Development of remote counseling protocols for OSAEC victims/survivors: Final report

Added Title

Development of remote counseling protocols for online sexual abuse and exploitation of children victims/survivors: Final report

College

College of Liberal Arts

Document Type

Book

Publication Date

2-2021

Abstract

1. In order to develop evidence-based remote counseling protocols for the OSAEC survivors/victims, the project team reviewed relevant literature on the victimization experience, needs, issues and concerns of children who have experienced online sexual abuse and exploitation. The team likewise conducted a systematic review of the various psychological interventions for OSAEC survivors, and the role of technology in remote counseling. Thirty-eight (38) key informants (OSAEC survivors, non-offending family members, social workers, mental health professionals, government and non-government referrors, experts in telehealth and data privacy) were interviewed to validate and corroborate the findings in the literature.

2. Since the onset of the pandemic, the use of technology for psychotherapy and counseling services has increased due to the community quarantine measures being implemented nationwide. This is especially important for vulnerable populations such as victims of OSAEC who continue to need psychological support in the midst of this global health crisis. In keeping with the Psychological Association of the Philippines’ (2020) guidelines on the conduct of telepsychology in the time of COVID-19, this research recognizes that there is an ethical way of delivering remote counseling services, to continue upholding the safety and protection of OSAEC victims. Whereas remote counseling increased the opportunity to provide continuity of care for this vulnerable population by improving their accessibility to the service provider (counselor) and providing convenience for both the service provider (counselor) and the client (OSAEC victim), there are inherent risks in the delivery of counseling services this way. Thus, the specific aspects of the use of technology for counseling was part of the major focus of the study. These aspects include adhering to safety and security standards that consider the privacy and confidentiality issues surrounding remote counseling and use of secure platforms.

3. Adopting the Multimodal Social Ecological Framework (Hopper, 2017), the proposed remote counseling protocol aims to be comprehensive and to address the issues and concerns of the OSAEC survivors at the individual, social-environmental, and systems level. These interventions are likewise trauma-informed, culturally and developmentally appropriate, and empowerment-focused.

4. Survivors of OSAEC have diverse profiles. Key informants described the children to be from various developmental stages and from different socio-economic backgrounds. Various socio-cultural and economic factors perpetuate the occurrence of OSAEC and put children at risk. Several key informants depicted survivors as coming from poor and dysfunctional families. But while poverty has been identified as a primary driver for engagement in OSAEC, other reasons have been unearthed such as parental neglect and peer influence especially among adolescents.

At a young age, victims are incapable of viewing themselves as victims, and contributing to this lack of awareness is the normalization of OSAEC in their families and communities. For older children, their felt obligation to bring their family out of poverty contribute to OSAEC’s widespread prevalence. Findings in both the desk review and key informant interviews confirm how the impact of the abuse and exploitation on very young children seemed to be of a lesser degree than older survivors due to a disparity in these children’s capacity to comprehend their experience. Also, the greater the grooming of perpetrators, the less the activities are perceived as abuse by the victims. While the OSAEC survivors interviewed in this study have been victims of online sexual exploitation, the researchers recognize that OSAEC could also have occurred for non- commercial purposes. This has been confirmed by the mental health professionals interviewed who are working in the school setting.

5. The extant literature does not have much to say about needs and issues specific only to victims of OSAEC. This has been confirmed by mental health professionals interviewed who reported similar needs and issues between OSAEC survivors and abused and exploited children in general. According to key informants, issues specific to OSAEC survivors include their lack of awareness that they have been abused and exploited, as many of the perpetrators are parents or relatives close to them. Many have also pointed out that the impact of different forms of OSAEC can vary depending on several factors, with researchers highlighting the additional complexities that OSAEC survivors face such as permanence and reach of images, possible re-victimization, and self-blame (Hamilton- Giachritsis et al., 2017; Hanson, 2017; Whittle et al., 2013). Some of the survivors face the dilemma of testifying against their facilitators or perpetrators with whom they have an emotional attachment. Key informants have observed that rescue operations often bring about OSAEC survivors’ traumatic feelings and high levels of anxiety because survivors tend to perceive being rescued as being kidnapped or captured. Dealing with separation from their families is therefore one major problem that needs to be addressed. Consistent with the literature, key informants observed the following issues among OSAEC survivors: shame, trust issues, self-blame, self-harm, suicidality (thoughts and attempts), low self-esteem, sexualized behaviors, aggressive behaviors, mood problems, memory problems, difficulty in comprehension, poor critical thinking skills and dysfunctionality in many aspects of their lives.

