Social Work in Assessing the Needs of Sexually Abused Children - Research Paper Example

How Social Workers can apply the Ecological Approach in Assessing the Needs of Sexually Abused Children and how these needs can be met The fact that social work is a challenging practice cannot be overstated. This is especially true in the case of children where social work intervention is frequently criticised across several sections of society including the media and in scholarly work. Sexually abused children are a significant and important category of social work in England and Wales as statistics from Radford et al (2011, pp. 45) indicate. A strong response is thus imperative from the social work practitioners, and one of the methods through which better child social work with children can be achieved is through the ecological approach. This study will provide an overview of the ecological method and then discuss and analyse in detail how this approach can be applied in the assessment of the needs of sexually abused children. The ways through which these needs can be met will be discussed. The Ecological Approach Before establishing how social workers can apply the ecological framework in assessment of the needs of sexually abused children, it is necessary to understand the concept behind this approach The ecological approach to social work is a strategy that involves addressing the complex transactions between people, in this case children, and the environment in which they live (Greene 2008, p. 199). It is one of the contemporary social work approaches unique in three aspects; its interest in the complementarily between an individual and the environment, identifying the person-in-environment as one entity or unitary system, and lastly drawing from concepts from many disciplines (200). In the issue of children social work, the ecological perspective of social work is adapted through identifying a child’s developmental needs, the parenting capacity and the family and environment factors (Garrett 2003, pp. 444-445). In doing this, the ecological approach proves to be sufficiently integrative through the three prime concepts of transaction, behavioural setting and the ecosystem which are interrelated to each other. In transaction, the reciprocal relationship between the child and the environment is investigated in regards to how it influences the child’s behaviour. The ecosystem view is that the needs of a child as identified through behaviour should be looked at from the perspective of multiple ecologies in which the child’s functioning occurs (Bolen 2001, pp. 139-140). The justification for studying how to apply the ecological approach in needs assessment of sexually abused children stems from the grim statistics on child sexual abuse in England and Wales. According to NSPCC (2011), research results from the year 2010-2011 indicates that 11.3% of young adults experienced contact sexual abuse during their childhoods and 17,727 sexual crimes on children under the age of 16 in the same year. 4.8% of children experienced contact sexual abuse in the year under question. Worryingly, 72% of sexually abused children did not reveal the incidents to anyone, while 27% told someone later with a significant 31% never revealing the sexual abuse. 7% of all children for whom there are child protection plans in England fall under the category of sexual abuse while for Wales the figure is at 10% (Radford et al 2011, pp. 45-46). Besides the statistics, it is also noted that childhood sexual abuse is an underlying contributor to other issues such as mental health problems (Beattie et al 2003, p. 8) and later perpetration of sexual offences as either child or adult sexual offenders (Aldgate and Rose 2009, 9; Lalor and McElvany 2001, pp. 7-8). Although the figures are lower compared to half a century ago (Radford et al 2011, p. 45), these statistics indicate that sexual abuse among children is still significant. The fact that a high number of these go unreported translates to the need for better assessment approaches, hence justifying this study. Assessment of Sexually Abused Children’s Needs through the Ecological Approach Child sexual abuse is defined as any completed or attempted sexual act, sexual contact or non-contact sexual interaction with a child (Gilbert et al 2009, p. 69). The framework used in assessment of children’s need based on an ecological approach in England and Wales is the Framework for the Assessment of Children in Need and their Families established by the DOH (2000) (Appendix 1). This is a triangle based framework that collects information on all the considerations that influence a child’s life. When using DOH needs assessment framework as a conceptual map, the central goal of the social worker is the safeguarding and promotion of child welfare. The framework caters for the person-in-environment ecological perspective through assessment of the needs of children in terms of three aspects; child’s developmental needs, parenting capacity and the family and environmental factors at play in the child’s life (Garrett 2003, pp. 444-445). Integrally, these three domains interact to have an impact on the short term and long term well being of children. In this specific case, the social worker can apply the ecological approach in assessing the needs of the child basing on the outcomes that accompany the sexual abuse incident on them. The social worker addresses how the child, parent/parental figure, family and wider community interact to determine the needs of the child. After the assessment, the social worker then establishes solutions that involve these players in the child’s life (DOH 2000). The following discussion will establish in detail how a social worker can use the ecological framework to holistically assess and meet the needs of sexually abused children. An analysis of the ecological approach will be undertaken after each of the three steps followed by an overall appraisal at the end of the discussion. Assessment of the Developmental Needs of Sexually Abused Children through the Ecological Approach According to the DOH (2000) framework, the developmental needs of children that a social worker should assess include the health, education, emotional and behavioural development, identity, family