Children’s Disclosure of Physical Abuse - The Process of Disclosing and the Responses from Social Welfare Workers

ABSTRACT

Children experiencing physical abuse by their parents are left with several difficult decisions. The present study aims at exploring the process of disclosing the abuse and the responses from social welfare workers from a child perspective, in a Swedish context. Data was obtained from in depth interviews with 15 children with a history of child physical abuse. A qualitative content analysis was conducted in order to capture the children's experiences. Disclosing abuse was described as a process including several judgements from the child. Children describe their everyday life before disclosing, with an escalation of violence making them think they have to act in order to prevent further abuse. They made several well-thought decisions and selected a trustworthy recipient. The decision to disclose was often made out of fear, but the fear could remain after the disclosure, not knowing what will happen next. Children seem to lose control over how their abuse narratives are handled after disclosing. The recipient and social welfare worker was acting but not informing or consulting the child. Children emphasize the importance of trustworthy and competent adults when disclosing physical abuse. Ethical issues and implications for practice are discussed.

Practitioner messages

• Disclosure is to be seen as a process, including several judgements by the child.

• Children emphasize the importance of trustworthy and competent adults when choosing to disclose physical abuse.

• Social welfare workers should inform and include children in their decision making.

KEYWORDS:

• Child physical abuse
• disclosure
• participation
• child welfare service

Introduction

Child physical abuse is a worldwide public health problem (Gilbert et al., 2009) with several possible short- and long-term severe outcomes (Mills et al., 2013; Moffitt, 2013; Norman, Byambaa, De, Butchart, & Scott, 2012). The prevalence rate is high, with 22.9% of children in Europe reporting at some time being victims of physical abuse (Stoltenborgh, Bakermans-Kranenburg, IJzendoorn, & Alink, 2013). Although the prevalence rate in Sweden is lower, 15% of all children in Sweden report victimization (Annerbäck, Wingren, Svedin, & Gustafsson, 2010). However, only a minor part of child physical abuse comes to the attention of social welfare service (Annerbäck et al., 2010; Lyon, Ahern, Malloy, & Quas, 2010). About one-third of all physically-abused children disclose their abuse to an adult, but only 7% of these children disclose their abuse to a professional. Moreover, about one-third of physically-abused children do not report their abuse to anyone (Annerbäck et al., 2010). The potential severe outcomes of physical abuse are well known, but further knowledge is needed about the process of disclosure. Child abuse includes physical abuse, sexual abuse, neglect and negligent treatment, emotional abuse, and exploitation (WHO, 2017). Previous research has largely focused on sexual abuse, especially concerning the process of disclosing abuse. This study aims to examine how children who are victims of physical abuse perpetrated by a family member experience disclosing the abuse. The process of disclosure is in this study expanded to follow the process from the disclosure, to how social welfare workers respond, from a child perspective.

When children are abused by a caretaker, there is a risk they will develop more harmful trauma symptoms as well as additional trauma compared to children who have experienced potential traumatizing events perpetrated by someone outside the family (Edwards, Freyd, Dube, Anda, & Felitti, 2012; Kisiel et al., 2014; Tang & Freyd, 2012). In addition, because these children are at greater risk that the abuse starts earlier in life, there is an increased risk that their abuse will last longer (Kisiel et al., 2014). The research and theory concerning attachment can be used to understand how children are affected when their abuser is also the person they depend on for survival (Morton & Browne, 1998). These children must create new associations for both themselves and their immediate surroundings (Sternberg, Lamb, Guterman, Abott, & Dawud-Noursi, 2005). The Betrayal Trauma Theory (Freyd, 1994), a theory that partly explains the harmful effect of being abused by a close caretaker, states that the relationship to the perpetrator affects how the abuse will be experienced and remembered (Foynes, Freyd, & DePrince, 2009; Freyd, 1994). To cope with physical abuse by a caretaker, children often blame themselves as they try to protect the image of good parental figures (Herman, 2015). Due to this dependency relationship, these children could exhibit a cognitive dissonance with respect to the perpetrator. If the perpetrator is a caretaker, the risk increases that the child will not remember the abuse (Foynes et al., 2009). By not remembering or diminishing the abuse, an abused child could retain a positive image of the perpetrator, preserving the attachment (Foynes et al., 2009). However, betrayal trauma affects both the child’s external and internal behaviour (Freyd, 1994). The same mechanism could hold true for the process of disclosure, as it is more likely that a victim discloses abuse from a perpetrator outside the family than from inside the family (Lorentzen, Nilsen, & Traeen, 2008; Lyon et al., 2010). These children often express an affection for their perpetrator, a concern for the perpetrator, and a wish to protect the perpetrator, decreasing the likelihood of disclosing the abuse perpetrated by a family member (Lemaigre, Taylor, & Gittoes, 2017). By not disclosing abuse, these children are at risk for further victimization and the possibility for support and therapy decreases (Foynes et al., 2009).

