Common Client Issues in Counselling An Australian Perspective Child Maltreatment

66 Child Maltreatment KAY AND SAMANTHA BROWN ABSTRACT Research across several decades has repeatedly pointed to the high prevalence of child maltreatment in our communities , and its impact on our physical and mental health . This chapter will provide an overview of key theoretical models of the nature and impact of child maltreatment explore key principles of practice and treatment when working with families and conclude with a discussion of the need for counsellors to practice , and when working with such vulnerable populations . Learning Objectives Identify the prevalence and of child maltreatment . Explore the impact of child abuse and neglect on physical and mental health . Identify general principles of care as it relates to screening , assessment , and intervention . Identify common interventions and programs utilised with children and families where there are concerns of child maltreatment . Evaluate the impact of traumatic stress on counsellors and organisations . INTRODUCTION ( 1977 ) argued that humans need to make strong emotional bonds and these bonds are initially with their caregivers . What happens when this is disrupted and becomes unsafe ?

What can we , as counsellors , do to support children and families in situations where their fundamental needs are being met ?

Research across several decades has exposed a high prevalence of child maltreatment in communities around the world , and shone new light on the impact on health and wellbeing across the lifespan . Adversity and maltreatment in childhood may be the result of intentional or unintentional behaviours , and can include acts of omission ( neglecting to provide sufficient food or shelter ) and commission ( physical abuse in the form of excessive physical discipline ) et , 2007 ) Fraught with situations that are complex and , working in the area of child maltreatment requires counsellors to not only be aware of best practice standards , but also reflective of their own reactions and wellbeing . Furthermore , given the high prevalence and deleterious impact of child maltreatment , all counsellors irrespective of their chosen area of practice , have a responsibility to be familiar with the complex nature of child maltreatment and how to best support these vulnerable families . as

CHILD MALTREATMENT 67 HOW ARE CHILD ABUSE AND NEGLECT DEFINED ?

In the early , Henry and his associates identified the battered child syndrome after encountering a number of children presenting to hospital with unexplained fractures and subdural hematomas , and speculated that they may have been inflicted by the parents ( et , 1962 ) The published findings described the scope of child abuse , and the report shocked many medical and social service professionals . The identification ofthis phenomenon drew significant attention to the problem . Since this time , definitions of various forms of child maltreatment have changed and have been debated around the world . Child maltreatment includes physical maltreatment , emotional maltreatment , sexual abuse , neglect . These forms result in actual or potential harm to the child including to their health , development , dignity , and in extreme cases , survival ( et , 2006 ) There are several forms of child maltreatment . The physical abuse of a child is defined as those acts of commission by a caregiver that cause actual physical harm or have the potential for harm ( 2009 ) Sexual abuse is defined as those acts where caregivers use a child for sexual gratification ( WHO , 2006 ) Definitions of emotional abuse include the failure of a caregiver to provide an appropriate and supportive environment , and include acts that have adverse effects on the emotional health and development of a child ( WHO , 2006 ) Such acts include restricting a child movements , denigration , ridicule , threats and intimidation , discrimination , rejection , and other forms of hostile treatment . Neglect refers to the failure of a caregiver to provide for the development of the child where the caregiver is in a position to do so in one or more of the following areas health , education , emotional development , nutrition , shelter , and safe living conditions ( WHO , 2006 ) Neglect is thus distinguished from circumstances of poverty in that neglect can occur only in cases where reasonable resources are available to the family and caregiver . Emerging research has also pointed to the adverse impact of witnessing domestic and family violence on children , with several scholars suggesting it as a form of child maltreatment in and of itself ( et , 2007 ) The research literature demonstrates that witnessing can involve a much broader range of incidents , including the child hearing the violence being used as a physical weapon being forced to watch or participate in assaults , or being informed that they are to blame for the violence because of their behaviour ( 2007 ) exposure to domestic and family violence has been found to have both and impacts on their development . Indeed , several studies indicate that the relation between exposure to violence and child adjustment problems is evident for periods of 10 years or more ( Narayan et , 2013 ) EPIDEMIOLOGY THE EXTENT OF THE PROBLEM While child maltreatment was previously believed to be a rare or infrequent occurrence , epidemiological studies have discovered higher rates of child maltreatment in the general population . The Adverse Childhood Experiences ( ACE ) Study ( 1998 ) in the United States found that up to two thirds of the adults surveyed in the study reported the experience of one or more types of adverse childhood events , and up to 87 of the sample reported the experience of two or more types of such events ( Anda et , 2006 ) Prevalence estimates ranged from , with the majority of studies finding rates between and 10 . Three contemporary Australian studies have measured child neglect in community samples ( Robertson et , 2010 ) Prevalence estimates of neglect ranged from to . Three recent Australian studies and one Australian systematic review have estimated the prevalence of emotional maltreatment . Although the studies were all conducted with relatively large community samples , their prevalence estimates were quite different , ranging from ( Rodgers , 2004 ) to 17 ( et , 2010 ) The best available evidence suggests that the prevalence rate for emotional maltreatment in Australia is between and 14 ( Chu et , 2013 Moore et , 2015 ) studies have estimated the extent to which Australian children are exposed to family violence ranging from to 23 of children ( et , 2010 )

