What Works for Children
There is a widespread evidence base shows that the right places, people and support can minimise children's distress and result in better outcomes for child victims of violence and abuse.
The right place
Safe, welcoming, child friendly spaces
Research highlights the importance of increasing children (and their caregivers) sense of psychological and physical safety to aid their wellbeing, recovery and the collection of evidence.
Design of the buildings in which children and their families engage with professionals has been demonstrated to play a role in supporting children’s sense of safety. Existing studies of children and carer’s experiences of Barnahus or Child Advocacy Centres (CAC’s), identify a ‘child friendly space’ as a significantly recognised and valued aspect of the service, associated with feelings of welcome, comfort and safety and the preferred option children and families identify for forensic interviews or medical examinations. (30)
Accounts from children and families who have engaged with health, welfare and justice services after abuse (including through Barnahus services) have often drawn attention to the impact of the spaces and places in which support is delivered. Spaces which prioritise children’s comfort, privacy and calm and are designed with their needs in mind are noted to minimise distress.
The location, entrance, appearance and sound quality of buildings, as well as the specific rooms in which children have to both wait for professionals or engage with professionals are all highlighted as impacting on their sense of wellbeing and safety. (31) Formal, institutional, unfamiliar spaces where children’s privacy feels compromised can also undermine children’s sense of safety at an already difficult time.(32) Specific elements such as therapy animals, the presence of child and youth friendly resources (e.g. games, art materials) can support their wellbeing. Children have highlighted a need for the space in which support was offered to prioritise helping them to feel safe, calm, comfortable, and age appropriate.
Multi-disciplinary teamwork and services ‘under one roof’
Co-location of multi-disciplinary professionals is widely credited with supporting effective information sharing and coordinated case management. (34) For children, the hope is that providing different services under one roof helps to minimise the burden of engagement with multiple professionals.
Studies identify that despite the intentions of a Barnahus (or related CAC models) there are often limits to coordinating all services under one roof and in some sites forensic interviews and medical examinations may continue to take place elsewhere in certain cases. (35) In a study where this was the case children and carers reported a preference for accessing services in a Barnahus, rather than a hospital or police station. (36)
A recent evaluation of England’s Barnahus model (the Lighthouse) identified that young people using the service recognised benefits of being able to access different services under one roof. They highlighted both the increased ‘practical ease’ for them at a stressful time and more integrated service provision, minimising a need to re-narrate experiences of abuse. (37) Furthermore, young people in this study specifically referenced awareness that their positive experience with the service was linked to effective behind the scenes communication between staff.
Minimising children’s contact with court and unnecessary retelling of their experience
The change in the approach to evidence gathering and minimising children’s need to retell accounts of abuse in court has been associated with improved criminal justice outcomes in Iceland where the model was first introduced and children are kept away from court. Unpublished evidence from the Icelandic Child Protection Agency, cited by the Children’s Commissioner for England suggests that since the introduction of the model, in cases of child sexual abuse, there has been a trebling of the number of perpetrators charged, a doubling of the number of convictions, and better therapeutic outcomes for children and their families. (39)
In other places the relationship between the introduction of Barnahus and children’s contact with courts appears to be linked to the wider legislative contexts of the country where they are based.
There is also evidence that Barnahus and related models may reduce the amount of time between an initial report about child abuse and a case concluding – supporting children’s recovery through less time spent awaiting the outcome of court processes.
The right people
Trusting relationships
Relationship-based practice is at the heart of what children and families’ need after experiencing abuse. This is essentially an approach to support which prioritises relationships of trust and understanding, in which professionals become attuned to the emotional world of the individual they support. Such support is enabled through the provision of consistent, caring and non-judgemental practice.
