Den tredje nordiska kongressen om barnmisshandel och

Transcription

Den tredje nordiska kongressen om
barnmisshandel och omsorgssvikt
The Third Nordic Congress
on Child Abuse and Neglect
12-14 maj 2004 / 12-14 May 2004
Åbo / Turku, Finland
Photo: TurkuTouring
Program och abstrakt
1
Programme and abstracts
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Innehåll
Välkommen ........................................................................... 4
Kongresskommittéer ............................................................... 5
Praktiska upplysningar ............................................................ 6
Inkvartering ........................................................................... 8
Plenarföreläsare .................................................................... 9
Kongressprogram ................................................................ 16
Socialt program ................................................................... 23
Plenarabstrakt ..................................................................... 24
Workshopabstrakt ................................................................ 33
Författarförteckning .............................................................. 83
Program
Onsdag
Torsdag
Fredag
12 maj 2004
13 maj 2004
14 maj 2004
08:00 Registrering och kaffe
08.00 Registrering
08.00 Registrering
10:00 Öppningsceremoni Sal IX
09:00 Plenarsession III Sal IX
09:00 Plenarsession V Sal IX
10:30 Plenarsession I Sal IX
11:20 Workshops - Fria föredrag III
11:00 Workshops - Fria föredrag V
12:00 Lunch
Film Sal XI
– Sexuellt missbruk - förebyggande
arbete Sal X
– Familjevåld II Sal XI
– Sexuellt missbruk - utredning Sal XIV
– Barn i fara - prevention Sal XV
– Sexuellt missbruk - utredning Sal XIV
– Erfaranheter från Storbritannien om
mångprofessionell samverkan Omhändertagna barn Sal IX
– Flickor på institution Sal XI
13:30 Workshops - Fria föredrag I
– Sexuellt missbruk bland omhändertagna
12:40 Lunch
barn Sal XI
– Familjevåld I Sal X
14:00 Workshops - Fria föredrag VI
– Fysisk barnmisshandel Sal XIV
– Barns rättssäkerhet Sal XV
– Sexuellt missbruk - unga kränkare Sal XI
– Familjevåld III Sal X
15:00 Kaffe
– Riskfaktorer i föräldraskapet Sal XIV
– Politiets roll i kriminelle sager, hvor børn
15:30 Plenarsession II Sal IX
er involveret - forebyggelse og
udredning Sal XV
16:45 Workshops - Fria föredrag II
15:30 Kaffe
– Barnmisshandel - läkarens roll Sal XI
– Pojkars omskärelse - vems rättigheter och
16:00 Plenarsession IV Sal IX
vems skyldigheter Sal X
– Sexuellt missbruk - arbete med förövare
17:15 Föreningsmöte Sal IX
Sal XIV
– Anknytningsteori - emotionell
försummelse Sal XV
19:00 Välkomstmottagning med Åbo stad
som värd Gamla akademihusets
sollennitetssal
19:30 Bussar från kongresshotellen
20:00 Kongressbankett Åbo slott
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12:30 Lunch
Film Sal XI
14:00 Plenarsession VI med
avslutningsceremoni Sal IX
15:30 Kaffe
Index
Welcome .............................................................................. 4
Congress committees ............................................................. 5
General information ................................................................ 6
Accommodation ..................................................................... 8
Plenary lecturers .................................................................... 9
Congress programme ........................................................... 16
Social programme ............................................................... 23
Plenary abstracts ................................................................. 24
Workshop abstracts .............................................................. 33
Author index ........................................................................ 83
Programme at a glance
Wednesday
Thursday
Friday
12 May 2004
13 May 2004
14 May 2004
08:00 Registration and coffee
08.00 Registration
08.00 Registration
10:00 Opening ceremony Lecture hall IX
09:00 Plenary session III Lecture hall IX
09:00 Plenary session V
Lecture hall IX
10:30 Plenary session I Lecture hall IX
11:20 Workshops - Free papers III
12:00 Lunch
Film Lecture hall XI
– Child Sexual Abuse - preventive work
Lecture hall X
– Domestic violence II Lecture hall XI
– Child Sexual Abuse - investigation
Lecture hall XIV
– Children at risk - aspects of prevention
Lecture hall XV
11:00 Workshops - Free papers V
13:30 Workshops - Free papers I
– Child Sexual Abuse and children in care
Lecture hall XI
– Domestic violence I Lecture hall X
– Child physical abuse and life after
Lecture hall XIV
– Children’s rights Lecture hall XV
15:00 Coffee
15:30 Plenary session II Lecture hall IX
16:45 Workshops - Free papers II
– Child abuse - the role of the doctor
Lecture hall XI
– Controversy of male ritual circumcision whose rights and whose obligations
Lecture hall X
– Child Sexual Abuse - working with
preparators Lecture hall XIV
– Attachment theory and emotional
abuse and neglect Lecture hall XV
19:00 Welcome recption hosted by the
City of Turku The Old Academy Hall
– Child Sexual Abuse - investigation
Lecture hall XIV
– Multiprofessional approaches - UK
experiences - Children in care
Lecture hall IX
– Children in residential care
Lecture hall XI
12:40 Lunch
14:00 Workshops - Free papers VI
– Child Sexual Abuse - young offenders
Lecture hall XI
– Domestic violence III Lecture hall X
– Children at risk - parental fators
Lecture hall XIV
– The role of the police in the criminal
process where a child is involved prevention and investigations
Lecture hall XV
15:30 Coffee
16:00 Plenary session IV Lecture hall IX
17:15 NFBO meeting Lecture hall IX
19:30 Bus transportation from the
congress hotels
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20:00 Congress Banquet Turku Castle
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12:30 Lunch
Film Lecture hall XI
14:00 Plenary session VI and
Closing ceremony
Lecture hall IX
15:30 Coffee
Välkommen / Welcome
Kära kolleger och vänner
På programkommitténs och organisationskommitténs vägnar välkomnar jag er till
Den tredje nordiska kongressen om barnmisshandel och omsorgssvikt.
Nordisk Forening mot Barnemishandling og Omsorgssvikt etablerades 1998 med
målet att främja det nordiska samarbetet på området. De flesta barn i Norden
växer upp i trygga närmiljöer, men trots nationella lagar och internationella
förordningar finns det en betydande skara barn som inte får sina basbehov
tillfredsställda och som blir utsatta för våld eller hot om våld. Dessa barn står i
fokus på vår kongress. Jag hoppas att kongressen kan bidra till att vi bättre än
tidigare skall kunna identifiera, bemöta, behandla och följa upp de barn som lever
i miljöer, som utgör en risk för deras hälsa och utveckling.
Jag önskar er alla varmt välkomna.
Raisa Lounamaa
Kongressens ordförande
Dear Colleagues and Friends
Welcome to Turku and the Third Nordic Congress on Child Abuse and Neglect.
The Nordic Society for the Prevention of Child Abuse and Neglect was
established in 1998 with the aim to promote collaboration and stimulate
exchange of experience between people of various professional backgrounds
working in child protection. In the Nordic countries, most children and young
people grow up in a safe home environment, but despite national laws and
international conventions the basic requirements of a considerable number of
children are neglected and abused. We hope the congress will contribute to
improve our knowledge and skills to identify, meet, treat and follow up children
who live in environments, which constitute a risk to their health and wellbeing.
On behalf of the programme committee I thank you for coming and our best
wishes to you for a successful meeting.
Raisa Lounamaa, MD
Congress Chair
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Kongresskommittéer / Congress committees
Programkommitté
Raisa Lounamaa, Finland, ordförande
Annlis Söderholm, Finland, sekreterare
Mona Jerkku, Finland
Cecilia Kjellgren, Sverige
Már V. Magnússon, Island
Kirsten L. Moesgaard, Danmark
Arne K. Myhre, Norge
Carin Nordenstam, Norge
Carl-Göran Svedin, Sverige
Organisationskommitté
Raisa Lounamaa, NFBO, Barnläkarföreningen i Finland
Annlis Söderholm, NFBO, Barnläkarföreningen i Finland
Heikki Sariola, NFBO, Centralförbundet för Barnskydd
Kongressbyrån / NFBO 2004
Lemminkäinengatan 14-18 B, 20520 Åbo, Finland
Tel. +358 2 333 6469 eller 5009, Fax + 358 2 333 5008
Email: [email protected]
http://congress.utu.fi/nfbo2004
Programme Committee
Raisa Lounamaa, Finland, chairman
Annlis Söderholm, Finland, secretary
Mona Jerkku, Finland
Cecilia Kjellgren, Sweden
Már V. Magnússon, Iceland
Kirsten L. Moesgaard, Denmark
Arne K. Myhre, Norway
Carin Nordenstam, Norway
Carl-Göran Svedin, Sweden
Organising Committee
Raisa Lounamaa, NFBO, Finnish Paediatric Society
Annlis Söderholm, NFBO, Finnish Paediatric Society
Heikki Sariola, NFBO, The Central Union for Child Welfare in Finland
Congress Office / NFBO 2004
Lemminkäisenkatu 14-18 B, 20520 Turku, Finland
Tel. +358 2 333 6469 or 5009, Fax + 358 2 333 5008
Email: [email protected]
http://congress.utu.fi/nfbo2004
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Praktiska upplysningar / General information
Kongressplats
Åbo Universitet, Byggnaden för Naturvetenskap
Adress: Universitetsbacken, Åbo / Turku, Finland
Registrering under kongressen
Kongressbyrån står till Din tjänst på kongressområdet under det vetenskapliga
programmet. Kongressbyråns telefonnummer under kongressen är +358 40 565
6716. För betalning på kongressplatsen accepteras kontanter och följande
kreditkort: Visa, Mastercard och Eurocard.
Kongressbyrån är öppen:
Tisdag, 11 maj
Onsdag, 12 maj
Torsdag, 13 maj
Fredag, 14 maj
17.00 - 19.00
08.00 - 17.00
08.00 - 17.30
08.00 - 15.30
Kongresspråk
Skandinaviska språk och engelska
Förhandsgranskning av presentationer
Du kan kontrollera dina powerpoint- och OH-presentationer i föreläsningssal XIII
på andra våningen i Byggnaden för naturvetenskap.
Congress venue
University of Turku, Building of Natural Sciences
Address: Yliopistonmäki, Turku, Finland
Registration on-site
The Congress Office will be ready to assist you at the congress venue during the
congress. The telephone number of the Congress Office during the congress is +358
40 565 6716. For on-site payments cash, Visa, Mastercard and Eurocard are accepted.
Opening hours of the Congress Office:
Tuesday, 11 May
17.00 - 19.00
Wednesday, 12 May
08.00 - 17.00
Thursday, 13 May
08.00 - 17.30
Friday, 14 May
08.00 - 15.30
Language
Skandinavian languages and English
Slide preview room
There is a slide preview room (lecture room XIII) on the second floor of the
Building of Natural Sciences. There you can check your slides and powerpoint
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presentations.
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Praktiska upplysningar / General information
Lunch och kaffe
Lunch och kaffe ingår i deltagaravgiften och serveras på kongressplatsen.
Namnlappen ger tillträde till lunch och kaffe och bör därför bäras synligt under
kongressen.
Övriga tjänster
Bank
Den närmaste banken finns på Tavastgatan. Bankerna är i huvudsak
öppna vardagar 9.30-16.30
Rökning
Rökning är förbjuden i allmänna byggnader.
Taxi
På kongressplatsen kan Du be Kongressbyrån ringa efter en taxi.
Telefonnummer +358 2 10041.
Buss
I hotellets reception får Du mer information angående de busar som
trafikerar sträckan Salutorget - Universitetsbacken (t.ex. buss nr. 30,
50, 51, 53, 54).
Telefon
På kongressplatsen finner Du allmänna telefoner nära huvudingången
till Byggnaden för naturvetenskap.
Lunch and coffee
Lunch and coffee are included for registered participants and are served at the
congress venue. Congress delegates are kindly asked to wear their badges
throughout the congress.
Other services
Bank
The nearest banks are in Hämeenkatu. Banking hours on weekdays
are mainly 9.30-16.30.
Smoking Smoking is prohibited inside public buildings.
Taxi
Bus
At the congress venue you can ask the Congress Office to call you a
taxi. Taxi tel. +358 2 10041.
You can require information from the hotel reception concerning the
General
information
most convenient
bus line (e.g. bus no.s 30, 50, 51, 53, 54) from the
Market Square to the University Hill.
Telephone At the congress venue public telephones can be found near the main
entrance in the Building of Natural Sciences.
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Inkvartering / Accommodation
Kongresshotell
General information
Holiday Club Caribia
Kongressgatan 1, 20540 Åbo
T. +358 2 651 111, F. +358 2 6511 2000
Sokos Hotel Hamburger Börs Köpmansgatan 6, 20100 Åbo
T. +358 2 337 381, F. +358 2 231 1010
Scandic Hotel Julia
Eriksgatan 4, 20110 Åbo
T. +358 2 336 311, F. +358 2 3360 2211
Sokos Hotel Seurahuone
Eriksgatan 23, 20100 Åbo
T. +358 2 337 301, F. + 358 2 251 8051
Sokos Hotel City Börs
Köpmansgatan 11, 20100 Åbo
T. +358 2 337 381, F. +358 2 231 1010
Centro Hotel
Universitetsgatan 12A, 20110 Åbo
T. +358 2 4690 469, F. +358 2 4690 479
Hotel Turun Karina
Österlånggatan 30B, 20700 Åbo
T. +358 2 265 7911, F. +358 2 265 7919
Congress hotels
Holiday Club Caribia
Kongressikatu 1, 20540 Turku
T. +358 2 651 111, F. +358 2 6511 2000
Sokos Hotel Hamburger Börs Kauppiaskatu 11, 20100 Turku
T. +358 2 337 381, F. +358 2 231 1010
Scandic Hotel Julia
Eerikinkatu 4, 20110 Turku
T. +358 2 336 311, F. +358 2 3360 2211
Sokos Hotel Seurahuone
Eerikinkatu 23, 20100 Turku
T. +358 2 337 301, F. + 358 2 251 8051
Sokos Hotel City Börs
Kauppiaskatu 11, 20100 Turku
T. +358 2 337 381, F. +358 2 231 1010
Centro Hotel
Yliopistonkatu 12A, 20110 Turku
T. +358 2 4690 469, F. +358 2 4690 479
Hotel Turun Karina
Itäinen Pitkäkatu 30B, 20700 Turku
T. +358 2 265 7911, F. +358 2 265 7919
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Plenarföreläsare / Plenary lecturers
Tom Erik Arnkil är professor i socialpolitik vid Helsingfors Universitet och
forskningsprofessor vid STAKES (Forsknings- och utvecklingscentralen för social
och hälsovård), där han leder en forskningsgrupp som fokuserar på
nätverksarbete och på att utveckla metoder vid dialog. Gruppen studerar
“virrvarret när många hjälper” och lösningsmodeller när situationen är låst.
Centrala forskningsområden är mångprofessionella nätverk i barn-, ungdomsoch familjeorienterat arbete samt nätverksarbete med långtidsarbetslösa. Inom
bägge områden förekommer viktiga gränsöverskridningar: mellan den offentliga
och den privata sfären när mänskor och deras personliga nätverk kommer i
kontakt med professionella nätverk och innanför det sektorbaserade,
specialiserade expertsystemet. Tom Erik Arnkil har skrivit flera böcker om mötet
mellan det professionella systemet och den värld klienten lever i och har
utvecklat metoder för förbättrad dialog mellan dessa kontrahenter. Böckerna
bygger på fortgående forskning och utvecklingsprojekt som fått sin början under
1980-talet. Prof. Arnkil med kolleger har utvecklat metoder för förbättrad dialog
mellan expertsystem och klient. Han redogör i sin plenarföreläsning för dessa
metoder och deras kontext.
Tom Erik Arnkil is a Research Professor at STAKES (National Research and
Development Centre for Welfare and Health) in Finland. He is also an associate
Professor of social policy at the University of Helsinki. In STAKES he leads a
group focusing on network research and dialogic methods. The groups studies
“multi-helper muddles” and develops methods for getting out of stuck situations.
The two main areas of study are multi-stakeholder networks in child, adolescent
and family oriented work, and networks in work with long term unemployed
persons. In both areas important boundary crossings - and boundary problems occur: between the public and the private sphere where citizens and their
personal networks are in contact with professional networks, and within the
sector based, specialised expert system. Tom Erik Arnkil has written a number of
books on the encounter between the helper system and the “life world” of
clients, basing on a succession of research and development projects starting in
the 1980’s and still going on. Through experimentation Arnkil and his colleagues
have developed methods for enhancing dialogues between the expert system
and the clients - methods for getting unstuck. He will give a plenary lecture on
these methods and their context.
Lucy Berliner är biträdande professor vid University of Washington Graduate
school of Social Work och chef för Harborview Sexual Assault Center, en
specialklinik vid samma universitet. Hennes aktiviteter inkluderar kliniskt arbete
och forskning med barn som utsatts för trauman och hon leder också ett projekt
om barn i fosterhem. Hon är en av författarna till läroboken The APSAC
Handbook on Child Maltreatment.
Lucy Berliners plenarpresentation är baserad på hennes erfarenheter av
terapeutiskt arbete med barn som traumatiserats bl.a. på grund av sexuella
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övergrepp eller fysisk misshandel. Hennes workshop behandlar samma tema.
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Lucy Berliner is Associated Professor at the University of Washington
Graduate School Plenary
of Social Work
and Director for Harborview Sexual Assault
lecturers
Center, a special clinic at the same university. Her work include clinical work with
research on children affected by traumatic events and she is the principal
investigator for a project of children in foster homes. Moreover, she is co-writer
of the textbook The APSAC Handbook on Child Maltreatment.
Lucy Berliner’s plenary lecture is based on her experiences of therapeutic work
with children affected by traumatic events as a result of sexual assaults or
physical abuse. Her workshop treats the same theme
Else Christensen är psykolog och senior forskare vid Dansk National Institut
for Social Forskning. Hon är fil.mag. från universitetet i Köpenhamn 1979 och
arbetade 1974-80 vid Universitetssjukhuset i Köpenhamn. 1981-90 arbetade hon
som psykolog och forskare vid Dannerhuset med misshandlade kvinnor och barn
som varit vittne till våld i familjen. Hennes professionella intresse rör försummelse
och våld mot barn och på vilket sätt barnens uppväxtvillkor influerar deras
utveckling – sker en polarisering redan under tidig barnaålder? I sitt
plenarföredrag kommer Else Christensen att ta upp tidig intervention vid
försummelse och hennes inlägg baseras på en kohortstudie av 5000 barn födda
1995.
Else Christensen is psychologist, senior researcher and Head of research
programme at the Danish institute of Social Research. She graduated from the
University of Copenhagen 1979, was employed at the University Hospital of
Copenhagen 1974-80. In 1981-90 she worked as attending psychologist and
researcher at the Danner House with physically abused women and children who
had witnessed violence in the family. Her professional interests concern child
abuse and neglect and to which extent the living conditions of the family and the
child affects their social mobility – is a polarisation established already in early
childhood? Her plenary presentation about neglect of children is based on results
from a follow up study of a cohort of children born in 1995.
Dr. Olof Flodmark är biträdande professor i neuroradiologi och pediatrisk
neuroradiologi vid Karolinska institutet och chef för den neuroradiologiska enheten
vid Karolinska sjukhuset i Stockholm. Hans specialintresse är neonatal
neuroradiologi. Han är en av de ledande läkarna i Sverige när det gäller
diagnostisering och intervenering vid fysisk misshandel av barn och hans arbete
har lett till ändrade attityder och rutiner vid barnmisshandel. Han har en
omfattande vetenskaplig produktion: 13 bokkapitel, 102 vetenskapliga
publikationer och nästan 300 vetenskapliga presentationer. Sedan 2000 är han
president för “European Society of Neuroradiology”. Plenarföreläsningen
behandlar radiologiska och neuroradiologiska undersökningar vid fysisk misshandel
av spädbarn.
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Dr. Olof Flodmark is Associate professor of Neuroradiology and Pediatric
Neuroradiology
at the Karolinska
Institute and Director of the Department of
Plenary
lecturers,
Workshops
Neuroradiology and MR Research at Karolinska Hospital in Stockholm. His special
interest is neonatal neuroradiology. He is one of the leading doctors when it
comes to diagnosing and intervening in child physical abuse in Sweden, especially
in shaken baby syndrome cases. He has an extensive scientific production: 13
book chapters, 102 original papers and almost 300 scientific and learned
presentations. Since 2000 he is President of the European Society of
Neuroradiology. His plenary presentation will look at child physical abuse from a
radiologic and neuroradiologic point of view.
James Garbarino är professor i Human Development vid Cornell University och
biträdande chef för Family Life Development Center. Han är en av världens
ledande forskare när det gäller försummelse och våld mot barn och har erhållit
det första C.Henry Kempe priset 1985 och också fått pris av American
Psychological Association´s Division on Child, Youth, and Family Services och
American Academy of Pediatrics Section on Behavioral and Developmental
Pediatrics. Han har skrivit många böcker, är medförfattare i boken Neglected
Children och har skrivit boken Lost Boys, som behandlar unga som begår
våldshandlingar. Därutöver har han en omfattande vetenskaplig produktion.
James Garbarinos första plenarpresentation handlar om det ekologiska
perspektivet vid försummelse av barn. Hans andra presentation behandlar
tonåringar som begår våldsbrott.