68 THEORIES OF CHILD MALTREATMENT The first major movement to protect children began during the early the doctrine of ( literally , the state as the father ) was introduced into English law to protect the rights of children . It allowed children to emancipate into adulthood at age 21 and protected the property rights of minors when the caregiver was abusing these rights . Since this time , many theories have been used to explain child maltreatment . The historical evolution of theories about child maltreatment falls into four progressive stages . The first is the speculation period of the when the phenomenon of child abuse and neglect first came into public awareness . The second is the introspection period of the when theories were prevalent . Third is the diversity period that explored more ecologically based theoretical explanations . Fourth was the classified as integration with the embrace of the model of child maltreatment that guides much of maltreatment practice and research today . 1979 ) first proposed an ecological perspective of human development , and ( 1980 ) applied the model to child maltreatment . What separates the ecological model from other theoretical models is its deviation from processes to a transactional and multilevel explanation . 1980 ) coupled the theoretical models of and to develop the ecological model . It is explained in four levels ( ontogenic ( and ( See Figure ) Ontogenic factors relate to the childhood histories of abusive caregivers ( 1980 ) The purpose of this exploration is to assess how a particular caregiver grows to behave in an abusive manner . The occurrence of abuse or neglect in childhood alone is insufficient to explain the phenomenon of child maltreatment because the majority of those who were maltreated fail to maltreat their own children . Yet the developmental history of the caregivers may predispose them to respond to certain situations in the or . The refers to the immediate context in which child maltreatment takes place and includes the family system , the maltreatment itself , and both caregiver and child characteristics . The encompasses the individual and family within larger social structures , including both formal and informal structures .

CHILD MALTREATMENT 69 MAC Attitudes and Ideologies of the culture . Social services INDIVIDUAL ( sex . age . health , etc ) Health services Local politics Figure ecological systems theory by is licensed under More recently , researchers have focused on the cumulative risk hypothesis that posits that human development may by constellations of risk rather than isolated adverse events ( see Figure Evans et , 2013 ) Referred to as the cumulative ecological transactional models of child maltreatment , such models suggest that the psychological health outcomes of children are dependent on the accumulation of risk actors across ( home , school ) and time ( during infancy , early childhood , adolescence ) Bryce , 2018 ) Measures of the effects of such cumulative harm have been found to be predictive of a wide range of physical and mental health problems , such as paediatric asthma ( et , 2008 ) obesity ( Evans et , 2013 ) stroke ( Mohan et , 2011 ) and psychiatric disorders ( 2020 ) These risk and protective actors are discussed further in the next section . Learning activity Listen to Professor speak about Child Maltreatment .

70 One or more interactive elements has been excluded from this version of the text . You can view them online here ?

WHAT ARE THE RISK FACTORS FOR CHILD ABUSE AND NEGLECT ?

As discussed in the earlier section , there is no single factor which causes child abuse and neglect . Factors related to the characteristics of the child that increase the risk of maltreatment include the age , sex , and presence ofa disability . Fatal cases of physical abuse are found largely among young infants ( Berkowitz , 2017 ) Physical abuse seems to peak for children at the age of to 12 years ( et , 2019 ) Sexual abuse rates , on the other hand , tend to rise after the onset of puberty , with the highest rates occurring during adolescence ( et , 2019 ) In most countries around the world , girls are at higher risk than boys for infanticide , sexual abuse , educational and nutritional neglect , and forced prostitution . Male children have been identified as being at greater risk of harsh physical punishment ( Berkowitz , 2017 ) Premature infants , twins , and children with disabilities have been shown to be at increased risk for physical abuse and neglect ( Henry , 2020 ) The multiple of child maltreatment have important implications for how counsellors understand a child and family needs and how they plan their interventions . Lay explanations of why child maltreatment occurs may be overly simplistic , blaming caregivers for not taking sufficient responsibility , or blaming societal trends and incidences on the increased incidence ) Assessment of a child and a needs across multiple domains and systems may highlight to the counsellor the systemic needs of both the child and the family that may need to be addressed , either before or in conjunction with , the counselling provided to the family . THE IMPACT OF CHILD ABUSE AND NEGLECT EFFECTS Children are impacted by maltreatment in various ways . et al . 2007 ) describe key dimensions by which children may vary in their experience of abuse and neglect the types and neglect the child is exposed to ( sexual abuse , physical abuse , neglect ) the frequency , severity , and duration of the maltreatment the age and developmental status ofthe child when the abuse occurred the relationship between the child and those who are seen as linked to the maltreatment occurring . Child abuse and neglect that occurred over different development stages has been found to have a profound and exponential impact over a child life , with adverse consequences felt throughout the life course ( 2018 ) Such findings highlight the importance of considering the history of maltreatment and its impact on the individual , rather than just an isolated episode of abuse . Referred to as maltreatment , vulnerable children are most often exposed to a number of different forms of maltreatment experiences across their

