The Psychosocial Rehabilitation of Children who have been Commercially Sexually Exploited

End Child Prostitution, Child Pornography and the Trafficking of Children for Sexual Purposes The Psychosocial Rehabilitation of Children who have been Commercially Sexually Exploited - Self Study Materials for Carers - Name Centre Date ECPAT International 328 Phaya Thai Road, Ratchatewi, Bangkok 10400 Thailand Tel (662) 215 3388 Fax: (662) 215 8272 Email: info@ecpat.net Website: http://www.ecpat.net Compiled & written by Colin Cotterill & Stephanie Delaney

SELF-STUDY MATERIALS The following materials are designed for centres for street children and abused young people that find themselves taking on new staff without having the resources or opportunity to provide training. Many NGOs operating on a low budget are forced to take on volunteer or inadequately trained staff, or students who are undergoing a formal education helping out part-time. Many centres around the world do not have the luxury of professionally trained counselors or therapists amongst their staff. Most groups know that their workers find themselves in the role of social worker, cook, educator, house parent, counselor and best friend to the children who pass through their care. Time is generally not affordable for in-service training or external workshops as the centres are already understaffed and busy 24 hours. These are sample materials for SELF-STUDY which may be downloaded, adapted or translated to be suitable for new caregivers of children who are sexually abused or exploited. Workers at centres can work through them in their own time and at their own pace. The suggestions given are based on experiences of a number of groups working with commercially exploited children from around the world. The materials have been adapted from various sources including: ECPAT International Fund for Children studies, ECPAT regional offices, Right to Happiness (BICE), and The Centre for the Protection of Children s Rights (Thailand), and have been trialled in Asia and East Africa. This workbook draft does not cover all aspects of psychosocial training and should not be used as an authoritative text as some of the findings may not apply to your country. It will need a good deal of supplementation and adaptation to reflect your own situation. If you are going to add to it, you may consider other topics such as Health, Drug and Alcohol use, Behaviour Management, HIV AIDS, PTSD, and caring for carers which are not dealt with at any length here. The center itself will need a deeper prevention section. But we hope the methodology will be a helpful guide for you to prepare your own self-access workbook. Please feel free to contact us here at ECPAT International if you need further advice or would like to make comments or recommendations. ECPAT International : Psychosocial Rehabilitation of CSEC, Self Study Materials Page 2 of 67

TABLE OF CONTENTS Unit One Child Sexual Abuse. Part One (page 5) What does child sexual abuse mean to you? Part Two (page 7) What knowledge and skills do caregivers need in order to work with CSA victims? Part Three: (page 9) What causes CSA and what effect does it have on a child? Part Four (page 13) How do children become victims? Part Five (page 14) How can we start to address the problems of CSA at our centre? Unit Two Commercial Sexual Exploitation of Children (CSEC) Part Six (page 16) What is CSEC? Part Seven (page 19) What are the differences between CSA and CSEC? Part Eight (page 20) What pressures are there on CSEC victims? Part Nine (page 22) How do children survive during CSEC? Part Ten (page 23) What is the most suitable location when working with CSEC victims? Unit Three Psychosocial Rehabilitation. Part Eleven (page 25) Why do we need to use psychosocial rehabilitation? Part Twelve (page 28) Can we solve these problems through counseling? Part Thirteen (page 31) Where does counseling fit into a psychosocial programme? Part Fourteen (page 33) What other people are involved in a psychosocial programme? ECPAT International : Psychosocial Rehabilitation of CSEC, Self Study Materials Page 3 of 67

Unit Four Centre Programmes Part Fifteen (page 34) What else should your programme include? Part Sixteen (page 37) What education can we realistically offer? Part Seventeen (page 39) Will vocational training keep children off the streets? Part Eighteen (page 40) What creative therapy will work at our centre? Part Nineteen (page 42) Isn t it too late to start introducing protective behaviours? Unit Five Reintegration Part Twenty (page 44) Should we really send these children back to the communities that turned them into what they are? Part Twenty One (page 45) What is SUCCESS? Unit Six Prevention Part Twenty Two (page 46) What role can caregivers play in prevention? ANSWERS (page 47) Working with Children who have been Commercially Sexually Exploited - Some Guiding Principles (page 66) ECPAT International : Psychosocial Rehabilitation of CSEC, Self Study Materials Page 4 of 67