James Garbarino is Professor of Human Development at Cornell University as
well as Co-Director of the Family Life Development Center. He is one of the
leading researchers when it comes to the impact of neglect and violence on child
development and he has received the first C. Henry Kempe Prize in 1985. He
has been awarded by the American Psychological Association’s Division on Child,
Youth, and Family Services as well as by the American Academy of Pediatrics
Section on Behavioral and Developmental Pediatrics. James Garbarino has an
extensive scientific production. He has written many books, among others Lost
Boys, which deals with teenagers committing violent acts, and he is co-author of
the book Neglected Children.
James Garbarino’s first plenary lecture deals with the ecological perspective on
the neglect of children. His other presentation is about teenagers committing
violent crimes. He considers the problem of neglect and violence from the point
of view of the individual, family and society.
Kari Killén är professor och äldre forskare vid Norsk institutt for forskning om
oppvekst, velferd og aldring. Hon har en lång både klinisk och forskningsmässig
erfarenhet av arbete med barn som varit utsatta för försummelse och våld. Hon
är en pionjär inom detta område och hennes stora insatser som lärare och
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påverkare både i Norge och internationellt har haft betydelse för flere
generationer av kliniker och teoretiker, som arbetar med utsatta barn. Hon har
skrivit och redigerat många böcker av vilka boken “Sveket. Omsorgssvikt er alles
ansvar” är översatt till 8 språk. Prof. Killéns nuvarande forskningsintresse rör
tidigt samspel och anknytning samt preventivt och mångprofessionellt arbete.
Prof. Killén har varit aktiv inom ISPCAN under många år och har varit president
för denna organisation.
Kari Killén is a Professor and Senior researcher at the Norwegian Institute of
Social Research. Her professional work over 40 years has combined direct clinical
work, consultations, training and research in child maltreatment. She is a pioneer
in this field also internationally and presently she is focusing on research on
attachment. She has published several books and articles on child maltreatment;
recognition, treatment, prevention and multiprofessional work. Prof. Killén has
been active in ISPCAN for many years and is former President of the
organisation.
Marcellina Mian är barnläkare och professor i pediatrik vid universitetet i Toronto. Hon har lång erfarenhet av medicinsk och psykosocial utvärdering av barn
som farit illa och har varit också internationellt aktiv på detta område. För
närvarande är hon president för ISPCAN (The International Society for the
Prevention of Child Abuse and Neglect) och hon fungerar som konsult åt World
Health Organization vid utformandet av internationella riktlinjer för det
förebyggande arbetet. Hon har gjort forskning om följderna av sexuella
övergrepp på barn under skolåldern och skrivit många artiklar om olika former av
våld mot barn. Prof. Mian kommer att i sitt plenarföredrag behandla betydelsen
av intersektoriell samverkan i det internationella preventiva arbetet.
Marcellina Mian is a general paediatrician and Professor in Paediatrics at the
University of Toronto. Since 1975 she has been active in the medical and
psychosocial assessment of abused children. Since 1984 she is a member of the
Board of the Toronto Child Abuse Centre. She is the current President of ISPCAN
(The International Society for the Prevention of Child Abuse and Neglect). Prof.
Mian is also a consultant to the World Health Organization to develop
international guidelines on child abuse and neglect prevention. Prof. Mian has
carried out research on the effects of sexual abuse on preschoolers and has
written numerous articles on various aspects on child abuse. In the last plenary
session prof. Mian will give a lecture on intersectorial approach to child abuse
prevention.
Kim Oates är professor i pediatrik och barnhälsa vid universitetet i Sydney och
chefsläkare vid Children´s Hospital at Westmead i Sydney. Hans intresse för
försummelse av och våld mot barn tog sin början 1970 med en studie om
“Failure to thrive”. Sedan dess har han publicerat 14 böcker och över 150 artiklar
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i huvudsak rörande barn som far illa. Han har över 20 år varit aktiv inom
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International Society for Prevention Child Abuse and Neglect (ISPCAN) och var
organisationens president åren 1988-1990. Han har också varit gästande
professor vid det världsberömda Henry Kempe Centret i Colorado, USA.
Kim Oates kommer under kongressen att ha två plenarföredrag. Den första
presentationen behandlar barnläkarens roll inom barnskyddet, följt av en
workshop om barnmisshandel och mångprofessionellt samarbete. Rubriken för
hans andra plenarpresentation är “What have we learnt in the last 40 years?”.
Kim Oates is Professor of Pediatrics and Child Health at the University of
Sydney and Chief Executive of the Children’s Hospital at Westmead, Sydney. His
interest for neglect and violence against children got its start in 1970 with a study
of “Failure to thrive”. From then on he has published 14 books and over 150
articles concerning principally maltreated children. For over 20 years, he has
taken an active part in the International Society for Prevention Child Abuse and
Neglect (ISPCAN) and he acted as President for the organization in 1988-1990.
Furthermore, he has acted as Visiting Professor at the world famous Henry
Kempe Center in Colorado, USA.
During the congress, Kim Oates is to give two plenary lectures. The first
presentation brings up the role of the children’s doctor for the child welfare,
followed by a workshop on child abuse and multiprofessional cooperation. The
topic of his second plenary presentation will be: “What have we learnt in the last
40 years?”.
Stefán Ólafsson innehar en professur vid fakulteten för socialvetenskaper vid
Universitetet på Island sedan år 1991. Jämsides med denna befattning är han
sedan år 2000 chef för Institutet för urbana studier vid samma universitet. Hans
akademiska forskning har inbegripit välfärdstudier, studier kring levnadsstandard,
arbetsmarknad och samhällsutveckling. Hans publikationer, huvudsakligen på
isländska, inkluderar fyra läroböcker, många kapitel i böcker och artiklar i
vetenskapliga journaler och ett stort antal forskningsrapporter. Han har också
haft ledande befattningar i de universitetsanställdas fackförening och inom
universitetets administration. Stefán Ólafssons plenarföredrag behandlar
välfärdsstaten och barnens situation ur ett isländskt perspektiv.
Stefán Ólafsson is full Professor in the Faculty of Social Sciences at the University of Iceland since 1991. He also became director of the Urban Studies Institute at The University of Iceland in 2000. He has been chairman of the Association
of University Employees in Iceland and been a member of the University Council
for two periods. His main fields of research are welfare studies and level of living,
labour market studies and societal development. His publications, mainly in
Icelandic, include four academic books, many chapters in books and journals and
a very large number of research reports. His plenary presentation deals with
children’s conditions in Iceland.
13
13
Jonathan Picken har under många år varit aktiv i British Association for the
Study and Prevention of Child Abuse and Neglect (BASPCAN) och är blivande
ordförande för denna organisation. Han arbetar som rådgivare och konsult för
mångprofessionella “Area Child Protection Committee´s” (ACPC´s) i
Storbritannien. Han har tidigare arbetat med unga klienter inom kriminalvården
och hans arbete som socialarbetare med både barn och vuxenklienter började
1984. Han har erfarenhet av arbete i barnskyddsteam och senare även av
arbete i en regional pediatrisk enhet. Hans speciella professionella intresse- och
kompetensområde inom ACPC’s är multiprofessionell handläggning av
försummelse av och våld mot barn. Han är också intresserad av internationellt
arbete och har fungerat som en “Honorary Lecturer” för WHO.
Jonathan Picken is currently Chair Elect of the British Association for the Study
and Prevention of Child Abuse and Neglect (BASPCAN). Jonathan is an InterAgency Training and Development Adviser working with multi-disciplinary “Area
Child Protection Committee’s” within the UK. He began working as a Social
Worker in1984, working in both adult and children’s services. Having studied
criminology his early career was spent working with young people within the
criminal justice system, before going on to work within a child protection team
and later a regional paediatric unit. During recent years he has worked specifically
with ACPC’s and has a specific interest in the multi-disciplinary management of
child abuse and neglect. Jonathan also has an interest in overseas development
work and has worked as an ‘Honorary Lecturer’ for the World Health
Organisation.
Minna Salmi är sociolog med mångårig forskarbakgrund vid Helsingfors
Universitet. Sedan 1993 har dr Salmi arbetat vid STAKES (Forsknings- och
utvecklingscentralen för social och hälsovård) där hon speciellt sysslat med
forskning kring vardagen, som hon definierar som de processer genom vilka
människor omvandlar de samhälleliga livsbetingelser och villkor som de lever med
till levd vardag. Med detta perspektiv som utgångspunkt har hon lett forskningsoch utvecklingsprojekt om barns välfärd och om sammanjämkningen av arbete
och familjeliv. Hennes senaste arbete tillsammans med andra forskare inkluderar
en studie om vilka följder den ekonomiska depressionen hade på barnen och
deras familjer, en analys av barnens position i samhällsutvecklingen på 1990-talet
och en studie av fattigdom i barnfamiljer. Hon har en omfattande vetenskaplig
produktion både på finska och engelska. På STAKES är Dr Salmi chef för enheten
“Barndom och familj”.
14
14
Minna Salmi is a sociologist. After working for several years as a researcher at
the University of Helsinki, she joined the staff of STAKES (National Research and
Development Centre for Welfare and Health) in 1993. Her research interests lie
in everyday life, which she defines as the process through which people
transform the social conditions of their life into lived everyday life. Having this
perspective as her starting point, she has led research and development
projects on the well-being of children and on the reconciliation of work and family
life. Her recent work together with other researchers includes a study on the
consequences of the economic depression on children and their families, an
analysis of children’s position in the societal development of the 1990s, and a
study of poverty in families with children. She has published several articles in
books both in English and in Finnish. Dr Salmi is Head of the Unit “Childhood and
Family” in STAKES.
Trygve Wyller är teologiedoktor, professor i systematisk teologi vid
Universitetet i Oslo och sedan 2003 den teologiska fakultetens vicedekan. Hans
doktorsavhandling 1994 i systematisk teologi fokuserade speciellt på diskussionen
om förhållandet mellan modern autonomi och kristen tro. Under senare år har
hans arbete i huvudsak rört två teman: tolkning och analys av kristet
omsorgsarbete och allmänna etiska dilemman i speciella omsorgstraditioner,
speciellt hur dessa relaterar till samspelet mellan vad som anses vara bäst för
klienten och erkännandet av klientens egen medverkan. 1993 blev han redaktör
för Norsk teologisk tidsskrift. Sedan år 1998 är han också professor vid
Høgskolen for diakoni og sykepleie vid Diakonissehuset Lovisenberg, Oslo och
chef för det nordiska nätverket “Forum for the Science of Diakonia”. Förutom
nyare systematisk teologi och diakoni omfattar prof. Wyllers professionella profil
bl.a. modernitetsteorier, teologisk och allmän etik samt barnskydd.
Trygve Wyller is Ph.D. in Theology and Professor of Systematic Theology at
the Faculty of Theology, University of Oslo. His doctoral work 1994 in Systematic
Theology focused especially on the discussion of the relationship between
modern autonomy and Christian belief. In recent years, his work has focused
on two principal subjects: the interpretation and analysis of the distinct history of
Christian care work and common ethical dilemmas in specific care traditions,
especially as they relate to the interplay between acting on the client’s best
interest and acknowledging the client’s agency. He is academic advisor for
diaconal and nursing studies within the health science major since 1996. Prof. II
at the College of Diakonia and Nursing at Lovisenberg Hospice, Oslo since 1998.
Editor of the Norsk teologisk tidsskrift since 1993. Member of the intl. reference
group for research projects at Uppsala University on the relationship between
the state and the church in Sweden. Director of the Nordic network “Forum for
the Science of Diakonia”. Opponent at doctoral disputations in theology at the
universities of Lund, Trondheim and Oslo. Advising five doctoral candidates and
approx. fifteen master’s students. Vice Dean at The Faculty of Theology 2003-.
15
15
Kongressprogram / Congress programme
Onsdag / Wednesday
12 maj / May 2004
08:00
Registrering och kaffe
Registration and coffee
10:00
Öppningsceremoni
Opening ceremony
10:30
Plenarsession I
Plenary session I
10:30
Minna Salmi: Children and structural indifference
- the position of children and their families in Finland today
Stefán Ólafsson: The Welfare State and Children’s conditions
- the case of Iceland P 1
Else Christensen: How can we prevent children to become
neglected children? P 2
11:00
11:30
Ordförande: Cecilia Kjellgren
Chair: Cecilia Kjellgren
12:00
Lunch
Film Den nødvendige samtale. Samtale med forældre om
bekymring for deres barn. WP 1
13:30
Workshops - Fria föredrag I
Workshops - Free papers I
13:30
13:55
14:20
14:45
Sexuellt missbruk bland omhändertagna barn
Child Sexual Abuse and children in care
Orförande - Chair: Carin Nordenstam
Christine Román: Processen från “icke-behandlingsbar” mot en positiv
personlighetsutveckling - metodutveckling på ett behandlingshem för
allvarligt störda och traumatiserade ungdomarWP 2
Bengt Söderström: “En gång när Lisa var liten...” WP 3
Geert Jørgensen: Sexual abuse on children taken into care WP 4
Grete Dyb: Alleged Sexual Abuse at a Day Care Center: Impact on
Parents WP 5
16
16
Onsdag / Wednesday
12 maj / May 2004
13:30
13:50
14:10
13:30
13:50
14:10
13:30
Familjevåld I
Domestic violence I
Ordförande - Chair: Maria Eriksson
Agneta Frick: Barn som bevittnar och upplever våld i hemmet. Att
möta och arbeta med barnen på Kriscentrum för våldsutsatta kvinnor
och deras barn i Malmö WP 6
Jan-Eric Gustavsson: Gruppbehandling för misshandlade mammor
kvinnor WP 7
Stefan Lindberg: Pappor i häkte WP 8
Fysisk barnmisshandel
Child physical abuse and life after
Ordförande - Chair: Már Magnusson
Charlotta Lindell: Social welfare services provided for physically abused
children in Sweden. Interventions at the abuse incident and four
years later. WP 9
Carl-Göran Svedin: A 16 year follow-up of children born at
psychosocial risk WP 10
Jaana Haapasalo: Official and Self-Reported Childhood Abuse and
Adult Crime of Young Offenders WP 11
Barns rättssäkerhet
Children’s rights
med juristerna
Marianne Ny: Barns rättssäkerhet i brottmål WP 12
Anne Brita Normann: Barns rättssäkerhet
15:00
Kaffe
Coffee
15:30
Plenarsession II
Plenary session II
15:30
Kim Oates: An overview of the problem of child neglect and abuse
with emphasis on the role of the doctor P 3
Olof Flodmark: Radiologiska och neuroradiologiska undersökningar
vid fysisk misshandel av spädbarn – styrkor och svagheter P 4
16:05
Ordförande: Carl-Göran Svedin
Chair: Carl-Göran Svedin
17
17
Onsdag / Wednesday
Preliminary12programme
maj / May 2004
16:45
16:45
17:05
17:20
17:40
16:45
16:55
17:30
16:45
17:05
17:25
16:45
19:30
Workshops - Fria föredrag II
Workshops - Free papers II
Barnmisshandel - läkarens roll
Child abuse – the role of the doctor
Ordförande - Chair: Annlis Söderholm
Sarimari Tupola: Management and paediatric follow-up of physically
abused children WP 13
Olof Flodmark: Intersectorial and multiprofessional work in child abuse.
Experiences from MIO-gruppen, Astrid Lindgren Hospital, Stockholm.
Arne K. Myhre: Normal genital anatomy: a study of non-abused
preschool girls WP 14
Kim Oates: Why is child physical abuse a difficult diagnosis?
Pojkars omskärelse - vems rättigheter och vems skyldigheter?
Controversy of male ritual circumcision – whose rights and
whose obligations?
Ordförande - Chair: Esko Länsimies
Kari Vanamo: Clinical phimosis – myth or fact?
Martin Scheinin: Male ritual circumcision – is social adequancy a human
right issue?
Yngve Hofvander: Violating a child’s bodily integrity – Circumcision in
boys and girls WP 15
Sexuellt missbruk – arbete med förövare
Child Sexual Abuse – working with perpetrators
Ordförande - Chair: Bengt Söderström
Vernon Jones: The identification management of child sexual abusers
as a means of protecting children from sexual exploitation and abuse:
Moving Towards a public health model. WP 16
Inga Tidefors: Stories told by the prepetrators - of any benefit for the
abused children? WP 17
Paula Heljestrand: Hans och Greta mottagningen, behandlingsmodell,
speciellt skyddssamtal, samt våra erfarenheter av första året WP 18
Anknytningsteori - emotionell försummelse
Attachment theory and emotional abuse and neglect
Ordförande - Chair: Kari Killén
Kari Killén: The relevance of attachment theory for understanding
and preventing emotional abuse and neglect
18
Välkomstmottagning med Åbo stad som värd
18
Torsdag / Thursday
13 maj / May 2004
08:00
Registrering
09:00
Plenarsession III
Plenary session III
09:00
Trygve Wyller: Between just anger and inapproproate/unreasonable
intimacy - vocational general ethics in an exposed/imperiled area P 5
James Garbarino: The Violent Teenager P 6
09:45
11:20
11:20
11:40
12:00
12:20
11:20
11:40
12:00
12:20
11:20
12:00
Ordförande: Kari Killén
Chair: Kari Killén
Workshops - Fria föredrag III
Workshops - Free papers III
Sexuellt missbruk - förebyggande arbete
Child Sexual Abuse - preventive work
Ordförande - Chair: Geir Borgen
Kaija Lajunen: Children´s Safety Skills programme WP 19
Eva Zachrison: “Att få mamma tillbaka...” WP 20
Aud Karin Bjørn: Tverrfaglig samarbeid som metode i overgrepssake
WP 21
Marianne Lind: Terapigrupper for menn som har vært utsatt for
seksuelle overgrep i oppveksten WP 22
Familjevåld II
Domestic violence II
Ordförande - Chair: Mikko Oranen
Inkeri Eskonen: Children’s perspectives of violence - Methodological
challenges of studying young children’s narratives WP 23
Åsa Källström Carter: Children’s strategies for understanding their
father’s violence WP 24
Hannele Forsberg: Supervised parenthood - the best interest of the
child? WP 25
Maria Eriksson: Gender, parenting and violence in close relationships
WP 26
Sexuellt missbruk – utredning
Child Sexual Abuse - investigation
Ordförande - Chair:
Anna Kaldal: Double perspective, children and police officers involved in
alleged child sexual abuse WP 27
Hanna Tähtinen: Child Forensic Psychiatric Examination Model in the
North Karelia Hospital
19 District WP 28
19
Torsdag / Thursday
Preliminary
13 programme
maj / May 2004
12:10
12:35
11:20
11:40
12:00
Mona Jerkku: Arbetsgruppen för rättspsykiatriska frågor rörande barn
vid Tammerfors Universitetssjukhus barnpsykiatriska klinik WP 29
Merja Mäki: Forensic Child Psychiatry at Tampere University Hospital
WP 30
Barn i fara - prevention
Children at risk – aspects of prevention
Ordförande - Chair: Cecilia Kjellgren
Madeleine Cocozza: Mandatory reporting as an instrument of finding
children in need for protection WP 31
Ruth Soonets: Child Mortality Rate and Inflicted Injuries That Lead
to Early Death of Children in Estonia WP 32
Karen Louise Christiansen: Professionelle dilemmaer i arbejdet med
omsorgssvigt blandt asylansøgerbørn i Danmark WP 33
12:40
Lunch
14:00
Workshops - Fria föredrag IV
Workshops - Free papers IV
14:00
14:20
14:40
14:00
14:20
14:40
Sexuellt missbruk - unga kränkare
Child Sexual Abuse – young offenders
Ordförande - Chair: Guðrún Frímannsdóttir
Marit Hellesnes: Søskenincest, - erfaringer formidlet av kvinner ved
Støttesenter mot Incest-Oslo WP 34
Mimi Strange: Danske børn/unge med sexuel overgrebsadfærd.
