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Hear me. Believe me. Respect me. A survey of adult survivors of child sexual abuse and their experience of support services

Authors:
Contents
Page 1 | Support for survivors
Page 2 | The Focus on Survivors team
Page 3 | Executive summary
Page 5 | 1. Introduction...
Page 6 | Aims and methodology
Page 10 | 2. Child sexual abuse in the UK...
Page 12 | Who commits child sexual abuse?
Page 13 | Disclosing abuse and getting help
Page 18 | 3. Support services for survivors...
Page 20 | Overall satisfaction with services
Page 27 | Counselling and psychotherapy
Page 28 | 4. Barriers to help...
Page 28 | Services as barriers
Page 29 | Access to counselling and psychotherapy
Page 30 | Information about services
Page 31 | Survivors speaking about abuse
Page 32 | 5. Listening to survivors, breaking down barriers...
Page 32 | Learning from survivors: scratching the surface
Page 33 | Misinformation as a barrier
Page 34 | ‘Not asking’: professional vigilance
Page 34 | Poor services as barriers
Page 35 | Breaking down barriers by building on strengths
Page 37 | 6. References...
Appendix
The research is about support available to people who have survived child sexual abuse. Whatever
your circumstances, if you feel that you need advice or support please contact one of the following
organisations:
Survivors in Transition (SiT)
A support centre for adult survivors of
childhood sexual abuse based in Suffolk.
84, Fore Street
Ipswich
Suffolk
IP4 1LB
Registered charity number 1144655
Website: http://www.survivorsintransition.co.uk
Tel: 07765 052282.
Email: info@survivorsintransition.co.uk
Tweet: @survivorsuffolk
The Survivors Trust (TST)
A national umbrella agency for 130 specialist
rape, sexual violence and childhood sexual
abuse support organisations throughout the UK.
Unit 2, Eastlands Court Business Centre
St Peter’s Road
Rugby
Warwickshire
CV21 3QP
Registered Charity Number: 1109305
Website: www.thesurvivorstrust.org
Tel: 01788 550554
Email: info@thesurvivorstrust.org
Tweet: @survivorstrust
For more information about the research please contact Professor Noel Smith at
noel.smith@ucs.ac.uk.
Support for Survivors
Page 1
Being listened to, believed and respected
The service-user reference group of Survivors
in Transition specifically advised the research
team that the survey should include questions
about being listened to, believed and
respected.
From the group’s perspective these questions
reflected essential basic qualities that services
needed to have in order to help adult survivors
of child sexual abuse.
As the group explained, being listened to is
essential for survivors who as children lacked
a voice or were ignored. Being believed is
essential for survivors who as children would
often be warned by their abusers that if they
told anyone of the abuse they would not be
believed. Being respected is essential for
those who felt degraded by their abuse.
Page 2
The Focus on Survivors study was devised and conducted by University Campus Suffolk and Survivors in Transition,
with support from the Survivors Trust.
Acknowledgements
The authors would like to acknowledge the important
contribution made by Dr Emma Bond, UCS, to the initial
design of the questionnaire. We thank Emma and
Bernadette Mooney, UCS, for their generous support for
the project generally.
Gratitude is due to Fay Maxsted and the Survivors Trust
for helping with the development of the questionnaire
design and the promotion of the survey to the Trust’s
members.
The service-user group of Survivors in Transition played a
vital role in the design of the research and interpretation
of results. The group’s support, insight and expertise is
greatly appreciated.
Above all, we are indebted to the hundreds of survivors
of child sexual abuse who took the time and care to
complete the survey. Without this the research would not
have been possible.
About Survivors in Transition (SiT)
SiT was established in Suffolk in 2009 to provide an
informal platform for survivors to come together and
support each other.
Demand on the organisation for support and therapeutic
intervention led to the SiT becoming a registered charity
in 2011 staffed completely by volunteers.
SiT currently supports over 800 male and female survivors
from across Suffolk and East Anglia per year.
The Focus on Survivors Team
This report is sponsored by Gotelee Solicitors, which is
a Suffolk based firm of solicitors with their head office
located in Ipswich. It has a specialist team of lawyers
dealing in the difficult and often traumatic area of
claiming abuse compensation on behalf of people who
have suffered sexual abuse.
Survivors in Transition and Gotelee Solicitors have come
together in partnership to help survivors who may wish
to pursue a legal claim for compensation in respect of the
abuse they suffered.
If you or someone you know is the victim of sexual abuse
and wish to make a claim for compensation then it is
important you contact a solicitor and seek legal advice
as soon as possible. Survivors in Transition can put you
in touch with the specialist lawyers at Gotelee Solicitors
who will happily have a free no obligation, confidential
discussion with you about your options.
Gotelee Solicitors are members of Association of Child
Abuse Lawyers (ACAL) and the Association of Personal
Injury Lawyers (APIL) and have a team of experts,
including doctors, counsellors, psychiatrists and specialist
barristers to ensure that your sexual abuse compensation
claim has the very best support.
Victims of sexual abuse often believe that they are not
entitled to compensation if the abuse happened many
years ago. It is important to understand that this is
not correct and it is indeed possible to be successful
in obtaining justice and compensation for survivors of
historic sex abuse.
Designs, layouts and info-graphics are designed by the
Information Team at Healthwatch Suffolk. Call 01449
703949 (www.healthwatchsuffolk.co.uk).
Local Healthwatch have the role to find out what people
think about health and social care services in their area.
They have powers to shape, influence and improve
services now and for the future.
Visit the Healthwatch England website
(www.healthwatch.co.uk) to find out how you can help to
improve services in your area.
Executive Summary
Focus on Survivors Survey
The research was undertaken in the context of a severe
lack of evidence about the support needs of adult
survivors of childhood sexual abuse (CSA) in the UK. It
is based on an on-line, national survey of nearly 400
survivors, making this one of the largest surveys ever
undertaken with this population.
The survey looked at experiences of abuse, satisfaction
with different types of service and the availability of
information about services.
CSA in the UK
In media coverage CSA tends to be portrayed as assaults
on children by adults outside of the family, often as
isolated or short term episodes, and often as involving
children on an opportunistic or random basis.
The survey suggests that this portrayal does not reflect
typical experiences of abuse:
Abuse by adults outside family networks is
not typical. Almost 70 per cent of respondents
reported that they were abused within the family or
extended family and over 20 per cent reported that
abuse happened in somebody else’s home.
CSA is not typically experienced as isolated or short
term episodes. The average duration of abuse was
7 years.
Rather than being random, opportunistic assaults,
the risks of CSA are better understood as being
concentrated among certain children. Over half of
respondents reported being abused by more than
one person.
In most cases (70 per cent) the abuse was not
reported to the police. Almost 90 per cent of
survivors have not seen their abusers brought to
justice.
It might expected that abuse is usually stopped as
and when children make disclosures but this is not
the case. Only 11 per cent of survivors said that
abuse stopped about the same time as they made
their disclosures. For most people (69 per cent) the
abuse had stopped well before they told anyone
about it. Alarmingly, 20 per cent of respondents
continued to be abused at least one year or more
after making disclosures. For this group, abuse
continued for an average of almost 6 years after
the first disclosure. Over 30 per cent of those
who had continued to be abused after making
disclosures had disclosed to a statutory service
such as GP, social worker, doctor or teacher.
Less than 20 per cent of survivors disclosed
because they were asked directly if they had been
sexually abused. Statutory services were no more
likely to proactively discover abuse by asking direct
questions than, say, survivors’ friends and family.
The onus falls on survivors to speak out about their
abuse and many can find this in itself traumatic.
Some survivors (34 per cent) first accessed support
services around the same time as they made
disclosures. However, many (42 per cent) did not
receive such support until long after disclosure
– on average 12 years later, with more than half
of respondents waiting at least 9 years. Many
services will be working with people who have
never disclosed being sexually abused as children:
25 per cent of respondents said that they had used
services specifically because of their abuse before
ever disclosing.
Support for survivors
Survivors use a range of support services. Counselling,
mental health and GP services were most commonly
used, with a half or more of survivors using these services
as a result of CSA.
The next most commonly used services were voluntary
sector sexual abuse and rape support services and
psychotherapy services, followed by the police, the
Samaritans, and Accident and Emergency and secondary
health services. Less than a fifth of survivors used social
services. Survivors used a range of services over a long
period of time - on average between four and five
services over a 10 year span between the first service
accessed and the most recent service use.
Satisfaction with services was closely related to some
basic qualities in the way services treated survivors – that
is, whether they made survivors feel listened to, believed
and respected:
Nearly all of those who used Sexual Assault Referral
Centre, Independent Sexual Violence Advisors,
voluntary psychotherapy and counselling services
and rape support services felt that they had been
listened to, believed and respected by services.
Less than half of those who used social services or
A&E and hospital services felt that they had been
listened to, believed and respected.
Taking into account use of all services, survivors
were more satisfied than dissatisfied with the
support they received.
However, there was a sharp contrast between
Page 3
satisfaction with statutory sector and voluntary and
independent sector organisations. Among survivors
who had used both sectors, over 70 per cent were
more satisfied with voluntary sector services than
with statutory services, while less than 20 per cent
rated statutory services over the voluntary sector.
Poor service experience can represent a barrier to
further service use. Survivors who are dissatisfied
with services at one point in time take longer to go
on to access new services. Survivors who fail to find
a satisfying service go on to more services over
a longer period of time than those who receive a
helpful service response at the outset.
Counselling and psychotherapy services are often
provided through sexual abuse and rape support
services, and this cluster of services represents
the provision which respondents found most
satisfying. When asked what, overall, had been the
most helpful support they had received, 48 per
cent of respondents referred to counselling and
psychotherapy, 21 per cent cited sexual abuse and
rape support services and 12 per cent specified
group support with other survivors.
However, 57 per cent of survivors said that they
wanted more counselling and psychotherapy
services. A number of problems were identified
with the availability and adequacy of provision:
insufficient free-at-point-of-use provision, long
waiting lists for too brief counselling programmes,
and limited options in terms of therapeutic
techniques.
A key barrier to getting help was the challenge for
survivors of overcoming the difficulty of talking
about their experiences of being sexually abused
as children.
“Sometimes the fear and the shame is too great
to be able to say anything no matter how long
ago it happened.” - Adult CSA survivors Focus
on Survivors survey respondent
Survivors taking part in the survey had used services over
a broad timespan, from 1975 to 2015. Given growing
awareness about CSA during this period it might be
expected that services would have developed over this
period. However, the research suggests that satisfaction
with services has not generally increased over time.
Information
Less than a third of respondents agreed that professionals
and services provided the information they needed, and
well over half said that they found the information they
needed on-line. Most respondents – over three-quarters
– did not find it easy to find the information they needed.
Problems with information related to both the volume
and relevance of what is available.
Learning from survivors
Conclusions from the research include:
Misinformation about CSA in the UK risks skewing
and undermining targeted strategies to tackle
typical forms of childhood sexual abuse.