6. Key informants have reported that assessment of the experiences of the OSAEC survivors is very crucial in preparing the children to receive psychosocial interventions. Assessing the level of trauma of each individual child who will be receiving interventions is important, since survivors tend to differ in terms of the depth of their involvement in OSAEC. Assessment of the children’s unique needs before therapy is also important in order to identify the most suitable intervention for them.

7. While there are various evidence-based psychological interventions that have been developed and are being used to address the mental health needs and issues of victims of child sexual abuse and exploitation, data from both the literature review and key informant interviews reveal the lack of specialized treatment approaches that are specific to the complex needs of OSAEC victims/survivors. Trauma-informed care and treatment endorsed by mental professionals and service providers in this study emphasize the importance of establishing safety and stability, developing emotional and self-regulation skills, building healthy relationships, and developing a positive sense of self and future orientation. CBT-based therapy, expressive therapies such as arts and play therapy, and narrative therapy are some of the identified treatment approaches, the choice of which is influenced by the mental health professional’s training, orientation and experience. Survivors of OSEC who received counseling and therapy expressed in interviews that they appreciate the intervention and identified ways in which this service has helped them. Some mentioned having increased confidence, a stronger sense of self, improved relationships with parents and siblings, learning some skills and becoming more focused on goals. Non-offending family members noticed significant changes in their functioning where their children have become more responsible and independent and showed improved relationships with family members. These indicators are consistent with what the mental health professionals look for to determine the effectiveness of psychotherapeutic interventions provided to these survivors.

8. Beyond providing a sense of physical safety and comfort for children in shelters or in communities where they are re-integrated, establishing a sense of psychological/emotional safety in the context of a therapeutic relationship would also be an important need that has to be taken into account in the design of a remote counseling protocol for OSAEC survivors. To address children’s difficulty in disclosing, remote counseling service providers need to exert effort in establishing rapport to build a trusting relationship with the children. Psychotherapists play a huge part in the process of healing of the OSAEC survivors and should have personal traits tailor fitted to the needs and circumstances of the child victims such as flexibility, competency, cultural sensitivity, openness and capacity to build good rapport with remote counseling clients. Getting to know and strengthening the children’s present support system is also crucial in the success of the delivered interventions, as these children’s relationships with their support system (e.g. house parent, social worker, peers) also need to be built and strengthened. The process of creating a safe space for them facilitates disclosure and assures them that there are individuals who are willing to support them in their journey to recovery.

9. Remote Counseling: There are available studies that examine the effectiveness of remote counseling and therapy for various mental health issues of youth, but none that were tested on complex trauma associated with child sexual abuse and exploitation. This study reveals several factors to consider before developing a remote counseling protocol. Even if most of the mental health professionals who participated in this study transitioned to delivering mental health services online, and survivors expressed their willingness to try this mental health service, there are still certain preferences, safety concerns, specific requirements, advantages and disadvantages of remote counseling that need to be carefully studied and addressed.

