ChddAburerC Ne&c~. Vol. 14. PP. 397-405, Pnnted in the U.S.A. All rights resw~ed.

1990 Copyright

0145.2134/90$3.00 + a0 0 1990 Pergamon Press plc

AN EVALUATION OF A SUPPORT GROUP FOR PARENTS WHO HAVE A SEXUALLY ABUSED CHILD MARK University

of Central

Florida

Department Orlando

A.

WINTON

of Sociology and Anthropology Regional Medical Center

and

Child

Protection

Team,

Abstract-This study investigates the effectiveness of a parent support group for parents who have a child who has been sexually abused. The parents completed pre- and post-evaluation packages to assess the effectiveness of the group. The Louisville Behavior Checklist, the Parenting Stress Index, and a subjective evaluation using a rating scale and content analysis were used. The results indicated that there were significant decreases in some of the children’s dysfunctional behaviors, and the parents found the group helpful and rated it highly stating that they learned coping skills and felt more confident as parents. The parents’ stress levels did not change signiticantly. The implications of the results and suggestions for further research are discussed. Key Words-Parent

support

group,

Parent education,

Sexual Abuse.

BACKGROUND THE NEED FOR OUTCOME RESEARCH on the effectiveness of parenting and therapy groups for parents of sexually abused children is apparent. Few studies have been conducted which evaluate the effectiveness of a parent group for parents who have a child who has been sexually abused. This study attempts to describe and evaluate a group for these parents. The various measures used were chosen in order to measure a variety of outcomes based on both the therapeutic and educational components of the Parent Support Group. The group is an educational/therapeutic group for parents who have a child who has been sexually abused and is part of the treatment components of a multidisciplinary hospital-based child abuse unit. The group meets once a week for two hours for 13 weeks. The group is open-ended, and there are between 5 to 18 members in the group at one time. A male and female therapist lead the group. The therapeutic component of the group is based on a blend of counseling theories and techniques. This may best be described as an eclectic approach to group therapy. The focus of the group sessions are on disclosing, understanding, and dealing with feelings of guilt, anger, fear, and confusion. The group is utilized to encourage a supportive environment where the participants feel free to discuss their concerns and resolve problems. The educative component of the group is based on three main approaches to parenting education and training. First, material from the parents’ handbook Systematic Training for Efictive Parenting

The Parent Support Group was originally designed by Chris Magaz, Sally Crumly, Barbara Mara and the author through the Child Protection Team. Orlando Regional Medical Center, from a grant from the State of Plot-i&Department of Health and Rehabilitative Services, Children’s Medical Services. Received for publication Reprint

August 22, 1988; 6nal revision received August 2 I, I S&9; accepted

requests to Mark A. Win.ton,

1861 Summerland

Avenue.

397

Winter

Park, FL 32789.

August 24.1989.

398

Mark A. Winton

(Dinkmeyer & McKay, 1982; Dinkmeyer, McKay, Dinkmeyer, Dinkmeyer, & McKay, 1987) is utilized throughout the parent education and training component of the group. Second, material from Parent Efictiveness Training (Gordon, 1975) is used. Third, behavioral approaches based on the behavior modification techniques of parent training are presented to the parents (Cautela & Cautela, 1983; Patterson, 1975). The need for an educational component was based on the following observations: 1. The parents demonstrated ineffective means of dealing with their children’s inappropriate behaviors. The ineffective parenting patterns were reported by the parents to the parent group therapists. Based on their experience, therapists, felt that ineffective parenting patterns appeared to be based on a response to the sexual abuse incident. Further investigation on parental effectiveness is needed in order to understand the relationship between sexual abuse and parenting effectiveness of nonoffending parents. 2. The parents attributed their children’s normal sexual behaviors to the sexual abuse. 3. The parents had unrealistic expectations of their children. 4. Some parents appeared to be trying to sabotage their child’s treatment plan. This sabotage of treatment appeared to be based on the parents’ desire to avoid having to deal with the sexual abuse. Some parents attempted to restore the family system by minimizing the sexual abuse. On the other hand, some parents were extremely supportive of their children. 5. There was a lack of parental involvement in the children’s treatment. 6. There was a lack of support systems for the parents and individual parent meetings were ineffective.

METHODOLOGY The following conceptual hypotheses have been developed based on the literature review (Coufal & Brock, 1984; Devoss & Newlon, 1986; Golub, Espinosa, Damon, & Card, 1987; Hildebrand & Forbes, 1987) and clinical experience of the author: 1. The group participants will report significant decreases in their children’s dysfunctional behavior on all of the Louisville Behavior Checklist scales. 2. The participants will indicate a significant decrease in their stress levels. 3. The participants will rate the Parent Support Group as a positive and helpful experience.