Greater professional vigilance in asking service
users if they had experienced CSA – rather than
relying on people to self-disclose – would be
important for bringing forward processes of
support and recovery for survivors. This would be a
vital and cost-neutral step towards more proactive
help for survivors and a more efficient service
response.
The impact of poor service experiences is more
than the absence of effective help at one point-in-
time. Instead, poor service experience is associated
with a delay in survivors accessing future services
and with survivors using more services over a
longer duration. As such a poor service can have a
long term impact and represent a barrier to support
for survivors. In contrast, a good service response
can result in survivors coming to a point of recovery
or resolution sooner in their lives while at the same
time making more efficient use of service resources.
In order to build on strengths, the voluntary and
independent sector (rather than statutory bodies) is best
placed to lead any national strategy to develop support
for CSA survivors in the UK.
Page 4
Background to the Focus on Survivors study
This study was motivated by two factors. First, there is
a remarkable lack of research about survivors of child
sexual abuse (CSA) in the UK. This is true generally and
particularly in relation to evidence about the availability
and quality of support availability to survivors.
A recent review of evidence about intrafamilial abuse for
the Office of the Children’s Commissioner suggests that
much more is known about the perpetrators of abuse
than about survivors of abuse (Horvath et al., 2014). What
research there is – for example, looking at the impacts
of abuse or assessing different therapeutic techniques –
tends to be informed by professional perspectives rather
than by survivors’ views. Indeed, in their systematic review
of international research, Chouliara et al. (2012) were able
to identify only nine studies since 1980 which assessed
psychotherapy and counselling services from survivors’
perspectives. Of these, only two were undertaken in the
UK and these were with small samples and rated as being
of poor methodological quality (Chouliara et al., 2012).
Second, the high profile media coverage of the Jimmy
Savile scandal and the design of the Government’s
Independent Inquiry into historic CSA focus on the
criminal aspects of child abuse. The chief concern is with
the perpetrators of abuse and how their crimes were dealt
with.
While this is important, it draws attention away from what
happens to people after they have been abused and away
from questions about how society supports survivors
of abuse. Instead, the current focus of attention risks
reinforcing an assumption that ‘historic abuse’ is ‘finished
business’ for survivors - something which they can
naturally move on from or something for which nothing
can be done to help after the fact.
“The media circus is so caught up in focusing on
the perpetrators that the victims are forgotten
about.- Adult CSA survivor, Focus on
Survivors survey respondent
At the same time, exposure to media coverage about
these scandals and the Inquiry can be traumatic for
survivors. The frequency and breadth of this coverage
mean that it is often unavoidable for survivors.
“I can’t get away from it. Why does society have
to push the most painful part of my existence in
my face every day? I live in a nightmare. Some
days I absolutely cannot function - you would
never know if you met me but I am losing my
grip inside.- Adult CSA survivor, Focus on
Survivors survey respondent
The Independent Inquiry and the Savile and other
scandals have been linked with a sharp increase in
disclosures: for example, according to the National Police
Chiefs’ Council there has been a 71 per cent increase in
the number of child sexual abuse cases reported to the
police in the three years leading to 2015 .
In 2015, the Government provided a new victims’ fund
of nearly £5m for organisations to provide support
to survivors specifically in response to the surge in
disclosures triggered by the Independent Inquiry. While
increased funding in a period of austerity appears
positive, this £5m needs to be viewed in the context of
the anticipated cost of the Independent Inquiry, which –
according to Ben Emmerson QC, counsel to the Inquiry
- could be in excess of £260m .
If the new victims’ fund reflects the value placed on
supporting victims then it is greatly outweighed by
the investment in an inquiry focusing on perpetrators
and prosecutions. Meanwhile, increased demand – and
reduced funding associated austerity – has resulted in a
growing crisis for support services. A recent investigation
by the Guardian found that up to 10,000 CSA survivors
are estimated to be waiting more than a year for
counselling; many never receive therapy while many
support groups are facing closure.
Funding for services to meet demand triggered by the
Independent Inquiry = £4.85m
Estimated cost of the Independent Inquiry = £260m
In this context, the Focus on Survivors study was
developed in order to gain an understanding of CSA
survivors’ experience of service use and to build an initial
evidence base of the adequacy of service provision. In
doing so, the research attempts to strengthen a focus
on the survivors of child sexual abuse and their needs
throughout their lives.
Page 5
1. Introduction
1 - http://news.npcc.police.uk/releases/over-1400-suspects-investigated-for-child-sexual-abuse-by-people-of-public-
prominence-or-within-institutions
2 - The Telegraph, 26/01/15: http://www.telegraph.co.uk/news/uknews/crime/11370756/Child-sex-abuse-inquiry-
could-cost-hundreds-of-millions.html
3 - The Guardian, 11/08/15: http://www.theguardian.com/society/2015/aug/11/sex-abuse-charity-funding-
crisis?CMP=share_btn_fb
Page 6
Aims and methodology
What is sexual abuse?
Sexual abuse involves an abuse of power – the abuser
being an adult or an older child. Sexual abuse also
involves an abuse of trust.
Childhood sexual abuse can include the following
things. (Please note that some people may find these
examples upsetting).
Being cuddled or kissed in a way that made you
feel uncomfortable
Being bathed in a way that made you feel
uncomfortable
Having to look at other peoples genitals
Having to touch other peoples genitals
Having your own breasts or genitals touched
Having to pose for photographs of a sexual
nature
Being shown films and/or having to listen to
sexual talk
Having your vagina or anus penetrated by a
penis, finger or object
This is not a definitive or exhaustive list.
The research aims to identify:
what services are used by adult CSA survivors in the
UK;
to what extent services met survivors needs; and
the adequacy and availability of information about
services.
The research used an on-line questionnaire which
respondents could complete anonymously. The
questionnaire was designed in consultation with service-
users of Survivors in Transition and with the Survivors Trust.
Ethical approval for the research was secured from the
relevant UCS Ethics Committee.
The questionnaire was in the three sections.
1. The first section asked people about how old they
when they were abused, when they told someone
and if the abuse was reported. The questionnaire
asks whether or not there was more than one
perpetrator and in what setting the abuse happened.
2. The main set of the questions asked about the
support available to survivors, what type of support
people received and if they felt that they had been
listened to.
3. Finally, the survey asked about what information is
available and how support could be improved.
In terms of services, respondents were asked about their
use of the following:
A&E and hospital services
Counselling services
Faith-based support groups
Independent Sexual Violence Advisor (ISVA)
NSPCC, Barnardos or other children’s charity
Psychotherapy
Sexual Assault Referral Centre (SARC)
Social Services
Childline or other helpline
Drug and alcohol advice
GP
Mental health services
Police
Samaritans
Sexual health services
Victim Support
Voluntary sector sexual abuse and rape support
services
Who completed the survey and is it representative?
Almost 400 people (n.395) completed the Focus on
Survivors on-line survey, making this one of the biggest
survey of CSA survivors in the UK to date.
Respondents were recruited through the Survivors Trust’s
national network of support organisations and a social
media campaign managed by Survivors in Transition.
Given the ethical and practical barriers to identifying and
contacting survivors directly this was the most efficient
approach to recruiting respondents.
Respondents defined themselves as survivors of child
sexual abuse. For those who wanted a definition of
childhood sexual abuse, the introduction to the survey
referred them to the below.
Page 7
Figure 1: Where respondents live
In terms of where respondents lived, the leading role
of Survivors in Transition (based in Ipswich) meant that
the eastern region is over-represented in the sample.
Otherwise, however, with the support of the Survivors Trust
network the survey included survivors from across the UK.
Potentially, recruiting respondents through support
organisations resulted in a slightly skewed sample
(compared with a randomly selected sample, if that was
possible). That is, it is possible that this sample over
represents survivors who had accessed support services
and under represents those who have not accessed
services.
To a point, this could be seen to be apparent in the profile
of the sample. In particular, 87 per cent of respondents
were female and only 13 per cent male.
While women are much more likely to have experienced
CSA than men, the gender balance in the Focus on
Survivors survey may not be a precise reflection of
survivors per se. For example, Radford et al. (2011)
suggest that among 11-17 year olds who had
experienced contact sexual abuse 72 per cent were
female and 28 per cent male.
Nevertheless, although the Focus on Survivors sample
might under represent the number of male survivors in
the population at large it is reasonable to argue that it
is a good reflection of the relative numbers of men who
seek support from services. That is, historically, there have
been more sexual violence and abuse services available to
women than to men. Where services are available, there
are anecdotal accounts to suggest that men are more
inhibited about accessing these services than women.
Respondents to the survey ranged in age from 15 to
72. Most (90 per cent) were between 20 and 59 and the
average age was 43.
For ethical reasons, recruitment for the Focus on Survivors
survey was targeted at adults, which explains the small
number of respondents under 20. The small number of
older people aged over 60 probably under represents
the number of older survivors in the general population
Page 8
0
5
10
15
20
25
16 18 20 22 24 26 28 30 32 34 36 38 40 42 44 46 48 50 52 54 56 58 60 62 64 66 68 70 74
72
Figure 2: Participants' age
and gender.
87%
13%
Number of respondents
Age of participants
Page 9
but is arguably a reasonable reflection of the number
of older survivors who have accessed support services.
That is, it is likely that older people would have had less
opportunity to access services over their lives because
of the relatively recent proliferation of specialist support
services, and because of changing public awareness of
and social attitudes to child sexual abuse.
“People didn’t listen when I was young. Abuse
was hidden and not talked about. It was as if
it just didn’t happen in that society.- Adult
CSA survivor, Focus on Survivors survey
respondent
One way of considering the how statistically
representative the size of Focus on Survivors sample
is would be to compare it with the size of the total
population of CSA survivors in the UK.
Given the fact that many survivors do not disclose their
abuse, this is difficult to estimate. For example, Horvath
et al.’s (2014) review of research on intrafamilial sexual
abuse found that estimates of prevalence rates vary
widely 2.5 per cent to 33 per cent (2014, p.91). Probably
the most authoritative evidence on this is the NSPCC’s
research of over 6,000 children and young people which
suggested that 4.8 per cent of children experience
contact sexual abuse before the age of 18 (Radford et
al., 2011).
If this is assumed to be the prevalence rate among the
adult population too, then the sample size for the Focus
on Survivors survey means that we can be reasonably
confident that findings accurately reflect the views of
the wider survivor population - at best (for example for
questions which all respondents answered) we can be
up to 95 per cent confident that answers are accurate
within a 5 per cent margin of error.
Report plan
In what follows (section 2) we look more closely at
the profile of the Focus on Survivors respondents to
consider what this tells us about childhood sexual abuse
in the UK.
The report goes on to report findings from the survey,
including survivors’ experience of services (section
3) and the barriers to receiving help (section 4). The
final discussion (section 5) draws together the study’s
conclusions and highlights the value and importance
of listening to survivors in order to inform the
development of support services in the future.
Although the main purpose of the research was to
examine service provision for survivors, it also provides
some important general insights into child sexual abuse
in the UK.
The first part of the survey asked respondents for some
information about themselves. This included details about
their age and the timescales in which the abuse happened
and when they accessed services. It also included some
information about their experience of abuse (without
asking for details about the nature of abuse).
