Psychotherapeutic care for sexually victimized children – does it meet the need? A multilevel analysis

Objectives: Surprisingly little is known on the decision to provide psychotherapy to sexually victimized children. Previous research on service provision for victims of child maltreatment has analyzed the impact of case... [ view full abstract ]

Objectives: Surprisingly little is known on the decision to provide psychotherapy to sexually victimized children. Previous research on service provision for victims of child maltreatment has analyzed the impact of case characteristics, e.g. child or caregiver functioning issues, lacking social support, and low socioeconomic status. Findings, however, show that the decision to provide services is not only need-driven but also affected by external factors such as provincial legislation, institutional policy, or availability and accessibility of services. By analyzing characteristics of the decision to provide psychotherapy to sexually abused children both at the case and institutional level, we aim at identifying if psychotherapy is provided to the ones most in need or if the decision is biased.

Method: The data for this analysis was drawn from the first nationally representative agency survey on reported incidents of child sexual victimization in Switzerland (Optimus Study). During a 6-month data-collection period (March 2010-August 2010), 165 child protective services, 87 penal authorities and 98 agencies in the health and social sector have documented a total of 911 incidents of child sexual abuse. A multilevel logistic regression was applied to analyze both factors at the case level and the level of totally 350 agencies from all regions of Switzerland.

Result: In 22.6% of the cases, psychotherapy was offered to the victim. The severity of consequences, repeated referrals and caregiver functioning issues significantly increased the likelihood of psychotherapeutic services. Institutional disparity in the decision to provide was large (Median Odds Ratio = 3.83). Factors measured at this second level were, however, not significantly associated with the dependent variable. Furthermore, biases were identified at the individual level: Victims born in Switzerland were more likely to be referred to a psychotherapy in the aftermath of child sexual abuse.

Conclusion: Psychotherapy is primarily provided to victims of severe sexual abuse. Beside needs, the decision also largely depends on the institution that takes care of the victim. Institutional factors driving this decision remain, however, obscure. Future research should therefore invest in scrutinizing contextual factors of child protective services decisions.