CHILD MALTREATMENT 71 development ( Higgins , 2003 ) This is an important consideration to understand the cumulative harm experienced by children , and their ongoing cumulative and chronic risk into the future ( 2019 ) Neurobiological development Infancy and early childhood are marked by rapid growth of the brain . Between birth and two years of age , the number of neurons , the cells that make up the brain , are said to have increased by 500 ( et , 2017 ) This rapid development ofthe brain is dependent on the child early experiences and the environments they live in . Thus , appropriate and responsive care and stimulation are important in order to allow for optimal growth of brain circuitry ( Sheridan Nelson , 2009 ) Researchers studying young children who were deprived care have found significant decreases in overall brain size and volume ( Perry , 2008 ) A decrease was particularly noted in children prefrontal cortex , often associated with complex cognitive tasks , such as decision making and controlling emotions ( et , 2017 Perry , 2008 ) Research on the physiological effects of maltreatment have focused on changes to the human stress response a complex phenomenon involving multiple human organs , designed to help us respond to threats and danger in our environment ( Pine , 2016 ) This stress response is said to have evolved as a survival mechanism , enabling people and other mammals to fight the threat off or flee to safety . Unfortunately , chronic exposure to stressful experiences may mean that our bodies overreact to stressors that are not , such as , work pressure , and family difficulties ( Pine , 2016 ) Findings have consistently shown that prolonged and chronic exposure to stress , sometimes referred to as toxic stress , alters the function and pattern of the physiological stress systems in children . This causes the child to either react with excessive feelings of stress to potentially benign situations to not identify or act protectively in situations of potential danger and threat ( et , 2011 ) Resource For an introduction to the impact of child maltreatment on the brain , be sure to read Bruce Perry seminal book , The Boy Who Was Raised as a Dog What traumatised children can teach us about loss , love and healing . Cognitive and language development Research has repeatedly found that exposure to adverse experiences early in childhood is consistently associated with critical lags in cognitive development and numerous academic difficulties ( et , 2001 Gould et , 2012 ) associated with attention , language skills and working memory . Cognitive and language are strong indicators of a child school readiness with respect to literacy , capacity to follow instructions , receptivity to performance evaluations , and ability to navigate peer interactions ( et , 2012 ) As early childhood is a sensitive period for language development , maltreated children are at particular risk for language delays . In a review examining maltreatment and language , et al . 2016 ) found that the language skills of children who have experienced abuse or neglect are delayed when compared to children without such experience with young children being particularly vulnerable to the language effects of maltreatment . Social and emotional development Social and emotional development involves the capacity to understand the self and others , to form relationships and to experience , regulate and express emotions . The development of such skills depends on the quality of relationships and the childhood environment ( Thompson , 2016 ) Attachment theory , first formulated by the , emphasised the need for infants to have an attachment to their caregivers . This attachment is a strong emotional bond , where caregivers were perceived as a source of comfort and reassurance , rather than just a source of fear and harm ( 1977 ) that attachment relationships had evolved to maintain proximity between infants and their caregivers , to increase the chance of protection particularly in times of danger and threat .

72 Building on work , and utilising observations of separations and reunions among infants and their caregivers , Mary identified three distinct patterns of infant attachment or attachment styles . The three styles were secure , and . Children classified as secure attached were found to welcome their caregiver return after separations , and if distressed , sought proximity and comfort from them ( et , 1978 ) In contrast , infants classified as having insecure attachments were found to either follow an or pattern . infants were found to show ambivalent behaviours towards their caregiver and an inability to be comforted during reunions with their caregivers . Infants classified as were found to avoid proximity or interaction with the caretaker on reunion ( et , 1978 ) More recent research has pointed to the presence of a fourth attachment style , commonly observed in maltreated children , labelled as disorganised ' It is a mix of and attachment styles frequently observed amongst infant and children exposed to unpredictable , chaotic , and frightening relationships and environments ( Main Solomon , 1990 ) Population level studies on attachment styles have found that up to of children have secure attachment styles , attachment styles constitute up to 25 and anxious attachment in 11 to 20 of the population . The disorganised attachment styles have been found to be prevalent in the general population between to , with up to 85 of children in foster care displaying behaviours consistent with a disorganised attachment style ( et , 1997 ) Learning activity For an illustration of the importance of healthy childhood attachment , watch this video of Professor Edward landmark research utilising the still face paradigm . One or more interactive elements has been excluded from this version of the text . Vou can view them online here ?