and social relationships, social presentation and self care skills. The general considerations when assessing and meeting the needs of sexually abused children through the ecological approach is that they first have similar needs as other children, they have unique needs as victims of sexual abuse and lastly each child has a set of unique needs. It is also important to take into consideration the age of the child which influences most of the considerations in the assessment. Sexual abuse also shapes their self development and their interrelationships with those around them (Ciarlante 2011). In the case of health considerations, the social worker can assess the overall health of the child basing on the knowledge that contact/penetrative health may result in physical consequences or spread of diseases to the child under assessment. This means that the social worker undertakes the health needs assessment through determination of the extent to which the physical health of the child may be affected by the sexual abuse on the child (DOH 2000, p. 80-82; LSCB 2007, p. 6). As is central to the ecological approach, the social worker also assesses the child has access to support (familial and communal considerations) and medical services (wider community). Strength-based assessment is valuable in this case and is achieved through enlightening the family on what they can do to ensure that the health needs of the child are met. The social worker also assesses whether the trauma arising from sexual abuse has impacts on the child’s physical health. The child’s needs in terms of health can be met through enlightening the parents on the health challenges that the child may be going through. In case the parent’s capacity to take care of the child’s healthcare needs is deemed insufficient and is difficult to improve, the social worker can establish whether members from the wider family can be brought in, besides providing means of access to relevant organisations to take care of the child’s health needs (DOH 2000, p. 1). It is also important to note the type of sexual abuse that happened (penetrative versus non-penetrative) since this is a direct determinant of the health outcomes of the child and will influence the treatment that will be instituted to meet the child health needs. the social worker thus has to inform and collaborate with health service response through involving Primary Care Trusts and Primary are Groups (Harper and Scott 2005, p. 81). The education needs of the child require the social worker to assess the extent to which the trauma from sexual abuse may be hindering academic pursuit. In cases where abuse is from parents, the assessor needs to establish whether the child is being provided with an education opportunity since parental abuse may also indicate neglect of the child’s needs. Highlighting the importance of education to the child, parents and entire family can be used by the social worker to meet the education needs of the child. The parents can also be made to realise how the sexual abuse to the child may be an underlying factor to the child’s education problems (Multi-agency Practice Guide 2006, p. 22). The assessment for emotional and behavioural development child needs involves establishing how the sexual abuse shapes the behaviour of the child. For instance, child-to-child sexual offences are associated with sexually abused children as is sexual harm behaviour (Multi-agency Practice Guide 2006, pp. 20-21). Other behaviours that may be present include drug abuse, juvenile delinquency, and aggressiveness among others. The social worker also assesses the child’s access to sources of emotional support as are available to all children and whether there is sufficient concern about the child’s emotional development. Promoting parental guidance and control and access to counselling services may serve as a way of meeting the needs arising from improper emotional and behavioural development (Nelson 2009, p.44). An important consideration that the social worker should take care of here is the age; cognitive development influences the child’s knowledge of what has happened to them. For instance, teenagers will understand what sexual abuse is, and may react through being aggressive, non-cooperative and other such traits usually associated with their age group which leaves their needs unattended to. However, all age groups of children will lose trust they had in adults care provision and even in close people (family and friends) since most perpetrators are usually not strangers. Counselling services should be fitted to these considerations (Harper and Scott 2005, p. 90). Assessment of identity needs also follow the same patterns for sexually abused children since the behavioural development of such children is influenced by the identity they establish. Assessment of the identity needs for the child involve establishing whether the child finds acceptance in the family and society in light of their situation. It also involves establishing the impact of identity role-modelling especially where offence perpetrators are parental figures or when such figures fail to respond to the child’s plight (DOH 2000, p. 85). Helping the family realise the importance of role modelling to formation of the child’s identity can be a way of meeting these needs besides promoting the acceptance of the child in the family (Nelson 2009, p. 44). Assessment of the family and social relationships involves the social worker determining the extent to which sexual abuse of the child influences their relationships with family, friends and generally those around them. For instance, a sexually abused child may withdraw from relationships and show hostility or fear of those around them. Stigmatisation may contribute to some of these symptoms. Closely related, the social worker also assesses the child’s needs in terms of social presentation where the extent to which the child’s interrelationship behaviour with society is influenced by the sexual abuse incident(s). The analysis also includes establishing whether the child has stable and secure family attachments and friendships, and how this is influenced by the sexual abuse incident(s). Sensitising the family on the consequences of stigma to the child and the