Sexually Traumatized Children - New Mexico State Universityswrtc.nmsu.edu/files/2013/10/Liar-LIar-Pants-on-Fire-Handouts... · Forensic vs. Therapeutic ... Clovis, CA: Author. Kenney-Noziska,

The 21st Annual Children’s Law Institute/Liar, Liar, Pants on Fire

Copyright 2014, Sueann Kenney-Noziska, MSW, LISW, LCSW, RPT-S 1

Liar, Liar, Pants on Fire:

Understanding Expert & Victim

Testimony from a Mental Health Perspective

Sueann Kenney-Noziska, MSW, LISW, LCSW, RPT-S

Learning Objectives

Identify 2 dynamics that occur during sexual abuse which make the behavior of child witnesses counterintuitive

Identify 2 short- or long-term psychological consequences for victims who testify in legal proceedings

Identify 3 areas to explore when questioning qualifications of a therapist

who is serving as an expert witness

Sexually Traumatized

Children



Sexually Traumatized Children

Highly diverse population with varying risks for mental health problems

Victim characteristics & abuse characteristics influence risk factors

Sexual abuse is usually not the only trauma sustained

Psychiatric comorbidity is common

(Saunders, 2012)

Sexually Traumatized Children

The nature & dynamics of sexual abuse & sexually abusive relationships are often traumatic (Hall & Hall, 2011)

Avoidant coping is problematic because it

masks symptoms (Saunders, 2012)

PTSD symptoms, internalizing problems, & externalizing problems,

are the most common effects (Trask, Walsh, & DiLillo, 2011)

Interventions & supports are needed before, during, & after testimony (Quas & Goodman, 2012)

Understanding the Impact of

Trauma



Impact of Trauma

Adverse Childhood Experiences (Anda, 2013)

Neurobiological impact (Perry, 2013)

Evidence-based treatment

Trauma-informed practice (Steele & Malchiodi, 2012)

How ACEs Play Out

Compared to someone with an ACE score of 0, those with an ACE score

of 4 or more are: Twice as likely to be smokers

7 times more likely to be an alcoholic

10 times more likely to have injected street drugs

12 times more likely to have attempted suicide

Dynamics of Child Sexual

Abuse



Child Sexual Abuse Accommodation Syndrome

Secrecy

Helplessness

Entrapment & accommodation

Delayed disclosure

Retraction

(Summit, 1983)

Traumagenic Dynamics Model

Traumatic sexualization

Betrayal

Stigmatization

Powerlessness

(Finkelhor & Browne, 1985)

Severe Trauma Factors

Disastrous response to disclosure

Distorted offender identification

Distorted victim identification

Sexual responsiveness

Terror (anticipation)

Footprints (coping skills)

Withheld report

Under age 12

Trauma bond

(Hindman, 1999)



Impact of Testifying

Impact of Testifying

Findings on the impact of testifying are mixed & complex

Empirical research largely supports that testifying is harmful

However, under certain circumstances, testifying may also be beneficial

Reactions to testifying are shaped by a complex interplay of multiple variables

(Quas & Goodman, 2012)

Predictors of Mental Health

How many times the child testifies

Corroborative evidence

Maternal support

Severity of the abuse




Predictors of Mental Health

Delays & continuances

Repeated interviews

Verdict/outcome of case

Age


Predictors of Attitudes

Case outcome

Testifying

Abuse severity

Number of interviews

Child’s age


Caveats to Findings

Findings are based on research to-date

Research remains limited with unintegrated findings

Generalizability is questionable

Supports, safeguards, accommodations & interventions are essential

Need more systematic studies




Findings

Children should be involved in criminal proceedings

Uniform bans on children testifying are unrealistic & overly simplistic

No study has demonstrated legal involvement causes trauma which warrants full exclusion of children

Negative consequences related to testifying can be avoided or reduced


Findings

Children can provide testimony without significant long-term harm

Some involvement may be beneficial

Children should be informed of the case outcome

Legal accommodations should be case-by-case

Professional collaboration may reduce trauma


Testimony from Mental Health Professionals



Mental Health Testimony

Broad category of professionals

Scope of practice

Continuum of care/services

General questions

Specific information pertaining to expertise

Scope of Practice

Masters degree

License to practice

Continuing education

General practice vs. specialzing

Scope of Practice

A license to practice therapy does not qualify a professional to work with cases of sexual abuse

An “expert” in one area of mental health does not make someone an “expert” in other areas