Psychology of disclosure

Disclosing various forms of abuse has been described as a process, not a single event (Alaggia, 2010; Foster & Hagedorn, 2014; Jensen, Gulbrandsen, Mossige, Reichelt, & Tjersland, 2005). Jensen et al. (2005) labelled this process as dialogical, where the child makes several judgements before disclosing. Several aspects could stop the child from disclosing, such as feelings of guilt, shame, embarrassment, and fear of not being believed (Foster & Hagedorn, 2014). Children could also express concerns about what will happen to them (Allnock & Miller, 2013; Foster & Hagedorn, 2014; Jensen et al., 2005) as well as the perpetrator after the disclosure (Foster & Hagedorn, 2014).

When children decide to disclose abuse to a professional, it is often a well-thought out decision (Jensen et al., 2005; Linell, 2015). Children seem to value their options and the decision to disclose is often made when they no longer had any hope for the abuse to end (Allnock & Miller, 2013; Linell, 2015). Fear, lack of security, and experiencing the abuse as intolerable could lead the abused children to recognize that the only way to relieve their pain is to disclose the abuse (Linell, 2015).

However, not all children decide to disclose in advance, and some children disclose only when an opportunity to reveal the abuse is available. This later type of disclosure is often labelled unintentional disclosure. Unintentional disclosures are often the result of unexpected discussions about abuse such as when a teacher brings up the topic during a lesson (Allnock & Miller, 2013; Jensen et al., 2005). Children also want adults to be observational and ask questions, optimizing the possibility for disclosure (Allnock & Miller, 2013; Lemaigre et al., 2017). However, children may make several disclosures before actions are taken (Allnock & Miller, 2013; Linell, 2017). These children often describe attempting to disclose to non-responsive adults, resulting in little or no actions to relieve the children of their abusive situation (Allnock & Miller, 2013).

School staff (e.g. teachers, school nurses, and counsellors) are the most significant adult people, outside the family, who children disclose to (Jobe & Gorin, 2013; Linell, 2015). Adolescents highlight the importance of competent adults in schools who can receive and act on a disclosure. They want the adults who receive disclosure to take it seriously and to provide them support (Allnock & Miller, 2013; Jernbro, Eriksson, & Janson, 2010). The decision to disclose could be the result of fear for what could happen, but this fear could remain even after the disclosure as the child has no way of knowing what will happen next (Foster & Hagedorn, 2014). Even after the abuse has ended, children could still feel victimized. Therefore, support from family, friends, as well as healthcare professionals is crucial (Lorentzen et al., 2008). Some children who disclose abuse describe not being believed or having their feelings minimised (Alaggia, 2010; Jensen et al., 2005; Lorentzen et al., 2008). This lack of trust could lead to a feeling of stigmatization as well as betrayal and guilt, emotional responses that could continue the traumatization (Lorentzen et al., 2008). For some children, the pressure from their families became even worse after the disclosure (Linell, 2015). These children report threats from family members, including being accused of lying by both the perpetrator and other family members (Linell, 2015).