importance of close, strong and stable social relationships can help meet such needs (DOH 2000, p. 22). The ecological considerations that the social worker makes are especially in terms of the lack of trust in adults that a sexually abused children develop hence reassuring the child is an important element of intervention (Ciarlante 2011). The other consideration for assessment is the self care abilities of sexually abused children where the social worker seeks to establish the extent to which sexual abuse limits the child’s self care ability. For instance, physical diseases or psychological problems resulting from sexual abuse may inhibit the child’s ability to take care of self as other normally developing children of the same age would do. The social worker also determines the level to which the parents of such children influence their self-care abilities for example through overreliance on the parent. This involves the social worker establishing whether the procedures and steps are explained to the child as they are being undertaken. The ecological approach advocates for a strengths-based approach to intervention with the child and family being sensitised on the correct level of independent caring the child can undertake (DOH 2000, p. 19). A key observation made so far about the ecological approach is its inclusion of the individuals around the child in assessing and meeting the needs of the sexually abused child. Analysis of use of the ecological approach for the assessment of the developmental needs of sexually abused children indicates that it is grounded on a number of theories and concepts. One of these is the resilience theory of social work in which assessment is approached from a strength-based approach with the aim of highlighting the child’s and family’s strengths in dealing with the situation at hand. In this approach, the interventions implemented in the situation are informed by the view that the child and the family have what it takes to deal with the situation with guidance from the social worker. Strength-based assessment is the initial step of resilience-based interventions (VanBrenda 2001, pp. 205-206). The assumptions made in the strength-based approach to assessment include the view that the child has certain specific strengths from which the social work can build upon and influence their developmental tangent positively. In all cases of intervention, the child and parents are being asked to control and guided on how to go about this by the social worker. Assessment of the Parental Capacity in the Case of Sexually Abused Children The considerations in this domain of the DOH (2000) ecological framework include the parents’ capacity to provide basic care, ensure warmth and safety, offer stimulation, and provide guidance and boundaries and stability to the sexually abused child. Assessment of the parent’s capacity to ensure basic care and safety involves the social worker establishing the level to which the child’s needs in terms of protection are met by the parent. Application of the ecological approach here involves the social worker realising that the sexual abuse incident on the child calls into question the parent’s capacity to care for the child. In this case, the social worker may determine whether the parent provides active protection, passive protection, neglect, active collusion/passive sexual abuse or active sexual abuse. The social worker also assess whether the child is in need of additional support. To what extent are the parents aware of the vulnerability of the child to sexual abuse and stigmatisation? The social worker is also required to assess the availability of safety channels for the child and alternatives in case these are absent (Multi-agency Practice Guide 2006, p. 23). Meeting the needs of children ecologically in this case involves support to the parent (for passive protection), police involvement, pre-court work and child witness support in the active sexual abuse and collusion cases. Therapeutic referral is implemented in all cases (24). Assessment of the parent’s capacity to meet the emotional warmth needs of the child includes the social worker determining whether the sexually abused child experiences warmth and affection from the parents as is appropriate. The social worker also assesses the level to which the child has access to secure, stable and affectionate relationships. Interventions to meet these needs for the child involve involving the family and explaining the importance of providing such warmth to the abused child. The social worker needs to realise that some of the developmental needs of the child such as social relationships and behavioural needs can be addressed through enhancing the parent’s capacity to provide warmth and affection, hence fulfilling the holistic aspect of the ecological approach. In case the parents are not in a position to do this as established from the assessment (for instance, mentally ill parents), providing access to carers can help meet these needs (DOH 2000, p. 4). In terms of stimulation, the social worker assesses the level of stimulation around the child as is appropriate to their situation (being a victim of sexual abuse). The social worker also establishes the extent to which the parents can access resources and ideas for stimulation of the sexually abused child, while also determining the child’s access to recreational and leisure opportunities that may help provide the necessary stimulation. The interventions in this case include facilitating the parents with access to stimulating resources and linking the child to additional sources of stimulation where the home is found to be deficient (Multi-agency Practice Guide 2006, p. 23). The ecological approach to assessment of the parent’s ability to provide guidance and boundaries to the child involves the social worker determining whether the child is supported to take reasonable risks in their everyday life considering they may be mentally still recovering from the abuse. The boundaries provided by the parents should be gauged for appropriateness in terms of the child’s age and level of understanding. Besides, the social worker should also establish whether the boundaries change with time as the child develops or the parents maintain the