For professionals, one of the saddest aspects of child sexual abuse is the way in which many victims struggle with blaming themselves for the terrible actions of others. This self-blame and feelings of guilt can cause suffering throughout a lifespan if it’s left untreated. Many evidence-based interventions specifically target these negative feelings and erroneous thoughts. But how do children come to believe this in the first place? What makes children mistakenly believe that they’re somehow responsible for the actions of adults?
Dr. Jouriles’ research set out to examine the relationship between whether and in what way caregivers’ and peers’ blame of victims influenced victims’ self-blame. And, while the results may not be surprising, the implications certainly are for child abuse professionals. How do we talk to parents and caregivers at the very earliest points of disclosure about the importance of supporting their child? How do we provide caregivers support in a way that ensures that they themselves have the emotional resources and resiliency needed to provide support to their children? And most importantly, how do we ensure that children know and believe that abuse is never, ever their fault?
Topics in this episode:
Links:
Ernest Jouriles, Ph.D., professor and co-director of the Family Research Center at SMU
“Non-supportive responses to adolescents who have experienced sexual abuse: Relations with self-blame and trauma symptoms,” Ernest N. Jouriles, Melissa J. Sitton, Adrianna Adams, Mindy Jackson, Renee McDonald. Child Abuse & Neglect, 2022, Vol. 134. doi.org/10.1016/j.chiabu.2022.105885
Dallas Children’s Advocacy Center, Dallas, Texas
We discussed the Child and Family Traumatic Stress Intervention (CFTSI) with Dr. Carrie Epstein in “PTSD Interrupted?” (Season 5, Episode 2; February 17, 2023)
For more information about National Children’s Alliance and the work of Children’s Advocacy Centers, visit our website at NationalChildrensAlliance.org. Or visit our podcast website at OneInTenPodcast.org. And join us on Facebook at One in Ten podcast.
Did you like this episode? Please leave us a review on Apple Podcasts.
For professionals, one of the saddest aspects of child sexual abuse is the way in which many victims struggle with blaming themselves for the terrible actions of others. This self-blame and feelings of guilt can cause suffering throughout a lifespan if it’s left untreated. Many evidence-based interventions specifically target these negative feelings and erroneous thoughts. But how do children come to believe this in the first place? What makes children mistakenly believe that they’re somehow responsible for the actions of adults?
Dr. Jouriles’ research set out to examine the relationship between whether and in what way caregivers’ and peers’ blame of victims influenced victims’ self-blame. And, while the results may not be surprising, the implications certainly are for child abuse professionals. How do we talk to parents and caregivers at the very earliest points of disclosure about the importance of supporting their child? How do we provide caregivers support in a way that ensures that they themselves have the emotional resources and resiliency needed to provide support to their children? And most importantly, how do we ensure that children know and believe that abuse is never, ever their fault?
Topics in this episode:
Links:
Ernest Jouriles, Ph.D., professor and co-director of the Family Research Center at SMU
“Non-supportive responses to adolescents who have experienced sexual abuse: Relations with self-blame and trauma symptoms,” Ernest N. Jouriles, Melissa J. Sitton, Adrianna Adams, Mindy Jackson, Renee McDonald. Child Abuse & Neglect, 2022, Vol. 134. doi.org/10.1016/j.chiabu.2022.105885
Dallas Children’s Advocacy Center, Dallas, Texas
We discussed the Child and Family Traumatic Stress Intervention (CFTSI) with Dr. Carrie Epstein in “PTSD Interrupted?” (Season 5, Episode 2; February 17, 2023)
For more information about National Children’s Alliance and the work of Children’s Advocacy Centers, visit our website at NationalChildrensAlliance.org. Or visit our podcast website at OneInTenPodcast.org. And join us on Facebook at One in Ten podcast.
Did you like this episode? Please leave us a review on Apple Podcasts.
Season 5, Episode 10
“Why Do Kids Blame Themselves After Abuse?”
[Intro music]
[Intro]
[0:08] Teresa Huizar:
Hi, I’m Teresa Huizar, your host of One in Ten. In today’s episode, “Why Do Kids Blame Themselves After Abuse?”, I speak with Dr. Ernest Jouriles, professor and co-director of the Family Research Center at SMU.
For professionals, one of the saddest aspects of child sexual abuse is the way in which many victims struggle with blaming themselves for the terrible actions of others. This self-blame—and also feelings of guilt—can cause suffering throughout the lifespan if it’s left untreated. And many evidence-based interventions specifically target these negative feelings and erroneous thoughts. But how do children come to believe this in the first place? What makes children mistakenly believe that they’re somehow responsible for the actions of adults?