Children mental health The impact of maltreatment on mental health has primarily been studied through its manifestations in symptoms of stress disorder ( Childhood trauma , and the resultant toxic stress response , has been defined as the emotional reaction to exposure to an event that threatens or causes harm to a child emotional and physical wellbeing ( 2015 ) symptoms can manifest themselves in the form of the traumatic event ( often through play in children ) avoidance of triggers that serve as reminders ofthe frightening and traumatic experience disturbed sleep increased irritability , aggression , and alertness temper tantrums and startled and extreme responses to stimuli ( et , 2015 ) Individuals with a history of childhood maltreatment were found to have poor response to treatment compared to individuals with similar mental health diagnoses ( Teicher Samson , 2016 ) SCREENING AND ASSESSMENT The first step in helping children who have been maltreated is to recognise signs of maltreatment as part of the screening and assessment process . The presence of a single sign does not necessarily mean that child

CHILD MALTREATMENT 73 maltreatment is occurring in a family , but a closer look at the situation may be warranted when these signs appear repeatedly or in combination . The assessment of the presence and impact of child maltreatment is crucial as part ofa rigorous screening and assessment process . For children and adolescents , identifying the signs of maltreatment and acting protectively addresses immediate safety concerns and stops the continuing of the child or adolescent . A child may directly disclose to you that he or she has experienced abuse or neglect . In such cases , it is important that you are acquainted with the relevant child protection legislative requirements of the jurisdiction in which you are working , and be aware of your organisation child reporting requirements . In , Australia , the Child Protection Act 1999 ( requires certain professionals , referred to as mandatory reporters , to make a report to child protection services , if they form a reasonable suspicion that a child has suffered , is suffering , or is at an unacceptable risk of suffering significant harm caused abuse , and may not have a caregiver able and willing to protect them . Please note that counsellors may or may not be considered mandatory reporters depending on your occupational setting and state or territory level legislation . As requirements are different across states in Australia , and across services , it is advised that you seek regarding your role in reporting child protection concerns . Learning activity Making decisions about removing a child from a potentially unsafe home environment can be complex . The Australian Broadcasting Corporation ( ABC ) offer an interactive news article to illustrate the complexities of decisions in child protection You decide Would you remove these children from their families ?

Prior to assessing the impact of child maltreatment , it is worth considering your role in the service within which you work , and how you may explain your role to the children and families with whom you are working . For example , some young clients might assume that counsellors are the police or child protective services and that they may get into trouble or removed for making disclosures or discussions of the impact of traumatic experiences . The process of assessment can require more than a single session to complete and should also use multiple avenues to obtain the necessary clinical information , including tools ( see Resource section below ) past and present clinical and medical records , structured clinical interviews , assessment measures , and collateral information from significant others , other behavioural health and child protection professionals and agencies . Learning activity There are a number of psychometric assessment tools that can support your assessment and monitoring of trauma symptoms in children and adolescents . The National Child Traumatic Stress Network ( from the United States offers a contemporary review of a number of reliable and valid measures All measure reviews PRACTICE IMPLICATIONS The following are some considerations when conducting assessments with clients exposed to child maltreatment . Clarify for the client what to expect in the screening and assessment process Inform the client , in a developmentally appropriate manner , that the screening and assessment phase focuses on identifying issues that might benefit from treatment . Inform them that during the interview , uncomfortable

74 thoughts and feelings can arise . Provide reassurance that , if they do , you will assist in dealing with this distress , but also let them know that , even with your assistance , some psychological and physical reactions to the interview may last for a few hours or perhaps as long as a few days after the interview , and be sure to highlight the fact that such reactions are normal ( Read et , 2003 ) Approach the client in a yet supportive manner Such an approach helps create an atmosphere of trust , respect , acceptance , and thoughtfulness ( 2000 ) Doing so helps to symptoms and experiences generated by the maltreatment consider informing clients that such events are common but can cause continued emotional distress if they are not treated . Clients may also find it helpful for you to explain the purpose of certain difficult questions . Demonstrate kindness and directness in equal measure when assessing clients ( 2002 ) Respect the client personal space Cultural and ethnic factors vary greatly regarding the appropriate physical distance to maintain during the interview . You should respect the client personal space , sitting neither too far from nor too close to the client . Let your observations of the client comfort level during the screening and assessment process guide the amount distance and position in the room . Clients with trauma may have particular sensitivity about their bodies , personal space , and boundaries . Adjust tone and volume of speech to suit the client level of engagement and degree of comfort in the interview process Strive to maintain a calm and quiet demeanour . Be sensitive to how the client might hear what you have to say in response to personal disclosures . Clients who have been experiencing symptoms of trauma may be more reactive even to benign or questions . Avoid phrases that about the maltreatment . For example , questions such as why did you tell someone when it happened ?

