CARES Institute: A culture of healing for abused children

Few people want to think about sexual abuse, let alone talk about it. However, approximately one in four girls and one in seven boys will experience inappropriate sexual contact by the time they reach the age of 18.

Such abuse can have devastating consequences if it is not identified and treated, disrupting children’s academic functioning and mental and physical health.

Searching for solutions

When pediatrician Dr. Martin Finkel began practicing, the medical literature provided no clues about how to diagnose child sexual abuse. Thus, he began focusing on developing child-sensitive diagnostic and documentation techniques to assess the medical needs of suspected victims of child sexual abuse.

In 1989, he recruited mental health researcher Dr. Esther Deblinger, and together they co-founded and co-direct the Child Abuse Research Education and Services (CARES) Institute, which is located at the Rowan University School of Osteopathic Medicine in Stratford. The CARES Institute provides clinical services and conducts research, examining diagnostic and treatment approaches for children impacted by abuse.

When she began her career, Deblinger said, there also was no documented effective treatment for childhood post-traumatic stress disorder, which affects many children impacted by sexual abuse, domestic violence and other traumas. She tirelessly pursued grants to research, design and evaluate a treatment model to help children overcome the effects of sexual abuse.

National and international impact

Decades later, Finkel and Deblinger are noted pioneers and national and international speakers in the field, renowned for their effective diagnostic and treatment techniques.

“The research that my colleagues and I have done around the development of evidence-based treatment for healing children and families who have been impacted by abuse or trauma led to a treatment model that is currently used worldwide,” Deblinger said. “This treatment model is specifically designed to treat children who have suffered post-traumatic stress disorder, depression and other emotional and behavioral problems.”

“One of the things that I’m particularly proud of in terms of the work that we do is that we’ve seamlessly integrated medicine and mental health,” Finkel said. “To this day, very few programs do that and do it successfully because, ultimately, the primary impact of any form of victimization is psychological.”

Finkel authored a reference textbook on medically evaluating and treating sexually victimized children published in its fourth edition by the American Academy of Pediatrics. He also has worked with the New Jersey State Legislature to draft the first legislation in the country creating a statewide network of regional child abuse diagnostic and treatment centers.

Healing trauma

Integral to the healing process at CARES is a therapy approach referred to today as trauma-focused cognitive behavioral therapy (TF-CBT), developed by Deblinger and her colleagues. TF-CBT therapists initially meet with children and caregivers in individual sessions.

“With the help of their therapists, children and caregivers develop coping skills and gradually explore and process the traumas endured,” Deblinger said. “Therapists also assist caregivers in developing parenting skills that help them respond optimally to their children’s emotional and behavioral difficulties. As therapy progresses, children and caregivers also are engaged in conjoint sessions to help them practice skills and process traumatic experiences together.”

A therapist has separate sessions with the child and parent, and then they work together during 12 to 16 sessions. “We did one study in which we documented that when children go through therapy here at CARES, they not only show reductions in their levels of post-traumatic stress disorder symptoms, depression and behavioral problems, but they also show significant improvement with respect to resilience,” Deblinger said.

Preparing health care professionals to help these children in the future, the program includes post-doctoral and post-master’s psychology fellows who receive specialized training in providing mental health services to children impacted by abuse or trauma.

Medical students also learn to have difficult but critical discussions with patients. “The way children begin to process their victimization is by actually talking about it,” Finkel said. “That’s the hardest thing for doctors to actually do, to sit down with a child and have a conversation in a way that’s nonjudgmental, facilitating, empathetic and supportive to learn what the child experienced. You see a sign of relief when kids share things that they’ve shared with no one else.”

Reluctant to discuss

Finkel explained that people often do not realize these services are available and are reluctant to discuss them because of the perceived stigma associated with sexual abuse. “But we have always remained optimistic because there’s amazing resilience,” he said. “With the right services, kids can move on and put these experiences behind them. That’s what our responsibility is to these kids, to help them process these issues in a very healthy and productive way.”

“We feel very hopeful that when children leave here, they not only exhibit improvements in terms of their emotional and behavioral well-being,” Deblinger said, “but parents and children grow stronger and closer to one another.”