boundaries in light of the sexual abuse that the child experienced. Enabling the parents provide the right and appropriate boundaries is one of the interventions that can be undertaken in this case, while also ensuring that the guidance and boundaries in place are for the child’s welfare (DOH 2000, p. 21). Assessment for the stability needs of a sexually abused child involves establishing the number of adults present in the child’s life, the frequency of change of these adults, the adults who provide intimate care for the child and the stability of settings in which child lives. For instance, a sexually abused child being raised by parents, a single mother or a neglected child would require different levels of intervention. To meet the needs of children in this case, the parents can be empowered to make plans to prepare the child for breaks in stability while trusted carers can also be brought in (DOH 2000, p. 21). The ecological approach to assessment of the parental abilities in caring for a sexually abused child can be seen to be based on the person-in-environment concept, where the role of the parental figures in the child’s life is appreciated as a determinant of the needs of the child. The assumptions it makes include the expectation of cooperation from the parents which may not be always forthcoming. It is however formidable in terms of identifying root causes of some of the child’s needs and equipping the parents to achieve better abilities of taking care of their child (Greene 2008, p. 200). Assessment of the Family and Environmental Factors that Influence the Needs of Sexually Abused Children The considerations in this domain include the family history and functioning, the wider family, housing, employment, income, family’s social integration and the resources available in the wider community. In terms of family history and functioning, the social worker needs to assess how the family copes with the event of sexual abuse on the child and its impacts. The place of the child in question in the family should also be assessed, besides establishing the effects of the siblings on the child (support versus stigmatisation, care, humiliation, sexual offender, fellow victims of sexual offence among other considerations). Other elements for assessment include the supports available for the family including access to professional counselling services, medical services and recreation among others (Wickham and West 2002, p. 152). The wider family considerations that may be assessed include the members of the wider family who are important in the child’s life and support and preservation of such relationships. In case parental capacity was found wanting from the previous domain of assessment, the wider family should be assessed in terms of provision of support to the child. Strengthening the relationships in existence between the child and relatives can help meet care and support needs besides helping shape identity and behaviour in the child who may be emotionally affected by life events (Howath 2009, pp.243-245). The housing issues assessed by the social worker include the presence of the basic amenities and facilities that are appropriate and necessary to meet the child’s needs. This may include lighting, ventilation, space and order. The social worker also needs to assess the availability of resources needed to make the necessary amends towards meeting the child’s needs. Enlightening the family about local solutions to some of these housing problems and liaising with appropriate organisations may help meet the child’s housing needs (HM Government 2005, p. 26). Employment plays an important part in determining the family income and in extension the ability of the family to meet the needs of the sexually abused child including medical, counselling, educations, recreation and other such important needs. The social worker thus has to assess whether there are considerable barriers to members of the family who would wish to work. The impacts of unemployment on deficiency of provision to the child’s needs should also be assessed (DOH 2000, pp. 23-25). The family can be introduced to avenues of access to relevant aid to take care of the short term needs of the child while advice and support geared towards increasing the chances of finding jobs can also be pursued. In terms of income, the family can be informed about benefits to which they are entitled (Nelson 2009, p. 44). The other element that the social worker needs to assess is the family’s social integration. This includes establishing whether the family faces barriers to their social integration, an example of which may be for cases of immigrants (Burnett and Peel 2001, pp. 544-547; RCN 2010). Limited social integration by the family inhibits the healing of the child from the traumatic sexual abuse experience while also impacting on their behavioural, identity and social presentation and relationships behaviour. The social worker can also assess whether support can be provided to facilitate the child’s integration into the wider community and thus plan relevant interventions to meet the family’s and child’s integration needs (Burnett and Peel 2001, pp. 544-547). The last consideration in this domain regards the community resources, whose availability and accessibility to the child the social worker needs to assess. The level to which they link to such resources, their ability to use and actual use should form the basis of this assessment. If use of such resources is not possible as established by assessment, the social worker should assess the steps necessary to break the barriers to inclusion and thus help the family and child have access to shared community resources (Nelson 2009, p. 44). The ecological approach draws from a number of theories and concepts which can be used to appraise it when used to assess the needs of sexually abused children. The first of this is the person-in-environment approach that is discernible in the ecological approach three domains of assessment of a child’s needs. The needs of the child are viewed as arising from his/her interaction with the environment which follows a transactional analysis. The child’s needs cannot be separated from their parent’s capacity to provide and the family’s and community’s