Data Sources The sample was composed of 27 parents/caretakers who had participated in the Parent Support Group and completed both the pre-group and post-group evaluation package. For the 27 cases, 13 incestuous and 10 non-incestuous cases were identified, while in 4 cases the perpetrator was not identified. Important to note is that three married couples and one unmarried couple participated in the program. Therefore while there was a total of 27 parents or caretakers, there was a total of 23 children in the care of the 27 parents and caretakers, as 8 of the participants were couples. The sample was a nonprobability convenience sample. Demographic characteristics are presented in Table 1.

Data Collection Techniques To test the above hypotheses, the following techniques were used. The pre- and post-evaluation self-administered packages were presented to the members of the four groups. These pre-group and post-group evaluation packages consisted of the Louisville Behavior Checklist

Parents’

support

399

group

Table 1. Demographic Characteristics the Groups

of

Characteristics Race White Black Sex of Parent Male Female Marital Status Married Divorced Single/Not Married Years Married M!%ln SD

Relationship to Child Mother Father Stepmother Stepfather Grandmother Grandfather Number ofchildren Mean SD

85% (23) 15% (4) 22% (6) 78% (21) 70%(19) 11% (3) 19% (5) 6.70 8.83 70%(19) 11% (3) 4%(l) 4%(l) 4%(l) 7% (2) 2.11 1.19

Age of Child IillWl SD

4.63 2.37

(Miller, 1984) which measures children’s pathological behaviors and the Parenting Stress Index (Abidin, 1983) which measures the parents’ stress levels in various domains. The postgroup evaluation package also contained the Subjective Evaluation Form, a self-administered questionnaire designed by the group therapists which asked the participants to rate the group therapists and the various topics covered in the group as well as open-ended questions about what the participants liked, disliked, would like to change, and what they had learned from the group. The pre-group evaluation package was administered during the first session of the group, and parents/caretakers made up any missed evaluations by the beginning of the third session. The post-group evaluation package was administered during the second to last session.

The evaluation data were analyzed using the paired samples t test and the Wilcoxon Matched-Pairs Signed-Ranks Test to compare the group means of the pre- and post-means of the Louisville Behavioral Checklist and Parenting Stress Index. The post-group subjective evaluation form was analyzed using percentages and content analysis. Several analytical limitations need to be mentioned. First, there was no control group to compare with the Parent Support Group. Second, the structure and content of each of the four groups were different. This decreased the reliability of the evaluation. Third, the sample was an available sample and may not have been representative of all parents who have a child who has been sexually abused; therefore, generalization of the data to a larger population is limited. While some parents were in the group on a voluntary basis, others were court-ordered

400

Mark A. Winton

to participate. Finally the data was non-random and did not meet the assumptions required for the t test, but are provided. The Wilcoxon Matched Pairs Signed-Rank Test was therefore used with the t test to provide a nonparametric statistical comparison. The Wilcoxon Matched-Pairs Signed-Rank Test is more appropriate for the nonprobability sample and strengthens any inferences to be made.

RESULTS In testing the first hypothesis, the t tests for the Louisville Behavior Checklist revealed significant decreases in some behaviors. The data support part of the hypothesis that the participants would report decreases in their children’s dysfunctional behaviors. Overall the parents did not appear to consider their children to have severe pathological behaviors as indicated by their ratings on the pre- and post-tests. This finding is somewhat confusing as we assumed in the first hypothesis that there would be pathological levels of behaviors reported by the parents on the pretest. This was not the case, and an explanation for this finding is not readily available. This finding could be due to over- and under-reporting of children’s dysfunctional behaviors by their parents, a small sample, or the measurement tool not picking up pathological behaviors which this sample might display. Significant decreases were noted in the areas of fear, inhibition, intellectual deficit/academic disability, cognitive disability/learning disability, severity level, normal irritability, rare deviance, neurotic behavior, psychotic behavior, and sexual behavior. The results are presented in Table 2. Similar significant differences using the Wilcoxon test were found for these same behaviors. Three cases were deleted from the analysis, as one case was incomplete and the other two cases had a child placed in foster care either before or during the group. The sexual behavior scale was elevated on the pretest compared to the other scales, which might be a result of the child learning and acting out sexual behaviors or the parent attributing a higher level of sexual behaviors due to the knowledge that sexual abuse had occurred. The second hypothesis, that the participants’ stress levels would decrease, was not supported by the Parenting Stress Index (see Table 3). The Wilcoxon test indicated a significant decrease in two scales, the Child Domain Score and the Adaptability scale 0, < .05), while the t-test results indicated no significant differences. The parents showed little change in their stress levels and maintained moderate to high levels of stress. The parents indicated that they felt both internal and external stress. The third hypothesis was supported, as a majority of the parents indicated on the subjective evaluation that they strongly agreed or agreed that the information was easy to understand and useful, the setting was comfortable, the lab/group leaders were knowledgeable and supportive, the other parents were supportive, bringing their child was helpful, and the handouts were understandable and helpful. A majority of the parents gave ratings of excellent or good for the sessions on the goals of behavior, child development, group therapy, parent resource center visitor, child protection team visitor, behavioral charting, stress management, sexual development, disciplining their child, and activities with their child. The content analysis identified themes in the evaluation written by the participants. For the question, “What did you like about the group,” the group participants described the educational material on parenting skills, the opportunity to express their feelings regarding the sexual abuse, the support of the therapists and other parents, learning coping skills, and the fact that they were not alone in the situation. The participants indicated for the question, “What you disliked about the group,” that some parents failed to participate in the group. When the participants were asked “What