The process following disclosing abuse

In 1979, Sweden became the first country in the world to prohibit all forms of corporal punishment. As one of the first countries, Sweden ratified the UN Convention on the Rights of the Child (CRC) in 1990. Compared to most countries, Sweden has strong structural support for vulnerable children, including providing legal support and social welfare service with a family-centred approach (Gilbert, 1997). Social workers both investigate the situation of the child (and family) and provide social assistance. They have legal authority to talk to the child without the consent or presence of the parents. However, children meeting social welfare workers after abuse has been disclosed are rarely seen as competent actors and some children describe social welfare workers as aloof and ignoring what they say (Callaghan & Alexander, 2015; van Bijleveld, Dedding, & Bunders-Aelen, 2015). Rasmusson (2006) found that social welfare workers tended to talk to children rather than with them, so the children feel they must be tactical and adapt their speech to be heard. Furthermore, van Bijleveld et al. (2015) found that when deciding about an intervention, social welfare workers were likely to think they knew what is in the best interest of the child, sometimes without asking for the child’s input. A good relationship with the social welfare worker affects the possibility of participation, but there is no consensus about what is considered participation among social welfare workers. Participation could vary from providing the child with information to listening to the child’s view to actually letting the child’s expression influence the outcome (van Bijleveld et al., 2015). Children, on their hand, express a right to participate in decision-making in matters that concern them (van Bijleveld et al., 2015). Participation could contribute to increased well-being and a feeling of more security (van Bijleveld et al., 2015), but children need to be invited to participate in a way that they understand the purpose of the meeting and the outcome (Archard & Skivenes, 2009). Interventions planned and decided together with the child are more likely to have a positive outcome (Vis, Strandbu, Holtan, & Thomas, 2011). Although there has been recent advancement in research on the disclosing of abuse, particularly for sexual abuse, there is little research about the child’s process of disclosing physical abuse and how that disclosure is handled.

Method

Participants

The study included children who had been reported to the social welfare service for being victims of physical abuse by one or both caretakers. This study included 15 children (age 9–16) from 15 families. The mean age was 11.6 years old (SD = 2.22). Twelve (80%) were girls and three (20%) were boys. As the children were from ten different municipalities in Sweden, their experiences as clients reflect ten different social welfare services. Of the participating children, 14 were born in Sweden and one outside Sweden. Four children had parents born outside Europe, and eleven children had both parents born in Sweden. Nine children lived with both of their parents and four children lived part time with separated parents. Two children lived with a single parent.

The abusive behaviour that the children had been exposed to consisted of spanking (with or without an object), pulling hair, choking, pushing, holding down, and throwing the child. The children were equally likely to be beaten by their mother as their father. In most cases, there was a combination of violent acts towards the child. The children and their parents were all referred to a specific treatment that aimed to reduce parental use of corporal punishment (Combined Parent Child-Cognitive Behavioural Therapy for families at risk of Child Physical Abuse [CPC-CBT]) after assessment. The intervention follows a structured treatment manual and aims at both teaching parentś non-abusive parental strategies and helping children process their experiences of physical abuse victimisation (Runyon & Deblinger, 2014). The treatment is organized in four phases: (1) Engagement and Psychoeducation; (2) Effective Coping Skills; (3) Family Safety, Planning, and Continuation of skill building; and (4) Abuse Clarification. All four phases address parenting skills and the intervention addresses the whole family, including the violent parent (Runyon & Deblinger, 2014).

Procedure

Children are part of a larger data collection concerning the effects of the CPC-CBT treatment. The participating children had come to social welfare service’s attention due to suspected (and later confirmed) child physical abuse. Social welfare workers initiated the CPC-CBT intervention. As mentioned, the intervention aims at decreasing parental use of corporal punishment. This topic is addressed weekly throughout the treatment. Social welfare was responsible for the safety of the child and judged however it was appropriate to offer out-patient care for the family.

After completion of the CPC-CBT treatment during 2015–2016, the children and their parents were asked about participation in the interview study. All the children who had completed treatment were asked about participation until saturation was obtained, which required 15 participants. This number of participants was considered to give rich information about the topic. Malterud, Siersma, and Guassora (2015) discuss information power as a tool for judging if adequate numbers of participants are obtained. The specificity of the aim, the competence of participants in relation to the topic, as well as how skilled the researcher is in interviewing are some factors that affect the outcome of the interviews (Malterud et al., 2015).