may imply blame and not sufficiently acknowledge complex psychological processes linked to shame , shock and stigma related to experiences and neglect . Provide appropriate symbols of safety in the physical environment These include paintings , posters and other room decorations that symbolise the safety of the surroundings to the client population . Such considerations may be particularly pertinent for children with autism and developmental disabilities , who may experience sensory issues . This can involve both ( and ( to a wide range of stimuli , including particular lights , sounds , and smells in the counselling setting . An assessment of such sensory sensitivities and preferences with such children may be advised . Give the client as much personal control as possible during the assessment Present a rationale for the interview and its potential , making clear that the client has the right to refuse to answer any and all questions . Giving the client ( where staffing permits ) the option of being interviewed by someone of the gender with whom he or she is most comfortable , postponing the interview if necessary ( Harris , 2001 )

CHILD 75 Allow time for clients to become calm and oriented to the present if they experienced very intense emotional responses when recalling or acknowledging feelings of distress At such times , avoid responding in excessively emotive ways ( 2000 ) If the client has difficulty soothing , guide them through strategies to help them with their distress ( grounding exercises ) Be mindful of barriers to disclosing child maltreatment There are two main barriers to the evaluation of child maltreatment and its impact on clients . The first is related to differences in the perceptions between the client and the counsellor in regard to what is considered abuse and neglect . Some clients might not have ever thought ofa particular event as abusive , or their response to it as traumatic , and thus might not report or even recall the event . Some clients might feel a reluctance to discuss something that they sense might bring up uncomfortable feelings ( especially with a counsellor whom they have only recently met ) Clients may avoid openly discussing traumatic events or have difficulty recognising or articulating their experience of trauma for other reasons , including a feeling unsafe to share experiences , feelings of shame , guilt , or fear of retribution by others associated with the event ( in cases of interpersonal or domestic violence ) Still others may deny their history because they are tired of being interviewed or asked to fill out forms and may believe it does not matter anyway . Cultural considerations Finally , as with all other presenting concerns , the screening and assessments of child maltreatment must take adequate consideration of culture , ethnicity , and race . Factors , such as norms for expressing psychological distress and the stigma associated with seeking help may influence engagement with the assessment process . INTERVENTION CARE AND SPECIFIC INTERVENTION CARE With increasing recognition of the pervasiveness of child abuse and neglect , and the impact of traumatic stress on children and families , awareness is growing of the importance of approaches to psychological interventions . care refers to the understanding , anticipating , and responding to issues , expectations , and special needs that a person who has been victimised may have in a particular setting ( Lang et , 2016 ) At a minimum , practitioners must endeavour to do no is , to avoid or blaming clients for their efforts to manage their traumatic reactions ( Harris , 2008 ) care requires a commitment from practitioners and services to understanding traumatic stress and to developing strategies for responding to the complex needs of survivors . PRACTICE IMPLICATIONS CARE PRINCIPLES Harris and ( 2001 ) have care as being grounded in eight key principles . These are . Understanding trauma and its impact Understanding traumatic stress and how it impacts people and recognising that many behaviours and

76 responses that may seem ineffective and unhealthy in the present , represent adaptive responses to past traumatic experiences . Promoting safety Establishing a safe physical and emotional environment where basic needs are met , safety measures are in place , and provider responses are consistent , predictable , and respectful . Ensuring cultural competence Understanding how cultural context influences one perception of and response to traumatic events and the recovery process respecting diversity , providing opportunities for clients to engage in cultural rituals , and using interventions respectful specific to cultural backgrounds . Supporting control , choice , and autonomy Helping clients regain a sense of control over their daily lives and build that will strengthen their sense of autonomy keeping consumers about all aspects of the system , outlining clear expectations , providing opportunities for clients to make daily decisions and participate in the creation of personal goals , and maintaining awareness and respect for basic human rights and freedoms . Sharing power and responsibility Promoting democracy and ofthe power differentials across the program and sharing power and across all levels of an organization , whether related to daily decisions or in the review and creation of policies and procedures . Integrating care Maintaining a holistic view of consumers and their process of healing and facilitating communication within and among service providers and systems . Healing happens in relationships Believing that establishing safe , authentic , and positive relationships can be corrective and restorative to survivors of trauma . Recovery is possible Understanding that recovery is possible for everyone regardless of how vulnerable they may appear instilling hope by providing opportunities for consumer and former consumer involvement at all levels of the system , facilitating peer support , focusing on strength and resiliency , and establishing goals . In this way , care is grounded in an understanding of and responsiveness to the impact of trauma . Such practices emphasise the physical , psychological , and emotional safety for both providers and survivors , and that creates opportunities for survivors to rebuild a sense of control and empowerment . Given the prevalence of childhood adversity , and the complex nature of assessing for these concerns , the principles of care form a standard for how interventions and practices are delivered to all clients not simply those who are diagnosed with , or have disclosed being exposed to traumatic experiences .

