How to support children and youth who have been sexually abused and their families

SINGAPORE - All adults who interact with children have a part to play in preventing them from being sexually abused, said the Ministry of Social and Family Development (MSF).

Whether it is across schools or social service agencies, or in the context of families, adults have a role in creating an environment where children feel safe and supported enough to tell someone if they are being sexually abused, said Ms Pooja Hemanth, principal clinical psychologist and assistant director at MSF’s Clinical and Forensic Psychology Service.

“Being aware of child sexual abuse, and that it happens to both boys and girls, is a good first step,” she said.

A study she led that looked at 252 cases of child sexual abuse in Singapore

found that several factors were more likely to delay such cases from coming to light,

like when the perpetrators are family members,

or the victim’s age when the first incident of abuse happened.

Introducing body safety skills

Education to prevent such abuse should be carried out from the pre-school years, said Ms Lin Xiaoling, director and group lead of research and advocacy at Singapore Children’s Society.

Children who have been taught body safety will be more likely to recognise inappropriate actions and tell someone about abuse, she added.

Such skills include knowing the anatomically correct terms of their private body parts, differentiating between right and wrong actions, and knowing how to seek help.

Body safety skills should ideally be taught at home and reinforced by educators and caregivers in an age-appropriate manner, she added.

“For parents, having open, honest discussions about body safety will help all siblings learn, as they are growing up, about body boundaries and appropriate behaviour with each other.”

The Singapore Children’s Society started a child sexual abuse prevention programme in 2000.

Since 2011, it has been reaching out to pre-school children and has been training pre-school educators and engaging parents to teach body safety skills to young children.

Paying attention

While there might be physical signs, most of the time, victims do not show obvious signs of abuse, said Ms Pooja.

Their distress might be reflected in changes in their emotions and behaviours such as more crying, spending more time by themselves, or self-harm or suicidal behaviour.

“Sensitively ask about what is bothering them, ask them if someone is doing something that is hurting them or making them uncomfortable, and if they say yes, ask them if they are being sexually abused,” she said.

“It may feel uncomfortable for the adult to ask a child about something like this so directly because, as a society, we may not feel comfortable talking about sex so openly, but we should seek to be open and willing to talk about it in a sensitive manner if we want the child to open up and share what’s happening.”

Adults should take a child’s account seriously, said Ms Lin. “While it can be daunting to report a suspected abuse case, it is better to nip it in the bud than to let it continue.”

Building rapport and following the child’s pace are important with those who are hesitant to disclose, she added.

Time and silence are also sometimes needed for the child to process what has happened, and adults should not resort to rapid-fire questions, which might frighten the child.

“Affirm them of their self-worth, engage the children in activities that they enjoy, and find other ways to gradually help them open up about what happened,” she said. “You may even use scripts like ‘When you’re ready to talk, I’ll be here to listen’. This will help create a safe space for the child to share more.”

Counselling psychologist Lau Wan Xin at clinical practice Pink Elephant said that children who know about abuse through their friends should be taught to report it to teachers or their own parents.

Adults should also avoid questions that doubt children, she added.

“We need to protect the child by reporting to the police without shaming them.”

Dr Peter Wong, a member of the Suspected Child Abuse and Neglect team at KK Women’s and Children’s Hospital (KKH), said that professionals who work with children, such as healthcare professionals and educators, have “a vital responsibility and great opportunity to act on behalf of these children”.

Doctors have to be sensitive when interacting with the child to minimise psychological distress, but also to get an accurate account of what happened, to guide medical assessment and care.

Professionals should report suspicions and disclosures promptly, and not wait until they are more certain that abuse has happened, he added.

The child must be supported emotionally at every stage, said Dr Wong, adding that many children who are suspected victims of sexual abuse by a family member go through a “multidisciplinary” interview process with trained professionals from the police, MSF and KKH.

To minimise distress, the child is interviewed just once at a one-stop centre in KKH, instead of being repeatedly interviewed by different professionals, he said.

The centre is a collaboration between the police, MSF and KKH.

Said Ms Lin: “There are various community support and help that we can tap, for example, MSF’s Child Protective Service, child protection specialist centres or family service centres.

“No one is alone in managing abuse concerns.”

Impact on other family members

Sexual abuse can involve grooming of the non-offending parent or caregiver, said Ms Nawal Adam Koay, assistant director and head of reunification service at the Singapore Children’s Society.

This refers to sending the parent “distorted messages”, like negative statements about the child and creating distance between parent and child, in order to gain trust and access.

This may impact the way the parent reacts to abuse coming to light, she said. They may deny it or blame the child, for example.

Denial is a common response because the parent perceives that there will be potential losses, like in relationships or in self-esteem, because they are deemed bad parents, said Ms Nawal.

With this in mind, professionals may focus on supporting the parent or caregiver to ensure the child’s future safety, she said.

Part of this involves educating them on how they have been groomed and how they can prevent such situations from happening again.