Extended Assessment of the Child Victim

Extended Assessments in Multidisciplinary Child Sexual Abuse Intervention

Extended Assessment is not a new term or concept. In the field of child sexual abuse it is often used synonymously with "forensic evaluation", "directed assessment", "abuse specific assessment", and "psychosocial evaluation". It is conducted for forensic purposes by clinical practitioners, but is differentiated from clinical assessments conducted for treatment goals.

The assessment is used to help determine if and by whom a child has been abused. The context, extent and nature of the abuse is also assessed. A psychosocial evaluation of the child's current functioning and needs identifies signs of traumatic effects of abuse that will effect interview approaches and treatment recommendations.

Historically, extended assessments became significant in child sexual abuse investigations as practitioners faced new and unprecedented challenges in determining what had/had not happened to the child, as well as providing convincing evidence for the veracity and reliability of the child's report. In order to "validate" or " substantiate" a report of child sexual abuse, the credibility of the child's report has become a cornerstone of case development, often determining what, if any, kind of intervention will occur.

The detailed, full disclosure needed to determine credibility cannot always be obtained in one or two interviews, even if the child is interviewed by experienced and knowledgeable investigators. Research and experience indicate that children often deny abuse in initial interviews (Bourg, et.al., 1999; Berliner, L. & Conte, J., 1993).

Disclosure as a process from tentative to active disclosure is now a recognized dynamic in child sexual abuse cases (Sorenson & Snow, 1991). Many mandated investigative agencies do not have sufficient personnel and/or time to conduct extended investigations and interviews, and therapists can be introduced into the process to provide time for progressive disclosure. If a child is not in active disclosure when first questioned about abuse, it becomes a professional's responsibility to provide a "vehicle" for moving the child forward in the process of determining if abuse has occurred. Extended assessment is such a vehicle. It provides an uninterrupted continuum of care for child victims in which time is provided to process the initial shock and denial that often accompany disclosure. In a safe place, at a safe pace, the child may become able to recall and relate frightening experiences that (s)he simply could not talk about at first try. If the child has been traumatized, the type of trauma experienced will determine how well and how soon (s)he will be able to recall and relate the experience. The extended time also allows the grief process to unfold, which when left unattended, can disrupt disclosure and result in recantation.

Some multidisciplinary teams at children's advocacy centers and other child abuse programs include onsite clinical staff to provide extended assessments, and some teams use community based therapists that participate in team review of cases. The therapists offer consultation and can review referrals in a timely manner.

Some advantages to having a clinical component on the team are:

1. Availability for emergency interviews/referrals, testimony, and prioritizing referrals with the team.
2. Coordination of assessments with the overall investigation.
3. Coordination with community mental health resources needed for case specific needs.

By incorporating extended assessments into the investigative phase, investigators are allowed more time to pursue all aspects of the investigation while the child is provided the opportunity for progressive disclosure. Incorporating therapists into the investigative phase also calls for clarification of traditional roles and distinctions between the investigative and clinical functions.

The therapist's role as a forensic evaluator has received considerable attention and has become more distinctly defined as extended assessments have become an integral part of many multidisciplinary teams. "Psychosocial assessors should first establish their role in the evaluation process. The difference between the evaluation phase and a clinical phase must be clearly articulated if the same person is to be involved" (APSAC, 1995).

The goal of forensic interviewing is to gather information to use as evidence in a legal proceeding. In clinical interviewing, therapists also gather information, often with the same tools used by investigators, but they use the information in different ways. Sometimes they use techniques to tap less consciously accessible material that produces emotional reactions requiring the safety and structure of a therapeutic setting. These techniques should not be used by investigators who have a more transitory role with the child and are not trained in therapeutic response. Conversely, as forensic evaluator, the therapist must understand and accept the parameters of forensic interviewing and know how the interview tools/techniques are used to produce the kind of uncontaminated data required for forensic review. If the child discloses abuse or provides information about a reported abuse, the therapist must provide the same kind of non-leading inquiry expected from other investigative interviewers.

The interviewing approaches and techniques described in this manual in the "Child and Adolescent Forensic Interview Guidelines" can be used by all forensic investigators and assessors to encourage detailed accounts of children's experiences and the context in which they occur. In addition, the effects of the child's experiences on the way the child is currently thinking, feeling, and behaving can also be evaluated in an extended assessment and documented for intervention and treatment goals.

The two professional organizations that currently provide guidelines for evaluating allegations of child sexual abuse are the American Professional Society on the Abuse of Children (APSAC, 1997) and the American Academy of Child and Adolescent Psychiatry (AACAP, 1990). These two guidelines are generally consistent and reflect current knowledge and consensus on the evaluation of suspected sexual abuse in children and adolescents.

Their recommendations include:

Amacher, E. (2000), Adapted from "Assessing Allegations of Child Sexual Abuse", by Kathryn Kuehnle, (1996).

It is important that mental health professionals know and communicate that they do not have a unique ability or formula for deciding if an individual is telling the truth (APSAC, 1997). They can, however, provide clinical skills and empirically based methodology and experience for providing thorough and extensive assessments of child abuse.

1. Long term, undisclosed abuse that creates the need for strong denial and psychologically unhealthy coping strategies. Time and less threatening interviewing processes are required to identify and break through defenses.
2. Very young children who are developmentally unable to provide clear narratives or details needed to corroborate abuse. Given time for observation and age appropriate prompts/props, they can often demonstrate and clarify their experiences.
3. Divorce/custody/visitation disputes when parents/caretakers make charges/counter-charges about abuse and the child's account is inconsistent or contradictory depending on who has access/custody of the child.
4. Children who have disclosed and recanted. Recantation occurs in 20-30% of valid accusations.
5. As many as 50%+ children deny abuse in the initial investigative interview. Time for the "tentative to full disclosure" process is needed when other case evidence warrants further investigation.
6. When children do not provide enough information for validation or prosecution, but significant Risk factors are uncovered during the investigation.
   Examples:
1. Manys sibling abusers have been abused by a family member.
2. The combination of pornography/erotica and substance abuse is a high risk for sexual exploitation.
7. Sexually acting-out behavior in children is a strong indicator of learned, reenactment behavior. Unacceptable sexual behaviors following founded or unfounded cases raise the s of suspicion that the child has been and/or is continuing to be abused.

In situations like the above, a follow-up to the initial investigative interviews helps determine the reliability of the report and the risk of further abuse.