Dr. Jouriles’ research set out to examine the relationship between whether and in what way caregivers’ and peers’ blame of victims influenced their own self-blame. And, while the results may not be surprising, the implications certainly are for child abuse professionals. How do we talk to parents and caregivers at the very earliest points of disclosure about the importance of supporting their child? How do we provide caregivers support in a way that ensures that they themselves have the emotional resources and resiliency needed to provide support to their children? And most importantly, how do we, as professionals, ensure that children know and believe that abuse is never, ever their fault?
I know you’ll be as interested in this thought-provoking conversation as I was. Please take a listen.
[1:58] Teresa Huizar:
Ernie, welcome to One in Ten.
Ernie Jouriles:
Thank you for having me. I really appreciate it.
Teresa Huizar:
So, just kind of starting at the very beginning, how did you come to research child sexual abuse, and specifically this interest that you have in non-supportive responses toward victims?
Ernie Jouriles:
I have been doing research on child survivors of violence for 30-plus years.
It started actually with domestic violence shelters and working with children who’ve been exposed to really frequent and severe intimate partner violence. Quickly realized that these children are not just exposed to intimate partner violence but they’re exposed to many other types of violence, including physical maltreatment, neglect, as well as sexual abuse.
So I’ve been studying violence and violence exposure for a long period of time. The Child Advocacy Center where I’m working now in Dallas was actually very interested in starting to do some research to better understand children and then adolescents who’ve experienced sexual abuse.
And I was fortunate enough to, you know, be at the right place at the right time in order to take advantage of the opportunity. So this is more of an extension of things that I’ve already been interested, but I also have a passion to try to figure out: How can we best help some of these children? What are some of the things that we can do in terms of not just working with the children, but working with people who are in the child’s environment?
And that’s where I have become very interested in how people are responding to these children. And that’s where the non-supportive responses comes into play.
[3:42] Teresa Huizar:
When we say that someone is non-supportive, can you give examples of that or describe what that might look like?
Ernie Jouriles:
Sure. What we are talking about specifically in our research would be things where the child interprets their being blamed for the abuse that had happened or that they’re being accused of lying or someone’s being angry at them because of what had happened.
Sometimes this is a result of a direct communication from someone, but sometimes it’s actually a miscommunication. In other words, a caregiver may be asking questions and may be asking questions over and over again, and the caregiver’s genuinely interested in terms of trying to find out what had happened or, you know, what they could have done differently.
Sometimes the child though, misinterprets that as, “All these questions, oh, they don’t believe me.” So, this feeling of being non-supported, again, can happen a number of different ways.
[4:44] Teresa Huizar:
I think it’s interesting what you’re pointing out, that there are cases where caregivers are gen— and others, friends, others are genuinely non-supportive.
But also, there’s this perceptual piece on the part of the child where, as you say, a child could perceive a parent or caregiver as non-supportive, but it doesn’t necessarily mean they are. It could because they’re being quizzed about, you know, what has happened or those kinds of things. You know, one of the things that you sort of commented on in the paper, and I think it’s been our experience in Children’s Advocacy Centers as well, is that children will sometimes say that the fact that they did not feel believed or supported is essentially as traumatizing or difficult as the abuse itself.
Why is that?
Ernie Jouriles:
I don’t think that we really know the exact reason, but let me speculate a little bit for you. I actually think that when children and adolescents disclose to someone that they trust, someone who that they feel should be protecting them, I think that they’re expecting a positive response. They’re expecting a supportive response. And I think that, when it’s non-supportive, this can be crushing. Not only did they experience the sexual abuse, but let’s say a friend or a caregiver who they were hoping was going to help them through this is wondering, you know, are they telling the truth or are they blaming them?
So I think that combination, again, can just be crushing to some of these children.
[6:23] Teresa Huizar:
I think what’s so difficult about this, of course, is that for caregivers, even really excellent parents can have a moment of “How could this possibly be true?”—not blaming the child necessarily, but not also having the best initial response that we might hope.
And I think that this is the very difficult thing that Children’s Advocacy Centers and other child abuse professionals grapple with every day because you’re needing to bring a caregiver along so they can be supportive. And not being overly blaming for their own reactions to it, which may be natural, but at the same time realizing that has a real-life effect on kids. You know, that if it’s not immediately supportive, that that’s going to be very hard to undo in terms of the child’s feelings and perceptions later.
