pre-Conditions
An integrated causal model to explain the dynamics of
child sexual abuse and the behaviors of an offender.
(Finkelhor, 1984)
Also helps explain the response and role of the nonoffending caregiver in sexual abuse.
• Motivation
• Internal
• External
• Characterizes of the Child
Motivation as a Barrier
Focus of the caregiver regarding the abuse
• Child focused
• Self focused
• Offender focused
• Other focused
Internal Factors as Barriers
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Cognitive limitations
Substance abuse
Mental health issues
Failure to believe abuse allegations
Serious physical health issues
Cultural/religious beliefs
Perception of her own powerlessness
Emotional dependence
Personal history of victimization
External Factors as Barriers
• Loss of financial support impacting housing,
transportation, child care, employment
• Loss of extended family support
• Impact of the community response
– Protective system: CPS, LE, CAC, GAL, school
– Social system: faith community, friends, neighbors
• Media response
Child Characteristics as Barriers
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Age
Impact of trauma on behavior
Child seen as competition
Mental health co-morbid issues (ie. behavioral
diagnosis of ADHD, OCD, ODD, etc.)
Tools to Engage Caregivers
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Protection Clarification
Life Mapping technique
Evidence-Based Treatment
MDT staffing protocol
The Clarification Process
Clarification is a Process aimed at:
• Empowering the caregiver vs. blaming
• Caregiver shift toward child focus
• Caregiver shift toward active protection
Protection Clarification
video
Protection Clarification
is needed because…
• Child’s view of adults as responsible
caregivers disrupted
• Developmental Issues
- Child believes parents know what child
knows
• Roles and responsibilities must be realigned
• Relationship between maternal support
and positive child outcomes
• Supports child’s disclosure of risk
Overview of the
Protection Clarification Process
• Caregiver Assessment including child and family history
• Clinical decision: verbal or written
• Clinician guides caregiver through components using draft
letters as an indicator of progress.
• Caregiver composes a final letter without benefit of previous
letters.
• Caregiver and child are individually prepared for Clarification
Conference.
• Clarification Conference takes place
• The Clarification Conference is processed by the child and by
the caregiver.
Components of the
Protection Clarification
Steps to Caregiver Engagement
1. Explain the purpose of the PC
2. Explain the role of the caregiver in the
outcome for the child
3. Identify barriers to engagement in the PC
process
4. Problem solve instrumental barriers
5. Follow up, track and monitor progress
6. Monitor first vs. second order change
7. Celebrate and reward PC completion
Sample Letter Excerpt
First draft:
“You were always wearing those skimpy clothes
and I told you what kind of person it would
attract…now look what’s happened. I was just
trying to keep you safe but why didn’t you listen
to me? See what happens to girls who don’t
listen to their mother?”
Sample Letter Excerpt
Later draft:
“This was not your fault. I know I’ve told you a lot that
the clothes you wear are too tight and skimpy, but
wearing those kinds of clothes doesn’t give anybody
the right to hurt your body. It wasn’t okay that he
forced you to have sex with him; it’s never okay for
anybody to touch your body unless you give them
permission. I am proud of you for telling your teacher;
telling was the right thing to do, and I’m not mad that
you told and I’m not mad at you. I’m mad that this
happened to you because I love you.”
Life Mapping Technique
• Builds upon the universal understanding of life
and/or life events as a journey that can be
illustrated along a continuum
• Utilizes visual mapping to help non-offending
caregivers reestablish order in their lives
following a disclosure of abuse or other
trauma
A road map is…
• A visual representation that is both structured
and simple.
• Tangible and can be “walked” both forwards
and backwards when needed.
• Can be viewed and processed in manageable
segments.
• Easily shared with others.
• Concrete and will not disappear like words do
in more traditional talk therapy.
Mapping is an intervention.
• Can be utilized to discover barriers, create
engagement with the caregiver and use that
engagement to work towards solutions.
• It won’t solve life’s problems but may help
view them from a different perspective
• Maps must be introduced clearly and
employed with careful attention to caregiver
engagement
• It is not about creating fine art!
Mapping supports the following
phases of treatment:
• Relating the trauma narrative.
• Identifying and processing powerful emotions
associated with a traumatic event/disclosure.
• Targeting coping skills necessary for recovery
from the trauma.
