Jose Miguel De Angula of MAP International discusses the prevalence of child sexual abuse, the severe mental and physical effects of the abuse, prevention programs, and how MAP International is working with abused children.

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A Holistic Response to
Child Sexual Abuse
MAP international
Jose Miguel De Angulo & Luz Stella Losada
Cochabamba
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1 out of 3 girls and 1 out
of 5 boys before 18 have
been sexually abused
Sexual Abuse affects the
lives of survivors in many
different ways.
Children’s violence exist in a context of an andocentric
society tolerant to women violence
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Devastating impact on the health
American Psychological Association, APA Online
“Children and adolescents who have been sexually abused
can suffer a range of psychological and behavioral
problems, from mild to severe, in both the short and long
term. These problems typically include depression, anxiety,
guilt, fear, sexual dysfunction, withdrawal, and acting out.
Depending on the severity of the incident, victims of sexual
abuse may also develop fear and anxiety regarding the
opposite sex or sexual issues and may display
inappropriate sexual behavior.”
http://www.apa.org/releases/sexabuse/effects.html
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Serious Mental Illness and
Unaddressed Sexual/Physical Abuse
• 51 – 98% of public mental health clients with
severe mental health diagnoses
Goodman et al, 1999, Mueser et al, 1998; Cusack et al, 2003
• 93% of psychiatrically hospitalized adolescents
Ipschitz et al, 1999
Criminal Justice Problems and
Unaddressed Sexual/Physical Abuse
• More than 75% of girls in juvenile justice
system Calhoun et al, 1993
• 80% of women in prison and jails
Smith, 1998
• 100% of men on death row
Freedman, Hemenway, 2000
• Boys are 1,000 times more likely to commit
violence than those who do not
van der Kolk, 1998
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The Relationship of Adverse Childhood
Experiences to Adult Health Status
A collaborative effort of Kaiser Permanente and The
Centers for Disease Control
Vincent J. Felitti, M.D.
Robert F. Anda, M.D.
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Adverse Childhood Experiences
determine the likelihood of the
ten most common causes of
death in the United States.
Top 10 risk Factors: smoking, severe obesity, physical
inactivity, depression, suicide attempt, alcoholism, illicit
drug use, injected drug use, 50+ sexual partners, h/o STD.
Long-Term Consequences of Unaddressed
Childhood Trauma
Disease and Disability Social Problems
• Ischemic heart disease • Homelessness
• Autoimmune diseases • Prostitution
• Lung cancer • Delinquency, criminal behavior
• Chronic obstructive pulmonary• Inability to sustain employment
disease • Re-victimization
• Asthma • Less ability to parent
• Liver disease • Teen and unwanted pregnancy
• Skeletal fractures • Negative self- and other
• Poor self-rated health • perception and loss of meaning
• Sexually transmitted infections Intergenerational abuse
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Positron Emission Tomography (PET) scan: The
temporal lobes (at the top of the graphic), which
regulate emotions and receive input from the senses,
are nearly quiescent. Such children suffer emotional
and cognitive problems.
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What is conventionally
viewed as a problem is
actually a solution to an
unrecognized prior
adversity.
Mechanisms by
Death Early which Adverse
Death Childhood
Experiences
Disease, Disability influence Health
& Social Problems and Wellbeing
Throughout the Life
Adoption of
Span
Health-risk Behaviors
Social, Emotional, &
Cognitive Impairment
Disrupted Neurodevelopment
Adverse Childhood Experiences
Concep
tion
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The brain
SPECT/PET (single photon/positron
emission computed tomography) is
a nuclear medicine imaging technique
that produces a three-dimensional
image or picture of functional
processes in the body
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Time-Lapse Imaging Tracks Brain Maturation
from ages 5 to 20
Red indicates more grey matter, blue
less grey mater. Grey matter wanes
in a back-to-front wave as the brain
matures and neural connections are
pruned. Source: National Institute of Mental health
Paul Thompson, Ph.D, Laboratory of Neuroimaging
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Corpus callosum:
the integration of the brain hemispheres
• Teicher et al (1997): children
(especially boys) who had a
history of neglect or abuse had
a marked reduction in the size
of the corpus callousm when
compared with the control
group.
Teicher et al. (2000)
• Boys’ corpus callosum was
more vulnerable in cases of
neglect
• Girl’s corpus callosum was
more vulnerable in cases of
sexual abuse.
Teicher et al, 2004
• Participants with a history of abuse/
neglect had a 17% smaller corpus
callosum area when compared with the
control participants (p = .0001).
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Amygdala
• Teicher et al. : 33
victims of repeated
sexual assault had a
size reduction of
8.4% in the left
amygdale (p< 0.02).
Hippocampus
Menna et al. (2002)
• those with a history of physical or
sexual abuse had an 18% smaller
mean of the left hippocampal
volume
Bremner et al. (1997)
• participants who had a history of
child abuse and had PTSD had a
12% smaller left hippocampal
volume compared with the
matched control (p < .05)
• This may be a cause for the
fragmentation of explicit
memories.
