Beacon of hope for child abuse victims

In the backstreets around Camden Town station is a discreet picture of a lighthouse. The sign by the door of a nondescript block is easy to miss. But once inside you come face to face with a project that is rewriting the rules on how we treat victims of child sex abuse.

Research shows the system is failing these children: the victim meets social workers and is interviewed at a police station kicking off a chain of referrals that wrap the child and their family in a complex web of different agencies, meetings and judicial processes. Emotional support is promised via Child and Adolescent Mental Health Services (CAMHS) but there is a waiting list of between six and 12 months.

The Lighthouse offers a dramatically different vision. It is a multi-agency service that follows in the footsteps of Iceland’s “Barnahus” model (see below), offering a range of support services under one roof for young victims of sexual abuse.

This is a child-centred space, a far cry from the tense atmosphere of a police station or hospital. The children are offered hot chocolate while they wait and everywhere they go there are sofas, rugs, throws and cushions.

A key innovation is the fact the police interview takes place at the Lighthouse rather than in a police station. In some cases the project is trialling a replica of the Icelandic model where the interview is led by a child psychologist while a police officer controls the video recording and takes notes next door.

The criminal justice element is just one part of the project. There are also on-site medical staff, child advocates and therapists to help the child and their family heal.

Many of these services existed prior to the Lighthouse, says Emma Harewood, the project’s development and service manager. “But they would have been in different places with different professionals rarely talking to each other and the family and child having to repeat their story again and again,” she says.

The majority of cases they see come under the umbrella of “serious sexual offences”. About 40 per cent of abuse will have taken place within a family, 21 per cent of cases are “peer on peer” while 17 per cent are to do with people outside a child’s family or friendship group such as a teacher.

FACTFILE THE LIGHTHOUSE PROJECT

What is it? A service in north London for children and young people who have experienced sexual abuse.

Who is it for? Children and young people aged 0-17 and young people with a learning disability up to the age of 25 – and their families. The catchment area is Barnet, Camden, Enfield, Haringey and Islington.

Which organisations are involved? Health and wellbeing services are provided by University College London Hospitals NHS Foundation Trust, The Tavistock and Portman NHS Foundation Trust, the NSPCC and Solace Women’s Aid. Other partners providing services include the Metropolitan Police, Camden Council, The Brandon Centre and Respond.

What services are on offer? Advocacy, medical and sexual health support, police interviews conducted by a clinical psychologist, emotional support and play therapy, police and social care liaison services.

How is it staffed? A full-time manager and the full-time equivalent of four data/admin officers; three paediatricians; a sexual health nurse and play specialist; five child and adolescent mental health services (CAMHS) practitioners including three clinical psychologists and psychiatric input; five NSPCC therapeutic practitioners; eight advocates; two police liaison officers; and two social care liaison officers.

Who funds it? The Lighthouse is funded though an £8m joint investment by the Home Office, NHS England, the Mayor’s Office for Policing and Crime and the Department for Education, with more than £1m additional funding from a partnership between Morgan Stanley and the NSPCC.

The Lighthouse gets involved early on in the process once a child has disclosed abuse with team members often attending an initial strategy meeting with children’s services. One of the service’s police liaison officers may then make direct contact with the investigating officer, explains social care liaison officer Eimear Timmons (pictured above).

“Not all officers will know about this – it’s a new way of working for all professionals,” she says. “We can get involved in that very early stage so when the officer and social worker go to visit that child they’re already thinking Lighthouse.”

Referrals to the Lighthouse mainly come from social services and schools and the service can also give advice beforehand on whether a referral is appropriate. In the service’s first year representatives from the Lighthouse attended 100 strategy meetings and 41 consultation meetings.

Sometimes a child may be referred to the service before the strategy meeting has taken place or the referral may follow that meeting. In some cases young people are referred many months or even years after a case has closed because only then are they ready for therapeutic and other support.

Once a referral is made, police and social care liaison officers check whether there are urgent safeguarding issues. If there has been a recent assault the child first goes to the CYP Havens service, the child sexual assault referral centre for London, which can carry out DNA tests.

Next comes an allocation meeting where a range of professionals at the Lighthouse discuss what services the child needs and how urgently. This is followed by the police VRI – video recorded interview, also referred to as an achieving best evidence or ABE interview – governed by the police protocol for interviewing vulnerable witnesses and children. It takes place in the Lighthouse’s Talking Room. It is a large room with white walls, blue sofas, armchairs and a low table. What look like big smoke alarms on the ceiling are actually cameras and there are sound boxes on the wall – they relay a live feed to the video room next door. There are no posters on the walls as they may be a backdrop in court evidence but on the floor a Mr Fox rug provides colour and informality.