• Identifying past and future risks for further
victimization.
• Setting goals for the future.
Mapping Basics
• Use simple lines to indicate the type of road
 Up or down?
 Bumpy or smooth?
 Circles or winding?
 Super highway or country road?
• Use familiar road signs
 Pothole ahead
 Stop sign
 Wrong turn
 Crossroads
Mapping Basics
• Use weather to illustrate the emotions
associated with each event/location
Making Your Own Map
• How did you get to this conference today?
• What were the steps along your journey?
• Were there any roadblocks or obstacles to
over come?
• How did you feel at various stages of the
journey?
Caregiver Role in
Evidence-Based Treatment
• Caregiver component included in all EBTs
• Focus on outcome goals for the caregiver
necessary to support the child’s treatment
• Identify barriers and work toward shifting
caregiver to be child focused (similar to PC)
• Need caregiver to be engaged to take an
active protective role
MDT Staffing Protocol
• Level 1: Information Gathering:
– To gather and assess information about the child, family, and
case from all involved with the family.
• Level 2: Treatment Coordination:
– To create a unified multidisciplinary treatment plan
identifying and matching the family’s known strengths, needs,
and problems to the appropriate treatment goals.
• Level 3: Family Involvement:
– To engage the family in treatment planning, overcome
barriers to achieving treatment goals as a team, and establish
consensus between the family and multidisciplinary team.
Three Level Staffing Process
• Not all staffing levels may be necessary for
every case.
• Whenever possible, integrate Levels 1 and 2
so that investigation and treatment planning
are achieved in one case review.
• The case will be able to move up or down a
Level depending on the needs of the case.
• Community partners will be able to request a
staffing for any Level.
Community Treatment Plan
Barriers and Monitoring
• Method to engage caregivers who may be
overwhelmed by multiple requests from agencies
involved
• May be used when delivering EST to provide
consistent message regarding rationale for treatment
• May be used when there does not appear to be buyin from the caregiver
• May help uncover previously unknown barriers to
caregiver engagement
Acknowledgements
• Protection Clarification was developed by M.
Elizabeth Ralston, Ph.D. and Polly Sosnowski,
LISW, ACSW, Dee Norton Lowcountry
Children’s Center and Julie Lipovsky, Ph.D.,
The Citadel,
• Terry Pifalo, MSEd., Dee Norton Lowcountry
Children’s Center, has explored the use of the
Life Mapping Technique and published
different ways to use it helping victims process
their trauma
Questions?
References
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Chess, Stella (Ed.); Hertzig, Margaret E. (Ed.); Philadelphia, PA, US: Brunner/Mazel, 1991.
292-306.
Elliott, Diana M.; Briere, John; Behavioral Sciences & the Law. Forensic Evaluation; Self
Disclosure; Sexual Abuse; Symptoms. Vol 12(3), Sum, 1994. 261-277.
Everson, M.D., Hunter, W.M., Runyan, D.K., Edelsohn, G.A., & Coulter, M.L. (1989).
Maternal support following disclosure of incest. American Journal of Orthopsychiatry, 59,
197-206.
Finkelhor, David. Child Sexual Abuse: New Theory and Research. New York: The Free Press,
1984 .
Lawson, L., Chaffin, M. (1992) Journal of Interpersonal Violence. False negatives in sexual
abuse disclosure interviews; incidence and influence of caretaker’s belief in abused in cases of
accidental abuse discovery by diagnosis of STD. Vol 7(4), 532-542.
Masten AS; Cicchetti D. Developmental cascades. Dev Psychopathol. 2010; 22:491–495
Masten, A. S.; Sesma, A. (1999). Risk and resilience among children homeless in Minneapolis.
Pifalo, T.A.; (2007) “Jogging the Cogs: Trauma-Focused Art Therapy and Cognitive
Behavioral Therapy with Sexually Abused Children.” Art Therapy: Journal of the American Art
Therapy Association, 24(4), 170-175.
Pifalo, T.A.; (2009) “Mapping the Maze: An art therapy intervention following a disclosure of
sexual abuse.” Art Therapy: Journal of the American Art Therapy Association, 26(1), 12-18.
Continue the discussion!
Anna Shaw
[email protected]
The Dee Norton Lowcountry Children’s Center
1061 King Street
Charleston, SC 29403
(843) 723-3600