Once an expert, not always an “expert”



Forensic vs. Therapeutic

Forensic Therapeutic

Purpose to discover truth

Procedures governed by laws & courts

Supportive but neutral

Alternative explanations explored

Details crucial

Purpose to promote well-being

Procedures governed by research & standards of practice

Advocates for child

Subjective reality accepted

General idea of abuse is enough

(Wolf, 2006; Based on conceptualization by Melissa Steinmetz)

Forensic Therapeutic

Verbal disclosure required

Techniques in which information is obtained are

critical to outcome

Generally, only 1 or 2 interviews are considered forensically acceptable

Nonverbal is enough

Techniques may or may not influence outcome

Process unfolds over longer period of time in successive sessions

(Wolf, 2006; Based on conceptualization by Melissa Steinmetz)



Important Questions

Fullest extent?

Professional license history & status?

Pending action?

Disciplinary review?

Denied professional or hospital privileges?

Important Questions

Denied or canceled professional liability insurance?

Renewal been refused or surcharged because of claims?

Malpractice claim, investigation, or lawsuit?

Resigned or been asked or resign?

Important Questions

Sanctioned by Medicare or Medicaid?

Convicted of any crime?

Chemical dependency and/or substance abuse problem?

Under the influence during working hours?

Additional information?



Important Questions

Recent & specific continuing education?

Professional organizations?

Journals?

Supervision, consultation?

Published?

Instructing, teaching, lecturing, etc.?

Questions & Answers

Summary & Closing Remarks



[email protected]

Thank-You

Copyright 2014, Sueann Kenney-Noziska, MSW, LISW, LCSW, RPT-S Page 13

References

Anda, R. (2013, April). Adverse childhood experiences and their relationship to social function & disease. Session presented at the Child Abuse & Family Violence Summit, Portland, OR.

Finkelhor, D., & Browne, A. (1985). The traumatic impact of child sexual abuse: A conceptualization. American Journal of Orthopsychiatry, 55, 530-541.

Hindman, J. (1989). Just before dawn: From the shadows of tradition to new reflections in trauma assessment and treatment of sexual victimization. Ontario, OR: AlexAndria Associates.

Kenney-Noziska, S. (2008a). Techniques-techniques-techniques: Play-based activities for children, adolescents, and families. West Conshohocken, PA: Infinity Publishing.

Kenney-Noziska, S. (2008b). The sexual abuse literature & considerations for play therapists. Association for Play Therapy Mining Report, October 2008, 1-3. Clovis, CA: Author.

Kenney-Noziska, S. (2010). A strengths-based approach to working with abused & traumatized children. In D.A. Crenshaw (Ed.), Reverence in healing: Honoring strengths without trivializing suffering (pp. 123-135). Lanham, MD: Jason Aronson.

Kenney-Noziska, S., & Lowenstein, L. (in press). Play therapy with children of divorce. In D.A, Crenshaw, & A. Stewart (Eds.), Play Therapy: A comprehensive guide to theory and practice. New York, NY: Guilford Press.

Perry, B. (2013). Helping children recover from trauma. Washington, DC: National Council on Behavioral Health.

Quas, J.A., & Goodman, G.S. (2012). Consequences of criminal court involvement for child victims. Psychology, Public Policy, & Law, 18, 392-414.

Saunders, B.E. (2012). Determining best practice for treating sexually victimized children. In P. Goodyear-Brown (Ed.), Handbook of childhood sexual abuse: Identification, assessment, and treatment (pp.173-197). Hoboken, NJ: John Wiley & Sons, Inc.

Steele. W., & Malchiodi, C.A. (2012). Trauma-informed practices with children and adolescents. New York, NY: Routledge

Summit, R.C. (1983). The child sexual abuse accommodation syndrome. Child Abuse & Neglect, 7(2), 177–193.

Trask, E.V., Walsh, K., & DiLillo, D. (2011). Treatment effects for common outcomes of child sexual abuse: A current meta-analysis. Aggression and Violent Behavior, 16(1), 6-19.

Wolf, M. (2006). How it happens: Understanding dynamics of sexual abuse. Unpublished presentation. Corona, CA.

Documents

Sexually Traumatized Children - New Mexico State Universityswrtc.nmsu.edu/files/2013/10/Liar-LIar-Pants-on-Fire-Handouts... · Forensic vs. Therapeutic ... Clovis, CA: Author. Kenney-Noziska,