CHILD MALTREATMENT 77 PREVENTION AND INTERVENTION Counsellors have an important role to play in designing and implementing primary prevention programmes for child maltreatment . At present , there are relatively few interventions available for children exposed to child maltreatment , and their families ( 2016 ) Research on efficacious interventions following concerns of child abuse and neglect involves a approach with a focus on interventions targeted at both the child and significant adults in the child life . While it is beyond the scope of this chapter to provide a detailed of interventions in detail , the remainder of this section will briefly review some promising approaches and programs for children of various ages . Children under five years For young children , interventions focused on improving the relationships between children and their key attachment figures ( often , caregiver ) are recommended . Programs such as the attachment and ( et , 2017 ) help the caregiver to respond more sensitively to children . Another example of such promising intervention is the circle of security parenting program ( Cooper et , 2009 ) The program focuses on attachment . takes an innovative approach to help caregivers increase their capacities to serve as a source of security for their children ( to provide a secure base ) 1988 ) with the idea that this increases caregiver sensitivity and reduces the risk of insecure and disorganised attachment . This intervention was designed with implementation efficiencies and value in mind , in collaboration with staff from the in which it is to be implemented and the diverse families it is intended to serve ( early childhood programs ) Cooper et , 2009 ) Similarly , the program psychotherapy ( et , 2006 ) uses the attachment relationship as the vehicle for improving the child emotional , cognitive , and social functioning . The child and caregiver are seen in joint sessions that focus on promoting emotion regulation in both the child and the caregiver ( et , 2006 ) Children aged 12 and under Significant research has focused on interventions aimed at improving skills amongst families using principles of behavioural theory and operant conditioning ( Skinner , 1972 ) For example , Pathways triple ( Petra Kohl , 2010 ) a modified version of the parenting program triple ( Sanders et , 2003 ) has shown promise in improving skills and attitudes , increasing efficacy , and reducing child behaviour problems of children and families ( Sanders et , 2004 ) Certain interventions have aimed to help with other psychological problems which are not exclusively associated with the role , such as anger management , mood regulation , and addressing drug abuse . For example , the parenting under pressure ( PUP ) program ( 2008 ) is an intensive , intervention underpinned by two key constructs ( i ) that child wellbeing is dependent on the capacity to provide a sensitive , responsive and nurturing environment and ( ii ) that in order for this to occur , a needs to be able to understand and manage their own affect both in relation to and to managing substance abuse problems ( Barlow et , 2013 ) The emergence of impacts of child maltreatment on the brain has spurred the development of programs such as the model of therapeutics ( Perry , 2006 ) offers assessments to children exposed to maltreatment and other forms of trauma , to support the sequencing of interventions ( educational , enrichment , and therapeutic ) in a way that reflects the child specific developmental needs in a variety of key domains , and is sensitive to core principles of ( Perry , 2008 ) With older children , the negative beliefs and beliefs about power and violence in relationships that evolve in response to the experience may be addressed in individual therapy ( trauma focused cognitive