Ernie Jouriles:
Yeah, I agree completely. But also to add to that, I think that if you ask caregivers if they’re being supportive, and if you ask the children or the adolescents if the caregivers are being supportive, there’s often a lot of disagreement there.
Teresa Huizar:
Oh, that’s really interesting.
Ernie Jouriles:
And I think that caregivers often feel that what they’re doing is supportive where the adolescent, again, is not experiencing it that way. And I think that that’s an important next step in terms of, well, why are there these different perceptions? What’s going on here?
Because I do think that the vast majority of caregivers that are bringing an adolescent or a child to a CAC, they really care about their children. They want to really help them through this. And I think that sometimes things are being done that are just being interpreted very differently than how the caregiver intends them to be interpreted.
[8:07] Teresa Huizar:
I think that that’s true, and it’s so interesting that you’re talking about that because one of our other guests on One in Ten was one of the developers of CFTSI. And one of the interesting things that their own research really turned up is that so much of the benefit of that intervention really ties to improved communication between the parent and the child about what symptoms they actually have so that those are understood by both in the same way. Because kids often were reporting different levels of distress, essentially, than what the parent was aware of. And so I think you’re raising an important point, even among the most well-intentioned parents, you know. And people who really are supportive and are trying to do things that are supportive, checking in to make sure that it’s felt that way, I think is important as well.
[8:57]
One of the things that I also appreciate about the paper is that you talked about the fact that this type of research has been done as it relates to mothers. You know, focusing on what’s the mother’s response to this prior to your paper, but not so much looking outside of moms really to look at sort of the broader social context that children have and what other relationships might be important in terms of being supportive.
Can you talk a little bit about the types of relationships you looked at and why you thought it was particularly important for the age group of the sample size that you had?
Ernie Jouriles:
Well, we were working specifically with adolescents, and what developmental research suggests is that as adolescents mature they spend more and more time outside of the family. They spend more and more time disclosing to others outside of their parents. And friends are a real, real key source of information, a key source of support.
So what we wanted to do with this research was, again, recognize that the caregivers are still playing an important role in children’s lives, but they’re not the only people who are playing important roles—
Teresa Huizar:
Right.
Ernie Jouriles:
—or potentially important roles.
And we were really interested again, in the friends. But it’s not just friends, again, with adolescents. They’re, you know, dealing with coaches. They’re dealing with quite a few people outside of their home who are adults who also have an influence.
So we were really, again, interested in some of these other individuals. Actually when we started this research, we thought that, well, that was going to be one of the main contributions. What are, not just the caregivers saying, but what are some of these other individuals saying?
[10:46] Teresa Huizar:
So just set it up for folks who haven’t read the study, even though we’re encouraging them to go and do that. But what were your initial hypotheses going in, and then what did you actually find?
Ernie Jouriles:
Well, what we wanted to do was, again, look at non-supportive responses that these children were getting, and specifically looking at it in terms of different people in their social environments who may be giving these non-supportive responses. And again, non-supportive responses would be where the child felt they were blamed, or the child felt that, oh, they were being accused of lying or the person was angry at them for what had happened.
We focused on adolescents, and specifically this would be a fairly wide age range: 11 to 17. This was work that was done at a Child Advocacy Center, and it was part of the routine screening that they were doing at the Child Advocacy Center. So it was done after a forensic interview where the child disclosed sexual abuse, they invited them back, and they were doing more of a sort of a check on family functioning and mental health.
Teresa Huizar:
Hmm.
Ernie Jouriles:
So this was done in that context.
We were able to get a fairly large sample for this type of research. It was well over 400 families that went through the screening process and consented for their information to be used for better understanding, you know, what’s happening in these types of cases.
What we were thinking was that some of these children were going to be experiencing non-supportive responses. And we thought that they would be experiencing them from caregivers, from friends, from other adults. We really didn’t have that good of an idea as far as how common this was going to be. And we were particularly interested in whether or not these non-supportive responses were related to both self-blame and the children’s reports of trauma symptoms.
What we also were looking at was whether or not if a child is getting a non-supportive response from a caregiver, is that child also more likely to get non-supportive responses from others in their social network? In other words, were there some commonalities with regard to getting non-supportive responses?
Teresa Huizar:
Mm, mm-hmm.
Ernie Jouriles:
What we found was that there were weak associations between, let’s say, getting a non-supportive response from a caregiver and getting a non-supportive response from a friend or another adult. So there was an association there, but it wasn’t really, really strong. It was fairly weak.
