Development and Initial Examination of a Group Treatment for Non-Offending, Non-Abused Siblings of Sexually Abused Youth Alayna Schreier, Katie M. Meidlinger, Elaine K. Martin, Grace S. Hubel, Tiffany West, Samantha L. Friedenberg, Kate L. Brungardt, Mary Fran Flood, & David. J. Hansen University of Nebraska-Lincoln Introduction Child sexual abuse (CSA) often leads to significant changes within a family unit (Baker et al., 2001). Beyond the myriad of psychological symptoms experienced by victims of CSA (e.g., Tyler, 2002), non-abused and non-offending siblings may also experience psychological effects, such as confusion or guilt (Bentovin, 1991), as well as more tangible consequences, including changing schools, moving, or interacting with law enforcement (Baker et al., 2001). Siblings of victimized children are also at an increased risk for experiencing later victimization (O’Brien, 1991). These effects may be heightened if the perpetrator is a member of the family unit (Finklehor, 1988). Families may attempt to hide the abuse from the non-abused sibling in order to protect them, further complicating the experience of these emotions (Bentovin, 1991). Despite the known effects, it is speculated that siblings typically present as sub-clinical on measures designed to evaluate emotional and psychological functioning after disclosures of CSA (Baker et al., 2001). As a result, there is a paucity of research on the implications of child sexual abuse on non-abused siblings. However, clinical case examples and client statements indicate that non-abused siblings experience a variety of negative consequences, such as anger, jealousy, sadness or worry (Baker et al., 2001; Hill, 2003). Current interventions do little to address the variety of emotional responses non-abused siblings face. Treatment approaches are needed to address the emotional and behavioral impact of child sexual abuse on nonabused siblings. Education about sexual abuse may help the non-abused sibling to better cope with the stress and family disruption caused by the abuse (Baker et al., 2001). Because these children are at an increased risk for abuse, treatment should focus on teaching skills to prevent future abuse (Tavkar & Hansen, 2011). Siblings may also serve as a protective factor within the family unit, having learned skills to better support the victimized child (Baker et al., 2001). The Project SAFE Sibling Group Treatment is a short-term group treatment for non-abused, non-offending siblings of sexually abused youth. Sibling Group is a six-week group treatment that runs concurrently with a 12week group treatment for sexually abused children and their non-offending caregivers (Sexual Abuse Family Education; Tavkar & Hansen, 2011). Session topics include psychoeducation, identification and regulation of feelings, cognitive restructuring, relaxation techniques, the impact of CSA on the family, sex education, and strategies to prevent victimization (Tavkar & Hansen, 2011) The current study provides an initial examination of the need for and impact of a group treatment for nonabused siblings of sexually abused youth. This evaluation focuses on identifying the presentation of non-abused, non-offending siblings who choose to participate and complete treatment. Non-abused siblings are a unique population; given the limited available research, these findings will provide an initial look into the characteristics of these children. To evaluate treatment efficacy, outcomes for non-abused siblings who completed treatment were assessed. Methods Participants Participants in the Project SAFE Sibling Group were referred from a multidisciplinary Child Advocacy Center. The sample included 56 non-offending, non-abused siblings, and 28 non-offending caregivers. Refer to Table 1 for non-offending caregiver and non-abused sibling demographics. Measures Adolescent Sexual Behavior Inventory (ASBI; Friedrich, 2004). The ASBI is a 47-item measure assessing problematic sexual behaviors in adolescents. Child Behavior Checklist – Youth Self-Report (CBCL-YSR; Achenbach, 1991). The CBCL-YSR is a 113-item measure designed to assess internalizing and externalizing behaviors in children. Child Depression Inventory (CDI; Kovacs, 1992). The CDI is a 27-item measure assessing depression in children and adolescents. Children’s Fears Related to Victimization (CFRV; Wolfe & Wolfe, 1986). The CFRV is a 27-item measure assessing level of fear in situations that may be distressing to sexually abused children. Coopersmith Self-Esteem Inventory (SEI; Coopersmith, 