78 behaviour therapy ( Cohen et , 2012 ) or even group therapy ( dialectical behaviour therapy for adolescents ( Miller , 2014 ) Children and young people aged 17 and under Interventions for older adolescents have focused on the wider system and aim to reduce stress and increase social support . Programs such as the therapy for child abuse and neglect ( Schaeffer , 2014 ) offer interventions that are tailored to the ecology of the family as mapped out during the assessment process . Some examples of interventions are working with the extended family to increase the amount of support they offer the child primary caretaker arranging a befriender , a home help or a counsellor service for an isolated parent arranging participation in a local parent support group or organising a place for the child and caretaker in a local mother and toddler group ( Schaeffer , 2014 ) In this way , the program acknowledges the factors across various systems impacting a child and their family , and works to modify aspects of these environments to mitigate the risks of child maltreatment in the future . PROFESSIONAL ISSUES SECONDARY TRAUMATIC STRESS AND Learning about child maltreatment often invokes strong feelings among health professionals . For example , some counsellors develop a strong urge to protect the child at all costs minimising or denying any loyalty the child may have towards their caregivers , or any potential for change on the part of the caregivers . Another common reaction can be a strong urge to protect or rescue the caregivers . In these cases , the counsellor may defend criticisms raised about the caregivers by other professionals , explain away or deny any shortcomings . These reactions may get in the way of professionals cooperating with each other and working in the best interests of the family . For example , many counsellors have had some personal loss or even traumatic experience in their own life ( loss of a family member , death of a close friend ) To some extent , the pain of experiences can be . Therefore , when professionals work with an individual who has suffered similar trauma , the experience often triggers painful reminders of their own trauma . Developing of such reactions and finding ways of being reflective of our work and thoughtful in our interactions , are important for working in cases involving child maltreatment . The following section will briefly describe common reactions to working with child maltreatment and childhood trauma . Strategies to manage one own reactions will be reviewed , and practical strategies for to prevent burnout among counsellors . SECONDARY TRAUMATIC STRESS AND COUNSELLORS Secondary traumatic stress is a risk we incur when we engage empathically with an adult or child who has been traumatised . Secondary traumatic stress is commonly defined as a set of natural , consequent behaviours resulting from knowledge about a event experienced by a significant other ( 1995 ) It is the stress resulting from wanting to help a traumatised or suffering person . It has only been recently that researchers and practitioners have acknowledged that professionals who work with or help people with childhood maltreatment or trauma are indirectly or secondarily at risk of developing the same symptoms as persons directly affected by the traumatic events . Counsellors who listen to adults or children describe the trauma are at risk a portion of the trauma ( Carr , 2015 ) PRACTICE IMPLICATIONS FOR INDIVIDUALS PREVENTION AND MANAGEMENT Training , support , and professional supervision can all reduce the risk of counsellors developing secondary traumatic stress disorder . Understanding what secondary trauma is and what causes it reduces a person

CHILD 79 vulnerability and increases resilience . Training in managing stress will increase a counsellor ability to respond to stress in ways that are less damaging . Similarly , training aimed at personal development also increases the counsellors sense of having an identity outside ofwork . Improving skills in a sport , or some other pursuit such as music or dance , increases the sense of joy in living which helps to protect us from the effects of stress ( Brady , 2012 ) An audit of one social support network , and methods to increase the quality of the support one is receiving , is possibly the most useful exercise in . Informal support may come from people within the network who are familiar with the concept of secondary traumatic stress disorder and who recognise the signs . Regular or feedback session that looks for any changes that might indicate that the person is developing a secondary stress disorder is critical for good ( et , 2015 ) For counsellors in Australia , professional development and involvement with counselling associations , such as Psychotherapy and Counselling Federation of Australia ( or Australian Counselling Association ( offer counsellors opportunities to network with other counsellors , seek peer support , and participate in group supervision . SECONDARY TRAUMATIC STRESS AND ORGANISATIONS It is important to note here that is not solely the responsibility ofthe counsellors themselves . In fact , without sufficient recognition or support from service , teams , or organisations , many of the strategies fall short of protecting counsellors from burnout . Social services and counselling organisations working in the child welfare sector often find themselves operating in the face of recurrent or constant crises . When left unchecked , such chronic stress has been found to influence organisational culture , leading to staff being unable to constructively confront problems , engage in complex , and be involved in all levels of staff decision making processes ( Bloom , 2008 ) In her seminal work on the impact of traumatic stress on organisations , Sandra Bloom ( Bloom , 2013 ) describes parallel processes within organisations , where communication networks tend to break down under stress , much like they do within vulnerable families that are the clients of the services . When communication networks break down in these services , so too do the feedback loops that are necessary for consistent and timely error correction ( Bloom , 2008 ) As making becomes increasingly and more reactive , an increasing number of policy decisions are made that appear to compound existing problems . and Harris ( 2008 ) describe a process by which organisations can start by looking at shared assumptions , goals , and existing practices with staff from various levels of the organisation . processes have been found to improve staff morale , as the leadership is seen as being open to new sources of information . Such organisational practices emphasise the development of more democratic , participatory processes is critical as these are the processes most likely to lend themselves to promoting amongst staff , and support in the development of solutions to the often complex problems facing the organisation ( Bloom , 2008 ) Learning activity Learn more about the impact of traumatic stress on organisations in our interview with Sandra Bloom on the education podcast . CONCLUSION Child maltreatment is a complex and multifactorial phenomenon . This chapter provides a cursory overview of some of the key considerations for counsellors in their work with children and their families . Counsellors are encouraged to be mindful of key risk factors associated with child maltreatment , and the cumulative impact of these problems and challenges faced by children and their families . From assessment to ongoing counselling , the provision of care is characterised by practices that ensure the physical and psychological

safety and their families . By collaborating effectively with families and key stakeholders , counsellors can support children in their recovery from child abuse and neglect . The sustainable provision of support requires practitioners to attend to their own wellbeing , while being equally supported by the organisations that employ them . Despite the devastating impact of child maltreatment , the presence of a calm , caring and reflective adult is often the key ingredient to a of healing from a traumatic past . Learning activity Watch this video of a clinician conducting an interview to assess for concerns of maltreatment . Despite being an instructional video , there are aspects of the interview that could be done different . As you watch the video , consider the following questions What do you think of the physical environment in which the session is being conducted ?