Undersøgelse, behandling og vidensindsamling WP 35
Cecilia Kjellgren: Ungdomar som begår sexuella övergrepp - hur
allvarligt är det? WP 36
Familjevåld III
Domestic violence III
Ordförande - Chair: Stefan Lindberg
Mikko Oranen: Children and violence within the family WP 37
Elli-Maija Laaksamo: Integrative practices in working with women and
children who have experienced violence and men who have used it
WP 38
Keith Pringle: Family, Violence and Childhood in the Nordic Welfare
Systems WP 39
20
20
Torsdag / Thursday
Submission of abstracts13 maj / May 2004
14:00
14:30
14:50
14:00
14:20
14:40
15:00
Riskfaktorer i föräldraskapet
Children at risk – parental factors
Ordförande - Chair: Helena Ewalds
Barbro Hindberg: Barn till föräldrar med utvecklingsstörning WP 40
Birthe Hagström: Samverkan kring familjer med späda och små barn
där föräldern lider av en psykisk störning WP 41
Tytti Solantus: Supporting Child Development in Families with Mentally
Ill Parents WP 42
Politiets rolle i kriminelle sager, hvor børn er involveret Forebyggelse og udredning
The role of the police in the criminal process where a child is
involved - Prevention and investigations
Ordförande - Chair: Kirsten L. Moesgaard
Sigþrúður Erla Arnardóttir: Cooperation between Midgardur and the
Reykjavik Police to find new ways to deal with child delinquency WP 43
Steen Hansen: Fængsledes børn – en udsat gruppe WP 44
Bo Ertmann: Ny betænkning om straffeprocessuelle tvangsindgreb
over for børn under den kriminelle lavalder og det fremtidig
samarbejde om at beskytte børn mod overgreb WP 45
Steen Hansen: Internettet. Det er der alt sammen. WP 46
15:30
Kaffe
Coffee
16:00
Plenarsession IV
Plenary session IV
16:00
James Garbarino: Ecological aspects on Child Neglect P 7
17:15
Föreningsmöte
NFBO meeting
19:30
Bussar från kongresshotellen
Bus transportation from the congress hotels
20:00
Kongressbankett på Åbo slott
Congress Banquet at Turku Castle
Ordförande: Annlis Söderholm
Chair: Annlis Söderholm
21
21
Fredag / Friday
14 maj / May 2004
08:00
Registrering
Registration
09:00
Plenarsession V
Penary session V
09:00
09:55
Lucy Berliner: Therapeutic interventions with children who have experienced abuse P 8
Tom Erik Arnkil: Dialogues between families and multi-helper networks in worrying
situations P 9
11:00
Workshops - Fria föredrag V
Workshops - Free papers V
11:00
11:20
11:40
11:00
11:40
11:00
Ordförande: Mona Jerkku
Chair: Mona Jerkku
Sexuellt missbruk – utredning
Child Sexual Abuse – investigation
Ordförande - Chair: Heikki Sariola
Katarina Finnilä: Factors influencing the clinical decision making of child sexual abuse
investigators in Finland WP 47
Carl-Göran Svedin: Trauma experiences and symptoms of traumatization WP 48
Kirsten L. Moesgaard: Videoafhøringer af børn som bevismateriale for
anklagemyndigheden: “Forensic interviewing” WP 49
Erfarenheter från Storbritannien om mångprofessionell samverkan
Omhändertagna barn
Multiprofessional approaches - UK experiences - Children in care
Ordförande - Chair: Carin Nordenstam
Lucy Berliner: The needs of children in foster care WP 50
Jonathan Picken: Multiagency-reponses to Child Maltreatment - UK Systems and
Experiences WP 51
Flickor på institution
Children in residential care
Ordförande - Chair: Ann-Christine Falk
Ann-Christine Falk: Flickor på institution - psykosocialt arbete med sexuellt utsatta
tonårsflickor WP 52
12:30
Lunch
Film Den nødvendige samtale. Samtale med forældre om bekymring for deres barn. WP 1
14:00
Plenarsession VI, avslutningsceremoni
Plenary session VI, Closing ceremony
14:00
14:35
15:10
Kim Oates: “What have we learnt in the last 40 years?” P 10
Marcellina Mian: Intersectoral approach to child abuse prevention world-wide P 11
Cecilia Kjellgren: Vad har vi lärt oss? - Sammanfattning av kongressen
22 of the conference
What have we learnt? - Summary
15:30
Kaffe Coffee
22
Ordför.: Raisa Lounamaa
Chair: Raisa Lounamaa
Socialt program / Social programme
Välkomstmottagning med Åbo stad som värd
Onsdag, 12 maj, Social
2004, kl. programme
19:00
Gamla akademihusets solennitetssal
Adress: Rothoviusgatan, mittemot Åbo domkyrkas kor
Kongressmiddag på Åbo slott
Torsdag, 13 maj, 2004, kl. 20:00
Adress: Slottsgatan 80
En Renässansfest i Hertig Johans sällskap på Åbo slott blir ett minne för livet. På
medeltiden besöktes slottet ofta av regenter och blev ett betydande administrativt
centrum. På 1500-talet utnämndes Gustav Vasas son Johan till hertig av Finland
och hämtade med sig stora rikedomar och en fläkt av den europeiska renässansen
till Åbo slott. Avnjut en utsökt supé tillsammans med Hertig Johan och hans
charmerande gemål, den polska prinsessan Katarina Jagellonica. I avgiften ingår
supé, program och busstransport. Bussarna avgår från kongresshotellen kl 19:30.
Welcome Reception hosted by the City of Turku
Wednesday, 12 May 2004 at 19:00
Old Academy Hall
Address: Rothoviuksenkatu, opposite the east end of Turku Cathedral
Congress Banquet at Turku Castle
Thursday, 13 May 2004 at 20:00
Address: Linnankatu 80
A Renaissance banquet hosted by John, Duke of Finland, at the old Turku Castle
will be a truly memorable experience. In the Middle Ages the castle was often
visited by monarchs and became an important administrative centre. In the 16th
century, Duke John established a luxurious Renaissance court in the castle. Enjoy
the medieval dinner hosted by him and his charming spouse Catharina Jagellonica.
The fee includes the transportation,
23 the programme and the dinner. The buses
leave from the congress hotels at 19:30.
23
P1
Plenarabstrakt / Plenary abstracts
THE WELFARE STATE AND CHILDREN´S CONDITIONS – THE CASE OF
ICELAND
Stefán Ólafsson1
1
University of Iceland, Iceland
The characteristics of the Icelandic welfare state are outlined in a Nordic
comparison, with a special emphasis on the deviations of the Icelandic model
from those of the other Nordic countries. Different welfare systems create
different conditions for families and for children. Issues of work and family,
education, social services, social and cultural environment are examined to
approach a characterization of the environment for children in contemporary
Iceland. Then we look more directly at conditions of children, deviance,
maltreatment and child care and child protection services. Lastly we relate the
welfare outcomes of Icelandic children to the contours of the societal
environment.
P2
HOW CAN WE PREVENT CHILDREN TO BECOME NEGLECTED
CHILDREN?
Else Christensen1
1
Research unit on children, integration and equal opportunities, Denmark
The presentation will focus on four questions:
What do we know about parents who expose their children to neglect?
· How will the parents themselves describe and understand their life or their
situation?
· How are the social conditions for those families?
How many children are at risk of being neglected by their parents?
· How many families with serious social problems can we find?
· Will the children in these families experience other problems as well?
Which professionals will get contact to the families?
· Nurses visiting the homes?
· Day care institutions?
· Social departments?
What can be done to reduce the risk of neglect?
· To become aware of children who have a difficult life
· To react directly to help the child
· To support the parents to get a better life
Limitations of this presentation
· The starting point has been families with serious social problems – neglect
may be found in other families as well
· Only focus on children until the age of eight year
24
24
P3
AN OVERVIEW OF THE PROBLEM OF CHILD ABUSE - KEEPING UP WITH
THE FUTURE
Kim Oates1
1
The Children’s Hospital at Westmead, Australia
There have been amazing advances in medical science since the discovery of the
double helix of DNA by Watson and Crick in 1953. Diagnostic techniques have
made enormous advances, new treatments are available and we are on the brink
of curing single gene disorders by gene therapy, as well as growing new tissues
through tissue engineering techniques. But in some areas of medical science the
rate of progress has been slower. These are in the areas of how we relate to each
other, how parents relate to children, how children fit into the wider community and
how we can help children reach their full potential, particularly children who are
neglected, disadvantaged or abused. We have done well in public and professional
awareness in understanding the complexity of abuse and have done well in
professional training. We have not done quite as well and producing and evaluating
effective prevention and treatment programs.This presentation will include information
from some of the author’s research studies on injuries which occur when children
fall out of bed and whether children’s allegations of sexual abuse can be believed.
The role of a paediatrician in abuse prevention and assessment is pivotal. The
paediatrician’s role involves some things which only a paediatrician can do and
others which can be done in co-operation with other professionals. Paediatricians
have a responsibility to remain involved in child abuse prevention, treatment, research
and evaluation, with much of this work being done in partnership with other
professional colleagues.
25
25
P4
RADIOLOGISKA OCH NEURORADIOLOGISKA UNDERSÖKNINGAR VID
FYSISK MISSHANDEL AV SPÄDBARN – STYRKOR OCH SVAGHETER
Olof Flodmark1
1
Karolinska Universitetssjukhuset Solna, Sverige
Säker diagnostik av fysisk misshandel av spädbarn är mycket svårt. Den kliniska
diagnostiken försvåras avsevärt av att skadornas natur gör att de i allmänhet
inte kan avslöjas vid även en noggrann klinisk undersökning. Osäkerheter kring
den historia som berättas av vårdnadshavaren bidrar ytterligare till klinikerns
svårigheter att diagnosticera spädbarn som misshandlats, särskilt med skakning
(SBS).
Radiologiska undersökningsmetoder har sedan mitten av 1940-talet spelat en
avgörande roll vid diagnostiken och otaliga är de fall där radiologen är den förste
som misstänker att ett spädbarn misshandlats. Ett korrekt utnyttjande av
radiologin som diagnostisk metod kräver inte bara tekniskt optimala
förutsättningar utan också en god och ofta specifik kompetens hos den
granskande radiologen men kanske framför allt en öppen kommunikation mellan
radiolog och kliniker.
Radiologisk undersökning är vidare en av hörnpelarna i den bevisning som bör
ligga till grund för den rättsliga prövning som alltför sällan följer på diagnos av
spädbarnsmisshandel.
I presentationen kommer de typiska radiologiska fynden vid SBS att diskuteras
både vad det gäller skelettskador och hjärnskador. Diagnostiska kriterier och
deras kliniska värde liksom bevismässiga relevans diskuteras. Det uttalade syftet
med denna del av presentationen är att höja kunskapsgraden hos icke
sjukvårdspersonal med avseende på radiologins förmåga att presentera
objektiva bevis för att spädbarnsmisshandel förekommit och hur dessa sedan
skulle kunna utnyttjas i den rättsliga processen.
26
26
P5
BETWEEN JUST ANGER AND INAPPROPROATE/UNREASONABLE INTIMACY VOCATIONAL GENERAL ETHICS IN AN EXPOSED/IMPERILED AREA
Trygve Wyller1
1
University of Oslo, Norway
The professional working with abused and neglected children must balance between a just
anger and an appropriate intimacy. But being sucsessful in this balance requires some
reflections on important positions in contemporary discussions of ethics. The polish-british
sociologist Zygmunt Bauman underlines the liquidity of modernity in his latest books. From
that point of view, the abuse of children is a symptom of the illness of modernity. There is
nothing solid any more, even love has become liquid. From the point of view of child abuse,
the interpretation of Bauman seems more than correct. There is though one problem with
this position: It can lead to the victimization of the child. And the child as victim soon
becomes the child as object which the professional can act on. In other parts of
postmodern thinking the concept of life as a gift is much discussed, also among feminists.
The paper will point at the impact of this other position when it comes to the professional
approach to abused children. From an ethical point of view the question will be: How can
the professional come close to the child, showing anger because of the graveness, without
at the same time invading and victimizating the child once more? The ethical answer must
start from the question what it means to consider to consider the child‘s life as a gift.
When life is a gift, it is not even owned by the professional.
THE VIOLENT TEENAGER
James Garbarino1
1
Cornell University, Family Life Development Center, USA
P6
Youth violence is a major problem in the United States. Understanding its origins in the
early experience of children is important for interpreting the actions of violent youth and
also for acting to reduce youth aggression.
This presentation seeks to illuminate these issues by tracing the developmental pathways
taken by difficult children who become criminally violent youth. It focuses on the
accumulation of risk factors in the lives of these children. These risk factors include the
experiences of child maltreatment and other forms of trauma, difficult temperaments,
parental and teacher mishandling of troubled children, and the social toxicity levels within
the community. Contributors to the social environment’s toxicity for children and youth
include instability of relationships, civic cynicism, terminal thinking, economic polarization,
desensitization to violence, “spiritual crisis,” and the nastiness of popular culture.
Interestingly, the effects of social toxicity are felt and expressed most by the most
vulnerable youth — e.g. those from de-stabilized families, those subject to racism, and
poverty, and those with disabilities. Efforts to deal with the issues of social toxicity involve
both strengthening youth to decrease their vulnerability, and simultaneously detoxifying the
social environment. The presentation is based Lost Boys : Why Our Sons Turn Violent and
How We Can Save Them. (New York: The Free Press, 1999).
27
27
P7
ECOLOGICAL ASPECTS OF CHILD NEGLECT
James Garbarino1
1
Cornell University, Family Life Development Center, USA
To understand the ecological aspects of child neglect we must recognize that the social
environment can become poisonous to the development of children and youth much as the
physical environment can undermine their physical well-being. This is particularly true for
kids who are especially vulnerable to developmental harm because of their difficult
temperament or emotional disability. Professionals and parents need conceptual tools to
detect and measure these poisons, particularly if they are dealing with a temperamentally
vulnerable child.
The term social toxicity parallels the concept of physical toxicity as a threat to human wellbeing and survival. A socially toxic environment contains widespread threats to the
development of identity, competence, moral reasoning, trust, hope, and the other features
of social maps that make for success in school, family, work, and the community.
What are the social and cultural poisons that are psychologically equivalent to lead and
smoke in the air, PCB’s in the water, and pesticides in the food chain? Feelings of fear about
the world, rejection by adults outside the family, experiencing violent trauma, absence of
adult supervision, and inadequate exposure to positive adult role models, economic
insecurity, a shallow materialist culture, and weak relationships with the neighborhood and
the larger community.
Just as some children are more vulnerable than other children to poisons in the ground and
in the air, some children are more vulnerable to factors like poor role models. Emotionally
troubled and temperamentally vulnerable children are like psychological asthmatics. Young
children are most vulnerable to aspects of life that threaten the availability and quality of
care by parents and other caregivers; while adolescents are most vulnerable to toxic
influences in the broader culture and community.
Adolescence is the crystallization of childhood experience, so the youth most at-risk are
those who develop psychological disabilities in childhood and then face social deprivation
and trauma in adolescence. Like social weathervanes, they can indicate the direction of
social change in their societies. Whatever the strongest cultural and social pathologies
present in a society will generally be most evident in the lives of these youth. It can be
drugs in Eastern Europe, prostitution in Thailand and the Philippines, or murderous violence
in the United States.
This presentation is based upon
J. Garbarino and C. Bedard. Parents Under Siege: Why You Are the Solution Not The
Problem in Your Child’s Life (NY: The Free Press, 2001).
J. Garbarino. Lost Boys : Why Our Sons Turn Violent and How We Can Save Them.
(New York: The Free Press, 1999).
J. Garbarino and E. deLara. And Words Can Hurt Forever: How to Protect
Adolescents from Bullying, Harassment, and Emotional Violence (NY: The Free
Press, 2002).
J. Garbarino Raising Children in a Socially Toxic Environment.
(San Francisco: Jossey28
Bass Publishers, 1995).
28
THERAPEUTIC INTERVENTIONS WITH CHILDREN WHO HAVE
EXPERIENCED ABUSE
Lucy Berliner1
1
Harborview Center for Sexual Assault & Traumatic Stress, USA
Child maltreatment has multiple causes and effects. Responding effectively
to child maltreatment situations usually requires a range of interventions
addressing the specific problems and needs of the family and child. This
presentation will discuss an approach that triages safety conditions to
first priority, and distinguishes accountability and clinical interventions
as part of the overall response. Proven clinical interventions for children
and families will be reviewed and treatment for the impact of maltreatment
on children will be highlighted. The major point will be that we now have
enough knowledge to apply evidence based clinical interventions that will
make families safer and promote children’s recovery.
29
29
P8
P9
DIALOGUES BETWEEN FAMILIES AND MULTI-HELPER NETWORKS IN WORRYING
SITUATIONS
Tom Erik Arnkil1
1
Stakes, Finland
The everyday life of family members is comprehensive, whereas the professional helping system is
sectored. In clearly defined (or definable) problems the interaction between families and the
professional system works well. Also co-operation within the professional system runs smoothly.
However, dealing with diffuse problems that cannot be “sliced” neatly out of the comprehensive
everyday life, or multi-faceted difficulties that cut across the professional division of tasks, may
send the professional system into complex interactions. In worrying situations - and child abuse
and neglect certainly are such - the professional system is especially vulnerable for muddles: The
professional system readily replicates the family interaction patterns it is dealing with.
Sectored service system,
specialised professions
Comprehensive everyday life
Diagram 1: Sectored professional system encountering everyday-life.
Professional’s worries are anticipations of their own diminishing possibilities of being helpful within
the resource network available. Emotions “recapitulate” the network constantly, putting out
feelers to “assess” what is happening to the child and my possibilities to help. Different
professionals have different basic tasks and different contacts to the child and the family and
other parts of the child’s private network. Each professional has special knowledge from within
their relationships, and their worries differ consequently.
Professional’s varying subjective worries concerning children and adolescents can be depicted in a
diagram:
(1)
No
worry.
(2)
Feelings of
slight worry
or wonder
now and
then; strong
confidence
in one’s own
possibilities
to support.
(3)
(4)
(5)
Repeated
Worry groMarked
thoughts of
wing; confiworry, own
worry and
dence in
resources
wonder;
own possirunning dry.
confidence
bilities
Clearly
in own
diminishing.
felt need
possibilities.
Wish for
for extra
Thoughts of extra supsupporters
a need for
porters and and controladditional
controllers.
lers.
resources.
SMALL WORRY
GREY ZONE
(6)
(7)
Constant
Worry
strong worvery deep
ry; child
and strong;
in danger.
child in
Own means
immediate
exhausted. danger. Own
Additional
means
resources
exhausted.
and control- change in
lers
the child’s
needed
situation
immediately
needed
immediately
GREAT WORRY
30and adolescents
Diagram 2: Professionals’ zones of worry encountering children
30
Anticipation Dialogues is a set of methods designed for clarifying situations in the grey zone of
worry. Connected persons are invited to “recall the future”, i.e. to make thought experiments
on a more satisfactory near future and to “reconstruct” the path leading to it. This is made in
facilitated network gatherings where talking and listening are separated. The participants - first
the family & priovate network members, then the professionals - reflect aloud one by one
while all others listen and dwell in their inner dialogues.
Variations of Anticipation Dialogues are applied also in zones of lesser worry: People gather to
plan co-operation in communities, schools, etc.
Recalling the future supports
- polyphony (all the important voices that have to be heard and made to echo in each other)
- plausible optimisim (every stakeholder’s hopes and worries about the future - heard and
listened to by everyone); thus enhancing
- personal commitment (everyone can see their own actions and interests in joint activity)
- co-ordination (a personal perspective for each actor: how do I connect to the whole
through my actions).
Conditions for co-operation:
- No common definitions of the problem - because there are no common problems.
Each one has his/her own problem - and they connect in one way or the other
- Talk about subjective worries. Problem talk defines characteristics (in others) - worry talk
deals with subjective anticipations.
- Each participant talks only about (and “from”) their own point of view - because that is the
only point of departure each person has.
Own points of view are enriched by others’ points of view.
- The present is approached from the future, because the hopes and fears about the future
are already present.
Hopes lead the way, worries and acts lessens them point out problems to solve.
- Talking and listening are separated in order to make room for inner dialogues and enhance
possibilities to depart from monologic “single alternatives”.
Intervening and commenting are curbed, so that each and everyone would have the patience
to listen to others and their own internal debates.
- In stead of “ideological consensus” co-ordination of acts is sought after.
The dialogue is facilitated by “network consultants”, thus freeing the participants from
controlling the social situation. The facilitators only ask questions and take (public) notes. Their
task is to avoid slipping into a “more-capable-problem-solver” position - which is readily offered
in “grey zone” situations.. The facilitators are only solving problems of dialogue, not those of
the “case”.
These “rules” aim at curbing “isomorphic” developments where the problematic interaction
dealt with takes over the interaction trying to deal with it. (Empathy is central for mutual
understanding, but also the channel through which the professionals and the clients may
become so alike in their modes of interaction that alternatives of action are lost.)
31
31
P 10
WHAT HAVE WE LEARNT IN THE LAST 40 YEARS
Kim Oates1
1
The Children’s Hospital at Westmead, Australia
Although history confirms that abuse, neglect and sexual exploitation of children
has always been present, it is only in the last 60 years, and particularly the last 40
years, that it has been more widely recognised by the professions and the public.
This presentation will review 20 of the most influential papers in the field of child
abuse. The papers were chosen from a survey of leaders in the field and the
number of times the papers had been cited in the literature. They range from
John Caffey’s 1946 paper “Multiple Fractures in the Long Bones of Infants Suffering
from Chronic Subdural Haematoma”, through to Kathy Spatz Widdom’s 1989 paper
“Does Violence Beget Violence”. These papers show some of the key turning
points in our awareness of abuse, such as the importance of understanding the
developmental needs of children, the emerging awareness of sexual abuse, the
importance of evaluating treatment programs, the value of using rigorous research
methodology, the understanding of the dynamics behind some forms of abusive
behaviour and the long-term consequences of abuse. The papers show how our
understanding of abuse has become more sophisticated over the years and also
show just how complex and multifaceted the problem can be. More recent papers
have not been included, as it is too early to judge how much influence they have
had in further developing our understanding.
P 11
INTERSECTORAL APROACH TO CHILD ABUSE PREVENTION WORLD-WIDE
Marcellina Mian1
1
The Hospital for Sick Children, Canada
For the last few years ISPCAN and the World Health Organizations have been
collaborating in the production of guidelines to serve as a template for
various communities & disciplines who wish to implement or improve their
approach to the prevention of child abuse in their context. The tool that
is being developed, and has already gone through one review process by
multidisciplinary experts from many nations, is intended to be child-centred, rights and
evidence based as well as culturally sensitive. The guidelines rely on available research
or best practice, depending on the best level of evidence. The tool is divided into 2
major parts: the CORE, in which the rationale, underlying principles and all
multidisciplinary practices are provided, and then Sector specific sections for the
Health, Social and Legal Sectors. In the Health section, physical and mental health are
included. The Legal also includes law enforcement professionals. This presentation will
provide an overview of how the tool was conceived its developed and the current
outline. Suggestions from the audience will be gladly entertained. A copy of the full
text of these guidelines can be obtained through the Member site on the ISPCAN web
page (www.ispcan.org) for ISPCAN members or by contacting me directly at
32
[email protected].
