1. The Protection Clarification
Strengthening the Role and Responsibility of the Non-Offending Caregiver in the Outcome for Child Victims
Presented by: Rachael J. Garrett, LMSW The Dee Norton Lowcountry Children’s Center Charleston, SC

2. Objectives Participants will:
Learn the importance of caregiver engagement.
Learn to identify potential barriers for non-offending caregivers to be a protective resource for the abused child.
Learn interventions to overcome these barriers.
Understand the role of the caregiver in evidence based treatment interventions.

3. Importance of the Caregiver
Role of protective caregiver in outcome for the child victim
The degree of maternal support at the time of disclosure impacts the victim’s adjustment.
Lack of support is associated with greater psychopathology for the victim and higher rates of out of home placement (Everson, et.al., 1999).

4. Identify Barriers to Protection
Motivation of caregiver (focus, impact, cost)
Internal barriers (cognitive capacity, mental health status, medical/physical conditions, impact of substance abuse)
External barriers (maintain a safe environment by restricting contact with the offender, emotional and physical support of child, financial resources, transportation, time, lack of support system)
Child Characteristics (impact of abuse on child, premorbid issues, behavior management issues)

5. Types of Barriers
Instrumental/Tangible (what they may tell us as to why they are not coming)
- Transportation, location, cost, job conflicts
Perceptual/Psychological (the real reason why they are not coming)
- Stigma, fear, shame, stereotypes, trust, cultural, denial, hopelessness, family, education, past experience, religion, substances
(information from Dr. Rochelle Hanson, MUSC Crime Victims Center)

6. Why focus on barriers?
Barriers to participation in treatment are significantly associated with therapeutic change (Kazdin & Wassell, 2000).
Perceived barriers matter!
- most salient predictor of adherence to tx recommendations (MacNaughton, 2001)
What does this mean?
- continuity of care may be seriously compromised if the perception of barriers by families is high.
(information from Dr. Rochelle Hanson, MUSC Crime Victims Center)

7. Interventions
Interventions are developed by the team of professionals who work in partnership with the Children’s Advocacy Center.
Evidence based practice is utilized to reduce risk and increase child safety.

8. Intervention: Clarification
Evaluated as one of sixteen intervention models that is supported and acceptable treatment for child physical and sexual abuse.
Was designed for use in a coordinated multidisciplinary community response to allegations of child abuse and neglect (CAC systems integration model).
Integrates the mandate of child protection, family preservation and offender accountability.
Creates a partnership between the family and the treatment provider/community response system.

9. Clarification: Theory and Rational
Goals to identify and reduce barriers to child safety and protection following the identification of abuse; to reduce any negative effects of abuse; to prevent future abuse
Based on the guiding principles from the empirical literature on child maltreatment, child protection state and federal mandates, and supports the overarching goal of family preservation or reunification with preconditions of child safety.
A uniform and comprehensive clinical assessment of the non-offending caregiver and child based on APSAC guidelines provides a baseline of history and experience of the child and family.

10. Engaging the Caregiver The Clarification Process
Clarification is a Process aimed at:
Empowering the caregiver vs. blaming
Caregiver shift toward child focus
Caregiver shift toward active protection

11. Modeling Appropriate Support and Protection Behaviors
The therapist has the opportunity to:
- provide information
- provide empathy and emotional support
- address the caregiver’s safety
- address the caregiver’s basic needs
- help the caregiver identify other supportive
individuals and systems
- help caregiver identify needs from community system
- identify the importance of the caregiver in the child’s safety and wellbeing

12. Basis of Protection Clarification
Child’s view of adults as responsible caregivers disrupted
Developmental Issues
- Child believes parents know what child knows.
Roles and Responsibilities must be realigned.
Relationship between maternal support and positive child outcomes
Supports child’s disclosure of risk.

13. Protective Caregiver
When the caregiver is willing and able to be a protective resource, the protection clarification can take place immediately.
This outcome supports the child protective services mandate for family preservation.
It also protects the child from placement away from a supportive family.

14. Non-Protective Caregiver
When the caregiver is unwilling or unable to be a protective resource immediately, family preservation becomes secondary to child protection and the child must be placed outside of the care of the non-offending and now non-protective caregiver.

15. The Clarification Process
Protection Clarification
Completed by a non-offending caregiver.
Assigns responsibility for protecting the child.
A precondition for safety and treatment
Addresses the child’s need to have their reality affirmed regarding the abuse and failed protection.
Provides a safety plan for the present.

16. Introducing Clarification to Caregivers
Identify the caregiver as the expert on the child.
Focus on the child and meeting child’s needs.
Help caregiver be specific regarding the child’s report of abuse.
Help caregiver identify what she wishes she had been able to do to protect the child.
Help the caregiver appreciate the child’s reporting.
Identify the therapist as a consultant to this process.

17. Four Steps of The Clarification Process
Define abusive
behaviors as wrong.
Acknowledge that
abuse happened.
CHILD FOCUS
Assign responsibility
for abuse and it’s consequences to offender.
Assign responsibility for protection to non-offending caregiver.
Define behaviors/actions
that will be put in place to
minimize risk.