A semi-structured interview guide was used. Children were asked to tell about their everyday life before getting contact with social welfare service and how they had experienced the process leading to help from social welfare. When children talked about their everyday life before getting contact with social welfare, they started to talk about the violence and how they wanted it to end. In that context, the process of disclosure was explored.

The interviews took place within the facilities where the children received treatment. Interviews were recorded and later transcribed verbatim by the interviewer. All children were interviewed individually without parents being present. The interviews were conducted by two researchers (14 by the first author and one by the second author). Both researchers are experienced in interviewing vulnerable children and youth.

Ethical considerations

The study was approved by the Regional Ethical Review Board of Linköping, Sweden in 2008 (Dnr: 2008/206-08) with a supplementary approval in 2013 (Dnr: 2013/189–32).

The interviewers orally informed both children and parents about the study, its purpose, and how the transcribed text would be handled and used. All children were informed that their participation was voluntary and that they could terminate their participation at any time. Written information was also provided. The parents gave their oral consent in front of their children so that the children could hear their parents provide consent for their participation. Since this research concerns a sensitive topic that could provoke feelings of anxiety and guilt, it was considered crucial for the child to hear their parents’ consent before the interview.

The interviewer noted any sign of ambivalence the child exhibited during the interview. Any sign, both non-verbal and verbal, was considered and some children needed breaks. Since the interviews were conducted where the child received treatment, therapists were available in the building. No child, however, expressed a wish to talk to former therapists after the interview.

In line with previous research concerning children experiencing violence (Cater & Øverlien, 2014; Evang & Øverlien, 2015), we hypothesized that children could be competent interviewees, contributing important experiences on the topic.

Analysis

The interviews were analysed using qualitative content analysis. Qualitative content analysis is used to identify, code, and categorise data. This type of analysis reveals certain patterns (Krippendorff, 2004). Every transcribed interview formed a unit of analysis (Graneheim & Lundman, 2004). All transcribed interviews were read several times by the two first authors to obtain an overall sense of the content. The authors independently identified meaning units and through condensing and abstraction they coded and categorized the texts into themes and categories (cf. Graneheim & Lundman, 2004). All the authors discussed the content and categorization until consensus was reached. One theme and four categories emerged (Table 1).

Table 1. Scheme of theme and categories.

Theme	Categories
The process of disclosure	Something became even worse	Unintentional disclosure	To select the receiver	To lose control

Results

The process of disclosure

The main theme – The process of disclosure – concerns the challenges children meet when deciding to disclose physical abuse. In their narratives, children recounted what prompted their decision to disclose and their initial disclosure, which was often to a teacher or school counsellor. In addition, they described their interaction with professionals such as police officers and staff at Barnahus (child advocacy centres) after the initial disclosure.

Something became even worse

In the first category, children described their family climate before the disclosure. Some of the children related how their parents’ violent behaviour became more intense, which later led to disclosure:

For example, it could be that we started fussing about some little thing, and it just kept getting bigger and bigger, and then it ended up sometimes with mum hitting me or something like that. [. . .] Sometimes she sat on me, and sometimes she sort of held on to me somewhere like this, on my arm, or something like that. [. . .] And once, just once, she like half strangled me. And that’s when I started getting really scared of my mum. (Girl, age 9)

The children described a family climate characterized by brawls, screaming, and violence. Although violence was common, some children described a worse situation. The violence became even more frightening and, in some cases, more dangerous:

And since [. . .] I have like a closed door, and then mum entered at any time and could open the door and be really angry and like this, she would hit me or something like that. And then after she’d done that a couple of times, then I was really scared that she would come back in and so I tried just to lie there and sleep so the next day would come, because I didn’t want to deal with that. (Girl, age 9)

Children expressed different feelings associated with the abuse and/or the abusive parent. Fear was the most common feeling and some of the children described being afraid of a parent and that the violence could happen at any time and at any place. Some children could not find any place within their homes where they felt secure and safe.

