**4. Interventions for NonOffending caregivers**

Nonoffending caregivers are primary supports for children who have been victims of CSA and the need for specific and tailored interventions for nonoffending caregivers is increasingly recognized in the literature and caregiver support has been identified as a crucial factors in children's recovery from CSA [32]. Caregiver interventions following sexual abuse of their child aim to reduce caregiver distress, increase adaptive caregiver coping as well as enhance support of the child [33]. Nonoffending caregivers have been referred to as "overlooked victims" in child sexual abuse cases [34]. A recent qualitative study with nonoffending caregivers of children under 13 who had been victims of CSA found that the majority of caregivers reported mental health services were necessary and beneficial for themselves to help them cope with the impact of their child's CSA [33]. Interventions for nonoffending caregivers may include group and/or individual treatment focusing on psychoeducation, information, supports, parenting guidance, and dealing with their own victimization (if relevant). When intrafamilial CSA occurs, the nonoffending caregiver has the essential role of assisting the CSA victims and other children in the family so that safety and security can be restored [35]. Simultaneously, the caregiver is likely experiencing shock, grief, fear and a myriad of other emotions, which are often overwhelming, while they are tasked with shepherding the child who has experienced CSA on their journey of healing and recovery. Nonoffending caregivers often need support, guidance and direction because in addition to the crisis of the CSA, they may be faced with a lack of financial support, legal proceedings, and possible conflict with and separation from extended family whose loyalties may lie with the perpetrator [35]. Caregiver support is an important mediating variable in outcomes for victims of CSA [32].

#### **4.1 Nonoffending caregiver support groups**

Support groups for nonoffending caregivers of children who have been sexually abused can provide critical psychoeducation and social support for the caregiver during this vulnerable time of rebuilding and redefining their family [32]. Nonoffending caregiver support groups offer a safe place to begin the difficult recovery process, to normalize feelings and thoughts about their child's CSA and to begin to build a support network with other families [34]. In the group, group therapists teach caregivers the relationship between thoughts, feelings and behaviors and provide guidance on thought restructuring which enables caregivers to deal with their own symptoms as well as modeling appropriate coping skills for their children and coaching their children on these skills. Additionally, caregiver support groups can provide practical information on social services, legal services, housing, school intervention and other needed resources [34].

#### **4.2 Nonoffending caregiver individual therapy**

Following disclosure or discovery that their child has been sexually abused, nonoffending caregivers may experience depression, posttraumatic stress and increases in anxiety [36]. Shields and colleagues found that following child sexual abuse disclosure, 24% of caregivers met diagnostic criteria for depression or PTSD or both [36]. Parental distress was associated with decreases in positive

*Intervention Strategies for Promoting Recovery and Healing from Child Sexual Abuse DOI: http://dx.doi.org/10.5772/intechopen.97106*

parenting and caregiver involvement with the victim. Individual therapy for the nonoffending caregiver can be beneficial to address mood symptoms, trauma reminders and to increase coping and implementation of parenting skills. This individual treatment can be provided in conjunction with group treatment. If a caregiver has their own history of CSA, they may also benefit from individual therapy to process how their child's victimization is triggering their own CSA experience, especially if the caregiver did not receive interventions for their own CSA victimization [34].

#### **4.3 Caregiver involvement in TF-CBT**

TF-CBT incorporates individual and caregiver-focused interventions to inform families of the reactions and effects of trauma in children. Caregivers can be parents, foster parents, relative caregivers or other supportive adults actively involved in the child's life. This caregiver component enhances the positive impact of treatment in terms of decreasing caregiver and child depressive and anxiety symptoms, as factors such as caregivers' emotional distress and caregiver support of the child have been found to be strong and significant mediators to treatment response [10]. Parental and caregiver support is a primary component of the PRACTICE interventions of the TF-CBT model and the caregiver is actively and collaboratively involved in the entire course of treatment with approximately half of the treatment time focused on caregivers [8, 10]. Through both individual caregiver sessions and conjoint sessions with their child, caregivers learn to be present while their child discusses the CSA and how it affected them and caregivers learn skills to be supportive of their child as they work through the recovery process. Through the PRACTICE components, caregivers are taught strategies to express and modulate their affect as well as being taught ways to manage intense emotions in their child [10]. Additionally, caregivers learn parenting and child behavior management skills specific to children who have been victims of CSA. Prior to terminating treatment, skills to safety plan for CSA victims and promote positive future engagement are addressed with caregivers [11].