Age and the start and duration child sexual abuse
Some respondents who were abused when very young
could not cite the precise age when the abuse started.
Approximately how old were you when the sexual abuse
started?
“I can’t remember it not happening - so very,
very young.”
“I’m not certain. I have spent thousands of
pounds trying to find out. Very young.
“Five - but I think earlier due to flashes that don’t
make sense.” - Adult CSA survivors, Focus on
Survivors survey respondents
The majority of respondents were aged under 11 when
they were first abused (see figure 3).
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2. Child Sexual Abuse in the UK
Figure 3: Respondents age when
abuse started.
A
g
e
a
b
u
s
e
b
e
g
a
n
7 yrs
1 yr
Average period of abuse
3 yrs
11 - 15
6 - 10
0 - 5
5 yrs
9 yrs
11 yrs
The average period over which respondents
experienced abuse was 7 years (see figure 4 above).
50 per cent of respondents were abused for six years
or more;
25 per cent were abused for 10 years or more.
The survey found a statistically significant correlation
between the age when abuse started and duration of
abuse: the younger someone started to be abused, the
longer they experienced abuse for. For example:
those whose abuse started aged under 5 were, on
average, abused for 11 years;
those whose abuse started when they were aged
between 6 and 10 were abused for 5.5 years on
average; and
when abuse started between 11 and 15 it lasted an
average of 4 years.
To an extent, this reflects findings from international
evidence which suggests that older children and young
people find it less difficult to reveal abuse and so rates of
disclosure increases with survivors’ age (Hershkowitz et
al., 2005).
If the findings can be generalisable for the total
population of CSA survivors, this demonstrates that child
sexual abuse tends to be sustained over long periods of
time, often through most of childhood. To view CSA as
isolated incidents within childhood would be inaccurate.
Figure 4: Age abuse began
and subsequent duration of
abuse.
Page 12
Almost 70 per cent of
respondents reported that
they were abused within the
family or extended family and
over 20 per cent reported that
abuse happened in somebody
else’s home. For 25 per cent of
respondents, the abuse took place
in two or three different settings.
Of these, the most common
situation was that respondents had
been abused within their family
and in somebody else’s home.
These findings clearly point to
the prevalence of child sexual
abuse within family and friendship
networks. At the same time they
highlight the inaccuracy of linking
most abuse with ‘stranger danger’.
While the prevalence of
intrafamilial CSA is becoming
more widely recognised (Horvath
et al., 2014) a key finding of the
Focus on Survivors survey is the
high prevalence of children being
abused by multiple perpetrators.
That is, over half of respondents
– 51 per cent – reported being
abused by more than one
person. If the risks of being
abused are equally distributed
among the population of children
in the UK, and if perpetrators
usually commit abuse on their own,
then the chances of being abused
by more than one person would be
very small.
However, these findings indicate
that this is not the case. Instead,
they suggest that CSA in the UK is
best understood in relation to one
of two factors, or a combination of
two factors:
the risks of being abused are
not evenly distributed but
are very concentrated among
particular children; and
perpetrators do not necessarily
operate alone and often abuse
is organised among multiple
abusers.
Who commits child sexual abuse?
0
10
20
30
40
50
60
70
80
In F
amily
In Fo
s
ter C
a
re
IIn somebody else
s hom
e
In R
esidential C
a
re
School
Hospital
Club or o
r
ganised
g
r
oup
Other place
68%
2%
22%
5% 7%
1%
6%
20%
Figure 5: Where abuse happened.
Most respondents were abused within family and friendship networks:
Given that respondents were recruited via support organisations it is not surprising that most – 94
per cent – had told somebody about their abuse.
The length of time between abuse starting and the
disclosure of abuse varied widely but was an average
of 16 years. Almost half of the respondents did not
disclose their abuse until they were aged 20 or older.
The survivors disclosed the abuse to people in various
settings, which we grouped in three main categories:
1. Professionals in a statutory setting (e.g., GP, police,
teacher or social worker)
2. Professionals in non-statutory support services
(e.g., helpline, counselling or rape crisis agencies)
and
3. Close person (parents, siblings, partner, other
family member or a friend)
The survivors made their disclosures to very
small number of people. Most – about 75 per
cent of those who disclosed abuse – told
only one person. However, almost 25
per cent had disclosed to two or more
people.
Disclosures had been made to a wide range of people,
though mainly friends and family (see figure 7).
Disclosing abuse and getting help
Figure 6: Respondents’ age when
disclosed abuse
Figure 7: To whom did the
respondents disclose the
abuse?
Page 13
Number of respondents
Age of respondents
There are some differences between respondents who
disclosed to friends and family and those who disclosed
to services. For survivors who disclosed to friends and
family, there tended to be a shorter gap between the
start of abuse and the point of disclosure. The opposite is
true for those who disclosed to (non-statutory) support
services, such as counselling and rape crisis agencies.
Those who disclosed to these agencies experienced a
longer duration between the start of abuse and both the
point of disclosure and the point of starting accessing
services (compared to those who did not disclose to
these types of agencies).
The explanation here is that survivors who decide to
disclose sooner after the abuse started are more likely to
do so to friends and family, but the more time that passes
since the start of abuse the more likely survivors are to
disclose to counsellors and voluntary support services.
Disclosing to a professional in a statutory setting such
as GP, social worker, doctor or teacher is associated with
a higher chance of the abuse being reported to the
police. However, disclosing to a statutory service did not
necessarily lead to a police referral. Indeed, only 41 per
cent of cases disclosed in this setting were reported to
the police.
Across all respondents, only 30 per cent said that their
abuse had been reported to the police. Where abuse had
been reported, in the majority of cases – 64 per cent –
perpetrators were not prosecuted. This means that even
among CSA survivors who have disclosed and accessed
support services, almost 90 per cent have not seen
their abusers brought to justice.
“I needed support as the CPS would not take
the monster who assaulted me to court. It took
great courage to speak out and very hard to live
with the fact I wasn’t given even a day in court.
I wanted to face him and to receive justice. Too
late now as he is dead. They let me down and it
took a long time to come to terms with that.
- Adult CSA survivor, Focus on Survivors
survey respondent
Nearly all of the respondents – 90 per cent - were
receiving or had received support from a service because
of their experience of abuse. Given that respondents were
recruited through support services this is not surprising.
There tended to be a considerable delay between the
experience of abuse and the point at which survivors
accessed services. For example, while there is wide
variation, the average duration between the start of
abuse and accessing support services is 20 years. Age
at time of abuse is again statistically significant here: the
younger someone started to be abused, the later they
started to access support services.
The survey shows three distinct dynamics in terms of the
relationship between point of disclosure and contact with
services.
1. 34 per cent of respondents started using services
around the same time (during the same year) as
they made disclosures.
2. 42 per cent of respondents made contact with
services more than a year after they had made
disclosures. For this group there is a notable lag
between the point at which survivors disclose abuse
and the point at which they access support. This
varies widely, but the average duration of the lag
between disclosure and service use is almost 12
years, with more than half of respondents waiting
at least 9 years. This may reflect the difficulty felt
by survivors about talking about their experiences to
support services, and the effects of age and time on
increasing their ability to approach services. However,
it may also raise questions about the accessibility of
services (in the broadest sense of the term) and the
responsiveness of services to survivors.
Page 14
Start of
abuse
Accessed support
services
20 Years
The average duration between the start of abuse and accessing support services
3. 25 per cent said that they accessed services
because of CSA before disclosing their abuse to
anyone. That is, they sought help because of CSA
without actually disclosing the fact to services that
they had been abused.
Perhaps more importantly the survey suggests that
disclosure is not always coterminous with abuse stopping.
1. For 11 per cent, abuse stopped in the same year as
they made their disclosures. For this group it may
be that disclosure led to abuse stopping.
2. For 69 per cent, abuse stopped one year or more
before making disclosures. This raises important
questions about what brings abuse to an end in cases
where it is not halted because of an intervention
triggered by a disclosure.
3. 20 per cent of respondents continued to be
abused at least one year or more after making
disclosures. For this group, abuse continued for an
average of almost 6 years after the first disclosure.
It is possible that some of these respondents
had experienced multiple, separate incidents of
sexual abuse. That is, for example, they had made
disclosures about abuse by one perpetrator, the
abuse stopped, but they were then subsequently
abused by another perpetrator. However, given the
sustained duration of abuse commonly experienced
by survivors, a more likely explanation is that for
this group disclosing did not result in stopping an
on-going experience of abuse. Indeed, in qualitative
responses in the survey, a number of respondents
explained that they had made disclosures but these
did not lead to any action and, as children, they had
been left in abusive environments. Almost 28 per cent
of these respondents had disclosed to more than one
person. Most of this group (75 per cent) had made
disclosures to family or friends. The failure to protect
children here may be partially explained if disclosures
had been made to other children or if disclosures had
been made to those in family/friendship networks in
which CSA was practiced and condoned.
A small number of this group (11 per cent) had made
disclosures to non-statutory services. Alarmingly,
over 30 per cent of those who had continued to be
abused after making disclosures had disclosed to a
statutory service such as GP, social worker, doctor or
teacher.
“I told a social worker aged 13 what was
happening and she said it couldn’t be
happening because my parents were middle-
class and then she never did anything and left
me living at home until I was 18”.
“I told many teachers, doctors and professionals
over the years whilst still a child and nothing was
done to help me escape the situation.
“I wasn’t believed when I was 12. A psychiatrist
just said “These things happen”. I am sure if I
had been believed then it wouldn’t continue to
have haunted me throughout my life.” - Adult
CSA survivors, Focus on Survivors survey
respondent
When survivors did disclose it was far more likely that
they told someone without being asked. Less than 20
per cent of survivors disclosed because they were asked
directly if they had been sexually abused.
While this finding could suggest that survivors will
disclose abuse themselves when they are ready and able
to do so, it could also be interpreted to indicate that the
onus tends to be placed exclusively on survivors to make
the first steps to disclosure, explaining the typically long
duration between abuse and disclosure.
The manner of disclosing (being asked versus disclosing
on their own) was not related to the type of person/
institution they disclosed to. For example there were
no more survivors, proportionally, who disclosed to
a professional in a statutory setting by being asked,
than who disclosed to other people by being asked.
This means that statutory services are no more likely to
proactively discover abuse by asking direct questions
than, say, survivors’ friends and family.
Were you asked directly if you had
been sexually abused or did you tell
someone without being asked? 19%
told without being asked.
19%
Page 15
11%
69%
20%
Abuse stopped in the same year
as they made their disclosures.
Abuse stopped one year or more
before making disclosures.
Continued to be abused for
an average of almost 6 years
after making disclosures.
Survivors who disclosed on their own differed from
the survivors who disclosed after being asked in some
important aspects: they tended to be older when abuse
stopped and tended to access the first support service at
an older age and after a longer period of time after abuse
started.
Survivors who had disclosed after being asked tended to
have experienced abuse over a longer period (compared
with survivors who disclosed on their own. This indicates
that it takes longer for the abuse to be identified if not
self-disclosed. The manner of disclosing was not related
to the sex of the survivors, the age of disclosure or the
duration between the start of the abuse and disclosure.