Some children described a turning point – i.e. when the violence became more severe. As the violence increased, some children felt their only option was to disclose the physical abuse in order to prevent further abuse:

It was a special incident that stood out since it was rather obvious that it was wrong, so I told the school counsellor about it and she reported it. (Girl, age 14)

Unintentional disclosure

Other children described a more unintentional or unplanned disclosure where the situation promoted telling. The topic of child maltreatment could be addressed in school, creating a context of recognition and associations with the child. Affected by the recognition of a potential receiver of their information, some children described how they could not keep their feelings inside anymore:

I was in fourth grade and we talked about something in school and then suddenly it just came out that my mum hits me. [. . .] I did not even want to tell because I was like thinking how mad my mum could be. And like she is not going to like me anymore and so. But it just came out and then it had to be like that. (Girl, age 11)

Experiencing the topic as open to talk about, together with a trusted recipient facilitated a disclosure. However, unplanned disclosure could evoke different feelings within the child. The children’s narratives were characterised by fear, guilt, and powerlessness. Revealing the abuse could lead to more fear with respect to how parents would react when finding out about their child’s disclosure. Some children expressed a desire to keep the disclosure a secret from friends and other extended family members. For some of the children, the pressure became even worse after disclosure, with extended family members coming to their house or telephoning to encourage the children to withdraw their stories. Some parents told their children that they could not do things they wanted such as going on vacation because the parents were obliged to pay a fine as the result of the disclosure. Several children expressed fear of family separation and/or being removed from their parent’s custody.

To select the receiver

Children describe how they chose a recipient for their disclosure. School staff – e.g. school counsellors, teachers, and nurses – were the most important people the children chose to disclose to. Children describe the importance of the receiver taking time to listen to their stories. In addition, several children stated that trusting an adult was the most significant reason for their decision to disclose. The children also noted that the adults they chose to disclose to needed to be kind and patient:

Being very, listening very closely because people, like people who stop listening or like they don’t take you seriously, like you wouldńt tell them. And they should be modest and try to be considerate and try to care for the student or the child. (Girl, age 14)

Some children needed to repeat their disclosure to emphasise the importance of the situation and to make the adults act on their behalf. However, they were not always informed about what would happen after their disclosure:

I started with mum and then I started to tell the school counsellor, then she started to tell a lot of teachers, then I don’t know who else she talked to. I really dońt know. Then I was like at the police station and was interviewed and it was also really tough to be there. (Girl, age 13)

A few children chose to disclose to the non-abusive parent, but these parents often were unable to offer support for the child:

It was like dad who had been sort of, he was kind of angry and he, like, hit me and was really mad and then he went to calm down and said he was sorry. But I didńt want to forgive him. I was hurt and I cried because I wanted my mum. And then I told her like every day about what was happening and then she’s always sitting and thinking: “I should divorce dad” but it never happened. And after we went to the child psychiatry clinic, when it was over, mum and dad started to separate, when the counselling was completely over they got a divorce. I was kind of disappointed because they should have done it before because then after school I could have been going home to mum and be safe and not be with dad then. (Girl, age 13)

The decision to disclose the physical abuse was often a well-thought out decision. Children described the importance of choosing a trustworthy recipient for their disclosure. They wanted to have a relationship with that person and trust that person to act on their behalf. Moreover, they wanted the recipient of their disclosure to listen to their concerns and to take their side, to be their advocate.