32
Workshopabstrakt / Workshop abstracts
WP 1
PRÆSENTATION AF EN VIDEOFILM OM: DEN NØDVENDIGE SAMTALE.
SAMTALE MED FORÆLDRE OM BEKYMRING FOR DERES BARN.
Mariann Hedin1
1
Frederiksborg Amts Børnerådgivning, Danmark
“Den nødvendige samtale” er en samtale, der skal finde sted mellem
fagpersoner og forældre, når de professionelle er så bekymrede for barnets
udvikling, at det er nødvendigt at underrette de sociale myndigheder. Det er en
samtale, som rummer komplicerede problemstillinger og mange dilemmaer.
Formålet med filmen er at nedbryde barrierer for underretning og fremme dialog
og samarbejde med forældre. Det overordnede formål er en tidligere og bedre
indsats. Filmen og det medfølgende teksthæfte er ment som et arbejdsredskab
og henvender sig til professionelle i de pædagogiske, sundhedsmæssige, sociale
og psykologiske faggrupper.
Filmen består af to konstruerede cases med hver sin problemstilling. Samtalerne
er instruerede og delvist improviserede og er en invitation til at reflektere over,
hvordan man selv ville gribe en sådan situation an. Vi har valgt at fokusere på
optakten til samtalen, selve samtalen og den aftale, som samtalen afsluttes
med.
Filmens længde er 44 min.
Idé: Frederiksborg Amts Børneråd-givning, Danmark [email protected] ved
Mariann Hedin, Anne Dissing, Mariann Rugård Jensen.
Tilrettelæggelse og instruktion Orla Fokdal. FOKDAL FILM.
33
33
WP 2
PROCESSEN FRÅN “ICKE BEHANDLINGSBAR” MOT EN POSITIV
PERSONLIGHETSUTVECKLING - METODUTVECKLING PÅ ETT
BEHANDLINGSHEM FÖR ALLVARLIGT STÖRDA OCH TRAUMATISERADE
UNGDOMAR.
Christine Román1
1
Roslagens Elevhem AB, Sverige
Roslagens Elevhem är ett behandlingshem för allvarligt störda och traumatiserade
ungdomar från 12 år. Deras uppväxtvillkor har präglats av svår försummelse, våld
och fysiska övergrepp och många har utsatts för sexuella övergrepp, inte sällan
med sadistiska inslag. Familjerna har ofta en historia flera generationer tillbaka av
utanförskap, kriminalitet, fattigdom, missbruk, psykisk störning och övergrepp.
När ungdomarna kommer till oss har de oftast en mängd misslyckade
behandlingsinsatser och placeringar bakom sig. De uppvisar ett kraftfullt destruktivt
agerande och/eller andra symptom som skrämmer omgivningen, ofta sexuellt och
våldsamt. De saknar tillit, ord och reflektionsförmåga.
Behandlingsarbetet vilar på en psykodynamisk, objektrelations-teoretisk
grundsyn. Ambitionen är att inte ge upp och låta ungdomarna straffa ut sig och
därmed möjliggöra anknytning, en positiv personlighetsutveckling och
socialiseringsprocess. Behandlingen består av processorienterad miljöterapi,
individualpsykoterapi, föräldraarbete samt en integrerad pedagogisk verksamhet.
Metodutveckling pågår med kompletterande kognitivbeteende-terapeutiska och
andra tekniker för specifika problemområden såsom A.R.T. med social
färdighetsträning, ilskekontroll och moralträning; förövarproblematik;
riskbedömning och behandlingsplanering; empatiträning; traumatisering vid våld.
34
34
WP 3
“EN GÅNG NÄR LISA VAR LITEN…”
Bengt Söderström1, Miriam Almebäck1
1
BUP Mottagning Vasa, Sverige
Ett stort antal barn hade utsatts för sexuella övergrepp av en personal på deras
daghem. Tiden efter avslöjandet hade olika stödinsatser riktade till personal och
föräldrar erbjudits. Få barn hade fått egen professionell hjälp och det rådde
osäkerhet om vilka barn som skulle erbjudas det.
Mottagning Vasa har som uppdrag att erbjuda konsultationer till övriga
barnpsykiatriska öppenvårdsmottagningar i Stockholms län samt behandling,
framförallt i grupp, som komplement till deras utbud. Vår insats blev att erbjuda
alla som så önskade att komma med sina utsatta barn på två grupptillfällen. Det
blev två grupper med sammanlagt 13 deltagare. Vi utformade en modell där vi
försökte klargöra och prata om det som hänt på ett rättframt sätt och befästa
det genom att låta barnen få göra en egen bok om vad de varit med om. Syftet
var att förebygga symtomutveckling och/eller bidra till symtomlindring samt ge
underlag för bedömning av vilka barn som behöver ytterligare terapeutisk hjälp.
Föräldrarna satt med och kunde se hur vi pratade med och bemötte barnen.
Vi redovisar denna gruppmodell, nödvändiga förberedelser och teoretiska
överväganden. Vi visar också med exempel hur det konkreta arbetet och
böckerna såg ut. Resultatet av en uppföljning med telefonintervjuer presenteras.
Åhörarna inbjuds att diskutera modellen och utbyta eventuella idéer om hur
arbetssättet kan utvecklas vidare.
35
35
WP 4
SEXUAL ABUSE OF CHILDREN TAKEN INTO CARE – HOW DO WE
PREVENT IT, AND WHAT ACTIONS DO WE TAKE IF IT HAPPENS?
Geert Joergensen1
1
LOS – The National Organisation of Residental Homes and Special Schools,
Denmark
In the beginning of April 2004 LOS – The National Organisation of Residental
Homes and Special Schools releases a guideline for all persons working with
children and young people taken into care in foster homes, residental care or
institutions. In the following I will use the phrase children, although I talk of both
children and young people.
Sexual abuse of children arise a feeling of disgust in most people. When this
abuse is even committed by persons given the responsibility to take care of
these children, that maybe is taken into care because of sexual abuse in the
family, it not only arises disgust but often also indignation and powerlessness.
Furthermore it’s a general knowledge among social workers, that an increased
number of both offenders and victims among children are taken into care.
A concrete case of sexual abuse, in the autumn 2003 led LOS to decide to turn
an increased attention on the subject. First LOS held a national conference in
November 2003 in Odense trying to enlighten various areas of the problem. With
a starting point in the conference LOS afterwards worked out a guideline for all
persons working with children taken into care – from the responsible local
authorities and social workers to foster families, residential homes, institutions,
and so on.
The guideline was developed in cooperation with Save the Child Denmark, and a
working group was established also representing The National Committee for the
Protection of Children, Project Janus, a project for young abusers, and the
leader of a familiy based residential home for abused girls.
The guideline is distributed in the beginning of April 2004 and is send to all
institutions, residental homes, foster care unions and local and county
authorities. In addition the guideline is placed on the website of LOS, www.los.dk
for free download.
In the workshop I’ll discuss the experiences up to now concerning sexual abuse
on children taken into care, actions when the suspicion arise and the responsibility
of local authorities and the supervisor.
I will bring a copy of the guideline (In Danish) for the participants of the
workshop.
36
36
WP 5
ALLEGED SEXUAL ABUSE AT A DAY CARE CENTER: IMPACT ON
PARENTS
Grete Dyb1, Are Holen, Alan M. Steinberg, Ned Rodriguez, Robert S. Pynoos
1
Norwegian University of Science and Technology, Norway
Objective: This report describes the cascade of stressful events and secondary
life changes experienced by parents in a case of alleged sexual abuse at a daycare program. The study evaluated parents’ Posttraumatic Stress Disorder
(PTSD) symptoms and general psychological responses to the stressful events 4
years after the alleged abuse, and explored predictive factors of parental
distress.
Methods: A total of 39 parents were interviewed about stressful events, life
changes and social support. Current distress reactions, psychological wellbeing,
and locus of control were assessed with a battery of standardized measures.
Results: Hearing about the sexual abuse, testifying in court, hearing the verdict
and being exposed in media reports were all rated by the parents as distressing
events. The majority of the parents experienced secondary life changes after
the alleged sexual abuse. Four years after the alleged sexual abuse, one-third
of the parents reported a high level of PTSD Intrusive symptoms and one-fourth
reported a high level of PTSD Avoidance symptoms. There was a significant
positive correlation between a measure of psychological wellbeing and PTSD.
Secondary life changes and locus of control significantly predicted PTSD.
Conclusion: This study demonstrates that the alleged sexual abuse of children
in day care and the resulting events in the legal system and the media constitute
significant and chronic stressors in the lives of the children’s parents. These
findings underscore the need to expand the focus of trauma-related sequelae
from the child victim to their parents and family.
37
37
WP 6
BARN SOM BEVITTNAR OCH UPPLEVER VÅLD I HEMMET. ATT MÖTA OCH ARBETA
MED BARNEN PÅ KRISCENTRUM FÖR VÅLDSUTSATTA KVINNOR OCH DERAS BARN I
MALMÖ.
Agneta Frick1
1
Kriscentrum Malmö Kommun, Sverige
Malmö Kommun antog ett handlingsprogram för våld mot kvinnor och deras barn hösten
1999. Bakgrunden var flera lokala initiativ och undersökningar som visat på att stöd och
skydd till våldsutsatta kvinnor och deras barn inte var tillfredsställande. Utifrån antalet
polisanmälningar bedömdes cirka 3000 kvinnor i Malmö vara utsatta för våld i nära
relationer. En kartläggning visade också att samverkan mellan myndigheter var nästan
obefintlig samt att barnens utsatthet glömdes bort och negligerades. Komitten mot
barnmisshandel indikerar på att ungefär 10% av alla barn upplever våld i hemmet någon
gång och cirka 5% upplever det ofta.
För att utveckla programmet bildades en arbetsgrupp med representanter från socialtjänst,
polis, åklagare, kriminalvård, sjukvård, psykiatrin, skolan samt frivilligorganisationer.
Den första åtgärden i programmet var att i december 2000 starta ett Kriscentrum för
våldsutsatta kvinnor och deras barn.
Uppdraget är att ge kvinnor och barn professionellt skydd dygnet runt, akut krishjälp,
psykosocialt stöd och praktisk hjälp i kontakt med andra myndigheter, ge barnen optimala
förutsättningar att bli sedda och berätta sina upplevelser utifrån ålder mognad och behov
samt stödja och stärka föräldrarollen för kvinnan. Arbetet ska ske i samverkan med andra
berörda verksamheter.
I verksamheten pågår ständiga metod och teoridiskussioner utifrån forskning och ny
kunskap inom området samt gemensamma utbildningar inom samverkansgruppen.
Barnarbetet: Målsättningen med arbetet är att hjälpa barnen bearbeta upplevelserna av
våldet de bevittnat samt i vissa fall också själv utsatts för.
Först måste mamman ge barnet tillåtelse att släppa på familjehemligheten för att vi
därefter ska kunna erbjuda enskilda samtal och möjlighet att deltaga i barngrupp.
Personalen på Kriscentrum är ofta den första vuxna utanför familjen som barnen berättar
om sina upplevelser för. I barngrupperna träffar de andra barn med samma upplevelser av
våld och hot och det har en läkande effekt att upptäcka att man inte är ensam.
Under året har en Fil.dr och forskare, Maria Bangura Arvidsson, från Lunds Socialhögskola
gjort en rapport utifrån barnens perspektiv, Att vara barn på kriscentrum. Där framkommer
bland annat hur viktigt det är för barnen att vara i trygghet med sin mamma, att det är
betydelsefullt med all uppmärksamhet från andra kvinnor samt från personalen men också
längtan att återgå till ett vanligt liv med kompisar och skolan.
Många av barnen är föremål för polisutredning och polisförhören genomförs så fort det är
möjligt. Kriscentrum är ett tryggt ställe för barnen att vara på och detta har visat sig att
förhören blir lättare att genomföra och barnen kan bearbeta sina upplevelser efteråt med
personalen.
Under våren öppnar vi ett Barnkriscentrum för barn som utsatts för sexuella övergrepp och
eller fysisk misshandel. Det kommer att finnas socionomer, polis och sjukvård BUP inom
samma verksamhet för att barnperspektivet ska tillgodoses på bästa sätt. Socionomerna
ska verka som samordnare under den svåra process som barnet måste igenom.
38
38
WP 7
GRUPPBEHANDLING FÖR MISSHANDLADE MAMMOR/KVINNOR - EN
HALVÖPPNA GRUPP PÅ BARN OCH UNGDOMSPSYKIATRISKA
MOTTAGNINGEN BÅGEN I STOCKHOLM
Jan-Erik Gustavsson1, Eva Zachrison1
1
BUP Bågen, Sverige
BUP Bågen är en mottagning för barn och ungdomar som upplevt familjevåld
vanligen att de sett och eller hört mammor blivit misshandlade. Många barn blir
traumatiserade av sina upplevelser och kan utveckla mer eller mindre allvarliga
symptom.
På Bågen får barnen hjälp att på olika sätt bearbeta sina upplevelser, individuellt
eller i grupp. Barnens mammor får hjälp och stöd och vår ambition är att också
inbegripa papporna. Inom denna ram har vi sedan januari –99 haft en halvöppen
grupp för misshandlade mammor. Gruppterapeuter har varit socionom och
psykoterapeut Eva Zachrison och som psykolog Jan-Eric Gustavsson.
I denna samtalsgrupp som träffas regelbundet varje vecka om 1½ timme får
mammorna/kvinnorna möjlighet att gå i samtalsgrupp maximalt 2 år och man
bestämmer sig för 1 termin i taget. Bakgrunden till denna möjlighet för
misshandlade kvinnor/mammor att arbeta med sina traumatiska upplevelser har
varit att vi vill ge de här mammorna ett utrymme för att arbeta - reflektivt med
sina tankar och känslor kring det som de upplevt.
Innan mammorna kommer till gruppen har de flesta gått i någon form av
behandling i Bågens regi. Ofta har det varit i en korttidsgrupp parallellt med en
barngrupp men även individuellt i ett krisarbete efter en familjevåldshändelse. De
mammor/kvinnor som kommer till gruppen kan beskrivas som traumatiserade.
De saknar tillit, trygghet och är psykiskt och socialt sköra med dåligt fungerande
nätverk. Man kan uttrycka det som att dessa mammor/kvinnor har drabbats av
en sorts perforering i det skyddande höljet som ska finnas runt varje människa,
eller med ett annat uttryck, att mammorna/kvinnorna hamnat i ett psykiskt
sammanbrott av den egna livscykeln. Sammanfattningsvis kan sägas att
psykiska höljet har blivit fullt av hål till följd av sinnesintryck, borttryckande och
kroppsmärkning.
I vår presentation kommer vi att tala om den metod som vi arbetat fram, om
det praktiska arbetet i gruppen med exempel och beskrivningar kring teman,
svårigheter och möjligheter med en sådan grupp. Vi reflekterar kring
grupprocessen och hur den påverkas av individerna, oss terapeuter och de olika
teman som kommer upp i gruppen. Vi kommer också att säga något kort om
den uppföljning som vi gjort på de mammor/kvinnor som avslutat gruppen.
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39
WP 8
PROJEKT “PAPPOR I HÄKTE”, BARN- OCH UNGDOMSPSYKIATRISKA
MOTTAGNINGEN BÅGEN
Stefan Lindberg1, Jan-Erik Gustavsson1, Inger Ekbom1
1
BUP Bågen, Sverige
BUP Bågen är en mottagning för barn och ungdomar som upplevt familjevåld, vanligen att
de sett och/eller hört sina mammor bli misshandlade. Många barn blir traumatiserade av
sina upplevelser och kan utveckla mer eller mindre allvarliga symtom.
På Bågen får barnen hjälp att på olika sätt bearbeta sina upplevelser, individuellt eller i
grupp. Även barnens mammor får hjälp och stöd. Vår ambition att också inbegripa
papporna är svår att uppnå. Många pappor känner sig utpekade som förövare då kvinnan
först fått ge sin version av vad som hänt och de befarar att de skall vara dömda på förhand
i våra ögon.
Vårt förhållningssätt är att vi försöker se det som hänt med barnens ögon och undvika att ta
ställning i föräldrarnas konflikt. För ett barn är det inte viktigt hur en konflikt eskalerat till
en misshandel utan det viktiga är att man som barn är fullständigt utlämnad till de vuxna
och den skräck och förtvivlan dessa utsätter en för. Föräldrarna skall efter bästa förmåga
skydda sina barn från allt ont och i en misshandelssituation misslyckas de med detta. Först
och främst är det pappan som misslyckas då han slår och även mamman misslyckas då hon
inte förmår skydda sitt barn. Även om båda föräldrarna ur barnets perspektiv misslyckas är
det dock alltid den som slår som bär ansvaret.
Många av barnens pappor känner mer eller mindre skuld för vad de utsatt sina barn för. Vi
tror att blott ett fåtal är helt oförstående och oberörda av sina barns öde och denna
minoritet har kanske de mest fasansfulla barndomsupplevelserna bakom sig. Skuld och
skam är känslor svåra att leva med och därför försöker människor bli kvitt dessa känslor.
Många män förtränger det som hänt och säger att det aldrig hänt. Andra försöker
bagatellisera sin roll i dramat och uppförstorar kvinnans roll i syfte att fördela skulden. De
säger att de blivit provocerade och tappat kontrollen.
Svårigheterna, som ovan beskrivits, att komma till tals med papporna kring barnens behov
har gett oss mycket huvudbry. Hur skall vi tidigt på få kontakt med barnens pappor, innan
förnekanden och bagatelliseringar tar över? En man ur vår första pappagrupp ledde oss in
på ett spår. Han berättade om hur han suttit häktad och hur det blivit en slags vändpunkt.
Han hade känt det som hans värld hade rasat, men med häktningstiden i backspegeln
kunde han se att häktningen också inneburit något gott. Misshandeln, ett beteende som han
i likhet med många andra män var skamsen över, hade blivit stoppad och han hade fått tid
att tänka efter. Vad han hade saknat mest var någon att prata med om sitt beteende och
om sin familj.
Den här mannens berättelse och gensvaret han fick från de andra männen ledde vårt
tänkande in på att i samverkan med polis och åklagare starta en uppsökande verksamhet
bland häktade män misstänkta för kvinnofridsbrott och med barn 0-17 år i hemmet. Här gör
vi ingen skillnad på pappor och styvpappor. Samtalen i häktet har som syfte att motivera
männen för vårt erbjudande om behandling i grupp. Innan en man får börja i grupp
kontaktar vi den misshandlade kvinnan för att få höra även hennes version och utröna om
barnet/barnen har ett behandlingsbehov. Projektet startade
40i september 2002.
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WP 9
SOCIAL WELFARE SERVICES PROVIDED FOR PHYSICALLY ABUSED
CHILDREN IN SWEDEN. INTERVENTIONS AT THE ABUSE INCIDENT AND
FOUR YEARS LATER.
Charlotta Lindell1
1
BUP Elefanten Linköping University, Sweden
A group of children that have been physically abused by their parent or equivalent
caretaker, that has been reported to the police, has been followed through their
social files (N=113). Of interest is what kind of interventions that are provided the
physically abused children and their families when the abuse incident is revealed
but also what kind of interventions that follow an investigation at the social welfare
department and what governs the receiving of different interventions. The children’s
social files are studied as well 4 years after the abuse incident and an analysis
concerning risk factors impact on social welfare duration is completed and discussed.
As many as 81% of the families had had interventions from the social services
prior to the abuse incident and 44% of the children had been previously reported
as suspected abuse victims. Thirty-two percent of the children were at the abuse
incident placed in foster home. This was significantly more common for injured and
immigrant children and for girls. Foster home placement, referrals to child and
adolescent psychiatric services and the receiving of a supportive contact were the
three most common interventions following the investigation. And there were on
the average 1.3 interventions per child while there were no interventions in 25% of
the cases.
Four years after the abuse incident studied 69 children (61%) were still receiving
social welfare for different reasons. This primarily concerned children whose families
had been the subjects for interventions prior to the abuse incident and children of
mentally ill mothers. There had been new reports on suspected abuse or neglect
regarding 80% of the children and 38% of the parents had due to this been
reported to the police. There were 149 additional interventions opened and the
children were in mean receiving 3.2 interventions from the social welfare department
at follow-up. There were major social problems surrounding these families as
substance abuse and mental illness was common.
Finally, the effectiveness of social welfare interventions is discussed along with the
chronic state physically abused children are found in, regarding social welfare
dependence.
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41
WP 10
A 16 YEAR FOLLOW-UP OF CHILDREN BORN AT PSYCHOSOCIAL RISK
Carl Göran Svedin1, Marie Wadsby2, Gunilla Sydsjö3
1
Dep. of child and adolescent psychiatry, Lund University, Sweden
2
Dep. of child and adolescent psychiatry, University of Linköping, Sweden
3
Dep. of obstetrics and gynaecology, University of Linköping, Sweden
Of the 1575 pregnant women registered at the public Antenatal Health Care Service in the city
of Linköping, Sweden during 1983, an index-group of 78 women were identified who met
specific well-defined psychosocial risk-criteria related to drug addiction, mental insufficiency,
and particular social circumstances of possible relevance to problems of pregnancy and early
child development. Seventy-eight pregnant women who did not meet the inclusion criteria
were used as a reference group. The present study was a 16-year follow up in which 43 of the
original index children and 63 of the original reference children were examined on indices of
mental health, and the presence of child abuse.
Their mental health was assessed with Child Behaviour Checklist (CBCL) completed by the
mothers and Youth Self Report (YSR) completed by the adolescents. The incidence of child
abuse and Social Welfare interventions was obtained from Social Welfare records.
