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Evolution of Therapeutic Care

When I commenced at Parky in July 2004, the standard mantra across WA; Australia and Internationally was 1/4 girls; 1/6 boys will be abused before they are 18 years old; 90% of those offended against will know their abuser.

Move on to February 2019, have the stats changed?

Well, no they haven’t, you may have occasion to see 1/7 boys in the USA article but generally speaking the stats remain the same.

The Australian data for 2016-2017 shows a 27% increase in substantiations, that’s 186 a day across Australia. Note I am quoting you the substantiations not the notifications or investigations which are lingering around 1039 and 485 a day, respectively.

The question arises, are we making a difference? Well, the answer is yes, we are. I don’t need to tell you this, our staff already witness the successes we have with children on a daily basis because of their outstanding commitment and skilled work. However, the extent of the problem of child abuse, the complexity of its effects, and the need for an agreed methodology for effective and empirically based treatment are still generating research and debate.

Dr Leah Bromfield from the Australian Centre for Child Protection and Parkerville Children and Youth Care are in partnership to trial an empirical model for treatment of Child Sexual Abuse in Perth and our discussions with both state and federal ministers are promising without the promise of funding at this point. We continue to chip away.

It is important that we listen to our researchers as new evidence comes to light on how to care for children with complex trauma. 15 years ago, the evidence was sparse, now it is growing exponentially. 15 years ago, the view emerged that abuse and neglect resulted in a similar impact on the brain and body of children, regardless of the type of abuse or neglect that served to prolong the stress response in children, disrupting their neuro-biological make up.

This view is being challenged by recent research conducted by Martin Teicher from Harvard University and his team. Teicher argues that trauma is not all the same. It does differ according to the type of abuse and neglect that children experience, leading to different alterations in brain structure and functions. For example, experiences of verbal abuse appear to affect part of children’s brain which are implicated in language development.

Some children show aggressive behaviour due to frustration with their experience at not being able to communicate effectively. Children who are witness to family violence have parts of their visual cortex affected, which leads them to experiencing difficulties with processing visuo-spatial information.

Teicher also points to research that highlights gender differences in the way abuse affects boys and girls. Boys under 7 years will have difficulty in how they respond to emotional/ sensory memories and are left to repeat complex behaviour that results from brain changes.

Girls have sensitive development periods with their hippocampus being most likely to be affected at ages 10-11 years and 15-16 years when they experience sexual assault. The implications for practice are that children’s care and support are experienced in real time and must be sensitively configured in the environment that they find themselves in.

Teicher suggests that it is critical to gather and analyse a detailed history of the type and timing of the experiences of trauma in children’s lives. He believes that therapeutic input needs to become more attenuated to the specific consequences of different types of abuse which occur at different times for children according to their gender and other background factors.

The stats may be the same but the knowledge we have now has grown significantly along with the skills we have acquired to work with children. We must always continue to grow that knowledge and be prepared to reflect on new practices emanating out of research.

Basil Hanna
Chief Executive Parkerville Children and Youth Care

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