These findings raise questions about whether services
should more routinely ask service users directly if they
have experienced child sexual abuse.
“I know I displayed all the signs in childhood
and teenage life particularly at school but no
one noticed, or did anything, I fell through
society’s net.
“During my childhood in the 1970’s nobody
ever took me to one side and asked if I was
alright, despite my poor behaviour, poor health
and falling school grades. I was written off as a
delinquent.- Adult CSA survivors, Focus on
Survivors survey respondents
Page 16
Page 17
Page 18
Access to services
The graph below (Figure 8) shows which services were
used by respondents.
Counselling, mental health and GP services were most
commonly used, with a half or more of survivors using
these services as a result of CSA.
The next most commonly used services were voluntary
sector sexual abuse and rape support services and
psychotherapy services, followed by the police, the
Samaritans, and Accident and Emergency and secondary
health services. Less than a fifth of respondents used
social services.
GPs were most commonly the first service respondents
had contact with as a result of CSA (see Figure 8 below).
The services which represent the ‘first port of call’ for
survivors can be listed below as follows (in order of those
most commonly used as the first service by survivors):
1. GP
2. Police
3. Statutory mental health services
4. Voluntary counselling
5. Rape support services
3. Support services for survivors
Figure 8: Services used by survivors.
Percentage of respondents
48.6%
16%
19.8%
44.3%
26.1%
22.3%
11.7%
6.8%
33.7%
26.1%
43.8%
17.5%
12.4%
43.5%
7.3%
13.9%
6.6%
21.3%
8.6%
6.1%
Page 19
How long do survivors receive support?
Findings about the length of respondents’ service use are
more complex.
When asked (near the beginning of the questionnaire)
whether they were receiving or had ever received support,
35 per cent of respondents answered ‘no’; 30 per cent
said that they had received support for one year or less;
33 per cent said that they had received support for longer
than one year. However, looking at survivors’ responses
when asked about specific services, it is apparent that far
more than 33 per cent of respondents had used services
over a longer duration.
Overall, 88 per cent survivors used at least one of the
services listed in the questionnaire - and on average
respondents used between four and five services.
The average time span of using services was over 10
years between the first service accessed and the most
recent new service.
An explanation for this apparent contradiction is
suggested by analysis of service satisfaction rates. That
is, respondents who initially declared that they are not
receiving or never received support, but subsequently
selected one or more services from the list tended to be
more dissatisfied with services than other respondents.
This suggests that when answering these questions
respondents differentiated between a) use of service
use per se and b) whether they had felt supported by
services.
If so, together these findings represent survivors’
experience as typified as being contact with multiple
services over a long period which included relatively
short, concentrated periods of effective support. Some
survivors though – a fifth or so – experienced more
sustained periods of effective support.
Figure 9: First service used by survivors
(number of respondents).
44.3%
33.7%
43.8%
43.5%
Respondents were asked to rate their experience of using a range of services (listed in chapter one)
in terms of overall satisfaction on a five point scale from ‘very poor’ to ‘very good’.
In the analysis we coded the overall satisfaction responses
as follows:
0 = very poor
1 = poor
2 = neither good nor poor
3 = good
4 = very good
If the respondents rated more than one service, an
‘average satisfaction’ was calculated, by taking the mean
of all ratings. Combining results for all services, the
median average satisfaction score was 2.5 – somewhere
between ‘neither good not poor’ and ‘good’, indicating
that, overall, respondents were more satisfied than
dissatisfied.
Being listened to, believed and respected by services
The questionnaire also asked survivors to rate their
experience of using a range of services (listed in chapter
one) in terms of:
whether or not they felt they had been listened
to;
whether or not they felt they had been believed;
and
whether or not they felt they had been treated
with respect.
Being listened to, believed and respected
The service-user reference group of Survivors in
Transition specifically advised the research team that the
survey should include questions about being listened to,
believed and respected.
From the group’s perspective these questions reflected
essential basic qualities that services needed to have in
order to help adult survivors of child sexual abuse.
As the group explained, being listened to is essential for
survivors who as children lacked a voice or were ignored.
Being believed is essential for survivors who as children
would often be warned by their abusers that if they told
anyone of the abuse they would not be believed. Being
respected is essential for those who felt degraded by
their abuse.
Figure 10 shows the results for these questions.
Page 20
Overall satisfaction with services
When asked what, overall, had been the most
helpful support they had received, a number of
respondents referred not to types of service but to
services which had:
Listened to and believed them.
Looking across these results it is apparent that, in terms of
responses for each individual service, results are clustered.
That is, the proportion of respondents who felt that they
had been listened to by a particular service was similar
to the proportion who felt that they had been believed
and respected by that service. However, there were clear
differences between services.
Table 1 provides a summary of responses to the three
questions. This shows that all or nearly all of those
who used SARCs, ISVAs, voluntary psychotherapy and
counselling services and rape support services felt that
they had been listened to, believed and respected by
services.
In contrast, less than half of those who used social
services or A&E and hospital services felt that they had
been listened to, believed and respected.
Figure 10: Did you feel listened to,
believed and respected?
Page 21
Page 22
Service Heard me
(%)
Believed me
(%)
Respected me
(%)
Cluster
SARC 96 89 92 90 - 100%
ISVA 100 96 96
Voluntary Psychotherapy 96 95 94
Voluntary Counselling 95 95 94
Rape Support 91 95 90
Samaritans 83 89 86 80 - 90%
Faith Groups 88 88 80
Voluntary Mental Health 81 87 85
ChildLine 81 84 82
Victim Support 75 81 78 50 - 80%
Statutory Psychotherapy 77 83 72
Alcohol and Drug 77 75 71
Statutory Counselling 72 77 68
GP 62 75 69
Children’s charities 66 71 62
Sexual Health 60 66 63
Stat mental health 53 67 68
Police 64 63 59
A&E 34 52 37 Less than 50%
Social Services 39 44 32
Table 1: Summary of responses: being listened to, believed and respected by services.
Being listened to, believed and respected were very
closely related to survivors’ overall satisfaction with
services. In direct comparisons, all three are strongly
correlated with the satisfaction rating for all services.
Moreover, when asked what overall had been the
most helpful support they had received, a number of
respondents referred not to types of the service but to
services which had listened to and believed them.
“It took my whole adult life to find a service that
listened to me - I could have had a better life if
someone listened sooner.
“People who take the time to listen and
sometimes just sit with me, have a coffee and
let me talk if I feel able to do so, but without
any pressure or expectation. Just being in the
presence of someone who cares is what is
needed.
“In the NHS services that I have experienced –
four or five different psychotherapists - I have
not felt supported or believed, and it was
suggested I was lying. Almost as demoralizing as
the abuse and rape.
At the time I was not believed. I stopped
expecting anybody to believe me. Only when I
had a complete breakdown did I feel somebody
was finally listening.” - Adult CSA survivors,
Focus on Survivors survey respondents
Has satisfaction with services changed over time?
Respondents accessed services over a broad timespan,
from 1975 to 2015. Given growing awareness about CSA
during this period it might be expected that services had
developed and service user satisfaction increased over
this period. However, the research suggests that - with
few exceptions (see below) - satisfaction with services has
not generally increased over time.
To put this another way, respondents’ satisfaction with
services was not dependent on whether they accessed
them more recently or more retrospectively.
While the year in which respondents accessed a service
could be expected to have a bearing on their experience
of the service, we also considered whether their age at
the time of accessing the service also had a bearing.
When analysing together both the year and the age when
the services were accessed, the services that received
better rating if accessed more recently were A&E and
hospital services, sexual health services and the police. GP
and voluntary mental health services tended to be rated
more positively if they were first accessed at an older age,
regardless of the year when they were first accessed.
Statutory, voluntary and independent sector services
The survey reveals a marked distinction between
statutory services and those provided by voluntary,
charity and independent organisations. Table 4 (below)
provides an overarching picture. If we look at the average
satisfaction with services we can see that, while the
overall median satisfaction score for all services was 2.5,
the median for statutory services was 2 (‘neither good
nor bad’) and for voluntary and independent services it
was 3 (‘good’).
Satisfaction (rating) Median Participants
Average satisfaction with all services 2.50 333
Average satisfaction with statutory services 2.00 286
Average satisfaction with voluntary services 3.00 284
Figures 11, 12, 13 and 14 show satisfaction ratings
differentiated by sector. In some cases, the distinction
between statutory and voluntary sector services is
not clear cut: for example, some statutory services are
delivered by the voluntary and independent sector; and
some counselling services and ISVA services are provided
by sexual abuse and rape support services.
Nevertheless these figures reveal a distinct pattern in
which respondents were more likely to rate voluntary and
independent sector services as being good and statutory
sector services as being poor.
More detailed figures of satisfaction ratings are provided
in the appendix.
Table 2: Average satisfaction with services, overall and by sector.
Figures 11 and 12: Satisfaction with services, overall and
by sector.
Page 23
Rated as good or very good
Rated as neutral
Rated as poor or very poor
Page 24
Figure 13: Proportion of
respondents who rated
services as either ‘good’
or ‘very good’.
Figure 14: Proportion of
respondents who rated
services as ‘poor’ or ‘very
poor’.
For respondents who used both statutory and voluntary
services it was possible to compare the average scores
they gave to each of these two groups of services.
Of this group, 72 per cent were more satisfied with
voluntary sector services than with statutory services,
while only 19 per cent rated statutory services over
the voluntary sector. 9 per cent rated them both the
same. Again, satisfaction is closely linked to whether
respondents felt listened to, believed and respected:
55 per cent of respondents felt that more
voluntary services listened to them than
statutory services. Only 13 per cent said that
statutory services were better than voluntary
services at listening.
44 per cent of respondents felt that more
voluntary services believed them than statutory
services. Only 12 per cent said that statutory
services were better than voluntary services at
believing.
55 per cent of respondents felt that more
voluntary services respecting them than
statutory services. Only 10 per cent said that
statutory services were better than voluntary
services at treating them with respect.
Looking more closely at statutory services, respondents
rated some services as being particularly good. For
example, although only a small number of respondents
used SARCs most who did rated than as good or very
good, and most felt that the service listened, believed
and respected them.
Statutory psychotherapy services are also rated highly
here. It should be noted that although these two services
are classified here as statutory sector services, it is often
the case that statutory services (e.g. health and police)
commission voluntary and independent sector agencies
to deliver these types of services.
Other statutory services fall into two broad camps. On
the one hand, there are services where a lower average
satisfaction rate reflects inconsistency in respondents’
experience of the service. This is true in the case of GP
services, the most widely used service in the survey. As
Figure 13 (right) shows, respondents’ experiences are
relatively evenly spread across those who rated it as good
or poor or were ambivalent either way.
A similar, rather even ‘spread’ of responses was also
found for sexual health services and statutory mental
health services.