The index mothers gave their children higher scored in total and on all subscales on the CBCL.
According to the mothers scoring of their children’s’ health on CBCL there was a significant
difference between the index-group and the reference group in the total score (p=.019) and
on the subscale “externalising” (p=.035).
The index children themselves scored higher on almost all scales on YSR. The index children
displayed a significantly poorer health according to the self-questionnaire YSR on total score
(p=.011). The total score differed significantly between the boys in the two groups (p=.019).
No significant differences were found between the girls in the two groups. In both groups girls
scored higher than boys.
The contacts for the Social Welfare Authority were examined for 116 mothers (54 index and
62 reference cases) of those originally included in the study.
Voluntary foster care ant voluntary placement at an institution according to the Swedish Social
Service Act had been implemented for 18 children in the index group and while 12 children
were placed outside the home according to the Swedish Care of Young People Act. In all 25 or
33% had sometime during their growth being placed outside the home.
By the age of eight 16 children had been investigated for the suspicion of child physical abuse
and additional 7 investigations had been done at the age of 16 rending in total of 20 children
being investigated during their first 16 years of life, or 26%. In the reference group only one
child during the age between 8-12 went through the same investigation.
Corresponding figures of children in suspected child sexual abuse investigations were 2 before
the age of 8 and another four up to the age of 16, rending a total of 6 investigations or 8% of
all index children. No child in the reference group was subject for a child sexual abuse
investigation.
In summery there was only a slightly elevated risk for mental ill health, especially among the
boys, while the Odds Ratio for being placed outside the home or subject for child abuse
investigations were high.
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42
WP 11
OFFICIAL AND SELF-REPORTED CHILDHOOD ABUSE AND ADULT
CRIME OF YOUNG OFFENDERS
Jaana Haapasalo1
1
Department of Education, City of Heinola, Finland
The purpose of the study was to predict adult criminal behavior using both
self-report and official data on childhood maltreatment and criminality in a
sample of 89 young male prison inmates. Data on childhood maltreatment
were gathered from interviews and files. Criminality data were collected using
a 33-item Self-Reported Criminality Scale and official criminal records. Overall,
the offenders convicted of violent vs. non-violent crimes did not differ in selfreported criminality. Unlike criminal record data, self-reported criminality was
predicted by childhood maltreatment. The findings provided evidence of
consistency between self-report and official criminal record data on violent
criminality. In all, the findings showed that physically abused children tend to
report having committed violent crime to a great extent in young adulthood.
BARNETS RÄTTSSKYDD I BROTTMÅL
Marianne Ny1
1
Åklagarmyndighetern i Malmö, Sverige
Hur skyddas minderåriga brottsoffers intressen under brottsutredning
(förundersökning) och rättegång i svensk lagstiftning? Vilka
konsekvenser har de valda lösningarna for barnet, dess anhöriga och
effektiviteten i brottsutredningen?
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43
WP 12
WP 13
MANAGEMENT AND PAEDIATRIC FOLLOW-UP OF PHYSICALLY ABUSED CHILDREN
Sarimari Tupola1, Pentti Kallio1, Johanna Hannikainen1, Satu Kivitie-Kallio1
1
Hospital for Children and Adolescents, Helsinki University, Finland
By recognizing and reporting child physical abuse, the cycle of abuse can be stopped in 90% of
the cases. But if abuse remain unrecognized, the child is at 30% risk for additional injury and
at 10% risk of death. Moreover, many abused children have signs of other forms of maltreatment.
In Finland, The National Research and Development Centre for Welfare and Health (STAKES)
is an expert agency under the Ministry of Social Affairs and Health. In May 2003 STAKES
expert group published national guidelines for treatment of child physical abuse. According to
the guidelines, all suspected cases should be immediately reported to child welfare personnel,
and, if the child has any injury (e.g bruises), child welfare personnel should report the case to
the police.
In our hospital, we have taken the new national guidelines in our practice. Criteria for inclusion
are: 1) High energy skull injury (skull fractures except parietal fissurae, subdural/intracerebral
bleeding) 2) Possible shaken baby syndrome 3) All fractures in children below 1 year of age,
rib and scapular fractures, and diaphyseal fractures of the humerus in children below 5 years
of age 4) bruises and/or superficial injuries inconsistent with the developmental status of the
child, 5) delineated patterned burns and 5) all cases with inconsistence between injury history
and clinical findings.
Children fulfilling the criteria are admitted to the surgical ward where families meet routinely
child psychiatrist and social worker. Before discharge meeting with child welfare is arranged.
In addition, children and their families visit the paediatrician in social paediatric unit 2-3 weeks
after acute treatment. That visit is as comprehensive as possible with special focus on the
signs of maltreatment. The paediatrician works closely with child psychiatrist and with child
welfare, if needed. Paediatric follow-up is planned individually, but our aim is to meet the child
in every three months during the first year, and after then 1-2 times per year.
Since March 2002 we have seen 44 children younger than 1 year in the paediatric follow-up.
Of them, 34 were infants with fracture(s), 7 were recovering from shaken baby syndrome,
two had bruises and one child suffered from burn injury. Paediatric problems such as poor
weight gain, atopic eczema, feeding and sleeping disturbances were diagnosed in 14 (32%)
patients. No-one of the patients has come to hospital because of suspected re-abuse.
The new national guidelines give protection under the law to child as well as clarify role of
health personnel, child welfare, and police in child abuse cases. Our own treatment protocol
helps us in preventing reabuse, in early recognition of maltreatment, and in giving support to
families in caring their child.
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44
WP 14
NORMAL GENITAL ANATOMY: A STUDY OF NON-ABUSED PRESCHOOL
GIRLS
NORMAL GENITAL ANATOMI: EN STUDIE AV IKKE-MISBRUKTE JENTER
Arne Kristian Myhre1, Kjell Berntzen1, Dag Bratlid2
1
Avd. for barn og unge, St. Olavs Hospital HF, Norge, 2Det medisinske fakultet,
NTNU, Norge
Formål: Formålet med studien var å beskrive den normale genitale variasjon
hos ikke-misbrukte jenter i førskolealderen.
Metode: 195 jenter i alderen 5 til 6 år ble rekruttert til studien etter at totalt
2731 jenter var invitert. Inklusjon var basert på selvseleksjon, hvor foreldre som
ikke mistenkte at barna hadde vært utsatt for overgrep ga informert samtykke
til deltagelse. I tillegg ble andre metoder brukt for å ekskludere mulig misbrukte
jenter samt jenter som hadde vært utsatt for aksidentelle genitale skader.
Genitalanatomien ble undersøkt med kolposkop og kamera, og barna ble
undersøkt i ryggleie med separasjons og traksjonsmetode samt i kne-albue leie.
Resultater: Flere genitale anatomiske forhold samt målinger vedrørende
jomfruhinna og jomfruhinneåpningens diameter er beskrevet og sammenlignet
med tidligere studier. En viktig observasjon var funn av en utoverbrettet bakre
jomfruhinnebrem hos relativt mange piker. Dette funnet kunne hos noen være
vanskelig å skille fra en smal og nærmest manglende bakre jomfruhinnebrem. Et
funn kalt “gaping hymenal orifice”, som tidligere er foreslått som et suspekt funn
i forhold til seksuelle overgrep, var relativt vanlig i studien.
Konklusjon: For å kunne skille mellom jenter med en utoverbrettet bakre
jomfruhinnebrem og jenter med en smal bakre jomfruhinnebrem anbefale vi å
benytte den såkalte “saltvannsmetoden”. Selv om vi nå har normative målinger
av jomfruhinna og dens åpning fra relativt mange jenter, bør slike målinger
benyttes med stor forsiktighet i overgrepsvurderinger.
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45
WP 15
VIOLATING A CHILD‘S BODILY INTEGRITY – CIRCUMCISION IN BOYS
AND GIRLS
Yngve Hofvander1
1
Uppsala University, Sweden
Circumcision (MGM) in boys dates back some 3000 years to old Egypt, the
original motive being obscure. At present there are basically four categories that
undergo MGM – Jews ( about 100000 annually), Moslems ( 15-20 millions),
Africans in traditional settings ( about 9 millions) and Anglo-Saxan boys/USA (
about 1 million). The claimed motive varies as will be discussed. Immediate
complication rates range from 2 – 10 % (or higher in traditional settings), long
term negative effects include physical and psychological suffering. Religious and
“ethnic” “right” to circumcise should be questioned as child cannot express his
will. In all four categories the economic motive is strong as is the tradition of
celebrating with a lavish feast- making it difficult to counteract the phenomenon.
Female circumcision (FGM) is performed on some 100000 girls annually, mainly in
Africa, probably originally in an effort to control female sexual desire and to be able
to get a higher bride price for an “untouched” girl. FGM is also a problem among
African immigrants in Europe although it is forbidden by law in many countries.
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46
WP 16
THE IDENTIFICATION MANAGEMENT OF CHILD SEXUAL ABUSERS AS A
MEANS OF PROTECTING CHILDREN FROM SEXUAL EXPLOITATION
AND ABUSE: MOVING TOWARDS A PUBLIC HEALTH MODEL
Vernon Jones1
1
Red Barnet, Save the Children, Denmark
“Child sexual abuse is seldom the impulsive act that many people seem to
think it is. Child sexual abusers have overcome substantial Internal and
External Impediments, plus the Childs resistance in order to commit a
serious criminal offence. It is important that protective adults and society
in general are aware of this process first described by the American
researcher David Finklehor in the 1980’s. Most sexual offences against
children are never reported to the police or child protection services which
results in a culture of silence and denial with drastic consequences for the
sexually abused child. Society fails to identify child sexual abusers or the
grooming methods they use to manipulate both their victims and potentially
protective adults. Raising awareness via a public health campaign could
alter this dangerous state of affairs.
It is now seen by many commentators and child protection experts that a
Public Health Approach to child sexual abuse should be adopted as a means of
prevention. Projects run by the organization Stop It Now in the USA, UK &
Ireland appear to confirm that this approach has a beneficial effect on
helping to prevent child sexual abuse. Other European countries should
assess the possibility of implementing this approach into their own child
protection strategies.”
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47
WP 17
STORIES TOLD BY THE PERPETRATORS – OF ANY BENEFIT FOR THE
ABUSED CHILD?
Inga Tidefors1
1
Dept. of Psychology, Göteborg University, Sweden
This presentation concerns a part of my dissertation “From childhood to crime – 20
men convicted of sexual abuse of 38 children”, in which 20 convicted child molesters
were interviewed in depth and tested with a number of psychological instruments
including a projective test. The interviews revealed the men’s biographic. They
concerned the time period from childhood to the revelation of the committed
preparations. The narratives include information about how the abuse started, the
men’s feelings before, during, and after the abuse, the images they had of the
child and the ongoing abuse, and how the abuse ended. The men had a temporary
mental breakdown and exploited a non-existing maturity in the children. Some of
the men did not recognize the child as a child, but as an equal lover whereas some
thought that the child was given something that it wanted. They made up a game
or a make-believe world and were disappointed when it was uncovered. They
missed the child and longed for it. From a sexual perspective, these narratives
were filled with more lust and life compared to anything the men had previously
talked about. All this is difficult to deal with for the abused child and not easy to talk
about. If the perpetrator is a parent, the child is forced to violate the incest-taboo.
This may lead to restrictions of what “is allowed” to talk about and perhaps a
therapist “forgets” asking. How then does the incest-taboo influence what is asked
or left out? Is the therapist able to feel and think beyond her or his own taboos?
More profound understanding of concrete abusive actions directed towards children
is of value to adults helping exposed children dealing with experiences of sexual
abuse.
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48
WP 18
SKYDDSSAMTAL MED DEN MISSTÄNKTE FÖRÖVAREN SOM
FÖREBYGGANDE ARBETE
Paula Heljestrand1, Christina Holmqvist1
1
Hans och Greta mottagningen, BUP, Sverige
Hans och Greta mottagningen i Örebro öppnade i september 2002.
Mottagningen är Barn och ungdomspsykiatrins specialistmottagning för arbete
mot sexuella övergrepp.
På mottagningen arbetar två socionomer och två psykologer med
psykoterapeutkompetens, samt en barnpsykiater, även han med
psykoterapilegitimation.
Mottagningen har hela Örebro län som sitt upptagningsområde.
Behandlingsmodellen som vi fortsätter att utveckla har följande grunder.
FN: s barnkonvention och etiska ställningstaganden om konsekvensetik och
autonomiskapande samt att vi arbetar systemiskt. Det systemiska betyder att vi
involverar nätverket i den omfattningen som patienten och dennes
vårdnadshavare bedömer lämpligt.
Arbetsmodellen består av följande delar.
• Nätverksinriktning
• Multimodalitet
• Krishantering
• Anonymitet – anmälningsplikt
• Neutralitet – polisanmälan
• Processorienterat
• Skyddssamtal
• Traumabehandling
Vår mottagning kännetecknas av att vi
är en krismottagning,
inte har väntetider
arbetar aktivt med skyddssamtal som en förutsättning för behandling
Vår Workshop kommer att handla om skyddssamtal och våra erfarenheter av
dessa. Dessutom presenteras statistik från första året.
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49
WP 19
CHILDREN’S SAFETYSKILLS PROGRAMME
Kaija Lajunen1, Kaija Kemppainen2
1
The Family Guidance Clinic of Helsinki, 2Stakes, Finland
Children’s SafetySkills is a Finnish preventive programme against violence and
sexual abuse of children. The programme aims to prevent physical,
psychological and sexual child abuse and neglect. Through professional
counselling in peer groups children are encouraged to protect themselves and
their capabilities to take action in confusing and threatening situations are
increased.
Preventing child abuse can’t, however, be entirely based on educating children. All
preventing actions must rely on adults’ (parents as well as authorities) increasing
understanding, awareness and ability to advance well-being and safety among
children.
Children’s SafetySkills programme was first developed in Kotka, Finland in 1991
as a multiprofessional project. Since 2002 the project has been carried on cooperatively with Kotka, Turku and Jyväskylä. Helsinki has joined the project later.
Experiences from practical work in these regions had raised a need for
developing a preventive programme. These experiences led to development of
Children’s SafetySkills programme that is carried out in collaboration with school,
daycare, church, treatment centers, youth activity groups and other institutions
involving children and their families.
Feedback from children, parents and other educators from different regions and
child groups have been unanimously positive and encouraging. Children have
gained from counselling and adults’ abilities to confront doubts of abuse have
improved. There have been no excessive actions or false revelations. Instead,
parents have insisted on equal counselling on safety issues to all Finnish children
regardless of age.
Four cities involved in Children’s SafetySkills project have set a long-term goal to
include SafetySkills programme in national school curricula and educational
programmes. Finland’s National Research and Development Centre for Welfare
and Health (STAKES) has already started a national project in order to develop
programmes concerning prevention and treatment of child abuse. Children’s
SafetySkills programme functions as a ground model of preventive work in
STAKES’s project.
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50
WP 20
“ATT FÅ MAMMA TILLBAKA”…
Eva Zachrison1, Miriam Almebäck1, Christina Citron1
1
BUP Mottagning Vasa, Sverige
Mottagning Vasa är Stockholms läns landsting specialenhet inom barn- och
ungdomspsykiatrin för behandling och konsultation vid bekräftade eller misstänkta
sexuella övergrepp. Gruppterapi är den huvudsakliga behandlingsformen.
Vi har under många år arbetat med barngrupper där föräldrarna går i en parallell
grupp samtidigt med barnen. Grupperna är traumafokuserade korttidsgrupper
som vilar på psykodynamisk grund med teman och pedagogiska inslag som
hjälpmedel. I dessa sammanhang har vi märkt vikten av de parallella processer
som sker mellan de två grupperna. Frågor vi har ställt oss är: Hur kan vi utnyttja
dem i vår behandling? Vilka processer är viktiga så att barnet kan läka de sår de
varit med om? Vad finns för olika metoder, förhållningssätt eller teman som vi
bör tillvarata? Vi vill gärna dela med oss, diskutera och få synpunkter på det
utifrån ett inslag som vi prövat i en flickgrupp med parallell mammagrupp.
Vår erfaranhet är att när ett barn utsatts för övergrepp av någon närstående
innebär det vanligen också ett brott i anknytningen mellan mor och barn, en “kil”
sätts emellan barnet och mamma. Med erfarenhet av det vi prövat att genom
målning och samtal i de parallella grupperna försöka hjälpa både mammor och
barn att gestalta hur de upplever relationen före, under och efter det sexuella
övergreppet samt hur de önskar att relationen skall se ut i framtiden.
Vi beskriver kort bakgrunden till metodinslaget och delar med oss hur vi tänker. Vi
visar med bilder och ger exempel på hur det terapeutiska arbetet går till.
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WP 21
TVERRFAGLIG SAMARBEID SOM METODE I OVERGREPSSAKER
Aud Karin Bjørn1, Ståle Luther2, Marianne Nordhov Fredriksen3
1
Universitetet I Tromsø, 2Troms Politidistrikt, 3Universitetssykehuset Nordnorge, Norge
Statens Helsetilsyn drev i 2001 og 2002 et landsomfattende kompetanseprosjekt på
fagområdet seksuelle overgrep mot barn. Dette prosjektet ble videreført i 2003 under Sosial
og Helsedirektoratet.
I Helseregion Nord har Universitetet i Tromsø, Avdeling for Barne- og ungdomspsykiatri,
(ABUP) verts- og driftsansvar, prosjektet er i alle 5 helseregionene i Norge, men de drives
på forskjellige måter.
Prosjektet har hatt og har som målsetning å utvikle tverretatlig og tverrfaglig kompetanse
på fagfeltet seksuelle overgrep mot barn, familievold, barnemishandling og alvorlig
omsorgssvikt: dvs både oppdagelse, beskyttelse, utredning/diagnostisering, behandling og
annen støtte til seksuelt misbrukte barn og deres familier.
Nord-Norges-prosjektet satser på bedre støtte til seksuelt misbrukte barn, barn som er
utsatt for eller vitne til familievold/vold i nære relasjoner eller annen barnemishandling/
omsorgssvikt, dette gjennom økning av kunnskap og handlingskompetanse.
Prosjektet er organisert med ett Tverrfaglig sammensatt spisskompetanseteam som gir
ukentlige veiledninger og råd til hjelpeapparatet i regionen i saker der det er mistanker eller
avdekking av seksuelle overgrep eller vold mot barn. Gruppen er sammensatt av
Barnepsykologer, barnelege, barnevern, helsesøstertjeneste, politi, voksenpsykiatri,
krisesenter, sosialtjeneste, voldtektsmottak og senter for forebygging av selvmord.
Prosjektet har registrert og laget statistikk over henvendelsene.
For 2002 som var det første året konsultasjonsteamene var i drift, hadde vi 80 saker med
107 barn involvert.
For 2003 har det vært en økning på 35 % på henvendeler, til 107 saker der ca. 156 barn er
involvert.
Vi har også sett at 30,2 % av overgripere er barn som forgriper seg mot andre barn, noe
som underbygges av forskning. Overgriper er i nært sagt alle tilfeller menn eller unge
gutter. Vi har kun en kvinnelig overgriper i vårt materiale.
Etter at prosjektet kom i gang har det vært en stor økning på avdekking av seksuelle
overgrep og vold mot barn i nord-norge. Noe av grunnen tror vi skyldes det tverrfaglige
samarbeidet som er kommet i gang.
Antal saker fordelt på type problematikk
Type
problematikk
(N)
%
Seksuelle
overgrep
Familievold
Totalt
87
81,3
20
107
18,7
100
52
52
WP 22
TERAPIGRUPPER FOR MENN SOM HAR VÆRT UTSATT FOR SEKSUELLE
OVERGREP I OPPVEKSTEN
Marianne Lind1
1
Støttesenter mot Incest - Oslo, Norge
Incestsenteret for Menn (IFM) i Oslo har de siste to årene organisert
gruppeterapi for sine brukere. To grupper med varighet på ett år er
gjennomført. 13 menn som har vært utsatt for seksuelle overgrep av en
nærstående person i oppveksten, har deltatt. De av mennene som hadde hatt
kontakt med hjelpeapparatet før de startet opp i gruppa, hadde oppgitt andre
grunner enn seksuelle overgrep som årsak. Vanligste grunn var rusmisbruk,
depresjon eller ekteskapsproblemer. Flesteparten av mennene hadde aldri satt
ord på de seksuelle overgrepene før de tok kontakt med IFM. Mennene var i
alderen 20 – 50 år. 50 % hadde vært misbrukt av en kvinne. De fleste oppga
flere enn en overgriper.
Mennenes vanligste problemer i dag oppgis å være gjentagende depresjoner,
alvorlige søvnproblemer, seksuelle problemer, isolasjonsproblemer, dårlige
familierelasjoner og vanskeligheter med nære relasjoner generelt.
Gruppemetoden er gestaltorientert psykoterapi. Terapien hjelper mennene til å
komme bak sitt forsvar og åpne opp for panikk, redsel og sårbarhet. Grovt sett
kan redselen beskrives som en relasjonell angst. I nærkontakt med andre
mennesker, må disse mennene forholde seg til sin egen panikk. Dette er en dyp
redsel for å bli avslørt som verdiløse. Redselen for å bli sviktet eller avvist, bli
misbrukt eller slått, bli gal eller miste kontroll, er det mennene selv kommer frem
med. For å takle sin panikkfølelse bruker mennene strategier som å dissosiere,
numme seg selv, spille roller eller isolere seg. Resultatet er uansett at de trekker
seg fra kontakt.