How do you think it helps and in what way might it hinder the session ?

What do you think of the language used and the communication style ?

Are there similarities or differences to how you may phrase questions and statements ?

In what way might the interview be more ?

One or more interactive elements has been excluded from this version of the text . Vou can view them online here ?

Learning activity Watch this video of the interview being conducted with the child . As you are watching , consider the questions listed in learning activity . Consider how the interview with the adult is different to that of the child . One or more interactive elements has been excluded from this version of the text . Vou can view them online here ?

GLOSSARY OF TERMS cause , set of causes , or manner of causation ofa disease other factors relating to health strong emotional bond that an infant forms with a caregiver ( such as a mother ) especially when viewed as a basis for normal emotional and social development

CHILD MALTREATMENT 81 syndrome as resulting from chronic workplace stress that has not been successfully managed adult who is responsible for the care of a child , including parent , adult sibling , grandparent , other family or kin member , or other appointed adult child forms of physical emotional , sexual abuse , neglect , or negligent treatment or commercial or other exploitation , results in actual or potential harm to the health , survival , development , or dignity in the context ofa relationship of responsibility , trust , or power emotional of a caregiver to provide an appropriate and supportive environment , and include acts that have an adverse effect on the emotional health and development ofa child related to the individual and family within larger social structures , including both formal and informal structures failure of a caregiver to provide for the development of the child where the caregiver is in a position to do so in one or more ofthe following areas health , education , emotional development , nutrition , shelter , and safe living conditions immediate context in which child maltreatment takes place and includes the family system , the maltreatment itself , and both caregiver and child characteristics related to the of the individual , community , and family within the larger cultural fabric study of cells of the nervous system and the organisation of these cells into functional circuits that process information and mediate behaviour . It is a of both biology and neuroscience . ontogenic related to the childhood histories physical of commission by a caregiver that cause actual physical harm or have the potential for harm stress particular set of reactions that can develop in people who have been through a traumatic event which threatened their life or safety , or that of others around them secondary traumatic set of natural , consequent behaviours resulting from knowledge about a event experienced by a significant other practice an active role in protecting one own wellbeing and happiness , in particular during periods of stress sexual where caregivers use a child for sexual gratification formal working alliance that is generally , but not necessarily , between a more experienced and a less experienced worker , in which the clinical work is reviewed and reflected upon with a view to improve one performance to the exposure to events that posed a threat to one life , or the lives of others around them framework for human service delivery that is based on knowledge and understanding of how trauma affects people lives and their service needs REFERENCES , Waters , Wall , 1978 ) Patterns of attachment . A psychological study of the strange situation . 2016 ) Universal violence and child maltreatment prevention programs for parents A systematic review . Psychosocial Intervention , 25 ( Anda , Walker , Perry , Giles , 2006 ) The enduring effects of abuse and related adverse experiences in childhood . European Archives and Clinical Neuroscience , 256 ( Barlow , Gardner , Macdonald , Parsons , 2013 ) An

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CHILD MALTREATMENT 85 AUTHOR INFORMATION , University of Southern is a clinical psychologist and senior lecturer in the School of Psychology and Wellbeing at the University of Southern . He has worked for over a decade in both public and private sectors offering child and adolescent mental health services . As a of the Trauma Informed Positive Behaviour Support ( program , research and clinical experience has focused on addressing the social emotional needs of children and adolescents impacted by child maltreatment . Kay , Edith University is a lecturer in Early Childhood Studies in the School of Education at Edith University Western Australia . She worked for the Department of Education for years as a classroom teacher in the early years , a deputy principal Early Years , an advisory visiting teacher in behaviour and a behaviour team leader . has worked extensively with disengaged and disruptive children , their teachers , and schools . Her research and her teaching focus on challenging behaviour of children includes those impacted by trauma , positive behaviour support , functional behaviour assessment and childhood wellbeing and resilience . Young Minds Psychology is a Clinical Psychologist with over 20 years of experience in working with children , adolescents and their families with mental health concerns and living with chronic complex medical conditions . She has worked in a range of settings in both the public and private sectors including child and youth mental health services , paediatric and adult health services and in private practice . Samantha Brown , University of Southern Brown is a clinical psychologist and lecturer in the School of Psychology and Wellbeing at the University of Southern . She has 20 years of experience working with children and their families in community and public health settings . She is the Program Director for Postgraduate Psychology and has a training and research interest in complex trauma . Please reference this chapter as , Brown , 2023 ) Child Maltreatment . In , Machin du ( Common Client Issues in Counselling An Australian Perspective . University of Southern ,