To lose control

The time following the disclosure was often turbulent for the participants. Many actions were taken, but the children had no possibility to control what happened after the disclosure. After revealing the abuse, the children had to talk to professionals at Barnahus, the police station, and/or social welfare services. During this process, the children seemed to lose control of how their narrative about the abuse was handled. The professionals acted, but the children were not always informed about how the abuse would be handled. This lack of communication may have affected the children severely. In addition, the parents were not always informed about the disclosure for weeks, leaving children in uncertainty about when their parents were going to find out and what would happen after they were informed. The children were burdened by their own thoughts and feelings of anxiety and sometimes guilt related to revealing the abuse:

I was really worried every single day as soon as I got to school then I was really scared that something would happen or that they would call mum and tell her. So I thought about it almost every single day and finally they called my parents one day and I was really scared. (Girl, age 11)

The children had no opportunity to control when to meet with the hospital staff, the police, or the social welfare workers. For example, one girl had prepared for a school presentation but had to leave school before the presentation to be interviewed by the police for a second time. This unexpected interruption caused stress because after returning to school she would be asked why she left school suddenly. Some children did not want to reveal where they had been, so they had to come up with stories:

I was like at the police station and they interviewed me and it was also quite hard to be there. Like I also had to miss a bunch of things. We were going to present something in school and I missed out on that [. . .] and I made myself look nice and all that. And then they, my teachers, said like you can’t be here because the police have to interview you again and I told them everything. I told like everything. Then they wanted me to come back. But then I don’t understand why and they say would you. [. . .] We want you to explain this thing again. So I was [. . .] like kind of like this [. . .] ok, but I thought it was really tough. (Girl, age 13)

Some of these children were stressed by these unexpected interruptions in their school day as they felt that their first meeting with the police was not “good enough”. Children also stated how important it was that professionals reminded the children that they did a good job and that the violence was never their fault.

When social welfare workers were considering an intervention, they rarely asked the child what he or she thought about the proposed intervention. Most of the children were not even informed about the treatment or asked if they wanted to participate:

They just said that we should start CPC-CBT, well then you just have to go along with it. So I did. (Boy, age 14)

Children want information, but the information must be given in a way they can understand it:

When I heard the word CPC-CBT [the Swedish name is KIBB] I thought it was a rock or something like that. (Girl age 10)

In summary, the children described the process before and following their disclosure as stressful. These children formed an opinion about their experiences and acted according to their interpretations of a given situation. When the violence escalated, often the only option they felt they had was to seek help through disclosure. That is, they believed that they must act to force a change within their families. However, revealing abuse could be a very emotional process with increased fear. Some children were afraid of their parents’ reactions and what would happen after the disclosure.

Discussion

This study examines how children experience disclosing physical abuse. To a great extent this study supports findings from previous studies that focus on disclosure of sexual abuse but adds knowledge about the specific conditions for children experiencing physical abuse perpetrated by a caretaker. Furthermore, it follows the process of disclosure and the responses by social welfare service from a child perspective.

Children describe the disclosure of physical abuse as a process that requires several decisions. Sometimes the violence escalated to such an extent that the child felt it impossible not to disclose. These children feared for their safety and found themselves agonizing over difficult decisions. It could be life threatening to remain at home, but disclosure could be equally terrifying. Children could describe a specific turning point where they had to change the way they were acting to change their family’s situation. Childreńs narratives, both in this study and in previous studies (Aadnanes & Gulbrandsen, 2017; Överlien, 2012), reveal how children use different strategies to influence the situation.

As stated, disclosing physical abuse should be seen as a process (e.g. Alaggia, 2010; Foster & Hagedorn, 2014; Jensen et al., 2005). Children had to disclose in steps: they had to choose a recipient and then wait for actions to be taken. Some children were taken to the police station or a Barnahus for a formal disclosure. Parents were not always informed about the disclosure until several weeks had passed, leaving children in fear of their reactions when being informed. When the parents received the information, the disclosure was complete, at least in one sense. This process, however, could continue with law proceedings and disclosure to other extended family members.

Facilitating disclosure of child physical abuse

For some children the disclosure was facilitated by a direct question or that the topic was brought up in school. Even if these disclosures are labelled unintentional it does not mean that it occurs “out of the blue” or is accidently revealed, as the situation must permit a disclosure, often including the topic being addressed in some way (Allnock & Miller, 2013; Jensen et al., 2005). Unintentional disclosure underlines the importance of schools addressing topics such as child abuse and children’s rights. Although most children in Sweden are aware of the ban against child physical abuse, the children in this study express the importance and need of hearing that the abuse was not their fault. Addressing abuse in school could provide more opportunities for disclosing different kinds of abuse. In addition, school is also an important arena due to the child´s relationship with adults outside the family. School staff, most often teachers, stand out as the most significant adult person to talk to when experiencing physical abuse (cf. Jobe & Gorin, 2013). The children expressed both the importance of trustworthy adults and the time it takes to build relationships. Furthermore, children want their recipient to be able to act. Because their parents are not always able to protect them, school staff could be an important advocate for these children.