Ved å fokusere på disse smertefulle temaene, sette ord på dem, dele dem med
andre menn, gjenkjenne seg i andre og få støtte av gruppa, skapes en så trygg
arena at disse mennene våger å komme frem med sin isolasjon og hjelpeløshet.
Til deres store forbauselse gjelder ikke dette bare mannens dype emosjonelle
kontakt med andre, men også en manglende kontakt med seg selv, sine følelser
og sin kropp.
Gruppeterapien fokuserer på det å dele det som er vanskelig og være i kontakt
med egne følelser på samme tid. Mye av tiden blir også brukt til å komme i
kontakt med, bli kjent med og respektere egen kropp, som igjen gjør det mulig
å oppdage og markere egne grenser.
60% av mennene er selv fedre. Følelsesmessig nærhet, fysisk kontakt og
nakenhet er meget vanskelige temaer. Det samme er alle sosiale relasjoner en
forelder må stille opp i som forelder. En mulighet til å bearbeide egen
problematikk vil ha en stor forebyggende effekt og hjelpe disse mennene til å bli
trygge fedre.
53
53
WP 23
CHILDREN’S PERSPECTIVES OF VIOLENCE
- METHODOLOGICAL CHALLENGES OF STUDYING YOUNG CHILDREN’S
NARRATIVES
Inkeri Eskonen1
1
Department of Social Policy and Social Work, University of Tampere, Finland
There have been lots of methodological challenges experienced in ongoing study
about how children exposed to violence in their own homes, talk about violence in
therapeutic groups made up of children exposed to domestic violence. The
paper will argue that we need a holistic approach in studying young children’s
narratives about violence. Holistic approach means that children are taken
seriously as active informants for they have a great deal to tell about violence.
Secondly, it means that research observes the versatility of children’s narration
and that it is sensitive to their scarce words. Thirdly, it is important to reflect how
various corpuses of data are being collected and in what sort of contexts children
are given a chance to generate knowledge about different things. The choice of
research methods may substantially influence the picture that is being generated
about children and childhood. For example, if a child is observed and heard in his
or her natural setting, different things may become central than would in an
interview outside of his or her familiar surroundings, even though the theme
would be the same. Fourthly, it is important to always examine the information
generated by a child in relation to his or her experience world. This can be done
by placing the talk into a wider context.
54
54
WP 24
CHILDREN’S STRATEGIES FOR UNDERSTANDING THEIR FATHER’S
VIOLENCE
Åsa Källström Cater1
1
Örebro Universitet, Sverige
In Sweden most children live in nuclear families with relatively few adults in their
social network, and their parents are important for helping the children understand
their worlds. But if their father has victimised the mother of violence, those that
could protect, comfort and explain are the perpetrator and victim, leaving the
children quite alone with the task of making sense of their experiences from their
own perspectives. Acts of violence within the family might be among the experiences
that for a child demands most attention and processing and might at the same
time be among the experiences that are most difficult for their parents to talk to
them about.
This study focuses on the processes through which children, who have
experienced their father’s violence against their mother, can understand their
own father and his actions within his relationship with the mother related to
possibly complex images, in their families as well as in their society, of fathers
and violence in general.
10 children, aged eight to twelve years and whose mothers had fled the fathers’
violence, participated in open interviews. The analysis shows how negotiations can
be part of children’s strategies for meaning conciliation. Some children seemed to
recognize a direct relation between their own father and violence, but to divide their
conception of fathers in general in relation to violence. Others seemed to target
their negotiation towards their understanding of their own father, so that he, by
different strategies, could be separated from the violence he was attributed. A
third strategy seemed to be constituted by negotiating the understanding of violence,
although less directed at violence in itself than as an expansion of the understanding
of its possible opposite, namely the concept of nice. An expanded understanding
of nice seemed to increase the possibility to classify acts as something else than
violence.
55
55
WP 25
SUPERVISED PARENTHOOD - THE BEST INTEREST OF THE CHILD?
Hannele Forsberg1, Tarja Pösö1
1
Department of Social Policy and Social Work, University of Tampere, Finland
In Finland the court may decide that contact between the non-residential parent
and the children can take place only in supervised circumstances (e.g. because
of the parent’s violence, mental problems, drug addiction or the incapacity to
care for the child). In the 1960’s, it was seen that the child would suffer from
meeting such a parent. At the present, keeping up the contact with the nonresidential parent is seen to be in the best interest of the child. During last years
the numbers of the supervised contacts has been increasing fast and at the
same time more and more concerns have been expressed about the positions
and rights of the individual parties involved in those contacts. On the basis of
ongoing study, the paper will consider the general profiles of children who meet
their parents (mostly fathers) under supervised conditions. The main interest is
however, to build up a conceptual frame from which such meetings could be
analysed and understood especially from the children’s point of view. Instead of
an abstract principle of the best interest or welfare of the child, space will be
given to a more concrete and actual aspects of children’s parental relations.
56
56
WP 26
GENDER, PARENTING AND VIOLENCE IN CLOSE RELATIONSHIPS
Maria Eriksson1
1
Uppsala University, Sweden
Drawing upon interviews from a thesis in sociology on family law and the handling
of fathers’ violence against mothers/co-parents and children, the paper
discusses what gendered notions of parenthood mean for professional practice in
cases where a child’s father is violent to the mother. More specifically, it is
discussed how a group of social workers’ specialised in investigations concerning
child custody, contact or residence perceive and interpret abused mothers and
violent fathers as parents. It is shown that the research-based knowledge on the
links between men’s violence to women and men’s violence to children is not
reflected in these interviews. The professionals tend to present violent fathers’
behaviours to mothers and to children as separate phenomena and they
assume that (unless proven otherwise) fathers who are violent to women are
not directly violent to children. It is argued that this is at least partly due to
gendered notions of parenthood. The professionals construct mothers as mainly
responsible for children’s needs, protection and safety. The mothers’
responsibilities can include a responsibility for the father, e.g. a responsibility for
maintaining and mediating the father-child relationship post-separation. As
regards the parenthood of violent fathers, the professionals use a double
standard: a) fatherhood as complementary to motherhood; and b) good
parenthood, which has motherhood as the standard. The notion “bad parent but
a good dad” is therefore culturally intelligible, while the notion “bad parent but a
good mam” is unintelligible. This gendered asymmetry in the norms adopted
contributes to the gendering of parenthood and to violent fathers’ space for
action. Furthermore, it transforms these fathers’ possible neglect of, and
violence to, their children into marginal issues. Against this backdrop the
implications for policy and practice are discussed, especially the dilemmas
associated with current Swedish attempts to create gender equality, shared
parenting, a “new father”; and to promote children’s interests post-separation.
The interviews with the social workers show how the symmetry of parents’
responsibilities for children post-separation presumed in policy can in professional
practice be created not through an emphasis upon symmetrical caring/parenting
abilities. It is argued that in the context of separation/divorce, notions of shared
and gender complementary parenthood seem to overshadow fathers’ violence
and abuse of power. They move the attention away from problematic aspects of
violent fathers’ practices as parents to children; they move attention away
from children’s possible need of support and protection from fathers postseparation.
57
57
WP 27
DOUBLE PERSPECTIVE, CHILDREN AND POLICE OFFICERS INVOLVED IN ALLEGED
CHILD SEXUAL ABUSE
Anna Kaldal1, Clara Gumpert1
1
Neurotec Department, Division of Forensic Psychiatry, Karolinska Institutet, Sweden
Background:
Investigations of alleged sexual abuse belong to the most complicated criminal
investigations. One of the central reasons is the lack of unambiguous evidence. In the
majority of all cases the only evidence the statement given by the child in question.
Therefore in many cases the outcome in the case completely depends on the quality of the
police interrogation. The Swedish supreme court have several times stated that the
evaluation of an oral evidence given by a child depends on the quality of the interrogation.
Despite efforts to improve interviewing techniques, the rate of prosecuted child sexual
abuse cases is still low.
Objectives:
The main objective of the study is to explore how knowledge of interview techniques is
implemented into the police investigation. A second goal is to explore the double
perspectives/experiences of the interviewer as well as the child.
Study design:
The data collection is built on a qualitative design, with in-depth interviews with police
officers and children. Police who are specialized in investigation cases of alleged child
abuse were included, and also children who had been interviewed by these same officers.
The main focus of the interviews was the subjective experience and feelings from the
interrogation situation on both parts (interviewer and child).
Preliminary results:
Most investigators interviewed in the study state that they don’t use any special methods of
questioning the child, but describe in different ways personal ways to conduct a child
interview. The intellectual averseness off this personal method differs. Most investigators
work alone but would like to work with a college Several police officers describe that it can
be very difficult to handle the many focuses that a child interrogation includes: establishing
and keeping a contact with the child during the interview, keeping the necessary legal
questions I mind, following the child’s story and emotional reaction and at the same time be
aware of not leading the child.
From a child perspective, it is clear that every new discussion on the alleged crime involves
a new decision to open up and talk. Despite the fact that these children all had been
motivated to talk they still needed a lot of help from the interviewers to produce the
necessary facts in order to pursue a legal process. Although the children all expressed
pressure from taking part in a police investigation, they did not regret disclosing abuse.
58
58
WP 28
CHILD FORENSIC PSYCHIATRIC EXAMINATION MODEL IN THE
NORTH KARELIA HOSPITAL DISTRICT
Hanna-Mari Tähtinen1, Marjatta Mannonen1, Minna Proskin-Karvonen1, Kristiina
Jalovaara1
1
North Karelia Central Hospital, Finland
Child Forensic Psychiatric team started working at the Child Psychiatry Policlinic at
the North Karelia Central Hospital in 1999. The team consists of a child
psychiatrist, two psychologists and a family psychotherapist. They are all
employees of the Child Psychiatry Policlinic and Child Forensic Psychiatric
examinations take about 7-25 % of their total working hours. The North Karelia
Hospital District is occupied by 180 000 residents of which 27 000 are under 14
years of age. There are 17 communes (the furthest is situated about 140
kilometres from the Central Hospital), 10 police stations and prosecutors work in
three jurisdictional districts.
The Child Forensic Psychiatric examinations always begin with a letter rogatory
from the police. Sexual abuse, maltreatment of a child and child as a victim of
some other crime are the most common indications for examination. Child
Forensic Psychiatric team does not work with the controversies of the custody of
the child, because in the North Karelia Hospital District they are dealt in Family
Guidance Centres and Child Welfare. The Child Forensic Psychiatric examinations
consist of a forensic psychological interview (under the presence of a police),
psychological assessment of the child’s emotional life, developmental level and
need for therapy. In case of children under seven years attachment is also
assessed. The Child Psychiatrist sets the diagnosis. The family psychotherapist
interviews the parents to collect the information about the history of the child
and her/his family, possible symptoms and general situation where the child lives.
Juridical consultation is available as needed for the Child Forensic Psychiatric
team. All the examinations are done and videotaped in the studio built in the
Child Psychiatry Policlinic.
The statistics of examined children between 1999 and 2003 show; 48 child
forensic psychiatric examinations varying from 4-22 examinations a year, 15 of
which were boys leaving a majority of 33 girls. Their age variation was 2 to 15
years of age wherein most were 5 to11 years old.
The new preliminary investigation law has been put forth in the beginning of this
year. It applies that the investigation process be performed under the presence
of police or by their own action. In a case where an underage child is a victim of
a crime, the police authorities of the North Karelia District receive aid from Child
Forensic Psychiatric team. The necessity to ask the police to investigate a crime
is in the hands of child’s home district’s Child Welfare. Of course the child’s
parents can also ask the police to investigate the matter.
59
59
WP 29
ARBETSGRUPPEN FÖR RÄTTSPSYKIATRISKA FRÅGOR RÖRANDE
BARN VID TAMMERFORS UNIVERSITETSSJUKHUS
BARNPSYKIATRISKA KLINIK
Mona Jerkku1, Monica Ilkka1, Merja Mäki1, Mervi Sinisalo1
1
Tammerfors Universitetssjukhus, Finland
Arbetsgruppen för rättspsykiatriska frågor rörande barn är en multiprofessinonell
arbetsgrupp som ger på undersökningar baserade expertutlåtanden åt olika
myndigheter. I detta anförande kommer vi att ta upp olika aspekter på vårt
arbete. Arbetsgruppens uppgifter och innehåll presenterar vi i vårt poster “
FORENSIC CHILDPSYCHIATRY AT TAMPERE UNIVERSITY HOSPITAL”.
Arbetsgruppen inleder sina undersökningar då polisen anhåller om professionell
hjälp i frågor rörande sexuella övergrepp på barn eller då socialvården begär om
ett expertutlåtande vid rättsfrågor rörande vårdnadstvister eller
omhändertaganden. Arbetsgruppen konsulterar även hälso- och socialvården
samt andra myndigheter.
De personer som arbetar inom arbetsgruppen för rättspsykiatriska frågor
behöver utveckla en ny professionell roll.Undersökningen runt det sexuella
övergreppet leds av polisen och utgör en del av polisens brottsundersöking men
arbetsgruppen bör även i undersökningen beakta den barnpsykiatriska aspekten;
barnets helhetssituation samt barnets behov av vård. För att kunna förena
dessa två synvinklar krävs en ny yrkesmässig inriktning.
Arbetsgruppen handhar ständigt frågor rörande sexuella övergrepp på barn samt
olika former av omsorgssvikt och arbetsgruppens medlemmarna utsätts
kontinuerligt för ställföreträdande traumatisering. Det undersökande
arbetsgreppet innebär att man granskar och bedömer klienternas traumatiska
erfarenheter. Arbetsgruppens medlemmar upprättar inga vårdförhållanden
emedan klienternas vård sker på annat håll. Detta betyder att man inom
arbetsgruppen inte ser resultatet av den fortsatta vården. Att ständigt
undersöka och granska traumatiserade personers berättelser är psykiskt mycket
betungande.
60
60
WP 30
FORENSIC CHILD PSYCHIATRY AT TAMPERE UNIVERSITY HOSPITAL
Merja Mäki1, Monica Ilkka1, Mona Jerkku1, Mervi Sinisalo1, Pälvi Kaukonen1, Tuula Tamminen1,
Kaija Puura1
1
Tampere University Hospital, Finland
Objective
The number of forensic child psychiatric patients has increased specially in the last decade in
Finland. In recent years in health care and child welfare there has been some 750 to 800
cases of suspected child sexual abuse (CSA) per year. This number is four times bigger than
it has been 15 years ago. This change has necessitated the development of forensic psychiatric
assessment models and programs.
A special forensic child psychiatry team for children started in 2001 at the Department of Child
Psychiatry, Tampere University Hospital. The team was the first of its kind in Finland. This
poster aims to evaluate the work done by the team and experiences gained so far.
Method
The outpatient team consists of a child psychiatrist, a psychologist, a psychiatric nurse, a
social worker and a secretary.
Aims of the team
to develop forensic psychiatric assessment models and programs for children, specially
in CSA
to make assessments of forensic psychiatric patients referred to the clinic
to cooperate with and give consultation to health care, child welfare agencies and
police
Reasons for referrals
suspected CSA
assessment of parenthood in custody disputes and children placements
The assessment program in CSA includes arrival meeting(s), interviews with the child
(videotaped), child psychiatric assessment, pediatric or gynaecological examination of the
child and interviews with the adults. In intra familiar CSA especially the interaction between
the child and his/her parents, likewice the psychiatric state of health of his/ her parents are
evaluated.
New recommendations on investigating CSA in Finland were issued by the Ministry of Social
Affairs and Health in June 2003. In suspected CSA notification to the police is mandatory prior
to assessment.
Results
Most patients (82 %) were referred for assessment because of CSA. Parenthood was assessed
in custody disputes and in children placements in 18 % of cases. The age range 1 to 15 years,
including 71 % girls and 29 % boys. The team developed a specific but flexible assessment
program for CSA including some 20 different types of outpatient visits per case.
Conclusions
The experiences of the team indicate that specializing in forensic psychiatric issues is also
worth while in child psychiatry. The team has improved in particular the assessment process
of CSA. Cooperation with child welfare agencies, the police and the courts in handling these
extremely complicated cases has also advanced and the feedback has been positive. Sufficient
supervision and legal consultation for the team and awareness of secondary traumatisation
61
are important.
61
WP 31
MANDATORY REPORTING AS AN INSTRUMENT OF FINDING
CHILDREN IN NEED FOR PROTECTION IN SWEDEN
Madeleine Cocozza1
1
Linköping University, Sweden
Objective
In some countries mandatory reporting is used to find children in need of
protection. Lately the instrument has been questioned since studies have shown
that many children are reported but few remains in the system. In Sweden
mandatory reporting is used but there is no national collection of data on how
many children that are reported. The aim of the present study was to describe
the filtering process of a cohort of mandatory reports in one municipality in
Sweden. A further aim was to compare the findings internationally.
Method
All the reports registered at the social service in a municipality in 1998 were located
and recorded into 21 variables. The filteringprocess of a report to a support was
then described and compared to a corresponding process in the UK.
Results
Of all the reports 41 % were judged to be unsubstantiated, and 33 % were
investigated ( 8 % dropped out and 18 % were reports regarding children that
were already under investigation). Finally 16 % of the reports led toa support in
the Swedish study compared to 17 % in the British one.
Conclusion
· It is difficult to measure the effectiveness of the legislation since there is a
considerable lack of information on how the legislation operates. We do not
know how many children that are reported, why children are reported and who
makes the reports in the wake of mandated reporting in Sweden.
· The findings in this study of one municipality( 68 % fell out the social care
system)
should lead to increased interest of the legislation’s effectiveness,
· This study shows that in a cohort of mandatory reported children in a Swedish
municipality a similar filtering process could be described as in the UK, though
the systems are different organised.
62
62
WP 32
CHILD MORTALITY RATE AND INFLICTED INJURIES THAT LEAD TO
EARLY DEATH OF CHILDREN IN ESTONIA
Ruth Soonets1, Katrin Lang2, Marika Väli3
1
Tartu Child Support Center, 2Tartu University Department of Public Health,
3
Institute of Pathological Anatomy and Forensic Medicine of Tartu University,
Estonia
Objective: to find out the range of inflicted injuries and its relations to child
mortality in Estonia, question is raised whether childhood victimisation might lead
to an increased risk of early death.
Methods: using data of official death certificates, and forensic reports.
Unbelievable but true, millions of children are abused and neglected by their
biological parents or caregivers. According to some studies 25-50% of children
report severe and frequent abuse, including being beaten, kicked, tied up by
people who are supposed to protect and guarantee their safety. It is estimated
that there were 57 000 homicides among children under 15 years of age worldwide in 2002. Very young children are at greatest risk. Homicide rates among
children aged 0-4 years are more than twice higher than these among children
aged 5-14 years.
Unlike in previous age child mortality in developed countries is not only the result
of diseases but also of inflicted injuries and accidents. Accidents happen or are
induced by different causes, including traffic accidents, fallings, drowning,
poisonings, fire accidents, etc.
The number of population in Estonia is 1,38 million, 18% of them are children.
Medical practitioners (incl. forensic specialist) have made research on injuries and
external causes of child mortality in Estonia during two previous years. Current
research is the first profound study on this subject since our re-independence in
1991, and is based on forensic medicine reports. In 2001the mortality rate of
children under 5 years of age was 10,9 ‰.
Based on UNICEF estimation continuous prevention could avoid death of nearly
12 000 children every year. According to the current situation each child of
developed country faces probability 1: 750 to die as a result of some injury
before the age of 15.
63
63
WP 33
PROFESSIONELLE DILEMMAER I ARBEJDET MED OMSORGSSVIGT
BLANDT ASYLANSØGERBØRN I DANMARK
Karen Louise Christiansen1
1
Dansk Røde Kors, Danmark
Dansk Røde Kors har i 2003 haft ansvar for indkvartering af 6460 asylansøgere.
Disse er bosiddende på centre i hele landet. Ud af denne gruppe er ca. 30 %
børn mellem 0 og 18 år.
Dansk Røde Kors har desuden ansvar for undervisningstilbud til skolebørn og
legestuetilbud til børn mellem 3 og 6 år. Organisationen har desuden ansvar for
sundhedstilbud svarende til alment praktiserende læger og forebyggende
sundhedsordninger. Andre behandlinger og foranstaltninger iværksættes via
bevilling fra Udlændingestyrelsen og finder sted udenfor Dansk Røde Kors regi.
Levevilkårene for asylansøgerbørn er præget af:
·
·
·
Trange boligforhold og mange flytninger.
Forældre med begrænsede ressourcer på grund af reaktioner på krig,
flugt og traumer.
Forældre der er belastet af usikkerhed om fremtiden, lang ventetid i
asylfasen samt meget få økonomiske ressourcer.
Erfaringerne med omsorgssvigtede børn og deres familier blandt asylansøgere
rejser en række spørgsmål?
·
·
·
·
Er der forskel på hvorledes omsorgssvigt hos asylansøgere og andre
børn skal observeres og vurderes?
Er det uheldigt at adskille børn og forældre, når et barn har været på
flugt og har flere tab bag sig?
Har det betydning for de professionelles grænse for intervention og
underretning at børnenes levevilkår og fremtidsudsigter er anderledes end
andre børns?
Har det betydning for kommunernes beslutning om intervention at
børnenes levevilkår og fremtidsudsigter er anderledes end andre børns?