On the other hand, there are services which respondents
more consistently rated as being poor. These included
social services, A&E and hospital services and the police
(see Figure 14 right). While most people who used
the police felt that they were listened to, believed and
respected, this is not the case for social services and A&E
and hospital services. There services were both rated
lowest in terms of overall satisfaction levels but were also
the only services in which the majority of respondents felt
that they had not been listened to or respected.
While most voluntary and independent sector services
were rated higher than statutory sector services, they did
not all do so. Children’s charities – as a broad category
including NSPCC and Barnardos – received a mixed
response, as did Victim Support. However, the sample
sizes here are too small here to draw any conclusions.
Satisfaction rates were higher for faith-based support
groups and Independent Sexual Violence Advisors (with
ISVAs having the highest overall satisfaction rates) but
sample sizes are again too small to make generalisations.
Other, more widely used voluntary sector organisations
had consistently high satisfaction rates. Most notable here
are counselling and psychotherapy services (discussed
in more detail in the section below) and voluntary sector
sexual abuse and rape support services.
After ISVAs, the next highest rated services were sexual
abuse and rape support services. These were rated ‘good’
or ‘very good’ by 77 per cent of respondents who had
used such services. Other services with consistently high
satisfaction rates included: helplines, such as Childline;
the Samaritans; and, to a lesser extent, drug and alcohol
advice services.
Page 25
Figure 15: Ratings of
voluntary and statutory
services.
Counselling and psychotherapy services are often provided through sexual abuse and rape
support services, and this cluster of services represents the provision which respondents found
most satisfying.
As suggested in Figure 15 above, 77 per cent of
respondents rated sexual abuse and rape support services
as good or very good. Over 90 per cent of respondents
felt that they had been listened to, believed and
respected by these support services.
When asked what, overall, had been the most helpful
support they had received, 48 per cent of respondents
referred to counselling and psychotherapy, 21 per cent
cited sexual abuse and rape support services and 12 per
cent specified group support with other survivors.
The distinction between statutory and voluntary sector
services is observable here again. The respondents were
asked whether they received services through statutory
services, voluntary services, or both, for counselling and
psychotherapy services. Some respondents were not
clear which sector provided these services, accounting for
about 7 per cent of respondents who used counselling
services and 6 per cent of those who used psychotherapy.
Other respondents were able to specify whether the
counselling and psychotherapy services they received had
been provided by the voluntary or statutory sector. Table
5 (below) shows that, while both voluntary and statutory
services are in general rated positively, the voluntary
services fare much better than the statutory ones.
We were able to verify this finding by looking at
respondents who used both statutory and voluntary
services and for whom, therefore, we were able to directly
compare their satisfaction with the two providers. For
both counselling and psychotherapy, respondents rated
voluntary sector providers significantly higher than
statutory providers (on average about 1 point higher on
the 0 to 4 rating scale).
% rate ‘good’ or
‘very good’
% felt they had
been listened to
% felt they had
been believed
% felt they had
been respected
Counselling Statutory 42% 72% 77% 68%
Voluntary 83% 95% 95% 94%
Psychotherapy Statutory 56% 77% 82% 72%
Voluntary 68% 95% 97% 94%
Table 3: Satisfaction rates for psychotherapy and counselling.
Counselling and psychotherapy
Page 27
Page 28
4. Barriers to help
Analysis suggests that poor experience of a service may not necessary be important just in terms
of representing an absence of adequate support.
There is some evidence to suggest that a poor service
experience can also represent a barrier to further service
use. There are several indicators supporting this idea:
there is a negative significant correlation between
the overall satisfaction with services and the duration
between accessing the first service and the most
recent service. This might indicate that people who are
dissatisfied with services at one point in time take longer
to go on to access new services.
When we looked at the average satisfaction with the first
service accessed, we found a similar pattern: significant
negative correlation with the duration between first and
last service. This indicates that people dissatisfied with
their first service are likely to access services over a longer
period of time. Moreover, respondents dissatisfied with
their first service tended to use more services in total as
well, probably in a struggle to find a service that suits
their needs.
These findings suggest that survivors who fail to find a
satisfying service go on to more services over a longer
period of time than those who receive a helpful service
response at the outset.
Some respondents gave examples of poor services in
the context where their abuse was acknowledged but,
for example, the service response was inconsistent, the
therapeutic response was inappropriate, there was an
over-reliance on medication, or survivors felt treated as a
‘number’ rather than as a person.
“The mental health system really needs to be
more sensitive to the needs of CSA survivors.
I have experienced good help but only from
one individual and then other help I have been
offered has resulted in more damage due to the
lack of training and understanding by staff.
“I feel that every time I see a new doctor or
counsellor I am having to rehash the entire
experience which can be really stressful.
“Services on offer to date were more like a
bandaid or drug induced coma”.
“Statutory agencies have no understanding,
no empathy and you are treated as a target
or a tick box instead of a real person.” - Adult
CSA survivors, Focus on Survivors survey
respondents
A particular theme in respondents’ accounts related to
services which failed to respond to survivors’ disclosures.
Many survivors find it difficult to speak about their
abuse and it can take many years after the experience of
abuse before they are able to do so. Points of disclosure
can therefore be critical moments in survivors’ lives.
Consequently, when services fail to respond adequately to
disclosure it can serve to bring survivors’ efforts to seek
help to an abrupt halt and stop or trigger a long delay in
their seeking help again.
“I told my GP that I was abused and needed
help. She believed me and shrugged her
shoulders saying there was nothing she could
do. I believed all sorts of things because of that...
It took me two years to ask for help again. You
have internal voices telling you not to tell and
that they will punish you if you break the rules
you’ve been living with all your life, rules that
have been keeping you safe. How can you risk it
all to tell the GP and be sent away with nothing
more than a tissue?”
“I was diagnosed with post natal depression
and my GP referred me to a psychotherapist. I
disclosed abuse to him - the first ever disclosure
- and he asked me if it still affected me. I
said I didn’t think so, he said “good” and we
moved on...” - Adult CSA survivors, Focus on
Survivors survey respondents
Services as barriers
Page 29
Respondents were asked if there were any types of help that respondents felt they needed but
could not find.
Of those who answered, 57 per cent said that they
wanted more counselling and psychotherapy services.
Moreover, the Focus on Survivors survey included a
number of ‘free text’ boxes where respondents could give
qualitative responses to general questions about what
services were most helpful, how services could improve
and what services are missing.
The strongest single theme across these qualitative
findings was the problem of restricted access to
counselling and psychotherapy. Access was restricted
by a number of factors. First, respondents talked about
long waiting lists in order to access services when, in fact,
survivors required a much more responsive approach.
“I had to wait two and a half years to get
dynamic psychotherapy because of staff
shortages and waiting lists. Being told I needed
help but there being no one there to help wasn’t
helpful at all.
“It’s very difficult to get counselling when it’s
needed. I went to the GP when I was in crisis and
had to wait a year for around 10 sessions”.
“The waiting list for therapy is very long and
the amount of therapy provided has been small.
I’ve only managed to get therapy through
feeling suicidal and in desperation.” - Adult
CSA survivor, Focus on Survivors survey
respondent
Second, services provided free at point of access were
time limited and respondents felt strongly that the lack
of sustained support was problematic. Ten per cent of
respondents specified that they wanted more sustained
counselling and psychotherapy support.
“What little support I had was severely time
limited and, if anything, made things worse.
“Even though I have had two years of counselling
with a voluntary organisation that was very good
I don’t feel it was long enough – I’m still suicidal”
“Survivors of abuse need more than six weeks of
free counselling. My counselling is not a luxury
but a necessary lifeline to enable me to recover
from my terrible experiences as a child.
“I’ve had support on and off through the years
but it was never consistent and only when I tried
to take my life then I would get some form of
help for a short period. Mainly it would be, ‘Take
these tablets, see you in a month’s time!’” - Adult
CSA survivors, Focus on Survivors survey
respondents
Third, respondents suggested that available services often
offered a limited range of therapies. Some respondents
talked about the importance of having choice and access
to therapeutic services tailored for individual needs.
Some referred to specific therapeutic approaches: 14
per cent wanted more group therapy; 9 per cent wanted
better access to Post-Traumatic Stress Disorder (PTSD)
treatments.
“Eighteen months of CBT didn’t help me, yet I am
made to feel the failure by psychologist.
“What next after therapy? I feel so alone and
abandoned. I feel ready for some group therapy
but there’s none available.
“The one-size-fits-all approach of the NHS
assumes depression and anxiety are what brings
people to therapy… We need consistency and
choice. We also need to not be fobbed off with
short term CBT courses.
“True trauma therapy doesn’t seem to exist.
Mental illness needs to be seen as a direct
physiologic effect from abuse. The bulk
of literature agrees but, in practice, all the
therapists/therapies seem oblivious”.
“I cannot access help with my experiences of
organised abuse because there are not enough
people trained in this that are able to offer free
help… It has left me with no help and being
Access to counselling and psychotherapy
stigmatised and not believed by medical staff
and other professionals. They seem to find it
easier to locate the problem in the individual
(by diagnosing you with some kind of disorder)
rather than recognise that you are coping with
the effects of trauma.- Adult CSA survivors,
Focus on Survivors survey respondents
Finally, the most commonly-cited problem for accessing
counselling and psychotherapy – and one underpinning
other factors – was the lack of free-at-point-of-access
services and the affordability of private services.
“Private psychotherapy has cost me thousands
of pounds that I have never really been able
to afford but that I have paid because I feel I
wouldn’t have survived without it.”
“The psychotherapy will take another year or
so - I have diagnosis of complex PTSD - my fears
and strategies are deeply embedded. There is
no funding available despite psychotherapy is
recommended by NICE. In July I will have to
self-fund to continue. I don’t work, I care for my
husband, my resources are limited. My GP won’t/
can’t fund. My local NHS Mental Health Service
won’t fund.
“I feel unless you are able to pay for treatment,
in certain postcode areas help is almost non-
existent.
“It is really important that resources are put into
place for people to access help free of charge.
It is unacceptable that trauma is managed on
an ability to pay basis. - Adult CSA survivor,
Focus on Survivors survey respondent
Page 30
Information about services
Problems accessing services also appear to be associated with the provision of information about
available help. Table 4 summarises respondents’ views on the availability of information about sup-
port and services for survivors.
Strongly
Agree
Agree Neither
Disagree Nor
Agree
Disagree Strongly
Disagree
Professionals and people in
organisations gave me the information
I needed
8% 23% 24% 23% 21%
I found the information I needed online 16% 40% 20% 15% 10%
It was easy to the find information I
needed
6% 21% 27% 29% 17%
I found enough information about the
services and support available
3% 19% 29% 30% 18%
The information I found was relevant
and appropriate
5% 32% 34% 19% 11%
Table 4: Respondents’ views on information available about support and services for adult CSA survivors.
These findings suggest that respondents were more likely
to rely on their own research to find support services
rather than on professional sign-posting or referrals. Less
than a third of respondents agreed that professionals
and services provided the information they needed, and
well over half said that they found the information they
needed on-line.
“I’m still discovering new things everyday out
there. There's no clear picture of what there is
available.- Adult CSA survivors, Focus on
Survivors survey respondent
At the same time, most respondents – over three-quarters
– did not find it easy to find the information they needed.