Research shows that after experiencing trauma, support that focuses on addressing feelings of powerlessness, disconnection and lack of safety can help children to recover. For children who have experienced sexual abuse, addressing issues of betrayal, shame and traumatic sexualisation (in the case of sexual abuse) are also identified as particularly significant. (41)
Research and consultation with children, young people and families across Scotland who have experienced abuse show that they explain their needs in straightforward terms: the need to be protected; seen and heard; believed and provided with support from people who ‘understand’ their circumstances and experiences. (42)
These findings closely mirror findings from wider UK studies with children who have experienced abuse. (43) For example, in a UK study of 53 children who had experienced sexual abuse in the family environment, ten key qualities that children seek and value from services that are there to help are identified as: care and compassion; being believed; choice and control; non-judgement; safety; optimism; active listening; understanding; advocacy and trustworthiness. (44)
These messages from research about children’s support and recovery after trauma which focus on help to address feelings of powerlessness, disconnection and lack of safety.
Advocacy support to ‘navigate’ the system
Children and their families’ access to advocacy support has been strongly linked to their sense of satisfaction with services provided by Barnahus and related CAC services. (46)
Within this context we use the term ‘advocacy’ not in the sense of a formal legal role but a role that focuses on the provision of accurate information to children and families about systems and processes, representation and support for sharing children and families’ views in professional settings and help to access a range of wider services.
Children and families note the value of support from a trusted individual to represent their views to professionals, keep them informed about the progress of justice processes and support them to understand the processes they have to engage with. The provision of advocacy support within Bairns Hoose responds to widespread evidence about vulnerable victims and witnesses’ experiences of justice and welfare processes as 'complex, confusing and hard to influence' which exacerbates their absence of control. A recent review focused on what helped child victims and witnesses in criminal justice processes after abuse highlighted the value of emotional support, guidance, preparation for court and testimonial support. (47)
Accessible, timely communication with children and families
Poor communication is repeatedly highlighted as a central concern for child victims and their families, contributing to lack of understanding of the welfare and justice processes, poor management of expectations, and erosion of their sense of control. Conversely systems (including Barnahus) that support children to better understand processes and decision making with which they are involved and manage realistic expectations (through advocacy or other inputs) are noted to contribute to children’s sense of control and calmness – fostering emotional safety and countering trauma dynamics.(49) Support to enable children’s views to be heard and considered by professionals is significant in enabling children to have influence, choice and a sense of control, noted to be key tenants of trauma informed practice. (50)
Studies of children and carer’s experiences in Barnahus and CAC services note that effective communication and support to understand processes varies, with this being a continuing concern for some.(51)
Effective communication with children has been shown to be dependent on a number of factors including professionals' access to up to date and accurate information about individual children’s cases and the multi-disciplinary processes they are engaged with. It also requires effective information sharing protocols and systems to allow the timely flow of information to children and families. Factors associated with Barnahus such as co-location and opportunities for increasing ‘informal’ contact between professionals in different roles have also been noted to support information sharing which benefits children and families. However, caution is noted in an evaluation of Swedish Barnahus that accessing services through a Barnahus model is not, on its own ‘a guarantee that children and parents receive comprehensible information… or feel safe throughout’. (52)
The right support
Family inclusive support models
The need for support for children who have experienced violence or abuse to extend to support for non-abusing family members has been well documented – particularly in relation to child sexual abuse and domestic abuse. It is widely recognised that children’s experiences of safety and recovery are relational – experienced in response to the experiences of those closest to them. Support to non-abusing family members and carers is demonstrated to support children’s recovery in four distinct ways:
- It helps family members to understand and respond appropriately to a child’s needs – bolstering protective support around the child.
- It responds to the direct impacts of identification of a child’s abuse or harm on wider family members – helping them to process and make sense of their own feelings.
- It promotes family stability and safe positive relationships at a time when disruption and change to family dynamics is likely to be intense and painful for those who have been abused.
- And finally, it reduces the responsibility (or burden) which children who have been sexually abused feel for non-abusing family members, avoiding further silencing the child and enabling them to focus on their own needs.
Evaluations of Barnahus in Sweden have identified that services where there is limited available support to ‘caregivers’, service satisfaction has been impacted. (55)
Timely access to recovery, emotional or mental health support
Children and families’ needs after abuse or maltreatment include timely intervention from services to ensure physical and psychological safety, obtain a sense of justice, receive therapeutic support to aid recovery and access treatment for related physical health conditions. Children and families’ needs are also noted to be wide ranging and systemic, in other words, impacting and intersecting with multiple aspects of their lives (e.g., family, education, communities).