considerations especially when considering that the sexual abuse, protection from it as well as the child’s needs can be met within the community. For instance, the child’s social presentation, identity and emotional and behavioural development may be interrelated with the issues of guidance, direction and stability as provided by the parent. They may also be related to community lifestyles, family history and the behaviours in the child’s wider family. The parent’s capacity to provide emotional warmth and stimulation may impact the child’s family and social relationships while provision of stability, guidance and direction may influence the child’s self-care skills (Garrett 2003, pp. 444-463). The transaction analysis makes the assumption that the needs of the child can be met by assessing the deficiencies in the child’s interactions with those around him/her and that these people will be willing to take part in meeting the needs of the child if given the opportunity or made to know how they can help. While this may not always be the case, the person-in-environment provides a holistic approach to assessment of the child’s needs and is thus exhaustive. The underlying problems that lead to the needs of the child are established hence the social worker is able to address the needs in a sustainable way (Bolen 2001, pp. 139-140). The other concept that is integrated into the ecological approach as can be visualised in assessment of the child’s needs is the client-centered approach. In this approach, the efforts of social work are directed at giving power to the client, appreciating that their contribution to the assessment and interventions is crucial to enhancing the overall efficiency of social work (National Services Framework 2004). The client’s views need to be sought, information availed and communicated to them at all steps of assessment, generation of solutions to meet the child’s needs and appraisal of the entire social work process (DOH 2000, pp. 57-59). The assumptions made in the client-centered approach include the view that child and the parent are in a position to contribute usefully to the social work process with the view of promoting the welfare of the child. The concept’s validity is arguably maintained by appreciating the view that traditional social work fails to solve underlying problems when it ignores the clients (DOH 2000, p. 17). For instance, the reasons that may be attributed to the low incident reporting of sexual abuse cases and in extension neglect of the child victims’ needs is due to failing to place the child at the center of the social work process. Hence, the client-centered approach as promoted by the ecological approach to assessment of the needs of sexually abused children is an important strength of the approach (DOH 2000, pp. 57). The ecological approach also draws from the resilience theory in which the social worker seeks to undertake assessment and intervention that takes into consideration the strengths that the clients have in meeting the needs of the child in question (Humphreys 2006, p. 3). For instance, assessment of the sexually abused child’s developmental needs may be done with emphasis placed on enhancing the self-care abilities of the child. To meet the needs arising from behavioural mal-development, the social worker can emphasise the role the parent plays in shaping the child and thus seek to improve the parent’s capacity in taking care of the needs of the child. While the approach thus assumes that there are inherent strengths in the child and the parents during assessment, the efficacy of promoting resilience in the child and family is not in question (Ungar 2008, pp. 6-7). Conclusion Social work with sexually abused children can be effectively undertaken through the ecological approach where the DOH Framework for the Assessment of Children in Need and their Families is used to assess the needs of such children. This approach involves assessing the child’s developmental needs, the parent’s capacity and the wider family and community as they relate to the needs of the child. The ecological approach integrates transactional analysis appreciating the role of interactions with those around the child in determining the child’s needs; client-centered social work in which the family and the child are empowered during assessment, considerations of intervention and application; resilience theory in which the child and the family are deemed to have strengths that can be promoted to meet the needs of the child. Although the approaches make a number of assumptions including cooperation from the parties involved and presence of strengths in the child and family, analysis indicates that they achieve holistic assessment, determine underlying causes of needs, empower the clients and ultimately ensure effectiveness of the measures put in place to meet the child’s needs. References Aldgate, J & Rose, W 2009, Assessing and managing risk in: Getting it right for every child, Scotland, viewed 25 November 2011, Bolen, RM 2002, Child sexual abuse: Its scope and our failure, Kluwer Academic Publishers, London. Burnett, A & Peel, M 2001, “Asylum seekers and refugees in Britain: health needs of asylum seekers and refugees”, BMJ, vol. 322, no. 7285, pp. 544-47. 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Multi-agency Practice Guide 2006, Sexual abuse of children and young people, Nottinghamshire and Nottingham City safeguarding children boards, viewed 30 November 2011, National Services Framework 2004, NSF Standard Two Person-centred care, viewed 25 November 2011 from, Nelson, S 2009, Care and support needs of male survivors of childhood sexual abuse, CRFR, UK. NSPCC 2010, Statistics on sexual abuse, RCN 2010, Asylum seekers and refugees, viewed 25 November 2011, Ungar, M 2008, Putting resilience theory into action: Five principles for intervention, UTP, Netherlands. VanBrenda, AD 2001, Resilience theory: A literature review, Social Work Research & Development, SA. Wickham, RE & Jane, W 2002, Therapeutic work with sexually abused children, SAGE, UK. Appendix 1: The Ecological Approach Assessment Framework The ecological approach that can be used by social workers to assess the needs of sexually abused children (Source: DOH 2000, p. 89) Read More