Problems with information related to both the volume
and pertinence of what is available. Only about a fifth
felt that there was enough information and well under
half felt that the information they found was relevant and
appropriate to their needs.
“Googling for help is hard to find the help that is
needed…if certain search words were entered I'm
often bombarded by triggering media reports
of the latest scandal. It puts you off searching.
- Adult CSA survivors, Focus on Survivors
survey respondent
Survivors speaking about abuse
Finally, a common and underlying theme in the qualitative
responses was that a key barrier to getting help was the
challenge for survivors of overcoming the difficulty of
talking about their experiences of being sexually abused
as children.
“Sometimes the fear and the shame is too great
to be able to say anything no matter how long
ago it happened.
“I wish I was strong enough to get in touch and
talk but every time I think about it I feel so sick.”
- Adult CSA survivors, Focus on Survivors
survey respondents
A number of respondents described using services as a
result of CSA but without their CSA experiences being
addressed. That is, symptoms resulting from CSA were
tackled but not the core issue of the experience of CSA
itself.
“In terms of the sexual abuse, I’ve had no
support but I have had all sorts of medication,
'therapy', CBT etc. on and off over the last 35
years due to anxiety, depression, suicidality,
OCD, living with fear... the abuse I suffered as
a child has never been addressed.- Adult
CSA survivor, Focus on Survivors survey
respondent
Several respondents highlighted that, for many survivors,
the process of recalling abuse, perceiving its impact
on their lives and attributing problems in adult life to
childhood experience is complex. Survivors may not
necessarily be conscious of the impact that CSA has had
on their lives when they seek help from services, and they
may well need expert support in order to identify their
abuse and its implications.
“You assume that if you have had contact with a
service as a result of sexual abuse that you will
have told them about it…. People have contact
with services because of distress, but there can
be all kinds of barriers to them naming that
distress. I have had contact with lots of the
services mentioned in this questionnaire, but no-
one took the time to work things out with me
and help me cut through the haze to the actual
issue.
“My contact with NHS services has been awful - I
was referred from service to service for years.
The problem for me was that I had repressed
memories that I was only able to access through
psychotherapy. My distress was really awful and I
had contact with my GP, police, NHS, but I didn't
know why and couldn't explain myself until I
paid for private psychotherapy myself. - Adult
CSA survivors, Focus on Survivors survey
respondents
Page 31
Page 32
5. Listening to survivors, breaking down barriers
“Listen to children. Stop thinking we make it up.
…Don't shy away from our bruises. Don't ignore
us when we are scared. Just ask and we will most
likely tell.
“[What’s missing is] a society where it's OK to
disclose abuse, that accepts how prevalent abuse
is, that meets disclosures of abuse with kindness,
compassion and belief.
“[What’s missing is] a service that recognises
that abuse doesn't necessarily stop just
because someone ceases to be a child.- Adult
CSA survivors, Focus on Survivors survey
respondents
Learning from survivors: scratching the surface
This research was undertaken in the context of a striking lack of evidence available about adult CSA
survivors in the UK.
If the recent NSPCC study (Radford et al., 2011) suggests
that up to 5 per cent of the UK population have
experienced contact sexual abuse in childhood then this
is similar to the UK’s population of people with diabetes.
However, while comparable in terms of prevalence,
the evidence base about CSA survivors appears paltry
compared to that for other public health issues such as
diabetes. This is problematic for children at risk of sexual
abuse and for survivors of abuse: without robust evidence,
efforts to develop effective strategies to prevent abuse
and support survivors will be inherently undermined.
This in turn risks heavy costs: human costs, of course, but
also substantial revenue costs and increased demand
on public spending. For example, based on remodelling
international evidence in the context of the UK, the
NSPCC suggests that as a conservative estimate the
annual cost of CSA is £1.6b (Saied-Tessiet, 2014).
Inevitably, as a single study, the Focus on Survivors
research can make only a limited contribution to the
evidence base. It concentrates on survivors’ use of
support services and yet even here we can only offer
partial insight into survivors’ support needs. For example,
in their qualitative answers, a number of respondents
highlighted that support from formal organisations was
not always the only help they accessed and was not
necessarily the most important help. Informal support
from and fellowship with other CSA survivors was highly
valued. Similarly, for some, support from partners, family
and friends had been the vital factor in dealing with the
trauma of abuse. This informal support is not properly
reflected in this research.
In terms of support from formal organisations there
is also much more to learn, not least regarding the
policies and training necessary to ensure that services
identify, respond to and support survivors as effectively
as possible. In future research to investigate these issues
it will be important for researchers to take a dynamic
perspective of survivors’ ‘service-user journeys’ to
examine both how they move between services and how
they access services over time and across the life-course.
Similarly, the evidence base would benefit from more
evaluation of the relative appropriateness and efficacy of
different counselling techniques, taking into account the
views of and sustained impact on survivors.
Nevertheless, it is hoped that the Focus on Survivors
does make a helpful contribution to understanding about
CSA survivors. There is an underlying sense across the
findings that ineffective service responses are not merely
problematic because they result in an absence of support.
Instead, they can further be understood as representing
barriers between survivors and the help they need. These
barriers can be described in terms of four themes.
Page 33
CSA in the UK is often depicted as opportunistic and isolated crimes, typically perpetrated outside
the family on a one-off or short term basis.
This is an enduring portrayal, from public awareness
campaigns about ‘stranger danger’ in the 1970s and
1980s to the current media profiling of the Jimmy Savile
scandal and the subsequent focus on crimes perpetrated
by celebrities and the establishment.
Only recently has media coverage of the child sexual
exploitation in Rotherham, Rochdale and elsewhere
highlighted cases of organised abuse by multiple
perpetrators, where sustained periods of grooming led to
sustained periods of abuse. However, the focus here again
is on abuse committed outside of the family and, indeed,
much media attention in these cases has focused on the
ethnicity and ‘otherness’ of the groups of perpetrators
involved.
In fact, these depictions are not representative of child
sexual abuse. The Focus on Survivors research suggests
that a far more typical model of CSA in the UK is one
where a child is abused in the family or family network.
In a half of cases, the child is abused by more than one
perpetrator. This must mean that, typically, abuse is
either explicitly organised between adults or that certain
children are at disproportionate risk of being abused by
multiple perpetrators acting independently. If certain
children face disproportionate risks, this must be because
their family environment makes them vulnerable to
multiple abusers and/or because grooming has left them
identifiable and susceptible to assaults by perpetrators
operating in isolation.
Abuse starts young – either at pre-school or primary
school age – and continues for a sustained duration (an
average of 7 years). Sometime abuse stops because the
child makes a disclosure, sometime the abuse continues
after the child makes a disclosure, but most typically
abuse stops for other reasons, well before any disclosure
is made.
Although it is obviously important to deal with failures
to address abuse by public figures and large organised
groups, the weight of media attention on these more
atypical cases can skew public debate and social
awareness. This in turn influences the political focus
and, hence, investment in and drivers of professional
interventions.
The Focus on Survivors research offers an opportunity to
promote understanding of more typical CSA in the UK.
So, for example, while it is well known that childhood
sexual abuse happens within families, it is important to
be clear the fact that abuse is far more likely to happen in
this context than in any other context.
This fact should mean that the dominant focus of political
and professional concern is on intrafamilial abuse, and it
should be this that drives the strategic response.
Within this context, the strategic response needs to be
further shaped by recognition that not all children face
the same chances of being abused. If we acknowledge
this fact then we also need to recognise that, in order
to effectively prevent abuse and serial abuse, there is an
urgent need for better understanding about why the risks
of sexual abuse are so highly concentrated among certain
children and not others.
The fact that children experience abuse typically over an
extended number of years – rather than as in isolated
assaults or short term episodes – is also critical. While
avoiding drawing any over-simplistic relationship between
the duration of abuse and impact of abuse, the sustained
nature of sexual abuse across childhood makes it plain
why for many survivors the impact of abuse extends well
into adulthood and across the life course.
However, the sustained nature of abuse also means
that there are sustained windows of opportunities
for intervention into the lives of children in abusive
situations. That is, if CSA usually happens as isolated,
opportunistic episodes then the chances that citizens and
services would be able to intervene to protect children
would be narrow. Instead, the fact that CSA is actually
more commonly experienced as sustained episodes
would suggest that there is a realistic opportunity for
intervention to protect children.
The fact that most experiences of abuse stopped without
disclosures being made raises additional important
questions about the dynamics of abuse. If abuse stops
without the child making others aware of the abuse – if
it stops, then, without external intervention – then what
are the determining factors for triggering this? Robust
understanding of these determinants could prove to be
important for informing effective strategies for preventing
and tackling abuse.
The Focus on Survivors research found that survivors’
satisfaction with services has not generally improved over
time. This is surprising given that the study surveyed CSA
survivors who had accessed services between 1975 and
2015 – a period of historic importance in terms of the
beginning of a new public recognition of the prevalence
of child sexual abuse, the introduction of key legislation
and development of new professional training and
services.
The fact that the awareness and expertise which has
developed over this era has not resulted in a marked
Misinformation as a barrier
improvement in services for survivors may indicate that
lessons learnt are not always being translated effectively
into practice. Arguably, to some extent this may result
from misinformation about what constitutes the most
common forms of CSA and a failure to maintain an
overarching strategic focus on intrafamilial abuse.
The research found considerable variation in survivors’ satisfaction with different types of services.
Satisfaction with services was closely related to some core, basic qualities in the way services
responded to and treated survivors – that is, whether they made survivors feel listened to, believed
and respected.
Overall, survivors were less satisfied with statutory
services than voluntary and independent services.
The poorest performing services were social services and
A&E and hospital services. In these services, between
about a half and two-thirds of service users felt that
they had not be listened to, believed or respected by
professionals. It is also important to note that certain
services represented the ‘first port of call’ for survivors –
that is, the first service accessed by survivors because of
CSA.
The most common first ports of call were all statutory
services: GPs, the police and statutory mental health
services. As the first port of call, these services would
have responsibility for provided support directly and/or
serving as gate-keepers in terms of referring survivors
on to other support services. Of these three services,
‘Not asking’: professional vigilance
The Focus on Survivors survey found that 80 per cent of survivors were not asked if they had been
abused.
Instead, they made their disclosures without being asked
which would have meant taking the step to bring up the
subject themselves and reveal traumatic experiences of
sexual abuse. For many survivors, making disclosures is
hugely challenging. In the survey survivors talked of the
stress, nausea and sense of shame they felt when talking
of their abuse, and the difficulty in breaking the secrecy
ingrained upon children by perpetrators.
“You have internal voices telling you not to
tell and that they will punish you if you break
the rules you've been living with all your life,
rules that have been keeping you safe.- Adult
CSA survivor, Focus on Survivors survey
respondent
It might be expected that professionals in services – with
informed awareness of the prevalence of CSA - would be
more likely than lay members of the public to ask about
abuse. However, those survivors who disclosed because
they were asked were no more likely to have been asked
by professionals than by friends and family. The survey
also found that a quarter of survivors had used services
because of their CSA without having disclosed their
abuse.
