Cooperation, Overview of Services, Referrals and Challenges in Daily Work

1. Cooperation, Overview of Services, Referrals and Challenges in Daily Work Barnahus Iceland Reykjavik 2016 Paola Cardenas psychologist, family therapist and expert interviewer

2. Before Barnahus • Lack of coordination between the CPS, Police, the judicial system and Health Services • Lack of specialisation • Lack of interdisciplinary approach • There were discrepancies in children’s disclosures • Children from rural areas did not get appropriate assessment, treatment and support

3. Before Barnahus The child was subjected to... • repeatedinterviews • conducted by many interviewers • disclosing at different locations • re-victimization/re-traumatisation was common

4. Guðríður Haraldsdóttir og Paola Cardenas

5. Fortunatelly things have changed…

6. Mission of Barnahus • To facilitate the collaboration and coordination of CPS, the police, prosecution and the medical profession in the investigation of child abuse • To provide a child-friendly environment for forensic interviews, treatment interventions and medical examination • To ensure the professional implementation of forensic interviews

7. Mission of the Barnahus • To ensure that the child victim and his/her family receives appropriate assessment, treatment and support • To establish professional work practices and guidelines through interdisciplinary cooperation • To enhance specialized knowledge on child sexual abuse and domestic violenceand to mediate that knowledges as appropriate to professionals and the public alike • Not to harm the child

8. Overview of Services • Child abuse from ages 3 ½ - 18 years. • Victims of sexual abuse, physical abuse and domestic violence and unaccompanied minors and children who seek asylum • Forensic interviews • Exploratory interviews • Court hearing interviews • Medical examination • Assessment and psychotherapy • Family counselling and support • Instructions to other professionals • Provide supervison to residency students in psychology

9. All services under one roof • Cooperation between: • CPS • Criminal justice system • University Hospital • Others • All professionals go to the child and not the other way around • Child-friendly approach

10. COOPERATION

11. Forensic interviews Court hearing interview Exploratory interview At the request of the CPS Only CPS is monitoring • Cases referred to the police • The court judge is in charge of the procedure • Monitoring are: • The prosecution • The police • ACPS representative • The child´s legal advocate • The defence lawyer • The alleged offender, few cases Investigative interview with unaccompanied minor/asylum seeker • At the request of the CPS • Monitoring are: • A CPS representative • A representative from the department of immigration • A representative from the Red Cross

13. Treatment intervention/psychotherapy • Specialists at Barnahus work in collaboration with the Child and Adolescent Psychiatric Ward of the National University Hospital, MST (Multisystemic Therapy) therapists, school counsellors, The State-run Treatment Home, SOK team, among others. • A CPS case worker monitors the multidisciplinary team ensuring the continuous support and follow up with the child and his/her family/caregiver(s).

14. Treatment intervention/psychotherapy • Barnahus psychotherapists are responsible for the treatment intervention provided to their assigned clients (children and their families). • Psychotherapists at Barnahus are in regular communication with the CPS case workers. This collaboration allows for the exchange of information between Barnahus’ psychotherapists and the CPS case workers to ensure the welfare of children and families who seek services at Barnahus.

16. Iceland – one Barnahus

17. Medical examination • Request of the police/CPS • Experienced pediatrician, nurse and gynaecologist • A child friendly examination room • Using video-colposcope • Anaesthetization exceptional low

18. Referral to Barnahus

19. Who can send referrals? • Child protection services (CPS) all around the country • Exploratory interview • Medical examination • Assessment and treatment • Court judges all around the country • Court hearing interview

20. Court judge Case reported to the police Police investigation Court hearing interview Obligatory Suspicion of abuse Referral to Barnahus for an exploratory interview Case reported to the CPS Assesment and treatment

23. Forensic interview – Referrals • A referral to Barnahus is sent parallel to a request form a police investigation • The forensic interview might take place at Barnahus, or at the police station (15-18 years) • If the child is interviewed somewhere other than Barnahus, Barnahus receives a transcript of the interview or a comprehensive report of the child’s disclosure

24. Exploratory interviews – Referrals • The suspected perpetrator is under the age of criminal responsibility (15 years) • The child exhibit inappropriate sexual behavior, engages in sexual play, draws picture with sexual content • Sexual play/abuse • Sibling(s) of the child victim • Cases on “grey area” • Children/adolescents suggest that something has happen but have not given a disclosure of sexual abuse • Peers (15-18 years) • Custody battles

25. Exploratory interview- Referrals • Child/parents refuse to press charges • A valid explanation is required from CPS if cases are not referred to the police • Consultation with the police regarding the exploratory interview, when necessary

26. Assessment and treatment intervention – Referrals • All victims of sexual abuse are entitled to treatment at BH, regardless the outcome of the police investigation • Victims or witnesses in physical abuse/domestic violence are entitled to treatment at Barnahus following a forensic interview. Only in cases where there is an open criminal investigation • Treatment at Barnahus is provided in cooperation with CPS. Between10-20 sessions • Cases of individuals between the ages of 18 to 20 who receive treatment at Barnahus have been refered to Barnahus before the individual turns 18

27. Challenges

28. Challenges in daily work in Barnahus • Difficult cases • Complex trauma • Taking work home with you • Working with children who have been abused • Dealing with parents • Non collaborative parents/caregivers • Abusive parents/caregivers • Disstressed parents/caregivers • Child custody battles

29. More challenges • Collaboration might sometimes prove to be challenging • CPS • The judicial system • Testifying in court as expert witnesses • Frustration when cases are dismissed • Traveling to remote areas around the country • Stuck in the middle of nowhere overnight

30. And more challenges • Keeping up to date with the best practices • Forensic interviewing • Assessment • Therapy • Plans might change all of a sudden • When court hearings are scheduled at the last moment • Some cases require imidiate action On the bright side….

31. On the positive side • A very rewarding job • Children recover • Families reunite • Specialized field of expertise • Witness justice being served • Keeping up to date with the best practices • Dinamic work Never boring…

32. Thank you!