Unfortunately, many disclosures are not addressed, so a lot of children have to repeat their disclosure (cf. Allnock & Miller, 2013; Linell, 2017). The children want adults who receive a disclosure about physical abuse to stand by the child and not question their stories. Some children in this study described having to disclose to several adults before actions were taken. Some children disclosed to their mothers, but the mothers did not take actions in order to protect the child, a finding also present in earlier research (Allnock & Miller, 2013; Linell, 2017). An adult’s inability to recognize the seriousness of a disclosure of physical abuse could lead to longer victimization as well as feelings of desolation. In this study, children described not getting the responses they had hoped for. They stressed the importance of attentive adults who listen to their stories and act on their stories as their advocate. When adults fail to meet these expectations, children could feel let down. The theory of betrayal trauma (Foynes et al., 2009; Freyd, 1994) stresses the importance of the relationship between the child and the perpetrator considering the impact of the abuse. Children being abused by their caretakers are particularly vulnerable. This relationship influences how the abuse impacts the child and the betrayal must be seen in light of the relationship. The concept of betrayal could be expanded to the process of disclosure. For example, if children carefully select adults to disclose their abuse who do not act on the disclosure, they will again experience betrayal by an adult. That is, children are at risk of feeling betrayed by their parents or other abusers as well as by a trusted recipient of their disclosure.

The process following the disclosure

Although several of the children intentionally disclosed the abuse, most lost control over how their story of abuse was handled after the disclosure. Even if social welfare service acted on the disclosure, social welfare workers often neither informed nor involved the child in further actions or the schedule of actions. As a result, some children spent weeks in fear of their parents’ reactions when finding out about the disclosure. Some children are left with this anxiety without any knowledge about what will happen next. It is important to stress the specific terms under which these children live. They are victims of a crime, but the perpetrators of the crime are in their home. Some children describe feelings of powerlessness, guilt, and fear. These children experience the reactions of their perpetrator and are in some cases under significant stress. This pressure could come from close family members as well as extended family members. The social welfare office needs to adapt routines for securing the child’s wellbeing during this process.

Children in this study were offered treatment following the disclosure of the abuse. However, these children were not consulted about treatment options and most of the children were not even informed about what kind of treatment they were to be given. Some were given only the name of the treatment, and others knew only that they were to receive treatment. The results indicate that there is a time lapse where children after their disclosure are removed from their position as participants. Social welfare workers do not seem to recognize these children as competent enough to consult, or even inform, even though the act of seeking support through their disclosure clearly indicates the children’s ability to be involved in their treatment decisions.

Implication for practice

The current study followed the process of disclosing child physical abuse until an intervention was offered by the social welfare service from the child’s perspective. By extending the timeline from the initial disclosure, we could see a loop of participation for these children, a pattern that is important for the social welfare service to be aware of and acknowledge. The narratives from the participating children reveal different degrees of participation in their own disclosure and follow-up of the disclosure, including a striking lack of participation. This inconsistency could be explained by the adults’ desire to protect these children by relieving them of difficult decisions (cf. van Bijleveld et al., 2015). However, the children expressed their courage and determination (often well-thought out) by trying to change a dysfunctional (and dangerous) pattern within their families. The children disclosed the abuse and later formally disclosed their situation to both social welfare workers and the police. Although they expressed feelings of guilt and fear during this process, they thought disclosure was necessary. These children must be recognized and allowed to participate in decisions concerning their own and their family’s future. To establish a child-friendly organization, the social welfare service needs to develop routines that make sure the child is consulted (e.g. Callaghan & Alexander, 2015). The implementation of Barnahus is a promising step to a more child-centred approach, but every work step inside a Barnahus must be done with the best interest of the child in mind. By listening to children and inviting them to participate in discussions about what actions to take, children will stand as rights holders and equal members in society. Furthermore, the social welfare service as well as the police must adapt routines to secure the emotional and physical safety of the child after the disclosure. Professionals must confirm the child’s performance during the investigation. When being called back to the police for further questioning, some children may feel that their first interrogation was not good enough or feel they were not believed. The police and social welfare service workers need to improve their practice to assure that the child will not feel blamed as the disclosure process unfolds.