These findings suggest that services often work with
people who have been abused, and who are seeking help
because of their abuse, but this is not made known to
services and services are not generally checking this out
with service users.
This is problematic because it means that services are
often not addressing the core needs of these service
users, so that survivors’ needs are left unmet and
organisations’ skills and resources are being used
inefficiently. Moreover, the survey also found that
survivors who disclosed because they were asked were
significantly more likely to access services younger and
sooner after their abuse compared with those who
disclosed without being asked.
This suggests that asking service users about CSA is
important for bringing forward processes of support and
recovery for survivors. This is particularly important in
the context where, overall, delays between disclosure and
accessing professional support are substantial: on average
12 years, with half of survivors waiting 9 years or more.
Greater professional vigilance, in this respect, would then
seem a vital and cost-neutral step towards more proactive
help for survivors and a more efficient service response.
Poor services as barriers
Page 34
Page 35
satisfaction was highest for GPs but, even here, between
a quarter and a third of survivors who used the service
did not feel listened to, believed or respected.
Survivors rated counselling and psychotherapy as the
best and most important services. However, they also
identified problems with the availability and adequacy of
provision: a lack of free-at-point-of-use provision, long
waiting lists for too brief counselling programmes, and
limited options in terms of therapeutic techniques. For
some, inadequate therapeutic provision did more harm
than good.
“What little support I have was severely time
limited and, if anything, made things worse.
- Adult CSA survivor, Focus on Survivors
survey respondent
The impact of poor experiences of services needs to be
assessed as more than the absence of effective help at
one point-in-time. In particular, the Focus on Survivors
survey found that if survivors have a poor experience
with the first service take longer to go on to access new
services. This suggests that a poor service experience can
put survivors off from trying to access help. Moreover,
poor service experience is significantly associated with
survivors using more services over a longer duration.
In contrast, someone who receives a helpful service
response at the outset uses fewer services over a
shorter period. In turn this suggests that a good service
response can result in both survivors coming to a point
of recovery or resolution quicker and a more efficient use
of organisational resources.
“It took my whole adult life to find a service
that listened to me - I could have had a better
life if someone listened sooner.- Adult
CSA survivor, Focus on Survivors survey
respondent
Breaking down barriers by building on strengths
As much as highlighting areas of poor satisfaction, the Focus on Survivors survey highlights
services which survivors rated very highly. For example, in a number of services – Sexual Assault
Referral Centres, Independent Sexual Violence Advisors, and voluntary sector counselling,
psychotherapy and sexual abuse and rape support services – over 90 per cent of survivors felt that
they had been listened to, believed and respected. A consistent theme in respondents’ qualitative
responses was the expression of gratitude for services which survivors felt had transformed or even
saved their lives.
“It is very important victims are listened to
because they can end up being scared for life…
thank you so much you`ve turned out to be a life
saver.
“I finally feel alive for the first time in my life… I
count myself lucky to have received such good
support…”
“…I thank them from the bottom of my heart for
helping me realise it was not my fault.
“I am now not held by my nightmares any
more… - Adult CSA survivors, Focus on
Survivors survey respondents
It is clear from the survey that voluntary and independent
sector services are leading the way, over statutory sector
services, in providing the support which survivors find
most helpful. The findings here are stark. In most cases,
less than 50 per cent of respondents rated any statutory
service as good while more than 50 per cent rated most
voluntary sector services as good.
Correspondingly, in most cases, over 20 per cent rated
most statutory services as poor; less than 20 per cent
rated any voluntary sector services as poor.
This observation is important for informing the future
direction of the UK’s strategic response to CSA. As a
public health issue, such a strategy demands well targeted
measures both to better protect children and to support
survivors. In the case of the latter, this includes direct
provision – particularly counselling and psychotherapy –
but also policy development and training to, for example,
improve the efficacy of statutory services’ response to
adult survivors of CSA.
Page 36
Recognising that successful practice is currently
concentrated in the voluntary and independent sector
should mean that this sector is tasked and resourced to
take the leading role in the future development of work in
this area in the UK.
Chouliara, Z., Karatzias T., Scott-Brien, G., Macdonald, A., MacArthur, J. and Frazer, N. (2012). ‘Adult survivors' of
childhood sexual abuse perspectives of services: A systematic review’. Counselling and Psychotherapy Research,
Volume 12, Issue 2, pp.146-161
Hershkowitz, I., Horowitz, D. and Lamb, M. (2005). ‘Trends in children's disclosure of abuse in Israel: a national study’.
Child Abuse and Neglect, Volume 29, Issue 11, pp. 1203–1214
Horvath, M.A.H., Davidson, J.C., Grove-Hills, J., Gekoski, A. and Choak, C. (2014). “It’s a lonely journey” A Rapid
Evidence Assessment on intrafamilial child sexual abuse. London: Office of the Children’s Commissioner. http://www.
childrenscommissioner.gov.uk/publications/%E2%80%9Cit%E2%80%99s-lonely-journey%E2%80%9D-rapid-evidence-
assessment-intrafamilial-child-sexual-abuse
Radford, L., Corral, S., Bradley, C., Fisher, H., Bassett, C., Howat, N., & Collishaw, S. (2011). Child abuse and neglect in the
UK today. London: NSPCC http://www.nspcc.org.uk/services-and-resources/research-and-resources/child-abuse-and-
neglect-in-the-uk-today/
Saied-Tessiet, A. (2014). Estimating the costs of child sexual abuse in the UK. London: NSPCC http://www.nspcc.org.uk/
services-and-resources/research-and-resources/estimating-costs-of-child-sexual-abuse-in-uk/
Page 37
6. References
Appendix
Very poor Poor Neutral
Service rating - Statutory services
Good Very Good
21.2%
13.8%
16.9%
27%
21.2%
50%
15%
16.7%
10%
8.3%
34.2%
15.8%
17.1%
23.7%
9.2%
25.5%
22.4%
18.2%
25.5%
8.5%
15.7%
18.6%
23.5%
20.6%
21.6%
14.6%
11%
18.3%
26.8%
29.3%
20%
13.3%
22.2%
15.6%
28.9%
3.9%
11.5%
7.7%
30.8%
46.2%
31.6%
11.3%
15.8%
21.1%
20.3%
Service rating - Voluntary services
Very poor Poor Neutral Good Very Good
6.9%
11.9%
15.8%
28.7% 36.6%
1.8%
5.3%
9.5%
27.2%
56.2%
16.7%
16.7%
8.3%
58.3%
8.2%
10.2%
28.6%
30.6%
22.5%
4.1% 8.8%
10.5%
20.5% 56.1%
31%
6.9%
13.8%
20.7% 27.6%
11.1%
7.4%
13%
35.2%
33.3%
12%
4%
28%
24%
32%
7.4%
7.4%
24.7%
28.4%
32.1%
16.7%
16.7%
66.7%
9.4%
18.8%
28.1%
18.8%
25%
Layout, designs and info-graphics created by the Information
Team at Healthwatch Suffolk. Call 01449 703949 or email
info@healthwatchsuffolk.co.uk.
This report is sponsored by:
Published October 2015
... However, some grey literature sources provided insufficient descriptions of methodology, thus limiting comprehensive judgements. The four mixed methods studies had lower methodological quality, due to ill-defined target populations, inadequate sampling strategies or unsatisfactory methodological detail (Allnock and Miller, 2013;Matthew and Barron, 2015;Smith et al., 2015;IICSA, 2017). When involvement with survivors was observed in quantitative (QUAN) components of mixed methods studies, this did not result in improved judgements of methodological quality. ...
... Of the 15 studies, 6 received suboptimal scores as survivors adopted the role of consultants on isolated areas of the research and were minimally aligned with the principles of the Survivors Charter (Perôt et al., 2018). Where information was provided, studies sought consultation on ethical guidelines and protocols to improve safety (Allnock and Miller, 2013), on data collection methods to ensure relevance and acceptability (Smith et al., 2015;Bond et al., 2018), or on analysis to improve the quality and credibility (Byrne et al., 2017;Lumbasi and Barron, 2016). Engagement with survivor advisory groups at multiple stages of the research process was less frequently observed but demonstrated a more genuine form of collaboration in two instances (IICSA, 2017;Seddon et al., 2012). ...
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Background: There are current concerns about whether appropriate support is provided for sexual abuse and assault survivors. We reviewed the published evidence for peer-led groups in the care of survivors. Aims: To determine the health and wellbeing outcomes of peer-led, group-based interventions for adult survivors who have experienced sexual abuse and assault and describe the experiences of participants attending these groups. Method: Systematic review. The following databases were searched: Medline, PsycINFO, Embase, Cochrane Library, Web of Science, Sociological Abstracts, IBSS. Papers focusing on adults using any research methodology were included. Quality appraisal was completed using the Mixed Methods Appraisal Tool (MMAT). Thematic analysis was undertaken using methods of constant comparison. Results: Initial, and updated searches identified 16,724 potentially eligible articles. Of these, eight were included. Thematic analysis revealed that peer-led group-based interventions have positive impact on participants’ psychological, physical and interpersonal well-being. Participation also presents challenges for survivors. However, there is a mutuality and interconnected benefit between the triggering of difficult emotions due to participation and the healing experiences gained. Conclusions: Scientific evidence of peer-led, group-based, approaches for adult survivors of sexual abuse and assault is limited, although generally suggestive of benefits to such individuals.
... Therefore, each interpersonal interaction around CSA disclosure is vital in the significant impact it has upon the individual (Lamb, 1994). Smith et al. (2015) suggests that disclosure usually first occurs when the individual is in their 20s, but this is contradicted by other research which finds that half of those who had experienced CSA had disclosed their abuse at the time (Kelly et al., 1991). The reason for the disparity in these results could be a lack of response to that disclosure. ...
... Thus, the response to disclosure as well as the conceptualisation of the victim are influenced by culture and gender. Smith, Dogaru and Ellis (2015) surveyed adults who had experienced CSA and highlighted the importance of support services responding positively to disclosure because a poor response in therapy would inhibit individuals from trying to access services again. Livesey (2002) found evidence to suggest 60% of disclosure incidents (of 80 incidents in total) were met with a negative response, with 25% of those being verbally abusive, including responses from professionals. ...
... All the therapies discussed above are evaluated through the use of clinically developed evaluation methods, but none asked the clients themselves for their subjective experience. Smith et al. (2015) surveyed 395 adults who had experienced CSA about their experiences of support services. Respondents highlighted the importance of interpersonal relationships. ...