Hello! These materials are designed for you to work through on your own. They include information on what to look for in children under your care who have been sexually abused or involved in sexual exploitation. There may be some parts that you will need to discuss with your supervisor. If you get to the end of a section and are still not clear about what you have learned, go back over that section again. There is a short quiz after each section. You don t win a prize for getting all the answers correct. Look at the answers as a part of the learning, not the end of it. They will help you understand the content. Unit One Child Sexual Abuse Part One What does child sexual abuse mean to you? ECPAT International : Psychosocial Rehabilitation of CSEC, Self Study Materials Page 5 of 67

1. A Do you really understand what sexual abuse is? A lot of people have some strange ideas. Let s just see whether we are starting at the same place. Here is a list of twenty statements about Child Sexual Abuse (CSA). Mark whether you think they are true T or false F (answers page 47) 1. CSA is a crime committed only by adults against children. T F 2. Most CSA leaves no physical evidence on the body. T F 3. Children often lie that they have been sexually abused. T F 4. Most CSA is committed by people the child doesn t know. T F 5. A sexually abused child will probably become an abuser when s/he grows up. T F 6. Children never invite sexual abuse voluntarily. T F 7. CSA will always be traumatic for a child. T F 8. Children will naturally hate the person who abuses them. T F 9. Abusers single out bright, outgoing children to abuse. T F 10. CSA is rarely a spontaneous action. It is usually carefully planned. T F 11. The child should immediately be removed from the abusive household. T F 12. If a child discloses CSA, s/he should have a medical examination as soon as possible. T F 13. It is best not to talk with the child about the abuse. T F 14. If the child is under 16 (local majority) but consents to sex with an adult, there s nothing the law can do. T F 15. The majority of CSA offenders are male. T F 16. Most CSA victims never report abuse. T F 17. Sexual abuse against boys is very rare. T F 18. Men who abuse young boys must be homosexual. T F 19. The majority of CSA victims are in their early teens. T F 20. CSA victims and CSEC (Commercial Sexual Exploitation) victims have the same problems. T F ECPAT International : Psychosocial Rehabilitation of CSEC, Self Study Materials Page 6 of 67

1. B From the information given in 1A, write your own definition of what CSA is. Write it in pencil in the following box. You can make changes to it as you work through this book. CSA Definition Part Two What knowledge and skills do caregivers need in order to work with CSA victims? 2. A Look at the following list of natural attributes. In column 1. Write the order from one to seven, of the importance of these attributes when working with CSA (most important = 1, least important = 8). In column 2. write your own strength in that attribute (1=strongest, 8=weakest) 1. Ability to listen. 2. Patience/perseverance 3. Non judgmental attitude 4. Problem solving 5. Love of children 6. Friendliness 7. Reliability/consistency 8. Acceptance ATTRIBUTE 1. Importance 2. Own strength Add other attributes to this list as you think of them ECPAT International : Psychosocial Rehabilitation of CSEC, Self Study Materials Page 7 of 67

Apart from personal attributes, the caregiver needs certain skills and knowledge to be able to work with CSA victims. Here is a checklist of some of the skills you will need to begin to work with CSA victims. 2. B Put a tickb beside skills you already possess, a dash - beside those you need to acquire, and a question mark? beside terms you don t understand. (You will need to ask your supervisor about these later. You can write them at the back of this book in the vocabulary section.) ncommunication skills nactive listening nassertiveness training nself-awareness skills nawareness of how working with abused clients affects workers emotionally nself-care skills to prevent burnout nawareness of values nunderstanding of abuse npositive attitude towards young people nassessment skills nhaving the knowledge to know when to refer to someone with more specialist skills nsuicide assessment nteamwork skills nknowledge about sexual abuse-the dynamics and the impact of abuse nawareness of issues around drugs and alcohol nconflict resolution skills nempathy nthe ability to put yourself into the situation of the other person with the goal of gaining an understanding into how that person is feeling. ndealing with behavioural problems nsetting boundaries ngiving constructive feedback about a person's behaviour nsetting limits on behaviour nreward systems ndealing with sexualised behaviour nproblem solving skills nexternalising the problem (the person is not the problem) ngenerating options nexploring the positives and negatives of each option nit is also important to understand the dynamics of CSA and how it affects the child. n A caregiver needs to be able to recognize the signs that a child has been sexually abused and know how to react appropriately. ECPAT International : Psychosocial Rehabilitation of CSEC, Self Study Materials Page 8 of 67