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The silence of the brain in the victims,
shows …
…the silence of the victims to disclose
and denounce
…and the silence of society to face
this horrible crime .
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Why society has kept in silence for so
many generations doing nothing to
analyze and deal with this horrible crime?
Two Fundaments of a Public
Health Approach
• Creating a culture of human rights respect
toward children by deconstructing the
androcentric and adultocentric society.
• Equipping society in the areas of informed
response to sexual violence in the
health care, criminal justice, educational
and human services systems,
organizations, families and society.
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A Public Health Approach
• I. Primary Prevention
• II. Secondary Prevention Early
detection and Intervention
• III. Tertiary prevention Creating Cultures of
Trauma-Informed response in Health Care, juridical
and educational systems as well as in society
(Healing environments and responses)
I. Primary Prevention
• To construct safe & healthy environments in
which children may experience comprehensive
development and protection from all forms of
sexual aggressions.
• Multiple strategies for reduction of risks in order
to avert human suffering and to control the
tremendous personal, family, social & economic
costs of sexual aggressions
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MAP International work in Bolivia
• Development projects focused on building local capacity to care
for the different personal and social health determinants.
• Those programs have a foundations this missions principle: “The
comprehensive proclamation of Jesus’ message of salvation
should always be incarnated on God’s redemptive actions
through Jesus’ followers committed to love and justice.”
– Encarnational in peoples sufferings and hopes
– Carry & lived up by communities (team based organization)
– Needs to be transformational pursuing justice & grace
removing the historical roots that generate personal and
social sins.
Breeze of Hope Center (CUBE)
The Comprehensive Management of Sexual Abused
Children Program with multiple activities of prevention,
advocacy and comprehensive management of cases.
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Centro Una Brisa de Esperanza
• CUBE came as a response to a long history of
inaction of the government, and society to
engage with the thousands of children victims
of sexual abuse each year are appearing in our
cities.
Objectives of the Program
• Multidisciplinary work on identification, investigation,
judicialization and treatment of sexual aggressions offering
psychological, legal, medical and social support to victims
• Massive information about consequences of sexual abuse, myths,
procedure when a victim is identified, prevention measurements,
and other related topics. (Schools, organizations, Universities,
churches, media, courts, government offices, etc)
• Advocacy and political incidence (Pressure the State to provide
Support Centre, prevention measures, and implement legal actions
against aggressors).
• Research and documentation of the situation to foster solid legal
protection of children rights, establishment of protection policies
and restoration centers.
• Production and provision of materials with information to be used
with different audiences.
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Holistic Cases Management
Psychotherapeutic Socio-
Perspective communitarian
Perspective
Trans
disciplinary
Teams
Medical
perspective
Legal
Perspective
One of the interdisciplinary team (lawyers, psychology and social
worker) planning case management
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Friendly
environments
facilitate young girls
to express
themselves
Different activities allow
the expression of difficult
situations reducing stress
and anxiety and providing
tools for individual therapy
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Music
therapy is
also a
valuable
tool to
process the
adverse
experiences
Activities like
sewing allows the
recuperation of
hands control.
A way also to
strength self esteem
creativeness and
relationships
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Enjoying lunch together
Fun activities with the children & youth
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Young mothers coping with their new role
Health Check ups
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Workshops with parents
-Myths
-Consequences of
Sexual
Aggressions
-Role in child
healing process
- Group therapy
Voluntaries network receiving training
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Massive communication means (TV, radios and
newspapers)
Workshops with students from different schools
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Youth to Youth skills
development
Training youth in the
different schools
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Information
provided to
members of
different
organizations
NGOs Network for mutual support
Public information and visualization of the
problematic of Sexual Aggression
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Workshops with teachers
Partnership with institutions advocating
for children’s rights protection
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Massive campaigns
against sexual abuse
and day of solidarity
with the victims.
•August 9th National
day of solidarity with
victims from SAs
Government recognition of
MAP’s work with children (2004)
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Authorities taking position against Sexual
violence
Workshop with the
elected people to make
the new constitution
for Bolivia
LAW 3773 “National law of
solidarity with victims and
against sexual
aggressions”
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Governor Resolution for getting committed to develop
program and policies on child sexual abuse prevention
Training youth in the
different schools
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Training for Administrators of Justice
THE MOST CHILDREN GROWING CITIZENS THAT ALWAYS
VALUABLE ON SAFE AND EXPERIENCED FULL
THINGS ARE NURTURING RESPECT FOR THEIR
FRAGILE & ENVIRONMENTS WILL RIGHTS … LEARN VERY
MANY TIMES BRING THE HIGHEST WELL TO RESPECT THE
PEOPLE ARE WEALTH & VALUES TO RIGHTS OF OTHERS
CARELESS OUR COUNTRIES
WITH THEM
A SOCIETY THAT CAN NOT TAKE CARE OF THE SOURCE OF LIFE OF ITS
COUNTRY, THE CITIZENS IN THEIR EARLY AND MOST CRITICAL STAGES OF
THEIR DEVELOPMENT, IS A SOCIETY CONDEMNED TO LIVE IN MISERY AND
DISINTEGRATION
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