Exposure to sexual violence as a child can lead to a broad range of mental and physical problems including depression, unwanted pregnancy, cardiovascular disease, and even diabetes. In order to help health service providers and social workers provide necessary services to children and adolescents in a compassionate manner, AIDSFree developed the Strengthening Linkages between Clinical and Social/Community Services for Children and Adolescents who Have Experienced Sexual Violence: A Companion Guide. On February 9, 2016, speakers from AIDSFree, Together for Girls, the International Rescue Committee, the Center for Global Social Work at Rutgers University, and USAID convened at the Kaiser Permanente Center for Total Health to discuss the importance of the guide and raise awareness of sexual violence and exploitation against children and adolescents. This resource builds upon 2013 clinical/forensic guidance for providers, The Clinical Management of Children and Adolescents who have Experienced Sexual Violence. Amelia Peltz, the Senior Gender Advisor at USAID’s Office of HIV/AIDS, moderated the event.
Michele Moloney-Kitts, Director of Together for Girls, began the conversation by discussing the motivation behind the Companion Guide. She recalled the early days of PEPFAR’s work on gender-based violence research where data was collected for the implementation of post-rape care services at community health centers in districts in Uganda and Rwanda. The findings revealed unexpected results: young girls and boys were presenting for post-rape care in far greater numbers than women of reproductive age. As Moloney-Kitts recalled, “It hit me like a sledgehammer and changed my career path. At that time none of the services were set up for children. No one thought about boys and kids.” In fact, survey data shows that one in four girls and one in seven boys have unwanted sexual experiences before the age of 18. One in three girls has an unintended pregnancy as a result. However, stigma remains a big issue; less than 50 percent of girls and even fewer boys tell anyone about their experiences. Moloney-Kitts stressed the importance of disseminating the guide to help start these conversations.
Echoing Moloney-Kitts’ sentiments, Gretchen Bachman, USAID Senior Technical Advisor and PEPFAR Team Lead for Orphans and Vulnerable Children, underlined the importance of circulating the Companion Guide. In particular, she emphasized putting the Companion Guide to practical use in the field, with the possibility of developing training exercises and materials to build upon the resource. “We don’t want a guide that sits on a shelf. We want one that gets out there and changes practices,” she stressed. Furthermore, Bachman highlighted the need to increase funding for non-governmental and community-based organizations, which help coordinate and investigate cases.
Marcy Levy, Senior HIV and AIDS Advisor at John Snow Inc./AIDSFree showcased the interactivity of the Companion Guide and the resources available within it. The Companion Guide contains nine sections, including detailed chapters on roles and responsibilities of stakeholders, mandatory reporting, job aids to set up a referral pathway, case management, guided principles, and program highlights and resources. All of the services a child or adolescent requires in immediate response and over the long term are covered. Levy stressed that resources are a vital part of this document, and contact information is included in many of the sections for readers to get more information.
Reflecting on her own experience as a case manager, Rebecca Davis, Director of the Center for Global Social Work, Rutgers University School of Social Work, conveyed the critical need for and challenges to changing practice. Case management and referral mechanisms are the glue that binds populations affected by HIV with services. Davis delineated that glue as knowledge, skills, systems, and processes. In other words, case managers set up and organize processes for decision-making. They build relationships with the victims, families, communities, and agencies. Davis highlighted the need for trauma-informed, gender-sensitive clinical assessments. “Sometimes it still takes that human warmth to take you through the system. That’s what case management is about,” she expressed.
A key influence in developing the Companion Guide was the Caring for Child Survivors of Sexual Abuse Guidelines developed by the International Rescue Committee. Kristin Kim Bart, Deputy Director of the Women’s Protection and Empowerment program, spoke about these guidelines which focus on humanitarian settings. The guidelines have helped service providers improve knowledge and skills, and build confidence in addressing the issue in conflict and violence settings. They provide detail on how to do a case assessment and create a child-friendly environment. The guidelines also include a case coordination system for service providers to collaborate across programs to allow for various perspectives and more efficiency. Focusing on the particular vulnerability of girls, the International Rescue Committee also developed programs on prevention and response, working with girls to help them develop the skills to respond in dangerous situations.
Though steps have been taken to meet the needs of children and adolescents who have experienced sexual violence and exploitation, the field is still in its infancy. The Companion Guide is a big step forward in providing the necessary guidance and tools. By raising questions and awareness about clinical and social/community services for children and adolescents who have experienced sexual violence and exploitation, and beginning to strengthen these linkages, great strides can be made.