Part Three What causes CSA and what effect does it have on a child? CORE INFORMATION FOR CAREGIVERS Understanding Sexual Abuse Although we may be able to find reasons for CSA, it is important to remember that there are no excuses for it. Ever! CSA is a blatant infringement of the child s rights and of the law. It is a crime of physical and mental terror perpetrated by cowards and bullies. No child ever deserves to be sexually abused or ever knowingly brings it upon themselves. Sexual abuse of children occurs within a social, political and cultural context. Before we can understand the impact of sexual exploitation on individual victims, it is first important to understand the societal context in which abuse most commonly occurs. 3. A A number of factors may increase children s vulnerability to sexual abuse. If you know of a child who has been sexually abused, tick the conditions that were present in that child s life at the time of the abuse. Poverty Lack of family structure Social isolation Insecure attachments Emotional deprivation Drug and alcohol abuse These factors should not be seen as causes of child sexual exploitation but rather as RISK FACTORS. They may compromise the child s ability to protect him/herself and may make him/her a target for perpetrators. ECPAT International : Psychosocial Rehabilitation of CSEC, Self Study Materials Page 9 of 67

THE DYNAMICS OF SEXUAL ABUSE How does CSA affect the child? Finkelor (1) believes that there are four major effects common in CSA victims. a) Traumatic Sexualisation: refers to the conditions of sexual abuse under which a child s sexuality is shaped in developmentally inappropriate ways. As a result, children become confused and acquire misconceptions about sexual behaviour and sexual morality. Additionally, unpleasant memories become associated in the child s mind with sexual activity. Because of rewards given for sexual behaviour, children learn to use sexual behaviour as a strategy for manipulating others to get their needs met. b) Betrayal: children discover that someone on whom they depended in some way has caused them or wishes to cause them harm. c) Stigmatization: refers to negative messages about the self-evilness, worthlessness, shame and guilt that are communicated to the child around the experience. These messages are communicated both directly and indirectly. But much of stigmatisation comes from the moral judgements they infer from those around them. As a result they develop a belief that they are damaged goods. It also contributes to children developing self-attributions to explain why it happened- I must have done something to lead him on d) Powerlessness: There are two main components of powerlessness: i) A child s will, wishes, and sense of self ownership are repeatedly overruled and frustrated; and ii) A child experiences the threat of injury or annihilation. One of the most basic forms of powerlessness is the experience of having one s body space repeatedly invaded. Other forms of powerlessness are the experiences of violence and coercion. Powerless leads to ongoing vulnerability and a feeling of entrapment. 1) Finkelor.D 1984. Child Sexual Abuse: New Theory and Research. New York. Free Press ECPAT International : Psychosocial Rehabilitation of CSEC, Self Study Materials Page 10 of 67

3. B Write down Traumatic Sexualisation, Betrayal, Stigmatization, and Powerlessness on a piece of paper. Close this book and write down what you understand about them. Check back in the book when you have finished. THE IMPACT OF SEXUAL ABUSE Here is a list of some of the problems found in children who have been sexually abused: Fear Depression Low self-esteem Poor social skills Repressed anger and hostility Inability to trust Blurred role boundaries and role confusion* Pseudo-maturity and failure to complete developmental tasks Sexualised behaviours Guilt Shame Sense of being different to others Social isolation Drug and alcohol abuse Self-mutilation Post traumatic stress disorder 3. C You need to understand all of the above terms. Look them up and write the definitions at the back of this book. If there are any words you don t understand, but can t find, ask your supervisor to explain them. ECPAT International : Psychosocial Rehabilitation of CSEC, Self Study Materials Page 11 of 67