64
64
WP 34
SØSKENINCEST - ERFARINGER FORMIDLET AV KVINNER VED STØTTESENTER MOT
INCEST-OSLO
Marit Hellesnes1
1
Støttesenter mot Incest - Oslo, Norge
Søskenincest er et alvorlig sosialt problem som stort sett har blitt oversett. Den siste norske
omfangsundersøkelsen i Norge viste at av de som hadde vært utsatt for seksuelle overgrep
som barn, hadde 3,4 % vært utsatt for milde og moderate overgrep, og 7,4 % for alvorlige
overgrep av søsken. Ca. 10 % av kvinnene som tar kontakt med SMI-Oslo oppgir at de har
vært utsatt for søskenincest.
Internasjonale undersøkelser viser at søsken har lengre overgrepskarriere, og begår grovere
overgrep enn andre overgripende barn og voksne. Dette er sammenfallende med våre
erfaringer. Mange har levd under konstant redsel og terror fra bror/brødre gjennom hele sin
barndom, og noen også i voksen alder.
Mange mener at alderforskjellen mellom offer og overgriper må være 5 år eller mer for at noe
skal kalles seksuelle overgrep. Dette er ikke sammenfallende med våre erfaringer. Vi har brukere
som har svært alvorlige senvirkninger, og som har vært utsatt for overgrep av brødre som bare
er ett år eldre enn dem.
Kvinnene har vært utsatt for overgrep helt fra tidlig spedbarnsalder og opp i voksen alder der
de selv allerede har fått egne barn. Brødrene har vært fra 1 til 14 år eldre enn søsteren, og
noen har begynt å begå alvorlige overgrep allerede i 6-7 års alderen. Overgrepene har stort
sett bestått i voldtekter og utuktig omgang med tillegg av seksuell trakassering og mobbing
gjennom mange år.
Følgende hovedproblemstillinger har utkrystallisert seg:
·
Bagatellisering. Samfunnet, familien, venner, fagfolk og kvinnen selv bagatelliserer
søskenincest, til tross for store lidelser og alvorlige senvirkninger.
·
Det er vanskelig å plassere skyld og ansvar fordi overgriperne ikke er voksne menn.
·
Enorm tapsfølelse og svikfølelse overfor ikke-krenkende søsken og foreldre, men
spesielt i forhold til mor. Det er vankeligere å konfrontere familien med overgrepene.
Både i barndom og i voksen alder velger foreldrene brorens side.
·
At offer og overgriper har samme mor og far virker svært kompliserende på familielivet
når overgrepene blir kjent. Det enkleste er å fortie sannheten, noe som rammer
offeret hardt.
·
Kvinnene har et stort behov for å møtes med andre som har vært utsatt for
søskenincest for å få hjelp til å fastholde virkeligheten de lever og har levd i.
Mange av kvinnen har felles erfaringer i tillegg til vanlige senvirkninger:
·
De bærer på mye raseri og følelse av urettferdighet.
·
Mange er skeptiske til å la mor være sammen med egne barn.
·
De aller fleste har lært at de ikke skal sladre og at de skal klare seg selv.
·
De har alltid blitt beskyldt for å overdramatisere.
·
Brødrene blir nesten alltid favorisert i familien.
·
De fleste vet eller har sterk mistanke om at moren har vært utsatt for seksuelle
overgrep som barn.
Kunnskapen vi har hentet i vår brukergruppe viser med all tydelighet at søskenincest må tas
alvorlig. Barn som utsettes for dette må bli trodd og få hjelp. Dette vil virke forebyggende
forhold til senvirkninger hos det enkelte barn, og i forhold til sosial arv med videreføring av
dysfunksjonelle familiemønstrene og seksuelle overgrep til senere generasjoner.
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WP 35
PROJEKT JANUS
DANSKE BØRN OG UNGE MED SEXUEL OVERGREBSADFÆRD.
UNDERSØGELSE, BEHANDLING OG FORSKNING.
FOREBYGGELSE AF SEXUELLE OVERGREB MOD BORN
Mimi Strange1
1
Projekt JANUS,Socialministeriet, Danmark
Præsentationen vil indeholde fremlæggelse af de foreløbige resultater fra det
første danske center til behandling af unge (12-18 år) med sexuel
overgrebsadfærd. Centret åbnede 1.9.03 og er i en treårig periode finansieret
af Socialministeriet og led i den danske regerings handleplan til forebyggelse af
sexuelle overgreb mod børn (publiceret august 2003).
Information om projektet, start af behandlingsklinik og vidensindsamling vil blive
præsenteret og anvendes som basis for at diskutere nogle undersøgelses,behandlings- og samarbejdsstrategier.
Tidlig intervention antages at kunne være en væsentlig del af en strategi til at
forebygge at sexuelt aggressive børn og unge fortsætter deres krænkende
adfærd i voksenlivet
Præsentationen vil også indeholde resultater fra en undersøgelse, publiceret
2002, som dels indeholder et kvalitativt studie med interviews med en lille gruppe
danske drenge/unge mænd og dels indeholder et internationalt litteraturstudie af
unge krænkere.
Mulig ætiologi og interventionsstrategier i forhold til denne klientgruppe diskuteres.
Arbejde med sexuelt aggressive unge nødvendiggør interdisciplinært samarbejde
og fokus på multidisciplinært samarbejde diskuteres som en nødvendig del af
arbejdet med disse unge
Studiet af unge krænkere er publiceret af Socialforskningsinstituttet (2002) og er,
som Projekt JANUS, finansieret af Socialministeriet.
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66
WP 36
UNGDOMAR SOM BEGÅR SEXUELLA ÖVERGREPP - HUR ALLVARLIGT
ÄR DET?
Cecilia Kjellgren1
1
Avd för Barn- o Ungdomspsykiatri, Lunds Universitet, Sverige
Ungdomar som begår sexuella övergrepp är en heterogen grupp. Vissa begår
ett antal övergrepp innan de identifieras och är i risk att fortsätta. Andra begår
ett övergrepp och kommer sannolikt inte att upprepa det.
Forskningen visar att vissa ungdomar fortsätter begå övergrepp i vuxen ålder.
En viktig uppgift är att tidigt identifiera de ungdomar som är i hög risk och har
stora behandlingsbehov.
Socialtjänsten har ett ansvar för att utreda ungdomens situation och behov av
behandling. En viktig fråga är att värdera allvaret och risk för att ungdomen kan
begå nya övergrepp. Kan 15-åringen som utsatt sin lillasyster för övergrepp vara
kvar i familjen och bli tillräckligt hjälpt av en öppenvårdskontakt. Behöver
tonåringen som vid ett tillfälle begår en överfallsvåldtäkt, någon omfattande
behandling. Kan placering i familjehem vara rätt insats för 13-åringen som vid
flera tillfällen utsatt mindre barn?
När man studerar ett kliniskt material med ungdomar som begått övergrepp ser
man att det beslutsunderlag som socialtjänst/barnpsykiatri stödjer sig på är
mycket skiftande. Ibland blir beteendet uppmärksammat och allvarligt värderat,
ibland kommer andra förhållanden kring familjen och den unge mer i förgrunden.
Professionellas förmåga att hantera denna typ av ärenden varierar och påverkar
arbetssättet.
För att få ett strukturerat stöd i att göra bedömningar av ungdomar som begår
sexuella övergrepp krävs att man utökar sin utredningsmetod. Information om
ungdomens sexualitet behövs i dessa ärenden och att risk- och skyddsfaktorer
identifieras.
I Kristianstad har en metod utvecklats och tillämpats sedan 1997. Ett hundratal
bedömningar av unga sexualförövare har genomförts. Metoden bygger på olika
modeller som använts internationellt.
En intervju genomförs med starkt fokus på sexualitet; den sexuella utvecklingen,
positiva/negativa erfarenheter och den unges upplevelse av att begå övergrepp.
Material från intervjun kan tillsammans med annat utredningsmaterial användas
för att göra en bedömning av risk för återfall och behandlingsbehov.
Riskbedömningsinstrumentet ERASOR (Estimate of Risk of Adolescent Sexual
Offense Recidivism) har använts som stöd för att skatta riskfaktorer.
Bedömningsmetoden kommer att beskrivas med hjälp av fallbeskrivningar.
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WP 37
CHILDREN AND VIOLENCE WITHIN THE FAMILY
Mikko Oranen1
1
Federation of Mother and Child Homes and Shelters, Finland
Children have often been described as invisible witnesses or silent victims of
domestic violence. In fact it would be correct to speak about blind or deaf adults
who have not been able to see nor hear these children. If somebody is ready to
see and willing to listen, she/he will soon realize that the children are full of
thoughts, feelings and sensations related to their experiences of violence.
It is estimated that in Finland 190 000 children and young people have been
witnessing their mother being abused. The figure is based on a national survey
on men’s violence against women. In reality the number of children exposed to
violence is even bigger since many of the abused women in the survey did not
know if their children had seen or heard abuse or did not answer the question
concerning children. Violence begets violence. A significant proportion of children
exposed to violence are also victims of violence.
The exposure to violence within the most important and close relationships is a
severe developmental risk factor. Seeing and hearing the mother being abused is
a trauma experience which can cause a posttraumatic stress disorder (PTSD).
Being a witness can corrupt child’s image of close relationships, distort the way
she/he thinks about loving and caring and affect her/his attitudes towards
violence. The relationships with mother and father can become loaded with
ambivalence.
The growing body of knowledge concerning the negative effects of witnessing
violence on children has forced adults to act. In all Nordic countries innovative
projects focusing on these children have been carried out. In the Federation of
Mother and Child Homes and Shelters in Finland such project was started in
1997. The project ended in 2001 but the working model developed by the
project is now in use in the Federation’s shelters and outreach services.
Children’s counsellors and group facilitators have become permanent part of
working teams.
Children’s rights for protection, participation and provision serve as guiding
principles in the Federation’s children’s services. Adults have a duty to protect
children so that they can feel safe and be safe.
Children have a right to participate in planning of and carrying out actions
affecting their life. The essential information should be shared with children.
Children also have a right to their fair share of the available resources
The actual working model will be outlined the presentation. The unique context of
work with victims, witnesses and perpetrators of violence will be described.
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68
WP 38
INTEGRATIVE PRACTICES IN WORKING WITH WOMEN AND
CHILDREN WHO HAVE EXPERIENCED VIOLENCE AND MEN WHO HAVE
USED IT
Elli-Maija Laaksamo1, Riitta Pohjoisvirta1, Hannu Säävälä1
1
Mother and Child Home and Shelter in Oulu, Finland
Since 1979 The Mother and Child Home and Shelter in Oulu has had a services
for women who been battered at home.
Since 1996 we have adopted an integrative model in our work with domestic
violence. The integrative model means that we have separate workers and
services for all family members: for the woman who has been battered, for the
child who has been battered or who has been exposed to violence towards her/
his mother and for the father who has battered his wife or/and children. We are
mainly working separately with each family member, but an essential part of the
work is the collaboration of the workers with each other in planning the services.
We have individual, group, family and couples meetings. Family and couples
meetings are used only when the batterer takes full responsibility of his violence
and the other members of the family are not traumatized by his violence or
afraid of him. Also the individual members of the family are not obliged to
participate in the family and couples meetings if they do not want to. Because of
the power imbalance in the family, special attention is paid on the views and
experiences of the child and the mother.
The child can not stop the violence. She/he must turn to parents to get help. In
our integrative model we have met the following challenges and questions:
How to evaluate the safety of the family members while working with them?
What are the consequences of taking up the issue of violence? Is it possible that
we raise the risk of violent encounters with our interventions?
How to make the situation of the child visible to parents in the context of
motherhood and fatherhood? How do we take into consideration the
genderedness of parenthood?
The question of space. How to reconcile the needs of the child and the needs of
the individual co-parents? How to secure that the child has a possibility to be a
client herself/himself? How to be a client and a parent at the same time?
The team is a tool. How do we utilize the different perspectives of individual
workers for the benefit of the process? How can we team members avoid
harmful disputes and arguments between ourselves when taking up the views
and experiences of the individual clients? A constructive confrontation between
69
the workers is a most beneficial tool in our work to help the individual parties of
domestic violence.
69
WP 39
FAMILY, VIOLENCE AND CHILDHOOD IN THE NORDIC WELFARE
SYSTEMS
Keith Pringle1
1
Aalborg University, Denmark, Malardalens Hogskola, Sweden, Warwick
University, UK
Focusing primarily but not exclusively on Sweden, this paper draws upon the
outcomes from two recently completed research projects: first a large qualitative
study, funded by the main social science research council in the United Kingdom,
of the ways in which the Swedish child welfare systems addresses (or does not
address) power relations in the lives of service users associated with the
dimensions of gender, ethnicity and age; secondly, a major European Unionfunded research network on men’s practices consisting of ten countries which
included both Norway and Finland. Using data from both these projects and with
a focus on family and childhood, the paper (re-)considers the largely positive
reputation of the Nordic welfare systems as seen for instance in the welfare
paradigm offered by Esping-Andersen. It does so by focusing not, as usual, on
issues of labour in the home and the market-place, but on issues of bodily
integrity – specifically violence to children. Using this focus, the paper suggests
that: (a) the reputation of the Nordic welfare systems for child-friendliness,
gender equality and benevolence towards minority ethnic groups can be seriously
questioned; (b) the responses of the Nordic welfare systems to issues of
violence in childhood, both sexual and physical, are in a considerable number of
important respects less impressive than the responses of a generally less wellregarded welfare system such as that of the United Kingdom despite all its wellknown and very real faults; (c) on the basis of this analysis of child abuse –
taken in conjunction with similar analyses which could be made of other issues of
bodily integrity such as welfare responses to violence to women or welfare
responses to racism in the lives of service users – the paper suggests that one
should consider inverting Esping-Andersen’s well-known welfare typologies in
relation to the protection of bodily integrity, with the Nordic systems occupying
relatively mediocre or low rankings. The paper goes on to propose a culturally
and historically-located explanation for this state of affairs. Finally, the paper
argues that whilst a truly empowering welfare system for children cannot
currently be found in either Nordic or UK settings, such a system might be
possible if the best elements of both could be combined – and that such a
development is more likely to occur within the Nordic countries than it is the UK.
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WP 40
BARN TILL FÖRÄLDRAR MED UTVECKLINGSSTÖRNING
Barbro Hindberg1
1
Barn- och Ungdomsforum, Sverige
Många barn till föräldrar med utvecklingsstörning kan sägas vara försummade både av sina
föräldrar och samhället. Syftet med min bok Barn till föräldrar med utvecklingsstörning
(Gothia förlag 2003) är att synliggöra dessa barn, öka kunskaperna om deras situation och
förbättra deras livsvillkor.
Det faktum att aktuell svensk forskning om barn till föräldrar med utvecklingsstörning
saknas, har inneburit att underlaget till boken till stor del måste bygga på annan typ av
kunskap. Viktiga källor har varit personer som i sitt arbete möter denna grupp, personliga
erfarenheter av att växa upp med utvecklingsstörda föräldrar och domar.
Boken utgår från barns behov och rättigheter och att barns bästa skall sättas i främsta
rummet. Detta är helt i enlighet med FN:s barnkonvention och svensk (liksom nordisk)
barnavårdslagstiftning, men i praktiken är det ingen självklarhet. Framför allt ställs frågan
om barns rätt till skydd respektive föräldrars rätt till integritet på sin spets. Det som
komplicerar frågan i jämförelse med när föräldrar sviktar i sin omsorgsförmåga av andra
skäl, är att utvecklingsstördas brister beror på ett handikapp, som de inte kan rå för och
heller inte göra något åt. Då vill man inte lägga sten på börda utan hoppas i det längsta att
föräldrarna skall klara föräldraskapet. Risken är att barnen osynliggörs och att de får betala
ett högt pris för att deras föräldrar skall få vara föräldrar.
I den debatt som förts i Sverige om utvecklingsstörning och föräldraskap sägs ibland att
utvecklingsstörda föräldrar inte ges en chans att visa att de klarar att vara föräldrar
beroende på fördomar och bristande stöd. Om man i stället ser på frågan ur barnens
perspektiv, kan man fråga sig om barn till föräldrar med utvecklingsstörning ges samma rätt
till en god uppväxt som andra barn. Av det material som boken bygger på framgår, att
många av dessa barn får leva under förhållanden, som inte skulle accepteras när det gäller
andra barn.
Ett skäl till att barn kan blir kvar i hemmet, trots att socialtjänsten anser att de borde
omhändertas, är svårigheterna att klart belysa problemen i dessa familjer. Domstolarna vill
ha bevis på att barnen far illa och på föräldrarnas omsorgsbrister. Allmän svaghet,
försummelse, brist på stimulans, känslomässig omognad etc. kan vara svåra att konkret
beskriva och är sådant som domstolarna har svårt att förstå innebörden av.
Vilka blir konsekvenserna av begåvningshandikappet i föräldraskapet? Vilka blir
konsekvenserna för barnen? Vad kan kompenseras om omsorgsförmågan inte räcker till?
Vilka föräldrafunktioner kan inte överlåtas till andra? Det är några av de frågor som tas upp
i boken och också kommer att fokuseras i seminariet. Jag kommer också att ta upp
betydelsen av handikappmedvetande för att nödvändig hjälp skall kunna ges till familjerna.
Bakom boken står stiftelsen Barn- och ungdomsforum, som bildades 1998. Stiftelsens
övergripande syfte är att förbättra psykosocialt utsatta barns och ungdomars livsvillkor. Mer
information finns på www.buf.a.se
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WP 41
BARN TILL PSYKISKT STÖRDA FÖRÄLDRAR – ETT SAMVERKANSPROJEKT MELLAN
BARNPSYKIATRIN, VUXENPSYKIATRIN OCH SOCIALTJÄNSTEN.
Birthe Hagström1
1
Social service in cooperation with child and adult psychiatry, Sweden
Allt fler mödrar med långvarig psykiatrisk problematik som sökte hjälp i sitt föräldraskap
uppmärksammades på en Barnpsykiatrisk behandlingsinstitution i Malmö. Man gjorde bedömningen
att en del av dessa mödrar behövde ytterligare hjälp och såg behovet av samordnade tvärfackliga
insatser för att tidigt uppmärksamma familjen och erbjuda stöd och behandling. Så startade ett
treårigt samverkansprojekt 1999 mellan barn- och vuxenpsykiatrin samt socialtjänsten dit även
representanter från mödra- och barnhälsovård samt förskolan länkades.
Syftet med projektet är att utveckla metoder i samverkan för att uppmärksamma och stödja
familjer under graviditet, späd och småbarnstid där en eller båda föräldrarna lider av psykisk
störning.
Projektet är politiskt förankrat och organiserat i en styrgrupp som består av chefer för de
medverkande verksamheterna samt en arbetande grupp, “utvecklingsgruppen”. Till den har
verksamheterna valt sina representanter, den sammanträder regelbundet och är länken mellan
projektet och verksamheterna. De personalkategorier som är involverade i projektet är läkare,
psykologer, kuratorer, socialsekreterare, barnmorskor, sjuksköterskor, skötare och pedagoger.
Vid projektstarten genomfördes en kartläggning för att få en uppfattning om hur många barn
som uppmärksammades inom de medverkande verksamheterna. Hur samverkan fungerade och
vilket stöd som fanns runt familjen.
Utifrån syftet med projektet och den kunskap som kartläggningen bidrog med prioriterades först
tre områden.
Information och utbildning: En grundidé är att personalen inom de medverkande
verksamheterna skall ha en liten men gemensam kunskapsplattform för att kunna öka sin
uppmärksamhet kring barnen och deras föräldrar och se behovet av att planera gemensamt och
samordna sina insatser. Riktade utbildningsinsatser har erbjudits samtliga verksamheter och som
komplement har forskare och kliniker inbjudits till gemensamma storföreläsningar som följts av
tvärfacklig diskussion. Parallellt med utbildningsinsatserna har funnits en stor beredskap för
information om projektet till olika arbetsgrupper.
Konsultationsteam: Ökad kunskap måste mötas med en ökad beredskap att gemensamt stödja
personal som uppmärksammar familjer. Utifrån detta startade konsultationsteamen, ett tvärfackligt
team i varje stadsdel som sammanträder regelbundet, är tidsbeställda och där som ges möjlighet
för personal att rådgöra om insatser kring familjer de möter under graviditet, späd och
småbarnstid. Teamen är väl utnyttjade och utvärderade efter ett års verksamhet. Utvärderingen
visar att den personal som använt sig av teamets tjänster anser att de fått hjälp i sitt arbete att
planera för bästa möjliga stöd för barnet/barnen och familjen.
Samverkan: En del av familjerna som varit aktuella i konsultationsteamen har, med familjernas
medgivande, utvecklats till samverkansarbete över längre eller kortare tid. Via enskilda familjers
svårigheter blir problem i samverkan tydligt och åtkomligt för förändring. Här har vi kunnat följa en
positiv utveckling hos familjer där man gjort en gemensam planering, ansvarsfördelning samt haft
kontinuerlig uppföljning av insatserna.
Arbetet i projektet har nu pågått i fyra år och övriga frågor som vi arbetat med är bl.a:
Föräldragrupp för mammor som lider av psykisk störning och har barn mellan 0-7 år. Gruppen
leds av två terapeuter en från barnpsykiatrin och en från vuxenpsykiatrin och fokus är barn och
föräldraskap.
Handlingsprogram för vuxenpsykiatrin “Vuxenpsykiatrins barn” som skall ses som ett stöd i
att uppmärksamma barns och föräldrars svårigheter, underlätta kontakten med andra vårdgivare
samt ge konkreta förslag om hur man kan möta barn och föräldrar inom psykiatrins öppen och
slutenvård.