10. In terms of infrastructure to sustain remote counseling services and increase utilization by intended users, some factors are important. First, especially for victims who are still reeling from trust and shame issues brought about by the trauma of abuse and exploitation, they have the opportunity to turn off their video any time they do not feel comfortable showing their faces. This is an advantage that can increase utilization of remote counseling. Second, ensuring proper coordination of stakeholders (from community level to shelter to home level) also ensures that victims can know about and utilize remote counseling services. Third, the infrastructure should consider physical space requirements necessary to conduct remote counseling and finally, apart from availability of a private space, availability of secure and stable internet connection as well as gadgets (e.g. mobile phone, laptop) is another important factor to consider in designing a protocol to increase utilization of remote counseling services. Providing equipment needed may also entail certain MOA restrictions prior to its actual release. Respondents suggested various ways of securing devices from complex to simple, such as creating a “white list” of devices, to making sure the camera on the gadget is equipped with a “cover” to prevent unintended viewing by unauthorized persons. Ensuring the sound and audio quality of gadgets to be used is as important as ensuring a private and quiet space because this facilitates the therapy process.

11. Privacy and confidentiality mean ensuring that the internet space and the remote counseling platforms are able to enable client privacy and data security, since information that is being shared between the counselor and the client is confidential. In establishing an infrastructure that supports remote counseling, ensuring that the online environment is truly private and confidential by designing technological safeguards as well as physical safeguards is crucial. These include assigning specific gadgets to be used only for counseling, installing firewalls, using secure VPN networks, encryptions and passwords for gadgets as well as for files, and discussing issues of privacy, permanence of digital footprints, with the clients. Additionally, it was found in the course of this research that most people still use potentially unsafe online platforms that do not offer end-to-end encryption, which is also found in literature (Szlyk et al., 2020). Some are aware of and use more secure and HIPAA (Health Insurance Portability and Accountability Act of 1996) [1] -compliant video-conferencing platforms such as Doxy.me and Zoom for Healthcare, but it seems convenience and client preference dictates what platforms professionals tend to use, such as the more common Zoom. This same lack of urgency in using secure emailing and text messaging/chatting apps is also noted in the study, with clients preferring the use of Viber and using the child’s regular email. Finally, protecting data gathered in between sessions is also crucial, such as when making and safeguarding counseling notes. Thus, making sure that the informed consent also includes provisions for requiring that only specific secure apps for pre-, post- and in-session interactions are used, and informing clients of data security, was emphasized in this study.

12. Integrating Duncan’s (2005) six-step model with KII data and literature, the remote counseling protocol for the OSAEC survivors was created. The protocol includes needs identification, infrastructure survey, partnership organization, structure configuration (protocols), pilot implementation, and solidification. The structure and protocols are detailed in the flowchart (Figure 2), starting from the inquiry to the remote counseling sessions.

13. Limitations and Recommendations a. There had been a limited representation of OSAEC survivors interviewed. All of them were victims of online sexual exploitation (OSEC). In the pilot-test of the developed remote counseling protocol, we recommend reaching to a wide and diverse set of end users who are not exclusively involved in online sexual exploitation but are representative of the wider and more inclusive term OSAEC. There has to be a mechanism in place that would make the existence of such services known, and a way to engage stakeholders in terms of increasing the accessibility, availability, and utilization of remote counseling interventions. b. Another limitation that the team encountered is the difficulty in reaching out to the survivors and their non-offending family members. This highlights the need to provide infrastructure and to capacitate users who are going to access the services. In addition, we recommend that supervised and unsupervised settings should continue to uphold the clients’ rights to privacy and confidentiality during the sessions. c. Both the extant literature and the valuable input from the mental health professionals should be considered in the design of remote counseling protocol for OSAEC survivors. This would allow the researchers to target important concerns and to set realistic therapy goals that can be achieved as the survivors go through the whole remote counseling process.

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Disciplines

Counseling Psychology | Social Control, Law, Crime, and Deviance

Note

"Principal investigator: Maria Caridad H. Tarroja, PhD; co-investigators: Ma. Araceli B. Alacala, MA, Patricia D. Simon, PhD, Agnes B. Villegas; MS project Consultant: Maria Christina Salud H. Enriquez, MA;  project assistant Gelivic Bacalso; transcribers: Maria Angela Del Fonso, Christian Mika Labrague, Knycolle Jan Navarro, Patricia H. Tarroja; coders: Ma. Dinah Asiatico Annabel Choy Hanzen Reyes

Keywords

Sexually abused children—Counseling of—Philippines; Computer sex—Philippines

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