Strengthening Linkages between Clinical and Social Services for Children and Adolescents Who Have Experienced Sexual Violence: A Companion Guide

"Similar to sexual violence against adults, sexual violence against children and adolescents is surrounded by a culture of secrecy, stigma, and silence. Too often, it is viewed as a private matter, especially when the perpetrator is a family member."

This guidebook intends to provide a basic framework, examples, resources, and contact information for health providers and managers who coordinate service provision for child victims of sexual violence and who ultimately work to ensure that children and adolescents receive the services they need. The resource is premised on the observation that such violence is a global human rights violation with severe immediate and long-term health and social consequences. It serves as a companion guide to the 2012 Clinical Management of Children and Adolescents Who Have Experienced Sexual Violence: Technical Considerations for PEPFAR Programs, which provides step-by-step guidance on the appropriate clinical/forensic care for children and adolescents who have experienced sexual violence and exploitation. The companion guide helps health providers and managers to better understand and facilitate linkages with critical social and community services for comprehensive care of children and adolescents who have experienced sexual violence and exploitation beyond the clinical exam, take additional steps to help children and adolescents receive information and support their needs, and contribute to changes in sociocultural norms that perpetuate a culture of violence and silence that can also increase HIV risk and vulnerability.

For example, the role of communication is an integrated, multisectoral response is highlighted in a box within the document that characterises children and adolescents with disabilities as among the most vulnerable, because they "are systematically denied basic information about sexual health and relationships, including sexual violence. They may be in isolated settings away from neighbors, extended family, or local community members who could play a role in identifying abuse. Staff at disability-specific organizations may lack training in recognizing ACEs [adverse childhood experiences], including sexual violence, and thus miss signs of abuse of their clients. Those services that do exist are likely not able to provide disability-specific services, due to physical barriers to access or lack of providers who are trained to work with children/adolescents with disabilities. Access to justice is routinely denied....(they are not considered credible witnesses, and/or their cases are not taken seriously, and/or the court system lacks appropriate services)."

The sections in the guide are organised as follows:

• Section 1: Background and Rationale - provides a basic overview of the key issues, with a focus on the intersection of sexual violence and exploitation and HIV.
• Section 2: Approaches for Integrated, Multisectoral Response - summarises the various integrated, comprehensive models.
• Section 3: The Minimum Package - gives an overview of the minimum services needed by children and adolescents who have experienced sexual violence and exploitation, and summarises key considerations. This section also contains links to further reading and tools, as well as a chart with recommended starting points and aspirational standards.
• Section 4: Roles and Coordination of Various Stakeholders and Essential Elements for Bridging Community-Facility Stakeholders - describes the major service providers for children and adolescents who have experienced sexual violence and exploitation. It is suggested that programmes develop their own, locally relevant job descriptions with roles and responsibilities for each cadre that forms a part of the overall response system.
• Section 5: Mandatory Reporting - explores some key issues regarding mandatory reporting laws and policies, and how to reconcile these with what is in the best interest of the child/adolescent.
• Section 6: Referral Pathways and Community/Facility Coordination - suggests a generic pathway that programmes can adapt to their contexts, and provides a checklist for setting up a network.
• Section 7: Case Management - offers a brief overview of case management processes, outlines case manager roles/responsibilities, and presents a basic flowchart that programmes can adapt to their particular settings.
• Section 8: Guiding Principles - provides an overview of principles and suggestions to help ensure that the actions that service providers take on behalf of children and adolescents are supported by standards of care designed to benefit the child/adolescent's health and wellbeing.
• Section 9: Program Highlights - presents brief overviews of 7 programmes that are addressing the needs of children and adolescents who have experienced sexual violence and exploitation. It includes details and contact information for each programme. (See, for example, the description of the Thohoyandou Victim Empowerment Programme (TVEP), in Limpopo, South Africa, which operates a number of integrated prevention, empowerment, and support interventions, such as rights-based community dialogues covering 5 thematic areas: sexual assault, domestic violence, child abuse, HIV and AIDS stigma mitigation, and rights for minority communities (foreign nationals, sex workers, and lesbian, gay, bisexual, transgender, and intersex (LGBTI) individuals.)
• Annex 1 - comprises a glossary.
• Annex 2 - offers lists and tools for various programmatic functions.

An associated series of job aids, which are excerpted from the guide, is designed to help those involved in care and support for children and adolescents who have experienced sexual violence to learn the steps for effective case management, mobilise crisis intervention support, and set up a referral pathway/coordination network. Click here to access the job aids.

Borrowing heavily from nongovernmental organisations (NGOs) and other groups that have developed promising guidelines and resources, the guide and job aids are made possible through the United States (U.S.) President's Emergency Plan for AIDS Relief (PEPFAR) with the U.S. Agency for International Development (USAID) under the terms of Cooperative Agreement Strengthening High Impact Interventions for an AIDS-free Generation (AIDSFree).