The results stress the school as an important place not only for teaching about the rights of the child but also for building relationships that facilitate disclosure. However, more knowledge is needed regarding how this education could be framed. Teachers need to be aware of their important role in these children’s lives. When a child has no secure base at home, schools could be their safe environment. In this study, the children want to disclose to adults who are non-judgemental and who will consult with them on how to proceed. Children want to be involved and want to trust the adult to act on their behalf. Therefore, in light of Betrayal Trauma Theory (Foynes et al., 2009; Freyd, 1994), it is important that the child not feel betrayed by the adult they disclose to. The decision to disclose is often well-thought out, and it is crucial to recognize the child’s agony and act on the disclosure promptly.

As hypothesized, the study reveals that children are competent participating in an interview study concerning a sensitive topic. All children in this study were asked how they experienced the interview. None of the children expressed discomfort or wanted to talk to a therapist after the interview. The results are consistent with previous research that focuses on children experiencing abuse (Cater & Øverlien, 2014) and having contacts with the child protection service (Jobe & Gorin, 2013).

This study prompts new thinking about how to view children’s disclosure of abuse by a parent. Further studies should explore what factors facilitate disclosure and how both the school system and the social welfare service could be more child-friendly in this concern.

Limitations

The present study adds to the current literature by focusing on children disclosing physical abuse. However, some limitations need to be addressed. The participating children have come to the social welfare service’s attention due to suspected child physical abuse. These children received treatment targeting their parents’ abusive behaviour. In treatment, children were encouraged to talk about their experiences and were acknowledged for their bravery when disclosing. Therefore, all these children received support after disclosure. However, not all disclosures are handled this way, so these children are not a normative sample. In addition, future studies should include children who do not receive help. That is, a nuanced picture about children’s experiences of social welfare procedures after a disclosure would include narratives from children not receiving support.

Acknowledgements

We would like to thank all participating children for their contributions. We are also grateful for the participating treatment units across Sweden for their collaboration on this study.

Disclosure statement

No potential conflict of interest was reported by the authors.

Notes on contributors

Johanna Thulin is a PhD student and lecturer in Social work at the Department of Social Work at Linnaeus University, Sweden. She is a clinical social worker with experience from working with abused and neglected children placed in out of home care. Her areas of research interest include child physical abuse, its consequences and effects of treatment, and the child within the child welfare service, with special interest in how children and youth experience their participation in child welfare processes.

Cecilia Kjellgren is a clinical social worker and senior lecturer in social work, Linnaeus University. She is experienced from clinical work with children being victims of abuse and neglect. One field of research is consequences of physical abuse of children and the effects of interventions. Another field focus on young people with harmful sexual behavior; prevalence, risk factors associated with the behavior and outcome of the interventions offered. She runs research projects on the aftermath of institutional sexual abuse and is involved in research exploring interventions for victims of domestic violence and effects experienced by clients.

Doris Nilsson is an Assistant professor in clinical psychology at the institution for behavioral sciences and learning, Department of Psychology at Linköping’s University. She is a licensed psychologist and psychotherapist as well as supervisor. She has for a long time been working clinically with abused children and adolescents but also with research about neglected and traumatized young persons. Her field of research is sexually and physically abused young people, poly-traumatization dissociation and bereavement quantitative as well as qualitative. She is affiliated to the National competence center Barnafrid at Linköping’s University.

ORCID

Johanna Thulin http://orcid.org/0000-0002-5560-363X

Cecilia Kjellgren http://orcid.org/0000-0002-4416-1223