401

Parents’ support group

Table 2. Pre- and Post Mean Scores for the Louisville Behavior Checklist Scale Infantile

Aggression

Hyperactivity Antisocial

Behavior

Aggression Social Withdrawal Sensitivity Fear Inhibition Intellectual

Deficit/Academic

Disability

Immaturity Cognitive

Disability/Learning

Severity Level Normal

Irritability

Prosocial Deficit Rare Deviance Neurotic

Behavior

Psychotic Behavior Somatic Behavior Sexual Behavior * School Disturbance

Predictor

Disability

Pre

Post

44.46 (7.49) (45.54 (9.41) 45.04 (5.27) 44.38 (7.63) 48.79 (9.16) 46.83 (10.60) 5 I .08 (12.33) 48.63 (I 1.31) 49.13 (9.86) 44.38 (9.07) 46.54 (9.04) 44.42 (9.88) 47.38 (8.87) 44.92 (7.7 I) 48.63 ( 10.63) 49.7 I (11.55) 48.00 (10.73) 49.46 (10.48) 54.62 (I I.1 I) 4 I .82 (9.57)

44.42 (8.57) 42.88 (9.73) 43.88 (6.07) 42.42 (8.38) 46.63 (7.41) 44.58 (9.22) 44.33 (10.54) 43.79 (9.77) 45.33 (9.49) 42.50 (5.91) 43.04 (7.98) 4 I .46 (9.6 I) 43.83 (9. IO) 43.42 (7.77) 43.96 (7.83) 44.96 (9.75) 44.46 (7.48) 46.08 (8.11) 49.92 (8.85) 4 I .68 (I 1.99)

.03 1.37 I .09 I .42 I.62 1.37 3.40**+++ 2.5 I *++ 2.71**+ I .42 2.68**+ 2.59*+ 2.53*+ 1.34 2.75 **+ 2.9 I**++ 2.44 *+ I .95 2.62*++ _I I

-

No/r. The top number is the mean score while the number in parentheses is the standard deviation (N = 24: *N = 22). a I-test. */7 i~c~~~~~nding~~~ss MO& I>istr3ctabilit~/ti~perrtcti\~it~ Reinthrccx

Parent

Parent Domain

Score

Depression Attachment Restriction

of Role

Scnsc 0fCompctcncc

I

737.67 (67.31) 109.85 (30.96) 26. I5 (7.21) 14.07 (4.84) ‘7 59 _-._ (7.35) Il.37 (4.19) 75.74 (7.75) 10.x1 (3.62) 127.81 (35.1X) Ic).XY (6.82) 14.50 (4.9Y) lY.15 (7.03) 30.67 (7.76)

I.lY

Ii.89 (5.00)

Isolation Relationship

Post

I7.2h (6.58) 12.37 (3.70) 12.37 (X.78)

With Spouse

Parent Health I.ifc Stress

I.82 I.18 I .4i .54 I .h9 .x7 1.34, .4x .37 -.YfJ 1.40 I.59 .37 -.60 p.73 .6X

,‘L’~uc‘I hc top number is the mean while the nurnhcr in parentheses isthcstandard deviation ( ,V 17).

also indicated that the group was not long enough in duration and that there needed to be more therapy sessions. The Parent Support Group appeared to have helped the parents increase their confidence as parents by teaching them parenting skills but was not long enough to deal with their stressors.

Mrs. R was referred to the Parent Support Group after her preschool-age son was sexually abused by a relative. She reported numerous

behavioral

problems with her son and resorted to physical punishment

when he misbehaved.