The police are focused on protecting children and vulnerable adults from abusers but also need to take into account trauma and the emotional impact of a criminal investigation, explains detective constable Lisa Isaacson, one of the project’s police liaison officers.

The video evidence a child gives will be used in any resulting trial. It means they will only have to attend court if they are cross-examined.

The use of a child psychologist, which is being funded for 33 cases a year, is a game-changer, explains Isaacson. “It’s really the first time in this country that someone outside the police or social care is leading evidential interviews with children,” she says.

The aim at interview is to go over the key points that need to be proved and test any possible defences the suspect might have. “You can’t not ask difficult questions just because it will be uncomfortable for the child,” says Isaacson. “However, the benefit of having the psychologist is they will be phrased in a thoughtful way so as not to come across as victim blaming.” The interview lasts between 30 minutes and two hours and can be spaced over a series of days if there is a lot to cover.

Decision to engage

The decision to press charges lies with the Crown Prosecution Service, although the young person and their family will be asked if they wish to support the investigation. The child doesn’t always want to engage, says Isaacson. “But with support from the Lighthouse we’ve had several children and teenagers change their mind and said ‘no I will engage’ which has been amazing,” she adds. After six months of support from the advocacy team one child decided she was ready to give a VRI interview, says Harewood. In that case the two perpetrators went on to plead guilty because the child’s evidence was so strong.

Crucially, the child has an advocate to help. Anna*, one of the child advocates at the Lighthouse, says child sex abuse can lead to “a huge amount of silence, shame and isolation”.

She will often start off by visiting the child at home. “Sometimes within the family there’s lots of different views on what they want to happen.” This can be “tricky”, she says but her focus is always on the child. “We try to promote their point of view in the professional network and help the parent to think about why the child might have that point of view,” she says.

Healthcare staff are another key part of the team. Someone who has been sexually abused may have concerns about pregnancy, sexually transmitted infections or damage to their body. A paediatrician and nurse are on site to carry out an initial assessment of the young person, including a physical examination.

The assessment, which looks at all aspects of a child’s health and wellbeing, can provide much-needed reassurance, explain children’s nurse Julie Griffiths and Dr Deborah Hodes, a paediatrician with a special interest in safeguarding. “The children are pleased to be here because we believe them, we listen to their story and tell them it’s not their fault,” says Dr Hodes (pictured above, left).

Children can feel less inhibited talking to a health professional, she explains. “One eight-year-old asked if she was pregnant – she didn’t feel able to ask others but could ask a nurse or doctor,” she says. In some cases the team may also be able to help gain more precise evidence by asking a child to point out on their body exactly where they were touched by an alleged abuser. “Many of these children are also neglected so they may have unmet medical needs that no one has bothered to do anything about before,” adds Dr Hodes.

Another main plank of the project is its emotional wellbeing team, which can support someone for up to two years. “The child might be presenting with disrupted sleep, struggling with concentration in school, suicidal thoughts, self-harm or having difficulty with relationships,” says Alex*, one of the NSPCC’s therapeutic practitioners.

Many of the rooms have felt-tip pens, paper and sand trays which can be used to tell stories. Play is a key part of helping a young child to express themselves, sometimes to startling effect. “In one session using a sand tray a child made a very clear disclosure so we took a photo of it,” Harewood recalls. “We hadn’t encouraged it, they did it spontaneously.”

Naz Taner (pictured above, right), a social worker by background, is another NSPCC therapeutic practitioner and says working with the service has “developed me as a practitioner and my understanding of the process children go through”.

“What I value is really working alongside other disciplines,” she says. “We are not battling to get information as we all work together. In turn that helps how I can support children.”

Emotional support for families

The emotional wellbeing team including NSPCC and CAMHS practitioners also provides emotional support to families, who may feel guilty, angry, be in denial or even disbelieve the allegations, especially if the alleged abuser is their partner or a close relative. They may receive one-to-one sessions, attend a parent psychoeducation course or be referred to a rape crisis friends and family service. Meeting other parents of abused children or an adult abuse survivor can also be therapeutic. Support from NSPCC practitioners may also be offered to the victim’s siblings.

The road to the first British Barnahus began with a document Harewood co-wrote in 2015. The Review of Pathway Following Sexual Assault for Children and Young People in London, funded by NHS England, exposed a convoluted system that delivered vastly different outcomes depending on which of the capital’s 32 boroughs a child inhabited.

The report made three key recommendations, one of which was to pilot the Barnahus model in the UK. The other two were to create a children’s sexual assault referral centre – the CYP Havens service – and Child Sexual Abuse (CSA) Hubs designed to bring agencies together to offer a more streamlined service to abuse victims and seen as an interim step to Barnahus. Soon there will be CSA Hubs up and running in five locations covering the whole of London. The CSA Hub in north London evolved into the Lighthouse, explains Harewood who says having an existing structure in place was key to getting the service off the ground.