HOW CHILDREN COPE DURING THE ABUSE Since children s bodies are undeveloped and unprepared for sexual activity, the physical sensations of the abuse can be overwhelming, creating discomfort, unbearable pain, as well as confusing pleasures. Each child learns to cope with the stress of sexual abuse in his/her own way. Due to the flooding of overwhelming emotions of fear, panic, confusion and betrayal along with the physical-suffering, children develop strategies to detach themselves from what is being done to them. Problems can arise when Survivors of sexual abuse continue to employ old coping methods in adult life where there is no longer any threat to their wellbeing. Since coping methods were developed during traumatic situations, they tend to be deeply ingrained and hard to let go of. The main strategy employed is that of dissociation.! Dissociation involves blocking out the experience from conscious memory. Survivors do this by divorcing themselves mentally from the discomfort and pain of abuse. ECPAT International : Psychosocial Rehabilitation of CSEC, Self Study Materials Page 12 of 67

Part Four How do children become victims? You will probably come into contact with two types of victims: those who have been kidnapped and/or raped, and those who have been carefully groomed by a perpetrator. Both types of child victim have a number of issues to work through. As well as the violation, the latter group has suffered emotional abuse which needs to be taken into consideration. THE PROCESS OF VICTIMIZATION 4. A How do perpetrators select their victims? In the following list, some words have been left out. Try to imagine what type of word it is and pencil it in. The intended words are at the end. (Answers page 49) " Perpetrators typically select victims who are targets. " The children often have ambivalent feelings towards the offender. " The offenders often develop a relationship with victims by developing trust and providing care and kindness to children who have previously been largely. " Offenders often make children feel special. In many cases the sexual abuse relationship filled a. " A common method of coercion involves the of a child s normal need to feel loved, valued and cared for. Children who do not have these needs met may be susceptible to the interest shown them by sexual offenders. " Disclosing the abuse poses a to the child s position. " Children often report that they did not know they were being sexually abused. The sexualised behaviour is often gradual. It may begin with normal affectionate contact or in the context of ordinary physical activities. " It is important to understand the role of in the victimisation cycle. " This process has an enormous impact on the victim s belief system. The young person s beliefs about the adult world have been formed in part by the abuse. Victim s may minimize the abuse and/or not be able to identify some behaviours as abusive. They may become to the abuse as a way of coping but also come to normalise their experiences if they have experienced mostly exploitative relationships. hneglected hvoid hexploitation hinitially hpower hdesensitised hvulnerablehthreat Victimisation and the grooming process both contribute to children feeling guilty and blaming themselves for the abuse or for not being able to stop the abuse. ECPAT International : Psychosocial Rehabilitation of CSEC, Self Study Materials Page 13 of 67

RAPE Although rape is a traumatic experience for anyone, it is particularly mystifying and frightening for a child. In many cases the child will not know what is happening and remember only the violence and the pain. As we have seen, the perpetrator is often someone known to the child. It may be an older child, even a boyfriend stamping his authority on the relationship. The child will experience disbelief and probably anger as well as the physical discomfort. As a caregiver it will be important to show the child that you are knowledgeable about sexual assault. 4. B These are emotions common after rape. What type of things may a child say to indicate how they re thinking? The first example is done for you. (Answers page 49) ANGER GUILT I WANT REVENGE. I HATE HIM. SELF BLAME RELATIONSHIPS DISBELIEF Part Five How can we start to address the problems of CSA, at our centre? One of the first steps is: CREATING A THERAPEUTIC COMMUNITY The centre you work at will have certain rules and regulations that make the environment safe and comfortable for the child. You will need to learn these rules and follow them. Their aim is to create a therapeutic community which can best help to heal the child. What is the community going to look like? ECPAT International : Psychosocial Rehabilitation of CSEC, Self Study Materials Page 14 of 67