She

stated that she felt guilty because she could have prevented the sexual ahusc. She also stated that she felt out ofconfroi and isalatcd as nobody would discuss her feelings with her. During

the group session, Mrs. R was able to share her

fcclings with the other group mcmhcrs. She asked for support. and the other group members responded. She was able

of a

to realize that it was not her fault that her son had been sexually ahuscd. Mrs. R hegan to use time-out

in place

spanking and found that it worked efbtively.

him, Mrs. R

She noted progress in her son’s therapy and supported

hecamc friendly with a few ofthe other group members. and they maintained together. the group.

Mrs.

phone contact and even went shopping

R was pleased with the progress that she made and felt more in control

of her life by the end of

Parents’ support group

DISCUSSION

AND

403

CONCLUSIONS

The original question of this research had to do with whether the Parent Support Group was providing aid and assistance to parents of children who had been sexually abused. The results of this research were that the group began to approach effectiveness, as evidenced by the parental report of decreases in the children’s dysfunctional behaviors and the group participants’ ratings and comments. The results of the Louisville Behavior Checklist indicated that the parents reported that their children showed less dysfunctional behaviors on the post-test. While the mean of the scores did not indicate severe pathology, changes were noted in several variables. It appeared that the parents felt that their children’s behaviors improved in some areas. If parents correctly judged a decrease in particular dysfunctional behaviors. then a confounding variable which may account for the reported decrease in the children’s dysfunctional behaviors is that many of the children of the participants were in a treatment program which precludes clear determination ofthe effects of the children’s treatment, parent’s treatment, or a combination of the two. It does seem likely that the Parent Support Group helped to reinforce the child’s progress in treatment. The participants were taught parenting and coping skills. and they indicated that these skills helped them to feel more confident as a parent. It would be helpful to determine whether the parents over- or under-report their children’s dysfunctional behaviors by correlating parent reports with reports of others who are familiar with the child such as therapists and other family members. A study ofthe factors surrounding the onset, duration, and type ofabuse would be helpful to understand the effects on the parentchild relationship. Future research might focus on evaluating children’s treatment with and without parent treatment. This could be done by using as a control group a matched group of parents who are waiting to begin treatment while their child is in treatment. Time series data would add to the understanding of the effects of treatment for both child and parent. The results of the Parenting Stress Index did not support the hypothesis that there would be a decrease in the overall level of parental stress. Only two significant differences were found for the Child Domain and Adaptability Score (Wilcoxon test), and this was not supported by the t test. The Parent Support Group may have helped the parents feel more confident and cope better as indicated by the subjective evaluation, but the parental stress levels remained the same. Perhaps 13 group sessions are not long enough to make an impact in the parental stress levels as measured by the Parenting Stress Index. Follow-up with this assessment tool would be useful to determine stress levels following the group experience. An extended time for the group might be used to assess how length of treatment is related to stress levels, and environmental factors could be factored into this research allowing for multivariate analysis. The subjective evaluation showed that the parents rated the group as positive in areas of content and group leader skills. The parents indicated that they wanted more group therapy sessions, which again suggests that the 13-session program was not long enough to address the therapeutic issues. Perhaps a model of the relationship between stress and level of parental effectiveness would help to clarify the interpretation of the above findings. A model which addresses the preabuse stress and effectiveness levels, the impact or effects of the sexual abuse, the parental definition of the event, and the subsequent levels of stress and parental effectiveness at different points in treatment would allow for a better understanding of the relationships between stress, sexual abuse, and parental effectiveness. It is possible that the sexual abuse incident leads to a decrease of parental effectiveness due to feelings of guilt, changes in the child’s behavior, and ineffective coping and parenting patterns. This might lead to increases in stress. While the

404

Mark A. Winton

Parent Support Group may have helped parents to feel more competent and increase their parenting skills, stress levels remained high. One area of exploration is the mixing of intra- and extrafamilial cases. The cases of incestuous (n = 13) and non-incestuous abuse (n = 10) were split into two groups. T tests were run on the Louisville Behavior Checklist and the Parenting Stress index to see if there were significant differences between the two groups on the pre- and post-tests. The findings indicated no significant differences between the two groups (except for two behaviors on the Louisville Behavior Checklist). From his experience, the author felt that the participants from non-incestuous and incestuous groups supported each other. The above sample was small, and further research might focus on clinical and statistical significance. The analysis of the incestuous and non-incestuous groups focused on the statistical findings. With such a small sample, the results should be interpreted with caution. Larger samples are needed to determine if differences exist. Research has demonstrated that short-term therapy for individuals involved in incest has not been shown to be effective while parenting skills training for the nonoffending parents has been effective. This is supported by this study. While the research on this topic is in its early stages, this study provides suggestions for further research, e.g., duration of treatment, type of treatment, and whether parent education and therapy should be combined or separated for parents of sexually abused children. This study demonstrates that the parents of sexually abused children are victimized and need treatment to deal with issues of sexual abuse and to help their children overcome the effects of sexual victimization. ..l~k,?oM,/cd~c,t~~~~/-The author thanks Drs. Barbara Mara. Ida Cook, Whelan-Williams and Michael Dey for their assistance and support.