1981). The SEI is a 58-item measure designed to assess children’s attitudes about themselves in a variety of social situations. Multidimensional Anxiety Scale for Children (MASC; March, 1998). The MASC is a 39-item measure assessing symptoms of anxiety in children. Child Behavior Checklist (CBCL; Achenbach, 1991). The CBCL is a 113-item parent-report checklist designed to assess social competency and behavioral problems in children. Child Sexual Behavior Inventory-2nd Edition (CSBI-2; Friedrich et al., 1992). The CSBI-2 is a 35-item parentreport measure designed to assess the presence of sexual behaviors in children. Parental Expectations Scale (PES; Meidlinger et al., 2012). The PES is an 8-item parent-report measure assessing how the caregiver feels their child will compare with other children over the next year. Post Sexual Abuse Expectations Scale (PSAES; Meidlinger et al., 2012). The PSAES is a parent-report measure assessing the negative impact the parent expects sexual abuse will have on their child over the next year. Weekly Problems Scale – Parent Version and Child Version (WPS; Sawyer et al., 2006). The WPS is a self-report measure that assesses the parent/child relationship and the child’s functioning over the previous week. Procedures The Project SAFE Sibling Group Treatment (Sexual Abuse Family Education; Tavkar & Hansen, 2011) was developed in 2004 and is a six-week group treatment for non-offending, non-abused siblings, and runs concurrently with the Project SAFE 12-week group treatment for victims and non-offending caregivers (Hansen et al., 1998). Session topics include psychoeducation, identification and regulation of feelings, cognitive restructuring, relaxation techniques, the impact of CSA on the family, sex education and strategies to prevent victimization (Tavkar & Hansen, 2011). See Table 2 for further description of session content. Self-report assessments were completed by both the child and caregiver at pre- and post-treatment and at 3 month followup in order to assess depression, anxiety, children’s views about themselves, and sexual knowledge and attitudes. Both the child and caregiver reported satisfaction ratings along with their perception of the effectiveness of treatment for their family. As this is an archival study, data are not available for some variables. Table 1 Univariate Statistics for Non-Abused Sibling Demographic Information. Variable Univariate Statistics Non-Abused Sibling Participants Age M = 10.38 SD = 2.70 N = 47 Gender Male 33 (58.9%) Female 20 (35.7%) Ethnicity European American 37 (66.1%) Hispanic 4 (7.1%) Asian American/Pacific 3 (5.4%) Islander Native American 3 (5.4%) Relationship to Victim Biological Sibling 37 (66.1%) Step Sibling 3 (5.4%) Half Sibling 3 (5.4%) Adoptive Sibling 3 (5.4%) Non-Offending Caregiver Participants Age M = 37.44 SD = 8.91 N = 27 Ethnicity European American 31 (55.4%) Hispanic 1 (1.8%) Asian American/Pacific 1 (1.8%) Islander Relationship to Sibling Biological mother 28 (50.0%) Step or adoptive mother 8 (14.3%) Biological father 4 (7.1%) Step or adoptive father 2 (3.6%) Grandmother 1 (1.8%) Highest Grade Completed High School Level 10 (17.8%) College Level 10 (17.8%) Graduate Level 1 (1.8%) Income $15,000 or less 7 (12.5%) $15,000-$25,000 3 (5.4%) $25,000-$40,000 3 (5.4%) $40,000-$60,000 4 (7.1%) $60,000-$100,000 4 (7.1%) Over $100,000 2 (3.6%) Note: Percentages do not add up to 100% due to missing data. Table 2. Session Summary of Non-Abused Sibling Group Session Title Summary of Session 1. Welcome and Feelings The purpose of the first session is to build rapport with the group, establish group rules, and discuss confidentiality. The first session focuses on emotion identification in themselves and others and examines the causes and consequences of feelings. 2. Learning About Our Bodies The second session provides information on “good” versus “bad” touches, “good” versus “bad” secrets, and age-appropriate sexual development. Personal space is discussed. 3. My Family & Offenders The third session discusses the impact of the abuse and disclosure on the family. Siblings discuss their families and other forms of social support. Information is provided about offenders. 4. Learning to Cope with My Feelings The fourth session focuses on exploring the relationship between feelings and behavior. Siblings continue to identify sources of social support. Coping strategies for handling negative thoughts and feelings are discussed. 