5. A If you already work at a centre, tick bwhether your centre offers the following. Safety Environment that builds trust Workers who are consistent in their approach to the young people Stable workforce of reliable workers Environment that acknowledges strengths Young people are aware of what is expected of them Structures in place to address the needs of the young people. b All of the workers at your centre will be members of the Therapeutic Community, from the director to the guards. 5B Look at these three case studies. Then look back at the lists of skills and attributes in 2A and decide how you would begin to address the problems you come across. Then look back at the table in 5A and see how the therapeutic centre community could help the children involved. Write a short description of possible actions you or the centre can take. Then look at our comments at the back of the book ( page 50). 1. Heather is 13 years old. Her drug-addicted parents have deserted her. Heather is also addicted to glue. She has been sent to stay at your centre but you have no control over her use of glue, as she seems to have an unlimited supply from a 'friend'. She has a very short attention span and thinks the centre activities are childish. There are suspicions that this older male friend is sexually abusing her. 2. Andy and Marko are both street kids about 13 years old. Both have been sexually abused as babies. They were playing a board game with a small group at the centre. Marko cheated in a small way but Andy reacted very violently. When you arrive there is a fight going on. 3. Milly is 12. She was removed from her home when her mother died. She is very popular at the centre and joins in all the activities. But she always seems to be talking about sex. She often playfully pretends to be masturbating and likes to rub up against the other girls. She dresses in sexy clothes. She says she doesn't have a boyfriend. ECPAT International : Psychosocial Rehabilitation of CSEC, Self Study Materials Page 15 of 67

Unit Two Commercial Sexual Exploitation of Children (CSEC) Part Six What is CSEC? In your work, you may come into contact with children who are involved with the Commercial Sexual Exploitation of Children (CSEC). These are children in prostitution, involved in the production of pornography, trafficked for sexual purposes, or bonded in some way to perform sexual services in return for cash or kind. Here we will focus on three types of CSEC A. SAM B. JO C. CHRIS Sam chooses to work in CSEC. Sam doesn t have an agent and can stop anytime. Jo has a pimp*. Jo is made to earn a certain amount of money (or kind) but may have some control over choice of clients. Chris is enslaved. Chris has no freedom and is forced to have sex. *pimp = an agent living off the proceeds of sex. ECPAT International : Psychosocial Rehabilitation of CSEC, Self Study Materials Page 16 of 67

6. A Based on the descriptions of the three types of CSEC victim A, B and C, on the previous page, look at the following children and see which category they fit into. (Answers page 52) a. X was trafficked from Nepal to India where she was sold to a brothel. b. X and her school friends have set up a call-girl service for wealthy clients. c. X answers adverts on the internet for men looking for sex. d. X s boyfriend gets her to have sex with his friends for money. e. X is a beach boy who is often invited to sleep with tourists. f. X is a street kid. To be allowed into the gang he must have sex with the leader g. X is a maid. She gets a small salary but is expected to sleep with the owner. h. X s father sends her out at night to earn him beer money from prostitution. i. X s pornographic photos still appear on paedophile websites ten years after they were taken. j. X s shelter director forces him to have sex and gives him presents to keep quiet. From these examples, you can see that there is not one typical CSEC victim. All of these children have specific physical and psychological needs. Group C victims are particularly difficult to successfully rehabilitate as they have been sexually abused repeatedly, have no control, and probably experienced violence. Group B have probably felt a sense of betrayal from someone they loved or trusted. Even the children in Group A, who are apparently free, are in fact asking for help for something lacking or disturbing in their lives. You cannot have a programme that covers all of the needs of all of the children. Each child presents unique symptoms. Each deserves a unique response. ECPAT International : Psychosocial Rehabilitation of CSEC, Self Study Materials Page 17 of 67

6. B What is it about the societies of the world that can cause so many children to become CSEC victims? Try to think of all of the societal, political and cultural reasons why children are forced into commercial sex. Below is a profile of a CSEC victim. Add the reasons to this diagram. Some are done for you. (Answers page53) ECPAT International : Psychosocial Rehabilitation of CSEC, Self Study Materials Page 18 of 67

Part Seven What are the differences between CSA and CSEC? The boat in the illustration is at the bottom of the river. It has a hole in it. How do we fix it? Do we drag it out of the river, dive into the water, or find some way of damming the river? Victims are very likely to have been abused before they became involved in CSEC. That first abuse was never dealt with. Our children are like the boat. They are at the bottom of the river of CSEC. They still have the wound of that first assault like the hole in the boat. Do we work with them while they are still selling sex or do we drag them out of CSEC? Is there any way to stop CSEC? These are the problems we face when we work with children. 7A Think about the children in Groups A and B* and write down any differences you can think of between CSA and CSEC. One example is done for you. List any others you can think of. Some ideas from other social workers are at the back of the book. (Page 54) CSA Child in powerless position. CSEC Child assumes position of power *The children in Group C are more likely to be included in the CSA column. ECPAT International : Psychosocial Rehabilitation of CSEC, Self Study Materials Page 19 of 67