The Lighthouse has just marked its first anniversary. The expected number of cases at the outset was 500 and so far 363 have been referred, with not all children or young people opting to attend. But those who do come “want every part of the service”, says Harewood. Only two cases have gone to trial so far because the criminal justice process takes around two years. There is much interest in setting up another Barnahus-style service – particularly from Wales, Scotland and Northern Ireland. However, an anticipated pilot in County Durham has not materialised as hoped. Instead the area’s service has added two clinical psychologists to improve their ABE interviews, Harewood says.

Despite the children’s commissioner for England calling for all police and crime commissioners to set up a Barnahus in their area there is no sign of a rollout. Harewood suspects people are waiting for the results of a full evaluation of the Lighthouse, not expected until July 2021, with an interim report scheduled for next year. Part of the caution may be because the Lighthouse still has to secure its own future. “We’re funded until September 2020 in the first instance, although obviously we’re hoping to continue the funding,” says Harewood.

According to Harewood, the service certainly addresses one of the main complaints from young sex abuse victims. “The one thing young people asked for was for someone to help them navigate what is a really complicated journey through social care investigations, police investigations, health, therapeutic support,” she says. “We do that for them by being in one place with an advocate to walk the journey with them.”

*Surname withheld

THE BARNAHUS MODEL

The Barnahus – which literally means child house – model was established in Iceland in 1998. It came about after the authorities there realised the response to child sexual abuse cases was uncoordinated and ineffective.

Young victims were being asked to give multiple interviews to each agency, which affected the quality of the evidence and meant few suspects were charged. It also left children traumatised.

The Barnahus approach drew on elements of children’s advocacy centres in the USA and focused on sexual abuse cases. Under the model, all services are delivered under one roof in an unmarked residential property designed to be non-threatening and child-friendly.

Interviews are conducted by qualified clinical child psychotherapists rather than police. The recorded interview serves as testimony in court, with few children under the age of 15 being required to give evidence in person. By interviewing the child immediately upon referral to the Barnahus, evidence is more reliable and the child can be offered therapeutic support quickly.

The impact has been dramatic. Twice as many cases of suspected sexual abuse have been investigated while the number of cases prosecuted has tripled – as has the number of sentences handed down to abusers. Sweden, Norway and Denmark have all tailored the model to their particular social, legal and political context.

Anne Longfield, the children’s commissioner for England, has called for the Barnahus approach to be adopted across the country. “It is now time for commissioners in England to look at how the model can be piloted here and adapted to our own legal system so as to help improve rates of prosecution and, ultimately, outcomes for children,” she said in a 2016 report on the model.

Previous research by the children’s commissioner suggests that in England only one in eight child victims of sexual abuse are identified by the authorities. On top of that, the police often fail to persuade children who do disclose to give evidence about their ordeal. A change of approach to a child-centred Barnahus model would go a long way to changing these poor outcomes, supporters argue.

TEAH’S STORY

Teah*, aged 11, is the oldest of three siblings and just one of the children and young people who has been helped by the Lighthouse project to date.

One day at school after a “stay safe” workshop she told her class teacher she’d had problems sleeping. After further discussion she revealed her stepfather had woken her up and “done things to her”. She was very upset and the school made an immediate referral to children’s social care.

The Lighthouse social care liaison officer joined the strategy meeting at children’ services and the project came on board. At the Lighthouse, Teah and her mother were supported by an advocate, play specialist and clinical psychologist. Teah went on to disclose more abuse that had gone on for a period of three months.

It turned out her eight-year-old sister was in the room when the abuse happened. Meanwhile, her mum revealed she was also the victim of sexual abuse as a child and suffered from depression.

The advocacy team at the Lighthouse worked with Teah’s school, her social worker and the police officer investigating her case throughout the criminal justice process. Teah and her sister were both able to access therapy at the Lighthouse and her mum joined a parents’ psychoeducation course so she could meet other parents and better support Teah. According to the Lighthouse team, the impact on Teah has been positive – she now feels listened to, her mood has improved and she has been able to stay engaged in the criminal justice process.

Teah’s stepfather was interviewed by the police. However, it can take a while for cases to make it to court as shown by The London Rape Review, conducted by the Mayor’s Office for Policing and Crime and the University of West London and published earlier this year.

Based on more than 500 rape cases from 2016, it shows that on average it took 18 months from the reporting of an alleged offence to the outcome of a trial – if the case got that far.

*Teah is a composite case study to avoid any children being identified