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'Little Steps' in Early Intervention with Sexually Abused Children: A Child-Centric Approach

Campbell, Catherine (2010) 'Little Steps' in Early Intervention with Sexually Abused Children: A Child-Centric Approach. PhD thesis, Murdoch University.

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      Abstract

      While early intervention and treatment are often advocated for young children who has been sexually abused, little attention has been directed to developing an evidence base for such interventions. Hence, this research series took place over two principal areas of study: (i) the development of targeted interventions for young children who had experienced sexual abuse; and (ii) the co-evolution of a Child-Centric Intervention Research Framework to evaluate their effectiveness.

      The research series began with a Participatory Action Research (PAR) and mixed method evaluation of a locally available Protective Behaviours program delivered across three groups of children aged four to seven years. Children in the participant sample were considered ‘at risk’ of, or with substantiated experiences of, interpersonal violence, including sexual abuse. Through iterative monitoring of their progress, contextual, summative and formative outcomes, which were both quantitative and qualitative in nature, were analyzed idiographically (within case) and nomothetically (across cases) to provide an idiothetic analysis of the program’s outcomes. This evaluation pointed to limited success of the program and provided impetus to develop a new approach to intervention for young and vulnerable sexually abused children. It also highlighted some of the challenges of evaluating programs for children, exposing the need for an iterative microanalytic approach focused on the child as an entity greater than his or her experience or symptoms, as well as an entity firmly embedded in a wider outcome-influencing system.

      A Developmental Intervention Research approach (DIR) was introduced to the research framework at this juncture and resulted in a 12-week abuse-specific cognitive behavioural program, entitled ‘Little Steps’. The application of this program with a young sub-clinical group of children was evaluated in two group program iterations and three individual/family therapy modalities. After refinements of the program’s components and delivery strategies, the evaluation revealed substantive improvements in outcomes relative to those found in the Protective Behaviours program evaluation. Specifically, children demonstrated adequate learning of program concepts and clinically significant markers of positive adjustment.

      The use of DIR and PAR used in conjunction highlighted a process driven approach to intervention development. However, even in combination these approaches provided only a bare framework for guiding the research endeavour. The framework was given life, meaning and strength in its application to working with this vulnerable group of children by infusing it with the sensibilities of the professional code of being a practitioner. That is, understanding the child and his/her relational context for engaging in the world informed the selection and development of measures, directed the process of observation (plan, observe, act and reflect), and program development at the immediate level of the ‘participant person’.

      A Child-Centric Intervention Research Framework evolved through the intervention studies. It centres on considered understanding child development across cognitive, social and emotional domains. It recognizes the systemic constraints in a child’s life, including their engagement in intervention. Most importantly, it recognizes play as the language of childhood through which learning occurs and through which stories can be told, even by the youngest children. This evaluation framework carefully centres on the understanding of particular vulnerabilities of presenting children, and their progress through interventions, against a normative perspective of child development. This normative perspective was integrated into this research through a study of children’s typical pre-sexual knowledge and body awareness. Developing normative measures of children’s appraisals of their relationships and sense of resilience was also undertaken. Measuring aspects of positive adjustment was an important feature of this research framework, as a point of comparison to better understanding adjustment difficulties indicated in a child’s symptomatology. Importantly, the framework was engendered through adherence to the practice values of clinicians and the collateral confluences of existing methodological approaches to outcome research. Underpinning this framework, the researcher-practitioners were the principal medium through which contextually rich data were collected and interpreted.

      Publication Type: Thesis (PhD)
      Murdoch Affiliation: School of Psychology
      Supervisor: Reid, Corinne, Collins, Marjorie and Dziurawiec, Suzanne
      URI: http://researchrepository.murdoch.edu.au/id/eprint/3425
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