William

Brown,

and Charles

Unkovic,

Sue

REFERENCES Abidin, R. R. ( 1983). Puren/ing s[rc~s index manwd. Charlottesville, VA: Pediatric Psychology Press. Cautela, J. R., & Cautela, J. ( 1983). ~~,nnsfi,rh~~avior unulwis with childrm Champaign, IL: Research Press. Coufal. J. D.. & Brock. G. W. (1984). A model for including children in parent skills training. ParentingSfudies. 1, 55-59. Devoss. J. A., & Newlon. B. J. (1986). Support groups for parents of sexually victimized children. Thr School Coww/or. 34. 5 I-56. Dinkmeyer. D.. & McKay. G. D. ( 1982). The pm-m/ ts hnndbook: S~s~emu~ic.truining./i,r &wive pawnring. Circle Pines, MN: American Guidance Service. Dinkmeyer, D.. McKay, G. D.. Dinkmeyer. D.. Dinkmeyer, J. S., & McKay. J. L. ( 1987). The c~//kcrivcpurmt. Circle Pines. MN: American Guidance Service. Golub. J. S.. Espinosa. M.. Damon. L.. &Card. J. ( 1987). A videotape parent education program for abusive parents. C’hild.~tm.tr& N&~c’~. 11, 255-265. Gordon, T. ( 1975). Puwnt ~~~jw/~wnc.v rruinrng. New York: Plume. Hildebrand. J.. & Forbes. C. (1987). Group work with mothers whose children have been sexually abused. Britrsh Jownul o/ SOCIUI Mbrk. 17. 285-304. Miller, L. C. ( 1984). Lozri.\vt/k hc&vioru/ chrcklisi man&. Los Angeles: Western Psychological Services. Patterson. G. R. ( 1975). Fumi/ic~ App/it‘urion of .socYu/lcurning to /&ni/j~ /if>. Champaign, IL: Research Press.

Resume-L’etude present&e ici a pour theme I’efficacite d’un groupe de soutien parental pour des parents ayant un enfant qui a ete victime de s&ices sexuels. Les parents “sujets” ont rempli un questionnaire avant et apres evaluation. questionnaire destine i tester I’efficacite du groupe de parents de soutien. On a utilise la “Louisville Behavior Checklist.” le “Parenting Stress Index,” ainsi qu’une evaluation subjective i I’aide d’une echelle de score et une analyse du contenu. Resultat: diminution signilicative chez certains des enfants quant i leur comportement dysfonctionnel et evaluation positive par les parents quant au groupe qu’ils ont trouve utile et ont bien apprecik affirmant qu’ils ont trot& utile et ont bien apprecie affirmant qu’ils ont appris des techniques pour faire face aux difficultis de leurs enfants et se sont sentis plus conliants en eux-memes. Par contre le niveau de tension des parents n’a pas change de

Parents’ facon signiticative. Les auteurs recherche ultirieure.

discutent

des applications

support

group

decoulants

405 de ces risultats

et font des suggestions

pour la

Resumen-Este proyecto investigo la efectividad de un grupo de ayuda a padres para padres con un nitio sexualmente abusado. Los padres completaron medidas pre y post evaluativas para determinar la efectividad del grupo. La Louisville Behavior Checklist. el Parenting Stress Index y una evaluation subjectiva usando una escala y el anilisis de contenido fueron utilizadas. Los resultados indicaron que hubo disminucion signihcativa en algunasde las conductas disfuncionales de 10s niiios y clue 10s padres experimentaron al grupo coma beneficial y lo estimaron altamente. atirmando que habian aprendido diversas maestrias y que sentian mis confianza en si mismos coma padres. Los niveles de stress de 10s padres no cambiaron signiticantemente. Se comentan las implicaciones de 10s resultados y se hacen diversas sugestiones para las investigaciones futuras.

An evaluation of a support group for parents who have a sexually abused child.

This study investigates the effectiveness of a parent support group for parents who have a child who has been sexually abused. The parents completed p...
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