Access to developmentally appropriate and trauma sensitive therapeutic services is recognised to be critical for many child victims of abuse, alongside support to families. Although not all children will want or require clinical therapeutic support, for those that do, early access to medium to long term support is noted to minimise poor mental health. (57)
Evidence regarding the efficacy of particular therapeutic models for child victims of abuse remains challenging. In studies addressing responses to child sexual abuse, the largest study of its kind found statistically significant improved wellbeing outcomes for victims of child sexual abuse associated with a flexible, medium term therapeutic model (Letting the Future In) based on strong relationship-based practice. The model used a combination of creative therapies, symbolic play, awareness and management of feelings, socio-educative work and a focus on identity and self-esteem. This model was delivered by a team of predominantly social work trained staff some of whom had additional therapeutic training. (58)
National Institute for Health and Care Excellence (NICE) guidelines on therapeutic interventions after child sexual abuse divide evidence-based approaches into those addressing physical abuse, emotional abuse or neglect. These (differentiated by age) include: attachment based interventions; parent-child psychotherapy; multi-systemic therapy and a range of other parent interventions. For children who have experienced sexual abuse they highlight evidence based interventions (differentiated by age) to include: Trauma Focused – Cognitive Behavioural Therapy (TF-CBT) and therapeutic programmes – such as Letting the Future In and psychoanalytic therapy. (59)
Meanwhile qualitative, in-depth research with children and young people highlights the value of strong trusting relationships with a named individual and key practice principles as outlined, rather than a specific model. (60)
30, See Rasmusson, B. (2010). Children’s Advocacy Centers (Barnahus) in Sweden. Child Indicators Research, 4, 301-321. doi: https://doi.org/10.1007/s12187-010-9094-y; Stefansen, K. (2017). Staging a caring atmosphere: Child-friendliness in barnahus as a multidimensional phenomenon. In Collaborating Against Child Abuse: Exploring the Nordic Barnahus Model (pp. 35–56). Scopus. https://doi.org/10.1007/978-3-319-58388-4_2
31 Mitchell, M., et. al. (2024) The story so far - North Strathclyde Bairns Hoose Evaluation – Phase two evaluation report. University of Edinburgh.
32 Beckett, H and Warrington, C (2013) Making Justice Work. Luton. University of Bedfordshire
33 Soares, C, Beckett H and Warrington C (2022) ‘There’s something there for everyone’ Learning about the Lighthouse: Young people’s perspectives on London’s Child House. Luton. University of Bedfordshire/MOPAC
34 Herbert, J. L., & Bromfield, L. (2016/9). Better together? A review of evidence for multidisciplinary teams
35 Herbert, J. L., & Bromfield, L. (2016/9). Better together? A review of evidence for multidisciplinary teams responding to physical and sexual child abuse. Trauma, Violence, & Abuse, 20(2), 214–228.
36 Rasmusson, B. (2010). Children’s Advocacy Centers (Barnahus) in Sweden. Child Indicators Research, 4, 301-321. doi: https://doi.org/10.1007/s12187-010-9094-y
37, 38 Soares, C, Beckett H and Warrington C (2022) ‘There’s something there for everyone’ Learning about the Lighthouse: Young people’s perspectives on London’s Child House. Luton. University of Bedfordshire/MOPAC
39 Children’s Commissioner for England (2016) Barnahus: Improving the response to child sexual abuse in England. London. Children’s Commissioner
40 Soares, C, Beckett H and Warrington C (2022) ‘There’s something there for everyone’ Learning about the Lighthouse: Young people’s perspectives on London’s Child House. Luton. University of Bedfordshire/MOPA
41 Carpenter, J, Hackett, S, Phillips, J, Jessiman, T, and Patsios, D (2016) Letting the Future In: Therapeutic Intervention for children affected by sexual abuse and their carers - evaluation of impact and implementation. NSPCC. London https://learning.nspcc.org.uk/media/1369/letting-the-future-in-evaluation.pdf
42 Hill, L. et al. (2021) Sharing Stories for Change, Edinburgh: Children First
43 Beckett, H and Warrington, C (2013) Making Justice Work. Luton. University of Bedfordshire; Allnock, D. and Miller, P. (2013) No one noticed, no one heard: a study of disclosures of childhood abuse. London: NSPCC.