What we found that I thought was more interesting was that non-supportive responses from caregivers and from friends both related to trauma symptoms, and they related in a cumulative way. In other words, a non-supportive response from a care caregiver was important, but if you’re getting a non-supportive response from a caregiver and a friend, it’s doubly important.
Teresa Huizar:
Right. There’s an additive effect to that.
Ernie Jouriles:
Exactly. Exactly. That was with trauma symptoms. With self-blame we found that the non-supportive responses from caregivers was really the main contributor.
So, well, as you said, Teresa, the effect was additive with trauma symptoms. With self-blame, the effects were more redundant.
[14:26] Teresa Huizar:
You know, one of the things—and correct me if I’m wrong here—but one of the things that I found interesting in reading it is that while non-supportive responses were problematic—of course—the connection between non-supportive responses and self-blame was specific to caregivers. Is that right?
Yes. And that that was particularly potent in terms of, then, trauma symptomology. Am I …
[Cross-talk]
Ernie Jouriles:
You have it correct.
Teresa Huizar:
Yeah. [Laughter]. You’re nodding. For our listeners, he’s nodding. OK.
So can you talk about—that … that’s kind of an interesting … I mean, on the one hand when you hear it, you’re like, well, there is some common sense to that, right? People care most deeply about their caregivers and parents, and if they feel that they’re blaming them, it makes some sense that children would feel that they should blame themselves. You know, sort of following that along. But it was interesting to me that the other relationships didn’t produce that result, you know? And so I’m just wondering when they’re non-supportive, what do you make of that?
Ernie Jouriles:
And I don’t have the answer to that. I think that it is fascinating that, again, caregivers’ non-supportive responses are related to self-blame. We aren’t the first ones to find that, though. I mean, others have found that, too.
I think it’s interesting to think about, well, why is that the case?
And I do think that, you know, if some of the non-supportive responses are direct blaming or direct questioning, I do think that the, again, it would be natural for a child or an adolescent to start questioning more in terms of, you know, “Well, did I, I do something wrong?”
Teresa Huizar:
Mm-hmm.
Ernie Jouriles:
Or “Was I at fault perhaps for not coming to my mother earlier about, let’s say, what had been happening?” So I do think that there would be a natural connection there.
Self-blame I see as just really, really harmful. It’s related to so many problematic outcomes. We were looking at trauma symptoms specifically in this study, but you know, when you’re blaming yourself for bad events, it’s almost like, you know, you’re thinking, “Well, something’s wrong with me as far as why this is happening.” The effects of that can be pervasive.
[16:47] Teresa Huizar:
And I think, you know, unfortunately, even if you have a more supportive parent, we can see that that’s part of what evidence-based interventions are designed to address. Because kids often have this feeling that there must have been something. I think because it’s such a puzzling thing. They know that other children may not be experiencing this, and so they’re trying to make sense out of the sort of senselessness of their selection and experience of child sexual abuse. And so it’s at some point, after looking and scanning, they sort of think to themselves, “It must be something about me.”
And we’ve had kids tell us things like, “Was it something about the way I smelled or the way I looked?” or—just interesting the way that kids, even when they have a supportive parent, may go in that direction and have to have really supportive messages to kind of divert that. So all, all the worse if you’re hearing blaming statements from a parent or caregiver, which is just reinforcing that awful message over and over again.
Ernie Jouriles:
Teresa, what you said, though, was really, really interesting, and I think it’s important for people to understand. I mean, what we were looking at in this particular study was non-supportive responses, but non-supportive responses from a caregiver occur in a context of other parenting behaviors. And one of the things that we’re really interested in with our work is, for example, if you have an emotionally supportive caregiver who said something that was interpreted as non-supportive, does that ruin the benefits of—
Teresa Huizar:
Interesting.
Ernie Jouriles:
—the supportive behaviors?
Teresa Huizar:
Yeah.
Ernie Jouriles:
And I think that, again, getting back to your original question with regard to caregivers, I wonder sometimes if that’s one of the reasons why, you know, the caregiver effect is more potent because it takes away from some of the potential benefits of the emotionally supportive behaviors.
This is a line of research that we’re pursuing. Just, you know, all these parenting behaviors, caregiving behaviors are occurring together. How are they interacting with each other in terms of producing different types of responses?
