Caring for Child Survivors of Sexual Abuse - UNICEF

1 Caring for Child Survivors of Sexual AbuseGuidelines for health and psychosocial service providers in humanitarian settingsFirst EditionCore Child Sexual Abuse Knowledge CompetenCie S internAtionAl reSCue CommitteeCover Photo: UNICEF /Jill Connelly/Democratic Republic of the Congo, 2010 2012 by International Rescue CommitteeAll rights reserved. International Rescue CommitteeAgency Headquarters122 East 42nd StreetNew York, NY +1 212 551 3000 more information about the Caring for Child Survivor s Resources please contact the IRC Women s Protection and Empowerment Technical Unit at To down-load the CCS Guidelines electronically, please go to publication was funded in part by the Bill & Melinda Gates Foundation and the 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 For Child SurViV orS oF Sexual Abuse guidelineSCCS Guidelines | Page 1 Caring For Child SurViV orS oF Sexual Abuse guidelineSACK nowledgementSThe 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.

2 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 behalf of the IRC, I would like to extend a special word of appreciation to the 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.

3 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.

4 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 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 LehmannDIRECTOR, WOMEN S PROTECTION AND EMPOWERMENT TECHNICAL UNITINTERNATIONAL RESCUE COMMITTEECore Child Sexual Abuse Knowledge CompetenCie S Page 2 | International Rescue CommitteeinternAtionAl reSCue CommitteetAble oF ContentSintroduCtion 4 Overview of the Caring for Child Survivors (CCS) ResourcesCCS Theory of ChangeUsing the CCS GuidelinesGlossary of TermsChaptER OnE: CORE Child Sexual Abuse KnOwlEdgE COmpEtEnCiES 21 Core Child Sexual Abuse Knowledge Competency AreasGuidelines for Assessing and Monitoring Core Knowledge CompetenciesChaptER twO: CORE Child -FRiEndly attitudE COmpEtEnCiES 51 Core Child -Friendly Attitude Competency Areas Guidelines for Assessing and Monitoring Core Attitude CompetenciesChaptER thREE: CORE SKillS.

5 Engaging and COmmuniCating with Child Survivors 59 Developing a Helping Relationship through Safe and Healing Communication StrategiesBest Practices for Communicating with Child SurvivorsGuidelines for Communicating with Children about their Experience of Sexual AbuseAddressing Common Communication ChallengesGuidelines for Assessing and Monitoring Core Communication Skill CompetenciesChaptER FOuR: guiding pRinCiplES and KEy iSSuES 87 Guiding Principles for Working with Child Survivors of Sexual AbuseCaring for Child Survivors Key IssuesIssue 1: Mandatory Reporting RequirementsIssue 2: Confidentiality Protocols in Child CasesIssue 3: Ensuring the Best Interest of the Child : Balancing Roles in Decision-MakingChaptER FivE: CaSE managEmEnt FOR Child Survivors 105 Introduction to Case Management Steps of Case Management for Child Survivors of Sexual AbuseStep 1: Introduction and EngagementStep 2: Intake and AssessmentStep 3: Develop Case Goals and Action PlanStep 4: Implement the Case Action PlanStep 5: Case Follow-up and Monitoring ProgressStep 6: Case Closure and Evaluating ServiceStep 7: Service EvaluationCAring For Child SurViV orS oF Sexual Abuse guidelineSCCS Guidelines | Page 3 Caring For Child SurViV orS oF Sexual Abuse guidelineSChaptER Six: pSyChOSOCial intERvEntiOnS FOR Child Survivors 187 Integrating Psychosocial Interventions into a Child and Family s Care and TreatmentAssessing the Psychosocial Needs of Child SurvivorsGuidelines for Implementing Core Psychosocial Interventions ChaptER SEvEn: bESt pRaCtiCES FOR CaSE COOR dinatiOn bEtwEEn SERviCE pROvidERS 231 Best Practice in Coordinating Child Case ResponseFinal nOtE tO thE REadER 239 CCS toolSPlease note: related staff monitoring tools and/or sample case management forms are included at the end of each chapter.

6 A list of the CCS tools and relevant page numbers are included 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 ChECKli St 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 StandaRdS FOR CaSE managEmEnt 240gbvimS intaKE and aSSESSmEnt FORm 241 Core Child Sexual Abuse Knowledge CompetenCie S Page 4 | International Rescue CommitteeinternAtionAl reSCue CommitteeintroduCtionOvERviEw OF thE Caring FOR Child Survivors (CCS) RESOuRCESThe International Rescue Committee (IRC), in partnership with the 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 model of care for Child Survivors of Sexual Abuse across humanitarian set-tings.

7 The purpose of developing these resources is to provide guidance on how to: Build the capacity of health and psychosocial service providers on the foundational (or core ) knowledge, attitudes and skills to work with Child Survivors of Sexual Abuse . Adapt case management for Child Survivors . Implement targeted psychosocial interventions. Improve coordinated care across multiple sectors and service providers. Monitor the quality of service 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 . gOalThe ultimate goal of the Caring for Child Survivors Resources is to enable and empower staff in humanitarian aid con-texts to provide high quality care to children and families affected by Sexual For Child SurViV orS oF Sexual Abuse guidelineSCCS Guidelines | Page 5 Caring For Child SurViV orS oF Sexual Abuse guidelineSThe Caring for Child Survivors (CCS) Resource Package is based on global research on Child Sexual Abuse and evidence from field practice.

8 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 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.

9 CCS thEORy OF ChangE and intEndEd OutCOmESThe 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 Core Child Sexual Abuse Knowledge CompetenCie S Page 6 | International Rescue CommitteeinternAtionAl reSCue CommitteeChild Survivors havE aCCESS tO Child SpECializEd CliniCal CaRE & tREatmEnt SERviCESC aseworkers have the knowledge, skills, attitudes and tools to provide Child - centered case management.

10 Understand and able to apply Child Sexual Abuse concepts in case management. Possess Child -friendly attitudes that contribute to recovery and healing. Able to communicate with Child Survivors according to age and developmental stage. Able to adapt case management services for Child Sexual Abuse cases. Understand and able to apply CCS Guiding Principles in case management. Able to use Child -friendly tools to aid effective case management services Able to appropriately engage caregivers in the Child s care and treatment. Able to monitor activities using established Survivors havE aCCESS tO Child CEntEREd CaSE managEmEnt SERviCEShealth providers have the knowledge, skills, attitudes and tools to provide specialized medico-legal care for Child Survivors . Understand Child growth and development and Child Sexual Abuse concepts. Able to communicate effectively with Child Survivors . Understand and able to apply CCS Guiding Principles in case management.