5. Standing Up For Your Rights The fifth session aims to teach siblings strategies to prevent the occurrence of abuse. Siblings roleplay problem solving and assertiveness. Information is provided about common tricks offenders may use. The sixth session reviews group content and discusses safety rules for the sibling and his/her family. Siblings are given an opportunity to provide feedback about the group and group content. 6. Good-Bye Results Results suggest that non-abused sibling participants displayed heterogeneity of symptom presentation prior to treatment. Univariate results indicate that siblings present as sub-clinical on all measures of assessment at pre-treatment (Table 3). Analysis of variance (ANOVA) results indicated that there were limited significant changes seen from preto post-treatment on sibling or parent measures (Table 4). There was a significant reduction in sibling report of the parent/sibling relationship and sibling functioning from pre- to post-treatment. Table 3. Univariate Statistics at Pre-Treatment for Non-Abused Siblings Univariate Statistics Variable M (SD) Non-Abused Sibling Participants Adolescent Sexual Behavior Inventory 10.58 (6.76) Child Behavior Checklist –Youth Self Report 47.50 (17.31) Children’s Depression Inventory 10.38 (2.70) Children’s Fears Related to Victimization 48.85 (13.98) Multidimensional Anxiety Scale for Children 51.06 (15.61) Self-Esteem Inventory 70.44 (22.63) Weekly Problems Scale - Child 25.78 (6.63) Non-Offending Caregiver Participants Child Behavior Checklist 50.42 (13.76) Child Sexual Behavior Inventory-2 3.38 (5.12) Parental Expectations Scale 88.13 (15.56) Post Sexual Abuse Expectations Scale 12.67 (6.04) Weekly Problems Scale - Parent 46.75 (17.88) N 12 12 47 34 34 34 36 26 16 16 15 24 Table 4. Summary of Pre- and Post-Treatment Outcomes for Non-Abused Siblings PrePostTreatment Treatment M (SD) M (SD) Caregiver Child Behavior Checklist 46.50 (13.55) 45.50 (9.68) Parental Expectations Scale Post Sexual Abuse Expectations Scale 93.18 (15.52) 11.18 (5.31) 86.91 (14.44) 13.18 (6.94) Weekly Problems Scale - Parent Sibling 43.40 (13.57) 41.20 (9.20) Children’s Depression Inventory 43.07 (8.67) 46.21 (11.06) Children’s Fears Related to Victimization 51.64 (7.80) 51.09 (12.36) Multidimensional Anxiety Scale for Children Self-Esteem Inventory 52.23 (12.72) 82.85 (9.20) 48.38 (14.09) 83.08 (11.27) Weekly Problems Scale - Child * p < .05 23.57 (3.78) 18.86 (5.96) F (1,15) .290 F (1,10) 1.421 1.257 F (1,9) .329 F (1,13) 1.516 F (1,10) .063 F (1,12) 1.217 .009 F (1,6) 6.892* Discussion Childhood sexual abuse has been associated with significant changes in the family unit, thus influencing the lives of non-abused, non-offending siblings. However, there have been limited evaluations of the impact of abuse on this population. The aim of the current study was to examine symptom presentation and to conduct a preliminary investigation of a group treatment for non-abused, non-offending siblings. As expected, results indicate that non-abused, non-offending siblings typically present as sub-clinical on measures designed to assess mood and psychological functioning. Though siblings did not show significant changes from pre- to post- treatment, the measures used in this study were not designed to identify changes in this population. Specifically, available abuse specific measures may not be relevant to non-abused siblings, and thus may not tap into concerns specific to this population (e.g., guilt/blame, helplessness, confusion). Subsequent to the collection of these data, the Project SAFE Sibling Group Treatment has begun collecting evaluation data from parents and siblings. Anecdotal information from participants has indicated that both parents and siblings have found group to be beneficial. Parents have reported that their children benefit from the opportunity to discuss their experiences and siblings have indicated that they appreciate the support they receive from other non-abused siblings. Additionally, victims have reported that they value their sibling’s participation in the concurrent group treatment. Results of this study are preliminary and exploratory and thus future directions include further evaluation of this group treatment, including parent and sibling report of clinical utility and benefit. Future research will include the development of a new measure designed to characterize concerns with which siblings may uniquely present. A measure designed specifically for siblings may be more sensitive to change from pre- to posttreatment. It is critical to continue to explore the impact of sexual abuse on non-abused siblings.