Adult survivors and their families: current needs and service responses
Not enough is yet known about the needs of adult survivors of childhood sexual abuse. Sexual abuse is hidden and the distress and shame that survivors often feel prevents many from seeking help. Although there is a plethora of research relating to the effects of childhood sexual abuse and a growing appreciation of the effects this can have on adult survivors, the lack of a co-ordinated approach in relation to service provision, training and policy issues for adult survivors of childhood sexual abuse is problematic (Stern Review, 2010; Survivors Trust, 2010). Thus, the purpose of this research was to provide an evidence base to inform future developments in policy, practice and service provision to better meet the needs of adult survivors of childhood sexual abuse and their current families.
From a range of stakeholder perspectives we sought to:
Better understand the challenges faced by adult survivors of childhood sexual abuse and where appropriate their families.
Explore how services (generic and specialist) respond to the needs of adult survivors and their families and consider unmet need.
Consider the perceived effectiveness of service responses.
Make policy and practice recommendations to improve support to adult survivors and their families and other vulnerable groups.
The work was completed over an eighteen month period using qualitative methods of data collection and analysis. We conducted 30 telephone interviews with managers and practitioners and 30 in-depth face-to-face interviews with adult survivors of childhood sexual abuse.
The three key areas arising from the study are:
- Individual life journeys
Establishing and maintaining relationships with others is experienced as a challenge by survivors throughout their adult life. Underpinned by issues relating to trust and seeking safety, these difficulties serve to further reinforce feelings of isolation and, for some, foster a sense of fear, anxiety and impaired self-efficacy. Being believed is critically important at the point of disclosure and thereafter; it is central to the building and maintaining of relationships with others, including professionals, and to the survivor’s individual journey.
Whilst survivors describe a number of common experiences, in particular, their sense of guilt, shame and feeling disconnected, their individual life journeys (characterised by seeking support, moving towards healing and moving on) are complex and unique. However, present service organisation and delivery arrangements are often inflexible and lack responsiveness to the individual’s lived experiences, personal preferences and priorities. Limited joint working and ineffective signposting compound the situation.
The important contribution of third sector organisations in delivering support is recognised by survivors and staff alike; however current funding deficits mean that the sector is unable to realise its full potential and, despite the best efforts of staff, flexibility and innovation are stifled. There are a number of serious and prevailing gaps in service provision.
Stigma is highlighted as a major issue. The taboo associated with childhood sexual abuse challenges the accepted view of a civilised society which places a high value on the safe care, development and nurturing of children and protection from harm and exploitation. Survivors reflect on the raft on negative emotions they experience; this includes speaking about the pervasive effects of guilt, shame, low self-worth and a disrupted sense of self, which they suggest are inextricably linked to the prevailing stigma associated with child sexual abuse.
Stigma serves as a barrier to accessing much needed help and support. Sometimes the reactions of staff to disclosures of sexual abuse during childhood, as well as their reactions to highly sensitive, intimate information serve to further reinforce survivors’ sense of stigma, as do professional expectations of what survivors might aspire to and achieve in their lives.
Health and social care practice tends to be reactive; the focus lies in treating the presenting symptoms and minimising the immediate harm rather than supporting survivors to explore aspects of their sexual abuse history or to develop strategies for coping positively with day-to-day life. This includes strategies for addressing feelings of stigma and shame.
Key implications for policy and practice
Our research findings highlight key areas where the organisation and delivery of services might be improved, as well as priorities for future service development. Areas for service improvement reflect the need to:
Address funding deficits, as reported by third sector organisations.
- Strengthen partnership working between key stakeholders.
- Deliver more flexible and diverse support.
- Improve choice and respect the personal preferences of adult survivors, particularly in relation to gender and language.
- Promote greater awareness, sensitivity and understanding amongst frontline service providers and the general public of the longer term challenges that may affect adults who experience sexual abuse during childhood.
- Monitor the effectiveness of support provided.