**20. Support for child witnesses**

To provide support to children and non-abusing parents in Cleveland, a specialist therapeutic project was set up and subsequently continued by Barnardo's [32], also piloting pre-trial therapy for children who were to give evidence in court. Not all children who face giving evidence at a criminal trial are given that benefit. In 2017 The Children's Commissioner concluded that 'Overall the lack of consistency or clarity about entitlement and provision of pre-trial therapy appeared to create an additional silencing mechanism, compounding children and young people's sense of feeling repressed from talking about their abuse and delaying their recovery process' ([21] p. 136).

Special measures have been introduced for all children under the age of 16 to have their evidence and cross-examination pre-recorded, although they still face long delays between investigation and trial. Multiple problems still face children and even when cases do reach court, there are long term devastating effects of the whole process. Longfield [21] commented that the vast majority of cases do not progress to this final stage of the justice system.

We conclude that despite the greatly increased knowledge about how to help and support child victims, neither the investigative framework or the courts have become significantly more child-friendly.

## **21. Developments in understanding trauma and dissociation**

Many victims of child sexual abuse become dissociated from the memory of the experience. This is a survival strategy, in which the brain helps the victim bear the ongoing pain and fear via a process of fragmentation which separates mind, body and memory and compartmentalises experiences. This psychological process is the only way that many victims can cope with ongoing abuse, but it means that they

cannot then readily bring the experience back into mind, even in a safe and supportive context. The victim is in effect prevented from accessing protection, and becoming a survivor. We observed the process of dissociation in some of the children in Cleveland but at that time we did not really understand it or know how to help.

While accounts in the clinical literature now shed light on this process in children, [33] the knowledge gained has not been easy for clinicians to apply. The work involved in helping such children is often attacked and misrepresented, especially in court despite a wealth of clinical and research evidence. Dissociation, with its characteristic amnesia, can be a major factor in keeping some children and adults in Group B.

Some perpetrators of organised abuse deliberately induce dissociative states in order to restructure the victim's personality, installing parts who will comply with the perpetrator's commands and remain amnesic for what has occurred [34]. The many mechanisms used by abusers to frighten, compromise and silence their child victims can be almost insurmountable obstacles to disclosing the experiences even in adulthood. Investigations tend to uncover only a part of what has happened. For example, abuse that is part of an organised network might be missed when a single victim comes forward.

In retrospect, some of the children in Cleveland who had gross physical symptoms of sexual abuse but made no complaint may have been dissociated. Many dissociative adults also fall into Group B. This is especially the case for adults suffering on-going abuse. Both adults and children in Group B lack a coherent narrative of what has happened and, if they get as far as an investigation, struggle to assist. There are cases of the victim then being charged with perverting the course of justice. Alternatively, the adult self can be well aware of the abuse but unwilling to report out of fear of the consequences or because of bad experiences of past failed investigations. These factors may be compounded by so-called attachment to the perpetrator, more accurately understood as a trauma bond. The stakes are high for anyone in this position. A debate is needed about how we view capacity in dissociative victims, that is, whether they have lost the conscious ability to take responsibility for behaviour, actions and decisions. This can be difficult to judge where dissociation causes awareness and mental states to fluctuate. We need to debate our role as advocates, and the mismatch between the victim's needs and the requirements of the legal system.

### **22. Implications of the nature of organised abuse**

At the time of Cleveland the organized nature of much child sexual abuse was not fully understood. The networks of perpetrators who deliberately enter professions such as child care, children's homes, teaching, and other youth work, or who groom those in such positions to procure children for them, have operated largely undetected or within a culture of impunity. In Cleveland we had glimpses of networks that could have been pursued, as did practitioners in Leeds [35]; but the investigative focus was mainly on abuse within families. A look back at NSPCC guidance from the 1990's on investigating organised abuse [36] shows how practice has receded, especially as joint investigations are no longer happening.

The difficulties of police officers investigating this dimension of abuse and the suppression of a piece of research by a UK police team are outlined by Mallard [37]. More than any other group, victims of this form of abuse suffer from 'iatrogenic doubting' [38] which reinforces what their abusers have told them, that they will never be believed.

Abusers formally entrusted with the care and protection of children are especially difficult to recognise. There are a number of examples of convictions of professionals who, over a long period, abused children entrusted to their care: care home workers, such as Frank Beck in Leicestershire, who also gave other adults access to abuse the children; and doctors such as the paediatric oncologist Dr. Myles Bradbury, convicted of sexual offences against boys aged 8 to 17 at Cambridge Crown Court in 2014.