Viktiga frågor nu, är ett utvecklingsarbete inom förskolan samt
72etableringen av ett team riktat till
den gruppen barn och föräldrar som behöver mer stöd än vad etablerade verksamheter kan
erbjuda.
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WP 42
SUPPORTING CHILD DEVELOPMENT IN FAMILIES WITH MENTALLY
ILL PARENTS
Tytti Solantaus1
1
Stakes, Finland
Parental mental illness increases children’s risk for developmental problems and
mental disturbances. Mental disorders affect the parents’ relationship abilities
including love and caring, guidance and monitoring and disciplining the child.
Parenting becomes more dependent on the parent’s own moods than the
children’ doings. These influence parent- child relationships and many of children’s
developmental needs might go unmet. It has been estimated in several studies
that about 60% of children of affectively ill parents will themselves suffer from
psychiatric disorders by the age of 25.
The health care system has traditionally offered no support for the families of
the mental patients. In Finland, a special program, The Efficient Family Project,
was initiated by Dr. Solantaus in 2001, to study and develop means to support
the families and promote child development. The program includes a randomised
controlled study of two interventions, a training program for clinicians,
implementation of the methods and the building of multiprofessional network.
The most challenging aim is to induce a lasting change in the routines of the care
of the mentally ill so that every patient with children will be offered support for
their families. The methods include a short parent intervention and a longer
family intervention (The Beardslee Preventive Family Intervention developed by
the Beardslee team in Boston, USA).
The impact of parental mental illness on children and family dynamics and an
overview of the interventions will be the foci of the presentation. Finnish families’
experiences of the interventions will also be described.
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WP 43
COOPERATION BETWEEN MIDGARDUR AND THE REYKJAVIK POLICE TO
FIND NEW WAYS TO DEAL WITH CHILD DELINQUENCY
Sigþrúður Erla Arnardóttir1
1
Midgardur – Family sevice center in Grafarvogur, Reykjavík, Iceland
The Circle - A constructive way for children, parents and others who work with
children in Grafarvogur
The Circle is a new way to deal with delinquency of children who live in the Grafarvogur
(burrough of Reykjavik), where the victim, offender and their families work together.
The Circle is based on early intervention by making the individual responsible for his
behavior, by using family therapy, mediation and the environment to work with the
child. The goal is to give a child who gets in contact with the police an opportunity
to learn from its experience and to help making the environment safe. The Circle
is a project that began in February 2001 and in charge of this program are Miðgarður,
a family service center in Grafarvogur and the police in Grafarvogur. Co-workers
are companies, institutes and organizations in Grafarvogur and the University of
Iceland.
In the Circle the offender, the victim and the community work together. The
offender and the victim apply for participation in the Circle. A group of professionals,
psychologist, social worker and the police then evaluate the application. The group
nominates the person who is responsible for each case. This person works closely
with the offender and his parent, the victim and an objective person from the
district. All participants’ meat regularly to find a solution to what has occurred.
Individuals who are under the age of 18, who live in Grafarvogur and commit an
offence that is reported to the police, are invited to participate in the Circle. Everyone
who is connected to the offense in any way is allowed to strengthen the community
instead of weakening it, by choosing to participate in the Circle.
The Circle’s motto is: Respect – Responsibility – Knowledge
The Circle’s goals are: to work with children in Grafarvogur who get in contact with
the police and to build stronger individuals with education and support of the
community.
The Circle’s guiding lights are: The community is based on justice, safety and
respect. Vandalism is an offense against individuals and society. The best
prevention is to strengthen a child who commits an offense in its own environment.
A powerful community is the result of cooperation of the residents, their responsibility
and their trust.
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WP 44
FÆNGSLEDES BØRN – EN UDSAT GRUPPE
Steen Hansen1
1
Det Kriminalpræventive Råd, Danmark
Fængsledes børn tilhører en gruppe af socialt belastede børn og unge med en
væsentligt øget risiko for at blive involveret i kriminalitet. Det ser ud til, at ingen
myndighed eller institution med sikkerhed kan forventes at hjælpe de fængsledes
børn – ud over det rent praktiske med at få tag over hovedet og tøj på
kroppen.
Emnet er tabuiseret. Børnene er derfor i en meget sårbar position og risikerer let
at blive marginaliseret. Det Kriminalpræventive Råd har udarbejdet en rapport
med et katalog af indsatser, som kan afhjælpe nogle af disse oversete
problemstillinger.
En arbejdsgruppe bestående af et relativt bredt udsnit af personer med kontakt
til fængsledes børn eller marginaliserede børn har besøgt forskellige fængsler i
Danmark og lyttet til berørte børn. Gruppen har taget udgangspunkt i
Socialforskningsinstituttets undersøgelse fra 1999, hvor indsatte, deres børn og
nogle samlevere blev interviewet. Det Kriminalpræventive Råds arbejdsgruppe
har også forsøgt at få et indtryk af problemets kvantitative omfang og er
kommet med anbefalinger til løsning af problemerne.
De foreslåede forebyggende indsatser retter sig mod børn, hvor kommunerne
ikke opdager problemerne. Der kan være flere veje til at komme i kontakt med
børnene, ligesom en række resursepersoner på forskellige måder kan forbedre
vilkårene for børnene eller de unge. Forslagene involverer først og fremmest til
Kriminalforsorgens socialrådgivere og fængselsfunktionærer samt de politifolk,
som anholder forælderen.
75
75
WP 45
NY BETÆNKNING OM STRAFFEPROCESSUELLE TVANGSINDGREB
OVER FOR BØRN UNDER DEN KRIMINELLE LAVALDER OG DET
FREMTIDIGE SAMARBEJDE OM AT BESKYTTE BØRN MOD OVERGREB
Bo Ertmann1
1
Teori og Metodecentret, Danmark
I Danmark har Strafferetsplejeudvalget under Justitsministeriet i november 2003
afgivet betænkning om straffeprocessuelle tvangsindgreb over for børn under
den kriminelle lavalder. De store børneorganisationer samlet under Børnesagens
Fællesråd har bifaldet, at der omsider tages initiativ til at lovfæste politiets
magtbeføjelser i forbindelse med efterforskning af kriminalitet begået af børn
under den kriminelle lavalder. Men Fællesrådet opfatter betænkningens forslag
som en legitimering af alvorlige tvangsindgreb over for børn, som mistænkes for
en kriminel handling
Udkastet til ny lovgivning på området synes på afgørende områder at være i
strid med FN´s Børnekonvention.
Straffelovsudvalgets betænkning rejser spørgsmålet om hvilket perspektiv på
barnet som retssubjekt som tegner sig i dansk lovgivning, og rejser derfor også
en række principielle spørgsmål om rammerne for det fremtidige samarbejde
med politi og domstole i sager om beskyttelse af børn og unge, som vil blive
diskuteret i workshoppen.
INTERNETTET - DET ER DER ALT SAMMEN
Steen Hansen1
1
Det Kriminalpræventive Råd, Danmark
WP 46
Internettet udbredes i disse år med stor hast, og det er nu er tilgængeligt for
børn og voksne i alle aldre. Men mange børn og voksne har endnu ikke lært de
nødvendige regler for færdsel på nettet, og derfor kan de ikke være tilstrækkeligt
opmærksomme på farerne. Overgreb mod børn i relation til Internettet kan finde
sted i forbindelse med produktion af billeder og film, som distribueres via
Internettet, eller når de som brugere af mediet udsættes for pornografisk
materiale eller seksuelt begrundede henvendelser. Men der er også mange andre
måder, børnene kan blive involveret i kriminalitet på – enten som ofre eller som
gerningsmænd.
Internettet er som livet – det er der alt sammen. Det er vigtigt, at både børn og
voksne klædes på til at udnytte nettet muligheder og undgå dets farer.
Foredraget vil vise eksempler på problemstillinger og på mulige løsninger.
Det Kriminalpræventive Råd samarbejder med en række organisationer med
henblik på at kunne rådgive voksne, så de kan hjælpe børnene til at undgå
overgreb. Foredraget er baseret på de erfaringer, som Det Kriminalpræventive
Råd og samarbejdspartnerne har gjort.
76
76
WP 47
FACTORS INFLUENCING THE CLINICAL DECISION MAKING OF CHILD
SEXUAL ABUSE INVESTIGATORS IN FINLAND
Katarina Finnilä1, Pekka Santtila1,2,3, Mikael Sainio2, Pekka Niemi1
1
Turun yliopisto, 2Polisyrkeshögskolan, 3Åbo Akademi, Finland
The purpose of this study was to investigate whether clinicians investigating child
sexual abuse (CSA) rely more on scientific knowledge or on clinical experience
when evaluating their own expertise. Another goal was to check what kind of
pretrial beliefs and attitudes the clinicians had. The connections between these
different factors were investgated. Third, the influence of these factors on the
clinicians decision making in a fictious CSA case was investigated. A questionnaire
covering items concerning demographic data, clinical experience, knowledge and
beliefs about CSA, self-evaluated expertise, and an ambiguous material based on
real trial documents concerning an alleged CSA case was given to 126 social workers,
60 child psychiatrists and 134 psychologists. The results showed that the clinicians
relied more on their clinical experience than on scientific knowledge when evaluating
their expertise as investigators of CSA. Furthermore, the study showed that social
workers possessed more extrem attitudes in favour of the child that led them to
be more prone to discard problems and shortcomings in the evidence than the
other groups, while child psychiatrists had more negative attitudes towards the
criminal justice system than the other groups had. Female participants also had
stronger pretrial attitudes than male participants. When evaluating the CSA case
clinicians were sensitive only to the presence of leading questions but not to the
presence of other suggestive techniques, and experience had effect only on the
sensitivity to leading questions. The clinicians were not sensitive to the possibility
that suggestive techniques could have been used when they did not read the
interview. Strong beliefs related to CSA lessened the sensitivity to leading questions.
Those holding strong beliefs were even more prone to prosecute when other
suggestive influences than leading questions were present than other subjects
were. The results of this study suggests that in the future education of CSA
experts should focus more on scientific knowledge and theoretical expertise together
with the clinical experience.
77
77
WP 48
TRAUMA EXPERIENCES AND SYMPTOMS OF TRAUMATIZATION
Carl Göran Svedin1, Doris Nilsson2, Charlotta Lindell2
1
Dep. of child and adolescent psychiatry, Lund University, Sweden
2
BUP-Elefanten, Dep. of child and adolescent psychiatry, University of Linköping
The aim of this study was to study differences in trauma related symptoms using
the Swedish translation of Trauma Symptom Checklist for Children, TSCC (Svedin,
Larson, Lindell, 1996) between a normative group (n=423) of Swedish adolescents
and a clinical sample of either sexually or physically abused (n=93).
We hypothesized that symptoms commonly associated with trauma should be
more frequent among the clinical cases than among children in the normative
sample. We also wanted to study the impact of so called abuse factors on the
severity of the symptomatology. In doing this we used the Abuse Dimensions
Inventory developed by Mark Chaffin and co-workers (1997) and social and family
background factors.
There were clear significant differences between the two groups on total score,
and the subscales anxiety, depression, anger, posttraumatic stress and
dissociation but not on the subscale sexual concern.
When comparing children who were sexually abused (n=78) with those that had
been physically abused there was no statistic significant difference between the
two groups except for Sexual Concerns and the two subscales Sexual
Preoccupation and Sexual Distress
Abuse specific factors such as severity of the abusive behavior, the role of the
perpetrator in the child’s life and the frequency and duration of the abuse
seemed not to have an important role to play in this clinical sample.
The usefulness of the TSCC, the impact of trauma specific data using the Abuse
Dimension Inventory (ADI) and the impact of social background factors will be
discussed
78
78
WP 49
VIDEOAFHØRINGER AF BØRN SOM BEVISMATERIALE FOR
ANKLAGEMYNDIGHEDEN: “FORENSIC INTERVIEWING”
Kirsten Laila Moesgaard1
1
Roskilde Amts Sygehus, Danmark
I Danmark videoafhøres børn under 12 år, når der er mistanke om seksuelle
overgreb.
Det er politiassistenter, der afhører børnene.
I september 2002 kom en arbejdsgruppe under justitsministeriet med forslag i
en betænkning til justitsministeriet vedrørende afhøringer af børn i straffesager.
Betænkningen medvirkede bl.a. til lovændringer: 1. Videoafhøringer kunne
anvendes som bevis i retten og 2. mistænkte havde ikke længere tilladelse til at
sidde udenfor i monitorrummet, medens barnet blev videoafhørt.
Overvejelserne i forbindelse med arbejdsgruppens forslag vil blive gennemgået.
Efter at undertegnede har gennemført en række videoafhøringer af børn mellem
5 og 12 år stilles spørgsmål i forhold til retssikkerheden ved den procedure og
fremgangsmåde, der anvendes ved videoafhøringer i Danmark.
Barnets svar, reaktioner og adfærd under en videoafhøring er grundlæggende for
om en sag kommer for retten. Problemet er, at der ikke bliver lagt vægt på, at
barnets udsagn er afhængig af afhørerens spørge teknik og spørgsmål. Yngre
børn skal som oftest være meget overbevisende for at få repræsentanter for
det juridiske system til at tro på, at et seksuelt overgreb har fundet sted.
Problemerne er hovedsagelige:
1.
2.
3.
4.
Der bliver ikke taget hensyn til barnets udviklingsprofil.
Afhøreren har manglende erfaring/træning i at tale med børn.
Afhøreren mangler viden om børns generelle udvikling, sprog,
tænke- og handlemåde.
Afhøringsteknikken er for ustruktureret, usystematisk og
tilfældige.
Konsekvenserne af videoafhøringer er, at der sjældent rejses tiltale, når yngre
børn fortæller om seksuelle overgreb. Bedre afhøringsteknik, træning i at tale
med børn og systematik ville være med til at forebygge seksuelle overgreb mod
børn.
79
79
WP 50
THE NEEDS OF CHILDREN IN FOSTER CARE
Lucy Berliner1
1
Harborview Center for Sexual Assault & Traumatic Stress, USA
Unfortunately some children must be placed in foster care temporarily or for the
longer term because their family homes are not safe. These children have both
been maltreated and may experience placement as rejection or abandonment.
As a result they often have emotional and behavioral problems and attachment
insecurity. These difficulties can put the placement at risk and exacerbate
children’s problems and disappoint foster parents. This work shop will discuss the
typical problems and needs of foster children and foster parents and offer
solutions to promote a positive experience while children are in care.
80
80
WP 51
MULTI-AGENCY RESPONSES TO CHILD MALTREATMENT – UK SYSTEM
AND EXPERIENCES
Jonathan Picken1
1
British Association for the Study and Prevention of Child Abuse and Neglect
(BASPCAN), UK
Like so many other statutory systems for the prevention and detection of child
abuse the UK system has been created through bitter experience.
In recent years the ‘refocusing’ of services away from a forensically driven
response to concerns for children’s welfare, toward family support models, and
partnership working have been widely supported, and in part have addressed a
perceived imbalance in our responses to children in need.
However it has taken a series of scandals in respect of children tortured, abused
and murdered at the hands of their perpetrators to prompt government inquiries
that have all highlighted failings within the very systems designed to ensure the
safety and wellbeing of young people in the UK.
In England it took the tragic death of a little girl named Victoria Climbie to trigger
an independent and systematic revision of current practice to be undertaken.
This has led to one of the most extensive revisions of social policy in respect of
children’s welfare and emphasises the necessity for integrated systems to apply
holistic approaches to abuse and the causes of abuse.
Moreover the complex dynamics and causation associated with the most serious
examples of maltreatment do not so easily lend themselves to such ‘public
health approaches’. In recent weeks the English Appeal Courts have considered
a number of less common and challenging cases of alleged maltreatment in
which children had either been removed from their parent’s care or a parent had
been convicted of a criminal offence and subsequently imprisoned.
In a number of cases the court have overturned earlier decisions and questioned
the evidence which had been put before, and accepted by, the responsible
court.
As a result public support and the mandate communities give to child protection
services has been adversely affected. This paper will explore how the central
requirement for objectivity continues to challenge both systems and
professionals working within them and the attempts being made to ensure
transparency and accountability at all stages of the English child protection
system.
81
81
WP 52
FLICKOR PÅ INSTITUTION - PSYKOSOCIALT ARBETE MED SEXUELLT
UTSATTA TONÅRSFLICKOR
FLICKOR SOM ÖVERLEVER OCH GÅR VIDARE
Ann-Christine Falk1
1
Ersta diakonisällskap, Sverige
Ersta diakonisällskap ska se, identifiera och arbeta för och med människor vars
livskvalitet och människovärde är hotat. Ersta flickherm ska genom
behandlingsarbetet se och våga lyssna till de flickor som blivit utsatta för sexuella
övergrepp och agera för att deras möjligheter och svårigheter synliggörs på olika
nivåer i samhället.
Under perioden 1999 – 2002 bedrevs ett utvecklingsprojekt, som syftade till att
inrikta verksamheten till flickor som misstänks ha blivit eller blivit sexuellt utsatta.
Människor, som blivit sexuellt utsatta upplever inte sällan en stor smärta och ett
stort lidande. Projektet resulterade i en organisering av arbetet som vi kallar
modell som vi kallar Ersta-Mentormodellen eftersom Ersta diakonisällskap och
Insamlingsstiftelsen Mentor Sverige samfinansierat utvecklingsprojektet.
Ersta flickhem med enheterna Marsta Gård och Lännahemmet välkomnar
tillsammans elva tonårsflickor i åldern 13 – 18 år som blivit sexuellt utnyttjade.
För de flickor som inte längre kan bo hemma, på grund av sitt beteende och
utagerande, kan vi erbjuda behandling och boende. Behandlingstiderna varierar,
men ett till tre år är en realistisk tid att planera för.
Ersta flickhem ska erbjuda en miljö som skyddar flickan i boendet, så att hon
kan utveckla färdigheter och kunskaper, få möjligheter att skaffa erfarenheter
som medför att flickan kan känna tillit och skapa ett värdigt liv.
Vi professionella behandlare måste tänka på flickorna med respekt, värme och
kärlek. Att ha fattat ett beslut om att det är fel att vuxna använder barn i åldern
0 – 18 år, för sexuell tillfredsställelse är nödvändig och aldrig möjligt att förhandla.
Det innebär att medarbetarna inte ska vara fördömande utan har att
ställföreträda och bistå barnet, för vår del flickorna i deras berättande och
utveckling.
Arbetsinsatsen och kostnaderna för att ge omvårdnad och behandling till de
människor som blivit utsatta för sexuella övergrepp är stor. Vårt uppdrag är att
fortsätta behandlingsarbetet och att skapa det behandlingsinnehåll som på bästa
sätt motsvarar flickornas behov. Att skaffa oss nya kunskaper och att dela med
oss av våra kunskaper och erfarenheter är ett väsentligt arbete.
Att skapa nätverk och få mötesplatser med dem som blivit utsatta och de som i
sin profession arbetar med behandling och stöd är angeläget. Ett sätt är att
berätta om Ersta flickhems arbete på årets kongress anordnad av Nordisk
forening mot barnmishanling og omsorgsvikt.
82
82
Författarförteckning / Author index
Almebäck M. (sida / page) 35, 51
Arnardóttir S. E. 74
Arnkil T. E. 30
Berliner L. 29, 80
Berntzen K. 45
Bjørn A. K. 52
Bratid D. 45
Christensen E. 24
Christiansen K. L. 64
Citron C. 51
Cocozza M. 62
Dyb G. 37
Ekbom I. 40
Eriksson M. 57
Ertmann B. 76
Eskonen I. 54
Falk A-C. 82
Finnilä K. 77
Flodmark O. 26
Forsberg H. 56
Frick A. 38
Garbarino J. 27, 28
Gumpert C. 58
Gustavsson J-E. 39, 40
Haapasalo J. 43
Hagström B. 72
Hannikainen J. 44
Hansen S. 75, 76
Hedin M. 33
Heljestrand P. 49
Hellesnes M. 65
Hindberg B. 71
Hofvander Y. 46
Holen A. 37
Holmqvist C. 49
Ilkka M. 60, 61
Jalovaara K. 59
Jerkku M. 60, 61
Jones V. 47
Jørgensen G. 36
Kaldal A. 58
Kallio P. 44
Kaukonen P. 61
Kemppainen K. 50
Kivitie-Kallio S. 44
Kjellgren C. 67
Källström Carter Å. 55
Laaksamo E-M. 69
Lajunen K. 50
Lang K. 63
Lind M. 53
Lindberg S. 40
Lindell C. 41, 78
Luther S. 52
Mannonen M. 59
Mian M. 32
Moesgaard K. L. 79
Myhre A. K. 45
Mäki M. 60, 61
Niemi P. 77
Nilsson D. 78
Nordhov Fredriksen M. 52
Ny, M. 43
Oates K. 25, 32
Ólafsson S. 24
Oranen M. 68
Picken J. 81
Pohjoisvirta R. 69
Pringle K. 70
Proskin-Karvonen M. 59
Puura K. 61
Pynoon R. S. 37
Pösö T. 56
Rodriguez N. 37
Román C. 34
Santtila P. 77
Sinisalo M. 60, 61
Soinio M. 77
Solantus T. 73
Soonets R. 63
Steinberg A. M. 37
Strange M. 66
Svedin C-G. 42, 78
Sydsjö G. 42
Säävälä H. 69
Söderström B. 35
Tamminen T. 61
Tidefors I. 48
Tupola S. 44
Tähtinen H. 59
Wadsby M. 42
Wyller T. 27
Väli M. 63
Zachrison E. 39, 51
83
83

Den tredje nordiska kongressen om barnmisshandel och

Transcription

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