44 Warrington, C. Ackerley, L, Allnock, D and Beckett, H (2017) Making Noise: Children’s Voices for positive change after sexual abuse
45 Soares, C, Beckett H and Warrington C (2022) ‘There’s something there for everyone’ Learning about the Lighthouse: Young people’s perspectives on London’s Child House. Luton. University of Bedfordshire/MOPAC
46 Herbert, J. L., & Bromfield, L. (2016/9). Better together? A review of evidence for multidisciplinary teams responding to physical and sexual child abuse. Trauma, Violence, & Abuse, 20(2), 214–228.
47 Field, N. and Katz. C. (2023) “The Experiences And Perceptions Of Sexually Abused Children As Participants In The Legal Process: Key Conclusions From A Scoping Literature Review”. Trauma, Violence, & Abuse, 24, Pp. 2758–2771.
48 Soares, C, Beckett H and Warrington C (2022) ‘There’s something there for everyone’ Learning about the Lighthouse: Young people’s perspectives on London’s Child House. Luton. University of Bedfordshire/MOPAC
49 Olsson, A.-M. E., & Kläfverud, M. (2017). To be summoned to barnahus: Children’s perspectives. In Collaborating Against Child Abuse: Exploring the Nordic Barnahus Model (pp. 57–74). Scopus. https://doi.org/10.1007/978-3-319-58388-4_3
50 NESS (2024) Trauma Informed Justice: A knowledge and Skills Framework for Working with Victims and Witnesses
51 Kaldal, A., Landberg, A., Eriksson, M., & Svedin, C. G. (2017). Children’s right to information in barnahus. In Collaborating Against Child Abuse: Exploring the Nordic Barnahus Model (pp. 207–226). Scopus. https://doi.org/10.1007/978-3-319-58388-4_10
52 Rasmusson, B. (2010). Children’s Advocacy Centers (Barnahus) in Sweden. Child Indicators Research, 4, 301-321. doi: https://doi.org/10.1007/s12187-010-9094-y
53 Soares, C, Beckett H and Warrington C (2022) ‘There’s something there for everyone’ Learning about the Lighthouse: Young people’s perspectives on London’s Child House. Luton. University of Bedfordshire/MOPAC
54 Warrington, C. Ackerley, L, Allnock, D and Beckett, H (2017) Making Noise: Children’s Voices for positive change after sexual abuse, London: Children’s Commissioner, University of Bedfordshire & NSPCC.
55 Johansson, J., Steffanson, K, Bakketeig E. And Kaldal, A (eds) (2017) Collaborating against Child Abuse: Exploring the Nordic Barnahus Model. Palgrave MacMillan
56 Warrington, C. Ackerley, L, Allnock, D and Beckett, H (2017) Making Noise: Children’s Voices for positive change after sexual abuse, London: Children’s Commissioner, University of Bedfordshire & NSPCC.
57 NICE (2017) Child abuse and neglect Guidelines NG76. Available at: https://www.nice.org.uk/guidance/ng76
58 Carpenter, J, Hackett, S, Phillips, J, Jessiman, T, and Patsios, D (2016) Letting the Future In: Therapeutic Intervention for children affected by sexual abuse and their carers - evaluation of impact and implementation. NSPCC. London https://learning.nspcc.org.uk/media/1369/letting-the-future-in-evaluation.pdf
59 NICE (2017) Child abuse and neglect Guidelines NG76. Available at: https://www.nice.org.uk/guidance/ng76
60 Warrington, C. Ackerley, L, Allnock, D and Beckett, H (2017) Making Noise: Children’s Voices for positive change after sexual abuse, London: Children’s Commissioner, University of Bedfordshire & NSPCC.
61 Soares, C, Beckett H and Warrington C (2022) ‘There’s something there for everyone’ Learning about the Lighthouse: Young people’s perspectives on London’s Child House. Luton. University of Bedfordshire/MOPAC