Thesis
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There is a great deal of research into multiple aspects of childhood sexual abuse, including prevalence, effects, treatment and recovery. However, very little research focusses on the knowledge held by people who have experienced CSA, and far fewer studies are designed by people who have experienced it. This thesis outlines insider designed and delivered research. It employs a salutogenic approach to examine what helps and hinders recovering. These issues are explored through thematic analysis of a qualitative survey (n=140) and 21 interviews. Participants described three types of harm caused by the abuse they had experienced, including physical and mental health consequences but also an underlying, enduring sense of danger. The results demonstrate that adults who have experienced CSA are active in their recovering, which they conceptualise as a movement towards health and well-being, rather than a binary of either being ill or well. Health services were very useful, particularly counselling and therapy. Respondents also valued personal relationships and interactions in supporting recovering. Finally, they described a sense of flow, a pleasurable absorption in a task, as being highly beneficial. However, they also described the ways in which society, at every level from micro to macro, inhibited recovering. Thus, they called for fundamental societal change, challenging destructive discourses around CSA and inhibiting structural issues. Further research is required to establish if these beneficial actions and challenges apply equally to individuals who identify as being in earlier stages of recovering.
... Studies use qualitative methods and typically draw on 'small' participant pools. The exceptions are one national survey with 395 adult survivors of child sexual abuse 18 and evidence from 172 survivors of child sexual abuse submitted to the Independent Inquiry into Child Sexual Abuse. 19 Survivors typically want timely, locally available services, a choice of therapy and long-term support from agencies taking a joined-up approach. ...
... 19 Survivors typically want timely, locally available services, a choice of therapy and long-term support from agencies taking a joined-up approach. 19 They want to feel listened to, believed and respected, 18 and the independence of VSS services from statutory services is seen as a key benefit. 20 Counselling and psychotherapy are often cited as the most helpful services but waiting lists are often long and commissioned therapy may be time-limited. ...
... 20 Counselling and psychotherapy are often cited as the most helpful services but waiting lists are often long and commissioned therapy may be time-limited. 18 Many survivors need and use VSS services over many years. 18 study AIMs And objECtIVEs This protocol reports a mixed-methods study involving survivors as co-researchers. ...
Article
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Introduction The voluntary sector provides a range of specialist services to survivors of sexual violence, many of which have evolved from grass roots organisations responding to unmet local needs. However, the evidence base is poor in terms of what services are provided to which groups of survivors, how voluntary sector specialist (VSS) services are organised and delivered and how they are commissioned. This will be the first national study on the role of the voluntary sector in supporting survivors in England. Methods and analysis This study uses an explanatory sequential naturalistic mixed-methods design with two stages. For stage 1, two national surveys of providers’ and commissioners’ views on designing and delivering VSS services will facilitate detailed mapping of service provision and commissioning in order to create a taxonomy of VSS services. Variations in the national picture will then be explored in stage 2 through four in-depth, qualitative case studies using the critical incident technique to explain the observed variations and understand the key contextual factors which influence service provision. Drawing on theory about the distinctive service contribution of the voluntary sector, survivors will be involved as co-researchers and will play a central role in data collection and interpretation. Ethics and dissemination Ethical approval has been granted by the University of Birmingham research ethics committee for stage 1 of the project. In line with the sequential and co-produced study design, further applications for ethical review will be made in due course. Dissemination activities will include case study and end-of-project workshops; good practice guides; a policy briefing; project report; bitesize findings; webinars; academic articles and conference presentations. The project will generate evidence about what survivors want from and value about services and new understanding about how VSS services should be commissioned and provided to support survivors to thrive in the long term.
... Sexual violence survivors have long described the way in which psychiatry can reinforce this silence, causing further harm to an already shattered self (e.g. Smith et al., 2015;Bond et al., 2018). Collectively, we may recognise the silencing of the past, of the wives and daughters placed in Victorian asylums. ...
... Sexual violence survivors may justifiably expect that psychiatric services have a long-held fundamental understanding of trauma and sexual violence, how it impacts on people and survivors' subsequent support needs. It often comes as a shock when survivors attempt to access help and realise that not only is there very little wellfunded support available, but that the response of psychiatry can be actively harmful (Smith et al., 2015;Bond et al., 2018). This can leave desperate people with a choice between harmful help, or no help (Jensen, 2004quoted in Russo, 2018. ...
... Further, asking for help with nothing changing can replicate damaging early experiences (e.g. see Smith et al., 2015). ...
Article
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Inter-personal trauma has at its core the abuse of power. This paper focuses on power abuses that manifest as sexual violence in all its subtleties and complexities, whilst understanding that many survivors have experienced multiple forms of abuse over long periods meaning that their experiences often do not map neatly onto the distinct categories used in research and practice. We also write in the knowledge that it can take people many years to understand that what they have experienced constitutes sexual violence.
... Access to trauma-informed mental health care is critical. However, there are longstanding problems with the funding model of the UK mental health system (Mason et al., 2011) including ongoing underfunding of community-based organisations, leading to long waiting lists and time-limited support (Smith et al., 2015). This is despite strategic commitments to lifelong services for survivors of rape and abuse (see, NHS England Document 2018-2023), with services for BAME communities particularly vulnerable to cutbacks (Imkaan, 2020). ...
Article
With evidence suggesting that females are more likely to be victims of child sexual abuse (CSA), much of the literature – including that on disclosure – focuses on females. Thus, male victims remain “under-studied”. Given this, the aim here is to contribute to the scant knowledge base on the sexual abuse of males and disclosure by focusing on males whose voices are even more rarely heard than those in the general male population: those who have perpetrated CSA. The men whose stories are told here had been convicted of, and imprisoned for, CSA in the United Kingdom (UK). They were part of a sample of 101 incarcerated males, 40 of whom reported at interview that they had been sexually abused in childhood. Eighteen of those 40 men are focused on here as they provided some detail as to whether they had disclosed that abuse in childhood or adulthood, the responses they had received, and also why they had not disclosed. Their narratives shed some much-needed light on the nature of sexual abuse experienced by males, its onset and duration, sexual re-victimization, relationships with perpetrators, the diverse nature of disclosure, the extent to which victims disclose and when, the responses received, and why they do not tell. Little is known of these aspects of male CSA. The implications of the findings are considered together with future research directions.
Chapter
Gegenwärtig fokussieren Unterstützungsmaßnahmen für von sexualisierter Gewalt betroffene Kinder und Jugendliche primär auf Zielgruppen „mit einheimisch deutscher Herkunft“ und vernachlässigen Adressat_innen mit Migrationshintergrund. Der Beitrag zeigt Bedarfe sowie Herausforderungen, aber auch Chancen in Disclosureprozessen von Kindern und Jugendlichen mit Migrationshintergrund aus Sicht von Fachkräften auf. Dazu werden Daten aus qualitativen Interviews mit Akteur_innen aus unterschiedlichen Bereichen, die mit betroffenen Kindern und Jugendlichen mit Migrationshintergrund arbeiten, präsentiert. Die Befunde veranschaulichen darüber hinaus die Erfahrungen der Fachkräfte mit Disclosureprozessen.
Technical Report
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Concerns about child sexual abuse within the family environment were raised by the Office of the Children’s Commissioner’s (OCC) Inquiry into child sexual exploitation in gangs and groups. This found that: …so many young people told us…of their early histories of being sexually abused within the family home and of their experiences never being acknowledged (Berelowitz, Clifton, Firmin, Gulyurtlu and Edwards, 2013, p.96). This prompted the OCC to commit to a new two year Inquiry into child sexual abuse within the family environment, for which this report forms the evidence base. What is child sexual abuse within the family environment? Child sexual abuse within the family environment is: Child sexual abuse perpetrated by a family member or that takes place within a family context or environment, whether or not by a family member. This is a broad definition, in accordance with Crown Prosecution Service Guidelines (2013) on the Sexual Offences Act 2003, which states: These offences reflect the modern family unit and take account of situations where someone is living within the same household as a child and assuming a position of trust or authority over that child, as well as relationships defined by blood ties, adoption, fostering, marriage or living together as partners. In much of the research assessed by this work, child sexual abuse within the family environment is referred to as ‘intrafamilial’ (IFCSA). For consistency, this report also uses the term ‘intrafamilial’ and the acronym IFCSA in presenting and discussing research evidence. How this research was conducted This research was focused around three questions: 1. What is known about the nature, scale, scope and impact of intrafamilial child sexual abuse or child sexual abuse linked to the family environment? Where do the gaps in knowledge lie? 2. What is known from the evidence about child protection and other action in response to victims of intrafamilial child sexual abuse or child sexual abuse linked to the family environment? Where are the gaps in these approaches? 3. What are the implications of the above when considering child protection activity and any legislative or formal guidance required to tackle intrafamilial child sexual abuse or child sexual abuse linked to the family environment? In order to answer these questions, we used a method known as rapid evidence assessment (REA). This is a tool for synthesising the available research evidence on a policy issue as comprehensively as possible, within the constraints of a given timetable.
Book
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This research report published by the leading child protection ngo in the UK, the NSPCC, presents findings from a UK wide (4 nations of England, Wales, Northern Ireland and Scotland) research study into the prevalence and impact of child maltreatment and other forms of childhood victimization in the UK. Based on 6196 computer interviews in households with parents/caregivers, children and young people and young adults randomly selected from the UK postcode address file.
Article
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To identify characteristics of suspected child abuse victims that are associated with disclosure and nondisclosure during formal investigations. The database included all suspected cases of physical and sexual abuse investigated in the state of Israel between 1998 and 2002. All investigative interviews were conducted using a single standardized protocol, the National Institute of Child Health and Human Development (NICHD) Investigative Interview Protocol. Overall, 65% of the 26,446 children made allegations when interviewed, but rates of disclosure were greater in the case of sexual (71%) than physical (61%) abuse. Children of all ages were less likely to disclose/allege abuse when a parent was the suspected perpetrator. Rates of disclosure/allegation increased as children grew older, with 50% of the 3- to 6-year-olds, 67% of the 7- to 10-year-olds, and 74% of the 11- to 14-year-olds disclosing abuse when questioned. Although most interviews of suspected victims yielded allegations, such rates of disclosure varied systematically depending on the nature of the alleged offences, the relationship between alleged victims and suspected perpetrators, and the age of the suspected victims. The findings obtained in this large and unselected data set confirm patterns previously reported in smaller and quite selective samples, most of them obtained in the United States.
Aims: This review summarises and evaluates evidence regarding psychotherapy/counselling services for childhood sexual abuse (CSA) from the survivors' perspective. Methods: Studies were identified from systematic literature searches of PubMed, PsycINFO, CINAHL, Psychology and Behavioural Sciences Collection. Selected studies were published in English after 1980. Results: Nine studies met the inclusion criteria for this review. Survivors identified a range of experiences of services. Positive experiences focused mainly on the therapeutic relationship, and the importance of awareness about issues specific to survivors. Negative experiences included taking a sexual interest in clients, dealing ineffectively with errors, being unresponsive, and prescription of heavy medications. Conclusions: There is a lack of research in this area, especially in the UK. Findings were limited due to selection bias, inconsistencies in recruitment and procedure, ill-described samples and analysis. Future research should obtain survivors' perspectives across genders, sexual orientation and ethnic background, and focus more on survivors' negative experiences.
Estimating the costs of child sexual abuse in the UK
  • A Saied-Tessiet
Saied-Tessiet, A. (2014). Estimating the costs of child sexual abuse in the UK. London: NSPCC http://www.nspcc.org.uk/ services-and-resources/research-and-resources/estimating-costs-of-child-sexual-abuse-in-uk/