18. The Clarification Process
First Order
Second Order
Child has NOT been removed
Caregiver initially child focused
Caregiver acknowledges responsibility
Caregiver is actively protective
Caregiver’s initial presentation may be ambivalent, not child focused, does not fully acknowledge abuse
Following immediate intervention, caregiver is able to shift focus on child’s needs
Child has been removed
Caregiver acknowledges reasons for removal
Caregiver acknowledges need for change but has not affected change
Caregiver may need treatment in order to assume responsibility
Caregiver initially not able to acknowledge abuse has engaged in and/or completed recommended treatment and taken actions necessary to provide safety for child
Caregiver able to demonstrate shift of focus during letter writing/revising process
Verbal
Written
Letter

19. Protection Clarification Assessment
Determine appropriate clarification based on child’s needs/caregiver’s responses.
What does the child need to hear from the caregiver in order to help the child feel safe and affirm the child’s reality?
What does the caregiver need to ensure that the information delivered to the child is appropriate and child focused?

20. Protection Clarification Process
The protection clarification process involves the therapist working with the non-offending parent(s)/caregiver(s) to identify specific information regarding responsibility for protection and responsibility for the abuse to the child through a clarification conference.

21. Protection Clarification Information
The information to be identified is elicited through the assessment and developed in the initial stages of treatment.
The information is written in a letter form to the child victim to ensure the non-offending parent/caregiver remains child-focused.

22. Issues to be Covered in Protection Clarification Letter
Acknowledge awareness of what happened (using the child’s words).
Empathy for what the child has experienced; the focus is to be on the child and not on the parent(s)/caregiver(s) own feelings.

23. Issues to be Covered in Protection Clarification Letter
Acknowledge that the offender is responsible for the abuse and any disruptions following disclosure.
Acknowledge any attempts made by the child to disclose.
Acknowledge that it is the parent’s responsibility to protect and care for their child.

24. Issues to be Covered in Protection Clarification Letter
Describe what did happen regarding protection.
Acknowledge any failure to know or question about the abuse.
Describe what actions the protective parent(s)/caregiver(s) wish they had taken.

25. Issues to be Covered in Protection Clarification Letter
Set up a safety plan to include how to communicate and what to expect for protection.
Commit to the best interest of the child.

26. Protection Clarification Letter is a Process
Address issues to be covered.
Discuss in group and with therapist.
Write initial letter – can start with what the caregiver thinks the child needs to hear.
Review and revise as many times as necessary in conjunction with additional feedback from child’s therapist.

27. Protection Clarification Letter is a Process
The letter is reviewed by the therapist who provides feedback to the non-offending caregiver to address any subtle shifts of responsibility, and to ensure that it is complete and accurate.

28. Delivering the Protection Clarification Letter
When letter is ready…
- Have caregiver write a final letter without benefit of earlier letter.
- Caregiver reads and is given feedback.
- Child’s therapist reviews drafts of letters with feedback.
- Rehearsal helps caregiver manage emotions.
- Incorporate feedback from child’s therapist and from rehearsal into letter.

29. Delivering the Protection Clarification Letter
Issues that must be revised are “grist for the treatment mill.”
Address barriers to believing, supporting, and protecting.
Caregiver reads letter to therapist at every session.
Can be helpful to read line by line and ask what the child would hear.
Write in age and developmentally appropriate language.

30. Clarification Conference
Explain rules to child/parent prior to conference.
Caregiver reads letter to the child in the presence of child’s therapist and other supportive adult.
Parent’s therapist is present for support.
Therapist orchestrates the session.
Process is stopped as necessary.
Child has opportunity to ask questions.
Child is given the letter.

31. Clarification Conference
Siblings of the index victim are included individually and the caregiver shares the letter developed for each.
Same process of questions and answers
No expectations of affection
No expectation of forgiveness
Ways to give child control in the process
Therapist can ask questions if child doesn’t.

32. Desired Outcome
The child understands why he or she was removed from the family.
Caregiver accepts responsibility for protection.
Child’s reality of the abuse and failed protection is acknowledged.
Commitment to future protective behaviors is clearly defined and stated.
Caregiver commits to providing emotional support and following through with treatment for self and for the child.

33. Desired Outcome
If the child’s caregiver is unable to complete clarification in a timely manner, the therapist, CPS worker or foster parent can clarify around the reasons for placement.
When the caregiver moves to a position of being able to be protective, the caregiver then presents the Protection Clarification.

34. Measurable Behavioral Change
Although there is no guarantee of any protective interventions, the Protection Clarification provides clear behavioral responses by the caregiver that are specifically designed to protect the child
Past barriers to child safety have been identified and interventions have been made to overcome those barriers and to reduce risk to the child.

35. Measurable Behavioral Change
New behaviors have been identified, discussed and implemented prior to the child returning home with the now protective caregiver
New rules, boundaries, roles and responsibilities are identified and implemented by the caregiver
Methods developed for the child to share future information regarding risk leads to increased communication and safety

36. Measurable Behavioral Change
The behavioral changes identified through treatment and then communicated to the child/children in the clarification are monitored by individual/family therapy providers
Family therapy offers an opportunity for both monitoring change and offering additional interventions for change as required

37. Additional Uses of Clarification Intervention
Although this intervention model was designed for use in child sexual abuse cases it is also appropriate for other typologies of abuse or neglect including abuse perpetrated by offenders out of family
Caregivers participate in the same process to appropriately assign responsibility for the abuse and to provide their child with information about what the caregiver will do in the future to protect the child

38. Additional Uses of Clarification Intervention
Child Protective Service professionals and treatment providers are often asked to provide recommendations regarding the safety of children who have been abused
This intervention provides observable behavioral indicators of change in support of child safety

39. Additional Uses of Clarification Intervention
The Protection Clarification process focuses specifically on caregiver protective behaviors
The successful completion of the Protection Clarification can be utilized as a precondition for family preservation, for visitation and/or family reunification

40. Questions and Comments
For more information please contact:
The Dee Norton Lowcountry Children’s Center
Rachael Garrett