[18:54 ] Teresa Huizar:
That is so interesting because I think one of the things that—I’m not going to speak for anybody but myself—that I may have assumed and we don’t know, perhaps wrongly, is that if an otherwise very supportive caregiver has an initial non-supportive response for whatever reason, or makes some non-supportive statement, that all of the other positive parenting that they’ve done sort of may act as some sort of buffer, you know, in the child’s experience.
But what if it doesn’t? When you think about other things that kids remember, they certainly remember, you know, statements from parents totally unrelated to child sexual abuse that are very negative, much more than they remember all the positive things. So that’s interesting how those things interact.
Ernie Jouriles:
Well, I would hope that what you’re saying is correct, that, you know, if a parent does say something that’s interpreted as non-supportive, by being emotionally supportive, they can correct that. But again, I think that that’s a question that we really don’t know the answer to yet. And that’s one of the things that we’re trying to investigate. My thinking is, is that if that’s not the case, well what we need to do is to try to figure out, well, how can it be corrected if emotionally supportive behaviors are not helping?
[20:08] Teresa Huizar:
One of the other things that you were mentioning that I want to come back to a minute is sort of the additive effect when, for example, you have a non-supportive—let’s say caregiver. And then let’s say you have non-supportive friends as well in terms of the statements that they’re making. And perhaps others in the family, too. And we’ve talked about the fact that that can be additive. What does that mean for CAC staff and child abuse professionals?
We often think that the point of our intervention relates specifically to kids and their caregivers, right? That’s very much our focus. But if it turns out that there are all of these sort of additive effects from others in the social environment and their responses, is there something we need to be doing additionally to address some of that?
Ernie Jouriles:
Well, I think the first thing would be to ask about it, to find out: Is this happening? I think that, ideally, if it is happening, what we try to do is problem solve with the caregivers on ways in which we can try to get it to stop or try to at least protect the child from hearing all this negativity.
Teresa Huizar:
Mm-hmm.
Ernie Jouriles:
And that’s challenging. That’s just very, very challenging. I think that sometimes these incidents of sexual abuse, they change the lives of these children and adolescents in ways that again, we’re not completely aware of. And I think that asking some of the questions to find out what’s going on is, again, the first step so that we can start to problem solve and figure out just how best to proceed.
[21:42] Teresa Huizar:
Often we think about this in the context of sort of face-to-face contact that kids are going to have. Like, what their parents are saying to their face, what their friends are saying to their face, what their grandparents or others might be doing. But kids also live in this online environment, basically all but 24/7. Right? All their waking hours. And I’m wondering how that plays into this in terms of support versus non-support. Because it feels to me like one of the challenges is that if you had friends, for example, peers who were non-supportive, you could be getting non-supportive messages, basically 16 hours a day from them.
Do you know what I mean? It’s not limited to your face-to-face contact. And I’m wondering, you know, first of all, if anybody has explored any of the impact of that sort of thing. The fact that this isn’t really the past when, you know, if Susie wasn’t very supportive, you could stay away from Susie. I mean, now Susie can basically be on your phone all the time sending whatever the messages they want. So, I have not run across any research about this, but I’m just wondering if you have or if you have any thoughts about that? Because it just seems to me that kids are just so challenged if someone’s not being supportive in all the ways they might be getting those messages.
Ernie Jouriles:
No, you’re absolutely right. It’s a very different world now than when you and I grew up in terms of just social media and, you know, just the different platforms in which children can read about themselves.
In terms of our research, we were looking at non-supportive responses. And these non-supportive responses could have been delivered through social media, particularly with the friends, but we didn’t distinguish that—
Teresa Huizar:
Mm. Mm-hmm.
Ernie Jouriles:
—in our research. I think it is interesting to think: Are there potentially unique effects with non-supportive responses that are done through social media or through that platform as opposed to in person? And I think if you hypothesize about it, you know, sometimes those messages are out there and they’re out there for lots of people to see. So it could be potentially more damaging.
I’m not aware of any research specifically that has looked at that particularly with the populations that we’re working with at CACs. But I think you’re raising some very interesting and important questions because I do think that, again, they’re brought to the Child Advocacy Centers primarily because of the sexual abuse incident. But, for example, the things that may be causing these children and adolescents distress, it may not be just the sexual abuse incident, but it may be, again, as we’ve been discussing, the reactions around that sexual abuse incident that might be, you know, really, really distressing and really need to be addressed in order for this child to get better.
[24:29] Teresa Huizar:
Yes.