Part Eight What pressures are there on CSEC victims? Centres have been known to refuse children who have been involved in CSEC because they are uncontrollable or are a bad influence on the other children. But it is these children who are most in need of care and understanding from you. You can help to find the child inside this troubled person who has come to you. Try to remember what pressures have been put on them to survive. Physical and Emotional Pressure on CSEC victim PHYSICAL hnormal pressures of being Child or Adolescent. hunresolved earlier physical or sexual abuse. hpressure as income generator for self or others hpsychosocial/health problems (HIV, blood disorder, anemia, vitamin deficiencies etc ) hdrugs & Alcohol (Most abuse some substance, 30% + are addicted) hno chance to become qualified adult (missed education, only career choice is illegal) EMOTIONAL hreal or Perceived Fear (Dangers of the work, threats from pimps/customers etc.) hdeep need to belong (Society and the law are against you) hself-esteem Issues (You believe that you are bad/at fault/a criminal) hescaping from someone or something. (Your past/an abuser/poverty etc.) 8A Close the book, write down PHYSICAL and EMOTIONAL and try to list the points mentioned above. Add any others you can think of. ECPAT International : Psychosocial Rehabilitation of CSEC, Self Study Materials Page 20 of 67

These pressures materialise in a number of ways in CSEC victims. The following list was taken from the notes on children at various shelters. Suicidal Confuses love/sex Self-abusive Depressed Emotionally unstable Slow development Aggressive No ability to structure Poor concentration Sees self as saleable Lost trust Distrusts adults Self-hate Rebellious Lack of Confidence Has temper tantrums Low Self Esteem Abuses others D&A problems High sexual arousal Pregnant Feels an outcast Has own child powerless Has aborted unworthy Debilitated unloved Malnourished degraded Regular Injuries violated Exhaustion Enters bad relationships Headaches Blames self TB/respiratory problems Confused Time concept AIDS/STDs 8B Do you know a child who was involved in CSEC? Go back over the list and (for that child) check against any conditions he or she exhibited. If not, ask a colleague who has experience. How many did you check? It s certain you didn t check only one box. The important thing is that the CSEC victim presents with many problems, some of which probably go back a long way. Some of these problems may heal themselves with love, care and nutrition provided by your centre. Others will not be that easy. ECPAT International : Psychosocial Rehabilitation of CSEC, Self Study Materials Page 21 of 67

Part Nine How do children survive during CSEC? It has been said that for children to cope with a life in CSEC and to survive on the streets, they need to develop a new personality. They often adopt a tough, secretive exterior, change their names and put on an act that they are enjoying this new life. 9. A Look at this list of coping mechanisms (ways that children survive) that have been noticed in CSEC victims. Put them in order from the most common-(1) to the least common-(8) (Answers page 54) Coping Mechanisms ( ) Rationalizing ("We're professionals, hostesses ) ( ) Pride in self-sufficiency ( I don t need any help from anyone. ) ( ) Materialistic attitude. Self-indulging, (buying clothes, going to restaurants, treating friends) ( ) Secrecy/anonymity (new name/change of personal history) ( ) Temporary mental lapses (child switches off past/present) ( ) Substance abuse (drugs/glue/alcohol etc.) ( ) Stoicism (pretending non affection) ( ) Dissociation of ego from body (the sex act by the body, not person inside) As a caregiver, you will be tested by the CSEC victim. Later in this book you will see how to react to difficult situations. In the beginning, remember that the child will probably see you as part of the problem, not as the solution. ECPAT International : Psychosocial Rehabilitation of CSEC, Self Study Materials Page 22 of 67

Part Ten What is the most suitable location when working with CSEC victims? What is the most suitable location when working with CSEC victims? 10. A Look back at the three types of CSEC victim in Part 6. Which setting below do you think would be most suitable to begin rehabilitation of each CSEC victim and why? (Write on a separate sheet) (Answers page 55) STREET Work at or near location where child is engaging in CSEC. DROP IN CENTRE Centre where child can come in at arranged times for activities, food, bath, etc. RESIDENTIAL CENTRE Child lives at a centre. ECPAT International : Psychosocial Rehabilitation of CSEC, Self Study Materials Page 23 of 67