So when you think about your study overall, what do you think are the primary implications—we’ve been talking about them a little bit—but the primary implications for Children’s Advocacy Center staff and also sort of the wider child abuse professional world?
Ernie Jouriles:
First of all, one of the implications would be, we want to find out: Is this happening, and is this happening particularly from the child’s perspective? Do they feel like they’re not getting supported? Because from my research as well as the research of others, we do know that that’s related to mental health outcomes. And, you know, the more non-support, the more problematic the mental health outcomes. So I think the first thing is to just get a better idea of what might be going on.
I would follow that up with trying to find out what exactly is non-supportive.
Teresa Huizar:
Yeah.
Ernie Jouriles:
In other words, what are they perceiving as non-supportive? As we talked about earlier, is it direct communications or is it questioning—you know, just trying to figure out what’s happening?
I do think that, again, the vast, vast majority of caregivers that are bringing their children and adolescents to a CAC, they want to help. They want to help with the recovery process. So I also think then this information can be used educationally to try to help caregivers respond to children and adolescents so that they feel supported. So that they feel like they’re believed. So that they feel like they’re not making their parents angry, and things like that.
And I do think that this can be done and this can be potentially extremely helpful for these children and adolescents who are just going through a difficult period. The caregivers are too. But, again, I think that, especially if this is due to a miscommunication, I think that that’s something that we can address.
[26:20] Teresa Huizar:
You know, as you were talking, I was thinking about all the different professions that connect on these cases and where this would have implications. I was thinking about the victim advocate who often has a period of time where they’re meeting with the parent while the child is being interviewed. And that’s a perfect time to, you know, share messages, as you’re saying, sort of educationally, you know: “Your child’s going to come out of the interview and they’re going to have questions or concerns and, you know, here’s how you may want to be thinking about this, because we know that if kids don’t feel supported, if they hear messages like this …” blah, blah, blah, blah, blah. And so I think that there’s a way to do that.
I’m also thinking that there are these clinical implications too, and in terms of, if we know that a child has had non-supportive responses, making sure that when we’re making a, you know, handoff to the therapist, that they’re aware of that, that they know what that has been. And that that can be helpful actually, both for the caregiver and for the child in that way. And I’m sure if I had another minute or two, I could think of other folks who need to be thinking about that as well.
But I think this has such practical value. It was one of the reasons that we did our research-to-practice abstract on your article and now we’re talking to you, because it just felt to me that it was so on point because it was done in partnership with the Children’s Advocacy Center, with our population of clients, and also with such good information to carry into the way that we’re interacting with caregivers and with kids.
[27:50]
And so I’m just sort of wondering: For you, what’s next research-wise with this? You know, anything? Or are you moving on to other topics? Or how are you thinking about what’s next?
Ernie Jouriles:
Well, let me respond to something that you said.
Teresa Huizar:
Sure.
Ernie Jouriles:
And then I’ll go into the [“What’s next?” question].
Teresa Huizar:
Yeah. Please.
Ernie Jouriles:
First of all, most of our work is actually with the family advocates directly. We talk with the family advocates, we share ideas with regard to what’s going on and what’s important and present our findings to the family advocates. We talk about them. We talk about the implications. And it’s the family advocates that are often the ones that are, you’re right, well-positioned where they can use some of these findings to help these families, to help these families during a time of distress.
I agree that it is not just beneficial to the family advocates. And there’s a great therapy team also at Dallas Children’s Advocacy Center that utilizes the findings too. But the family advocates are the ones that we’re primarily doing the work with.
In terms of what’s next, I think that what we do want to find out a little bit more is: What are these children, again, perceiving as non-supportive? Do non-supportive responses hurt or ruin a caregiver’s efforts to be supportive?
In other words, does this spoil things and we need to do something different, you know, to address this?
Teresa Huizar:
Mm-hmm.
Ernie Jouriles:
Or do the supportive efforts help mitigate the effects of the non-supportive responses? Some of those questions are also questions that we’re really interested in.
Another issue that we’re going to be tackling in the near future: The study that you read and did the write-up on, was a cross-sectional study. It was a study that involved just one time point. What we are finding is that many CACs, when they do their screenings, they find a child is suffering from a mental health perspective, they often make a referral for treatment. Some of these Child Advocacy Centers though, do have wait lists in terms of when a child can receive treatment. Or if they’re making a referral outside of the Child Advocacy Center, there’s a wait list. What we’re trying to understand is: What happens with these kids while they’re on a wait list?
Teresa Huizar:
Mmm.
Ernie Jouriles:
We do know that, for example, in most circumstances, trauma symptoms will dissipate over time. But that doesn’t happen in all circumstances. In some circumstances they stay the same. In some circumstances it gets worse.
And here’s where, what I’m wondering is: Are there things that we can detect during a screening assessment that would help us better understand the course of trauma symptoms, the course of other problems, while these adolescents, while these children are waiting for services? This is another area where I think non-supportive responses may actually be extremely important. That—
Teresa Huizar:
Mm-hmm.
Ernie Jouriles:
—these are the kids that, let’s say the problems may get worse because they’re getting these non-supportive responses and even if it’s just, just one. I mean, thinking about it can make things grow worse and worse over time,
[31:17] Teresa Huizar:
Especially if there’s no intervention, as you’re saying. You can just imagine there’s a kid on a wait list. There’s some non-supportive response, whether it’s once or more, and that there’s nothing really to buffer against that because they’re still on the wait list. They’re still waiting for a more positive intervention. So very, very interesting, I think.
I really hope that you’ll come back and talk to us when this, these research pieces are finished and published. Because I think it’s something that is really important for us to understand—and how sort of upstream we need to be. You know, we talk about things from the point that families come to the Children’s Advocacy Center. But I think we also know that there’s some time period, often, between the child’s disclosure and the day and time they arrive for their appointment. And so during that—
Ernie Jouriles:
Yeah.
Teresa Huizar:
—period of time, you know, what supportive or non-supportive response is happening? And is there a way to get further up that chain I think is something that I’m really curious about. So that we’re influencing things almost from the point of disclosure or report and not, you know, from the four or five days later when the child comes in, or whenever that might be, just depending on the acuity of it.
Ernie Jouriles:
Yeah. Another thing—and you actually mentioned this earlier on—what I’m really interested in is trying to figure out: Are there ways that we can improve services that would really, really help these families? One of the things that you had talked about is that you know, sometimes the caregivers don’t recognize the distress—
Teresa Huizar:
Yes.
Ernie Jouriles:
—that these children are in. What we’re finding in some of our research is that caregivers are reporting problems. But when you ask the children or the adolescents, they’re reporting higher levels of problems on average.
Teresa Huizar:
That’s right.
Ernie Jouriles:
And I think that what that means is that, you know, when we’re doing screenings, well, it might be useful to get both the caregiver’s perspective as well as the adolescent’s perspective. And I’m thinking that if we are able to get both perspectives, in cases where the adolescent is reporting a lot more problems than the caregivers aware of, well that can help us, I think, engage families. Engage families that may otherwise not think that there’s that big of a deal or that big of an issue into treatment services that have been shown to work through—well, through empirical evidence, through, you know, people’s experiences as far as doing this. I think we do have treatments that can help, and I think that it’s frustrating for many people at Child Advocacy centers where it’s hard to get some of these families to take advantage of these services.
So I think that that’s, again, another area that I’m interested in trying to figure out: Are there things that we can do that might help with the engagement process?
[34:10] Teresa Huizar:
It’s interesting that you mentioned that because, you know, we too have found that perceptual barriers—actually caregivers themselves self-report that perceptual barriers are the biggest barriers to treatment for them.
So it’s not to say that barriers like travel and transportation and childcare are non-factors, but they’re not the deciding factor in whether or not a parent takes their child for treatment. It’s whether or not they believe that the child needs it. And it’s interesting because we found that when you ask Children’s Advocacy Centers about that, they were like, “Well—,” they would talk about all these practical barriers. Then we got this data where caregivers are saying, “Yeah, that’s a small part of it. But that’s not it. It’s because I don’t think that—.”
I think you’re keying in on something because I think we think sometimes that engaging a family means sort of talking up the empirical evidence. You know what I mean?
Like “It’s evidence-based, and it’s wonderful, and you’re going to love it, and it’s going to be great.” But at a practical level, sometimes caregivers don’t really understand or believe that their child needs treatment. And so if they think, “Well, my kid’s having an occasional nightmare” but it turns out that the child really is having night terrors every single night, that’s a very different thing. Right? Or you know, they think, “Well, the kid’s not doing great in school right now,” but the child is really reporting that they’re basically triggered all day long. That’s a very different thing.
And so I think you’re right to say that there’s a way that we could describe this to parents based on information we collect from both parties and sharing the child’s experience with the parent in a way that may make them much more receptive to mental health care. Because I think, you know, parents want what’s best for their kids and if they think their kid, quote unquote, “doesn’t need it,” it’s not that they don’t care about their child, it’s that they, for whatever reason, are not seeing that their child is as distressed, you know, as the child may actually be.
Ernie Jouriles:
Yeah. And you’re hitting on I think, two very important components. One is just to help make the caregivers a little bit more aware of the distress, but to communicate that in a way that’s going to be understandable. And I think those are two different things.
Teresa Huizar:
Yes. [Laughter] Right.
Ernie Jouriles:
And I think that, you know, we as a field just need to figure out how best to do that.
Teresa Huizar:
Mm-hmm.
Ernie Jouriles:
It’s complicated. Especially at a Child Advocacy Center where, you know, there’s so much going on that first visit. And even the second visit, where, you know, just trying to figure out how to fit everything in and—
Teresa Huizar:
Yes. Of course.
Ernie Jouriles:
—how to accomplish this. It is difficult.
[36:54] Teresa Huizar:
Yes. Yes and I think that … that when we take this down to a really practical level, that’s where caregivers start responding. When you’re like, “You know, you’re talking about your child seeming to be tired all the time. Look, they seem to be having night terrors all the time, and if we can get them to sleep more, they’re going to do better in school.”
I mean, some of these be behavioral things, which are often, you know, honestly what parents are struggling with most is the child’s behavior at home and school. One of the things that I see is that sometimes we start in kind of with our “professional speak-ese” about, you know, the benefits of therapy or some other aspect of what we’re dealing with, or trauma, when the parent is basically trying to get through the day, you know. And trying to help their child get through the day.
And so my hope would be that, as your research continues to shine a light on these things, that we can take that and translate that into sort of common sense and practical language that we can use with the folks who come through the doors, you know?
Ernie Jouriles:
Yeah. And again, I think what you’re saying is very important with regard to the translation. In meetings with different Child Advocacy Centers, I’m told stories that sometimes the parents, they, you know, they talk about, “Well, we tried therapy” or “We had therapy,” and what they’re referring to sometimes is the forensic interview.
Teresa Huizar:
Right.
Ernie Jouriles:
There’s a miscommunication that the forensic interview was actually part of therapy and, well, that didn’t help. That …
Teresa Huizar:
Yeah. Oh. So, goodness. Yes.
Ernie Jouriles:
Yes. I think part of it is really trying to understand where miscommunications may be occurring and to try to resolve those. And, again, it’s complicated, especially, you know, during some of those initial visits where so much is going on.
[38:46] Teresa Huizar:
Yes, absolutely. Well, thank you for the work that you’re doing with victim advocates and CACs to help us translate research into practice.
I’m just wondering, you know, I’m not a clinician and I’m not a researcher, so is there any question that I should have asked you and I didn’t? Or anything else that you want to make sure that we talk about today?
Ernie Jouriles:
One of the things that I want to mention is that the relationship that I have with the Child Advocacy Centers where I’m working is mutually rewarding. I mean, it’s very rewarding to me. I learn so much talking with the family advocates and the therapists at these different centers. I do my best to explain, you know, some of the things that we’re finding, and then we brainstorm together as far as how some of this can be used. But it is a very rewarding experience from a researcher’s perspective.
The other thing is, is that I think that it’s important also, from a research perspective, that you’re committed to really trying to help these children and adolescents.
Teresa Huizar:
Mm-hmm.
Ernie Jouriles:
It’s not just doing a study.
Teresa Huizar:
You’re not just curious.
Ernie Jouriles:
Yeah. I mean, what you’re doing is really trying to do multiple things where the end goal is to really try to improve services to help the children and families. And I think that you have to be patient. That takes time. It takes time to do good research. It takes time to figure out with, you know, staff there, you know, well, what are the really meaningful or important questions to ask?
Those are a couple of things that I can think of in terms of just encouraging others to do this type of work, that it is rewarding. You have to be patient, but it is extremely rewarding.
[Outro music starts]
[40:30] Teresa Huizar:
Well, from your lips to God’s ears, Ernie, on more researchers taking it up, partnering with CACs on this way and doing this type of research. And we welcome you back to One in Ten at any time. Thanks so much for joining us today.
Ernie Jouriles:
Teresa, thank you so much. I appreciate it.
[Outro]
[40:47] Teresa Huizar:
Thanks for listening to One in Ten. If you liked this episode, please share it with a friend. And for more information about this episode and any of our others, please visit our website at OneInTenPodcast.org.